Community Test 2 set

What was the poverty guideline for a family of four in mainland United States in 2013? a. Below $23,550 b. Below $25,250 c. Below $28,550 d. Below $32,250

ANS: A A four-person household must make less than $23,550 to be considered under the poverty guideline according to the U.S. Department of Health and Human Services. DIF: Cognitive Level: Understand (Comprehension) REF: p. 174

Which of the following advanced nurses does not have advanced education in a clinical specialty? a. Clinical nurse leader b. Clinical nurse specialist c. Nurse midwife d. Nurse practitioner

ANS: A All the nurses have advanced education in some aspect of clinical care, such as obstetrics or primary care. However, the clinical nurse leader is a manager of care at some point of care and does not have a clinical specialty. DIF: Cognitive Level: Understand (Comprehension) REF: p. 193

Which of the following statements best summarizes all of the changes resulting from attempts to control costs? a. Conflict between providers, patients, employer, and insurance plans raged. b. Costs were controlled, at least temporarily. c. Demand for health care drastically dropped. d. Most employers discontinued their insurance plans for employees.

ANS: A All these changes resulted in conflicts among providers, patients, employers, and the insurance plans, particularly when services deemed necessary by the consumer and provider were denied insurance coverage. Everyone blamed everyone else. This did not allow for costs to be controlled, impact the demand for health care, or cause employers to discontinue their insurance plans for employees. DIF: Cognitive Level: Understand (Comprehension) REF: p. 212

Which of the following best describes how the federal government determines which projects are awarded special funding for health care? a. Those that are consistent with societal priorities, such as 2020 Health Objectives b. Those that are supported by legislators c. Those that are written by health care organizations that have special needs d. Those that are consistent with the state's long-term health goals

ANS: A Allocation of federal resources is based on societal priorities, such as the 2020 Health Objectives. Legislative priority, priority within health care organizations, and priority within individual states are not as important for federal funding as the societal priorities outlined in Healthy People 20

Which of the following statements best describes the message that public health leaders are trying to emphasize to the public? a. Assume responsibility for your own health by choosing healthy behaviors b. Have a primary physician and get yearly checkups c. Obtain immunizations and screenings when they are offered d. Support legislative efforts to improve our medical care system

ANS: A Although there are many public health messages in the media, from quitting smoking to getting a checkup, the primary message currently being emphasized by public health, as well as all the media coverage of the constantly increasing cost for health care, is for each person to take responsibility for his or her own health through choosing healthy lifestyle behaviors. Supporting legislative efforts is not as important as the need for individuals to take responsiblity for their own health. DIF: Cognitive Level: Understand (Comprehension) REF: p. 206

Which of the following is the basis for any American citizen to feel comfortable expressing an opinion on a political issue? a. Amendments to the Constitution b. Articles of the Constitution of the United States c. Declaration of Independence d. Gettysburg Address

ANS: A Amendments to the Constitution, later known as the Bill of Rights, were added after the original Articles of the Constitution were ratified. These amendments protect individuals' rights and freedoms. The Declaration of Independence announced the freedom of America from the British Empire. The Gettysburg Address was a speech given by President Abraham Lincoln following the Civil War. DIF: Cognitive Level: Understand (Comprehension) REF: p. 170

Which of the following current issues are leading the World Health Organization (WHO) to reconsider its initial definition of health? (Select all that apply.) a. Environmental issues such as industrial toxins or carcinogenic commercial products b. Global, not local, problems such as spread of antibiotic-resistant bacteria c. Need to move from containment and treatment to social intervention d. Pressure from industrialized nations to emphasize chronic diseases rather than infectious diseases e. Realization that government actions influence the basic human right of health f. Worldwide pandemics such as human immunodeficiency virus (HIV) and swine flu, which require a different approach

ANS: A, B, C, E, F WHO is refocusing as it attempts to deal with environmental issues of nuclear contamination and industrial toxins, and the exploration of carcinogenic commercial products (such as tobacco). Globally, WHO is trying to eliminate antibiotic-resistant bacteria and the HIV pandemic. HIV has changed the paradigm from traditional containment and treatment to a more comprehensive approach of social intervention. There is a realization that health is a basic human right and health problems are linked to government action and affect human rights. The WHO is not emphasizing the chronic diseases faced by industrialized nations. DIF: Cognitive Level: Understand (Comprehension) REF: p. 168

A nurse is unable to be actively involved in attending meetings at the state level. Which of the following actions would be most useful for the nurse? a. Asking students to remain informed regarding proposed legislation b. Communicating, with rationales, her stand on proposed legislation to legislators c. Remaining uninvolved so incorrect information is not inadvertently given d. Writing letters to the local newspaper asking nurses to become involved

ANS: B Grassroots cooperation can influence decisions. A high number of communications from individual constituents via e-mail, telephone, or postal mail have great influence. DIF: Cognitive Level: Apply (Application) REF: p. 180

Which of the following best describes the most crucial step in policy formation? a. Convincing both political parties and independents to support the proposed policy b. Defining the issue and placing it on the agenda for possible action c. Determining who has vested interest in what aspects of the policy d. Trying to simplify the proposed legislation so the public will support it

ANS: B How an issue is defined determines what the possible approaches to resolution might be. With all the demands on legislators' time, it is difficult for an issue to be seen as important enough to have action taken. Defining the issue as crucially important and worthy of a place on the agenda for possible action is the most critical step. DIF: Cognitive Level: Understand (Comprehension) REF: p. 177

Which of the following best describes what physicians did to compete with new competition from health maintenance organizations (HMOs)? a. Accepted employment directly under the insurance company b. Organized preferred provider organizations (PPOs) to negotiate with insurance companies c. Created private practices with colleagues within hospital medical complexes d. Decided to strike and refused to work in the new HMOs

ANS: B In an effort to compete with HMOs, physicians and hospitals organized the independent practice model, which provided services to enrollees of one insurance company. This model evolved into the PPO, which offered services at a reduced rate in exchange for a guaranteed increase in consumers. Physicians did not become directly employed by insurance companies, set up private practices with colleagues, or decide to strike in order to compete with the HMOs. DIF: Cognitive Level: Understand (Comprehension) REF: p. 210

The forces for the proposed bill are roughly as persuasive, powerful, and well financed as the forces against the proposed bill. Which of the following describes the most likely outcome? a. The bill will be debated through a public hearing. b. The bill will fail. c. The bill will pass. d. The bill will remain in the legislature until one side or the other has a majority of votes.

ANS: B It is far easier to defeat a bill than get one passed; therefore, the opposition always has the advantage. DIF: Cognitive Level: Apply (Application) REF: p. 172

Which of the following federal agencies is responsible for administering most of the federal health-related activities? a. Centers for Disease Control and Prevention (CDC) b. Department of Health and Human Services (DHHS) c. Health Resources and Services Administration (HRSA) d. National Institutes of Health (NIH)

ANS: B Most health-related activities at the federal level are implemented and administered by the DHHS. The responsibility of the CDC is to keep the public safe and healthy. The responsibility of the HRSA is to improve access to health care services for vulnerable groups in the population. The main responsibility of the NIH is biomedical and health-related research. DIF: Cognitive Level: Remember (Knowledge) REF: p. 189

A nurse suggests to the students that they attend the local district nurses' association meeting, where the nurse is an officer. Which of the following provides the best rationale for this action? a. Meeting outside the clinical area allows for more effective informal learning based on discussion and interaction. b. Role models are typically the major influence on nurses choosing to become politically active. c. Students are often given extra credit from their instructor for such community involvement. d. Such groups want students to attend their meetings to encourage them to join and to accept a committee responsibility.

ANS: B Professional groups do not usually accept students into membership (especially since many students may want a different specialty practice). Nurses most often identify positive role models as the major influence that assisted them to become politically active. Therefore, mentorship at the student level up to the expert level is important. Providing extra credit should not be the motivator for students to learn from these role models. The learning that occurs is a formal learning process related to learning more about political advocacy and something that is difficult to demonstrate in a classroom environment. DIF: Cognitive Level: Apply (Application) REF: p. 178

Which of the following best describes the most important factor in legislation? a. The amount of financing and lobbying behind each choice b. The beliefs, attitudes, and values of the policy c. The preferences of the majority of American voters d. The president's ongoing encouragement for one particular choice

ANS: B Public policy encompasses the choices made regarding goals, priorities, and how resources are allocated. Policy choices reflect the values, beliefs, and attitudes of those designing the policy. The influence of the president, preferences of Americans, and amount of financing related to the legislation are not as important as the beliefs, attitudes, and values of the policy. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 166-167

Which of the following best describes why so many Americans continue to engage in unhealthy behaviors? a. Americans are not knowledgeable on how to change their behavior. b. Americans believe that most illnesses can be cured with insurance footing the bill. c. Health is not a concern to most Americans. d. Most Americans do not know which behaviors are unhealthy.

