Chapter 2: Health Care Delivery System(Free) Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. Health care costs increased dramatically from 1965 to 1985 as a result of:

a.

Unrestricted medical prescription

b.

Increased numbers in the work force

c.

Increased incidence of acute disease

d.

A growing birth rate

ANS: a

a. During most of the 20th century, little restriction was placed on the prescription of care and treatment of clients. As a result, health care costs grew out of control.

b. The increase in members within the work force is not responsible for the dramatic increase in health care costs.

c. There is an increased incidence of chronic disease in the United States and hospitalized clients are more acutely ill. Neither condition accounts for the dramatic increase in health care costs from 1965 to 1985.

d. After the baby boom, the birth rate proportionately declined from 1965 to 1985.

REF: Text Reference: p. 28

2. In an attempt to reduce the tremendous increase in health care costs, regulatory or government interventions for cost reduction were initiated. These interventions include:

a.

Prospective payment systems

b.

Federal guidelines for treatment

c.

State limits on health care fees

d.

Court review of insurance coverage

ANS: a

a. As a means to reduce health care costs, in 1983, Congress established the prospective payment system in which hospitals are reimbursed a set dollar amount for each diagnosis-related group, regardless of the length of stay or use of services in the hospital.

b. Federal guidelines for treatment have not been used to reduce the cost of health care. Rather, the focus has been on financial reimbursement.

c. State limits on health care fees have not been used nationwide to reduce health care costs.

d. Court review of insurance coverage has not been a primary intervention to reduce health care costs.

REF: Text Reference: p. 28

3. Health care professionals are affected by increasing health care costs. Nurses may be most directly influenced by cost control because they:

a.

Constitute a large percentage of the health care budget

b.

Achieve higher salary levels than do other health care professionals

c.

Provide direct client care without reimbursement

d.

Deliver the least cost-effective care

ANS: a

a. Nursing typically makes up a large percentage of a health care institutions labor budget. To save money, an organization may hire fewer nurses and instead hire less-educated technical staff, placing greater responsibility on the nurse.

b. Nurses do not necessarily achieve higher salary levels than do other health care professionals.

c. The impact of cost control on nurses is not because nurses provide client care without direct reimbursement from the client.

d. Nurses do not deliver the least cost-effective care. Many negative, and costly, outcomes may be avoided when patients are under the direct care of a registered nurse.

REF: Text Reference: p. 29

4. Levels of prevention are used by the nurse to provide a framework or guide for nursing interventions. Focus is based on the clients needs and the care or service that is provided. An example of a true health promotion service is a(n):

a.

Immunization clinic

b.

Diabetic support group

c.

Aerobic dance class

d.

Smoking cessation clinic

ANS: c

c. Examples of health promotion activities include exercise classes, prenatal care, well-baby care, nutrition counseling and family planning.

a. An immunization clinic is an example of an illness prevention service.

b. A diabetic support group may be an example of a rehabilitation service to adapt to a change in lifestyle.

d. A smoking-cessation clinic may be a part of rehabilitation or offered as an illness prevention service.

REF: Text Reference: p. 31

5. A wide variety of health caredelivery agencies exist. An example of an agency that provides secondary level care is a:

a.

Home health agency

b.

Hospice

c.

State-owned psychiatric hospital

d.

Nursing home

ANS: c

c. A state-owned psychiatric hospital is an example of the secondary level of care in which clients with signs and symptoms of disease are diagnosed and treated.

a. A home health agency is an example of either restorative or continuing care, depending on the clients condition.

b. Hospice care is an example of continuing care.

d. A nursing home is an example of continuing care.

REF: Text Reference: p. 30, Text Reference: p. 34, Text Reference: p. 35

6. Which of the following fits within the occupational safety and health categories?

a.

Motorcycle helmets

b.

Firearms safety

c.

Swimming lessons

d.

Noise exposure

ANS: d

d. Exposure to environmental hazards within the workplace such as noise exposure, is one aspect of occupational safety and health.

a. Motorcycle helmets do not fit within the occupational safety and health category.

b. Firearms do not fit within the occupational safety and health category.

c. Swimming lessons do not fit within the occupational safety and health category.

