NURSING MISC. TEST BANK Chapter 10: The Evolution of Professional Nursing Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition

Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. When planning health care, the nurse should be mindful that members of the Asian culture tend to: a. miss appointments because they are present oriented and time is viewed as flexible. b. look to their ancestors for guidance. c. plan ahead and be future oriented. d. arrive early because they have no concept of time. ANS: A In Asian culture, individuals tend to be present oriented and time is viewed as being more flexible than in the Western culture; being on time for appointments is not seen as a priority. DIF: Comprehension REF: p. 194 2. A nurse is admitting a Mexican-American child, and the mother comments that the child was exposed to mal ojo. The nurse should expect to find which symptom associated with this exposure? a. Fever b. Nervous tension c. Bruising d. Somnolence ANS: A The child has what is referred to as mal ojo or “evil eye,” which can lead to diarrhea, fever, and even death. DIF: Comprehension REF: p. 198 3. A Mexican-American patient is attacked and beaten. This patient is at risk for “fright disease,” which is known as: a. susto. b. empacho. c. bilis. d. mal ojo. ANS: A Susto is an emotion-based illness common among Mexicans. An unexpected fall, a barking dog, or a car accident could cause susto. Symptoms include colic, diarrhea, high temperature, and vomiting. DIF: Comprehension REF: p. 198 4. A priority action for the nurse who works with culturally diverse clients is completion of a: a. sign language course. b. cultural self-assessment. c. cultural client assessment. d. continuing education course on how to speak Spanish. ANS: B The first step to becoming a culturally sensitive and competent health care provider is to conduct a cultural self-assessment. Through identification of health-related attitudes, values, beliefs, and practices, the nurse can better understand the cultural aspects of health care from the client’s perspective. DIF: Application REF: p. 191 5. A nurse is caring for a recent Asian immigrant client and is overheard making the following comment, “These rituals you believe in are false. You live in America now and must believe in realistic health practices, like Americans do.” The nurse is exhibiting: a. stereotyping. b. ethnocentrism. c. cultural accommodation. d. empathy. ANS: B Ethnocentrism is the belief that one’s own ethnic group, culture, or nation is best. DIF: Comprehension REF: p. 180 6. The nurse is preparing a plan of care for an black patient who has had a change of bowel habits from being constipated and having only two firm stools weekly to having three or more loose stools daily. Which comment is related to cultural variation for health information? a. The individual states, “I will need to discuss health care options with my grandmother.” b. The eldest male member of the family will make all health care decisions. c. The patient has high respect for the nurse and nods approvingly, although she has no intention of complying with instructions or plan of care. d. The individual speaks very quietly and gently reaches to hold the nurse’s hand for support. ANS: A In the African-American culture, women, especially “Granny,” play a key role in health care decisions. DIF: Application REF: p. 189 |p. 191, Table 10-1 7. A nurse is submitting a grant application to improve access to health care and mortality for minority groups. The grant focuses on the six causes of death that are identified as priorities for minorities, which include: a. chronic obstructive pulmonary disease. b. malnutrition. c. cirrhosis of the liver. d. cancer. ANS: D Cancer is identified as a leading cause of excessive death among minority group members. The six leading causes are cancer, cardiovascular disease and stroke, chemical dependency, diabetes, homicides/accidents, and infant mortality. DIF: Comprehension REF: p. 182 8. A nurse is given a referral to make a home visit to a Russian immigrant. The nurse knows very little about the health beliefs of this ethnic group. To research this group, she can use an Internet search engine and enter the term “Russian cultures” or “Russian health beliefs.” To obtain more generalized information, she could also search under: a. federally recognized minorities. b. marginalized populations. c. Asian/Pacific Islander cultures. d. Latino cultures. ANS: B Marginalized populations include recently arrived immigrants. Their lives and health care needs are often kept secret and are understood only by them. DIF: Comprehension REF: p. 182 9. Which statement is true regarding health care for minorities? a. Federal legislation that provides free health insurance for minorities has resulted in fewer minorities than members of the general population who lack health insurance. b. Higher costs of health care coupled with lower wages for minorities have prevented most minorities from seeking health care. c. Because many Mexican Americans are highly skilled workers with comparable wages, they have the lowest uninsured rate. d. Asians, because of their quiet demeanor and unwillingness to challenge the health care system, have the highest rate of uninsured people. ANS: B Most families with racially or ethnically diverse backgrounds have a lower socioeconomic status than is observed in the population at large. Dramatic changes in technology and specialization in the health care field have caused health care costs to skyrocket. Therefore, not everyone can afford health care services. DIF: Comprehension REF: p. 182 10. While completing a nursing degree in