Subacute Cutaneous Lupus Erythematosus - American Osteopathic College of Dermatology (AOCD)

Subacute thyroiditis is a rare type of thyroiditis. Learn more about symptoms, causes, diagnosis, and treatment.

Diagnosed with subactute thyroiditis? Here is a list of what you need to know and what you should expect if you have this thyroid condition.

Learn about what subacute rehabilitation is, including how it's paid for, how long you might stay, and what you can expect.

We present a case of subacute myocardial infarction with saphenous vein graft occlusion managed successfully with catheter-directed intra-graft thrombolysis and aspiration thrombectomy to reduce the risk of embolization and limit the zone of treatment. from Cath Lab Digest. Transradial Multivessel PCI

LBMC, recognized as a Top 50 Firm nationally and among the Southeast’s leading accounting and business consulting firms, announced healthcare industry

Chronic or subacute Budd-Chiari syndrome should be considered in unexplained liver dysfunction (in the laboratory test), particularly if ascites is a principal feature, or if risk factors for Budd-Chiari syndrome exist.

Hospital and patient whiteboards. We can create hospital communication boards with custom printing custom sizes. Bilingual options! Request a quote today.

When blood flow to certain regions of the brain is cut off from a stroke, that particular communication center no longer relays messages to corresponding parts of the body. So, as with all stroke issues, the problem begins in the brain but becomes aggravated by the weakening of the body part itself. The key to rehabili

Learn everything you need to know about Complete vs Incomplete spinal cord injuries.

melas - pt with subacute infarct. And melas

Depending on which stage eczema is in—acute, subacute, or chronic—the skin condition may look different. A doctor may treat it differently, too.

Depending on which stage eczema is in—acute, subacute, or chronic—the skin condition may look different. A doctor may treat it differently, too.

I recently wrote a blog post about strategies to improve word finding , because I have many students (and adults - as I work in subacute reh...

While many people may now be familiar with loss of smell or taste or ”Covid toes” (red and sore toes) as markers of Covid-19 infection, there is now another possible clinical condition to consider: subacute thyroiditis, otherwise referred to as "SAT".

A three-year-old female patient was admitted to our institution due to subacute fever, intermittent vomiting, persistent bilateral mydriasis after cycloplegia, right central facial palsy, and mild right hemiparesis with hyperreflexia. Brain MRI shows encephalitis in frontal, parietal, insular, and left putamen course and loss of cortical volume and white matter of the entire left hemisphere which are features described in Rasmussen's encephalitis (RE). Therapy with intravenous methylprednisolone bolus was initiated, with adequate clinical response. We consider in this case the diagnosis of atypical RE by imaging criteria in the subacute stage. There are few reports of atypical RE without epilepsy or continuous partial epilepsy. Our purpose is to present a case of a patient with RE images without epilepsy seizures and review the diagnostic and therapeutic approach of RE.

