Community Chap. 10-12 Quiz Practice

Which is an example of a human rights violation? Select all that apply. A. Failure to prevent starvation B. Not having colleges or universities within the vicinity C. Not having grocery stores with healthful food available D. Contaminating water with waste from state-owned facilities E. Denying access to information and services related to sexual and reproductive rights

A failure to prevent starvation D. contaminating water with waste from state-owned facilities E. denying access to information and services related to sexual and reproductive rights Rationale: Human rights violations occur when the government fails to provide the infrastructure, services, and information necessary to promote health, reduce risk, and control disease. Examples of human rights violations include failure to prevent starvation, contaminating water with waste from state-owned facilities, and denying access to information and services related to sexual and reproductive rights. Not having colleges or universities within the vicinity and not having grocery stores with healthful food available would not be considered violations of a community's human rights.

Which is a strategic plan priority for the Centers for Disease Control and Prevention's (CDC) Strategic Framework? Select all that apply. A. Improve health security at home and around the world B. Strengthen public health and health care collaboration C. Better prevent the leading causes of illness, injury, disability and death D. Achieve health equity, eliminate disparities, and improve the health of all age groups E. Create social and physical environments that promote quality of life, health development, and health behaviors across all life stages

A, B, C Rationale: The Strategic Plan Priorities for the CDC's Strategic Framework are to improve health security at home and around the world; strengthen public health and health care collaboration; and better prevent the leading causes of illness, injury, disability, and death. Both achieve health equity, eliminate disparities, and improve the health of all age groups. Creating social and physical environments that promote quality of life, health development, and health behaviors across all life stages are overarching goals of Healthy People 2020.

The nurse working at a local health department expects which service(s) to be included within the department's scope? Select all that apply. A. Immunizations B. Inspection of restaurants C. Home healthcare services D. Correctional institutional services E. Disease prevention during epidemics

A, B, C, D Rationale: There are four major categories of services offered by a local health department: community health services (giving immunizations), environmental health services (inspection of restaurants), personal health services (providing care in correctional institutions or as home healthcare services), and mental health services. Disease prevention during epidemics is not a task exclusive to the scope of a local health department.

The nurse is on a team that tracks administrative costs for a health insurance company. Which costs are included in the administrative costs incurred by insurers? Select all that apply. A. Marketing B. Utilization review C. Premium collection D. Agents' commissions E. Medical underwriting F. New employee orientation

A, B, C, D, E Rationale: Administrative costs incurred by insurers include marketing, utilization review, premium collection, agents' commissions, and medical underwriting. New employee orientation is not a part of administrative costs.

Which statement is true of common law? Select all that apply. A. Can fill gaps in the law B. Law made by the courts C. Interprets the wording of statute law D. Does not result in remedial action in court E. Useful when unforeseen situations arise that aren't covered by statutes

A, B, C, E Rationale: Common law can fill in gaps in the law. Common law is a law made by the courts, rather than by legislation. Common law interprets the wording of statute law and is useful in situations where circumstances arise that aren't covered by statutes. Common law is a law like those passed by legislation and can result in a court judgment that may award damages, punishment, sanctions, or other remedial actions.

Which changes have contributed to the increase in healthcare costs? Select all that apply. A. Drug utilization B. Aging of society C. Technological advances D. Shift to nonprofit health care E. Previously unhealthy lifestyles

A, B, C, E Rationale: Costs of prescription drugs have risen dramatically and have become a significant part of health expenditures in the past several decades. As people live longer, the percentage of those older than 85 years is also increasing. Therefore the number of people consuming the greatest amount of healthcare resources will rise more rapidly than the number who provide the monetary support for these resources. Technological advances have the potential to save many lives but can be very expensive. Although significant lifestyle changes have been adopted by many people in the past 30 years, many patients utilizing the healthcare system today may have health conditions that are in part caused by, or worsened by, many years of living an unhealthy lifestyle. The shift was not to nonprofit health care but from nonprofit health care to for-profit health care. This shift placed an emphasis on profit and mechanisms for achieving higher reimbursement that have in turn affected healthcare costs.

Which costs are considered capital costs? Select all that apply. A. Taxes B. Interest C. Marketing D. Depreciation E. Leases and rentals F. Salary and benefits

A, B, D, E Rationale: Capital costs include taxes, interest, depreciation, and leases and rentals. Marketing is considered an administrative cost. Salary and benefits are not considered capital costs or administrative costs.

Which interventions were created to reduce unnecessary utilization of health care? Select all that apply. A. Establishment of a "gatekeeper" B. Limited patient provider choice C. Reimbursement with multiple insurers D. Limited coverage for preexisting conditions E. Exclusion of participants with exorbitant use F. Requirement of preauthorization for some services

A, B, D, E, F Rationale: Restrictions on use of health care, such as the establishment of a "gatekeeper," limited patient provider choice, requirement of preauthorization for some services, limited coverage for preexisting illnesses, and exclusion of those participants whose use was deemed exorbitant were instituted in an attempt to reduce unnecessary utilization. Reimbursement with multiple insurers does not reduce unnecessary utilization; expenses for health care in America vary according to types of care and sources of funding because of reimbursement with multiple insurers.

Which essential benefits are covered under the Affordable Care Act? Select all that apply. A. Mental health B. Long-term care C. Preventive care D. Ambulatory care E. Cosmetic surgery F. Emergency services

A, C, D, F Rationale: Essential benefits covered under the Affordable Care Act include mental health, preventive care, ambulatory care, and emergency services. Long-term care and cosmetic surgery are not considered essential health benefits under the Affordable Care Act.

The nurse is speaking with an employer who is considering changing from an HMO to a self-insured plan. Which statements are true regarding self-funded plans? Select all that apply. A. Self-insurance allows for control of plan design. B. The administrative costs of self-funding are high for the employer. C. Self-insurance requires a great deal of risk and fiduciary responsibility. D. Self-insured groups have to offer the ACA-mandated essential health benefits. E. The self-insured group purchases healthcare services from an established insurance plan.

A, C, E Rationale: Self-insurance allows for control of plan design. Design is at the discretion of the employer; therefore, self-funded plans can be redesigned as needed. However, self-insurance requires a great deal of risk and fiduciary responsibility for the employer. There is always a risk for higher utilization or a larger number of individual claimants than expected. The self-insured group administer its own healthcare plan and purchases healthcare services from an established insurance plan. The administrative costs of self-funding are not typically higher for the employer. In fact, the development of self-funded plans has enabled organizations and industries to reduce the administrative cost of insurance. Although most self-insured groups continue to offer ACA-mandated essential health benefits, they are not required to.

The nurse understands which is a problem associated with the current healthcare system in the United States? Select all that apply. A. High cost of routine and basic care B. Lack of technological advancement C. Poor quality care for some communities D. Too high of a role in preventative medicine E. Poor access for people most in need of care

A, C, E Rationale: The American healthcare system is often criticized for its high cost of routine and basic care, poor quality care for some communities, and lack of access to care for the people who need it most. Lack of technological advancement is not an issue with the current healthcare system. Lack of preventative care is, in fact, one of the major issues in the American healthcare system rather than it playing too much of a role.

Which are the key components of public health infrastructure that allow public health organizations at the federal, tribal, state, or local level to deliver public health services? Select all that apply. A. A capable and qualified workforce B. Politically active community members C. Up-to-date data and information systems D. Nurse case managers with master's degrees E. Public health agencies capable of assessing and responding to public health needs

A. A capable and qualified workforce C. Up-to-date data and information systems E. Public health agencies capable of assessing and responding to public health needs Rationale: The key components of public health infrastructure include a capable and qualified workforce, up-to-date data and information systems, and public health agencies that are capable of assessing and responding to public health needs. Politically active community members may be helpful but are not a key component. A nurse case manager's optimums education level is debatable. The basic nursing education for case managers required by employers can vary. Some require a Baccalaureate degree, and others do not. In some settings, a master's degree is required.

