Exam 2

A nurse is using the problem identification phase of the case management process. To which of the following phases of the nursing process does this correspond? a. Assessment phase b. Diagnosis phase c. Planning phase d. Implementation phase

b. Diagnosis phase The diagnosis phase of the nursing process is analogous to the identification of the problem in the case management process. It is during this phase that the case manager determines conclusions based on the assessment. During the assessment phase, the nurse develops networks with the target population and disseminates written materials. In the planning phase, the nurse validates and prioritizes problems with all participants. When working through the implementation phase, the nurse contacts providers and negotiates contracts and services.

Which of the following services would be covered under Medicare Part A? a. Blood draw to assess PT/INR b. Physical therapy visit c. Stay in skilled nursing facility d. Transportation by an ambulance

c. Stay in skilled nursing facility Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B covers "medically necessary" services, such as health care provider services, outpatient care, home health, and other medical services such as diagnostic services and physiotherapy.

Three nurses disagree over the appropriate treatment for a woman who is an excellent candidate for hospice care. The first nurse believes that deciding on care rather than cure is the woman's decision and no one else can decide for her. The second nurse says that it is the responsibility of the health care team to do good for the woman, and if the physician thinks there is still a possibility of cure, then the nurses should do everything they can to implement the treatment plan. The third nurse states that it isn't fair for the family members to expend all their resources on the woman, who is probably going to die anyway. Which of the following conclusions can be drawn from this dispute? (Select all that apply.) a. Ethical principles can conflict with one another. b. The nurses are each using different ethical approaches. c. The first nurse is correct because autonomy demands that the woman decide for herself. d. There is no single accepted approach for resolving such disagreements.

A, B, D One of the criticisms of using ethical principles is that they can conflict with one another in any given situation. No rule exists for helping resolve such conflicts. Each nurse can apply different ethical principles to reach their own ethical decision. Because there is no one

A nurse recognizes that although a patient speaks English, the patient is from a culture with which the nurse is unfamiliar. Therefore, a cultural assessment should be attempted. Which of the following questions should the nurse ask? (Select all that apply.) a. "Can you tell me where your family is from?" b. "Do you practice a particular religious faith?" c. "What other countries have you lived in?" d. "Is there anything special we need to know about your food preferences?" e. "What do you think is causing your health problem?"

A, B, D, E In a general cultural assessment, nurses ask clients about their ethnic background, language, education, religious affiliation, dietary practices, family relationships, hospital experiences, occupation and socioeconomic status, cultural beliefs, and language. Nurses want to also ask about the client's perception of the health issue and what caused it and how it should be treated as well as the results they expect from the care they get. Such basic data help nurses understand the client from the client's point of view and recognize what is unique about the person, thus avoiding stereotyping. Knowing the other countries that the client has lived in may be helpful; however, necessary information about the client's culture should be able to be collected through broad questions about the client's culture.

An undocumented immigrant comes to a primary care provider's office to receive care. Which of the following services can the client receive? (Select all that apply.) a. Treatment for tuberculosis b. Treatment for type 2 diabetes c. Immunization for polio d. Physical examination e. Sutures for a laceration

A, C, E Undocumented immigrants or illegal aliens are individuals who have crossed a border into the United States illegally or whose legal permission to stay in the United States has expired. They are eligible only for emergency medical services, immunizations, treatment for the symptoms of communicable diseases, and access to school lunches. Undocumented immigrants are not eligible to receive treatment for chronic diseases such as type 2 diabetes or physical examinations.

For a bedridden Muslim patient, the nurse rearranges the room and moves the bed so that it faces toward Mecca for the patient's daily prayers. Which of the following is the nurse demonstrating through these actions? a. Accommodation b. Awareness c. Brokering d. Imposition

a. Accommodation Cultural accommodation involves including aspects of the patient's religious beliefs and/or folk practices in the traditional health care system to implement essential treatment plans. For this patient, daily prayer in the tradition of Islam is important—from the patient's perspective, possibly more important than medical treatment. Cultural awareness is the self-examination and in-depth exploration of one's own biases, stereotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients. Cultural imposition is the belief in one's own superiority, or ethnocentrism, and is the act of imposing one's values on others.

At a local hospital, the postpartum care policy requires that nurses observe the mother during infant care to assess the mother's ability to care for the new baby and to promote bonding. A new mother expresses concern that in her country, all infant care is provided by other family members so that the mother can rest and recover. Which of the following actions would be taken by a culturally competent nurse? a. Allow family members to provide the newborn's care and assess the mother's knowledge of child care through discussion. b. Reinforce the importance of bonding and that all good mothers gladly assume these responsibilities. c. Explain that the process of postpartum recovery does not require this much rest and require that she provide infant care. d. State that she must abide by hospital policy because documentation of the mother's ability to give the infant care is required for discharge.

a. Allow family members to provide the newborn's care and assess the mother's knowledge of child care through discussion. Culturally competent nursing care focuses on the specific patient, reflects the patient's individual beliefs and values, and is provided with sensitivity. The nurse should accept the cultural norms and behaviors of this client and her family. Thus, the nurse should provide culturally competent care and comply with the client's desire. This should take priority over any judgments the nurse could make about this client or hospital documentation related to infant care by the mother. This respect of culture makes the other options incorrect.

A nurse is caring for a client of another culture. Which of the following actions would be the most appropriate for the nurse to take? a. Alter personal nonverbal behaviors to reflect the cultural norms of the client. b. Keep all behaviors culturally neutral to avoid misinterpretation. c. Rely on friendly gestures to communicate caring for the client. d. Avoid any pretense of prejudice by treating the client in the same way as any other client.

a. Alter personal nonverbal behaviors to reflect the cultural norms of the client. Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent are expected to respect other cultures and value diversity. These behaviors tend to provide more responsive care. Nurses should be knowledgeable of other cultures and communicate with the client based on cultural norms. Culturally skillful nurses understand the unique difference among individuals within a given culture and work with those individuals to learn more about their culture and provide culturally sensitive care.

Which of the following best describes most Americans' attitude toward immigrants? a. Ambivalence, because there are no clear solutions about how to address their needs. b. Strongly negative, because immigrants take jobs that native-born Americans could have instead. c. Strongly positive, because immigrants bring useful job skills and often join previous family members already in the United States. d. Strong opposition to further immigration, because of the increasing population in the United States.

a. Ambivalence, because there are no clear solutions about how to address their needs. Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that it is a complex issue that has no clear solutions. Because Americans are ambivalent, there is neither a strong negative nor a positive attitude toward immigrants. However, many times immigrants do enter the United States because they have useful job skills or family ties. They are more likely to be low-income workers who work in low-wage, blue-collar jobs and industries.

An American nurse says, "I'm not going to change the way I practice nursing based on where the client is from because research shows that Western health care technology and research is best." Which of the following is being demonstrated by the nurse's statement? a. Ethnocentrism b. Prejudice c. Racism d. Stereotyping

a. Ethnocentrism Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that one's own group determines the standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think, "The way we do it is the only right way to provide this care." Prejudice refers to having a deeply held reaction, often negative, about another group or person. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals, beauty, or self-worth. Stereotyping occurs when attributing certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences.

When teaching a nutrition class to a student group with a large Latino population, the school nurse incorporates foods such as salsa and other healthy dishes familiar to students into the presentation. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary preventions

a. Primary prevention Primary prevention involves activities such as health teaching to prevent a problem from occurring. Secondary prevention occurs when a nurse completes screenings. Tertiary prevention occurs after a problem has occurred and aims to restore the client to the highest level of functioning as possible.

A nurse who is explaining to an immigrant client why it is important to take medication states, "The medication takes a couple of weeks to be effective, but then you should feel better." When the client is next seen, no medication has been purchased. Which of the following is the most likely explanation? a. The nurse emphasized that eventually the client would feel better, but the client needed to feel better immediately so didn't bother with the drug. b. The medication required a trip to the pharmacy, and the client just hadn't had time to obtain the drug yet. c. The medication was too expensive for the client's family. d. The client really hadn't understood why the medication was important.

a. The nurse emphasized that eventually the client would feel better, but the client needed to feel better immediately so didn't bother with the drug. If we look closely at what the nurse stated, there may have been a cultural disconnect based on time perception. Many nurses are future oriented, whereas many families may place greater value on quality of life and view present time as being more important. When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus on the immediate benefits these clients would gain rather than emphasizing future outcomes. The cultural disconnect of time should be the immediate concern of the nurse. It is possible that the client did not have the necessary resource or did not understand the importance of the medication, but the nurse should first investigate the potential cultural disconnect.

A new nurse states to a nursing colleague, "But why do I have to be involved in politics? I just want to be the very best clinical nurse I can." Which of the following would be the best response from the nursing colleague? a. "As long as you pay your membership fee to the American Nurses Association, you have participated in the profession's political endeavors." b. "Political action is the way you try to fulfill your ethical responsibilities to clients." c. "You're absolutely right; if you are good clinically, you have fulfilled your obligation." d. "When you've completed your clinical orientation, then you'll have time to be involved in politics."

b. "Political action is the way you try to fulfill your ethical responsibilities to clients." To be a good clinical nurse, the nurse needs resources and supportive policies that can be obtained only through political action to ensure those very resources and policies. Many clients are members of vulnerable groups who have often previously lacked access to quality care at an affordable cost. The American Nurses Association Code of Ethics for Nurses emphasizes political action as the mechanism to affect social justice and reform regarding homelessness, violence, and stigmatization. Nurses need to be involved in the political process in more ways than only being a dues paying member to the American Nurses Association. Clinical practice is not the same as political involvement; political involvement is necessary to achieve the advocacy role of the nurse. Nurses must make a conscious effort to be involved in political action.

A nurse states, "The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and needs." What does this statement reflect in relation to culture? a. Awareness b. Blindness c. Knowledge d. Preservation

b. Blindness Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different cultures may have different expectations, wants, and needs. Cultural awareness is the self-examination and in-depth exploration of one's own biases, stereotypes, and prejudices that influence behavior. Cultural knowledge is information about organizational elements of diverse cultures and ethnic groups; emphasis is on learning about the client's worldview from an emic (native) perspective. Cultural preservation means that the nurse supports and facilitates the use of scientifically supported cultural practices from a person's culture along with those from the biomedical health care system.

A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first? a. Complete a survey of all the various ethnicities represented in the nurse's community. b. Consider how the nurse's own personal beliefs and decisions are reflective of his or her culture. c. Invite a family from another culture to join the nurse for an event. d. Study the beliefs and traditions of persons living in other cultures.

b. Consider how the nurse's own personal beliefs and decisions are reflective of his or her culture. Cultural awareness requires self-examination and an in-depth exploration of one's own beliefs and values as they influence behavior. Cultural awareness is the first element in the model of cultural competence. Following the development of cultural awareness, the next step is cultural knowledge in which information about organizational elements of diverse cultures and ethnic groups is collected. The next stage of the model, cultural skill, occurs with the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients. The fourth construct essential to this model is cultural encounter, which is the process that permits nurses to seek opportunities to engage in cross-cultural interactions with clients of diverse cultures to modify existing beliefs about a specific cultural group.

