ANCC IQ Domains 5 answered all correctly answered;
latest updated summer 2022.
1. You see a patient for a routine medication visit. At the end of the session, the patient
asks questions and the session ends up 50 minutes in length. You normally charge for
the 30-minute appointment, but instead you charge for the 1-hour appointment. The 1-
hour appointment includes a full body assessment that you did not perform. This
violation is known as:
- Over-coding
- Super-coding
- Down-coding
- Up-coding
- Up-coding
Rationale: Up-coding is a fraudulent practice in which the provider services are billed at
higher procedure codes than were actually performed, resulting in a higher payment by
Medicare or other third-party payers.
1. During a session, your patient asks to be able to contact you via your Facebook page
on the internet. You reply:
- I cannot do that because I have a concealed Facebook identity; and I cannot reveal
that to my patients
- I would be happy to communicate with you. It makes it easier for me to reach you this
way.
- I would be happy to use Facebook but you will have to use a private message so that
you can be anonymous
- I cannot do that because Facebook does not protect your Private Health Information
- I cannot do that because Facebook does not protect your Private Health Information
Rationale: Using Facebook breaks patient-provider confidentiality, in addition to blurring
ethical boundaries of the therapeutic relationship. Facebook does not protect private
health information. Information on the site is available for anyone to see or hack into
even if private messaged.
1. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) insures which
of the following?
- Small employers who insure 50 or fewer covered lives are exempt from the provisions
of this MHPAEA law.
- Annual or lifetime dollar limits on mental health and substance use disorder benefits
are no lower than any such dollar limits for medical and surgical benefits offered by a
group health plan.
- Mental health and substance use disorder benefits must be available through both in-
network providers and out-of-network providers by a group health plan.
- Group health plans may obtain an exemption if they can demonstrate expected cost
increase resulting from implementation of the parity provisions greater than a 5%
increase in the cost under existing plan.
,- Annual or lifetime dollar limits on mental health and substance use disorder benefits
are no lower than any such dollar limits for medical and surgical benefits offered by a
group health plan.
Rationale: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
provides federal legislation that requires any annual or lifetime limits on medical and
surgical benefits be the same for mental health and substance use disorder benefits.
Small employers who insure 2 to 50 employees can apply for an “opt-out” waiver, but
they are not automatically exempt from the MHPAEA requirements. The group health
plan will be required to provide in-network and out-of-network mental health and
substance use disorder benefits only if it provides both in-network and out-of-network
medical and surgical benefits. The group health plan my obtain an exemption or waiver
if the first year of implementation results in 2% increase in group health plan costs over
prior year that covers the following year, and if implementation results in 1% increase in
group health plan costs in subsequent years. A section on actuarial determination of
these increased costs is included in the law.
1. A 68-year-old, retired African-American widower who served for 30 years as an Army
officer was recently diagnosed with terminal lung cancer. He made plans to die at home
with hospice care. He was hospitalized for a broken hip and succumbed to
complications in the hospital. Despite his request to be addressed as "Mr. Baxter" the
hospital staff persisted in calling him by his first name, "John." Which principle of
culturally competent care does this violate?
- Autonomy
- Advocacy
- Collaboration
- Respect
- Respect
Rationale: Respect of cultural values and beliefs is violated in this scenario.
1. PMHNPs seeking admitting privileges at a community hospital with inpatient
psychiatric services need to influence policymakers at which of the following levels?
- State board of nursing
- State legislature
- County board of health
- Local hospital
- Local hospital
Rationale: Local PMHNPs who want admitting privileges will want to persuade the
appropriate hospital decision maker, through facts, figures, and a presentation of
projected benefits to the hospital, of the need to change policy and allow PMHNPs to
admit patients.
1. To demonstrate her support for social justice, within her role as a PMHNP caring for
the person who is homeless with mental illness, the PMHNP:
- Volunteers to serve food at the local Home for Girls.
- Teaches Sunday School.
- Volunteers to walk at the March of Dimes walk each year.
- Volunteers her clinical services at the psychiatric clinic, run by a local mission project.
- Volunteers her clinical services at the psychiatric clinic, run by a local mission project.
, Rationale: Social justice is bringing things to those who have the least means of getting
them but need them the most. In this case, the homeless mentally ill need the PMHNP’s
skills more.
