Chapter 03: Public Health and Primary Health Care Systems and Health Care Transformation(FREE) Nursing School Test Banks

Stanhope: Public Health Nursing, 8th Edition

Chapter 03: Public Health and Primary Health Care Systems and Health Care Transformation

Test Bank


1. According to the 1999 Institute of Medicine report, as many as 98,000 deaths each year are caused by:
a. Cardiovascular disease
b. Obesity
c. Medical error
d. Drug overdose
In 2000, it was thought that our health care system was expensive and that access and quality were not optimal, but we had not considered this important fact: many people die of preventable medical errors in the United States.

DIF: COG: Remembering REF: 49 OBJ: 1

2. In the United States, the majority of health care dollars are spent on:
a. Prescription drugs
b. Hospital care
c. Physician services
d. Public health services
The largest share of health care expenditures goes to pay for hospital care, with physician services the next largest item. The money spent for public health services is significantly lower than the other categories and prescription drugs accounted for only 10% of expenditures in 2008.

DIF: COG: Remembering REF: 46 OBJ: 1

3. The number of uninsured Americans has dramatically increased because:
a. Medicare took over payment of health care costs.
b. With a declining population, the costs for health care rose.
c. Nursing salaries greatly increased, causing health care costs to rise.
d. Health insurance coverage was dropped from employment-based health plans.
Although the majority of Americans continue to obtain health insurance from their employer as a benefit, employment does not guarantee insurance. Employer-sponsored health insurance is sensitive to both the general economy and changes in health insurance premiums. As costs for insurance premiums rose, employers either shifted more of these costs to their employees or declined to offer employment-based health coverage at all.

DIF: COG: Understanding REF: 46 OBJ: 1

4. The primary purpose of the World Health Organization is to:
a. Coordinate surveillance at the global level.
b. Prevent outbreaks of disease.
c. Prevent the transmittal of communicable disease among nations of the world.
d. Provide humanitarian support in times of disaster.
The World Health Organization, comprised of 192 member countries, is uniquely positioned to coordinate surveillance and response at the global level.

DIF: COG: Understanding REF: 52 OBJ: 1

5. One of the benefits that a public health agency will experience by choosing to implement the electronic health record is:
a. Facilitation of interprofessional care
b. Improved client compliance with medical regimens
c. Cost-savings to the agency
d. Compliance with JACHO standards
The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; and increased client safety and decline in medication errors.

DIF: COG: Applying REF: 52 OBJ: 1

6. African American females have a higher mortality rate from breast cancer than Caucasian females. This is an example of:
a. Projection
b. Disparity
c. Racism
d. A sentinel event
Disparities are racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention.

DIF: COG: Applying REF: 46 OBJ: 1

7. A nursing program has initiated a recruitment campaign focusing on increasing the minority students in its program. The rationale for this campaign is that:
a. The number of minority versus non-minority nurses should be equal.
b. Minority health care professionals who share the same culture with the clients may provide more effective care.
c. The profession should be more diverse.
d. Minority nurses can mentor other nurses when providing care for diverse populations.
The Pew Commission suggests that increasing minority representation in the health workforce not only is a commitment to diversity but also will improve the health care delivery system. Minority health professionals can be expected to practice in underserved areas at a greater rate and health professionals who share the same culture and language with the clients they serve can provide more effective care.

DIF: COG: Applying REF: 51 OBJ: 1

8. A community health nurse utilizes telehealth because it:
a. Enables clients to get nursing care in their homes
b. Substitutes for health department delivered care
c. Improves access to care in rural areas
d. Replaces face-to-face care for those who cannot afford it
Telehealth provides increased access to health care by the use of a computer monitor and telephone line. It is useful for monitoring clients with chronic disease, but is not a substitute for health care.

