Test Bank for Fundamentals of Nursing Care: Concepts, Connections And Skills, 3rd Edition

Chapter 2: Health-Care Delivery, Settings, and Economics Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A client has a federal government’s health insurance program for people older than 65 years. Which type of health insurance should the nurse expect to see documented in the client’s medical record? 1. Medicaid 2. Medicare 3. Social security 4. Private insurance ____ 2. The health-care organization uses a system of health-care delivery aimed at managing the cost and quality of access to health care. Which type of delivery system should the nurse review prior to arriving for an interview for a position? 1. Medicaid 2. Medicare 3. Managed care 4. Private insurance ____ 3. The nurse reviews the purpose and functions of a skilled nursing facility (SNF) with a new nurse colleague. Which statement by the new nurse indicates that additional teaching about an SNF is required? 1. “Medicare will most likely pay for my client’s care at the SNF.” 2. “I hope that my client gets to return home after going to the SNF.” 3. “My client will never get to go home again if he’s transferred to an SNF.” 4. “My client will receive skilled nursing care, such as physical therapy as needed.” ____ 4. The nurse is preparing to transfer a client to a skilled nursing facility (SNF). For which reason will this client’s Medicare policy pay for the care at the SNF? 1. The client stays longer than 100 days per year. 2. The client enters the SNF within 60 days of a hospitalization. 3. The client has been hospitalized for at least 1 day before admission. 4. The client makes regular progress as documented by medical professionals. ____ 5. The charge nurse observes a staff nurse prepare to transfer a client to a rehabilitation facility. For which statement will the charge nurse intervene when hearing the staff member explain about this type of care setting? 1. “You will receive intense therapy services while you’re here.” 2. “You must participate in at least 6 hours of therapy each day.” 3. “You will be seen by a physician who specializes in rehabilitation.” 4. “If you get sick while you’re here, we can transfer you to the hospital.” ____ 6. An infant is brought into a medical center and diagnosed with measles, a communicable disease. Which action should the nurse take? 1. Refer to a rehabilitation facility 2. Notify the local police department 3. Prepare the client for hospice care 4. Notify the health department ____ 7. The nurse begins caring for clients who arrive at the health maintenance organization (HMO) office for an appointment. In which way will the care providers be reimbursed for the care provided? 1. Capitation Copyright © 2019 F. A. Davis Company 2. Medicaid 3. Medicare 4. Single payer ____ 8. The spouse of a client with a terminal illness asks about hospice. Which information should the nurse include when responding to the spouse? 1. “It is a service that provides care to the terminally ill client only.” 2. “This type of care is warranted when the client still seeks a cure for the terminal illness.” 3. “It is a program that focuses on palliative treatment and emotional support.” 4. “It is appropriate when the client is expected to live for fewer than 9 months.” ____ 9. The instructor reviews the delivery approach of client-centered care before taking the students to the clinical area. For which student statement should the instructor review the information again? 1. “It fosters a feeling of dependence.” 2. “This type of care is often seen in a rehabilitation setting.” 3. “It empowers the client to manage his or her care.” 4. “This type of care empowers the client to have a voice in establishing goals.” ____ 10. The nurse is working in a critical care unit where the focus is on primary care nursing. Which action will the nurse take to demonstrate understanding of this care delivery approach? 1. Ask an unlicensed assistant to give a bed bath. 2. Ask another nurse to call the physician for orders. 3. Provide all aspects of nursing care for assigned patients. 4. Instruct the nursing assistant to take the client’s vital signs. ____ 11. The nurse asks the case manager to explain the benefits a client on Medicaid has while hospitalized. What should the case manager explain about Medicaid? 1. It offers the same benefits in every state. 2. It is funded by the city health department. 3. It is a county government-matching funding program. 4. It offers assistance for poor and medically indigent individuals. ____ 12. A case manager is giving an in-service about public health insurance to a group of nursing students. For which student comment should the case management provide more information? 1. “Aetna is an example of public health insurance.” 2. “Medicaid is an example of public health insurance.” 3. “Medicare is an example of public health insurance.” 4. “Indian Health Service is an example of public health insurance.” ____ 13. The instructor is reviewing the scope of practice for the licensed practical/vocational nurse (LPN/LVN) with a group of students. For which student statement should the instructor provide more information about the role? 1. “The LPN/LVN can practice independently.” 2. “The LPN/LVN can practice under the supervision of a dentist.” 