Leadership And Management Nurses Core Competencies 3rd Edition By Finkelman – Test Bank

Complete Test Bank With Answers

 

 

Sample Questions Posted Below

 

 

Chapter 5

Question 1

Type: MCMA

Choose the options that are examples of the microlevel view of healthcare finance.

Standard Text: Select all that apply.

1. Capitation

2. Managed care organization

3. Diagnostic-related groups

4. Budgeting

5. Cost center

Correct Answer: 4,5

Rationale 1: This is a concept that pertains to the global issues of finance, not the individual organization’s finances, so this is a macrolevel issue.

Rationale 2: This is a concept that pertains to the global issues of finance, not the individual organization’s finances, so this is a macrolevel issue.

Rationale 3: This is a concept that pertains to the global issues of finance, not the individual organization’s finances, so this is a macrolevel issue.

Rationale 4: Budgeting is an example of microlevel finance since it pertains to the organization.

Rationale 5: A cost unit is the smallest functional unit that can be identified for cost control and accountability. This is an example of microlevel finance.

Global Rationale: NA

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 01. Distinguish between the macrolevel and microlevel view of healthcare economics.

Page: pp. 120, 146

Question 2

Type: MCMA

Which statements regarding United States national healthcare expenditures should be included in a classroom discussion of the topic?

Standard Text: Select all that apply.

1. The largest portion of healthcare expenditures is found in non-hospital services.

2. Healthcare reimbursement in the United States occurs via a pluralistic payment system.

3. Pharmaceuticals and medical supplies do not necessarily affect national healthcare expenditures.

4. The cost of premiums for employer-based health insurance continues to grow.

5. The average employee contribution to company-provided health insurance is increasing.

Correct Answer: 4,5

Rationale 1: The largest portion of healthcare expenditures is found in the hospital industry, despite the fact that there is a decrease in length of stay and increasing use of non-hospital services.

Rationale 2: Healthcare reimbursement in the United States is complex, with many players and motivations, and a long history of change.

Rationale 3: The healthcare industry’s financial issues affect all aspects of provision of care, including drugs and medical supplies.

Rationale 4: These premiums are increasing for all sizes of companies providing coverage.

Rationale 5: This contribution continues to rise as the premiums charged to the employer rise.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 03. Discuss critical issues related to current national healthcare expenditures.

Page: p. 120

Question 3

Type: MCMA

Which statements, made by a nursing student, would the faculty interpret as a good understanding of the role of third-party payers in healthcare financing?

Standard Text: Select all that apply.

1. Third-party payers have the power to influence care and reimbursement.

2. Third-party payers manage or administer the pool of money from individuals who decide to join an insurance plan.

3. Third-party payers carry all the financial risk for healthcare.

4. Third-party payers pay or underwrite coverage for healthcare for another entity.

5. Third-party payers use reimbursement strategies primarily aimed at reducing the financial risk.

Correct Answer: 1,2,4,5

Rationale 1: This is a true statement regarding the third-party payer system. This power can be misused or can be misinterpreted by the insured.

Rationale 2: When individuals decide to join an insurance plan, they put a specific amount of money into the pool or the insurance fund. The third-party payer is responsible for managing and administering this money.

Rationale 3: The financial risk for healthcare is carried by the patients, the providers, and the third-party payers.

Rationale 4: The third-party payer is the organization that pays or underwrites coverage for healthcare for another business or entity.

Rationale 5: These strategies have been developed for this very purpose.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 03. Describe the role of the third-party payer.

Page: p. 124

Question 4

Type: MCSA

Which payment method offers to pay the provider a specific percentage of the provider’s usual charge?

1. Discounted fee-for-service

2. Per diem rates

3. Diagnosis-related groups

4. Capitation

Correct Answer: 1

Rationale 1: Discounted fee-for-service is a payment method that offers to pay the provider a specific percentage of the provider’s usual charge, or a reduced rate.

Rationale 2: A per diem rate is reimbursement that is fixed, based on each day in a healthcare facility.

Rationale 3: DRGs are a statistical prospective payment system that classifies care or diagnoses into groups that then are used to identify payment rates.

Rationale 4: Capitation is a prepayment to a provider to deliver healthcare services to enrollees of a health plan.

