Case Study: Mountain View Health Center

This case study of Mountain View Health Center, with information about the types of activities performed there, organizational structure, strategic priorities, and financial allocations. Use this for this assignment.

1. Mountain View Health Center is a nonprofit, 54 beds, short-term, acute care community-based hospital in Townsville, a poor rural community located approximately 93 miles from the closest metropolitan city.

2. The hospital is the only source of acute care outside the metropolitan city (it is a critical access hospital and is an important component of the town’s economic and social fabric.

3. It is also the largest employer in town. The hospital is not considered to be a teaching hospital because the closest medical, nursing, and allied health schools are more than 100 miles away.

4. The population approx.. 27,000 of Townsville is multicultural, with a large number of Hispanic residents represented in the most recent census

5. The primary industry is farming, which brings in significant numbers of seasonal migratory workers during harvest season

6. These farmworkers frequently suffer from poor living and working conditions that lead to an array of health problems, including work-related injuries and long-term exposure to fungi and dust.

7. Lack of safe drinking water often results in cases of dehydration and heatstroke. Pesticide poisoning, falls, and injuries related to exposure to the elements are also commonly seen in the ER.

8. Farmworkers rarely have insurance, they can’t afford to pay for health care. In addition, language is a barrier to care and treatment

9. The hospital has a small ER, 2 surgical beds, an OB. There are 5 ICU beds.

10. The hospital attempts to meet the minimum RN staffing guidelines for RNs mandated by the state of California but must request waivers. Primary care is provided by both MD and advanced practice nurses.

11. The remote location and small hospital size have resulted in MD shortages, although this is not always a concern. Wages at the hospital is among the highest in town, although slightly below the median for the region.

12. The hospital actively collaborates with the tertiary hsps in the region. It participates in formal or informal alliances with rural hsp networks. It also work closely with community organizations that serve the low income and homeless populations in the community.

13. Like other rural hospitals, the cash-strapped hospital is struggling to survive due to increased costs, a high number of uninsured or under insured, reduced payments from public and private insurance, and expenses related to maintaining an older building

14. Payer mix is predominantly beneficiaries of Medicare and Medicaid

15. The hospital recovers about 95cents on the dollar, 80 cents on the dollar from Medicaid, about 4 cents from self pay. Hospital had about $41 million in revenue this past year but had to write off about $8.5 million for bad debt or charity care, resulting in a total projected loss of $1.8 million. In patient days declined the past year as patients delayed elective surgeries due to higher deductibles, and the economic downturn.

16. Despite these fiscal challenges, the hospital maintains an active quality monitoring program, with most performance indicators scoring at the average level as compared with national benchmarks.

17. Like most rural hospitals, this one also lacks electronic health records. The hospital did apply for federal funding to begin implementation but meeting meaningful criteria is not expected for another 5 years.

18. The board of directors, composed of local community leaders debate whether the goal should be to remain an independent hospital or to focus on ensuring access to health care.

19. Local doctors have expressed interest in contracting or bundling their services with these regional health care systems to ensure financial viability in their private practices.

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Question

Week 6 quiz

Question 1

A 65-year-old woman has an advanced form of rheumatoid arthritis. Her treatment includes a regular dosage of methotrexate. The nurse will advise her to take which of the following vitamin supplements while taking the drug?

A) Vitamin A

B) Vitamin B

C) Vitamin C

D) Vitamin D

Question 2

To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should

A) administer calcium supplements.

B) position the patient in the side-lying position.

C) administer carbohydrates.

D) monitor for nausea and vomiting.

Question 3

A female patient with a diagnosis of type 1 diabetes mellitus has been experiencing increasing neuropathic pain in recent months, a symptom that has not responded appreciably to conventional analgesics. The patient’s care provider has begun treatment with gabapentin (Neurontin). How is the addition of this drug likely to influence the management of the patient’s existing drug regimen?