Which of the following is considered the most important goal in nursing today? a. Adapting to technological advances such as electronic medical records b. Demonstrating caring as the basis of nursing practice c. Distinguishing nursing care from medical care d. Seeking evidence-based outcomes to demonstrate nursing's contribution to care

b. Demonstrating caring as the basis of nursing practice Since the mid-1980s, nurses have written about caring as the essence of nursing and as the ethical and moral ideal of nursing practice. Caring is part of the core values of public health nursing and addresses the importance of the fiduciary relationship between the patient and the care provider. The primary goal of nursing is not to adapt to technological advances, distinguish nursing from medical care, or seek evidence-based outcomes; rather, the goal of nursing is to implement caring which has been the moral ideal of nursing for many years.

How can nurses know whether they have been effective in assessing the community and planning and implementing appropriate interventions? a. Ask community leaders for their opinion of the interventions. b. Examine the morbidity and mortality rate of the community. c. Reassess the community to determine whether obvious needs have been met. d. Systematically survey community residents regarding their perception.

b. Examine the morbidity and mortality rate of the community. The end products of appropriate advocacy are decreased morbidity and mortality. In other words if advocacy has been effective, public health problems will be decreased. Effectiveness cannot be assessed accurately by asking community leaders for their opinions, reassessing the community, or surveying community members regarding their perception; data must be collected to determine results.

With which of the following ethical approaches are Gilligan and Noddings associated? a. Distributive justice approach b. Feminine ethic c. Principlism approach d. Virtue ethics

b. Feminine ethic Gilligan and Noddings are associated with the approach known as the feminine ethic, which focuses on the morality of responsibility in relationships that emphasize connection and caring as a moral imperative. Distributive justice (fair distribution of the benefits and burdens of society), Principlism (relying on ethical principles for decision- making), and virtue ethics (seeking to enable persons to flourish as human beings) were not developed by Gilligan and Noddings.

Earlier in the week, a nurse carefully taught a patient from a different culture exactly how much medication to take and emphasized the importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdose although the patient denies taking more than the label indicated. Which of the following is the most likely explanation? a. The patient was taking more mediation in the hope of getting well faster. b. The patient was also taking folk medicines that had many of the same effects and perhaps some of the same ingredients as the prescribed medication. c. The patient truly did not understand and thought the dose being taken was correct. d. The patient had a unique response to the medication and should have a smaller dose ordered.

b. The patient was also taking folk medicines that had many of the same effects and perhaps some of the same ingredients as the prescribed medication. For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop feelings of inadequacy and helplessness because they are often unable to effectively help their clients. It is unlikely that the patient was taking too much medication, taking the incorrect dose, or having a unique reaction to the medication. Rather the nurse should first interview the patient about use of folk medicine which may interact with the prescribed medication regimen.

A patient who identifies as Buddhist enters the hospital for diagnostic testing just before lunch time. The nurse tells the aide to give a meal tray to the new patient, because no tests will be done until later that evening. The aide gives the patient a meal of Salisbury steak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. Which of the following considerations was omitted by the nurse? a. The patient should not be served any food until a primary care provider's order is obtained. b. The patient's Buddhist faith probably requires a vegetarian diet. c. The patient may be too frightened about the tests to want to eat very much. d. The patient may have diabetes or be allergic to some foods.

b. The patient's Buddhist faith probably requires a vegetarian diet. Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and don't eat meat. The nurse should be aware of the cultural considerations that should be made for Buddhist patients. The nurse should ask the client about dietary restrictions before ordering a meal for the client so that these considerations can be made. The nature of the test determines the fasting requirements; no order is needed. Whether the client is diabetic or allergic to some foods should be determined upon admission.

A client is crying softly and saying, "What did I do to deserve this punishment, Lord?" Which of the following responses by the nurse would be the most appropriate? a. "God doesn't punish people. You're sick just because of bad luck." b. "I can call the hospital chaplain to help you talk about these feelings." c. "What can I do to be helpful to you right now?" d. "Would you like to confess your sins and repent so this illness will go away?"

c. "What can I do to be helpful to you right now?" Some clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do not share their beliefs. Because the nurse may not be a member of the client's religious faith group, an open-ended response showing caring is the most appropriate statement. The most therapeutic response from the nurse is an open-ended question. This allows the client to share information and not feel like his or her actions are being judged by the nurse. Also, this allows the nurse to not give advice or offer false information to the client.

A 40-year-old Bosnian, Muslim woman who does not speak English presents to a community health center in obvious pain. She requests a female health care provider. Through physical gestures, the woman indicates that the pain is originating in either the pelvic or genital region. Which of the following interpreters would be the most appropriate in this situation? a. A Bosnian male who is certified as a medical interpreter b. A female from the client's community c. A female who does not know the client d. The client's 20-year-old daughter

c. A female who does not know the client Although having experience in medical interpretation is important, in many cultures it is inappropriate to have a male interpreter for females. This client has specifically requested a female provider; therefore, one might anticipate that the client will not be as forthcoming with a male interpreter. Regardless of certification and ability, the interpreter cannot interpret information the client may withhold because she feels it inappropriate to discuss private matters in front of a male. This client may also feel it inappropriate to have private matters interpreted by her daughter (especially if they are of a sexual nature or if they involve infidelity). Additionally, to avoid a breach of confidentiality, the nurse should avoid using an interpreter from the same community as the client.

How are ethics and public policies similar? a. Both are abstract principles that often differ in actual practice. b. Both are best achieved by persons in high political office who can effect change. c. Both strive for the public good. d. Both use general principles in making decisions.

c. Both strive for the public good. An important goal of both policy and ethics is to achieve the public good, and both are involved in good citizenship. Ethics involves the application of specific principles when making decisions. There is nothing that supports that ethics and public policies are better achieved by those in high political office.

The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin prescribed because his illness is "hot" and he believes that penicillin, a "hot" medicine, will not provide balance. Which of the following terms best describes the action taken by the NP when the client's prescription is changed to a different yet equally effective antibiotic? a. Cultural awareness b. Cultural brokering c. Cultural knowledge d. Cultural skill

c. Cultural knowledge Cultural knowledge is information about organizational elements of diverse cultures and ethnic groups; emphasis is on learning about the client's worldview from an emic (native) perspective. Cultural skill involves the provision of care that is beneficial, safe, and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nurse practitioner's need to prescribe an effective antibiotic. Cultural awareness is the self-examination and in-depth exploration of one's own biases, stereotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients.

How can ethics be applied to public health nursing practice? a. Ethics and actual nursing practice are not related. b. Knowing ethics allows nurse to recognize the source of most problems. c. Ethics is constantly involved in nurses' clinical decisions. d. Although ethics is important, political and legal responsibilities are more important in practice.

c. Ethics is constantly involved in nurses' clinical decisions. Ethical problems in public health nursing include inequities in power, unacceptable practices, inequitable resource allocation, conflict between ethics and law, and inadequate systems support for nursing. Therefore, ethics permeates every aspect of public health nursing as nurses attempt to meet the needs of the community. Ethical principles are applied in nursing practice on a regular basis and assist with problem-solving. The use of ethics does not allow the nurse to recognize the source of most problems. The used of ethics is more important than political and legal responsibilities in practice.

An immigrant who takes metamizole (banned in the United States) for pain may experience life-threatening agranulocytosis. Which of the following actions would be taken by a nurse who employs cultural re-patterning? a. Complete a cultural assessment to identify any other dangerous medications that the client may be taking. b. Put this into perspective by considering that many drugs used in the United States cause agranulocytosis. c. Explain the harmful effects of metamizole and recommend an alternative medication for pain. d. Recognize that taking metamizole is common among persons living in Mexico and accept this as a cultural tradition.

c. Explain the harmful effects of metamizole and recommend an alternative medication for pain. Cultural re-patterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when the practice is harmful to them. Completing a cultural assessment involves learning more about the client's culture but does not address the need to consider changing or modifying cultural practices. In order to complete cultural re-patterning, the nurse has to take an action to resolve this potential problem.

A nurse gives detailed information on how to apply for Medicaid to a new mother who moved to the United States from Russia about 10 years ago. The nurse's next client is an African-American mother of newborn twins who worked until the children were born. The nurse knows the woman is eligible to maintain her insurance after her employment was lost and does not discuss insurance options at all. Which of the following errors is being made by the nurse? a. Covert intentional prejudice b. Covert unintentional prejudice c. Overt intentional prejudice d. Overt unintentional prejudice

c. Overt intentional prejudice The nurse may have assumed that the African-American mother knew the available resources and could negotiate for assistance on her own and that the immigrant Russian woman had no experience negotiating government programs and thus needed the nurse to advocate for her and inform her of the programs available to her. The nurse, not knowing the health-seeking behaviors of either client, stereotyped both women and intentionally used her informational power to help one client while denying assistance to the other client. Covert prejudice involves subtle or passive acts of prejudice. This can occur intentionally or unintentionally. In this case, the actions of the nurse were intentional, which means it was an overt behavior. Overt prejudice includes any action that intends to give unequal treatment to an individual or group. Given the scenario, it appears that the action of the nurse was intentional, not unintentional.

A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a client's history. He stopped doing this around specific clients after being told that they were offended when he exposed the sole of his foot (shoe) to their face. Which of the following was exhibited by the nurse when he changed his behavior? a. Cultural accommodation b. Cultural imposition c. Cultural re-patterning d. Cultural skill

d. Cultural skill Cultural skill is the effective integration of cultural knowledge and awareness to meet client needs—in this case, the clients need to not be offended by having the bottom of the nurse's foot or shoe in view of the client's face. The nurse using cultural skill makes sure that nonverbal communication techniques take into consideration the client's use of body language and space. Cultural accommodation involves negotiation with clients to include aspects of their folk practices with the traditional health care system to implement essential treatment plans. Cultural imposition is the process of imposing one's values on others. Cultural re-patterning is working with clients to make changes in their health practices if cultural behaviors are harmful or decrease their well-being.

A Spanish-speaking family comes to the public health department. No one in the family speaks English, and nobody at the health department speaks Spanish. Which of the following actions should be taken by the nurse? a. Attempt communication using an English-Spanish phrase book. b. Call the local hospital and arrange a referral. c. Emphatically state, "No hablo Español" (I don't speak Spanish). d. Obtain an interpreter to translate.

d. Obtain an interpreter to translate. Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the client's language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client. The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received. The nurse must contact an interpreter in order to provide the best care for the client—attempting communication using a book, stating that he or she does not speak English, and arranging for a referral do not address the priority action of finding an interpreter.

A health care worker tells a nurse, "It does no good to try to teach those Medicaid clients about nutrition because they will just eat what they want to no matter how much we teach them." Which of the following is being demonstrated by this statement? a. Cultural imposition b. Ethnocentrism c. Racism d. Stereotyping

d. Stereotyping Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food. Cultural imposition is the belief in one's own superiority, or ethnocentrism, and is the act of imposing one's values on others. Ethnocentrism is a type of cultural prejudice at the population level which involves the belief that one's own group determines the standards for behavior by which all other groups should be judged. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals, beauty, or self-worth.

