Foundations of Nursing in the Community: Community-Oriented Practice Stanhope 3rd Edition Te

Foundations of Nursing in the Community:

Community-Oriented Practice Stanhope 3rd Edition
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 Stanhope: Foundations of Nursing in the Community: Community-
Oriented Practice, 3rd Edition

Chapter 8: Economic Influences

Test Bank

MULTIPLE CHOICE

1. To make decisions regarding the most cost-effective way to allocate health care
resources, a nurse must be knowledgeable about:
a. Insurance resources
b. Health care rationing
c. Health economics
d. Medical technology
ANS: C
Economics is the science concerned with the use of resources; health economics is
concerned with how scarce resources affect the health care industry. The other options
are important components of health economics but by themselves do not provide the
broad understanding called for in this question.

DIF: Cognitive Level: Knowledge REF: p. 129

2. Which of the following is most typical of families in the United States who do not have
health insurance?
a. Adult in the family is employed in a low-paying, part-time, or temporary job.
b. Both parents are employed but do not receive benefits.
c. No one in family is employed.
d. Workers are not eligible for health insurance because they lack legal status in
United States.
ANS: A
The typical uninsured person is a member of the workforce or a dependent of this worker.
Uninsured workers are most likely to be employed in low-paying jobs, part-time or
temporary jobs, or jobs at small businesses that do not provide health insurance as a
benefit. Such employees are typically unable to afford to pay for health insurance.

DIF: Cognitive Level: Knowledge REF: p. 130

3. What single factor is most closely correlated with poor health?

a. A combination of age and gender (i.e., older males)
b. Low socioeconomic status
c. Minority race status
d. High-risk lifestyle behaviors
ANS: B

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 8-2

Poverty is more closely related to health status even when controlling for age, gender,
race, education, and lifestyle behaviors.

DIF: Cognitive Level: Knowledge REF: p. 130

4. For children whose parents do not receive health insurance as an employee benefit and
who do not have the financial resources to pay for health care out of pocket, what referral
should the nurse make?
a. A managed care organization
b. An emergency department
c. Medicaid
d. Medicare
ANS: C
Medicaid provides coverage for adults with low income and their children.

DIF: Cognitive Level: Application REF: p. 131

5. How does the government inadvertently encourage low-income persons to use emergency
departments as their primary care provider?
a. A huge amount of paperwork is required when Medicaid clients go to a physician’s
office
b. Government regulations require Medicaid clients to use emergency departments
when their primary health care provider is unavailable.
c. Legally, emergency departments must see clients even if clients can’t pay.
d. Physicians’ limited office hours make them unavailable during evenings and
nights.
ANS: C
People on Medicaid frequently have no primary care provider and may not be able to pay
for their care. Although physicians can choose clients based on their ability to pay,
emergency departments are required by law to evaluate every client regardless of ability
to pay. Emergency department copayments are modest and are frequently waived if the
client is unable to pay. Thus low out-of-pocket costs provide incentives for Medicaid
clients and the uninsured to use emergency departments for primary care services.

DIF: Cognitive Level: Knowledge REF: p. 131

6. Of the four main factors that affect health, which is the least important?
a. Environment
b. Human biology
c. Lifestyle choices
d. Health care system
ANS: D

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 8-3

Of the four major factors that affect health—personal behavior (or lifestyle),
environmental factors (including physical, social, and economic environments), human
biology, and the health care system—medical services are said to have the least effect.
Behavior (lifestyle) has been shown to have the greatest effect, but environment and
biology account for 70% of all illnesses.

DIF: Cognitive Level: Knowledge REF: pp. 131-132

7. Which nurse action is most likely to result in maximizing quality of life while reducing
health care costs?
a. Assisting in cast application for a client who was injured in a skateboard incident
b. Irrigating the eyes of a client splashed with chemicals
c. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a
client with a heart condition
d. Teaching a high school boy about sexually transmitted infections and proper
condom application
ANS: D
Education is primary health care prevention. A proactive investment in disease
prevention and health promotion targeted at improving health behaviors and lifestyle has
the potential to improve health status and reduce health care costs.