Virginia, a student who is interested in teaching in Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of Mexican-Americans live there. This nursing student values: a. cultural competence. b. ethnocentrism. c. prejudice. d. stereotyping. ANS: A Cultural competence is the responsibility of all nurses to become knowledgeable about the values, beliefs, and health care practices of the culturally diverse groups that are dominant in the nurse’s particular practice area. DIF: Application REF: p. 188 11. A Southeast Asian woman brings her baby into the clinic because the baby is lethargic. The nurse determines that the baby has had diarrhea and vomiting for several days, resulting in dehydration. Physical examination reveals small, round burns on the abdomen. These burns probably are the result of cigarettes or burning cotton used to: a. try to quiet the child and is considered child abuse. b. bring out toxic wind from the body. c. balance heat loss from the body. d. brush the body with ruda to allow spirits to return. ANS: C In the Southeast Asian culture, touching a burning cigarette or piece of cotton to the skin, usually the abdomen, is done to compensate for “heat” lost through diarrhea. This type of burning is a common part of self-care. DIF: Comprehension REF: pp. 196-197 12. A cultural phenomenon that is based on biologic variation would include: a. belief that exposure of a pregnant woman to an eclipse can result in cleft lip. b. denser bones in blacks result in less morbidity associated with osteoporosis. c. the grandmother who determines that her grandchild has scoliosis and should seek treatment, then informs the parents of her decision. d. a family that participates in feasts prepared to celebrate and make decisions. ANS: B Biologic variations include denser bones in blacks. Biologic variations such as body build and structure, genetic variations, skin characteristics, susceptibility to disease, and nutritional variations exist among different cultures. Other common variations include skin color, eye shape, hair texture, and adipose tissue deposits. DIF: Analysis REF: p. 191 13. A nurse plans to move to an area that is rich in immigrants from several countries and is concerned about respecting others’ cultural beliefs. The nurse’s first step to ensure cultural competence and sensitivity is to: a. enroll in a nursing theories course to increase knowledge about transcultural practices. b. become immersed in nursing literature about culturally diverse clients. c. participate in continuing education that focuses on health assessment variations among cultural groups. d. conduct a cultural self-assessment. ANS: D A cultural self-assessment allows the nurse to identify attitudes about individuals from different cultures. DIF: Application REF: p. 196 14. A nurse is preparing discharge teaching for an Asian-American woman with a fractured hip. The nurse reviews the client’s diet history while hospitalized and is concerned that the patient refused milk and yogurt, placing her at risk for osteoporosis. What cultural variation is the nurse overlooking? Asian Americans: a. have denser bones than other ethnic groups. b. consume diets rich in pork bone and shells, reducing the risk of osteoporosis. c. would participate in the practice of burning to compensate for this injury. d. would consult a curandero for dietary consultation. ANS: B Pork bones and shells are rich in calcium, reducing the risk of osteoporosis. DIF: Comprehension REF: p. 197 15. A nurse is preparing to teach a class related to risk factors for cancer to a diverse ethnic group attending a health fair. The nurse should be aware: a. that Hispanic women overestimate the prevalence of cancer and strictly following breast self-examination guidelines. b. of the importance of risk factors such as smoking and alcohol consumption that increase esophageal cancer when speaking with black. c. that American-Indian women have a higher rate of ovarian cancer than the general population. d. that cancer as well as heart disease and stroke are lower in ethnic groups. ANS: B Black men have a higher risk for esophageal cancer than the general population so teaching risk factors is needed. DIF: Comprehension REF: p. 191 16. A nurse performing a history and physical on a newly admitted Hispanic patient learns the patient has just used the services of a savador to: a. determine which herbs would best reduce hot flashes in a menopausal woman. b. communicate with a family member who recently died. c. receive treatments to reduce lower back pain. d. receive acupuncture to stop smoking. ANS: C Hispanic patients may want the support and care of a savador, which is similar to that offered by a chiropractor. DIF: Comprehension REF: p. 195 17. An Asian teenager is admitted with an eating disorder which she contributes to by not meeting the academic expectations of her parents. The nurse is overheard saying, “That isn’t the reason; all Asians are really smart.” This nurse is demonstrating: a. cultural humility. b. stereotyping. c. cultural assimilation. d. acculturation. ANS: B Stereotyping is associating certain behavior or competencies with an ethnic group without considering the individual. DIF: Comprehension REF: p. 180 18. A nurse caring for a Hispanic child admitted with diarrhea notices the child is wearing red yarn around the wrist. The nurse compliments the child’s “jewelry,” knowing it is believed to prevent: a. mal ojo. b. susto. c. bilis. d. empacho. ANS: A Mal ojo is due to “admiration” from a stranger resulting in diarrhea. DIF: Application REF: p. 198 19. A Hispanic patient is visited by several family members and the nurse witnessed one