Which of the following would confirm that the nurse's advocacy has been truly successful or effective? a. Audiences agree with the nurse who is serving as advocate. b. Legislators discuss appropriate legislation to better allocate resources. c. People verbalize that the disenfranchised should be better treated. d. Systematic social changes are made to improve quality of life.

d. Systematic social changes are made to improve quality of life. Advocacy is the application of information and resources to effect systematic changes that shape the way people in a community live to reduce death and disability and improve quality of life in the community. Only when systematic social changes are made to improve quality of life can advocacy be considered truly effective. Systematic change encompasses the complete role of the nurse as an advocate. Audiences do not necessarily have to agree with the nurse who is serving as advocate as different populations may have different views than the nurse. Advocacy goes beyond only working with legislators to allocate resources. Serving those who are disenfranchised is only one part of the advocacy role.

A health care provider refuses to order pain medication for a drug addict who has been severely injured in a car accident. When reminded by nurses that pain medication has not been ordered, the provider merely replies that the patient's suffering from the pain of his injuries will build character and that the addicted patient needs to get off drugs. Which of the following ethical theories is being using (or misusing)? a. Consequentialism b. Communitarianism c. Deontological ethics d. Virtue ethics

d. Virtue ethics Virtue ethics emphasizes practical reasoning applied to character development. Although such action by a care provider is paternalistic and unethical on many grounds, the physician may truly be concerned with enabling the injured addict to learn from his experience and possibly develop into a drug-free person. Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. When decisions are based on outcomes or consequences, it is known as consequentialism. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.

A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as durable medical equipment. Which of the following best describes this part of Medicare? a. Part A b. Part B c. Part C d. Part D

b. Part B Medicare Part B is a supplemental (voluntary) program; it provides coverage for services that are not covered by Part A, such as laboratory services, ambulance transportation, prostheses, durable medical equipment, and some supplies. Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part C plans are coordinated care plans that include health maintenance organizations, private fee-for-service plans, and medical savings accounts. Medicare Part D provides prescription drug coverage.

A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the following interventions is the nurse most likely completing? a. Applying for a grant to establish a daycare center to serve dependent older adult clients living with working families b. Persuading legislators to pass a bill offering health care financial aid to families at risk c. Screening cocaine addicts for financial assistance eligibility for drug treatment d. Referring clients with renal failure to apply for Medicare

b. Persuading legislators to pass a bill offering health care financial aid to families at risk Primary prevention occurs before an illness or condition develops. Of the options provided, only persuading legislators to pass a bill offering health care financial aid to families at risk addresses initiating interventions before an illness occurs. Applying for a grant and referring clients with renal failure both demonstrate the use of tertiary prevention as the illness or condition has already developed. Screening cocaine addicts displays the use of secondary prevention as a screening technique is being used to identify the problem as soon as possible.

Which of the following programs demonstrates the use of tertiary prevention? a. Developing an in-school clinic that provides birth control counseling and contraception b. Providing a diabetes management program for persons with diabetes mellitus c. Providing cardiovascular fitness evaluations at annual health fairs d. Setting up free blood pressure screenings at popular department stores and supermarkets

b. Providing a diabetes management program for persons with diabetes mellitus The aim of tertiary prevention programs is to reduce complications from disease. Persons with diabetes mellitus already have the disease, thus meaning that tertiary prevention would be implemented with this population. Developing an in-school clinic is a primary prevention (pregnancy has not occurred). Fitness evaluations at health fairs and blood pressure screenings are secondary prevention programs (screening identifies conditions early and determines incidence/prevalence).

Which of the following statements best describes the law in relation to clinical practice by nursing students? a. Students are considered certified until licensure is obtained. b. Students are expected to meet the same standard of care as the professional nurse. c. Students are not legally liable for errors because they practice under the license of their instructor. d. Students have a scope of practice determined by the nurse practice act.

b. Students are expected to meet the same standard of care as the professional nurse. Nursing students need to be aware that the same laws and rules that govern the professional nurse apply to them as well. Students are expected to meet the same standard of care as that met by any licensed nurse practicing under the same or similar circumstances. Although it is true that students cannot practice outside the scope of practice determined by the nurse practice act, they also cannot perform the tasks and responsibilities of the licensed practitioner within the scope of practice until they have received adequate knowledge; therefore, the scope of practice for the student is determined by the instructor, based on the student's level of education.

Which of the following best describes the purpose of strategic planning? a. To anticipate client needs now and in the future b. To match client needs, provider strengths, and agency resources c. To maximize effective use of agency resources d. To utilize provider strengths and competencies

b. To match client needs, provider strengths, and agency resources Strategic planning involves the successful matching of client needs, with specific provider strengths and competencies and agency resources. Everyone involved can anticipate what will be needed to implement the program, what will occur during implementation, and what the outcomes will be. Strategic planning addresses the client, agency, and provider. The other responses address only one of these factors not all three of them which all need to be considered during the strategic planning process.

Which of the following statements by a client indicates a lack of understanding regarding an appropriate reason to sue for professional negligence? a. "Because the health care workers didn't turn my mother every 2 hours, she developed bedsores." b. "I received permanent nerve damage because they would not remove a cast that was too tight." c. "My daughter wasn't given a call light, and for a whole shift no one checked on her condition." d. "They amputated the wrong leg during surgery."

c. "My daughter wasn't given a call light, and for a whole shift no one checked on her condition." Professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury. All of the choices specify an injury, except for "My daughter wasn't given a call light, and for a whole shift no one checked on her condition," in which case the care was substandard but no injury resulted. The incorrect responses all specify an injury whereas professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury.

A client spends a great deal of time on the Internet or reading articles related to diabetes and its long-term effects. One day, the client asks why the nurse has not suggested a life care plan. Which of the following would be the best response by the nurse? a. "Life care plans are only for young persons who are newly diagnosed." b. "Life care plans are primarily used to determine long-term financial needs for legal reasons." c. "You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn't currently appropriate." d. "I was waiting for you to express interest in having a life care plan."

c. "You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn't currently appropriate." Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice. Others who benefit from life care planning are those who have sustained injury when younger and whose care requirements have changed as a result of aging. Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice, not young persons with a newly diagnosed illness. The life care plan is a customized, medical-based document that provides assessment of all present and future needs (i.e., medical, financial, psychological, vocational, spiritual, physical, and social), including services, equipment, supplies, and living arrangements for a client. These plans may be used by either a plaintiff or a defense lawyer to analyze damages. They are also used to set financial rewards, which can be used to pay for care in the future and create a lifetime care plan.

Which of the following Medicaid clients would most likely receive case management? a. An elderly person b. A person receiving rehabilitation following an injury c. A person who has a high-cost chronic disease d. A person with acute illness

c. A person who has a high-cost chronic disease Some states, through their Medicaid programs, are developing disease management programs for high-cost chronic diseases among their populations, such as asthma and diabetes. An elderly person is most likely to receive Medicare services, not Medicaid services. Additionally, there is not any information that states that the elderly person has a high-cost chronic disease. A person who is receiving rehabilitation following an injury or who has an acute illness does not have a diagnosis that warrants case management, as case management is reserved for those with high-cost chronic diseases.

A nurse is completing a case management advocacy activity which corresponds to the implementation phase of the nursing process. Which of the following activities would the nurse most likely use? a. Asking the client what is most important b. Seeking appropriate referrals for the client c. Assuring the client that his wishes will be supported d. Determining the order in which actions will occur

c. Assuring the client that his wishes will be supported Assuring the client is a component of the advocacy process that corresponds to the implementation phase. Asking the client what is most important is a way to illuminate values, which occurs in the assessment phase. Seeking appropriate referrals for the client occurs in the assessment phase. Determining the order in which actions will occur is a prioritization of action, which occurs in the planning phase.

Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "It is a wife's responsibility to care for an ill husband." Which of the following ethical approaches is being used by this nurse? a. Consequentialism b. Communitarianism c. Deontological ethics d. Principlism

c. Deontological ethics The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. Based upon this understanding, none of the other options correctly describes the nurse's statement.

The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient. Which of the following approaches should the nurse use in personally deciding what is right? a. Do whatever will not get the nurse in trouble with employer. b. Do whatever is supported by an ethical expert, such as the hospital chaplain. c. Do whatever the nurse would recommend to anyone in a similar situation. d. Do whatever the nurse supervisor would feel comfortable reporting to administration.

c. Do whatever the nurse would recommend to anyone in a similar situation. One of the rules in deontological decision-making is to determine whether the proposed actions can be generalized so that all persons in similar situations are treated similarly. In the same way, Principlism suggests the nurse examine the context and make the decision that can be morally justified within that context. In order to apply the deontological ethics decision process, the nurse must first determine the moral rules that serve as standards by which individuals can perform their moral obligations, examine their own personal motives, and then determine whether the proposed actions can be generalized. Doing whatever will not get the nurse in trouble, whatever is supported by an ethical expert, or whatever the nurse supervisor feels comfortable with is not an appropriate way to make an ethical decision.

A case manager implements a primary prevention activity. Which of the following actions would the nurse most likely complete? a. Advocating for the client whose values conflict with those of the medical service provider b. Collaborating between nursing and occupational health personnel c. Educating a group regarding community services that are available if ever needed d. Resolving conflict between a primary care clinic and a tertiary health care facility

c. Educating a group regarding community services that are available if ever needed Primary prevention involves the use of the information exchange process to increase the client's understanding of how to use the health care system. Primary prevention occurs at a point before illness or problem exists. In the remaining options, the client has a problem for which interventions have been employed.

Which of the following best describes the ultimate goal of program planning? a. Avoid unanticipated conflicts in the program development phase. b. Provide adequate funding to meet the program's resource requirements. c. Ensure that health care services are acceptable, equal, effective, and efficient. d. Prevent unnecessary duplication of services.

c. Ensure that health care services are acceptable, equal, effective, and efficient. The comprehensive goal of program planning is to ensure that health care services are acceptable, equal, efficient, and effective. The other options are aspects of program planning, but they address only limited concerns.

A nurse checks health department records to compare the number of new teen clients presenting for birth control counseling and management in the 2 months before and after an education intervention program to decrease teen pregnancy. Which of the following steps of the evaluation process is being completed by the nurse? a. Engage stakeholders b. Justify conclusions c. Gather credible evidence d. Focus on the evaluation design

c. Gather credible evidence When the nurse gathers credible evidence, the following information is collected: indicators that will be used, sources of data, quality of the data, quantity of information to be gathered, and the logistics of the data gathering phase. Data gathered should provide credible evidence and should convey a well-rounded view of the program. Engaging stakeholders includes those who are involved in planning, funding, and implementing the program; those who are affected by the program; and the intended users of its services. When the nurse justifies conclusions, the conclusions of the evaluation should be validated by linking them to the evidence gathered and then appraising them against the values or standards set by the stakeholders. When focusing on the evaluation design, the nurse will describe the purpose for the evaluation, the users who will receive the report, how it will be used, the questions and methods to be used, and any necessary agreements.

A nurse is completing a summative evaluation of a program designed to decrease obesity in school-age children. Which of the following is the most important question for the nurse to ask? a. Are school-age children satisfied with the program? b. Can parents and guardians support the program requirements? c. Has obesity in school-age children decreased? d. What is the program cost compared with the program benefit?

c. Has obesity in school-age children decreased? Summative evaluation looks at the end result of the program. The major benefit of program evaluation is that it shows whether the program is meeting its purpose. It should answer the following questions: are the needs for which the program was designed being met? Are the problems it was designed to solve being solved? If the program does not achieve the purpose for which it is designed, important concerns of satisfaction and cost are irrelevant. So if the program purpose is to decrease obesity, the outcome of importance is a decrease in obesity. Formative evaluation serves the purpose of assessing if objectives are met or if planned activities are completed. This type of evaluation begins with an assessment of the need for a program and is ongoing as the program is implemented. The considerations of satisfaction, support, and cost are all issues that could be addressed in planning and ongoing assessment of the program.

Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocate health care resources? a. Insurance resources b. Health care rationing c. Health economics d. Medical technology

c. Health economics Economics is the science concerned with the use of resources; health economics is concerned with how scarce resources affect the health care industry. Insurance resources, health care rationing, and medical technology are important components of health economics but by themselves do not provide the broad understanding called for in this question.

Which of the following is the first and most crucial step in a generic ethical decision-making process? a. Assess the context or environment in which the decision must be made. b. Consider the various ethical principles or theories. c. Identify the ethical issues and dilemmas. d. Make a decision and act on it.

c. Identify the ethical issues and dilemmas. The first step in the ethical decision-making framework is to identify the ethical issue or dilemma. After the first step of identifying the ethical concern, the following steps are: (2) place the ethical issue or dilemma within a meaningful context, (3) obtain all relevant facts, (4) reformulate ethical issues or dilemmas, if needed, (5) consider appropriate approaches to action or options, (6) make the decision and take action, and (7) evaluate the decision and action.

Which of the following best describes case management? a. A tool of health maintenance organizations b. Targeted toward a specific segment of the population c. Implemented with individual clients d. Used to monitor the health status, resources, and outcomes for an aggregate

c. Implemented with individual clients Case management, in contrast to the definition of care management, involves activities implemented with individual clients in the system. Managed care is a tool of health maintenance organizations. Care management is an enduring process in which a population manager establishes systems and monitors the health status, resources, and outcomes for an aggregate—a targeted segment of the population or a group.

A nurse didn't know what to do when faced with a particular ethical dilemma because an option that would have a good outcome didn't seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the following best describes the nurse's actions? a. Appropriate, because the supervisor is responsible for the nurse's choices. b. Intelligent, because the supervisor has access to resource persons (clergy, physicians, administrators) who might know of options the nurse hadn't considered. c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision. d. Wise, because the supervisor would be more knowledgeable concerning agency priorities and traditional practices.

c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision. Ethically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience to a supervisor or any external rule or policy. The supervisor is not responsible for the nurse's choices, the nurse must maintain responsibility for his/her own decisions. The nurse should have access to the same resources as the supervisor and should have similar knowledge as the supervisor.

Which of the following best explains how the government unintentionally encourages low-income persons to use emergency departments as their primary care provider? a. A huge amount of paperwork is required when Medicaid clients go to a physician's office. b. Government regulations require Medicaid clients to use emergency departments when their primary health care provider is unavailable. c. Legally, emergency departments must see clients even if clients can't pay. d. Physicians' limited office hours make them unavailable during evenings and weekends.

c. Legally, emergency departments must see clients even if clients can't pay. People on Medicaid frequently have no primary care provider and may not be able to pay for their care. Although physicians can choose clients based on their ability to pay, emergency departments are required by law to evaluate every client regardless of ability to pay. Emergency department co-payments are modest and are frequently waived if the client is unable to pay. Thus, low out-of-pocket costs provide incentives for Medicaid clients and the uninsured to use emergency departments for primary care services. Limited physician office hours over the weekend does make it difficult for low-income persons to access care through a primary care provider; however, this is not influenced by a government decision. The government does not require Medicaid clients to use the emergency department when their primary care provider is unavailable, rather the policies of the emergency department to see all clients regardless of ability to pay may inadvertently encourage them to use this service. The paperwork at a physician's office that needs to be completed by a Medicaid client is not any different than any other client receiving care at the office.

A nurse meets with a senator to lobby for passage of a bill to increase funding for interpreter services. With which of the following branches of the government is the nurse working? a. Constitutional branch of government b. Executive branch of government c. Legislative branch of government d. Judicial branch of government

c. Legislative branch of government The legislative branch of government is composed of the Senate and the House of Representatives. The legislative branch identifies problems and proposes and then debates, passes, and modifies laws to address those problems. There is not a constitutional branch of the government. The executive branch administers and regulates policy. The judicial branch interprets laws.

Which of the four main factors that affect health, is the most important? a. Environment b. Human biology c. Lifestyle choices d. Health care system

c. Lifestyle choices Personal biology and behavior (or lifestyle), environmental factors and policies (including physical, social, health, cultural, and economic environments), social networks, living and working conditions, and the health care system—medical services are said to have the least effect. Behavior and lifestyle have been shown to have the greatest effect on longevity, with the environment and biology accounting for the greatest effect on the development of all illnesses.

The nurse suggests use of telehealth to assess how a client is progressing. Which of the following resources must be available for continuing care to be implemented? a. A primary care provider who is willing to use wireless prescriptions and plans of care b. Family permission for the nurse to make home visits c. Long-distance telephone service or a computer with Internet access d. Willingness of the caregiver to drive the client to the nearest clinic

c. Long-distance telephone service or a computer with Internet access Telehealth is an organized health care delivery approach to triage and to provide advice, counseling, and referral for a client's health problem using phones or computers with cameras. The client is usually in the home, and the nurse is at an office, health care facility, or phone bank location. Wireless prescriptions and plans of care are not necessary for a client who is receiving telehealth services. Home visits may not be necessary for a telehealth client. Through the use of telehealth, the need to visit clinics is decreased.

A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family? a. A managed care organization b. An emergency department c. Medicaid d. Medicare

c. Medicaid Medicaid provides coverage for adults with low income and their children. Managed care is a type of private insurance while Medicare is available to persons aged 65 and older. The emergency department would charge a co-pay for care given to both the child and the parents.

A man entered the emergency department bleeding profusely and screaming, "I've got to see a doctor right now! I've got a right to see a doctor! I'm hurt. You have to take care of me!" Which of the following premises would ethically justify such a demand for immediate attention? a. All hospitals receive federal money and all capable employed adults pay taxes, so all adults have a right to what their tax money has purchased. b. Saving an individual's life improves society and upholds tradition. c. Our society believes that all persons should be treated equally and that basic needs, such as not dying if death can be avoided, should be met. d. The man has a property right to his own body, and the government is responsible to ensure that property rights are protected.

c. Our society believes that all persons should be treated equally and that basic needs, such as not dying if death can be avoided, should be met. The ethical theory of egalitarianism suggests that everyone is entitled to equal rights, equal treatment, and an equal share of the goods of society—and that the government's role is to ensure this happens, at least on a basic level. Therefore, the man has a right to emergency care. Hospital funding and use of taxpayer money does not demonstrate the use of an ethical principle. Saving an individual's life may or may not improve society. There is not an ethical principle that states that the man has a property right to his own body.

Based on projected increases in the number of older US citizens, a planning committee wants to establish a day care program for the community's older adult population. During which stage is the need for this program being assessed? a. Inactive stage b. Interactive stage c. Preactive stage d. Reactive stage

c. Preactive stage The preactive stage is one in which assessment is based on the projection of a future need. The stages that are not being described are: reactive—defining the problem based on past needs identified by the client or the agency; inactive—defining the problem based on the existing health status of the population to be served; and interactive—describing the problem using past and present data to project future population needs.

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "But it doesn't have to be an either/or situation. Perhaps each family member could take a turn calling in sick just 2 or 3 days. That way they could all take a turn at helping and yet not upset their employers. Wouldn't that be fair?" Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism

c. Principlism The nurse is focusing on ethical principles—in this case, beneficence (do good for the ill family member), nonmaleficence (do no harm, even to the employer), and justice (everyone takes a turn and shares equally). Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make.

Which of the following laws established programs for provision of health services for women and children and supported community-oriented nursing practice? a. Early Periodic Screening and Developmental Testing (EPSDT) Initiative b. Healthy People 2000 Initiative c. Sheppard-Towner Act d. State Child Health Improvement Act (SCHIP)

c. Sheppard-Towner Act The Sheppard-Towner Act of 1921 played an important role in the development of public health policy, public health nursing, and social welfare policy. Of particular importance was the fact that it established standards for programs to serve women and children and made nurses available to provide these services in the community setting. Within the Sheppard-Towner Act was a provision to start the EPSDT initiative. SCHIP provides insurance for children and families who cannot otherwise afford health insurance. Healthy People 2000 focuses on promoting health and preventing disease for all Americans.

Who is responsible for determining the scope of practice for registered nurses? a. American Nurses Association b. Federal legislators c. State legislators d. US Department of Health and Human Services

c. State legislators Health care practitioners are subject to the laws of the state in which they practice. The state nurse practice acts define the practice of professional nursing, identify the scope of nursing practice, set educational qualifications, and determine legal titles. The nurse practice act is governed by legislators in each state. The American Nurses Association, US Department of Health and Human Services, and federal government do not determine the scope of practice for nurses; this responsibility is the role of state governments. The US Department of Health and Human Services is the agency most heavily involved with the health and welfare of US citizens.

Which of the following statements best describes why the federal government has become involved in health care? a. The states asked the federal level to become involved. b. Because of rising costs to the states, the federal budget needed to be used to pay for necessary services. c. The Constitution gives the federal government the power to promote the general welfare. d. This step was necessary to standardize care on a national level

c. The Constitution gives the federal government the power to promote the general welfare. One of the first constitutional challenges to a federal law passed by Congress was in the area of health and welfare in 1937. The Supreme Court (judicial branch) reviewed the legislation in question and determined, through interpretation of the Constitution, that such federal governmental action was within the powers of Congress to promote the general welfare. According to Article I, Section 8 of the US Constitution Congress has multiple roles in relation to health care: provide for the general welfare, regulate commerce among the states, raise funds to support the military, and provide spending power. Thus, Congress was within its role to become involved in health care and was not asked to do so by the states or used to standardize care on the national level.

A nurse, client, family, and other care providers meet to discuss what will be the best approach to use to continue care. Which of the following best describes why the nurse suggests changing the goal from obtaining appropriate long-term care placement to ensuring that the client's recovery is beneficial and safe? a. To consider all possible consequences of long-term care placement b. To encourage the group to review the client outcomes in the different settings c. To expand the goal so that different solutions can be generated and considered d. To help the group focus on the critical aspects the client's family considered most important

c. To expand the goal so that different solutions can be generated and considered One problem with seeking solutions is stating the problem in such a narrow fashion that only one possible outcome is acceptable. To avoid this, the nurse may restate the problem. By expanding the goal, different solutions can be generated. Clients and advocates may feel limited in their options if they generate solutions before completely analyzing the problems, needs, desires, and consequences. Changing the goal allows other possibilities, which may or may not include long-term care, to be considered. The client outcomes in different settings are not being addressed at this time. Examining the aspects that the family feels is most important can better be considered by broadening the goal.

Which of the following agencies has the most influence on the health and welfare of US citizens? a. Agency for Healthcare Research and Quality (AHRQ) b. Centers for Disease Control and Prevention (CDC) c. US Department of Health and Human Services (USDHHS) d. World Health Organization (WHO)

c. US Department of Health and Human Services (USDHHS) As the agency to which most health care legislation is delegated, the USDHHS is the agency most heavily involved with the health and welfare of citizens. The AHRQ and CDC are divisions of the USDHHS. WHO's policy-making body provides policy options and guides but not laws. In the textbook, only the USDHHS is discussed regarding its responsibility for Medicare and Medicaid through the Centers for Medicare and Medicaid Services (CMS).