What are the core functions of public health? Select all that apply. A. Assurance B. Assessment C. Public safety D. Health promotion E. Policy development

A. Assurance B. Assessment E. Policy development Rationale: The three core functions of public health are assurance, assessment, and policy development. Public safety and health promotion and are not included in the core functions of public health.

Multiple groups, including the American Nurses Association and the American College of Nurse Practitioners, joined forces to raise funds for a national advertising campaign designed to recruit new nurses into the profession. Which kind of group was formed? A. Coalition B. Organization C. Lobbying group D. Political Action Committee

A. Coalition Rationale: A coalition is an alliance of organizations that join together for combined action. An organization is an organized body of people with a particular purpose, be it a business, society, association, etc. A lobbying group is a group of individuals who attempt to influence business and government leaders to create legislation or conduct an activity that will help a particular organization. A political action committee is an organization that raises money privately to influence elections or legislation, especially at the federal level.

Which branch of government will the nurse approach when attempting to change a regulation restricting healthcare access to a particular population? A. Congress B. The Supreme Court C. The State Department of Health D. The Department of Health and Human Services

A. Congress Rationale: Congress is responsible for changing rules and regulations as well as writing laws and would be the best branch of government to approach. The Supreme Court interprets the Constitution and directs the role of government in health care. The Department of Health and Human Services coordinates federal health-related services. The State Department of Health directs health policy at the state level and is not responsible for changing healthcare regulations.

Which federal agency will the school nurse contact for clarification about school health protocols? A. Department of Education B. U.S. Environmental Protection Agency C. Women, Infants, and Children Program D. Department of Health and Human Services

A. Department of Education Rationale: In the United States, there are many federal organizations that perform health-related activities. The Department of Education is involved in both health education and school health issues. School-related health issues do not fall under the purview of the Department of Health and Human Services. The U.S. Environmental Protection Agency and the Women, Infants, and Children Program do have health-related functions but are not directly involved with school health protocols.

Which is an example of a common law? A. Doctor-patient confidentiality B. The Health Insurance Portability and Accountability Act (HIPAA) C. Mandatory training requirements for employees of nursing facilities D. The Clinical Practice Guidelines on the window for tissue plasminogen activator

A. Doctor-patient confidentiality Rationale: A common law is a law based on custom, tradition, and court decisions rather than on written legislation. The doctor-patient confidentiality that binds a medical professional from disclosing what they know about a person's medical condition is an example of a common law. HIPAA is a law. Both mandatory training requirements for employees of nursing facilities and the Clinical Practice Guidelines on the window for tissue plasminogen activator are regulations.

Which statement accurately describes governmental health insurance? A. Funded through a payroll tax of most working citizens B. Provides for long-term care services and personal care services C. Pays specified health services for all people 60 years of age and older D. Does not cover people with disabilities; these people are covered by Medicaid

A. Funded through a payroll tax of most working citizens Rationale: Medicare is financed through a payroll tax that is paid by the majority of working people. Medicare does not provide for long-term care services and personal care services, although Medicaid does. Medicare only pays specified health services for those 65 years of age and older who are eligible to receive Social Security benefits, people with permanent disabilities, and those with end-stage renal disease.

What social determinants of health and factors contributing to homelessness have been identified as key issues in economic stability by Healthy People 2020? Select all that apply. A. Housing stability B. Employment status C. Access to primary care D. Inadequacy of supportive services E. Access to community-based programs

A. Housing stability B. Employment status Rationale: The social determinants of health and factors contributing to homelessness that have been identified as key issues in economic stability by Healthy People 2020 include housing stability and employment status. Access to primary care, inadequacy of supportive services, and access to community-based programs are not considered social determinants and key issues of health for the homeless population.

Which type of healthcare plan pays all costs of covered services provided to the enrollee, allowing the enrollee free choice of provider and services, preserving the enrollee's right of choice with personal management of health care? A. Indemnity plan B. Point-of-service C. Preferred provider organization D. Health maintenance organization

A. Indemnity plan Rationale: Indemnity plans pay all costs of covered services provided to the enrollee, allow the enrollee to enjoy free choice of provider and services, and preserve the enrollee's right of choice to manage his or her own health care. A point-of-service plan covers care within the individual's network. A preferred provider organization negotiates with healthcare providers for services at a reduced rate in exchange for a guaranteed increase in consumers. In a health maintenance organization, preventive care is covered and encouraged, but specialty care can be more restricted.

Which nurse was instrumental in the development of the Children's Bureau and associating the connection between health and social conditions? A. Lillian Wald B. Lavinia Dock C. Mary Breckenridge D. Florence Nightingale

A. Lillian Wald Rationale: Lillian Wald was a political activist in the early 1900s who recognized the connections between health and social conditions. She was a driving force behind the federal government's development of the Children's Bureau in 1912. Lavinia Dock was a prolific writer and political activist. She waged a campaign for legislation to allow nurses rather than physicians to control the nursing profession. Mary Breckenridge worked to develop nursing in rural Kentucky in the 1920s, establishing the Frontier Nursing Service. Florence Nightingale was asked to establish the first nurse corps to tend to soldiers in the Crimea War in the 1850s.

A nurse sends an email to other nurses to ask them to sign a letter that will be sent to a legislator in an attempt to get a clean-air bill passed. What is this activity called? A. Lobbying B. Advocacy C. Social policy D. Political action committee

A. Lobbying Rationale: This activity is an example of lobbying, which occurs when an individual or group of individuals tries to influence or persuade legislators. Advocacy is when the nurse pleads the patient's cause or acts on the patient's behalf, with a focus on developing the community, system, and individual or family's capacity to plead their own cause or act on their own behalf. Social policy is the branch of public policy that advances social welfare and enhances participation in society. A political action committee is a nonpartisan entity that promotes the election of candidates believed to be sympathetic to their interests.

Which structure of the U.S. Department of Health and Human Services directly provides support for nursing research to improve patient care? A. National Institutes of Health B. Administration for Community Living C. Agency for Healthcare Quality and Research D. Healthcare Resources and Services Administration

A. National Institutes of Health Rationale: The National Institutes of Health directly provides support for nursing research to improve patient care. The Administration for Community Living provides support for the aged and disabled. The Agency for Healthcare Quality and Research works to improve the quality, safety, efficiency, and effectiveness of healthcare services. The Healthcare Resources and Services Administration is concerned with the development of health services programs and facilities.

The nurse is reviewing documents written with the intent of ensuring laws and regulations are applied consistently and fairly to all parties, including patients and employees. What type of document is the nurse reviewing? A. Policies B. Statutes C. Regulations D. Common laws

A. Policies Rationale: Policies describe how it is ensured that laws and regulations are applied consistently and fairly. Statutes are federal laws enacted by the U.S. Congress that have been passed as bills and must be followed by every state in the country. Regulations are a form of delegated legislation that provide detail on the administration of principles in the law. Common law is unwritten law that is based on custom or court decision.

Which organizational types should the nurse involve when trying to find housing during the winter months for a patient who is homeless and struggling? Select all that apply. A. Public B. Private C. Voluntary D. Managed care E. Patient-centered medical homes

A. Public B. Private C. Voluntary Rationale: There are several different types of organizations that can assist with finding housing for the homeless: public, private, and voluntary agencies are all options the nurse can suggest to a homeless patient. Managed care organizations are not involved in finding housing for homeless patients. Patient-centered medical homes are practices that offer a comprehensive and primary care approach to patient care. They do not provide housing assistance.

Which referral is most appropriate for the nurse to make during discharge for a patient who reports that it is increasingly difficult to live at home alone? A. Social worker B. Physical therapist C. Occupational therapist D. Unlicensed assistive personnel

A. Social worker Rationale: A social worker is the best person to assist the nurse with figuring out a safe and appropriate discharge plan for patients who have been struggling to live independently. Physical and occupational therapists can sometimes play an important role in a patient's discharge, but ensuring safety typically requires more than is included in the scope of those roles. An unlicensed assistive personnel can help provide care but won't develop a comprehensive discharge plan.

