Chapter 10: Policy, Politics, Legislation, and Community Health Nursing
Test Bank
MULTIPLE CHOICE
1. Which of the following nurses fought to have American nursing controlled by nurses rather
than physicians?
a. Clara Barton
b. Florence Nightingale
c. Lavinia Dock
d. Lillian Wald
ANS: C
Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to
control the nursing profession. Florence Nightingale was the first nurse to exert political
pressure on a government. Clara Barton was responsible for organizing relief efforts during
the U.S. Civil War. Lillian Wald was the driving force behind the federal government’s
development of the Children’s Bureau in 1912.
DIF: Cognitive Level: Remember (Knowledge)
REF: p. 166
2. Which of the following nurses used political expertise to influence the federal government to
develop a Children’s Bureau?
a. Clara Barton
b. Florence Nightingale
c. Lavinia Dock
d. Lillian Wald
ANS: D
Lillian Wald recognized the connection between social conditions and health. She was a
driving force behind the federal government’s development of the Children’s Bureau in 1912.
Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to
control the nursing profession. Florence Nightingale was the first nurse to exert political
pressure on a government. Clara Barton was responsible for organizing relief efforts during
the U.S. Civil War.
DIF: Cognitive Level: Remember (Knowledge)
REF: p. 166
3. Which of the following best describes the most important factor in legislation?
a. The amount of financing and lobbying behind each choice
b. The beliefs, attitudes, and values of the policy
c. The preferences of the majority of American voters
d. The president’s ongoing encouragement for one particular choice
ANS: B
Public policy encompasses the choices made regarding goals, priorities, and how resources
are allocated. Policy choices reflect the values, beliefs, and attitudes of those designing the
policy. The influence of the president, preferences of Americans, and amount of financing
related to the legislation are not as important as the beliefs, attitudes, and values of the policy.
DIF: Cognitive Level: Understand (Comprehension)
REF: pp. 166-167
4. Which of the following is accomplished through the use of public policy?
a. Solutions to problems of public concern are developed.
b. A rational, logical problem-solving decision-making process is implemented.
c. Public safety nets for vulnerable populations are created.
d. Economic and business management principles are applied.
ANS: A
The field of public policy involves the study of specific policy problems and governmental
responses to them. Political scientists involved in the study of public policy attempt to devise
solutions for problems of public concern. The use of public policy may not involve the
implementation of a logical problem-solving decision-making process. Public policy
addresses more than safety nets for vulnerable populations. Additional principles besides
economics and business management are applied through the use of public policy.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 167
5. Which of the following best describes why it is so difficult to change the paradigm of health
care from disease orientation to promoting health orientation?
a. The belief exists that those without insurance could obtain insurance if they
worked hard enough.
b. People find it difficult to agree on what the ideal paradigm should be.
c. People realize the media have exaggerated the problems that result from lack of
insurance.
d. Serious reallocation of resources would have to occur.
ANS: D
A shift in the paradigm would necessitate a substantial reallocation of resources because the
vast majority of health spending is currently directed to medical care and biomedical research
and reflects a viewpoint of health care as a commodity. The allocation of resources has the
most influence on creating a paradigm shift. Individual opinions and the use of media do not
play as great of role as where resources are spent.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 168
6. Which of the following best describes how the government controls conditions that
individuals cannot?
a. Appeals to the common sense and good nature of the citizens
b. Establishes social mores that enable groups to control individuals’ behaviors
c. Passes and enforces law
d. Uses fear reinforced by police power
ANS: C
Government regulates conditions that individuals cannot control and provides individual
protection through a population-wide focus. These tasks are accomplished through passage
and enforcement of laws. These laws control individuals’ behaviors, which may lead to the
establishment of social mores and common sense related to the laws that have been
established.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 169
7. Which of the following statements best describes why the federal government is unable to do
whatever politicians currently in power want?
a. The citizens would rise up in rebellion if actions were outrageous.
b. The lack of funds to implement actions are seen as unreasonable by a majority of
voters.
c. Only the actions authorized by the Constitution are legitimate.
d. The states would rebel and withdraw from the union.
