TEST 2 - UNIT C - EF - HEALTHCARE DELIVERY

Question 1

Accrediting organizations such as The Joint Commission and the National Committee for Quality Assurance set standards for

Answer 1

facilities to develop policies and procedures to ensure the quality and safety of clients.

Question 2

Client satisfaction tools such as the ____________&___________ survey can be used to improve the delivery of care within an organization.

Answer 2

Hospital Consumer Assessment of Healthcare Providers and Systems and the Press Ganey

Question 3

Nursing excellence programs such as the __________&______________ provide structure for organizations to empower and involve nurses and increase employee engagement, which in turn increases retention and decreases turnover.

Answer 3

Magnet Recognition Program and the Pathway to Excellence Program

Question 4

Insurance reform has

Answer 4

changed the reimbursement structure for health care, and it continues to undergo changes today.

Question 5

Health care disparities relate to

Answer 5

inequalities beyond race and ethnicity.

Question 6

Health care disparities include

Answer 6

These include social, economic, and environmental differences, all of which influence good health.

Question 7

Clients can receive health care in a

Answer 7

wide variety of settings.

Question 8

Understanding the expertise of each member of the Interprofessional health care team can improve

Answer 8

communication and collaboration among team members, improve client care, lead to fewer preventable errors, and reduce costs.

Question 9

· Affordable Care Act (ACA)

Answer 9

o A law enacted in 2010 to improve health care quality while lowering costs and expanding the Medicaid program.

Question 10

· American Nurses Credentialing Center (ANCC)

Answer 10

o An organization that supports nurses to improve client care through education, certifications, and professional designations.

Question 11

· assisted living

Answer 11

o Provides services for clients who are mostly independent in their living but who choose to live in a community setting for assistance with some part of their daily life—for example, with meals, medication management, laundry, housekeeping, or transportation.

Question 12

· Centers for Medicare and Medicaid Services (CMS)

Answer 12

o A government agency that oversees the health care delivery of Medicare, Medicaid, and CHIP programs.

Question 13

· Children’s Health Insurance Program (CHIP)

Answer 13

o Government health care coverage that provides for children who may not meet Medicaid’s requirements but need health coverage.

Question 14

· diagnosis-related groups (DRGs)

Answer 14

o A fixed payment system for reimbursement for health care services based upon client diagnosis and procedures performed.

Question 15

· fee for service (FFS)

Answer 15

o Reimbursement payments made to service providers based on the volume of services delivered.

Question 16

· home care

Answer 16

o The delivery of continued health care services within the client s home. Services can include nurse visits as well as occupational therapy, physical therapy, and social work.

Question 17

· hospice care

Answer 17

o Services provided to clients when it is determined the client has less than six months to live. The goal is comfort and support services for the client and family, not curative.

Question 18

· Hospital-Acquired Condition Reduction Program (HACRP)

Answer 18

o A program instituted by the Centers for Medicare & Medicaid (CMS) to increase the quality of care in health care facilities. This program denies reimbursement for services associated with specific health care-acquired infections.

Question 19

· hospital-acquired infections (HAIs)

Answer 19

o An infection a client develops during an admission to an acute care facility.

Question 20

· inpatient prospective payment system (IPPS)

Answer 20

o A method of standardized insurance reimbursement based on the client’s diagnosis and procedures performed within the acute care setting.

Question 21

· long-term care hospital (LTCH)

Answer 21

o A facility that specializes in providing care for stable clients who require a lengthy period of treatment such as for severe burns, trauma, or ventilation needs.

Question 22

· Magnet Recognition Program®

Answer 22

o A program that recognizes acute care facilities that demonstrate excellence in nursing based upon meeting standards in five categories.

Question 23

· Medicaid

Answer 23

o Government health care coverage for a client who must meet eligibility requirements based on the client’s income in relation to the poverty level.

Question 24

· Medicare

Answer 24

o Government health care coverage for a client who is age 65 or older, under age 65 with disabilities, or any age with End Stage Renal Disease (ESRD).

Question 25

· Minimum Data Set (MDS)

Answer 25

o A clinical assessment of a client s physical and cognitive status required to be conducted on nursing home residents who receive Medicare and Medicaid benefits.

