Test Bank for Nursing Leadership and Management for Patient Safety and Quality Care, 1st Edition

Chapter 2: Health-Care Environment and Policy Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The nurse in the newborn nursery is educating new parents about the scheduling of immunizations. Where should the nurse refer parents of limited income to obtain these immunizations at a free or reduced cost? 1. 2. 3. 4. ____ 2. The nurse is discussing available health care with an individual who will turn 65 years of age in approximately 6 months. This individual is very concerned about the availability of benefits for prescription medication. What part of Medicare will the nurse discuss specifically with this patient in reference to prescription benefits? 1. 2. 3. 4. ____ Employment Government subsidy Prior military service Universal health care 5. The nurse in the emergency department (ED) knows that many people come to the ED for seemingly minor problems and knows it is the result of what issues related to health-care access? 1. 2. 3. 4. ____ Private insurance Private charities Taxpayer dollars Private pay 4. The nurse is aware that the majority of individuals in the United States with private insurance obtain this insurance in what manner? 1. 2. 3. 4. ____ Part A Part B Part C Part D 3. The nurse is discussing with a patient the types of services available at the local health department and knows that most health-care agencies in the public section receive the majority of their funding from what source? 1. 2. 3. 4. ____ Return to the newborn nursery Contact the county health department Request reduced fees at a private pediatrician’s office Defer immunizations until funds are available There are not enough health-care providers to see all the patients who need care. Wait time is faster in the ED than in a private office. Private practice clinics do not have to accept patients who are unable to pay. Patients believe the care is better in EDs. 6. The nurse manager of an ED that cares for many patients, many who are repeatedly seen for minor problems, is concerned over the negative mood of many of the nurses. What information could the nurse manager give to the staff that would improve the nurses’ perceptions of these patients? Copyright © 2017 F. A. Davis Company 1. 2. 3. 4. ____ 7. The nurse manager is discussing possible changes to staffing in the nursing unit and shares with the staff that what accounts for the largest expense of the total hospital budget? 1. 2. 3. 4. ____ Diagnostic imaging equipment Food services Nursing staff Maintenance 8. The nurse manager was reviewing incident reports for the unit and noted that patients most commonly reported what type of error? 1. 2. 3. 4. ____ Patients use the ED because of its excellent reputation. Most of these patients are unable to afford private health-care practitioners. Many of the patients come to the ED because they are not required to pay for services. The ED is open 24 hours/day and patients can be seen after work. Falls Equipment failures Incorrect medication dosage Incorrect patient identification 9. The nurse manager is aware that the number of medical errors can be reduced by what mechanism? 1. 2. 3. 4. Evidence-based continuing education Increased number of staff per patient ratio Improved patient education Personal caregivers at each patient’s bedside ____ 10. A group of nurses is discussing ways to improve the health of the local community. Which action would be an example of a local health policy? 1. 2. 3. 4. Substituting diet beverages for drinks that have sugar in them at the local gym. Building a children’s play area that incorporates healthy exercises in the equipment. Teaching a class to high school juniors about eliminating fast foods from the diet. Petitioning the local grocery store to carry locally grown vegetables. Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 11. The nurse manager is aware that what situations exist for leaders and managers in nursing in relation to the cost and quality of healthcare? Select all that apply. 1. 2. 3. 4. 5. Health-care costs continue to rise. Reimbursement rates for health-care services are slowly rising. Existing health-care resources are limited. There are increased numbers of people with health insurance. There are increasing numbers of health-care providers. ____ 12. The director of nurses is orienting a new nurse manager concerning the responsibilities that are a part of this new role. The new nurse manager must learn to use which skills required of the position? Select all that apply. Copyright © 2017 F. A. Davis Company 1. 2. 3. 4. 5. Promote a work environment that focuses on unit efficiency. Develop a corrective discipline program for nurses and nurse’s aides on the unit. Plan ad campaigns for the health-care facility. Manage the annual operating budget. Ensure compliance with legal and regulatory guidelines. Copyright © 2017 F. A. Davis Company Chapter 2: Health-Care Environment and Policy Answer Section MULTIPLE CHOICE 1. ANS: 2 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Explore differences between private and public, including government-provided, health care. Chapter page reference: 28 Heading: Systems Within the Health-Care Environment Integrated Processes: Teaching and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate 1 2 3 4 Feedback The newborn nursery is used only for care of infants who were born within the last 72 hours. It is rarely used for outpatient treatment and is not an appropriate place for the referral of parents of