REF: Text Reference: p. 32

7. The health care for an employee of a large corporation may be paid, at a discount, through a contractual agreement between a hospital and the corporation. This is an example of a(n):

a.

Preferred Provider Organization (PPO)

b.

Medicare Health Management Organization (HMO)

c.

Fee-for-service plan

d.

Third-party payment

ANS: a

a. A preferred provider organization (PPO) is characterized by a contractual agreement between a set of providers (e.g., hospitals, physicians, or clinics) and a purchaser (i.e., the corporations insurance plan). Comprehensive health services are provided at a discount to the companies under contract. Enrollees are limited to a list of preferred hospitals, physicians, and providers. An enrollee pays more out-of-pocket expenses for using a provider not on the list.

b. A Medicare health maintenance organization (HMO) is the same as a managed care organization (all care provided by a primary care physician) but designed to cover costs of senior citizens.

c. Private insurance is the traditional fee-for-service plan in which payment is computed after services are provided based on the number of services used.

d. In third-party payment, an entity (other than the patient or health care provider) reimburses health care expenses. Third-party payers include insurance companies, governmental agencies, and employers.

REF: Text Reference: p. 29

8. A client comes to the ambulatory care clinic for management of a chronic condition. While speaking with the nurse, he asks for an explanation as to the difference between Medicare and Medicaid. The nurse tells the client that the Medicaid insurance program is best described as:

a.

A two-part federally funded health care program for older and disabled persons

b.

Acute care hospital insurance for older persons

c.

A state-regulated health care program for persons of low income

d.

A fee-for-service insurance plan that supports preventive health care

ANS: c

c. Medicaid is a federally funded, state-operated program of medical assistance to people with low incomes. Individual states determine eligibility and benefits.

a. This option describes Medicare.

b. This option describes Medicare Part A.

d. This option does not describe Medicaid.

REF: Text Reference: p. 29

9. Quality care management is an innovative approach to delivering health care. The major factor in its success is that it:

a.

Focuses on the process

b.

Uses outcomes to manage the client care

c.

Is used exclusively in the acute care setting

d.

Allows a high degree of flexibility for the nurse delivering the care

ANS: b

b. Health care providers are defining and measuring quality in terms of outcomes. An outcome is a measure of what actually does or does not happen as a result of a process of care.

a. The focus in quality care management is on the outcome, not the process.

c. Quality care management is not used exclusively in the acute care setting. It may be used in various health care settings.

d. Because quality care management is based on achieving outcomes, it does not allow a high degree of flexibility for the nurse in delivering care.

REF: Text Reference: p. 42

10. Case management is one strategy for coordinating health care services. What best describes this care-giving approach?

a.

It is designed for clients requiring minimal to moderate levels of care.

b.

Continuity of care is the primary concern.

c.

The physician is the coordinator of the client care.

d.

This focus of care may be more expensive.

ANS: b

b. With the case management model of care, the case manager coordinates the efforts of all disciplines to achieve the most efficient and appropriate plan of care. Continuity of care is of primary importance.

a. Case management is not entirely based on the level of care required.

c. The physician may or may not be the coordinator of client care. The case manager typically is a nurse or social worker.

d. If the efforts of all disciplines are well managed, repetition or delays may be avoided with a resultant shortened hospital stay. Therefore, this focus of care may not be more expensive.

REF: Text Reference: p. 34

11. The payment mechanism that Medicare uses for its health care financing is:

a.

Capitation

b.

Prospective payment

c.

Fixed payments

d.

Direct contracting

ANS: b

b. Inpatient hospital services for Medicare clients are reimbursed a set amount for each diagnosis-related group (DRG), regardless of the clients length of stay or use of services in the hospital.

a. Capitation is the payment mechanism in which providers receive a fixed amount per enrollee of a health care plan.

c. Medicare is based not on fixed payments, but rather on a set dollar amount according to the DRG.

d. The payment mechanism that Medicare uses is not direct contracting.

REF: Text Reference: p. 28

12. A student nurse visiting a nurse-managed clinic should expect to see which of the following services offered?

a.

