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Conceptual Foundations The Bridge Professional Nursing 6th Edition Friberg Creasia Test Bank
Chapter 06: Health Policy and Planning and the Nursing Practice Environment
MULTIPLE CHOICE
- The nurse studying the development of the American health care system understands that before the 1990s, health care funding was primarily
| a. | driven by fee-for-service costs. |
| b. | from charitable organizations. |
| c. | paid for by entitlement programs. |
| d. | the responsibility of each state. |
ANS: A
Before the involvement of the federal government in health care financing in the 1990s, physicians (and health care facilities) charged a fee for services, which was generally paid for either out of pocket by the individual or by private health insurance companies.
There has always been some charitable health care, but this has not been the primary method of payment.
Entitlement programs, such as Medicare, cover health care expenses for certain designated groups.
States are involved in some health care financing but certainly not the majority of it.
DIF: Cognitive Level: Remember REF: 89
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse studying the intersection of politics and health care describes the relationship best by saying that
| a. | hiring lobbyists is the most effective way to communicate ideas. |
| b. | only national organizations really have a voice in health care. |
| c. | politics provides a means for differing voices to be heard. |
| d. | voting in elections is the primary way to influence policy. |
ANS: C
Through the political process, individuals, groups, agencies, and government entities have a voice in developing our health care system via regulations, establishing outcomes, and developing policy.
Lobbyists can be an effective tool, but they are expensive, and in the case of issues that are very popular with the general public, they may not be necessary at all.
Everyone has a voice in our national health care system.
There are multiple avenues for influencing health care policy; voting is one but is not necessarily the primary method.
DIF: Cognitive Level: Apply TOP: Integrated Process: Teaching/Learning
MSC: NCLEX Client Needs: N/A
- A politically savvy nurse is explaining to co-workers that a plank in a political party’s platform refers to the
| a. | documents that will be voted on. |
| b. | financing arm of the convention. |
| c. | party’s stand on specific issues. |
| d. | supporters of various programs. |
ANS: C
The party’s stands on specific issues are called planks, which come together to form a platform, which represents the consensus of party delegates on specific issues of importance to the party leaders.
The party votes on issues during the political conventions, which then become the basis of arguments made during a political race.
The financing means of the convention is not known as a plank.
The supporters of various programs are not known as planks.
DIF: Cognitive Level: Understand REF: 90
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- Today’s nurse understands that the mission of political action committees (PACs) has changed over the years to become more
| a. | invested in social and corporate agendas. |
| b. | involved at the state rather than the national level. |
| c. | fiscally responsible to the general population. |
| d. | responsive to needs of underserved groups. |
ANS: A
Originally intended to represent traditionally underrepresented groups, PACs now typically represent particular groups interested in specific issues.
PACs are active at both the national and state levels.
The lack of transparency in financial matters related to politics and to PACs has led to grass-roots advocacy regarding inappropriate financing.
Being responsive to needs of underserved groups was the original mission of PACs, but this has evolved to include specific groups of people with specific interests.
DIF: Cognitive Level: Understand REF: 90 | 92
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse wishing to give money to a national political party without designating it for a specific purpose is donating what is called __________ money.
| a. | hard |
| b. | soft |
| c. | unencumbered |
| d. | unrestricted |
ANS: B
Soft money is money donated to a national political party without a designated purpose.
Hard money is given to specific campaigns.
The term unencumbered money was not discussed in the chapter.
The term unrestricted money was not discussed in the chapter.
DIF: Cognitive Level: Remember REF: 92
TOP: Integrated or Nursing Process: N/A MSC: NCLEX Client Needs: N/A
- A nurse wishes to encourage people to vote and energize those who feel strongly about a particular political issue. The nurse would best accomplish this by
| a. | donating money to a political action committee (PAC). |
| b. | joining the office staff of an involved lobbyist. |
| c. | serving on a national candidate’s platform staff. |
| d. | volunteering for a related 527 political group. |
ANS: D
A 527 political group is usually involved in voter mobilization, issue advocacy, and other political activities that do not call for endorsing a particular candidate.
PACs typically work to raise money, assist in campaigns, and lobby on behalf of special interest groups.
Lobbyists work for special interest groups, often as part of a PAC.
Serving on the platform staff or on a convention staff would not be involved with “get out the vote” campaigns.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- An elected member of Congress wishes to arrange discussion of a new bill related to heart disease during February, which has been declared National Heart Month. Which action by the legislator would most likely lead to this happening as desired?
| a. | Arrange the dates for discussion with the party whip’s secretary. |
| b. | Hire a lobbyist to present the proposed bill and timeline for debate. |
| c. | Meet with the appropriate committee chairperson to make the request. |
| d. | Reserve rooms in chambers for public discussion and debate on the issue. |
ANS: C
Committee chairpersons develop the calendar for discussion of issues; this would be the appropriate avenue for this idea.
The party whip is the minority leader and does not set the agenda.
A lobbyist might be very helpful in getting bills passed, but the lobbyist would most likely not have any influence on the timing of debate.
Public discussion is not the same thing as legislative debate.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- A bill has passed both Houses. Before it gets sent to the president, it must be
| a. | approved by appropriate party chairs. |
| b. | fully financed with appropriations. |
| c. | registered as a pending law to sign. |
| d. | resolved in conference committee. |
ANS: D
After both Houses pass their version of a bill, a conference committee works on the bill to resolve any differences between the two versions that passed.
After a bill passes in both Houses, it does not go to the party chairs. The party chairs run the political party; the committee chairs set the legislative agenda.
Bills may be passed fully, partially, or not funded at all.
Bills that have passed do not need to be registered anywhere as pending laws.
DIF: Cognitive Level: Remember REF: 95
TOP: Integrated or Nursing Process: N/A MSC: NCLEX Client Needs: N/A
- A nurse wants to see a bill passed that includes an increase in federal income taxes to fund it. A friend should encourage the nurse to
| a. | call the appropriate committee members. |
| b. | provide information to the party secretary. |
| c. | send a petition to the nurse’s representative. |
| d. | write a letter to the nurse’s senator. |
ANS: C
This answer is correct because all bills that call for increases in federal income tax must originate in the House of Representatives, and the nurse’s representative could direct the petition or the nurse to the appropriate chairperson.
Committees can send forward ideas for bills, but only the House of Representatives can originate bills that call for increases in federal income tax.
The party secretary would not be the appropriate place to send this request because bills that call for increases in federal income tax must originate in the House of Representatives.
