Health Care Systems NCLEX study questions NSG 3645

Health Care Systems NCLEX study questions | NSG 3645 megan_buermann_theis Save Ch. 11 Health Care Delivery System ...10 terms Ceela1115Preview

Fundamentals of Nursing: Chapter 2...

15 terms worldtravelerjamie Preview Legal/Ethics practice questions (ncl...21 terms kristie_g_hamilton Preview Nursing 16 terms jacq Nursing students are reviewing information about health care delivery systems in preparation for a quiz the next day. Which statements describe current U.S. health care delivery practices? 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 the underserved populations.

c) Every health insurance plan in the 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 America 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.

c, e, f The Marketplace is designed to help people more easily find health insurance that fits their budget. Every health insurance plan in the Marketplace offers comprehensive coverage, from doctors to medications to hospital visits. Fifty years ago, half of the doctors in America practiced primary care, but today fewer than one in three do. 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.

A nurse is providing secondary health care to patients in a health care facility. Which patients are receiving this level of care? Select all that apply.

a) A patient enters a community clinic with signs of strep throat.

b) A patient is admitted to the hospital following a myocardial infarction.

c) A mother brings her son to the emergency department following a seizure.

d) A patient with osteogenesis imperfecta is being treated in a medical center.

e) A mother brings her son to a specialist to correct a congenital heart defect.

f) A woman has a hernia repair in an ambulatory care center

b, c, f Secondary health care treats problems that require specialized clinical expertise, such as an MI, a seizure, and a hernia repair. Treating strep throat is primary health care.Tertiary health care involves management of rare and complex disorders, such as osteogenesis imperfecta and congenital heart malformations.A nurse working in a physician's office prepares insurance forms in which the provider is given a fixed amount per enrollee of the health plan.What is the term for this type of reimbursement?

• capitation
• prospective payment systems
• bundled payment
• rate setting

a Capitation plans give providers a fixed amount per enrollee in the health plan in an effort to build a payment plan that consists of the best standards of care at the lowest cost. The prospective payment system groups inpatient hospital services for Medicare patients into DRGs. With bundled payments, providers receive a fixed sum of money to provide a range of services. Rate setting means that the government could set targets or caps for spending on health care services.A nursing instructor is teaching students about the utilization of health care services and how the U.S. health care dollar is spent. Place the following care areas in order from the highest percentage of health care money spent to the lowest.

a) Physician/clinical services

b) Home health care

c) Long-term care facility services

d) Retail prescription drugs

e) Government administration

f) Hospital care

f, a, d, c, b, e The national health expenditures in 2010 were hospital care 31%, physician/clinical services 20%, retail prescription drugs 10%, long-term care facility services 5%, home health care 3%, and government administration 1%.

A nurse researcher keeps current on the trends to watch in healthcare delivery. What trends are likely included? Select all that apply.

a) Globalization of economy and society

b) Slowdown in technology development

c) Decreasing diversity

d) Increasing complexity of patient care

e) Changing demographics

f) Shortages of key health care professionals and educators

a, d, e, f Trends to watch in health care delivery include: globalization of the economy and society, increasing complexity of patient care, changing demographics, shortages of key health care professionals and educators, technology explosion, and increasing diversity.A nurse is caring for patients in a primary care center. What is the most likely role of this nurse based on the setting?

a) Assisting with major surgery

b) Performing a health assessment

c) Maintaining patients' function and independence

d) Keeping student immunization records up to date

b Performing patient 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 an extended-care facility, and keeping student immunization records up to date is a role of the school nurse.A caregiver asks a nurse to explain respite care. How would the nurse respond?

• "A service that allows time away for caregivers"
• "A special service for the terminally ill and their family"
• "Direct care provided to individuals in a long-term care facility"
• "Living units for people without regular shelter"

a Respite care is provided to enable a primary caregiver time away from the day-to-day responsibilities of homebound patients.A nurse caring for patients in a primary care setting submits paperwork for reimbursement from managed care plans for services performed.Which purpose best describes managed care as a framework for health care?

a) A design to control the cost of care while maintaining the quality of care

b) Care coordination to maximize positive outcomes to contain costs

c) The delivery of services from initial contact through ongoing care

d) Based on a philosophy of ensuring death in comfort and dignity

a Managed care is a way of providing care designed to control costs while maintaining the quality of care

A nurse cares for dying patients by providing physical, psychological, social, and spiritual care for the patients, their families, and other loved

ones. This service is known as:

a) Respite care

b) Palliative care

c) Hospice care

d) Extended care

c The hospice nurse combines the skills of the home care nurse with the ability to provide daily emotional support to dying patients and their families. Respite care is a type of care provided for caregivers of homebound ill, disabled, or older patients. Palliative care, which can be used inconjunction with medical treatment and in all types of health care settings, is focused on the relief of physical, mental, and spiritual distress.Extended-care facilities include transitional subacute care, assisted-living facilities, intermediate and long-term care, homes for medically fragile children, retirement centers, and residential institutions for mentally and developmentally or physically disabled patients of all ages.A nurse is evaluating a patient diagnosed with renal disease for treatment in a Hospital at Home program. Which statement accurately describes a step in this program?

a) The patient is evaluated upon hospital admission and is given daily nursing care in the home after discharge for as long as necessary.

b) Any urgent or emergent situation requires an ambulance trip from the home to the hospital.

c) Patients are transported to physicians' offices from the home for weekly evaluations.

d) The clinicians use care pathways, clinical outcome evaluations, and specific discharge criteria.

d In the Hospital at Home program, the clinicians use care pathways including illness-specific care maps, clinical outcome evaluations, and specific discharge criteria. A patient requiring admission for one of the target illnesses is identified in the emergency department or ambulatory site. Staff assess whether the patient is a good candidate for the program using validated criteria. If the patient is eligible and consents to participate, the Hospital at Home physician evaluates the patient, who is then transported home, usually by ambulance. Nurses are available 24 hours a day/7 days a week for any urgent or emergent situations. The patient is evaluated daily in the home by the Hospital at Home physician, who completes an assessment and continues to implement appropriate diagnostic and therapeutic measures Patient Protection and Affordable Care Act (PPACA) Provides Medicaid or subsidized coverage to qualifying people with incomes up to 400% poverty Health Insurance Marketplace Designed to help people more easily find health insurance that fits their budget Relationship-Based care Purpose to establish a therapeutic relationship between nurses and patients and their families during their episode of care, to accomplish essential nursing interventions and to maximize collaborative, interdisciplinary practice