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Managed care organizations are insurers that carefully plan and closely supervise the distribution of healthcare services. What is one of the goals of managed care?
- A. Preventing illness through screening and promotion of health activities
- B. Improving training of healthcare professionals
- C. Eliminating health disparities between segments of the population
- D. Providing hospice or home hospice care
Correct Answer: A
Rationale: Preventing illness through screening and promotion of health activities is one of the goals of managed care. Improved training of healthcare professionals is the priority for international health and not the goal of managed care. Eliminating health disparities between the segments of population is a goal of Healthy People 2030. Providing hospice or home hospice care is only for terminally ill clients.
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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.
The hospital is having a problem with healthcare-associated infections. A committee has been established to study the problem and make recommendations. The nurse working on the committee knows that this work addresses what?
- A. Inpatient quality indicators
- B. Prevention quality indicators
- C. National Patient Safety Goals
- D. Patient safety indicators
Correct Answer: C
Rationale: The Joint Commission has established National Patient Safety Goals that are updated annually. These safety goals have changed how patients are identified and prevent adverse effects. Some of the 2016 goals include reducing the risk of healthcare-associated infections. Patient safety indicators reflect the quality of care in hospitals but focus on potentially avoidable complications. Prevention indicators identify hospital admissions that could be avoided through high-quality outpatient care. Inpatient indicators reflect quality of care inside the hospital.
A 72-year-old client who is hospitalized will be going on anticoagulant therapy and will require home healthcare nurses to visit once weekly to draw blood for coagulation studies. What coverage does the client have that will cover this service?
- A. Medicaid
- B. Medicare Part A
- C. Medicare Part B
- D. Medicare Part C
Correct Answer: B
Rationale: Medicare covers individuals who are 65 years of age or older, permanently disabled workers of any age with specific disabilities, and persons with end-stage renal disease. Medicare Part A covers hospital care, skilled care, hospice, and home health services. Medicare Part B covers medically necessary services such as physician services that are not covered under Part A. Medicare Part C is the Medicare Advantage Plan and includes Parts A and B. Medicaid coverage is coverage for indigent patients that are unable to afford healthcare and qualify financially.
The nurse is collecting data at the clinic from a new client who is being seen for an employee physical. The client informs the nurse that both parents have a history of high blood pressure, with one of them having a stroke at the age of 52 years. The nurse discusses diet and exercise programs that may benefit the client. What is the nurse displaying with this information?
- A. Early detection
- B. Health maintenance
- C. Health promotion
- D. Illness prevention
Correct Answer: D
Rationale: Illness prevention involves identifying risk factors such as 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. 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.
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.