Chapter 07: Healthcare Organizations Nursing School Test Banks

Chapter 07: Healthcare Organizations
Yoder-Wise: Leading and Managing in Nursing, 6th Edition

MULTIPLE CHOICE

1. To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are:
a. Units that provide only primary care services.
b. Owned by the institutions.
c. A feature of all public institutions.
d. Units that serve large populations.
ANS: D
Healthcare networks are interconnected units. Their aim is serving large regional populations.

REF: Page 123 TOP: AONE competency: Knowledge of the Health Care Environment

2. A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. An HMO:
a. Provides more expensive care than other types of insurance plans.
b. Has a centralized administration that directs and compensates physician services.
c. Pays physicians on a fee-for-service basis.
d. Does not pay as much for acute care as other practice plans.
ANS: B
The HMO is a configuration of healthcare agencies that provide basic and supplemental health maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee without regard to the amount of services used. HMOs have a centralized administration that directs and pays salaries for physician practice (e.g., HMOs).

REF: Page 123 | Page 124
TOP: AONE competency: Knowledge of the Health Care Environment

3. With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze childrens health. School health programs are:
a. Increasingly seen as primary care sites for children.
b. Providing only health education programs for children and their parents.
c. Capable only of providing referrals for health problems to primary care providers.
d. Funded exclusively by local authorities.
ANS: A
Traditionally, school health programs were organized to control infectious disease outbreaks, treat and control on-site injuries, and educate parents and children about basic health. Increasingly, schools are being seen as primary healthcare sites for children.

REF: Page 125 TOP: AONE competency: Knowledge of the Health Care Environment

4. The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services:
a. Care for the specific needs of individual families in the community.
b. Focus on the treatment of community-wide problems rather than on individual health problems.
c. Do not include services provided by public health departments.
d. Provide personal health follow-up for all acute care hospitalizations.
ANS: B
Community services, including public health departments, are focused on the treatment of the community rather than that of the individual. These funds provide personal health services, care for communicable diseases, services for children with birth defects, mental health care, investigation of epidemiology, and treatment of bioterrorism threats and attacks. Monies are allocated also for environmental services and for health resources.

REF: Page 125 TOP: AONE competency: Knowledge of the Health Care Environment

5. A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in:
a. Critical pathways.
b. Healthcare networks.
c. Health maintenance organizations.
d. Managed care.
ANS: D
Managed care strives to contain costs (e.g., through limitation of time in care) while maintaining quality. Managed care combines care delivery with financing and provides comprehensive services for a fixed prepaid fee. Group practice plans take various forms. One form has a centralized administration that directs and pays salaries for physician practice (e.g., HMOs).

REF: Page 123 TOP: AONE competency: Knowledge of the Health Care Environment

6. A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organizations changes are:
a. Creating more jobs in the community for registered nurses.
b. Resulting in an overall loss of jobs for registered nurses.
c. Controlled by the federal and state governments.
d. Controlled by the insurance agency.
ANS: A
Home care agencies staffed appropriately with adequate numbers of professional nurses have the potential to keep older adults, those with disabilities, and persons with chronic illnesses comfortable and safe at home. Home care is the fastest growing segment in health care and the volume of home health care may have a subsequent impact on the numbers of nurses required.

REF: Page 125 TOP: AONE competency: Knowledge of the Health Care Environment

7. You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example?
a. First level
b. Second level
c. Fourth level
d. Fifth level
ANS: D
Consolidated systems tend to be organized into five levels. The fifth level involves special interest groups that own and operate units along religious lines, teaching interests, or related special interests that drive their activities. In this example, the facilities are funded and managed by a religious organization that provides care that is congruent with its particular faith-based values.

REF: Page 123 TOP: AONE competency: Knowledge of the Health Care Environment

8. A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide:
a. Rehabilitative or long-term care.
b. Disease-restorative care.
c. First access to care.
d. Only outpatient services.
ANS: C
The spectrum of care services provided are typically described as primary care (first-access care), secondary care (disease-restorative care), and tertiary care (rehabilitative or long-term care). Ambulatory care centers are an example of primary care.

REF: Page 120 TOP: AONE competency: Knowledge of the Health Care Environment

9. A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations:
a. Pay dividends to stockholders.
b. Can refuse clients who are unable to pay.
c. Have no paid employees.
d. Pay no taxes.
ANS: D
Not-for-profit organizations, often referred to as voluntary organizations, are controlled by voluntary boards and provide services to both paying and charity clients. Funds are redirected toward maintenance and growth as opposed to profit shares for stockholders. Historically, non-profit organizations have been exempt from paying taxes as they commit to providing an important community service.