Global Rationale: NA

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 04. Explain how healthcare insurance is financed and by whom.

Page: p. 126

Question 5

Type: MCSA

Which statement best describes the impact diagnosis-related-groups (DRGs) have on the healthcare system?

1. Coordination of all aspects of care has become less critical with this system.

2. The focus has changed from how much it costs to provide the care required to how much a provider will be paid.

3. This system requires nurses to document care accurately.

4. Hospitals face a strong financial incentive to reduce the length of stay and minimize procedures performed.

Correct Answer: 4

Rationale 1: Coordination of all aspects of care is critical with this system of reimbursement in order to meet length of stay requirements for a specific DRG.

Rationale 2: The focus has changed from how much a provider will be paid to how much it costs to provide the care required.

Rationale 3: It is important that this documentation provide the information required to assign the DRG to a specific patient. However, this is not the best description of the impact that DRGs have had on healthcare.

Rationale 4: DRGs are a per-stay reimbursement structure, and when patients stay longer, they incur more costs; therefore, this system has provided a financial incentive to reduce the length of stay and minimize procedures performed.

Global Rationale: NA

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 05. Discuss the importance of the various government benefit programs.

Page: pp. 132-133

Question 6

Type: MCMA

From this list of patients, choose the ones that would be eligible to receive Medicare Part A benefits without paying premiums.

Standard Text: Select all that apply.

1. An unemployed 16-year-old mother of a 6-month-old infant.

2. A 45-year-old father of three children receiving governmental financial assistance.

3. A 75-year-old retired postal worker who receives Social Security benefits.

4. A 66-year-old woman who never worked outside the home, but whose husband had Medicare-covered government employment.

5. A 35-year-old man who can no longer work due to end-stage renal disease.

Correct Answer: 3,4,5

Rationale 1: Medicaid is the health plan for low-income individuals.

Rationale 2: Medicaid is the health plan for low-income individuals.

Rationale 3: Medicare provides coverage for those 65 or older. These people can receive Part A benefits at age 65 without having to pay premiums if the person is eligible to get Social Security benefits or had a spouse who had Medicare-covered government employment.

Rationale 4: Medicare provides coverage for those 65 or older. These people can receive Part A benefits at age 65 without having to pay premiums if the person is eligible to get Social Security benefits or had a spouse who had Medicare-covered government employment.

Rationale 5: The person under age 65 can receive Part A benefits without having to pay premiums if the person has received Social Security or Railroad Retirement Board disability benefits for 24 months or if the person has end stage renal disease.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 05. Discuss the importance of various government benefit programs.

Page: p. 134

Question 7

Type: MCSA

What is an important result of trying to lower hospital admissions that impacts acute care nursing?

1. Patients are sicker on admission requiring more care.

2. Primary care has increased in the system.

3. The goal is to reduce Medicare readmissions within 40 days of discharge.

4. There is more staffing to care for patients in acute care.

Correct Answer: 1

Rationale 1: Greater effort is made to keep patients out of hospitals and thus when admitted often are sicker requiring more care.

Rationale 2: There is more primary care, but this does not directly relate to how nursing practice in acute care.

Rationale 3: The goal is to reduce Medicare readmissions within 30 days of discharge.

Rationale 4: Staffing levels have not necessarily increased.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 08. healthcare reimbursement changes found in the affor. Analyze healthcare finances at the microlevel, including budgeting process, productivity, cost containment, and impact on nursing

Page: p. 145

Question 8

Type: MCMA

You have been a nurse manager for 2 months and are told that the budget process will begin. You ask for information about the process. What would you be told?

Standard Text: Select all that apply.

1. The CNO and the CFO are responsible for the nursing department budget.

2. The budget is prepared and submitted to the CEO.

3. Your role is to act as a reviewer of the nursing department budget.

4. Budgeting requires compromises during the process.

5. Annual budgets are developed in a short-time period, such as a month.

Correct Answer: 1, 2, 4

Rationale 1: The CNO is responsible for the nursing department budget development with help from the CFO.

Rationale 2: Ultimately the CEO must review and approve the total budget. 

Rationale 3: Your role is to prepare a budget for your unit, which becomes part of the nursing department budget.

