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Chapter 05: Economics of Health Care Delivery
Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition
MULTIPLE CHOICE
- Which statement regarding poverty and health insurance is true?
| a. | Millions of people in the United States are without health insurance. |
| b. | The poor in the United States are as healthy as persons with higher incomes. |
| c. | Persons with money or health insurance are less likely to seek health care. |
| d. | The poor are more likely to receive health care through private agencies. |
ANS: A
In 2012, 48 million people were without health insurance in the United States. The poor in the United States are generally not as healthy as persons with middle or higher incomes. Persons with money and/or health insurance are more likely to seek health care. The poor are less likely to receive health care through private agencies.
DIF: Cognitive level: Understanding REF: p. 95
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- The allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care is called:
| a. | economics. |
| b. | health economics. |
| c. | public health economics. |
| d. | microeconomic theory. |
ANS: B
Health economics is the allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care. Economics is the science concerned with the use of resources, including the production, distribution, and consumption of goods and services. Public health economics focuses on the production, distribution, and consumption of goods and services as related to public health and where limited public resources might best be spent to save lives or increase the quality of life. Microeconomic theory deals with the behaviors of individuals and organizations and the effects of those behaviors on prices, costs, and the allocation and distribution of resources.
DIF: Cognitive level: Remembering REF: p. 96
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- Public health economics focuses on the:
| a. | use of resources. |
| b. | availability and usage of goods and services related to public health. |
| c. | scarcity of resources in the health care industry. |
| d. | management and use of monies to improve the health of populations. |
ANS: B
Public health economics focuses on producing, distributing, and consuming goods and services related to public health. Economics is the science concerned with the use of resources, including the production, distribution, and consumption of goods and services. Health economics is the allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care. Public health finance involves the acquiring, managing, and use of monies to improve the health of populations through disease prevention and health promotion strategies.
DIF: Cognitive level: Understanding REF: p. 96
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse discusses services with a federal congressman. Which of the following services would the nurse most likely be discussing?
| a. | Family planning |
| b. | Counseling |
| c. | Policy making |
| d. | Prevention of communicable diseases |
ANS: C
Policy making is offered at the federal level. Family planning, counseling, and preventing communicable and infectious disease are offered at the state and local levels.
DIF: Cognitive level: Applying REF: p. 97
TOP: Nursing process: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A business offers wellness incentives to its employees and then notices a decrease in the frequency of physician visits among employees. Which of the following terms best describes what has happened?
| a. | Macroeconomic theory |
| b. | Efficiency |
| c. | Supply and demand |
| d. | Microeconomic theory |
ANS: D
Microeconomic theory is examining the behaviors of individuals and organizations that result from trade-offs in utility and budget constraints of health care. Efficiency refers to producing maximum output using a given set of resources. Supply and demand are two basic principles of microeconomic theory. Macroeconomic theory focuses on the “big picture.”
DIF: Cognitive level: Applying REF: p. 97
TOP: Nursing process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse is using the principles of supply and demand in daily practice. Which of the following best describes this phenomenon?
| a. | The demand for nurses in public health is low, but the supply is high. |
| b. | Few goods or services are available, the price tends to rise. |
| c. | Supplies are low, nurses must find alternate resources. |
| d. | Lesser-developed countries receive supplies from other countries. |
ANS: B
Supply and demand is in force when few goods or services are available, and then the price tends to rise. The other examples do not demonstrate the use of the laws of supply and demand.
DIF: Cognitive level: Analyzing REF: pp. 97-98
TOP: Nursing process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse is faced with a macroeconomics issue. Which of the following best describes what is happening?
| a. | The evaluation of client access to services |
| b. | A health policy that makes the development of a new program possible |
| c. | Informing clients and others of the cost of service |
| d. | The referral of clients to available services |
ANS: B
Macroeconomics focuses on the “big picture,” such as a program, whereas microeconomics focuses on the individual or organization.
DIF: Cognitive level: Analyzing REF: p. 98
TOP: Nursing process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A public health nurse applies the principles of the macroeconomics theory when working with a community. Which of the following best describes why this theory would be used?
| a. | The nurse is concerned with factors that determine prices and affect resource allocation. |
| b. | The nurse is concerned with the positive effect of competitiveness on health care costs. |
| c. | The nurse is concerned with the supply, demand, and costs of services available to their clients. |
| d. | The nurse is concerned with the policies to support programs to improve the health of the community. |
ANS: D
Macroeconomic theory focuses on the “big picture”—the total, or aggregate, of all individuals and organizations (e.g., behaviors such as growth, expansion, or decline of an aggregate). The primary focuses of macroeconomics are the business cycle and economic growth. These cycles are influenced by a number of factors, such as political changes, policy changes, knowledge and technology advances, or simply the belief by a recognized business leader that the cycle is or should be shifting. Microeconomics focuses on the individual or an organization. Factors such as levels of income, employment, general price levels, and rate of economic growth are important in microeconomics.
