ch 8/9 community questions

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

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. The other options are important components of health economics but by themselves do not provide the broad understanding called for in this question.

A public health nurse is counseling a client who is trying to determine if a health maintenance organization (HMO) or preferred provider organization (PPO) will provide the better health care coverage. Which of the following best describes one main difference between these two types of coverage? a. HMOs provide comprehensive care to members for a fixed fee. b. PPOs designate providers that members can choose. c. PPOs provide one model of care delivery. d. HMOs provide financial incentives to encourage members to select HMO providers.

HMO PROVIDE COMPREHENSIVE CARE TO MEMBERS FOR A FIXED FEE The HMO is a provider arrangement whereby comprehensive care is provided to members for a fixed, "per member per month," fee. A PPO uses predetermined rates for services to be delivered to members. HMOs do not have one model of care delivery. PPOs provide financial incentives to encourage members to select PPO providers

A nurse is investigating a bacterial illness that has caused a health problem in the community. Only some of the people exposed to the bacteria have become ill. Which of the following factors best explains why this would have happened? a. Chemical agent factors b. Environmental factors c. Host factors d. Physical agent factors

HOST FACTORS

A nurse is planning to host a health screening at a large urban mall. Which of the following variables will help the nurse determine which screenings should be included? (Select all that apply.) a. Adequate space for persons to lie down after testing until side effects are reduced b. Health problems for which the specific population is at risk c. Whether adequate privacy can be obtained for the invasive or embarrassing procedures d. Whether health care providers are available to follow up on any positive screening results

Health problems for which the specific population is at risk Whether health care providers are available to follow up on any positive screening results

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

HEALTH CARE SYSTEM Of the four major factors that affect health—personal behavior (or lifestyle), environmental factors (including physical, social, and economic environments), human biology, and the health care system—medical services are said to have the least effect. Behavior (lifestyle) has been shown to have the greatest effect, but environment and biology account for 70% of all illnesses.

Which of the following statistics is used by countries to compare the success of their health care systems? a. Attack rate b. Infant mortality rate c. Cause-specific morbidity rate d. Cause-specific mortality rate

INFANT MORTALITY RATE Infant mortality is used around the world as an indicator of overall health and availability of health care services.

Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting? a. There is limited access to information useful to the nurse in giving care in the community. b. More paperwork and forms are required when giving care in the home. c. It is more challenging to control the environment in the community. d. Specialization isn't possible in the community setting.

IT IS MORE CHALLENGING TO CONTROL THE ENVIRONMENT IN THE COMMUNITY In the community, nurses often use epidemiology, since the factors that affect the individual, family, and population group cannot be as easily controlled as in acute care settings. It is essentially impossible to control the environment in the community.

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

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.

Which of the following best describes the type of study the nurse is conducting? a. Descriptive epidemiological study b. Ecological study c. Prospective cohort study d. Retrospective cohort study

RETROSPECTIVE COHORT STUDY

Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist? a. She convinced other women to join her in giving nursing care to all the soldiers. b. She demonstrated that a safer environment resulted in decreased mortality rate. c. She obtained safe water and better food supplies and fought the lice and rats. d. She met with each soldier each evening to say goodnight, thereby giving psychological support.

SHE DEMONSTRATED THAT A SAFER ENVIRONMENT RESULTED IN DECREASED MORTALITY RATE Nightingale examined the relationship between the environment and the recovery of the soldiers. Using simple epidemiological measures, she was able to show that improving environmental conditions and adding nursing care decreased the mortality rates of the soldiers. Nightingale used statistics to document decreased mortality rates when the environmental factors were improved.

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

STAY IN SKILLED NURSING FACILITY Medicare Part A covers hospital care, home care, and skilled nursing care.

A nurse is concerned about the high incidence of STDs in the community college population and sets up a special STD screening. Which of the following groups of students would be encouraged to attend? (Select all that apply.) a. Sexually active students currently receiving treatment for an STD b. Sexually active students who had been screened the previous year c. Students who claimed to not be sexually active and do not plan to become sexually active d. Students who are sexually active but never "go all the way"

Sexually active students who had been screened the previous year c. Students who claimed to not be sexually active and do not plan to become sexually active d. Students who are sexually active but never "go all the way"

A nurse is trying to maximize the quality of life of her 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

TEACHING A HIGH SCHOOL BOY ABOUT STI 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.

