Chapter 11: Health Care Delivery System

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Which of the following statements accurately describe an aspect of managed care? Select all that apply.

A) Managed care systems control the cost of care with a lower quality of care.

B) The care of the patient is carefully planned and monitored by the primary care provider.

C) The nurse is considered the gatekeeper in the managed care system.

D) The managed care system expands the choice of care providers.

E) The managed care system may required approval for specialty care.

F) Planning and monitoring are conducted to ensure standards are followed.

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1

Which of the following statements accurately describe an aspect of managed care? Select all that apply.

A) Managed care systems control the cost of care with a lower quality of care.

B) The care of the patient is carefully planned and monitored by the primary care provider.

C) The nurse is considered the gatekeeper in the managed care system.

D) The managed care system expands the choice of care providers.

E) The managed care system may required approval for specialty care.

F) Planning and monitoring are conducted to ensure standards are followed.

B) The care of the patient is carefully planned and monitored by the primary care provider.

E) The managed care system may required approval for specialty care.

F) Planning and monitoring are conducted to ensure standards are followed.

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2

Which of the following is a characteristic of primary healthcare? Select all that apply.

A) It is essential healthcare based on sound methods and technology.

B) It is made universally accessible to individuals and families in the community.

C) It does not require the full participation of the individual and family.

D) It brings healthcare as close as possible to where people live and work.

E) It is the same concept as primary healthcare in that it refers to the delivery of healthcare.

F) The concept was developed based on an increase in illness and death in third- world countries.

A) It is essential healthcare based on sound methods and technology.

B) It is made universally accessible to individuals and families in the community.

D) It brings healthcare as close as possible to where people live and work.

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3

Which of the following phrases is characteristic of case management as a method of healthcare delivery?

A) brings healthcare to where people live and work

B) essentially the same method as primary care

C) planned and monitored by patients themselves

D) maximize positive outcomes and contain costs

D) maximize positive outcomes and contain costs

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4

Which of the following phrases best describes hospitals today?

A) focus on chronic illnesses

B) focus on acute care needs

C) primary care centers

D) voluntary agencies

B) focus on acute care needs

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5

A man is scheduled for hospital outpatient surgery. He tells the nurse, I dont know what that word, outpatient, means. How would the nurse respond?

A) It means you will have surgery in the hospital and stay for 2 days.

B) It means the surgeon will come to your home to do the surgery.

C) Why would you ask such a question? Dont worry about it.

D) You will have surgery and go home that same day.

D) You will have surgery and go home that same day.

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6

What is one responsibility of nurses who work in physicians offices?

A) prescribing medications

B) conducting health assessments

C) performing minor surgery

D) making independent home visits

B) conducting health assessments

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7

A nurse in a walk-in healthcare setting provides technical services, such as, administering medications, determines the priority of care needs, and provides patient teaching on all aspects of care. Which of the following terms best describes this type of healthcare setting?

A) hospital

B) physicians office

C) ambulatory center

D) long-term care

C) ambulatory center

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8

Nurses who are employed in home care have a variety of responsibilities. Which of the following is one of those responsibilities?

A) provide all care and services

B) maintain a clean home environment

C) advise patients on financial matters

D) collaborate with other care providers

D) collaborate with other care providers

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9

Which of the following is true of long-term care facilities?

A) They provide care only to older adults.

B) They provide care for homeless adults.

C) They provide care to people of any age.

D) They care for people only with dementia.

C) They provide care to people of any age.

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10

A grade school is preparing a series of classes on the dangers of smoking. Who would be most likely to teach the classes?

A) the principal

B) an outside consultant

C) a teacher

D) the school nurse

D) the school nurse

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11

An elderly woman has total care of her husband with Alzheimers disease. What type of care might the nurse suggest to give her some much-needed time of her own?

A) primary care

B) respite care

C) bereavement care

D) palliative care

B) respite care

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12

What population do hospice nurses provide with care?

A) those requiring care to improve health

B) children with chronic illnesses

C) dying persons and their loved ones

D) older adults requiring long-term care

C) dying persons and their loved ones

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13

Who provides physicians with the authority to admit and provide care to patients requiring hospitalization?

A) the healthcare institution itself

B) Board of Healing Arts

C) American Medical Association

D) State Board of Nursing

A) the healthcare institution itself

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14

After a stroke, a patient is having difficulty swallowing. The nurse may make a referral to what member of the healthcare team?

A) physical therapist

B) speech therapist

C) social worker

D) respiratory therapist

B) speech therapist

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15

Medicare uses a prospective payment plan based on diagnosis-related groups (DRGs). What are DRGs?

A) locally supported healthcare financing, usually by donations

B) a public assistance program for low-income individuals

C) predetermined payment for services based on medical diagnoses

D) a private insurance plan for subscribers who pay a copayment

C) predetermined payment for services based on medical diagnoses

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16

A patient has a private insurance policy that pays for most healthcare costs and services. Why is this plan called a third-party payer?

A) The insurance company pays all or most of the costs.

B) The family of the patient is required to pay costs.

C) The patient gets the bill and pays out-of-pocket costs.

D) Medicare and Medicaid will pay most of the costs.

A) The insurance company pays all or most of the costs.

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17

A person receiving healthcare insurance from his employer knows that he should check the approved list of contracted healthcare providers before seeking services in order to receive them at a lower cost. What type of insurance is most likely involved?

A) Medicaid

B) preferred provider organization

C) health maintenance organization

D) long-term care insurance

B) preferred provider organization

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18

What is the primary focus of healthcare today?

A) care of acute illnesses

B) care of chronic illnesses

C) health promotion

D) health restoration

C) health promotion

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19

In which of the following ways have cost-containment issues affected the delivery of healthcare in the U.S.? Select all that apply.

A) The U.S. healthcare system has been experiencing a financial crisis.

B) The cost of healthcare in the United States has decreased dramatically.

C) Short- and long-term results of cost-containment measures are undetermined.

D) Historically, payment for healthcare services encouraged the use of expensive services.

E) In the past, healthcare focused primarily on prevention of illnesses since it was covered by insurance.

F) Competition among hospitals has further fueled the increase in health costs.

A) The U.S. healthcare system has been experiencing a financial crisis.

C) Short- and long-term results of cost-containment measures are undetermined.

D) Historically, payment for healthcare services encouraged the use of expensive services.

F) Competition among hospitals has further fueled the increase in health costs.

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20

A patient who requires treatment for breast cancer is referred to an oncologist. She is receiving chemotherapy at a hospital and interacts with many other healthcare providers in the course of her treatment. What is the confusion that might arise concerning her treatment and care is a problem known as?

A) cost containment

B) fragmentation of care

C) healthcare rationing

D) knowledgeable consumers

B) fragmentation of care

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21

Which of the following is a trend to watch in healthcare delivery?

A) decreasing diversity

B) lower costs of healthcare

C) uneducated consumers

D) current nursing shortage

D) current nursing shortage

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22

What is one way in which nurses can help shape healthcare reform?

A) do their job and do it well

B) refuse to participate in organizations

C) support legislation to improve care

D) become a member of a support group

C) support legislation to improve care

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