Community Chapter 11 NCLEX Questions
Which advanced nurse does not have advanced education in a clinical specialty? a. Clinical nurse leader b. Clinical nurse specialist c. Nurse midwife d. Nurse practitioner
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 level 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
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
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 describes why a health care agency would want to achieve accreditation? (Select all that apply.) a. Accreditation assesses the quality of services and care of the organization. b. Accreditation requires achievement of certain minimum standards. c. Accreditation instills public confidence in the health care agency. d. Accreditation is necessary in order to be reimbursed for services provided. e. Accreditation provides a means for an organization to get outcomes data. f. Accreditation assists with having the best technology at the agency.
A,B,C Accreditation is one means to assess the quality of services and care of the organization. Specific minimum standards must be met by an organization to obtain accreditation. Indeed, accreditation serves the purpose of instilling public confidence in a program, institution, or organization (IOM, 2016). Accrediting organizations require outcomes data, which they use to assess overall performance, but these data are collected by the agency, not the accrediting organization.
Which would be offered as part of the community health services of a local health department? (Select all that apply.) a. Immunization programs b. Food inspection programs c. Health promotion education d. School-based clinics e. Maternal-child programs f. Community-based mental health programs
A,C,E The local health department is responsible for monitoring the health status and meeting the health needs of their constituents. This includes identifying unmet needs and taking actions to meet these needs. Most services to groups and individuals are provided at the local level. These services fall into the following four major categories: Community health services include control of communicable disease such as surveillance and immunizations, maternal-child health programs, nutrition services, and education; environmental health services include food hygiene such as inspection of food-producing and food-processing plants and restaurants; protection from hazardous substances; control of waste, air, noise, and water pollution; and occupational health; personal health services provide care to individuals and families in clinics, schools, and correctional institutions; mental health services are provided through community-based mental health care.
Which would most likely be found in a patients' bill of rights? gave? (Select all that apply.) a. A statement about guaranteeing confidentiality b. A statement about how to create a living will c. A statement about who has access to the client's medical information d. A statement about completing the patient satisfaction survey e. A statement about who will be the payer of the services provided f. A statement about patient autonomy when making decisions
A,C,F Health care facilities often have a "patients' bill of rights." Typically, a patients' bill of rights is a list of guarantees or promises for those receiving care at that facility or by providers. Generally included are guarantees of confidentiality, promises of access to information, fair treatment, informed consent, and autonomy over decisions, among other rights. Other patients' rights issues that are vitally important that continue to be discussed and debated are information disclosure, physician and provider choice, direct access to specialists, reimbursement for emergency care, and reimbursement denial.
Which 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
A,D,E,F 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 federal agency 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 (HHS) c. Health Resources and Services Administration (HRSA) d. National Institutes of Health (NIH)
B Most health-related activities at the federal level are implemented and administered by the HHS. 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 accurately describes the impact that the ACA had on expanding Medicaid? a. There was no impact as Medicaid is funded by state governments. b. Each state determined if they would accept the federal expansion of Medicaid. c. Program enrollment decreased as less money was invested in Medicaid. d. The cases of fraud and abuse within the Medicaid system rose.
B One of the major provisions of the ACA resulting in large numbers of Americans receiving health care coverage was through the expansion of Medicaid; however, each state was allowed to determine whether they would accept this expansion. Ultimately, 31 states and the District of Columbia elected to extend Medicaid coverage through the ACA and 19 chose not to.
Which federal agency 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
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 statement 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
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 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
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
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
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, 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 statement about the Agency for Healthcare Research and Quality (AHRQ) is accurate? a. The AHRQ provides funding for medical and nursing research studies. b. The AHRQ implements strategies to eliminate health disparities across the country. c. The AHRQ works to improve the safety of the health care system by publishing clinical guidelines. d. The AHRQ is a division of the Institute of Medicine.
C The Agency for Healthcare Research and Quality (AHRQ) is the main federal organization that works to improve the safety and quality of the health care system. This was largely through funding research to make care safer and to improve quality by publishing materials to educate health care systems and professionals to put research into practice and through generation of measures and data to be used by providers and policymakers (AHRQ, 2017). AHRQ support efforts for clinicians and providers includes clinical guidelines and recommendations. AHRQ publishes research and reports specifically related to health care disparities, quality, and evidence-based practice but does not implement strategies.
Which 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
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 best describes a health disparity that exists in the United States? a. Caucasians have higher rates of mortality than minority groups. b. Caucasians have increased access to see specialist physicians. c. Minority groups have increased access to government insurance options. d. Minority groups have a higher prevalence of chronic conditions than Caucasians.
D Health disparities refer to observable or quantifiable differences in the presence of disease, health outcomes, or access to health care among different groups or populations. In the United States, health disparities have long been recognized as particularly problematic among ethnic minorities, including blacks, Native Americans, and Hispanics. Research indicates that often these groups have a higher prevalence of chronic conditions and higher rates of mortality and poorer health outcomes when compared with the white population.
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
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 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 organiztions
D Managed care has become a 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 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.
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 report states 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
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 best describes one of the current goals for the HHS? a. Mandate minimum nurse to patient staffing ratios b. Decrease medical malpractice claims c. Monitor for health care fraud and abuse d. Advance scientific knowledge and innovation
D The HHS goals for 2015-2018 are: strengthen health care; advance scientific knowledge and innovation; advance health, safety, and well-being of the American people; and ensure the efficiency, transparency, accountability, and effectiveness of HHS programs. The goals do not address nurse-patient staffing ratios, medical malpractice, or monitoring for fraud and abuse.
Which 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
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 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.
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 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
D,E A lternative 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.