Deck 7: Health Care Organizations

Question 1

You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood.As the manager,your concern about sustainability is related to:

A) The possibility of violence.
B) An increase in prescription drugs available for abuse.
C) Decisions of the public board.
D) An increase in uncompensated care events.

Answer 1

An increase in uncompensated care events.

Question 2

Which of the following is an example of an HMO?

A) Nurse practitioners are paid promptly at discounted fees for each service rendered at a women's health clinic.
B) Physicians in a large urban center are reimbursed for visits made to their clients.
C) Physicians are paid for each service delivered to enrolled patients through a prepaid plan.
D) Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

Answer 2

Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

Question 3

Tracy is an RN case manager who interfaces between the Centers for Medicare and Medicaid.Tracy's responsibilities most likely would include:

A) Managing physician-led research.
B) Monitoring physician documentation of the need for medical care.
C) Determining which services are designated fee-for-service.
D) Identifying errors in physician diagnoses.

Answer 3

Monitoring physician documentation of the need for medical care.

Question 4

To prepare for the orientation of newly hired nurses,the nurse manager plans a presentation outlining the concept of healthcare networks.Healthcare networks are:

A) Units that provide only primary care services.
B) Owned by the institutions.
C) A feature of all public institutions.
D) Units that provide a full spectrum of services.

Question 5

Which of the following would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service?

A) Programs to educate the community on preparing healthy meals for a limited cost
B) Reduction of injuries from alcohol-related accidents
C) Pain management for patients with low back pain
D) Reduction of falls among seniors

Question 6

A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center.She has been hired because of her expertise in TJC accreditation.To initiate the changes,the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center,which is a primary care institution.Primary care institutions are facilities that provide:

A) Rehabilitative or long-term care.
B) Disease-restorative care.
C) First access to care.
D) Only outpatient services.

Question 7

The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service.Community services:

A) Care for the specific needs of individual families in the community.
B) Focus on the treatment of community-wide problems rather than on individual health problems.
C) Do not include services provided by public health departments.
D) Provide personal health follow-up for all acute care hospitalizations.

Question 8

As a nurse manager,you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization.In setting up the facility,which of the following would require reassessment?

A) Patients admitted to the facility must have adequate health insurance to cover the services provided.
B) A local nurse education program asks you if nursing students can gain clinical experience with recovering surgical patients in the facility.
C) Public funding will be provided to enable care of patients who have an ordinary course of recovery.
D) The facility is an older house that is more than 30 minutes away from the acute care center.

Question 9

A merger has occurred between a hospital and a local home health agency,creating new roles for the nursing staff in both agencies.The nurse managers of both systems begin to evaluate and revise patient care processes and systems.With the merger,the healthcare organization's changes are:

A) Creating more jobs in the community for registered nurses.
B) Resulting in an overall loss of jobs for registered nurses.
C) Controlled by the federal and state governments.
D) Controlled by the insurance agency.

Question 10

A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit packages that uses specific standards to approve a period of time for the use of inpatient and community health services)is participating in:

A) Critical pathways.
B) Healthcare networks.
C) Health maintenance organizations.
D) Managed care.

Question 11

In reviewing the current delivery model,the nurse manager is aware that a demographic change that will have a significant effect on the healthcare delivery systems of the future is:

A) Changes in staffing patterns.
B) Increasing reports of violence in the workplace.
C) The increasing percentage of the population that will be over age 65.
D) Escalations in the cost of health care.

Question 12

As a nurse manager,you have been offered a position at a Veterans Administration hospital.In accepting the position,it is important for you to understand that veterans' hospitals provide:

A) Primary care and are privately funded.
B) A range of services and are responsible to government and taxpayers.
C) Secondary care only and are publicly administered and funded.
D) Services to veterans under an HMO.

