A nurse is collaborating with a case manager for a client who is part of a health maintenance organization. Which of the following payment structures does a health maintenance organization typically use?

The provider directly bills the client for a predetermined percentage of the cost of services.

The client pays the insurer a percentage of the total costs for each service provided.

The provider receives a fixed sum from the client on a monthly or yearly basis.

The client pays the provider directly for each individual service rendered.

Answer and Explanation

The Correct Answer is C

Choice A rationale

While it’s true that some healthcare providers may bill clients directly for a predetermined percentage of the cost of services, this is not typically how health maintenance organizations (HMOs) operate. In an HMO, the provider usually has a contract with the HMO and receives payment directly from the HMO, not the client.

Choice B rationale

This choice describes a type of cost-sharing arrangement known as coinsurance, where the client pays a percentage of the total costs for each service provided. However, this is more characteristic of certain types of insurance plans, such as preferred provider organizations (PPOs), rather than HMOs.

Choice C rationale

This is the correct answer. In an HMO, the provider typically receives a fixed sum from the HMO on a monthly or yearly basis, regardless of the number of services rendered. This payment structure is known as capitation.

Choice D rationale

This choice describes a fee-for-service payment structure, where the client pays the provider directly for each individual service rendered. While this was a common payment method in the past, it is not typically used by HMOs. In an HMO, the provider usually receives payment directly from the HMO, not from the client.

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Correct Answer is B

Explanation

Choice A rationale

Discussing the risks of being homeless with the client is an important part of understanding their situation, but it is not the nurse’s initial action when caring for a client who is homeless. The nurse’s initial action should be to establish trust and understand the client’s perspective.

Choice B rationale

This is the correct answer. Determining the client’s understanding of their living situation is the nurse’s initial action when caring for a client who is homeless. This helps the nurse to understand the client’s perspective and to tailor care to meet the client’s unique needs.

Choice C rationale

Assisting the client to develop goals for obtaining shelter is an important part of the care plan for a client who is homeless, but it is not the nurse’s initial action. The nurse’s initial action should be to establish trust and understand the client’s perspective.

Choice D rationale

Developing client teaching using a variety of strategies is an important part of nursing care, but it is not the nurse’s initial action when caring for a client who is homeless. The nurse’s initial action should be to establish trust and understand the client’s perspective.

A. Wide-angle glaucoma. B. Chronic kidney disease. C. Chronic obstructive pulmonary disease. D. Osteoarthritis.

Correct Answer is D

Explanation

Choice A rationale

Wide-angle glaucoma is a type of eye condition that can affect vision, but it is not typically associated with an increased risk of falls.

Choice B rationale

Chronic kidney disease can have many effects on the body, but it is not typically identified as a direct risk factor for falls.

Choice C rationale

Chronic obstructive pulmonary disease (COPD) can cause shortness of breath and fatigue, which could potentially contribute to instability. However, it is not one of the most common conditions associated with an increased risk of falls.

Choice D rationale

Osteoarthritis can cause pain and stiffness in the joints, which can lead to mobility issues and an increased risk of falls. Therefore, a nurse should identify osteoarthritis as a condition that increases a client’s risk for falls.

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A nurse is collaborating with a case manager for a client who is part of a health maintenance organization. Which of the following payment structures does a health maintenance organization typically use?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is homeless. What should be the nurse’s initial action?

Correct Answer is B

Explanation

A home health nurse is assessing the health history of a new client.Which of the following conditions should the nurse identify as increasing the client’s risk for falls?

Correct Answer is D

Explanation

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