DIF: Cognitive level: Applying REF: pp. 98-99
TOP: Nursing process: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse implements a teen pregnancy prevention program in a high school that has been shown to decrease the rate of teen pregnancy. Which of the following best describes the nurse’s action?
| a. | Effectiveness |
| b. | Efficiency |
| c. | Microeconomics |
| d. | Production |
ANS: A
Effectiveness refers to the extent to which a health care service meets a stated goal or objective, or how well a program or service achieves what is intended. Efficiency refers to producing maximum output using a given set of resources. Microeconomic theory is examining the behaviors of individuals and organizations that result from trade-offs in utility and budget constraints of health care. Production refers to how goods are produced or created.
DIF: Cognitive level: Applying REF: p. 98
TOP: Nursing process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- A nurse conducts a class at a public health clinic on breast self-examination for a group of 50 women. Which of the following best describes the nurse’s action?
| a. | Supply and demand |
| b. | Macroeconomics theory |
| c. | Efficiency |
| d. | Effectiveness |
ANS: C
Efficiency refers to producing maximum output, such as a good or service, or using a given set of resources or inputs, such as labor, time, and available money. Teaching one topic to many people is an example of this. Macroeconomic theory focuses on the “big picture.” Supply and demand is in force when few goods or services are available, and then the price tends to rise. Effectiveness refers to the extent to which a health care service meets a stated goal or objective, or how well a program or service achieves what is intended.
DIF: Cognitive level: Applying REF: p. 98
TOP: Nursing process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is promoting efficiency within the public health department. Which of the following describes the action the nurse would be taking?
| a. | Evaluating how well a program of service achieves what was intended |
| b. | Trying new products provided by sales representatives |
| c. | Using time wisely by delegating non-nursing tasks to unlicensed care providers |
| d. | Setting up a clinic to look aesthetically pleasing to clients |
ANS: C
Efficiency relates to producing maximal output given a set of resources. Using time wisely through delegation is the best example of using efficiency. Program evaluation, trying new products, and setting up a clinic are not examples of producing maximal output given a set of resources.
DIF: Cognitive level: Analyzing REF: p. 98
TOP: Nursing process: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse enrolls in a microeconomics course at a local college. Which of the following best describes the rationale for taking this course?
| a. | Nurses are often the ones to allocate resources to solve a problem. |
| b. | Nurses are often involved in federal policy making. |
| c. | Health care policy can be influenced using these principles. |
| d. | Health care supplies can be very costly and nurses must use them wisely. |
ANS: A
Nurses often allocate resources, design, plan, coordinate, and evaluate community-based health services. Policy making addresses a macroeconomics issue. It is true that nurses need to know about microeconomics in order to use resources appropriately, but the scope of quality of care and use of health care supplies is larger than the scope of only microeconomics.
DIF: Cognitive level: Analyzing REF: p. 99
TOP: Nursing process: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse evaluates a smoking cessation program, the gained or increased financial income, the improvements in the community attributable to the program, and the costs that would result if the program was not offered. Which of the following best describes the action of the nurse?
| a. | Cost-effectiveness analysis |
| b. | Cost-benefit analysis |
| c. | Supply and demand |
| d. | Microeconomic theory |
ANS: B
Cost-benefit analysis involves the listing of all costs and benefits that are expected to occur from an intervention during a prescribed time. Cost-effectiveness analysis expresses the net direct and indirect costs and cost savings in terms of a defined health outcome. Supply and demand is in force when few goods or services are available, and then the price tends to rise. Microeconomic theory is examining the behaviors of individuals and organizations that result from trade-offs in utility and budget constraints of health care.
DIF: Cognitive level: Analyzing REF: p. 99
TOP: Nursing process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is working with members of the community to assist them with acquiring health insurance. Which of the following individuals is most likely to be uninsured?
| a. | An 82-year-old woman with chronic medical problems |
| b. | A 2-year-old whose mother is on welfare |
| c. | A 50-year-old businessman who works for a large corporation |
| d. | A 32-year-old man who works part-time at a small business |
ANS: D
The typical uninsured person is one who works at a low-paying job, part-time or temporary, or at a small business. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, since most large businesses provide it.
DIF: Cognitive level: Analyzing REF: p. 100
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse is examining the characteristics that affect one’s health. Which of the following would be of greatest concern to the nurse?
| a. | Obesity |
| b. | Marital status |
| c. | Health insurance |
| d. | Age |
ANS: A
Personal behavior/lifestyle (obesity) has the greatest effect on health. Environmental factors (marital status) and human biology (age) are next followed by the health care system (health insurance).
