HITPRO -

Which of the following characteristics are part of the definition of a disease?

*A combination of symptioms & physical findings attributed to a specific cause. *Impairment of a specific structure of the body producing symptoms. *Impairment of a specific function of the body producing physical findings.

A syndrome is best defined as....

*A combination of symptoms and physical findings not easily attributable to a specific cause.

A primary care physician typically provides routine care including health maintenance and managment of new and chronic disease. Which specialty was specifically mentioned as delivering primary care by default?

*Emergency Medicine

Which of the following is a healthcare quality outcome measure?

-Mortality from hospitalization for acute MI -Proportion of individuals who receive beta blocker medication, a medication known to be of benefit during hospitalization from acute MI. -Proportion of cardiologists in a hospital specializing in heart diseases who have achieved specialty certification. -Presence of an EHR in hospital. Answer - Mortality from hospitalization for acute MI; the mortality from a hospitalization for acute MI is a healthcare quality outcome measure.

Which of the following is a healthcare quality process measure?

-Mortality from hospitalization for acute MI -Proportion of individuals who receive beta blocker medication, a medication known to be of benefit during hospitalization from acute MI. -Proportion of cardiologists in a hospital specializing in heart diseases who have achieved specialty certification. -Presence of an EHR in hospital. Answer - Proportion of individuals who receive beta blocker medication, a medication known to be of benefit during hospitalization from acute MI; The proportion of patients who receive a therapy that is known to be beneficial is a healthcare quality process measure.

Inpatient care is usually defined as admission for medical care longer than....

24 hours

Which of the following is NOT an example of comparitive effectiveness research?

A clinical trial comparing the two best known treatments for a disease against each other. A study comparing the two most commonly used diagnostic tests for a disease. A systematic review comparing all of the studies that have looked at different drugs showing efficacy in a specific disease. NOT --- A systematic review of studies comparing different drugs to a placebo in a diseach for which there are several known effective treatments. Because, comparing a placebo to a drug when there are several known effective treatments is not an example of comparative effectiveness research.

Which regulation will have the highest precedence in enforcing the HIPAA Privacy Rule.

A state-level regulation is more stringent than federal law; State level regulations may supersede federal regulations under the HIPAA Privacy Rule, but the federal regulations are a floor.

Which of the following is a synopsis in the hierarchy of evidence?

A summary of the evidence with succinct recommendations for application in clinical practice for a specific disease and its treatment. -- A succinct summary of evidence is a synopsis.

A constellation of symptoms and signs that tend to occur together because of te underlying disorder of physiology is referred to as:

A syndrome

(Data in terms of hierarchy) The physician notes that the patient has a cough, fever, chills, and is bringing up a productive expectoration when she coughs.

A syndrome is a constellation of symptoms and signs

What is the biggest difference between counselors, MSWs, Psychologist and Psychiatrist?

Ability to prescribe medication.

A sanction polity is an example of what type of safeguard in teh HIPAA Security Rule?

Administrative - a sanction is an example of an administrative safeguard.

Which of the following duties might a nurse perform?

Advise a hospital administrator about patient care procedures. Conduct research. Teach the public about preventing heart disease. RN play wide range of roles, any of above could be included in RN duties.

Provide a brief description of the training and roles of a PT or occupational aide, assistant and therapist.

Amount and degree of trianing increases so does the level of responsibility.

All but which of the following are required for an effective screening test?

An effective treatment for the disease being screened. A screening test of high sensitivity that detects just about all cases of the disease. A relatively inexpensive test that can be administered to a large population. A high specificity screening test that makes sure all cases found are truly positive. Answer - A high specificity screening test that makes sure all cases found are truly positive. Important for an initial screening test are that te tests be low cost and high sensitivity for a disease that has effective treatments.

According to the AMIA - a health informatics professional should:

Answer patients questions about their rights to review and revise their medical data. Assist a patient who wishes to exercise those rights. BOTH -- the code of ethics of the American Medical Informatics Association says informatics professionals should truthfully answer all patient questions about their rights to review and revise their own medical data. They should also be helpful when patients wish to exercise those rights.

Which of the following is NOT a part of the 5step nursing process?

Assess the patient Diagnosis the problem Follow standards of care Evaluate the patient's response to treatment Answer - Nurses must follow standards of care, but the 5 steps in the nursing process are to: assess the patient, diagnose the problem, create a plan of care, implement the plan, and evaluate the plan.

The type of long term care organization that typically provides an apartment or room and includes personal care, meals and housekeeping is...

Assisted Living

Which of the following are the 4 core principles of medical ethics?

Autonomy, beneficience, justice, non-maleficence; Many people who study healthcare ethics say the basics can be captured in the application of the 4 basic ideas.

