Professional Role - Ethical Guidelines and Advanced Practice Laws

Question 1

Ethical Concepts: Beneficence

Answer 1

The obligation to help patient
- to remove harm
- prevent harm
- promote good (“do no harm)
- acting in the pt’s best interest
- compassionate pt care
* Core principle in pt advocacy

Ex:
- educating pt w/ a new prescription about how to take the medication
- encouraging a pt to stop smoking and enroll in smoking cessation program
- calling surgeon to get a prescription for stronger pain meds (a narcotic) for a postsurgical pt who c/o severe pain

Question 2

Ethical Concepts: Nonmaleficence

Answer 2

The obligation to avoid harm
- protecting a patient from hard

Ex: A middle-age woman w/ osteoporosis wants to be treated w/ bisphosphonates; however, NP advises against as pt is not a good candidate for these drugs d/t PMHx of GI bleeding and PUD. NP decides not to prescribe bisphosphonates.

Question 3

Ethical Concepts: Utilitarianism

Answer 3

The obligation to act in a way that is useful to or benefits the majority
- the outcome of the action is what matters w/ utilitarianism
- also means to use a resource (e.g., tax money) for the benefit of most
- may resemble justice but not in the same concept

Ex: The WIC program is only for pregnant women and children, not other adults and elderly men. The reason may be that it would cost society more if women (and their fetuses), infants, and children are harmed by inadequate food intake (e.g., affects brain growth).

Question 4

Ethical Concepts: Justice

Answer 4

The quality of being fair and acting w/ a lack of bias
- fair and equitable distribution of societal resources

Ex: A homeless alcoholic man w/out health insurance presents to ED w/ abdominal pain. The pt is triaged and tx w/ the same manner as the other pts who have health insurance

Question 5

Ethical Concepts: Dignity

Answer 5

The quality of state of being worthy of ethical and respectful treatment
- respect for human dignity is important
- a person’s religious, personal, and cultural beliefs can influence greatly what a person considers “dignified” treatment

Ex:
- hospital gowns should be secured correctly so that when pts get up to walk, their backs are not visible
- foley catheter urine bags should not be visible to visitors so pts are not embarrassed. NPs should move urine bans to the opposite bed rail that they not visible to outsides

Question 6

Ethical Concepts: Fidelity

Answer 6

The obligation to maintain trust in relationships
- dedication and loyalty to one’s patients
- keeping one’s promise

Ex:
- the relationship b/w a patient and their healthcare team is important
- the PCNP should try their best to develop a trust relationship w/ a pt

Question 7

Ethical Concepts: Confidentiality

Answer 7

• The obligation to protect the pt’s identity, personal information, rest results, medical records, conversations, and other health information
• the “right” is also protected by the HIPPA act, which restricts release of pt information
• Psychiatric and mental health medical records are protecting information and require separate consent

Ex: The HIPPA rule protects most “individually identifiable health information in any form [oral, paper, electronic]
- AA protected health information (PHI), includes:
- demographic information (name, address, date of birth), social security # + individual’s past, present, or future physical/mental health and provision of cares

Question 8

Ethical Concepts: Autonomy

Answer 8

The obligation to ensure that mentally competent adult pts have the right to make their own health decisions
- express treatment preferences
- if pt is mentally incapacitated (dementia, coma), the designated surrogate’s choices are respected (advance healthcare directives)
- a mentally competent pt can decline or refuse treatment even if their adult children disagree

Ex: An alert elderly woman who has breast CA decides to have a lumpectomy after discussing the treatment options w/ her oncologist. The woman’s daughter tells the NP that she does not want her mother to have the surgery because she thinks her mother is too old. The NP has a duty to respect the pt’s decision.
- This case is also a good ex of the NP acting as the pt’s advocate

Question 9

Ethical Concepts: Accoutability

Answer 9

Healthcare providers are responsible for their own choices and actions and do not blame others for their mistakes