Which governmental level is involved in establishing health codes and licensing healthcare facilities? A. State B. Local C. County D. Federal

A. State Rationale: The state government establishes health codes and licenses healthcare facilities. The local, county, and federal governments are not involved in these responsibilities.

Which factor enhances and improves access to healthcare services? A. Technology B. Regulations C. Provider fees D. Hospitalization

A. Technology Rationale: Technology enhances and improves access to healthcare services. For example, through technology, patients can attend virtual appointments with their providers, reducing transportation and travel barriers. Provider fees, regulations, and hospitalization do not enhance or improve access to healthcare services.

Which system should the nurse consider when attempting to expand healthcare access in an underserved community? A. Telehealth B. Social media C. Accreditation D. Electronic health records (EHRs)

A. Telehealth Rationale: Telehealth uses information technology to provide care to patients in underserved communities via telephone, computer, or other type of video screen. Social media allows people to share and provide information but does not provide healthcare access to patients. Accreditation is a way to assess the quality of care a healthcare organization provides. An EHR is a way to collect and store patient health information in a digital format so that it can be shared across healthcare settings; it does not address the issue of limited access to care.

To which department will the nurse file a complaint about the quality of a pharmaceutical product? A. The Food and Drug Administration B. The Centers for Disease Control and Prevention C. The Centers for Medicare and Medicaid Services D. The Agency for Toxic Substances and Disease Registry

A. The Food and Drug Administration Rationale: The Food and Drug Administration (FDA) monitors food and pharmaceutical products to ensure they are safe and effective. The FDA is the department best suited to manage a complaint about the quality or safety of a pharmaceutical product. The Centers for Disease Control and Prevention (CDC) supports programs aimed at preventing the spread of infectious diseases. The Agency for Toxic Substances and Disease Registry is a division of the CDC that works to limit exposure to toxic substances. The Centers for Medicare and Medicaid Services administers the Medicare and Medicaid plans.

The nurse is preparing for an accreditation visit by an agency that sets and maintains standards for healthcare organizations. Which organization is performing the inspection? A. The Joint Commission B. Agency for Healthcare Research and Quality C. The National Committee for Quality Assurance D. Health Plan Effectiveness Data and Information Set

A. The Joint Commission Rationale: The Joint Commission was founded in 1951 to promote healthcare quality by setting and maintaining standards for healthcare organizations. The Agency for Healthcare Research and Quality is the main federal organization responsible for improving the safety and quality healthcare system. The agency publishes materials to educate healthcare systems and professionals but does not set standards. The National Committee for Quality Assurance oversees accreditation programs for individual physicians and health plans but not for healthcare organizations. The Health Plan Effectiveness Data and Information Set is a collection of data concerning healthcare plans collected to measure performance and consumer satisfaction.

The nurse wants to partner with a nongovernmental nonprofit agency to help direct health services to an underserved region. To which type of organization should the nurse reach out? A. Voluntary agency B. The Joint Commission C. Managed care organization D. Patient-centered medical home

A. Voluntary agency Rationale: Voluntary agencies are nongovernmental and nonprofit entities that help direct health services, including to underserved areas. The Joint Commission is an accrediting agency and plays no role in directing health care. Managed care organizations are for-profit organizations and don't direct care. Patient-centered medical homes are practices that offer a comprehensive, primary care approach to patient care.

Which steps should a new graduate nurse take to improve the nursing workforce to ensure more nurses are hired to address public health needs? Select all that apply. A. Become politically active B. Act as a positive role model C. Fundraise for nursing education D. Keep informed on public health issues E. Apply technology to create real-work change

A. become politically active B. act as a positive role model D. keep informed on public health issues Rationale: Nurses are agents of change and can make a difference in public health initiatives and the nursing shortage by becoming politically active and remaining informed on issues. It is important for nurses to be educated on the Title VIII Nursing Workforce Reauthorization Act of 2017 and become active in its implementation. Likewise, being a positive role model/mentor to other nurses will encourage a larger voice through larger numbers. Fundraising for nursing education and using technology to create change, while useful, are not typically a primary means for addressing public health needs.

What key goals of Healthy People 2020 are supported by public health infrastructure? Select all that apply. A. Improving health B. Creating environments that promote health C. Promoting healthy development and behaviors D. Linking people to needed personal healthcare services when unavailable E. Monitoring of health status to identify and solve community health problems

A. improving health B. creating environments that promote health C. promoting healthy development and behaviors Rationale: The key goals of Healthy People 2020 that the public health infrastructure supports include improvement of health, creation of environments that promote health, and promotion of healthy development and behaviors. Monitoring health status to identify and solve community health problems and linking people to needed personal healthcare services when unavailable are components aimed at fulfilling the 10 essential public health services.

What benefits does the Patient Protection and Affordable Care Act (or Health Care Reform Act) have at the national level? Select all that apply. A. Prohibits insurers from dropping policyholders when they get sick B. Prohibits insurance companies from placing lifetime limits on the dollar value of coverage C. Requires health plans to cover all preventative care and screening at no cost to the consumer D. Establishes low-risk pools to provide health coverage to those with preexisting conditions E. Prohibits insurers from disallowing coverage for some individuals with preexisting conditions

A. prohibits insurers from dropping policyholders when they get sick B. prohibits insurance companies from placing lifetime limits on the dollar value of coverage E. prohibits insurers from disallowing coverage for some individuals with preexisting conditions Rationale: The benefits of the Patient Protection and Affordable Care Act (or Health Care Reform Act) at the national level include prohibiting insurers from dropping policyholders when they get sick, prohibiting insurance companies from placing lifetime limits on the dollar value of coverage, and prohibiting insurers from disallowing coverage for some individuals with preexisting conditions. The act establishes high-risk pools to provide health coverage to individuals with preexisting conditions and requires health plans to cover some types of preventative care and screenings without consumer cost-sharing.

What duties and tasks are performed by the Centers for Medicare and Medicaid Services? Select all that apply. A. providing health insurance B. regulating laboratory testing C. improving the quality of care D. developing coverage policies E. providing health promotion and wellness programs F. providing oversight of the surveying and certifying of nursing home and continuing care providers

A. providing health insurance B. regulating lab testing C. improving the quality of care D. developing coverage policies E. providing oversight of the surveying and certifying of nursing home and continuing care providers Rationale: Activities undertaken by Centers for Medicare and Medicaid Services include improving the quality of care, providing health insurance, developing coverage policies, regulating laboratory testing, and providing oversight of the surveying and certifying of nursing home and continuing care providers. The Centers for Medicare and Medicaid Services do not directly provide health promotion and wellness programs.

Which staff member should the nurse consider adding to the clinic to help patients manage their care after hospitalization? A. Social worker B. Physician assistant C. Occupational therapist D. Clinical nurse specialist

A. social worker Rationale: A social worker can help patients with housing, managed care issues, and discharge planning. Adding a social worker can help patients improve care and health post-discharge. A physician assistant provides direct clinical care as an extension of a physician and is not as involved in post-discharge care management. Occupational therapists help patients regain lost skills. They are not involved in discharge planning. Clinical nurse specialists are advanced practice nurses who provide care specializing in one particular area.

Which statement accurately describes the Constitution of the United States? A. The Bill of Rights was in the original articles of the Constitution B. Free speech and freedom of religion are defined in the Bill of Rights C. The constitution only set forth the responsibilities of the federal government D. As soon as the Bill of Rights was ratified, its rights were guaranteed within the states

B Rationale: The rights guaranteed in the Bill of Rights include free speech and freedom of religion. The Bill of Rights was added after the original articles of the Constitution and was ratified in 1787. The constitution not only set forth the responsibilities of the federal government, but it also provided for individual citizens' rights and freedoms. The Bill of Rights was not guaranteed within the states for 72 years. Originally, it only applied to the laws and actions of the federal government.