DIF: Cognitive level: Applying REF: p. 102
TOP: Nursing process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
- A community health nurse is assisting clients to access health care. Which of the following individuals would most likely experience a barrier when accessing health care?
| a. | A 40-year-old female who speaks English |
| b. | A 25-year-old female with health insurance |
| c. | A 50-year-old male with hypertension |
| d. | A 30-year-old male who is unemployed |
ANS: D
Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, child care needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income.
DIF: Cognitive level: Analyzing REF: p. 101
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse plans to implement a primary prevention strategy in the community. Which of the following would the nurse most likely complete?
| a. | Development of a smoking prevention program |
| b. | Development of a support group for widows |
| c. | Development of a hypertension screening program |
| d. | Development of a hospice care program |
ANS: A
Primary prevention’s aim is preventing disease. Development of a smoking prevention program is primary prevention. Development of a support group for widows and development of a hospice care program are examples of tertiary prevention. Development of a hypertension screening program is an example of secondary prevention.
DIF: Cognitive level: Applying REF: p. 102
TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance
- The first phase of development of the health care system was characterized by:
| a. | the rise in technology. |
| b. | epidemics of infectious disease, such as typhoid, influenza, and malaria. |
| c. | physicians and nurses who attained their skills in scientifically based programs. |
| d. | an expansion of hospital clinics and long-term care facilities. |
ANS: B
Phase one was concerned with epidemics and infectious disease control. Technology is characteristic of phase four, and physicians and nurses attained skills in scientifically based programs in phase two. Phase three included the expansion of hospital clinics and long-term care facilities.
DIF: Cognitive level: Understanding REF: pp. 103-104
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A characterization of the fourth developmental phase of the health services delivery framework is:
| a. | nurses in the United States being predominantly women. |
| b. | the expansion of the number and type of health care facilities. |
| c. | dependence on technology for patient care. |
| d. | the discovery and development of pharmacological advances. |
ANS: C
Nurses have become dependent on technologies to monitor client progress, make decisions about care, and deliver care in innovative ways as part of the fourth phase. The discovery and development of pharmacological advances is only one way that technology has increased during the fourth phase. Phase one was concerned with epidemics and infectious disease control. Physicians and nurses attained skills in scientifically based programs in phase two. Phase three included the expansion of hospital clinics and long-term care facilities.
DIF: Cognitive level: Understanding REF: p. 105
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- Which was considered the first national health insurance plan in the United States?
| a. | Health Maintenance Organization (HMO) Act |
| b. | Marine Hospital Service |
| c. | Medicare |
| d. | Medicaid |
ANS: B
The Marine Hospital Service was created in 1798 by the federal government to provide medical service for sick and disabled sailors and to protect the nation’s borders against the importing of disease through seaports. The HMO Act provided assistance and expansion for HMOs in the 1970s. Medicare and Medicaid were established in 1965 to provide health care services to certain populations.
DIF: Cognitive level: Remembering REF: p. 110
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- An employee is able to receive health insurance from a former employer after changing jobs. Which of the following best describes the legislation that makes this possible?
| a. | Health Insurance Portability and Accountability Act (HIPAA) |
| b. | Omnibus Budget Reconciliation Act |
| c. | Balanced Budget Act of 1997 |
| d. | Social Security Act of 1935 |
ANS: A
HIPAA is a federal intervention to protect health insurance coverage for workers and families following a job change or loss. The Omnibus Budget Reconciliation Act was a major effort to regulate and control the costs of physician fees. The Balanced Budget Act of 1997 determined that payments to Medicare skilled nursing facilities (SNFs) would be made on the basis of prospective payment system (PPS). The Social Security Act of 1935 signaled the federal government’s increasing interest in addressing social welfare problems.
DIF: Cognitive level: Applying REF: p. 115
TOP: Nursing process: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- Which statement about the Medicare program is accurate?
| a. | Part A provides coverage for hospitalization. |
| b. | Part A requires payment of a monthly premium for coverage. |
| c. | Part B provides payment for home health services and extended care facilities. |
| d. | Part B is available without cost to all elderly people who have paid social security taxes. |
ANS: A
Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B is a supplemental program available to all Medicare-eligible persons for a monthly premium.
DIF: Cognitive level: Understanding REF: p. 110
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- Medicare and Medicaid are:
| a. | available to any citizen who wishes to enroll. |
| b. | two federal programs that provide insurance to special groups. |
| c. | private insurance providers. |
| d. | funded by the state government. |
ANS: B
Medicare provides insurance for persons over 65, and Medicaid provides financial assistance to states and counties to pay for medical services for the aged poor, the blind, the disabled, and families with dependent children who are below state poverty income levels. Medicare is financed by the federal government. Medicaid is jointly financed by state and federal government. They are not private insurance providers by definition.