ANS: B Society sees insurance as an economic shield protecting against all disease and illness. The belief in cure rather than prevention, combined with this financial safety net, encourages society to become a passive participant in health care. The pervasive societal thought is "I don't have to worry; I have insurance." Americans are aware of which behaviors are unhealthy, have knowledge on how to change their behavior, and are concerned about health, but insurance has allowed them to take a passive approach to health. DIF: Cognitive Level: Understand (Comprehension) REF: p. 206

Which of the following federal agencies is responsible for the Women, Infants, and Children (WIC) program, food stamps, and school-based nutrition programs? a. Aid to Dependent Children Department b. Department of Agriculture c. Department of Education d. Department of Health and Human Services

ANS: B The Department of Agriculture administers the inspection of meat and milk, and provides funds for the WIC program (supplemental nutrition), the food stamp program, and the school-based nutrition program. The Aid to Dependent Children is a program, not a department, that provided financial assistance to families with limited financial resources. The Department of Education administers and coordinates resources related to education. The Department of Health and Human Services is responsible for protecting the health of all Americans. DIF: Cognitive Level: Remember (Knowledge) REF: p. 189

Which of the following suggestions was made by the Health Professions Education report? a. Expand efforts to increase enrollment in nursing education programs. b. Interdisciplinary teams should use informatics to provide patient-centered care. c. Primary care should be emphasized over education for specialty practice. d. All health professions should be required to communicate and collaborate in patient education.

ANS: B The Health Professions Education report concluded there were five core competencies—provide patient-centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, and use informatics. The expansion of enrollment in nursing programs, emphasis in primary care education, and emphasis on patient education were not suggestions made through this report. DIF: Cognitive Level: Understand (Comprehension) REF: p. 196

Which of the following statements best describes the significance of the Health Plan Effectiveness Data and Information Set (HEDIS)? a. Data are publicized so consumers can make informed decisions about where to go for care. b. Data are used to measure performance in the accreditation of managed care organizations (MCOs). c. Obvious improvement in the provision of health care has resulted from requiring health care providers to collect and analyze such data. d. Physicians and other health care providers can publicize the data to market their services to new clients.

ANS: B The National Committee for Quality Assurance accredits MCOs and uses HEDIS to measure performance and consumer satisfaction. Some outcome data are available to informed consumers on the Web, but the data are not widely available. To date, these efforts have not been successful to ensure quality care. Errors continue to be high and patients continue to be dissatisfied. DIF: Cognitive Level: Understand (Comprehension) REF: p. 197

Which of the following best describes the first government step in trying to stop constantly rising costs? a. Insurance companies were told to cease adding new members to their plan. b. Payment reimbursement was based on diagnosis and client characteristics rather than on treatment given. c. Physicians were limited to a maximum amount that would be paid for any particular service. d. Reimbursement was based on prospective payment; that is, in advance of admittance for care.

ANS: B The first efforts to control costs were made by the federal government when Medicare hospital reimbursement was based on a prospective payment system. Payment would be based on a classification system that identified costs according to diagnosis and client characteristics. Restricting insurance companies to add new members to their plan was not part of the first steps to try to stop constantly rising costs. DIF: Cognitive Level: Understand (Comprehension) REF: p. 205

Which of the following best describes a current trend related to health care services? a. Nonprofit organizations are assuming responsibilities for service from for-profit organizations. b. Health care organizations are offering services low in cost and higher in reimbursement. c. Ways to minimize reimbursement using current procedural terminology (CPT) codes have been created. d. Postponing computerized medical record programs increases profitability.

ANS: B There is a national shift from nonprofit health care to for-profit health care as large for-profit organizations take over smaller community organizations. Because emphasis is on profit, mechanisms of achieving higher reimbursement have been developed. Coding of the patient's illness from the CPT codes results in an increase in reimbursement. Use of computerized medical record programs almost ensures that service can be reimbursed at the highest rate possible. This has changed health care practices to the use of services that are low in cost and higher in reimbursement. High-cost services are limited or not offered. DIF: Cognitive Level: Understand (Comprehension) REF: p. 207

The local nursing association and the local medical association disagreed vehemently on advanced practice nursing reimbursement. Which of the following best describes why the two groups agreed to join a coalition to send representatives to testify on a particular bill? a. Although there was disagreement, both groups agreed to behave politely and professionally. b. Both associations had formed a coalition to collaborate on a bill that would benefit patients. c. Because the legislators had asked both groups to appear, the groups did not have a choice. d. The two groups were sharing costs and expenses, but their testimony would give opposing viewpoints.

ANS: B When two or more groups join to maximize resources, increasing their influence and improving their chances of success in achieving a common goal, it is a coalition. Professional groups often form coalitions to advance their shared interests. DIF: Cognitive Level: Apply (Application) REF: p. 179

Which of the following statements best describes what happened to health care providers during the Great Depression? a. The amount of charity care greatly increased. b. Both hospitals and physicians went bankrupt. c. Government funding was legislated to assist those in need. d. Public health greatly expanded to care for those in need.

ANS: B With 25% of the population out of work, the number of patients capable of paying their medical bills was reduced. Because public financing was limited, hospitals, physicians, and other providers went bankrupt. Because hospitals and physicians were going bankrupt, there was no way to increase charity care or services for those in need. DIF: Cognitive Level: Remember (Knowledge) REF: p. 203

A nurse is employed by the state nursing association to serve as a lobbyist. Which of the following would be the most crucial task to achieve? a. Be seen as a reliable and credible source of accurate information b. Convince colleagues in nursing to join their local nursing organization and write to encourage legislators to vote according to nurses' goals c. Offer to make large donations to the legislator who can forward nursing's agenda d. Visit every single legislator so the nurse is recognized in this role

ANS: A An individual who establishes a reputation as a reliable and accurate resource as a lobbyist has substantial influence. Certainly, it is also useful to convince colleagues to join nursing organizations and write legislators or contribute to campaigns of legislators supportive of nursing goals. Legislators rely on lobbyists to educate them on issues. The official must trust the lobbyists to give accurate (though predictably biased) information, which is timely and up to date. DIF: Cognitive Level: Apply (Application) REF: p. 180

Which of the following statements best describes why nurses should contribute whenever possible to their state nursing association political action committee (PAC)? a. As PACs are a reality of political life, nursing needs to be heard. b. Contributing money may result in a future political appointment. c. Only money really has any influence on legislative votes. d. PACs are being used to increase nursing salaries and working conditions.

ANS: A Because PACs are a reality of political life, nurses need to recognize their power and support those that are committed to electing candidates sympathetic to health care issues. The contribution of money will support the current nursing practice initiatives which will change as nursing practice changes. These contributions will most likely not have any relationship to a future political appointment. Legislative votes are influenced by a variety of factors and are not limited only to money. DIF: Cognitive Level: Understand (Comprehension) REF: p. 180

Which of the following best describes a carve-out service? a. A particular service that is offered only by a designated provider or group. b. A particular procedure that receives limited reimbursement. c. A particular treatment is not allowed within a particular diagnosis. d. A particular prescription drug that is only available to those with certain conditions.

ANS: A Carve-out services might be designated for those who need the services the least. A carve-out service (for example, mental health care) is provided within a standard benefit package but delivered exclusively by a designated provider or group. The other definitions do not correctly describe a carve-out service. DIF: Cognitive Level: Understand (Comprehension) REF: p. 204

Which of the following conclusions can be drawn from reviewing how health care costs are spread over a person's lifetime? a. Health care expenditures increase with age. b. Premature newborns incur more costs than other children from birth through adulthood. c. The majority of cost is incurred during middle age when chronic diseases strike. d. Persons aged 85 years and above spend the most money on health care.