Same-day surgery

b.

Family support services

c.

Ongoing psychiatric therapy

d.

Physical therapy

ANS: b

b. Nurse-managed clinics focus on health promotion and health education, disease prevention, chronic disease management, and support for self-care and caregivers.

a. Same-day surgery is not offered in a nurse-managed clinic.

c. Psychiatric therapy is not offered in a nurse-managed clinic.

d. Physical therapy is not typically offered in a nurse-managed clinic.

REF: Text Reference: p. 32

13. The client with a disability is being discharged from the medical unit in the hospital but still requires restorative care to return to a prior level of functioning. This client should be referred to a(n):

a.

Assisted living facility

b.

Ambulatory health center

c.

Sub-acute care unit

d.

Home health care agency

ANS: d

d. A home health care agency provides health services to individuals and families in their home to promote, maintain, or restore health, or to maximize the level of independence while minimizing the effects of disability and illness.

a. Assisted living is a long-term care setting in which clients need some assistance with activities of daily living, but otherwise remain independent.

b. An ambulatory health center is not the best referral for restorative care.

c. A sub-cute care unit is not the best referral for restorative care.

REF: Text Reference: p. 35

14. Which of the following is an appropriate referral for an older client who requires some assistance with daily activities within a partially protective environment?

a.

Respite care

b.

Rehabilitative care

c.

Assisted living

d.

Extended care

ANS: c

c. This option describes assisted living. A group of residents live together, each resident having his or her own room, yet sharing dining and social activity areas.

a. Respite care is a service that provides short-term relief for persons providing home care to the ill or disabled.

b. Rehabilitative care includes physical, occupational and speech therapy and social services to help restore a person to the fullest ability.

d. An extended care facility provides intermediate medical, nursing, or custodial care for clients recovering from acute or chronic illness or disabilities.

REF: Text Reference: p. 38

15. The nurse recognizes that discharge planning for clients begins:

a.

After a diagnosis has been established

b.

Once the long term needs are identified

c.

When the acute care therapies are completed

d.

Immediately on admission to a health care facility

ANS: d

d. Discharge planning should begin at the time of admission to the hospital, by using the strengths and resources of the client, providing resources to meet the clients limitations, and focusing on improving the clients long-term outcomes.

a. The clients diagnosis does not have to be established before discharge planning can begin.

b. Discharge planning should include preparation for long-term needs of the client.

c. Acute care therapies may affect a clients discharge and should be a part of the plan from the beginning.

REF: Text Reference: p. 34

16. A neighbor is asking about what is included in a managed care organization (MCO). He says that he isnt sure how this type of health insurance works. You respond to the neighbor most appropriately by explaining that the MCO:

a.

Allows the individual to go to any physician that he desires

b.

Provides reimbursement for all requested health services

c.

Offers additional coverage for illness-oriented care

d.

Focuses on primary health care for designated members

ANS: d

d. In a managed care organization (MCO), a primary care physician provides all care, and the focus is on health maintenance and primary care.

a. In an MCO, referral by the primary care physician is necessary for access to specialists and for hospitalization.

b. An MCO does not necessarily provide reimbursement for all health services requested.

c. An MCO does not offer additional coverage for illness-oriented care. The focus is on health maintenance and primary care.

REF: Text Reference: p. 29

17. Levels of prevention are used by the nurse to provide a framework or guide for nursing interventions. Focus is based on the clients needs and the care or service provided. An example of the application of the secondary level of prevention is demonstrated by the nurse:

a.

Providing well-baby care

b.

Completing a community health blood pressure screening

c.

Administering a bronchodilating medication

d.

Instructing the client in the cardiac rehabilitation program

ANS: c

c. Administering a bronchodilating medication is an example of secondary care (acute care).

a. Well-baby care is an example of preventive care.

b. A blood pressure screening is an example of illness prevention in the level of preventive care.

d. Rehabilitation is an example of the restorative level of care.

REF: Text Reference: p. 30

Copyright 2005 by Mosby, Inc. All rights reserved.

Leave a Reply