Contemporary Nursing Issues-Trends 7th Edition - Test Bank

Chapter 03: The Influence of Contemporary Trends and Issues on Nursing Education Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. A current trend is for students to be evaluated to determine whether they demonstrate competence in the actual client care environment or with a standardized patient. This process occurs in addition to or instead of traditional pencil-and-paper evaluations. This type of evaluation is referred to as: a. core practice competencies. b. continuing competence. c. distance learning. d. performance-based assessment. ANS: D Performance-based assessment is the evaluation of abilities based on an objective demonstration of specific required competencies. This may include performance in actual or simulated situations. DIF: Knowledge REF: p. 44 2. One of the major trends that currently influences nursing education and practice is: a. increased technology in the field of critical care. b. a narrowing scope of practice for nurses. c. incivility or disregard of others’ rights in social interactions. d. a decrease in ethnicity due to international programs allowing students to study from a distance. ANS: C Incivility has escalated and can be demonstrated by the common practice of text-messaging during class and an increase in academic dishonesty. DIF: Comprehension REF: pp. 46-47 3. Although the use of technology and the Internet provides nursing faculty and students with unlimited resources and current information, an outcome associated with this trend is that: a. users of electronic resources spend a disproportionate amount of time looking for pertinent content. b. additional time is available to study and revise curricula because special skills are not needed to access information via the Internet. c. immediate results and outcomes are expected from students and faculty, thus enhancing time management. d. skills that require problem solving and reflective abilities are developed. ANS: A Students can easily become distracted by pursuit of the intriguing web of links they encounter while they search websites to complete assignments or find pertinent content. DIF: Analysis REF: pp. 41-43 4. A new trend in nursing education that is consistent with real-world practice is focused on: a. outcomes. b. objectives. c. goals. d. subjective appraisals. ANS: A Outcomes and criteria establish real expectations for clinical practice and have a powerful influence on nursing education and practice at all levels. Outcomes are used in all areas of nursing in the nursing process. DIF: Knowledge REF: p. 43 5. The practice of nurses, nursing students, and faculty is affected by demographic changes due to: a. the growing percentage of adults ages 50 to 55 years. b. increasing numbers of obese children and adults. c. changes by which families are becoming more nuclear. d. social programs that are essentially eliminating poverty. ANS: B The United States is experiencing an epidemic of obesity with major consequences for health and the health care system. DIF: Knowledge REF: p. 46 6. The first university to offer nursing graduates a baccalaureate degree was: a. Columbia Teachers College. b. Yale University. c. Harvard University. d. the New York Regents Program. ANS: B In 1924, Yale University offered the first separate Department of Nursing, whose graduates earned a baccalaureate degree. DIF: Knowledge REF: p. 53 7. Which nursing model is referred to as the “class without walls”? a. Articulation b. Career ladder (2 + 2) c. External degree d. Second degree ANS: C An external degree does not require attendance and provides no course classes; it enrolls thousands and is accessible regardless of geographic location. DIF: Knowledge REF: p. 56 8. When focusing on addressing issues identified by the 2000 Institute of Medicine report, the nursing faculty will access information associated with which initiative? a. Quality and Safety in Nursing Education b. Competency Outcomes and Performance Model (COPA) c. The National Organization of Nurse Practitioner Faculties (NONPF) d. Academic Center for Evidence-Based Practice (ACE) ANS: A In response to the Institute of Medicine report (IOM, 2000), The Robert Wood Johnson Foundation funded a national initiative, Quality and Safety in Nursing Education (QSEN), to help nursing programs reorganize curricula to focus on patient safety and quality care. DIF: Application REF: p. 43 9. The number of reported medical errors demonstrates a need for what priority intervention? a. Simulation experiences b. Performance competency exercises c. Comprehensive instructor-constructed examinations d. Detailed care planning exercises ANS: B The increase in reported medical-related errors vividly emphasizes the need for more effective validation of performance competence in schools and the workplace. DIF: Application REF: p. 45 10. Which trend is an effect of the nursing shortage on nursing education? a. Only devoted qualified nurses are continuing to provide bedside nursing because of the complexity of care required, resulting in excellent preceptorships for students. b. The number of applicants to nursing programs has risen, but enrollment is limited because of a decrease in the number of available scholarships and grants. c. With an increase in the number