Chapter 11

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

d. Large number of underinsured and uninsured citizens