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 A
Explanation
The correct answer is choice A. Providing quiet time during visits for prayer or meditation is an appropriate intervention for a client who has been diagnosed with end-stage breast cancer. This intervention helps the client reduce stress, anxiety, and promote spiritual well-being. The faith community nurse should aim to provide holistic care that addresses the physical, emotional, social, and spiritual aspects of the client's health. The nurse should be aware of the client's cultural and religious beliefs and support the client in a way that aligns with these beliefs.
Choice Bis not the correct answer. Hospice services should be recommended based on the client's wishes and not suggested without discussion with the client. The nurse should provide the client with information about all available options and allow the client to make an informed decision.
Choice Cis not the correct answer. Placing the client's name and medical condition on an online prayer chain violates the client's privacy and confidentiality. The nurse should respect the client's wishes regarding sharing health information.
Choice D is not the correct answer. The nurse should encourage the client to express feelings and concerns about their health status. The nurse should be an active listener and provide emotional support to the client.
Correct Answer is C
Explanation
The correct answer is Choice C because, "Review the immunization records of the child's classmates." Koplik spots are a sign of measles, a highly contagious viral illness. Reviewing the immunization records of the child's classmates can help determine if there is an outbreak and assist in preventing further spread of the illness. Checking the child's classmates for parotid gland enlargement (Choice A is wrong because) is not relevant because it is a sign of mumps, a different illness. Asking the caregivers if the child recently used alcohol-based mouthwash (Choice B is wrong because) and instructing the caregivers to increase the child's Vitamin B12 intake (Choice D is wrong because) are not relevant because they do not relate to the presence of Koplik spots.
Choice A is wrong because: Checking the child's classmates for parotid gland enlargement is not relevant because it is a sign of mumps, not measles.
Choice B is wrong because: Asking the caregivers if the child recently used alcohol-based mouthwash is not relevant to the presence of Koplik spots.
Choice D is wrong because: Instructing the caregivers to increase the child's Vitamin B12 intake is not relevant to the presence of Koplik spots.
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