The Senate cannot originate bills that call for increases in federal income tax.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- A nurse is worried about an upcoming judicial appointment. A co-worker explains that the nurse can voice opinions about such matters best by
| a. | calling the majority party’s leadership. |
| b. | phoning the nurse’s House member. |
| c. | sending a petition to the president. |
| d. | writing to the senator from that state. |
ANS: D
The Senate has the primary responsibility for such political appointments as judges, ambassadors, the surgeon general, cabinet members, and federal agency directors. The nurse should write (or call) the senators from his or her state.
The majority party’s leadership would not necessarily be involved in a judicial appointment.
The House of Representatives does not have primary responsibility for judicial appointments.
The president nominates people for judicial appointments but does not get them appointed.
DIF: Cognitive Level: Apply TOP: Integrated Process: Teaching/Learning
MSC: NCLEX Client Needs: N/A
- A nursing manager is concerned about staffing levels and their impact on patient safety. What action by the nurse would have the best chance of influencing this issue?
| a. | Call senators from the state, explaining the need for staffing laws. |
| b. | Donate money to the American Nurses Association for lobbying. |
| c. | Organize a petition drive calling for a city ordinance on staffing. |
| d. | Work with the state nurses association on related state legislation. |
ANS: D
The nurse should work with the state nurses association in that state because state legislatures typically are the level of government to regulate nursing working environments, including staffing levels.
Mandatory staffing issues are typically taken up at the state level.
The American Nurses Association is a strong force to join, but staffing levels are typically mandated at the state level.
A city ordinance would not be an effective way to ensure safe staffing levels.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Communication and Documentation
MSC: NCLEX Client Needs: Safe and Effective Care Environment: Management of Care
- Bills that include funding requests are known as __________ bills.
| a. | authorization |
| b. | finalized |
| c. | funded |
| d. | supplemental |
ANS: A
Bills that contain requests for funding are known as authorization bills.
A finalized bill might be one that has passed both houses and has been resolved in conference committee, but the chapter does not discuss finalized bills.
A program or mandate gets its funding via authorization bills.
A supplemental bill might be used to provide funding for emergencies that were not anticipated and therefore not funded.
DIF: Cognitive Level: Remember REF: 97
TOP: Integrated or Nursing Process: N/A MSC: NCLEX Client Needs: N/A
- A congresswoman is explaining that she occasionally votes for bills that need, but do not contain, provisions for funding because
| a. | appropriations bills are usually considered in specific years. |
| b. | once the bill has passed, it is often easier to find funding for it. |
| c. | she can support the cause without having to find money for it. |
| d. | there isn’t enough money left in the budget for some issues. |
ANS: C
Congressional representatives often vote for bills that do not contain funding so they can be seen as supporting the cause without having to provide funding.
Authorization bills for funding programs, if present, usually pass around the time the original bill passed, and the first authorization bill for a program is often named for the program it funds.
Bills are not usually passed in the hope that funding can be found at a later date.
It certainly may be true that there is not enough money left in the budget, but it is not the reason that this is done as a practice.
DIF: Cognitive Level: Understand REF: 97
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- A voter is angry that his or her congressman voted for a bill that contained an amendment unrelated to the bill without knowing about the amendment. The congressman explains that this occurs because
| a. | aides do not have time to fully read bills and inform congressional members. |
| b. | amendments sometimes are added at the last minute. |
| c. | representatives do not get copies of full bills before they vote on them. |
| d. | there simply is not enough time to understand each bill. |
ANS: B
Amendments are sometimes added at the last minute in order to get a specific congressional member to vote for the bill. Other legislators may not be aware of the addition of such “pork barrel” legislation to the bill and may vote for (or against) the bill without knowing that they are voting on specific projects.
Aides do read bills and give reports to their congressional members, but members should not rely totally on the aides to understand bills.
Representatives do get the bills before voting on them; however, to gain the vote of specific congressional members, “pork barrel” legislation (for special “pet” projects) is often added to the bill at the last moment (and some members may not be aware of this).
Congressional members should take the time to fully understand the contents of each bill before voting.
DIF: Cognitive Level: Understand REF: 98
TOP: Integrated or Nursing Process: N/A MSC: NCLEX Client Needs: N/A
- A nurse does not understand why the U.S. Department of Health and Human Services (USDHHS) cannot allocate more money for public health efforts. Another nurse explains that money for public health and other expenditures is limited because the majority of the USDHHS budget must fund
| a. | any program deemed in need of funding. |
| b. | initiatives according to Healthy People 2020. |
| c. | Medicare and other legislated programs. |
| d. | United Nations health and wellness plans. |
ANS: C
About two thirds of the budget of the USDHHS goes to fund Medicare and other entitlement programs, leaving a minority of funds for other items.
Only about one third of USDHHS’s budget is discretionary; the remainder goes to fund other legislated programs.
Healthy People 2020 does focus on the health care priorities of the nation, but budgetary expenditures from USDHHS for these initiatives are limited because of fixed spending on entitlements.
The USDHHS budget does not fund United Nations plans.
DIF: Cognitive Level: Understand REF: 99
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse understands that the first major government involvement in health care occurred with passage of the __________ Act.
| a. | Brady |
| b. | Hill-Burton |
| c. | Nurse Reinvestment |
| d. | Social Security |
ANS: D
The Social Security Act of 1935 was the first incursion of the federal government in health care and provided grants to the states for specific health programs.
The Brady Act (1993) concerned gun control and the prevention of handgun violence.
The Hill-Burton Act (1946) concerned building hospitals and improving their physical capabilities.
The Nurse Reinvestment Act (2008) is a training act funded as a discretionary health care expenditure.
DIF: Cognitive Level: Remember REF: 99
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse is confused because a federal agency does not seem to be providing services according to the law. Another nurse explains that this can happen because
| a. | agencies do not work under any specific federal laws. |
| b. | agency interpretation is needed to implement the law. |
| c. | not all government agencies fall under specific laws. |
| d. | there is considerable infighting among different agencies. |
ANS: B
Agencies are charged with implementation of law according to their interpretation of the intent of the law, and agencies can change their procedures without revising the original law. Often, interpretation—and, hence, action—varies according to the personnel at the agency.
Agencies do work that falls under their jurisdiction according to law, whether that is at the state or federal level.
All government agencies fall under the auspices of some law.
Agencies have specific established functions and so would not be fighting among themselves over how each agency should do its job.