REF: Page 121 TOP: AONE competency: Knowledge of the Health Care Environment

10. In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on the healthcare delivery systems of the future is:
a. Changes in staffing patterns.
b. Increasing reports of violence in the workplace.
c. The increasing percentage of the population that will be over age 65.
d. Escalations in the cost of health care.
ANS: C
A demographic change that will significantly impact the healthcare system of the future is the increasing proportion of individuals 65 years and older. By 2025, more than 18% of the population is expected to be 65 years and older, which means that new healthcare organizations will evolve as the system attempts to maintain older adults in the community for as long as possible.

REF: Page 130 TOP: AONE competency: Knowledge of the Health Care Environment

11. A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered:
a. A healthcare network.
b. A tertiary care institution.
c. Rehabilitative.
d. Long-term care.
ANS: A
Healthcare networks embrace and provide wellness and illness services, including primary, secondary, and tertiary care, through a network of providers.

REF: Page 120 TOP: AONE competency: Knowledge of the Health Care Environment

12. Healthcare organization XYZ provides womens health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered:
a. Primary care, specialized.
b. Tertiary care, long-term.
c. Acute care, specialized.
d. Public care, specialized.
ANS: C
The AHA defines an acute care hospital as a facility in which the average length of stay is less than 30 days. Because of the focus on womens health services, it would also be considered specialized.

REF: Page 119 | Page 120
TOP: AONE competency: Knowledge of the Health Care Environment

13. You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to:
a. The possibility of violence.
b. An increase in prescription drugs available for abuse.
c. Decisions of the public board.
d. An increase in uncompensated care events.
ANS: D
Public and non-profit hospitals are tax exempt and have a concomitant responsibility to provide mandated community service such as delivering care to the poor and indigent. To keep a non-profit status, facilities must make a good-faith effort to provide community service and charity care Non-profit organizations located in impoverished urban and rural areas are often economically disadvantaged by the amount of uncompensated care that they provide.

REF: Page 121 | Page 122 TOP: AONE competency: Business Skills

14. A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and:
a. Lower salary compensation for staff.
b. Rising expectations of impoverished and indigent individuals for services.
c. Poor orientation and retention practices for staff.
d. An overwhelming emphasis on accepting learners from health disciplines.
ANS: A
For-profit hospitals tend to have lower wage and salary costs that are most likely connected to aggressive goals for profit.

REF: Page 122 TOP: AONE competency: Business Skills

15. Which of the following is an example of an HMO?
a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a womens health clinic.
b. Physicians in a large urban center are reimbursed for visits made to their clients.
c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan.
d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.
ANS: D
Fee-for-service systems provide compensation to healthcare providers in group practices based on fee-for-service, which in PPQs means that fees are paid promptly but at a discounted rate. HMOs are configurations of healthcare agencies that provide health maintenance and services for enrolled patients for a fee that is preestablished regardless of utilization of service.

REF: Page 123 | Page 124
TOP: AONE competency: Knowledge of the Health Care Environment

16. As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, which of the following would require reassessment?
a. Patients admitted to the facility must have adequate health insurance to cover the services provided.
b. A local nurse education program asks you if nursing students can gain clinical experience with recovering surgical patients in the facility.
c. Public funding will be provided to enable care of patients who have an ordinary course of recovery.
d. The facility is an older house that is more than 30 minutes away from the acute care center.
ANS: D
Because of the types of patients being accepted for care and the distance of the subacute facility from acute care, emergency response and seamless transfer issues in the event of an unanticipated crisis must be addressed. As a nurse manager, an important part of your position may be assisting to develop strategies to maximize the benefits and minimize the risks in this situation.

REF: Page 124 TOP: AONE competency: Knowledge of the Health Care Environment

17. Which of the following would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service?
a. Programs to educate the community on preparing healthy meals for a limited cost
b. Reduction of injuries from alcohol-related accidents
c. Pain management for patients with low back pain
d. Reduction of falls among seniors
ANS: C
Nurse-managed and nurse-owned healthcare services are part of a growing number of organizations that extend health care beyond that offered through traditional services. Growth in these organizations and services has been spurred by the implementation of the prospective payment system, which resulted in early discharge of many patients from acute care facilities. These nurse-managed and nurse-owned services focus on the care of individuals and families rather than on community-based outcomes for populations such as older adults, or on community-based issues such as injuries related to drunk driving.

REF: Page 124 TOP: AONE competency: Knowledge of the Health Care Environment

18. As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that veterans hospitals provide:
a. Primary care and are privately funded.
b. A range of services and are responsible to government and taxpayers.
c. Secondary care only and are publicly administered and funded.
d. Services to veterans under an HMO.
ANS: B
Veterans Administration hospitals provide a range of services to veterans and are responsible to government and thus to taxpayers, who support the hospitals.

