Contemporary Nursing Issues Trends And Management 4th Edition By Jacob -Test Bank A+

Description

Chapter 6: Nursing Research and Evidence-Based Practice

MULTIPLE CHOICE

1. Institutional review boards determine whether research studies involving human subjects will

A.	be published.
B.	add to the body of nursing knowledge.
C.	cause harm.
D.	receive funding.

ANS: C

(C) is correct because the institutional review board (also called the human subjects committee) examines research proposals to make sure that the ethical rights of those individuals participating in the research study are protected. This board makes sure that persons who participate in research are assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is protected. (A) is incorrect because research publication is not controlled by institutional review boards. (B) is incorrect because institutional review boards do not review the merit or significance of research to nursing knowledge. (D) is incorrect because institutional review boards do not award grants or allocate funds.

DIF: Knowledge REF: Page 120

1. The nurse is interested in understanding the meaning of the human experience of surviving polio. Subject recruitment targets persons who have been diagnosed with the disease. The researcher reflects on the data and identifies common themes in order to understand the “lived experience.” These characteristics are consistent with the qualitative research method known as

A.	grounded theory.
B.	ethnography.
C.	phenomenology.
D.	case study.

ANS: C

(C) is correct because phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. (A) is incorrect because grounded theory is a qualitative research design that is used to collect and analyze data with the aim of developing theories grounded in real-world observations. This method is used to study a social process. (B) is incorrect because ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection, description, and analysis of data to develop a theory of cultural behavior. (D) is incorrect because case study is a method of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or other social unit.

DIF: Application REF: Page 110

1. The use of research to guide nursing practice is called

A.	utilization.
B.	dissemination.
C.	generalizability.
D.	analysis.

ANS: A

(A) is correct because utilization of research guides nursing practice. Clinical agencies need to make a commitment to implementing research findings and then developing policies and procedures to guide the implementation process. (B) is incorrect because dissemination is defined as the spreading of information, generally through published reports or by word of mouth. (C) is incorrect because generalizability is the inference that findings can be generalized from the sample to the entire population. (D) is incorrect because analysis is the second step or phase of the nursing process.

DIF: Comprehension REF: Pages 111-113

1. The CURN project is an example of research

A.	utilization.
B.	needs assessment.
C.	dissemination.
D.	pilot study.

ANS: A

(A) is correct because the major goal of the CURN project was to increase the use of research findings in nursing practice by disseminating research findings. For this project, research utilization was considered an organizational process rather than a process that should be implemented by an individual nurse. (B) is incorrect because a needs assessment is a study in which the researcher collects data to estimate the needs of a group, usually for resource allocation. (C) is incorrect because dissemination is the distribution. (D) is incorrect because a pilot study is a smaller version of a proposed study conducted to develop or refine methodology, such as treatment, instruments, or a data collection process, to be used in a larger study.

DIF: Comprehension REF: Page 113

1. A public health nurse is interested in determining which educational programs are needed in the aggregates served. The researcher personally interviews individuals who are walking on the streets in the community. This type of research design is

A.	quasi-experimental.
B.	survey.
C.	case study.
D.	ethnography.

ANS: B

(B) is correct because survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. (A) is incorrect because quasi-experimental research design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. (C) Is incorrect because case study designs are used to present an in-depth analysis of a single subject, group, institution, or other social unit. The purpose is to gain insight and provide background information for more controlled, broader studies. (D) is incorrect because ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection and description and analysis of data for the purpose of developing a theory of cultural behavior.

DIF: Analysis REF: Page 109

1. Which of the following organizations provides federal funding for research?

A.	National Institutes of Health
B.	Robert Wood Johnson Foundation
C.	W.K. Kellogg Foundation
D.	Sigma Theta Tau International

ANS: A

(A) is correct because the National Institutes of Health is a federal agency that provides federal funding for health care research. (B) Robert Woods Johnson is a private foundation. (C) W.K. Kellogg Foundation is also a private foundation. (D) Sigma Theta Tau International is a nursing organization.

DIF: Knowledge REF: Page 107

1. Which type of data analysis results in the non-numerical organization of data?

A.	Descriptive
B.	Inferential
C.	Qualitative
D.	Quantitative

ANS: C

(C) is correct because qualitative data analysis results in the organization of words or phrases, not numbers. Interviews are reviewed and are transcribed line by line in an effort to group common conceptual meanings. (A) is incorrect because descriptive statistics consists of numerical data. (B) is incorrect because inferential statistics consists of numerical data. (D) is incorrect because quantitative research is a formal, objective, systematic process in which numerical data are used.