Which of the following is NOT an aspect of professionalism?

Behaving ethically on the job. Gaining the technical ability to do a good job. Learning ethical codes. Setting & achieving aspirational goals. Answer - Professionalism means acting in a way that meets the standards of one's profession. These standards may incorporate ethical obligations, best practices, and other norms within a profession. By definition, an aspirational goal is a standard taht would be met in an ideal world, but is not currently achievable in the real world.

Which of the following is NOT a type of advanced practice nurse?

Certified cancer nurse Certified nurse midwife Certified registered nurse anesthetist NP Certified Cancer Nurse is not a type of advanced practice nurse. There are 4 types of advanced practice nures, the type missing is the clinical nurse specialist.

Unintended consequences of technological change include:

Changes in the workflow may not improve overall system efficiency. Outcome measures may not be positive Even though the technology may be good, the implementation my be flawed and lead to adverse events.

Which type of nurse has the least amount of education?

Clinical nurse specialists Licensed practical nurses Nurse practitioners Registered nurses LPN - lease education

What 2 divisions may be combined to form a single diagnostic and therapeutic division?

Clinical support & ancillary services

The typical sequence of education and training required to be a nephrologists would be...

College, Medical School, Residency, Fellowship

FQHCs include the following...

Community Health Centers, Migrant Health Centers, Healthcare for the Homeless Programs & Public Health Primary Care Programs.

Components of Universal Protocol include:

Conducting a pre-procedure patient/site verification process. Marking the procedure site Performing a pre-procedure time-out. All of the above

You were once diagnosed with an STD and you do not want the physician to share the information with your employer. This is an example of:

Confidentiality - the right to keep information about yourself from being disclosed to others is confidentiality.

Define "Continuum of Care"

Continuum of Care can be defined as the provision of care from the entry of the patient into the system until care is no longer needed. May include examples of birth to death and or dx until return to normal function.

Describe how the organizational structure may be affected by the size and type of the institution....

Core functions are required to deliver healthcare, but the number and responsibilities of personnel vary with the size & type of the organization.

What type of communication can allow data to easily be viewed throughout the institution?

Digital

(Data in terms of hierarchy) The patient is dx with pneumonia due to an organism called Streptococcus pneumoniae

Disease is a specific condition that causes a constellation of sxs and signs

(Data in terms of hierarchy) The description of the physicians office environment

Empirium is the description of clinic, staff, lighting, sound, etc.

Most states allow an LPN to administer an IV push medication; True or False

FALSE

The major difference between an academic and community hospital is the type of care they provide...True or False

False

True or False - Evidence based decision making means relying only on diagnostic and treatment methods that are scientifically proven.

False - Evidence based decision making emphasized scientifically proven methods but there is room in the decision making process fo rthe nurses knowledge and experience, as well as patients preferences.

True or False - Health informatics professionals have no ethical responsibilities toward healthcare providers who are not their employers.

False - In many workplaces, informatics professionals work with docors, nurses, and other providers who are their co-workers, not their employers. It is an ethical responsibility of informatics professionals to help healthcare providers meet their own professional obligations to patients. Ths includes making sure that healthcare providers have timely & secure access to usable, high-quality EHRs.

True or False - Weed's Problem Oriented Medical Record system puts the clinicians impression or dx at the top of the note so that the reader can see at a glance what the note is about.

False - Weed's system, the data is recorded first, which helps the clinician think through the problem before committing to a specific impression

True or False - When making a clinical judgment about a patient, a nurse should consider only the data in the patients chart and what he or she finds by examining the patient.

False - nurses gather both objective and subjective information about patients, they might talk to the patient and the family to find out about situations/cultural values/health problems/social situation, etc.

True or False: When clinicians record information in an H&P, the information is recorded as unstructured text.

False - the H&P is a highly structured way of organizing clinical data that has been used by clinicians for generations.

The clinical process is an orderly, discrete, linear sequence of steps that includes obtaining a history from the patient, performing a physical exam, combining information in an assessment, & subsequently formulating a plan.

False - these steps are part of the clinical process, but it is most often not an orderly linear sequence of steps but an iterative and often circular one.

Which CMS program assesses patient satisfaction with hospital care?

HCAPHS - The Hospital Consumer Assessment and Healthcare Systems survey measures patient satisfaction with hospital care.

The ethical principle of autonomy implies all of the following except:

Healthcare professionals must get informed consent from patients before treating them. Patients have the right to refuse treatment. Patients medical records must be kept confidential. Answer - All of the above except, treatments must designate to maximize benefits and minimize risks. It is true treatments must maximize benefits and minimize risks, but this is implied by the principles of beneficence and non-maleficence, respectively. The principle of autonomy is applied to informed consent, voluntary decision-making and medical confidentiality.

