Health Care Delivery Assessment

A nurse is teaching about Medicaid to a client who is concerned about paying for health care. Which of the following statements should the nurse make? a) "Your income will determine if you are eligible for Medicaid." b) "You must be age 65 or older to qualify for Medicaid." c) "Laboratory services are not covered by Medicaid." d) "Medicaid is fully funded by the federal government."

a) "Your income will determine if you are eligible for Medicaid." - To qualify for Medicaid, the client must meet eligibility requirements based on the client's income in relation to the poverty level.

A nurse in a provider's office is speaking with a client about a Press Ganey survey. The nurse should inform the client that this survey will be conducted by which of the following methods? a) Email b) Automated phone attendant c) Postal mail d) Telephone call

a) Email - The nurse should inform the client that they will receive a Press Ganey survey via email following their office visit. The Press Ganey survey evaluates client satisfaction with health care delivery and is sent to all clients who receive care.

A nurse is hired to be a case manager in a facility. Which of the following services should the nurse expect to perform? a) Facilitate transfer of clients to meet the required level of care. b) Perform physical assessments on clients. c) Administer medications to clients. d) Provide wound care to clients.

a) Facilitate transfer of clients to meet the required level of care. - Case managers are responsible for managing resources, reviewing care delivery in the acute care setting, and facilitating transfer to the required level of care, either within the facility or to another facility.

A nurse is completing the Minimum Data Set (MDS) assessment for a resident in a skilled-nursing facility. Which of the following information should the nurse include in the assessment? (Select all that apply.) a) Input from members of the client's interdisciplinary team b) The client's cognitive status c) Description of the client's home environment d) Each physical therapy visit e) The client's need for assistance with activities of daily living

a) Input from members of the client's interdisciplinary team b) The client's cognitive status d) Each physical therapy visit e) The client's need for assistance with activities of daily living - The MDS assessment is an interdisciplinary document used by the Centers for Medicare & Medicaid Services (CMS) to determine reimbursement. It should include input from the client's interdisciplinary team members to ensure that the facility receives the correct payments, cognitive status of the client, the need for assistance with activities of daily living, and the number of treatments and therapies provided.

A graduate nurse notes that a hospital with Pathway to Excellence recognition is hiring staff. Which of the following should the nurse expect from this facility? (Select all that apply.) a) The facility has practices in place that lead to the healthy workplace environment. b) The facility must have underwent an on-site review to receive the Pathway to Excellence award. c) The facility emphasizes shared governance. d) The facility emphasizes practices that positively affect a nurse's well-being. e) The facility focuses on improving clinical quality indicators.

a) The facility has practices in place that lead to the healthy workplace environment. c) The facility emphasizes shared governance. d) The facility emphasizes practices that positively affect a nurse's well-being. - Pathway to Excellence recognized facilities are committed to providing a healthy, supportive environment for their staff. Shared governance is one strength of the Pathway to Excellence Program. Having structures in place that positively affect the nurse's well-being promotes a healthy workplace environment.

A nurse working in an acute care facility is caring for a client who has a total brain injury and is receiving mechanical ventilation. Which of the following facilities should the nurse anticipate the client to be transferred to for further treatment. a) Skilled nursing facility (SNF) b) Long-term care hospital (LTCH) c) Assisted living d) Hospice care

b) Long-term care hospital (LTCH) - LTCHs specialize in hospitalization for long-term care, such as clients who have severe burns, trauma, or ventilation needs. LTCHs provide a higher level of care than a SNF, such as is required for a client who is receiving mechanical ventilation.

A nurse is teaching a class about the Hospital-Acquired Condition Reduction Program (HACRP). Which of the following information should the nurse include? a) The HACRP reimburses a medical facility based on the client's primary diagnosis. b) The HACRP links Medicare payments to health care quality. c) The HACRP determines the length of hospitalization for clients who have the same diagnosis. d) The HACRP is not used in the acute care setting.

b) The HACRP links Medicare payments to health care quality. - The HACRP reduces reimbursement to facilities that have poor outcomes related to five different hospital-acquired infections. Centers for Medicare & Medicaid Services will not reimburse the facility for the costs associated with treatment for the infection and the extended stay of the client. The HACRP was implemented to incentivize hospitals to provide high-quality care for their clients.

A nurse is discussing hospice care with a newly licensed nurse. Which of the following should the nurse identify as the goal of hospice care? a) Provide comfort measures for clients who are receiving active treatment for illness. b) Allow a client's caregiver to take a break from caring for their loved one. c) Provide care for a client who has less than 6 months to live. d) Offer services such as strength exercises for the client within the client's home.

c) Provide care for a client who has less than 6 months to live. - Hospice care is provided for clients when the provider has determined the client has less than 6 months to live. The goal is not to treat or cure the client's illness but to provide comfort and supportive services.

A nurse is teaching a newly licensed nurse about the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) tool. Which of the following information should the nurse include? a) The HCAHPS tool is provided to clients upon admission to a facility. b) The HCAHPS tool is issued to every client who is admitted to the facility. c) The HCAHPS tool is issued to measure client satisfaction with the health care service. d) The HCAHPS tool is emailed to clients.

c) The HCAHPS tool is issued to measure client satisfaction with the health care service. - The HCAHPS tool is issued to measure client satisfaction with the health care service. The information is publicly reported and ensures the accountability and transparency of the facilities that participate. The HCAHPS tool uses a broad range of questions issued to the client regarding their care. This information is published publicly to show how the facility is performing and their accountability.

A nurse is teaching a client about the Affordable Care Act (ACA). Which of the following information should the nurse include? a) The ACA does not provide coverage for pre-existing conditions. b) The ACA enforces a lifetime limit to covered benefits. c) Clients who have insurance pay a fee for preventable screenings. d) A focus of the ACA is disease prevention.

d) A focus of the ACA is disease prevention. - Aside from making insurance coverage more affordable and available, a focus of the ACA is disease prevention. Clients are encouraged to sign up for insurance and seek preventative care before they get sick, so they can stay well.

A nurse in a provider's office is calling a client's insurance company to obtain permission prior to scheduling a magnetic resonance imaging (MRI) test. Which of the following is the nurse obtaining? a) Fee-for-service b) Diagnosis-related group (DRG) c) Retrospective review d) Precertification

d) Precertification - The nurse is obtaining precertification from the client's insurance company prior to scheduling the client's MRI. Before an elective surgery, hospital admission, or procedure such as a magnetic imaging study, a client needs to obtain precertification or authorization approval from the insurance company, or the service can risk denial of payment.

A nurse is teaching a newly licensed nurse about The Joint Commission (TJC). Which of the following information should the nurse include? a) TJC is a for-profit organization. b) Accreditation by TJC is required for all inpatient facilities. c) Accreditation by TJC is restricted to inpatient facilities. d) TJC ensures organizations remain up-to-date with state guidelines.

d) TJC ensures organizations remain up-to-date with state guidelines. - TJC monitors state legislative and regulatory changes and updates its standards accordingly. This monitoring acts as a two-part system to ensure that accredited organizations remain current with state requirements.