ISSUES/TRENDS/POLICY Flashcards
You want to get more funding for your hospital’s Rapid Response Team. How should you present this issue to the committee?
Stress importance of the team (answer is worded as looking up evidence about how the team affects outcomes, like a meta-analysis)
What is the best way for the AGACNP to get involved in policy making?
Join a hospital committee
What is the best way for the AGACNP to demonstrate and advocate for full scope of practice?
Bill for independent services
Which of the following is considered a high acuity role for the AGACNP
Cardiology office
What is the best way to advocate for gay and lesbian population in your area?
Start at your facility
(answers are worded differently. One of them is “decrease bias in healthcare” and another is something like “create inservices in healthcare” and another is “obtain funding to increase access.”
Which of the following is most important to evaluate statistical significance when reviewing the literature?
Consider the sample size
When closing a practice, the NP is required to do all of the following:
The NP IS required to: Give the pt adequate time to find another provider, Keep all of the patient’s records for a minimum of five years and Provide names of other providers for future care
You are NOT required to: Send a certified letter with a return receipt requested (this is for discharging/firing a patient from your practice)
Which of the following components of an evidenced based research process is the most important for NP to participate in?
Formulating the research problem
A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP’s practice. Which of the following forms of defamation is this?
libel
Can you tell the pt’s wife, for her protection, that her husband has HIV?
No, not without his permission.
How can the ANCP prepare to get involved in future mass casualty event?
Pre-enroll in disaster volunteer program
An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after “spending down” to qualify?
Medicaid
Your pt is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid
Pays after insurance and 3rd party payers have paid
You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that works. What ethical principles does this challenge?
Veracity and Fidelity
Health Literacy average
Average American-8th grade education level
What is Quality assurance
a process for evaluating the care of pts using established standards of care to ensure quality
CPI measures what 3 measures to improve nursing?
Structure, processes, and outcomes
A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based polices to establish clinician-family communication standards in the unit. These policies should include:
guidelines for having discussions with family members that are geared toward establishing treatment goals.
Which clinical scenario does the NP evaluate for a quality improvement process change?
An increased incidence of a problem..like postoperative sternal wound infections
Goals set forth in “Healthy People 2020” by the United States Department of Health and Human Services include:
elimination of health disparities. (and ↑QOL/LOL)
Based on the individual’s culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership w/the patient by
Tailoring his or her communication style to the patient’s preference.
A 70-year-old pt with a hx of DM, HTN, OAs, and a new diagnosis of coronary artery disease, is being discharged. The adult-gerontology acute care nurse practitioner teaches the patient that the first point of contact for health care needs is the:
primary care provider
The NP is asked to provide evidence to the hospital administration about the safety of NP placing central lines. Which resource provides the strongest level of evidence?
A systematic review (meta-analysis is even stronger)
What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?
Balanced Budget Act
True/False: restraining an unwilling patient is grounds for malpractice?
False, if they are a danger you can restrain
Pt presents to the clinic for routine f/u and passes out. You revive the pt and admit overnight. Which of the following would qualify as incident-to-billing?
Temperature and weight recording
The NP program initiated, primarily, because of what issue in healthcare at the time?
Pediatric physician shortage
Elderly F pt takes a turn for the worse. The husband is crying when you enter the room and begins telling you what end-of-life care he prefers. What do you do?
Ask him to speak candidly with you
Pt calls to complain about bills and states he has Medicare, which should cover all costs. You explain
Since you are healthy, exams are not covered.
Doc calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient
Nope, HIPPA
Pt in ER not doing well, primary md calls
Give him info
NP working on ESRD research project . A colleague renal specialist asks for pt info on your patients
HIPPA breach.
Who enforces HIPPA
Office of Civil Rights /Dept. Health and Human Services
Who ISN’T covered by HIPPA?
Law enforcement/Municipal Offices, CPS/Schools, Employers/Workman’s Comp, Life insurance
Insurance company calling to verify some patient appointments.
You have to pick out that there is already a medical release signed by the patient. The answer is to give the requested information to them.
Root Cause Analysis
very basic question where RCA is the answer and the question is the definition
Benchmarking
how institution compares with similar organizations
Managed Care
know what this is and how it has improved costs. Something about putting caps on payments…
Peer review
timely, not anonymous, and NP knows how peer review will impact yearly evaluation
Sensitivity vs
refers to a test’s ability to designate an individual with disease as positive.
A highly sensitive test means that there are few false negative results, and thus fewer cases of disease are missed. The specificity of a test is its ability to designate an individual who does not have a disease as negative.
Specificity
he specificity of a test is its ability to designate an individual who does not have a disease as negative. A highly specific test means that there are few false positive results.
Reliability
When implementing a new study… tested over and over. The consistency of a measurement, or the degree to which an instrument measures the same way over time
Validity of results in an article:
P-value. Probability of falsely rejecting the null hypothesis. Want it to be low
What is the most important to evaluate statistical significance when reviewing literature?
look at sample size ; p value.
Medical futility
unlikely to produce any significant good for the pt
Privileging
may be granted in full or part by the hospital. Credentialing committee is made of physicians.
Institutional bylaws
may further restrict practice (Facility limited scope of practice)
Informed Consent:
state indicating pt has received adequate instruction/information regarding aspects of care to make a prudent, personal choice regarding such Tx. Includes benefits and risks. Includes competence: pt. ability to CURD: communicate, understand, reason, differentiate good and bad
Case management
Mobilize, monitor, and control resources that a pt uses during course of an illness while balancing quality and cost (“move pts thru the system appropriately”). There was a 50-60’s year old patient with a new diagnosis of cancer. To appropriately plan for discharge, what should the NP do? Options were to consult CM, consult SW, refer to Oncology, or I think refer to hospice
Nondisclosure
not disclosing patient PHI without their permission (confidentiality)
Negligence
failure of individual to do what any reasonable person would do, resulting in injury to the patient
When serving as a nurse researcher, the NP is guided by which ethical principle to ensure that research participants are protected from harm or exploitation?
Nonmaleficence
Quantitative
amount/numbers
Qualitative
descriptive, like case studies
difference between advanced directive and living will: Living will provides
Living will provides “POA/healthcare proxy”
NP sees a pt for HF and performs an H & P. What % is expected to be paid?
Medicare pays 80% of the total bill, Pt pays 20%. NP is reimbursed 85% of what the MD is reimbursed for physician services, and for procedure is paid 80% of that 85%
focus of palliative care
basic improvement in QOL of anyone with an illness at any stage
Collaboration
“true partnership” in which all players have and desire power, share common goals, and recognize/accept separate areas of responsibility/activity
4 Roles of a Nurse Practitioner
Education, Research, Clinician, Consultant/Collaborator
Pt is getting dc and needs wound care, pulmonary, and follow up: NP’s role is:
to coordinate services
Government is moving towards being cost effective. What is the best way?
Allow NP to treat a wider variety of pts.
How should the ACNP stay up to date with current information
Evidence based guidelines
What medicare level covers hospce
Medicare A
A pt presents to the ER with c/o CP and SOB. The NP misinterprets the EKG and admits the pt for further monitoring without consulting Cardio. Later in the shift, the pt decompensates and goes into cardiac arrest. The pt. was resuscitated but sustained permanent brain damage. What grounds of malpractice is the NP accountable for?
Lack of skill
Healthcare exchange
= health insurance marketplaces = orgs. in each state thru which pple can purchase health insurance,
