Fitzgerald Professional Issues - chpt 20

True/False In keeping with HIPAA's requirements: __1. You cannot announce a patient's name in a waiting room. __2. If interrupted during a patient visit, prior to leaving the exam room, the healthcare provider should lock or otherwise disable the electronic health record (EHR) to minimize the risk of unauthorized access to information. __3. A healthcare provider can leave a patient a message on his or her answering machine unless specifically asked not to do so but the amount of information disclosed should be limited. __4. Unless asked not to do so by the patient, a healthcare provider is allowed to leave a message with a family member or other person who answers the phone when the patient is not home. __5. If interrupted during a patient visit, prior to leaving the exam room, the healthcare provider should take the paper healthcare record with him/her, in order to minimize the risk of unauthorized access to information. __6. Unless under the control of the healthcare provider or staff, paper records should be kept in a secure location, such as a locked desk, locked filing cabinet or office with appropriate staff. __7. An employee of a healthcare facility is only able to access patient records for legitimate, job-related purposes.__

1. F 2. T 3. T 4. T 5. T 6. T 7. T

The APRN writes a prescription for trimethoprim-sulfamethoxazole for a patient who has a skin and soft tissue infection and known sulfa allergy. The patient takes two doses of the medication, has no reaction, then realizes this might be one of the problematic antibiotics. The patient notifies the practice and the APRN changes the medication. He makes a full recovery. Yes or No 1. Is there negligence? 2. Is there damage? __ Copyright © Fitzgerald Health Education Associates, LLC. All rights reserved. Question 35 of 51

1. yes 2. no

A 50-year-old man of Croatian ancestry has a follow-up appointment after cardiac bypass surgery. The patient brings his father with him into the examination room. They are both fluent English speakers. The NP provides culturally sensitive care by the following action. A. Ask the patient's father if he has any questions regarding his son's care. B. Request the patient's father to leave the room due to confidentiality issues. C. Acknowledge the father's presence and complete the visit while reporting all findings to the patient. D. Perform the clinical evaluation, then report to the patient's father the examination findings.

A

A 90-year-old woman with moderate dementia, heart failure, and chronic renal insufficiency presents with a new onset of weakness. Further evaluation reveals marked hyperkalemia with a eGFR=22 mL/min/1.73 m2. Nephrology recommends hemodialysis. When discussing this option with the patient, she declines this treatment. She also inaccurately reports the current year, location, and name of the USA president. When asked why she does not want dialysis, she states, "I do not want to be on a machine. I am quite old and my health is not good." When asked what she believes will happen if she does not have dialysis, she states, "I guess I will die. That is OK." In reflecting on this patient, the NP appreciates that: A. She demonstrates competency in this situation and her wishes can be followed. B. Due to her inability to report accurate date, location, or current president, she is not competent to make healthcare decisions. C. A patient with a documented diagnosis of dementia is considered incompetent to make all healthcare decisions. D. Court-appointed guardianship should be sought.

A

A malpractice suit concerning a delayed cancer diagnosis is filed naming a NP in a primary care practice. Will the APRN be held to standard of care of an APRN with the same level of education and practice in primary care or in an oncology practice? A. Primary Care B. Oncology Practice

A

An APRN prescribes clarithromycin for the treatment of sinusitis in a woman taking simvastatin. While on the antibiotic, the patient develops rhabdomyolysis. Can you see a correlation between the above events? A. Yes B. No

A

The relationship between obesity and type 2 diabetes is best described as: A. Causal B. Correlational C. Indirect D. Qualitative

A

What type of professional liability insurance policy covers you only if the injury occurs within the policy period and the claim is filed during the period the policy is in effect? A. Claims-made B. Occurrence C. Interval coverage D. Incident petition

A

Which of the following describes the ethical principle of utilitarianism? A. Healthcare resources are allocated so that the best is done for the greatest number of people. B. The healthcare provider must be truthful and avoid deception. C. The healthcare provider has an obligation to be faithful to commitments made to self and others. D. The responsibility of the healthcare provider is to treat all people in the same fair manner.