visitor who pinches a piece of skin at the waist. The nurse asks the purpose and learns the “provider” is listening for a snap from the abdominal region, which is then repeated several times. The patient most likely suffers from: a. mal ojo. b. susto. c. bilis. d. empacho. ANS: D Empacho is believed to be caused by lodged food particles, causing acute stomach/intestinal pain. DIF: Comprehension REF: p. 198 20. A nurse is seeking to become culturally competent in regard to obtaining information during health history and when performing physical diagnosis. The nurse is aware that which biologic variation is found in all of the following ethnicities: blacks, Asians, Hispanics, and American Indians? a. Mongolian spots b. Sickle cell anemia c. Lactose intolerance d. Thalassemia ANS: C Lactose intolerance is found in all four of the noted ethnicities. DIF: Application REF: p. 193, Table 10-2 MULTIPLE RESPONSE 1. Six cultural phenomena that vary among cultural groups are known to affect health care. The influence of the consequences of these phenomena can be seen in which of the following? (select all that apply) a. Asians and American Indians tend to be nonadherent with medications because they believe that the environment has no control over their fate. b. Some cancers such as stomach cancer occur less frequently among blacks. c. Blacks and American Indians often resist direct eye contact. d. Mexican Americans are more likely to stand close and touch health care providers. e. Whites are often late for health care appointments. ANS: C, D The use of eye contact is a cultural communication phenomenon. Cultures such as black and American Indian may view direct eye contact as rude behavior. Space and touch are cultural phenomena factors. In some cultures, touching strangers is inappropriate. On the other hand, Mexican Americans tend to be comfortable with less space because they like to touch persons with whom they are talking. DIF: Analysis REF: pp. 191-192 2. A nurse involved in researching the leading causes of death for minorities considers the federally defined minority groups, which include: (select all that apply) a. Blacks b. Russians c. Hispanics d. Asians or Pacific Islanders e. Scandinavians ANS: A, C, D The Federally defined minority groups include blacks, Hispanics, American Indians, and Asians or Pacific Islanders. DIF: Comprehension REF: pp. 181-182 COMPLETION 1. On the scale from 1 to 10, with 1 being no prejudice and 10 being extreme prejudice, the placement of hate on the continuum would be at number . ANS: 10 Hate is the extreme negative manifestation of prejudice, followed by contempt, then tolerance, which is more neutral. DIF: Application REF: p. 183, Figure 10-1 2. Although communication varies among members of different cultures, the greatest obstacle to providing multicultural care is differences in _. ANS: language Language can be the greatest obstacle to providing multicultural care. If the client does not speak the same language as the nurse, a skilled interpreter is mandatory. DIF: Comprehension REF: p. 191 Chapter 16: Emergency Preparedness and Response for Today’s World Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. Nurses and community officials are working together to ensure that churches and schools have needed supplies to provide shelter for large numbers of individuals in the event of a natural or manmade disaster. These activities represent which phase of a disaster continuum? a. Preparedness b. Relief response c. Recovery d. Crisis intervention ANS: A Every disaster response begins as a local event known as the preparedness phase, which consists of planning, preparedness, prevention, and warning. DIF: Comprehension REF: p. 285 2. A nurse at a school notices that several students have “blisters” on their bodies. Further investigation reveals that a terrorist incident has occurred, causing smallpox. If the chemical, biologic, radiologic, nuclear, and explosive (CBRNE) agent categories are used, this incident would be classified as: a. chemical. b. biologic. c. radiologic. d. nuclear. ANS: B The biologic category refers to diseases such as plague or smallpox. DIF: Comprehension REF: p. 284, Table 16-1 3. The Metropolitan Medical Response System (MMRS): a. is totally financed by the federal government national disaster fund. b. consists of responders who have obtained specialized training and equipment to deal with mass casualty events. c. has a storehouse of medications and antidotes to be used during response in times of national emergencies. d. arranges for patient admissions to federal hospitals. ANS: B The MMRS responds to disaster with trained individuals who have expertise in this type of situation and who have the equipment required to be effective. DIF: Comprehension REF: p. 286 4. A community in the New Madrid fault zone experiences an earthquake resulting in injuries from propelled objects and abrasions for many victims. The local supply of antibiotics is quickly exhausted. Local authorities would contact the: a. Commissioned Corps Readiness Force. b. Strategic National Stockpile. c. Department of Homeland Security. d. local Young Men’s Christian Association (YMCA). ANS: B The Strategic National Stockpile provides antibiotics, antidotes, and medical and surgical items when local and state supplies have been exhausted. DIF: Comprehension REF: p. 287 5. During the relief response phase of a disaster resulting from a “dirty bomb”: a. treatment for burns and poisoning is provided for victims. b. emergency plans are coordinated between agencies. c. reconstruction of destroyed facilities and homes begins. d. food stores are collected for potential