TEST BANK FOR CONTEMPORARY NURSING 8TH EDITION, WITH ALL CORRECT ANSWERS .

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1. An older adult client was admitted to the hospital with the condition classified as “pneumonia.” Reimbursement for care was based on a predetermined fixed price. What is this classification sys... tem referred to as? a. Diagnosis-related groups (DRGs) b. Subjective symptom management c. Acuity classification system d. Organized managed care ANS: A DRGs are used in reimbursement for health care services based on a predetermined fixed price per case or diagnosis in 468 categories. Under DRGs, each Medicare client is assigned to a diagnostic grouping based on his or her primary diagnosis at hospital admission. Medicare limits total payment to the hospital to the amount preestablished for that DRG. DIF: Comprehension 2. The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a nurse. a. case management b. quality assurance c. utilization review d. cost-control ANS: C Hospital-based utilization review nurses review medical records to determine the most appropriate DRG for clients. Financial gains can be made through careful diagnosis of clients according to their highest potential DRG classification. DIF: Knowledge 3. Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing what component of care? a. Hospital admission rates b. Length of hospital stay c. Outpatient services d. Specialty groups ANS: B Hospitals face a strong financial incentive from the DRG reimbursement system to reduce the client’s length of stay and minimize procedures performed. If hospital costs exceed the DRG payment for a client’s treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. DIF: Comprehension [Show More]

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