DIF: Comprehension REF: Page 108

1. A nurse researcher who is seeking funding for a study should identify

A.	board members of funding agencies.
B.	priorities of funding agencies.
C.	budgets of funding agencies.
D.	accreditation of funding agencies.

ANS: B

(B) is correct because the priorities of funding agencies indicate their preferences for funding; these are more likely to be funded than are studies that are not aligned with funding preferences. (A), (C), and (D) consist of information about the funding agencies that is descriptive of the agency, but that would not be helpful in the preparation of a study proposal.

DIF: Application REF: Page 104

1. A nurse studied a community to determine if there were patients who would benefit from a hospice program if one were developed. This type of research is

A.	a survey
B.	quasi-experimental.
C.	a needs assessment method.
D.	a pilot study.

ANS: C

(C) is correct because a needs assessment method is a study in which the researcher collects data for the purpose of estimating the needs of a group; commonly used to prioritize the needs of an organization or community. (A) is incorrect because a survey is a research design that is used to collect demographic information, social characteristics, behavioral patterns, and other information. (B) is incorrect because quasi-experimental research is a type of quantitative research that lacks one of the components of an experimental design. (D) is incorrect because a pilot study is a smaller version of a proposed study conducted to develop or refine methodology, such as treatment, instruments, or a data collection process, to be used in a larger study.

DIF: Analysis REF: Page 109

1. The research hypothesis is that aromatherapy reduces stress more effectively than does acupuncture. The researcher does not identify a control group. This study would be a _____ design.

A.	experimental
B.	quasi-experimental
C.	survey.
D.	meta-analysis.

ANS: B

(B) is correct because in quasi-experimental studies a control group, randomization, or the manipulation of one or more variables is missing. (A) is incorrect because an experimental design must have a control group. (C) is incorrect because the purpose of a survey design is to collect information, not to compare groups. (D) is incorrect because a meta-analysis is a process whereby multiple research studies are reviewed.

DIF: Application REF: Page 109

1. A qualitative researcher reviews data collected while he participated in a grief support group to develop a theory of how widows and widowers mourn. The researcher is using which qualitative research design?

A.	Phenomenology
B.	Grounded theory
C.	Case study
D.	Hypothesis generation

ANS: B

(B) is correct because grounded theory is a qualitative research approach that describes a social process and has theory generation as its main purpose. (A) is incorrect because phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. (C) is incorrect because case study design is a type of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or social unit. (D) is incorrect because hypothesis generation is the first step in the basic research process.

DIF: Analysis REF: Page 110

1. Which of the following statements about qualitative research is true?

A.	Qualitative research requires less time than quantitative research because complex statistical analysis is not necessary.
B.	To be statistically significant, qualitative studies must consist of large, randomly selected sample sizes.
C.	Because qualitative studies deal with human concepts such as suffering and quality of life, results can be generalized.
D.	Interviews are the primary means of collecting data that enable the researcher to describe unclear phenomena.

ANS: D

(D) is correct because qualitative research involves ambiguous concepts. Analysis of interviews with participants who are experiencing the phenomena enables the researcher to describe unclear phenomena. (A) is incorrect because qualitative research is time consuming and costly. One-on-one interviewing takes time, and the interviews must be recorded, typed, transcribed, and analyzed. (B) is incorrect because qualitative studies use small sample sizes that are not randomly selected. (C) is incorrect because the small sample sizes used in qualitative research do not allow results to be generalizable to the whole population.

DIF: Analysis REF: Page 108

MULTIPLE RESPONSE

1. The informed consent must include (Select all that apply.)

A.	potential risks and benefits to participants in the study.
B.	medical terminology rather than lay terms to prevent misunderstanding of the study.
C.	a statement on how the anonymity and confidentiality of participants are protected.
D.	the cost of the study.
E.	details on how to contact the investigator.

ANS: A, C, E

(A), (C), and (E) are correct because informed consent explains the study to the participants and assures them of their rights, including their right to refuse to participate or to withdraw from the study. The informed consent must also include essential study information and statements about potential risks and benefits, protection of anonymity and confidentiality, voluntary participation, compensation, and alternative treatment, along with specific information on how to contact the investigator. (B) is incorrect because informed consent is always written in lay terminology so that participants can clearly understand. (D) is incorrect because the actual cost of the study is not included on the informed consent form.

