PNC TEST 2 UPDATED ACTUAL Exam
Questions and CORRECT Answers
An older adult was admitted to the hospital with the condition as "pneumonia." Reimbursement
was based on predetermined fixed price. This classification system is referred to as: - CORRECT
ANSWER - Diagnosis-related groups {DRGs}: Usd in reimbursement for health care
services based on predetermined fixed price per case.
The precise classification of clients according to the highest diagnosis-related group has created
a new role for nurses, known as - CORRECT ANSWER - Utilization review-
Review medical records to determine the most appropriate DRG for clients.
Diagnosis-related groups [DRGs] have attempted to reduce health care costs by decreasing: -
CORRECT ANSWER - length of hospital stay
When reviewing the literature on the effects of Medicaid on healthcare for the poor, thee nurse
researcher found that the poor: - CORRECT ANSWER - Lack consistent providers
[Also less likely to use preventative services, and are more likely to be hospitalized for avoidable
conditions]
Lack of insurance, uninsured populations, and uncompensated care are covered by charging
more to those who can pay. This practice is referred to as: - CORRECT ANSWER - Cost
shifting
A contractual agreement between the insurer and the providers in which covered members are
encouraged to use specific health care providers in return for reduced rates in which type of
arrangement? - CORRECT ANSWER - Preferred provider organization:
Member pays a premium for a fixed percentage of expense coverage. Requires deductible and a
copayment
In the triad of healthcare, which would be considered the third-party payer? - CORRECT
ANSWER - Insurance company:
,Any organization other than the client and the supplier [hospital or physician]
A physician bills the insurance company for a CT, lab test, CXR, and an extended visit and
receives revenue for each procedure billed. This type of payment system is a ________ payment
system. - CORRECT ANSWER - Retrospective
A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client
undergoes coronary artery bypass grafting. The cost of care for this client is increased because of
a four-pack-per-day smoking hx and that resulted in extension of the client's intensive care unit
[ICU] stay by 3 days because of respiratory problems. The case manager realizes that under the
terms of the diagnosis-related group [DRG] payment system for this diagnosis: - CORRECT
ANSWER - Although the cost of care for this client was greater than the DRG
reimbursement amount, the hospital will be reimbursed only at the set fee
-If the hospital costs exceed the DRG amount, the hospital incurs a loss
A young mother has detected a lump in her breast, and because she lives at the poverty level, she
is covered under medicaid. This individual: - CORRECT ANSWER - Will more likely
wait to seek care and will require hospitalization for mastectomy, which could have been
avoided if care had been sought out earlier
A client who is reading a newspaper asks, "This article about health care states that many
providers of healthcare lack effectiveness. What is the difference between effectiveness and
efficiency?" The nurse explains that: - CORRECT ANSWER - Effective means
performing the correct test or intervention whereas efficiency refers to the wise use of supplies
and resources for the desired outcomes.
A nurse is offered several healthcare plans as part of employee benefits. Which plan is based on
a monthly fee per participant and offers a range of preventive, diagnostic, and treatment
services? - CORRECT ANSWER - Capitation: Insurance company pays the provider a set
amount of money each month
In Feb, 2010, Congress passed legislation to support universal health care for all Americans. At a
local health fair, an individual asks about the difference between universal healthcare and a
single payer system. The nurse explains the difference is that: - CORRECT ANSWER -
, With universal health, one payer is responsible for all health care costs, providing healthcare to
all citizens.
An elderly person, age 80, is finding it difficult to live alone and the family is considering long-
term care. The elderly person is reasonably health, with only normal again declines, and
maintains a healthy appetite. All meds are administered orally and require only minimal
assistance. She is financially secure with an income based on retirement from both the military
and factory from her deceased husband and herself. The family contacts long-term care and is
told that, based on this patients information: - CORRECT ANSWER - Medicare will pay
for home health services should these additional services meet the needs of the individual
Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act
[PPACA] based on religious beliefs that prohibit circumcision and blood transfusions. These
individuals believe the PPACA is unconstitutional because it: - CORRECT ANSWER -
Mandates that all US and legal residents must secure health insurance
A nurse is newly employed by a state-owned hospital that provides health care insurance
requiring a deductible paid by the employee with the majority of the premium cost covered by
the employer. The insurance provided to the nurse is: - CORRECT ANSWER - Private
health insurance
Health care is one of the major stories in the newspaper and television and a group of nurses are
interested in how the economy impacts their nursing practice. The group critiques the
relationship between contemporary economic trends and professional nursing practice and finds:
- CORRECT ANSWER - with pay for performance, nurses have a significant effect on the
quality of patient outcomes by reducing errors and providing care based on best practice
A patient is eligible to change health care providers and insurance and asks, "I am interested in
health promotion activities; I walk, swim, and eat healthy. Which health insurance plan would
support these activities rather than just pay for services when I am sick"? Which, if any, health
insurance plan would best meet the needs of this patient? - CORRECT ANSWER - Health
maintenance organization
A patient is upset because her health insurance plan refused to pay for a mammogram and
services by a women's health specialist because the primary care physician did not order the
Questions and CORRECT Answers
An older adult was admitted to the hospital with the condition as "pneumonia." Reimbursement
was based on predetermined fixed price. This classification system is referred to as: - CORRECT
ANSWER - Diagnosis-related groups {DRGs}: Usd in reimbursement for health care
services based on predetermined fixed price per case.