A nurse wishes to see a bill passed to support funding for the use of interpreters for clients with limited English proficiency. Which of the following would be the best time for the nurse to request support from the local senator, who is not on the committee that is reviewing this bill? a. When the bill is first assigned to a committee. b. When the bill is discussed and debated within the committee. c. When the bill moves out of committee to be heard by the entire Senate. d. When the bill passes the Senate and moves to the House of Representatives.

c. When the bill moves out of committee to be heard by the entire Senate. Once the bill is passed by committee and moves out of committee to be heard by all senators, it will be important to contact this senator, who will then be in a position to act on it. To contact the senator when the bill is first assigned to the committee or is being discussed and debated within the committee is too early to effectively influence the individual senators. The nurse would not want to wait until after the vote has been taken in the Senate because it would then be too late for the senator to act.

Which person is most likely to be uninsured? a. An 82-year-old woman with chronic medical problems b. A 2-year-old whose mother is on welfare c. A 50-year-old business man who works for a large corporation d. A 24-year-old man who works part-time at a small business

d. A 24-year-old man who works part-time at a small business Young adults (ages 19 to 25 years) account for a disproportionately large share of the uninsured, largely due to their low incomes. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, because most large businesses provide it.

Which of the following individuals would most likely experience a barrier when accessing health care? a. A 40-year-old female who speaks English as a second language b. A 25-year-old female with co-pay health insurance c. A 50-year-old male with hypertension d. A 30-year-old male who is unemployed

d. A 30-year-old male who is unemployed Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, childcare needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income. Those who speak English as a second language and have health insurance even with co-pay requirements should both find it easier to access health insurance than someone who is unemployed since the inability to afford health care is a primary barrier. Medical diagnoses, such as having hypertension, do not present a barrier to accessing health care.

Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in the United States? a. Education of health care providers moved into universities. b. People finally had enough money to pay for medical care. c. The improved outcomes of hospital care were recognized. d. Advances were made in sewage disposal, and water and milk quality.

d. Advances were made in sewage disposal, and water and milk quality. Environmental conditions influencing health began to improve with major advances in water purity, sanitary sewage disposal, milk quality, and urban housing quality. The health problems of this era were no longer mass epidemics but individual acute infections or traumatic episodes. The education of health care providers did move into universities during this time period; however, this is not the reason why there was an increased focus on infections and trauma. Health care was paid for primarily by individuals during this time period so there was not an increase in the amount of money available to pay for health care. The outcomes of hospital care improved because of the advances that were being made in technology, not because health care providers were focusing more on infections and trauma.

A nurse is conducting an assessment to determine whether participants of an educational program felt the stated objectives were met. Which of the following data sources would the nurse most likely use? a. Community forum b. Interview c. Focus group d. Attitude survey

d. Attitude survey Attitude scales are probably used most often and are usually phrased in terms of whether a program met its objectives. The client satisfaction survey is an example of an attitude scale often used in the health care delivery system to evaluate the program objectives. Focus groups, community forums, and examination of community indicators are all time consuming and not as directed toward evacuating program goals.

When did medicine in the United States make a shift away from the treatment of acute infection to care of chronic illnesses? a. Between 1890 and 1920 b. Between1920 and 1940 c. Between 1940 and 1960 d. Between 1945 and 1984

d. Between 1945 and 1984 The later part of the 20th Century (1945-1984) ushered in a shift away from acute infectious health problems of previous stages toward chronic health problems such as heart disease, cancer, and stroke.

A nurse is asked to meet with a family who recently immigrated from Botswana (Africa). After the physician tells the husband the wife's diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse's most important action? a. Emphasizing that the family must set up a surgical appointment for the wife immediately b. Assessing the family's current living situation, including insurance and other assets c. Educating the family concerning the usual treatment and the prognosis of breast cancer d. Interviewing the family concerning their perspective of the threat to the family's well-being

d. Interviewing the family concerning their perspective of the threat to the family's well-being The United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, the health care professionals must understand the family's cultural, psychological, social, communal, and environmental contexts, because these contexts affect the way issues are formulated and decisions are made. Consequently, it is crucial to interview the family to determine their understanding of the situation before deciding what, if any, intervention must be made. In many cultures, the family, rather than the individual, is the unit of primary concern. Setting up a surgical appointment immediately would not be an appropriate action for the nurse to take as this would be a premature action for anyone who has just been told that she has cancer. Assessing the family's current living situation would not be the first concern of the nurse; the first concern should focus on the family's well-being. After assessing the family's well-being, the next action of the nurse may be to educate the family about the treatment and prognosis of breast cancer.

What was the significance of the 1979 Surgeon General's report? a. It planned the goals and priorities for the entire Veterans Administration medical system. b. It vastly increased funding for health promotion activities. c. It identified the use of tobacco as a cause of lung cancer. d. It created national goals for promoting health and preventing disease.

d. It created national goals for promoting health and preventing disease. The 1979 Surgeon General's report began a focus on preventing disease and promoting health for all Americans. It was a national effort with all levels of government, as well as other interested parties, involved. The 1979 report did not plan goals and priorities for the Veterans Administration medical system; rather it looked at health of all Americans. There was no funding associated with the report. It addressed prevention of disease and promotion of health for multiple diseases, not just lung cancer.

The state board of nursing has written new regulations to clarify in a more concrete manner what the nurse practice act allows and requires. Which of the following effects will this change have on nurses in this state? a. None, because they are just helpful guidelines for maximum safety. b. None, because they just give specifics that may change over time. c. Major, because prudent nurses would follow such regulations. d. Major, because these rules and regulations have the effect of law and must be obeyed.

d. Major, because these rules and regulations have the effect of law and must be obeyed. When the legislature passes a law and delegates its oversight to an agency, it gives that agency the power to make regulations. Because regulations flow from legislation, they have the force of law. Whether prudent or not, nurses are obligated to practice consistent with these regulations. All nurses have the responsibility to follow the changes that are in place by legislation. They are laws that must be followed, not guidelines

A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the following would most likely be a consequence of capitation? a. Coercing clients to attend health promotion education classes b. Encouraging clients to seek care elsewhere c. Increasing the number of interventions to maximize payment d. Neglecting to order certain tests or treatment to minimize cost to the provider

d. Neglecting to order certain tests or treatment to minimize cost to the provider In capitated arrangements, physicians and other practitioners are paid a set amount to provide care to a given client for a set period of time and amount of money. Thus, neglecting to order certain tests or treatment would be a way for the provider to maximize the amount of money received to provide care to members of this group. In a capitated arrangement, the provider would most likely not increase the number of interventions used or coerce clients to attend health promotion classes as both of these strategies would cost the provider more money, and the provider will be receiving a set amount of money to provide care for a given client for a set period of time. It is unlikely that the provider would encourage clients to seek care elsewhere; rather the provider would be conscientious about the number of tests and treatments that are ordered in order to try to contain costs.

A case manager advocates for a client by helping an insurer understand the client's needs and desires and by helping the client understand programs and benefits offered by the insurer. What role is the nurse? a. Arbitrator b. Systems allocator c. Mediator d. Negotiator

d. Negotiator Negotiating is a strategic process used to move conflicting parties toward an outcome. Parties must see the possibility of achieving an agreement and the costs of not achieving an agreement. As a systems allocator, the nurse distributes limited health care resources according to a plan or rationale. Mediating is the process of assisting parties to understand each other's concerns and to determine their conclusion of the issues. The mediator has no authority to decide, whereas an arbitrator is legally allowed to suggest an appropriate outcome.

Which of the following best describes the primary problem that can result from health care today being given by many different care providers? a. Clients are not sure which provider to see first. b. Health care providers have to make referrals to other providers. c. Clients sometimes are not sure who their primary provider is. d. Overuse, underuse, or gaps in care may result.

d. Overuse, underuse, or gaps in care may result. A particularly challenging problem is the fragmenting of services, which can result in overuse, underuse, gaps in care, and miscommunication. Clients who have a primary care provider typically know who that provider is and recognize that this is the provider that should be seen first. The referral system is not a primary problem with health care being given by various providers. It is the fragmentation of services that causes the problems within the system.

Which of the following criterion is now used for deciding the amount of the reimbursement before care is provided? a. A proportion of actual cost arbitrarily decided by the Medicare panel b. The federal budget constraints for the current fiscal year c. Hospital and health care provider feedback and political persuasion d. Prospective payment scale based on the medical diagnosis

d. Prospective payment scale based on the medical diagnosis As a result of rising health costs, Congress passed a law in 1983 that mandated an end to cost-plus reimbursement and instituted a prospective payment system (PPS) for inpatient hospital services to shift the cost incentives away from the providing of more care and toward more efficient services. The basis for prospective reimbursement is the 468 diagnosis-related groups (DRGs). There is not a Medicare panel that determines the actual cost of services. Payments are determined in advance based on DRGs and are not determined by the budget of the federal government. Hospital and health care provider feedback do not influence the prospective reimbursement; rather, the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client.

A nurse is advocating for the public health department to increase the number of public health nurses that it employs. Which of the following factors should the nurse emphasize? a. Providing disease investigation training b. Providing research opportunities c. Providing leadership experiences d. Providing salaries commensurate with responsibilities

d. Providing salaries commensurate with responsibilities Through the input of the Division of Nursing's National Advisory Council for Nursing Education and Practice (NACNEP), the Division of Nursing sets policy for nursing nationally. A few of the factors indicated by the NACNEP that need to be in place to support the public health nurse role are competitive salaries commensurate with responsibilities, experience in health promotion and prevention, long-term trusting relationships in the community, and a commitment to social justice and eliminating health disparities. The Division of Nursing's National Advisory Council for Nursing Education and Practice (NACNEP) did not emphasize the importance of providing disease investigation training, research opportunities, or leadership experiences.

The nurse contacts participants who completed an educational program on breast self-examinations to see whether they have any questions and to determine whether they are doing breast self-examinations. Which of the following types of evaluation is being implemented by the nurse? a. Final evaluation b. Formative evaluation c. Goal evaluation d. Summative evaluation

d. Summative evaluation Summative evaluation assesses program outcomes after the program is completed. Formative evaluation occurs on an ongoing basis while the program exists. Goal evaluation and final evaluation are not types of formal evaluation that are addressed in the textbook.

A committee concludes that a program's objectives were met and that activities received positive ratings from the community; yet the program will be discontinued because cost was triple the amount anticipated. Which of the following program evaluation measures created a problem? a. Adequacy b. Effectiveness c. Impact d. Sustainability

d. Sustainability The aspect of program evaluation is sustainability—enough resources (usually money) to continue the program. Other aspects of program evaluation include: adequacy—program addresses the extent of the need; effectiveness—ability to meet program objectives and the results of program efforts; impact—long-term changes in the client population.