ANS: C
The federal government is a government of limited powers, which means that, for a federal
action to be legitimate, it must be authorized. Only those actions that are within the scope of
the Constitution, the supreme law of the land, are authorized. Power of the states and citizens
is limited under the overall umbrella of the federal government. Funding is also controlled
through the powers of the federal government.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 170
8. Which of the following is the basis for any American citizen to feel comfortable expressing an
opinion on a political issue?
a. Amendments to the Constitution
b. Articles of the Constitution of the United States
c. Declaration of Independence
d. Gettysburg Address
ANS: A
Amendments to the Constitution, later known as the Bill of Rights, were added after the
original Articles of the Constitution were ratified. These amendments protect individuals’
rights and freedoms. The Declaration of Independence announced the freedom of America
from the British Empire. The Gettysburg Address was a speech given by President Abraham
Lincoln following the Civil War.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 170
9. Which of the following best describes who has the authority to act in every area except those
specifically mentioned in the Constitution?
a. Any individual citizen
b. Federal government
c. Local government
d. State government
ANS: D
Any powers not delegated to the federal government are reserved for the states. Thus,
individual citizens, the federal government, and local governments are excluded.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 170
10. Which of the following best describes how the local government is provided authority?
a. Through the ability to tax local residents to meet local needs
b. Through the people themselves who band together to create the community
c. Power delegated from the federal level to the local level
d. Power delegated from the states
ANS: D
States may delegate powers to the local government. Which powers they delegate vary widely
from state to state. The federal government does not directly delegate power to the local level,
this occurs through state government. Taxation and creation of a community do not provide
the local government with authority.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 170
11. Which of the following statements best describes how policies in the private sector are
different from policies in the public sector?
a. Private sector policies are slow, deliberate, and reactive to events.
b. Private sector policies are determined by the opinions and feelings of those
employed in that sector.
c. Private sector policies are based on economics and market trends.
d. Private sector policies are based on rational decision making.
ANS: C
Private policy is largely influenced by theories of economics and business management,
including consumerism and market trends. Such policies can react quickly and are often
proactive. In comparison, public policies are slow and reactive, and economics is just one of
many factors involved. Public policies are determined by voting shifts, electoral realignment,
and term limits.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 171
12. The president was sent a bill that he did not really like, but he would have been unpopular if
he vetoed it, so he did nothing. Which of the following best describes what will happen to the
bill?
a. The bill is dead.
b. The bill returns to both houses to see if enough votes can be obtained to pass the
bill even without the president signing the bill.
c. The bill becomes law.
d. The bill sits there until the president signs it or vetoes it.
ANS: C
A bill that has been passed by the legislature goes to the president. The president may sign it
so it becomes law; however, if he neither signs nor vetoes it, the bill becomes law by default.
DIF: Cognitive Level: Apply (Application)
REF: p. 172
13. The forces for the proposed bill are roughly as persuasive, powerful, and well financed as the
forces against the proposed bill. Which of the following describes the most likely outcome?
a. The bill will be debated through a public hearing.
b. The bill will fail.
c. The bill will pass.
d. The bill will remain in the legislature until one side or the other has a majority of
votes.
ANS: B
It is far easier to defeat a bill than get one passed; therefore, the opposition always has the
advantage.
DIF: Cognitive Level: Apply (Application)
REF: p. 172
14. Which of the following statements best describe what happened to the hospitals built or
expanded by Hill-Burton Act funds?
a. Many such hospitals have consolidated or closed.
b. Not needing to expand, hospitals have used the funds to upgrade their facilities.
c. They have continued to use such funds to expand.
d. When funding ceased, so did hospital expansion.