DIF: Cognitive Level: Understand REF: 99
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse working for a governmental agency is charged with establishing evaluation plans for the programs the agency oversees. To show the agency is meeting health-related objectives, the nurse would most likely compare the agency’s outcomes to
| a. | benchmarks for health care at the local level. |
| b. | budget guidelines imposed by Congress. |
| c. | goals established in Healthy People 2020. |
| d. | taxpayer satisfaction with health programs. |
ANS: C
Healthy People is a blueprint to the nation’s health, and many funding decisions are based on attempting to meet targets set forth in this document.
A federal agency would most likely look to national, not local, benchmarks when evaluating specific programs.
Staying within budget guidelines is important, but this does not give information about how well an agency is meeting health-related objectives.
Taxpayer satisfaction is certainly an important issue, but this would not allow evaluation on whether or not health-related goals have been met.
DIF: Cognitive Level: Evaluate TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs: N/A
- A nursing dean wishes to establish a center to study the feasibility of creating a curriculum based on community-based nursing. To acquire funding, the dean would most likely apply to the
| a. | National Institutes of Health. |
| b. | Pew Charitable Trusts. |
| c. | state board of nursing. |
| d. | Surgeon General’s office. |
ANS: B
The Pew Charitable Trusts is a philanthropic foundation that supplies grants for health care demonstration projects, research studies, and training and education of health care professionals.
The National Institutes of Health do provide funding for health-related projects, but most are research studies.
The state board of nursing is involved in regulation of nursing practice, not funding studies.
The Surgeon General’s office works to ensure health programs that affect the nation as a whole are effective.
DIF: Cognitive Level: Apply TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs: N/A
- An undergraduate nursing dean is expecting a site visit from the school’s accrediting agency. To ensure that the school meets the agency’s objectives for accreditation, it would be most important that the dean would assess whether course work provided opportunities for students in
| a. | different types of health care organizations and levels of care. |
| b. | mastering basic science concepts as they apply to nursing care. |
| c. | providing charitable care through nurse-run clinics and offices. |
| d. | working with community-based clients and regional health needs. |
ANS: D
The two agencies that accredit schools of nursing (the National League for Nursing Accreditation Commission and the Commission on Collegiate Nursing Education) require undergraduate nursing programs to tailor their curricula to local and regional health care needs. Having the ability to work within several different types of agencies providing multiple levels of care is a good skill but is not one of the specific requirements of the two accreditation agencies.
Students do need a mastery of basic science skills in order to advance to more sophisticated concepts, but this is not a specific requirement of the accreditation agencies.
Nurse-run clinics are an increasingly used method of providing care and educating students, but they are not a specific requirement of accreditation agencies.
DIF: Cognitive Level: Evaluate TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs: N/A
- A nurse has been investigating how health care policy is made and believes that the system is too complicated and difficult to navigate. Which statement best justifies this position? Health care policy is
| a. | created at many governmental levels and affected by multiple variables. |
| b. | enacted mostly by federal law, which requires compromise by both parties. |
| c. | funded by appropriations bills, making additional policies hard to enact. |
| d. | politicized with the current administration’s party views taking priority. |
ANS: A
Health care policy can be developed by federal or state law; by federal, state, or local rules and regulations; or by think tanks and philanthropic organizations. Policy is affected by funding decisions, public opinion, the economy, demographics, technology, and many other factors. This creates a system that is very complex and difficult for the average person to navigate.
Policy is not only enacted by federal law but can be enacted at the state level and created by agencies and organizations.
Funding does occur through appropriations bills, but this is not the reason the system is complicated.
This statement is true; however, this viewpoint is too narrow to explain the complexity of the entire system.
DIF: Cognitive Level: Analyze
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- A nurse is explaining to a co-worker that the Patient Self-Determination Act, the Ryan White Act, and the McKinney Homelessness Act are all examples of
| a. | bills that were passed without matching appropriations bills. |
| b. | health care policies and regulations created in the 1990s. |
| c. | laws that were enacted after involvement of philanthropies. |
| d. | the only times nurses will ever make differences in legislation. |
ANS: B
The 1990s were a very prolific time for health care laws and regulations. These bills were all passed during that decade.
The McKinney bill was partially funded, the Ryan White Act was a funding bill, and the chapter does not describe funding for the Patient Self-Determination Act.
Philanthropies may or may not have been instrumental in getting some of these bills passed; the chapter provides no information on this.
Nurses can make a difference in any legislation that is proposed, debated, or passed.
DIF: Cognitive Level: Understand REF: 105
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse is able to correlate Medicare regulations with which major trend in health care? Medicare has influenced decisions regarding
| a. | creation of policies related to genetic privacy acts. |
| b. | inclusion of women and children in research studies. |
| c. | purchasing prescription drugs from foreign countries. |
| d. | reimbursement through capitated cost agreements. |
ANS: D
Care provided under capitated costs are the major way in which health care is paid for by third parties and is a direct result of the diagnostic-related groups, which were the cost agreements negotiated under Medicare rules.
Genetic privacy is an issue, resulting in the Genetic Information Nondiscrimination Act of 2008, but this is not a major trend influenced by Medicare.
Inclusion of women and children into research studies has been a topic of national prominence lately, but it has not been influenced by Medicare regulations.
Medicare regulations have not required prescriptions to be purchased in foreign countries.
DIF: Cognitive Level: Apply TOP: Integrated Process: Teaching/Learning
MSC: NCLEX Client Needs: N/A
- A chief nursing officer (CNO) wishes to demonstrate to the community that the quality of nursing in his or her particular hospital meets or exceeds professional standards. The best method for demonstrating this would be for the CNO to
| a. | advertise nurse–patient ratios. |
| b. | apply for magnet hospital status. |
| c. | hire advanced practice nurses. |
| d. | publish complication rates. |
ANS: B
Applying for and receiving magnet hospital status from the American Nurses Association shows a facility meets or exceeds eight standards of care and can be used to publicize the quality of nursing services in that facility.
Advertising nurse–patient ratios would give the public some information about nursing quality, but many individuals would not understand the implications of specific nurse–patient ratios.
Hiring more advanced practice nurses would not specifically demonstrate that the hospital had met or exceeded professional standards.
Publishing complication rates for specific procedures or populations of patients would be valuable information to some consumers, but this often reflects medical care more than nursing care.
