A nurse is working with a case 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 provider is paid a fixed sum for the client on a monthly or yearly basis.
The provider bills the client directly for a predetermined percentage of the cost of services.
The client is participating in a fee-for-service health care insurance program.
The client pays the insurer a percentage of the total costs for each service rendered by the provider
The client pays the insurer a percentage of the total costs for each service rendered by the provider.
The Correct Answer is A
The correct answer is Choice A because, "The provider is paid a fixed sum for the client on a monthly or yearly basis." A health maintenance organization (HMO) provides a fixed payment to the provider for the client on a monthly or yearly basis.
Choice B is wrong because, "The provider bills the client directly for a predetermined percentage of the cost of services," is not the correct answer. This is an example of a fee-forservice payment structure, not an HMO payment structure.
Choice C is wrong because, "The client is participating in a fee-for-service health care insurance program," is not the correct answer. This is not an HMO payment structure.
Choice D is wrong because, "The client pays the insurer a percentage of the total costs for each service rendered by the provider," is not the correct answer. This is an example of a preferred provider organization payment structure, not an HMO payment structure.
Explanation: An HMO provides a fixed payment to the provider for the client on a
monthly or yearly basis. The provider billing the client directly for a
predetermined percentage of the cost of services, the client participating in a feefor-service health care insurance program, and the client paying the insurer a percentage of the total costs for each service rendered by the provider are not examples of HMO payment structures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is Choice D because "Explore possible solutions with the partner." When a hospice nurse is concerned that the partner of a client is experiencing caregiver burden, the first step is to explore possible solutions with the partner. This involves assessing the partner's needs, concerns, and limitations, and working collaboratively to develop a plan of care that meets the needs of both the client and the partner. This may involve arranging for additional support, such as respite care or home health services, or modifying the care plan to make it more manageable for the partner.
Choice A is wrong because Suggesting assistive personnel visits daily to provide client care (Choice A is wrong because) may provide additional support, but it does not address the partner's caregiver burden.
Choice B is wrong because Teaching the partner about getting enough rest (Choice B is wrong because) may be helpful, but it does not address the underlying caregiver burden and may be perceived as dismissive of the partner's concerns.
Choice C is wrong because Encouraging the partner to invite family members to assist with client care (Choice C is wrong because) may provide additional support, but it assumes that the partner has family members who are available and willing to assist and does not address the underlying caregiver burden.
Correct Answer is C
Explanation
The correct answer is Choice C because, "Clients will schedule bone density screenings." Postmenopausal women are at an increased risk for osteoporosis, and bone density screenings can help identify early signs of the disease, enabling early intervention to prevent complications.
Choice A is wrong because, "Clients will start hormone replacement therapy," is not the correct answer because hormone replacement therapy is not appropriate for all women and can have
negative side effects. It is not an appropriate outcome for an educational program.
Choice B is wrong because, "Clients will significantly decrease caloric intake," is not the correct answer because this outcome is not relevant to postmenopausal women specifically. Additionally, significant caloric restriction can lead to malnutrition and other negative health outcomes.
Choice D is wrong because, "Clients will arrange for mammograms every 3 years," is not the correct answer because while mammograms are an important screening tool for breast cancer, they are not specific to postmenopausal women and should be recommended to all women starting at age 40. Bone density screenings are a more appropriate outcome for a program specifically targeting postmenopausal women.
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