ANS: A
The Hill-Burton Act authorized federal assistance in construction of hospitals, making
hospitals more accessible. However, with the high cost of health care and the decreasing
lengths of stay and increasing use of primary care, many hospitals are closing. Because
hospitals have closed, they are not further expanding or upgrading facilities.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 174
15. An individual has been terminated from his job and has lost his health insurance. Which of the
following federal laws allows him to continue his insurance benefits for a specified period of
time?
a. Health Insurance Portability and Accountability Act of 1996 (HIPAA)
b. Family Support Act of 1988
c. Health Maintenance Organization Act of 1973 (HMO)
d. Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
ANS: D
An important requirement of COBRA focuses on the problem of the loss of insurance when a
person loses his or her job. With the growing number of unemployed, COBRA is even more
important. Employers who terminate an employee must continue benefits for the employee
and dependents for a specified period of time if the employee had health benefits before the
termination. HIPPA offers protections for patient privacy and confidentiality. The Family
Support Act expanded coverage for poor women and children and required states to extend
Medicaid coverage for 12 months to families who have increased earnings but are no longer
receiving cash assistance. The HMO Act provides grants for HMO development.
DIF: Cognitive Level: Apply (Application)
REF: p. 175
16. Which of the following statements best describes an effect of the Welfare Reform Act of
1996?
a. Individuals who were required to obtain employment lost their health coverage.
b. Many were happy to be off the government dole and self-supporting.
c. Persons sought and obtained employment that often included insurance benefits.
d. The food stamp program decreased in size.
ANS: A
The law decreased the number of people on welfare and forced many individuals to take
low-paying jobs, many of which did not offer health insurance. Many individuals, particularly
women and children, subsequently lost Medicaid coverage.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 175
17. Which of the following best describes the history of the State Child Health Improvement Act
(SCHIP) of 1997?
a. The law included goals and programs but no funding to achieve them.
b. The law received extensive support by both Republicans and Democrats.
c. The law was extended, not renewed by the Bush administration, and then renewed
by the Obama administration.
d. The law was passed by the majority of states but not by the federal government.
ANS: C
The law was extended several times, and then it was not renewed by the Bush administration.
In January 2009, the law was renewed again by the Obama administration.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 175
18. Which of the following best describes what happened after the Medicare Modernization Act
of 2003 was enacted?
a. Additional restrictions in coverage were imposed.
b. Experimental treatments were approved for reimbursement.
c. Reimbursement procedures became more efficient.
d. A prescription drug benefit was added.
ANS: D
The Medicare Modernization Act of 2003 provides seniors and people living with disabilities
with some prescription drug benefit coverage, as well as more choices and better benefits. The
act did not impose additional restrictions to coverage, approve experimental treatments, or
provide efficiency with reimbursement procedures.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 175
19. A nurse is employed by the state public health department. Which of the following activities
would she most likely complete?
a. Set up a flu shot clinic at a neighborhood church
b. Lobby for health care reform to cover more preventive services
c. Monitor the incidence of influenza in the state
d. Serve as a volunteer for a state legislator’s campaign
ANS: C
One of the state health care functions is assessment of health needs based on statewide data
collection. This could be done by monitoring the incidence of influenza in the state. Setting up
a flu shot clinic would most likely be done at the local level, while lobbying for health care
reform would most likely be done at the federal level. Serving as a volunteer for a campaign
may be something a nurse would do, but would not be specifically related to employment by
the state public health department.
DIF: Cognitive Level: Apply (Application)
REF: p. 176
20. It has been proposed that a new, better approach to health care be tested with a small group to
evaluate its effectiveness. Which of the following best describes why this cannot be done?
a. Any employment in the project would be only temporary, so it would be difficult
to find professionals to staff the program.
b. It is challenging to find appropriate sites located in the target area from which to
offer the pilot project service.
c. No one wants to accept free services if they include being a guinea pig in a
research project.
d. Offering a service establishes a precedent and a sense of entitlement, so it is
difficult to discontinue the program.
ANS: D
Once a direct health care service is offered, it is difficult to discontinue it. Existing programs
create tradition by establishing vested interest and a sense of entitlement.
