Chapter 14: Health Care in the United States My Nursing Test Banks

Chapter 14: Health Care in the United States

Test Bank

MULTIPLE CHOICE

1. Which of the following is not included as an overarching goal of Healthy People 2020?

a.

Eliminating health disparities

b.

Creating environments that promote good health

c.

Lengthening the average lifespan by a decade

d.

Attaining longer lives free of preventable diseases and injury

ANS: C

Feedback

A

Eliminating health disparities is part of the overarching goals of Healthy People 2020.

B

Creating social and physical environments that promote good health is part of the overarching goals of Healthy People 2020.

C

Lengthening the average lifespan by itself is not one of the overarching goals ofHealthy People 2020.

D

Attaining longer lives free of preventable disease and injury is part of the overarching goals of Healthy People 2020.

DIF: Cognitive Level: Knowledge REF: p. 286 | Figure 14-1

2. Which of the following is an example of health promotion and maintenance?

a.

Talking to a womens church group about having an annual mammogram

b.

Establishing an exercise program for postmenopausal women to reduce bone loss

c.

Providing colonoscopy examinations for high-risk individuals

d.

Talking to a state legislator about supporting a motorcycle helmet law

ANS: A

Feedback

A

Health promotion and maintenance involves activities to assist individuals to remain healthy, prevent diseases and injuries, detect diseases early, and promote healthier lifestyles. Mammograms can detect disease early.

B

Establishing an exercise group to reduce bone loss is illness prevention based on the presence of risk factors.

C

Having a colonoscopy examination is illness prevention based on risk factors.

D

Speaking to a state legislator about supporting a helmet law may or may not lead to changes in the law.

DIF: Cognitive Level: Comprehension REF: p. 286

3. Which of the following is an example of illness prevention?

a.

Viewing a program on television about the increased incidence of heart disease

b.

Speaking to a high school group about the value of exercise

c.

Encouraging women at a health fair to have an annual mammogram

d.

Counseling people recently experiencing death of a spouse about signs and symptoms of depression

ANS: D

Feedback

A

At best this is an example of health promotion, although health promotion requires active participation. Watching a program on television is passive but could provide health-promoting education.

B

Speaking to high school groups about exercise is an example of health promotion.

C

Health promotion includes early detection, and the goal of screening for breast cancer is early detection, not prevention.

D

Illness prevention is used when a person is already at risk for development of a health problem because of behavior or circumstance.

DIF: Cognitive Level: Comprehension REF: p. 286

4. Health promotion differs from illness prevention in that health promotion

a.

addresses identified health problems.

b.

occurs before the identification of disease risk factors.

c.

identifies and ameliorates a health problem.

d.

returns an individual to optimal functioning after an illness.

ANS: B

Feedback

A

Health promotion is focused on helping prevent health problems.

B

The goal of health promotion is to keep the person healthy and involved in healthy lifestyles to prevent the development of risk factors.

C

Health promotion does not identify health problems.

D

Returning to optimal function occurs with rehabilitation.

DIF: Cognitive Level: Comprehension REF: p. 286

5. Which of the following is an example of diagnosis and treatment?

a.

Attending smoking cessation classes

b.

Computerized tomography (CT) scan to rule out gallbladder inflammation

c.

Screening in the workplace for tuberculosis

d.

Prenatal classes

ANS: B

Feedback

A

Attending smoking cessation classes is illness prevention based on the known risks of smoking.

B

The CT scan will diagnose disease that may then be treated.

C

Screenings are examples of early detection activities.

D

Prenatal classes are health promotion activities.

DIF: Cognitive Level: Comprehension REF: p. 287

6. Which of the following is an example of rehabilitation and disease management?

a.

Prompt treatment for hypertension

b.

Attending weight loss classes

c.

Teaching patients with newly diagnosed diabetes the signs of hypoglycemia and hyperglycemia

d.

Taking an antibiotic for a sinus infection

ANS: C

Feedback

A

Prompt treatment of hypertension is an example of diagnosis and treatment.