DIF: Cognitive Level: Apply TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs: N/A
- A nursing school dean is looking for external funding for an innovative program that recruits underemployed sectors of the workforce into nursing. Which action by the dean would most likely result in gaining external funding for this new program?
| a. | Apply for federal grants through the Department of Health and Human Services Bureau of Health Professions (DHHS BHP). |
| b. | Contact governmental agencies to gain scholarship money for specific students. |
| c. | Negotiate with a local hospital to sponsor, or fund, education for some students. |
| d. | Work with the Alumni Association to find corporate or individual sponsors. |
ANS: A
The largest source of external funding for nursing education is through the DHHS BHP. This funding is generally for programs, not individual students.
There are governmental agencies that provide some student scholarships; however, the question specifically asked about program funding.
Hospitals do sometimes sponsor students who are already employees of theirs, but this question asked about program funding.
Corporate or individual sponsors are important sources of funding for most institutions, but the largest source of external funding for nursing education is the federal government.
DIF: Cognitive Level: Apply TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs: N/A
- The nurse researcher explains to a co-worker that the priority in funding for research today is research studies that examine
| a. | effectiveness of care as evidenced by specified outcomes. |
| b. | how standards improve the cost effectiveness of therapies. |
| c. | if local standards of care measure up to national standards. |
| d. | ways to determine whether health disparities are being addressed. |
ANS: A
Outcomes research is a priority in health care research today. Meeting outcomes demonstrates effective and accountable practice and, in fact, is a required element of research.
Using standards of care may improve cost effectiveness of therapies, but determining this is not as important as determining whether care meets stated outcomes.
Local standards of care should, for the most part, be reflective of national standards.
Health disparities are important, especially as addressed in Healthy People 2010, but determining whether these had been addressed would be a form of outcomes research, which is too narrow in scope to be the correct answer.
DIF: Cognitive Level: Understand REF: 112
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
MULTIPLE RESPONSE
- An individual is an ardent supporter of a specific candidate in a federal election. This person wants to contribute $2800 to the candidate’s campaign. How can the individual make this kind of contribution? The individual can give (Select all that apply.)
| a. | $2600 to the candidate and $200 to the national party. |
| b. | all of it to the candidate of choice without restriction. |
| c. | half to the candidate and the other half to the national party. |
| d. | the entire amount to the national party without restriction. |
ANS: A, C, D
In 2013 and 2014, individuals were restricted to giving $2600 to an individual candidate and $32,400 to a national party, so this contribution would maximize the donation to the specific candidate and use the remainder toward a contribution to the national party.
A person can give up to $2600 to an individual candidate and up to $32,400 to a national party, so splitting it in half would be possible.
A person can make a donation of up to $32,400 to a national political party, so one option would be to give it all to the national party and assume that some of it is being used for the candidate the individual favors. This probably is not the best option, but it is a possible choice.
Because the individual restriction on donations to specific candidates is $2600, the person cannot give all of it to the particular candidate favored.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- A student nurse understands that state nurse practice acts delineate (Select all that apply.)
| a. | eligibility for licensure. |
| b. | national accreditation standards. |
| c. | required educational preparation. |
| d. | rules for members of compacts. |
| e. | scope of practice for nurses. |
ANS: A, C, E
Eligibility for licensure is explained in the individual state nurse practice acts.
The required educational preparation nurses must obtain is included in state nurse practice acts.
The scope of practice for nurses is outlined within each state’s nurse practice act.
Nursing students have to graduate from a program approved by the state board of nursing, but this program does not have to have national accreditation.
State compacts allow nurses who have licenses in one member state to practice nursing in the other member states without having to get another license. Rules for these compacts are not included in the state nurse practice acts. These compacts were developed by the National Council of State Boards of Nursing.
DIF: Cognitive Level: Understand REF: 108
TOP: Integrated Process: Teaching/Learning
MSC: NCLEX Client Needs: Safe and Effective Care Environment: Management of Care
- A nurse is concerned about an upcoming debate on a proposed state health care policy change. What actions can the nurse take in order to have his or her voice heard on this issue? (Select all that apply.)
| a. | Contact legislators by phone to express opinions. |
| b. | Encourage nursing experts to testify at hearings. |
| c. | Gather information and speak at the hearings. |
| d. | Run for election to governmental office. |
| e. | Write letters to supportive state representatives. |
ANS: A, B, C, E
Nurses have many avenues for becoming politically active and ensuring that their voices are heard. To influence the outcome of this proposed change, the nurse can contact legislators by phone, encourage experts to testify, speak at hearings, and write letters. Running for office will allow the nurse great political involvement but will not affect the outcome of a policy change soon to be debated.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Communication and Documentation
MSC: NCLEX Client Needs: Safe and Effective Care Environment: Management of Care
Chapter 07: Economic Issues in Nursing and Health Care
MULTIPLE CHOICE
- While studying health care economics, the nursing professor explains to a class that the economic principle of opportunity costs means that
| a. | economic decisions are based on the best opportunity that arises. |
| b. | free market failure occurs when efficient use of resources is lacking. |
| c. | satisfying one desire eliminates the possibility of satisfying another. |
| d. | we make our decisions based on opportunities to benefit others. |
ANS: C
Because resources spent on one set of desires cannot be used to satisfy other desires, decisions are made based on the value of what was not chosen. This is the principle of opportunity costs; in other words, what has acting on this one opportunity cost you?
Although we do make many decisions based on the best choices or opportunities that arise for us, this is not a complete or accurate description of the concept.
A lack of efficient use of resources contributes to market failure, not opportunity costs.
Making decisions to benefit others is not as common as making decisions based on self-interest.
DIF: Cognitive Level: Understand REF: 124 | Box 7-1
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- The nurse is explaining the American health care system to a patient from another country that has government-sponsored health care. The nurse would explain that one driving force for private insurance has been
| a. | consumer-driven markets demanding insurance. |
| b. | necessary rationing of scarce health care resources. |
| c. | the lack of government involvement in health care. |
| d. | uncertainty related to the need for medical care. |
ANS: D
Most health care needs, other than those for preventive care, occur in an unpredictable manner and are costly enough that people cannot typically save or borrow enough money to pay for them. This led to the rise of private insurance.
Private insurance was not created out of a demand from the consumer-driven marketplace. Rather, it was created from the uncertainty related to medical need.
Private insurance and the lack of private insurance have contributed to what is essentially rationing of health care resources (not the other way around). People who are uninsured or underinsured often do not get the care they need.
The federal government has been involved in health care at least since the 1960s.