DIF: Cognitive Level: Apply (Application)
REF: p. 177
21. Which of the following best describes the most crucial step in policy formation?
a. Convincing both political parties and independents to support the proposed policy
b. Defining the issue and placing it on the agenda for possible action
c. Determining who has vested interest in what aspects of the policy
d. Trying to simplify the proposed legislation so the public will support it
ANS: B
How an issue is defined determines what the possible approaches to resolution might be. With
all the demands on legislators’ time, it is difficult for an issue to be seen as important enough
to have action taken. Defining the issue as crucially important and worthy of a place on the
agenda for possible action is the most critical step.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 177
22. A nurse suggests to the students that they attend the local district nurses’ association meeting,
where the nurse is an officer. Which of the following provides the best rationale for this
action?
a. Meeting outside the clinical area allows for more effective informal learning based
on discussion and interaction.
b. Role models are typically the major influence on nurses choosing to become
politically active.
c. Students are often given extra credit from their instructor for such community
involvement.
d. Such groups want students to attend their meetings to encourage them to join and
to accept a committee responsibility.
ANS: B
Professional groups do not usually accept students into membership (especially since many
students may want a different specialty practice). Nurses most often identify positive role
models as the major influence that assisted them to become politically active. Therefore,
mentorship at the student level up to the expert level is important. Providing extra credit
should not be the motivator for students to learn from these role models. The learning that
occurs is a formal learning process related to learning more about political advocacy and
something that is difficult to demonstrate in a classroom environment.
DIF: Cognitive Level: Apply (Application)
REF: p. 178
23. Which of the following statements best describes why nurses are not more effective in
creating political change?
a. Nurses are not listened to by politicians.
b. Nurses are not perceived as leaders in the health care field.
c. Nurses do not act or do not agree on what changes are needed.
d. Nurses do not know how to negotiate, communicate, and collaborate to create
change.
ANS: C
Nurses know how to communicate, collaborate, negotiate, and serve as leaders who can make
themselves heard. However, the various nursing subgroups do not agree on public policies.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 179
24. The local nursing association and the local medical association disagreed vehemently on
advanced practice nursing reimbursement. Which of the following best describes why the two
groups agreed to join a coalition to send representatives to testify on a particular bill?
a. Although there was disagreement, both groups agreed to behave politely and
professionally.
b. Both associations had formed a coalition to collaborate on a bill that would benefit
patients.
c. Because the legislators had asked both groups to appear, the groups did not have a
choice.
d. The two groups were sharing costs and expenses, but their testimony would give
opposing viewpoints.
ANS: B
When two or more groups join to maximize resources, increasing their influence and
improving their chances of success in achieving a common goal, it is a coalition. Professional
groups often form coalitions to advance their shared interests.
DIF: Cognitive Level: Apply (Application)
REF: p. 179
25. A nurse is employed by the state nursing association to serve as a lobbyist. Which of the
following would be the most crucial task to achieve?
a. Be seen as a reliable and credible source of accurate information
b. Convince colleagues in nursing to join their local nursing organization and write to
encourage legislators to vote according to nurses’ goals
c. Offer to make large donations to the legislator who can forward nursing’s agenda
d. Visit every single legislator so the nurse is recognized in this role
ANS: A
An individual who establishes a reputation as a reliable and accurate resource as a lobbyist has
substantial influence. Certainly, it is also useful to convince colleagues to join nursing
organizations and write legislators or contribute to campaigns of legislators supportive of
nursing goals. Legislators rely on lobbyists to educate them on issues. The official must trust
the lobbyists to give accurate (though predictably biased) information, which is timely and up
to date.