victims. ANS: A During the relief response phase of a disaster, emergency responders provide assistance to victims and stabilize the scene; with a dirty bomb, radioactive material causes burns and poisoning. DIF: Analysis REF: p. 288 6. A nurse learns of a mass casualty disaster following a known terrorist attack. On arriving at the scene, the nurse knows that: a. the response of local hospitals will be dictated by the federal government. b. the same ground rules practiced in other settings and during smaller crises will be applicable. c. the least experienced nurses will be assigned to triage low-risk victims and victims who have no chance of survival. d. multiple incident commanders ensure a quick, effective response. ANS: B The fundamentals of nursing applied to other settings and situations can be used in a disaster. DIF: Comprehension REF: p. 283 7. Nurses caring for the victims of a mass casualty incident: a. determine the common terminology to be used by hospitals and participating agencies. b. take charge of communicating with the news media. c. determine whether there is a credible threat of a terrorist attack. d. give priority for care to those with the greatest chance of survival rather than those most critically ill. ANS: D Care is shifted from categorizing patients at low, intermediate, and critical risk to using resources to serve those with the greatest likelihood of survival. DIF: Comprehension REF: p. 283 8. During a community health fair the disaster medical assistance team (DMAT) informs participants that every community must be ready to provide disaster care. A participant asks, “In a disaster, the local community cannot possibly be effective, so why not have a plan to call federal agencies immediately to provide relief?” The correct response by the DMAT is: a. “Unless known terrorist activities involving mass destruction occur, the federal government does not become involved.” b. “The community is essentially the ‘first responder’ to any disaster.” c. “The preparedness phase of a disaster is the responsibility of the community, the relief response phase is assigned to state agencies, and the recovery phase is the responsibility of federal agencies.” d. “Unless local health care facilities are incapacitated, state and federal agencies will withhold assistance.” ANS: B Each disaster begins locally, and each community responds first and receives assistance from state and federal agencies when local resources are not adequate for the situation. DIF: Comprehension REF: p. 285 9. A nurse who is conducting a staff in-service on the phases of a disaster continuum teaches participants that, during the impact/response stage, activities focus on: a. community awareness in anticipation of a terrorist attack or natural disaster. b. determining the effectiveness of the disaster medical assistance team (DMAT). c. the use of an all-hazards approach. d. initiating response activities. ANS: D Response activities during the relief response phase consist of immediate actions to save lives and meet basic human needs. DIF: Comprehension REF: p. 288 10. Following a terrorist attack, victims are exhibiting posttraumatic stress syndrome, and care providers are exhibiting compassion fatigue. Which federal response system should be initiated? a. Strategic National Stockpile b. Metropolitan Medical Response System (MMRS) c. Commissioned Corps Readiness Force d. National Disaster Medical System ANS: B The MMRS is concerned with deploying trained responders who are able to provide mental health care for victims and health care providers. DIF: Comprehension REF: p. 286 11. The crisis communication officer may first inform the public or health care facility of a disaster or an act of terrorism. This representative has the responsibility to: a. contain the facts to within the administration group. b. incite the public to quickly take cover and obtain emergency supplies. c. provide understandable and straightforward facts about the event within the facility and possibly to the news media. d. inform the public that no information can be released until it has been confirmed by state and federal agencies. ANS: C The crisis communication officer is the first contact for patients, families, and employees within the facility or news media, so they may better understand the situation and know how to react and protect themselves. DIF: Comprehension REF: p. 289 12. The disaster medical assistance team works quickly to contain contaminants from a chemical plant explosion. Afterward, personnel undergo a special process to remove harmful chemicals from equipment and supplies. This removal process is known as: a. containment. b. decontamination. c. triage. d. scene assessment. ANS: B Decontamination is the physical process of removing harmful substances from personnel, equipment, and supplies. DIF: Knowledge REF: p. 280 13. A group of local volunteers respond to a tornado. Volunteers have completed an emergency response course and are able to assist with triage of injured citizens. They also participate in local health fairs to teach residents how to react during tornadoes. The responders are members of the: a. Medical Reserve Corps (MRC). b. Metropolitan Medical Response System (MMRS). c. National Disaster Medical System (NDMS). d. Commissioned Corps Readiness Force (CCRF). ANS: A The MRC are local volunteers trained to respond to local emergencies. DIF: Comprehension REF: p. 285 14. Troops from the United States participating in a peace mission in a foreign country were the victims of suicide bombers and many soldiers were evacuated back home to receive specialized medical care. The nation’s medical