Foundations of Nursing in the Community 4th Edition by Marcia Stanhope-Test Bank Chapter 03: The U.S. Health and Public Health Care Systems Test Bank MULTIPLE CHOICE

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Foundations of Nursing in the Community 4th Edition by Marcia Stanhope-Test Bank Chapter 03: The U.S. Health and Public Health Care Systems Test Bank MULTIPLE CHOICE 1. A public health agency is... planning to implement the electronic health record. Which of the following is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standardsANS: A 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 upto-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors. DIF: Cognitive Level: Apply (Application) REF: p. 37 2. A community health nurse is trying to increase enrollment in SCHIP. Which of the following interventions would be most effective? a. Explaining the program to children enrolled in public school systems b. Handing out SCHIP applications to uninsured children seen in local hospital emergency departments c. Having a newspaper campaign with information and applications printed in the newspaper d. Sending literature about the SCHIP program home with schoolchildren each year ANS: B SCHIP builds on Medicaid to provide insurance coverage to low-income, uninsured children who are not eligible for Medicaid. Thus, the population that needs to be targeted for SCHIP is those being seen for medical care who do not have insurance. DIF: Cognitive Level: Apply (Application) REF: p. 373. A nurse is explaining the health care system in the United States to a group of physicians visiting from South America. How would the nurse best describe the current health care system? a. “It is a logical, rational approach to meeting expressed needs while still trying to control costs.” b. “It is a system in the process of reform as problems have become increasingly apparent.” c. “It is divided primarily into two components: private health care and public health care.” d. “It is the best in the world with outstanding research and high-technology care available to all.” ANS: C Health care in the United States consists of a personal care system and a public health system, with overlap between the two. DIF: Cognitive Level: Apply (Application) REF: p. 39 4. Which of the following best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principlesANS: B Primary health care is generally defined as essential care made universally accessible to individuals and families in a community with their full participation and at a cost that the community can afford. DIF: Cognitive Level: Understand (Comprehension) REF: p. 39 5. How does managed care attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider’s permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services ANS: B Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers). DIF: Cognitive Level: Remember (Knowledge) REF: p. 40 6. An 80-year-old woman comes to the community health care facility 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. “Let’s go through these medications and see which ones we can delete.”b. “You can get these medicines at this clinic for free.” c. “Let’s see if we can get some help from Medicare to help you pay for these medications.” d. “These medications are important. Do your best to pay for them.” ANS: C This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions. DIF: Cognitive Level: Analyze (Analysis) REF: p. 40 7. A nurse is determining which health care services must be offered at a local public health clinic. Which of the following factors is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations of Healthy People 2020 d. Services mandated by the state governmentANS: D At the local level, health departments provide care that is mandated by state and federal regulations. DIF: Cognitive Level: Apply (Application) REF: p. 40 8. A nurse is planning to conduct research on patient care outcomes. Which of the following agencies would the nurse use as a resource? a. Agency for Health Care Research and Quality b. Federal Agency for Patient Care Outcomes c. National Center for Nursing Research d. U.S. Agency for Patient Care Effectiveness ANS: A The Agency for Health Care Research and Quality conducts research on health care systems, health care quality and cost issues, access to health care, and effectiveness of medical treatments. It provides evidence-based information on health care outcomes and quality of care. DIF: Cognitive Level: Apply (Application) REF: p. 42 9. How does the Department of Agriculture promote the health of U.S. citizens? a. By collecting surplus food left after mechanical harvests and distributing it to the poor b. By inspecting food, so no foodborne illnesses can occurc. By collaborating with others to provide food or food stamps to needy persons d. By providing direct education and grants to dietitians and nutritionists ANS: C The Department of Agriculture collaborates with state and local government welfare agencies to provide food stamps to needy persons to increase their food-purchasing power. Other programs include school breakfast and lunch programs; the Supplemental Food Program for Women, Infants, and Children (WIC); and grants to states for nutrition education training. The Department of Agriculture also engages in plant, product, and animal inspections, but limited funding prevents absolute surety that food is safe to eat. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 43-44 10. Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers’ complaints and general unhappiness d. Increased pressure to decrease overlap in services ANS: B Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies. DIF: Cognitive Level: Understand (Comprehension) REF: p. 45 11. Which of the following principles has been used by the American Nurses Association (ANA) when encouraging health care reform? a. High-technology interventions to reduce nursing time, effort, and medical errors must be expanded. b. Nurses must be recognized and rewarded for health promotion efforts. c. Nursing research into patient care outcomes must be expanded and funded. d. Universal access to essential health services should be available for all citizens. ANS: D The ANA’s position is based on the belief that health care is a basic human right. Thus, a restructured health care system must ensure universal access to a standard package of essential health care services for all citizens and residents. DIF: Cognitive Level: Understand (Comprehension) REF: p. 47 12. African-American females have a higher mortality rate from breast cancer than White females. This is an example of: a. Projectionb. Disparity c. Racism d. A sentinel event ANS: B 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: Cognitive Level: Apply (Application) REF: p. 34 MULTIPLE RESPONSE 1. What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that apply.) a. Approximately 12% of the U.S. population was born in a different country. b. Hispanics are the largest minority group population. c. Households consisting primarily of intact families continue to grow. d. Mortality for both genders in all age groups declined.ANS: A, B, D Demographic figures confirm that 12% of the current U.S. population is foreign-born, with most immigrants coming from Latin America and about half as many from Asia. Families make up about 69% of all households, a decline from 81% in 1970. Although African Americans used to be the largest minority group, as of 2003, Hispanics now have that distinction. The population of the United States continues to increase, and mortality for both genders from all age groups has declined. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 34-35 2. Which of the following statements are accurate descriptions of current social and economic trends in the United States? (Select all that apply.) a. Citizens are appreciating the quality of life enjoyed in the United States. b. Enjoying life is not as important as the need to take care of oneself. c. Many families are seeing decreases in family income. d. Massive and unexpected social and economic changes have occurred. ANS: A, C, D One of the social trends influencing health care is a growing appreciation of the quality of life. The first decade of the twenty-first century has added massive and unexpected changes to health, economic, and social conditions in the form of terrorist attacks, hurricanes, fires, floods, and infectious diseases. In addition to layoffs, outsourcing, and other economic forces, many families are seeing wage decreases. DIF: Cognitive Level: Understand (Comprehension) REF: p. 35 3. Which of the following provides evidence that the U.S. health care system is in crisis? (Select all that apply.)a. Full-time employees may not have health insurance as a benefit. b. Incompetent or negligent nurses are an ongoing source of medical errors. c. Long work hours and provider fatigue are a major factor in medical errors. d. More punitive measures must be taken to decrease provider errors. ANS: A, C Although 61% of the non-elderly population continues to obtain health insurance through their employer as a benefit, employment does not guarantee insurance. As a result of the nursing shortage, nurses work longer hours and provider fatigue is a major factor in errors. The Institute of Medicine’s (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care. DIF: Cognitive Level: Understand (Comprehension) REF: p. 37 4. A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting? (Select all that apply.) a. Administering the Medicaid program b. Assessing the health needs of the state’s citizens c. Employing and supervising school health nurses d. Establishing and maintaining free clinics for HIV-positive drug abusersANS: A, B State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in such areas as ongoing assessment of health needs. DIF: Cognitive Level: Apply (Application) REF: pp. 38, 44 Chapter 04: Ethics in Community Health Nursing Practice Test Bank MULTIPLE CHOICE 1. When and by whom was nursing’s first code of ethics written? a. 1893, by Lystra Gretter b. 1950, by the ANA House of Delegates c. 1953, by the International Council of Nurses (ICN) d. 2001, by the ANA House of Delegates ANS: A The Nightingale Pledge, considered nursing’s first code of ethics, was written by Lystra Gretter in 1893.DIF: Cognitive Level: Remember (Knowledge) REF: p. 53 2. A nurse didn’t know what to do when faced with a particular ethical dilemma because an option that would