A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Treatment, but not prevention

TERTIARY PREVENTION Interventions that prevent worsening of a condition are tertiary prevention activities. In this instance, the client already has a health problem (osteoporosis). By advising adequate dairy intake, the nurse aims to ensure that enough calcium is available to limit worsening of the osteoporosis.

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

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

In a particular community, several high school students were diagnosed with diabetes mellitus Type 2 during the annual high school health fair. Over the next few years, the nursing staff developed and implemented educational programs about the risk factors for diabetes mellitus Type 2 and proper nutrition. Which of the following would be most useful for the nurses to use to determine if they are having any impact? a. The epidemic of diabetes in the high school is gradually ending. b. The incidence of diabetes is slowly decreasing during screening events. c. The prevalence of diabetes is slowly decreasing during screening events. d. The risk for diabetes is slowly increasing over time.

THE INCIDENCE OF DIABETES IS SLOWLY DECREASING DURING SCREENING EVENTS Incidence rates and incidence proportions are the measure of choice to study etiology because incidence is affected only by factors related to the risk of developing disease and not to survival or cure. Prevalence is a fairly stable number over time, but incidence reacts more quickly to changes in risk factors or intervention programs. If the educational programs are having the desired impact, the incidence of diabetes being diagnosed will decrease in future screenings.

The nursing staff has attempted to screen the entire African-American population in the community for diabetes. Which of the following would provide immediate verification of the success of the nursing staff's efforts? a. An epidemic of diabetes will be recognized. b. The incidence of diabetes will increase in the community. c. The prevalence of diabetes will decrease in the community. d. The risk for diabetes in the community will increase.

THE INCIDENCE OF DIABETES WILL INCREASE IN THE COMMUNITY If the screening has been successful, more diabetes will be diagnosed and, hopefully, treated. Thus, the incidence of new cases will increase. Overall, prevalence will also increase, but that is not one of the answer options.

A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school organizations. Which of the following best describes why the nurse would reject this suggestion? a. This method of data collection would result in classification bias. b. This method of data collection would result in confounding bias. c. This method of data collection would result in personal bias. d. This method of data collection would result in selection bias

THE METHOD OF DATA COLLECTION WOULD RESULT IN SELECTION

A woman is sitting in a corner of the clinical waiting room, crying audibly. The nurse asks, "What's wrong? Can I help?" The woman responds, "They just told me I have a positive mammogram and I need to see my doctor for follow-up tests. I know I'm going to die of cancer. How can I tell my family?" Which of the following information does the nurse need to know in order to help the woman cope with this finding? a. The negative predictive value of mammography b. The positive predictive value of mammography c. The reliability of mammography d. The validity of mammography

THE POSITIVE PREDICTIVE VALUE OF MAMMOGRAPHY The positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease.

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

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, child care 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.

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 32-year-old man who works part-time at a small business

32 YEAR OLD MAN WHO WORKS PART TIME AT A SMALL BUSINESS The typical uninsured person is one who works at a low-paying job, part-time or temporary, or at a small business. 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.

A public health nurse found that out of the 70 people who ate the potato salad at a school picnic, 63 developed symptoms of food poisoning. Which of the following best describes the attack rate? a. 63% b. 70% c. 90% d. 100%

90% The attack rate is the proportion of persons exposed to an agent who develop the disease. Because 63 of the 70 persons became ill, the attack rate is 63:70, or 90%.

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 and immunizations d. An employer requests reimbursement for employee transportation costs

A BUSINESS PAYS FOR PART OF HEALTH INSURANCE PREMIUMS FOR ITS EMPLOYEES AN EMPLOYER PROVIDES HEALTH SCREENING AND IMMUNIZATIONS 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.

Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest of the city. Assuming all else is the same, which of the following is the most likely explanation for a single neighborhood having such a different pattern of illness? a. A cultural or ethnic concentration in the neighborhood b. The geographical location of the neighborhood within the city c. A statistical fluke without meaning d. The time of year the different statistics were collected throughout the city

A CULTURAL OR ETHNIC CONCENTRATION IN THE NEIGHBORHOOD

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

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.

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 safe water, sewage disposal, and pasteurization of milk.

ADVANCES WERE MADE IN SAFE WATER SEWAGE DISPOSAL AND PASTEURIZATION OF MILK 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.

Which of the following explains why contagious infections are becoming a central focus of public health? (Select all that apply.) a. Americans are fearful of terrorists using biological agents. b. Awareness of human susceptibility to animal diseases has been publicized. c. Drug-resistant strains of "old" diseases have evolved. d. Media coverage exaggerates the dangers of exposure to crowds.

AMERICANS ARE FEARFUL OF TERRORISTS USING BIOLOGICAL AGENTS DRUG RESISTANT STRAINS OF OLD DISEASES HAVE EVOLVED

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

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.

A man is diagnosed with prostate cancer. Which of the following data should the nurse know to answer the man when he asks, "What are the chances I'll survive this thing?" a. Attack rate b. Case fatality rate c. Cause-specific morbidity rate d. Crude mortality rate

CASE FATALITY RATE The case fatality rate (CFR) is the proportion of persons diagnosed with a particular disorder (i.e., cases) who die within a specified period. The CFR is considered an estimate of the risk for death within that period for a person newly diagnosed with the disease. Persons diagnosed with a particular disease often want to know the probability of surviving. The CFR provides that information.

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.

CLIENTS MAY HAVE PREEXISTING CONDITIONS NOT COVERED BY INSURANCE MANY PHYSICIANS WONT ACCEPT MEDICAID CLIENTS MEDICAID WONT OAY FOR CERTAIN MEDICAL INTERVENTIONS 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.

Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits and risks of a particular nursing intervention for senior citizens living in the community? a. Cross-sectional study b. Ecologic study c. Clinical trial d. Retrospective analysis

CLINICAL TRIAL

Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate. Which of the following communities should the nurse suggest receive funding first? a. Community A—with 23 single teenage pregnancies in a city of 500 b. Community B—with 45 single teenage pregnancies in a city of 1000 c. Community C—with 90 single teenage pregnancies in a city of 2000 d. Community D—with 90 single teenage pregnancies in a city of 1500

COMMUNITY D Without doing any actual math, it should be fairly obvious that 23:500, 45:1000, and 90:2000 are all about the same proportion but that 90:1500 is a larger proportion. Doing the math, the pregnancy rates of A, B, and C are 45-46:1000, whereas the rate in Community D is 60:1000.

Which of the following are some major differences in health care today, as compared with the first half of the twentieth 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.

CONSUMERS ARE INFLUENCED BY ADVERTISING FOR SPECIFIC HEALTH CARE AGENTS OR PROCEDURES EDUCATION AND SPECIALIZATION OF PERSONNEL HAVE INCREASED 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.

A nurse is administering a tuberculosis skin test to a client who has AIDS. Which of the following results should the nurse anticipate when using this screening test? a. Decreased positive predictive value b. Decreased reliability c. Decreased sensitivity d. Decreased specificity

DECREASED SENSITIVITY

A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing? a. Reviewing communicable disease statistics b. Determining factors contributing to childhood obesity c. Analyzing locations where family violence is increasing d. Documenting population characteristics for healthy older citizens

DETERMINING FACTORS CONTRIBUTING TO CHILDHOOD OBESITY Epidemiology refers not only to infectious epidemics but also to other health-related events. Analytic epidemiology looks at the etiology (origins or causes) of disease.

Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community? a. Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations b. Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings c. Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD d. Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for those diagnosed with CAD

DISTRIBUTION OF HANDOUTS Education in schools, the community, and high-risk populations focuses only on primary prevention activities. Online activities focus only on primary and secondary prevention. Efforts focused only on those who already have CAD are not primary prevention. Distributing handouts includes all three levels of prevention to target all members of the population. Targeting all members of the population and implementing all levels of prevention increase the likelihood of positive outcomes for the community as a whole.

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."

DONT 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.

