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, "State health departments report selected STIs to the National Institutes of Health." This is the correct answer because state health departments are responsible for reporting selected STIs to the National Institutes of Health, which is an important regulation regarding STIs.
Choice A is wrong because, "Clients who have STIs are legally required to provide a list of sexual partners," is
not the correct answer because while clients who have STIs are strongly encouraged to provide a list of sexual partners for partner notification and treatment purposes, there is no legal requirement for them to do so.
Choice B is wrong because, "Congress mandates the requirements for STI reporting," is not the correct answer because STI reporting requirements are set by public health agencies, not by Congress.
Choice C is wrong because, "Nurses should withhold the name of the client who has an STI during partner notification," is not the correct answer because while nurses are required to maintain confidentiality of their clients, they are also obligated to report certain communicable diseases, including STIs, to public health authorities, who may need to conduct partner notification and treatment efforts.
Correct Answer is A
Explanation
The correct answer is Choice A because, "I am obese because it's in my genes." The client is using rationalization as a coping mechanism by justifying their obesity as being predetermined by their genes, rather than acknowledging their personal responsibility in managing their weight. Rationalization is a defense mechanism in which a person gives a false or socially acceptable explanation for an unacceptable behavior or situation.
Choice B is wrong because, "I have difficulty resisting the items in vending machines," is not the correct answer because it is an excuse rather than a rationalization.
Choice C is wrong because, "I know you don't like me because I am obese," is not the correct answer because it is an example of projection, in which the client attributes their own feelings of dislike to others.
Choice D is wrong because, "I have lots of health problems from being obese," is not the correct answer because it is a justification, not a rationalization
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