A nurse is trying to maximize the quality of life of clients while reducing health care costs. Which of the following actions would most likely be completed by the nurse? a. Assisting in cast application for a client who was injured in a skateboard incident b. Irrigating the eyes of a client splashed with chemicals c. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a client with a heart condition d. Teaching a high school boy about sexually transmitted infections and proper condom application

d. Teaching a high school boy about sexually transmitted infections and proper condom application Education is primary health care prevention. A proactive investment in disease prevention and health promotion targeted at improving health behaviors and lifestyle has the potential to improve health status and reduce health care costs. Assisting in a cast application, irrigating a client's eyes, and restoring a normal cardiac rhythm are all tertiary prevention methods as a condition has already occurred and the nurse is focusing on restoring health. In order to maximize quality while reducing health care costs, the nurse should focus on primary prevention strategies.

After completing a needs assessment, the nurse presents ideas at a community interest meeting that focuses on community needs. Unfortunately, attendees show essentially no interest in being involved. Knowing that the health problem must be addressed, the nurse proceeds with implementation as planned. Which of the following is the most likely outcome of the program? a. Community members will become increasingly positive about the new program. b. Others will recognize the importance of the program and become involved. c. The public health agency will both publicize and expand the program. d. The program will fail because of the community's lack of interest.

d. The program will fail because of the community's lack of interest. Perspectives on the program, or what people think about the need for a program, might differ among health providers, agency administrators, policymakers, and potential clients. These groups are considered the stakeholders in the program. Collecting data on the opinions and attitudes of all persons, whether directly or indirectly involved with the program, is necessary to determine if the program is feasible, if there is a need to redefine the problems, or if a new program should be developed or an existing program expanded or modified. If a new or changed program is to be successful, it must not only be available, but also be accessible and acceptable to the people who will use it. If community members do not accept the programming, it is unlikely that they will become increasingly positive about it or invite others to become involved. The public health agency could attempt to publicize and expand the program, but without the acceptance of the community, it will most likely fail.

Which of the following best describes the goal or priority of the nurse advocate? a. To gain organizational and governmental support for the promotion of nursing objectives b. To improve community service needs identified by research findings c. To integrate evidence-based practice guidelines in the provision of community nursing service d. To promote the client's rights and self-determination

d. To promote the client's rights and self-determination In today's practice, the nurse advocate makes the client's rights the priority. Thus, the goal of advocacy is to promote self-determination in a constituency or client group. Integrating evidence-based practice is part of the role of the nurse as a researcher. Gaining organizational and government support and improving community service needs identified by research are not roles of the nurse as an advocate. In the advocate role, the nurse promotes the self-determination of the group.

Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care? a. Doing what is best for the community b. Doing what is best for the family c. Obeying legal mandates d. Upholding ethical principles

d. Upholding ethical principles In acute care settings with a single localized issue, the primary ethical principles are usually applied, with patient autonomy being the dominant or most crucial principle. Upholding ethical principles should be the first consideration before obeying legal mandates or doing what is best for the community or family.

Which of the following methods would be the most interactive approach to assessing a community's need? a. Define needs based on the current health status of the community. b. Examine past needs as identified by the agency as well as the community. c. Project future needs based on current trends. d. Use past and current data to project future needs.

d. Use past and current data to project future needs. The interactive approach to assessing the needs of the community includes describing the problem using past and present data to project future population needs. Projecting a future need describes the preactive stage. The reactive stage defines the problem based on past needs identified by the client or the agency. The inactive stage involves defining the problem based on the existing health status of the population to be served.

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "The whole family is being affected and will fall apart if they don't focus on their family's needs first before anything else." Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism

d. Utilitarianism By focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time of stress, the nurse is taking a utilitarian approach. Principlism relies on these ethical principles to guide decision-making. Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.

A nurse is assessing a community to determine the feasibility of implementing a new program on bike safety for youth in the community. Which of the following aspects should the nurse investigate to make this determination? a. Whether the community, especially agency clients, desire a program b. Whether local politicians support the agency's idea for a program c. Whether agency professionals think a program is needed d. Whether all involved support the need for such a program

d. Whether all involved support the need for such a program Feasibility means the program's viability, practicality, achievability, or likelihood of success. Everyone involved must be supportive for a program to succeed. What people think about the need for a program, or program feasibility, might differ among health providers, agency administrators, policymakers, and potential clients. Thus, it is important to get all who are involved to support the program.

A nurse would like to become involved in political action. Which of the following actions would be most appropriate for the nurse to accomplish this goal? (Select all that apply.) a. Become a member of the state nurses association. b. Be friendly with everyone, whether supportive or not of your ideas. c. Focus on being appointed to the state level committees. d. Focus all your efforts on your specialty practice area and your employment site. e. Volunteer to serve on relevant committees.

A, B A nurse wishing to become politically involved should begin by joining the state nurses association, networking with others involved, and volunteering to serve on committees or in offices. Be friendly and network to increase your knowledge beyond your own workplace or specialty and seek opportunities to share expertise with others. Becoming involved locally is a good opportunity to start becoming involved in political action and allows for networking at the local level. Seeking opportunities beyond one's workplace or specialty area allows the nurse to gain additional knowledge and share expertise in specialty area with others.

Which of the following best explains why clients who have Medicaid have poor health outcomes? (Select all that apply.) a. Clients may have preexisting conditions not covered by insurance. b. Many physicians won't accept Medicaid clients. c. Medicaid won't pay for certain medical interventions. d. Medicaid recipients are noncompliant with their health care providers' recommendations. e. There is a general hesitancy among those eligible to seek health care.

A, B, C The primary reasons for delay, difficulty, or failure to access care include inability to afford health care and a variety of insurance-related reasons, including the insurer not approving, covering, or paying for care; the client having preexisting conditions; and physicians refusing to accept the insurance plan. Practical problems such as lack of childcare, transportation, long waiting periods, and communication issues also interfere. Noncompliance is not a primary reason why Medicaid clients have poor outcomes. There is no research to confirm that Medicaid recipients are reluctant to seek medical care. Rather there are usually other compounding factors that interfere with the client following the regimen or accessing other needed health care services which result in the poor health outcomes.

A nurse is testifying at a committee meeting about a health bill. Which of the following actions should be taken by the nurse? (Select all that apply.) a. Briefly describe professional education. b. Discuss how the bill affects more than just nurses. c. Include factual data and, if possible, statistical information in visual form. d. Provide written proof of personal and professional qualifications e. Provide information about relevant expertise and related experience.

A, B, C, E Language must be simple and carefully chosen to convey information to listeners and to avoid professional jargon. The nurse must share a bit of personal education, experience, and expertise to be seen as a credible source, but written proof of credentials is not necessary unless specifically requested. The testimony must go beyond just nursing's interest and include accurate, credible data. The data must be accurate and credible which may not be the case when getting names from the media.

1. Which of the following are the primary goals of case management? (Select all that apply.) a. To ensure that care coordination occurs across the continuum b. To emphasize evidence-based clinical decision-making c. To manage resource use and control expenses d. To stress the advantages and benefits of community-based care e. To reduce institutional care as a means of achieving wellness

A, B, C, E The goals in case management are to reduce institutional care while maintaining quality processes and satisfactory outcomes; manage resource use through protocols, evidence-based decision-making, guideline use, and disease management programs; and control expenses by managing care processes and outcomes. Case management involves more aspects of care than only care that occurs in the community. Thus, stressing the advantages and benefits of community-based care is not part of the primary goals of case management.

Which of the following activities is the responsibilities of the Centers for Disease Control and Prevention (CDC)? (Select all that apply.) a. Conduct research to enhance disease prevention. b. Detect and investigate infectious disease problems. c. Develop public health policies. d. Publish national goals for promoting health and preventing disease. e. Serves as an advocate of public health polices

A, B, C, E The mission of the CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. To monitor health, the CDC will detect and investigate health problems, conduct research that will enhance prevention, and develop and advocate sound public health policies and other prevention strategies. The safety and health of the workplace is the specific responsibility of OSHA. The CDC cannot write or pass legislation. The USDHHS published national health goals in Healthy People 2020.

A case manager is concerned about exposure to possible lawsuits. Which of the following are appropriate actions to take to minimize this risk? (Select all that apply.) a. Assure clients they can appeal any decision. b. Carefully document client involvement and reasons for decisions. c. Share client information with the other involved providers and agencies. d. Confirm credentials and capabilities of providers or agencies to give care. e. Being mindful to maintain effective lines of communication with all clients.

A, B, D, E Elements that reduce risk exposure include clear documentation of the extent of participation in decision-making and reasons for decisions; records demonstrating accurate and complete information on interactions and outcomes; use of reasonable care in selecting referral sources, which may include confirming credentials and capabilities of providers and agencies; maintaining good communication with clients; and informing clients of their rights of appeal. In compliance with the Health Insurance Portability and Accountability Act (HIPAA), no nurse is allowed to share information with others without written consent of the client.

In which of the following situations would the federal government provide money through tax relief for private enterprise? (Select all that apply.) a. A business pays for part of health insurance premiums for its employees. b. A business purchases gifts for its employees to award them for their service. c. An employer provides health screenings. d. An employer requests reimbursement for employee transportation costs. e. An employer offers immunizations to all eligible employees.

A, C, E Businesses can pay for disease prevention and health promotion services for employees (and sometimes their families) in the form of immunizations, health screenings, and counseling. The business can then deduct these costs as a business expense, which reduces the amount the business owes the government in taxes on their profits. Similarly, when businesses subsidize health insurance for their employees—and families—this is also a business expense, which decreases the amount the business would otherwise pay in taxes. Thus, the government indirectly provides the money, but the business, a part of the private sector, decides how it is used. A business purchasing gifts for its employees and an employer requesting reimbursement for employee transportation costs do not result in tax relief for the business. Rather, the business providing health insurance and health promotion/disease prevention services allows the amount of taxes that the business owes to the government to be reduced.

Which of the following are some major differences in health care today, as compared with the first half of the 20th century? (Select all that apply.) a. Consumers are influenced by advertising for specific health care agents or procedures. b. The emphasis is on the continued expansion of health care facilities, especially acute care hospitals. c. Education and specialization of personnel have increased. d. The need to create new ways to pay for health care is a central focus. e. Hospital stays are much shorter.

A, C, E Since the 1980s, the United States has been in a period of limited resources, with an emphasis on containing costs, restricting growth in the health care industry, and reorganizing care delivery. Results have included shorter hospital stays and substitution of one set of personnel (such as nurse practitioners) for another set (physicians). Such trends are made more challenging by increased direct marketing to consumers. Also with increased knowledge has come increased education and specialization. Shorter hospital stays continue to occur so there is a focus on expanding care in the community, not in acute care hospitals. Containment of costs is a major focus; however, creation of new payment methods has not been part of this conversation.

A nurse is visiting a state legislator to encourage the legislator to vote for a particular health bill that the state nurses association has endorsed. Which of the following actions would be most important for the nurse to complete? (Select all that apply.) a. Encourage the legislator or staff to ask relevant questions. b. Be friendly and engage in small talk so that rapport can be established. c. Be aware that legislators are well informed; don't insult the legislator by stating information that is obvious. d. Have a handout that summarizes all the major points in support of the bill.

A, D Legislators might not be well informed about every issue, so they need and want important information. The nurse should allow time for questions or clarifications of information shared and have the material on a handout for the legislator's convenience. It is also helpful to invite the legislator to attend nursing conferences or meetings where health issues will be discussed. The nurse should not waste time with small talk but briefly present his or her stand, emphasizing other nurses who support the bill, because numbers count. Legislators might not be well informed about every issue, so they need and want important information that the nurse can provide.

