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Chapter 16 Managing Care in Secondary and Tertiary Health Care
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Chapter 16 Managing Care in Secondary and Tertiary Health Care
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Chapter 16: Managing Care in Secondary and Tertiary Health CareClaywell: LPN to RN Transitions
MULTIPLE CHOICE
1. The nurse is listening to a lecture on the Orem’s theory. Which statement indicates that
teaching has been effective?
a. “Patients enter the acute health care setting when they are experiencing a
dependent-care agency.”
b. “Patients enter the acute health care setting when they are experiencing a
community-care agency.”
c. “Patients enter the acute health care setting when they are experiencing a
dependent-care deficit.”
d. “Patients enter the acute health care setting when they are experiencing a
community-care deficit.”
ANS: C
At various times in life, a person will have a health care demand, either a self-care or
dependent-care demand that exceeds his or her self-care agency. When this happens, the
person is said to have a self-care or dependent-care deficit. When this deficit is such that the
person needs the specialized training of health care professionals, the person enters the health
care setting and engages in a collaborative relationship with the RN and other health care team
members. All other answer options are incorrect.
DIF: Cognitive Level: Evaluation
OBJ: Discuss the theoretical fram
Nework for managing in secondary care.
TOP: Managing Secondary Care
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
2. The nurse is listening to a lecture on the acute care environment and the role of the RN.
Which statement indicates that the teaching has been effective?
a. “The RN ensures more independence in self-care ability.”
b. “The RN avoids discussing wait times as the patient progresses through the illness
state.”
c. “The RN changes the medical plan of care according to the RN’s assessments.”
d. ”The RN delegates the majority of decisions to the medical assistants.”
ANS: A
Acute health care requirements vary with the progress of the disease either toward a cure or
through complications that can occur. The RN uses information from many different sources
to identify potential and actual problems with the patient’s progress. The overall focus is to
prevent complications while promoting a higher level of health. Changing the medical plan of
care is not the role of a nurse. The nurse would not delegate decision making to the medical
assistant staff.
DIF: Cognitive Level: Evaluation OBJ: Identify outcome priorities for secondary care.
TOP: Managing Secondary Care
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
, 3. A nurse writes the diagnosis of “potential for infection” for a postoperative patient. The
charge nurse makes certain not to place a patient with a diagnosed infection in the same room
with the fresh postoperative patient. The nurse does this to manage which of the following?
a. The potential for noise in the room
b. The potential for patient complaints related to odors
c. The physical environment of the secondary health setting
d. The social environment within the secondary health setting
ANS: C
Much within the environment of the acute care setting has the potential to extend the patient’s
length of stay by introducing unexpected complications. Moving the patient through the acute
care setting effectively and safely requires the RN to pay attention as the patient responds to
the environment, as well as to anticipate the potential effects of the environment, including
staffing issues. A common nursing diagnosis is “potential for infection,” and nosocomial, or
hospital-acquired, infection is just one of the problems that competent nursing management
can prevent. The charge nurse can manage this environmental concern by basing bed
assignments on the diagnoses of the patients and then subsequently basing caregiver
assignment on qualifications. The potential for noise, the potential for complaints, and the
social environment have nothing to do with infections or the potential for infections.
DIF: Cognitive Level: Analysis OBJ: Analyze factors influencing patient outcomes.
TOP: Managing Secondary Care
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
4. After being diagnosed with cancer, the patient appears angry. At this point it would be
appropriate for the nurse to assess for which kind of distress?
a. Environmental
b. Developmental
N
c. Physical
d. Spiritual
ANS: D
Patients facing stressful health care-related events may also experience spiritual distress.
Illness states can place a patient in a position that forces consideration of the fragile nature of
life. Resulting from a potential life-or-death experience or a life-changing event, spiritual
distress may take on many manifestations. Much as in the grief process, the patient may
display anger, blame, bargaining, or denial or may overtly cling to a spiritual guide. RNs
assess for spiritual distress and implement interventions that will help the patient cope, such as
facilitating the patient’s spiritual connection either through a referral or just by respecting
personal wishes. Environmental, developmental, and physical distresses are not typically
related to chronic or terminal disease situations.
DIF: Cognitive Level: Analysis OBJ: Analyze factors influencing patient outcomes.
TOP: Managing Secondary Care: Spirituality
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
5. Some cultures see personal touching as an insult unless you are intimately related. In the acute
care setting, the need for touching to administer care may produce what within the patient?
a. Cultural strain
b. Impaired functioning
c. Cultural insult
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