A) The patient may be required to temporarily hold her other medications until a stable serum level of gabapentin is achieved.

B) It is unlikely to influence the patient’s other medications because gabapentin does not interact with other drugs.

C) Gabapentin is contraindicated with the use of exogenous insulin.

D) The patient’s medication-related risk for renal failure must be assessed prior to the use of gabapentin.

Question 4

A nurse is caring for a patient who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for which of the following?

A) History of taking anticoagulant drugs

B) Allergy to seafood

C) Hirsutism

D) The patient’s age

Question 5

A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor which of the following?

A) Prothrombin time and partial thromboplastin time

B) Urine specific gravity

C) Alanine aminotransferase and total bilirubin levels

D) Follicle-stimulating hormone levels

Question 6

A nurse is assessing a patient who has come to the emergency department complaining of back spasms. The patient states that he has a history of opioid addiction and does not want to take any drug that “puts me at risk of becoming physically dependent.” Which of the following medications would the nurse question, if ordered?

A) Methocarbamol (Robaxin)

B) Orphenadrine (Norflex)

C) Cyclobenzaprine (Flexeril)

D) Metaxalone (Skelaxin)

Question 7

A 40-year-old woman with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize when updating the nursing care plan for this patient?

A) Risk for Injury related to CNS depressant effects

B) Diarrhea related to anticholinergic effects

C) Altered Nutrition, Less than Body Requirements, related to appetite suppression

D) Impaired Swallowing related to increased muscle tone

Question 8

A nurse is working with a 57-year-old man who is a former intravenous drug abuser. He has been prescribed a weekly dosage of methotrexate for his rheumatoid arthritis. Which of the following will the nurse include in her teaching plan for this patient?

A) Avoid high-fat foods

B) Drink plenty of water every day

C) Take the tablets before bedtime

D) Avoid red meat

Question 9

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine?

A) The resident has not eaten breakfast because of a recent loss of appetite

B) The resident’s apical heart rate is 112 beats/minute with a regular rhythm

C) The resident had a fall during the night while transferring from her bed to her bathroom

D) The resident received her annual influenza vaccination the previous day

Question 10

A nurse is caring for a 61-year-old man who has had a severe attack of gout while in the hospital for food poisoning. The nurse administers colchicine intravenously in order to

A) avoid aggravating the gastrointestinal tract.

B) ensure quick distribution of the drug.

C) prevent the risk of infection or bleeding.

D) minimize the risk of depressed bone marrow function.

Question 11

A patient receives 25 units of NPH insulin at 7.AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?

A) After breakfast

B) Before lunch

C) Late afternoon

D) Bedtime

Question 12

A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient’s

A) blood pressure.

B) potassium level.

C) use of alcohol.

D) use of salt in his diet.

Question 13

A male patient with a diagnosis of relapsing-remitting multiple sclerosis is in the clinic to discuss with the nurse the possibility of self-administration of glatiramer. During the patient education session for self-administration, the nurse will emphasize

A) the need to rotate the injection site of the drug.

B) the need to avoid crushing the tablet.

C) the need to place the tablet under the tongue.

D) the need to use only the thigh muscle for the drug injection site.

Question 14

A diabetic patient being treated for obesity tells the nurse that he is having adverse effects from his drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which of the following adverse effects would need the nurse’s immediate attention?

A) Decreased libido

B) Increased blood glucose

C) Dry eyes

D) Jittery feeling

Question 15

A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?

A) Wash hands before and after taking the medicine

B) Keep track of any gastrointestinal tract infections

C) Monitor glucose levels closely

D) Note the time the medicine is taken each day

Question 16

A 13-year-old patient has juvenile arthritis. He has recently had oral surgery and was told by the surgeon to take aspirin for the pain. The nurse will monitor for which of the following?