B

Attending weight loss classes is illness prevention because of the risk for disease development.

C

Knowing the signs of hypoglycemia and hyperglycemia will help the person manage the disease of diabetes.

D

Taking medication is treatment of a disease.

DIF: Cognitive Level: Comprehension REF: p. 287

7. Which of the following is characteristic of public agencies?

a.

They are supported by donations from the public.

b.

Most only provide primary care services.

c.

They are not involved in the education of health care providers.

d.

They provide health care services at the national, state, and local levels.

ANS: D

Feedback

A

Public agencies are supported by taxes from the community they serve.

B

Public agencies offer all levels of health care services, although not all agencies offer all levels.

C

Many public agencies provide educational opportunities or funding for education.

D

Public agencies can serve the nation, state, or local community.

DIF: Cognitive Level: Comprehension REF: p. 287

8. Which of the following is not a public agency?

a.

National Institute of Nursing Research

b.

American Red Cross

c.

Centers for Disease Control and Prevention

d.

State board of nursing

ANS: B

Feedback

A

The National Institute of Nursing Research is a governmental (public) agency.

B

The American Red Cross is an organization that is supported by private donations to provide health services. Originally all services were provided by volunteers; this is why this type of agency is frequently called a voluntary agency.

C

The Centers for Disease Control and Prevention is a governmental (public) agency.

D

The State board of nursing is a governmental (public) agency.

DIF: Cognitive Level: Knowledge REF: p. 288

9. Governmental agencies differ from voluntary agencies in which way?

a.

Level of community served

b.

Administrative structure

c.

Funding source

d.

How the profits are used

ANS: C

Feedback

A

Both types of agencies can provide services at the national, state, or local levels.

B

The administrative structures can be very similar in the two types of agencies.

C

Governmental agencies are funded through tax dollars, whereas voluntary agencies are funded by donations.

D

All governmental agencies are also nonprofit as are most voluntary agencies.

DIF: Cognitive Level: Comprehension REF: pp. 287-288

10. A health care agency that uses its profits to better the institution rather than paying stockholders would be classified as a

a.

for-profit agency.

b.

not-for-profit agency.

c.

voluntary agency.

d.

private agency.

ANS: B

Feedback

A

For-profit agencies distribute profits earned to partners or stockholders.

B

Not-for-profit agencies use their income to pay personnel, improve services, advertise services, provide educational programs, or otherwise contribute to the mission of the agency.

C

Voluntary agencies can be for-profit agencies.

D

Private agencies can also be for-profit agencies.

DIF: Cognitive Level: Comprehension REF: p. 288

11. The school health clinic treats common health problems, as well as conducting health promotion and illness prevention activities. The clinic provides which level of health care?

a.

Subacute care

b.

Primary care

c.

Secondary care

d.

Tertiary care

ANS: B

Feedback

A

Subacute care is inpatient care that lies between hospital care and long-term care.

B

Care provided at the point at which a person first enters the health care system is considered primary care. Care provided can include emergency care, health maintenance, and chronic care, as well as health promotion.

C

Secondary care involves the prevention of complications from disease. This level of care may occur in hospitals as well as other types of agencies.

D

Tertiary care is provided to the acutely ill, those requiring long-term care, those requiring rehabilitation services, and terminally ill patients.

DIF: Cognitive Level: Comprehension REF: pp. 288-289

12. An agency that treats temporary health dysfunction requiring intervention to prevent complications is providing which level of health care?

a.

Subacute care

b.

Primary care

c.

Secondary care

d.

Tertiary care

ANS: C

Feedback

A

Subacute care is inpatient care that lies between hospital care and long-term care.

B

Primary care is provided at the point at which a person first enters the health care system. Care provided can include emergency care, health maintenance, and chronic care, as well as health promotion.

C

Secondary care involves the prevention of complications from disease. This level of care may occur in hospitals as well as other types of agencies.

D

Tertiary care is provided to the acutely ill, those requiring long-term care, those requiring rehabilitation services, and terminally ill patients.