DIF: COG: Applying REF: 51 OBJ: 1

9. An 80-year-old woman comes to the community health center with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse?
a. Lets go through these medications and see which ones we can delete.
b. You can get these medicines at this clinic for free.
c. Lets see if we can get some help from Medicare to pay for these medications. I will refer you to our social worker.
d. These medications are important. Do your best to pay for them.
This elderly patient probably is eligible for benefits through Part C, the Medicare Advantage program, but often a patient needs help negotiating the system. The Medicare Advantage program incorporates private insurance plans into the Medicare program including HMO and PPO managed care models and private fee-for-service plans. These plans receive payments from Medicare to provide Medicare benefits, including hospital, physician, and often, prescription drug benefits.

DIF: COG: Evaluating REF: 55 OBJ: 1

10. Residents of rural communities report that they must travel for long distances to obtain health care services. As a result, they seek health care only for emergencies and severe illnesses. Which aspect of the health care system in the United States is illustrated in this situation?
a. Access to care
b. Cost
c. Quality
d. Advances in technology
Funding to clinics in rural areas has been reduced, leading many rural uninsured individuals to use emergency rooms for many illnesses.

DIF: COG: Evaluating REF: 47 OBJ: 1

11. A nurse exploring a job opportunity at a community health center would expect that the center:
a. Would be located in a large metropolitan area
b. Provides care only to the economically disadvantaged
c. Offers comprehensive primary care services and supportive services
d. Is used for preventive services such as flu shots
Community health centers serve the entire community for primary health care services, regardless of income. They are located in a high need or medically underserved community, which can be urban or rural.

DIF: COG: Applying REF: 47-48 OBJ: 2

12. If a 25-year-old woman visits a community health center to obtain a gynecological examination and birth control pills, these activities are termed _____ care.
a. Tertiary health
b. Public health
c. Primary health
d. Specialized care
By definition, primary health care includes basic health care services with the emphasis on prevention.

DIF: COG: Applying REF: 53 OBJ: 2

13. A client who receives primary health care services would expect that:
a. The care would be provided by a physician.
b. Private insurance would be necessary to receive care.
c. The emphasis of care provided would be on prevention.
d. A referral would be made to a specialist after receiving services.
The focus of primary health care is a broad range of services that are designed to be affordable for the recipients of the care and the governments who provide them. The emphasis of care is on prevention and the means of providing the care is based on practical, scientifically sound, culturally appropriate, and socially acceptable methods.

DIF: COG: Applying REF: 53-54 OBJ: 2

14. When compared to public health care, primary care is:
a. Focused on individuals
b. Provided by specialists
c. Self-reliant
d. Community focused
Primary care also is provided by generalists, is dominated by health care professionals, and is not community focused.

DIF: COG: Analyzing REF: 53 OBJ: 2

15. What initiative began as a result of a resolution adopted by the World Health Organization (WHO) in 1977?
a. Declaration of Alma Ata
b. Medicare
c. Healthy People
d. Primary health care movement
The WHO adopted a resolution accepting the goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives. The name of the resolution that was adopted was the Declaration of Alma Ata.

DIF: COG: Understanding REF: 53 OBJ: 3

16. Primary health care in the United States:
a. Has dramatically improved since the passage of the Declaration of Alma Ata
b. Focuses on the use of government-funded insurance programs
c. Lacks community participation and a multidisciplinary health care delivery team
d. Utilizes Preferred Provider Organizations to meet needs of the citizens
Although primary health care (PHC) has been endorsed by the United States, it faces many challenges. PHC emphasizes broad strategies, community participation, self-reliance, and a multidisciplinary health care delivery team; however, this is not the primary method of health care delivery in the United States.

DIF: COG: Understanding REF: 54 OBJ: 3

17. A community health nurse reviews Healthy People 2020 when considering the health needs that will be addressed in the community. Which goal would the nurse find in this document?
a. Promote healthy behaviors for children.
b. Cure cancer.
c. Eliminate health disparities.
d. Provide primary care to all citizens.
Elimination of preventable disease, disability, injury, premature death; achievement of health equity; elimination of health disparities; and creation of social and physical environments that will promote good health and healthy development and behavior at every stage of life are the four major goals cited in Healthy People 2020.

