NR 511 FINAL EXAM WEEK 8 STUDY GUIDE|Questions with 100% Correct Answers

NR 511 FINAL EXAM WEEK 8 STUDY GUIDE|Questions with 100% Correct Answers Define diagnostic reasoning -A type of critical thinking -Includes systematic way of thinking that evaluates each new piece of data to support some hypothesis and reduce others -Evaluates if all the avenues have been explored and that the conclusion is based on evidence -To solve problems, promote health, screen for dz/illness: all require sensitivity to complex stories, contextual factors, sense of probability/uncertainty Discuss & identify subjective & objective data Subjective: what a pt reports, complains of, tells me in response to my questions. Includes ROS, CC, HPI Objective: info you can see/feel Lab results/data Discuss & identify the components of the HPI O: onset L: location D: duration (does it come and go?) C: characteristics A: aggravating factors R: relieving factors T: treatments attempted S: severity of pain Specifically related to CC only Detailed breakdown of CC Describe the differences between medical billing and medical coding Billing: process of submitting and following up on claims made to a payer in order to receive payment for medical services rendered by healthcare provider. Coding: the use of codes to communicate with payers about which procedures were performed and why. Compare & contrast the 2 coding classification systems that are currently used in the US healthcare system CPT: common procedural terminology Offical procedural rules and guidelines required when reporting services/procedures performed by providers Recognized universally Provide logical means to be able to tract healthcare data, trends, outcomes Represented by 5 digit code Every CPT must have dx that corresponds/explains why procedure was done ICD-10: 10th version Shorthand for pt's dx used to provide payer info on necessity of visit/procedure Which of the following statements are true? Eliciting a detailed hx through open-ended questioning and active listening offers critical clues to determining a dx. Obtaining meaningful hx involves collecting subjective info and organizing it into meaningful chunks of knowledge. Data acquisition in hx taking is most effective if it is hypothesis driven. All of the above All of the above Which of the following statements is NOT true regarding insurance? Providers are not required to follow the billing carrier's guidelines Discuss how specificity, sensitivity, predictive value contribute to usefulness of diagnostic data Specificity: greater when it has few false positives The number of true negatives divided by the number of all tested individuals who do not have the dz Sensitivity: greater when it has few false negatives The number of true positives divided by the number of tested individuals that do have the dz Predictive value: in part dependent on prevalence of condition Positive predictive value: the number of true positives divided by all those that are positive Negative predictive value: the number of true negatives divided by all those that are negative False positive: when a pt does NOT have dz, but has positive reading False negative: when a pt that DOES have dz, but has negative reading Discuss the elements that need to be considered when developing a plan Pt's preferences/actions Research evidence Clinical state/circumstances Clinical expertise Diagnostic testing (what tests need to be conducted to clarify assessment) Education (specific problems being managed) Follow-up (when will the pt need to be seen again) Be honest Negotiate what to cover Describe the components of medical decision making (MDM) in E&M coding Three key components that determine risk based E&M codes: History Physical MDM E&M coding requires a decision-maker MDM is another way of quantifying complexity of the thinking that is required for the visit Complexity of visit is based on 3 criteria: Risk Data Dx MDM score gives us credit for the excess work involved in management of a more complex pt. Correctly order the E&M office visit codes based on complexity from least to most complex New: 99201 (minimal/RN visit) 99202 (problem-focused) 99203 (expanded problem-focused) 99204 (detailed) 99205 (comprehensive) Established: 99211 (minimal/RN visit) 99212 (problem-focused) 99213 (expanded problem-focused 99214 (detailed) 99215 (comprehensive) Discuss a minimum of 3 purposes of the written H&P in relation to the importance of documentation -Important reference that gives concise info about pt's Hx and exam findings -Outlines plan for addressing issues that prompted visit. Info should be presented in logical fashion that prominently features all data immediately relevant to pt's condition. -A means of communicating info to all providers who are involved in care of the pt. -Important medical-legal document -Essential in order to accurately code and bill for services. Why does every procedure code need a corresponding dx code? To explain necessity of why it was done May represent actual procedure or nonprocedural encounter (like office visit) Correctly ID a pt as new or established given the historical info New: a pt who has not received services from this provider before or who has not been seen by provider in >3yrs Established: pt who has seen provider within last 3yrs ID 3 components required in determining an outpt office visit E&M code Plan of service Type of service Pt status Describe the components of MDM in E&M coding Risk Data Dx Explain what a well-rounded clinical experience means To experience a variety of pts during clinical across the lifespan 15% peds of total clinical time in program 15% women's health of total clinical time in program State max number of hrs that time can be spent rounding in a facility No more than 25% of total practicum hrs in that course State 9 things that must be documented when inputting data into clinical encounter Date of service Age Gender & ethnicity Visit E&M code Chief concern Procedures Tests performed/ordered Dx Level of involvement (mostly student, mostly preceptor, together, etc.) ID and explain each part of SNAPPS S: summarize (present pt's H&P findings) N: narrow (narrow down DD, find top 2-3) A: analyze (analyze DD; compare/contrast H&P findings for each DD, coming down to 1) P: probe (ask preceptor questions about what you're not sure) P: plan (management plan, as specific as possible) S: self-directed learning (opportunity to investigate more about topics which you're not sure) Drew Brees is scheduled for acute visit for skin lesion. After looking at his lesion, he pulls out a long list of things he wants to discuss. You are 30min behind on your schedule & only have 15min for this appointment. Which of the following is the best response to the pt? I see you have a list of concerns and I want to discuss them but my schedule will only allow for a few items today. Let's look at them together and ID the 3 most important items to discuss