A 66-year-old man calls for an appointment with the PMHNP. He tells the administrative assistant that he will have no problem paying his bill because he has Medicare Part A. Which of the following is NOT covered by Medicare Part A?
Skilled nursing facility services up to 100 days
Hospice for up to 6 months
Hospitalizations up to 90 days
Ambulatory services
The Correct Answer is D
Choice A reason: Medicare Part A covers skilled nursing facility care for up to 100 days following a qualifying hospital stay. This includes rehabilitation and medically necessary services.
Choice B reason: Hospice care is covered under Medicare Part A for individuals certified as terminally ill, typically for up to 6 months, though extensions are possible based on continued eligibility.
Choice C reason: Inpatient hospital care is a core benefit of Medicare Part A, covering up to 90 days per benefit period, with additional lifetime reserve days available.
Choice D reason: Ambulatory services, such as outpatient visits and procedures, are covered under Medicare Part B—not Part A. Part A is limited to inpatient and facility-based care.
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Correct Answer is D
Explanation
Choice A reason: Original Medicare includes Part A (hospital insurance) and Part B (medical insurance), but it does not cover outpatient prescription drugs.
Choice B reason: Medicare Advantage (Part C) may include drug coverage, but it varies by plan. It is not the designated part of Medicare for prescription drug coverage.
Choice C reason: Medigap is supplemental insurance that helps cover out-of-pocket costs not paid by Original Medicare. It does not include prescription drug coverage.
Choice D reason: Medicare Part D is specifically designed to cover outpatient prescription drugs. It is the correct answer for identifying the part of Medicare that pays for medications.
Correct Answer is D
Explanation
Choice A reason: Calling her mother to take her home does not address the acute psychiatric risk. The client is experiencing psychosis, has expressed paranoid delusions, and made threatening statements. Sending her home without intervention poses a danger to herself and others.
Choice B reason: Administering Geodon (ziprasidone) may help manage agitation or psychosis temporarily, but it does not resolve the underlying safety concerns. Additionally, administering medication without consent in a non-emergency outpatient setting may violate ethical and legal standards.
Choice C reason: Having the mother sign a medication contract is inappropriate in this context. The client is acutely manic and psychotic, and her capacity to consent or adhere to treatment is compromised. Delaying intervention for a week could result in harm.
Choice D reason: Involuntary commitment is warranted when a client poses a danger to themselves or others due to mental illness. The client’s delusions, threats of violence, and impaired judgment meet criteria for involuntary hospitalization. This ensures safety and allows for stabilization and treatment.
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