RNSG1260 Exam 1 Foundations Latest 2023/2024 Updated Questions with Answers, Exams of Nursing

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RNSG1260 EXAM 1 FOUNDATIONS LATEST

2023/2024 UPDATED QUESTIONS WITH ANSWERS

BEST FOR FINAL EXAM ALREADY GRADED A+

01: Nursing Today

MULTIPLE CHOICE

1. Which nurse most likely kept records on sanitation techniques and the effects on health? 1. Florence Nightingale 2. Mary Nutting 3. Clara Barton 4. Lillian Wald ANS: A Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentery. Mary Nutting, Clara Barton, and Lillian Wald came after Nightingale, each contributing to the nursing profession in her own way. Mary Nutting was instrumental in moving nursing education into universities. Clara Barton founded the American Red Cross. Lillian Wald helped open the Henry Street Settlement. 2. The nurse prescribes strategies and alternatives to attain expected outcome. Which standard of nursing practice is the nurse following? 1. Assessment 2. Diagnosis 3. Planning 4. Implementati on ANS: C In planning, the registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. During assessment, the registered nurse collects comprehensive data pertinent to the patient’s health and/or the situation. In diagnosis, the registered nurse analyzes the assessment data to determine the diagnoses or issues. During implementation, the registered nurse implements (carries out) the identified plan. 3. An experienced medical-surgical nurse chooses to work in obstetrics. Which level of proficiency is the nurse upon initial transition to the obstetrical

floor?

1. Novice

2. Proficient
3. Competent
4. Advanced beginner ANS: A A beginning nursing student or any nurse entering a situation in which there is no previous level of experience (e.g., an experienced operating room nurse chooses to now practice in home health) is an example of a novice nurse. A proficient nurse perceives a patient’s clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. A competent nurse understands the organization and specific care required by the type of patients (e.g., surgical, oncology, or orthopedic patients). This nurse is a competent practitioner who is able to anticipate nursing care and establish long- range goals. A nurse who has had some level of experience with the situation is an advanced beginner. This experience may only be observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care. 4. A nurse assesses a patient’s fluid status and decides that the patient needs to drink more fluids. The nurse then encourages the patient to drink more fluids. Which concept is the nurse demonstrating?
5. Licensure 2. Autonomy
6. Certification
7. Accountabili ty ANS: B Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. To obtain licensure in the United States, the RN candidate must pass the NCLEX- RN®. Beyond the NCLEX-RN®, the nurse may choose to work toward certification in a specific area of nursing practice. Accountability means that you are responsible, professionally and legally, for the type and quality of nursing care provided. 5. A nurse prepares the budget and policies for an intensive care unit. Which role is the nurse implementing?
8. Educator 2. Manager
9. Advocate

4. Caregiv er ANS: B A manager coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or facility. As an educator, you explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient’s progress in learning. As a patient advocate, you protect your patient’s human and legal rights and provide assistance in asserting these rights if the need arises. 6. The nurse has been working in the clinical setting for several years as an advanced practice nurse. However, the nurse has a strong desire to pursue research and theory development. To fulfill this desire, which program should the nurse attend?
5. Doctor of Nursing Science degree (DNSc) 2. Doctor of Philosophy degree (PhD)
6. Doctor of Nursing Practice degree (DNP)
7. Doctor in the Science of Nursing degree (DSN) ANS: B Some doctoral programs prepare nurses for more rigorous research and theory development and award the research-oriented Doctor of Philosophy (PhD) in nursing. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. 7. A nurse attends a workshop on current nursing issues provided by the American Nurses Association. Which type of education did the nurse receive?
8. Graduate education
9. Inservice education 3. Continuing education
10. Registered nurse education ANS: C Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions. After obtaining a baccalaureate degree in nursing, you can pursue graduate education leading to a master’s or doctoral degree in any number of

graduate fields, including nursing. Inservice education programs are instruction or training provided by a health care facility or institution.

