Nursing Chapter 5 What Type Formulary Does This Insurance Company

subject Type Homework Help
subject Pages 9
subject Words 3118
subject Textbook Leadership and Management for Nurses: Core Competencies for Quality Care 3rd Edition
subject Authors Anita Finkelman

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13) The vice president of nursing services is completing a budgetary report for the governing
board meeting this week. In which category should this nurse place the total expenditure for
health benefits for nursing employees?
1. Salary and wages
2. Operations
3. Capital
4. Accounts receivable
14) The nurse manager has been asked to provide numbers associated with productivity to the
hospital chief financial officer. Which components should the manager report?
1. The ratio of staff to patients
2. The number of patients to the number of FTEs
3. The ratio of department output to the resources consumed
4. The department input divided by its output
15) One of the strategies used by insurers to control costs and quality is the delineation of the
services that will and will not be covered. Choose the services that would typically be covered by
most insurance plans. Select all that apply.
1. Outpatient and inpatient surgery
2. Elective abortions
3. Nursing services
4. Diagnostic tests
5. Mental healthcare
16) Understanding the microlevel of healthcare financing is most important to which nurse?
1. The nursing student
2. The new graduate
3. The staff nurse
4. The nurse manager
17) Which factors influence the financing of healthcare in the United States? Select all that
1. Political factors
2. Increasing length of stay
3. Social expectations
4. Public indifference
5. The national economy
18) Today's healthcare is generally financed through a third party payer system. Who is the
second party in this system?
1. Provider
2. Medicare
3. Patient/enrollee
4. Insurance company
19) Based on data presented in this textbook, which HAC is the most costly based on 2012-2013
1. Falls
2. Pressure ulcers
3. Catheter-associated urinary track infections
4. Adverse drug events
20) If you were explaining Medicare and Medicaid, which of the following statements would
you include? Select all that apply
1. Medicare is funded by the state and federal government.
2. Poverty levels impact enrollment in Medicaid.
3. The Affordable Care Act of 2010 has had an impact on Medicare and Medicaid.
4. Social security payments impact Medicare.
5. DRGs were developed to improve Medicare reimbursement.
21) The pharmacist tells a patient that the insurance company will pay for a new medication, but
that the patient will have to pay an additional co-pay of $45. What type of formulary does this
insurance company maintain?
1. Exclusionary
2. Open
3. Incentive
4. Closed
22) Which strategy started by managed care is now the most important strategy used to try to
manage outcomes?
1. Formularies
2. Provider performance
3. Efficiency management
4. Provider panels
23) The parent of a child with a serious health problem has an opportunity to take a new job but
is concerned about insurance coverage. Which statements are true concerning this situation and
the Healthcare and Education Reconciliation Act of 2010? Select all that apply.
1. Young adults will be able to stay on their parent's insurance until their 30th birthday.
2. Lifetime benefits are capped at one million dollars.
3. Children with preexisting conditions cannot be excluded from coverage.
4. Annual limits on coverage are less restrictive.
5. Families will receive a $1,000.00 rebate to help provide care until new insurance is valid.
24) Which statement, made by a newly promoted nurse manager, indicates good understanding
of full-time equivalents (FTE) as a component of the unit budget? Select all that apply.
1. An FTE is equal to 2,080 hours per year.
2. FTE is different from worked FTE.
3. FTEs can be used to measure a nurse's productivity.
4. FTEs are a measure of effectiveness.
5. FTE is a count of the people working on the unit at any specific time.
25) The nurse notices that there are four boxes of 180-gauge IV start catheters in the supply
room even though the standard IV start on the unit is done with a 20-gauge IV catheter. What
should the nurse do?
1. Consult with the nurse manager about the situation.
2. Send the catheters back to central supply.
3. Send the catheters to a unit that uses this size.
4. Start using 18-gauge catheters for IV starts on the unit.
26) What approach does the IOM/NAM report Best Care at Lower Costs emphasize?
1. Reducing cost of care for complex illness
2. Leadership focused on continuous learning
3. Emphasize quality improvement in the acute care sector
27) What is area of healthcare has the highest percentage of the nation's healthcare dollar (2011)?
1. Physicians and clinics
2. Prescriptions
3. Hospital care
4. Nursing care facilities and continuing care retirement communities
28) What is the difference in the healthcare customer and the healthcare consumer?
1. The customer pays for all services the patient receives.
2. The healthcare provider is the customer and the patient the consumer.
3. The employer may be the customer and the consumer.
4. The customer contracts with the insurer and the consumer receives the care.

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