Nokea
Nursing students are reviewing information about health care delivery systems in post conference. Which statements describing current U.S. health care delivery practices should be included in the discussion? Select all that apply.
- A. Access to care depends only on the ability to pay, not the availability of services.
- B. The Patient Protection and Affordable Care Act provides private health care insurance to underserved populations.
- C. Every health insurance plan in the Health Insurance Marketplace offers comprehensive coverage, from doctors to medications to hospital visits.
- D. The uninsured pay for more than one third of their care out of pocket and are usually charged lower amounts for their care than the insured pay.
- E. Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do.
- F. Quality of care can be defined as the right care for the right person at the right time.
Correct Answer: C,E,F
Rationale: The Health Insurance Marketplace is designed to help people more easily find health insurance that fits their budget. All plans in the Marketplace offer comprehensive coverage, from doctors to medications to hospital visits. There are many fewer primary care providers in the United States than there were 50 years ago. Quality is the right care for the right person at the right time. Access to care depends on both the ability to pay and the availability of services. The Patient Protection and Affordable Care Act provides Medicaid or subsidized coverage to qualifying people with incomes up to 400% of poverty. The uninsured pay for more than one third of their care out of pocket and are often charged higher amounts for their care than the insured pay.
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Nursing students are asked to provide interprofessional care during their clinical experience. Which member of the health care team will the student contact for an uninsured patient?
- A. Nurse practitioner
- B. Admissions coordinator
- C. Social worker
- D. Hospital chaplain
Correct Answer: C
Rationale: Social workers assist patients and families in dealing with the social, emotional, and environmental factors that affect their well-being, including making referrals to community resources and assisting with health care finances for uninsured patients. Nurse practitioners manage medical and nursing needs, admissions coordinators handle administrative tasks, and hospital chaplains address spiritual needs.
A nursing student is assisting with nursing care for patients in a primary care center. Based on the setting, what activities will the student expect to perform?
- A. Assisting with major surgery
- B. Performing health assessments
- C. Maintaining patients' function and independence
- D. Maintaining immunization records
Correct Answer: B
Rationale: Performing health assessments is a common role of the nurse in a primary care center. Assisting with major surgery is a role of the nurse in the hospital setting. Maintaining patients' function and independence is a role of the nurse in a rehabilitation or extended-care facility, and keeping student immunization records up to date is a role of the school nurse.
A nurse working in a pediatric clinic provides codes for a patient's services to a third-party payer who pays all or most of the care. How does the nurse refer to this method of payment?
- A. Out-of-pocket payment
- B. Individual private insurance
- C. Employer-based group private insurance
- D. Government financing
Correct Answer: B
Rationale: The four basic modes of paying for health care are out-of-pocket payment, individual private insurance, employer-based group private insurance, and government financing. With individual private insurance, members pay monthly premiums either by themselves or in combination with employer payments. These plans are called third-party payers because the insurance company pays all or most of the cost of care. Out-of-pocket payment is paying for health care with cash payments. Employer-based private insurance is employer-sponsored coverage, and government financing is provided through Medicare and Medicaid, and other federally funded programs.
The caregiver for a patient who is immobile and requires tube feedings asks the nurse to explain respite care. How does the nurse best explain this type of care?
- A. It's a type of service that allows time away for caregivers.
- B. It provides comfort and end-of-life services for the terminally ill and their families.
- C. It is skilled care provided to older adults in a long-term care facility.
- D. It provides living units available to people without regular shelter.
Correct Answer: A
Rationale: Respite care is provided to enable a primary caregiver time away from the day-to-day responsibilities of homebound patients. The other options describe palliative care, long-term care, and homeless shelters, respectively.
During a meeting with nurses at all levels in an acute care hospital, the Director of Nursing discusses lost revenue due to Medicare penalties. The nurses plan improvements in practice designed to prevent penalties from which events? Select all that apply.
- A. Urinary catheter-related infections
- B. Blood infections from central venous catheters
- C. Excessive readmissions
- D. Pressure injuries
- E. High blood pressure
Correct Answer: A,B,C,D
Rationale: Medicare penalties are given to hospitals when patients are readmitted soon after discharge; this is designed to ensure patients receive needed coordinated care after discharge. In addition, Medicare no longer reimburses hospitals for conditions that result from preventable errors and lead to increased costs, including pressure injuries, infections associated with indwelling urinary catheters, and vascular catheter-associated infections. High blood pressure is not a preventable hospital-acquired condition subject to penalties.