A) Bronchoconstriction

B) Hepatotoxicity

C) Aplastic anemia

D) Agranulocytosis

Question 17

A nurse has been invited to speak to a support group for persons with movement disorders and their families. Which of the following statements by the nurse addresses the chronic nature of these diseases and the relevant drug therapies?

A) “Drug therapy can consist of one or more drugs to eliminate the symptoms of these diseases.”

B) “Drugs do not cure these disorders; they instead enhance quality of life.”

C) “Persons of all cultures are treated similarly and respond in similar ways to treatment.”

D) “Drugs used to treat these disorders always pose a risk of severe liver and kidney dysfunction.”

Question 18

A patient in need of myocardial infarction prophylaxis has been prescribed sulfinpyrazone for gout. Which of the following will the nurse monitor the patient most closely for?

A) Hypothermia

B) Hypotension

C) Renal dysfunction

D) Bleeding

Question 19

A nurse is developing a care plan for a patient who has multiple sclerosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in

A) chest pain.

B) fatigue.

C) breathing difficulties.

D) heart palpitations.

Question 20

A 32-year-old female patient is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the patient and her husband that the adverse effect that poses the greatest safety risk to the patient is

A) constipation.

B) dry mouth.

C) fatigue.

D) hypotension.

Question 21

A 34-year-old male patient is prescribed methimazole (MMI).The nurse will advise him to report which of the following immediately?

A) Vertigo

B) Intolerance to cold

C) Loss of appetite

D) Epigastric distress

Question 22

A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium).In light of this new addition to her drug regimen, what teaching point should the woman’s nurse provide?

A) “This will likely relieve your muscle spasms but you’ll probably develop a certain amount of dependence on the drug over time.”

B) “We’ll need to closely monitor your blood sugar levels for the next week.”

C) “There’s a small risk that you might experience some hallucinations in the first few days that you begin taking this drug.”

D) “You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity.”

Question 23

A patient with type 1 diabetes has been admitted to the hospital for orthopedic surgery and the care team anticipates some disruptions to the patient’s blood glucose levels in the days following surgery. Which of the following insulin regimens is most likely to achieve adequate glycemic control?

A) Small doses of long-acting insulin administered four to five times daily

B) Doses of basal insulin twice daily with regular insulin before each meal

C) Large doses of rapid-acting insulin combined with long-acting insulin each morning and evening

D) Divided doses of intermediate-acting insulin every 2 hours, around the clock

Question 24

During long-term desmopressin therapy in a 48-year-old woman, it will be most important for the nurse to assess which of the following?

A) The patient’s environment

B) The patient’s diet

C) The condition of the patient’s skin

D) The condition of the patient’s nasal passages

Question 25

A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to

A) crush the tablet before swallowing.

B) swallow the tablet whole.

C) swallow the tablet with milk or food.

D) avoid drinking milk for 3 hours after swallowing the tablet.

Question 26

A nurse will instruct a patient taking allopurinol to take each dose

A) at night.

B) first thing in the morning.

C) after a meal.

D) before a meal.

Question 27

The nurse is conducting a medication reconciliation of a new resident of a long-term care facility. The nurse notes that the resident takes allopurinol on a daily basis for the treatment of gout. What is the primary purpose of this drug?

A) To balance urate concentration and prevent gout attacks

B) To promote the remodeling of damaged synovium

C) To potentiate the metabolism of dietary purines

D) To achieve pain relief in joints affected by gout

Question 28

A nurse is teaching a patient about his newly prescribed drug, colchicine, for gout. The nurse will instruct the patient to avoid which of the following foods?

A) Green beans

B) Shrimp

C) Eggs

D) Milk

Question 29

A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which of the following instructions?

A) Eat a high-protein diet

B) Decrease the dosage if any adverse effect is experienced

C) Wear appropriate clothing and sunscreen whenever he is in direct sunlight

D) Have a complete blood cell count done weekly

Question 30

A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider?

A) Dietary habits

B) Work environment

C) Typical daily fluid intake

D) Ethnicity

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