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issues trends and health policy Flashcards

1
Q

Lack of eye contact is a sign of respect in which culture

A

Asian

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2
Q

Offering to call the clergy is not always the best answer because

A

not all people are religious

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3
Q

Name four fundamentals of therapeutic communication

A

listen more than you talk

open ended questions “tell me…”

Don’t use “why”, “why did you ride with a drunk driver”

ask about feelings, label feelings “mad, sad, afraid, ashamed”

no euphamisms (no indirect or vague terms)

be direct (I’m sorry they died.)

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4
Q

Who do you call if a person in the hospital is a danger to himself or others?

A

hospital security (they are the police of the hospital)

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5
Q

Offering self means

A

Telling the patient “I am here to help you”

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6
Q

In a grief situation, using therapeutic communication it is important to:

A

acknowledge their feelings (Im sorry you are feeling sad)

offer self (I am here, is there something I can do for you)

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7
Q

The written statement regarding about the patient’s intent regarding medical treatment, according to the patient self determination act any hospitalization has the right to execute one.

A

advance directive

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8
Q

Specifies life prolonging measures that one does or doesn’t want to have done should they be incapacitated/incompetent. Often identifies proxy/durable power of attorney.

A

living will

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9
Q

What is the job of a proxy?

A

to articulate the wishes outlined in the advance directive

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10
Q

HIPPA title two protects what?

A

information, healthcare records, confidentiality

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11
Q

HIPPA title one protects what?

A

workers and health insurance for workers when they lose their job for up to 18 months (COBRA, consolidation omnibus reconciliation act)

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12
Q

What entities are required to follow HIPPA?

A

healthplans (insurance)

healcare providers

healthcare clearing houses (collect data for death rates, census)

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13
Q

Can you violate HIPPA without naming the patient?

A

yes

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14
Q

A patient has the right to see their chart, have correction made to their chart, file a complaint if their information is inappropriately being shared, determine who their information is shared with

A

HIPPA

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15
Q

What entities are not required to follow HIPPA?

A

life insurance

police

employers

schools

state agencies

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16
Q

The patient safety and quality imrovement act

A

established allowance of reporting of medical errors, its confidential, greater reporting and analysis should results in better patient care (quality improvement)

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17
Q

Duty to warn supercedes the right to confidentiality IF the patient is:

A

a threat to himself or others, endangers others

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18
Q

What are the two goals of healthy people 2020?

A

Increase the quality of years of healthy life

eliminate health disparities

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19
Q

Increase the quality of years of healthy life

eliminate health disparities

A

the goals of healthy people 2020

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20
Q

Criminal acts and danger with a weapon must be reported by the NP to who?

A

police

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21
Q

Are the police allowed to read medical records without a subpeona?

A

no, but they can with a record

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22
Q

What 5 things have to be reported to the health department by the NP in most states?

A

Gonorrhea

Chlamydia

Syphilis

HIV

TB

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23
Q

Animal bites have to be reported to

A

animal control

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24
Q

Suspected or actual child or elder abuse is legally required to be reported to

A

social services, and then social services reports further to the police as needed

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25
Q

Are you legally required to report domestic violence?

A

no, because it is two adults in a consensual relationship

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26
Q

True partnership where all players have and desire power, they share common goals, and recognize separate areas of responsibility and activity

A

collaborative practice per ANA

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27
Q

Who helps with domestic violence, elder abuse, help with resources for the uninsured?

A

social services

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28
Q

Anybody who is a danger to himself or others is referred to who?

A

psych

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29
Q

Who deals with joints, ROM, walking, strengthening, gross motor?

A

physical therapy

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30
Q

Who deals with fine motor, things to help pt’s get back into a job?

A

occupational therapy

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31
Q

Requirements for hospice include:

A

have a death diagnosis

prognosis death within 6 months

only comfort measures

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32
Q

SNF

A

skilled nursing facility

basically a nursing home with a room for therapy (PT/OT)

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33
Q

What are evaluation and management codes (E &M codes) used for?