The type of long term care organization that provides services to people living with and dying from a fatal condition is...

Hospice

According to this unit, the term "hidden curriculum" refers to:

How medical students acquire their ethical standards. Many experts say that when it comes to prevailing ethical values, medical education contains a "hidden curriculum." Such things as institutional policies, standards for evaluation, resource allocation decisions, and institutional language can influence what medical students learn about ethics.

Resistance to change can be overcome by:

Identifying champions Alleviating fears Collaborating to solve problems All of the above

Which of the following is NOT true about advance directives?

In a durable power of attorney for healthcare, a person states who should make decisions for them if they are unable to make them. In a living will, a person states their wishes about life-prolonging care. A living will and a durable power of attorney for healthcare can be combined into one document. Patients on Medicaid are required to write a living will. Answer - Patients on Medicaid are not required to write a living will. Living will is optional for everyone.

Healthcare systems in developing nations have a higher incidence of medical error than healthcare systems in developed nations because:

Infrastructure and equipment are inadequate Drug supply and quality are unreliable Operating costs are often underfinanced All of the above, healthcare systems in developing nations have a multitude of issues that increase the incidence of medical errors.

What type of foreground question does the following study answer: What is the difference in the mortality rate between patients treated fro colon cancer with surgery alone or with surgery plus chemotherapy?

Intervention (therapy); A study of outcomes from a comparison of treatments is a question of intervention.

Describe common patient perceptions of the enhancements communicated with the provider or health system after implementation of EHR?

Less need to duplicate entry of patient information in each department, less repeat lab tests, and better dissemination of consultation and diagnostic results among different providers and departments.

Medication assistants in many states are restricted to administering medication in....

Long-term care facilities.

A NP typically requires what degree?

Masters degree

Which department would usually be a part of the information division (at a hospital or care facility)?

Medical Records.

Observational data, like the history, results of the physical exam and summary of surgery or procedure is recording using what type of data?

Narrative

(Data in terms of hierarchy) The history and physical taken by the physician

Observations - are everything the physician noted

A quality measure assessing the mortality rate for treatment of congestive heart failure after treatment in a hospital falls into which of Donabedian's quality categories?

Outcome - the measure of mortality rate from a treament is an outcome measure.

Since 2007, new pharmacist are required to have what degree?

Pharm D.

You once dropped out of college years ago and do not want to tell any of your current healthcare providers. This is an example of:

Privacy - the right to keep information about yourself secret is privacy.

A quality measure assessing how many patients receive colon cancer screenings after an effort to improve screening rates falls into which of Donabedian's quality categories?

Process - a measure of people who receive colon cancer screenign is a process measure.

What can we say is true generally about healthcare quality, even if there are some counterexamples?

Quality of care is provided for better by more experienced physicians. Quality of care is not related to the number of procedures a medical center does. Proper medical care is only provided slightly more than half the time. Answer - proper medical care is only provided slightly more than half the time. McGlynn's study showed tha tin aggregate, proper medical care is only provided 54.9% in the US. Other studies showed that physicians in practice longer provide lower quality care and that for most, but not all conditions, centers performing a higher volume of care provided better quality.

A study using tests for the presence of multiple genes in a patient to determine disease is best described as what kind of clinical study?

Randomized controlled trial Clinical prediction study Cohort study Case control study Answer - clinical prediction study, a study that uses multiple tests to predict a clinical diagnosis is called a clinical prediction study.

Which of the following is an example of two-factor authentication?

Retinal scan. Password you must change every 6 months Smart card with RFID chip Answer - Both password you must change and Smart card with RFID chip -- 2 factor authentication uses two things for authentication, something you know and somethign you have.

The 5 "rights" of medication administration are:

Right patient Right drug Right time Right dose Right route

Primary Care Organizations typically refer patients to what other types of organizations?

Secondary & Tertiary care

A quality measure assessing the number of computer workstatons available to nurses in a hospital falls into which of Donabedian's quality categories?

Structural - the measure of components of a hospitals infrastructure, such as number of computer workstations, is a structural measure.

When trying to reach a dx, a clinician chooses to use the abbreviation "VINDICATE" to help think through the possibilities, this is an example of what type of approach -

Systematic approach

An encryption algorithm is an example of what type of safeguard in the HIPAA Security Rule?

Technical - Encryption is an example of a technical safeguard.

Attributes of a clinician which were described in this unit on the clinical process include all of the following, except:

The clinician acts in the best interest of the patient The clinician underwent experiential training The clinician has a direct relationship with the patient NOT -- the clinician possesses a doctor of medicine degree

Which of the following is NOT necessary for a successful malpractice lawsuit?