A nurse would like to help members of the community focus on receiving primary preventive health care services. Which of the following interventions should be implemented by the nurse? (Select all that apply.) a. Publicize data on success of health promotion efforts. b. Lobby for decreased reimbursement for secondary and tertiary care services. c. Establish standards for appropriate screenings at specific intervals. d. Encourage members of the military service to engage in appropriate healthy lifestyle behaviors. e. Provide transparency to the public regarding service costs and savings.

A, E Reasons given for the lack of emphasis on prevention in clinical practice and lack of financial investment in prevention include provider uncertainty about which clients should receive services and at what intervals, lack of information about preventive services, negative attitudes about the importance of preventive care, lack of time for delivery of preventive services, delayed or absent feedback regarding success of preventive measures, less reimbursement for these services than for curative services, lack of organization to deliver preventive services, and lack of use of services by the poor and elderly. Considering how health care dollars are spent in the United States, it would not be reasonable to lobby for decreased funding for secondary and tertiary services, as this would result in less care available for individuals. Requiring people to change their lifestyle would be illegal.

Which of the following best describes the importance of the World Health Organization (WHO) to the United States? (Select all that apply.) a. Provides daily information on disease occurrences. b. Establishes international standards for antibiotics and vaccines. c. Creates international legislation regarding international cooperation. d. Supports national programs to fight disease when asked to do so. e. Monitors for adverse drug reactions.

A,B,D,E Some WHO services that benefit all countries (including the United States) are providing day-to-day information service on the occurrence of internationally important diseases; publishing the international list of causes of disease, injury, and death; monitoring adverse reactions to drugs; and establishing international standards for antibiotics and vaccines. Individual countries can request assistance with strengthening the delivery of health services, supporting national programs to fight disease, and training health workers—which the United States does not. WHO can suggest but cannot legislate to individual countries.

Which of the following are elements of the MAPP (Mobilizing for Action Through Planning and Partnership) Program Planning Model? (Select all that apply.) a. Generating shared visions and common values b. Assessing priorities in health problems c. Developing a framework for long-range planning d. Choosing health priorities e. Conducting a needs assessment related to community change

A,C The elements of MAPP include mobilizing community members and organizations, generating shared visions and common values; developing a framework for long-range planning; conducting needs assessments in four areas: community strengths, local public health system, community health status, and focus of change; and implementing the plan. Assessing priorities in health problems and choosing health priorities are part of other program planning models

The ethical principle of justice is encountered by the case manager in which of the following issues? A. A new and expensive medication is given to the client with financial means when it would also be advantageous to the client without funding. B. Excessive attention to containing costs supersedes or impairs the nurse's duty to improve heatlh or relieve suffering. C. A client is in end stages of congestive heart failure but is led to believe that treatment will continue to be beneficial. D. The client's preferred provider is no longer contracted with insurance company and the client is forced to choose another provider.

A. A new and expensive medication is given to the client with financial means when it would also be advantageous to the client without funding.

Which of the following describes the significance of the passage of The Public Health Threats and Emergencies Act? (Select all that apply.) a. It funded ongoing activities of the public health system. b. It led to improved water quality and food safety guidelines. c. It included funding for public health activities. d. It validated that the public health system was prepared for terrorism. e. Expanded the role of Secretary of HHS to include aspects of public health emergencies.

B, C The Public Health Threats and Emergencies Act was the first federal law to comprehensively address the public health system's preparedness for bioterrorism and other infectious disease outbreaks and signaled the beginning of renewed interest in public health as the protector for entire communities. The focus of this law was to address emerging threats to the public's health and authorize the Secretary of HHS to take appropriate response actions during a public health emergency, including investigations, treatment, and prevention. A focus was the improvement of water quality and food safety. It did not support the ongoing activities of public health. It did not validate the public health system was prepared for terrorism.

A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Which of the following statements would be most appropriate for the nurse to make? a. "Don't drop out of school." b. "Sign up for childbirth classes." c. "Sign up for the WIC program." d. "Take your prenatal vitamins daily."

a. "Don't drop out of school." The question specifies the health of both the mother and the child. Socioeconomic conditions improve with education. Because socioeconomic status is inversely related to mortality and morbidity, by becoming better educated, the mother-to-be will be less likely to live a life of poverty and, as a consequence, will enjoy a greater chance of better health for herself and for her child. The priority of the nurse should be to encourage the teenager to stay in school as this choice will provide for the best long-term outcome for the client. Signing up for childbirth classes, the WIC program, and taking prenatal vitamins all address short-term outcomes which are not as important as the future of the teenager raising this child

A client states to the nurse, "I have heard the Affordable Care Act is supposed to help improve the health care I receive, but so far I have seen no benefits from this legislation." Which of the following statements would be the best reply by the nurse? a. "Maybe you have not directly seen the changes; however, several things have changed in health care because of this bill." b. "It will take years to see any effects from the act because of the delays in implementation of the changes." c. "This legislation will primarily improve care for the elderly and poor populations, so this is why you may not have seen any benefits." d. "The way health care operates at the federal and state levels has changed, so most individuals will not see any direct impact."

a. "Maybe you have not directly seen the changes; however, several things have changed in health care because of this bill." It is possible that unless one has been in a situation where changes have been made, that one may not realize any of the effects of this law. The goal of the Affordable Care Act was to improve the health of the nation and access care. Several changes to health care have already been made because of this legislation, and more changes will continue in the future. Multiple provisions of the act will affect individuals and families.

Which of the following activities is completed by the executive branch of the federal government? a. Administration of policy b. Interpretation of policy c. Proposal of policy d. Passage of policy

a. Administration of policy The executive branch administers and regulates policy. The legislative branch proposes policy (as bills) and passes policy (as laws). The judicial branch interprets laws.

The nurse learns that a family has declined an elective medical intervention for a health care problem because paying for the care would drastically reduce the family's resources and ability to meet the needs of other family members. Ethically, which of the following actions should be taken by the nurse? a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice. b. Stress that each individual in society has a right to health care and the family will have to create some way to raise funds for the needed treatment. c. Talk to the media to see whether a campaign to raise funds for the family can be created. d. Try to convince the agency to give the care for free, even if it means economic stress for the agency, because the medical need is obvious.

a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice. According to Callahan, although the nurse may attempt moral persuasion to change the family's values, in the absence of immediate and grievous harm, no ethical requirement exists to interfere with the family's values. Because there is no immediate or grievous harm, it is not in the best interest of the nurse to interfere with the family's decision. Thus, the other answers are not an appropriate action for the nurse to take.

Which of the following best describes the steps in program management? a. Assess, plan, implement, evaluate b. Identify, initiate, implement c. Organize, operationalize, mobilize, subsidize d. Substantiate, negotiate, evaluate

a. Assess, plan, implement, evaluate The program management process is similar to the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. The other steps mentioned in other options are not part of program management. The process of program management, such as the nursing process, consists of a rational decision-making system to help nurses determine the complete process of program development, implementation, and evaluation.

A nurse is planning a program to teach cardiac health at the senior citizens' center. Which of the following is an effectively written objective for the program? a. By the end of the program, each participant will report walking at least 30 minutes a day at least 5 days each week. b. By the end of the program, each participant will voice a commitment to walk at least 30 minutes a day. c. By the end of the program, each participant will understand the need for physical exercise. d. Each participant will voice a commitment to engage in physical exercise each day.

a. By the end of the program, each participant will report walking at least 30 minutes a day at least 5 days each week. Useful program objectives must include a statement of the specific behaviors desired, using an action verb that can be seen and measured. Only "will report walking 30 minutes a day at least 5 days each week" has a specific outcome action that can be seen and measured. Voicing a commitment is not an outcome action; it is only a verbal agreement. The verb understand is not an action verb that can be seen and measured.

Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients regardless of the services needed and provided? a. Capitation b. Fee for service c. Rationing d. Retrospective reimbursement

a. Capitation In payment by capitation, practitioners are paid a set amount to provide care to a given client or group of clients for a set period of time. In the fee-for-service payment system, which is like the retrospective reimbursement, the practitioner determines the costs of providing a service, delivers the service to a client, submits a bill for the delivered service to a third-party payer, and is paid by the third-party payer. Rationing implies reduced access to care and potential decreases in the acceptable quality of services offered.

Which of the following best explains why every client doesn't receive care from a case manager? a. Case management time is demanding; thus it is restricted to complex cases. b. Many health agencies do not employ case managers. c. Most clients would not benefit from case management. d. Most nurses do not know how to function as case managers.

a. Case management time is demanding; thus it is restricted to complex cases. Case management can be labor intensive, time consuming, and costly. Because of the increasing number of clients with complex problems in nurses' caseloads, the intensity and duration of activities required to support the case management function may soon exceed the demands that the direct caregiver can meet. Health agencies continue to employ more case managers as the cost spent for the care saves the agency money in the long term. Because case management is labor intensive and costly, it is unrealistic for all clients to have a case manager although additional clients could benefit from case management. Nurses fulfill the roles of advocate, care coordinator, and referral agent which are necessary to function as case managers.

A nurse is conducting program evaluation. Which of the following would be the first action the nurse would take? a. Choose the type of evaluation to be done. b. Determine who will be involved in the evaluation. c. Identify the goal and objectives for the evaluation. d. Obtain answers to specific questions related to the program being evaluated.

a. Choose the type of evaluation to be done. To do a program evaluation, first choose the type of evaluation you wish to do. After the type of evaluation to be done has been chosen, the nurse will identify the goal and objectives for evaluation, decide who will be involved in the evaluation, and finally, answer the questions related to the type of evaluation.

Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of reducing the need for professional health care intervention and therefore also lowering cost? a. Managed care plan b. Fee-for-service payment c. Prospective reimbursement d. Retrospective reimbursement

a. Managed care plan The concept of managed care is that costly care could be reduced if consumers had access to education and health promotion. Fee-for-service payment encourages more services to be given. Reimbursement, whether prospective or retrospective, is based on the same criteria, but managed care integrates the financing and the delivery of health care.

Which of the following is generally considered to be nursing's first code of ethics? a. Nightingale Pledge b. Code for Professional Nurses c. Code of Ethics for Nurses d. Principles of the Ethical Practice of Public Health

a. Nightingale Pledge The Nightingale Pledge is generally considered to be nursing's first code of ethics. After the Nightingale Pledge, the Code for Professional Nurses was formally adopted by the ANA House of Delegates in 1950. It was amended and revised five more times, until, in 2001 the ANA House of Delegates adopted the Code of Ethics for Nurses with Interpretive Statements. The Principles of the Ethical Practice of Public Health was approved in 2002.

Which of the following demographic factors is expected to have the greatest influence on national health care spending? a. The aging population b. Use of diagnosis-related groups to determine reimbursement c. Insurance reform d. An increasing number of people without health insurance

a. The aging population The aging population is expected to affect health services more than any other demographic factor. The majority of older adults rely on publicly funded programs. As the Baby Boom generation ages and retires, federal expenses for Social Security and health care will increase. The use of diagnosis-related groups to determine reimbursement started in 1983 and is not expected to have a great influence on national health care spending at this time. Insurance reform is not a demographic factor. Due to the Affordable Care Act, the number of people without health insurance is decreasing.

