Levels of Care

Every question here, with the answer

1. A patient calls the clinic asking where to go for an annual physical, a flu shot, and treatment for seasonal allergies. Which level of care should the nurse recommend as the usual starting point?

   1. Tertiary health care at a distant specialty facility
   2. Secondary health care through a specialist office
   3. Hospital admission for acute care
   4. Primary health care with a primary care provider

   Answer: Primary health care with a primary care provider

   Primary health care is the most fundamental level and is used for prevention, health maintenance, annual physicals, vaccinations, and minor common concerns such as seasonal allergies. Secondary and tertiary care are used when problems require specialty, acute, or highly complex services.

2. A nurse is helping design services for a new primary care clinic. Which services or functions fit the goals of primary health care? Select all that apply.

   1. Coordinate care across other levels as a medical home
   2. Serve as a patient’s first contact with the healthcare system
   3. Perform major surgery for critical injuries
   4. Refer patients to secondary or tertiary providers when more complex care is needed
   5. Provide preventive care and screening for illness

   Answer: Coordinate care across other levels as a medical home, Serve as a patient’s first contact with the healthcare system, Refer patients to secondary or tertiary providers when more complex care is needed, Provide preventive care and screening for illness

   Primary care emphasizes health promotion, disease prevention, early identification, continuity, and coordination of care. Major surgery for critical injuries is more consistent with tertiary care, not the routine goals of primary care.

3. A nurse calls a patient with x-ray results. The provider wants the patient referred to a urologist for a large kidney stone. The patient asks, “Do I need to worry about surgery?” Which response best follows the communication approach described in the section?

   1. “You should not worry; surgery will not be needed for this condition.”
   2. “It is a possibility, but the urologist has many treatment options and will work with you to find the best one.”
   3. “I cannot answer any questions, so you will need to wait for the urologist.”
   4. “The urologist will definitely schedule surgery because the stone is large.”

   Answer: “It is a possibility, but the urologist has many treatment options and will work with you to find the best one.”

   The nurse should be honest and reassuring without giving treatment details or predicting what the specialist will do. Saying surgery is definite or impossible goes beyond the nurse’s role, while refusing to answer any question misses the supportive communication shown in the scenario.

4. A patient is being evaluated by secondary care providers. Which ordered services are consistent with secondary healthcare procedures described in the section? Select all that apply.

   1. Major surgery using specialty tools in a tertiary facility
   2. Computed tomography scan
   3. Childhood immunizations managed by the PCP
   4. Nonsurgical setting and casting of a fracture
   5. Organ-specific laboratory work such as cardiac enzymes

   Answer: Computed tomography scan, Nonsurgical setting and casting of a fracture, Organ-specific laboratory work such as cardiac enzymes

   Secondary procedures often focus on a specific body part or organ and are noninvasive or minimally invasive, such as imaging, casting, and organ-specific laboratory work. Childhood immunizations are listed as primary care, while major surgery with advanced specialty resources is tertiary care.

5. A patient’s screening colonoscopy finds polyps, and pathology shows colon cancer. The patient is referred to a metropolitan cancer facility for surgery, chemotherapy, and radiation therapy. Which level of care is this patient receiving at the cancer facility?

   1. Secondary care
   2. Tertiary care
   3. Primary care
   4. Routine preventive care

   Answer: Tertiary care

   Tertiary care is used when a health problem cannot be managed at the primary or secondary level and may involve invasive procedures, major surgery, and advanced treatments. In the section’s example, cancer treatment with surgery, chemotherapy, and radiation is identified as tertiary health care.

6. An older patient has multiple chronic illnesses and sees several specialty providers who prescribe medications. Which nursing recommendations support the role of a PCP as a medical home? Select all that apply.

   1. Tell the patient tertiary care should permanently replace primary care
   2. Explain that a medical home can improve quality and efficiency of care
   3. Encourage coordination of care through a single location
   4. Encourage the PCP to coordinate care across other levels of health care
   5. Recognize that multiple specialists prescribing without communication can make patients sicker

   Answer: Explain that a medical home can improve quality and efficiency of care, Encourage coordination of care through a single location, Encourage the PCP to coordinate care across other levels of health care, Recognize that multiple specialists prescribing without communication can make patients sicker

   For patients with multiple chronic conditions, a PCP functioning as a medical home helps coordinate care, quality, and safety across providers. Tertiary care is specific and temporary, so it should not permanently replace the patient’s primary care relationship.