Chapter 2 Health Care Delivery System Fundamentals of Nursing 11th Edition (Potter & Perry) 50 NCLEX-Style Exam Questions with Detailed Rationales

1. A nurse explains Medicare to a client. Which of the following individuals would be eligible for Medicare Part A coverage? A. A 23-year-old with a chronic kidney condition B. A 45-year-old with end-stage cancer C. A 65-year-old recently retired teacher D. A 30-year-old who just gave birth Correct Answer: C Rationale: Medicare Part A is available to individuals aged 65 and older, covering inpatient hospital stays and limited skilled nursing facility care. Other options may qualify under special conditions, but age is the most direct qualifier. ________________________________________ 2. A patient asks the nurse about the purpose of managed care. What is the primary goal of managed care organizations? A. To allow unlimited access to all providers B. To eliminate the need for primary care providers C. To provide quality care while reducing costs D. To extend hospital stays for chronic illness Correct Answer: C Rationale: Managed care systems aim to control costs while ensuring quality health care, often through preventive services, care coordination, and restricted provider networks. ________________________________________ 3. A nurse is orienting a new colleague on Medicaid. Which patient scenario best qualifies for Medicaid? A. A wealthy retired lawyer needing a hip replacement B. A low-income pregnant teenager C. A 50-year-old business owner with private insurance D. A veteran receiving care through the VA Correct Answer: B Rationale: Medicaid is a joint federal and state program providing coverage to eligible low-income individuals, including pregnant women, children, and disabled adults. ________________________________________ 4. Which of the following is an example of primary health care? A. Immunization clinic B. Cardiac catheterization lab C. Emergency department treatment D. Hospice care Correct Answer: A Rationale: Primary care focuses on prevention and health promotion. Immunizations are a key preventive measure and represent primary health care. ________________________________________ 5. A nurse is working in a rehabilitation facility. Which level of care is the nurse providing? A. Preventive care B. Tertiary care C. Restorative care D. Continuing care Correct Answer: C Rationale: Restorative care helps individuals regain maximum function and independence after an acute illness or injury, typically offered in rehabilitation settings. ________________________________________ 6. What is a major benefit of an integrated health care delivery system? A. Clients can bypass referrals B. It encourages fragmented care C. Improves communication among providers D. Focuses only on acute illness Correct Answer: C Rationale: Integrated systems enhance coordination and continuity of care across various settings and providers, reducing duplication and improving outcomes. ________________________________________ 7. A nurse caring for patients in a long-term care facility is providing: A. Tertiary care B. Continuing care C. Preventive care D. Secondary care Correct Answer: B Rationale: Continuing care supports individuals with chronic conditions or disabilities in residential settings like nursing homes or assisted living facilities. ________________________________________ 8. A client recovering at home after a stroke receives visits from a home health nurse. This is an example of: A. Tertiary care B. Secondary care C. Restorative care D. Palliative care Correct Answer: C Rationale: Home health services that assist recovery and rehabilitation are considered part of restorative care, aimed at improving function and independence. ________________________________________ 9. Which agency ensures compliance with national patient safety goals in health care organizations? A. FDA B. The Joint Commission C. CDC D. OSHA Correct Answer: B Rationale: The Joint Commission is an independent body that accredits and certifies health care organizations, promoting quality and patient safety. ________________________________________ 10. A nurse working in a community clinic providing prenatal care is delivering: A. Primary care B. Tertiary care C. Acute care D. Continuing care Correct Answer: A Rationale: Prenatal services are preventive and form part of primary care focused on maintaining maternal and fetal health. ________________________________________ 11. A nurse schedules a mammogram for a patient. This is considered which type of care? A. Primary care B. Preventive care C. Restorative care D. Continuing care Correct Answer: B Rationale: Preventive care includes screenings to detect diseases early, such as mammograms and colonoscopies. ________________________________________ 12. A newly licensed nurse is learning about hospital accreditation. Why is The Joint Commission accreditation important? A. It is mandatory for all facilities B. It replaces government inspections C. It demonstrates commitment to quality care D. It increases profit margins Correct Answer: C Rationale: Accreditation by The Joint Commission signifies that a hospital meets specific quality and safety standards. ________________________________________ 13. A nurse is discussing the role of a case manager. Which function is most appropriate? A. Directly administering medications B. Coordinating patient care across services C. Providing bedside hygiene care D. Scheduling diagnostic tests Correct Answer: B Rationale: Case managers coordinate services and ensure continuity of care, especially for complex or chronic cases. ________________________________________ 14. A patient in an HMO plan is required to see their primary care provider before a specialist. This demonstrates which principle? A. Capitation B. Continuity C. Gatekeeping D. Fee-for-service Correct Answer: C Rationale: Gatekeeping requires primary care approval before specialist referrals, helping manage costs and utilization. ________________________________________ 15. The nurse identifies an accountable care organization (ACO) as: A. A for-profit insurance company B. A hospital-based emergency care group C. A group of providers focused on cost-effective care D. A patient-led health advocacy coalition Correct Answer: C Rationale: ACOs are groups of providers working together to provide coordinated, high-quality, cost-effective care. ________________________________________