Ex: An NP has an adult male pt w/ acute bronchitis who c/o acute onset of chest pain. He is diagnosed w/ pleurisy. The pt goes to the ED and is diagnosed w/ acute MI. The NP made an error in diagnosis and is held accountable for the decision and actions in a court of law

Question 10

Ethical Concepts: Paternalism

Answer 10

• describes situations in which one person interferes w/ or overrules the autonomy of another. In healthcare, it occurs when a provider/family member makes decisions for an elderly pt because they ‘believe” that it is in the pt’s best interest. The opinion (or desire) of the pt is minimized or ignored. The pt is “powerless”

Question 11

Ethical Concepts: Veracity

Answer 11

The obligation to present information honestly and truthfully. In order for pts to make an informed and rational decision about their healthcare pertinent information (including “bad” news) should not be withheld or omitted.

Ex:
- the mammogram results of a 64-year-old female pt is highly indicative of breast CA. The pt’s son does not want his mother to know about the results. The NP has a duty to discuss the mammogram results w/ the pt and refer her to a breast surgeon

Question 12

The ANA Code of Ethnics for Nurses

Answer 12

The American Nurses Association (ANA) Code of Ethics of Nurses With Interpretation Statements (2015) contains “the ethical standard for the profession and provides a guide for nurses to use in ethical analysis and decision-making.”

According to the ANA, the Cod “is a nonnegotiable standard.” Each nurse “has an obligation to uphold and adhere to the code of ethics.”

Ex: Under Provision 4.4, “Nurses may not delegate responsibilities such as assessment and evaluation; they may delegate selected interventions according to state nurse practice acts (ANA, 2015)

Question 13

Legal Terms: Ombudsman

Answer 13

a person who acts as an intermediary (or as a liaison) between pt and an organization (long-term care facilities or nursing homes, hospitals, governmental agencies, courts)
- the ombudsman investigates and mediates the complaint from both sides and attempts to reach a fair conclusion

Question 14

Legal Terms: Guardian Ad Litem

Answer 14

An individual who is assigned by a court (and has the legal authority) to act in the best interest of the ward.

The ward is usually a person who is a child or someone who is frail or vulnerable. Adults who are incompetent may be assigned a guardian ad litem by the court.

Question 15

Legal Terms: Advance Healthcare Directives - Living Will

Answer 15

A document containing the pt’s instructions and preferences regarding healthcare if the pt becomes seriously ill or is dying
- contains the pt’s preferences (or not) for aggressive life-support measures
- healthcare providers should ensure that there is a copy of the document in pt’s chart

Question 16

Legal Terms: Advance Healthcare Directives - Healthcare power of Attorney

Answer 16

The pt designates a person (family member or a close friend) who has the legal authority to make future healthcare decisions for the pt in the even that the pt becomes mentally incompetent or incapacitated (e.g., comatose)
- AKA “healthcare proxy,” “durable medical power of attorney,” or “healthcare surrogate)

• goes into effect when pt’s doctor has determined that they are physically/mentally unable to communicate in a willful manner
• to be legal, it must be signed in the presence of 2 adult witnesses who must also sign the document (the designated surrogate cannot act as a witness)
• Power is only for healthcare decisions (not financial assets)

Question 17

Legal Terms: Advance Healthcare Directives - Power of Attorney

Answer 17

A document whereby the pt designates a person (the “agent”) who has the legal authority to make ALL decisions for the incapacitated pt. The document should be signed and notarized.
- AKA “durable power of attorney”
- this role is broader and encompasses not only healthcare decisions but also other areas of the pt’s life, such as those relating to financial affairs

Question 18

Health Insurance Portability and Accountability Act

Answer 18

AKA “HIPAA Privacy Rule”
or Public Law 104-191
- Law was passed by the US Congress and enacted in Aug 1996
- provides protections for “the use and disclosure of individuals’ health information” –called “protected health information” by organization subject to the Privacy Rule, which are called “covered entities”

Question 19

Health Insurance Portability and Accountability Act - Covered Entities

Answer 19

• all healthcare providers, health insurance companies, healthcare plans, laboratories, hospitals, skilled nursing facilities (SNFs), and third-party administrators (TPAs) who electronically transmit health information MUST follow HIPAA regulations

Question 20

What is a Third-Party Administrator?