Question 26

· National Committee for Quality Assurance (NCQA)

Answer 26

o An organization that focuses on improving the quality of health care through the development of evidence-based standards for care.

Question 27

· palliative care

Answer 27

o Services provided to clients to promote comfort while in the last stages of life. Services can be received during active treatment. A treatment approach that is focused on the management of symptoms of chronic or life-threatening illnesses while maintaining the highest level of quality of life possible for the client.

Question 28

· Pathway to Excellence Program®

Answer 28

o A program for long-term or outpatient facilities to recognize excellence in nursing.

Question 29

· Press Ganey®

Answer 29

o A survey tool designed to evaluate the client’s perception of their experience within the outpatient setting of the health care system.

Question 30

· private insurance

Answer 30

o Insurance coverage that is not provided by a government agency.

Question 31

· resource utilization groups (RUGs)

Answer 31

??

Question 32

SNFs provide

Answer 32

short-term rehabilitation care, such as occupational and physical therapy, as well as oversight for activities of daily living.

Question 33

LTCHs specialize in

Answer 33

hospitalization for long-term care, such as clients who have severe burns, trauma, or ventilation needs. LTCHs provide a higher level of care than a SNF, such as is required for a client who is receiving mechanical ventilation.

Question 34

Assisted living facilities

Answer 34

provide services for clients who live independently but may require assistance with some tasks of their daily living, such as medications and meals.

Question 35

Hospice care is provided to

Answer 35

clients when the provider has determined they have less than 6 months to live.

Question 36

The goal of care is not to

Answer 36

treat or cure the illness, but to provide comfort and support services for clients who have less than 6 months to live.

Question 37

Hospice care can be provided to a client in

Answer 37

many settings, including inpatient facilities or the client’s home.

Question 38

The hospice team continues to support the family after

Answer 38

the client has passed, sometimes up to a year.

Question 39

Social determinants of health are

Answer 39

economic and social conditions that affect health promotion and disease prevention. Economic stability is a social determinant of health that encompasses employment. Lack of employment can lead to food insecurity, housing instability, and poverty.

Question 40

Education is a

Answer 40

social determinant of health that encompasses early childhood education and development, higher education, high school graduation, and language and literacy.

Question 41

Social and community context is a social determinant of health that encompasses

Answer 41

civic participation, discrimination, incarceration, and social cohesion.

Question 42

Neighborhood and built environment is a

Answer 42

social determinant of health that encompasses access to foods that support healthy eating patterns, crime and violence, environmental conditions, and quality of housing.

Question 43

Initiatives to reduce health care disparities is a component of the

Answer 43

Healthy People program.

Question 44

The overall goal of the Healthy People programis to address the

Answer 44

physical and social well-being of people.

Question 45

Activities to improve social determinants of health is a component of the

Answer 45

Healthy People program. The overall goal of the program is to address the physical and social well-being of people.

Question 46

Providing preventative care services is not a component of

Answer 46

the Healthy People program.

Question 47

Improving access to health care is a component of the

Answer 47

Healthy People program. The overall goal of the program is to address the physical and social well-being of people.

Question 48

Reducing the infection rate is not an objective that

Answer 48

the Healthy People program focuses on.

Question 49

With the fee-for-service delivery system, health care providers and organizations are reimbursed by insurance companies based on

Answer 49

the volume of services provided versus providing quality care across the continuum.

Question 50

Obtaining information from a client’s insurance company is not

Answer 50

obtaining a fee-for-service insurance reimbursement.

Question 51

DRG is a classification system that is used to

Answer 51

establish a payment structure for clients based on their primary diagnosis, age, and sex.

Question 52

Obtaining information from a client’s insurance company prior to a procedure is not using the

Answer 52

DRG payment structure.

Question 53

A retrospective review is reviewing services

Answer 53

after they have been rendered. This can include the review of the retrospective fee for service and DRG to determine coverage and eligibility.

Question 54

The nurse is obtaining precertification from the client’s insurance company prior to scheduling the client’s MRI. Before an elective surgery, hospital admission, or procedure such as a magnetic imaging study, a client needs to obtain

Answer 54

precertification or authorization approval from the insurance company, or the service can risk denial of payment.