responses will be augmented by: a. the federally coordinated National Disaster Medical System. b. local homeland communities where troops receive care. c. the Medical Reserve Corps, which organizes and utilizes public health, nursing, medical, and other volunteers. d. the National Incident Management System, which guides government, nongovernmental organizations, and the private sector to work seamlessly during disaster situations. ANS: A The National Disaster Medical System supplements care for casualties evacuated back to the United States from overseas and federally declared disasters including national disasters, major transportation accidents, technologic disasters, and acts of terrorism. DIF: Comprehension REF: pp. 286-287 15. A nurse is informed that the Federal Bureau of Investigation has determined that a bomb has been detected and is in the possession of a known terrorist group. The government buildings in the local community are the target. This situation is termed a(n): a. all-hazards approach. b. biologic event. c. credible threat. d. natural disaster. ANS: C A credible threat is a situation in which the Federal Bureau of Investigation (FBI) determines that a terrorist threat is probable and verifies the involvement of a weapon of mass destruction in the developing terrorist incident. DIF: Comprehension REF: p. 280 16. The emergency response team responded to a terrorist attack where hundreds of people died following symptoms of chest tightness, palpations, seizures, and finally paralysis. A colorless odorless liquid known as Sarin (GB) was the agent, which is primarily inhaled with limited exposure through the skin. The concentration of Sarin has not been measured. What level is the minimum level of personal protection and safety equipment (PPE) that would be needed? a. A b. B c. C d. D ANS: B Level B requires a high level of respiratory protection, but less skin protection, providing a chemical splash–resistant suit with hood and self-contained breathing apparatus (SCBA). It provides maximum respiratory protection but less skin protection than level A equipment. DIF: Analysis REF: p. 289 17. A state is devastated by a tornado killing many people, destroying communication systems, utility services, homes, and medical facilities. The state requests immediate assistance from the U.S. Congress and from surrounding states. The affected state should first contact the: a. Emergency Management Assistance Compact (EMAC). b. Institute of Medicine (IOM). c. Red Cross. d. Strategic National Stockpile. ANS: A The EMAC is an organization authorized by the U.S. Congress through which a state impacted by a disaster can request and receive assistance from other member states quickly and efficiently. DIF: Comprehension REF: p. 280 18. A nurse is interested in learning the phases of the disaster continuum and realizes it has many similarities to the nursing process. To better understand the phases of a disaster, which is true when comparing the phases of the disaster continuum to the nursing process? a. The preparedness phase of the disaster continuum is consistent with the assessment and planning steps of the nursing process. b. The recovery phase of the disaster continuum is consistent with the planning step of the nursing process. c. The recovery phase of the disaster continuum is consistent with the implementation step of the nursing process. d. The response relief phase of the disaster continuum is consistent with the evaluation step of the nursing process. ANS: A The preparedness phase requires assessing possible needs of the community and planning appropriate interventions and is consistent with the assessment and planning steps of the nursing process. DIF: Comprehension REF: p. 285 19. In the preparedness phase for disasters, the community plans for a possible terrorist attack using anthrax as the weapon of destruction. What treatments and/or preparations would be needed? a. Vaccines and Level B Personal Protection Equipment (PPE) b. Treatment for burns, decontamination, and Level A PPE c. Social distance determination, decontamination for radioactive fallout d. Identify and detect incendiary devices, treatment for burns and propellants ANS: A Anthrax is a biologic weapon and requires Level B protection since it is a known agent and can be carried in wind or surfaces. Timing of treatment is critical and vaccines are available. DIF: Analysis REF: pp. 282-284, Table 16-1 MULTIPLE RESPONSE 1. Health care professionals have been activated to respond to a disaster, and the registered nurse who is coordinating the effort realizes that: (select all that apply) a. in the event of a mass casualty incident, care is prioritized to those who have the greatest chance of surviving. b. communities should use their own resources first to attempt to stabilize and organize the response. c. state assistance occurs any time a disaster occurs, regardless of the community’s resources. d. the emergency operating plan developed by one central agency rather than individual facilities should be put into operation. e. strict protocols regarding the use of resources must be followed. ANS: A, B Care is shifted to doing the most good for the most people. Efforts begin at the local level. DIF: Comprehension REF: pp. 283-284 2. When teaching community preparedness for a community group, the nurse explains that components of the National Disaster Medical System (NDMS) provide for: (select all that apply) a. a nationwide bomb disposal squad team for the rapid removal of explosive devices. b. teams of health care providers who are experts and have specialized supplies and equipment. c. structures for patient