DIF: Analysis REF: Page 120

1. A researcher is interested in quality of life and after an extensive literature review quantitatively integrates data from identified studies and describes the findings. This researcher is using which approach? (Select all that apply.)

A.	Survey
B.	Triangulation
C.	Meta-analysis
D.	State of the science summary
E.	Quasi-experimental design

ANS: C, D

(C) and (D) are correct because meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. State of the science summary is a merging of findings from several studies that explored the same topic. (A) is incorrect because survey research design is used to obtain information regarding the prevalence, distribution, and interrelationships of variables within a population. (B) is incorrect because triangulation is defined as the use of a variety of methods to collect data on the same concept. (E) is incorrect because quasi-experimental design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design.

DIF: Analysis REF: Page 109

COMPLETION

1. Development and validation of the body of knowledge and foundation on which practice is based is ____________________.

ANS:

research

Research refines and enhances new and existing knowledge and provides accountability for nursing practice.

DIF: Knowledge REF: Page 103

Cherry: Contemporary Nursing, 4^th Edition

Test Bank

Chapter 7: Paying for Health Care Services in America: Rising Costs and Challenges

MULTIPLE CHOICE

1. An older adult patient was admitted to the hospital and his condition was 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

Choice (A) is correct because diagnosis-related groups (DRGs) are used in reimbursement for health care services that is based on a predetermined fixed price per case or diagnosis in 468 categories. Under DRGs, each Medicare patient is assigned to a diagnostic grouping on the basis of his/her primary diagnosis at hospital admission. Medicare limits total payment to the hospital to the amount preestablished for that DRG. (B), (C), and (D) are incorrect because these are not reimbursement types that are based on predetermined pricing.

DIF: Comprehension REF: Page 127

1. The precise classification of patients according to the highest DRG has created a new role for nurses, referred to as

A.	case management nurse.
B.	quality assurance nurse.
C.	utilization review nurse.
D.	cost-control nurse.

ANS: C

Choice (C) is correct because hospital-based utilization review nurses review medical records to determine the most appropriate DRG for patients. Financial gains can be made through careful diagnosis of patients according to their highest potential DRG classification. (A) is incorrect because a case management nurse coordinates the patient’s care throughout the course of an illness. Case managers generally do not perform direct care duties but assume a planning and evaluation role and collaborate with the interdisciplinary health care team to ensure that goals are met, quality is maintained, and progress toward discharge is made. (B) is incorrect because the quality assurance nurse facilitates patient care delivery through quality monitoring and quality improvement initiatives. (D) is incorrect because a cost-control nurse is not a standard role in hospitals.

DIF: Knowledge REF: Page 127

1. 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

Choice (B) is correct because hospitals face a strong financial incentive from the DRG reimbursement system to reduce the patient’s length of stay and minimize procedures performed. If hospital costs exceed the DRG payment for a patient’s treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. (A) is incorrect because decreasing hospital admission rates has not been shown to reduce the costs of health care. (C) is incorrect because decreasing outpatient services would actually drive costs up because more services would have to be performed as in-patient procedures. (D) is incorrect because decreasing specialty groups would not affect hospital reimbursement, which is the focus of the DRG payment system.

DIF: Application REF: Page 127

1. 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

Choice (C) is correct because 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. (A) is incorrect because both the poor and uninsured may have limited transportation, limiting their access to health care facilities. (B) is incorrect because the poor generally receive very few treatments because of lack of payment to the provider or facility. (D) is incorrect because the poor rarely seek preventive services, which explains why their overall health status is lower.

DIF: Comprehension REF: Page 128

1. 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

Choice (B) is correct because 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. (A) is incorrect because charity is the donation or benevolent gift of money or tangible goods or services. (C) is incorrect because price sharing is not a standard term related to lack of insurance, uninsured populations, or uncompensated care. (D) is incorrect because governmental reimbursement is received when the government actually remits money to providers for services rendered.

DIF: Comprehension REF: Page 128

1. Which two industrialized countries do not have a national health insurance system?

A.	France and Great Britain
B.	Canada and Australia
C.	United States and South Africa
D.	Germany and France

ANS: C

Choice (C) is correct because the United States and South Africa are the only industrialized countries without a national health insurance system that covers all of their citizens. (A), (B), and (D) are incorrect because these countries all include a substantial amount of central government planning in their health systems, leading to a fully centralized or nationalized system of health care.