DIF: Cognitive Level: Apply (Application)
REF: p. 180
26. A nurse represents the state professional association. Which of the following actions would
the nurse complete in relation to legislation?
a. Be prepared to contribute to campaigns of legislators who vote consistently with
nursing goals
b. Be prepared to confront verbally those on the opposite side of legislative issues
c. Be prepared to provide testimony and comment on relevant issues
d. Be prepared to visit schools of nursing to present about the current legislative
issues
ANS: C
Although a nurse might do any of the above, the most effective is to provide testimony and
comment on issues of importance to nursing. Contributing is dependent on the financial
resources of the nurse. Legislators often appreciate volunteer hours spent on campaign tasks
as much as sums of money. Giving presentations to schools may be useful, but it may be
assumed that most nursing faculty can discuss legislative health issues. Verbal confrontations
are not always useful.
DIF: Cognitive Level: Apply (Application)
REF: p. 180
27. A nurse is unable to be actively involved in attending meetings at the state level. Which of the
following actions would be most useful for the nurse?
a. Asking students to remain informed regarding proposed legislation
b. Communicating, with rationales, her stand on proposed legislation to legislators
c. Remaining uninvolved so incorrect information is not inadvertently given
d. Writing letters to the local newspaper asking nurses to become involved
ANS: B
Grassroots cooperation can influence decisions. A high number of communications from
individual constituents via e-mail, telephone, or postal mail have great influence.
DIF: Cognitive Level: Apply (Application)
REF: p. 180
28. A nurse states that he or she does not want to become involved in politics because of family,
school, work, and other commitments. Which of the following would be the best reply to this
statement?
a. “Good for you. We should all stay out of such dirty game playing!”
b. “I am sorry to hear that but I do understand.”
c. “It doesn’t matter; politics have nothing to do with nursing practice.”
d. “It won’t take much time to join ANA and pay dues so their lobbyist can represent
you.”
ANS: D
Some of the nursing organizations have full-time lobbyists who work in Congress, including
the American Nurses Association (ANA). These lobbyists help represent the interests of
nurses and society. Politics play a major role in nursing practice and nurses should be
encouraged to participate in organizations, even if it is through paying dues, so that their voice
can be represented.
DIF: Cognitive Level: Apply (Application)
REF: p. 180
29. Which of the following statements best describes why nurses should contribute whenever
possible to their state nursing association political action committee (PAC)?
a. As PACs are a reality of political life, nursing needs to be heard.
b. Contributing money may result in a future political appointment.
c. Only money really has any influence on legislative votes.
d. PACs are being used to increase nursing salaries and working conditions.
ANS: A
Because PACs are a reality of political life, nurses need to recognize their power and support
those that are committed to electing candidates sympathetic to health care issues. The
contribution of money will support the current nursing practice initiatives which will change
as nursing practice changes. These contributions will most likely not have any relationship to
a future political appointment. Legislative votes are influenced by a variety of factors and are
not limited only to money.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 180
30. Which of the following best describes what is being discussed in relation to concerns over
patients’ safety and nurse fatigue?
a. All hospitals are now required to report errors made that are a result of low nurse
staffing.
b. The Centers for Disease Control and Prevention (CDC) is monitoring the incidence
of medical errors caused by nurse understaffing.
c. The Registered Nurse Safe Staffing Act was passed by Congress in 2013.
d. Legislation has been suggested that staffing systems require the input of direct care
registered nurses.
ANS: D
The Registered Nurse Safe Staffing Act of 2013 was introduced in Congress to address
concerns of inadequate and inappropriate staffing, which threatens patients’ safety and the
nurses’ health. The act would encourage development of staffing systems that require the
input of direct care registered nurses, as well as protection for RNs who speak out about
patient care issues. This suggested legislation has not been acted on. The CDC is not involved
in monitoring medical errors caused by nurse understaffing. Hospitals are not required to
report errors that occur due to nurse understaffing.