Rationale 4: Budgeting requires compromises during the process as not everyone will get what they want.

Rationale 5: Developing the budget takes time, and has many levels of participation and drafts.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 08. Analyze healthcare finances at the microlevel, including budgeting process, productivity, cost containment, and impact on nursing.

Page: p. 146

Question 9

Type: MCSA

The nurse managers of a hospital are working to identify the physical skills and actual nursing time spent to accomplish specific procedures. This work is most closely associated with which type of reimbursement strategy?

1. Discounted fee-for-service

2. Diagnostic-related group

3. Capitation

4. Resource-based relative value scale

Correct Answer: 4

Rationale 1: This is a payment method that offers to pay the provider a specific percentage of the provider’s usual charge, or offers a reduced rate.

Rationale 2: DRGs are per-stay reimbursement plans that focus on a single episode of care related to a diagnosis, and include all predetermined expected services delivered for that episode of care.

Rationale 3: This is a prepayment to a provider to deliver healthcare services to enrollees of a health plan.

Rationale 4: In this system, payments for services are determined by the resource needed to provide the service. Managers work to assure that practice approximates this scale.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 06. Explain the service and reimbursement strategies used by insurers to control costs and improve quality and their association with managed care.

Page: pp. 125-136

Question 10

Type: MCSA

The staff at a primary care office is asked to document the time the patient checks in, the time the patient is called into the exam room, and the time the patient is checked out. This is an example of what managed care strategy?

1. Provider performance

2. Length of stay management

3. Capitation

4. Formularies

Correct Answer: 1

Rationale 1: Wait time for appointments is an example of an evaluation indicator under the provider performance strategy.

Rationale 2: Length of stay strategy has to do with days in the hospital.

Rationale 3: Capitation is the payment of fixed monthly fees to provide healthcare.

Rationale 4: Formularies are used to cope with increasing pharmaceutical costs.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 06. Explain the service and reimbursement strategies used by insurers to control costs and improve quality and their association with managed care.

Page: pp. 140-141

Question 11

Type: Drag and Drop

The nursing unit is being asked to decrease costs by 10% this year. The manager takes this request to the nursing staff for suggestions to meet the goal. Which suggestions would be helpful in this endeavor?

Standard Text: drag and drop

1. Liability that is incurred from the acquisition of an asset

2. Costs that do not increase or decrease due to changes in volume

3. Smallest functional unit

4. A financial statement identifying assets and liabilities

5. A decrease in the organization’s equity due to operations

Choices:

Balance sheet

Cost center

Expense

Fixed costs

Indirect costs

Liability

Overhead

Correct Answers:

• Liability
• Fixed costs
• Cost center
• Balance Sheet
• Expense

Rationale 1: This is the definition for liability.

Rationale 2: This is the definition fixed costs.

Rationale 3: This is the definition for cost center.

Rationale 4: This is the definition for balance sheet

Rationale 5: This is the definition for expense.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 08. Analyze healthcare finances at the microlevel, including budgeting process, productivity, cost containment, and impact on nursing.

Page: pp. 146-147

Question 12

Type: MCSA

The nurse manager has been asked by the administration to research nursing salaries paid by hospitals across the United States. Which factor is this nurse researching?

1. Variable costs

2. Unit of service

3. Indirect overhead

4. Wage index

Correct Answer: 4

Rationale 1: Variable costs are costs that fluctuate with census or patient days, treatments, clinic visits, home visits, etc. 

Rationale 2: This is the specific unit of healthcare service that a department or unit provides to its community.

Rationale 3: Indirect overhead is costs that cannot be associated with a specific patient care provided or support service.

Rationale 4: Wage index is the factor used to compare wages paid to specific categories of personnel across the country.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 08. Analyze healthcare finances at the microlevel, including budgeting process, productivity, cost containment, and impact on nursing.

Page: pp. 133, 148

Question 13

Type: MCSA

The vice president of nursing services is completing a budgetary report for the governing board meeting this week. In which category should this nurse place the total expenditure for health benefits for nursing employees?

1. Salary and wages

2. Operations

3. Capital

4. Accounts receivable

Correct Answer: 1

Rationale 1: Salary and wages include all salary and benefits to the employee. This includes sick time, vacation time, health benefits, premium time, merit raises, etc.