DIF: Cognitive level: Understanding REF: p. 110
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses, such as laboratory services and equipment. Which of the following parts of Medicare is being described?
| a. | Part A |
| b. | Part B |
| c. | Part C |
| d. | Part D |
ANS: B
Medicare Part B is a supplemental (voluntary) program; it provides coverage for services that are not covered by Part A, such as laboratory services, ambulance transportation, prostheses, equipment, and some supplies. Part A provides coverage for hospital care, home care, and skilled nursing care. Part C is an option that can be chosen for additional coverage. Part C includes services of both Parts A and B. The Part C plans are coordinated care plans that include HMOs, private fee-for-service plans, and medical savings accounts (MSAs). Part C provides for all health care coverage costs after a high deductible. Part D provides prescription coverage.
DIF: Cognitive level: Applying REF: p. 111
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse is caring for a client who has end-stage kidney failure and is on dialysis. The nurse recognizes that this client is eligible for which of the following?
| a. | Medicaid |
| b. | Blue Cross |
| c. | Medicare |
| d. | HMO |
ANS: C
Medicare is available to anyone on dialysis regardless of age. Blue Cross and HMO are both private insurance options. Medicaid provides financial assistance to states and counties to pay for medical services for the aged poor, the blind, the disabled, and families with dependent children who are below state poverty income levels.
DIF: Cognitive level: Applying REF: p. 113 (Table 5-4)
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse is discussing the services that are covered under Medicare Part A with a client who has recently become eligible for Medicare. Which of the following services is the nurse most likely to mention?
| a. | Blood draw to assess prothrombin time (PT)/International Normalized Ratio (INR) |
| b. | Physical therapy visit |
| c. | Stay in skilled nursing facility |
| d. | Transportation by an ambulance |
ANS: C
Medicare Part A covers hospital care, home care, and skilled nursing care. Laboratory and physical therapy services and transportation by ambulance would be covered by Medicare Part B.
DIF: Cognitive level: Analyzing REF: p. 110
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse is providing care to an individual who has Medicaid. Which of the following would most likely describe this individual?
| a. | An 85-year-old female who has hypertension |
| b. | A 25-year-old female who is pregnant |
| c. | A 50-year-old male who is blind |
| d. | A 70-year-old male who is hearing impaired |
ANS: C
Medicaid provides financial assistance to states and counties to pay for medical services for the aged poor, the blind, the disabled, and families with dependent children who are below state poverty income levels. Medicaid does not provide coverage to those who have hypertension, are pregnant, or are hearing impaired unless they meet income guidelines.
DIF: Cognitive level: Analyzing REF: p. 112
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- When a health care organization’s fees for delivery of services are not decided until after they are provided, it is called:
| a. | retrospective reimbursement. |
| b. | prospective reimbursement. |
| c. | fee-for-service. |
| d. | capitation. |
ANS: A
Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered. Prospective reimbursement is whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering services to the client. Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays the bill. Capitation is similar to prospective reimbursement for health care organizations; third-party payers determine the amount that practitioners will be paid for a unit of care.
DIF: Cognitive level: Understanding REF: p. 116
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse is working with a client who receives health insurance through a managed care organization. Which of the following best describes this insurance?
| a. | Medicare |
| b. | Medicaid |
| c. | MSAs |
| d. | Health maintenance organizations |
ANS: D
Health maintenance organizations and preferred provider organizations are types of managed care. Medicare and Medicaid are government insurance programs. MSAs are not a type of health insurance.
DIF: Cognitive level: Applying REF: p. 115
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- When a third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the service to the client, it is called:
| a. | retrospective reimbursement. |
| b. | prospective reimbursement. |
| c. | fee-for-service. |
| d. | capitation. |
ANS: B
Prospective reimbursement is the method of paying an organization whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client. Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered. Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays the bill. Capitation is similar to prospective reimbursement for health care organizations; third-party payers determine the amount that practitioners will be paid for a unit of care.
DIF: Cognitive level: Understanding REF: p. 116
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A physician receives a set amount of money to provide care to a given group of clients for a set period of time. Which of the following terms is being described?
| a. | Retrospective reimbursement |
| b. | Prospective reimbursement |
| c. | Fee-for-service |
| d. | Capitation |
ANS: D
Capitation describes the practice of paying physicians and other practitioners a set amount to provide care to a given client or group of clients for a set period of time and amount of money. This is similar to prospective reimbursement for health care organizations. Prospective reimbursement is the method of paying an organization whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client. Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered. Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays the bill.
DIF: Cognitive level: Applying REF: p. 117
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- Which statement about the reimbursement of health services for nurses is accurate?
| a. | Reimbursement for health care services can be directed only to physicians. |
| b. | Nurse practitioners and clinical nurse specialists are reimbursed for Medicare Part B services. |
| c. | Nursing care is a separate budget item in determining hospital service costs. |
| d. | Nursing care is reimbursed separately from medical care in outpatient settings. |
ANS: B
Nurse practitioners and clinical nurse specialists were granted third-party reimbursement for Medicare Part B services only on January 1, 1998 under Public Law 105-33. Nursing care is not billed for or reimbursed for in hospital or outpatient settings.