ANS: A Expenditures increase with age. About one third of costs are incurred during middle age; half during the senior years; and, for those older than 85 years, one third of their lifetime costs occurs during their last year of life. DIF: Cognitive Level: Understand (Comprehension) REF: p. 206

Which of the following best describes how hospitals initially coped when Medicare reimbursement became based on diagnosis-related groups (DRGs)? a. Charged more for patients whose care was paid by insurance b. Decreased nursing staff to cut labor costs c. Lobbied politicians to increase Medicare reimbursement to reflect actual costs d. Refused to accept Medicare patients

ANS: A Hospitals developed cost shifting to supplement losses caused by Medicare funding. Because private insurance reimbursements were cost based, hospitals included the loss in their total costs; therefore private insurance paid for covering care to both their enrollees and Medicare patients. The implementation of DRGs did not cause hospitals to decrease nursing staff, lobby politicians to increase Medicare reimbursement, or refuse to accept Medicare patients. DIF: Cognitive Level: Understand (Comprehension) REF: p. 211

Which of the following best describes what was done by large industrial giants to stop the constant increase in their costs for health insurance for their employees? a. Assembled their own health care programs b. Established health promotion programs that employees were required to attend c. Signed only certain providers to give care at a reduced rate in exchange for so many new patients d. Suggested that employees seek only the most necessary services

ANS: A Large industrial giants, such as Kaiser Permanente, decided to assemble their own health care programs. They built hospitals, hired physicians, and provided health care services to their employees. In an effort to market this concept, the phrase health maintenance organization was created. These organizations were designed to provide comprehensive care to employees. As these large health care programs were established, enrollees had limited freedom of choice. Preventive care was covered and encouraged, but care was somewhat restricted, and care providers were encouraged to reduce costs by providing only the most necessary services. DIF: Cognitive Level: Understand (Comprehension) REF: p. 210

Which of the following statements best describe what happened to the hospitals built or expanded by Hill-Burton Act funds? a. Many such hospitals have consolidated or closed. b. Not needing to expand, hospitals have used the funds to upgrade their facilities. c. They have continued to use such funds to expand. d. When funding ceased, so did hospital expansion.

ANS: A The Hill-Burton Act authorized federal assistance in construction of hospitals, making hospitals more accessible. However, with the high cost of health care and the decreasing lengths of stay and increasing use of primary care, many hospitals are closing. Because hospitals have closed, they are not further expanding or upgrading facilities. DIF: Cognitive Level: Understand (Comprehension) REF: p. 174

Which of the following levels of government primarily establishes regulations and provides funding for health care? a. Federal government b. Local health departments c. Regional health districts d. State health departments

ANS: A The federal government has been assuming a larger role in the protection of the population through regulation and funding. Local health departments establish local health codes, fund public hospitals, and provide services to populations at risk who often lack health insurance. State health departments are highly dependent on the federal level of resources and guidance. Regional health districts are not used as a level of government in the United States. DIF: Cognitive Level: Remember (Knowledge) REF: p. 192

Who primarily provides care for military personnel, their families, and veterans, as well as Native Americans? a. Federal government b. Local health departments c. Regional health districts d. State health departments

ANS: A The federal government is responsible for the health care of specified populations including military personnel, their families, and veterans. The federal government also is responsible for health care for Native Americans. Local health departments and state health departments are not the primary provider of care for these populations. Regional health districts are not used to provide care for these populations. DIF: Cognitive Level: Remember (Knowledge) REF: p. 195

Which of the following is accomplished through the use of public policy? a. Solutions to problems of public concern are developed. b. A rational, logical problem-solving decision-making process is implemented. c. Public safety nets for vulnerable populations are created. d. Economic and business management principles are applied.

ANS: A The field of public policy involves the study of specific policy problems and governmental responses to them. Political scientists involved in the study of public policy attempt to devise solutions for problems of public concern. The use of public policy may not involve the implementation of a logical problem-solving decision-making process. Public policy addresses more than safety nets for vulnerable populations. Additional principles besides economics and business management are applied through the use of public policy. DIF: Cognitive Level: Understand (Comprehension) REF: p. 167

Which of the following actions would be the least expensive approach to treating chronic diseases? a. Choose healthy lifestyle behaviors to retain health b. Continue media campaigns encouraging early detection and treatment c. Encourage patients to seek care at a local neighborhood health clinic d. Suggest self-therapies that have been demonstrated to be effective

ANS: A The five leading causes of death and illness can be positively affected by changes in lifestyle. Healthy lifestyles can modify or even prevent most chronic illnesses. Seeking care at a neighborhood health clinic, producing media campaigns, and engaging in self-therapies are all more expensive approaches to treating chronic diseases than choosing healthy lifestyle behaviors. DIF: Cognitive Level: Understand (Comprehension) REF: p. 205

Which of the following statements best describes an effect of the Welfare Reform Act of 1996? a. Individuals who were required to obtain employment lost their health coverage. b. Many were happy to be off the government dole and self-supporting. c. Persons sought and obtained employment that often included insurance benefits. d. The food stamp program decreased in size.

ANS: A The law decreased the number of people on welfare and forced many individuals to take low-paying jobs, many of which did not offer health insurance. Many individuals, particularly women and children, subsequently lost Medicaid coverage. DIF: Cognitive Level: Understand (Comprehension) REF: p. 175

A client living in the 1920s received health care services. Which of the following would have been the most likely form of payment? a. Patients paid out of their pockets for whatever care the provider charged. b. Public health employees gave care to those who needed it. c. There was little health care to be had, regardless of a person's wealth. d. Workers who belonged to a union had their bills paid by insurance.

ANS: A Until the 1930s, the predominant method of health care financing was self-payment. Health care providers charged a fee for the services they rendered, and the patient paid the out-of-pocket expense. The assumption was that those who could pay would pay and those who could not pay should receive care and pay what they could. Insurance companies did not exist in the 1920s. DIF: Cognitive Level: Apply (Application) REF: p. 203

Which of the following describe current legislation acts that limit what managed care organizations (MCOs) are allowed to do? (Select all that apply.) a. Allowing patients to see a specialist without having to obtain approval from their primary care provider b. Allowing patients to go to the emergency department without first telephoning for approval c. Allowing patients the right to choose a physician d. Requiring the MCO to fulfill expectations of the national patients' rights bill e. Requiring the MCO to accept any provider who meets plan requirements f. Requiring the MCO to accept advanced practice nurses as primary care providers

ANS: A, B, C In 1999, the House and Senate passed bills that focused on client rights in the managed care environment, but more needs to be done to improve client rights. Client rights issues that are vitally important are information disclosure, physician and provider choice, direct access to specialists, reimbursement for emergency care, and reimbursement denial. As has been discussed, there is still no national patients' bill of rights. DIF: Cognitive Level: Understand (Comprehension) REF: p. 198

Which of the following best describes what insurance companies did to decrease their constantly increasing costs? (Select all that apply.) a. Did not cover any illnesses that were diagnosed before the person (or his or her employer) purchased insurance b. Limited coverage to only certain services, eliminating any that were experimental, nontraditional, or too costly c. Reimbursed only the care that was requested by the patient's primary physician d. Limited providing insurance to companies who hired mainly young, healthy persons e. Required preapproval before expensive services were used f. Ceased coverage on any person who used an exorbitant number of services, whenever possible

ANS: A, B, C, E, F Insurance companies attempted to reduce unnecessary use by limiting coverage for certain services and people. Restrictions such as the establishment of a gatekeeper that required preauthorization, limited coverage for preexisting illnesses, and exclusion of participants whose use was deemed exorbitant were instituted. Such restrictions increased resentment and resistance and were not very successful. DIF: Cognitive Level: Understand (Comprehension) REF: p. 205

Which of the following statements best describes what was unfortunate about the original private health insurance plans that were developed? (Select all that apply.) a. Because providers were paid for any service they gave, it was economically advantageous for them to give as much care as possible. b. Health care costs increased very rapidly. c. Health education and health promotion interventions were not included in the idea of health insurance. d. It was immediately seen how much profit could be made by owning or managing an insurance company. e. Patients wanted any and all care that might help, regardless of how expensive it was. f. There was no limit on what care could be sought and given.