1. You have students from local psychiatric nurse practitioner programs follow you in
your clinical practice to show them what you do as a PMHNP. This is called being a:
- Preceptor
- Mentor
- Teacher
- Professor
- Preceptor
Rationale: The preceptor is a 1;1 relationship sustained over a short time where each
person brings something to the relationship. It is a contracted, defined role with goals.
The preceptor is in a teaching role. Teaching is completed through the observed
performance, examples, and role modeling.
1. As an individual advanced practitioner, you cannot afford to have a standalone
Electronic Health Record (EHR) system to keep all of your patients' health information
on a computer-based system. How could you problem-solve this dilemma?
- Process your patient records manually, in your current fashion. You are keeping a full
record according to HIPAA.
- Process your notes manually and keep them in a locked file. The records are available
for copy and distribution at any time.
- Process your notes and patient records on a laptop that you are able to transport
between your office and home office. You always have the records available if needed.
- Process your notes and patient records in a secure electronic system with a template
for patient information and interactions, supporting quick access within your network.
- Process your notes and patient records in a secure electronic system with a template
for patient information and interactions, supporting quick access within your network.
Rationale: Having an EHR system is the ideal situation according to the US Health and
Human Services and The Office of Clinical Quality and Safety. Not all offices have the
ability to afford installation and maintenance of such systems. The US government has
established financial help for EHRs in rural hospitals. For single practitioner offices,
doing the best possible to keep information ready for quick access is the best possible
solution. Without an EHR, incentives for having an EHR will not be available to you.
1. You are in a meeting of your state nurse practitioner legislative group. The group's
director has asked you to present information on a law bill (LB) that is being presented
for public hearing in the state legislature. The information covers how best to approach
securing support from the state's Health and Human Services Committee (state
senators and congressmen). As you begin to present the information, two of your
colleagues on the committee begin to talk over you about their ideas and will now quiet
down. The group director does not intervene to settle the meeting. You decide to:
- Talk over colleagues. Ask them to allow you to finish before they make comments.
Take questions at the end of the presentation.
- Clear your voice and ask for attention. When that does not work, stop speaking until
the situation resolves. If it does not resolve, sit down quietly until the behavior stops.
- Confront the speakers for their ill behavior and ask them to be quiet until you have
finished your presentation.
latest updated summer 2022.
1. You see a patient for a routine medication visit. At the end of the session, the patient
asks questions and the session ends up 50 minutes in length. You normally charge for
the 30-minute appointment, but instead you charge for the 1-hour appointment. The 1-
hour appointment includes a full body assessment that you did not perform. This
violation is known as:
- Over-coding
- Super-coding
- Down-coding
- Up-coding
- Up-coding
Rationale: Up-coding is a fraudulent practice in which the provider services are billed at
higher procedure codes than were actually performed, resulting in a higher payment by
Medicare or other third-party payers.
1. During a session, your patient asks to be able to contact you via your Facebook page
on the internet. You reply:
- I cannot do that because I have a concealed Facebook identity; and I cannot reveal
that to my patients
- I would be happy to communicate with you. It makes it easier for me to reach you this
way.
- I would be happy to use Facebook but you will have to use a private message so that
you can be anonymous
- I cannot do that because Facebook does not protect your Private Health Information
- I cannot do that because Facebook does not protect your Private Health Information
Rationale: Using Facebook breaks patient-provider confidentiality, in addition to blurring
ethical boundaries of the therapeutic relationship. Facebook does not protect private
health information. Information on the site is available for anyone to see or hack into
even if private messaged.
1. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) insures which
of the following?
- Small employers who insure 50 or fewer covered lives are exempt from the provisions
of this MHPAEA law.
- Annual or lifetime dollar limits on mental health and substance use disorder benefits
are no lower than any such dollar limits for medical and surgical benefits offered by a
group health plan.
- Mental health and substance use disorder benefits must be available through both in-
network providers and out-of-network providers by a group health plan.
- Group health plans may obtain an exemption if they can demonstrate expected cost
increase resulting from implementation of the parity provisions greater than a 5%
increase in the cost under existing plan.
,- Annual or lifetime dollar limits on mental health and substance use disorder benefits
are no lower than any such dollar limits for medical and surgical benefits offered by a
group health plan.
Rationale: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
provides federal legislation that requires any annual or lifetime limits on medical and
surgical benefits be the same for mental health and substance use disorder benefits.