8. A nurse identifies gaps between local and best practices. Which Quality and Safety Education for Nurses (QSEN) competency is the nurse demonstrating? a. Safety b. Patient-centered care c. Quality improvement d. Teamwork and collaboration ANS: C Quality improvement identifies gaps between local and best practices. Safety minimizes risk of harm to patients and providers through both system effectiveness and individual performance. Patient- centered care recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. Teamwork and collaboration allows effective functioning within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making. 9. A nurse has compassion fatigue. What is the nurse experiencing? 1. Lateral violence and intrapersonal conflict 2. Burnout and secondary traumatic stress 3. Short-term grief and single stressor 4. Physical and mental exhaustion ANS: B Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress. Compassion fatigue may contribute to what is described as lateral violence (nurse-nurse interactions, not intrapersonal). Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue. Stressors, not a single stressor, contribute to compassion fatigue. Physical and mental exhaustion describes burnout only. 10. A patient is scheduled for surgery. When getting ready to obtain the informed consent, the patient tells the nurse, “I have no idea what is going to happen. I

couldn’t ask any questions.” The nurse

does not allow the patient to sign the permit and notifies the health care provider of the situation. Which role is the nurse displaying?

1. Manager
2. Patient educator 3. Patient advocate
3. Clinical nurse specialist ANS: C As a patient advocate, the nurse protects the patient’s human and legal rights, including the right of the patient to understand procedures before signing permits. Although nurses can be educators, it is the responsibility of the surgeon to provide education for the patient in preparation for surgery, and it is the nurse’s responsibility to notify the health care provider if the patient is not properly educated. Managers coordinate the activities of members of the nursing staff in delivering nursing care, and clinical nurse specialists are experts in a specialized area of nursing practice in a variety of settings. 11. The patient requires routine gynecological services after giving birth to her son, and while seeing the nurse-midwife, the patient asks for a referral to a pediatrician for the newborn. Which action should the nurse-midwife take initially?
4. Provide the referral as requested. 2. Offer to provide the newborn care.
5. Refer the patient to the supervising provider.
6. Tell the patient that is not allowed to make referrals. ANS: B The practice of nurse-midwifery involves providing independent care for women during normal pregnancy, labor, and delivery, as well as care for the newborn. After being apprised of the midwifery role, if the patient insists on seeing a pediatrician, the nurse-midwife should provide the referral. The supervising provider is an obstetric provider, not a pediatrician. A nurse- midwife can make referrals. 12. The nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). Which activity is appropriate for a CRNA?
7. Manages gynecological services such as PAP smears 2. Works under the guidance of an anesthesiologist
8. Obtains a PhD degree in anesthesiology
9. Coordinates acute medical conditions

ANS: B

Nurse anesthetists provide surgical anesthesia under the guidance and supervision of an anesthesiologist, who is a physician (health care provider) with advanced knowledge of surgical anesthesia. Nurse practitioners, not CRNAs, manage self-limiting acute and chronic stable medical conditions; certified nurse-midwives provide gynecological services such as routine Papanicolaou (Pap) smears. The CRNA is an RN with an advanced education in a nurse anesthesia accredited program. A PhD is not a requirement.

13. A nurse teaches a group of nursing students about nurse practice acts. Which information is most important to include in the teaching session about nurse practice acts? 1. Protects the nurse 2. Protects the public 3. Protects the provider 4. Protects the hospital ANS: B The nurse practice acts regulate the scope of nursing practice and protect public health, safety, and welfare. They do not protect the nurse, provider, or hospital. 14. A bill has been submitted to the State House of Representatives that is designed to reduce the cost of health care by increasing the patient-to-nurse ratio from a maximum of 2:1 in intensive care units to 3:1. What should the nurse realize? 1. Legislation is politics beyond the nurse’s control. 2. National programs have no bearing on state politics. 3. The individual nurse can influence legislative decisions. 4. Focusing on nursing care provides the best patient benefit. ANS: C Nurses can influence policy decisions at all governmental levels. One way is to get involved by participating in local and national efforts. This effort is critical in exerting nurses’ influence early in the political process. Legislation is not beyond the nurse’s control. National program can have bearing on state politics. The question is focusing on legislation and health care costs, not nursing care. 15. A nurse is using a guide that provides principles of right and wrong to provide care to patients. Which

guide is the nurse using?

