what is the main purpose of a utilization review

ATI RN

ATI Leadership Practice B

1. What is the main purpose of a utilization review?

A. Evaluate patient outcomes
B. Ensure compliance with regulations
C. Reduce hospital readmissions
D. Assess financial impact

Correct answer: A

Rationale: The main purpose of a utilization review is to evaluate patient outcomes and ensure that patients receive appropriate care based on medical necessity and quality standards. While ensuring compliance with regulations, reducing hospital readmissions, and assessing financial impact are important aspects of healthcare management, the primary goal of utilization review is to focus on the quality and effectiveness of patient care.

2. What is the primary objective of healthcare accreditation programs?

A. To increase financial profitability
B. To ensure patient safety and quality care
C. To streamline healthcare operations
D. To reduce hospital readmissions

Correct answer: B

Rationale: The primary objective of healthcare accreditation programs is to ensure patient safety and quality care by meeting established standards. Choice A is incorrect because while financial aspects may be indirectly impacted, the main focus is on patient care. Choice C is incorrect as the primary goal is not operational efficiency but rather quality of care. Choice D is incorrect as reducing hospital readmissions is a specific goal that may be influenced by accreditation but not the primary objective.

3. Nurse Managers work with staff to educate them about ways to diffuse potentially violent situations. Which of the following diagnoses can staff expect to be more frequently associated with violence?

A. Alcohol or drug withdrawal
B. Anxiety
C. Depression
D. Confusion

Correct answer: A

Rationale: Alcohol or drug withdrawal is more frequently associated with violence as these conditions alter a person's inhibitions. Gilmore (2006) highlights that working with the public involves inherent risks and stressors. Individuals with head trauma, mental illnesses, and those withdrawing from substances are more likely to respond with violence. Anxiety, depression, and confusion do not typically lead to increased violent behavior compared to conditions involving substance withdrawal.

4. You believe that you are working harder than other nurses and that you take care of patients that are more complex. You are angry that other staff nurses have less complex and lower acuity patients, but you __________ .

A. Avoid discussing the situation because you do not want to be perceived as a complainer.
B. Know that you need to discuss the inequity with the nurse manager because you are resenting the work and becoming more dissatisfied in your job
C. A & B
D. None of the above

Correct answer: C

Rationale: Professionals communicate their views in a respectful and direct manner. In discussing the situation with the manager, professionals may gain insights about their reactions to stress and how they can cope with the intense demands of the healthcare environment. Choice A is incorrect because avoiding discussing the situation does not address the underlying issue and may lead to increased frustration. Choice B is correct as it emphasizes the importance of addressing the inequity with the nurse manager to find a constructive solution. Choice D is incorrect as it does not provide any guidance on how to handle the situation effectively.