Rationale 2: The operational budget includes the estimate of the volume, and the mix of activities and series and resources required to provide them.

Rationale 3: The capital budget is the estimate of purchases of major capital items, such as equipment, building, and furniture.

Rationale 4: Accounts receivable is the part of the budget report that indicates the amount due to the hospital for services rendered.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 08. Analyze healthcare finances at the microlevel, including budgeting process, productivity, cost containment, and impact on nursing.

Page: p. 148

Question 14

Type: MCSA

The nurse manager has been asked to provide numbers associated with productivity to the hospital chief financial officer. Which components should the manager report?

1. The ratio of staff to patients

2. The number of patients to the number of FTEs

3. The ratio of department output to the resources consumed

4. The department input divided by its output

Correct Answer: 3

Rationale 1: This ratio does not take output into consideration.

Rationale 2: This ratio does not take output into consideration.

Rationale 3: Productivity is the ratio of output to input (resources consumed).

Rationale 4: This is the wrong formula. It should be output divided by input.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 08. Analyze healthcare finances at the microlevel, including budgeting process, productivity, cost containment, and impact on nursing.

Page: p. 152

Question 15

Type: MCMA

One of the strategies used by insurers to control costs and quality is the delineation of the services that will and will not be covered. Choose the services that would typically be covered by most insurance plans.

Standard Text: Select all that apply.

1. Outpatient and inpatient surgery

2. Elective abortions

3. Nursing services

4. Diagnostic tests

5. Mental healthcare

Correct Answer: 1,3,4

Rationale 1: This service is covered by most health plans.

Rationale 2: Elective abortions and mental health services are often specifically excluded from coverage.

Rationale 3: This service is covered by most health plans.

Rationale 4: This service is covered by most health plans.

Rationale 5: Elective abortions and mental health services are often specifically excluded from coverage.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 06. Explain service and reimbursement strategies used by insurers to control costs and

improve quality and their association to managed care

Page: p. 128

Question 16

Type: MCSA

Understanding the microlevel of healthcare financing is most important to which nurse?

1. The nursing student

2. The new graduate

3. The staff nurse

4. The nurse manager

Correct Answer: 4

Rationale 1: While microlevel healthcare finance is important to all nurses, it is most important to the nurse manager.

Rationale 2: While microlevel healthcare finance is important to all nurses, it is most important to the nurse manager.

Rationale 3: While microlevel healthcare finance is important to all nurses, it is most important to the nurse manager.

Rationale 4: The nurse manager will use the components of microlevel healthcare financing on a daily basis to manage the unit.

Global Rationale: NA 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 01. Distinguish between the macrolevel and microlevel view of healthcare financial issues.

Page: pp. 120, 146

Question 17

Type: MCMA

Which factors influence the financing of healthcare in the United States?

Standard Text: Select all that apply.

1. Political factors

2. Increasing length of stay

3. Social expectations

4. Public indifference

5. The national economy

Correct Answer: 1,3,5

Rationale 1: The healthcare industry is an extremely large industry whose financing is influenced by many factors, particularly social expectations, economic trends, technological developments, political factors, and in the last few years the U.S. economy.

Rationale 2: Length of stay has been decreasing.

Rationale 3: The healthcare industry is an extremely large industry whose financing is influenced by many factors, particularly social expectations, economic trends, technological developments, political factors, and in the last few years the U.S. economy.

Rationale 4: Overall, the public is intensely interested in healthcare financing.

Rationale 5: The healthcare industry is an extremely large industry whose financing is influenced by many factors, particularly social expectations, economic trends, technological developments, political factors, and in the last few years the U.S. economy.

Global Rationale: NA

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 02. Discuss critical issues related to current national healthcare expenditures.

Page: p. 120

Question 18

Type: MCSA

Today’s healthcare is generally financed through a third party payer system. Who is the second party in this system?

1. Provider

2. Medicare

3. Patient/enrollee

4. Insurance company

Correct Answer: 1

Rationale 1: The provider is the second party.

Rationale 2: Medicare is a third party payer.

Rationale 3: The patient/enrollee is the first party.

Rationale 4: Insurance companies are third party payers.

