Nokea
A client complaining of bloody urine has scheduled an appointment with a family practitioner. What type of care is the client receiving?
- A. Tertiary
- B. Secondary
- C. Skilled nursing care
- D. Primary
Correct Answer: D
Rationale: The first provider that clients contact about a health need provides primary care; this person is typically a family practitioner or nurse practitioner. Secondary care includes referrals to facilities for additional testing. Tertiary care focuses on more complex medical and surgical intervention. Skilled nursing care occurs in facilities or units that offer prolonged health maintenance or rehabilitative services.
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The nurse is providing a program at the local YMCA about stress-reduction techniques combined with a 1-mile walk around the indoor track once a week. What does this type of program address for the community?
- A. Health promotion
- B. Health maintenance
- C. Illness prevention
- D. Early detection of illness
Correct Answer: A
Rationale: Health promotion refers to engaging in strategies to enhance health such as eating a diet high in grains and complex carbohydrates, exercising regularly, balancing work with leisure activities, and practicing stress-reduction techniques. Illness prevention involves identifying risk factors such as a family history of hypertension or diabetes and reducing the effects of risk factors on one's health. Early detection uses screening diagnostic tests and procedures to identify a disease process earlier, so that treatment may be initiated earlier and be more effective. Health maintenance refers to protecting one's current level of health by preventing illness or deterioration, such as by complying with medication regimens, being screened for diseases such as breast and colon cancers, or practicing safe sex.
A client with terminal cancer is being referred to hospice services to assist with care of the client and the family in the home environment. What type of care does the nurse determine this is?
- A. Primary care
- B. Secondary care
- C. Tertiary care
- D. Acute care
Correct Answer: C
Rationale: Tertiary care focuses more on complex medical and surgical interventions, cancer care, rehabilitative services, long-term care such as burn care, and palliative and hospice care. This client is terminally ill and being referred for hospice service. Secondary care includes referrals to facilities for additional testing such as cardiac catheterization, consultation, and diagnosis as well as emergency and acute care interventions. The client does not fall into the acute care category. Primary care would include being seen by the client's primary physician.
In an effort to cut costs, hospitals have instituted many changes. Which of these cost-cutting factors is most likely to jeopardize the quality of care?
- A. Using unlicensed assistive personnel
- B. Increasing numbers of clients in hospitals
- C. Not devoting enough time to the client
- D. The rise of medical care costs in healthcare systems
Correct Answer: A
Rationale: Hospitals are using unlicensed assistive personnel to perform some duties practical and registered nurses once provided. Many are concerned that the use of unlicensed assistive personnel will jeopardize the quality of care. Increasing numbers of clients in hospitals, not devoting enough time to the client, or the rise of medical costs are less likely to jeopardize the quality of care.
An HMO client obtained a second opinion regarding a diagnosis of colon cancer. There was no authorization obtained for this second opinion from the client or primary care provider. What is the consequence of this action?
- A. The client will be responsible for the entire bill for the second opinion.
- B. The client will still receive full coverage.
- C. The client will be dropped from the HMO for breaking the rules.
- D. The client will be fined by the HMO for not using the authorization process.
Correct Answer: A
Rationale: Members of an HMO must receive authorization for secondary care, such as second opinions from specialists or diagnostic testing. If members obtain unauthorized care, they are responsible for the entire bill. In this way, HMOs serve as gatekeepers for healthcare services. The member will not be fined or dropped from the program but will not receive coverage for the service rendered from the second opinion.
What does the nurse understand is the focus of healthcare when a client receives services from a health maintenance organization (HMO)?
- A. Avoiding coverage for needed services
- B. Health promotion and maintenance
- C. To offer discounted services to all patients
- D. High-quality service and contain cost
Correct Answer: B
Rationale: If the HMO does not require much high-cost care, providers make money; if members use many high-cost resources, providers lose money. This method of financing provides the strongest incentives for limiting use of expensive services and focusing healthcare on health maintenance and promotion. If services such as diagnostic testing are required, the HMO will cover this and not avoid payment. Services are not discounted for patients that are nonmembers or members. The goals of a physician hospital organization (PHO) are to maintain high-quality service and contain costs while fostering group contracts, collaboration, and capitation.