of nurses who are entering graduate school to escape bedside nursing, students will soon enjoy a lower faculty/student ratio. d. Students may be assigned to preceptors who have not yet developed expertise in the field of interest. ANS: D Qualified preceptors are few. DIF: Analysis REF: p. 49 11. The NCLEX® examination is created and administered by the: a. American Association of Colleges of Nursing (AACN). b. American Nurses Association (ANA). c. National Council of State Boards of Nursing (NCSBN). d. National League for Nursing (NLN). ANS: C The NCSBN coordinates licensure activities on a national level and creates and administers the licensure examination (NCLEX®). DIF: Knowledge REF: p. 57, Box 3-1 12. A student is planning to enroll in prerequisite courses after graduating from high school and is researching options for nursing programs. During a career fair the student compares different types of nursing education programs and discovers that: a. diploma programs focus on family and community, with an emphasis on health promotion. b. most practicing RNs graduated from diploma programs because this was the first type of RN program. c. baccalaureate programs focus on technical and hands-on nursing skills in diverse community settings. d. master’s programs such as that for the clinical nurse leader provide entry into practice with a focus on interdisciplinary and bedside nursing care for complex client populations. ANS: D A clinical nurse leader oversees the care coordination of groups of clients and actively provides direct client care in complex situations, evaluates client outcomes, and has the decision-making authority to change care plans when necessary. DIF: Comprehension REF: p. 55 13. When preparing to complete a competency examination involving a neurologic assessment in a simulation laboratory, the nurse reviews the critical elements, which consist of: a. those steps that result in life or death of a client. b. required criteria that must be incorporated into the assessment for the desired outcome. c. fundamental strategies unique to complex dynamic care environments. d. objective data that can be used to determine the likelihood that the client will recover. ANS: B Critical elements include the application of mandatory principles that must be used according to established practice standards. DIF: Comprehension REF: p. 40 14. An RN with a diploma preparation wants to participate in decisions about health care and decides the first step is to obtain a BSN. The nurse enrolls in a nursing program offering self-scheduling and a self-paced curriculum. This nurse is taking advantage of: a. educational mobility. b. a traditional nursing program. c. training for advanced practice nursing. d. credit by examination. ANS: A Education mobility is the progressive movement from one level or type of education to another—in this instance, diploma to BSN. Programs are aimed to make the transition possible through creative flexible scheduling. DIF: Application REF: p. 56 15. A nursing student scores 95% on the written examination for the adult health course. To be successful in this course, this same student must then perform an indwelling catheter insertion and wound care in a simulated environment meeting core competencies. The student asks, “What are core competencies?” The nursing instructor replies, “Core competencies are: a. a trend used in nursing education to reduce attrition in prelicensure students.” b. those skills necessary for safe, competent nursing practice.” c. educational opportunities that provide remediation when student is unable to perform psychomotor skills correctly.” d. critical thinking exercises aimed to improve reading and math skills.” ANS: B Core competencies are those skills and elements that are fundamental and essential for safe, competent practice. DIF: Comprehension REF: pp. 39-40 16. A nurse realizes that a health care concern related to globalization was: a. the emergence of epidemic hepatitis A. b. the pandemic of H1N1 “swine flu.” c. reemergence of polio. d. an increase in chronic illnesses. ANS: B In 2009, there was a pandemic of H1N1 on every continent and a reemergence of Staphylococcus aureus (MRSA). DIF: Knowledge REF: pp. 47-48 17. A student nurse is preparing a presentation that requires identification of outcomes for the care of heart failure patients. Which is a correctly written outcome? a. Develop a teaching program to address physical activities that result in improved cardiac function. b. Discuss the clinical manifestations associated with Level 4 heart failure. c. List the most common pharmaceutical approaches to reduce preload in heart failure patients. d. Recognize the economic impact that recidivism has on the patient and health care facility. ANS: A Outcomes use action words, actions that nurses actually do, such as develop, plan, implement, integrate, plan, or conduct. DIF: Application REF: p. 43 18. A member of a nursing students study group comments, “I wish our instructor would just tell us the important information that we will be tested on in our course and on NCLEX®. Instead, we spend some time early in the class discussing key facts then the most of the time working through case studies, then practicing on the simulator rather than caring for ‘real’ patients.” This