DIF: Cognitive Level: Comprehension REF: p. 289

13. Hospices that provide care to terminally ill patients and their families in hospitals, in the home, or in special hospice facilities provide which level of health care?

a.

Subacute care

b.

Primary care

c.

Secondary care

d.

Tertiary care

ANS: D

Feedback

A

Subacute care is inpatient care that lies between hospital care and long-term care.

B

Primary care is provided at the point at which a person first enters the health care system. Care provided can include emergency care, health maintenance, and chronic care, as well as health promotion.

C

Secondary care involves the prevention of complications from disease. This level of care may occur in hospitals as well as other types of agencies.

D

Tertiary care is provided to the acutely ill, those requiring long-term care, those requiring rehabilitation services, and terminally ill patients.

DIF: Cognitive Level: Comprehension REF: p. 289

14. An agency that provides inpatient care related to less complex conditions and does not require high-technology monitoring or complex diagnostic procedures is providing which level of care?

a.

Subacute care

b.

Primary care

c.

Secondary care

d.

Tertiary care

ANS: A

Feedback

A

Subacute care is inpatient care that lies between hospital care and long-term care.

B

Primary care is provided at the point at which a person first enters the health care system. Care provided can include emergency care, health maintenance, and chronic care, as well as health promotion.

C

Secondary care involves the prevention of complications from disease. This level of care may occur in hospitals as well as other types of agencies.

D

Tertiary care is provided to the acutely ill, those requiring long-term care, those requiring rehabilitation services, and terminally ill patients.

DIF: Cognitive Level: Comprehension REF: p. 289

15. Which of the following is a responsibility of many health care agencies chief executive officers (CEOs)?

a.

Managing the budgets of each department in the agency

b.

Recruiting and hiring of staff

c.

Overall operation of the agency on a daily basis

d.

Establishing policies governing the operation for the agency

ANS: C

Feedback

A

Although the CEO is concerned about the cost-effectiveness of the institution as a whole, he or she does not deal with individual department budgets.

B

The CEO is not responsible for staffing.

C

The CEO makes sure that the institution runs efficiently and cost-effectively and carries out policies established by the board.

D

The CEO carries out the policies established by the board.

DIF: Cognitive Level: Knowledge REF: p. 290

16. Which of the following is a responsibility of many nurse executives (chief nursing officers)?

a.

Recruiting, hiring, and training new staff

b.

Managing day-to-day staff scheduling

c.

Managing budget for assigned unit

d.

Participating as a member of the board of directors

ANS: D

Feedback

A

Recruiting, hiring, and training new staff is a function of middle management.

B

Managing day-to-day staff scheduling is a function of middle management.

C

Managing budget for assigned unit is a function of middle management.

D

The chief nurse executive is often a member of the board of directors.

DIF: Cognitive Level: Knowledge REF: p. 291

17. Within a nursing shared governance model, the role of the clinical nursing staff is to

a.

determine the expectations and goals for the unit.

b.

manage the budget for the unit to be cost-effective.

c.

focus on the unit activities related to nurses only.

d.

adhere to standards and quality benchmarks to ensure professional practice.

ANS: D

Feedback

A

Determining the expectations and goals for the unit is a function of the nurse manager.

B

Managing the budget for the unit to be cost-effective is a function of the nurse manager.

C

Depending on the organization of the institution, unit governance may involve other personnel besides just nurses.

D

Shared governance is based on the philosophy that nurses have both the right and responsibility to govern their own work.

DIF: Cognitive Level: Comprehension REF: p. 291

18. The purpose of continuous quality improvement (CQI) is to

a.

monitor processes involved in the provision of safe, effective care for patients.

b.

restructure hospital departments to initiate cost savings.

c.

provide an opportunity for staff members to participate in self-governance.

d.

deliver appropriate nursing care to patients.

ANS: A

Feedback

A

CQI focuses on using groups of employees to decide how care will be delivered, decide on the desired outcomes, and design systems to create those outcomes. Every effort is made to anticipate potential problems and prevent their occurrence.

B

CQI may involve restructuring to improve patient care, but it may not relate to cost-effectiveness.