MARYVILLE NURS 623 EXAM 2 QUESTIONS AND ANSWERS WITH COMPLETE SOLUTION Which of the serum laboratory findings are present in the client with Cushing's syndrome? Correct Answer- Increased cortisol, HYPERnatremia, and HYPOkalemia Alice, age 48, has a benign thyroid nodule. The most common treatment involves: Correct AnswerWatchful waiting with an annual follow-up ACE inhibitors are given to clients with diabetes who have Correct Answer- persistent proteinuria A newly diagnosed client with diabetes who has an HbA1c of 7.5 is started on therapeutic lifestyle changes (TLC) and medical nutritional therapy (MNT). Which oral antidiabetic agent is recommended as monotherapy? Correct Answer- metformin An elderly client with hyperthyroidism may present with atypical symptoms. Which of the following manifestations are commonly seen in the elderly with hyperthyroidism? Correct Answer- a-fib, depression, weight loss Diane has had Cushing's disease for 20 years and has been taking hydrocortisone since her diagnosis. Today, she appears with a thick trunk and thin extremities. She has a "moon face," a "buffalo hump," thin skin with visible capillaries, and a number of bruises that appear to be slow in healing. To what do you attribute these symptoms? Correct Answer- excessive levels of cortisol The following is a client's self-monitoring blood glucose log. The client receives 20 units Novolin 70/30 in the morning (a.m.) and 20 units Novolin 70/30 in the evening (p.m.): Fasting a.m. pre-dinner: 90, 150, 105, 144, 101, 172, 98, 201. What changes would you make? Correct Answer- increase A.M. insulin Dan, age 45, is obese and has type 2 diabetes. He has been having trouble getting his glycohemoglobin under control. He's heard that exenatide (Byetta) causes weight loss and wants to try it. What do you tell him? Correct Answer- "Let's try it. You're glycohemoglobin will be lowered and you may lose weight."Which is the only treatment option that is curative for primary hyperparathyroidism? Correct Answerparathyroidectomy The most common worldwide cause of hypothyroidism is: Correct Answer- iodine deficiency What should be assessed for during exam on pt with HYPOparathyroidism? Correct Answer- chvostek's sign Morton has Type 2 diabetes. His treatment, which includes diet, exercise, and oral antidiabetic agents, is insufficient to achieve acceptable glycemic control. Your next course of action is to Correct Answer- ADD LONG-ACTING INSULIN Joy has gout. In teaching her about her disease, which food do you tell her is allowed in her diet? Correct Answer- Broccoli What controls the amount of calcium in the blood? Correct Answer- Parathyroid Thyroid hormones regulate Correct Answer- metabolism Which tests should you order to confirm a diagnosis of hypothyroidism? Correct Answer- t3 & Free T4 (preferred over T4) What are the hallmark signs of Grave's disease? Correct Answer- enlarged thyroid and increased T3 What is the gold standard screening for thyroid TUMOR/NODULE? Correct Answer- ULTRASOUND What is the diagnostic screening for thyroid cancer? Correct Answer- FINE NEEDLE BIOPSY What is the preferred treatment of Grave's disease in pregnancy Correct Answer- Propylthiouracil (PTU): Before starting anti-thyroid