DIF: Cognitive level: Understanding REF: p. 117
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
- Factors that influence health care costs include which of the following? (Select all that apply.)
| a. | Technology and intensity |
| b. | Demographics—the aging population |
| c. | Chronic illness |
| d. | Use of the health care system |
| e. | Type of health care insurance |
ANS: A, B, C
Technology and intensity, demographics (especially the aging population), and chronic illness all influence health care costs. The fact that individuals have, over time, consumed more health care is not an adequate explanation for an influence of health care costs. The type of health care insurance does not influence health care costs.
DIF: Cognitive level: Understanding REF: pp. 108-110
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
Chapter 30: Major Health Issues and Chronic Disease Management of Adults Across the Life Span
Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition
MULTIPLE CHOICE
- Which statement about eating disorders is correct?
| a. | Individuals with anorexia frequently complain about weight loss. |
| b. | Purging is associated with anorexia. |
| c. | Most women with bulimia are concerned with the shape and weight of their body. |
| d. | Bulimia has more medical complications than anorexia. |
ANS: C
Those with bulimia are usually concerned with the shape and weight of their body. Those with anorexia view themselves as normal or overweight; purging is associated with bulimia; and anorexia is considered to have more complications than bulimia.
DIF: Cognitive level: Understanding REF: p. 681
TOP: Nursing process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- An older person is in the last stages of dying. Which type of care would be the best for him?
| a. | Home health |
| b. | Assisted living |
| c. | Nursing home |
| d. | Hospice |
ANS: D
Hospice would be the best form of care for a person in the last stages of dying. Home health care provides individual and environmental assessments, direct skilled care and treatment, and short-term guidance for individuals in the home. Assisted living offers a wide variety of living choices, from a single shared room to a full-service, life-care community. Nursing homes provide care to meet the health care needs of those needing rehabilitation, as well as for those needing a permanent supportive residence.
DIF: Cognitive level: Applying REF: p. 688
TOP: Nursing process: Planning
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse is caring for a client who has designated someone else to make health care decisions when he or she is unable to do so. Which of the following is being used by the client?
| a. | An advanced medical directive |
| b. | A living will |
| c. | A durable medical power of attorney |
| d. | The Patient Self-Determination Act |
ANS: C
Durable medical power of attorney is the legal way for a client to designate someone else to make health care decisions when he or she is unable to do so. An advanced medical directive includes both a living will and a durable medical power of attorney. A living will allows the client to express the wishes regarding the use of medical treatments in the event of a terminal illness. The Patient Safe Determination Act requires those providers receiving Medicare and Medicaid funds to give clients written information regarding their legal options for treatment choices if they become incapacitated.
DIF: Cognitive level: Applying REF: p. 674
TOP: Nursing process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- The nurse is caring for an elderly client who has written advanced medical directives. Which of the following best describes what this means?
| a. | The client has made decisions regarding treatment if he becomes incapacitated. |
| b. | The client has a living will. |
| c. | The client has a Do Not Resuscitate order. |
| d. | The client’s family has decided on a medical treatment regimen. |
ANS: A
Two parts of advance directives are the living will and a durable power of attorney. An advance directive indicates treatment choices if clients become incapacitated. A living will allows the client to express the wishes regarding the use of medical treatments in the event of a terminal illness. A Do Not Resuscitate order is a specific order from a physician not to use cardiopulmonary resuscitation.
DIF: Cognitive level: Applying REF: p. 674
TOP: Nursing process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her to take an extended leave from work to care for a family member?
| a. | Personal Responsibility and Work Opportunity Reconciliation Act |
| b. | Women’s Health Equity Act (WHEA) |
| c. | Temporary Assistance for Needy Families (TANF) |
| d. | Family and Medical Leave Act (FMLA) |
ANS: D
The FMLA provides job protection and continuous health benefits where applicable for eligible employees who need extended leave for their own illness or to care for a family member.
DIF: Cognitive level: Applying REF: p. 673
TOP: Nursing process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A nurse is providing home care for several elderly clients in the community. Which of the following situations would most likely be indicative of elder abuse?
| a. | A daughter refuses to visit her mother due to work commitments. |
| b. | A child runs around a grandparent’s house breaking items. |
| c. | A young man repeatedly steals money from his grandmother. |
| d. | An older person demands that the family come for dinner. |
ANS: C
Theft or mismanagement of money or resources is an element of abuse. Recognition of abuse includes these other possibilities as well: willful infliction of physical pain or injury, inflection of debilitating mental anguish and fear, or unreasonable confinement or the depriving of services. The other examples do not describe these elements of abuse.