DIF: Cognitive Level: Understand (Comprehension)
REF: pp. 182-183
31. A nurse would like to influence an internal private health policy. Which of the following
actions should the nurse take?
a. Build or join a private entrepreneurial practice to provide lower cost services to
underserved groups
b. Participate in public discussions regarding quality and managed care
c. Support nursing research done that demonstrates positive clinical and economic
outcomes
d. Write managed care organizations to request that nurses receive reimbursement for
health services to clients
ANS: C
Internal nursing action is from within the agency, such as holding an important management
position. Nurses can support and use nursing research that demonstrates positive clinical and
economic outcomes. Such action also serves to validate the importance of nursing within the
health system. External strategies can include participation in discussions regarding aspects of
care or seeking employment in entrepreneurial practices.
DIF: Cognitive Level: Apply (Application)
REF: p. 184
32. What was the poverty guideline for a family of four in mainland United States in 2013?
a. Below $23,550
b. Below $25,250
c. Below $28,550
d. Below $32,250
ANS: A
A four-person household must make less than $23,550 to be considered under the poverty
guideline according to the U.S. Department of Health and Human Services.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 174
MULTIPLE RESPONSE
1. Which of the following best describes the purposes of professional societies such as the
American Nurses Association (ANA)? (Select all that apply.)
a. Providing control and oversight of the occupation
b. Creating licensing laws to control entry into the profession
c. Determining appropriate requirements for education into the profession
d. Establishing standards for practice
e. Protecting the interests of the practitioners
f. Safeguarding the public trust
ANS: A, D, E, F
Professional societies seek to further a particular profession, the interests of persons engaged
in that profession, and the public interest. Their roles are to maintain control and oversight of
the occupation—such as by writing standards for practice—as well as safeguarding the public
trust. Licensure and educational standards are responsibilities of individual states.
DIF: Cognitive Level: Understand (Comprehension)
REF: pp. 167-168
2. Which of the following is one legally required to obey? (Select all that apply.)
a. Directions to a destination provided by a police officer
b. Court decisions related to legislative law
c. Delegation of responsibility for a task by a physician
d. Executive decisions, such as your employer requirements
e. Laws passed by your state or the federal government
f. Rules and regulations from agencies, such as the state board of nursing
ANS: B, E, F
Laws that all must obey include legislative law, regulatory agency rules and regulations, and
judiciary rulings regarding the law. Although physicians may delegate a task, a physician
cannot delegate responsibility.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 167
3. Which of the following current issues are leading the World Health Organization (WHO) to
reconsider its initial definition of health? (Select all that apply.)
a. Environmental issues such as industrial toxins or carcinogenic commercial
products
b. Global, not local, problems such as spread of antibiotic-resistant bacteria
c. Need to move from containment and treatment to social intervention
d. Pressure from industrialized nations to emphasize chronic diseases rather than
infectious diseases
e. Realization that government actions influence the basic human right of health
f. Worldwide pandemics such as human immunodeficiency virus (HIV) and swine
flu, which require a different approach
ANS: A, B, C, E, F
WHO is refocusing as it attempts to deal with environmental issues of nuclear contamination
and industrial toxins, and the exploration of carcinogenic commercial products (such as
tobacco). Globally, WHO is trying to eliminate antibiotic-resistant bacteria and the HIV
pandemic. HIV has changed the paradigm from traditional containment and treatment to a
more comprehensive approach of social intervention. There is a realization that health is a
basic human right and health problems are linked to government action and affect human
rights. The WHO is not emphasizing the chronic diseases faced by industrialized nations.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 168
4. Which of the following best describes the new national health goals as seen in Healthy People
2020? (Select all that apply.)
a. Achieve a plan for universal basic health care for citizens
b. Create social and physical environments that promote good health
c. Eliminate health disparities
d. Eliminate preventable disease, disability, injury, and premature death
e. Achieve health equity
f. Promote healthy behaviors at every stage of life
ANS: B, D, F
Building on previous iterations, the updated 2020 version has four "over-arching goals" for
2020: (1) attain high quality, longer lives free of preventable disease, disability, injury, and
premature death; (2) achieve health equity, eliminate disparities, and improve the health of all
age groups; (3) create social and physical environments that promote good health for all; and
(4) promote quality of life, health development, and health behaviors across all life stages.