meds what should be checked? Correct Answer- LIVER FUNCTIONSwhat is the goal of thyroid treatment Correct Answer- euthyroid state What are signs and symptoms of hypothyroidism overtreatment? Correct Answer- hyperglycemia; cardiac arrhythmias (Afib); adrenal insufficiency; increased myxedema. Hyperthyroidism causes an excessive secretion of which thyroid hormones? Correct Answer- T3 & T4 What are S/S of hyperthyroidism? Correct Answer- "Hot/buldging/fast" heat intolerance, eye buldge, tachycardia, weight loss, diarrhea, systolic HTN, enlarged thyroid What are S/S of HYPOthyroidism? Correct Answer- "cold, slow, tired" cold intolerance, slow speech, fatigue, lethargy, weight gain, constipation, brittle nail/hair What is the most common cause of hyperthyroidism? Correct Answer- Graves disease Name the two thyroid hormones produced by the thyroid gland? Correct Answer- T3 & T4 Name the hormone produced by the pituitary gland, state the purpose of the hormone Correct AnswerTSH; regulate the production of hormones by the thyroid gland IN GRAVES DISEASE THE THE TSH IS _________ AND THE T3/T4 ARE __________ Correct Answer- LOW; HIGH IN HASHIMOTO'S DISEASE THE THE TSH IS _________ AND THE T3/T4 ARE __________ Correct AnswerHIGH; LOW WHAT allows the resolution of hyperthyroidism, although patients then become hypothyroid and require thyroid replacement therapy for life Correct Answer- ABLATIVE DOSE IODINE According to the American Association of Clinical Endocrinologists, the usual dose of levothyroxine per day for full replacement? Correct Answer- 1.6 mcg/kg per day 50-100 MCG DAYwhat pt education do you give with levothyroxine? Correct Answer- take meds on empty stomach 30 mins before morning meal (may cause insomnia if taken at night) How would you alter the dose for initiating synthetic thyroid replacement with an older patient with hx of cardiac issues? Correct Answer- Begin with one-half of the expected replacement dose or 25 to50 mcg/day PO, increasing the dose gradually by 25 mcg/day once every 4 to 6 weeks; cardiac start at 12.5 mcg/day What is the long standing effects of HYPERthyroidism? Correct Answer- OSTEOPOROSIS CONSIDER BONE DENSITY TESTING, VIT D, & CALCIUM SUPPLEMENTS IN OLDER PT How long will the patient require thyroid replacement therapy after ablative radioactive treatment for hyperthyroidism? Correct Answer- FOR LIFE Which treatment FOR hyperthyroidism is recommended for middle age and older adults? Correct Answer- Radioactive iodine 131 WHAT works by inhibiting thyroid hormone synthesis at multiple steps. They are used as a treatment to reduce the level of hormone on initiation of radioactive iodine therapy,( not used as primary or sole treatment) Correct Answer- ANTI-THYROID MED (Propylthiouracil (PTU) Methimazole (MMI) What should those treated with radioactive die be aware of? Correct Answer- AVOID CONTACT WITH INFANTS, CHILDREN, AND PREGNANT WOMEN FOR 7 DAYS What is the test that assesses the functional status (hot and cold spots) of the thyroid gland to differentiate between Grave's disease and subacute thyroiditis and toxic nodular goiters? Correct Answer- RADIO IODINE UPTAKE SCAN What is the gold standard test for confirming Hashimoto's? Correct Answer