A

identify the level of care that is provided

the codes match the level of service matching the complexity of the problem

the more codes generated the higher the reimbursement

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34
Q

How many levels of service are there in billing?

A

1-5

level one lowest

level 5 highest (most complex)

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35
Q

Who sets the standard of cost/reimbursement for reimbursement in this country?

A

Medicare

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36
Q

In the physical exam there are 4 options for levels of documentation of physical exam:

A
  1. limited exam of the affected body area or organ system
  2. expanded problem focus: limited exam of the affected body organ or system, and any other symptomatic or related body system (i.e. cellulitis + lower extremity assessment)
  3. detailed: extensive exam of the body system and organs and any other related
  4. comprehensive: general multisystem exam OR a complete exam of a single system and any other symptomatic or related ones (i.e. new complaint of SOB because you are working up multiple symptoms)
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37
Q

If they ask you what type of exam you would do on a new patient (limited, detailed, comprehensive) you would choose:

A

comprehensive (because you don’t know the patient)

38
Q

Medicare part A covers what?

A

inpatient hospital services and post hospital associated care

We are all supposed to get this at age 65 if we worked enough

Medicare part A does not require a premium

39
Q

Medicare part B covers what?

A

outpatient labs, medical equipment, diagnostic procedures

outpatient visits

supplemental insurance (the patient has to pay a premium)

40
Q

How much do NPs get reimbursed from medicare if they don’t fulfill the “incident to” clause?

A

85% of the physician fee

41
Q

Medicare part C, AKA medicare advantage. You must have A+B to get C. C allows you to ________ your HMO/PPO from a list.

A

Medicare part C allows you to Choose your HMO/PPO

Medicare part C does not require a premium

42
Q

Medicare part D covers what?

A

D = Drugs

LIMITED prescriptive drug coverage

the patient has to pay a premium and a copay

43
Q

Which two forms of medicare require the patient to pay a premium?

A

medicare part B and medicare part D require a premium

44
Q

What can the NP bill for by ICD 9 and CPT code?

A

diagnosis

therapy

consultation

care plan oversight

45
Q

According to Barkley, what services do not meet physician services definitions?

A

Well patient screenings and regular physical exams under medicare

46
Q

For an NP to qualify to be a medicare provider they must:

A

hold a state liscense

be certified by a national certifying body

hold at least a master’s degree

no facility or other provider charges are paid (you can’t double bill)

47
Q

For procedures, medicare reimburses _______of the 85% of the physician fee when the NP bills under her number.

A

80%

48
Q

Incident to billing means:

A

Incident to a physicians service

the services are billed under the MD provider number even though the patient is seen by the NP

the service must be provided by an employee under direct supervision of the MD

the MD doesn’t have to be in the same room, but must be in the same office at that time and immediately available

The MD must see the patient at some undefined interval

THERE IS NO INCIDENT TO BILLING IN THE HOSPITAL

49
Q

Is incident to billing allowed in the hospital?

A

No, you must bill under your provider number for 85% reimbursement.

However, if the MD comes after you and charts “agreed” on your charting and signs, they can now bill 100%.

The MD is NOT cosigning your chart, but doing it for billing.

50
Q

For inpatients can both the NP and MD bill medicare?

A

No, double billing is not allowed even if you see the patient and then later the MD sees the patient.

51
Q

Who is medicaid for?

A

low income

federally administered, varies from state to state

52
Q

This evaluates the care of patients based on established standards:

A

QA: quality assurance

53
Q

Root cause analysis helps move beyond the culture of blame and move to a process of:

A

safety

54
Q

To be credible the root cause analysis must include:

A

participation within the organization

include 5 whys (asking why 5 times, why did that happen)

drilling down

55
Q

Sentinal events are:

A

events that cause death

serious psychological or physical injury or risk thereof

(i.e. loss of limb or function)

*not all sentinal events are the result of error

56
Q

Sentinel events require what type of analysis?

A

sentinel events require a root cause analysis

57
Q

Who mandates your scope of practice?

