Nokea
Which of the following would NOT be considered medically necessary by an insurance company?
- A. Surgery to remove an infected gallbladder
- B. Breast implants to increase breast size
- C. Breast implants after breast cancer surgery
- D. Botox injections to decrease facial wrinkles
- E. Skin grafts to repair a spider bite injury
Correct Answer: B, D
Rationale: Cosmetic procedures like breast implants for enhancement and Botox for wrinkles are typically not deemed medically necessary.
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If an elderly person needed help with meals, medications, and personal care but did not need continuous nursing care, which inpatient setting would be the most appropriate level of care?
- A. A skilled nursing facility
- B. A long-term acute care hospital
- C. An assisted living facility
- D. A long-term care facility
Correct Answer: C
Rationale: Assisted living facilities provide support for daily activities without continuous nursing care, suitable for this scenario.
You are working on a large medical unit with 30 patients who require medications, therapies, dressing changes, and pain management. Nursing staff for the day shift consists of two RNs, three LPNs, and three CNAs. Which type of nursing care delivery would you expect to work best on this unit?
- A. Team nursing
- B. Client-centered care
- C. Primary care nursing
- D. Case management
Correct Answer: A
Rationale: Team nursing is effective in settings with multiple staff types and high patient loads, allowing collaborative care.
Eligibility for the HIS is:
- A. based on having a CDIB.
- B. available to all people with at least 25% Indian blood.
- C. set by each tribe.
- D. determined by presenting a family genealogy.
- E. determined by blood type.
Correct Answer: A, C
Rationale: Eligibility for Indian Health Service (HIS) requires a Certificate of Degree of Indian Blood (CDIB) and is often determined by tribal enrollment criteria.
Payment to hospitals for the care of Medicare patients is based on:
- A. a specified amount per member per month.
- B. the actual costs of all supplies, equipment, tests, and nursing care.
- C. DRGs.
- D. a previously negotiated discount rate.
Correct Answer: C
Rationale: Medicare payments are based on Diagnosis-Related Groups (DRGs), which set reimbursement rates for specific conditions.
A patient who is terminally ill with cancer is no longer being treated with radiation or chemotherapy (cancer-attacking medication). The most appropriate level of care for this patient would be:
- A. home health care.
- B. hospice.
- C. a skilled nursing facility.
- D. a long-term care acute hospital.
Correct Answer: B
Rationale: Hospice care is designed for terminally ill patients focusing on comfort and quality of life.