ANCC IQ domain 5 Exam
Questions with Complete
Solutions
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 - Correct Answers: - 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 - Correct
Answers: - 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.
- Correct Answers: - 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 - Correct Answers: - 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 - Correct Answers: - 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. - Correct
Answers: - 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 - Correct Answers: - 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. - Correct Answers: - 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 t - Correct Answers: - 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.
Rationale: She should wait quietly for them to stop their behavior. This is a situation of indirect bullying
where the two colleagues were directly subverting the information that the presenter was attempting to
present to the group. The definition of social bullying, which is defined as persistent, demeaning,
downgrading activities incorporating vicious word and cruel acts that undermine self-esteem. Bullying is
malicious and psychologically damaging. The speaker could choose to make a spectacle and shout over
the persons interfering and cause chaos, throwing bad publicity on the nursing group as a whole. She
could lose her own power by asking the group director to manage the rowdy persons.
1. Your mother calls you at the office and asks you to call in a prescription for her. The medication is for
her sleeping pills, Eszopiclone (Lunesta) 3 mg 1 PO QHS #30. You:
- Tell her to call the provider who normally prescribes that medication for her.
- Call your mother's provider and ask the provider to call your mother's script in for her.
Questions with Complete
Solutions
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 - Correct Answers: - 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 - Correct
Answers: - 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.
- Correct Answers: - 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 - Correct Answers: - 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 - Correct Answers: - 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. - Correct
Answers: - 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 - Correct Answers: - 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. - Correct Answers: - 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 t - Correct Answers: - 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.
Rationale: She should wait quietly for them to stop their behavior. This is a situation of indirect bullying
where the two colleagues were directly subverting the information that the presenter was attempting to
present to the group. The definition of social bullying, which is defined as persistent, demeaning,
downgrading activities incorporating vicious word and cruel acts that undermine self-esteem. Bullying is
malicious and psychologically damaging. The speaker could choose to make a spectacle and shout over
the persons interfering and cause chaos, throwing bad publicity on the nursing group as a whole. She
could lose her own power by asking the group director to manage the rowdy persons.
1. Your mother calls you at the office and asks you to call in a prescription for her. The medication is for
her sleeping pills, Eszopiclone (Lunesta) 3 mg 1 PO QHS #30. You:
- Tell her to call the provider who normally prescribes that medication for her.
- Call your mother's provider and ask the provider to call your mother's script in for her.