The healthcare provider being sued is a doctor. The healthcare provider failed to meet minimum standards of care. The healthcare provider had a duty to the patient. The injury resulted in damages (harm). Answer - The provider beign sued is a doctor. Other healthcare providers besides doctors, including nurses, pharmacists, and physical therapists can be successfully sued in a court of law if the elements of a malpractice case are met.

Which of the following best describes the law(s) about the duties of healthcare providers who have a moral or religious objection to a certain medical intervention?

The laws about conscientious objection vary from state to state ---- Laws vary, for example some states protect the right of doctors and pharmacists to refuse to dispense emergency contraception, while other states hae laws that require these professionals to provide patients with that medical intervention.

Each of the following is an example of an item in the patients history except:

The reason for admission or CC The past medica hx Information about Allergies Information on occupation and habits NOT the BP measured by clinician - this is an element of the physical exam or objective data. Other items are elements of the patients history.

Which of the following about mistakes are INCORRECT?

They are errors of unconscious thought Rule-based errors usually occur during problem-solving when a wrong rule is applied. Knowledge-based errors usually occur because of the lack of expertise Rule based errors can be reduced by using clinical decision support. Answer - they are errors of unconcious thought.

PHI can be disclosed in all but which of the following circumstances?

Transfer of a patient from one hospital to another. Submitting a claim to an insurance company for payment. Informing patient about supplies offered by a medical supply house in the community. Referral of a patient from one physician to another for a consultation. Answer -- Informing patient about supplies.... TPO allows the PHI to be disclosed. Disclosure of information for marketing is now allowed under HIPAA pricacy rule.

Which of the following best describes what an ambulatory care nurse does?

Treats non-urgent heatlh problems over several visits.

Secondary Care Organizations provide the majority of specialty diagnosis and treatment...True or False

True

True or False - Technology has assisted the evolution of the scientific method by allowing automation of complex statistical calculations in research.

True

True or False - the leapfrog group voluntary program initiated by large employers and organizations of purchasers do improve patient safety.

True

True or False - Administration errors are especially common with IV medications.

True - IV drug pumps are typically programmed by nurses at the bedside & the wide range of options makes it easy to deliver incorrect doses of medication.

True or False - In the past, errors ended to be blamed on the individual, while now the emphasis of error recognition and correction is on fixing inadequacies in the system.

True - as a society we are moving away from assigning individual blame towards improving the system. Now looking to change the system rather than impose punitive measures on individuals.

True or False - heuristics are "rules of thumb" that are subject to errors and biases.

True - heuristics are rules of thumb that are prone to weaknesses such as cognitive errors and biases, they are fast, almost immediate processes that are markedly non-analytical in nature.

True or False - the ethics of end of life care is complicated because there is no clear line between life and death.

True.

Which of the following is not an example of someone's PHI under HIPAA

URL of personal home page Email address Automobile registration number Political party afiliation Fingerprint Answer - political party affiliation is not considered to be PHI.

Which of the following is a core quality measure for EPs?

Venous thromboembolism discharge instructions Childhood immunization status Hypertension: blood pressure mgmt Diabetes: foot exam Answer - HTN, BP mgmt is a core quality meaure for EPs

Which of the following is a core quality measure for EHs?

Venous thromboembolism discharge instructions Childhood immunization status Hypertension: blood pressure mgmt Diabetes: foot exam Answer - Venous thromboembolism discharge instructions

The largest integrated healthcare system in the US is...

Veterans Health Administration

Is any type of nurse allowed to prescribe medication?

Yes, an NP is allowed to prescribe medication independently of a physician.

Do people in the US Pay more for healthcare services than other Western countries?

Yes, people in the US pay more for healthcare although do not get more services. In addition there would be some savings in their insurance permiums if care were provided to the uninsured (although they would likely pay higher taxes).

When trying to reach a dx, a clinician may use which of the following approaches

an anatomic approach a pathophysiologic approach a systematic approach Bayes Theorem ALL of the ABOVE

Clinicians organize information by:

recoding information using a narritive structure rearranging information into a H&P and physical format rearranging information into a specific hierarchy reformulating information into a structure that can be utilized by an EHR. (All of the above)

When executing a managment plan for a patient, a clinician may need to communicate with which of the following:

the patient the patients family and friends insurance companies clinical staff such as RN and Pharm ALL of the ABOVE

When developing a management plan, a clinician must consider not ony the diagnosis and recommended treatment, but also which of the following into consideration:

the personal preferences of the patient the local practices tha may be prevalent in the community any coexisting conditions that the patient may have economic constraints and hardships faced by the patient and their family ALL of the ABOVE