Which example reflects how governmental powers are separated among the branches of government? Select all that apply. A. The president, members of Congress, and judiciary are all elected B. Congress must present a bill to the president before it can become law C. The president needs consent of the Senate to appoint Supreme Court justices D. The legislation has the right to request a change to the courts' final judgments E. The Supreme Court has the power to decide political questions and actual cases or controversies

B, C Rationale: Congress must present a bill to the president before it can become law, and the president needs the consent of the Senate to appoint Supreme Court justices. Although the president and members of Congress are elected, the judiciary is appointed. The president may nominate any individual to serve on the Supreme Court, but that person must receive confirmation by the Senate. Legislation is prohibited from interfering with the courts' final judgments. Federal courts will refuse to hear a case if they find that it presents a political question.

Which statements are true of health maintenance organizations (HMOs)? Select all that apply. A. Use of HMOs continues to increase B. Preventive care is always covered by HMOs C. Speciality care is somewhat restricted in HMOs D. HMOs allow for a great deal of freedom of choice E. HMOs are considerably less expensive than other insurance plans

B, C Rationale: Preventive care is covered and encouraged by HMOs. With HMOs, specialty care can also be somewhat restricted. Loss of choice has led to a decrease in the popularity of HMOs that peaked in the mid-1990s. HMOs now represent a small portion of available plans. HMOs lack enrollee freedom of choice. HMOs were considerably less expensive than other insurance plans at one time, but the difference is now relatively small.

Which patients does the nurse identify as having barriers to healthcare access? Select all that apply. A. A patient who is waiting for a new private insurance plan to start B. A patient who needs to travel 1.5 hours each way for the appointment C. A patient who has to find a bus route that goes to the provider's office D. A patient who is unable to take off from work to get a procedure done E. A patient who does not want to cancel vacation plans for an appointment F. A patient who cannot schedule an appointment without checking with the babysitter

B, C, D, F Rationale: There are many barriers to health care that patients experience based on socioeconomic level. The patient who cannot schedule an appointment without checking with the babysitter has childcare needs; this is a barrier to health care. The patient who cannot take off from an hourly work position has financial needs, another barrier to health care. The patient who needs to travel 1.5 hours each way for the appointment is facing the barrier of long-distance travel. The patient who has to find a bus route that goes to the provider's office has transportation needs, which is also a barrier. Patients with transportation needs are more inclined to cancel or not set up their next appointments. The patient who is choosing to not schedule an appointment during vacation does not have a known barrier. The patient who is waiting for new health insurance to start does not have a known barrier.

Which statements are true of preferred provider organizations (PPOs)? Select all that apply. A. PPOs are less expensive than HMOs. B. PPOs evolved from the independent practice model to compete with HMOs. C. The covered individuals must use in-network providers to receive full benefits. D. Providers have no incentive to consider cost of services provided for individuals with a PPO. E. PPOs negotiate with healthcare providers for services at a reduced rate in exchange for a guaranteed increase in consumers.

B, C, E Rationale: In an effort to compete with the HMOs, physicians and hospitals organized the independent practice model that was a separate entity that provided services to enrollees of one insurance company. This model evolved into what is referred to as PPO plans. PPOs are more flexible than HMOs, but covered individuals must use network providers to receive full benefits. PPOs negotiate with healthcare providers for services at a reduced rate in exchange for a guaranteed increase in consumers. PPOs are not less expensive than HMOs. In fact, they can be more expensive than HMO plans. PPOs receive a specific amount of reimbursement, regardless of the rendered services, that gives providers the incentive to be more conscious of how much the services provided cost.

Which statements are true regarding provision of Medicaid? Select all that apply. A. Eligible children can receive both Medicaid and CHIP. B. State government can choose to provide care to more citizens than mandated by federal government. C. The federal government will pay 90% of the cost for newly eligible Medicaid beneficiaries for several more years. D. All states must participate in the Affordable Care Act (ACA) and provide health care for all adults below the poverty line. E. Mandated services covered by Medicaid for eligible recipients include inpatient and outpatient hospital care, physician's services, vaccines for children, and family planning services.

B, C, E Rationale: The federal government sets baseline eligibility requirements for Medicaid. However, state governments that wish to provide care to more citizens through the Medicaid program can alter the eligibility requirements. The ACA covered payment of services for newly eligible Medicaid beneficiaries until 2016. The federal government will continue to pay 90% of the cost for several more years. Children eligible to receive CHIP (Children's Health Insurance Program) may not receive Medicaid; CHIP is a program that provides insurance for children from low-income families who do not qualify for Medicaid. When the ACA was implemented, funds were made available to provide health care for all adults below the poverty line. However, individual states could elect to not participate.

Which statements are true regarding payment for home health care? Select all that apply. A. Payment is made only after the episode of care is completed. B. Reimbursement is for episodes of care for a period of 60 days. C. Reimbursement is based on the diagnosis alone and not the level of care. D. Patients are placed in a home health group using the Outcome and Assessment Information Set. E. To control expenditures, Medicare changed from a prospective payment system to a fee-for-service system.

B, D Rationale: The reimbursement model for home health care has each episode beginning on the first billable day and proceeding for a period of 60 days. Through the use of a comprehensive evaluative tool, the Outcome and Assessment Information Set, a patient is placed in a home health resource group. Payment is determined by this group. Payment for home health care is received in two parts: 60% at the start of care and 40% after the episode of care is completed. Reimbursement is based on the diagnosis, type, and predicted level of care that will be required. In an effort to control home health expenditures, Medicare changed from a fee-for-service system to a prospective payment system.

Which statement is true of statutes? Select all that apply. A. Even when enacted, a statute will never have the full authority of a law B. Statutes develop over time as new laws are adopted and existing laws are amended C. No amendments are allowed to be added before a bill is submitted for final approval D. Statutes are how states define the rules necessary to maintain social order and justice E. The authority of a statute is derived from the constitution and founding documents of a state

B, D, E Rationale: Bills are developed over time as new laws are adopted and existing laws are amended. Once these bills have passed, they become statutes, which are laws that must be followed by every state in the nation. Amendments are not only allowed but are usually added to a bill before it is submitted for final approval. A committee studies the bill in detail, may receive witnesses, and holds public hearings before recommending amendments. Statutes are used by states to define the rules necessary to maintain social order and justice. It is true that the authority of a statute is derived from the constitution and founding documents of a state; a statute cannot violate the constitution. Statutes are laws; in fact, they are federal laws enacted by the United States Congress that have been passed as bills and must be followed by every state in the country.

The nurse is explaining Medicare fraud to a patient. Which examples could the nurse provide to illustrate fraud? Select all that apply. A. Employing an after-hours call service B. Billing Medicare for services not received C. Advising a patient to go to the emergency room D. Use of another's Medicare card to obtain services E. Billing Medicare for services other than those received F. Scheduling next year's annual physical at the end of this year's exam

B, D, E Rationale: Examples of Medicare fraud include billing Medicare for services not received, using someone else's Medicare card to obtain services, and billing Medicare for services other than those received. Employing an after-hours call service, advising a patient to go to the emergency room, and scheduling a patient's annual physical for the next year at the end of the current year's examination are not examples of Medicare fraud.

A patient is trying to choose between a Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) insurance plan. Which statement could the nurse make that would be an accurate reflection of HMO and PPO plans? Select all that apply. A. The PPO will have a lower premium. B. There will be a greater selection of providers with the PPO. C. With the PPO, there will be no or reduced deductibles or copayment. D. A gatekeeper referral will be necessary to see a specialist with the HMO. E. With both the HMO and the PPO, there is the potential for lower-quality care to maximize costs.

B, D, E Rationale: There will be a greater selection of providers with a PPO plan. HMO plans are restricted to providers who are part of the plan, except for in the case of emergencies. With an HMO, a gatekeeper referral will be necessary to see a specialist. The potential for lower quality care to maximize cost exists with both HMO and PPO plans. With HMOs, specialist care is somewhat restricted and costs are reduced by providing only the most necessary services. With PPOs, providers are offered a specific reimbursement, regardless of the services rendered.