DIF: Cognitive level: Analyzing REF: p. 673
TOP: Nursing process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is investigating the overall health status of a population. Which of the following indicators would most likely be used by the nurse?
| a. | Life expectancy |
| b. | Health status |
| c. | Morbidity rate |
| d. | Prevalence |
ANS: A
Life expectancy is a measure that is often used to gauge the overall health of a population. Health status indicators are the quantitative or qualitative measures used to describe the level of well-being or illness present in a defined population or to describe related attributes or risk factors. Morbidity measures rate of disability or illness. Prevalence is the proportion of the population that has a specific disease or illness.
DIF: Cognitive level: Applying REF: p. 675
TOP: Nursing process: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- Which of the following characteristics indicates a man is at a higher risk for developing prostate cancer?
| a. | Being of Caucasian descent |
| b. | Has not had a prostate-specific antigen (PSA) test |
| c. | Has a father or brother who has had prostate cancer |
| d. | Has benign prostatic hypertrophy (BPH) |
ANS: C
Having a father or brother who has had prostate cancer places a man at higher risk for developing prostate cancer. Being of African American descent places a man at higher risk for developing prostate cancer. The PSA test is not accurate in terms of sensitivity or specificity, but it is used as a screening test. BPH can cause an elevated PSA test result.
DIF: Cognitive level: Understanding REF: p. 684
TOP: Nursing process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is caring for a client who is considered obese. Which of the following best describes this client?
| a. | An individual with a body mass index (BMI) of 15 |
| b. | An individual with a BMI of 20 |
| c. | An individual with a BMI of 30 |
| d. | An individual with a BMI of 25 |
ANS: C
A person is considered obese when the BMI reaches 30. A person is considered overweight with a BMI of 25 to 29.9. A BMI of 18.5 to 24.9 is considered of healthy weight. An individual with a BMI of less than 18.5 is considered to be underweight.
DIF: Cognitive level: Applying REF: p. 680
TOP: Nursing process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is educating a community women’s group about the importance of monthly breast self-exam and annual mammograms. Which of the following best describes why this community health education is important?
| a. | Increased screening will lead to a decreased incidence of breast cancer. |
| b. | Early detection of breast cancer typically leads to a better prognosis. |
| c. | The death rate of breast cancer continues to rise. |
| d. | The potential harm from screening needs to be discussed. |
ANS: B
Secondary prevention measures, including screening techniques, make a difference in the death rates for breast cancer. Early detection often means cure, whereas late detection typically results in an unfavorable prognosis. A potential harm from screening does not exist.
DIF: Cognitive level: Analyzing REF: p. 682
TOP: Nursing process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is implementing Wagner’s Chronic Care Model (CCM). Which of the following actions would most likely be taken by the nurse?
| a. | Educate a community group about hypertension control |
| b. | Create a budget for chronic disease management |
| c. | Administer immunizations to community members |
| d. | Conduct depression screenings in the community |
ANS: A
Use of electronic health records, provider reminders for key evidence-based care components, interprofessional teams communicating regularly, and community health classes to educate people with chronic diseases are various ways the CCM is being implemented. Creating a budget is not a way to use CCM. Administration of immunizations and conducting depression screenings do not address the management of the most common and costly chronic diseases: heart disease, diabetes, stroke, cancer, and arthritis.
DIF: Cognitive level: Analyzing REF: p. 677
TOP: Nursing process: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- Testicular cancer is commonly found in which age-group?
| a. | 10 to 14 years |
| b. | 15 to 40 years |
| c. | 41 to 50 years |
| d. | 51 to 70 years |
ANS: B
Testicular cancer is commonly found in men 15 to 40 years old, with the peak incidence between the ages of 18 and 40 years.
DIF: Cognitive level: Remembering REF: p. 684
TOP: Nursing process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
- Which type of cancer is the second leading cause of cancer deaths in the United States?
| a. | Gastrointestinal |
| b. | Prostate |
| c. | Skin |
| d. | Testicular |
ANS: B
Prostate is the most common non-skin cancer and second leading cause of cancer deaths in the United States. Testicular cancer is rare. Skin cancer and gastrointestinal cancer are not among the leading causes of cancer deaths.
DIF: Cognitive level: Remembering REF: p. 684
TOP: Nursing process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
- Current research on hormone replacement therapy (HRT) has found that it:
| a. | does not prevent heart disease. |
| b. | should be used to prevent osteoporosis. |
| c. | is useful with complementary therapies. |
| d. | causes breast cancer. |
ANS: A
HRT does not prevent heart disease. To prevent heart disease, women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol, maintain a healthy weight, and be physically active. HRT should be used to prevent osteoporosis only among women who are unable to take nonestrogen medications. HRT is not useful with complementary therapies and does not cause breast cancer.