Achieving a plan for universal basic health care for citizens, eliminating health care
disparities, and achieving health equity are not seen as national health goals in Healthy People
2020.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 168
5. Which of the following statements best describes a notable change of the Omnibus Budget
Reconciliation Act? (Select all that apply.)
a. Legislated a funding increase for RN staffing
b. Changed from process evaluation to outcome evaluation when evaluating care
c.
d.
e.
f.
Established guidelines for the use of restraints
Created health maintenance organizations nationwide
Added prescription drug benefits for Medicaid recipients
Required all states to review certificates of need before agencies could expand
ANS: B, C, E
The Budget Reconciliation Act influenced funding and set up guidelines and regulations about
several issues including a move from process to outcome evaluation, use of restraints, and
prescription drugs for Medicaid recipients. The Health Maintenance Organization Act of 1973
established health maintenance organizations. The National Health Planning and Resources
Act of 1974 required health care facilities to obtain prior approval from the state for expansion
in the form of a certificate of need. The Nurse Training Act in 1964 provided funds for
nursing school construction and loans and scholarships for full-time study.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 175
6. Which of the following were among the outcomes of the 1979 report Healthy People: The
Surgeon General’s Report on Health Promotion and Disease Prevention? (Select all that
apply.)
a. A national committee was established to have hearings and study the problem
further.
b. Increased funds were allocated for health planning and health care.
c. Many of the recommendations were adopted on the federal level.
d. The Health Objectives Planning Act of 1990 was passed.
e. The federal government began to identify and monitor national health care goals.
f. The president addressed the American people about the need for health care
reform.
ANS: D, E
The federal government began to take a direct approach in identifying and monitoring national
health care goals after the Surgeon General’s report. The Healthy Objectives Planning Act of
1990 was passed. Healthy People 2000, Healthy People 2010, and Healthy People 2020 are
continuing the efforts. The establishment of a national committee, increased funding for
health planning and health care, adoption of recommendations at the federal level, and the
need for health care reform were not outcomes of the 1979 report.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 175
7. Which of the following critical issues in health care were addressed by The Health Insurance
Portability and Accountability Act (HIPAA) of 1996? (Select all that apply.)
a. Portability of insurance coverage
b. COBRA, maintaining coverage for those who lose their jobs
c. Insurance companies having a total monopoly in a certain geographic area
d. Insurance companies setting limits on coverage of longer than 12 months
e. Insurance companies charging seriously ill persons more than healthy persons
f. Insurance companies paying the same for mental health coverage as for physical
illnesses
ANS: A, D
The HIPAA of 1996 addressed insurance issues. Critical were the portability of coverage and
preexisting conditions. Insurers cannot set limits on coverage longer than 12 months. COBRA
was established through the Consolidated Omnibus Budget Reconciliation Act of 1985. The
McCarren-Ferguson Act of 1945 gave states the exclusive right to regulate health insurance
plans. The Mental Health Parity and Addictions Equity Act of 2008 mandated that insurance
companies must provide the same coverage for mental health as for physical illness. Health
Care Reform legislation prevents insurance companies from charging seriously ill persons
more than healthy persons.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 175
8. Which of the following actions represent a shift in philosophy at the Centers for Disease
Control and Prevention (CDC)? (Select all that apply.)
a. Collecting and analyzing health data
b. Creating integrated health information systems
c. Allocating resources to treat specific diseases
d. Encouraging partnerships and strategic alliances
e. Creating transaction-based relationships
f. Leveraging resources to steer the larger health system
ANS: B, D, F
Rather than allocating resources, resources will be leveraged to influence the larger health
system. Rather than collecting and analyzing health data, they now are creating integrated
health information systems. Rather than transaction-based relationships, they now encourage
partnerships and strategic alliances.
DIF: Cognitive Level: Understand (Comprehension)
REF: p. 168