Question 13

A nurse manager in a for-profit environment finds it difficult to recruit staff.This difficulty may be most related to aggressive profit goals and:

A) Lower salary compensation for staff.
B) Rising expectations of impoverished and indigent individuals for services.
C) Poor orientation and retention practices for staff.
D) An overwhelming emphasis on accepting learners from health disciplines.

Question 14

You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate,faith-based care.What level of consolidated system is represented in this example?

A) First level
B) Second level
C) Fourth level
D) Fifth level

Question 15

A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days,and who require inpatient and ambulatory care for addictions,through a spectrum of wellness and illness services and providers,would be considered:

A) A healthcare network.
B) A tertiary care institution.
C) Rehabilitative.
D) Long-term care.

Question 16

A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization.Not-for-profit organizations:

A) Pay dividends to stockholders.
B) Have funds that are redirected to the organization for maintenance and growth.
C) Have no paid employees.
D) Pay no taxes.

Question 17

Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days).This facility would likely be considered:

A) Primary care, specialized.
B) Tertiary care, long-term.
C) Acute care, specialized.
D) Public care, specialized.

Question 18

With the help of a federal grant,the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children's health.School health programs are:

A) Increasingly seen as primary care sites for children.
B) Providing only health education programs for children and their parents.
C) Capable only of providing referrals for health problems to primary care providers.
D) Funded exclusively by local authorities.

Question 19

A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization).The nurse manager has had to educate staff and personnel about the financial implications of this partnership.A health maintenance organization:

A) Provides more expensive care than other types of insurance plans.
B) Has a centralized administration that directs and compensates physician services.
C) Pays physicians on a fee-for-service basis.
D) Does not pay as much for acute care as other practice plans.

Question 20

A group of patients with early Alzheimer's disease and their spouses approach you regarding help with the establishment of a local Alzheimer's Society for the support and education of affected individuals and their families.As a manager in an ambulatory care clinic,you would advise that:

A) Self-help groups are, by nature, directed, funded, and led by those requiring help, and that the patients and families should need no help from your clinic.
B) Your healthcare organization will be pleased to help as long as your organization financially takes over responsibility for direction, leadership, and management.
C) Partnering with patients and families to provide self-help geriatric services is a growing trend in health care.
D) The services that the patients and spouses are proposing are likely being offered somewhere else already.

Question 21

In capitation,which of the following scenarios is most likely to occur?

A) If the costs of caring for a patient are less than the capitated amount, the organization realizes a profit.
B) If the capitated amount is less than the costs of caring for a patient, the organization realizes a profit.
C) In capitation, profit is not directly tied to the costs for provision of care.
D) Capitation has little or no effect on the aims and purposes of providing care.

Question 22

Which of the following patients would be most likely to be covered under Medicare?

A) Jim, who lives on the street and has occasional infections
B) Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections
C) Karen, a housewife, 45 years of age, whose husband recently abandoned the family
D) Dan, who is 68 years of age and in good health

Question 23

As a nurse manager in a for-profit hospital,you are interested in promoting teaching programs for physicians,as evidence suggests that hospitals with teaching programs tend to promote better care for patients.Your administration indicates that it cannot support your ideas or proposal because of

A) Increased salary costs.
B) Duplication of tests and procedures.
C) Higher costs of technology.
D) Potential damage to reputation through learner error.

Question 24

As a nurse manager,you would expect which of the following to be the major contributor to funding and revenues in your organization?

A) The federal government
B) Medicare
C) Medicaid
D) Blue Cross/Blue Shield

Question 25

The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS.This means that the Wellington facility:

A) Could not accept mental health patients who were Medicare beneficiaries.
B) Would be able to care for only Medicaid and not Medicare beneficiaries.
C) Has not met the standards set by the CMS as determined by an external review panel.
D) Has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

Question 26

Which of the following is an outcome of managed care?

A) Shift of patients to outpatient and home health services
B) Less complexity in funding sources
C) Less complexity in rules for consumers to follow
D) Greater consistency in the quality of care