Chapter 23: Economic and Legal Issues My Nursing Test Banks

Chapter 23: Economic and Legal Issues

Test Bank

MULTIPLE CHOICE

1. Which of the following statements is true about health care costs for older adults in the United States?

a.

Older adults become eligible for full Social Security benefits upon reaching the age of 65 years.

b.

Medicare, Part A, covers physician visits, whereas Part B covers prescription drugs.

c.

Health maintenance organizations (HMOs) can obtain an exemption from Medicares per capita spending limit.

d.

Older adults pay a fixed premium and low out-of-pocket costs in a preferred provider organization (PPO).

ANS: C

If an HMO is granted a per capita waiver, it cannot refuse an applicant on the basis of a preexisting condition. The eligibility age for full Social Security benefits is 66 years of age for persons born after 1937 and 67 years of age for those born in 1960 or later. Medicare, Part A, covers hospitalizations and other inpatient care. Medicare, Part B, which is optional insurance purchased by the beneficiary, covers outpatient services, physician visits, some therapy sessions, and some home health care. Older adults that pay a fixed premium and low out-of-pocket costs is a description of an HMO rather than a PPO.

PTS:1DIF:RememberREF:10-11

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

2. Managed care systems are most effective for an older adult who does which of the following?

a.

Avoids using the system until it is really needed in an emergency.

b.

Avoids seeing generalists and seeks health care only from specialists.

c.

Uses high-tech treatments to reduce expenses over the long term.

d.

Seeks regular primary care and preventive strategies to maintain health.

ANS: D

Managed care is most effective for individuals who, over a long period of enrollment, use primary care and preventive behavior to avoid the need for intensive treatment.

Avoiding using the system until it is needed in an emergency is both costly and detrimental to the clients health. Managed care systems limit access to specialists and encourage the use of primary care. Managed care systems favor ongoing subacute care and prevention to avoid the need for high-tech, acute treatments.

PTS:1DIF:UnderstandREF:10-11

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

3. When an older adult is considering long-term care insurance (LTCI), which is an important consideration?

a.

Carefully scrutinize all exclusions before enrolling.

b.

Apply at the oldest age possible for lower rates.

c.

Avoid purchasing LTCI through a group policy.

d.

Delay application until the government sponsors LTCI.

ANS: A

As with everything else in life, always read the fine print. For example, many plans strictly limit benefits for those with Alzheimer disease. The rates may go up with age at application. The best LTCI packages have been obtained by large organizations with considerable negotiating power. LTCI plans do not receive any government support; therefore the subscriber finances his or her own LTCI.

PTS:1DIF:UnderstandREF:15

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

4. Which of the following statements is true about case management and care management for older adults?

a.

A case manager works for a health care system to save time and money.

b.

Care managers are usually paid from public agencies such as the Area Agency on Aging (AAA).

c.

One nurse can only perform care management.

d.

The Outcomes-Based Quality Improvement system is designed to evaluate the expected benefit of a procedure.

ANS: A

A case manager works for a health care system to save time and money. Care managers are rarely paid through the AAA or similar agencies; they are usually paid privately and sometimes through Medicare or Medicaid. The nurse can perform case management and care management. The aspects measured in an Outcomes Based Quality Improvement System are known as efficacy, effectiveness, and efficiency.

PTS:1DIF:UnderstandREF:16

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

5. Which of the following statements describes one of the standards of case management during hospitalization?

a.

Begin discharge planning on the first day of hospitalization.

b.

Keep an older adult in the hospital as long as necessary.

c.

Accept the hospital discharge planners (HDP) proposal for discharge.

d.

Assist hospital personnel to focus on the admission complaint.

ANS: A

Discharge planning begins on the first day of hospitalization. The case manager is responsible for ensuring that quality care is given accordingly in a specific time frame. The case manager facilitates discharge and contacts community-based resources to assist in the continuation of care. Keeping an older adult in the hospital as long as necessary is not required for the patient to receive the care he or she needs. Hospitalization is dangerous to older adults; therefore early discharge is encouraged. The case manager should negotiate with the HDP for the least restrictive level of care. Once the patient is in the hospital, any condition that the patient may have been neglecting should also be assessed and treated.

PTS:1DIF:UnderstandREF:16-17

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

6. An older woman is resisting her sons help to make her money last longer. He wants to have her declared incapacitated so he can manage her finances. Which nursing assessment can be used by the court to declare incapacitation?

a.

Prepares very few meals and avoids cleaning the house.

b.

Ambulates around her local community without difficulty.

c.

Balances her checkbook weekly and pays her bills on time.

d.

Resists medical advice to remove a stage I malignant tumor.

ANS: D

Refusing surgery to remove a malignant tumor at an early stage after receiving medical advice to do so can indicate impaired cognitive functioning; early treatment offers the best chance for a cure.