today. Then we can make a plan to address the remaining concerns for another visit. Which statement(s) regarding practice guidelines is (are) NOT true? They should be utilized in every circumstance T/F A max of 20 alternative hrs can be used as part of the 125hr practicum requirement for each clinical course True T/F New practitioners especially need support to develop confidence in their diagnostic and tx-planning capabilities. True Which of the following statement(s) is (are) true? Clinical logs are not legal documents. You may make an amendment to your NR511 clinical log when you are in NR601. Clinical logs must demonstrate a well-rounded clinical experience by graduation. All of the above. Clinical logs must demonstrate a well-rounded clinical experience by graduation Your pt presents w/sore throat x2 days. You suspect he may have strep pharyngitis because his best friend had it last week. You do not have rapid antigen tests in your office, so you send throat swab for culture. Which ICD-10 should you use on the lab req? Acute pharyngitis, unspecified (J02.9) Point of care strategy involves: All of the above (having readily available evidence-based resources, asking clinical question, applying findings to individual pt) Which statement is true regarding SOAP notes? All of the above (a way to document interaction between pt and provider, become part of pt's permanent record, can serve as means of communication between healthcare professionals) Which statement is true? The DD is the final dx determined for visit A problem list is a list of possible dx for the pt's CC A differential is a list of plausible dx that fit the presentation/findings of pt The differential is ranked in order from least likely to most likely A differential is a list of plausible dx that fit the presentation/findings of pt Which of the following statements regarding diagnostic reasoning is NOT true? Diagnostic reasoning involves using person's intuition as sole basis for decision making T/F The level of E&M coding for new & estab pt's is based on documentation that is provided in pt's medical record. True Systemic reviews of randomized clinical trial studies are considered what Level of evidence? 1 T/F Experience is necessary in exercising clinical judgement. True Tom Brady is seen in your office with c/o sore throat x2 days. Which body system would not be included in H&P for this problem-focused visit? Skin Neuro EENT Resp Neuro Which statement is true regarding documentation of your clinical encounter? Using correct codes in clinical encounter log is esp important because it provides evidence of the population of pt's that you have seen. When faculty reviews your log, we will be looking for both preventative and complaint office visit codes across all age groups. If I do not see a sufficient amount of a certain population, such as peds or complex visits, I may be required to find a different practicum site than what I originally had planned in a future course. All of the above. All of the above HIPAA legislation is important to daily management of practitioner practice setting. Precautions should be used to protect pt electronic personal info at all times. Which of the following is an appropriate precautionary measure? Use of computer screens T/F Episodic visits are also known as problem-focused visits. True T/F Cam Newton received a passing midterm and final eval from his preceptor along w/76% in the didactic portion of the class. Cam will pass the class. False T/F Reimbursement policy changes by insurance carriers over the years has resulted in a reduction of healthcare spending. False T/F Having a family practice site for all 5 practicum courses guarantees that you will have a well-rounded clinical experience to all ages and conditions. False Which of the following is NOT a secondary prevention measure? Testosterone replacement Testicular self-exam Bone density test Perform digital rectal exam Testosterone replacement Maddie has h/o asthma that is classified as mild intermittent. She comes to office today w/wheezing which is not improving w/her inhaler. Which would be the best ICD-10 code to apply w/only the info given? Mild intermittent asthma with acute exacerbation (J45.21) Aaron Rogers presents to your clinic in the off-season with a painful, red, swollen L calf. Without any other further info given, which of the following is a reasonable differential to investigate further? All of the above (cellulitis, DVT, acute musculoskeletal injury) Which one of the following preceptors would NOT meet the FNP program preceptor requirements? Board Certified Pediatric Nurse Practitioner working in a pediatric care setting w/6mo experience in an advanced practice role. T/F You are required to submit at least 4 SOAP notes from your practicum site for this class. False The Resource-Based Relative Value Scale (RBRVS) is used by CMS to set reimbursement rates, which are designed to reflect costs needed to provide services. Which of the following is NOT one of the components in determining set reimbursement rates for provider services? Pt's insurance coverage Alternative activities can be used toward your clinical requirement. Which of the following should NOT be documented as an alternative activity? Tele-visit or e-visit Malaria in Southern Hemisphere (Africa) is considered a(an) __________ disease. Endemic T/F Morbidity refers to the number of people who have died from a particular dz. False Which one of the following do NOT meet requirements of this program? DNP degree w/board certification as Acute Care Nurse Practitioner (ACNP) What are 3 main components in determining E&M code? Hx PE MDM Chloe c/o acute pain in R ear. Exam reveals normal exam on L side. R external ear is non-erythemic, non-tender. EAC is free of debris/obstruction, without redness. TM is visible, bright red, bulging w/cloudy fluid. Which is the best ICD-10 dx code for your findings? Acute suppurative otitis media without spontaneous rupture of ear drum, right ear (H66.001) Seat belt use is considered _______ prevention. Primary Evidence from well-designed case-control and cohort studies are considered which level of evidence in research design? 4 Which one of the following students is not meeting practicum expectations? Hannah texts friend during "down-time" in between pt's. Which of the following is NOT true? Diagnostic tests can be used to confirm/rule out hypotheses. Diagnostic tests may be used to screen for conditions Diagnostic tests may be used to monitor progress in managing chronic conditions Diagnostic tests vary in usefulness based on severity, specificity, predictability Diagnostic tests vary in usefulness based on severity, specificity, predictability T/F Sporadic outbreaks occur when there are occasional cases of an event unrelated in space or time. True Which of the following is NOT a requirement when developing a CPG? Panel of experts must all be physicians Define components of SOAP note