Question 55

Pathway to Excellence® recognized facilities are committed to

Answer 55

providing a healthy, supportive environment for their staff.

Question 56

Magnet facilities need an

Answer 56

on-site review to receive the Magnet Recognition Program® award.

Question 57

Shared governance is one strength of the

Answer 57

Pathway to Excellence® Program.

Question 58

Pathway to Excellence® Program. facility emphasizes practices that positively affect a

Answer 58

healthy workplace environment.
Having structures in place that positively affect the nurse’s well-being promotes a

Question 59

Having structures in place that positively affect the nurse’s well-being promotes a

Answer 59

healthy workplace environment.

Question 60

The Magnet Recognition Program® focuses on

Answer 60

improving clinical quality indicators.

Question 61

A limited income to purchase food is a

Answer 61

social determinant of health.

Question 62

A poor quality school system is a

Answer 62

social determinant of health.

Question 63

An inability to read food labels is a

Answer 63

social determinant of health.

Question 64

The nurse should identify that poor air quality is a

Answer 64

physical determinant of health.

Question 65

Physical determinants of health are related to the client’s

Answer 65

physical environment.

Question 66

Other physical determinants of health can include

Answer 66

leaky pipes, lead paint, housing that requires maintenance, and living in a confined area with multiple families.

Question 67

In general, social workers collaborate with the interprofessional health care team to help

Answer 67

find solutions to client challenges and advocate for resources to help resolve issues.

Question 68

Dietitians assist clients with

Answer 68

food choices, nutrition, and therapeutic diets related medical conditions.

Question 69

Physical therapists offer services to

Answer 69

improve clients’ movement and alleviate pain. This can include exercises, stretching, and joint manipulation to improve function and mobility and can be provided in the client’s home.

Question 70

Occupational therapists assist clients with their

Answer 70

ADLs due to an illness, surgery or injury. ADLs can include bathing, dressing and eating.

Question 71

Social workers collaborate with the interprofessional health care team to help

Answer 71

find solutions to client challenges, such as finances and finding housing for clients who are unable to go back to their home.

Question 72

An APRN is a p

Answer 72

rimary care provider who can diagnose and treat clients, as well as write prescriptions. Some APRNs can work independently, while others must work under a physician’s license depending on their state’s scope of practice.

Question 73

PAs can

Answer 73

treat, diagnose, and prescribe medication for clients. They work under the direction and supervision of a physician.

Question 74

Pa’s work under the direction / supervision of

Answer 74

a physician.

Question 75

Pharmacists

Answer 75

prepare and dispense medications according to a prescription ordered by a provider. However, they cannot write prescriptions.

Question 76

Can pharmacist write prescriptions

Answer 76

No

Question 77

Many primary care providers are

Answer 77

physicians.

Question 78

A physician

Answer 78

diagnoses and treats illness, and can prescribe medication and therapies as needed.

Question 79

Competition is not one of the five competencies identified by

Answer 79

the IOM that health care professionals need in order to reduce errors.

Question 80

Cooperation is one of the five competencies identified by

Answer 80

the IOM that health care professionals need in order to reduce errors.

Question 81

Communication is one of the five competencies identified by

Answer 81

the IOM that health care professionals need in order to reduce errors.

Question 82

Resolution is not one of the five competencies identified by

Answer 82

the IOM that health care professionals need in order to reduce errors.

Question 83

Coordination is one of the five competencies identified by the

Answer 83

IOM that health care professionals need in order to reduce errors.

Question 84

The ACA does provide coverage for clients who have

Answer 84

pre-existing conditions.

Question 85

The ACA banned maximum payout amounts of covered insurance benefits to provide

Answer 85

preventative and maintenance health care to clients.

Question 86

Clients who have insurance are not charged co-pays or deductibles for

Answer 86

preventable screenings.

Question 87

Aside from making insurance coverage more affordable and available, a focus of the ACA is

Answer 87

disease prevention. Clients are encouraged to sign up for insurance and seek preventative care before they get sick, so they can stay well.

Question 88

Clients are encouraged to sign up for insurance and seek preventative care before

Answer 88

they get sick, so they can stay well.

