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A group insurance plan requires a client to pay a present, fixed fee for healthcare services. What type of insurance plan does the nurse understand the client to have?
- A. A preferred provider organization (PPO)
- B. A health maintenance organization (HMO)
- C. Medicare
- D. Medicaid
Correct Answer: B
Rationale: An HMO is a group insurance plan in which participants pay a preset, fixed fee in exchange for healthcare services. The fee is not based on the number of services provided but rather is projected to the number of participants and expected services. A PPO operates on the principle that competition can control costs. Acting as agents for health insurance companies, PPOs create a community network of providers who are willing to discount their fees for service in exchange for a steady stream of referred customers. Medicare is for people that are age 65 years and older or disabled. Medicaid is coverage for those clients who are unable to afford healthcare.
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After hip surgery, a client is admitted to the rehabilitation hospital. What type of care is the client receiving?
- A. Secondary
- B. Tertiary
- C. Rehabilitation
- D. Primary
Correct Answer: B
Rationale: Hospitals where specialized technology is available provide tertiary care. Primary care is the initial contact that a client has, such as an appointment with a family practitioner. Secondary care includes referrals for additional testing. Rehabilitation is aimed at restoring a people to their fullest abilities.
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.
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.
The nurse informs the administrative assistant that a client is expected to come in for lab work. The administrative assistant asks why the nurse refers to the individual as a client. What is the best response by the nurse?
- A. We should refer to everyone as a client. They pay for our service.'
- B. That's how the physician wants us to refer to them.'
- C. Using the term client implies that they are an active partner in nursing care.'
- D. Using the term client is more respectful that using the term patient.'
Correct Answer: C
Rationale: A client is an active partner in nursing care, and the person receiving healthcare services should no longer play a passive, ill role. The use of the term client reflects the attitude of personal responsibility for health. Though clients may be paying for these services, some physicians may request their staff members to use this terminology, and some people may consider it to be a more respectful term than 'patient', these are not the primary reasons to refer to the individual as a client.
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.