The precise classification of clients according to the highest diagnosis-related group has created
a new role for nurses, known as - CORRECT ANSWER - Utilization review-
Review medical records to determine the most appropriate DRG for clients.
Diagnosis-related groups [DRGs] have attempted to reduce health care costs by decreasing: -
CORRECT ANSWER - length of hospital stay
When reviewing the literature on the effects of Medicaid on healthcare for the poor, thee nurse
researcher found that the poor: - CORRECT ANSWER - Lack consistent providers
[Also less likely to use preventative services, and are more likely to be hospitalized for avoidable
conditions]
Lack of insurance, uninsured populations, and uncompensated care are covered by charging
more to those who can pay. This practice is referred to as: - CORRECT ANSWER - Cost
shifting
A contractual agreement between the insurer and the providers in which covered members are
encouraged to use specific health care providers in return for reduced rates in which type of
arrangement? - CORRECT ANSWER - Preferred provider organization:
Member pays a premium for a fixed percentage of expense coverage. Requires deductible and a
copayment
In the triad of healthcare, which would be considered the third-party payer? - CORRECT
ANSWER - Insurance company:
,Any organization other than the client and the supplier [hospital or physician]
A physician bills the insurance company for a CT, lab test, CXR, and an extended visit and
receives revenue for each procedure billed. This type of payment system is a ________ payment
system. - CORRECT ANSWER - Retrospective
A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client
undergoes coronary artery bypass grafting. The cost of care for this client is increased because of
a four-pack-per-day smoking hx and that resulted in extension of the client's intensive care unit
[ICU] stay by 3 days because of respiratory problems. The case manager realizes that under the
terms of the diagnosis-related group [DRG] payment system for this diagnosis: - CORRECT
ANSWER - Although the cost of care for this client was greater than the DRG
reimbursement amount, the hospital will be reimbursed only at the set fee
-If the hospital costs exceed the DRG amount, the hospital incurs a loss
A young mother has detected a lump in her breast, and because she lives at the poverty level, she
is covered under medicaid. This individual: - CORRECT ANSWER - Will more likely
wait to seek care and will require hospitalization for mastectomy, which could have been
avoided if care had been sought out earlier
A client who is reading a newspaper asks, "This article about health care states that many
providers of healthcare lack effectiveness. What is the difference between effectiveness and
efficiency?" The nurse explains that: - CORRECT ANSWER - Effective means
performing the correct test or intervention whereas efficiency refers to the wise use of supplies
and resources for the desired outcomes.
A nurse is offered several healthcare plans as part of employee benefits. Which plan is based on
a monthly fee per participant and offers a range of preventive, diagnostic, and treatment
services? - CORRECT ANSWER - Capitation: Insurance company pays the provider a set
amount of money each month
In Feb, 2010, Congress passed legislation to support universal health care for all Americans. At a
local health fair, an individual asks about the difference between universal healthcare and a
single payer system. The nurse explains the difference is that: - CORRECT ANSWER -
, With universal health, one payer is responsible for all health care costs, providing healthcare to
all citizens.
An elderly person, age 80, is finding it difficult to live alone and the family is considering long-
term care. The elderly person is reasonably health, with only normal again declines, and
maintains a healthy appetite. All meds are administered orally and require only minimal
assistance. She is financially secure with an income based on retirement from both the military
and factory from her deceased husband and herself. The family contacts long-term care and is
told that, based on this patients information: - CORRECT ANSWER - Medicare will pay
for home health services should these additional services meet the needs of the individual
Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act
[PPACA] based on religious beliefs that prohibit circumcision and blood transfusions. These
individuals believe the PPACA is unconstitutional because it: - CORRECT ANSWER -
Mandates that all US and legal residents must secure health insurance
A nurse is newly employed by a state-owned hospital that provides health care insurance
requiring a deductible paid by the employee with the majority of the premium cost covered by
the employer. The insurance provided to the nurse is: - CORRECT ANSWER - Private
health insurance
Health care is one of the major stories in the newspaper and television and a group of nurses are
interested in how the economy impacts their nursing practice. The group critiques the
relationship between contemporary economic trends and professional nursing practice and finds:
- CORRECT ANSWER - with pay for performance, nurses have a significant effect on the
quality of patient outcomes by reducing errors and providing care based on best practice
A patient is eligible to change health care providers and insurance and asks, "I am interested in
health promotion activities; I walk, swim, and eat healthy. Which health insurance plan would
support these activities rather than just pay for services when I am sick"? Which, if any, health
insurance plan would best meet the needs of this patient? - CORRECT ANSWER - Health
maintenance organization
A patient is upset because her health insurance plan refused to pay for a mammogram and
services by a women's health specialist because the primary care physician did not order the
