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[Osborn] chapter 3

Learning Objectives [Number and Title ]


Learning Objective 1
Discuss how major trends in health care quality and patient
safety are related to nursing practice.
Learning Objective 2
Compare the differences between the types of managed care
plans: health maintenance organizations, preferred provider
organizations, Medicare, and Medicaid.
Learning Objective 3
Describe the key components of the budget process for
hospitals and health care systems.
Learning Objective 4
Explain the nurses role in assisting patients with insurance and
financial issues.
Learning Objective 5
Differentiate between the three types of standards used to
measure quality in health care settings.
Learning Objective 6
Compare and contrast the impact of licensure, regulation, and
accreditation on health care delivery systems.
Learning Objective 7
Differentiate between the types of advance directives for health
care and describe the nurses responsibility in advocating and
documenting the patients wishes related to an advance
directive.
Learning Objective 8
Explain the patients rights with regard to his or her medical
record according to the legal principles of documentation in the
patients medical record.
Learning Objective 9
Identify the three main components of the Health Insurance
Portability and Accountability Act.
Learning Objective 10 Identify the components of case management in the hospital
and the associated acute care nursing responsibilities.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Review the National Patient Safety goals for implementation strategies to reduce falls.
Ask the health care provider for an order for restraints.
Contact the staffing office to request a sitter for the patient.
Instruct the patient to call for help and place the bed in the high position.

Correct 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.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Continuous quality improvement


Quality assurance
Quality improvement
Total quality management

Correct 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 organizations 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.
Cognitive Level: Analyzing
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Quality improvement
Self-assessment
Departmental assessment
Continuous quality improvement study

Correct 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.
Cognitive Level: Analyzing
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Health maintenance organization.


Independent practice association.
Preferred provider organization.
Exclusive provider organization.

Correct 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-forservice 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.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Preferred provider organization


Health maintenance organization
Independent practice association
Medicare

Correct 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.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
Correct 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.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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 organizations budget?
1.
2.
3.
4.

Capital
Supplies
Purchased services
Overhead

Correct Answer: Capital


Rationale: Capital budgets determine the organizations 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.
Cognitive Level: Analyzing
Nursing Process: Planning
Client Need: Safe, Effective Care Environment
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Salaries/wages
Charges
Deduction from revenue
Nonoperating revenue

Correct 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.
Cognitive Level: Analyzing
Nursing Process: Evaluation
Client Need: Safe, Effective Care Environment
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Operating expenses
Revenue
Nondiscretionary expenses
Deductions from revenue

Correct 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.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Contact social services to help with health insurance coverage.


Suggest to the health care provider that the patient should be discharged.
Find out which treatments can be reduced.
Ask the patient if her husband is eligible for unemployment benefits.

Correct 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 hospitals 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 husbands
unemployment with the patient.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

11. A patient refuses to take any medication because he cant afford it. Which of the following
should the nurse do to help this patient?
1.
2.
3.
4.

Find out of the patient is eligible for medication assistance counseling.


Call the health care provider.
Mark the medication as refused in the administration record.
Ask the patient how he expects to get better if he does not take the medication.

Correct 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 patients ability to
rest and recover. It is premature to call the health care provider. Recording the patients 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.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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 patients 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.
Correct Answer: Find out what services are covered by Emergency Medical Treatment and Labor Act
(EMTALA) and explain that the patients 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 hospitals 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.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Structure
Process
Outcome
Improvement

Correct 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.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Turn and reposition bed-rest patients every 2 hours and as needed.


Every nurse scheduled to work has current cardiopulmonary resuscitation certification.
A patients output is 2400 cc after receiving one dose of a diuretic.
Patient is able to ambulate without assistance.

Correct 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 patients urine output after a
medication and a patients ability to ambulate would be considered outcome standards.
Cognitive Level: Analyzing
Nursing Process: Evaluation
Client Need: Safe, Effective Care Environment
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

15. The nurse is reviewing a patients post-hospitalization survey, which states that the care received was
adequate. The nurse realizes this information is considered as which quality standard?
1.
2.
3.
4.

Outcome
Process
Structure
Continuous quality improvement

Correct Answer: Outcome


Rationale: Outcome standards address the patients 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.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Occupational Health and Safety Administration.


Joint Commission.
Centers for Disease Control.
Centers for Medicare and Medicaid.