Which of the following accurately describes a challenge that will be faced by health care providers in the twenty-first 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

EMERGENCE OF NEW AND OLD COMMUNICABLE AND INFECTIOUS DISEASES In the twenty-first 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.

A nurse reports that in comparison to all the children in a particular school, the children who are members of the Cub Scouts have 0.3 risk for obesity before entering the sixth grade. Which of the following recommendations would the nurse make to the new parents of two boys who had just moved into this school's neighborhood? a. Discourage the parents from enrolling their sons in Cub Scouts because of the risk. b. Don't say anything about Cub Scouts, because it isn't relevant to nursing care. c. Encourage the parents to enroll their sons in Cub Scouts. d. Share the finding and let the parents draw whatever conclusions they feel appropriate.

ENCOURAGE THE PARENTS TO ENROLL THEIR SONS INTO CUB SCOUTS

A nurse is examining all of the various factors which can lead to disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Natural history of disease

EPIDEMIOLOGIC TRIANGLE The epidemiologic triangle categorizes factors as agent, host, or environment. The model encourages the health care provider to examine all the influences that lead to increased risk. Levels of prevention are actions taken to improve health outcomes. Health promotion addresses health improvement, not the risk for disease.

A nurse is employed as a nurse epidemiologist. Which of the following activities would most likely be completed by the nurse? a. Eliciting the health history of a client presenting with an illness b. Evaluating the number of clients presenting with similar diseases c. Performing a physical examination of an ill client d. Providing treatment and health education to a client with a disease

EVALUATING THE NUMBER OF CLIENTS PRESENTING WITH SIMILAR DISEASES Epidemiology differs from clinical medicine, which focuses on the diagnosis and treatment of disease in individuals. Epidemiology monitors the health of the population.

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

FEDERAL AND STATE GOV 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.

Which of the following best explains how the government inadvertently 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.

LEGALLY EMERGENCY DEPARTMENTS MUST SEE CLIENTS EVEN IF CLIENTS CANT 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 copayments 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.

The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation. Which of the following sources of information would be most helpful? a. Local data drawn from a professional survey in the city b. The National Health Interview Survey c. The National Hospital Discharge Survey d. The state's vital statistics

LOCAL DATA DRAWN FROM A PROFESSIONAL SURVEY IN THE CITY

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

LOW SOCIOECONOMIC STATUS Poverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors.

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

MANAGED CARE PLAN 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. The concept of managed care is that costly care could be reduced if consumers had access to education and health promotion.

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

MEDICAID Medicaid provides coverage for adults with low income and their children.

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

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, equipment, and some supplies.

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 day care 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

PERSUADING LEGISLATORS TO [ASS 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 beforean illness occurs.

This year 600 of 8000 young women ages 17 to 20 years at a university health center tested positive for a sexually transmitted infection (STI). Which of the following terms best describes this data? a. An epidemic b. Incidence c. Prevalence d. Risk

PREVALENCE Because we do not have baseline data, we have no way to conclude that this is an epidemic with higher-than-normal results from the screening. Incidence refers to new cases, whereas prevalence means all cases. We don't know whether the finding represents the first time a woman was told she had an STI or whether she had previously been diagnosed with the problem. Therefore, we can't say whether these are new cases (incidence), but the results do represent all cases (prevalence). Risk is the probability of developing an STI, but no risk factors are discussed.

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

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).

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, including cost savings. 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.

PUBLICIZE DATA ON SUCCESS OF HEALTH PROMOTION EFFORTS INCLUDING COST SAVINGS EST STANDARDS FOR APPROPRIATE SCREENINGS AT SPECIFIC INTERVALS 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. Although all of the above suggestions may have some merit, some would be illegal, such as requiring people to change their lifestyle.

A nursing staff has successfully screened for diabetes in the community. Which of the following might best persuade the health board to increase funding for diabetic clinics in this community? a. An epidemic of diabetes is now recognized and must be addressed. b. The incidence of diabetes is now higher than previously recognized in the community. c. The prevalence of diabetes is now higher than previously recognized in the community. d. The risk for diabetes in the community could decrease if funding is received.

