A nurse is working with a care manager for a client who participates in a health maintenance organization. The nurse should identify that a health maintenance organization provides which of the following payment structures?
The client is participating in a fee-for-service health care insurance program.
The provider is paid a fixed sum for the client on a monthly or yearly basis.
The client pays the insurer a percentage of the total costs for each service rendered by the provider.
The provider bills the client directly for a predetermined percentage of the cost of services.
The Correct Answer is B
Choice A reason: A fee-for-service health care insurance program is not a payment structure of a health maintenance organization. In a fee-for-service program, the client pays a premium to the insurer, and the insurer pays the provider for each service rendered, regardless of the outcome or quality of care.
Choice B reason: A fixed sum payment for the client on a monthly or yearly basis is a payment structure of a health maintenance organization. In this structure, the provider receives a set amount of money per client per period of time, regardless of the number or type of services provided. This encourages the provider to deliver preventive and primary care, and to avoid unnecessary or costly procedures.
Choice C reason: A percentage of the total costs for each service rendered by the provider is not a payment structure of a health maintenance organization. This is a type of cost-sharing arrangement, where the client pays a portion of the expenses and the insurer pays the rest. This may result in higher out-of-pocket costs for the client and higher utilization of services by the provider.
Choice D reason: A predetermined percentage of the cost of services is not a payment structure of a health maintenance organization. This is a type of discounted fee-for-service arrangement, where the provider agrees to accept a lower fee than the usual charge for each service. This may reduce the costs for the insurer, but not necessarily for the client or the provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Reviewing flashcards that identify holding techniques with the group is not an instructional strategy that the nurse should use to promote psychomotor learning. This is a cognitive strategy that can help the participants to recall and recognize the information, but it does not involve the practice or performance of the skills.
Choice B reason: Showing the group a video on breastfeeding techniques is not an instructional strategy that the nurse should use to promote psychomotor learning. This is an affective strategy that can help the participants to observe and appreciate the techniques, but it does not involve the practice or performance of the skills.
Choice C reason: Facilitating a discussion group about the benefits of breastfeeding is not an instructional strategy that the nurse should use to promote psychomotor learning. This is an affective strategy that can help the participants to express and share their opinions and feelings, but it does not involve the practice or performance of the skills.
Choice D reason: Providing dolls for the participants to demonstrate positioning is an instructional strategy that the nurse should use to promote psychomotor learning. This is a psychomotor strategy that can help the participants to apply and practice the skills in a simulated setting, and to receive feedback and guidance from the nurse.
Correct Answer is B
Explanation
Choice A reason: This comment does not indicate rationalization, but rather a recognition of the consequences of obesity. The client may be expressing a need for help or motivation to change their lifestyle.
Choice B reason: This comment indicates rationalization, which is a defense mechanism that involves making excuses or justifying one's behavior or situation. The client may be avoiding personal responsibility or denying the possibility of change by blaming their obesity on their genes.
Choice C reason: This comment does not indicate rationalization, but rather a challenge or barrier that the client faces in achieving their health goals. The client may be acknowledging their weakness or seeking support to overcome their temptation.
Choice D reason: This comment does not indicate rationalization, but rather a projection or displacement of the client's negative feelings onto others. The client may be feeling insecure or rejected because of their obesity, and assuming that others share the same opinion.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today