ANS: A, B, C, E, F The majority of the population was protected. The emphasis was placed on illness care, because providers received a fee only when a service was rendered, and all costs were reimbursed. Insulated from having to pay for health care, consumers demanded complex and technologically advanced services. These demands were a major force rapidly increasing health care costs because people with insurance felt entitled to care, and, after all, there was a guaranteed payer. Medical orientation was on curing at any cost. The profits of owning or managing an insurance company were not immediately seen. DIF: Cognitive Level: Understand (Comprehension) REF: p. 205

Which of the following best describes why it is so difficult to change the paradigm of health care from disease orientation to promoting health orientation? a. The belief exists that those without insurance could obtain insurance if they worked hard enough. b. People find it difficult to agree on what the ideal paradigm should be. c. People realize the media have exaggerated the problems that result from lack of insurance. d. Serious reallocation of resources would have to occur.

ANS: D A shift in the paradigm would necessitate a substantial reallocation of resources because the vast majority of health spending is currently directed to medical care and biomedical research and reflects a viewpoint of health care as a commodity. The allocation of resources has the most influence on creating a paradigm shift. Individual opinions and the use of media do not play as great of role as where resources are spent. DIF: Cognitive Level: Understand (Comprehension) REF: p. 168

Which of the following best describes a major problem faced by the U. S. health care system? a. Inadequate number of licensed professional caregivers b. Lack of sufficient clinics to serve all communities and neighborhoods c. Ongoing increase in infections, such as nosocomial infections d. Large number of underinsured and uninsured citizens

ANS: D Although the health care reform legislation of 2010 should significantly reduce the number of uninsured individuals, it is estimated that following full implementation in 2017, there will still be about 13 million people without any health care coverage and many with inadequate coverage. Thus, universal health coverage remains an important question. Considering there will still be a large number of underinsured and uninsured citizens, the consideration of an inadequate number of providers or clinics may not be an issue if citizens are unable to access care. The lack of health insurance is a greater concern at this time than the increase of infections among Americans. DIF: Cognitive Level: Understand (Comprehension) REF: p. 192

Which of the following best describes how complementary and alternative therapies differ from traditional health care? (Select all that apply.) a. Alternative therapies have been documented as ineffective. b. Complementary medicine is expanding because of paid media coverage. c. Nurses rarely are involved in complementary or alternative therapies. d. Providers vary in training and licensure. e. Reimbursement is often unavailable. f. Alternative therapies lack any research related to their effectiveness.

ANS: D, E Alternative or complementary therapies are expanding because of consumer demand, although reimbursement for these services is lagging. The National Center for Complementary and Alternative Medicine is currently researching their effects on health and disease. Training and licensure requirements vary widely. Many nurses have incorporated alternative therapies into their practice and seek more continuing education on such care. DIF: Cognitive Level: Understand (Comprehension) REF: p. 194

An individual has been terminated from his job and has lost his health insurance. Which of the following federal laws allows him to continue his insurance benefits for a specified period of time? a. Health Insurance Portability and Accountability Act of 1996 (HIPAA) b. Family Support Act of 1988 c. Health Maintenance Organization Act of 1973 (HMO) d. Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

ANS: D An important requirement of COBRA focuses on the problem of the loss of insurance when a person loses his or her job. With the growing number of unemployed, COBRA is even more important. Employers who terminate an employee must continue benefits for the employee and dependents for a specified period of time if the employee had health benefits before the termination. HIPPA offers protections for patient privacy and confidentiality. The Family Support Act expanded coverage for poor women and children and required states to extend Medicaid coverage for 12 months to families who have increased earnings but are no longer receiving cash assistance. The HMO Act provides grants for HMO development. DIF: Cognitive Level: Apply (Application) REF: p. 175

Which of the following best describes who has the authority to act in every area except those specifically mentioned in the Constitution? a. Any individual citizen b. Federal government c. Local government d. State government

ANS: D Any powers not delegated to the federal government are reserved for the states. Thus, individual citizens, the federal government, and local governments are excluded. DIF: Cognitive Level: Understand (Comprehension) REF: p. 170

Which of the following best describes how providers can legally improve their profit under the current reimbursement process? a. Accept more patients and work more hours so former high income is retained b. Order the cheapest generic medications and treatments possible c. Convince patients that they do not want expensive treatments d. Practice conservatively to earn an incentive payment

ANS: D As a reward for conservative medical practices, health care providers may receive a specified amount of money or a percentage of the agreed reimbursement if services are delivered below the limit set by the third-party payer. Thus, it is the responsibility of the provider to use this conservative practice. Patient care should not be compromised as providers practice conservatively. DIF: Cognitive Level: Understand (Comprehension) REF: p. 214

Which of the following was a major change after Medicare began a prescription drug benefit? a. Number of prescriptions ordered by physicians decreased b. Medications increased without affecting patient care outcomes c. U.S. expenditures on drugs approached the same level as that of other industrialized nations d. Use of drugs and their cost immediately increased

ANS: D As with other health care services, once a funding source has been established, usage and costs increase. Thus, the number of prescriptions ordered increased. For 2006, the United States expenditure for pharmaceuticals was 1.5 times that of other industrialized countries, and these expenditures continue to rise. DIF: Cognitive Level: Understand (Comprehension) REF: p. 207

Which of the following has led to the more recent focus on cooperation between the state and the federal level in relation to public health? a. The emphasis of Healthy People 2020 b. The ongoing continued restriction of financial resources c. The new presidential administration's goals d. The threat of bioterrorism

ANS: D Cooperation between the state and federal levels has been brought to the forefront with efforts to plan for bioterrorism, an event that would necessitate cooperation and sharing. In addition, the state is highly dependent on the federal level for resources and guidance. The administrative goals of the president, emphasis of Healthy People 2020, and restriction of available financial resources have not been the main factor that has led to an increase in cooperation related to public health. DIF: Cognitive Level: Understand (Comprehension) REF: p. 191

When was the idea of national health care insurance first debated in the United States? a. Clinton's 1992 presidential campaign as he attempted to achieve such a plan b. During President Johnson's administration when Medicare and Medicaid were instituted in the 1960s c. President Franklin Roosevelt's attempt to include health insurance in Social Security legislation in the 1930s d. President Theodore Roosevelt advocated such national medical coverage in 1916

ANS: D European countries began a social model of health insurance in the early 1900s. President Theodore Roosevelt advocated a similar plan for the United States in 1916. The other attempts mentioned came after Theodore Roosevelt's initial attempt in 1916. DIF: Cognitive Level: Remember (Knowledge) REF: p. 216

Which health care provider organization is seeing an increase in the demand for their services? a. Physician practice b. Hospice service c. Hospitals d. Long-term care facilities

ANS: D Hospital stays have shortened and patients who are admitted are more acutely ill and require more intensive care. Consequently, decreased hospital stays result in more home care admissions and more discharges to long-term care facilities for short-term recovery and rehabilitation. Hospice services and physician practices have not been as impacted as greatly by this shift in where care is provided. DIF: Cognitive Level: Understand (Comprehension) REF: p. 192

Which of the following best describes a flaw of indemnity plans? a. Blue Cross and Blue Shield had a great idea, but they went bankrupt. b. Cost sharing was expected of Blue Cross and Blue Shield enrollees. c. Enrollees could not choose their provider or manage their own care. d. Plans lacked any incentives to contain costs.

ANS: D Indemnity plans paid all the costs of covered services provided to the enrollee. The enrollee enjoyed free choice of provider and services. They preserve the enrollee's right of choice and allow the person to manage his or her own health care. These plans lack incentives for cost containment. Today, cost-sharing efforts (e.g., copayments, deductibles) help contain costs. Blue Cross and Blue Shield continue to be a provider of health insurance. DIF: Cognitive Level: Understand (Comprehension) REF: p. 205

Which of the following nurses used political expertise to influence the federal government to develop a Children's Bureau? a. Clara Barton b. Florence Nightingale c. Lavinia Dock d. Lillian Wald

ANS: D Lillian Wald recognized the connection between social conditions and health. She was a driving force behind the federal government's development of the Children's Bureau in 1912. Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to control the nursing profession. Florence Nightingale was the first nurse to exert political pressure on a government. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War. DIF: Cognitive Level: Remember (Knowledge) REF: p. 166

Which of the following best describes the most common organization for receiving personal health care in the United States today? a. A group of physicians all in a particular specialty group who share an office b. Community health center that includes educational and social services c. Fee for service by a physician in practice by himself or herself d. Managed care organization with capitated payments to providers, both professionals and organizations

ANS: D Managed care has become the dominant paradigm in health care. This model has replaced fee for service by a physician in independent practice or physicians in a group practice, and care in a community health center. DIF: Cognitive Level: Understand (Comprehension) REF: p. 187

Which of the following best describes the approach to health care used by states? a. Federal funding encourages experimentation in creating new programs. b. Insurance regulations concerning reimbursement cross state lines. c. Information about successful programs is known to legislators. d. States frequently develop new programs as federal funds become available to pay for them.

