Nokea
A patient is upset because her health insurance plan refused to pay for a mammogram and services by a women's health specialist because the primary care physician did not order the referral or the mammogram. Which type of insurance plan adheres to this type of payment system?
- A. Fee for Service
- B. Health Maintenance Organization (HMO)
- C. Preferred Provider Organization (PPO)
- D. Point of Service (POS)
Correct Answer: B
Rationale: The correct answer is B: Health Maintenance Organization (HMO). In an HMO, services are typically provided by a primary care physician who acts as a gatekeeper for all medical services, including referrals to specialists and diagnostic tests like mammograms. The primary care physician must authorize and order these services for them to be covered by the insurance plan. This system helps control costs and ensures coordinated care.
A: Fee for Service does not require a primary care physician to authorize referrals or services.
C: PPO allows patients to see out-of-network providers without referrals.
D: POS plans offer more flexibility in choosing healthcare providers without requiring a primary care physician's referral.
You may also like to solve these questions
Nurses caring for the victims of a mass casualty incident:
- A. determine the common terminology to be used by hospitals and participating agencies.
- B. take charge of communicating with the news media.
- C. determine whether there is a credible threat of a terrorist attack.
- D. give priority for care to those with the greatest chance of survival rather than those most critically ill.
Correct Answer: D
Rationale: The correct answer is D because prioritizing care based on the greatest chance of survival maximizes the number of lives saved in a mass casualty incident. This approach follows the principle of triage, which aims to allocate resources efficiently. Choice A is incorrect as it pertains to coordination rather than immediate patient care. Choice B is incorrect as it is not the primary role of nurses during a mass casualty incident. Choice C is incorrect as determining a credible threat is the responsibility of security and law enforcement, not nurses.
The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse:
- A. is showing empathy and as long as she lets the patient know the money is not from her, she is not violating any social media guidelines.
- B. is at risk for HIPAA violations.
- C. has properly followed policy and protected the patient by not using her name.
- D. is demonstrating the logical fallacy of slippery slope.
Correct Answer: B
Rationale: The correct answer is B because the nurse is at risk for HIPAA violations by sharing patient information on social media. The Health Insurance Portability and Accountability Act (HIPAA) protects patients' privacy and prohibits healthcare providers from disclosing their health information without consent. In this scenario, the nurse shared specific details about the patient's health condition, visit to the ED, and financial situation, which could easily identify the patient. This violates the patient's right to privacy and confidentiality. Choices A, C, and D are incorrect because the focus should be on the HIPAA violation rather than empathy, policy following, or logical fallacies. The nurse should have found alternative ways to help the patient without compromising their privacy.
A nurse is preparing to teach a class related to risk factors for cancer to a diverse ethnic group attending a health fair. The nurse should be aware:
- A. that Hispanic women overestimate the prevalence of cancer and strictly following breast self-examination guidelines.
- B. of the importance of risk factors such as smoking and alcohol consumption that increase esophageal cancer when speaking with black.
- C. that American-Indian women have a higher rate of ovarian cancer than the general population.
- D. that cancer as well as heart disease and stroke are lower in ethnic groups.
Correct Answer: C
Rationale: The correct answer is C because it provides accurate information about a specific risk factor related to a particular ethnic group. American-Indian women do have a higher rate of ovarian cancer than the general population, making it crucial for the nurse to be aware of this when teaching about cancer risk factors.
A is incorrect as it discusses breast cancer and not ovarian cancer. B is incorrect as it mentions esophageal cancer, which is not the specific focus of the question. D is also incorrect as it makes a general statement about cancer, heart disease, and stroke in ethnic groups without providing specific information about ovarian cancer in American-Indian women.
A nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to the physician. The nurse is at risk for being charged with:
- A. negligence.
- B. assault.
- C. defamation of character.
- D. tort.
Correct Answer: A
Rationale: Correct Answer: A - Negligence
Rationale:
1. Negligence is the failure to provide the standard of care resulting in harm to the patient.
2. The nurse failed to report a significant change in the patient's condition, breaching the duty of care.
3. The increase in blood pressure could lead to serious complications, indicating the severity of negligence.
Summary:
B: Assault - Involves intentional threat or harm, not applicable in this scenario.
C: Defamation of character - Involves false statements damaging reputation, not relevant in the context of patient care.
D: Tort - A broader legal term encompassing various civil wrongs, but negligence is a specific type of tort applicable here.
According to current data related to the nursing shortage: (select all that apply)
- A. salaries of nurses are competitive with those of other professionals such as teachers.
- B. only 19% of nurses are minorities.
- C. overall, nurses are satisfied with their jobs but leave the profession because of fear of contracting fatal diseases.
- D. the employment opportunities for nurses continue to be strong.
Correct Answer: D
Rationale: Rationale for Answer D: The correct answer is D because the statement aligns with current data indicating a strong demand for nurses leading to ample job opportunities. This information is supported by various reports and studies highlighting the ongoing nursing shortage and the need for more healthcare professionals. Employment opportunities for nurses are indeed robust, with job growth projected to continue in the coming years due to factors like an aging population and increasing healthcare needs.
Summary of Other Choices:
A: Salaries of nurses being competitive with other professionals like teachers may vary depending on location and specialty, but it is not a direct indicator of the nursing shortage.
B: The percentage of minority nurses is not directly related to the nursing shortage issue, making this statement irrelevant to the current data on the shortage.
C: Job satisfaction and reasons for leaving the nursing profession may include various factors, but fear of contracting diseases is not a primary reason cited in current data on the nursing shortage.