C

CQI may or may not be part of self-governance.

D

The goal of CQI is quality care, not appropriate care.

DIF: Cognitive Level: Comprehension REF: pp. 292-293

19. Differences between treatment outcomes for different populations are known as

a.

health care outcomes.

b.

population variability.

c.

treatment choices.

d.

health care disparities.

ANS: D

Feedback

A

Health care outcomes are measurable results of the health care system.

B

Population variability relates to the variation of characteristics of the population.

C

Treatment choices are options offered for care of the patient.

D

The differences in disease management and treatment outcomes have been found in different ethnic and racial groups as well as in different gender and age groups.

DIF: Cognitive Level: Knowledge REF: p. 293

20. A contributing factor to health care disparities may be

a.

genetic factors.

b.

provider bias.

c.

standard treatment options.

d.

diagnostic differences.

ANS: B

Feedback

A

Genetic factors may influence disease occurrence; however, once the disease is found, all occurrences should be treated in a similar manner.

B

The health care disparities could be the result of the options offered or care provided on the basis of ethnicity, gender, or age.

C

Standard treatment options available for specific diseases or injuries should not affect disparities.

D

Disparities have been shown to exist among patients with the same diagnosis.

DIF: Cognitive Level: Knowledge REF: p. 293

21. Which of the following is not recognized as part of the role of the nurse as a member of the health care team?

a.

Patient advocate and educator

b.

Collaborator and provider of care

c.

Manager of care and resources for a group of patients

d.

Performance of physician functions under direct supervision of a physician

ANS: D

Feedback

A

Advocate and educator are roles of the nurse.

B

Collaborator and provider of care is the role of the nurse.

C

Manager of care and resources for a group of patients is the role of the nurse.

D

The physicians assistant performs many functions of the physician under the direct supervision of the physician.

DIF: Cognitive Level: Comprehension REF: pp. 297-299

22. The nurse who recognizes that the strict visiting hours policy that has existed on the pediatric unit is outmoded and begins to gather data to support a new policy liberalizing visiting hours based on evidence of better patient care is taking on the role of

a.

provider of care.

b.

patient advocate.

c.

counselor.

d.

educator.

ANS: B

Feedback

A

The nurse as the provider of care provides nursing care to patients.

B

A nurse advocate knows how to work through bureaucracy to provide for the patients best interest at all times.

C

The nurse as a counselor provides basic counseling and support to patients in relation to their emotional responses to health and illness.

D

The nurse as an educator provides information to patients and their families related to health and illness issues.

DIF: Cognitive Level: Application REF: p. 299

23. A nurse caring for a preoperative patient is told by the patient, The doctor just had me sign a paper. I wish I knew what it was all about. The nurse goes to report this to the physician. The nursing role adopted by the nurse is

a.

provider of care.

b.

counselor.

c.

change agent.

d.

patient advocate.

ANS: D

Feedback

A

The nurse as the provider of care provides nursing care to patients.

B

The nurse as a counselor provides basic counseling and support to patients in relation to their emotional responses to health and illness.

C

The nurse as a change agent is involved in making changes in the health care system or in the provision of patient care.

D

A nurse advocate works to provide for the best interest of patients at all times.

DIF: Cognitive Level: Application REF: p. 299

24. A nurse places high priority on working with patients and families, including them in planning care and in establishing goals. Which nursing role has this nurse assumed?

a.

Patient advocate

b.

Provider of care

c.

Change agent

d.

Collaborator

ANS: D

Feedback

A

A nurse advocate works to provide for the best interest of patients at all times.

B

The nurse as the provider of care provides nursing care to patients.

C

The nurse as a change agent is involved in making changes in the health care system or in the provision of patient care.

D

The nurse who works collaboratively with patients and families includes them in planning care and outcomes.

DIF: Cognitive Level: Comprehension REF: p. 299

25. Which of the following is a characteristic of the team model of nursing care delivery?

a.

Each member of the team uses his or her abilities to the fullest in patient care.

b.

