NU180/NU180 EXAM 3: (NEW 2025/2026
UPDATE) NURSING AND HEALTHCARE II
GUIDE| QUESTIONS & ANSWERS| GRADE A|
100% CORRECT (VERIFIED SOLUTIONS)
1. A method of financing health care costs in which physicians are paid a fee
by the patient for each service they provide is known as: fee for service
2. Diagnosis related groups (DRG's) and prospective payment systems are
most clearly the reason for: critical pathways and managed care
3. The yearly amount an insured person must spend out-of-pocket for health
care services before a health insurance policy will begin to pay its share is
known as the: deductible
4. Which program offers an incentive to hospitals to discharge patients as
quickly as possible?: prospective payment system
5. Once a deductible has been met, the percentage of the total bill paid by the
insured person is known as the: coinsurance
6. Many older adults who are covered only by Medicaid Parts A and B find it
difficult to pay the cost of what?: prescription drugs while living at home
7. A 70-year-old patient tells the nurse "I can't go to the hospital for treatment
because I have no hospital insurance. My social security and my pension pay
my living expenses, but I don't have any savings." The nurse's response
should be focused on?: providing information regarding medicare
,8. Which response by the nurse best explains the advantage of health insurance
when a patient states "I didn't sign up for the health care insurance at my job
because I am young and healthy and can use the money in other ways": with
insurance you are spreading the risk in case you have a serious health
event, such as cancer or major trauma
9. A mother and her three children often seek medical services at the
emergency room. The nurse realizes that they have no primary care provider.
This situation is most likely due to: lack of health insurance coverage for
preventive care
10.The type of health insurance plan that requires members to choose a primary
care physician and obtain referrals to see specialists is known as: health
maintenance organization (HMO)
11.A patient asks the nurse, "What does my Medicare Part B cover?" The
nurse's best response is: outpatient services, physician visits, and
preventive care
12.Which statement by a patient indicates understanding of how a preferred
provider organization (PPO) works?: "I can see any doctor, but I pay less
if I use doctors in the network"
13.The federal health insurance program for people age 65 and older, regardless
of income, is called: Medicare
14.A patient with end-stage renal disease asks the nurse if they qualify for
Medicare. The nurse's response should be: yes, Medicare covers
individuals with end-stage renal disease regardless of age
, 15.The part of Medicare that covers prescription drugs is known as: Medicare
Part D
16.A nurse explains to a patient that the prospective payment system uses
diagnosis-related groups (DRGs) to: determine a fixed reimbursement
amount based on the patient's diagnosis
17.Which patient would most likely be eligible for Medicaid?: a low-income
pregnant woman with no health insurance
18.The managed care concept that focuses on preventing illness and promoting
wellness to reduce healthcare costs is called: health promotion and disease
prevention
19.A patient tells the nurse, "My insurance requires me to pay $40 every time I
see my doctor." The nurse recognizes this as the: copayment
20.The maximum amount a policyholder must pay out-of-pocket in a year
before the insurance company pays 100% of covered services is known as
the: out-of-pocket maximum
21.Which statement about capitation is accurate?: providers receive a fixed
monthly payment per patient regardless of services provided
22.A nurse is teaching a patient about flexible spending accounts (FSAs).
Which statement by the patient indicates understanding?: "I must use the
money I put in by the end of the year or I lose it"
23.The health insurance program that covers military veterans is
called: TRICARE
UPDATE) NURSING AND HEALTHCARE II
GUIDE| QUESTIONS & ANSWERS| GRADE A|
100% CORRECT (VERIFIED SOLUTIONS)
1. A method of financing health care costs in which physicians are paid a fee
by the patient for each service they provide is known as: fee for service
2. Diagnosis related groups (DRG's) and prospective payment systems are
most clearly the reason for: critical pathways and managed care
3. The yearly amount an insured person must spend out-of-pocket for health
care services before a health insurance policy will begin to pay its share is
known as the: deductible
4. Which program offers an incentive to hospitals to discharge patients as
quickly as possible?: prospective payment system
5. Once a deductible has been met, the percentage of the total bill paid by the
insured person is known as the: coinsurance
6. Many older adults who are covered only by Medicaid Parts A and B find it
difficult to pay the cost of what?: prescription drugs while living at home
7. A 70-year-old patient tells the nurse "I can't go to the hospital for treatment
because I have no hospital insurance. My social security and my pension pay
my living expenses, but I don't have any savings." The nurse's response
should be focused on?: providing information regarding medicare
,8. Which response by the nurse best explains the advantage of health insurance
when a patient states "I didn't sign up for the health care insurance at my job
because I am young and healthy and can use the money in other ways": with
insurance you are spreading the risk in case you have a serious health
event, such as cancer or major trauma
9. A mother and her three children often seek medical services at the
emergency room. The nurse realizes that they have no primary care provider.
This situation is most likely due to: lack of health insurance coverage for
preventive care
10.The type of health insurance plan that requires members to choose a primary
care physician and obtain referrals to see specialists is known as: health
maintenance organization (HMO)
11.A patient asks the nurse, "What does my Medicare Part B cover?" The
nurse's best response is: outpatient services, physician visits, and
preventive care
12.Which statement by a patient indicates understanding of how a preferred
provider organization (PPO) works?: "I can see any doctor, but I pay less
if I use doctors in the network"
13.The federal health insurance program for people age 65 and older, regardless
of income, is called: Medicare
14.A patient with end-stage renal disease asks the nurse if they qualify for
Medicare. The nurse's response should be: yes, Medicare covers
individuals with end-stage renal disease regardless of age
, 15.The part of Medicare that covers prescription drugs is known as: Medicare
Part D
16.A nurse explains to a patient that the prospective payment system uses
diagnosis-related groups (DRGs) to: determine a fixed reimbursement
amount based on the patient's diagnosis
17.Which patient would most likely be eligible for Medicaid?: a low-income
pregnant woman with no health insurance
18.The managed care concept that focuses on preventing illness and promoting
wellness to reduce healthcare costs is called: health promotion and disease
prevention
19.A patient tells the nurse, "My insurance requires me to pay $40 every time I
see my doctor." The nurse recognizes this as the: copayment
20.The maximum amount a policyholder must pay out-of-pocket in a year
before the insurance company pays 100% of covered services is known as
the: out-of-pocket maximum
21.Which statement about capitation is accurate?: providers receive a fixed
monthly payment per patient regardless of services provided
22.A nurse is teaching a patient about flexible spending accounts (FSAs).
Which statement by the patient indicates understanding?: "I must use the
money I put in by the end of the year or I lose it"
23.The health insurance program that covers military veterans is
called: TRICARE