limited income. Vaccination services and sexually transmitted diseases are often handled by county public health departments and offer reduced payment options or free care for qualified individuals. A private pediatrician’s office does not usually offer free or reduced payment for immunizations. Immunizations cannot be deferred because this may allow the newborn to become ill with a communicable disease and then may pass that disease to someone else. PTS: 1 CON: Health Promotion 2. ANS: 4 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Explore differences between private and public, including government-provided, health care. Chapter page reference: 30 Heading: Current Status of Health Care in the United States Integrated Processes: Teaching and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate 1 2 3 Feedback Part A of Medicare covers hospital visits, laboratory tests, surgery, doctor visits, and home health care. Part B of Medicare covers doctor services, outpatient care, durable medical equipment, and some preventative services. Part C of Medicare coverage is also known as Medicare Advantage. Copyright © 2017 F. A. Davis Company 4 Part D of Medicare covers prescriptions, but services are dependent on the plan specifics, and there may be additional cost depending on income. PTS: 1 CON: Health Promotion 3. ANS: 3 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Explore differences between private and public, including government-provided, health care. Chapter page reference: 28 Heading: Systems Within the Health-Care Environment Integrated Processes: Teaching and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate 1 2 3 4 Feedback Private insurance may pay for some of the services at a local health department, but the majority of the funding comes from tax dollars. Private charities’ funds are used to fund programs for individuals who do not have access to private, public, or government health-care systems. Taxpayer dollars are the primary source of funding for state and local health departments to provide needed services such as immunizations. Private pay from an individual provides some source of revenue to local health departments, but the majority is funded by tax dollars. PTS: 1 CON: Health Promotion 4. ANS: 1 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Explore differences between private and public, including government-provided, health care. Chapter page reference: 28 Heading: Systems Within the Health-Care Environment Integrated Processes: Teaching and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate 1 2 3 4 Feedback Employment-based private insurance accounts for over 50% of those individuals who hold private health insurance. Government subsidies such as Medicare and Medicaid may be operated by private insurance companies, but they are not the same as private insurance. Prior military service may give an individual access to the Veteran’s Administration health-care system, which is different from private insurance. Universal health care is not available in the United States. PTS: 1 CON: Health Promotion Copyright © 2017 F. A. Davis Company 5. ANS: 3 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Explore differences between private and public, including government-provided, health care. Chapter page reference: 30 Heading: Current Status of Health Care in the United States Integrated Processes: Teaching and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate 1 2 3 4 Feedback Although there may be a limited number of health-care providers in rural areas, the main reason EDs are used is because private practices do not have to see patients who are unable to pay for services. Wait times in EDs can be very long, and the inappropriate use of EDs adds to this wait time. EDs are often used inappropriately because private practices do not have to see patients who are unable to pay for services, and EDs are subject to the Emergency Medical Treatment and Labor Act that requires any ED receiving Medicare funds to provide emergency services to people seeking help regardless of their ability to pay. Patients do not believe care is better in EDs, only that care is available in EDs. PTS: 1 CON: Health Promotion 6. ANS: 2 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Explore differences between private and public, including government-provided, health care. Chapter page reference: 30 Heading: Current Status of Health Care in the United States Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Leadership and Management Difficulty: Moderate 1 2 3 4 Feedback The majority of repeat patients come to the ED for relatively minor illness due to the lack of access to care and lack of funds to pay for care at a local provider. Informing the nurses that patients were coming for the ED’s excellent reputation would not improve the nurses’ perception of the patients. Informing the nurses about the real reason that repeat patients are seen in the ED may help the nurses view the patients in a more holistic, understanding manner. Most repeat patients come to the ED with the expectation of paying for services, though they may not be able to pay the full amount. Even though there is some convenience to the ED, for instance, being open 24/7, this knowledge would not improve the nurses’ perceptions of the repeat patients. Copyright © 2017 F. A. Davis Company PTS: 1 CON: Leadership and Management 7. ANS: 3 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Identify barriers experienced within the U.S. health-care system. Chapter page reference: 30 