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HIPAA is a set of laws designed to__________. (select the best option) - answer-
maintain patient privacy and confidentiality
What is the medical abbreviation for the condition described as "blood clot in the
lungs"? (Use the abbreviation form of the condition) - answer-PE
What chronic condition would require diagnosis through a lipid panel? Use the
abbreviation form. - answer-HLD
Which of the following are considered non-reimbursable chief complaints? (Select all
that apply) - answer-*follow-up
*check-up
*medication refill
*lab results
T/F. A family friend was recently evaluated for IDDM and lost his paperwork and does
not know what medications he should be taking at home. He asks you to look up his
medical record when you go to your shift today, giving you verbal permission to access
his information. In this scenario, it is justifiable for you to use your EMR login to look up
the important patient information. - answer-False
A patient is s/p angioplasty with stent and quadruple cardiac bypass. What chronic
condition should be included in their diagnosis today? Expand the abbreviation? -
answer-coronary artery disease
A patient states that he has been having abdominal pain for the last three days, and it
varies between mild and severe. Which of the following would best describe the Timing?
- answer-Waxing and waning
The patient reports a tenderness in their right upper abdomen that began 2 weeks ago.
Based on that information, do you document RUQ tenderness under the physical
exam? - answer-No
What condition correctly describes "heart attack"? Use the abbreviated form of the
condition. - answer-MI
A patient reportedly had their tonsils removed as a child. What PSHx would you record
into the chart? - answer-tonsillectomy
, What is the medical term for an elevated heart rate (over 100 beats per minute)? -
answer-tachycardia
27. Identify what details are included in the following Assessment. (Select all that apply.)
"Patient is a 56 y/o male with CRF first diagnosed 3 years ago in acute exacerbation
today. He reports decreased urinary output that has progressively worsened since onset
5 days ago. Creatinine and BUN elevated and worsening compared to last visit 3 weeks
ago. Patient recommended emergency dialysis today and warned that he may be at risk
for death and other complications if he does not seek further urgent medical attention.
Patient understands and agrees to be transferred to the ED." - answer-*Age and sex
*PHx, if relevant
*Diagnosis
*Results
*HPI
*Prognosis/Plan
T/F. All symptoms documented in the ROS are also documented in the HPI. - answer-
False
What is the medical term for "open heart surgery"? Expand the abbreviation - answer-
coronary artery bypass graft
30. Identify which of these PE systems contains contradictory findings: - answer-
Respiratory: No respiratory distress, tachypnea, lungs clear to auscultation bilaterally
If a patient signs a waiver giving you permission to capture photo of their unique rash,
would you be committing a HIPAA violation by using your cellphone to capture the
photo? Select best - answer-Yes because the phone is not an approved hospital device
and it is not encrypted
What condition correctly describes "narrowing of the coronary arteries limits blood
supply to the heart muscle causing ischemia"? Use the abbreviated form of the
condition - answer-CAD
What medical term is used to describe the physician examining the patient by touch? -
answer-palpation
Organize the parts of the chart from top (1) to bottom (5). - answer -1) HPI
2) ROS
3) PE
4) Assessment
5) Plan