Ch.19- Issues in Primary Care

What factors primarily determine the ability of an Advanced Practice Registered Nurse (APRN) To obtain clinical privledges in an institution? correct answer- Institutional policy, medical staff bylaws, state law, and Joint Commission on Accreditation of Healthcare Organizations accreditation standards. In the outpatient setting, the most common reason for a malpractice suit is failure to ?? correct answer- diagnose correctly and in a timely fashion. The primary nursing responsibility during a crisis situation is to? correct answer- establish a therapeutic relationship What is the best way to monitor compliance? correct answer- Ask the client To reinforce client teaching, a useful strategy is to? correct answer- model or demonstrate the desired behavior. Concrete strategies used to keep your client's attention as you institute client education include? correct answer- translating theoretical information into practical terms. Legal authority for advanced practice nursing rests with? correct answer- The state laws and regulations. Which of the following statements is true regarding the consultative aspects of the APRN role? correct answer- The problem is identified by the clinician who then may decide to call in a consultant, a recognized expert, and a nonhierarchical relationship ensues or is established. When caring for a client that speaks a language different than yours, the ideal strategy is to? correct answer- review the case first with an interpreter before beginning the clinical visit. Some sources suggest that you create a marketing portfolio with documents that support what you have to offer as an APRN. These documents include? correct answer- the state nurse practice act and regulations, prescriptive authority legislation, third-party reimbursement rules and regulations, and practice protocols. According to the Joint Commission on Accreditation of Healthcare Organizations, decisions regarding policy and client care should be made based on? correct answer- research findings Which of the following statements related to statistical techniques and their usage in research is true? correct answer- To determine the appropriate statistical test to use, consider sample size, level of measurement, and data type. According to the health belief model, motivation, or readiness to act, is determined by which of the following components? correct answer- Perceived threat, efficacy, benefits of action, and perceived barriers to action. The Agency for Healthcare Research and Quality (AHRQ) was established to? correct answer- promote evidence-based practice. The primary purpose of an institutional review board is to? correct answer- protect human subjects The primary purpose of professional licensure is to? correct answer- protect the public by ensuring a minimum standard for competency. There are advantages to owning your own practice. However, there are also barriers to the ability to do this. These barriers include which of the following? correct answer- Getting and keeping a collaborative physician if required by law, getting on managed care panels, and getting privledges at hospitals. The best way in which you, as an individual APRN, can make a difference or true impact is by? correct answer- writing letters to the editor supporting APRNs. Schedule IV drugs include which of the following? correct answer- Depressants such as alprazolam, clonazepam, diazepam, and flurazepam. Advanced Practice Nurse refers to? correct answer- nurse practitioners, nurse anesthetists, clinical nurse specialists, and nurse midwives. According to standards of care and legal prescribing, which of the following questions must you ask each client before prescribing any medication? correct answer- Are you breastfeeding? Are you allergic to any medications? Are you pregnant? Have you taken this medication before? Do you have kidney or liver problems? What other medications are you taking? What medical problems do you have? Ethical responsibilities of the nurse practitioner as an employee include? correct answer- protecting the employer's trade secrets such as client mailing lists and remaining unimpaired by drugs or alcohol. An emancipated minor is a client who is younger than age 18 but who is considered a competent adult with the authority to accept or refuse medical treatment. How do you determine if the 16-year old you are seeing is an "emancipated minor"? correct answer- Although definitions vary among states, the term usually implies that the minor has entered into a valid marriage, is a member of the military, or has been granted this status by a court. Indemnity insurer refers to an insurer? correct answer- That pays for the medical care of the insured but does not provide that care. "Do not resuscitate" orders are decided by the? correct answer- physician in consultation with the client, family, or surrogate decision maker. The stages of grief include? correct answer- shock, reality, and recovery. Motivational interviewing is a that can be useful in implementing behavior change because it? correct answer- assists clients to acknowledge and verbalize the changes they need to make. The purpose of a block grant is to? correct answer- allow states to have greater flexibility in providing services to the poor. You are seeing your client for the first time and he says, "I like that you are a physician assistant." You tell him that you are a nurse practitioner, and he asks you how they are different. Your best answer is? correct answer- Physician assistants are health-care