Small employers who insure 2 to 50 employees can apply for an “opt-out” waiver, but
they are not automatically exempt from the MHPAEA requirements. The group health
plan will be required to provide in-network and out-of-network mental health and
substance use disorder benefits only if it provides both in-network and out-of-network
medical and surgical benefits. The group health plan my obtain an exemption or waiver
if the first year of implementation results in 2% increase in group health plan costs over
prior year that covers the following year, and if implementation results in 1% increase in
group health plan costs in subsequent years. A section on actuarial determination of
these increased costs is included in the law.
1. A 68-year-old, retired African-American widower who served for 30 years as an Army
officer was recently diagnosed with terminal lung cancer. He made plans to die at home
with hospice care. He was hospitalized for a broken hip and succumbed to
complications in the hospital. Despite his request to be addressed as "Mr. Baxter" the
hospital staff persisted in calling him by his first name, "John." Which principle of
culturally competent care does this violate?
- Autonomy
- Advocacy
- Collaboration
- Respect
- Respect
Rationale: Respect of cultural values and beliefs is violated in this scenario.
1. PMHNPs seeking admitting privileges at a community hospital with inpatient
psychiatric services need to influence policymakers at which of the following levels?
- State board of nursing
- State legislature
- County board of health
- Local hospital
- Local hospital
Rationale: Local PMHNPs who want admitting privileges will want to persuade the
appropriate hospital decision maker, through facts, figures, and a presentation of
projected benefits to the hospital, of the need to change policy and allow PMHNPs to
admit patients.
1. To demonstrate her support for social justice, within her role as a PMHNP caring for
the person who is homeless with mental illness, the PMHNP:
- Volunteers to serve food at the local Home for Girls.
- Teaches Sunday School.
- Volunteers to walk at the March of Dimes walk each year.
- Volunteers her clinical services at the psychiatric clinic, run by a local mission project.
- Volunteers her clinical services at the psychiatric clinic, run by a local mission project.
, Rationale: Social justice is bringing things to those who have the least means of getting
them but need them the most. In this case, the homeless mentally ill need the PMHNP’s
skills more.
1. You have students from local psychiatric nurse practitioner programs follow you in
your clinical practice to show them what you do as a PMHNP. This is called being a:
- Preceptor
- Mentor
- Teacher
- Professor
- Preceptor
Rationale: The preceptor is a 1;1 relationship sustained over a short time where each
person brings something to the relationship. It is a contracted, defined role with goals.
The preceptor is in a teaching role. Teaching is completed through the observed
performance, examples, and role modeling.
1. As an individual advanced practitioner, you cannot afford to have a standalone
Electronic Health Record (EHR) system to keep all of your patients' health information
on a computer-based system. How could you problem-solve this dilemma?
- Process your patient records manually, in your current fashion. You are keeping a full
record according to HIPAA.
- Process your notes manually and keep them in a locked file. The records are available
for copy and distribution at any time.
- Process your notes and patient records on a laptop that you are able to transport
between your office and home office. You always have the records available if needed.
- Process your notes and patient records in a secure electronic system with a template
for patient information and interactions, supporting quick access within your network.
- Process your notes and patient records in a secure electronic system with a template
for patient information and interactions, supporting quick access within your network.
Rationale: Having an EHR system is the ideal situation according to the US Health and
Human Services and The Office of Clinical Quality and Safety. Not all offices have the
ability to afford installation and maintenance of such systems. The US government has
established financial help for EHRs in rural hospitals. For single practitioner offices,
doing the best possible to keep information ready for quick access is the best possible
solution. Without an EHR, incentives for having an EHR will not be available to you.
1. You are in a meeting of your state nurse practitioner legislative group. The group's
director has asked you to present information on a law bill (LB) that is being presented
for public hearing in the state legislature. The information covers how best to approach
securing support from the state's Health and Human Services Committee (state
senators and congressmen). As you begin to present the information, two of your
colleagues on the committee begin to talk over you about their ideas and will now quiet
down. The group director does not intervene to settle the meeting. You decide to:
- Talk over colleagues. Ask them to allow you to finish before they make comments.
Take questions at the end of the presentation.
- Clear your voice and ask for attention. When that does not work, stop speaking until
the situation resolves. If it does not resolve, sit down quietly until the behavior stops.
- Confront the speakers for their ill behavior and ask them to be quiet until you have
finished your presentation.