A

While walking in the parking lot of a grocery store, an NP notices an elderly man fall and hit his head on the ground. The NP quickly rushes to provide aid to the man. This is an example of: A. Beneficence B. Autonomy C. Veracity D. Utilitarianism

A

Your neighbor asks you to refill her high blood pressure medicine as she could not make her last office visit to her provider due to a family emergency. You are aware that she is going through a rough time personally and agree to call in the prescription. Is she now your patient? A. Yes B. No

A

A clinical trial is studying whether a vaccine prevents disease. Among those who receive the vaccine, 10% get the disease compared to 40% who received placebo. In this case, the RRR is: A. 10% B. 30% C. 75% D. 300%

A Relative Risk Reduction (% risk removed by treatment = # Treatment failed /# Treatment worked

An organization has donated 1000 pediatric vaccines to a community clinic. Ensuring that the distribution of the vaccines is done in a fair and unbiased manner is an example of: A. Utilitarianism B. Justice C. Beneficence D. Fidelity

B

CPT stands for: A. Clinical procedures and techniques B. Current procedural terminology C. Coding for practice tasks D. Codes for price tracking

B

In the preceding question, the dependent variable is the: A. iPhone® application. B. 10% weight loss. C. Gender. D. Sample Size.

B

Which of the following best demonstrates the intent of informed consent? A. Discussing the risks of surgery with the parent of a 20-year-old B. Advising a 48-year-old woman about the likely course of illness if no treatment is rendered C. Conferring with the husband of a 30-year-old woman who has pneumonia about the benefits of antimicrobial therapy D. Recommending a course of treatment to a 70-year-old man with prostate cancer

B

Mr. Miller is a 60-year-old man with hypertension. On today's office visit, his blood pressure is noted to be 122/78. The rest of his history and physical examination are unremarkable. He mentions that, in addition to his antihypertensive medication you have prescribed, he uses a teaspoon of hot pepper sauce in a glass of warm water daily to help "clean my blood and lower the pressure. I feel much better when I take it." Your most appropriate response is to: A. Advise Mr. Miller to stop using the hot pepper sauce. B. Explore what Mr. Miller means by "clean my blood." C. Inform Mr. Miller that this practice can result in serious gastrointestinal complications. D. Ask Mr. Miller to stop the hot pepper sauce use until you can examine the contents of the product he uses.

B

Which of the following describes the ethical principle of beneficence? A. The right of the competent person to choose a personal plan of life and action. B. The obligation of the healthcare provider to help people in need. C. The duty of healthcare provider to do no harm. D. The responsibility of the healthcare provider to treat all in the same fair manner.

B

Which of the following describes the ethical principle of veracity? A. Healthcare resources are allocated so that the best is done for the greatest number of people. B. The healthcare provider must be truthful and avoid deception. C. The healthcare provider has an obligation to be faithful to commitments made to self and others. D. The responsibility of the healthcare provider is to treat all people in the same fair manner.

B

You see a 24-year-old mother who presents with her healthy 18-month-old son. He is being seen for a well child visit. An interactive child who is quite playful, his examination is within normal limits. When you ask if the mom has any concerns, she states, "I do not like it when people stare at my baby. He is going to get sick." You respond: A. "What type of illness do you think your son will get when people look at him?" B. "You are concerned he will get sick if people look at him?" C. "Please make sure you come back for a sick visit with your baby whenever you have concerns about your son." D. "Your baby is just delightful. I can imagine that people often look at him."

B

A 52-year-old woman who is Muslim arrives for an office visit. Her last primary healthcare visit was more than 10 years ago. She mentions that she does not want to disrobe or remove her head cover for a physical exam. You consider that: A. Her healthcare visit cannot proceed until the patient is able to disrobe for the physical exam. B. A mammogram should be ordered without prior breast examination. C. The option of having a modified physical examination with minimal disrobing should be discussed with the patient. D. The health history can be completed today and the physical examination deferred until a future office visit.