1. Code of ethics

2. Standards of practice
3. Standards of professional performance
4. Quality and safety education for nurses ANS: A The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. The Standards of Practice describe a competent level of nursing care. The ANA Standards of Professional Performance describe a competent level of behavior in the professional role. Quality and safety education for nurses addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments. 16. A graduate of a baccalaureate degree program is ready to start working as an RN in the emergency department. Which action must the nurse take first?
5. Obtain certification for an emergency nurse. 2. Pass the National Council Licensure Examination.
6. Take a course on genomics to provide competent emergency care.
7. Complete the Hospital Consumer Assessment of Healthcare Providers Systems. ANS: B Currently, in the United States, the most common way to become a registered nurse (RN) is through completion of an associate’s degree or baccalaureate degree program. Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become registered nurses in the state in which they will practice. Certification can be obtained after passing the NCLEX and working for the specified amount of time. Genomics is a newer term that describes the study of all the genes in a person and interactions of these genes with one another and with that person’s environment. Consumers can also access Hospital Consumer Assessment of Healthcare Providers Systems (HCAHPS) to obtain information about patients’ perspectives on hospital care. 17. While providing care to a patient, the nurse is responsible, both professionally and legally. Which concept does this describe?
8. Autonomy 2. Accountability
9. Patient advocacy
10. Patient education

ANS: B

Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. As a patient advocate, the nurse protects the patient’s human and legal rights and provides assistance in asserting these rights if the need arises. As an educator, the nurse explains concepts and facts about health, describes the reasons for routine care activities, demonstrates procedures such as self-care activities, reinforces learning or patient behavior, and evaluates the patient’s progress in learning.

18. A nurse is teaching the staff about Benner’s levels of proficiency. In which order should the nurse place the levels from beginning level to ending level?

1. Expert
2. Novice
3. Proficient
4. Competent
5. Advanced beginner
   1. 2, 4, 5, 1, 3 2. 2, 5, 4, 3, 1
   2. 4, 2, 5, 3, 1
   3. 4, 5, 2, 1, 3 ANS: B Benner’s levels of proficiency are as follows: novice, advanced beginner, competent, proficient, and expert. MULTIPLE RESPONSE 1. A nurse is preparing a teaching session about contemporary influences on nursing. Which examples should the nurse include? (Select all that apply.) 1. Human rights 2. Affordable Care Act 3. Demographic changes 4. Medically underserved 5. Decreasing health care costs ANS: A, B, C, D

Multiple external forces affect nursing, including the need for nurses’ self- care, Affordable Care Act (ACA) and rising (not decreasing) health care costs, demographic changes of the population, human rights, and increasing numbers of medically underserved.

2. After licensure, the nurse wants to stay current in knowledge and skills. Which programs are the most common ways nurses can do this? (Select all that apply.) 1. Master’s degree 2. Inservice education 3. Doctoral preparation 4. Continuing education 5. National Council Licensure Examination retakes ANS: B, D Continuing education programs help nurses maintain current nursing skills, gain new knowledge and theory, and obtain new skills reflecting the changes in the health care delivery system. Inservice education programs are provided by a health care facility to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can help the nurse stay current. Master’s degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. 3. A nurse wants to become an advanced practice registered nurse. Which options should the nurse consider? (Select all that apply.) 1. Patient advocate 2. Nurse administrator 3. Certified nurse-midwife 4. Clinical nurse specialist 5. Certified nurse practitioner ANS: C, D, E Although all nurses should function as patient advocates, “advanced practice nurse” is an umbrella term for an advanced clinical nurse such as a certified nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or certified nurse-midwife. A nurse administrator is not an example of advanced practice. 4. The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses. The orthopedic unit has agreed to “float” two of its nurses to the oncology unit if oncology

can “float” a nursing assistant to the orthopedic unit to help with obtaining vital signs. Which concepts does this situation entail? (Select all that apply.)

1. Autonomy 2. Informatics 3. Accountability 4. Political activism 5. Teamwork and collaboration ANS: A, C, E Staffing is an independent nursing intervention and is an example of autonomy. Along with increased autonomy comes accountability or responsibility for outcomes of an action. When nurses work together this is teamwork and collaboration. Informatics is the use of information and technology to communicate, manage knowledge, mitigate error, and support decision making. Political activism usually involves more than day-to-day activities such as unit staffing.