teaching-learning style represents: a. memorization of basic facts presented early in the lecture. b. Objective Structured Clinical Examinations (OSCE). c. peer-to-peer learning. d. practice-based competency. ANS: D Practice-based competency includes active engagement and application in real practice situations and interactive strategies such as case studies and simulation. DIF: Application REF: pp. 43-44 19. Which experience is best designed to support a nursing student’s preparation for interprofessional team participation? a. Attending a seminar on interprofessional team cooperation b. Completing a preceptorship with an advanced practice nurse c. Carrying for three patients with varying medical diagnoses d. Presenting patient information at the daily care planning meeting on a mental health unit ANS: D While interprofessional educational experiences are encouraged for all health care disciplines, Delunas and Rouse (2014) cite the importance of preparation of students for interprofessional educational experiences, and the need for regular meetings when students are engaged in learning as a member of a health care team. DIF: Application REF: pp. 47-48 20. A person interested in employment in the health care sector has less than 1 year to pursue his or her education and wants to focus on functional aspects of patient care. He/she desires to work in a long-term facility. Which type of nursing program should this person request information about? a. Bachelor’s degree in nursing (BSN) b. Licensed practical nurse (LPN) c. Associate degree in nursing d. Master’s degree in nursing ANS: B LPN programs provide basic technical bedside care and employment opportunities at hospitals, nursing homes, home care, and doctor offices. DIF: Comprehension REF: p. 52, Table 3-2 MULTIPLE RESPONSE 1. A nurse is concerned that the policy of using povidone-iodine (Betadine) to clean foot ulcers may lead to unwarranted allergic reactions and drying of surrounding tissue. A literature review is performed to determine the “best practice” related to care of foot ulcers. This nurse: (select all that apply) a. is applying evidence-based practice to the clinical setting. b. is using critical thinking to change procedures performed in the care of foot ulcers. c. is minimally educated at the master’s level and participating in research to provide cost-effective care (soap is less expensive than povidone-iodine). d. lacks clinical competence in health assessment and in application of theory to the clinical setting. e. is using information to problem-solve and ensure safe, competent care. ANS: A, B, E Critical thinking is an essential part of applying evidence-based practice—that is using research findings to guide actual practice. DIF: Analysis REF: p. 44 COMPLETION 1. The oldest, most traditional type of program that prepares a candidate for RN licensure is the hospital-based _________ program. ANS: diploma The earliest training programs for nurses were hospital based and designed to meet the needs of the particular institution; these were referred to as diploma programs. DIF: Knowledge REF: p. 52 2. According to Lenburg, the use of practice-based assessments in nursing education is aimed toward the target of __________. ANS: competence The target that students need to meet to practice safely in today’s complex health environment is achieving critical competencies and demonstrating of practice-based skills. DIF: Comprehension REF: p. 45 Chapter 07: Paying for Health Care in America: Rising Costs and Challenges Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. An older adult client was admitted to the hospital with the condition classified as “pneumonia.” Reimbursement was based on a predetermined fixed price. This classification system is referred to as: a. diagnosis-related groups (DRGs). b. subjective symptom management. c. acuity classification system. d. organized managed care. ANS: A DRGs are used in reimbursement for health care services based on a predetermined fixed price per case or diagnosis in 468 categories. Under DRGs, each Medicare client is assigned to a diagnostic grouping on the basis of his or her primary diagnosis at hospital admission. Medicare limits total payment to the hospital to the amount pre-established for that DRG. DIF: Comprehension REF: p. 3 |pp. 9-10 |p. 106 | pp. 108-109 2. The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a _____ nurse. a. case management b. quality assurance c. utilization review d. cost-control ANS: C Hospital-based utilization review nurses review medical records to determine the most appropriate DRG for clients. Financial gains can be made through careful diagnosis of clients according to their highest potential DRG classification. DIF: Knowledge REF: p. 109 3. Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing: a. hospital admission rates. b. length of hospital stay. c. outpatient services. d. specialty groups. ANS: B Hospitals face a strong financial incentive from the DRG reimbursement system to reduce the client’s length of stay and minimize procedures performed. If hospital costs exceed the DRG payment for a client’s treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. DIF: Comprehension REF: p. 109 4. When reviewing the literature on the effects of Medicaid on health care for the poor, the nurse researcher found that the poor: a. have less access than even the uninsured. b. receive many unnecessary treatments. c. lack consistent providers. d. abuse preventive services. ANS: C The poor are more likely to lack a usual source of care, are less likely to use preventive services, and are more likely to be hospitalized for avoidable conditions than are those who are not poor. DIF: Comprehension REF: p. 111 5. Lack of insurance, uninsured populations, and uncompensated care are covered by charging more to those who can pay. This practice is referred to as: a. charity. b. cost shifting. c. price sharing. d. governmental reimbursement. ANS: B Cost shifting occurs when providers increase their charges against households and public and private insurers who pay for their own care while making some contribution to the care of the uninsured population. DIF: Comprehension REF: p. 111 6. A contractual agreement between the insurer and the provider in which covered members are encouraged to use specific health care providers in return for reduced rates is which type of arrangement? a. Health maintenance organization b. Preferred provider organization c. Fee-for-service arrangement d. Philanthropic agency ANS: B A preferred provider organization is an arrangement by which the member pays a premium for a fixed percentage of expense coverage. This method includes a required deductible and a copayment. The member may select a physician but pays less for physicians and facilities on the plan’s preferred list. DIF: Comprehension REF: p. 110, Table 7-2 7. In the triad of health care, which would be considered the third-party payer? a. Client b. Health care provider c. Insurance company d. Government agency that sets reimbursement rules for services ANS: C The third-party payer is an organization other than the client and the supplier (hospital or physician), such as an insurance company, that assumes responsibility for payment of health care charges. DIF: Knowledge REF: p. 107 |p. 113 8. A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a _____ payment system. a. prospective b. retrospective c. diagnosis-related group d. capitated ANS: B A retrospective payment system is a method of reimbursing health care providers (such as physicians and hospitals) in which professional services are rendered and charges are billed on the basis of each service provided; this is also known as a fee-for-service payment system. DIF: Comprehension REF: p. 107| p. 110, Table 7-2 9. A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client undergoes coronary artery bypass grafting. The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client’s intensive care unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis: a. the cost of caring for this client was $5000 greater than the DRG reimbursement fee, and the hospital will be allowed to collect the additional fees from the insurance company. b. although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee. c. the client will be sued to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease. d. the physician who admitted the client will receive a reduced payment to cover the loss incurred by the hospital. ANS: B Since 1983, if hospital costs exceed the DRG payment for a client’s treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. Hospitals face strong financial incentives to reduce the client’s length of stay and minimize procedures performed. DIF: Comprehension REF: p. 106| pp. 108-109 10. A young mother has detected a lump in her breast, and because she lives at the poverty level, she is covered under Medicaid. This individual: a. is more likely to participate in mammography screening than are individuals covered by private insurance. b. has designated primary care and a specialist as sources of care. c. will more likely wait to seek care and will require hospitalization for a mastectomy, which could have been avoided if care had been sought earlier. d. has decreased access to health care when compared with the uninsured. ANS: C Even with improved access as compared with the uninsured, Medicaid recipients are not as likely to obtain needed health services. The poor are more likely to lack a usual source of care, are less likely to use preventive services, and are more likely to be hospitalized for avoidable conditions than are those who are not poor. DIF: Comprehension REF: pp. 110-111 11. A client who is reading a newspaper asks, “This article about health care states that many providers of health care lack effectiveness. What is the difference between effectiveness and efficiency?” The nurse explains that: a. effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome. b. effective refers to competence in clinical practice and efficiency describes quick completion of the task. c. efficiency means wasting and meeting a minimum standard and effectiveness refers to taking all the time needed to exceed expectations. d. efficiency refers to speed and effectiveness refers to the usefulness of the implementation. ANS: A Efficiency means using the right combination of resources—energy, time, and money—to accomplish a task, and effectiveness means doing the right thing right in health care. DIF: Comprehension REF: p. 115 12. A nurse is offered several health care plans as part of employee