Which of the following best defines the word politics? a. The art of influencing others b. The outcome of governmental policies c. A provision of power for making decisions d. The result of legislative action

a. The art of influencing others Politics is the art of influencing others to accept a specific course of action. Political action results in governmental policies and legislation. The result of legislative action typically is done in the form of laws and policies. The provision of power for making decisions is typically assumed by the government.

From an ethical standpoint, what is the problem with the belief that everyone should receive his or her fair share, that life should always be fair, and that everyone should make his or her own decisions? a. With this belief, the needs of society as a whole are ignored. b. Insufficient resources exist to give everyone a fair share. c. This belief leads to a propensity for some people to like to be taken care of. d. Some people think they deserve more than others.

a. With this belief, the needs of society as a whole are ignored. All principles of justice focus on the individual, which ignores the needs of society as a whole. The rights of an individual may conflict with the rights of the community as a whole. It is recognized that distribution should be based on what needs and deserves there is considerable disagreement that exists when considering what these terms mean in the context of fairness.

Which of the following public health nurse applicants is the least qualified for a position of case manager in a rural county? a. A 24-year-old who has a master's degree in public health b. A 34-year-old who will be moving from a large city c. A 44-year-old who was born and raised in the community d. A 54-year-old who, until recently, was a member of the community's school board

b. A 34-year-old who will be moving from a large city Case management competency requires the following knowledge and skills: knowledge of community resources and financing methods; written and oral communication and documentation skills; negotiation and conflict resolution skills; critical thinking processes to identify and prioritize problems from the provider and client views; and identification of best resources for the desired outcomes. Because communities are unique, someone new to the area will lack knowledge of community resources and financing methods. There is nothing in the descriptions of the other public health nurses that indicates a lack of current knowledge or skills.

A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed as the criterion that is used to ration health care? a. Clinic operating hours b. Ability to pay for services c. Availability of local provider services d. Transportation availability

b. Ability to pay for services Because there are not enough health care services available to provide desired services to everyone, the focus has been on reducing costs by controlling the use of services. All of the factors listed affect health care access and therefore affect health care rationing (either directly or indirectly). The primary determinant, however, is the ability to pay for services. Without this ability, services are denied; therefore, those without insurance that is accepted by a provider or institution or who do not have the money to pay out of pocket are unable to obtain services regardless of operating hours, transportation issues, or availability.

Which of the following best describes why planning care for an individual is so challenging in today's health care system? a. Because today's clients have high expectations of the health care system b. Because multiple providers, payers, and settings have to be coordinated c. Because of the new high technology constantly being created and used for client treatment d. Because so many different health care providers are in the acute care setting today

b. Because multiple providers, payers, and settings have to be coordinated Case management practice is complex because of the coordinating activities of multiple providers, payers, and settings throughout a client's continuum of care. Planning care is so challenging because of the complexities of the system, not the high expectations of the population, new technology, or different providers. Coordination of all of these aspects of care, not just one of them, is what makes planning so difficult.

A nurse is using a case management plan to maximize patient care outcomes. Which of the following describes an important consideration that should be made by the nurse? a. Case management plans should be used only by nurses to manage care. b. Case management plans should be individualized for each client. c. Case management plans provide additional expense to the client and family. d. Case management plans focus on the natural progression of the disease.

b. Case management plans should be individualized for each client. Adaptation of the case management care plan to each client's characteristics is a crucial skill for standardizing the process and outcome of care. It links multiple provider interventions to client responses and offers reasonable predictions to clients about health outcomes. Institutions report that sharing case management plans with clients empowers the clients to assume responsibility for monitoring and adhering to the plan of care. Case management plans should link the care that is provided together and involve multiple providers. Case management is part of the standard of care that is provided and does not provide an additional expense to the client, although it may cause an additional expense to the agency. Disease management, not case management, focuses on the natural progression of the disease.

A community is examining which programs are needed within the community, the populations they will target, and how they will be funded. Which of the following would be the least risky decision for the community to make? a. Choose whichever option is the least expensive of agency resources. b. Choose to do nothing. c. Choose whatever the agency administration prefers. d. Choose whatever the majority of clients prefer.

b. Choose to do nothing. A "do nothing" decision is always the decision with the least risk to the provider. The need and demand for a program are determined by working with the client. This stage of planning creates options for solving the problem and considers several solutions. Each option for program solution is examined for its uncertainties (risks) and consequences.

The case manager explains to two disagreeing parties that coming to an agreement will save personnel costs for both of them. Which of the following terms best describes this action? a. Assertiveness b. Collaboration c. Cooperation d. Compromising

b. Collaboration In collaborating, an individual attempts to work with others toward solutions that satisfy the needs of both parties. Assertiveness is the ability to present one's own needs. Cooperation is the ability to understand and meet the needs of others. When compromising, an individual attempts to find a mutually acceptable solution that partially satisfies both parties.

A nurse is determining whether a hospital has the right to require infected patients to be isolated against their will. To which type of law will the nurse refer? a. Common law b. Constitutional law c. Legislation and regulation d. Judicial law

b. Constitutional law Constitutional law provides the right to intervene in a reasonable manner to protect the health, safety, and welfare of the citizenry. State power concerning health care is called police power. This power allows states to act to protect the health, safety, and welfare of their citizens. The state must show that it has a compelling interest in taking actions, especially actions that might infringe on individual rights. The state can isolate an individual to prevent an epidemic, even though this infringes on individual rights. The community's rights are deemed more important than the individual's rights when there is a threat to the health of the public. Judicial law, based on court and jury decisions, and the principles of common law (precedent, justice, fairness, respect for an individual's autonomy, and self-determination) are both used by court's as the basis to make a decision and do not relate to having the right to isolate a patient. Legislation is law that comes from the legislative branches of the government and regulations are specific statements of law related to defining or implanting individual pieces of legislation. Neither are as important in this case as the constitutional law of the police power of the states in regards to isolation of a patient.

A bill with the potential to decrease health care services is passed by Congress. Which of the following actions should the nurse take to influence the bill's implications? a. Exercise veto power by calling for petitions from health care agencies. b. Contact the regulatory agency and participate in public hearings. c. Call members of congress to request that they rescind the legislation that was passed. d. Discuss the change in services with the administrators at the hospital.

b. Contact the regulatory agency and participate in public hearings. Once a bill is passed and becomes law, it is too late to influence congressional members to change their vote; however, it is not too late to influence the outcome of the vote because the nurse can influence how the law is regulated. An agency typically writes the regulations that control how the law is implemented in more specific detail. Often this process can be just as important as lobbying against a bill because it shapes the final implementation of the law. Health care agencies do not have the ability to veto a bill. After a bill has been passed, it is too late to contact members of congress. Calling the hospital will not change the implications of the bill. Contact must be made with the regulatory agency in order to influence how the law is regulated.

A nurse reviews with the client what can be expected during the next 3 days, as well as how the client should expect to feel each of those days. The client laughs and says, "You've got my care all mapped out." Which of the following tools is the nurse using to determine what will happen when? a. Care planning b. Critical pathway c. Demand management d. Use management

b. Critical pathway Critical paths are tools that name activities to be used in a timely sequence to achieve desired outcomes for care with measureable outcomes. Care planning involves developing a plan of care for an individual. Use management attempts to redirect care and monitors the appropriate use of provider care and treatment services. Demand management seeks to control use by providing clients with correct information to empower themselves to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system.

Which of the following accurately describes a challenge that will be faced by health care providers in the 21st century? a. Lack of available space to provide care for clients in hospitals b. Emergence of new and old communicable and infectious diseases c. New guidelines for chronic disease management d. Increased use of technology leading to a decreased need for health care workers

b. Emergence of new and old communicable and infectious diseases In the 21st century, the emergence of new and the reemergence of old communicable and infectious diseases are occurring as well as larger foodborne disease outbreaks and acts of terrorism. Care for clients continues to move out of the hospital setting and into the community. Chronic disease management will be a challenge for health care providers; however, new guidelines should ease the care provided for these diseases and wouldn't be seen as a challenge. The use of technology will continue to increase, but the need for health care workers will not be decreasing. New health care careers will emerge because of the changes in technology.

Which of the following groups pays the largest amount for health care in the United States today? a. Consumers b. Federal and state government c. Insurance companies and other third-party payers d. Hospitals and health care providers

b. Federal and state government Combined state and federal governments paid the most for health care in 2018. Health care financing has evolved from a time when the most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, and finally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than private insurance companies or consumers. From 1960 to 2018, the percentage of third-party public insurance payments increased and the percent of out-of-pocket payments declined.

A committee of health care professionals would like to establish a countywide program to improve Hispanic immigrant access to culturally competent health care services. Which of the following persons would be most helpful as a key informant? a. Hospital administrator b. Hispanic community leader c. National expert on cultural competency d. Politician or county official

b. Hispanic community leader Key informants are leaders in the community who are knowledgeable about community needs. In this scenario, the Hispanic leader most likely knows more about the needs of the Hispanic community than the others listed. The hospital administrator, national expert on cultural competency, and politician are most likely not as knowledgeable about this immigrant population as the Hispanic community leader.

Evaluation is under way for a statewide program to decrease teen injury and death associated with teens that drive while under the influence of alcohol. Which of the following questions would best be used for the summative evaluation of the program? a. Are program participants continuing to attend the programs, and do their satisfaction scores indicate that they are pleased with the program? b. How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? c. How does the amount of alcohol intake by teens compare before and after participants enter into the program? d. What problems are identified as the program is implemented?

b. How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? Summative evaluation is the evaluation to assess program outcomes or as a follow-up of the results of the program activities. The goal is addressed in the question about statistics. Two of the options are examples of questions used for formative evaluation (satisfaction and problems with program implementation). The goal was not to decrease drinking of alcohol but to decrease driving when drinking alcohol.

Which would be an appropriate descriptor that meets all criteria for defining a client to be served by a program? a. All women ages 40 to 50 who have not had a menstrual period for three consecutive months b. Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency c. Pregnant women who have received nutritional counseling but whose nutritional status did not improve d. Children ages 18 months to 5 years who have been treated for nutritional deficiencies at the Central County Clinic

b. Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency The client should be defined by biological and psychosocial characteristics, by geographic location, and by the problems to be addressed. For example, in a community with a large number of preschool children who require immunizations to enter school, the client population may be described as all children between 4 and 6 years of age residing in Central County who have not had up-to-date immunizations. This example tells the reader who the client is, what the need is, how large the population is, and where they are located. In order to meet all criteria for defining a client that is to be served by the program, information about the biological and psychosocial characteristics, geographical location, and the problems addressed needs to be included. The incorrect responses do not contain all of this necessary information.

Which of the following is most closely correlated with poor health? a. Age and gender (i.e., older males) b. Low socioeconomic status c. Minority race status d. High-risk lifestyle behaviors

b. Low socioeconomic status Poverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors. The rate of uninsured remained higher among people with lower incomes and lower among those with higher incomes. Households of three with less than $20,000 annual income are at the highest risk for being uninsured. Socioeconomic status has the closest correlation to health status; thus, age, gender, minority race status, and high-risk lifestyle behaviors do not have the closest correlation.