The U.S. Health and Public Health Care Systems

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 standards

ANS: 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 up-to-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. 37

3. 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 principles

ANS: 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 government

ANS: 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 occur
c.
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.
Projection
b.
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 abusers

ANS: 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