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Population and Community Health Nursing Chapter 12

Terms in this set (10)

Linked model

Correct: In linked models, case managers make referrals for services to independent services and networks.
A home health nurse is working with a client who lives in a rural setting and requires multiple outside services for rehab. So far, the nurse has made referrals to separate agencies for occupational therapy, speech therapy, physical therapy, and the state job retraining services. This is an example of which model of case management?

a. Linked model
b. Supportive model
c. Comprehensive model
d. Intensive model
Intensive model

Correct: In this model the majority of services are provided by a single organization. In the case of a patient who is noncompliant, this may make management easier.
A client who has utilized the community health system numerous times has returned, needing a lengthy variety of health care services. The nurse working with this client is also aware the client has a history of non-compliance and poor follow-through. The case management model that would best serve this client is the:

a. High-risk disease management model
b. Intensive model
c. Linked model
d. Supportive model
Best care provided most efficiently
Correct: Cost-efficiency is a system-centered goal.

Decreased fragmentation of care
Correct: Reduced duplication and fragmentation of services is a system-centered goal.

Cost containment
Correct: Cost containment is a system-centered goal.
Case management involves goals centered on the client and the system. Which goals would the nurse classify as system-centered?

a. Best care provided most efficiently
b. Decrease need for acute care services
c. Decrease fragmentation of care
d. Prevention of deterioration in health status
e. Cost containment
The client requires a variety of services and resources.

Correct: Case management does not "manage" people, but services and resources they require.
A client with multiple, chronic health problems is scheduled for discharge. The client has been difficult to work with at times and has a limited support system. The client will require extensive follow-up with a variety of health care services. The health care team decides that this is an appropriate client for case management based on which of the following principles?

a. The health care team needs to work with this client.
b. The client is difficult to work with.
c. The client requires a variety of services and resources.
d. The client has a limited support system.
Abandonment

Correct: Abandonment occurs when a health care provider terminates services to a client with continuing needs without notifying the client or arranging for services from another provider.
A home health nurse has been providing services to a client who has dementia. On the last visit, the client slapped the nurse, so the nurse has stopped going to the patient's home. The nurse could be guilty of which ethical infraction?

a. Negligence
b. Reportability
c. Abandonment
d. Lack of autonomy
Review all documentation and justification.

Correct: Denial of services includes failure to authorize services due to lack of justification of medical necessity or appropriateness of services.
A community health nurse has been involved in the management of a client for some time. The client was denied disability services after the nurse recommended this option. The first action for the nurse, in this situation, is to:

a. Review all documentation and justification.
b. Make a formal request to the insurance company.
c. Call the physician.
d. Recommend that the client re-submit the application.
Breach of contract

Correct: Breach of contract, in the legal sense, applies to care of individual clients, although communities might be said to breach an unwritten contract with citizens when they discontinue needed service programs.
A community service, which includes food and clothing distribution to the needy or homeless, was notified that funding would be dropped and the service would need to become self-supporting. The decision was made at the city council level, without strategies in place for future funding needs. This is an example of:

a. Negligence
b. Wrongful denial of services
c. Breach of contract
d. Abandonment
Address this issue with the client.

Correct: The nurse should first discuss the suspicion with the client.
A population health nurse is very concerned that a 24-year-old client may have been physically abused by the intimate partner. What is the nurse's first action?

a. Report this suspicion to the primary care provider
b. Report this suspicion to the health department
c. Address this issue with the client
d. Add the suspicion to the plan of care so others can assess
Borderline personality disorder

Correct: Personal indicators may include: diminished functional status; a history of substance abuse or mental illness (borderline personality disorder); poor cognitive abilities; prior noncompliance with treatment plans; over 65 years of age; experience of a major life change or significant change in self-image; potential for severe emotional response to illness; or unrealistic expectations of potential outcomes of care.
A community health nurse is assessing a client in the need for case management. Which situation is an example of a personal indicator in this client's background?

a. Single parent
b. Borderline personality disorder
c. History of anorexia
d. Recent drug overdose
A home visit to a hospice client who needs assistance with bathing.

Correct: Bathing is a hands-on activity and does not involve steps of the nursing process. There are many steps to consider when delegating tasks and the case management must review all before decisions should be made.
A home health case manager is delegating tasks to even-out the workload among employees. Of the following, which task would be the most appropriate to delegate to an unlicensed personnel?

a. Selecting appropriate assistive devices for a client with sensory decline.
b. Helping a new client with medication administration.
c. A home visit to a hospice client who needs assistance with bathing.
d. Visiting a client who has been having problems with physical and cognitive decline.
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