professionals who are authorized by the state to practice medicine under the license of a physician, wheras the nurse practitioner has an independent base of knowledge- advanced nursing knowledge-and independent licensure to practice. The type of health care delivery system that allows the client the greatest freedom of choice is a? correct answer- fee-for-service plan. The majority of Medicaid enrollees are? correct answer- young women and children. The research function of the APRN may be operationalized as both a consumer of research findings and a researcher. Being a consumer of research findings involves a number of activities, including ? correct answer- reading the literature, analyzing its clinical applicability, and using new interventions. The marketing process is guided by a number of factors. These include? correct answer- product, price, place, and promotion. Goals and objectives for Healthy People 2020 include? correct answer- reducing disparities in health care, increasing healthy life span, and increasing access to health care for all Americans. What is a strategy that can help to foster client compliance? correct answer- Providing positive feedback and reinforcement. It is important to prepare for your interview as an APRN. You should be prepared to answer which of the following? correct answer- Why you should be hired, how many clients per day you will see, what you can bring to the practice, your willingness to work eventings and or weekends and to take calls and how independent you are in your practice. Sally , an APRN, sees Mr. Bell, who is suffering from congestive heart failure. She increases his diuretic but makes no note of his potassium and orders no replacement potassium. Mr. Bell returns a week later for routine laboratory testing. His potassium level is found to be low; however, Mr. Bell has no complaints. Sally orders a potassium supplement to begin immediately and a follow-up potassium level measurement. Is Sally guilty of malpractice? correct answer- No, because no harm came to the client. As an APRN, you begin a new job in a small practice with two other physicians. You have been hired to be a partner in the practice, but the eldest partner is reluctant to allow you to take on new clients. This is an example of ? correct answer- role conflict You are attempting to elicit a history from Mr. Barnes during his first visit to your office. He is becoming increasingly angry and belligerent. He says, "Can't you hurry up? Dr. Smith never takes this long! Why are all these questions necessary?" You respond? correct answer- You seem very upset, Mr. Barnes. Could you share with me what is bothering you? Credentialing means that? correct answer- the practitioner has met certain criteria through licensure, certification, and education. Which of the following is the best method for evaluating the efficacy of a new clinical intervention? correct answer- A randomized, controlled clinical trial. According to the Center for Medicare and Medicaid Services (CMS), one of the core reasons for the adoption of electronic health records is to? correct answer- reduce the incidence of medical error by improving the accuracy and clarity of medical records. Mrs. Smith, age 85, lost her husband 6 months ago. Since that time, she has been overwhelmed and has had difficulty coping. Today, she is in your office, tearful, weak, and discouraged. Her mobility is also becoming increasingly limited because of her need for a hip replacement. She is indecisive, expresses fear about the surgery, and tells you that she does not want the surgery. Your action is to? correct answer- treat the client's psychological problems and provide support. If conflict arises during a job negotiation, you should consider? correct answer- separating the issue from the person. The requirements for reportable communicable disease vary among states. Which of the following lists include diseases that must be reported in every state? correct answer- Syphilis, tuberculosis, and hepatitis. When applying for a new position, a nurse practitioner is counseled to assess the work environment. What does this include? correct answer- Call time; support staff and what they will do; supervising relationships; whether you will be building your own panel of clients and or seeing those overbooked. Collaboration is best defined as ? correct answer- cooperation with another to achieve mutual goals while not losing sight of one's own interests. Mr. Bill, age 50, is a house painter who has smoked two to three packs of cigarettes per day since he was 20 years old. He comes into the clinic complaining of a chronic cough. When you discuss his smoking behavior, he states, "I know I need to stop smoking, but I'm under too much stress right now." Mr. Brill is at which stage of learning? correct answer- A) The precontemplative stage. (suggested right answer) B.) The contemplative stage- he knows he has a problem*** this is the correct answer. Mr. Griffin, age 85, has been given a diagnosis of bowel cancer, and surgery is indicated. He is mentally alert; however, he is refusing to give consent for the procedure. You respond by? correct answer- respecting his wishes. You are interviewing a client who becomes tearful. An appropriate response is to? correct answer- sit quietly with the client and offer a tissue. What must you do as an APRN before billing for visits? correct answer- Obtain a provider number and familiarize yourself with the rules and policies of the third-party payer. Your Native American client is convinced