3. “The LPN/LVN can practice under the supervision of a physician.” 4. “The LPN/LVN can practice under the supervision of a registered nurse.” ____ 14. The nurse is caring for a client with increasing difficulty breathing. With which health-care worker should the nurse collaborate to address this client’s health problem? 1. Physical therapist 2. Respiratory therapist 3. Occupational therapist 4. Speech and language therapist Copyright © 2019 F. A. Davis Company ____ 15. The nurse manager is reviewing risk management data collected for the care area after the staff attended an educational program on health-care collaboration. Which outcome indicates that this program has been successful? 1. Number of client falls reduced by 85% 2. Two clients readmitted for wound infections 3. Same number of medication errors as the last month 4. Five clients delayed discharge because of catheter-related infections ____ 16. The department of nursing within a large hospital implements Team STEPPS on all of the care areas. Which is an expected outcome from this program? 1. Reports of incivility 2. Enhanced teamwork 3. Increased absenteeism 4. Inappropriate delegation ____ 17. The nurse, who is working in a setting that has implemented interprofessional collaboration, asks the occupational therapist to adjust a client’s device to promote self-care. Which response indicates that the care providers are practicing this approach to client care? 1. “Sure, how can I help?” 2. “I’ll get to it after lunch.” 3. “I’m busy now and I can’t help you.” 4. “Not now. I’ll do it tomorrow.” ____ 18. A client is concerned that the health insurance plan will not cover a diagnostic test. Which information should the nurse explain about medical necessity? 1. “The insurer will cover the test if they like the physician.” 2. “Most tests are covered even if they have no connection to the health problem.” 3. “If the test is found reasonable and necessary for your illness, it will be covered.” 4. “There is no guarantee that any test will be covered. It depends upon the reviewer.” ____ 19. A client who comes into the community clinic is experiencing adverse effects from using heroin for several years. To which facility should the nurse expect this client will be transferred? 1. Acute care 2. Rehabilitation 3. Residential care 4. Outpatient mental health ____ 20. A client on Medicare asks which part of the program will cover hospitalization for surgery. Which program should the nurse review with the client? 1. Part A 2. Part B 3. Part C 4. Part D Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 21. The nurse manager is reviewing the unit budget to determine the number of new positions needed for the next fiscal year. Which will the manager use to help guide decisions about client care? Select all that apply. 1. Appropriate level of care 2. Type of health insurance Copyright © 2019 F. A. Davis Company 3. Medical necessity 4. Location of the facility 5. Education of the staff ____ 22. A client no longer needs care in an acute care facility. What should be considered to ensure this client continues to receive the most appropriate level of care? Select all that apply. 1. Cost 2. Safety 3. Location 4. Activities 5. Effectiveness Copyright © 2019 F. A. Davis Company Chapter 2: Health-Care Delivery, Settings, and Economics Answer Section MULTIPLE CHOICE 1. ANS: 2 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective:1. Define various terms associated with health-care delivery and economics. Page: 23 Heading: Health-Care Economics Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System | Leadership and Management Difficulty: Easy Feedback 1 2 3 4 This is incorrect. Medicaid is a federal-state program in which the federal government helps states pay for the health care of those with an income below the poverty level, as well as certain other individuals. This is correct. Medicare is the federal government’s health insurance program for people older than 65 years or those with certain disabilities or conditions. This is incorrect. Social security is a federal insurance program that provides benefits to retired people and those who are unemployed or disabled. This is incorrect. Private insurance is provided by a number of companies and purchased by the individual or his or her employer. PTS: 1 CON: Health-Care System | Leadership and Management 2. ANS: 3 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 10. Describe various types of private health insurance. Page: 17 Heading: Determining the Delivery of Effective Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System | Leadership and Management Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. Medicaid is a federal-state program in which the federal government helps states pay for the health care of those with an income below the poverty level, as well as certain other individuals. This is incorrect. Medicare is the federal government’s health insurance program for people older than 65 years or those with certain disabilities or conditions. This is correct. Managed care is defined as a system of health-care delivery aimed at managing the cost and quality of access to health care. This is incorrect. Private insurance is insurance that is provided