THE PREVALENCE OF DIABETES IS NOW HIGHER THAN PREVIOUSLY RECOGNIZED IN THE COMMUNITY If more people are now being diagnosed with diabetes and need support, more ongoing services will be needed for this population. Incidence may go up and down, but prevalence is a fairly stable number.

Between 2000 and 2005, 1000 of 10,000 young women ages 17 to 20 years at a university tested positive for a sexually transmitted infection (STI). Of the 1000 diagnosed STIs, 300 were gonorrhea and 500 were chlamydia. Which of the following statements best summarizes these findings? a. The proportion of cases of gonorrhea to all STIs was 300:1300. b. The proportion of cases of gonorrhea to chlamydia was 300:500. c. The proportion of cases of gonorrhea to all STIs was 50%. d. The proportion of STIs to the total population was 100:1000.

THE PROPORTION OF STIS TO THE TOTAL POP WAS 100,000 If the proportion is small, we can express the number per 1000. The answer of 300:1300 adds the total of the numerator to the denominator, which is unnecessary because the gonorrhea cases were already included in the denominator. In the answer of 300:500, the ratio comparing gonorrhea to chlamydia does not meet the epidemiological definition of proportion (i.e., the denominator must contain the numerator). Although proportions may be expressed as percentages, in the answer of 50% the percentage reflects the number of gonorrhea cases to all STIs, which doesn't summarize the total STI problem. The answer of 100:1000 correctly summarizes that 1000 of 10,000 (or 100:1000) young women had the problem.

Persons in an auditorium may have been exposed to a disease. If they are infected, it is crucial that they receive immediate treatment and not take the disease home to their families. Which of the following characteristics would be most important to consider when selecting the screening test to be used? a. The negative predictive value b. The positive predictive value c. The sensitivity of the test d. The specificity of the test

THE SENSITIVITY OF THE TEST Because it is most important to identify every case, the sensitivity of the test is crucial. High sensitivity is needed when early treatment is important and when identification of every case is important.

Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal. Which of the following best explains this similarity in the two women? a. They are both members of the same birth cohort. b. They are close friends. c. They attended the same school. d. They both go the same church.

THEY ARE BOTH MEMBERS OF THE SAME BIRTH COHORT

A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community. Which of the following may be lacking when obtaining blood pressure readings? a. Reliability b. Sensitivity c. Specificity d. Validity

VALIDITY Validity is the accuracy of a test or measurement, or how closely it measures what it claims to measure. With only one regular BP cuff, the nurse cannot obtain accurate measurements on those who are extremely obese or extremely thin. A thigh cuff and a pediatric cuff would allow the nurse to obtain accurate—that is, valid—measurements.

A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Web of causality

WEB OF CAUSALITY The web of causality model recognizes the complex interrelationships of many factors interacting to increase or decrease the risk for disease. Causal relationships (one thing or event causing another) are often more complex than the epidemiologic triangle conveys. With all the various antecedents identified, the nurse can then decide in which areas interventions are possible.

A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a secondary prevention intervention that the nurse could implement? a. Giving a presentation on the importance of exercise and physical fitness b. Designing a game in which students select healthy food choices c. Weighing students to identify those who are overweight d. Putting students on a diet if they weigh greater than 20% of their ideal weight

WEIGHING STUDENTS TO ID THOSE WHO ARE OVERWEIGHT Secondary prevention refers to interventions that increase the probability that a person with a condition will have the condition diagnosed early. Health screenings are the mainstay of secondary prevention. Weighing students and assessing whether the weight is higher than recommended will allow for early intervention so that obesity may be avoided.

A nurse believes a new mouth care procedure (MCP) is causing more mouth problems than it is helping to avoid. Which of the following must be present for the nurse to go to administration with confidence that the new mouth care procedure (MCP) is causing problems? (Select all that apply.) a. A plausible explanation of how the new MCP could cause harm b. A strong feeling that the MCP is the cause c. Consistently seeing mouth inflammation in many of the patients who have received the MCP d. Documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented

a. A plausible explanation of how the new MCP could cause harm c. Consistently seeing mouth inflammation in many of the patients who have received the MCP d. Documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented