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.
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What are general explanations that scholars use to explain, predict, control, and understand commonly occurring events?
- A. Theories
- B. Constructs
- C. Systems
- D. Propositions
Correct Answer: A
Rationale: The correct answer is A: Theories. Theories are comprehensive explanations that scholars use to understand commonly occurring events by organizing and explaining a set of principles or laws. Theories help in predicting and controlling events based on established frameworks. Constructs (B) refer to abstract concepts within theories, systems (C) are organized structures of elements, and propositions (D) are statements that describe relationships between concepts, but they do not provide the comprehensive explanations that theories do.
An RN testifies at a trial where domestic violence is being investigated. She had previously assisted with specimen collection and had assessed the victim. The nurse is involved in nursing.
- A. triage
- B. forensic
- C. flight
- D. entrepreneurial
Correct Answer: B
Rationale: The correct answer is B: forensic. In this scenario, the nurse's involvement in specimen collection and assessment of the victim relates to forensic nursing, which involves providing healthcare in legal contexts like investigations and court proceedings. Triage (A) is the process of prioritizing patient care based on severity. Flight (C) and entrepreneurial (D) have no relevance to the situation described.
A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency?
- A. Safety
- B. Timely
- C. Equitable
- D. Patient-centered care
Correct Answer: A
Rationale: The correct answer is A: Safety. The team of nurses developing algorithms and checklists aims to ensure standardization of procedures, which directly relates to patient safety. Safety is a fundamental competency in healthcare, as it involves minimizing harm to patients. Standardization through checklists helps reduce errors and promote consistency in care delivery. Timely care (B) focuses on providing care promptly, equitable care (C) emphasizes fairness and eliminating disparities, and patient-centered care (D) prioritizes individual preferences and needs. While these competencies are important in healthcare, in this scenario, the team's primary focus on standardization aligns with the safety competency.
A person who is covered by Medicaid moves from one state to another and asks the nurse at the health department why the benefits changed. The correct response by the nurse is:
- A. "Local government controls which benefits each county can provide to Medicaid recipients."
- B. "The federal government does not fund any part of Medicaid, so each state must find ways to pay for benefits."
- C. "Each state determines benefits on the basis of the present economy."
- D. "Medicaid is funded by both state and federal governments, but benefits vary from state to state."
Correct Answer: D
Rationale: The correct answer is D: "Medicaid is funded by both state and federal governments, but benefits vary from state to state."
Rationale:
1. Medicaid is a joint federal and state program, meaning it is funded by both levels of government.
2. States have flexibility in designing and administering their Medicaid programs, leading to variations in benefits across states.
3. When an individual covered by Medicaid moves to a different state, they may experience changes in benefits due to these state-specific variations.
Summary:
A: Incorrect. While local governments may have some influence, Medicaid is primarily funded by both state and federal governments.
B: Incorrect. The federal government does provide funding for Medicaid, but states also contribute, and benefits do vary across states.
C: Incorrect. State benefits under Medicaid are not solely determined by the present economy; they are influenced by various factors and state policies.
A patient with kyphosis is visiting a practitioner of chiropractic medicine for the first time and asks, "How does this therapy work?" The practitioner replies, "I will use my hands along with heat to correct the misalignment of your spine by placing pressure on the nerves that have produced pain. The misalignment of your spine is referred to as:
- A. subluxation."
- B. a sprain."
- C. a fracture."
- D. epicondylitis."
Correct Answer: A
Rationale: The correct answer is A: subluxation. Subluxation in chiropractic terms refers to the misalignment of the vertebrae in the spine, which can put pressure on nerves and cause pain. Chiropractors believe that by using manual adjustments, they can correct these subluxations and restore proper alignment, which can alleviate pain and improve overall health. The other choices, B: a sprain, C: a fracture, and D: epicondylitis, do not accurately describe the misalignment of the spine that is being addressed in chiropractic care. Sprain refers to ligament injury, fracture refers to bone breakage, and epicondylitis refers to inflammation of the tendons.