by a number of companies and purchased by the individual or his or her employer. PTS: 1 CON: Health-Care System | Leadership and Management Copyright © 2019 F. A. Davis Company 3. ANS: 3 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 5. Describe inpatient health-care settings and their services. Page: 17 Heading: Determining the Delivery of Effective Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care System | Leadership and Management Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. An SNF level of care is usually covered by Medicare and most private insurances. This is incorrect. Clients may stay in an SNF for a few days or as long as 100 days, but they eventually move to a rehabilitation facility, nursing home, or home setting. This is correct. The client will eventually move to a rehabilitation facility, nursing home, or home setting after the required number of days, up to 100. This is incorrect. SNF care consists of skilled nursing care and physical, occupational, and speech therapy as needed. PTS: 1 CON: Health-Care System | Leadership and Management 4. ANS: 4 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 5. Describe inpatient health-care settings and their services. Page: 17 Heading: Determining the Delivery of Effective Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System | Leadership and Management Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. An SNF level of care is usually covered by Medicare and most private insurances, but there are certain requirements. There is a 100-day stay maximum per year related to any one hospitalization and diagnosis. This is incorrect. An SNF level of care is usually covered by Medicare and most private insurances, but there are certain requirements. The client must enter the nursing home within 30 days of a hospitalization. This is incorrect. Medicare will pay for SNF care if the client was hospitalized for at least 3 days prior to admission. This is correct. An SNF level of care is usually covered by Medicare and most private insurances, but there are certain requirements. The client must be making regular progress as documented by medical professionals. PTS: 1 CON: Health-Care System | Leadership and Management 5. ANS: 2 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 7. Explain two types of rehabilitation services. Copyright © 2019 F. A. Davis Company Page: 18 Heading: Determining the Delivery of Effective Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care System | Leadership and Management Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. Rehabilitation is a level of care in which the client can receive intense physical, occupational, and speech therapy services. This is correct. As a rule of thumb, the client must be capable of participating in at least 3 hours of therapy a day to be admitted to a rehabilitation facility. This is incorrect. A physician specialist in physical medicine and rehabilitation oversees the client’s care during his or her stay. This is incorrect. If the client becomes ill or has other medical problems while in rehabilitation, the client will be transferred back to an acute care hospital. PTS: 1 CON: Health-Care System | Leadership and Management 6. ANS: 4 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 6. Describe outpatient health-care settings and their services. Page: 20 Heading: Determining the Delivery of Effective Care Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection | Safety | Communication | Health-Care System Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. A rehabilitation facility is a hospital or freestanding facility where a client can receive intense physical, occupational, and speech therapy services. This is incorrect. The primary responsibility of the police department is crime prevention and law enforcement. This is incorrect. The appropriate time for hospice care is when the client is no longer seeking treatment to arrest or cure the disease and is expected to live for 6 months or fewer. This is correct. Health departments are responsible for the tracking and treatment of certain communicable diseases, which are diseases transmitted through direct contact with an infected individual or indirect contact through a carrier. Some examples of communicable diseases that health departments treat and track include tuberculosis, sexually transmitted diseases, measles, mumps, rubella, hepatitis, influenza, and certain viruses. PTS: 1 CON: Infection | Safety | Communication | Health-Care System 7. