The nurse compares the characteristics of a health maintenance organization (HMO) and a
preferred provider organization (PPO). Which information should the nurse include about
HMOs?
a. HMOs require a set fee of each
member monthly.
b. HMOs allow the member to select his
health care provider.
c. HMOs permit admission to any facility
the member prefers.
d. HMOs offer unlimited diagnostic tests
and treatments.
ANS: A
HMOs require a set fee from each member monthly (capitation). The patient will be
treated by the HMO staff in HMO-approved facilities. Excessive use of diagnostic tests
and treatments is discouraged by the HMO.
PTS: 1 DIF:Cognitive Level: 9
Application REF:
OBJ: 9 TOP: Managed Care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
A patient asks the nurse what Medicare Part A covers. Which response is correct?
a. Medicare Part A covers inpatient
hospital costs.
b. Medicare Part A covers
reimbursement to the physician.
c. Medicare Part A covers outpatient
hospital services.
d. Medicare Part A covers ambulance
transportation.
pg. 2
,ANS: A
Medicare Part A covers inpatient hospital expenses, drugs, x-rays, laboratory work, and
intensive care. Medicare Part B pays thephysician, ambulance transport, and outpatient
services.
PTS: 1 DIF: Cognitive Level: REF 7, Box Comprehension
: 1-4
OBJ: 9 TOP: Government-Sponsored
Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
Which is the main cost-containment component of diagnosis-related groups (DRGs)?
a. Hospitals focus only on the specific
diagnosis.
b. Hospitals treat and discharge
patients quickly.
c. Reduced cost drugs are ordered for
specific diagnoses.
d. Diagnostic group classification
streamlines care.
ANS: B
DRGs are a prospective payment plan in which hospitals receive a flat fee for each
patient’s diagnostic category regardless of the length of time in the hospital. If
hospitals can treat and discharge patients before the allotted time, hospitals get to keep
the excess payment; cost is contained, and the patient is discharged sooner.
PTS: 1 DIF: Cognitive Level: REF 8 Comprehension
:
OBJ: 9 TOP: Government-Sponsored
Health Insurance
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
pg. 3
, The nurse is assessing a group of patients. Which patient would most likely qualify for
Medicaid?
a. A 35-year-old unemployed single mother with diabetes
b. A 70-year-old Medicare recipient with retirement income who
needs to be in a long-term care facility
c. An 80-year-old blind woman living in her own home who has
inadequate private insurance
d. A 67-year-old stroke victim with Medicare Part A and an income
from investments
ANS: A
Medicaid is a joint effort of federal and state governments geared primarily for low-
income people with no insurance.
PTS: 1 DIF: Cognitive Level:
Application REF: 8, Box 1-5
OBJ: 9 TOP: Government-Sponsored Health
Insurance–Medicaid
KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment:
Coordinated Care
Which area is the major focus of Healthy People 2020 and the primary mechanism
through which to improve the healthof Americans in the second decade of the century?
a. Research funding
b. Health information
distribution
c. Healthy lifestyle
encouragement
d. Health improvement
program designs
ANS: C
Healthy People 2020 focuses on expanding ongoing programs to include support and
information to reduce infant mortality, cancer, cardiovascular disease, and HIV/AIDS, and
to increase effective immunizations, healthy eating habits, and healthy weight.
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