Heading: Current Status of Health Care in the United States Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Leadership and Management Difficulty: Moderate 1 2 3 4 Feedback Labor is the largest component of total costs with nursing being the largest component. Labor is the largest component of total costs with nursing being the largest component. Labor is the largest component of total costs with nursing being the largest component. Labor is the largest component of total costs with nursing being the largest component. PTS: 1 CON: Leadership and Management 8. ANS: 3 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Identify barriers experienced within the U.S. health-care system. Chapter page reference: 33 Heading: Quality of Care Integrated Processes: Caring Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Leadership and Management Difficulty: Moderate 1 2 3 4 Feedback Falls do occur on a hospital unit, but it is not the most common error reported by patients. Failure of equipment that caused harm or threat of harm does not occur very often and is rarely reported by patients. Wrong medication or incorrect medication dosage are the most common errors reported by patients. Incorrect patient identification can and does occur, but it is not a common error. PTS: 1 CON: Leadership and Management 9. ANS: 1 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Identify barriers experienced within the U.S. health-care system. Chapter page reference: 33 Heading: Quality of Care Integrated Processes: Caring Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Leadership and Management Copyright © 2017 F. A. Davis Company Difficulty: Moderate 1 2 3 4 Feedback Adequate continuing education with a focus on evidence-based practice will help to rectify the individual and system deficiencies that lead to medical errors and patient harm. Increasing the RN-to-patient ratio has been shown to reduce mortality, but just increasing staff will not have the same effect. Improving education to patients has not been shown to be an effective way to reduce harm or reduce medical errors. Ensuring a personal caregiver at each patient’s bedside may prevent some patient falls but will not reduce the deficiencies present in the systems. PTS: 1 CON: Leadership and Management 10. ANS: 2 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Highlight the role of nurse leaders and manager, and nurses overall, in the area of health policy. Chapter page reference: 40 Heading: Health Policy Integrated Processes: Caring Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Leadership and Management Difficulty: Moderate 1 2 3 4 Feedback Substituting diet beverages for beverages with sugar in them at a local gym is not an example of local health policy. It must be an activity that benefits the entire community. Building a play area for children that incorporates exercise equipment would be an example of the implementation of local health policy. It has the potential to affect the health of all of the children in the community. While it is important to share good nutrition information, providing to high school juniors a class that emphasizes the elimination of fast foods would not be seen as a local health policy because it does not benefit the entire community or a significant portion of it. Local health policy must have the potential to impact all members of the community so petitioning a local grocery to carry locally grown vegetables is a laudable idea, but it does not meet the needs of the community who may not be able to afford to go to the store. PTS: 1 CON: Leadership and Management MULTIPLE RESPONSE 11. ANS: 1, 3, 4 Chapter number and title: 2, Health-Care Environment and Policy Copyright © 2017 F. A. Davis Company Chapter learning objective: Highlight the role of nurse leaders and managers, and nurses overall, in the area of health policy. Chapter page reference: 28 Heading: (None-Intro to chapter) Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Leadership and Management Difficulty: Moderate 1. 2. 3. 4. 5. Feedback Nurse managers and leaders must deal with increasing health-care costs. Reimbursement rates for health care are decreasing, not rising Limited resources are available for patients. Increasing numbers of individuals are expected obtain health insurance through the Patient Protection and Affordable Care Act (ACA). The number of health-care providers is not sufficient to meet the needs of those who need health care. PTS: 1 CON: Leadership and Management 12. ANS: 2, 4, 5 Chapter number and title: 2, Health-Care Environment and Policy Chapter learning objective: Highlight the role of nurse leaders and managers, and nurses overall, in the area of health policy. Chapter page reference: 31 Heading: The Cost of Health Care Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Leadership and Management Difficulty: Moderate 1. 2. 3. 4. 5. Feedback Nurse managers are responsible for promoting a healthy work environment, not one that focuses on efficiency. Nurse managers are responsible for the development of educational programs, workforce planning, and corrective discipline. Nurse managers are responsible for the promotion of the image of nurse and the organization through effective media, not the development of an ad campaign for the health-care facility. Nurse managers are responsible for the management of the annual operating budget. Nurse managers are responsible for ensuring compliance with legal and regulatory guidelines. PTS: 1 CON: Leadership and Management Copyright © 2017 F. A. Davis Company