evacuation from the disaster area to an unaffected area. d. arrangements for hospitalization in federal and volunteer nonfederal acute care hospitals. e. providing mental health care for the community, for victims, and for health care providers. ANS: B, C, D The NDMS provides specially trained teams of people along with equipment designed for disaster relief. The NDMS is responsible for removing patients from unsafe to safe areas. The NDMS coordinates efforts to evacuate victims to federal or nonfederal volunteer hospitals that can care for disaster victims. DIF: Comprehension REF: p. 286 COMPLETION 1. The emergency preparedness term that is used to describe the process of limiting the emergency situation within a well-defined area is . ANS: containment Containment is correct because the focus is to prevent the agent that caused the disaster from spreading. DIF: Knowledge REF: p. 280 2. The term used during a pandemic disaster that refers to the attempt to contain germs by limiting socialization and personal interactions is . ANS: social distancing The term social distancing refers to the attempt to keep people as far apart as possible so as to limit the possibility of spreading germs. DIF: Knowledge REF: p. 291 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 08: Legal Issues in Nursing and Health Care Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 7th Edition MULTIPLE CHOICE 1. A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client is an immigrant and is uninsured. Which act would prevent the client from being transferred to another facility? a. Emergency Medical Treatment and Active Labor Law b. Health Insurance Portability and Accountability Act c. Patient Self-Determination Act d. The Patient Safety and Quality Improvement Act ANS: A The Emergency Medical Treatment and Active Labor Law is a federal statute that was enacted in 1986 to prohibit the transfer of unstable clients, including women in labor, from one facility to another. This law also prohibits refusal of care for indigent and uninsured clients who seek medical assistance in the emergency department. DIF: Comprehension REF: p. 123 2. A nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to the physician. The nurse is at risk for being charged with: a. negligence. b. assault. c. defamation of character. d. tort. ANS: A Negligence is defined as failure to act in a reasonable and prudent manner. The most frequent allegations of nursing negligence include failure to ensure client safety, improper treatment, failure to monitor the client and report significant findings, medication errors, and failure to follow the agency’s policies and procedures. DIF: Comprehension REF: p. 120|p. 132 3. A nurse is caring for a client who just suffered a stroke and is medicated for pain. The nurse completes the following interventions: places the client on the examining table, completes a thorough history and physical, covers the client with a sheet, places the call button within reach, and goes out in the hall to speak with the client’s physician. The client tries to get up to speak with his family and falls, sustaining a hematoma on the head and a broken hip. The nurse’s actions reflect: a. invasion of privacy. b. libel. c. slander. d. negligence. ANS: D The nurse is failing to ensure client safety after medication administration; this is defined as negligence. DIF: Comprehension REF: p. 120|p. 132 4. A nursing student planning to apply for licensure knows that being charged with which offense would result in a minor criminal offense? a. Solicitation of illegal drugs b. Stealing a car c. Failing to report elder abuse d. Billing Medicare for services not rendered ANS: C Failing to report elder abuse can lead to penalty of fine or imprisonment. DIF: Comprehension REF: p. 150 5. When differentiating between slander and libel, the nurse knows that libel: a. results from defamation caused by subjective comments written in the nurse’s notes. b. results from negative subjective comments made to those who are not providing care. c. occurs when the nurse verbally describes to the oncoming nurse assigned to the client objective data that place the client in a negative light. d. consists of repeating prejudiced comments made by the primary caregiver to a neighbor at the local supermarket. ANS: A Libel is defined as comments that are written about a person that are defaming. Nurses may be subject to a charge of libel for subjective comments meant to denigrate the client that are placed in the medical record or in other written materials read by others. DIF: Comprehension REF: p. 149 6. Which statement regarding informed consent is correct? Informed consent: a. is mandated by federal but not state law. b. must reveal expected benefits. c. requires concealing any known risks. d. allows the RN to communicate information needed so that informed consent can be provided. ANS: B The information that constitutes informed consent for the client includes the nature of the therapy or procedure, expected benefits and outcomes of the therapy or procedure, potential risks of the therapy or procedure, alternative therapies to the intended procedure and their risks and benefits, and risks of not having the procedure. DIF: Comprehension REF: p. 152 7. A client states, “I am leaving. No one here knows what they are doing.” The nurse completing the Against Medical Advice form must: a. defer notifying the provider until the client has had ample time to leave. b. state in medical terms the risks of leaving. c. inform the client that leaving could result in complications and impairment. d. detain the person with the use of soft restraints until security