benefits. Which plan is based on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment services? a. Prospective payment system b. Retrospective payment system c. Single-payer system d. Capitation ANS: D Capitation is a method of reimbursing providers (usually, primary care providers such as physicians or nurse practitioners) in which the insurance company pays the provider a set amount of money each month to provide a defined set of health care services under this plan. Payment is generally received as a per-member–per-month payment. Defined health care services generally include preventive, diagnostic, and treatment services. DIF: Comprehension REF: p. 106 13. In February 2010, Congress passed legislation to support universal health care for all Americans. At a local health fair, an individual asks about the difference between universal health care and a single payer system. The nurse explains the difference is that: a. with universal health, one universal payer, usually the government, pays all expenses for health care. b. single-payer systems offer health care only to eligible persons based on income. c. single-payer systems rely on insurance companies to pay predetermined fees for services. d. with universal health, one payer is responsible for all health care costs, providing health care to all citizens. ANS: D Universal health has one payer (usually the government) and provides health care for all citizens. DIF: Comprehension REF: p. 107 |p. 113 14. An elderly person, age 80, is finding it difficult to live alone and the family is considering long-term care. The elderly person is reasonably healthy, with only normal aging declines, and maintains a healthy appetite. All medications are administered orally and require only minimal assistance. She is financially secure with an income based on retirement from both the military and factory from her deceased husband and herself. The family contacts long-term care and is told that, based on this patient’s information: a. Medicare will cover the cost of stay since skilled services are required. b. Medicaid is only for families with dependent children. c. Medicare will pay for home health services should these additional services meet the needs of the individual. d. Medicare will pay regardless of household income or financial status for nursing home care. ANS: C Medicare does cover home health care. DIF: Comprehension REF: p. 113 15. Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act (PPACA) based on religious beliefs that prohibit circumcision and blood transfusions. These individuals believe the PPACA is unconstitutional because it: a. mandates that all U.S. and legal residents must secure health insurance. b. replaces current Medicare and Medicaid plans. c. requires all citizens to participate in offered preventive services. d. prohibits use of health practices outside of Western medicine. ANS: A The PPACA is a type of national health insurance program to provide funding for U.S. citizens and legal residents to secure health insurance beyond the current programs such as Medicare and Medicaid. DIF: Comprehension REF: p. 106 |p. 110, Table 7-2 16. A nurse is newly employed by a state-owned hospital that provides health care insurance requiring a deductible paid by the employee with the majority of the premium cost covered by the employer. The insurance provided to the nurse is: a. private health insurance. b. a federal insurances program known as PPACA. c. state-subsidized Medicaid insurance. d. single-payer system coverage. ANS: A Private health insurance is a method for individuals to maintain insurance coverage for health care costs through a contract with a health insurance company that agrees to pay all or a portion of the cost of a set of defined health care services and is typically provided through an individual’s employer with a portion of the cost paid by the employer and a portion paid by the employee. DIF: Comprehension REF: p. 106 |p. 113 17. Health care is one of the major stories in newspaper and television and a group of nurses are interested in how the economy impacts their nursing practice. The group critiques the relationship between contemporary economic trends and professional nursing practice and finds: a. the implementation of the DRG system led to the nursing shortage since cost of nursing care is not billed. b. nursing care is focused on technologically advanced acute care rather than preventive, patient-centered care. c. with pay for performance, nurses have a significant effect on the quality of patient outcomes by reducing errors and providing care based on best practices. d. economic issues have little or no impact on nursing practice. ANS: C Pay for performance, where providers are reimbursed based on the quality of care, gives nurses an opportunity to reduce costs and adopt practices that improve quality of care. DIF: Comprehension REF: pp. 113-114 18. A patient is eligible to change health care providers and insurance and asks, “I am interested in health promotion activities; I walk, swim, and eat healthy. Which health insurance plan would support these activities rather than just pay for services when I am sick”? Which, if any, health insurance plan would best meet the needs of this patient? a. Health Maintenance Organization (HMO). b. Fee for