DIF: Cognitive Level: Synthesis REF: Entire chapter

8. Epidemics were the focus of health concern before 1900 in the United States. What
changed and caused health care providers to begin to focus on individual infections and
trauma?
a. Education of health care providers moved into universities.
b. People finally had enough money to pay for medical care.
c. People recognized the helpfulness of hospitals.
d. Advances were made in safe water, sewage disposal, and pasteurization of milk.
ANS: D
Environmental conditions influencing health began to improve with major advances in
water purity, sanitary sewage disposal, milk quality, and urban housing quality. The
health problems of this era were no longer mass epidemics but individual acute infections
or traumatic episodes.

DIF: Cognitive Level: Knowledge REF: p. 133

9. What demographic factor is expected to have the greatest influence on national health
care spending?
a. The aging population
b. Use of diagnosis-related groups to determine reimbursement
c. Insurance reform
d. An increasing number of people without health insurance
ANS: A

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 8-4

The aging population is expected to affect health services more than any other
demographic factor. The majority of older adults rely on publicly funded programs. As
the baby boom generation ages and retires, federal expenses for Social Security and
health care will increase.

DIF: Cognitive Level: Knowledge REF: p. 136

10. Who pays the largest amount for health care in the United States today?
a. Consumers
b. Federal and state government
c. Insurance companies and other third-party payers
d. Hospitals and health care providers
ANS: B
Health care financing has evolved from a time when the most money was expended by
consumers, then to a system financed by third-party payers such as insurance companies,
and finally, to today, when state and federal government payments (primarily through
Medicare and Medicaid) pay more than private insurance companies or consumers.

DIF: Cognitive Level: Knowledge REF: p. 138

11. In the past, Medicare paid the usual and customary cost, as determined by the involved
health care providers and facilities. However, what criterion is now used for deciding the
amount of the reimbursement before care is provided?
a. A proportion of actual cost arbitrarily decided by the Medicare panel
b. The budget constraints in the fiscal year
c. Hospital and health care provider feedback and political persuasion
d. Prospective payment scale based on the medical diagnosis
ANS: D
As a result of rising health costs, Congress passed a law in 1983 that mandated an end to
cost-plus reimbursement and instituted a prospective payment system (PPS) for inpatient
hospital services to shift the cost incentives away from the providing of more care and
toward more efficient services. The basis for prospective reimbursement is the 468
diagnosis-related groups (DRGs).

DIF: Cognitive Level: Knowledge REF: p. 140

12. Which area of service absorbs the majority of state Medicaid funds?
a. Early periodic screening, diagnosis, and treatment for young persons
b. Laboratory and radiology services
c. Outpatient hospital care
d. Skilled nursing care at home and in nursing homes
ANS: D
The major expense categories for the Medicaid program have historically been inpatient
(not outpatient) hospital care and skilled nursing care at home and in nursing homes.

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 8-5

DIF: Cognitive Level: Knowledge REF: p. 141

13. What payment system tries to keep clients healthy through education and health
promotion, with the goal of reducing the need for professional health care intervention
and therefore also lowering cost?
a. Managed care plan
b. Fee-for-service payment
c. Prospective reimbursement
d. Retrospective reimbursement
ANS: A
Fee-for-service payment encourages more services to be given. Reimbursement, whether
prospective or retrospective, is based on the same criteria, but managed care integrates
the financing and the delivery of health care. The concept of managed care is that costly
care could be reduced if consumers had access to education and health promotion.

DIF: Cognitive Level: Knowledge REF: p. 143

14. What is it called when a nurse practitioner receives a set monthly payment to take care of
a group of clients regardless of the services needed and provided?
a. Capitation
b. Fee for service
c. Rationing
d. Retrospective reimbursement
ANS: A
In payment by capitation, practitioners are paid a set amount to provide care to a given
client or group of clients for a set period of time.

DIF: Cognitive Level: Comprehension REF: p. 144

15. Some people have expressed concern that health care coverage based on capitation may
have negative side effects. What might capitation encourage?
a. Coercing clients to attend health promotion education classes
b. Encouraging clients to seek care elsewhere
c. Increasing the number of interventions to maximize payment
d. Neglecting to mention certain tests or treatment to minimize cost to the provider
ANS: D
The textbook does not discuss this issue, but if providers are paid a flat amount per
person and have to provide care at this set cost, providers might be tempted to not
provide necessary care to reduce costs and ensure their own profit.