arrives. ANS: C The nurse must articulate to the client the dangers associated with leaving the facility if the primary provider is not present. The nurse’s notes on this form should reflect the specific advice given to the client, which should include the fact that leaving the facility could aggravate the current condition and complicate future care, result in permanent physical or mental impairment or disability, or result in complications that can cause death. DIF: Application REF: p. 93 8. When can a nurse detain a client by using restraints? a. Staffing resources are insufficient to monitor a patient with hemiplegia. b. The client is confused. c. The family requests the restraints to prevent the client from leaving the facility. d. There are current physician orders following a medical evaluation. ANS: D A written physician’s order that is timed and dated is required for the use of restraints. Renewal of orders must be accompanied by evidence of medical evaluation and nursing reassessment. DIF: Comprehension REF: p. 155 9. When the client is unable to make medical decisions for himself or herself, authorization that allows another person to make these decisions is called: a. living will. b. durable power of attorney. c. informed consent. d. immunity. ANS: B Durable power of attorney involves preselection by the client of a person who has been authorized legally to make health care decisions once the client becomes incompetent to do so. Several states have enacted a Uniform Durable Power of Attorney Act, which sanctions a durable power of attorney for health care. DIF: Knowledge REF: p. 152 10. All hospitals receiving Medicare and Medicaid funds must ask clients whether they have a living will or a durable power of attorney. This act is known as the: a. Emergency Treatment and Active Labor Law. b. Americans with Disabilities Act. c. Uniform Health Care Decisions Act. d. doctrine of res ipsa loquitur. ANS: C The Uniform Health Care Decisions Act of 1993 is a federal statute that was established to support individuals in expressing their preferences about medical treatment and making decisions about end-of-life care. DIF: Comprehension REF: p. 152 11. A nurse who functions in the role of team leader can be held negligent for matters involving: a. inadequate training. b. lack of development of proper policies and procedures. c. failure to discipline unsafe workers. d. delegation of client care tasks. ANS: D Delegation of client care tasks falls within the role of the team leader, and inappropriate delegation of client care tasks could result in negligence. Team leaders, charge nurses, and managers are held to the standard of care of the reasonably prudent nurse employed in that role. DIF: Comprehension REF: p. 144 12. Although a hospital reversed all charges when a client was the victim of wrong site surgery, the court awarded the client $1.5 million. The client was able to return to work in 6 weeks and had no permanent damages. This monetary compensation is termed: a. res ipsa loquitur. b. punitive damages. c. vicarious liability. d. immunity. ANS: B Punitive damages are monetary compensation to an injured client that is greater than amount of loss. DIF: Application REF: p. 120 |p. 135 13. A physician orders a drug for a patient with a known allergy resulting in anaphylactic shock. The nurse: a. realizes that disclosure of the error will result in more severe ramifications for the agency than if the negligence is discovered by the patient or family. b. should disclose the occurrence before speaking with the physician who ordered the drug or with hospital management. c. recognizes disclosure as an essential component of the national patient safety movement. d. should report the occurrence to the patient’s insurance company to decrease patient costs. ANS: C The National Quality Forum identified the process of disclosure as a key element of the national patient safety movement. DIF: Application REF: p. 139 14. A nurse is charged with battery after helping an invalid patient back to bed and not calling for help due to a reduced staffing level. The patient sustained excessive bruising, sore joints, and extended stay. In this case, the: a. patient is the plaintiff. b. nurse can be charged with forcefully restraining the patient without orders. c. nurse is accountable due to the decreased level of staffing. d. charge of invasion of privacy may be withheld. ANS: A The complaining person in a lawsuit is the plaintiff. DIF: Application REF: p. 120 15. A nurse working in a privately owned hospital is charged with a negligent act after failing to check laboratory reports prior to giving a dose of digoxin (Lanoxin) resulting in the patient’s condition becoming critical due to decreased cardiac output and falling leading to a broken hip and concussion. A nurse is brought in who testifies that a professional with the knowledge and skill of an RN should understand that, before administering this drug, potassium level and pulse level is always checked to prevent such an occurrence. The nurse’s testimony as to what constitutes reasonable care is based on: a. the legal definition of standard of care. b. the legal definition of the informed consent process. c. the doctrine of res ipsa loquitur. d. governmental immunity. ANS: A Standard of care is the legal criteria against which the nurse’s (and physician’s) conduct is compared to determine whether a negligent act or malpractice occurred. Nurses are specialists in hospital care who, in the final analysis, hold the well-being—in some instances, the very lives—of patients in their hands. DIF: Comprehension REF: p. 120 16. On a nursing unit all