DIF: Cognitive level: Understanding REF: p. 682
TOP: Nursing process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is educating a client about reducing her risk factors for the development of colorectal cancer. Which of the following lifestyle changes should the nurse recommend?
| a. | Increase in consumption of dairy products |
| b. | Reduction in consumption of processed meats |
| c. | Decrease in exposure to the sun |
| d. | Increase in sedentary lifestyle |
ANS: B
Obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and insufficient intake of fruits and vegetables are risk factors for colorectal cancer.
DIF: Cognitive level: Applying REF: p. 679
TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance
- A nurse advises a client who has HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is being used?
| a. | Primary prevention |
| b. | Secondary prevention |
| c. | Tertiary prevention |
| d. | Health promotion |
ANS: C
Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability. Primary prevention focuses on prevention on disease before it occurs. Secondary prevention aims for early detection and screening. Health promotion is not a level of prevention.
DIF: Cognitive level: Applying REF: p. 679 (Levels of Prevention box)
TOP: Nursing process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is developing a community-based exercise program for a group of women who have cardiovascular disease. Which of the following levels of prevention is being used?
| a. | Primary prevention |
| b. | Secondary prevention |
| c. | Tertiary prevention |
| d. | Health promotion |
ANS: C
Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention focuses on prevention on disease before it occurs. Secondary prevention aims for early detection and screening. Health promotion is not a level of prevention.
DIF: Cognitive level: Applying REF: p. 679 (Levels of Prevention box)
TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is providing contraceptive counseling to a female. Which of the following goals does the nurse plan to obtain?
| a. | Encourage the individual to choose abstinence |
| b. | Ensure the individual is educated to make an informed choice about reproduction |
| c. | Advocate for increased funding for reproductive services |
| d. | Reduce the health risks of the individual |
ANS: B
The goal of contraceptive counseling is to ensure that women have appropriate instruction to make informed choices about reproduction. The nurse should provide a nonjudgmental approach during counseling and allow the woman to choose the appropriate contraceptive method. Nurses do advocate for reproductive services for women, but that is not a goal of contraceptive counseling. Reduction in the health risks of the individual is a goal of preconceptual counseling.
DIF: Cognitive level: Analyzing REF: p. 681
TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is providing preconceptual counseling to a woman. Which of the following supplements would be recommended to help prevent neural tube defects?
| a. | Iron |
| b. | Calcium |
| c. | Folic acid |
| d. | Vitamin C |
ANS: C
400 µg of folic acid are recommended daily. Supplements of iron and Vitamin C are not recommended during preconceptual counseling. Supplements of calcium may be recommended to prevent bone loss, but not for preconceptual counseling.
DIF: Cognitive level: Applying REF: p. 681
TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance
- A community health nurse would like to reduce the prevalence of sexually transmitted diseases (STDs) in the community. Which of the following activities would most likely be used?
| a. | Establish immunization clinics to prevent STDs |
| b. | Educate people with HIV about the mode of transmission |
| c. | Explain to women that HIV is transmitted to women usually by intravenous drug abuse |
| d. | Develop an STD clinic to increase community access to services |
ANS: D
The goal of Healthy People 2020 is to promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent STDs and their complications. Nursing activities should align with these goals through development of an STD clinic to increase community access to services. Immunization clinics will not prevent the spread of most STDs. Education without access to services will not assist with reducing the problem.
DIF: Cognitive level: Analyzing REF: p. 680
TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance
- Which of the following statements about health disparities is accurate?
| a. | African American women have a much higher incidence of breast cancer. |
| b. | Health disparities are the result of negligent health care practices. |
| c. | Health disparities vary among racial/ethnic groups. |
| d. | Men have more obstacles to receiving health care than women. |
ANS: C
Improvements have been made in some areas of health disparities among various populations. However, health disparities vary among each racial/ethnic group. African American women have much higher death rates from breast cancer, not necessarily a higher incidence. The awareness of health disparities remains low among the general public. These health disparities are typically not the result of negligent health care practices.
DIF: Cognitive level: Understanding REF: p. 674
TOP: Nursing process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
- Which of the following factors has the largest impact on health disparities among all populations?
| a. | Ethnicity |
| b. | Education level |
| c. | Lifestyle choices |
| d. | Poverty |
ANS: D
Poverty is a strong and underlying current factor that affects all special groups. Other factors that may also influence disparities are: education, insurance status, segregation, immigration status, health behaviors and lifestyle choices, health care provider behavior, employment, and the nature and operation of the health system in the community.
DIF: Cognitive level: Understanding REF: p. 685
TOP: Nursing process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
- A nurse plans to address the increasing prevalence of depression in the community. Which of the following would be the best strategy to implement?
| a. | Educate the community about how depression affects men |
| b. | Recognize available community resources |
| c. | Advocate for health policy changes |
| d. | Understand how free clinics are able to provide mental health services to those without health insurance |
ANS: A
Depression between men and women is recognized differently in the community. More women than men are classified as having depression. Men with depression often go unrecognized and underreported. Men tend to be stoic and do not verbalize how they feel, are reluctant to talk about health issues, and often do not have positive relationship with their health care provider. Recognition is key in order to get those with depression the necessary services that they need. Once depression has been detected, these individuals can be referred to the appropriate resources. Health policy changes and the understanding of free clinics would not provide the most immediate solution to the community.
DIF: Cognitive level: Analyzing REF: pp. 684-685
TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is working with incarcerated adults who are being released from prison. Which of the following nursing interventions would be most appropriate to implement?
| a. | Connect offenders with community-based mental health programs |
| b. | Provide community supervision for mentally ill offenders |
| c. | Advocate for increased prison time to decrease recidivism rates |
| d. | Educate about available state resources |
ANS: A
Connecting offenders with community-based mental health programs at the time of release from prison can decrease recidivism rates, as many incarcerated adults experience major psychiatric disorders. It would be impossible for the nurse to supervise all mentally ill offenders in the community. Increased prison time is not shown to decrease recidivism rates and education about available state resources is not the most important nursing intervention to provide for this population.
DIF: Cognitive level: Analyzing REF: pp. 685-686
TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance
- What is the purpose of adult day health centers?
| a. | Provide support of life until death occurs |
| b. | Provide assistance to people who may need help with activities of daily living (ADLs) |
| c. | Provide treatment for those needing rehabilitation |
| d. | Provide respite care relief for caregivers |
ANS: D
Adult day health care is for individuals whose mental or physical function requires them to obtain more health care and supervision. It serves as more of a medical model than the senior center, and often individuals return home to their caregivers at night. Hospice provides support of life until death occurs. Assisted living provides assistance to people who may need help with ADLs. Long-term care facilities provide treatment for those needing rehabilitation.
DIF: Cognitive level: Understanding REF: p. 688
TOP: Nursing process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- An elderly person is living independently in a single room in a full-service life care community. Which of the following terms best describes this living arrangement?
| a. | Adult daycare |
| b. | Home care |
| c. | Nursing home |
| d. | Assisted living |
ANS: D
An elderly person living independently in a single room in a full-service life care community is a client of an assisted living facility. Adult day health care is for individuals whose mental or physical function requires them to obtain more health care and supervision; it serves as more of a medical model than the senior center, and often individuals return home to their caregivers at night. Nursing home facilities provide treatment for those needing rehabilitation. Home care provides individual and environmental assessments, direct skilled care and treatment, and short-term guidance for individuals in the home.
DIF: Cognitive level: Applying REF: p. 688
TOP: Nursing process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE
- Which of the following factors are cited as obstacles to improving men’s health? (Select all that apply.)
| a. | Reluctance to consult their primary care provider |
| b. | Emphasis of physical strength and competitiveness on masculinity |
| c. | Lack of a primary care provider |
| d. | Lack of access to health care by African American and Hispanic men |
| e. | Emphasis on the male role as the head of the family |
ANS: A, B, C
Obstacles to improving men’s health include reluctance to consult their primary care provider, the concept that masculinity emphasizes physical strength and competitiveness, and the fact that many men do not have a primary care provider.
DIF: Cognitive level: Understanding REF: pp. 683-684
TOP: Nursing process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is caring for an elderly female population. Which of the following considerations should be made? (Select all that apply.)
| a. | Postmenopausal women are more likely than men to experience hypertension. |
| b. | Women use more health services than men. |
| c. | Women report lower rates of disability than men. |
| d. | Women and men have similar socialization patterns. |
| e. | Postmenopausal women are less likely than men to experience depression. |
ANS: A, B
Postmenopausal women are more likely than men to experience hypertension; prior to menopause, the rate is higher among men. Women use more health services than men. Women report higher rates of disability than men. Women and men have different socialization, expectations, and lifestyles.
DIF: Cognitive level: Analyzing REF: pp. 675-676
TOP: Nursing process: Planning
MSC: NCLEX: Health Promotion and Maintenance
- A nurse is planning to implement Wagner’s CCM. Which of the following essential elements should be considered by the nurse? (Select all that apply.)
| a. | Clinical information systems |
| b. | Evidence-based change |
| c. | Self-management support |
| d. | Community |
| e. | Clinical practice guidelines |
ANS: A, C, D
The essential elements of CCM are: the community, the health system, self-management support, delivery system design, decision support, and clinical information systems. Evidence-based change concepts are found under each of the essential elements and help to foster productive interactions between clients and providers.
DIF: Cognitive level: Applying REF: p. 677
TOP: Nursing process: Planning
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
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