DIF: Cognitive Level: Understand REF: 124
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A practicing nurse is interested in health care economics. To create an environment where health care more closely resembles the consumer market, this nurse would place high priority on activities revolving around
| a. | educating patients and families. |
| b. | exploring the costs of treatment. |
| c. | understanding payment options. |
| d. | using less expensive supplies. |
ANS: A
In the consumer market, consumers have knowledge that allows them to dictate conditions. In the health care market, “consumers” often have much less information on which to base decisions about what to “buy.” This violates a basic assumption of economics, so having more highly educated “consumers” would help to rebalance this situation.
All nurses should have a basic understanding of the costs of health care, but this in itself does not address a difference in general economics and the economics of health care.
Understanding payment options will not address a difference in general economics and the economics of health care.
Using less expensive supplies may be a good idea if quality is not sacrificed, but this does nothing to address a difference in general economics and the economics of health care.
DIF: Cognitive Level: Analyze TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs: N/A
- In trying to understand current problems in today’s health care environment, the nurse could reframe the discussion as a problem created by
| a. | competing interests of market and governmental forces. |
| b. | tension between for-profit and not-for-profit institutions. |
| c. | too many different agencies providing the same services. |
| d. | unchecked rises in providers’ salaries and fees for service. |
ANS: A
The U.S. health care system is a mix of market forces (based on equilibrium created through pricing mechanisms) and government entities (which should be based on egalitarian ideals). This mix of systems is primarily responsible for inequities in the health care system today.
There are both for- and not-for-profit organizations operating in health care today. Not-for-profit status is a tax designation; all entities must make enough profits to continue operating.
Redundancy in health care does exist, but it is not one of the root causes of its problems.
Unchecked rises in fees were part of the reason managed care came into being, but this is not broad enough to reframe an entire concept.
DIF: Cognitive Level: Analyze
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- A nurse is explaining Medicaid and Medicare to a patient and describes the biggest difference in the programs as being the
| a. | duration of benefits. |
| b. | health services provided. |
| c. | level of administration. |
| d. | waiting period for coverage. |
ANS: C
Whereas Medicare is purely a federal administered program, Medicaid programs are administered by individual states.
The duration of benefits is dependent on meeting the criteria for inclusion.
Both programs cover specified health services, and both do determine coverage for health care services (set at the state level for Medicaid and the federal level for Medicare), but this is not the biggest difference in the two programs.
The waiting period for coverage is not a major differentiator between the two programs.
DIF: Cognitive Level: Understand REF: 126
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse wishes to get a job in a large city with many hospitals from which to choose but is dismayed to learn that the wages for nurses are nearly as low in the city as in the rural area where the nurse lives. The nurse concludes that
| a. | city hospitals have agreed on wage levels for nurses. |
| b. | demand for nurses in the city is similar to the rural area. |
| c. | state government has mandated wage scales for nurses. |
| d. | the cost of living in the city is similar to the rural area. |
ANS: A
The situation of low wages and a nursing shortage is an economic contradiction. The model of monopsony describes a situation in which a market containing few hospitals will set a nurse’s wage according to the returns that the nurse brings to the organization; hence, in that organization, wages stay low despite a nursing shortage. In markets with more opportunities for nurses, wages are more competitive. In this situation, the nurse concludes that the city hospitals have created an artificial monopsony model by banding together to set wages for nurses contrary to market principles.
The relative demand might be the same, but the sheer number of hospitals in a city compared with a rural area would mean that there were more organizations competing for nurses, leading to higher wages.
Although it is possible for a state government to mandate wage scales for nurses, it is not probable.
Costs of living in the city and rural area might be comparable, but the larger number of hospitals in the city should equate to higher demand and therefore higher wages for nurses.
DIF: Cognitive Level: Synthesize TOP: Nursing Process: Analysis
MSC: NCLEX Client Needs: N/A
- A state nurses association has convinced hospitals in that state to offer very attractive wage and benefits packages to nurses. To determine whether this strategy is working to provide a long-term solution to the nursing shortage, the association would measure the
| a. | comparative RN vacancy rates before and after the change. |
| b. | hospitals’ use of agency personnel to fill nursing positions. |
| c. | number of students admitted to nursing schools in that state. |
| d. | percentage of nurses stating on a survey that they work second jobs. |
ANS: C
Wage increases can improve the nursing shortage by both short- and long-term methods. In the short term, nurses reenter the job market, work more hours, or add part-time nursing jobs. In the long term, the improved wages influence individuals in deciding to enter nursing school and join the profession.
An improvement of vacancy rates would show that the increased wages and benefits have had a short-term effect on the nursing shortage in that state.
Hospitals often use agency personnel to cope with nursing shortages, but this is a short-term solution.
Working a second nursing job would help alleviate the nursing shortage, but this is considered a short-term mechanism.
DIF: Cognitive Level: Evaluate TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs: N/A
- A chief nursing officer (CNO) is concerned about the ongoing nursing shortage and wants to implement strategies to keep it from getting worse. Which action by the CNO would best meet this goal?
| a. | Create a career ladder for registered nurses. |
| b. | Institute an across-the-board wage hike. |
| c. | Offer tuition reimbursement at area colleges. |
| d. | Provide perks, such as unit holiday parties. |
ANS: A
Organizational attributes, including workload, management style, and opportunity for promotion, all figure into nurses’ decisions to work. A career ladder provides a forum for promotion without competing for scarce management jobs.
An across-the-board wage hike may attract and keep nurses, but research demonstrates that opportunities for promotion are more important for entering or remaining in the workforce, so this is not the best answer.
Tuition reimbursement, similar to many other perks, may affect some nurses’ work decisions; however, a specific perk may not be relevant to specific nurses’ decisions about working.
Holiday parties can contribute to a collegial environment, but research shows that other organizations characteristics are more important, including the availability of promotion.
DIF: Cognitive Level: Apply TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs: N/A
- A nurse midwife has moved into town and wishes to establish a practice. Economically speaking, what could this nurse do that would best enhance her chances of establishing a successful practice?
| a. | Become affiliated with the busiest maternity group. |
| b. | Find a sponsor who will provide low-interest loans. |
| c. | Investigate the costs associated with physician care. |
| d. | Locate offices near a hospital that has a lot of births. |
ANS: C
Having costs that are lower than the competition will help bring in business according to the economic concept of substitutes. When two items or services are relatively equal in substance, an increase in the cost of one will drive up the demand for the other, which people will use as a substitute for the first item. By understanding the cost of physician care, this nurse can keep her prices low as the physicians raise theirs, leading patients to choose the midwife.