Global Rationale: NA

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 03. Describe the role of the third-party payer.

Page: p. 124

Question 19

Type: MCSA

Based on data presented in this textbook, which HAC is the most costly based on 2012-2013 data?

1. Falls

2. Pressure ulcers

3. Catheter-associated urinary track infections

4. Adverse drug events

Correct Answer: 2

Rationale 1: Falls is the fourth most common.

Rationale 2: Pressure ulcers is the highest.

Rationale 3: Catheter-associated urinary track infections is the third most common.

Rationale 4: Adverse events is the second most common in the data provided.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 06. Explain service and reimbursement strategies used by insurers to control costs and

improve quality and their association to managed care.

Page: p. 143

Question 20

Type: MCMA

If you were explaining Medicare and Medicaid, which of the following statements would you include?

Standard Text: Select all that apply

1. Medicare is funded by the state and federal government.

2. Poverty levels impact enrollment in Medicaid.

3. The Affordable Care Act of 2010 has had an impact on Medicare and Medicaid.

4. Social security payments impact Medicare.

5. DRGs were developed to improve Medicare reimbursement.

Correct Answer: 2, 3, 4

Rationale 1: Medicaid is funded by state and federal government, not Medicare.

Rationale 2: The poverty level has an impact on who can enroll in Medicaid, with those below the poverty level given more access.

Rationale 3: The ACA had had an impact on Medicare and Medicaid, for example Medicaid has expanded in some states and some provisions related to required covered services also apply to Medicare and Medicaid.

Rationale 4: Social security payments fund current Medicare expenses.

Rationale 5: Diagnosis-related groups was developed for Medicare reimbursement.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 05. Discuss the importance of the various government benefit programs.

Page: pp. 129-132

Question 21

Type: MCSA

The pharmacist tells a patient that the insurance company will pay for a new medication, but that the patient will have to pay an additional co-pay of $45. What type of formulary does this insurance company maintain?

1. Exclusionary

2. Open

3. Incentive

4. Closed

Correct Answer: 3

Rationale 1: This is not a type of formulary discussed in the text.

Rationale 2: In an open formulary, the enrollee pays extra premiums to use non-formulary drugs.

Rationale 3: This formulary and additional co-pay situation is designed as an “incentive” for the patient and the patient’s provider to stay within the formulary.

Rationale 4: In a closed formulary, there is no reimbursement for drugs that are not in the formulary.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 06. Explain service and reimbursement strategies used by insurers to control costs and

improve quality and their association to managed care.

Page: p. 142

Question 22

Type: MCSA

Which strategy started by managed care is now the most important strategy used to try to manage outcomes?

1. Formularies

2. Provider performance

3. Efficiency management

4. Provider panels

Correct Answer: 2

Rationale 1: Formularies have been used for a long time, but they are not the most important strategy used today.

Rationale 2: Evaluating provider performance is the most important strategy used today to try to control costs and improve care.

Rationale 3: This is not the most important strategy.

Rationale 4: Provider panels do help control some aspects of care but this is not considered to be the most important strategy today.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 06. Explain service and reimbursement strategies used by insurers to control costs and

improve quality and their association to managed care.

Page: p. 141

Question 23

Type: MCMA

The parent of a child with a serious health problem has an opportunity to take a new job but is concerned about insurance coverage. Which statements are true concerning this situation and the Healthcare and Education Reconciliation Act of 2010?

Standard Text: Select all that apply.

1. Young adults will be able to stay on their parent’s insurance until their 30th birthday.

2. Lifetime benefits are capped at one million dollars.

3. Children with preexisting conditions cannot be excluded from coverage.

4. Annual limits on coverage are less restrictive.

5. Families will receive a $1,000.00 rebate to help provide care until new insurance is valid.

Correct Answer: 3,4

Rationale 1: This is not true. Young adults will be able to stay on their parent’s insurance until the child’s 27th birthday.

Rationale 2: Lifetime limits on benefits will be prohibited.

Rationale 3: This is a true statement.

Rationale 4: This is a true statement.

Rationale 5: This is not part of the Act.

Global Rationale: NA

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 07. Examine healthcare reimbursement changes found in the Affordable Care Act of 2010.