Answer 20

An organization that does the processing of claims and administrative work for another company (heath insurer, health plan, retirement plan)

Question 21

HIPAA Requirements (Not inclusive)

Answer 21

• Health providers are required to provide each pt w/ a copy of their office’s HIPAA policy (pt to sign the form)
• HIPAA form must be reviewed and signed annually by the pt
• A mental health provider has the right to refuse pt’s requests to view their psychiatric and mental health records
• When pt request to review the medical records, the health provider has up to 30 days to comply
• Pts are allowed (under HIPAA) to correct errors in their medical records
• Providers must keep identifying information (name, date of birth, address, SS#) and any diagnosis/disease or health concerns private except under certain conditions

Question 22

When Patient Consent is NOT required

Answer 22

• To contact the health plan/insurance company that is paying for the medical care
• To contact a 3rd party or business associate (e.g., accounting, legal, administrative) that the insurance company or doctor’s office hires to assist in payment of their services (e.g., medical billing services)
• To perform certain healthcare operations (medical services review, sale of healthcare plan, audits)
• To contact collection agency for unpaid bills
• To report abuse/neglect or domestic violence
• To consult w/ other healthcare providers

Question 23

HIPAA Case Scenarios: If a staff member, who is not involved in the pt’s care, calls the attending NP and wants to discuss a pt’s progress, should the NP release information?

Answer 23

No. The NP cannot release information to the staff member.

Question 24

HIPAA Case Scenarios: How to communicate results of lab tests or procedures?

Answer 24

The Rule “does not prohibit us from leaving messages for pts on their answering machines,” however, we must “reasonably safeguard” their privacy
- it is prudent to avoid leaving messages about lab results, medication names, or types of tests in the pt’s voicemail
- leave the clinic name (exceptions exist), your name, and phone number for the pt to contact you

Question 25

HIPAA and Patient Care:
1. Putting pt charts on door box
2. Having sign-in sheets on front desk
3. Calling a patient in the waiting room to go inside the clinic exam room

Answer 25

1. • Place the chart so that the front of the chart is facing the door (so that pt name is hidden)
     - Limit access to certain areas
     - ensure area is supervised
2. • This is allowed if it does not like pt’s diagnosis
     - attendance list can show names, dates, and time
3. • use only first name
     - if more than one person w/ same first name, use the first letter of last name
     - if you have 2 pts named Ann (e.g., Ann Lee and Ann Smith), use Ann L., and Ann S.

Question 26

HIPAA and Patient Care:
4. Leaving messages on voice mail
5. Having a colleague who works in same clinic or hospital call, waiting information about a pt’s progress
6. Having a family member call, wanting information about pt’s progress

Answer 26

4. • when calling, first provide your name and contact information
     - be concise
     - limit to 60 seconds
     - maximum of 3 calls/week
     - information that can be given may include appt reminders, notification about prescriptions, and preoperative/postoperative instructions
     - avoid leaving messages about lab results, diagnosis, or other sensitive info on pt’s voicemail
5. • if staff member is not part of the healthcare team, no pt info can be released to that person
     - HIPAA also does not allow such a person to access a friend’s or family member’s records w/out permission
6. • put on hold and tell pt about the call
     - if pt gives permission, you can speak w/ the family member
     - If pt does not consent, then advise the family member about the pt’s decisions
     - do NOT release pt info

Question 27

HIPAA and Patient Care:
7. Having inappropriate access of health information on the computer
8. Using personal devices (smartphones, laptops, tablets)
9. Discussing pt’s drugs and other instructions w/ a health aide who is w/ the pt
10. Discussing pt’s treatment in front of a pt’s friend who is visiting