DIF: Cognitive Level: Synthesis REF: p. 144

16. What is the criterion by which health care rationing is primarily determined in the United
States?
a. Clinic operating hours

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 8-6

b. Ability to pay for services

c. Availability of local provider services
d. Transportation availability
ANS: B
Because there are not enough health care services available to provide desired services to
everyone, the focus has been on reducing costs by controlling the use of services. All of
the factors listed affect health care access and therefore affect health care rationing (either
directly or indirectly). The primary determinant, however, is the ability to pay for
services. Without this ability, services are denied; therefore those without insurance that
is accepted by a provider or institution or who do not have the money to pay out of
pocket are unable to obtain services.

DIF: Cognitive Level: Synthesis REF: Entire chapter

17. What is the best advice a nurse can give to a pregnant teen to improve the health
outcomes of both the teen and her unborn child?
a. “Don’t drop out of school.”
b. “Sign up for childbirth classes.”
c. “Sign up for the WIC program.”
d. “Take your prenatal vitamins daily.”
ANS: A
The question specifies the health of both the mother and the child. Socioeconomic
conditions improve with education. Because socioeconomic status is inversely related to
mortality and morbidity, by becoming better educated, the mother-to-be will be less
likely to live a life of poverty and, as a consequence, will enjoy a greater chance of better
health for herself and for her child.

DIF: Cognitive Level: Synthesis REF: Entire chapter

18. Which economic prevention strategy by the nurse is considered primary prevention?
a. Applying for a grant to establish a day care center to serve dependent older adult
clients living with working families
b. Persuading legislators to pass a bill offering health care financial aid to families at
risk
c. Screening cocaine addicts for financial assistance eligibility for drug treatment
d. Referring clients with renal failure to apply for Medicare
ANS: B
Primary prevention occurs before an illness or condition develops. Of the options
provided, only option 2 addresses initiating interventions before an illness occurs.

DIF: Cognitive Level: Synthesis REF: p. 131 (Levels of Prevention box)

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 8-7

19. A medical office assistant is sending out bills to all clients seen at the clinic today. Two
clients had the same procedure done; one of these clients had insurance and the other did
not. Thus one bill for this procedure is being sent to an insurance company, and another
bill for the same procedure is being sent to a client who paid personally by check. What is
probably true about these two bills?
a. Both bills were for the same amount because both clients had the same procedure
done.
b. The insurance company was charged more.
c. The client who paid privately (personally) was charged more.
d. The physician discounted the bill for the person who had to pay out of pocket.
ANS: C
Because insurance companies often negotiate for discounted charges, the client who pays
privately (personally) will probably be charged more. If a client has health insurance, the
payment to the provider is less than the payment made by the client who does not have
health insurance.

DIF: Cognitive Level: Synthesis REF: p. 142

MULTIPLE RESPONSE

1. The federal government uses taxes, fees, and charges to fund what health services? Select
all that apply.
a. Building capacity for promoting population health
b. Collecting data about U.S. health and delivery systems
c. Distributing regulations detailing facility requirements
d. Regulating medical technology and computer expansion
e. Making appropriate policies
f. Ensuring public health protection
ANS: A, B, E, F
When the government provides the funding and controls the use of a service, the money
comes from taxes (e.g., purchase of alcohol or cigarettes), user fees (e.g., licensing fees),
and charges to consumers of the services. Services offered at the federal government
level include
policymaking, ensuring public health protection, collecting and sharing information about
U.S. health care and delivery systems, building capacity for promotion of population
health, and providing direct health services.

DIF: Cognitive Level: Knowledge REF: p. 129

2. In what situations does the federal government provide money through tax relief for
private enterprise? Select all that apply.
a. Businesses help pay for health insurance for employees.
b. Businesses contribute gifts for employee awards for service.
c. Employers provide health screenings and immunizations.
d. Employers request and receive reimbursement for employee transportation costs.

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 8-8

e. Employers share stories in public media about employees.

f. Employers establish and maintain pension plans for employees.
ANS: A, C
Businesses can pay for disease prevention and health promotion services for employees
(and sometimes their families) in the form of immunizations, health screenings, and
counseling. The business can then deduct these costs as a business expense, which
reduces the amount the business owes the government in taxes on their profits. Similarly,
when businesses subsidize health insurance for their employees—and families—this is
also a business expense, which decreases the amount the business would otherwise pay in
taxes. Thus the government indirectly provides the money, but the business, a part of the
private sector, decides how it is used.

