Chapter 6- Understanding the Healthcare Environment and Its Financing My Nursing Test Banks

Import Settings:

Base Settings: Brownstone Default

Information Field: Client Needs

Information Field: Cognitive Level

Information Field: Difficulty

Information Field: Integrated Process

Information Field: Objective

Information Field: Page and Header

Highest Answer Letter: E

Multiple Keywords in Same Paragraph: No

Chapter: Chapter 6: Understanding the Healthcare Environment and Its Financing

Multiple Choice

1. Which of the following clients would be a good candidate to receive care in an assisted-living facility?

A) A 30-year-old victim of a car accident who has been in a coma for the past 2 months.

B) A 78-year-old widower who is living independently but needs help with preparing meals, doing laundry, and remembering to take his medications.

C) A husband and wife approaching retirement age who have no difficulty with ADLs but desire to age in place.

D) A 72-year-old woman diagnosed with Alzheimer disease who is described by her daughter as having good days and bad days.

Ans: B

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 2

Page and Header: 205, Assisted-Living Facilities

Feedback: The assisted-living facility provides care for those needing help with up to three ADLs. In an assisted-living arrangement, the resident can maintain maximum independence and use a shared decision-making model to decide when additional help or support is needed. A patient in a coma, an individual with significant cognitive deficits, and a couple with no difficulty in achieving ADLs would not be appropriate for assisted-living.

2. Mr. Kline is a construction worker who is recovering from surgery on his dominant hand that he injured on the job. Which member of the healthcare team would the nurse contact to help Mr. Kline learn how to feed himself using modified utensils?

A) Registered physical therapist

B) Doctor of osteopathy

C) Registered dietitian

D) Occupational therapist

Ans: D

Client Needs: B

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3

Page and Header: 210, Roles of Healthcare Workers

Feedback: Occupational Therapists are educated in the assessment and management of ADLs, especially when assistive devices are required. A physical therapist focuses primarily on mobility and would not introduce assistive devices aimed at achieving ADLs. Osteopaths and dietitians would not manage the use of assistive devices.

3. Which of the following is a current trend related to the education and scope of practice of healthcare providers within the healthcare system?

A) The Flexner Report limited the involvement of hospitals in research and education of medical students, resulting in a decrease in internships and residencies.

B) Pressure from insurers has mandated an increased use of specialty physicians over general practice physicians.

C) There is a short supply of qualified individuals in most health occupations, including nursing.

D) As the healthcare system has grown more and more complex, it is imperative for one individual educated to a specific role, to manage all aspects of care.

Ans: C

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 4

Page and Header: 212, Healthcare Worker Supply

Feedback: Nurses are not the only healthcare workers in short supply. There are predicted shortages in almost all areas of healthcare over the next 15 years. As the population ages and more people enter the system due to expansion of healthcare insurance coverage, the shortages are likely to persist. The Flexner Report increased the involvement of hospitals in research and education of medical students. There is pressure to increase the involvement of general practice physicians. As the healthcare system grows more complex, it is clear that it is impossible for one individual educated to a specific role, to manage all aspects of care.

4. Which of the following statements is an accurate representation of the nature of healthcare coverage available worldwide?

A) In the United States, healthcare is seen as a right or entitlement of every citizen.

B) In developing nations, healthcare is adequately provided by governmental agencies and nonprofit organizations, such as the World Health Organization.

C) The US healthcare system has been simplified by the existence of standards for funding and controlling healthcare.

D) In most of the industrialized world, governmental healthcare systems are in place to accomplish overall health outcomes.

Ans: D

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 213, Paying for Healthcare

Feedback: In most of the industrialized world healthcare is seen as a right, or an entitlement, of every citizen. This stands in contrast the views of many in the United States. Developing nations often lack basic healthcare and the US healthcare has increased in complexity over the years.

5. Mr. Gomez is a patient on Medicare receiving care in a hospital following cardiac surgery. What method would be used to determine payment for the services provided for this client?

A) Resource utilization groups

B) Minimum data sets

C) Capitation

D) Diagnosis-related groups

Ans: D

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 5

Page and Header: 224, Diagnosis-Related Groups

Feedback: Diagnosis-related groups (DRGs) are used to determine the payment for each Medicare client admitted to the hospital. Payment is not determined using resource allocation groups, minimum data sets, or capitation.

6. A nurse provides care in a hospital that is owned and operated by the Roman Catholic Church. According the classification system of healthcare organizations that is based on ownership, how would this hospital be classified?

A) Proprietary corporation

B) Sole proprietorship

C) Nonprofit organization

D) Community organization

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Easy

Integrated Process: Communication and Documentation

Objective: 1

Page and Header: 196, Table 6.2

Feedback: Healthcare institutions that are operated by religious organizations are normally categorized as nonprofit. They are not proprietorships or community organizations.

Multiple Selection

7. The number and importance of hospitals increased greatly during the development of the American healthcare system. Which of the following phenomena have contributed to this trend? (Select all that apply.)

A) Increased health literacy of the American public

B) The development of more sophisticated medical technology

C) Increased incidence and prevalence of chronic diseases

D) The development of professional nursing

E) The growth of the health insurance industry

Ans: A, B, D, E

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 4

Page and Header: 198, Factors Affecting the Development of Hospitals

Feedback: The growth of the hospital as a primary healthcare institution was the result of numerous factors, including the medical technology, the growth of professional nursing, and the emergence of the health insurance industry. This trend has not been closely linked to changes in health literacy and chronic diseases.

Multiple Choice

8. Historically, health insurance was for hospital care and related services only. What effect did this characteristic have on the health behaviors of individuals enrolled in such plans?