a. Florence Nightingale b. Mary Nutting c. Clara Barton d. 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. DIF:Understand (comprehension) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Evaluation MSC: Health Promotion and Maintenance 2. The nurse prescribes strategies and alternatives to attain expected outcome. Which standard of nursing practice is the nurse following? a. Assessment b. Diagnosis c. Planning d. Implementation 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. DIF:Understand (comprehension) OBJ:Discuss the development of professional nursing roles. TOP: Planning MSC: Management of Care 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? a. Novice b. Proficient c. Competent d. 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. DIF:Apply (application) OBJ:Discuss the development of professional nursing roles. TOP: Evaluation MSC: Management of 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? a. Licensure b. Autonomy c. Certification d. Accountability 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. DIF:Apply (application) OBJ:Discuss the roles and career opportunities for nurses. TOP: Implementation MSC: Management of Care 5. A nurse prepares the budget and policies for an intensive care unit. Which role is the nurse implementing? a. Educator b. Manager c. Advocate d. Caregiver 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. As a caregiver, you help patients maintain and regain health, manage disease and symptoms, and attain a maximal level function and independence through the healing process. DIF:Apply (application) OBJ:Discuss the roles and career opportunities for nurses. TOP: Implementation MSC: Management of Care 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? a. Doctor of Nursing Science degree (DNSc) b. Doctor of Philosophy degree (PhD) c. Doctor of Nursing Practice degree (DNP) d. 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. The DNP is a practice doctorate that prepares advanced practice nurses such as nurse practitioners. DIF:Understand (comprehension) OBJ:Compare and contrast the educational programs available for professional registered nurse (RN) education. TOP: Teaching/Learning MSC: Management of Care 7. A nurse attends a workshop on current nursing issues provided by the American Nurses Association. Which type of education did the nurse receive? a. Graduate education b. Inservice education c. Continuing education d. 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. Registered nurse education is the education preparation for an individual intending to be an RN. DIF:Apply (application) OBJ:Compare and contrast the educational programs available for professional registered nurse (RN) education. TOP: Teaching/Learning MSC: Management of Care 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. DIF:Understand (comprehension) OBJ:Discuss the roles and career opportunities for nurses. TOP: Evaluation MSC: Management of Care 9. A nurse has compassion fatigue. What is the nurse experiencing? a. Lateral violence and intrapersonal conflict b. Burnout and secondary traumatic stress c. Short-term grief and single stressor d. 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. DIF:Understand (comprehension) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Assessment MSC: Health Promotion and Maintenance 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? a. Manager b. Patient educator c. Patient advocate d. 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. DIF:Apply (application) OBJ:Discuss the roles and career opportunities for nurses. TOP: Evaluation MSC: Management of Care 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? a. Provide the referral as requested. b. Offer to provide the newborn care. c. Refer the patient to the supervising provider. d. 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. DIF:Analyze (analysis) OBJ:Discuss the roles and career opportunities for nurses. TOP: Implementation MSC: Management of Care 12. The nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). Which activity is appropriate for a CRNA? a. Manages gynecological services such as PAP smears. b. Works under the guidance of an anesthesiologist. c. Obtains a PhD degree in anesthesiology. d. 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. DIF:Understand (comprehension) OBJ:Discuss the roles and career opportunities for nurses. TOP: Implementation MSC: Management of Care 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? a. Protects the nurse. b. Protects the public. c. Protects the provider. d. 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. DIF:Understand (comprehension) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Teaching/Learning MSC: Management of Care 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? a. Legislation is politics beyond the nurse’s control. b. National programs have no bearing on state politics. c. The individual nurse can influence legislative decisions. d. 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. DIF:Analyze (analysis) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Evaluation MSC: Management of 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? a. Code of ethics b. Standards of practice c. Standards of professional performance d. 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. DIF:Understand (comprehension) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Implementation MSC: Management of Care 16. A graduate of a baccalaureate degree program plans to start working as a registered nurse (RN) in the emergency department. Which action must the nurse take first? a. Obtain certification for an emergency nurse. b. Pass the National Council Licensure Examination. c. Take a course on genomics to provide competent emergency care. d. 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 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. DIF:Remember (knowledge) OBJ:Compare and contrast the educational programs available for professional registered nurse (RN) education. TOP: Implementation MSC: Management of Care 17. While providing care to a patient, the nurse is responsible, both professionally and legally, for the appropriateness and proper execution of the care. Which concept does this describe? a. Autonomy b. Accountability c. Patient advocacy d. 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. DIF:Remember (knowledge) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Evaluation MSC: Management of Care 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 a. 2, 4, 5, 1, 3 b. 2, 5, 4, 3, 1 c. 4, 2, 5, 3, 1 d. 4, 5, 2, 1, 3 ANS: B Benner’s levels of proficiency are as follows: novice, advanced beginner, competent, proficient, and expert. DIF:Understand (comprehension) OBJ:Discuss the development of professional nursing roles. TOP: Teaching/Learning MSC: Management of Care 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.) a. Human rights b. Affordable Care Act c. Demographic changes d. Medically underserved e. 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. DIF:Understand (comprehension) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Teaching/Learning MSC: Management of Care 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.) a. Master’s degree b. Inservice education c. Doctoral preparation d. Continuing education e. 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. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. National Council Licensure Examination retakes are not to keep current; this test is taken to enter RN practice. DIF:Understand (comprehension) OBJ:Compare and contrast the educational programs available for professional registered nurse (RN) education. TOP: Teaching/Learning MSC: Management of Care 3. A nurse wants to become an advanced practice registered nurse. Which options should the nurse consider? (Select all that apply.) a. Patient advocate b. Nurse administrator c. Certified nurse-midwife d. Clinical nurse specialist e. 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. DIF:Understand (comprehension) OBJ:Discuss the roles and career opportunities for nurses. TOP: Teaching/Learning MSC: Management of Care 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.) a. Autonomy b. Informatics c. Accountability d. Political activism e. 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. DIF:Analyze (analysis) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Evaluation MSC: Management of Care Chapter 02: Health Care Delivery System Potter: Fundamentals of Nursing, 11th Edition 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? a. Capitation provides the hospital with a means of recovering variable charges. b. The hospital will be paid for the full cost of the patient’s hospitalization. c. Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost. d. 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. DIF:Understand (comprehension) OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. TOP: Planning MSC: Management of Care 2. A nurse is teaching the staff about integrated health care systems. Which model of care should the nurse include in the teaching about seam-less care delivery? a. Affordable Care Act b. Hospital Value–Based Purchasing c. Bundled Payments for Care Improvements d. The patient-centered medical home model ANS: D Basically, two types of integrated health care systems are found: an organizational structure that follows economic imperatives (such as combining financing with all providers, from hospitals, clinics, and physicians to home care and long-term care facilities) and a structure that supports an organized care delivery approach (coordinating care activities and services into seamless functioning). The patient-centered medical home model is an example of an integrated health care system that strengthens the physician-patient relationship with coordinated, goal-oriented, individualized care. All the other options are more related to the financial accessibility of health care. DIF:Understand (comprehension) OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. TOP: Teaching/Learning MSC: Management of 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? a. A family can choose whether to have health insurance with no consequences. b. Primary care physician payments from Medicaid services can equal Medicare. c. Adult children up to age 26 are allowed coverage on the parent’s plan. d. Quality hospital outcome scores are tied directly to patient satisfaction. ANS: C The Affordable Care Act ties payment to organizations offering Medicare Advantage plans to the quality ratings of the coverage they offer. If hospitals perform poorly in quality scores, they receive lower payments for services. Quality outcome measures include patient satisfaction, more effective management of care by reducing complications and readmissions and improving care coordination. 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. DIF:Remember (knowledge) OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. TOP: Teaching/Learning MSC: Management of Care 4. A nurse is caring for a patient in the hospital. When should the nurse begin discharge planning? a. When the patient is ready. b. Close to the time of discharge. c. Upon admission to the hospital. d. 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 to help the transition of patient care from the hospital to home or other care facility. DIF:Remember (knowledge) OBJ:Discuss the role of nurses in various health care settings. TOP: Planning MSC: Management of Care 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? a. Secondary acute b. Continuing c. Restorative d. Tertiary 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. Tertiary care includes intensive care and subacute care. DIF:Understand (comprehension) OBJ:Discuss the role of nurses in various health care settings. TOP: Implementation MSC: Management of Care 6. A nurse provides immunization to children and adults through the public health department. Which type of health care is the nurse providing? a. Primary care b. Preventive care c. Restorative care d. 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. DIF:Understand (comprehension) OBJ:Summarize the six levels of health care. TOP: Implementation MSC: Health Promotion and Maintenance 7. In order to receive payment for care provided, nursing centers must comply with requirements outlined in what federal legislation? a. Omnibus Budget Reconciliation Act b. Medicare Act c. Medicaid Act d. Affordable Care Act ANS: A Nursing centers must comply with the Omnibus Budget Reconciliation Act of 1987 and its minimum requirements for nursing facilities to receive payment from Medicare and Medicaid. The Affordable Care Act ties payment to organizations offering Medicare Advantage plans to the quality ratings of the coverage they offer. DIF:Understand (comprehension) OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. TOP: Implementation MSC: Management of Care 8. The nurse is trying to determine risk factors unique to home care patients. What resource should the nurse access? a. Pew Health Professions Commission b. The Outcome and Assessment Information Set (OASIS) c. American Nurses Credentialing Center (ANCC) Magnet Recognition Program d. Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) ANS: B OASIS (the Outcome and Assessment Information Set) includes a group of standardized core assessment items for an adult home care patient. OASIS forms the basis for measuring patient outcomes for the purposes of outcome-based quality. Data items within OASIS include socio-demographic, environmental, support system, health status, functional status, and health service utilization characteristics of a patient. The OASIS assessment tool was designed to gather the data items needed to measure both outcomes and patient risk factors in the home setting. 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. The Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey developed to measure patient perceptions of their hospital experience. The Magnet Recognition Program recognizes health care organizations that achieve excellence in nursing practice. DIF:Understand (comprehension) OBJ:Discuss the features of an integrated health care system. TOP: Assessment MSC: Management of Care 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. Assisted living offers an attractive long-term care setting with an environment more like home and greater resident autonomy. DIF:Apply (application) OBJ:Summarize the six levels of health care. TOP: Teaching/Learning MSC: Management of Care 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? a. Continuing care b. Restorative care c. Preventive care d. Tertiary care ANS: D