Becoming affiliated with the busiest maternity group would not be the best choice; in a large group, the midwife might not have any control of overhead costs or decisions about how the practice is run or what to charge patients.
Having low-interest loans will help the bottom line, but it would be more important to begin bringing in income.
Locating offices near a hospital that has a lot of births may not be possible, and it may not lead to a successful business anyway.
DIF: Cognitive Level: Apply TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs: N/A
- An insurance company’s internal statistics show that the company is losing a great deal of money processing small, frequent claims submitted by its customers. The company accountant suggests that the best way to decrease this loss is to
| a. | delay payment until the claims reach a set figure. |
| b. | educate customers on how much these claims cost. |
| c. | increase the deductible customers must satisfy. |
| d. | refuse to accept claims below a certain amount. |
ANS: C
Deductibles and co-payments are types of cost sharing used by most insurers. Deductibles are designed to persuade customers to make better decisions about care and to dissuade them from submitting small claims.
Delaying payment until the claims reach a set figure might serve to annoy customers, who then might choose another insurer. This approach might also cost more because someone would have to track the claims.
There probably is not an effective way to educate perhaps millions of customers enough to dissuade them from submitting claims for reimbursements or payments they are owed.
Refusing to accept claims below a certain amount would probably be an unpopular action, perhaps leading to customers switching insurance companies.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- A health care practice has changed its mix of patients and now accepts fewer self-paying and more insured patients. The office manager tells the staff to anticipate
| a. | caring for more-educated patients. |
| b. | offering expanded office hours and days. |
| c. | ordering more diagnostic tests. |
| d. | providing more preventive care. |
ANS: C
When consumers carry health insurance, they become insulated from the cost of medical care, and the demand for health care services increases.
Insured patients are not necessarily more-educated patients.
Having more insured patients does not necessarily translate into the need for expanded hours and days of operation.
Insured patients generally demand more health care services of all types, not just preventive care.
DIF: Cognitive Level: Synthesize
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- A nurse economist is explaining to a class that the health care market exists in a state of “market failure” because
| a. | complex variables prevent a consensus on health care “production.” |
| b. | health care fails to meet the needs of its customers and consumers. |
| c. | more health care practices are failing economically in this market. |
| d. | practices suffer as their investments in the stock market fail to grow. |
ANS: A
The economics of health care are unlike any other business sector. Demand for health care is not directly related to the quality and availability of services. Incomplete information by “consumers” and uncertainty related to the need for future health care result in a situation in which society cannot agree on an acceptable level of “output.” This is known as market failure.
It can be argued that health care today is not meeting demands, but this is unrelated to the concept of market failure.
It may be true that more health care practices are failing economically in this market, but it is not related to the concept of market failure.
Investment in the stock market is not related to market failure.
DIF: Cognitive Level: Understand REF: 134
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- The student nurse know that employer-sponsored health insurance was
| a. | a new idea for health care financing invented after World War II. |
| b. | created by the federal government to stimulate the economy. |
| c. | never envisioned as being a permanent part of the health care arena. |
| d. | originally a way to increase revenue for doctors and hospitals. |
ANS: D
During the Depression, doctors and hospitals saw their revenue decline because people were not able to pay for health care. The American Hospital Association created Blue Cross of California in 1939 with the intent of securing income.
Employer-sponsored health insurance came into existence during the Great Depression.
The federal government did not create employer-sponsored insurance plans.
Employer-sponsored insurance was not created as a temporary solution.
DIF: Cognitive Level: Remember REF: 135
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- At a rally for better health care coverage, a nurse hears someone say that government-sponsored health programs are inherently unfair. What statement best justifies this position?
| a. | Government-sponsored plans have no system of ensuring accountability. |
| b. | Taxes should not be used for anything other than running the government. |
| c. | The people who pay the most in taxes often get the fewest benefits. |
| d. | There are no tax deductions for the contributions made to the plans. |
ANS: C
Whereas healthy, middle-income people often pay more in taxes than they receive in benefits, the less affluent usually pay less than the value of the health care services they receive.
Government activities have the ultimate accountability: the vote.
Many people argue that taxes should not be used for anything other than running the government, but this does not get at the equity debate. In fact, if the government were not somehow involved in health care financing, there would be less equity because many individuals would have no way of paying for needed health care.
Social security taxes are not deductible, but this affects everyone equally.
DIF: Cognitive Level: Evaluate
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- A nursing manager wants to be involved in activities that would systematically improve quality care. The manager would best accomplish this by
| a. | ensuring that temporary agency nurses fill open positions. |
| b. | hiring only baccalaureate-prepared nurses on that unit. |
| c. | preparing cost estimates for a new telemetry system. |
| d. | teaching nurses on the unit to use positive conflict-resolution skills. |
ANS: C
Nurse managers are involved in quality improvement activities in two ways: by creating a culture that is supportive of quality improvement and by making business cases for investments in technology and structural changes. By preparing a cost analysis for a new telemetry unit, this nurse manager is participating in systemic quality improvement.
Filling open positions is important to maintain quality in the hospital, but using temporary agency nurses is working from a crisis mode and not working toward long-term quality improvement.
Policy groups do recommend a higher proportion of BSN-prepared nurses on staffs. However, this does not guarantee improved quality.
Conflict-resolution skills are a great asset, but this does not address quality improvement.
DIF: Cognitive Level: Apply TOP: Nursing Process: Application
MSC: NCLEX Client Needs: Safe and Effective Care Environment: Management of Care
- A chief nursing officer (CNO) wants to respond to a threatened reduction in nursing positions in a hospital where financial conditions are poor. Which action by the CNO would be best?
| a. | Compare nurse–patient ratios nationwide, describing the impact of layoffs. |
| b. | Hire a lobbyist to put political pressure on the hospital’s administration. |
| c. | Prepare a cost–benefit analysis of the effect of nursing care in that hospital. |
| d. | Use a cost-minimization strategy to show how nursing costs can decrease. |
ANS: C
A cost–benefit analysis is a powerful tool for justifying investments into nursing care.
A nationwide comparison of nurse–patient ratios might yield important information, but information that is national in scope is easily dismissed as “someone else’s problem” and might not convince administrators of the value of nursing care in this hospital.
Hospital administrators are not elected to their positions, so political pressure probably would not garner the desired results.