Which statement is true of retrospective reimbursement? A. This is the form of reimbursement for Medicare. B. The "umbrella" of costs include salaries, supplies, equipment, building depreciation, utilities, and taxes. C. Care, no matter what the provider's cost, is reimbursed to hospitals according to a predetermined amount. D. Reimbursement rates are based on diagnoses and patient characteristics and are designated by the term diagnosis-related group.

B. Rationale: In retrospective reimbursement, calculation of the fee is based on the cost of providing the service. This "umbrella" of costs can include salaries, supplies, equipment, building depreciation, utilities, and taxes. Prospective reimbursement, not retrospective, is the form of reimbursement used by Medicare. Regardless of the provider's cost, prospective reimbursement is also used to reimburse hospitals according to a predetermined amount. These amounts are determined by diagnoses and patient characteristics and designated by diagnosis-related group.

In what year was the Social Security Act of 1935 amended to create Medicare and Medicaid? A. 1956 B. 1965 C. 1975 D. 1983

B. 1965 Rationale: The Social Security Act of 1935 was amended to create Medicare and Medicaid in 1965. This provided indemnity insurance for individuals over 65 years old and created a source of funding for the poor and disabled. In 1956, the act was amended to establish the Disability Insurance (DI) program. In 1975, legislation went into effect that determined benefits would rise in accordance with the rise of cost-of-living. In 1983, major legislation was passed that restored solvency to the Old Age and Survivors Insurance and Disability Insurance program.

Which factor has MOST contributed to social change affecting the development of community health nursing practice? A. Role of nursing B. Health insurance C. The environment D. Health of the aggregate client

B. Health insurance Rationale: Health insurance is the biggest contributor to social change affecting the development of community health nursing practice. The role of nursing, the environment, and the health of the aggregate patient have also been influence by health insurance and have had less effect on community health nursing practice

Which care department is part of a public health system? A. Skilled care facilities B. Local health department C. Hospital ambulatory centers D. Rehabilitative-restorative care

B. Local health department Rationale: The public healthcare system includes local, state, and federal-level health departments and agencies that promote the general health of the community. Skilled care facilities, hospital ambulatory centers, and rehabilitative-restorative care centers are part of the private health system

Which type of partnership is reflected by the nurse working with first responders to increase access to opioid overdose medication in the community? A. State agencies B. Local-level public partners C. Local-level private partners D. State-level private partners

B. Local-level public partners Rationale: First responders, such as emergency medical services, police, and fire, are examples of local-level public partners. State agencies include offices such as the Attorney General and Departments of Public Safety, Education, or Agriculture. Local-level private partners include hospitals, private medical practices, civic groups, and community-based organizations. State-level private partners include trade associations and nonprofit organizations.

A patient is required to designate an in-network physician as the primary health care provider (PCP). Unless he or she is referred by the PCP, the patient will be responsible for most of the costs if he or she goes outside the network of care. Which type of insurance does this patient have? A. Indemnity plan B. Point-of-service (POS) C. Preferred provider organization (PPO) D. Health maintenance organization (HMO)

B. Point-of-service Rationale: The patient most likely has a point-of-service plan that combines elements of HMOs and PPOs. With an indemnity plan, the enrollee enjoys free choice of providers and services. PPOs are more flexible than HMOs, but to receive full benefits, the covered individual must use in-network providers. HMOs lack freedom of choice and only the most necessary services are provided.

What agency determines an individual's status for disability benefits? A. National Council on Disability B. Social Security Administration C. Office of Disability Employment D. Rehabilitative Services Administration

B. Social Security Administration Rationale: The Social Security Administration ultimately determines the individual's status for disability benefits. The Office of Disability Employment focuses on increasing job opportunities for people with disabilities. The National Council on Disability ensures that persons with disabilities have the same opportunities as others and promotes policies and programs that assist people with disabilities. The Rehabilitative Services Administration helps persons with disabilities get jobs and live more independently; it is part of the U.S. Department of Education.

Which should the nurse consult to find which bills are currently in process or have been legislated? A. Congressional directory B. State representative or senator office C. Congressional Quarterly Weekly Report D. Government documents section of selected public or university libraries

B. State representative or senator office Rationale: A state representative or senator could provide information regarding bills that are in progress or have been legislated. The congressional directory contains short biographies of each member of the Senate and House. Congressional Quarterly Weekly Report contains the congressional terms of service. The government documents section of selected public or university libraries can provide information about congressional committee assignments.

Why was Medicaid created? A. To help ration healthcare services and goods B. To improve access to health care for the poor C. To provide private insurance to the upper class D. To teach people about the importance of health promotion

B. To improve access the health care for the poor Rationale: Medicaid is a government program that was intended to improve access to health care for the poor. Medicaid acts as a type of health insurance for those who qualify based on income and poverty levels. Medicaid does not provide private insurance to the upper class, teach people about health promotion, or help ration healthcare services and goods.

The nurse employed by a health plan is tasked with reviewing healthcare services to determine the medical necessity, efficiency, and appropriateness of the services. Which duty is the nurse performing? A. Risk assessment B. Utilization review C. Care management D. Actuarial classification

B. Utilization review Rationale: Utilization review is a formal prospective, concurrent, or retrospective assessment of the medical necessity, efficiency, and appropriateness of healthcare services. Risk assessment is a statistical method used to estimate claims costs of enrollees. Care management is the process used to improve quality of care by analyzing variations in and outcomes for current practice in the care of specific health conditions. Actuarial classification is the classification of enrollees that is determined by use of the mathematics of insurance, including probabilities, to ensure adequacy of the premium to provide future payment.

What national healthcare recommendations for routine preventative care have been developed by a federal government body? A. Routine perinatal care B. Vaccine administration C. Preventative dental care D. Screening for breast cancer

B. Vaccine administration Rationale: The Advisory Committee on Immunization Practices is the only federal government body that provides written recommendations for the routine administration of vaccines for children and adults in the civilian population. The American Congress of Obstetrics and Gynecologists has defined perinatal guidelines. The American Dental Association provides recommendations for preventative dental care. The American Cancer Society provides recommendations for breast cancer screening.

A nursing student asks the nurse how the current healthcare system has affected advanced nursing practice. Which nursing reply is appropriate? A. "Advanced practice nurses are needed more than ever in specialty care." B. "Many advanced practice nurses are finding that their scope of practice is limited." C. "Many advanced practice nurses are assuming the primary practice role in various clinical settings." D. "Advanced practice nurses are now primarily employed by hospitals or in acute care settings."

C Rationale: The provision of health care is changing dramatically for both physicians and nurses. More advanced practice nurses (APNs) are assuming primary practice roles in many different settings, including community clinics, private practices, and home health. Advanced practice nurses are not seeing an increased need for specialization or a restriction in their scope of practice. Many APNs are working in primary care rather than in hospitals or acute care settings.

The long-term care nurse mentions that as hospital care changes, the services offered in long-term care will also change. Which statement explains the reason for this change? A. Increased Medicare funding led to the expansion of long-term recovery units B. Hospital patients tend to be less acute so they can be discharged home C. More patients are discharged to long-term care facilities because of shortened hospital stays D. Fewer patients are moved into long-term because of the increase in the length of hospital stays

C Rationale: There is an increasing focus on primary and ambulatory care, which has led to more acute patients being admitted to the hospital. Shortened stays in the hospital have in turn caused an increase in discharges to long-term care and rehabilitative facilities. There is nothing to support the claim that increased Medicare funding has caused the expansion of long-term recovery care. Hospital patients tend to be more acute, not less acute. More patients are moved into long-term care because of decreased hospital stays.

According to Healthy People 2020, what are the components of public health infrastructure that enable a public health organization to deliver public health services at the federal, tribal, state, or local level? Select all that apply. A. Buildings and equipment B. Aligning spending and need C. A capable and qualified workforce D. Up-to-date date and information systems E. Public health agencies capable of assessing and responding to public health needs

C, D, E Rationale: Healthy People 2020 describes three components of public health infrastructure as: (1) a capable and qualified workforce, (2) up-to-date data and information systems, and (3) public health agencies capable of assessing and responding to public health needs. Buildings and equipment, and aligning spending and need, are important components of public health infrastructure but are not among the three components described in Healthy People 2020.