have a good outcome didn’t seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the following best describes the nurse’s actions? a. Appropriate, because the supervisor is responsible for the nurse’s choices b. Intelligent, because the supervisor has access to resource persons (clergy, physicians, administrators) who might know of options the nurse hadn’t considered c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision d. Wise, because the supervisor would be more knowledgeable concerning agency priorities and traditional practices ANS: C Ethically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience to a supervisor or any external rule or policy. DIF: Cognitive Level: Apply (Application) REF: p. 54 3. Which of the following is the first and most crucial step in the ethical decision-making process? a. Assess the context or environment in which the decision must be made. b. Consider the various ethical principles or theories.c. Identify the ethical concerns. d. Make a decision and act on it. ANS: C The first step in the ethical decision-making framework is to carefully identify the ethical issue or dilemma. DIF: Cognitive Level: Understand (Comprehension) REF: p. 54 4. A nurse is asked to meet with a family who recently emigrated from Botswana (Africa). After the clinical doctor tells the husband the wife’s diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse’s most important action? a. Emphasizing that the family must set up a surgical appointment for the wife immediately b. Assessing the family’s current living situation, including insurance and other assets c. Educating the family concerning the usual treatment and the prognosis of breast cancer d. Interviewing the family concerning their perspective of the threat to the family’s well-being ANS: D Any of the actions might be taken. However, the United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, the health care professionals must understand the family’s cultural, psychological, social, communal, and environmental contexts, because these contexts affect the way issues are formulated and decisions are made. Consequently, it is crucial to interview the family to determine their understanding of the situation before deciding what, if any, intervention must be made. In many cultures the family, rather than the individual, is the unit of primary concern. DIF: Cognitive Level: Analyze (Analysis) REF: p. 54 5. The nurse learns that a family has decided not to accept medical intervention for a health care problem because paying for the care would drastically reduce the family’s resources and ability to meet the needs of other family members. Ethically, which of the following actions should be taken by the nurse? a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice. b. Stress that each individual in society has a right to health care and the family will have to create some way to raise funds for the needed treatment. c. Talk to the media to see whether a campaign to raise funds for the family can be created. d. Try to convince the agency to give the care for free, even if it means economic stress for the agency, because the medical need is obvious. ANS: A As Callahan described, although the nurse may attempt moral persuasion to change the family’s values, in the absence of immediate and grievous harm, no ethical requirement exists to interfere with the family’s values. DIF: Cognitive Level: Apply (Application) REF: p. 54 6. Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “It is a wife’s responsibility to care for an ill husband.” Which of the following ethical approaches is being used by this nurse?a. Consequentialism b. Communitarianism c. Deontological ethics d. Principlism ANS: C The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. DIF: Cognitive Level: Apply (Application) REF: p. 55 7. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “The whole family is being affected and will fall apart if they don’t focus on their family’s needs first before anything else.” Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontological ethics c. Principlism d. UtilitarianismANS: D By focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time of stress, the nurse is taking a utilitarian approach. DIF: Cognitive Level: Apply (Application) REF: p. 55 8. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “But it doesn’t have to be an either/or situation. Perhaps each family member could take a turn calling in sick just 2 or 3 days. That way they could all take a turn at helping and yet not upset their employers. Wouldn’t that be fair?” Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontological ethics c. Principlism d. Utilitarianism ANS: C The nurse is focusing on ethical principles—in this case, beneficence (do good for the ill family member), nonmaleficence (do no harm, even to the employer), and justice (everyone takes a turn and shares equally). DIF: Cognitive Level: Apply (Application) REF: p. 56 9. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “It’s not up to us; it’s the family’s decision. They know what is best for them.” Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontological ethics c. Principlism d. Utilitarianism ANS: C The nurse is using an ethical principle, namely autonomy, in which each person or group can choose those actions that fulfill its values and goals. Therefore, the nurse is using principlism—that is, basic principles are the basis of the nurse’s actions. DIF: Cognitive Level: Apply (Application) REF: p. 56 10. Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care? a. Doing what is best for the community b. Doing what is best for the family c. Obeying legal mandates d. Upholding ethical principlesANS: D In acute care settings with a single localized issue, the primary ethical principles are usually applied, with patient autonomy being the dominant or most crucial principle. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 56-57 11. The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient. Which of the following approaches should the nurse use in personally deciding what is right? a. Do whatever will not get the nurse in trouble with employer b. Do whatever is supported by an ethical expert, such as the hospital chaplain c. Do whatever the nurse would recommend to anyone in a similar situation d. Do whatever the nurse supervisor would feel comfortable reporting to administration ANS: C One of the rules in deontological decision making is to determine whether the proposed actions can be generalized so that all persons in similar situations are treated similarly. In the same way, principlism suggests the nurse examine the context and make the decision that can be morally justified within that context. DIF: Cognitive Level: Apply (Application) REF: p. 5512. A man entered the emergency department bleeding profusely and screaming, “I’ve got to see a doctor right now! I’ve got a right to see a doctor! I’m hurt. You have to take care of me!” Which of the following premises would ethically justify such a demand for immediate attention? a. All hospitals receive federal money and all capable employed adults pay taxes, so all adults have a right to what their tax money has purchased. b. Saving an individual’s life improves society and upholds tradition. c. Our society believes that all persons should be treated equally and that basic needs, such as not dying if death can be avoided, should be met. d. The man has a property right to his own body, and the government is responsible to ensure that property rights are protected. ANS: C The ethical theory of egalitarianism suggests that everyone is entitled to equal rights, equal treatment, and an equal share of the goods of society—and that the government’s role is to ensure this happens, at least on a basic level. Therefore, the man has a right to emergency care. DIF: Cognitive Level: Apply (Application) REF: p. 57 13. From an ethical standpoint, what is the problem with the belief that everyone should receive his or her fair share, that life should always be fair, and that everyone should make his or her own decisions? a. With this belief, the needs of society as a whole are ignored. b. Insufficient resources exist to give everyone a fair share. c. This belief leads to a propensity for some people to like to be taken care of.d. Some people think they deserve more than their fair share. ANS: A All principles of justice focus on the individual, which ignores the needs of society as a whole. Indeed, the rights of an individual may conflict with the rights of the community as a whole. DIF: Cognitive Level: Apply (Application) REF: p. 57 14. A physician refuses to order pain medication for a drug addict who has been severely injured in a car accident. When reminded by nurses that pain medication has not been ordered, the physician merely replies that the patient’s suffering from the pain of his injuries will build character and that the addicted patient needs to get off drugs. Which of the following ethical theories is the physician using (or misusing)? a. Consequentialism b. Communitarianism c. Deontological ethics d. Virtue ethics ANS: D Virtue ethics emphasizes practical reasoning applied to character development. Although such action by a care provider is paternalistic and unethical on many grounds, the physician may truly be concerned with enabling the injured addict to learn from his experience and possibly develop into a drug-free person.DIF: Cognitive Level: Apply (Application) REF: p. 58 15. Which of the following is considered the most important goal in nursing today? a. Adapting to technological advances such as electronic medical records b. Demonstrating caring as the basis of nursing practice c. Distinguishing nursing care from medical care d. Seeking evidence-based outcomes to demonstrate nursing’s contribution to care ANS: B Since the mid-1980s, nurses have written about caring as the essence of nursing and as the ethical and moral ideal of nursing practice. DIF: Cognitive Level: Remember (Knowledge) REF: p. 58 16. With which of the following ethical approaches are Gilligan and Noddings associated? a. Distributive justice approach b. Feminine ethic c. Principled approach d. Virtue ethicsANS: B Gilligan and Noddings are associated with the approach known as the feminine ethic, which focuses on the morality of responsibility in relationships that emphasize connection and caring as a moral imperative. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 58-59 17. How are ethics and public policies similar? a. Both are abstract principles that often differ in actual practice. b. Both are best achieved by persons in high political office who can effect change. c. Both strive for the public good. d. Both use general principles in making decisions. ANS: C An important goal of both policy and ethics is to achieve the public good, and both are involved in good citizenship. DIF: Cognitive Level: Understand (Comprehension) REF: p. 60 18. A new nurse states to a nursing colleague, “But why do I have to be involved in politics? I just want to be the very best clinical nurse I can.” Which of the following would be the best response from the nursing colleague? a. “As long as you pay your membership fee to the American Nurses Association, you have participated in the profession’s political endeavors.” b. “Political action is the way you try to fulfill your ethical responsibilities to clients.” c. “You’re absolutely right; if you are good clinically, you have fulfilled your obligation.” d. “When you’ve completed your clinical orientation, then you’ll have time to be involved in politics.” ANS: B To be a good clinical nurse, the nurse needs resources and supportive policies that can be obtained only through political action to ensure those very resources and policies. Many clients are members of vulnerable groups who have often previously lacked access to quality care at an affordable cost. The American Nurses Association Code of Ethics for Nurses emphasizes political action as the mechanism to effect social justice and reform regarding homelessness, violence, and stigmatization. DIF: Cognitive Level: Apply (Application) REF: p. 62 19. Which of the following would confirm that the nurse’s advocacy has been truly successful or effective? a. Audiences agree with the nurse who is serving as advocate. b. Legislators discuss appropriate legislation to better allocate resources. c. People verbalize that the disenfranchised should be better treated. d. Systematic social changes are made to improve quality of life.ANS: D Advocacy is the application of information and resources to effect systematic changes that shape the way people in a community live to reduce death and disability and improve quality of life in the community. Although all of these options could be seen as beneficial, only when systematic social changes are made to improve quality of life can advocacy be considered truly effective. DIF: Cognitive Level: Apply (Application) REF: p. 63 20. How can nurses know whether they have been effective in assessing the community and planning and implementing appropriate interventions? a. Ask community leaders for their opinion of the interventions. b. Examine the morbidity and mortality rate of the community. c. Reassess the community to determine whether obvious needs have been met. d. Systematically survey community residents regarding their perception. ANS: B Although all these options might be useful, the end products of appropriate advocacy are decreased morbidity and mortality. In other words, if advocacy has been effective, public health problems will be decreased. DIF: Cognitive Level: Apply (Application) REF: p. 63 21. What is the relationship between ethics and a community health nursing practice? a. Ethics and actual nursing practice are not related.b. Knowing ethics allows nurse to recognize the source of most problems. c. Ethics is constantly involved in nurses’ clinical decisions. d. Although ethics is important, political and legal responsibilities are more important in practice. ANS: C Ethical problems in public health nursing include inequities in power, unacceptable practices, inequitable resource allocation, conflict between ethics and law, and inadequate systems support for nursing. Therefore, ethics permeates every aspect of public health nursing as nurses attempt to meet the needs of the community. DIF: Cognitive Level: Analyze (Analysis) REF: p. 52 MULTIPLE RESPONSE 1. Three nurses disagree over the appropriate treatment for a woman who is an excellent candidate for hospice care. The first nurse believes that deciding on care rather than cure is the woman’s decision and no one else can decide for her. The second nurse says that it is the responsibility of the health care team to do good for the woman, and if the physician thinks there is still a possibility of cure, then the nurses should do everything they can to implement the treatment plan. The third nurse states that it isn’t fair for the family members to expend all their resources on the woman, who is probably going to die anyway. Which of the following conclusions can be drawn from this dispute? (Select all that apply.) a. Ethical principles can conflict with one another. b. The nurses are each using different ethical approaches. c. The first nurse is correct because autonomy demands that the woman decide for herself.d. There is no single accepted approach for resolving such disagreements. ANS: A, D One of the criticisms of using ethical principles is that they can conflict with one another in any given situation. No rule exists for helping resolve such conflicts. DIF: Cognitive Level: Analyze (Analysis) REF: p. 5 [Show More]

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