Answer 27

7. • viewing the records of your relatives, friends, or coworkers is a HIPAA violation
     - do NOT allow someone to use your computer password
8. • ideally, it is best to avoid using personal devices at work
     * Requirements: Secure Wi-Fi w/ passwords, regular encrypted backups, antivirus software, policies, etc
     - If you want to use a personal device, discuss it w/ your manager and/or consult IT
     - best practice is to use the facility’s or clinic’s devices
9. discussing information is alloweable
   - if pt has capacity to make healthcare decisions, discussing information is allowable
10. Discussing tx w/ the pt’s friend is allowable if pt gives consent or requests that the friend come inside the treatment room
    - discussing pt info w/ others is allowable if pt agrees to it

• Remember, no separate consent is required for entities that pay or process the pt’s health bills, such as health insurance companies, HMOs, medical billers, or collection agencies (or 3rd-party contractors hired by the company to pay/process claims)

Question 28

HIPAA, Psychotherapy, and Mental Health Records

Answer 28

• Psychotherapy records made by a mental health professional are treated differently under HIPAA
• they should be separated from pt’s other medical records
• a separate consent form is needed to release psychotherapy records

Exceptions:
- mandatory reporting of abuse
- “duty to warn” when pt threatens serious/imminent harm to others
“In situations where the pt is given an opportunity and does not object, HIPAA allows the provider to share or discuss the pt’s mental health information w/ family members or other persons involved in the pt’s care or payment for care”

Question 29

Minors

Answer 29

The health records of a minor (by law, an individual <18 years) can

be released to parents or legal guardians w/out minor’s consent
- if authorization is needed to release a minor’s medical record, the parent/legal guardian must sign for it (except for emancipated minors)
- emancipated minors can sign their own legal documents

Question 30

Health Insurance: The Affordable Care Act (2010)

Answer 30

• A national health insurance legislation
• AKA Patient Protection and Affordable Care Act (ACA)
• unofficially nicknamed Obamacare
• signed by President Obama in March 2010 and upheld by the US Supreme Court in 2012

Goal: expanding health insurance for the millions of Americans who were then uninsured
- expanded health coverage through various provisions (e.g., allowing adult children <26 to be insured under parent’s healthcare)

• This comprehensive reform prohibited an insurance company from rejecting people w/ preexisting health conditions
• There is also a penalty for employers (and individuals) who choose not to participate in the national health plan

Although ↑ # of Americans gained insurance as a result of law’s passage, many millions still lack coverage

Question 31

Health Insurance: Consolidated Omnibus Budget Reconciliation Act of 1985

Answer 31

AKA: Cobra coverage
- provides for continuation of coverage of preexisting group health insurance (from employer) for workers and their families who lose their coverage (b/t jobs, quit job, or are fired) for a fixed period of time
- COBRA coverage is generally offered for 18 months (up to 36 months in some cases)

• Remember, COBA is a law that allows a person to continue group health insurance coverage from a job even if they have quit (the individual has too pay the insurance premiums)

Question 32

Health Insurance: Managed Care

Answer 32

• both health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are classified as “managed healthcare plans”

Question 33

Health Insurance: Managed Care - Health Maintenance Organizations

Answer 33

• pts are assigned a PCP, who is the “gatekeeper”
• pt has a set “copay” per visit
• participating physician/health provider is paid a set fee (per pt) monthly
• the physician receives a monthly check from the HMO

Specialist/consultant → the PCP must first approve the referral; the pt is limited to seeing the physicians/specialists who are enrolled in the HMO’s network

“Out-of-network” physicians or not referred by the PCP → the visit may not be covered, or it will be reimbursed at a lower rate