ANS: D Many state and local government programs were developed on the basis of availability of federal funds. Funds are accompanied by regulations, which apply to all recipients. These have served to standardize health policy. Federal funding is limited, thus there is limited opportunity for experimentation. Legislators must be involved in ongoing education in order to keep up to date on what is happening with programs that have been implemented. Insurance regulations are monitored by individual states so reimbursement concerns are unable to cross state lines. DIF: Cognitive Level: Understand (Comprehension) REF: p. 191

It has been proposed that a new, better approach to health care be tested with a small group to evaluate its effectiveness. Which of the following best describes why this cannot be done? a. Any employment in the project would be only temporary, so it would be difficult to find professionals to staff the program. b. It is challenging to find appropriate sites located in the target area from which to offer the pilot project service. c. No one wants to accept free services if they include being a guinea pig in a research project. d. Offering a service establishes a precedent and a sense of entitlement, so it is difficult to discontinue the program.

ANS: D Once a direct health care service is offered, it is difficult to discontinue it. Existing programs create tradition by establishing vested interest and a sense of entitlement. DIF: Cognitive Level: Apply (Application) REF: p. 177

Which of the following best describes how the government was successful at containing costs? a. The original legislation for Medicare and Medicaid had built-in cost controls. b. Certificate-of-need requirements restricted provider overtreatment. c. Utilization review determined appropriateness of care. d. Prospective payments were based on diagnosis-related groups (DRGs). e. Peer standard review organizations were effective watchdogs.

ANS: D Prospective payment based on DRGs proved to be effective. The cost reduction that resulted gave rise to the managed care revolution as providers searched for the most cost-effective mechanism of care provision. Various efforts from, for example, certificate-of-need, peer review, and utilization review were not effective. DIF: Cognitive Level: Understand (Comprehension) REF: p. 211

A nurse states that he or she does not want to become involved in politics because of family, school, work, and other commitments. Which of the following would be the best reply to this statement? a. "Good for you. We should all stay out of such dirty game playing!" b. "I am sorry to hear that but I do understand." c. "It doesn't matter; politics have nothing to do with nursing practice." d. "It won't take much time to join ANA and pay dues so their lobbyist can represent you."

ANS: D Some of the nursing organizations have full-time lobbyists who work in Congress, including the American Nurses Association (ANA). These lobbyists help represent the interests of nurses and society. Politics play a major role in nursing practice and nurses should be encouraged to participate in organizations, even if it is through paying dues, so that their voice can be represented. DIF: Cognitive Level: Apply (Application) REF: p. 180

Which of the following best describes why large employers would decide to self-insure? a. To claim to offer more benefits to employees b. To have more control over health care providers c. To be more effective at keeping employees happy d. To reduce administrative costs charged by insurance companies

ANS: D Some organizations have decided to self-insure their employees. This reduces the administrative cost of insurance. Self-insurance does not claim to offer more benefits to employees, allow for more control over health care providers, or do a better job at keeping employees happy. DIF: Cognitive Level: Understand (Comprehension) REF: p. 215

Which of the following best describes how the local government is provided authority? a. Through the ability to tax local residents to meet local needs b. Through the people themselves who band together to create the community c. Power delegated from the federal level to the local level d. Power delegated from the states

ANS: D States may delegate powers to the local government. Which powers they delegate vary widely from state to state. The federal government does not directly delegate power to the local level, this occurs through state government. Taxation and creation of a community do not provide the local government with authority. DIF: Cognitive Level: Understand (Comprehension) REF: p. 170

Which of the following reports state that nurses should practice to the full extent of their education and training? a. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care b. Keeping Patients Safe: Transforming the Work Environment c. Priority Areas for National Action d. The Future of Nursing

ANS: D The Future of Nursing report contains four key messages. One of the key messages is that nurses should practice to the full extent of their education and training. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care addresses potential causes of disparities in health care. Keeping Patients Safe: Transforming the Work Environment addresses critical quality and safety issues with a particular focus on nursing care and nurses, and examines these issues from the perspective of the work environment. Priority Areas for National Action identified 19 priority areas that should be addressed to improve quality. DIF: Cognitive Level: Remember (Knowledge) REF: p. 200

Which of the following best describes what happened after the Medicare Modernization Act of 2003 was enacted? a. Additional restrictions in coverage were imposed. b. Experimental treatments were approved for reimbursement. c. Reimbursement procedures became more efficient. d. A prescription drug benefit was added.

ANS: D The Medicare Modernization Act of 2003 provides seniors and people living with disabilities with some prescription drug benefit coverage, as well as more choices and better benefits. The act did not impose additional restrictions to coverage, approve experimental treatments, or provide efficiency with reimbursement procedures. DIF: Cognitive Level: Understand (Comprehension) REF: p. 175

Which of the following best describes what is being discussed in relation to concerns over patients' safety and nurse fatigue? a. All hospitals are now required to report errors made that are a result of low nurse staffing. b. The Centers for Disease Control and Prevention (CDC) is monitoring the incidence of medical errors caused by nurse understaffing. c. The Registered Nurse Safe Staffing Act was passed by Congress in 2013. d. Legislation has been suggested that staffing systems require the input of direct care registered nurses.

ANS: D The Registered Nurse Safe Staffing Act of 2013 was introduced in Congress to address concerns of inadequate and inappropriate staffing, which threatens patients' safety and the nurses' health. The act would encourage development of staffing systems that require the input of direct care registered nurses, as well as protection for RNs who speak out about patient care issues. This suggested legislation has not been acted on. The CDC is not involved in monitoring medical errors caused by nurse understaffing. Hospitals are not required to report errors that occur due to nurse understaffing. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 182-183

Which of the following best describes the primary conclusion of the report To Err Is Human: Building a Safer Health System? a. Hospital staffing must be improved to focus on safety rather than cost containment. b. Quality of care and medical error are not easily defined. c. Patients must recognize that care providers are human and errors will occasionally be made. d. System failures are resulting in an incredible amount of harm from medical errors.

ANS: D The first key message from this report was the emphasis on the incredible magnitude of harm resulting from medical errors, which are largely due to system problems, not individual failure. Error reporting programs are needed as health care systems are encouraged to focus on error reduction. The report clearly states that there is no one answer to solving this problem. Errors are directly related to outcomes, which is a significant concern in quality improvement efforts. DIF: Cognitive Level: Understand (Comprehension) REF: p. 194

Why did employers decide to offer health insurance as an employee benefit? a. Hospitals and physicians quit offering charity care to those who could not pay. b. Society was focused on not having to pay for doctor visits and other needed health benefits. c. Teachers were role models for unions to demand insurance as a benefit. d. To obtain and retain the limited number of persons available to work when government rules prohibited raising wages, insurance was offered.

ANS: D The idea of paying a small fee for guaranteed health care to have sickness cured was very popular. Health care providers liked knowing they would receive payment for their services. During World War II, faced with a limited workforce and governmental restrictions on wages, employers began to see health insurance as a means of supplying workers' benefits without granting a wage increase. Teachers were not demanding insurance as a benefit. Hospitals and physicians continued to provide charity care as they were able. Society understood that they needed to pay for health services; however, businesses realized that providing insurance was a way to keep their needed workforce. DIF: Cognitive Level: Understand (Comprehension) REF: p. 203

Which of the following statements best describes a major event that occurred in the 1960s that affected health care? a. The amount of charity care by health care providers greatly increased. b. Hospitals began to voluntarily pay taxes to the communities where they were located. c. Legislation greatly expanded funds available to train physicians, nurses, and other health care providers. d. The Social Security Act was amended to create Medicare and Medicaid legislation.