assigned breaks including lunch/dinner breaks are assigned at the beginning of the shift. A nurse caring for a patient with anemia and heart failure prepares to hang a unit of packed red blood cells and realizes her break is in 5 minutes. She decides it is not necessary to have another nurse check the blood against the patient’s information since the patient’s blood type is O+ which she incorrectly remembered to be the universal donor. She hangs the blood, noting the patient is “reading and vital signs normal.” She leaves the floor for her break and does not report leaving or ask anyone to perform required vital signs. Upon returning she meets a family friend who is visiting and time “just flies.” She returns to the patient’s room after admitting a new patient. The patient is hypotensive and color is cyanotic and anxious. She reports the findings to the charge nurse, who then contacts the physician. A blood reaction occurrence is noted. The nurse providing care is charged: a. with comparative negligence. b. with a preventable adverse event. c. with criminal negligence. d. under the doctrine of res ipsa loquitur. ANS: C In this case, criminal negligence charges would be based on “reckless and wanton” disregard for the safety, well-being, or life of an individual; behavior that demonstrates a complete disregard for another, such that death is likely in the transfusion reaction. Type “O” is the universal donor rather than universal recipient; however, regardless of blood type, policy and procedures for assessing vital signs and patient status during blood transfusion must be followed. DIF: Comprehension REF: p. 120|p. 136 17. A physician shares with the patient’s family that, while a central line was being inserted, the patient’s lungs were inadvertently punctured, which required oxygen administration. The physician also explains that a chest x-ray indicated the lung remained intact and no additional treatment was required. The physician’s role in this instance is based on the legal principle of: a. comparative negligence. b. gross negligence. c. disclosure. d. the Emergency Medical Treatment and Active Labor Act (EMTALA). ANS: C Disclosure is a process in which the patient’s primary provider (physician or advanced practice nurse) gives the patient, and when applicable, family members, complete information about unanticipated adverse outcomes of treatment and care. DIF: Comprehension REF: p. 120| p. 139 18. A nurse is assigned to a unit other than the one she is normally assigned due to increased census on the alternate unit. She is assigned to care for seven patients and participates in walking rounds where the patient’s condition and needs are discussed between oncoming and off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall from her pocket, which contain the above information that contains patient sensitive data. The liabilities arising from this incident would be covered under: a. the Health Insurance Portability and Accountability Act. b. the ANA Scope and Practice Act. c. affirmative duty failing to question order. d. personal liability with floating and cross-training. ANS: A HIPAA protects patient information and ensures confidentiality of data. DIF: Analysis REF: p. 125 MULTIPLE RESPONSE 1. Which types of abuse are the nurse required to report or be subject to fines and imprisonment for not reporting? (select all that apply) a. Animal b. Child c. Alcohol d. Infant e. Emotional ANS: B, D State laws have been created as a result of the 1973 Child Abuse Prevention and Treatment Act. These laws dictate that health professionals must report infant and child abuse and specified communicable diseases. Failure by the nurse to comply can result in fines and/or imprisonment. DIF: Comprehension REF: p. 130 2. A patient asks, “What is an advance directive?” The nurse explains that examples of advance directives are: (select all that apply) a. preserving cord blood for possible future needs of a child. b. providing instructions that life-sustaining medical procedures should be withheld in the event of a terminal situation. c. giving someone the legal right to act on one’s behalf when one becomes incapacitated. d. completing hospital admission paperwork before being admitted to the hospital. ANS: B, C Advance directives document an individual’s desires regarding end-of-life care. These wishes are generally stated through the execution of a formal document known as the living will. Right-to-die statutes vary from state to state; therefore, nurses must become familiar with their state-specific statute. DIF: Analysis REF: p. 120|p. 151 3. A nurse learns in orientation that an incident report does not “blame” anyone but concisely documents the events leading up to an occurrence. Which events would warrant completion of an incident report? (select all that apply) a. The client is crying and distraught when he learns of a diagnosis of cancer. b. An intravenous antibiotic given preoperatively does not infuse because of a faulty pump. c. The nurse is unable to carry out orders written by the specialist because of illegibility. d. A client falls while in the shower, although she was told not to get up alone. e. The registered nurse is not available to complete the preoperative checklist. ANS: B, C, D, E Nurses are legally bound to report critical incidents to their nurse managers, agency administration, and risk manager through a formal intra-agency document generally titled the “incident report.” Circumstances under which an incident report should be filed include malfunction or failure of medical equipment. DIF: Analysis REF: p. 146 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 res