Deck 2: The Health Care Delivery System

Question 1

A student nurse visiting a nurse-managed clinic should expect to see which of the following services offered?
1) Physical therapy
2) Same-day surgery
3) Family support services
4) Ongoing psychiatric therapy

Answer 1

3
Nurse-managed clinics focus on health promotion and health education,disease prevention,chronic disease management,and support for self-care and caregivers.
Physical therapy is not typically offered in a nurse-managed clinic.
Same-day surgery is not offered in a nurse-managed clinic.
Psychiatric therapy is not offered in a nurse-managed clinic.

Question 2

Regulatory interventions were initiated to reduce the rise in health care costs.These interventions include:
1) Prospective payment systems
2) State limits on health care fees
3) Federal guidelines for treatment
4) Court review of insurance coverage

Answer 2

1
As a means to reduce health care costs,in 1983 Congress established the prospective payment system in which hospitals are reimbursed a set dollar amount for each diagnosis-related group,regardless of the length of stay or use of services in the hospital.
State limits on health care fees have not been used nationwide to reduce health care costs.
Federal guidelines for treatment have not been used to reduce the cost of health care.Rather,the focus has been on financial reimbursement.
Court review of insurance coverage has not been a primary intervention to lower health care costs.

Question 3

Levels of prevention are used by the nurse to provide a framework or guide for nursing interventions.Focus is based on the client's needs and the care or service that is provided.An example of a true health promotion service is a(n):
1) Aerobic dance class
2) Immunization clinic
3) Diabetic support group
4) Smoking cessation clinic

Answer 3

1
Examples of health promotion activities include exercise classes,prenatal care,well-baby care,nutrition counseling,and family planning.
An immunization clinic is an example of an illness prevention service.
A diabetic support group may be an example of a rehabilitation service to adapt to a change in lifestyle.
A smoking cessation clinic may be a part of rehabilitation or offered as an illness prevention service.

Question 4

A contractual agreement between a hospital and a corporation to pay the health care expenses of the corporation's employees is an example of a(n):
1) PPO
2) HMO
3) Private insurance
4) Third-party payment

Question 5

Which of the following is an appropriate referral for an older client who requires some assistance with daily activities within a partially protective environment?
1) Respite care
2) Extended care
3) Assisted living
4) Rehabilitative care

Question 6

A client states that she does not understand managed care organization (MCO)health insurance.The nurse responds most appropriately by explaining that the MCO:
1) Reimburses nursing home funding
2) Focuses on health maintenance and primary care
3) Allows the individual to go to any physician that he desires
4) Requires a contractual agreement between the health provider and client's employer

Question 7

The payment mechanism that Medicare uses within its health care financing is:
1) Capitation
2) Fixed payments
3) Direct contracting
4) Prospective payment

Question 8

Case management is one strategy for coordinating health care services.What best describes this caregiving approach?
1) Continuity of care is the primary concern.
2) This focus of care may be more expensive.
3) The physician is the coordinator of client care.
4) It is designed to provide minimal to moderate levels of care.

Question 9

A disabled client requiring restorative care should be referred to a(n):
1) Nursing home
2) Subacute care unit
3) Home health care agency
4) Ambulatory health center

Question 10

There are many types of health care delivery agencies.An example of a secondary level care agency is a:
1) School
2) Nursing home
3) Drug rehabilitation center
4) State-owned psychiatric hospital

Question 11

A nurse is consulting with a homeless family who has a 12-year-old disabled child.The nurse suggests which of the following services to best assist with the child's health care needs?
1) Medicare
2) Medicaid
3) Long-term care insurance
4) An extended care faculty

Question 12

Which form of health care is of primary importance when dealing with managed care?
1) Health promotion
2) Disease prevention
3) Tertiary treatment
4) Secondary treatment

Question 13

Which of the following fits within the occupational safety and health categories?
1) Noise exposure
2) Firearms' safety
3) Swimming lessons
4) Motorcycle helmets

Question 14

Discharge planning for clients begins:
1) After a diagnosis has been established
2) Once the long-term needs are identified
3) Upon admission to a health care facility
4) When the acute care therapies are completed

Question 15

The Medicaid insurance program is best described as:
1) Acute care hospital insurance for the older adult population
2) A funded health care program for older and disabled persons
3) A state-regulated health care program for persons of low income
4) A fee-for-service insurance plan that supports preventive health care

Question 16

Quality health care is an innovative approach to delivering health care.The major factor for its success is that it:
1) Focuses on the nursing process
2) Uses outcomes to manage client care
3) Is used exclusively in the acute care setting
4) Allows a high degree of flexibility delivering the care