ANS: D The popularity and benefits of employer-provided insurance plans were recognized, as was the reality that some segments of society were being neglected. The 1960s, with a pervasive thrust for social justice, presented the opportunity to move toward universal health care coverage. Titles XVIII and XIX of the Social Security Act created Medicare and Medicaid, respectively. There was no increase in funding for training of health care providers, voluntary payment of taxes by hospitals, and an increase in the amount of charity care provided in the 1960s. DIF: Cognitive Level: Understand (Comprehension) REF: p. 207

Which of the following best describes the effect of President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry report (1999)? a. Created improvement in both physician and nurse educational programs b. Demonstrated the incredible influence on health care made by the insurance industry c. Increased national interest in improving health care and seeking reform d. Stimulated the Institute of Medicine to explore quality in more depth

ANS: D The report had a major impact in that it stimulated a series of more in-depth explorations of the health care delivery system, which resulted in a series of reports developed by the Institute of Medicine called the Quality Chasm Series. These reports then caused several other movements within the health care system. DIF: Cognitive Level: Understand (Comprehension) REF: p. 194

Which of the following best describes the principal factor behind ongoing legislation on the federal level related to health care? a. Change is needed to reflect differences in health needs today. b. Efforts must be put in place to control constantly increasing costs. c. There is a need to focus on the population as a whole. d. Technological breakthroughs should be expanded.

ANS: B With the rapid growth of technology and increased demands on the private and public health care subsystems, health care costs have become prohibitive. Cost-effectiveness and cost containment have become critical driving forces as health care delivery system changes are made; however, cost-effectiveness often conflicts with the provision of quality care. The Institute of Medicine (IOM) report Best Care at Lower Costs: The Path to Continuously Learning Health Care in America "presents a vision of what is possible if the nation applies the resources and tools at hand by marshaling science, information technology, incentives, and care culture to transform the effectiveness and efficiency of care—to produce high-quality health care that continuously learns to be better" (2012, p. ix). Since 1999, the IOM has completed many extensive reports examining the status of health care in the United States. Some improvement has been seen in the delivery system, but much more needs to be done. This report addresses these critical concerns again. DIF: Cognitive Level: Understand (Comprehension) REF: p. 187

Which of the following best describes how eligibility for Medicaid services is determined? (Select all that apply.) a. Anyone over age 65 years who is eligible for Social Security benefits may apply for Medicaid. b. Baseline eligibility is established by the federal government, but states may be more lenient. c. Children in low-income families are eligible for free care. d. Eligibility depends on family size and total family income. e. Federal government establishes eligibility and gives funds to the states in reimbursement for this care. f. State government establishes guidelines for whether to participate and who will be covered.

ANS: B, C, D Medicaid provides universal health care coverage for the indigent and children. Eligibility is dependent on the size and income of the family. The federal government sets baseline eligibility requirements. State governments who wish to provide care to more citizens can lower the eligibility requirements. The federal government mandates covered services, but state governments may provide more services. DIF: Cognitive Level: Understand (Comprehension) REF: p. 208

Which of the following best describes the effects of Medicare and Medicaid? (Select all that apply.) a. All persons who were temporarily disabled now receive free care. b. A previously unseen rise in demand for services occurred. c. Many persons previously without access now receive health care. d. Medicare reimbursement rates became the standard for all insurance carriers. e. Indemnity insurance plans were offered. f. Public health education was now financed.

ANS: B, C, D, E The enactment of Medicare and Medicaid created an unprecedented demand for services, and many persons without access to health care were now able to receive care using an indemnity insurance plan. Medicare reimbursement rates generally became the standard for all insurance carriers. These plans did not provide services for the temporarily disabled or change financing for public health education. DIF: Cognitive Level: Understand (Comprehension) REF: p. 205 | p. 211

Which of the following best describes how voluntary health agencies fit into the overall health care system? a. They fill in the gaps between services offered by private and public health systems. b. They primarily serve as sources of financial aid for the underserved. c. They supplement the effort of the public health care system. d. They support research, education, and services for particular groups of patients.

ANS: D Voluntary health agencies are committed to specific diseases, organ or body structures, health and welfare of special groups, or particular phases of health. Philanthropic groups support research and programs. These organizations provide major sources of help in preventing disease, promoting health, treating illness, consumer education, and advocacy and research. Unfortunately, there continue to be overlaps among private, voluntary, and public agencies, but without voluntary agencies, fewer services would be available. DIF: Cognitive Level: Understand (Comprehension) REF: p. 188

Which of the following best describes what happens when a health care organization receives federal funding for a special health care need? a. Other groups see the project and write grants wanting similar projects in their geographic area. b. Participants continue to demand the services so local funding has to be readjusted to continue the care. c. Research is done to demonstrate whether or not the intervention was successful and should be replicated. d. When funds cease, so does the health care; therefore, continuity is lacking.

ANS: D When the funding is no longer provided, the programs cease, which results in lack of continuity of care. Research may be done related to the program, other programs may be developed because of the current program that is being implemented, and participants may encourage local funding to continue. However, the most likely outcome is that the program will end when the funding ends, so there is no continuity in the services that are provided. DIF: Cognitive Level: Understand (Comprehension) REF: p. 209

Which of the following statements best describes a notable change of the Omnibus Budget Reconciliation Act? (Select all that apply.) a. Legislated a funding increase for RN staffing b. Changed from process evaluation to outcome evaluation when evaluating care c. Established guidelines for the use of restraints d. Created health maintenance organizations nationwide e. Added prescription drug benefits for Medicaid recipients f. Required all states to review certificates of need before agencies could expand

ANS: B, C, E The Budget Reconciliation Act influenced funding and set up guidelines and regulations about several issues including a move from process to outcome evaluation, use of restraints, and prescription drugs for Medicaid recipients. The Health Maintenance Organization Act of 1973 established health maintenance organizations. The National Health Planning and Resources Act of 1974 required health care facilities to obtain prior approval from the state for expansion in the form of a certificate of need. The Nurse Training Act in 1964 provided funds for nursing school construction and loans and scholarships for full-time study. DIF: Cognitive Level: Understand (Comprehension) REF: p. 175

Which activities would be a responsibility of local health departments? (Select all that apply.) a. Ensuring quality of nursing education programs b. Determining the safety of residents' wells c. Establishing requirements for professionals to maintain their licensure d. Providing free health screenings e. Providing health education programs on proper nutrition f. Inspecting restaurants

ANS: B, D, E, F Local health departments are responsible for the health needs of their constituents. Community health services include surveillance and immunizations, as well as health education programs. Environmental health services on the local level include inspection of food processing plants and restaurants and control of waste, air, and noise and water pollution. Local health departments protect the environment through such activities as inspecting wells and public swimming pools. Ensuring quality of nursing education programs and continuing competence of health professions are both state functions. DIF: Cognitive Level: Understand (Comprehension) REF: p. 191

Which of the following best describes the new national health goals as seen in Healthy People 2020? (Select all that apply.) a. Achieve a plan for universal basic health care for citizens b. Create social and physical environments that promote good health c. Eliminate health disparities d. Eliminate preventable disease, disability, injury, and premature death e. Achieve health equity f. Promote healthy behaviors at every stage of life

ANS: B, D, F Building on previous iterations, the updated 2020 version has four "over-arching goals" for 2020: (1) attain high quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all age groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, health development, and health behaviors across all life stages. Achieving a plan for universal basic health care for citizens, eliminating health care disparities, and achieving health equity are not seen as national health goals in Healthy People 20

Which of the following is one legally required to obey? (Select all that apply.) a. Directions to a destination provided by a police officer b. Court decisions related to legislative law c. Delegation of responsibility for a task by a physician d. Executive decisions, such as your employer requirements e. Laws passed by your state or the federal government f. Rules and regulations from agencies, such as the state board of nursing

ANS: B, E, F Laws that all must obey include legislative law, regulatory agency rules and regulations, and judiciary rulings regarding the law. Although physicians may delegate a task, a physician cannot delegate responsibility. DIF: Cognitive Level: Understand (Comprehension) REF: p. 167

Which of the following statements best describes an unfortunate consequence of using diagnosis-related groups (DRGs) to determine reimbursement? (Select all that apply.) a. Insurance companies had to greatly increase their funding from employers. b. The incentive was to undertreat and underuse health resources. c. Health care providers had to accept losses for each patient treated. d. Health care providers learned to cheat the system. e. Health care providers refused to accept more patients whose reimbursement was based on DRGs. f. High quality of care was no longer assured.