C

A clinical trial is studying whether a vaccine prevents disease. Among those who receive the vaccine, 10% get the disease compared to 40% who received placebo. In this case, the ARR is: A. 10% B. 30% C. 75% D. 300%

C

A mother presents her 3-year-old son with a 2-day history of cough and runny nose without fever. The NP explains that this is likely a viral infection and treatment should focus on symptom management. However, the mother is insistent on getting a prescription for antibiotics despite the NP's explanation that antibiotics will have limited effectiveness and may cause adverse effects. In this scenario, which of the following best demonstrates the ethical principle of nonmaleficence? A. Providing a prescription for an antibiotic regimen. B. Providing a 2-day sample of antibiotics with follow-up at 3 days to determine if additional antibiotics are needed. C. Denying a prescription for antibiotics. D. Getting approval from a physician prior to giving the antibiotic prescription

C

A patient who underwent CABG following a MI develops a surgical site infection. Upon reviewing the patient's records, the NP notices that standard antimicrobial prophylaxis was not provided prior to surgery. The ethical principle of ________ requires the NP to report this finding. A. Nonmaleficence B. Justice C. Veracity D. Utilitarianism

C

Which of the following represents a valid ICD 10 code? A. 370.21 B. 99202 C. K25.1 D. AZ5.32

C

A mentally competent patient with advanced cancer is explained 2 treatment options. He decides to take the less invasive technique, despite counseling him that his choice has a lower chance for success. Respecting the patient's choice demonstrates the ethical principle of: A. Justice B. Veracity C. Paternalism D. Autonomy

D

A new family nurse practitioner is beginning a practice in weight management. While reviewing the literature on techniques to promote weight loss, he finds a research report of 30 adult women who recorded their daily caloric intake on a new iPhone® application while on a weight loss plan. The women lost an average of 10% starting weight during the study. In the discussion section of the paper, the author suggested that based on these data, adult women who used this iPhone® application while on a weight loss plan would lose 10% of starting weight. The new FNP questions whether or not the iPhone® application is the cause of the weight loss.This suggests questionable: A. Reliability. B. Power. C. Confidence level. D. External validity.

D

A researcher wishes to evaluate the effectiveness of Antimicrobial Z for complicated skin infections by analyzing patient charts over the past 3 years. This is generally considered what type of study? A. Double-blind B. Single-blind C. Prospective D. Retrospective

D

For an individual to demonstrate the capability to make an informed healthcare decision, all of the following must be present except: A. The patient has the ability to understand the nature of the clinical condition. B. The patient can interpret the information presented. C. The patient is able give a reason for the choice if asked. D. The patient does not need to be able to communicate what the care preference is.

D

Mr. Nelson is a 75-year-old man in need of surgery. Mr. Nelson has been treated unsuccessfully with conservative therapy for a bowel obstruction. Documented on his record is his consent to surgery that was obtained by the chief surgical resident. During your preoperative visit with Mr. Nelson, he is alert and relatively comfortable. His wife mentions that her husband had a dose of promethazine (Phenergan®) to manage his nausea around the time the surgical consent was obtained. Mrs. Nelson asks, "Is the consent OK since my husband clearly does not feel well?" You respond: A. Since the chief surgical resident obtained the surgical consent, this should be considered valid. B. Legal counsel should be obtained prior to proceeding. C. That surgical consent should be obtained from Mrs. Nelson as she is Mr. Nelson's de facto healthcare proxy. D. You will call the chief surgical resident to clarify the issue of consent.

D

Mr. Santorini is a 71-year-old man with a 10-year history of hypertension. He is currently taking a fixed-dose lisinopril/hydrochlorothiazide tablet daily and reports excellent adherence. On today's visit, he is without complaint and physical examination is within normal limits, with BP=138/84. He mentions that, for the past three months, he has been sprinkling a "pinch" of cumin and coriander mixture on his food once a day to "help control my blood pressure" and reports "feeling like I have more energy" since starting this. You consider that: A. This mixture will likely interact with his antihypertensive medications. B. Using cumin or coriander could raise his blood pressure. C. Additional medications can be prescribed if his blood pressure control worsens. D. He is advocating for his health and the practice should be supported.