02: The Health Care Delivery

System

MULTIPLE CHOICE

1. The nurse is caring for a patient whose insurance coverage is Medicare. The nurse should consider which information when planning care for this patient? 1. Capitation provides the hospital with a means of recovering variable charges. 2. The hospital will be paid for the full cost of the patient’s hospitalization. 3. Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost. 4. Medicare will pay the national average for the patient’s condition. ANS: C In 1983, Congress established the prospective payment system (PPS), which grouped inpatient hospital services for Medicare patients into diagnosis- related groups (DRGs), each of which provides a fixed reimbursement amount based on assigned DRG, regardless of a patient’s length of stay or use of services. Capitation means that providers receive a fixed amount per patient or enrollee of a health care plan. DRG reimbursement is based on case severity, rural/urban/regional costs, and teaching costs, not national

averages.

2. A nurse is teaching the staff about managed care. Which information should the nurse include in the teaching session? 1. Managed care insures full coverage of health care costs. 2. Managed care only assumes the financial risk involved. 3. Managed care allows providers to focus on illness care. 4. Managed care causes providers to focus on prevention. ANS: D Managed care describes health care systems in which the provider or the health care system receives a predetermined capitated (fixed amount) payment for each patient enrolled in the program. Therefore, the focus of care shifts from individual illness care to prevention, early intervention, and outpatient care. The actual cost of care is the responsibility of the provider. The managed care organization (provider) assumes financial risk, in addition to providing patient care. 3. A nurse is teaching a family about health care plans. Which information from the nurse indicates a correct understanding of the Affordable Care Act? 1. A family can choose whether to have health insurance with no consequences. 2. Primary care physician payments from Medicaid services can equal Medicare. 3. Adult children up to age 26 are allowed coverage on the parent’s plan. 4. Private insurance companies can deny coverage for any reason. ANS: C Adult children up to the age of 26, regardless of student status, are allowed to be covered under their parents’ health insurance plan. All individuals are required to have some form of health insurance by 2014 or pay a penalty through the tax code. Primary care physician payments for Medicaid services increased to equal Medicare payments. Implementation of insurance regulations prevents private insurance companies from denying insurance coverage for any reason and from charging higher premiums based on health status and gender. 4. A nurse is caring for a patient in the hospital. When should the nurse begin discharge planning? 1. When the patient is ready

2. Close to the time of discharge

3. Upon admission to the hospital

4. After an order is written/prescribed ANS: C Discharge planning begins the moment a patient is admitted to a health care facility. When the patient is ready may be too late. Close to the time of discharge and after an order is written/prescribed are too late. 5. The nurse is applying for a position with a home care organization that specializes in spinal cord injury. In which type of health care facility does the nurse want to work? 1. Secondary acute 2. Continuing 3. Restorative 4. Tertiar y ANS: C Patients recovering from an acute or chronic illness or disability often require additional services (restorative care) to return to their previous level of function or reach a new level of function limited by their illness or disability. Restorative care includes cardiovascular and pulmonary rehabilitation, sports medicine, spinal cord injury programs, and home care. Secondary acute care involves emergency care, acute medical-surgical care, and radiological procedures. Continuing care involves assisted living, psychiatric care, and older- adult day care. 6. A nurse provides immunization to children and adults through the public health department. Which type of health care is the nurse providing? 1. Primary care 2. Preventive care 3. Restorative care 4. Continuing care ANS: B Preventive care includes immunizations, screenings, counseling, crisis prevention, and community safety legislation. Primary care is health promotion that includes prenatal and well-baby care, nutrition counseling, family planning, and exercise classes. Restorative care includes rehabilitation, sports medicine, spinal cord injury programs, and home care.

Continuing care is assisted living and psychiatric care and older- adult day care.

