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A nurse is working for a health care provider who participates in a health maintenance organization (HMO) and will be assisting with the billing. What type of information regarding capitation does the nurse need to understand?
- A. Fees are not based on the number of services provided but rather are projected to the number of participants and expected services.
- B. Fees are based on the number of services billed for by the primary care provider.
- C. The HMO makes money based on the degree of illness and number of diagnostic tests that are performed.
- D. The fees that are charged are different even with the same diagnosis.
Correct Answer: A
Rationale: With an HMO, fees are not based on the number of services provided but rather are projected to the number of participants and expected services. This type of financial management is referred to as capitation, which refers to the actual head or person count. Fees are not based on the number of services a provider bills for rather are based on capitation. The HMO makes money by keeping people healthy and out of the hospital and does not base fees on the client's degree of illness or the number of diagnostic tests done. The fees are the same regardless of the actual service or frequency of care provided.
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A nurse has applied for a position in the hospital emergency department and is told that the facility only hires RNs and unlicensed assistive personnel (UAPs) in the emergency department. What concern does the nurse have with the practice of hiring UAPs in place of LPNs?
- A. LPNs will be phased out of the healthcare field altogether when more UAPs are hired.
- B. UAPs are performing some of the duties that practical nurses typically provide and may jeopardize the quality of care.
- C. UAPs will replace nurses because they deliver a better quality of care.
- D. State boards of nursing will begin to credential UAPs.
Correct Answer: B
Rationale: Changes in the healthcare industry have also affected employment for healthcare workers. Hospitals employ UAPs to perform some duties that practical and registered nurses once provided. Many are concerned that the use of UAPs will jeopardize the quality of care. There is no evidence to indicate that LPNs will be phased out of the healthcare system or that UAPs will replace nurses. State boards of nursing cannot credential an unlicensed person that does not go through a formal education program.
The nurse is leading a cardiac rehabilitation support group. How can the nurse best demonstrate meeting the client's needs holistically?
- A. Lead an exercise, show a video about healthy lifestyle changes, and invite a spiritual leader to talk with the group.
- B. Have the clients share various healthy low-cholesterol recipes and participate in a cooking class.
- C. Have the clients discuss ways to relieve stress and practice stress reduction.
- D. Demonstrate low-impact aerobic exercise to the group and bring in a lecturer on Tai Chi.
Correct Answer: A
Rationale: Nurses practice from the perspective of holism, which is viewing a person's health as a state balance between body, mind, and spirit. Leading an exercise, showing a video about healthy lifestyle changes, and inviting a spiritual leader to talk with the support group are all ways the nurse can meet the clients' needs holistically. By combining these activities, the nurse addresses the needs of the body, mind, and spirit. Cooking classes, having clients discuss stress reduction, and demonstrating exercise techniques are each only addressing one type of need, and therefore are not on their own holistic methods.
A client with chronic obstructive pulmonary disease visits a local long-term care facility once a week to lead a bingo game for the residents. How does the nurse determine that this client is achieving a high level of wellness?
- A. The client enjoys the activity that the nurse provides to the clients.
- B. The client finds satisfaction in socialization with the residents.
- C. The client is achieving a high quality of life within the limits of the illness.
- D. The client needs to feel a part of a group setting.
Correct Answer: C
Rationale: Clients with chronic illness can achieve a high level of wellness if they can experience a high quality of life within the limits of that illness. By engaging in a personal and social activity weekly, this client would be considered healthy. Although the client may enjoy the activity, find satisfaction in socialization, or need to feel a part of a group, choosing to take part in an activity that promotes a high quality of life within the limits of the client's illness is what demonstrates wellness to the nurse.
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.
The nurse is assisting with the development of a program to administer flu shots to a group of senior citizens. What type of prevention does this program reflect?
- A. Primary prevention
- B. Secondary prevention
- C. Tertiary prevention
- D. Prevalence
Correct Answer: A
Rationale: Primary prevention is prevention of the development of disease in a susceptible or potentially susceptible population and includes health promotion and immunization. Secondary prevention is the early diagnosis and treatment to shorten duration and severity of an illness, reduce contagion, and limit complications. Tertiary prevention is healthcare to limit the degree of disability or promote rehabilitation in chronic, irreversible diseases. Prevalence is the number of cases of a disease in a specific population during a specific period.