Workbook for Introductory Medical-Surgical Nursing (Edition 11) Answer Key

Answer Key for
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Workbook for Introductory Medical-Surgical Nursing, 11e
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Chapter i1

SECTION i1: iASSESSING iYOUR iUNDERSTANDING

Activity iA

1. Illness

2. Client

3. Healthcare idelivery isystem

4. Health

5. Medicaid



Activity iB

1. Holism

2. Healthcare iteam

3. Medicare

4. Diagnosis-related igroups

5. Wellness



Activity iC

1. C

2. D

3. E

,4. A

5. B



Activity iD

1. The imajor idifference ibetween iillness iand idisease iis ithat iillness iis ihighly iindividual iand

i personal, iwhereas idisease iis isomething imore idefinitive iand imeasurable. iFor iexample, ia iclient

i with iarthritis ipresents iwith idistinct ipathologic ichanges iassociated iwith ithe idisease. iA iperson,

i however, imay ior imay inot ibe iill iwith iarthritis. iThe idegree iof ipain, isuffering, iand iimmobility

i varies ifrom iperson ito iperson.



2. Health imaintenance irefers ito iprotecting ione’s icurrent ilevel iof ihealth iby ipreventing iillness ior

i deterioration, isuch ias iby icomplying iwith imedication iregimens, ibeing iscreened ifor idiseases

i such ias ibreast icancer ior icolon icancer, ior ipracticing isafe isex. iHealth ipromotion irefers ito

i engaging iin istrategies ito ienhance ihealth isuch ias ieating ia idiet ihigh iin igrains iand icomplex

i carbohydrates, iexercising iregularly, ibalancing iwork iwith ileisure iactivities, iand ipracticing

i stress-reduction itechniques.



3. Medicare icovers iindividuals iwho iare i65 iyears ior iolder, ipermanently idisabled iworkers iof iany

i age iwith ispecific idisabilities, iand ipersons iwith iend-stage irenal idisease.



4. The iteam iincludes iphysicians, inurses, ipsychologists, ipharmacists, idietitians, isocial iworkers,

i respiratory iand iphysical itherapists, ioccupational itherapists, inursing iassistants, itechnicians,

, and iinsurance icompany istaff. iAll imembers iof ithis iteam icollaborate ion iclient iissues i(medical,

i social, iand ifinancial) ito iachieve ithe ibest ipossible ioutcomes.



5. Groups isuch ias ichildren, iolder iadults, iethnic iminorities, iand ithe ipoor iare imost ilikely ito ibe

i underserved iby ithe ihealthcare isystem.



Activity iE

1. Point-of-service i(POS) iorganizations iinvolve ia inetwork iof iproviders. iClients iselect ia iprimary

i care iphysician iwithin ithe igroup iwho ithen iserves ias ithe igatekeeper ifor iother ihealthcare

i services. iClients ican iuse ihealthcare iproviders iin ior iout iof ithe iprovider igroup, ibut imay ipay

i additional ifees, isuch ias ia ihigher ideductible ior icopayment, ifor iproviders ioutside ithe igroup,

i unless ithe iprimary iphysician iapproves.



2. Clients iselect ia iprimary icare iphysician iwithin ithe igroup iwho ithen iserves ias ithe igatekeeper ifor

other ihealthcare iservices. iAs iwith iother itypes iof imanaged icare iorganizations, ithe ifocus iis ion
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i prevention ias ithe ibest iway ito imanage ihealthcare icosts.



3. Benefits ifor ithe iinsurer iinclude idiscounted iservices, ireduced iservices, iand ielimination iof

i unnecessary ireferrals i(Chitty i& iBlack, i2011).



4. All iare itypes iof imanaged icare inetworks. iThey iprovide ia inumber iof iservices iwithin ithe

i network iat ia icontrolled icost. iAll iprovide iincentive ito istay iwithin ithe inetwork iby iproviding

i lower icost iservices. iSeeking iservices ioutside ieach iof ithe iorganizations iwould iincur ihigher

, costs ifor ithe iclient iwith ithe iexception iof ithe ipoint-of iservice i(POS) iplan, iwhich iallows iit iif

i approved iby ithe iprimary icare iphysician iwho iserves ias ithe igatekeeper. iThe igoal iof iall ithe

i organizations i(POS, iPPO, iand iPHO) iis ito imaintain ihigh-quality iservice iand icontain icosts.



SECTION i2: iAPPLYING iYOUR iKNOWLEDGE

Activity iF

1. Members iof ian iHMO imust ireceive iauthorization i(referral) ifor isecondary icare, isuch ias isecond

i opinions ifrom ispecialists ior idiagnostic itesting. iIf imembers iobtain iunauthorized icare, ithey iare

i responsible ifor ithe ientire ibill. iIn ithis iway, iHMOs iserve ias igatekeepers ifor ihealthcare

i services.



2. Some iindividuals idelay iseeking iearly itreatment ifor itheir ihealth iproblems ibecause ithey icannot

i afford ito ipay ifor iservices. iWhen ian iillness ibecomes iso isevere ithat ithe ionly ichoice iis ito iseek

i medical iattention, imany iturn ito itheir ilocal ihospital iemergency idepartments ifor iprimary icare.

i This iexpensive ialternative iusually iinvolves ilong iwaits iand ino ifollow-up icare.



3. Possible ipremature idischarge iof iclients iand iincreased iresponsibility ifor ifamily imembers iwho

i may ibe iunable ito iprovide iadequate icare icreates imuch icriticism iof ithe iprospective ipayment

i system. iThese isystems ihave ialso icaused ishifts iin icosts ifrom iclients iwith iMedicare ito ithose

i who ihave iprivate iinsurance. iProviders icharge iprivately iinsured iclients iinflated iamounts ito

i make iup ifor ilosses iin iMedicare irevenues.