7. A nurse is following the PDSA cycle for quality improvement. Which action will the nurse take for the letter “A”? 1. Act 2. Alter 3. Assess 4. Approac h ANS: A There are many models for quality improvement and performance improvement. One model is the PDSA cycle: plan, do, study, and act. “A” does not stand for alter, assess, or approach. 8. The nurse is trying to determine how well a certain health plan compares with other health plans. To gather this type of data, which information will the nurse utilize? 1. Pew Health Professions Commission 2. Healthcare Effectiveness Data and Information Set (HEDIS) 3. American Nurses Credentialing Center (ANCC) Magnet Recognition Program 4. Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) ANS: B Health plans throughout the United States rely on the Healthcare Effectiveness Data and Information Set (HEDIS) as a quality measure. HEDIS compares how well health plans perform key areas: quality/effectiveness of care, access to care, and patient satisfaction with the health plan and doctors. The Pew Health Professions Commission, a national and interdisciplinary group of health care leaders, recommended 21 competencies for health care professionals in the twenty-first century. 9. An older adult patient has extensive wound care needs after discharge from the hospital. Which facility should the nurse discuss with the patient? a) Hospice b) Respite care c) Assisted living d) Skilled nursing

ANS: D

An intermediate care or skilled nursing facility offers skilled care from a licensed nursing staff. This often includes administration of IV fluids, wound care, long-term ventilator management, and physical rehabilitation. A hospice is a system of family-centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness. Respite care is a service that provides short-term relief or “time off” for people providing home care to an individual who is ill, disabled, or frail.

10. A nurse working in a community hospital’s emergency department provides care to a patient having chest pain. Which level of care is the nurse providing? 1. Continuing care 2. Restorative care 3. Preventive care 4. Tertiary care ANS: D Hospital emergency departments, urgent care centers, critical care units, and inpatient medical- surgical units provide secondary and tertiary levels of care. Patients recovering from an acute or chronic illness or disability often require additional services (restorative care) to return to their previous level of function or reach a new level of function limited by their illness or disability. Continuing care is available within institutional settings (e.g., nursing centers or nursing homes, group homes, and retirement communities), communities (e.g., adult day care and senior centers), or the home (e.g., home care, home-delivered meals, and hospice). Preventive care is more disease oriented and focused on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs. 11. A nurse is teaching about the effects of globalization. Which information should the nurse include in the teaching session? 1. Increased spread of communicable diseases 2. Increased homogeneous mix of nursing staff 3. Decreased poverty and increased “health tourism” 4. Decreased urbanization as populations shift to the suburbs ANS: A Although globalization of trade, travel, and culture has improved the availability of health care services, the spread of communicable

diseases

such as tuberculosis and severe acute respiratory syndrome (SARS) has become more common. In an effort to improve the quality of care, health care institutions are recruiting nurses from around the world to work in the United States, forcing hospitals to better understand and work with nurses from different cultures. Poverty is still deadlier than any disease and is the most frequent reason for death in the world today. The growth of urbanization also is currently affecting the world’s health. Improved communication, easier air travel, and easing of trade restrictions are making it easier for people to engage in “health tourism.”

12. A nurse is using research findings to improve clinical practice. Which technique is the nurse using? 1. Performance improvement 2. Integrated delivery networks 3. Nursing-sensitive outcomes 4. Utilization review committees ANS: A Performance improvement activities are typically clinical projects conceived in response to identified clinical problems and designed to use research findings to improve clinical practice. Larger health care systems have integrated delivery networks (IDNs) that include a network of facilities, providers, and services organized to deliver a continuum of care to a population of patients at a capitated cost in a particular setting. Nursing- sensitive outcomes are patient outcomes and nursing workforce characteristics that are directly related to nursing care such as changes in patients’ symptom experiences, functional status, safety, psychological distress, registered nurse (RN) job satisfaction, total nursing hours per patient day, and costs. Medicare-qualified hospitals had physician- supervised utilization review (UR) committees to review the admissions and to identify and eliminate overuse of diagnostic and treatment services ordered by physicians caring for patients on Medicare. 13. Which finding indicates the best quality improvement process? a) Staff identifies the wait time in the emergency department is too long. b) Administration identifies the design of the facility’s lobby increases patient stress. c) Director of the hospital identifies the payment schedule does not pay enough for overtime. d) Health care providers identify the inconsistencies of some of the facility’s policy and procedures.

ANS: A

The quality improvement process begins at the staff level, where problems are defined by the staff. It is not identified by administration, the hospital director, or health care providers.