ANS: B, F Because costs were contained by both the federal programs and insurance companies, the providers had a strong incentive to undertreat and underuse health resources. The public feared that the quality of care being provided was less to keep costs as low as possible. DIF: Cognitive Level: Understand (Comprehension) REF: p. 212 | p. 218

The president was sent a bill that he did not really like, but he would have been unpopular if he vetoed it, so he did nothing. Which of the following best describes what will happen to the bill? a. The bill is dead. b. The bill returns to both houses to see if enough votes can be obtained to pass the bill even without the president signing the bill. c. The bill becomes law. d. The bill sits there until the president signs it or vetoes it.

ANS: C A bill that has been passed by the legislature goes to the president. The president may sign it so it becomes law; however, if he neither signs nor vetoes it, the bill becomes law by default. DIF: Cognitive Level: Apply (Application) REF: p. 172

A nurse represents the state professional association. Which of the following actions would the nurse complete in relation to legislation? a. Be prepared to contribute to campaigns of legislators who vote consistently with nursing goals b. Be prepared to confront verbally those on the opposite side of legislative issues c. Be prepared to provide testimony and comment on relevant issues d. Be prepared to visit schools of nursing to present about the current legislative issues

ANS: C Although a nurse might do any of the above, the most effective is to provide testimony and comment on issues of importance to nursing. Contributing is dependent on the financial resources of the nurse. Legislators often appreciate volunteer hours spent on campaign tasks as much as sums of money. Giving presentations to schools may be useful, but it may be assumed that most nursing faculty can discuss legislative health issues. Verbal confrontations are not always useful. DIF: Cognitive Level: Apply (Application) REF: p. 180

Which of the following is the best definition of economics? a. Assets that can be traded for different assets b. Income and outgo of monies c. Science of allocation of resources d. Study of goods, services, talents, and transportation

ANS: C Economics represents the science of allocation of resources. Resources are goods or services. The other definitions do not fully describe economics. DIF: Cognitive Level: Understand (Comprehension) REF: p. 203

Which of the following best describes how having health insurance has affected lifestyle behaviors? a. Health promotion disease prevention programs are attended because they are reimbursable. b. Health education is widespread, because insurance companies promote such education. c. Medications and medical treatment are relied on for cure. d. Screening is widespread because of insurance sponsorship.

ANS: C Funding for behavioral changes is limited, inadequate, or unavailable. Weight loss programs or smoking cessation programs are not reimbursable treatment regimens, although more expensive pharmaceutical interventions are reimbursable. Therefore, it is financially wise not to worry until illness strikes because illness care is reimbursable, whereas preventive health care is not. DIF: Cognitive Level: Understand (Comprehension) REF: p. 206

Which of the following best describes how the government controls conditions that individuals cannot? a. Appeals to the common sense and good nature of the citizens b. Establishes social mores that enable groups to control individuals' behaviors c. Passes and enforces law d. Uses fear reinforced by police power

ANS: C Government regulates conditions that individuals cannot control and provides individual protection through a population-wide focus. These tasks are accomplished through passage and enforcement of laws. These laws control individuals' behaviors, which may lead to the establishment of social mores and common sense related to the laws that have been established. DIF: Cognitive Level: Understand (Comprehension) REF: p. 169

Which of the following statements best describes why nurses should be knowledgeable about health care funding? a. To be able to be an effective employee for insurance companies b. To be knowledgeable when media asks for opinions on some new legislation c. To better serve as patient advocates in policy making for funding that provides appropriate care for the greatest good d. To know how to write nursing notes that reflect higher reimbursement possibilities

ANS: C Increasing knowledge of health care funding and policy making will empower nurses to advocate for the type of funding that provides appropriate care to obtain the greatest good. Nurses need to use their political power. Nurses must advocate for health promotion disease prevention funding. Although these skills are helpful when working for insurance companies, talking to the media, and writing nurses notes, the primary reason why nurses need this knowledge is to engage in the role as a patient advocate. DIF: Cognitive Level: Understand (Comprehension) REF: p. 218

A nurse would like to influence an internal private health policy. Which of the following actions should the nurse take? a. Build or join a private entrepreneurial practice to provide lower cost services to underserved groups b. Participate in public discussions regarding quality and managed care c. Support nursing research done that demonstrates positive clinical and economic outcomes d. Write managed care organizations to request that nurses receive reimbursement for health services to clients

ANS: C Internal nursing action is from within the agency, such as holding an important management position. Nurses can support and use nursing research that demonstrates positive clinical and economic outcomes. Such action also serves to validate the importance of nursing within the health system. External strategies can include participation in discussions regarding aspects of care or seeking employment in entrepreneurial practices. DIF: Cognitive Level: Apply (Application) REF: p. 184

Which of the following nurses fought to have American nursing controlled by nurses rather than physicians? a. Clara Barton b. Florence Nightingale c. Lavinia Dock d. Lillian Wald

ANS: C Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to control the nursing profession. Florence Nightingale was the first nurse to exert political pressure on a government. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War. Lillian Wald was the driving force behind the federal government's development of the Children's Bureau in 1912. DIF: Cognitive Level: Remember (Knowledge) REF: p. 166

Which of the following statements best describes why nurses are not more effective in creating political change? a. Nurses are not listened to by politicians. b. Nurses are not perceived as leaders in the health care field. c. Nurses do not act or do not agree on what changes are needed. d. Nurses do not know how to negotiate, communicate, and collaborate to create change.

ANS: C Nurses know how to communicate, collaborate, negotiate, and serve as leaders who can make themselves heard. However, the various nursing subgroups do not agree on public policies. DIF: Cognitive Level: Understand (Comprehension) REF: p. 179

A nurse is employed by the state public health department. Which of the following activities would she most likely complete? a. Set up a flu shot clinic at a neighborhood church b. Lobby for health care reform to cover more preventive services c. Monitor the incidence of influenza in the state d. Serve as a volunteer for a state legislator's campaign

ANS: C One of the state health care functions is assessment of health needs based on statewide data collection. This could be done by monitoring the incidence of influenza in the state. Setting up a flu shot clinic would most likely be done at the local level, while lobbying for health care reform would most likely be done at the federal level. Serving as a volunteer for a campaign may be something a nurse would do, but would not be specifically related to employment by the state public health department. DIF: Cognitive Level: Apply (Application) REF: p. 176

Which of the following best describes the health care services that are provided by philanthropic groups? a. Direct care to patients with problems related to the group's primary interest area b. Legislative lobbying for increased funding for their special interests c. Informational and research activities d. Special services such as housing, transportation, or appearance aids

ANS: C Philanthropic funding, whose services are typically research or disease oriented, pays a limited amount of health care. Services are limited to the specific disease or population of interest. Informational and research activities constitute the majority of services provided, although some give direct care or meet ancillary needs such as housing, transportation, or wigs. Legislative lobbying and special services are not the primary health care services provided by philanthropic groups. DIF: Cognitive Level: Understand (Comprehension) REF: p. 209

Which of the following statements best describes how policies in the private sector are different from policies in the public sector? a. Private sector policies are slow, deliberate, and reactive to events. b. Private sector policies are determined by the opinions and feelings of those employed in that sector. c. Private sector policies are based on economics and market trends. d. Private sector policies are based on rational decision making.

ANS: C Private policy is largely influenced by theories of economics and business management, including consumerism and market trends. Such policies can react quickly and are often proactive. In comparison, public policies are slow and reactive, and economics is just one of many factors involved. Public policies are determined by voting shifts, electoral realignment, and term limits. DIF: Cognitive Level: Understand (Comprehension) REF: p. 171

Which of the following actions would help decrease the total health care costs in the United States? a. Consolidate major health care facilities while expanding neighborhood primary care clinics b. Continue the move to computer-based medical records and other efficiencies in informatics c. Decrease current fraud and abuse d. Streamline and make more consistent all documents needed for third-party reimbursement

ANS: C The billions of dollars spent on health care and struggles for control between providers, consumers, and health care organizations have increased the risk of fraud and abuse. The Federal Bureau of Investigation (FBI) estimates that health care fraud costs the U.S. $80 billion annually (FBI, 2012). Thus, decreasing the fraud and abuse in the system would have the largest impact over any of the other proposed actions. DIF: Cognitive Level: Understand (Comprehension) REF: p. 207

Which of the following statements best describes why the federal government is unable to do whatever politicians currently in power want? a. The citizens would rise up in rebellion if actions were outrageous. b. The lack of funds to implement actions are seen as unreasonable by a majority of voters. c. Only the actions authorized by the Constitution are legitimate. d. The states would rebel and withdraw from the union.