REF: Page 121 TOP: AONE competency: Knowledge of the Health Care Environment

19. A group of patients with early Alzheimers disease and their spouses approach you regarding help with the establishment of a local Alzheimers Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, what suggestion or advice would you offer this group?
a. Self-help groups are, by nature, directed, funded, and led by those requiring help, and therefore, the patients and families should need no help from your clinic.
b. Your healthcare organization would be pleased to help as long as your organization financially takes over responsibility for direction, leadership, and management.
c. Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group.
d. The services that the patients and spouses are proposing are likely being offered somewhere else already.
ANS: C
Self-help groups often are made up of, and are directed by, peers who have healthcare needs. A growing trend is the development of community-based geriatric organizations in partnership with healthcare organizations. The request of the patients and their spouses indicates that this service is needed in the community and that they are looking for assistance in setting up the Alzheimers Society rather than having your agency take over the management of the group.

REF: Page 126 TOP: AONE competency: Knowledge of the Health Care Environment

20. Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid. Tracys responsibilities most likely would include:
a. Managing physician-led research.
b. Monitoring physician documentation of the need for medical care.
c. Determining which services are designated fee-for-service.
d. Identifying errors in physician diagnoses.
ANS: B
Nurse case managers serve as interfaces for the Centers for Medicare & Medicaid Services (CMS) and are key in monitoring compliance with Conditions of Participation (CoP) elements. The case managers routinely monitor for appropriate physician documentation of medical necessity and other required CoP elements.

REF: Page 126 | Page 127
TOP: AONE competency: Knowledge of the Health Care Environment

21. The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility:
a. Cannot accept mental health patients who are Medicare beneficiaries.
b. Can care for only Medicaid and not Medicare beneficiaries.
c. Has not met the standards set by the CMS as determined by an external review panel.
d. Has been reviewed and accredited by the AOA, which is a deeming authority for CMS.
ANS: D
CMS accreditation or external review of an organizations compliance with the standards set by the CMS can be conducted by the AOA, which is a deeming authority for CMS.

REF: Page 127 TOP: AONE competency: Knowledge of the Health Care Environment

22. As a nurse manager in a hospital, you would expect which of the following to be the major contributor to funding and revenues in your organization?
a. The federal government
b. Medicare
c. Medicaid
d. Blue Cross/Blue Shield
ANS: A
The federal government is responsible for both Medicare and Medicaid and is the largest and most influential health insurance program in the United States. The federal government is the primary payer of healthcare costs in the United States.

REF: Page 126 TOP: AONE competency: Knowledge of the Health Care Environment

23. As a nurse manager, you have been asked to be part of a design team for health services that have vertical integration. In planning for these services, your team will design a proposal that will:
a. Cluster like services together, such as outpatient clinics for the care of children with various developmental and medical needs.
b. Plan for the smooth transition of patients from the emergency services department to other units in the hospital.
c. Ensure that funding follows the patient from acute care to long-term care services.
d. Bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.
ANS: D
When organizations align to provide a full array or continuum of services, the arrangement is referred to as vertical integration. Benefits attributed to vertical integration include enhanced coordination of services, efficiency, and customer services.

REF: Page 129 TOP: AONE competency: Knowledge of the Health Care Environment

24. Which of the following patients would be most likely covered under Medicare?
a. Jim, who lives on the street and has occasional infections
b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections
c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family
d. Dan, who is 68 years of age and in good health
ANS: D
Medicare is a federal government program for individuals over 65 and with certain permanent illnesses, such as end-stage renal disease. Medicaid provides financing of health care for the medically indigent.

REF: Page 126 TOP: AONE competency: Knowledge of the Health Care Environment

25. Which of the following is an outcome of managed care?
a. Shift of patients to outpatient and home health services
b. Less complexity in funding sources
c. Less complexity in rules for consumers to follow
d. Greater consistency in the quality of care
ANS: A
A goal of managed care is to reduce the cost of expensive acute hospital care by focusing on out-of-hospital preventive care and illness follow-up care, which has led to shifts in where health care is delivered.

REF: Page 123 TOP: AONE competency: Knowledge of the Health Care Environment

MULTIPLE RESPONSE

1. As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of (select all that apply):
a. Increased salary costs.
b. Duplication of tests and procedures.
c. Graduate medical education.
d. Potential damage to reputation through learner error.
ANS: A, B, C
Teaching hospitals tend to incur higher costs because of the salaries required for supervision of physicians, duplication of tests and procedures through the learning process, longer times required to process patients, costs of state-of-the art technology, biomedical research, and stand-by capacity of specialized care. Because of the additional costs, few for-profit agencies and organizations support teaching programs.

REF: Page 122 TOP: AONE competency: Business Skills

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