Communication among the team saves time, so the model is cost-efficient.

c.

Team nursing emphasizes holistic care for the patients and their families.

d.

This model increases continuity of care for the patients.

ANS: A

Feedback

A

Both the professional and nonprofessional members of the team provide the level of care they are best prepared to offer. The team members are utilized to their fullest.

B

Communicating patient information to all involved in patient care is time consuming.

C

Team nursing fragments the care for the patients because multiple people are involved.

D

The continuity of care can be fragmented because of the multiple providers over the time the patient is in the hospital.

DIF: Cognitive Level: Comprehension REF: p. 300

26. The care delivery model in which a registered nurse provides direct care and also has 24-hour responsibility for updating the patients plan of care is known as

a.

functional care.

b.

team nursing.

c.

primary care.

d.

case management.

ANS: C

Feedback

A

Functional nursing divides tasks among care team members.

B

Team nursing uses different skill levels to provide care in teams.

C

The primary care nurse retains accountability for care outcomes 24 hours a day while the patient is on the unit.

D

Case management coordinates care and resources.

DIF: Cognitive Level: Knowledge REF: p. 301

27. Which care delivery model uses critical pathways and continuous quality improvement to guide care practices?

a.

Managed care

b.

Primary care

c.

Case management

d.

Care redesign

ANS: C

Feedback

A

Managed care uses health maintenance organizations and preferred provider organizations for prospective reimbursement.

B

Primary care identifies one nurse as responsible for the patients care and evaluation of outcomes the entire time the patient is on the unit.

C

Case management uses critical pathways as guides to care and outcomes and continuous quality improvement to assess the cause of variances in the critical pathway.

D

Care redesign was an attempt during the 1990s to reintroduce team nursing.

DIF: Cognitive Level: Knowledge REF: p. 301

28. Which of the following patients is likely to benefit most from referral for case management?

a.

Child injured in a playground accident

b.

Elderly patient with total hip replacement

c.

A 49-year-old man in the emergency department with chest pain

d.

A 20-year-old with appendectomy

ANS: B

Feedback

A

Injuries sustained to a child on a playground are likely to be different from many other childhood injuries and thus outcomes will be less predictable. The injury may also be minor in nature and not need the involvement of a case manager.

B

The best referral to case management is a patient who falls within a specific diagnostic group and whose outcomes can be reasonably predicted within a set period of time.

C

A middle-aged man with chest pain does not yet have a diagnosis that would put him in a diagnostic group benefiting from case management.

D

A young person with an acute illness requiring surgery is likely to have an uncomplicated recovery.

DIF: Cognitive Level: Application REF: p. 301

29. A nursing case manager requests a meeting with the nursing staff after discovering variances from critical pathways related to timely discharge of patients having hip replacement. Patients are not being discharged on time because they are refusing their physical therapy as a result of poor pain control. Meeting with the staff to discuss potential improvements in pain management is an example of

a.

performance improvement.

b.

continuous quality improvement.

c.

team building.

d.

Joint Commission compliance.

ANS: B

Feedback

A

Performance improvement is designed to address individual employee performance and manager performance.

B

Continuous quality improvement focuses on establishing procedures for ensuring high-quality care.

C

Team building is about building professional relationships.

D

Joint Commission compliance is adherence to a set of criteria established by the Joint Commission.

DIF: Cognitive Level: Comprehension REF: p. 292 | p. 302

30. Which of the following is a characteristic of the patient-centered care model of nursing care delivery?

a.

It is easily explained to patients because it is based on traditional models of nursing care.

b.

Communication among team members is not required to make the model work.

c.

A multidisciplinary team emphasizes continuum of care and focuses on the patients right to individualized care.

d.

It decreases the number of registered nurses required to provide care.

ANS: C

Feedback

A

The patient-care model is complex, and it is difficult to explain all the roles of the team members.

B

For the patient-care model to work, there has to be a high degree of collaboration and communication between the team members.

C

The patient-care model is a contemporary model that is implemented by a multidisciplinary team that focuses on the patients right to individualized care.