that her illness has been caused by the ill will of a fellow tribeswoman. Her description of her illness is an example of her? correct answer- explanatory reasoning. Which of the following statements is true about Medicaid? correct answer- Medicaid is a program for the indigent financed jointly by the federal and the state governments. Reviewing the literature refers to the ability to research existing literature about a specific problem, whether clinical or policy. The most important skill necessary to performing a thorough review of the literature is? correct answer- critiquing the findings and synthesizing the results. What is the NPI (national provider identifier)? correct answer- A unique identifying number for health-care providers required by CMS (Centers for Medicare and Medicaid). APRNs are affected by laws and rules, although these vary by state. Which of the following is affected by state law and regulation? correct answer- Delegation of authority by physicians. What is the maximum number of points you should attempt to make in one teaching session? correct answer- Three to Four Medicare is a federal program administered nationally by the Centers for Medicare and Medicaid Services (CMS) and administered locally by Medicare carrier agencies. The CMS has developed Guidelines for Evaluation and Management Coding, which all Medicare providers, including nurse practitioners, are expected to follow in coding client visits for reimbursement purposes. Which of the following is an important consideration regarding billing practices? correct answer- Failing to bill for billable services will lead to unnecessarily low revenues. The gerontological population is designated as a vulnerable one when it comes to obtaining informed consent to serving as a research subject because of the potential for exploitation of older adults. Safeguards you should adhere to when conducting research on a geriatric population include which of the following? correct answer- Assess the competence of the individual before obtaining consent. What conditions must be met for you to bill "incident to" the physician, receiving 100% reimbursement from Medicare? correct answer- The physician must be on-site and engaged in client care. You are working in an emergency department as an APRN. An adolescent boy is brought in, unconscious, with a head injury after being struck by a car. He has no identification, and there is no parent or adult with him. What should you do? correct answer- Provide the appropriate medical treatment even if it involves surgery. The primary purpose of certification is to? correct answer- document competence and specialization. An effective method used to assess a client's retention and understanding of educational material is? correct answer- asking the client to restate what you have reviewed. According to the 2008 APRN Consensus Model, a nurse should refer to himself or herself as an APRN if his or her specialty role is? correct answer- a primary care nurse practitioner (CNP), a certified nurse midwife (CNM), or a certified registered nurse anesthetist (CNRA). Prescriptive authority for APRNs ? correct answer- varies by state. Which of the following statements is true about case management? correct answer- Case management is organized around a system of interdisciplinary resources and services. Strategies for developing cultural competence include which of the following? correct answer- Learning basic words and sentences in the client's language. Medicare is divided into Part A and Part B. What is the difference between these two parts? correct answer- Medicare Part A provides coverage for hospital care and skilled nursing facility and home care; Part B pays for outpatient fees at 80% of what Medicare determines to be reasonable. Most health maintenance organizations (HMOs) use a reimbursement mechanism called capitation. This means that the? correct answer- HMO reimburses the provider a predetermined fee per client, per month, based on the client's age and sex. Advance directives, such as health-care proxies and durable powers of attorney, are important for all clients to consider. In particular, persons who are unable to marry legally and those who are single by choice or circumstances may preserve their health- care wishes by? correct answer- executing a durable power of atorney for health care. Mr. Jones, age 44, is admitted to the emergency department complaining of chest pain. Which of the following actions would be the best way to establish a therapeutic relationship with Mr. Jones? correct answer- Ask open-ended questions to elicit pertinent clinical data. Health behaviors can be difficult to change. Which of the following is most important in influencing behavioral change? correct answer- Motivation Human research subjects are entitled to all of the following Except? correct answer- the right to compensation for their participation. Which of the following are third party payers? correct answer- Indemnity insurance companies and businesses that contract for certain services. A good way to use an interpreter is to? correct answer- try to use an interpreter who is of the same sex as and older than the client. The levels of evaluation and management (E/M) services are based on which types of histories? correct answer- Expanded problem focused There are a number of barriers to full implementation of autonomous role for APRNs in primary care. Major barriers are? correct answer- prescriptive authority, scope of practice, and reimbursement. You have seen a client who has tested