Cost-minimization strategies are rarely useful in health care settings because of the variability in interventions and outcomes.
DIF: Cognitive Level: Apply TOP: Nursing Process: Application
MSC: NCLEX Client Needs: Safe and Effective Care Environment: Management of Care
- A nurse performing a technology assessment understands that the results of the assessment will be used to
| a. | compare different brands of equipment. |
| b. | determine whether up-to-date items are being used. |
| c. | distribute technology evenly across units. |
| d. | make decisions on resource allocation. |
ANS: D
Technology assessments are used to look at safety, effectiveness, and costs associated with technology, with the final outcome being decisions on resource allocation.
A technology assessment is not used to compare different brands of equipment.
A technology assessment does not evaluate equipment for its currentness.
The technology assessment findings would not be used to distribute technology evenly across units.
DIF: Cognitive Level: Understand REF: 144
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs: Safe and Effective Care Environment: Management of Care
- The nurse studying health care economics understands that a system that valued attaining competitive advantage as its primary goal would be classified as operating in the model of _____-sum competition.
| a. | negative |
| b. | normative |
| c. | positive |
| d. | zero |
ANS: D
Zero-sum competition is associated with profit maximization. In health care, this is done via limiting resources dedicated to patient care.
Negative-sum competition is not an economic model.
Normative-sum competition is not an economic model.
Positive-sum competition creates value as its central goal.
DIF: Cognitive Level: Remember REF: 146
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse economist is explaining the principle of stakeholder cooperation as part of positive-sum competition to students. The student who understands this concept would paraphrase the concept as
| a. | encouraging stakeholders to cooperate to allow continuous change. |
| b. | giving stakeholders options in design and output of the system. |
| c. | many entities working together to satisfy each group’s needs. |
| d. | valuing each stakeholder’s contribution to the system’s creativity. |
ANS: C
The principle of stakeholder cooperation says that over the long run, the interests of each group must be satisfied by the organization, and mutual support from all entities is needed for this to happen.
Encouraging stakeholders to cooperate to allow continuous change corresponds to the principle of continuous creation.
Giving stakeholders options in design and output of the system more closely relates to the principle of emergent competition.
The principle of continuous creation states that entities cooperate with each other to create change and value.
DIF: Cognitive Level: Understand REF: 147
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse realizes that nurse-run clinics demonstrate increasing economic value in nursing because they
| a. | allow these nurses to set their own salaries. |
| b. | create value by filling unmet health needs. |
| c. | focus on nurses’ economic competitiveness. |
| d. | provide new job opportunities for nurses. |
ANS: B
Based on the principles of stakeholder cooperation and emergent competition, nurse-run clinics are an example of increased economic value in nursing, because they fill an unmet need.
Setting one’s own wage or salary is definitely a perk, but this does not provide evidence of economic value.
Economic competitiveness implies winners and losers and does not show system-wide value.
Nurse-run clinics are a source of new job opportunities for nursing, but this is not related to demonstrating economic value.
DIF: Cognitive Level: Remember REF: 148
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A student is discussing the impact of magnet hospitals as an example of positive-sum competition. The student would best describe magnet hospitals’ contribution to this model as
| a. | a workplace culture encouraging collegiality balanced with autonomy for best care. |
| b. | having a positive-sum revenue stream using technologically advanced practice. |
| c. | providing a quantitative analysis of the value of nursing care to stakeholders. |
| d. | having the ability to compete within the health care marketplace in a positive manner. |
ANS: A
Magnet hospitals are an example of positive-sum competition because their leadership philosophy stresses developing cultures and systems that promote clinical excellence through collegiality, autonomy, and excellent performance.
A positive-sum revenue stream is not related to positive-sum competition.
Analyses of the value of nursing care are not a component of positive-sum competition.
Although it might be true that magnet hospitals contribute to the ability to compete within the health care marketplace in a positive manner, this is a very vague benefit and does not get to the heart of the characteristics making up an organization that values positive-sum competition.
DIF: Cognitive Level: Understand REF: 147
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- An economist explains that consumerism is not a preferred mechanism for the health care market because of the
| a. | ethical viewpoint that equal access to health care is a universal human right. |
| b. | inability of most people to save for or borrow enough money to pay for care. |
| c. | trend for prices of health care goods and services that continue to skyrocket. |
| d. | variability in people’s ability to articulate current and future health care needs. |
ANS: D
The inability to predict future health care needs, the difficulties undereducated people have in negotiating the complex health care system, and the information imbalance make it very difficult for people to articulate their needs, and consumerism is based on being able to demand when and how people want health care services delivered.
People disagree as to whether or not health care is a universal human right, but consumerism says that people should dictate when and how they want health care services, not whether or not it is a right.
It is true that people cannot generally save or borrow enough money to pay for expensive health care, but this is not related to consumerism because of the advent of insurance, which guarantees continuing payment for services.
Prices and salaries and wages do continue to rise, but this does not explain why consumerism is not a good model for health care.
DIF: Cognitive Level: Understand REF: 148
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A patient who returns to the emergency department 2 days after being seen is feeling no better. On assessing the patient, the nurse learns that the antibiotic prescription the patient left with has not been filled. Which question or statement by the nurse would elicit the most information about this situation?
| a. | “I’d like to know why you haven’t gotten that filled.” |
| b. | “Is that medicine too expensive for you to get filled?” |
| c. | “Please tell me about the type of insurance you have.” |
| d. | “Why haven’t you gotten that prescription filled yet?” |
ANS: C
In a recent survey sponsored by the Kaiser Family Foundation, 33% reported relying on home remedies and over-the-counter drugs rather than visiting a doctor, and 28% postponed necessary care. Seventeen percent reported experiencing serious financial problems because of family medical bills. Seven percent reported being unable to pay for basic necessities such as food, heat, or housing because of health care costs. Forty percent reported being “very worried” about having to pay more for their health care or health insurance. The nurse should assess insurance status using open-ended statements.
Although the nurse is interested in why the prescription has not been filled, the goal is not to sound accusing.
“Is that medicine too expensive for you to get filled?” is a yes/no question that will elicit only a limited amount of information.
“Why” questions frequently promote defensive responses and are not the best choice for asking about sensitive information.