Question 34

Health Insurance: Managed Care - Preferred Provider Organization

Answer 34

• pt can visit any provider in the network w/out a referral
• Not assigned PCP, like in HMOs
• pt can choose their own PCP
• no referral is needed to see a specialist who is part of the PPO panel
• PPOs are usually more expensive than HMOs

Question 35

Health Insurance: Medicare and Medicaid

Answer 35

Both are programs under the aegis of the Centers for Medicare & Medicaid Services (CMS)
- CMS is one of the agencies under the US Department of Health a nd Human Services (DHHS)

Question 36

Health Insurance: Medicare Part A

Answer 36

Inpatient Hospitalization
- “Automatic” at age 65 if the person paid the premiums (automatically deducted from paycheck by the employer)
- if person never paid premiums (e.g., full-time housewife), the person is not eligible for Medicare coverage
- also covers persons w/ end-stand renal diseases at any age
- certain religious groups (e.g., Amish, Mennonites) do not participate in Medicare

Medicare Part A will pay for the following” medically necessary” services:
- Inpatient hospitalization (including inpatient psychiatric hospitalization)
- hospice care
- home healthcare
- SNF care

Will NOT pay for custodial care (nursing homes, retirement homes)

Question 37

Health Insurance: Medicare Part B

Answer 37

Outpatient Insurance
- voluntary program w/ monthly premiums
- one must enroll during the “general enrollment period”

Medicare Part B will pay for the follow “medically necessary” services:
- Outpatient visits (including walk-in clinics, urgent care clinics, ED visits)
- laboratory and other types of tests (EKG, X-ray, CT scans)
- Durable medical equipment
- “Second opinions” with another physician (surgery)
- Kidney dialysis (outpt), self-dialysis equipment/supplies, organ transplants, and many others
- ambulance service for emergency care or transportation to a hospital or SNF if transport in any other vehicle will endanger pt’s health

Will NOT pay for:
- most eyeglasses and eye exams (except following cataract surgery that implants an intraocular lens)
- hearing aids
- most dentures and dental care
- cosmetic plastic surgery (unless it is medically necessary)
- OTC drugs and most prescription drugs

DOES pay for SOME health prevention services:
- Abdominal aortic aneurysm screening
- Influenza shots once a year and Pneumovax and Prevnar 14 (each once in a lifetime)
- screening mammogram (once Q12 months for women age >40)
- Hepatitis B vaccine series for individuals at medium-high risk
- hepatitis C screening if high risk
- Screening colonoscopy or flexible sigmoidoscopy (age ≥50 years) Q10 years if low risk
- Routine Pap smears (once Q2 years or once Q12 months for women at high risk)
- Prostate CA screening (digital rectal exam [DRE] and prostate specific antigen [PSA] once a year after age 50)
- Bone density testing allowed once Q24 months if at risk for osteoporosis, taking prednisone, taking bisphosphonate therapy to monitor progress
- HIV screening; STD/infection screenings covered once Q12 months
- physical exams (once a year)
- Smoking-cessation counseling and treatment
- Alcohol misuse screening and counseling
- Diabetes screening (twice yearly if at risk)
- Cardiovascular disease screening

• Remember, Medicare Part B will pay for an ambulance for emergency care; if transport in any other vehicle will endanger the pt’s health, transport by ambulance is allowed
• Medicare Part B does NOT reimburse for dentures, eyeglasses, or hearing aids

Question 38

Health Insurance: Medicare Advantage (Medicare Part C)

Answer 38

• Medicare Advantage Plans cover both inpt (Part A) and outpt (Part B) + some plans cover some prescription drugs
• administered by private health insurance companies, approved by Medicare

Question 39

Health Insurance: Medicare Part D

Answer 39

• AKA Medicare prescriptions drug benefit
• only individuals who are enrolled (or eligible) for Medicare Part A and/or Part B are eligible.
• One type of Part D coverage is called the Medicare Advantage (MA) plan
• All prescription dug plans have a list of preferred drugs (the formulary)
• if nonformulary drug is used, it may not be covered, and pt has to pay for it “out of pocket”