A) Some individuals neglected health promotion measures.

B) Many individuals began to pay out-of-pocket for superior care.

C) Individuals avoided hospitals because of the association of hospitals with illness.

D) Some individuals who qualified for Medicare did not enroll in the program.

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 215, Health Insurance Plans

Feedback: Insurance coverage for inpatient treatment created a disincentive towards preventative measures and health promotion activities since these were nor insured benefits. The focus on inpatient care did not prevent participation in Medicare or dissuade people from visiting hospitals.

9. In 2010 the US Congress passed the Patient Protection and Affordable Care Act, commonly referred to as the Healthcare Reform. This Act aims to change the provision of healthcare in the United States by

A) bringing the health insurance industry under the umbrella of the federal government.

B) increasing the number of nonprofit and public hospitals.

C) placing limits on healthcare costs and limits on the growth of health maintenance organizations (HMOs).

D) requiring every American to be enrolled in some type of health insurance plan.

Ans: D

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 5

Page and Header: 213, Paying for Healthcare; 32, Paying for Healthcare

Feedback: Healthcare Reform set up a process through which the United States would move toward healthcare coverage for all by requiring everyone to be enrolled in some type of health plan. This goal of universal coverage is not being sought through taking control of the insurance industry, building public hospitals, or limiting the role of HMOs.

10. A 63-year-old man has qualified for Medicaid. His qualification for Medicaid will be based primarily on what factor?

A) His medical history and present health status

B) His income

C) His employment history

D) His military service

Ans: B

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Communication and Documentation

Objective: 5

Page and Header: 221, Medicaid

Feedback: Medicaid provides funds for healthcare for those dependent on public assistance and certain other low-income individuals. Qualification is not based on work history, health status, or military service.

11. A hospital is currently undergoing scrutiny in terms of a number of hospital healthcare outcomes. Which of the following would be considered an outcome?

A) The ratio of care providers to managers and administrators in the hospital

B) The incidence of nosocomial infections in the hospital

C) The demographics of the population that the hospital serves

D) The major sources of revenue for the hospital

Ans: B

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 6

Page and Header: 236, Hospital Healthcare Outcomes

Feedback: Outcome measures are specific, measurable aspects of healthcare that show the effectiveness of the system as a whole. An example of an important outcome measure is the incidence of nosocomial infections in a care setting. The staffing mix, the demographics of the community, and the revenue sources of the hospital may be important data but they are not considered to be outcomes.

12. Historically nurses have had limited power in the healthcare system. How can a nurse best exercise power to move the provision of healthcare in a positive direction?

A) By participating in shared governance

B) By providing evidence-based care

C) By establishing collaborative relationships with physicians

D) By becoming accredited in a specialty area

Ans: A

Client Needs: A-1

Cognitive Level: Application

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 7

Page and Header: 239, Nurse Power

Feedback: One of the most effective ways for nurses to effect change in the healthcare system is by taking advantage of opportunities to participate in shared governance. Accreditation, collaboration, and high-quality care are all positive actions, but they are less directly related to the exercise of power and influence.

13. There has been a great increase in the sophistication of healthcare technology in recent decades. What effect has increased technology primarily had on the provision of healthcare?

A) Health technologies have made healthcare more accessible to larger numbers of Americans.

B) High-technology equipment requires a large capital investment in the short-term but reduces healthcare costs in the long-term.

C) Health technologies improve patient care and provide an incentive for innovative people to enter the healthcare field.

D) Sophisticated health technologies can improve patient outcomes but increase healthcare costs greatly.

Ans: D

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 8

Page and Header: 226, High Technology and New Facilities

Feedback: Health-related technologies often have the potential to improve patient outcomes but they typically increase costs to healthcare institutions and, ultimately, to healthcare consumers. They do not normally result in decreased costs in the longer term and their ability to directly attract innovators to the healthcare industry has not been proven.

14. Many consumers and advocacy groups in the United States have raised concerns around the practices of the pharmaceutical industry. These concerns are most often motivated by the fact that

A) drug research and development is conducted overseas but most drugs are sold domestically.

B) residents of other industrialized countries have better availability of drugs.

C) drug costs are higher in the US than in many other industrialized countries.

D) pharmaceutical companies have shown an unwillingness to develop new drugs.

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 8

Page and Header: 226, High Technology and New Facilities

Feedback: Drug companies often sell identical drugs in other countries for far less money than what they charge consumers in the United States, a fact that contributes to the high cost of healthcare in the United States. Overseas research and development is not a contentious issue and drug companies are continually active in the development of new drugs. Despite the high costs, the availability of drugs in the United States is unmatched.

15. Nurse T. has been providing care for Mr. James for the past several days during his admission to hospital for the exacerbation of his chronic obstructive pulmonary disease (COPD). How can Nurse T. best help Mr. James, and other patients, navigate the healthcare system effectively and efficiently?

A) Encourage Mr. James to take ownership of his health and be proactive with prevention measures.

B) Teach patients how to use technology to minimize their reliance on care providers.

C) Educate patients about the varied roles that nurses can play in the provision of healthcare.

D) Become familiar with the organization of healthcare and apply this knowledge to patient teaching.

Ans: D

Client Needs: B

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 9

Page and Header: 240, Implications for Nurses

Feedback: Nurses should become familiar with the complexities of healthcare and use this knowledge to help patients and families navigate the system. Technology and the roles of nurses of not topics that are likely to benefits patients in a tangible way. Prevention measures are important for health but they do not necessarily aid in navigating the system.

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