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 1. Define various terms associated with health-care delivery and economics. Page: 24 Heading: Health-Care Economics Copyright © 2019 F. A. Davis Company Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System | Leadership and Management Difficulty: Easy Feedback 1 2 3 4 This is correct. Capitation refers to the payment system used by HMOs. In this system, primary care physicians (PCPs) are paid a set amount per member per month to manage the health care of those members. This is incorrect. Medicaid is a federal-state program in which the federal government helps states pay for the health care of those with an income below the poverty level, as well as certain other individuals. This is incorrect. Medicare is the federal government’s health insurance program for people older than 65 years or those with certain disabilities or conditions. This is incorrect. In a single-payer system, the federal government covers the cost of all health-care services. PTS: 1 CON: Health-Care System | Leadership and Management 8. ANS: 3 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 6. Describe outpatient health-care settings and their services. Page: 21 Heading: Determining the Delivery of Effective Care Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Grief and Loss | Communication | Health-Care System Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. Hospice is defined as an interdisciplinary program of palliative care and support services that addresses the physical, spiritual, social, and economic needs of terminally ill clients and their families. This is incorrect. The appropriate time for hospice care is when the client is no longer seeking treatment to arrest or cure the disease. This is correct. Hospice services include management of the client’s pain and symptoms (palliative treatment), emotional support to the client and family, medications, medical supplies and equipment, caregiver instructions and support, coordination of all health-care services, and grief support for surviving loved ones and friends. This is incorrect. The appropriate time for hospice care is when the client is expected to live for 6 months or less. PTS: 1 CON: Grief and Loss | Communication | Health-Care System 9. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 8. Distinguish between types of nursing care delivery systems. Page: 21 Heading: Delivery of Nursing Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Copyright © 2019 F. A. Davis Company Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care System Difficulty: Moderate Feedback 1 2 3 4 This is correct. Client-centered care allows the client to achieve independence within the limits of his or her disability by permitting the client to have a voice in his or her rehabilitation, schedule, goals, and method of attaining those goals. This is incorrect. Client-centered care is often seen in a rehabilitation setting. This is incorrect. Client-centered care empowers the client to take control of and manage his or her care. This is incorrect. Client-centered care empowers the client to have a voice in establishing goals. PTS: 1 CON: Health-Care System 10. ANS: 3 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 8. Distinguish between types of nursing care delivery systems. Page: 22 Heading: Delivery of Nursing Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. In primary care nursing, one nurse is responsible for all aspects of nursing care. This means that no one else bathes the client or changes the bed. This is incorrect. In primary care nursing, one nurse is responsible for all aspects of nursing care for his or her assigned clients. This means that there is no other nurse to call the physician or take orders. This is correct. In primary care nursing, one nurse is responsible for all aspects of nursing care for his or her assigned clients. This is incorrect. In primary care nursing, one nurse is responsible for all aspects of nursing care. This means that there is no unlicensed assistant or nursing assistant who takes vital signs. PTS: 1 CON: Health-Care System 11. ANS: 4 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 9. Contrast Medicare and Medicaid. Page: 23 Heading: Health-Care Economics Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Leadership and Management | Health-Care System Difficulty: Easy Feedback Copyright © 2019 F. A. Davis Company 1 2 3 4 This is incorrect. Because the state is required to set coverage policies and administer the program, Medicaid benefits are slightly different in each state. This is incorrect. Medicaid is a federal-state government-matching funding program and not funded by the city health department. This is incorrect. Medicaid is a federal-state government-matching funding program, not a county government matching-funding program. This is correct. Medicaid offers assistance for poor and medically indigent individuals, pregnant women with an income below the poverty level, children meeting certain income-level requirements, and certain disabled individuals meeting income-level requirements. PTS: 1 CON: Leadership and Management | Health-Care System 12. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 10. Describe various types of private health insurance. Page: 23 Heading: Health-Care Economics Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Leadership and Management | Health-Care System Difficulty: Easy Feedback 1 2 3 4 This is correct. A private insurance carrier such as Aetna is not a type of public health insurance. This is incorrect. Public health insurance is funded by the federal or state governments, or a combination of both and includes Medicaid. This is incorrect. Public health insurance is funded by the federal or state governments, or a combination of both and includes Medicare. This is incorrect. Public health insurance is funded by the federal or state governments, or a combination of both and includes the Indian Health Service. PTS: 1 CON: Leadership and Management | Health-Care System 13. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 4. Describe members of the health-care team and their functions. Page: 15 Heading: The Health-Care Team Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Professionalism | Health-Care System Difficulty: Moderate Feedback 1 2 3 This is correct. The LPN/LVN cannot practice independently. This care provider takes direction from the registered nurse, physician, or dentist. This is incorrect. The LPN/LVN can practice under the supervision of a dentist. This is incorrect. The LPN/LVN can practice under the supervision of a physician. Copyright © 2019 F. A. Davis Company 4 This is incorrect. The LPN/LVN can practice under the supervision of an RN. PTS: 1 CON: Professionalism | Health-Care System 14. ANS: 2 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 4. Describe members of the health-care team and their functions. Page: 15 Heading: The Health-Care Team Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Oxygenation | Professionalism | Collaboration Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. A physical therapist provides services to help improve or restore function and mobility, relieve pain, and prevent or limit permanent physical disabilities for clients suffering from injuries and disease. This is correct. A respiratory therapist evaluates, treats, and cares for clients with breathing problems caused by heart and lung disease. This is incorrect. An occupational therapist assists clients with disabilities to develop, recover, or maintain their skills for daily activities and work. This is incorrect. A speech and language therapist assesses, diagnoses, treats, and helps to prevent disorders related to speech, language, voice, swallowing, and fluency. PTS: 1 CON: Oxygenation | Professionalism | Collaboration 15. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 2. Discuss health-care collaboration and how it links to patient safety. Page: 16 Heading: The Health-Care Team Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Professionalism | Collaboration Difficulty: Moderate Feedback 1 2 3 4 This is correct. When health-care workers collaborate with one another, one of the most positive outcomes is improved patient safety. Poor quality care occurs, along with a higher rate of preventable errors, when health-care personnel act alone, or in a “silo.” This is incorrect. Collaboration improves the quality of care, and infections should be reduced. This is incorrect. Medication errors are preventable, which will improve with collaboration. This is incorrect. Catheter-related infections are preventable, which will improve with collaboration. PTS: 1 CON: Professionalism | Collaboration 16. ANS: 2 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Copyright © 2019 F. A. Davis Company Objective: 2. Discuss health-care collaboration and how it links to patient safety. Page: 16 Heading: The Health-Care Team Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism | Collaboration Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. If Team STEPPS is implemented, communication and teamwork will improve. Incivility should be reduced. This is correct. The program, called Team STEPPS, uses evidence-based teamwork to improve communication and teamwork skills. This, in turn, eliminates barriers to quality and safety. This is incorrect. If Team STEPPS is implemented, communication and teamwork will improve. There is no data to suggest that absenteeism will increase because of this program. This is incorrect. If Team STEPPS is implemented, communication and teamwork will improve. Delegation should be appropriate with this program. PTS: 1 CON: Professionalism | Collaboration 17. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 2. Discuss health-care collaboration and how it links to patient safety. Page: 16 Heading: The Health-Care Team Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Professionalism Difficulty: Easy Feedback 1 2 3 4 This is correct. Interprofessional collaboration helps improve the ability of health-care professionals to consider one another’s unique perspectives to better address the needs of all clients and their families. This response shows the health-care professionals are willing to work with one another. This is incorrect. Interprofessional collaboration helps address the needs of the clients. Making a client wait does not support interprofessional collaboration. This is incorrect. Interprofessional collaboration supports each care provider’s unique contribution to client care. Communication should be improved to indicate that the provider is willing to help. This is incorrect. Interprofessional collaboration helps to understand each care provider’s perspective; however, the client’s needs should be met. PTS: 1 CON: Professionalism 18. ANS: 3 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 3. Identify the two most important factors in health-care delivery and economics. Copyright © 2019 F. A. Davis Company Page: 17 Heading: Determining the Delivery of Effective Care Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Communication | Health-Care System Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. Medical necessity must be proved for reimbursement to occur. It