Answer Key for

Workbook for Introductory Medical-Surgical Nursing, 11e

Chapter 1

SECTION 1: ASSESSING YOUR UNDERSTANDING

Activity A

1. Illness

2. Client

3. Healthcare delivery system

4. Health

5. Medicaid

Activity B

1. Holism

2. Healthcare team

3. Medicare

4. Diagnosis-related groups

5. Wellness

Activity C

1. C

2. D

3. E

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4. A

5. B

Activity D

1. The major difference between illness and disease is that illness is highly individual and

personal, whereas disease is something more definitive and measurable. For example, a client

with arthritis presents with distinct pathologic changes associated with the disease. A person,

however, may or may not be ill with arthritis. The degree of pain, suffering, and immobility

varies from person to person.

2. Health maintenance refers to protecting one’s current level of health by preventing illness or

deterioration, such as by complying with medication regimens, being screened for diseases

such as breast cancer or colon cancer, or practicing safe sex. Health promotion refers to

engaging in strategies to enhance health such as eating a diet high in grains and complex

carbohydrates, exercising regularly, balancing work with leisure activities, and practicing

stress-reduction techniques.

3. Medicare covers individuals who are 65 years or older, permanently disabled workers of any

age with specific disabilities, and persons with end-stage renal disease.

4. The team includes physicians, nurses, psychologists, pharmacists, dietitians, social workers,

respiratory and physical therapists, occupational therapists, nursing assistants, technicians,

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and insurance company staff. All members of this team collaborate on client issues (medical,

social, and financial) to achieve the best possible outcomes.

5. Groups such as children, older adults, ethnic minorities, and the poor are most likely to be

underserved by the healthcare system.

Activity E

1. Point-of-service (POS) organizations involve a network of providers. Clients select a primary

care physician within the group who then serves as the gatekeeper for other healthcare

services. Clients can use healthcare providers in or out of the provider group, but may pay

additional fees, such as a higher deductible or copayment, for providers outside the group,

unless the primary physician approves.

2. Clients select a primary care physician within the group who then serves as the gatekeeper

for other healthcare services. As with other types of managed care organizations, the focus is

on prevention as the best way to manage healthcare costs.

3. Benefits for the insurer include discounted services, reduced services, and elimination of

unnecessary referrals (Chitty & Black, 2011).

4. All are types of managed care networks. They provide a number of services within the

network at a controlled cost. All provide incentive to stay within the network by providing

lower cost services. Seeking services outside each of the organizations would incur higher

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costs for the client with the exception of the point-of service (POS) plan, which allows it if

approved by the primary care physician who serves as the gatekeeper. The goal of all the

organizations (POS, PPO, and PHO) is to maintain high-quality service and contain costs.

SECTION 2: APPLYING YOUR KNOWLEDGE

Activity F

1. Members of an HMO must receive authorization (referral) for secondary care, such as second

opinions from specialists or diagnostic testing. If members obtain unauthorized care, they are

responsible for the entire bill. In this way, HMOs serve as gatekeepers for healthcare

services.

2. Some individuals delay seeking early treatment for their health problems because they cannot

afford to pay for services. When an illness becomes so severe that the only choice is to seek

medical attention, many turn to their local hospital emergency departments for primary care.

This expensive alternative usually involves long waits and no follow-up care.

3. Possible premature discharge of clients and increased responsibility for family members who

may be unable to provide adequate care creates much criticism of the prospective payment

system. These systems have also caused shifts in costs from clients with Medicare to those

who have private insurance. Providers charge privately insured clients inflated amounts to

make up for losses in Medicare revenues.

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