14. A nurse is providing home care to a home-bound patient treated with intravenous (IV) therapy and enteral nutrition. What is the home health nurse’s primary objective? 1. Screening 2. Education 3. Dependence 4. Counseli ng ANS: B Health promotion and education are traditionally the primary objectives of home care, yet at present most patients receive home care because they need nursing care. Screening is preventive care. 15. A nurse hears a co-worker state that anybody could be a nurse since it is so automated with infusion devices and electronic monitoring; technology is doing the work. What is the nurse’s best response? 1. “Technology use has to be combined with nursing judgment.” 2. “The focus of effective nursing care is technology.” 3. “If it’s so easy, why don’t you do it?” 4. “That is true in the 20th century.” ANS: A In many ways, technology makes work easier, but it does not replace nursing judgment. Technology does not replace your critical eye and clinical judgment. Most importantly, it is essential to remember that the focus of nursing care is not the machine or the technology; it is the patient. Using “why” is not beneficial when communicating with others. Agreeing with the statement furthers misconceptions. 16. A nurse is completing a minimum data set. Which area is the nurse working? 1. Nursing center 2. Psychiatric facility 3. Rehabilitation center

4. Adult day care center ANS: A Nurses who work in a nursing center (nursing home or nursing facility) are required to complete a minimum data set on each patient. Minimum data set is not needed for psychiatric, rehabilitation, or adult day care centers. Patients who suffer emotional and behavioral problems such as depression, violent behavior, and eating disorders often require special counseling and treatment in psychiatric facilities. Rehabilitation restores a person to the fullest physical, mental, social, vocational, and economic potential possible. Patients require rehabilitation after a physical or mental illness, injury, or chemical addiction. Adult day care centers provide a variety of health and social services to specific patient populations who live alone or with family in the community. Services offered during the day allow family members to maintain their lifestyles and employment and still provide home care for their relatives. **MULTIPLE RESPONSE

1. Which government-instituted programs should the nurse include in a teaching session about controlling health care costs? (** Select all that apply. **)
2. Professional standards review organizations
3. Prospective payment systems
4. Diagnosis-related groups 4.** Third-party payers 5. “Never events” ANS: A, B, C The federal government, the biggest consumer of health care, which pays for Medicare and Medicaid, has created professional standards review organizations (PSROs) to review the quality, quantity, and costs of hospital care. One of the most significant factors that influenced payment for health care was the prospective payment system (PPS). Established by Congress in 1983, the PPS eliminated cost-based reimbursement. Hospitals serving patients who received Medicare benefits were no longer able to charge whatever a patient’s care cost. Instead, the PPS grouped inpatient hospital services for Medicare patients into diagnosis-related groups (DRGs). In 2011, the National Quality Forum (not a government facility) defined a list of 29 “never events” that are devastating and preventable. Through most of the twentieth century, few incentives existed for controlling health care costs.

Insurers or third-party payers paid for whatever health care providers ordered for a patient’s care and treatment.

2. A nurse is teaching the staff about the Institute of Medicine competencies. Which examples indicate the staff has a correct understanding of the teaching? ( Select all that apply. ) 1. Use informatics. 2. Use transparency. 3. Apply globalization. 4. Apply quality improvement. 5. Use evidence-based practice. ANS: A, D, E The Institute of Medicine competencies include: Provide patient- centered care; work in interdisciplinary teams; use evidence-based practice; apply quality improvement; and use informatics. Transparency is included in the 10 rules of performance in a redesigned health care system, not a competency. While globalization is important in health care, it is not a competency. 3. A nurse is evaluating care based upon the nursing quality indicators. Which areas should the nurse evaluate? ( Select all that apply. ) 1. Patient satisfaction level 2. Hospital readmission rates 3. Nursing hours per patient day 4. Patient falls/falls with injuries 5. Value stream analysis for quality ANS: B, C, D The American Nurses Association developed the National Database of Nursing Quality Indicators (NDNQI) to measure and evaluate nursing- sensitive outcomes with the purpose of improving patient safety and quality care. Nursing quality indicators include the following: Hospital readmission rates, nursing hours per patient day, and patient falls/falls with injuries. While every major health care organization measures certain aspects of patient satisfaction, it is not a nursing quality indicator. Value stream analysis is a method that focuses on improvement of processes in a health care institution.