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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?
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?
. 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?
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?
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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?
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An infant is brought into a medical center and diagnosed with measles, a communicable disease. Which action should the nurse take?
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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?
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The spouse of a client with a terminal illness asks about hospice. Which information should the nurse include when responding to the spouse?
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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?
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. 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?
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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?
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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?
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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?
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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?
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The nurse manger 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?
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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?
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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?
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A client is concerned that the health insurance plan will not cover a diagnostic test. Which information should the nurse explain about medical necessity?
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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?
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. A client on Medicare asks which part of the program will cover hospitalization for surgery. Which program should the nurse review with the client?
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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.
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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.
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Study Notes
Health Insurance and Care Delivery Systems
- A client over 65 years old is expected to have Medicare, a federal government's health insurance program.
- Managed care delivery systems aim to manage the cost and quality of access to healthcare.
Skilled Nursing Facility (SNF)
- A SNF provides care to clients who require skilled nursing care, but no longer need acute care.
- Medicare will pay for care at a SNF if the client was hospitalized for at least 3 days before being transferred.
Rehabilitation Facility
- A rehabilitation facility provides care to clients who need intensive rehabilitation, but not acute care.
- The staff nurse should not explain that a rehabilitation facility provides acute care.
Communicable Disease
- When an infant is diagnosed with a communicable disease like measles, the nurse should take immediate action to isolate the infant and prevent the spread of the disease.
Health Maintenance Organization (HMO)
- In an HMO, care providers are reimbursed for care provided through a prepaid capitation fee.
Hospice Care
- Hospice care focuses on providing comfort and support to clients with terminal illnesses, rather than curing the illness.
- The nurse should explain the focus of hospice care and its benefits to the client's spouse.
Client-Centered Care
- Client-centered care focuses on individualized care and collaboration with clients to meet their needs.
- The instructor should review the delivery approach again if students do not understand its focus on individualized care.
Primary Care Nursing
- Primary care nursing focuses on providing holistic care to clients, taking into account their physical, emotional, and social needs.
- The nurse can demonstrate understanding of primary care nursing by involving the client in their care plan.
Medicaid
- Medicaid is a public health insurance program for low-income individuals and families.
- The case manager should explain that Medicaid benefits include coverage for hospitalization, but may have limitations.
Licensed Practical/Vocational Nurse (LPN/LVN) Role
- The instructor should provide more information about the LPN/LVN role if students do not understand their scope of practice.
Collaboration in Healthcare
- The nurse should collaborate with respiratory therapists to address a client's breathing difficulties.
- The outcome of successful healthcare collaboration is improved communication and reduced risk.
Interprofessional Collaboration
- Interprofessional collaboration involves working together with different healthcare professionals to provide comprehensive care.
- The nurse and occupational therapist can work together to adjust a client's device to promote self-care.
Medical Necessity
- The nurse should explain that medical necessity is the primary factor in determining insurance coverage for diagnostic tests.
Substance Abuse Treatment
- A client experiencing adverse effects from heroin use should be transferred to a substance abuse treatment facility.
Medicare Coverage
- Medicare Part A covers hospitalization, including surgery.
Budgeting and Client Care
- The nurse manager should use data on client care needs to guide decisions about staffing and budgeting.
Continuity of Care
- To ensure continuity of care, the nurse should consider the client's needs, availability of resources, and potential for home care when transferring from an acute care facility.
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Description
This quiz is about identifying the type of health insurance program a client has, specifically Medicare, which is a federal government's health insurance program for people 65 years and older.