Which statements are true of healthcare alliances? Select all that apply. A. They regulate insurance prices. B. They are not responsible for collecting premiums. C. Medicare is currently participating in healthcare alliances. D. They help consumers choose among competing insurers and plans. E. They define basic benefits that all insurers would have to offer to everyone at the same price. F. The consumer's choice is based on published, simple, standard information about benefits and outcomes

C, D, E, F Rationale: Medicare is currently participating in healthcare alliances and offers enrollees a choice of traditional Medicare, Medicare parts A and B, or Medicare Advantage. Alliances help consumers choose among competing insurers and plans. Alliances outline basic benefits that all insurers must offer at the same price to all consumers, regardless of health status. The consumer's choice is based on published, simple, standard information about the benefits and outcomes of each available plan. It is not true that alliances would regulate insurance prices. One of the roles of the alliances would be to collect premiums.

Which is an overarching goal of Healthy People 2020? Select all that apply. A. Measure the impact of prevention activities B. Encourage collaborations across communities and sectors C. Create social and physical environments that promote good health for all D. Achieve health equity, eliminate disparities, and improve the health of all age groups E. Promote quality of life, health development, and health behavior across all life stages F. Attain high-quality, longer liver free of preventable disease, disability, injury, and premature death

C, D, E, F Rationale: The four overarching goals of Healthy People 2020 are (1) to create social and physical environments that promote good health for all; (2) achieve health equity, eliminate disparities, and improve the health of all age groups; (3) promote quality of life, health development, and health behavior across all life stages; and (4) attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Measuring the impact of prevention activities and encouraging collaborations across communities and sectors are ways that Healthy People establishes benchmarks and monitors progress, but are not overarching goals.

Which mandated services are covered by Medicaid for eligible recipients? Select all that apply. A. Hospice B. Rehabilitation C. Home health care D. Optometrist services E. Rural health clinic services F. Laboratory and radiography services

C, E, F Rationale: For eligible recipients, the federally mandated services covered by Medicaid include home health care, rural health clinic services, and laboratory and radiography services. Optional services that states may elect to provide include hospice, rehabilitation, and optometrist services.

The nurse is speaking to a community group about health care. Which statement by a community member indicates effective teaching? A. "The current healthcare system is exclusively private." B. "Public health care is the primary system in the U.S." C. "Our healthcare system is a blend of both private and public health care." D. "The American healthcare system is neither public nor private, but something else entirely."

C. "Our healthcare system is a blend of both private and public health care." Rationale: The current healthcare system in the United States consists of both private and public healthcare systems. The private sector consists of personal insurance systems and other various agencies, whereas the public health system deals with disease prevention. It is neither exclusively public nor private, nor is it an entirely different kind of system.

What is required for a local health department to maintain public health accreditation? A. Community health education B. Community health promotion C. Community health assessment D. Community health management

C. Community health assessment Rationale: Community assessments, which produce data, are part of the requirement for a local health department to maintain accreditation. Community health promotion, management, and education are services rendered by the public health department, not requirements for accreditation.

In an ideal situation, which document guarantees the basic human rights of the people? A. Policies B. Statutes C. Constitution D. Common law

C. Constitution Rationale: Ideally, the basic human rights of the people will be guaranteed by a nation or state's constitution. A constitution is the grounding legal and democratic principles upheld by government. Policies describe how it is ensured that laws and regulations are applied consistently and fairly. Statutes are written laws passed by the federal government and can't violate a nation's constitution. Common law is unwritten law that is based on custom or court decision; it generally lacks provisions describing the obligation of governments to take active measures to promote and protect human rights.

Which program allows citizens to collect a percentage of recovered funds if fraudulent Medicare claims are reported and monies are collected as a result? A. Medicare Integrity Program B. Fraud and Abuse Control Program C. False Claims Act Amendments of 1986 D. Health Care Fraud and Abuse Data Collection Program

C. False Claims Act Amendments of 1986 Rationale: The False Claims Act Amendments of 1986 allow private citizens to collect a percentage of recovered funds if they report fraudulent Medicare claims and monies are collected as a result. The Medicare Integrity Program, Fraud and Abuse Control Program, and Health Care Fraud and Abuse Data Collection Program are provided by the Health Insurance Portability and Accountability Act (HIPAA). These programs do not allow receipts to collect a percentage of recovered funds.

In the event of a health emergency in a developing country, which agency would be responsible for deploying nurse volunteers? A. Local agencies B. State agencies C. Federal agencies D. Public health agencies

C. Federal agencies Rationale: Federal agencies perform interventions that address the health of the general population, special populations, and the international community. Federal activities include disaster provision both nationally and internationally. State, local, and public health agencies are not involved in disaster relief or international health issues.

Which enacts statutory laws passed by a legislative body at the state level? A. Congress B. State courts C. General assembly D. Regulatory agencies

C. General assembly Rationale: The general assembly executes statutory laws at the state level. Congress enacts statutory laws at the federal level. The state courts insulate against oppressive governance and professional malpractice, fraud, and abuse. Regulatory agencies are used to implement laws administered and enforced by the executive branch.

Which type of policy would institutional goals be categorized under for a community health clinic? A. Health B. Public C. Institutional D. Organizational

C. Institutional Rationale: Institutional policies are rules that govern worksites and identify the institution's goals, operation, and treatment of employees, so goals and policies for the community clinic would fall in this category. Health policies are in response to a goal in health care and a plan for achieving that goal. Public policy works to address specific policy problems and governmental responses to them. Organizational policies are rules that govern organizations and their positions on issues with which the organization is concerned.

A policy that bans alcohol or tobacco use in the workplace is an example of which type of policy? A. Public policy B. Health policy C. Institutional policy D. Organizational policy

C. Institutional policy Rationale: A policy banning alcohol or tobacco use in the workplace is an example of an institutional policy, which governs worksites. Public policies describe the principles upon which social laws are based, such as the institution of wage and hour laws. Health policies reflect the decisions, plans, and actions undertaken to achieve specific healthcare goals within a society. Organizational policies dictate an organization's position on issues that involve them.

To which voluntary agency will a nurse refer a family for ongoing care of an older adult? A. Local health department B. Community health center C. National Council on Aging D. Centers for Disease Control and Prevention

C. National Council on Aging Rationale: The nurse can refer the patient to the National Council on Aging to obtain ongoing support for the patient and the family. The National Council on Aging is a voluntary agency that is part of the private healthcare system. The local health department, community health center, and Centers for Disease Control and Prevention are less suitable.

The nurse understands which function is likely to be part of the role within the public health sector? A. Admitting clients to the acute care unit B. Providing direct client care at a local community clinic C. Partnering with other stakeholders to establish new health policy D. Determining which client is eligible for coverage in the managed care system

C. Partnering with other stakeholders to establish new health policy Rationale: The public health system is concerned with the health of a population. Nurses working in public health form relationships and partner with other stakeholders to establish new health policies and rules. Admitting clients to an acute care unit and providing direct client care are more likely to be in the job description of a hospital or community health nurse, which are not part of the public health sector. Determining coverage in the managed care system is not within the realm of public health.

The nurse is writing a set of explicit statements about the benefits, risks, and costs of specific courses of medical action. These statements, which help healthcare practitioners, patients, and others make decisions, are known as which type of decision-making tools? A. Risk assessment B. Utilization review C. Practice guidelines D. Diagnosis-related group

C. Practice guidelines Rationale:Practice guidelines are explicit statements of what is known and believed about the benefits, risks, and costs of particular courses of medical action. These statements are intended to assist practitioners, patients and others in making decisions about appropriate health care for specific clinical conditions. Risk assessment is a statistical method used to estimate the claims costs of enrollees. Utilization review is a formal, prospective, concurrent, or retrospective assessment of the medical necessity, efficiency, and appropriateness of healthcare services. Diagnosis-related groups are a system of payment classification for inpatient hospital services based on the principal diagnosis, procedure, age and gender of the patient, and complications.