Question 89

To qualify for Medicaid, the client must meet eligibility requirements based on the

Answer 89

client’s income in relation to the poverty level.

Question 90

Medicaid provides coverage regardless of

Answer 90

age if the client meets the income requirements.

Question 91

In order to qualify for Medicare, the client must be

Answer 91

age 65 or older, under age 65 with disabilities, or any age with end-stage renal disease (ESRD).

Question 92

Medicaid is administered under the

Answer 92

federal government and mandates that every state must provide inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services for clients who have Medicaid.

Question 93

Medicaid is partially funded by

Answer 93

state governments and is administered under the federal government. Income eligibility varies from state to state.

Question 94

Case managers are responsible for

Answer 94

managing resources, reviewing care delivery in the acute care setting, and facilitating transfer to the required level of care, either within the facility or to another facility.

Question 95

Case managers manage the

Answer 95

care of services delivered to clients. They do not provide

Question 96

Case managers manage do not provide

Answer 96

client care or perform physical assessments.

Question 97

Case managers manage care services for clients with c

Answer 97

omplex conditions to reduce the number of acute services needed. They do not provide direct client care or administer medications.

Question 98

Case managers manage care services for clients with

Answer 98

complex conditions to reduce the number of acute services while maintaining quality care. They do not provide direct client care such as wound care.

Question 99

A skilled nursing facility, sometimes referred to as a nursing home, provides

Answer 99

long-term nursing care and short-term rehabilitation, such as occupational and physical therapy, as well as oversight for activities of daily living.

Question 100

A long-term care hospital is one that specializes in clients that

Answer 100

require hospitalization for long-term care for severe burns, trauma, ventilation needs, or a chronic condition. These clients are unable to live independently and require partial or total assistance of health care staff.

Question 101

Acute care facilities specialize in clients who require

Answer 101

short term treatment (ex 7 days) , such as IV medications, diagnostic procedures, and dressing changes.

Question 102

Assisted living is available for

Answer 102

independent clients who wish to live in a community setting and have their own residence, such as an apartment. These clients might need assistance with taking medication and meals.

Question 103

Diagnosis-related groups (DRGs) establish a

Answer 103

reimbursement based on a client’s age, sex, and primary diagnosis.

Question 104

The HACRP reduces reimbursement to facilities that have

Answer 104

poor outcomes related to five different hospital-acquired infections.

Question 105

Centers for Medicare & Medicaid Services will not reimburse the facility for the costs associated w/

Answer 105

treatment for the infection and the extended stay of the client.

Question 106

The HACRP was implemented to incentivize hospitals to

Answer 106

provide high-quality care for their clients.

Question 107

The HACRP reduces reimbursement to facilities that have poor outcomes related to

Answer 107

five different hospital-acquired infections. What are the five infections

Question 108

The Inpatient Prospective Pay System uses a formula to determine the

Answer 108

length of hospitalization for clients who have the same diagnosis.

Question 109

The HACRP is used in the acute care setting to incentivize hospitals to

Answer 109

provide high-quality care for their clients.

Question 110

Resource utilization group (RUG) is a reimbursement structure that is

Answer 110

not used in the acute care setting.

Question 111

Access to foods that support healthy eating patterns is correct. The nurse should identify that access to foods that support health eating patterns is a part of the _________&__________ determinant category, which is one of the five social determinants of health according to Healthy People 2020.

Answer 111

eighborhood and built environment

Question 112

Access to health care is under the category health and health care, which is one of the

Answer 112

five social determinants of health according to Healthy People 2020.

Question 113

The nurse should identify that crime and violence are a part of the

Answer 113

neighborhood and built environment determinant category, which is one of the five social determinants of health according to Healthy People 2020.

Question 114

The nurse should identify environmental conditions are a part of the

Answer 114

neighborhood and built environment determinant category, which is one of the five social determinants of health according to Healthy People 2020.

Question 115

Civic participation is under the category

Answer 115

social and community context factor, which is one of the five social determinants of health according to Healthy People 2020.

Question 116

TJC is a

Answer 116

non-profit organization that works to ensure safe, high-quality client care and identify areas of improvement.

Question 117

Accreditation by TJC is

Answer 117

voluntary for all health care facilities.