A

The state board of nursing, the state nurse practice act

it is based on the legal allowances in that state

*You cannot prescribe medications to patients on vacation in other states. You do not have priviliges outside your state of licensure.

58
Q

Prescriptive authority is determined by:

A

the state board of nursing, the state practice act

59
Q

Credentials

A

your required education, license, certification to practice as an NP.

They establish minumum standard

60
Q

What is the difference between licensure and certification?

A

Licensure is granted by a government body, implies minimum basic competency

Certification is granted by a non-governmental agency and implies mastery

61
Q

Who said that NPs could admit to the hospital?

A

JCAHO

62
Q

Credentialing/privileging

A

the privilege to work in the hospital

granted by the hospital

63
Q

What constitutes patient medical abandonment?

A

terminate a relationship without reasonable arrangements for follow up

1) Did you accept the assignment?
2) Did you provide reasonable notice for termination of care?

64
Q

If you refuse an assignment for a double shift is that patient abandonment?

A

Not if you gave enough notice

65
Q

Risk management is

A

a systematic effort to reduce the risk

begins with a formal written plan

articulates immunity from retaliation for those that report sensitive information

66
Q

What is the most common method of documentation of risk management?

A

incident reports

67
Q

Satisfaction surveys are a part of risk management because:

A

they help to identify problems before they happen

68
Q

Interventions that are unlikely to procude any significant benefit is called

A

medical futility

69
Q

To give informed consent the patient must be competent which means they must be able to do what 4 things?

A

differentiate between good and bad

understand

reason

communicate

70
Q

Informed consent is assumed in what situations?

A

life threatening situations

71
Q

What are the 7 major ethical principles?

A

veracity: truth
fidelity: faithful
justice: fairness
autonomy: independence
beneficence: doing good, an act that is done for the benefit of other

non-maleficence: do no harm

utilitarianism: greatest good for the greatest number (like military mass casualty mindset)

72
Q

How long must you keep medical records?

A

5 years

73
Q

Where did the first NP program began and in what area?

A

pediatrics, Colorado

74
Q

What three things contributed to the development of the ACNP role?

A
  1. managed care
  2. decrease in hospital residency program hours
  3. hospital restructuring
75
Q

What are the four distinct roles of the NP?

A

clinician

consultant

educator

researcher

76
Q

What type of research includes descriptive and ex post facto/correlational data?

A

Non-experimental

77
Q

What type of research requires a randomized experiment/intervention AND a control and test group?

A

experimental research

78
Q

What type of research includes manipulation of variables but lacks either a comparison group OR control group?

A

quasi-experimental

79
Q

What type of research includes case studies, ethnography, observation, has no likert scale, may have a small sample but produces rich findings?

A

qualitative research

80
Q

What are some problems with qualitative research?

A

1) researcher bias
2) the generalizability of the findings are questionable

81
Q

In statistics, an interval with the specified probability of including the parameter being estimated, the tighter the more useful

A

confidence interval

82
Q

the average amount of deviation from of values from the mean

A

standard deviation

(think of the bell curve)

83
Q

The probability level of which the results of a statistical analysis are judged to indicate a statistically significant difference

A

level of significance

p-value

84
Q

What is a t-test?

A

A test to evaluate a difference of means between two groups

85
Q

What is the difference between reliability and validity?

A

Reliability: support that the results are the same over time or repeatedly, consistantly

Validity: the degree to which a variable measures what it is intended to measure

86
Q

CLAS culturally and linguistically appropriate services

A

aim to eliminate racial and ethnic health disparities and improve the health of all Americans.

You are legally required to use an interpreter because the patient has a right to understand.

87
Q

Assault vs. battery

A

assualt (threat of bodily harm with apparent ability to follow through)

battery (actually hurting the person with contact)

88
Q

Who is responsible to document the reason for restraints and that the circulation checks were documented?

A

the NP is responsible for both

Yes, you are responsible to ensure the nurse documented circulation checks or the NP could be liable

89
Q

If we aid at the scene of the accident what statute protects us as long as we stay in our scope of practice?

A

Good Samaritan

90
Q
A

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