Page: pp. 131-132

Question 24

Type: MCMA

Which statement, made by a newly promoted nurse manager, indicates good understanding of full-time equivalents (FTE) as a component of the unit budget?

Standard Text: Select all that apply.

1. An FTE is equal to 2,080 hours per year.

2. FTE is different from worked FTE.

3. FTEs can be used to measure a nurse’s productivity.

4. FTEs are a measure of effectiveness.

5. FTE is a count of the people working on the unit at any specific time.

Correct Answer: 1,2

Rationale 1: An FTE is a full-time position that is equated to 40 hours of work per week, 80 hours per pay period, or 2,080 hours per year.

Rationale 2: FTE and worked FTE are two different measures.

Rationale 3: FTE is used as a component of productivity of a unit, but is not used to measure a specific nurse’s productivity.

Rationale 4: Effectiveness is not measured by FTEs.

Rationale 5: An FTE is not a person but a unit of time or time actually worked.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 08. Analyze healthcare finances at the microlevel, including budgeting process, productivity, cost containment, and impact on nursing.

Page:  p. 151

Question 25

Type: MCSA

The nurse notices that there are four boxes of 180-gauge IV start catheters in the supply room even though the standard IV start on the unit is done with a 20-gauge IV catheter. What should the nurse do?

1. Consult with the nurse manager about the situation.

2. Send the catheters back to central supply.

3. Send the catheters to a unit that uses this size.

4. Start using 18-gauge catheters for IV starts on the unit.

Correct Answer: 1

Rationale 1: In many instances, nurse managers are not involved in direct care, so the manager may not realize the catheters are in the supply room. If these catheters are not used, their sterility dates will expire and they will be a loss to the unit’s budget.

Rationale 2: This action should not be done without talking to the manager.

Rationale 3: This should not be done because the cost of the catheters will still be charged to the originating unit.

Rationale 4: Nurses should not change procedures just to use up supplies.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 08. Analyze healthcare finances at the microlevel, including budgeting process, productivity, cost containment, and impact on nursing.

Page:  p. 152

Question 26

Type: MCSA

What approach does the IOM/NAM report Best Care at Lower Costs emphasize?

1. Reducing cost of care for complex illness

2. Leadership focused on continuous learning

3. Emphasize quality improvement in the acute care sector

4. Increase public/community health services

Correct Answer: 2

Rationale 1: This is not a recommendation.

Rationale 2: The report emphasizes the need to learn more about the problem in order to improve healthcare.

Rationale 3: This is not a recommendation.

Rationale 4: This is not a recommendation.

Global Rationale: NA

Cognitive Level: Analysis

Client Need:  Safe effective environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; V. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing process, assessment

Learning Outcome: LO 01. Distinguish between the macrolevel and microlevel view of healthcare economics.

Page: 120

Question 27

Type: MCSA

What is area of healthcare has the highest percentage of the nation’s healthcare dollar (2011)?

1.  Physicians and clinics

2. Prescriptions

3. Hospital care

4. Nursing care facilities and continuing care retirement communities

Correct Answer: 3

Rationale 1: Physicians and clinics 20%

Rationale 2: Prescriptions 10%

Rationale 3: Hospital care 31%

Rationale 4: Nursing care facilities and continuing care retirement communities 6%

Global Rationale: NA

Cognitive Level: Understanding

Client Need: Safe effective environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; V. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing process, assessment

Learning Outcome:  LO 01. Distinguish between the macrolevel and microlevel view of healthcare economics.

Page: p. 121

Question 28

Type: MCSA

What is the difference in the healthcare customer and the healthcare consumer?

1. The customer pays for all services the patient receives.

2. The healthcare provider is the customer and the patient the consumer.

3. The employer may be the customer and the consumer.

4. The customer contracts with the insurer and the consumer receives the care.

Correct Answer: 4

Rationale 1: Both the customer and the consumer usually pay for services.

Rationale 2: The healthcare provider is not the customer.

Rationale 3: The customer is who contracts with the insurer—the employer typically.

Rationale 4: This is a correct description of the customer and consumer.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe effective environment

Client Need Sub: 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

Nursing/Integrated Concepts: Nursing process, assessment

Learning Outcome: LO 03. Describe the role of the third-party payer.

Page: p. 124