Preparing few meals and avoiding cleaning the house may be potential evidence of not understanding the consequences of her actions and may be potential evidence of impaired capacity to make medical decisions. If the aspects of daily living are not important to her, then ambulating around her local community without difficulty does not reflect impaired capacity. Balancing her checkbook weekly and paying her bills on time, which are indications that she is managing her finances, are evidence of intact capacity; functional status is irrelevant in a capacity hearing.

PTS:1DIF:ApplyREF:18-22

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

7. A health care provider asks the nurse about an older mans durable power of attorney (DPA) because consent is needed for a medically necessary invasive procedure. The patient has end-stage disease, is intubated, and is on mechanical ventilation. Which steps should the nurse implement?

a.

Refer to the patients advance directive for a name.

b.

Assist with obtaining informed consent from the patient.

c.

Use the oral trail-making test to measure cognitive function.

d.

Apply the Confusion Assessment Method for critical care.

ANS: D

The health care provider assumes the intubated older adult lacks the cognitive skill to give consent for treatment. Before the search begins for the DPA and to help determine the patients cognitive status, the nurse assesses the patient for delirium using the Confusion Assessment Method for the intensive care unit. As the patients advocate, the nurse implements this valid and reliable tool because the nurse wants to give the patient every opportunity to participate in the plan of care and make his own determinations.

If the patient has an advance directive, then the attorney-in-fact named in the power of attorney should be on that document. However, because the patient has the right to make his own decisions about care, his cognitive status should be established first. Before informed consent can be given, the patients cognitive status must be determined. The patient is unable to perform an oral test while he is intubated.

PTS:1DIF:ApplyREF:18-22

TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

8. An older woman is brain dead, and the attorney-in-fact or surrogate named in her DPA is opposed to organ donation; the law in the state allows a surrogate with a DPA to make end-of-life decisions. Although she failed to document it, her family states that she wanted to donate her organs. Given the law about a DPA, what does the nurse expect the surrogate to do?

a.

Deny consent.

c.

Refuse to decide.

b.

Provide consent.

d.

Get a second opinion.

ANS: B

A DPA acts at the pleasure of the designator, can manage the designators finances, and functions as the designators health care surrogate, making judgments for the designator using substituted judgment when the designator is unable to do so. Therefore, in accordance with the law and the womans wishes according to her family, the surrogate should provide consent for organ harvesting. It is against the law and unethical for the DPA for this older adult to deny consent for organ harvesting. Because the attorney-in-fact named in the DPA is her health care surrogate, the attorney-in-fact must make a decision on behalf of the woman and cannot refuse to do so. The attorney-in-fact can get another opinion on the older adults neurological status but not as a way to avoid the decision concerning organ harvesting.

PTS: 1 DIF: Apply REF: 18-25 TOP: Nursing Process: Planning

MSC: Safe, Effective Care Environment

9. The older adult wants to appoint an attorney-in-fact with DPA for a specific period around a forthcoming surgery. Which should the nurse implement?

a.

Help the patient find a qualified attorney.

b.

Explain the legal rights and responsibilities of an attorney-in-fact with a DPA.

c.

Suggest using a guardian for the surgical period.

d.

Offer to act as the patients guardian during surgery.

ANS: A

The nurse provides safe, effective, and comprehensive care but should not provide legal advice to an older adult; rather, the nurse should refer the patient to experts in the law and can assist the older adult with finding a suitable attorney. The nurse must avoid participating in the selection of the individual attorney to avoid conflict of interest.

The nurse can provide short general explanations about powers of attorney to assist the patient in finding suitable legal counsel, but the nurse should leave explanations about the law surrounding a DPA to an attorney. The nurse should avoid providing legal advice to an older adult and avoid offering to participate in an older adults legal affairs to avoid a conflict of interest.

PTS:1DIF:ApplyREF:18-25

TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

10. The wife of an older man who has diabetes mellitus brings him to primary care. He has severe bilateral infections forming black rings around each ankle. He tells the nurse it is caused by tight shoes. Which intervention should the nurse implement first to investigate this individuals health care regimen?

a.

Examine his health insurance coverage.

b.

Question the man without the wife present.

c.

Consult with social services about neglect.

d.

Analyze his glycosylated hemoglobin level.

ANS: D

Infected, black rings around both ankles of an individual who has diabetes is a potential clinical indicator of prolonged hyperglycemia because of nonadherence, neglect, or abuse. To begin the assessment of his health care regimen, the nurse checks his glycosylated hemoglobin to quantify his exposure to hyperglycemia. This is the best intervention because the nurse fulfills the duty owed to the patient by implementing a patient-focused action.