Fluoridation of community water supplies is an example of which type of intervention? A. Treaty B. Health policy C. Public health law D. Institutional policy

C. Public health law Rationale: Fluoridation of community water supplies is an example of public health law and would fall under the area of practice of disease and injury prevention. A treaty is a formally concluded and ratified agreement between countries. A health policy defines a healthcare goal and a plan for achieving the stated goal. A public health law is the overall body of rules and regulations American industries are required to remain in compliance with. Institutional policies govern worksites.

Which statements about The World Health Organization (WHO) are correct? Select all that apply. A. WHO concentrates on health conditions affecting adults B. WHO defines health as the absence of disease or infirmity C. WHO works to prevent and treat communicable diseases D. WHO is concerned with environmental issues, such as nuclear contamination E. WHO does not focus on noncommunicable diseases such as stroke or cancer

C. WHO works to prevent and treat communicable diseases D. WHO is concerned with environmental issues, such as nuclear contamination Rationale: The WHO is concerned with both the prevention and treatment of communicable diseases and environmental issues. The WHO does not only focus on health conditions affecting adults but emphasizes promoting health throughout the life cycle. Health is no longer defined as the absence of disease or infirmity; it is now described as complete physical, mental, and social well-being. The WHO also targets noncommunicable diseases such as stroke and cancer.

What benefit is provided by having a national public health infrastructure? A. Promotes standardization of services and improved performance B. Provides evidence-based information for community interventions C. Provides a framework for addressing social determinants of health D. Addresses legal and political challenges as a result of increased levels of chronic illness

C. provides a framework for addressing social determinants of health Rationale: The importance of a national public health infrastructure is that it provides a framework for addressing social determinants of health. The emerging issues that have been identified by the public health infrastructure include accreditation of public health agencies, public health systems research, and public health law. Accreditation of public health agencies provides standardization of services and improved performance. Public health systems research is focused on expanding the evidence base for community interventions and for the effective organization, administration, and financing of public health services. Public health laws encompass policies that are being developed to address legal and political challenges resulting from new and re-emerging infectious diseases and increasing levels of chronic disease.

At the federal level, which department administers funding for health promotion and disease-preventive measures via "health-specific" grants? A. Department of State B. Department of Justice C. Department of Veterans Affairs D. Department of Health and Human Services

D Rationale: At the national level, the U.S. Department of Health and Human Services administers funding for health promotion and disease-preventive measures through "health-specific" grants. The Department of State, Department of Justice, and Department of Veterans Affairs do not provide funding for health promotion and disease-preventive measures.

The private practice nurse is training other nurses on the use of an electronic medical record (EMR). Which statement by a trainee indicates effective teaching? A. "EMRs are required by the Joint Commission for accreditation." B. "EMRs are relatively inexpensive to implement in private practice." C. "An EMR can seamlessly interact with other electronic systems in use at the office." D. "EMRs make it easier for patient health information to be shared among providers."

D Rationale: Electronic medical records allow for systemization of patient health information and make it easier to share information among providers. EMRs are not required by the Joint Commission for accreditation. EMRs have several potential problems, including high cost of implementation and difficulty interacting with other software systems in use by healthcare organizations.

The nurse is proposing the implementation of a telehealth system to reach more community residents. Which statement should be included in a presentation to the medical staff? A. "Telehealth services use social media to reach clients." B. "The medical quality of Telehealth services can be questionable." C. "Patients will need a smart phone to access Telehealth services." D. "Telehealth services can help provide access to residents who live in underserved areas."

D Rationale: Telehealth services help people living in underserved communities access medical care via a computer, interactive TV, or video monitor. Telehealth does not use social media to reach clients. Medical doctors and other healthcare providers provide care using telehealth; therefore poor quality of care is not usually an issue. Patients do not need to have a smart phone to access telehealth services.

The nurse has asked a group of students to develop a mock program in agreement with the Department of Health and Human Services' goals. Which statement by a student indicates the need for further teaching? A. "The program must strengthen the quality and accessibility of health care." B. "The program must work to improve the health and well-being of the American people." C. "This program will need to advance scientific and technological knowledge and innovation." D. "The program must be focused on the reduction of untreated substance abuse and mental health disorders."

D Rationale: The Department of Health and Human Services (HHS) maintains a strategic plan to address specific goals to improve health in the United States, including strengthening the quality and accessibility of health care, advancing scientific knowledge and innovation, advancing the health and well-being of the American people, and ensuring the transparency and accountability of all HHS programs. Reduction of untreated substance abuse and mental health disorders is not a goal of the HHS strategic plan.

Which statement regarding the process by which a bill becomes a law is correct? Select all that apply. A. Health legislation is usually passed fairly easily B. It is easier to pass a bill than it is to defeat one C. An explicit veto can't be overridden under any circumstances D. The chief executive must approve a bill that has moved successfully through the legislative process E. In 49 of 50 states, a bill must succeed through the House of Representatives and the Senate to become a law

D, E Rationale: A bill that has moved successfully through the legislative process must get the chief executive's approval in the form of a clear endorsement with signature. In 49 of 50 states, a bill must succeed through both the House of Representatives and the Senate to become a law; the exception is Nebraska. Health legislation is very difficult to pass for numerous reasons, including that it is not easily quantified in economic terms and it is often costly to implement. It is always easier to defeat a bill than it is to pass one, so the opposition always has the advantage. If the president chooses to veto a bill, in most cases, Congress can vote to override that veto and the bill becomes a law.

Which statements are true of prospective reimbursement? Select all that apply. A. Prospective payment leads to overtreatment and overuse of the system. B. Implementation of prospective reimbursement led to overall healthcare savings. C. Prospective reimbursement was originally used for Medicare and private insurance. D. Prospective reimbursement rates are based on diagnoses and patient characteristics. E. If the provider can provide the treatment for less than is estimated based on the diagnoses related groups, a profit is made.

D, E Rationale: Prospective reimbursement rates are based on diagnoses and patient characteristics and are designated by the term diagnosis-related group. Provider payment is made according to whether the treatment provided was deemed appropriate for the patient's health issues. Therefore providers can make a profit if the service is provided for less than the cost that was estimated for it. Prospective payment does not lead to overtreatment and overuse of the system. While it does create incentives to control costs, it can also lead to undertreatment and underuse of the system. Implementation of prospective payment led to a reduction in Medicare costs but did not result in overall healthcare cost savings as intended. Originally, only Medicare used prospective reimbursement. Private healthcare plans followed the government's lead and adopted the payment method several years after it was introduced by Medicare.

What is included in the U.S. Department of Health and Human Services' strategic plan to address health care in the United States? A. Increase services to underserved populations B. Strengthen health care's electronic infrastructure C. Develop research studies to support government initiatives D. Advance the health, safety, and well-being of the population

D. Advance the health, safety, and well-being of the population Rationale: The plan includes the goal to advance the health, safety, and well-being of the population. Developing research, increasing services to the underserved populations, and strengthening health care's electronic infrastructure are not specifically identified in this plan.

The nurse manager needs to hire a practitioner to see patients in a primary care medical office. Which type of nurse should the manager consider hiring? A. Registered Nurse B. Clinical nurse leader C. Clinical nurse specialist D. Advanced nurse practitioner

D. Advanced nurse practitioner Rationale: Advanced nurse practitioners obtain additional education in caring for patients and tend to work in a primary care capacity. Clinical nurse leaders and clinical nurse specialists (CNS) also obtain additional education but tend to work in a specialty area rather than primary care. The CNS also guides the work of others in the practice. Registered nurses are not able to practice independently.

Administrative agencies are part of which branch of government? A. Judicial B. Executive C. Legislative D. All three branches

D. All three branches Rationale: Administrative agencies exercise all of the powers of government: executive, legislative, and judicial.