DIF: COG: Applying REF: 54 OBJ: 4

18. When researching advanced practice nursing options, a nursing student discovers that:
a. Nurse practitioners may work as independent practitioners.
b. Certified nurse midwives have limited prescriptive authority.
c. Clinical nurse specialists typically provide primary care services.
d. The Doctorate in Nursing Practice emphasizes the importance of research.
Nurse practitioners may work as independent practitioners and can be reimbursed by Medicare or Medicaid for services rendered. Certified nurse midwives have prescriptive authority in some form in all states. Clinical nurse specialists may provide primary care services, but often work in consultation, research, education, and administration. The Doctorate in Nursing Practice role is a clinical role.

DIF: COG: Applying REF: 55 OBJ: 4

19. A nursing student interviews a member of the local congressional district to learn more about the health care system in the United States. Which statement made by the congressman would be accurate?
a. Managed care was short-lived because too many consumer groups endorsed the plans.
b. Under managed care, clients had unlimited access to providers of their choice.
c. Managed care failed because Americans were used to free access to providers of their choice.
d. Managed care in the United States has been replaced by the Affordable Health Care for America Act.
Consumer groups were not only accustomed to freedom of choice and unlimited service, but they did not like the ideas of short-stay maternity care and denial of bone marrow transplantation for breast cancer patients, thus managed care failed in the United States.

DIF: COG: Evaluating REF: 55 OBJ: 4

20. The federal agency of the public health system that is most involved with the health and welfare of United States citizens is the:
a. Centers for Medicaid and Medicare Services
b. Department of Health and Human Services
c. Public Health Service
d. Secretary for Health
The Department of Health and Human Services is charged with regulating health care and overseeing the health status of Americans.

DIF: COG: Understanding REF: 55-56 OBJ: 5

21. Which program would typically be found in a state health department?
a. Senior health
b. Dental services
c. HIV/AIDS service
d. Mental health
Typical programs in a state health department include: communicable disease service, HIV/AIDS service, and budget and finance. Senior health, dental health, and mental health are typically found in a local health department.

DIF: COG: Applying REF: 58 OBJ: 5

22. An expected action by the Department of Homeland Security would be:
a. Prevention and protection against terrorist attacks
b. Regulation of licensure of medical personnel
c. Inspection of the safety of food and cosmetics
d. Regulation of managed care organizations
This agency was created after the terrorist attacks of September 11, 2001, to prevent and deter terrorist attacks and to protect against and respond to threats and hazards to the nation.

DIF: COG: Applying REF: 58 OBJ: 5

23. An example of a public health law instituted to protect the health of the community is:
a. Requiring all persons to have health insurance coverage
b. Administering flu shots in the late fall and early winter
c. Mandating immunizations for all children entering kindergarten
d. Monitoring and licensing nuclear power plants
Public health laws protect the community. Required immunizations are an example.

DIF: COG: Analyzing REF: 56 OBJ: 5


1. What are some of the untoward events categorized in the Institute of Medicine (IOM) report about medical errors? Select all that apply.
a. Wrong-site surgery
b. Adverse drug events
c. Improper transfusions
d. Restraint related deaths
ANS: A, B, C, D
All of the abovewrong-site surgery, adverse drug events, improper transfusions, and restraint-related deathsare listed in the IOM report.

DIF: COG: Understanding REF: 49 OBJ: 1

2. Which statement(s) about the health care workforce are true? Select all that apply.
a. There is a shortage of nurses in the United States.
b. Schools of nursing turn away qualified applicants due to lack of faculty and limitations of clinical sites.
c. More than one million nurses will be needed by 2012 to replace those who are retiring.
d. More students are choosing laboratory science, pharmacy technology, and radiology technology over nursing.
ANS: A, B, C
All are true except the last option. The fields listed in it have also seen declining enrollment.

DIF: COG: Applying REF: 50 OBJ: 1

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