D

The patient-care model actually requires more registered nurses to provide the best patient-centered care.

DIF: Cognitive Level: Comprehension REF: pp. 302-303

31. What is the relevance of the concepts of supply and demand, free market, and price sensitivity with regard to health care costs?

a.

The undersupply of available health care has driven up costs.

b.

In a free market, increased numbers of people are able to pay for health care.

c.

Consumer insensitivity to costs has increased demand for health care services.

d.

Third-party payers have demanded more health care services.

ANS: C

Feedback

A

There is an oversupply of health care services, so costs should decrease.

B

In a free market, the consumption of health care services would be based on the individuals ability to pay.

C

Because more consumers have health insurance, they pay only a small portion of the cost and, therefore, request more services.

D

The demand for services has come from consumers not third-party payers.

DIF: Cognitive Level: Comprehension REF: p. 304

32. An impact of health care cost-containment measures on nursing has been

a.

adding more registered nurses to the skill mix of the nursing team.

b.

the concern about the assurance of quality care.

c.

large annual salary increases for nurses.

d.

development of standards of nursing practice

ANS: B

Feedback

A

Frequently the solution to increased costs is to reduce nursing personnel, not increase the numbers.

B

Frequently the solution to increased costs is to reduce nursing personnel, raising the concern that the quality of care will be affected.

C

Salaries have not increased significantly for nurses as a result of cost-containment measures.

D

Cost-containment measures have not influenced the development of nursing standards.

DIF: Cognitive Level: Comprehension REF: p. 305

33. What service is covered by Medicare, part D?

a.

Home health care

b.

Prescription drug costs

c.

Inpatient hospital stays

d.

Physician office visits

ANS: B

Feedback

A

Some home health care is covered under part A.

B

Prescription drugs costs are covered under part D.

C

Inpatient hospital stays are covered under part A.

D

Physician office visits are covered under part B.

DIF: Cognitive Level: Knowledge REF: p. 306

MULTIPLE RESPONSE

1. Which of the following areas experience serious disparities in health care access and outcomes for minorities? (Select all that apply.)

a.

Infant mortality

b.

Arthritis

c.

Cardiovascular disease

d.

Oral health

e.

Immunizations

ANS: A, C, E

Feedback

Correct

The African-American infant mortality rate is 2.5 times that of white infants. The incidence of heart disease is 29% higher among African-American adults than among white adults. Hispanics and African Americans, aged 65 years and over, were less likely than whites to report receiving influenza and pneumococcal vaccines.

Incorrect

Differences in arthritis and oral health have not been thoroughly studied.

DIF: Cognitive Level: Comprehension REF: p. 294

2. To whom does the nurse provide information when working in the role of educator? (Select all that apply.)

a.

Families about illnesses and treatments

b.

Community groups about injury prevention

c.

Student nurses about nursing standards and ideals

d.

Health care team members about the patient

e.

Physician assistants about invasive procedures

ANS: A, B, C, D

Feedback

Correct

Nurses can be key educators for many different groups and on a variety of health and professional topics.

Incorrect

The physician supervises physician assistants and should provide information to them about invasive procedures they are doing.

DIF: Cognitive Level: Comprehension REF: p. 298

3. How can staff nurses play an important role in controlling health care costs? (Select all that apply.)

a.

Becoming aware of cost of supplies

b.

Questioning the need for unnecessary or repetitive tests

c.

Suggesting the use of brand-name medications to support the economy

d.

Handwashing to prevent infections

e.

Assuring that the payment method is identified on admission

ANS: A, B, D

Feedback

Correct

Knowing the cost of supplies will help the nurse select the most appropriate supply, as well as the amount used. The numbers of laboratory tests and/or other diagnostic tests increase the costs to the institution, the patient, and the payer. The prevention of hospital-caused infections will decrease length of stay and need for antibiotic treatment.

Incorrect

Brand-name medications are generally more expensive than generic forms. The identification of the payment method will not influence the cost of the care.

DIF: Cognitive Level: Comprehension REF: pp. 307-308

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