Although the nurse might be suspicious of potential abuse or neglect and because it is doubtful that tight shoes have caused the rings, the nurses priority is the older adult. Information about his health insurance can provide clues about nonadherence to therapy if the insurance provider denies coverage for diabetic supplies or other necessary health care services. Questioning the man without the wife present is a low priority for the nurse who is faced with a patient who has such a serious health problem. Although the nurse can gather clues concerning the origin of the patients infection by questioning him without the wife present, talking to him in privacy does not guarantee that he will be forthcoming with information or will be a reliable source of information. Consulting with social services about neglect is secondary to his physical needs and a premature intervention because the nurse has not completed an assessment. However, when the nurse completes the patient assessment and gathers evidence supporting a claim of abuse or neglect, social services is a valuable resource for connecting the older adult to community services. The nurse should follow agency policy regarding abuse and neglect.

PTS:1DIF:AnalyzeREF:21-27

TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

11. Which is the fundamental difference between Medicare Part A and Medicare Part B?

a.

Hospice care

c.

Home care services

b.

Health care setting

d.

Invasive procedures

ANS: B

The primary difference between Medicare Part A and Part B is the care setting. Part A covers acute, inpatient care and some specialized care. Part B covers some costs of outpatient and ambulatory services. Hospice care is not a difference; Part A and Part B coverage is no longer available for a patient in hospice care. Home care services are not included in Part B, therefore home care cannot be compared with Part A. Invasive procedures are potentially covered by both Part A and Part B.

PTS:1DIF:UnderstandREF:5-8

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

12. Which of the following statements is true about conservators?

a.

A conservatorship entails control over property, whereas a guardianship entails control over the person.

b.

The most legally restricting way individuals and property can be handled are through conservatorships and guardianships.

c.

Conservators cannot be members of the conservatees (patients) family.

d.

Because a conservatorship is the least restrictive alternative, a court hearing is not required.

ANS: B

A conservator can be responsible for the conservatees property, person, or both. The conservatee is a ward of the conservator or guardian and has no decision-making rights and, in many states, has no legal right to sue to terminate the conservatorship or guardianship. The conservator is the individual appointed by the court; this person can be a family member or someone who has a conflict of interest. Conservatorship is a most restrictive alternative and requires a court hearing.

PTS:1DIF:UnderstandREF:18-25

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

MULTIPLE RESPONSE

1. The nurse distrusts the male caregiver, the son of an older woman, and collaborates with social services about potential resources for abused older adults. Which characteristics of the caregiver does the nurse report to social services as indicators of potential elder abuse? (Select all that apply.)

a.

Collects unemployment benefits.

b.

Finds fault with any nursing care.

c.

Takes frequent breaks for smoking.

d.

Lives in the same house as his mother.

e.

Makes demands on assistive personnel.

f.

Sits at his mothers bedside for hours daily.

ANS: B, D, E

The male caregiverand sonof this woman excessively criticizes the nursing care and demonstrates a lack of appreciation, which are common characteristics of an elder abuser. Because the majority of caregiving occurs in the home and a majority of abuse occurs in the family, this caregiver has the characteristics of a potential abuser. Aggressive, combative, provocative, and overly demanding behavior is also characteristic of an older adult abuser. The lack of employment is not a characteristic of an elder abuser, although this problem can frustrate the individual; however, financial dependency on the abused is a predictor for abuse. Although smoking is an unhealthy habit and exposes the older adult to second-hand unhealthy air, smoking is not a characteristic of an elder abuser. Sitting at the patients bedside for hours, in itself, is not a characteristic of an older adult abuser; concerned, caring family members often keep bedside vigils.

PTS:1DIF:UnderstandREF:21-27

TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment

2. The nurse understands which of the following indicator(s) describe(s) the profile of an abused older adult? (Select all that apply.)

a.

Resides in safe housing.

b.

Is from a lower socioeducational level.

c.

Is a woman who lives with an abuser and is socially isolated.

d.

Has nonwhite ethnicity.

ANS: B, C, D

A profile of an abused older adult consists of one who is married and comes from a lower socioeducational level. Women who are 80 years of age or older are more often abused; the abused older adult often lives with the abuser and is socially isolated. The abused are often nonwhite, have a mental or physical disability, are dependent on the abuser, and reside in unsafe or inadequate housing.

PTS:1DIF:UnderstandREF:43

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

3. The nurse understands which of the following indicator(s) describe(s) the profile of an elder abuser? (Select all that apply.)

a.

Does not have a history of abuse.

b.

Has mental health problems.

c.

Has substance abuse problems.

d.

Is stressed with the caregiving role.

ANS: B, C, D

The abuser often has mental health and substance abuse problems and is stressed or frustrated with the caregiving role. The abuser is often financially dependent on abused and has inadequate financial resources of his or her own. The abuser has had or currently has health problems, and may have a history of abuse and being abused.

PTS:1DIF:UnderstandREF:43

TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

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