Exam (elaborations)
NURS 6531 Final, part one
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- 6521 Advanced Pharmacology Final
NURS 6531 Final, part one
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NURS 6531 Final, part oneA small, rural hospital is part of an Accountable Care Organization (ACO) and is
designated as a Level 1 ACO. What is part of this designation? p. 2
a. Bonuses based on achievement of benchmarks
b. Care coordination for chronic diseases
c. Standards for minimum cash reserves
d. Strict requirements for financial reporting - ANS-ANS: A
A Level 1 ACO has the least amount of financial risk and requirements, but receives
shared savings bonuses based on achievement of benchmarks for quality measures
and expenditures. Care coordination and minimum cash reserves standards are part of
Level 2 ACO requirements. Level 3 ACOs have strict requirements for financial
reporting.
What was an important finding of the Advisory Board survey of 2014 about primary care
preferences of patients? p. 2
a. Associations with area hospitals
b. Costs of ambulatory care
c. Ease of access to care
d. The ratio of providers to patients - ANS-ANS: C
As part of the 2014 survey, the Advisory Board learned that patients desired 24/7
access to care, walk-in settings and the ability to be seen within 30 minutes, and care
that is close to home. Associations with hospitals, costs of care, and the ratio of
providers to patients were not part of these results.
Which assessments of care providers are performed as part of the value-based
purchasing (VBP) initiative? (Select all that apply.) p. 1
a. Appraising costs per case of care for Medicare patients
b. Assessing patients' satisfaction with hospital care
c. Evaluating available evidence to guide clinical care guidelines
d. Monitoring mortality rates of all patients with pneumonia
e. Requiring advanced IT standards and minimum cash reserves - ANS-ANS: A, B, D
Value-based purchasing looks at five domain areas of processes of care, including
efficiency of care (cost per case), experience of care (patient satisfaction measures),
and outcomes of care (mortality rates for certain conditions). Evaluation of evidence to
guide clinical care is part of evidence-based practice. The requirements for IT standards
and financial status are
part of Accountable Care Organization standards
,What is the purpose of Level II research? p. 6
a. To define characteristics of interest of groups of patients
b. To demonstrate the effectiveness of an intervention or treatment
c. To describe relationships among characteristics or variables
d. To evaluate the nature of relationships between two variables - ANS-ANS: C
Level II research is concerned with describing the relationships among characteristics or
variables. Level I research is conducted to define the characteristics of groups of
patients. Level II research evaluates the nature of the relationships between variables.
Level IV
research is conducted to demonstrate the effectiveness of interventions or treatments.
Which is the most appropriate research design for a Level III research study? p. 6
a. Epidemiological studies
b. Experimental design
c. Qualitative studies
d. Randomized clinical trials - ANS-ANS: B
The experimental design is the most appropriate design for a Level III study.
Epidemiological studies are appropriate for Level II studies. Qualitative designs are
useful for Level I studies. Randomized clinical trials are used for Level IV studies.
What is the purpose of clinical research trials in the spectrum of translational research?
p. 6
a. Adoption of interventions and clinical practices into routine clinical care
b. Determination of the basis of disease and various treatment options
c. Examination of safety and effectiveness of various interventions
d. Exploration of fundamental mechanisms of biology, disease, or behavior - ANS-ANS:
C
Clinical research trials are concerned with determining the safety and effectiveness of
interventions. Adoption of interventions and practices is part of clinical implementation.
Determination of the basis of disease and treatment options is part of the preclinical
research phase. Exploration of the fundamental mechanisms of biology, disease, or
behavior is part
of the basic research stage.
Which statement made by a health care provider demonstrates the most appropriate
understanding for the goal of a performance report?
a. "This process allows me to critique the performance of the rest of the staff."
b. "Most organizations require staff to undergo a performance evaluation yearly."
c. "It is hard to be personally criticized but that's how we learn to change."
d. "The comments should help me improve my management skills." - ANS-ANS: D
,The goal of the performance report is to provide guidance to staff in the areas of
professional development, mentoring, and leadership development. A peer review is
written by others who perform similar skills (peers). The remaining options may be true
but do not provide evidence of understanding of the goal of this professional
requirement.
