Nursing Fundamentals/Medical Surgical
Nursing Questions And correct Answers 2025
, Chapter 02: The Health Care Delivery System
Potteretal.:FundamentalsofNursing,9thEdition
MULTIPLECHOICE
1. ThenurseiscaringforapatientwhoseinsurancecoverageisMedicare.Thenurseshould
consider which information when planning care for this patient?
a. Capitationprovidesthehospitalwithameansofrecoveringvariable charges.
b. Thehospitalwillbepaidforthefull costofthepatient’s hospitalization.
c. Diagnosis-relatedgroups (DRGs)provideafixedreimbursementofcost.
d. Medicarewill paythenationalaverageforthepatient’s condition.
ANS:C
In1983,Congressestablishedtheprospectivepaymentsystem(PPS),whichgroupedinpatient
hospital services for Medicare patients into diagnosis-related groups (DRGs), each of which
provides a fixed reimbursement amount based on assigned DRG, regardless of a patient’s
length of stay or use of services. Capitation means that providers receive a fixed amount per
patient or enrollee of a health care plan. DRG reimbursement is based on case severity,
rural/urban/regional costs, and teaching costs, not national averages.
DIF: Understand(comprehension) REF:15
OBJ:Compare the various methods for financing health care. TOP:Planning
MSC:Management of Care
2. Anurseisteachingthestaffaboutmanagedcare.Whichinformationshouldthenurseinclude in the
teaching session?
a. Managedcareinsuresfullcoverageofhealthcarecosts.
b. Managedcareonlyassumesthefinancialrisk involved.
c. Managedcareallowsproviderstofocusonillnesscare.
d. Managedcarecausesproviderstofocusonprevention.
ANS:D
Managed care describes health care systems in which the provider or the health care system
receives a predetermined capitated (fixed amount) payment for each patient enrolled in the
program. Therefore, the focus of care shifts from individual illness care to prevention, early
intervention,andoutpatientcare.Theactualcostofcareistheresponsibilityoftheprovider. The
managed care organization (provider) assumes financial risk, in addition to providing patient
care.
DIF: Understand(comprehension) REF:15
OBJ:Explain the structure of the United States health system. TOP:Teaching/Learning
MSC:Management of Care
3. Anurseisteachingafamilyabouthealthcareplans.Whichinformationfromthenurse
indicates a correct understanding of the Affordable Care Act?
a. Afamilycanchoosewhetherto havehealth insurancewith no consequences.
b. PrimarycarephysicianpaymentsfromMedicaidservices canequalMedicare.
c. Adultchildrenuptoage 26areallowedcoverage ontheparent’splan.
d. Privateinsurance companies candenycoverageforanyreason.
Nursing Questions And correct Answers 2025
, Chapter 02: The Health Care Delivery System
Potteretal.:FundamentalsofNursing,9thEdition
MULTIPLECHOICE
1. ThenurseiscaringforapatientwhoseinsurancecoverageisMedicare.Thenurseshould
consider which information when planning care for this patient?
a. Capitationprovidesthehospitalwithameansofrecoveringvariable charges.
b. Thehospitalwillbepaidforthefull costofthepatient’s hospitalization.
c. Diagnosis-relatedgroups (DRGs)provideafixedreimbursementofcost.
d. Medicarewill paythenationalaverageforthepatient’s condition.
ANS:C
In1983,Congressestablishedtheprospectivepaymentsystem(PPS),whichgroupedinpatient
hospital services for Medicare patients into diagnosis-related groups (DRGs), each of which
provides a fixed reimbursement amount based on assigned DRG, regardless of a patient’s
length of stay or use of services. Capitation means that providers receive a fixed amount per
patient or enrollee of a health care plan. DRG reimbursement is based on case severity,
rural/urban/regional costs, and teaching costs, not national averages.
DIF: Understand(comprehension) REF:15
OBJ:Compare the various methods for financing health care. TOP:Planning
MSC:Management of Care
2. Anurseisteachingthestaffaboutmanagedcare.Whichinformationshouldthenurseinclude in the
teaching session?
a. Managedcareinsuresfullcoverageofhealthcarecosts.
b. Managedcareonlyassumesthefinancialrisk involved.
c. Managedcareallowsproviderstofocusonillnesscare.
d. Managedcarecausesproviderstofocusonprevention.
ANS:D
Managed care describes health care systems in which the provider or the health care system
receives a predetermined capitated (fixed amount) payment for each patient enrolled in the
program. Therefore, the focus of care shifts from individual illness care to prevention, early
intervention,andoutpatientcare.Theactualcostofcareistheresponsibilityoftheprovider. The
managed care organization (provider) assumes financial risk, in addition to providing patient
care.
DIF: Understand(comprehension) REF:15
OBJ:Explain the structure of the United States health system. TOP:Teaching/Learning
MSC:Management of Care
3. Anurseisteachingafamilyabouthealthcareplans.Whichinformationfromthenurse
indicates a correct understanding of the Affordable Care Act?
a. Afamilycanchoosewhetherto havehealth insurancewith no consequences.
b. PrimarycarephysicianpaymentsfromMedicaidservices canequalMedicare.
c. Adultchildrenuptoage 26areallowedcoverage ontheparent’splan.
d. Privateinsurance companies candenycoverageforanyreason.