DIF: Knowledge REF: Page 131

1. A contractual agreement between the insurer and the provider by 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

Choice (B) is correct because 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 co-payment. The member may select a physician but pays less for physicians and facilities on the plan’s preferred list. (A) is incorrect because health maintenance organizations require that the member pay a premium with a fixed co-pay and select a primary care physician approved by the HMO. (C) is incorrect because the fee-for-service arrangement is one in which the member pays a premium for a fixed percentage of covered expenses and is allowed to choose physicians and specialists without restraint. (D) is incorrect because a philanthropic agency provides care without fees, but the member does not select providers.

DIF: Comprehension REF: Page 129

1. In the triad of health care, which of the following would be considered the third party?

A.	Patient
B.	Health care provider
C.	Insurance company
D.	Government agency that sets reimbursement rules for services

ANS: C

Choice (C) is correct because the third party payer is an organization other than the patient and the supplier (hospital or physician), such as an insurance company, that assumes responsibility for payment of health care charges. (A) and (B) are incorrect because neither the patient nor the health care provider is considered the third party in the health care triad. (D) is incorrect because the government that sets reimbursement rules is not part of the health care triad.

DIF: Knowledge REF: Page 124

1. 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

A.	prospective payment.
B.	retrospective payment system.
C.	diagnosis-related group payment system.
D.	capitated payment system.

ANS: B

Choice (B) is correct because the 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; also known as the “fee-for-service” payment system. (A) is incorrect because the prospective payment system is a method of reimbursing health care providers in which the total amount of payment for care is predetermined on the basis of the patient’s diagnosis. This is the predominant method of payment in today’s health care system. (C) is incorrect because the diagnosis-related group payment system refers to reimbursement for health care services that is based on a predetermined fixed price per case. This method of payment is also called the prospective payment method. (D) is incorrect because the capitated payment system is a method of reimbursing providers (usually primary care providers such as physicians and 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 for the patient enrolled in the insurance company’s health plan.

DIF: Comprehension REF: Page 124

1. A patient is admitted with “chest pain.” A series of diagnostic tests are ordered, and the patient undergoes coronary artery bypass grafting. The cost of care for this patient is increased because of his 4-pack-per-day smoking history that resulted in extension of his ICU stay by 3 days caused by respiratory problems. Which of the following is correct in terms of the diagnosis-related group (DRG) payment system for this diagnosis?

A.	The cost of caring for this patient 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 patient was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee.
C.	The patient 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 patient will receive a reduced payment to cover the loss incurred by the hospital.

ANS: B

Choice (B) is correct because since 1983, if hospital costs exceed the DRG payment for a patient’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 patient’s length of stay and minimize procedures performed. (A), (C), and (D) are incorrect because none of these statements describes a currently allowable method of medical reimbursement.

DIF: Analysis REF: Page 127

1. 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

Choice (C) is correct because 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. (A) is incorrect because the poor are less likely to participate in preventive services. (B) is incorrect because the poor usually do not have a usual source of care. (D) is incorrect because through Medicaid, the patient actually has enhanced access to health care resources.

DIF: Comprehension REF: Page 128

1. A patient 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 this 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

Choice (A) is correct because 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. (B), (C), and (D) are incorrect answers because they do not represent accurate definitions of effectiveness and efficiency in health care.

DIF: Application REF: Pages 135-136

1. A nurse is offered several health care plans as part of her 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

Choice (D) is correct because 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. (A) is incorrect because a prospective payment system is a method of reimbursing health care providers in which the total amount of payment for care is predetermined on the basis of the patient’s diagnosis. (B) is incorrect because a retrospective payment system is a method of reimbursing health care providers in which professional services are rendered and charges are billed according to each service provided. (C) is incorrect because the single payer system is a method of reimbursement whereby one payer, usually the government, pays all health care expenses for all citizens with the use of funding acquired through taxes.

DIF: Comprehension REF: Page 123

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-effectiveness measures.

ANS: B, C, E

Choices (B), (C), and (E) are correct because economic forces are motivating the shift toward a model of health promotion and preventive care to achieve cost-effectiveness, including a shift to provision of more services and procedures in outpatient settings. The technology of the Internet offers promise for information and education that will allow consumers (or patients) to access health care educational resources more effectively. (A) is incorrect because health care is shifting from acute care services to preventive and community-based services such as ambulatory care and home care. (D) is incorrect because physicians no longer control all health care decision making; insurance companies play an increasingly stronger role in health care decision making through requirements for preauthorization of procedures and treatment plans.

DIF: Analysis REF: Page 135

COMPLETION

1. The largest single payer of hospital charges in the United States is ____________________.

ANS:

Medicare

Medicare is correct because it 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: Page 127