DIF: Cognitive Level: Knowledge REF: p. 130

3. Since Medicaid will pay for health care insurance for low-income persons, why do these
persons still have such poor health outcomes? Select all of the reasons that apply.
a. Clients may have preexisting conditions not covered by insurance.
b. Many physicians won’t accept Medicaid clients.
c. Medicaid won’t pay for certain medical interventions.
d. Medicaid recipients are noncompliant with their health care providers’
recommendations.
e. Practical problems interfere, such as lack of childcare or transportation.
f. Some persons prefer not to attend Medicaid clinics because of social stigma.
ANS: A, B, C, E
The primary reasons for delay, difficulty, or failure to access care include inability to
afford health care and a variety of insurance-related reasons, including the insurer not
approving, covering, or paying for care; the client having preexisting conditions; and
physicians refusing to accept the insurance plan. Practical problems such as lack of
childcare, transportation, long waiting periods, and communication issues also interfere.

DIF: Cognitive Level: Knowledge REF: p. 131

4. What actions might convince Americans to focus on primary preventive health care
rather than secondary and tertiary interventions? Select all that apply.
a. Publicize data on success of health promotion efforts, including cost savings.
b. Don’t allow institutions to make a profit on secondary or tertiary care.
c. Establish standards for appropriate screenings at specific intervals.
d. Require all military service personnel and their family members to engage in
appropriate healthy lifestyle behaviors.
e. Reimburse health care providers for health promotion and education efforts.
f. Stop all advertising for proprietary drugs to decrease demand.
ANS: A, C, E

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 8-9

Reasons given for the lack of emphasis on prevention in clinical practice and lack of
financial investment in prevention include provider uncertainty about which clients
should receive services and at what intervals, lack of information about preventive
services, negative attitudes about the importance of preventive care, lack of time for
delivery of preventive services, delayed or absent feedback regarding success of
preventive measures, less reimbursement for these services than for curative services,
lack of organization to deliver preventive services, and lack of use of services by the poor
and elderly. Although all of the above suggestions may have some merit, some would be
illegal (e.g., option 4, requiring people to change their lifestyle, would be coercive).

DIF: Cognitive Level: Synthesis REF: p. 132

5. What events allowed health care providers in the first half of the twentieth century to
focus on chronic disease problems? Select all that apply.
a. Apprenticeships were replaced by college-based education for health care
providers.
b. Pharmacological agents, such as insulin and sulfa, were discovered and/or
developed.
c. The federal government began creating public health departments.
d. The incidence of many infections, such as STDs, notably decreased.
e. Local governments began to pay for care of local residents.
f. Major technological advances were made in diagnosis and treatment.
ANS: B, F
Clinical medicine entered its Golden Age during the first half of the twentieth century.
Major technological advances in surgery and the identification of disease processes
increased the ability to diagnose and treat diseases. The discovery and development of
pharmacological agents increased treatment options and decreased morbidity and
mortality from acute infections.

DIF: Cognitive Level: Knowledge REF: p. 133

6. What are some major differences in health care today, as compared with the first half of
the twentieth century? Select all that apply.
a. Consumers are influenced by advertising for specific health care agents or
procedures.
b. The emphasis is on the continued expansion of health care facilities, especially
acute care hospitals.
c. Education and specialization of personnel have increased.
d. The need to create new ways to pay for health care is a central focus.
e. Patients are sicker but hospitalized for shorter periods of time.
f. The substitution of less expensive personnel for more costly ones has increased.
ANS: A, C, E, F

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Foundations of Nursing in the Community: Community-Oriented Practice Stanhope 3rd Edition Te

Test Bank 8-10

Since the 1980s, the United States has been in a period of limited resources, with an
emphasis on containing costs, restricting growth in the health care industry, and
reorganizing care delivery. Results have included shorter hospital stays and substitution
of one set of personnel (such as nurse practitioners) for another set (physicians). Such
trends are made more challenging by increased direct marketing to consumers. Also with
increased knowledge has come increased education and specialization.

DIF: Cognitive Level: Knowledge REF: pp. 134-135

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

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