Which practice is reflected when the physician's office receives a maximum reimbursement amount for the provision of care, regardless of the actual cost of the care? A. Rationing B. Cost sharing C. Access limitation D. Capitated reimbursement

D. Capitated reimbursement Rationale: Capitated reimbursement is the maximum reimbursement amount that the healthcare provider will receive for the provision of care, regardless of the actual cost. The capitated (or maximum) payment for services is determined by statistical norms, practice parameters, and population data. Rationing refers to determining the appropriate use of health care or directing the health care where it can do the most good. In cost sharing, employees pay more to increase the covered services not provided by the basic plan. Access limitation refers to the necessity of gatekeeper approval to access some services.

A patient is responsible for 20% of the cost of specialist office visits. Which term defines this 20% fee? A. Premium B. Deductible C. Copayment D. Coinsurance

D. Coinsurance Rationale: Coinsurance is cost sharing required by a health plan whereby the individual is responsible for a net percentage of the charge for each service. The premium is the amount paid periodically to purchase health insurance benefits. The deductible is cost sharing whereby the individual pays a specified amount before the health plan pays for a covered service. Copayment is a form of cost sharing whereby the individual pays a specified fixed dollar amount for each service.

Which is a law that governs society and holds authority derived from the founding documents of a country? A. Policies B. Statutes C. Regulations D. Constitution

D. Constitution Rationale: A constitution is the grounding legal and democratic principles upheld by government, and the authority for a constitution is derived from the founding documents of a country. Policies describe how it is ensured that laws and regulations are applied consistently and fairly. Statutes are federal laws enacted by the U.S. Congress that have been passed as bills and must be followed by every state in the country. Regulations are a form of delegated legislation that provide detail on the administration of principles in the law.

The nurse has assessed that certain ethnic groups are not accessing health care at a rate comparable to other ethnic groups. Which phenomenon is reflected by this assessment? A. Quality care B. Patient rights C. Accreditation D. Health disparities

D. Health disparities Rationale: Health disparities are observable or noticeable differences in the presence of disease or access to health care among different populations. Quality care is a concept that is difficult to measure but drives healthcare organizations toward improved care and reduced errors. Patient rights are basic rights that all patients have when accessing care, such as confidentiality and fair treatment. Accreditation is a way to assess the quality of health care that an organization provides.

How does the nurse help patients of low socioeconomic status access healthcare services? A. Find out why the patient is of low socioeconomic status B. Give patients stipends that allow for free health care appointments C. Loan patients money for bus fare, child care, or other known barriers D. Identify the patient's barriers and offer ideas for the patient to overcome them

D. Identify the patient's barriers and offer ideas for the patient to overcome them Rationale: The nurse can help patients of low socioeconomic status overcome their barriers to accessing health care by identifying barriers to access and offering ideas on how to overcome them. For example, the nurse might provide the patient with information about a clinic that is closer to the patient's home or give the patient information on community resources to help the patient get free healthcare supplies, such as bandages. The nurse will not give patients a stipend for a free healthcare appointment because this would not be up to the nurse to decide. The nurse will not loan the patient money because this crosses professional boundaries. The nurse would not find out why the patient has low socioeconomic status because this information is beyond the nurse's influence and will not be helpful in getting the patient healthcare services.

Which subsystem would the nurse reach out to for assistance while organizing a new health center with improved healthcare access for people living with HIV/AIDS? A. State agencies B. Federal agencies C. State-level private partners D. Local-level health department

D. Local-level health department Rationale: Local-level health departments are responsible for the direct delivery of healthcare services to local residents, such as that demonstrated by a new community health center. State agencies direct public health policy for the state and coordinate between the federal and local levels. The state level of public health is not as directly involved in community health as local-level agencies are. Federal agencies direct policy for the entire country and target the health of the general population. Like state agencies, state-level private partners coordinate between federal and local levels rather than directly delivering health care.

Which source should the nurse consult to find state election laws and procedures? A. City clear (city hall) B. Secretary of state (state capitol) C. County clerk (county courthouse) D. Office of lieutenant governor (state capitol)

D. Office of lieutenant governor (state capitol) Rationale: The office of lieutenant governor would be the source for state election laws and policies, the legislative information telephone number, and campaign finance reports. The city clerk (city hall) would be an appropriate choice to get information about political jurisdictions for each household address. The secretary of state would be the appropriate source for state government operations and political subdivisions. The county clerk could provide the nurse with information related to local government operations, political subdivisions, the legislative information telephone number, local election laws and procedures, and local campaign finance reports.

Which part of Medicare was created in 2003 to help alleviate the costs of prescriptions for seniors? A. Part A B. Part B C. Part C D. Part D

D. Part D Rationale: Medicare Part D is a prescription drug supplement provided through private insurance companies that have contracts with the government. All Medicare recipients are eligible to purchase insurance coverage to offset the costs of prescription drugs. Part A is part of the original government-run Medicare program. It includes coverage for inpatient care, some home health care, and hospice. Part B is also part of the original Medicare program and helps cover costs for doctor's services, testing, outpatient care, home health services, durable medical equipment, and some preventive services. Medicare Part C policies allow private health insurance companies to provide Medicare benefits. These policies are known as Medicare Advantage plans and may include vision, hearing, and dental care, and other services and supplies not covered by Medicare Parts A, B, and D.

A ruling passed by legislation making it illegal for a child to be unvaccinated against specified health conditions is an example of which type of rule? A. Regulation B. Public policy C. Common law D. Public health law

D. Public health law Rationale: A ruling that makes it illegal for a child to be unvaccinated against a specified health condition is an example of a public health law, which typically has three major areas of legal practice: (1) police power, (2) disease and injury prevention, and (3) the law of populations. Regulations are a rule or directive made and maintained by an authority, but it is not illegal if one fails to follow them. Public policies are objectives set by an organization or government. Policies help a government come up with proposed laws (bills). Common law is unwritten law based on custom or court decision; it is not passed by legislation.

A group of community health nurses are advocating for a law similar to New York's statute that requires every person in parental relation to a child to have the child vaccinated against childhood diseases such as poliomyelitis, mumps, and measles. For which type of policy should the group lobby? A. Regulation B. Health policy C. Social policy D. Public health law

D. Public health law Rationale: Requiring parents to immunize their children is public health law (New York State Public Health Law §2164) and should be lobbied for through legislation. Reporting of communicable diseases to state and local health departments, which then report them to the Centers for Disease Control and Prevention, is considered regulation. Health policy is a statement of a decision regarding a goal in health care and a plan for achieving that goal, such as inoculating a population against a disease. Social policy can be defined as the branch of public policy that advances social welfare and enhances participation in society

A health insurance company forms a group to raise money for donations that will be given to specific candidates. Which is the name of this type of group? A. A coalition B. An organization C. An administrative agency D. A political action committee

D. a political action committee Rationale: This describes a political action committee, which is organized for the purpose of raising and spending money to elect and defeat candidates. Most political action committees represent business, labor, or ideological interests. A coalition is composed of two or more groups joined to maximize resources, increase their clout, and better their chances of success in achieving a common goal; all of the members in this group are from the same organization. An organization is an organized body of people with a particular purpose; this could be a business, society, association, etc.

What provides the capacity to prepare for and respond to both emergency and ongoing threats to the nation's health? A. Treaties B. Public policy C. Common law D. Infrastructure

D. infrastructure Rationale: Infrastructure is the foundation for planning, delivering, and evaluating public health, and it provides communities, states, and the Nation the capacity to prevent disease, promote health, prepare for, and respond to both acute threats and chronic challenges to health. A treaty is a formally concluded and ratified agreement between countries. Public policies describe the principles on which social laws are based, such as the institution of wage-and-hour laws. A common law is a law based on custom, tradition, and court decisions, rather than on written legislation.

Which concepts are likely to require changes in policy to see a shift in the health of a population? Select all that apply. A. Tobacco use B. Physical activity C. Genetic makeup D. Adequacy of diet E. Social environment F. Physical environment

E. social environment F. physical environment Rationale: Social environment and physical environment are the concepts most likely to require policy change to see a shift. Tobacco use and physical activity can be changed on an individual basis and often do not require policy change. Genetic makeup cannot be changed. The adequacy of a diet can be changed on an individual basis.