Which assessment question would a health care provider ask when engaging in the
previsit stage of the new model for primary care? (Select all that apply.)
a. "Are you ready to discuss some of the community resources that are available?"
b. "Are you experiencing any side effects from your newly prescribed medications?"
c. "Do you anticipate any problems with adhering to your treatment plan?"
d. "Are you ready to discuss the results of your laboratory tests?"
e. "Do you have any questions about the lab tests that have been ordered for you?" -
ANS-ANS: B, C, E
The nursing responsibilities in the previsit stage include assessing the patient's
tolerance of prescribed medications, understanding of existing treatment plan, and
education about required lab testing. The primary care provider is responsible for
screening lab data and
discussing community resources during the actual visit.
What is the Quadruple Aim? p. 15 - ANS-1) Improved patient satisfaction
2) Reduce per capita costs
3) Improve population health
4) Improve patient care team experience
To reduce adverse events associated with care transitions, the Centers for Medicare
and Medicaid Service have implemented which policy?
a. Mandates for communication among primary caregivers and hospitalists
b. Penalties for failure to perform medication reconciliations at time of discharge
c. Reduction of payments for patients readmitted within 30 days after discharge
d. Requirements for written discharge instructions for patients and caregivers -
ANS-ANS: C
As a component of the Affordable Care Act, the Centers for Medicare and Medicaid
Service developed the Readmissions Reduction Program reducing payments for certain
patients readmitted within 30 days of discharge. The CMS did not mandate
communication, institute penalties for failure to perform medication reconciliations, or
require written discharge instructions.
According to multiple research studies, which intervention has resulted in lower costs
and fewer rehospitalizations in high-risk older patients?
, a. Coordination of posthospital care by advanced practice health care providers
b. Frequent posthospital clinic visits with a primary care provider
c. Inclusion of extended family members in the outpatient plan of care
d. Telephone follow-up by the pharmacist to assess medication compliance - ANS-ANS:
A
Research studies provided evidence that high-risk older patients who had posthospital
care coordinated by an APN had reduced rehospitalization rates. It did not include clinic
visits with a primary care provider, inclusion of extended family members in the plan of
care, or telephone follow-up by a pharmacist
1. Which advantages are provided to the chronically ill patient by personal electronic
monitoring devices? (Select all that apply.)
a. Helps provide more patient control their health and lifestyle
b. Eliminates need for regular medical and nursing follow-up visits
c. Helps the early identification of patient health-related problems
d. Helps health care providers in keeping track of the patient's health status
e. Cost is often covered by Medicare - ANS-ANS: A, C, D, E
A primary care provider administers the "Newest Vital Sign" health literacy test to a
patient newly diagnosed with a chronic disease. What information is gained by
administering this test?
a. Ability to calculate data, along with general knowledge about health
b. Ease of using technology and understanding of graphic data
c. Reading comprehension and reception of oral communication
d. Understanding of and ability to discuss health care concerns - ANS-ANS: A
The "Newest Vital Sign" tests asks patients to look at information on an ice cream
container label and answer questions that evaluate ability to calculate caloric data and
to grasp general knowledge about food allergies. It does not test understanding of
technology or directly measure reading comprehension. It does not assess oral
communication. The "Ask Me 3" tool teaches patients to ask three primary questions
about their health care and management.
What is the main reason for using the REALM-SF instrument to evaluate health
literacy? p. 27
a. It assesses numeracy skills.
b. It enhances patient-provider communication.
c. It evaluates medical word recognition.
d. It measures technology knowledge. - ANS-ANS: C
The Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) is an easy
and fast tool that measures medical word recognition. It does not evaluate numeracy.
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