Question 40

Health Insurance: Medicaid

Answer 40

• authorized by Title XIX of the Social Security Act
• a federal and state matching program
• provides health insurance coverage for low-income individuals and their families who meet the federal poverty-level criteria
• covers children, pregnant women, adults, seniors, and individuals w/ disabilities (e.g., blindness)
• pays for healthcare and prescription drugs
• Currently, Medicaid the single largest payer for mental health services in the US
• covers care offered by substance use ds and family planning services (including contraception) + maternal and infant health programs

Question 41

Health Insurance: Children’s Health Insurance Programs (CHIP)

Answer 41

• CHIP and the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) cover uninsured children (infancy to adolescents) and pregnant women

Question 42

Case Management: Case Managers

Answer 42

Healthcare care managers are usually experienced RNs who act as coordinators for Output management of pts w/ certain diagnoses, usually chronic, resource-intensive ds (e.g., asthma [children], COPD, chronic heart failure, diabetes)
- process is called “case management”
- mainly done by telephone

Question 43

Patient-Center Medical Home (PCMH)

Answer 43

• healthcare delivery model
• AKA primary care medical home
• another way to delivery patient-centered primary care
• pt and family are considered important members of the healthcare team
• most of the pt’s healthcare needs are taken care of in the home setting

Other team members:
- physicians
- APPs/PAs
- nurses
- pharmacists
- nutritionists
- social workers
- educators
- care coordinators

• Delivery of healthcare is coordinated to ensure smooth transition b/w home and hospital, home health agency, and community services
• Pt and/or family has 244/7 access to a member of the team by phone, video chat, or email

*Exam tip:
- “Medical term” is a method of primary healthcare delivery
- healthcare providers and therapists (PT/OT/SLP) deliver care in pt’s home w/ the family
- these pts have long-term illness
- to communicate, technology is used, such as phone, video chat, or email

Question 44

Quality-Improvement Programs

Answer 44

involves:
- monitoring
- identifying problems
- measuring outcomes
- establishing new parameters for improved performance

Goal:
- improve quality of care
- ↓ complications
- ↓ hospitalizations
- ↓ patient mortality
- ↓ system errors
- ↑ patient satisfaction
* Patient outcomes are important indicators of a health system’s quality

Ex: A “problem” is identified (e.g., diabetic complications such as peripheral neuropathy and retinopathy). Then outcome measures are identified (e.g., AIC <6.5%)
- Be familiar w/ what a good outcome is for a disease (ex: for diabetics, a good outcome is AIC <6.5%) and what a poor outcome is (A1C >8%)

Question 45

Risk Management in Healthcare

Answer 45

• important aspect of quality-improvement/quality-assurance programs in the healthcare setting
• systematic organizational process used to identify risky practices to minimize adverse pt outcomes and corporate liability
• promotes safe and effective patient care practices

Ex:
- high-risk areas that are usually checked by risk management are medication errors, hospital-acquired infections, patient identification problems, and falls

*Exam Tip:
- Use common sense in answering questions on quality improvement and risk management

Keep in mind the goals of these process:
- improve quality of care
- decrease complications
- decrease hospitalizations
- lower pt mortality
- decrease system errors
- increase pt satisfaction
* Look for the answer that fit these goals

Question 46

Accreditation

Answer 46

• a voluntary process through which a nongovernmental association evaluates and certifies that an organization (e.g., hospital, clinic, nursing program) has met the requirements and excels in its class

Ex:
- the ANCC and National League for Nursing Accrediting Commission are accreditation organizations

Question 47

The Joint Commission

Answer 47

• an independent, not-for-profit organization that accredits healthcare organizations (hospitals, nursing homes, home care, laboratories) via inspection and evaluation of their facilities (charged as a fee)
• achieving TJC certification means that a facility has met or surpassed the organization’s strict requirements
• purpose of the accreditation process is to enhance quality of care and pt safety