has nothing to do with the physician being liked by the health plan. This is incorrect. Tests will be covered if they are found necessary to the diagnosis or treatment of an illness. This is correct. Insurers determine medical necessity by comparing the patient’s clinical/medical information against accepted medical review criteria. According to government funding sources, medical necessity is defined as services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. This means that the services must seem reasonable and necessary to the entity paying for them. This is incorrect. Tests found to be necessary for the diagnosis or treatment of an illness or injury will be covered. PTS: 1 CON: Communication | Health-Care System 19. ANS: 2 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 7. Explain two types of rehabilitation services. Page: 18 Heading: Determining the Delivery of Effective Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Health-Care System | Leadership and Management Difficulty: Moderate Feedback 1 2 3 4 This is incorrect. An acute care facility may not have the appropriate resources to assist a client who is withdrawing from a substance. This is correct. One type of rehabilitation facility focuses on treating clients with chemical dependency and mental health issues. Some of these facilities provide medical care in the form of detoxification, or the removal of drugs and alcohol from the person’s body, which generally takes several days. This is incorrect. The term residential care is used to describe care given in settings where the clients, or residents, stay for long periods of time. This is not the type of facility to treat substance use. This is incorrect. Outpatient mental health facilities provide therapy and counseling but do not assist with withdrawing from a specific substance. PTS: 1 CON: Health-Care System | Leadership and Management 20. ANS: 1 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Copyright © 2019 F. A. Davis Company Objective: 9. Contrast Medicare and Medicaid. Page: 23 Heading: Health-Care Economics Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System | Leadership and Management Difficulty: Moderate Feedback 1 2 3 4 This is correct. Part A is insurance for hospitalization, hospice, home health, and skilled nursing facility services. This is incorrect. Part B is supplementary health insurance to help pay participating providers, such as health-care providers, laboratories, x-ray technicians, and home-health nurses, and for durable medical equipment. This is incorrect. Part C, Medicare Advantage Plans, are health insurance plans administered by private insurance companies in place of traditional Medicare. This is incorrect. Part D, also known as Medicare Prescription Drug Coverage, provides payment for prescribed medications and is run by insurance companies or other private companies approved by Medicare. PTS: 1 CON: Health-Care System | Leadership and Management MULTIPLE RESPONSE 21. ANS: 1, 3 Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 3. Identify the two most important factors in health-care delivery and economics. Page: 17 Heading: Determining the Delivery of Effective Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System | Leadership and Management Difficulty: Moderate 1 2 3 4 5 Feedback This is correct. When the economics of care is a foremost consideration, the appropriate level of care helps guide decisions about client care. This is incorrect. The type of health insurance is not used to guide decisions about client care. This is correct. When the economics of care is a foremost consideration, medical necessity helps guide decisions about client care. This is incorrect. The location of the facility is not used to guide decisions about client care. This is incorrect. The education of the staff is not used to guide decisions about client care. PTS: 1 22. ANS: 1, 2, 5 CON: Health-Care System | Leadership and Management Copyright © 2019 F. A. Davis Company Chapter: Chapter 2, Health-Care Delivery, Settings, and Economics Objective: 3. Identify the two most important factors in health-care delivery and economics. Page: 17 Heading: Determining the Delivery of Effective Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Application [Applying] Concept: Health-Care System | Leadership and Management Difficulty: Moderate 1 2 3 4 5 Feedback This is correct. An aspect of paying for health care requires determining an appropriate level of care to meet the client’s needs. It is important that the client is cared for at the most cost-effective approach. This is correct. An aspect of paying for health care requires determining an appropriate level of care to meet the client’s needs. It is important that care is safe. This is incorrect. Location is not a consideration when ensuring that the client receives the most appropriate level of care. This is incorrect. Activities are not a consideration when ensuring the client receives the most appropriate level of care. This is correct. An aspect of paying for health care requires determining an appropriate level of care to meet the client’s needs. It is important that care is effective. PTS: 1 CON: Health-Care System | Leadership and Management Copyright © 2019 F. A. Davis Company