,Chapter 01: The Health Care System
Linton: Introduction to Medical-Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. An 89-year-old man, who was recently discharged from a rehabilitation hospital because of an
inability to concentrate and frequent memory lapses, cannot be left alone while his family
works. What options should the discharge planning team suggest that will satisfy safety
concerns and give the greatest quality of life to the patient?
a. Placement in a day care center from 8 AM to 5 PM daily
b. Placement in a long-term psychiatric facility
c. Placement in a high-security nursing home
d. Admission to a general hospital for evaluation
ANS: A
Day care centers provide supervision, safety, nutritious meals, and socialization while the
caregiving family works.
DIF: Cognitive Level: Application REF: p. 7 OBJ: 5
TOP: Day Care Centers KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Reduction of Risk
2. A 66-year-old hospitalized patient is anxious about how the physician will be paid now that he
is on Medicare Parts A and B, instead of his previous privately funded insurance plan. Who
should the nurse explain is the payor to the physician on this plan?
a. Previous privately funded insurance plan
b. Medicare Part A
c. Medicare Part B
d. Patient or patient’s family
ANS: C
Part A pays skilled care facilities. Part B pays for physician’s services. The previously held
insurance is no longer available because of the patient’s age. The family or patient is not
responsible because Part B is in effect.
DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 4
TOP: Health Care Funding KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
3. What health care plan is the best referral for an unemployed 42-year-old patient with renal
failure who has lost his job-related private insurance?
a. Medicare
b. Medicaid
c. Public health facility
d. Community-based outpatient clinic
ANS: B
Medicaid is available to needy low-income persons younger than 65 years of age who have a
permanent disability. Medicare is for persons 65 years and older. Public health services are
involved with prevention more often than with chronic care.
, DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 4
TOP: Health Care Funding KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
4. A patient with terminal lung cancer with extensive metastasis is requesting a hospice transfer.
What criteria are included as requirements for this transfer?
a. The patient requests and agrees to the guidelines of hospice care without requiring
a physician’s order.
b. The physician confirms that the patient has 6 months or less of life remaining and
has provided a written order for hospice care.
c. Proof confirms that the family can no longer care for the patient at home.
d. The patient’s specific diagnosis is included on a list of accepted diseases that
qualifies the patient for hospice care.
ANS: B
The four criteria for transfer to hospice care are (1) diagnosis of any terminal illness, (2)
prognosis of less than 6 months of life, (3) informed consent of patient, and (4) written
physician’s order.
DIF: Cognitive Level: Comprehension REF: p. 7 OBJ: 5
TOP: Hospice Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
5. A patient admitted yesterday with a diagnosis-related group (DRG) diagnosis of abdominal
pain of an unknown cause is being discharged this afternoon because all diagnostic test results
have been negative. What does this scenario exemplify?
a. Effective laboratory response
b. Medicare guidelines limiting hospital stay
c. Cost containment related to a DRG diagnosis
d. Patient who should not have been admitted in the first place
ANS: C
Cost containment is a means by which the cost of hospitalization time is reduced when the
need for acute hospital care is no longer necessary.
DIF: Cognitive Level: Comprehension REF: p. 11-12 OBJ: 6
TOP: Cost Containment per DRGs KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
6. A nurse is discussing discharge to a transitional subacute facility with a 72-year-old patient
diagnosed with diabetes and bilateral leg amputation. What should the nurse inform the
patient regarding the stay in the new facility?
a. It will be limited to 25 days.
b. It will be limited to 50 days.
c. It will be limited to 75 days.
d. It is totally unlimited.
ANS: D
Medicare limitations are waived for patients who have undergone amputations.
DIF: Cognitive Level: Comprehension REF: p. 8 OBJ: 4
TOP: Stay in a Skilled Care Facility KEY: Nursing Process Step: Planning
, MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
7. A patient is applying for Medicaid. What does the receipt of benefits require?
a. Following a supervised health maintenance plan
b. Enrolling in the Medicare-Preferred Drug Plan
c. Qualifying for the food stamp program
d. Having an annual income of less than $10,000
ANS: B
The Medicare-Preferred Drug Plan is a condition of Medicaid eligibility. Nonenrollment may
cause the loss of all health care benefits.
DIF: Cognitive Level: Knowledge REF: p. 11 OBJ: 4
TOP: Medicare-Preferred Drug Plan KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Coordinated Care
8. Which is true concerning proprietary agencies?
a. They are organized to be nonprofit operations.
b. They are organized to make a profit on their operation.
c. Any profit they make is immediately used to purchase better equipment and
services.
d. They must participate in Medicare.
ANS: B
These agencies are usually owned by large corporations and established for the purpose of
making a profit. Although most such agencies do participate in Medicare, it is not required.
DIF: Cognitive Level: Comprehension REF: p. 6 OBJ: 6
TOP: Proprietary Agencies KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
9. Which patient should the nurse recognize as eligible for a referral to Medicaid?
a. Military automobile mechanic with severe asthma
b. Pregnant unmarried young woman employed at a discount retail store for 3 years
c. College student on scholarship who works part-time at the college library and who
needs medication for arthritis
d. Unemployed young mother on welfare who needs diabetic medication for one of
her children
ANS: D
Medicaid covers medication and health care services for welfare recipients for child health
and long-term care.
DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 4
TOP: Medicaid Services Eligibility KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Coordinated Care
10. Why was the Balanced Budget Act of 1997 the cause of closures of many proprietary home
health care agencies?
a. It specified that all care be given by registered nurses (RNs).
b. It listed specific diagnoses that could qualify a patient for home health care.
c. It limited the amount of money that could be spent on a patient.
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