Question 48

Sentinel Event Reporting

Answer 48

Sentinel event (SE) is a patient safety event (not primarily related to the natural course of pt’s illness or condition) → any of the following:
- death
- permanent harm
- severe temporary harm w/ intervention required to sustain life

• when an SE occurs, the healthcare organization is expected to conduct a root cause analysis (RCA), make improvements to reduce risk, and monitor effectiveness of the improvements
• Accredited organizations are strongly encouraged but are not required to report SEs to the TJC

Question 49

Examples of Sentinel Events

Answer 49

• suicide that occurs while receiving care in a staffed around-the-clock facility or within 72 hrs of discharge
• unanticipated death of an infant or discharge of infant to the wrong family
• rape or assault of a staff member, visitor, or vendor
• invasive procedures on the wrong pt, the wrong procedure is done on a patient, or the procedure is done to the wrong limb
• unintended retention of a foreign object
• fire, flame, or unanticipated smoke or heat during an episode of patient care

Question 50

Root Cause Analysis (RCA)

Answer 50

• a structured, facilitated team process used in healthcare to identify the contributing factors that result in an error
• TJC mandated the use of RCA to analyze SEs
• gathered data are analyzed for the root causes (usually a combination of human, environmental, and system factors)

Goal:
- to identify the system breakdowns that resulted in an advertent mistake
- to purpose at least one corrective action to reduce/eliminate each root cause

When SE occurs, and RCA is recommended
- the focus is on system and not on blaming individuals

Question 51

Outcomes Analysis

Answer 51

• refers to analysis and tracking of pt outcomes by using outcome measures such as surveys and questionnaires

Question 52

Hospice

Answer 52

• majority of hospice care in US takes place in pt’s homes (59%) die in their own homes
• available for both pediatric + adults

Goal:
- palliative care, not curative care
- ensuring pt’s quality of life + comfort

Composes of an interdisciplinary team:
- primary physician
- hospice physician
- RN
- nursing assistants
- therapists
- social workers
- grief counselors
- clergy

• Staff are on call 24 hrs/day
• provide grief-and-loss counseling for pts and family members
• covered under Medicare Part A + most health insurance plans
• pts are allowed to have PT, OT, SLP if prescribed

Question 53

Hospice: Eligibility Criteria

Answer 53

• Hospice physician and pt’s physician certify pt is terminal and has 6 months or less to live
• hospice physician approves of admission
• pt is rapidly declining or exhibits worsening so
• pt needs assistance w/ 2+ ADLs
• Pt accepts palliative care, not curative care; if they do not want to be in hospice (even if all. Criteria are met) then pt is not eligible
• Remember, a pt may meet the criteria for hospice admission, but if pt refuses hospice, then pt is not eligible
• If pt meets criteria, Medicare Part A will reimburse hospice

Question 54

Examples of Terminal Conditions

Answer 54

• Metastatic cancers (e.g., lung cancer, colon CA)
• End-stage lung ds (e.g., COPD)
• End-stage heart ds (e.g., congestive heart failure [CHF] class III or IV)
• end-stage liver ds
• HIV/AIDS w/ comorbidities and refusal/discontinuation of antivirals
• End-stage renal ds w/ plan to discontinue dialysis
• Amyotrophic lateral sclerosis, Parkinson’s ds, stroke, coma
• End-stage dementia (e.g., Alzheimer’s ds)

Question 55

Respite Care

Answer 55

• short-term respite care for primary caregiver, reimbursed by Medicare
• gives the primary caregiver a break, even if only for a few hours

Ex: Respite care gives the caregiver a chance to go see a movie and to “relax” and rest

Question 56

Human Genetic Symbols

Answer 56

• Exam may include questions about genetic symbols
• symbol for a healthy male is a empty square
• for a diseased/affected male is a filled square
• healthy female is an empty circle
• diseased/affected female is a filled circle
• a diagonal dash across a symbol means the person is dead