Correct 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.
Cognitive Level: Application
Nursing Process: Planning
Client Need: Safe, Effective Care Environment
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Licensure
Regulation
Accreditation
Life safety

Correct 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.
Cognitive Level: Analyzing
Nursing Process: Evaluation
Client Need: Safe, Effective Care Environment
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Inspect for fire and life safety standards and regulations.


Contact the Centers for Disease Control and Prevention.
Inform the state board of nursing.
Contact the Joint Commission to schedule a survey.

Correct 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.
Cognitive Level: Analyzing
Nursing Process: Planning
Client Need: Safe, Effective Care Environment
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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 isnt, he wants all possible medical treatment. Which of the
following should the nurse do?
1.
2.
3.
4.

Contact the health care provider for the patient to discuss the patients decision.
Document the patients wishes in the medical record.
Tell the patient that he cannot change is mind or treatment plan.
Contact social services to discuss the change in plans.

Correct Answer: Contact the health care provider for the patient to discuss the patients decision.
Rationale: Advance directives can be changed as the individuals needs and goals change. The nurse
should contact the health care provider so that the patients advance directive can be provided to the
health care provider for documentation in the medical record.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 7

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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
patients medical record, the nurse realizes that the friend is considered:
1.
2.
3.
4.

The patients health care power of attorney.


The patients best friend.
The patients brother.
The patients next-door neighbor.

Correct Answer: The patients 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 patients medical record to ensure the information about the friend was present. There is not enough
information to determine if the friend is the patients best friend, brother, or next-door neighbor.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 7

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

21. A patient hands the nurse an advance directive during the admission process. Which of the following
should the nurse do?
1.
2.
3.
4.

Place the document in the patients medical record.


Read the document and hand it back to the patient.
Make a copy of the document and give the copy to the patient.
Call social services to collect the document.

Correct Answer: Place the document in the patients 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.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 7

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

22. The nurse is planning to document a patients 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.
2.
3.
4.

Patient was nontalkative and sat in a chair for 4 hours.


Patient argued with everyone who came into his room today.
Patient was overheard telling his wife to phone his lawyer to sue the hospital.
Patient appeared to be angry and had a poor appetite for all meals today.

Correct Answer: Patient was nontalkative and sat in a chair for 4 hours.
Rationale: The nurses 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.
Cognitive Level: Applying
Nursing Process: Planning
Client Need: Safe, Effective Care Environment
LO: 8

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
Correct 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.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 8

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

24. A patient tells the nurse that he does not understand the information in his medical record because
its all a bunch of letters and numbers that dont 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 doesnt make sense to her either.
Correct 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.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 8

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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.
2.
3.
4.

Document that the brother is not permitted to review the patients medical record.
Tell the other nurses during change of shift report about the brothers employment.
Ask the patient why she is concerned.
Nothing.

Correct Answer: Document that the brother is not permitted to review the patients 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 patients medical record. The nurse should not talk about the
brothers employment during change of shift report. The nurse should not ask the patient to justify her
request. Doing nothing is inappropriate.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 9

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

26. The estranged husband of a patient is seen picking up and reading the patients 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.
2.
3.
4.

Report this violation to the hospital administration.


Tell the patient that she has no idea how he learned of her health status.
Nothing.
Ask the patient how she knows that her husband is aware of her health status.

Correct 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.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 9

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

27. A nurse is overheard telling someone about a patient who was admitted for an alcohol problem.
The information appears in the next days newspaper and names the nurse as the informant. Which of
the following should be done?
1.
2.
3.
4.

Implement the policy for an intentional violation of the HIPAA law regarding patient privacy.
Contact the newspaper and ask for a retraction.
Ignore the information in the paper, claiming it was hearsay.
Nothing.

Correct 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.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 9

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

28. The case manager reviews a patients 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.
2.
3.
4.

Utilization review.
Care planning.
Discharge planning.
Social services.

Correct 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.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 10

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

29. The nurse is planning the discharge of a patient. Which of the following activities would be
considered as discharge planning?
1.
2.
3.
4.

Ordering oxygen to be used at home


Evaluating how long the patient was in the hospital
Counting the number of times the patient went to physical therapy
Helping the patient complete health insurance paperwork

Correct 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.
Cognitive Level: Analyzing
Nursing Process: Planning
Client Need: Safe, Effective Care Environment
LO: 10

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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 patients ongoing care needs?
1.
2.
3.
4.

Utilization review
Discharge planning
Social services
Case management does not cover the clients situation

Correct 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.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 10

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.