Question 118

TJC works to ensure

Answer 118

safe, high-quality client care, and identify areas of improvement.

Question 119

Health care facilities that are accredited by the TJC meet the

Answer 119

basic quality standards required by The Centers for Medicare and Medicaid Services.

Question 120

TJC accredits

Answer 120

health care organizations in over nine different types of health care settings, from inpatient hospitals to pharmacies.

Question 121

TJC monitors

Answer 121

state legislative and regulatory changes and updates its standards accordingly. This monitoring acts as a two-part system to ensure that accredited organizations remain current with state requirements.

Question 122

DRGs do not establish

Answer 122

reimbursement amounts for hospitals based on the length of the client’s hospitalization. DRGs establish reimbursement amount based on client’s age, sex, and primary diagnosis.

Question 123

To encourage hospitals to provide quality care to their clients, Medicare requires payment reduction to facilities that have

Answer 123

poor outcomes related to hospital-acquired infections.

Question 124

This is not a requirement for reimbursement. However, reimbursement can be reduced if a

Answer 124

client acquires an infection after admission.

Question 125

IPPS is a

Answer 125

prospective payment system that determines the length of stay and the reimbursement amount for a client depending on their DRG. However, payment is not made to the facility in advance according to the IPPS.

Question 126

Palliative care services provide

Answer 126

comfort measures for clients who are receiving active treatment for their illness.

Question 127

Respite care provides care for a client to

Answer 127

allow their caregiver a break from the responsibilities of caring for their loved one.

Question 128

Hospice care is provided for clients when the provider has determined the client has

Answer 128

less than 6 months to live. The goal is to not treat or cure the client’s illness but to provide comfort and supportive services.

Question 129

Physical therapists offer services to improve

Answer 129

clients’ movement and alleviate pain. This can include exercises, stretching, and joint manipulation to improve function and mobility and can be provided in the client’s home.

Question 130

The MDS assessment is an

Answer 130

interdisciplinary document used by the Centers for Medicare & Medicaid Services (CMS) to determine reimbursement. It should include input from the client’s interdisciplinary team members to ensure that the facility receives the correct payments.

Question 131

The MDS assessment is an interdisciplinary document used by the Centers for Medicare & Medicaid Services (CMS) to determine reimbursement. It should include the

Answer 131

cognitive status of the client,
the need for assistance with activities of daily living,
and the number of treatments and therapies provided.

Question 132

A description of the client’s home environment is ____included in the MDS assessment.

Answer 132

not

Question 133

The HCAHPS tool is provided to clients

Answer 133

48 hr to 6 weeks after discharge from a facility to measure client satisfaction with the health care service.

Question 134

The HCAHPS tool is issued to a

Answer 134

random sample of clients 48 hr to 6 weeks after discharge from a facility to measure client satisfaction with the health care service.

Question 135

The HCAHPS tool is issued to

Answer 135

measure client satisfaction with the health care service. The information is publicly reported and ensures the accountability and transparency of the facilities that participate. The HCAHPS tool uses a broad range of questions issued to the client regarding their care. This information is published publicly to show how the facility is performing and their accountability.

Question 136

The HCAHPS tool is issued to clients via a

Answer 136

phone call or through the postal mail, not via an email.

Question 137

An SNF sometimes referred to as a nursing home, provides nursing care for

Answer 137

short term rehabilitation, such as occupational and physical therapy, as well as oversight for activities of daily living.

Question 138

A client who is receiving hospice care does not require admission to

Answer 138

a SNF or a LTC facility or assisted living facility

Question 139

An LTCH specializes in hospitalization for

Answer 139

long-term care such as clients who have severe burns, trauma, or ventilation needs. These clients are unable to live independently and require partial or total assistance by health care staff.

Question 140

The nurse should recommend that the client’s partner consider placing the client in respite care. Respite care is a benefit offered under

Answer 140

hospice care that allows clients to receive up to 5 days of care. This can help provide client caregivers relief and rest from the duties of caring for their loved one.

Question 141

Assisted living is available for

Answer 141

ndependent clients who wish to live in a community setting and have their own residence, such as an apartment. These clients might need assistance with taking medication and meals. A client who is receiving hospice care does not qualify for admission to assisted living.