ANS: C The federal government is a government of limited powers, which means that, for a federal action to be legitimate, it must be authorized. Only those actions that are within the scope of the Constitution, the supreme law of the land, are authorized. Power of the states and citizens is limited under the overall umbrella of the federal government. Funding is also controlled through the powers of the federal government. DIF: Cognitive Level: Understand (Comprehension) REF: p. 170

Which of the following best describes the history of the State Child Health Improvement Act (SCHIP) of 1997? a. The law included goals and programs but no funding to achieve them. b. The law received extensive support by both Republicans and Democrats. c. The law was extended, not renewed by the Bush administration, and then renewed by the Obama administration. d. The law was passed by the majority of states but not by the federal government.

ANS: C The law was extended several times, and then it was not renewed by the Bush administration. In January 2009, the law was renewed again by the Obama administration. DIF: Cognitive Level: Understand (Comprehension) REF: p. 175

Which of the following best describes a conclusion of the report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care? a. Disparities are found only in particular disease categories. b. Lack of access in some neighborhoods is a primary cause of inequities. c. Provider bias and stereotyping contribute to inequalities. d. Physiological racial and ethnic differences lead to disparities in outcomes.

ANS: C The report observed that bias and stereotyping on the part of heath care providers might contribute to differences in care. The report did not address disparities among particular disease categories, lack of access, or physiological racial and ethnic differences. DIF: Cognitive Level: Understand (Comprehension) REF: p. 199

Who may receive benefits under Medicare? (Select all that apply.) a. Federal employees b. Persons aged 55 to 65 years who have bought into the system c. Persons with end-stage renal disease d. Those over 65 years of age, if eligible for Social Security benefits e. Those who are dependents of elderly grandparents, usually because their parents are in prison as a result of drug abuse f. Those with permanent disabilities

ANS: C, D, F Medicare pays specified health care services for all people 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 are also covered. DIF: Cognitive Level: Understand (Comprehension) REF: p. 207

Which of the following were among the outcomes of the 1979 report Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention? (Select all that apply.) a. A national committee was established to have hearings and study the problem further. b. Increased funds were allocated for health planning and health care. c. Many of the recommendations were adopted on the federal level. d. The Health Objectives Planning Act of 1990 was passed. e. The federal government began to identify and monitor national health care goals. f. The president addressed the American people about the need for health care reform.

ANS: D, E The federal government began to take a direct approach in identifying and monitoring national health care goals after the Surgeon General's report. The Healthy Objectives Planning Act of 1990 was passed. Healthy People 2000, Healthy People 2010, and Healthy People 2020 are continuing the efforts. The establishment of a national committee, increased funding for health planning and health care, adoption of recommendations at the federal level, and the need for health care reform were not outcomes of the 1979 report. DIF: Cognitive Level: Understand (Comprehension) REF: p. 175

Which of the following activities are consistent with the conclusions of the report Crossing the Quality Chasm? (Select all that apply.) a. Increased emphasis on evidence-based practice b. Improved reimbursement schedules that allow primary care providers to spend more time with each individual client c. Increased attention to patients' needs for health education and self-management d. Increased communication, cooperation, and collaboration between various components of the health care system e. Increased use of information technology (electronic medical records and data management) f. Improved organization of the health care system

ANS: A, C, E The report suggested the following changes: need for evidence-based planned care; reorganization of practices to meet needs of patients who require more time; attention to patients' need for information and behavioral change; ready access to clinical expertise needed; and supportive information systems. Current trends, which reflect these suggestions, are the focus on evidence-based care; more patient education; need for accepting self-management responsibility; and expansion of electronic medical records and other information technologies. Health care may be improving its organization, but it is not an obvious trend with obvious change, nor are reimbursement schedules allowing care providers more time to spend with clients. Cost containment is decreasing the time care providers can spend with clients. DIF: Cognitive Level: Understand (Comprehension) REF: p. 195

Which of the following conclusions were made when Congress asked for a report on the federal government's quality enhancement process on the care the federal government gave? (Select all that apply.) a. A clear responsibility at the federal level is to lead by example. b. Computerized clinical data have enabled practice guidelines to be written. c. Federally sponsored education and training programs have a strong impact. d. Quality assurance information has been consistent and useful in improvement. e. The quality of federal health care was very good. f. Writing regulations influences nonfederal health care providers and organizations.

ANS: A, C, F The report Leadership by Example concluded that there is a lack of consistent performance measurement, the information is not useful, computerized clinical data are missing, and the approach to gathering data is not systematic. The federal government is the largest purchaser of care because it gives direct care to specified groups and requires conforming to regulations for those accepting Medicare and Medicaid funds. Sponsored research, education, and training also have an impact. The report concluded that the federal government must accept leadership both by example and by coordinating improvement in health care quality. DIF: Cognitive Level: Understand (Comprehension) REF: p. 195

Which of the following critical issues in health care were addressed by The Health Insurance Portability and Accountability Act (HIPAA) of 1996? (Select all that apply.) a. Portability of insurance coverage b. COBRA, maintaining coverage for those who lose their jobs c. Insurance companies having a total monopoly in a certain geographic area d. Insurance companies setting limits on coverage of longer than 12 months e. Insurance companies charging seriously ill persons more than healthy persons f. Insurance companies paying the same for mental health coverage as for physical illnesses

ANS: A, D The HIPAA of 1996 addressed insurance issues. Critical were the portability of coverage and preexisting conditions. Insurers cannot set limits on coverage longer than 12 months. COBRA was established through the Consolidated Omnibus Budget Reconciliation Act of 1985. The McCarren-Ferguson Act of 1945 gave states the exclusive right to regulate health insurance plans. The Mental Health Parity and Addictions Equity Act of 2008 mandated that insurance companies must provide the same coverage for mental health as for physical illness. Health Care Reform legislation prevents insurance companies from charging seriously ill persons more than healthy persons. DIF: Cognitive Level: Understand (Comprehension) REF: p. 175

Which of the following best describes the purposes of professional societies such as the American Nurses Association (ANA)? (Select all that apply.) a. Providing control and oversight of the occupation b. Creating licensing laws to control entry into the profession c. Determining appropriate requirements for education into the profession d. Establishing standards for practice e. Protecting the interests of the practitioners f. Safeguarding the public trust

ANS: A, D, E, F Professional societies seek to further a particular profession, the interests of persons engaged in that profession, and the public interest. Their roles are to maintain control and oversight of the occupation—such as by writing standards for practice—as well as safeguarding the public trust. Licensure and educational standards are responsibilities of individual states. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 167-168

Which of the following functions are responsibilities of the states?? (Select all that apply.) a. Delegating power to localities and holding them accountable for results b. Creating managed health organizations to decrease state health care costs c. Establishing and managing local health departments d. Licensure of professional health care providers e. Overseeing all insurance programs f. Providing access to necessary health services

ANS: A, D, E, F State governments focus particularly on financing and delivery of services and oversight of insurance. The state is responsible for addressing the mission of public health—assessment, policy development, and assurance—throughout the state. Tasks include assessment of health needs based on statewide data collection; establishment of statewide health objectives; and delegating power to localities as appropriate and holding them accountable. States license health professionals as part of the statewide effort to develop and maintain essential personnel. Creating managed health organizations and establishing and managing local health departments are not a main responsibility of the state. DIF: Cognitive Level: Understand (Comprehension) REF: p. 191

Which of the following best describes the strengths of the American health care system? (Select all that apply.) a. Offering the availability and use of technological advances in equipment and procedures b. Having the ability to overcome concerns regarding access and rationing c. Providing the highest quality of life among any industrialized nation d. Having the lowest maternal and infant mortality rate among industrialized nations e. Leading the world in laboratory and clinical research f. Creating the best patient care outcomes

ANS: A, E The United States leads the world in laboratory and clinical research. The United States also exceeds other industrialized countries in the availability and use of technological advances. We do not rank near the top in length of life or patient care outcomes, although we spend far more on health care than other industrialized nations. We are just beginning to confront the issues of access and rationing. DIF: Cognitive Level: Understand (Comprehension) REF: p. 206