DIF: Cognitive Level: Apply TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs: N/A
- A nurse is lobbying for a bill to allow more third-party reimbursement for expanded nursing roles, such as those in retail clinics. To best make the argument for expanded reimbursement, the nurse should provide data on
| a. | how many other countries have similar reimbursement. |
| b. | marketing to increase expanded community nursing roles. |
| c. | quality, cost effectiveness, and need for these services. |
| d. | patient dissatisfaction with traditional medical practices. |
ANS: C
Nurses need to demonstrate the quality, cost effectiveness, and need for services in justifying their current and future roles and benefits of third-party reimbursement for care.
Global trends may be of interest, but this would not be the most important information to provide.
A marketing plan would not help make the argument for expanding third-party reimbursement.
Patient dissatisfaction with traditional medical practices might be part of the data set, but focusing on this would not be the best method of demonstrating the need for third-party reimbursement.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Communication and Documentation MSC: NCLEX Client Needs: N/A
- The Director of Nursing (DON) at a large urban hospital is tasked with increasing the hospital’s profits and improving quality. What action by the DON is best?
| a. | Engage in monopsony with regional hospitals. |
| b. | Hire more nonprofessional ancillary staff. |
| c. | Implement policies to prevent hospital-acquired infections. |
| d. | Purchase capital budget items only when necessary. |
ANS: C
The provisions of the Affordable Care Act encourage quality improvement through the development of reliable quality measurements and enforcing accountability. Specifically, the Act reduces payments to hospitals with 25th percentile or higher rate of hospital-acquired infections. To avoid losing that money and to show quality, the DON would implement policies that are designed to prevent hospital-acquired infections. Monopsony is the practice of hospitals setting nurses’ wages to maximize profits. This does not ensure quality. Hiring more nonprofessional staff may save money but does not improve quality. Purchasing capital budget items only when necessary may be a sound financial strategy but may have a deleterious effect on quality. The only option to both improve profit and quality is to prevent hospital-acquired infections.
DIF: Cognitive Level: Apply TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
- The student studying health care economics knows that this includes (Select all that apply.)
| a. | capital inputs. |
| b. | diagnostic equipment. |
| c. | medical supplies. |
| d. | patients. |
| e. | personnel. |
ANS: A, B, C, E
Capital inputs, including items such as hospitals, nursing homes, and medical equipment, are included in health care resources.
Diagnostic equipment falls under capital inputs and, as such, is part of health care resources.
Medical supplies, such as gloves, linens, and pharmaceuticals, are part of health care resources.
Personnel are included as a category within the health care resources.
Patients are not included in the list of items in the health care system as defined by economists.
DIF: Cognitive Level: Remember REF: 123
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A faculty member explains to a class of nursing students that Medicare (Select all that apply.)
| a. | covers children younger than 18 years of age. |
| b. | covers persons older than 65 years of age. |
| c. | helps pay for medications. |
| d. | includes some chronic disability. |
| e. | is a federal insurance program. |
ANS: B, D, E
Medicare is for those older than 65 years of age.
Medicare Part D does cover prescription drugs, but the supplement must be purchased; it is not automatically included in Medicare coverage.
Other populations covered by Medicare include those with selected severe and chronic disabilities.
Medicare is administered by the federal government.
Medicare is for those older than 65 years of age.
DIF: Cognitive Level: Remember REF: 126
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse working in a retail clinic correctly describes the practice environment as (Select all that apply.)
| a. | incorporating retail items. |
| b. | limited to wealthier patients. |
| c. | located in retail facilities. |
| d. | providing limited services. |
| e. | staffed by physicians. |
ANS: C, D
Retail clinics got their name from the fact that they are located in retail outlets such as drug stores or grocery stores.
Retail clinics provide limited acute and preventive services.
Retail clinics are so named because they are located in retail outlets, not because they sell items.
Retail clinics are increasingly viewed as a safety net for patients underserved by traditional practices.
Retail clinics are staffed by advanced practice nurses or physician assistants.
DIF: Cognitive Level: Understand REF: 132
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A nurse is evaluating an economic analysis paper. In critiquing the analysis, the nurse should note whether it (Select all that apply.)
| a. | considers from whose viewpoint the analysis is being considered. |
| b. | demonstrates that the interventions discussed are clinically effective. |
| c. | determines whether the analysis was based on a clearly defined question. |
| d. | includes a description of the type of analysis performed. |
| e. | evaluates interventions that can be performed in all practice settings. |
ANS: A, B, C, D
Determining the viewpoint from which the analysis is written can give information as to possible biases.
An analysis of interventions that are not all effective produces a skewed report.
To be useful, there has to be a defined and clear clinical question that drove the analysis.
To fully critique an analysis, the nurse needs to know the type of analysis performed as well as its appropriateness to this study.
To be valid, the interventions have to be sensible and workable in the specific practice setting. Comparing interventions that don’t work across all practice settings would not give the person reading the report useful information about the quality of the report.
DIF: Cognitive Level: Evaluate TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs: N/A
- The student learning about the Affordable Care Act (ACA) understands the three entities that were created to oversee and evaluate the quality of care and cost of the health care system. Which entities are involved in this process? (Select all that apply.)
| a. | Center for Medicare and Medicaid Innovation |
| b. | Centers for Medicare and Medicaid Services |
| c. | Children’s Health Insurance Program |
| d. | Patient-Centered Outcomes Research Institute |
| e. | The Independent Payment Advisory Board |
ANS: A, D, E
The ACA established three entities to oversee and evaluate the quality of care and cost of health care. They include the Center for Medicare and Medicaid Innovation, The Patient-Centered Outcomes Research Institute, and the Independent Payment Advisory Board. The Centers for Medicare and Medicaid Services and the Children’s Health Insurance Program are not included in this list.
DIF: Cognitive Level: Remember REF: 149
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
- A student is explaining the Health Insurance Marketplace to a relative. What information does the student provide? (Select all that apply.)
| a. | Available at both the state and federal levels |
| b. | Publishes quality-related data for insurers |
| c. | Provides information on types of insurance available |
| d. | Shows consumers if they are eligible for subsidies |
| e. | Penalties for the noninsured are set by the Centers for Medicare and Medicaid |
ANS: A, B, D
Health Exchanges, or the Health Insurance Marketplace, is available at both the state and federal levels, provides consumers with information on insurance options, and allows consumers to determine if they are eligible for subsidies. It does not publish quality data. Penalties for not being insured are set by the Internal Revenue Service.
DIF: Cognitive Level: Understand REF: 149
TOP: Integrated Process: Teaching/Learning MSC: NCLEX Client Needs: N/A