D

The adult daughter of an 88-year-old man telephones the nurse practitioner to inquire about her father's medications. The daughter reports that "my father relies upon me to explain everything to him." The nurse practitioner's initial response is to: A. Ask the daughter to provide a copy of the patient's advance directive document. B. Assure the daughter that the NP can share the requested information. C. Inform the daughter that she must come to the clinic to discuss her father's care. D. Tell the daughter that the NP can discuss the information only with the patient.

D

Which information concerning the use of email messages is included in the Health Insurance Portability and Accountability Act? A. Email messages are not an acceptable form of communication under any circumstances. B. Email messages are suitable only if this communication contains medical record numbers, instead of patient names. C. Email messages are acceptable between healthcare providers, but not between healthcare providers and patients. D. Email messages containing private patient information are acceptable if the information is encrypted.

D

You see a 54-year-old woman, Senora Sanchez, who is not fluent in speaking English, who comes into the emergency department of a 300-bed hospital with a chief complaint of abdominal pain and is accompanied by Tomas, her 10-year-old nephew. Tomas states, "I am here to help my aunt since she does not speak English." Which of the following is the most appropriate way in conducting this clinical encounter? A. Direct questions to Tomas, asking him to translate the information to his aunt. B. Direct questions to Senora Sanchez, asking Tomas to translate. C. Advise that Senora Sanchez return with an adult interpreter. D. Call the hospital's interpreter services department for assistance.

D

You see a 62-year-old man, Mr. Tran, who is from Southeast Asia. He is accompanied in the exam room by his 39-year-old son. Both are fluent English speakers. Mr. Tran is seen in follow-up on type 2 diabetes and hypertension. As you speak with Mr. Tran, he smiles, nods his head in response to your questions. He frequently looks down at the floor. You consider that: A. Mr. Tran is conveying that he understands your questions. B. His downcast gaze should trigger an assessment for depression or other mood disorder. C. Directing your questions to Mr. Tran's son is likely a more appropriate approach to the visit. D. Mr. Tran is showing respect for the healthcare provider's authority.

D

Billing and coding are basically the same thing. True False

False

Medicaid benefits are paid to the enrollee, then the enrollee is responsible for paying the healthcare bill. True False

False

Once I have achieved national certification, I can practice as a nurse practitioner. True False

False

A 45-year-old woman calls up your practice and speaks to the triage nurse, stating, "I am going to sue you all. That NP gave me amoxicillin and now I have a have yeast infection." Does this meet the "damages" standard? Yes No

No

Most cost effective form of health care?

Primary prevention - #1 vaccines

A person who is Medicaid eligible in one state might be deemed to be ineligible in another state. True False

True

Dental care for Medicaid enrollees under the age of 21 years is a basic requirement of the plan. True False

True

Impoverishment is the primary requirement for Medicaid eligibility. True False

True

Medicaid is the largest payer for nursing facility care. True False

True

State level authorization dictates the ability of the NP to obtain a Federal DEA number. True False

True

The Medicare program pays for any services that are covered by Medicare before any payments are made by the Medicaid program, since Medicaid is always the payer of last resort. True False

True

The charge of the State Board of Nursing is to ensure public safety. True False

True

The majority of NPs are eligible to obtain a Federal DEA number. True False

True

The services rendered under Medicaid that is provided by one state can differ considerably in amount, duration, or scope from services provided in similar or neighboring states. True False

True

Utilitarianism

allocation of healthcare resources so the best is done for the greatest number of ppl

Beneficence

do good, help ppl in need

Nonmaleficence

do no harm

Atonomy

patient independence

Justice

treating people fairly and equally

Veracity

truthful, avoid deception, full disclosure, risks and benefits