Service. c. Preferred Provider Organization (PPO). d. None, because health insurance plans currently cover only disease management, not preventive care. ANS: A HMOs encourage preventive care. DIF: Comprehension REF: p. 110, Table 7-2 19. A patient is upset because her health insurance plan refused to pay for a mammogram and services by a women’s health specialist because the primary care physician did not order the referral or the mammogram. Which type of insurance plan adheres to this type of payment system? a. Fee for Service b. Health Maintenance Organization (HMO) c. Preferred Provider Organization (PPO) d. Point of Service (POS) ANS: B HMOs require patients to select a primary care physician approved by the HMO who then must refer or order any test/diagnostic procedures before payment is approved or preapproval must be sought. DIF: Comprehension REF: p. 110, Table 7-2 20. A patient wants to reduce health care costs by being a model for making wise decisions that both promote health and reduce cost. Which statement by the patient would indicate a need for further teaching? a. “I will ask for the brand name drug Tylenol rather than acetaminophen since it works better and I won’t be sick as long.” b. “I looked up urinary tract infection prevention on the Internet.” c. “I had my weight, body fat, and blood sugar measured at a local health fair.” d. “My allergies are really bothering me. I spoke to the pharmacist, who recommended an over-the-counter antihistamine.” ANS: A Ways to reduce health care costs as a consumer include choosing generic drugs whenever possible. DIF: Analysis REF: pp. 115-116 21. A nurse is very interested in learning more about health care economics and how she can use that knowledge to become a better patient advocate. She comments, “Nurses should not only deliver care one day at a time in one facility but should coordinate patient care as they move from acute care to rehabilitation to home care.” This nurse would be a candidate for which nursing role? a. Disease management program (DMP) for chronic illnesses b. A hospital-based utilization management nurse who reviews medical records to determine the most appropriate DRG for patients c. Case management d. Reviewer for Managed Care Organization ANS: C Case management offers nurses the opportunity to demonstrate cost-effectiveness by coordinating patient care at the appropriate level of care across the continuum of care. Patient advocacy and understanding current health care economics are critical to this role. DIF: Comprehension REF: pp. 108-109 MULTIPLE RESPONSE 1. A nurse who speaks at a health fair states that current attempts to increase efficiency of health care include: (select all that apply) a. an increase in acute care, so that specialized care can be provided. b. the growing use of outpatient services. c. shifting toward health promotion and prevention. d. allowing physicians to control health care decision making. e. the use of technology to educate the public about cost-effective measures. ANS: B, C, E Economic forces are motivating the shift toward providing more services and procedures in outpatient settings. Economic forces are motivating the shift toward a model of health promotion and preventive. The Internet can inform and educate consumers (or clients) about how to access health care educational resources more effectively. DIF: Analysis REF: p. 106 |p. 115 2. Medicare would be responsible for: (select all that apply) a. a hospital stay following a total knee replacement for a 70-year-old client. b. nursing home cost for a 67-year-old adult receiving hemodialysis. c. rehabilitation care costs for a 24-year-old client with a broken femur resulting from a fall at work. d. prescription cost for a young mother who meets eligibility for Aid to Families with Dependent Children (AFDC). e. home health services to administer heparin to a 27-year-old truck driver following a thrombus. ANS: A, B Medicare coverage is based on age and Part A covers inpatient hospital services. Medicare eligibility is based on age and disability with hemodialysis resulting from chronic renal failure classified as a disability. DIF: Comprehension REF: p. 110, Table 7-2 COMPLETION 1. The largest single payer of hospital charges in the United States is ___________. ANS: Medicare Medicare is the largest health insurance program; it covers the disabled persons with end-stage renal disease, and persons 65 years of age and older who qualify for Social Security. Since enactment of this program in 1965, the population covered by Medicare has doubled. DIF: Knowledge REF: p. 113 2. A 72-year-old client is admitted to have the right kidney removed after a diagnosis of cancer. The surgeon removed the left kidney. Medicare will no longer pay for preventable medical errors known as ____________. ANS: never events Medicare identified 28 medical errors that were preventable and with serious consequences for which they will no longer pay. These errors are called never events. DIF: Knowledge REF: p. 114 3. The type of insurance that shifts the largest percentage of costs for goods and services to employees and consumers is _____________ insurance. ANS: private Private insurance shifts a more costs to employees and consumers than does any other type of insurance. DIF: Knowledge REF: p. 107