positive for syphilis. You have treated the client, tested the client for other potential sexually transmitted diseases including HIV infection, counseled the client about safe sexual practices, and scheduled the client to return at 3 and 6 months for repeat serological testing. The tests at those times demonstrated that no further syphilis was present. Should you have taken any other action? correct answer- Yes, you must report the case to the local health authorities. Elder abuse and neglect are increasing concerns, and it is estimated that 4-10% of older Americans are abused or neglected. What is the legal responsibility of the health- care provider in reporting elder abuse and neglect? correct answer- The health-care provider must report the suspected abuse or neglect to the appropriate state protective agency. When negotiating a contract for employment as a nurse practitioner, there are number of important factors to consider. What are some important questions to ask? correct answer- What is the most frequently billed current procedural terminology (CPT) code for this practice, and what amount does the practice bill and receive, on average, for that CPT code? One of the two organizations that offer certification to the FNP is? correct answer- the American Academy of Nurse Practitioners When teaching your client about medication that you are prescribing, the most important points to discuss initially are? correct answer- what it is for, how much to take, and when to take it. Usual and customary refers to? correct answer- an insurance term for how a charge compares with charges made to other persons receiving similar services and supplies. Who oversees the APRN's prescribing of controlled substances? correct answer- The federal government. Regulation of the APRN consists of four essential elements. They are? correct answer- licensure, certification, education, and accreditation. A situation in which medical information may be passed on without client consent is when? correct answer- the client has a gunshot wound. What are some important negotiating points for the nurse practitioner seeking a job? correct answer- Salary, benefits, and work environment. Which of the following are ways one may risk breaching client confidentiality? correct answer- Leaving a client's record within view. Mrs. Hernandez, age 79, is insisting on discharge from the skilled nursing facility where she is receiving rehabilitation after a left hip replacement. She lives alone and has very little support. You do not think she is ready for discharge. Mrs. Hernandez's insistence on discharge is an example of your client exercising her right to? correct answer- self- determination A good resume can be crucial to your success in obtaining a job. It should include? correct answer- community service As measured by the Center for Medicare and Medicaid, national health expenditures are grouped into which two categories? correct answer- Research and medical facilities construction and payments for health services and supplies. When caring for clients from a different culture, which of the following is an important piece of assessment data? correct answer- Determining the ultimate decision maker. Certain characteristics differentiate research from quality improvement. Which of the following is an example of research? correct answer- A new intervention is implemented and compared with current practice to determine which is better. Denial of provider status is something that seriously impedes a nurse practitioners' ability to practice. If that occurs, some steps one can take include? correct answer- writing letters to the organization's president and CEO, activating others to lobby on your behalf, and reapplying after a 6-month period. Negotiating a salary in a practice is important. A factor to consider is? correct answer- what payment method will be used-straight salary, percentage of net receipts, base salary plus percentage, or hourly rate. Relapse is a common phenomenon seen during behavioral change. Useful strategies for the healthcare provider to institute to aid the client in a relapse situation include? correct answer- telling the client that the relapse is a learning opportunity in preparation for the next action stage. A comprehensive history includes which of the following elements? correct answer- Chief complaint; review of systems; history of present illness; and past, family, and social history. What is the responsibility of the primary care provider? correct answer- The primary care provider is the coordinator of the client's health care. Which of the following nonverbal communication techniques is important to the establishment of rapport with the client? correct answer- Making direct eye contact with the client with periodic breaks to check or take notes. Multiple regression and analysis of variance and covariance are tests of? correct answer- prediction Techniques used to enhance a client's adherence to a treatment plan include? correct answer- giving clear written instructions and simplifying the drug regimen. What is important to do before negotiating a contract? correct answer- Do your homework Zero-base budgeting refers to a budgeting system that? correct answer- justifies each budget on its own merits, not on the basis of the previous periods' budget. Which of the following verbal communication techniques is helpful in establishing rapport with the client? correct answer- Speaking directly to the client, introducing yourself by name, and establishing the purpose of the interaction.