This Document Contains Chapters 10 to 12 Chapter 10 Question 1 The nurse is preparing the client for discharge from the acute care facility. Potential LTC facilities for this client include: Standard Text: Select all that apply. 1. A SNF 2. LTAC 3. Hospice 4. Home 5. Residential care facility Answer: 1, 2, 3, 5 Rationale 1: A skilled nursing facility provides care for residents with a higher acuity than available in a long-term care facility Rationale 2: A long term acute care facility provides a subacute level of care to inpatients who have post intensive care needs for an extended period of time before they are well enough to qualify for moving to a rehabilitation facility or skilled care facility Rationale 3: Hospice provides end-of-life care for terminally ill clients either in a residential setting or in the client’s home Rationale 4: Home care is not a long-term care facility Rationale 5: The residential care facility, for the independent resident offers consultation with nurses at the residents’ request Question 2 The average length of stay in the acute care hospital is 1. 30 days 2. 2 days 3. Less than 30 days 4. More than 30 days Answer: 3 Rationale 1: The average length of stay in the acute care hospital is less than 30 days Rationale 2: The average length of stay in the acute care hospital is less than 30 days Rationale 3: The average length of stay in the acute care hospital is less than 30 days Rationale 4: The average length of stay in the acute care hospital is less than 30 days Question 3 The nurse is caring for a client who is preparing for discharge. The client lives alone, and has a complicated wound dressing that needs to be changed daily, as well as needing assistance with many ADLs at this time. The appropriate discharge arrangement for this client would be: 1. A rehabilitation facility 2. A residential care facility 3. Hospice 4. Home Answer: 1 Rationale 1: The rehabilitation facility strives to help clients return to maximum possible functionality after accidents, severe injuries, illnesses, strokes, or serious surgery Rationale 2: The residential care facility is not set up to provide this client with the appropriate level of care Rationale 3: This client is not in the process of dying Rationale 4: The client does not have the appropriate support at home at this time Question 4 Services that a nurse may provide the client in the rehabilitation facility include 1. Visiting the Client’s home 2. Holistic support during the dying process 3. Providing care only when requested 4. Counseling Answer: 4 Rationale 1: A nurse provides home visits for the client within the home setting Rationale 2: The nurse provides support during the dying process in the hospice setting Rationale 3: The nurse in the residential care facility provides care only when requested Rationale 4: The nurse in the substance abuse rehabilitation facility may provide counseling Question 5 Services that are available in the home setting may include: Standard Text: Select all that apply. 1. Dressing changes 2. Assistance with ADLs 3. Physical therapy 4. Range of Motion 5. Acute care Answer: 1, 2, 3, 4 Rationale 1: The client who is discharged to home care may have dressing changes performed by a nurse Rationale 2: The client who is discharged home may receive assistance with ADLs such as bathing and dressing from unlicensed assistive personnel Rationale 3: The client who is discharged home may receive physical therapy if ordered by the physician Rationale 4: The client who is discharged to home care may receive range of motion therapy from healthcare providers Rationale 5: Acute care is not provided in the home setting Question 6 The nurse is discussing the discharge plan for a client with the interdisciplinary team. The client lives alone, and will require long-term intravenous therapy, and mechanical ventilation for a period of time. The appropriate placement for this client would be: 1. A residential care facility 2. Home 3. Hospice 4. SNF Answer: 4 Rationale 1: A residential care facility is not equipped for the client with long term skilled nursing needs Rationale 2: The client with long-term ventilation and IV therapy needs who lives alone will not be able to care for him-or her self at home Rationale 3: Hospice is not indicated by the information provided; this client is not in the process of dying Rationale 4: The skilled nursing facility is appropriate for residents whose acuity levels require a higher level of nursing care, such as tube feeding, intravenous therapy, chronic wound therapy or mechanical ventilators Question 7 The nurse is evaluating two job opportunities, one in home care and one in a SNF. Similarities in the two care settings include: Standard Text: Select all that apply. 1. Assessments are required in a timely manner 2. There are government-mandated forms for both settings 3. ADLs are assessed in only the SNF setting 4. Funding may be dependent on charting 5. Billing may be done prior to assessments being completed Answer: 1, 4, 5 Rationale 1: Assessments are required on admission to the care setting, and at mandated intervals Rationale 2: There are government mandated forms for the SNF setting; the home care setting may not have to use specific forms, but may choose to for ease of communication Rationale 3: ADLs are assessed in both the home care and the SNF setting Rationale 4: Funding (third-party payment) may be dependent on charting Rationale 5: Billing is generally not done before the client forms are complete in all aspects within a specified time frame Question 8 The charge nurse is providing orientation to a group of new nurses in a SNF. Regulations that are important to explain to the new employees include: Standard Text: Select all that apply. 1. Any possible violation of a resident’s rights must be verbally investigated 2. The MDS 3.0 must be use to assess the resident’s needs and desires 3. The MDS 3.0 may be completed by the nurse 4. CMS requires updated assessment at specific and situational intervals 5. Medical records only need to be reviewed by the staff on the unit Answer: 2, 4 Rationale 1: Any violation of a resident’s rights or standard of care must be investigated and documented in writing Rationale 2: The MDS 3.0 must be used to assess the residents’ needs and desires Rationale 3: The MDS 3.0 Must be accomplished by direct interview of the individual resident and/or family member Rationale 4: Centers for Medicare &Medicaid Services (CMS) require updated assessments ate admission, quarterly, annually, as well as with any significant change in the resident’s condition Rationale 5: A quality assurance committee must monitor the maintenance of resident’s medical records Question 9 The skilled nursing home is the appropriate setting for which of the following clients: 1. A client who is able to get around but requires some assistance with bathing 2. A client who is detoxifying from prescription medication 3. A client who requires complicated dressing changes and physical therapy 4. A client who has become forgetful and gets confused at night Answer: 4 Rationale 1: The setting for the client who requires minimal assistance would be the residential care facility or assisted living facility Rationale 2: The appropriate setting for the client who is detoxifying from prescription medication addiction would be a substance abuse rehabilitation facility Rationale 3: The appropriate setting for the client who requires complicated dressing changes and physical therapy would be the rehabilitation facility Rationale 4: The appropriate set for the client who can no longer live independently due to physical debilitation or neurological condition such as dementia is the skilled nursing facility Question 10 The nurse is explaining that the care of client’s in a nursing home involves many elements of regulations, including: 1. Calling the patients in nursing homes patients 2. Handing each client a list of rights and responsibilities to read 3. Treating the client as family, and using ‘honey’ or ‘sweetie’ to address the client 4. Calling the patients in nursing homes residents Answer: 4 Rationale 1: Patients in nursing homes are not called patients Rationale 2: Each resident must have his rights and responsibilities explained at the time of admission Rationale 3: The client is not to be called ‘honey’ or ‘sweetie’; this is a violation of the standard of care Rationale 4: Patients in nursing homes are called residents; they live in the facility Question 11 The nurse is caring for a client who is returning to the nursing home after being admitted to the hospital for chest pain. Appropriate actions include: Standard Text: Select all that apply. 1. Writing a short note in the client’s chart that includes the date and time of re-admission 2. Updating the resident’s assessment information 3. Thoroughly documenting the transfer 4. Reviewing the residents assessment information 5. Identify the changes in the comprehensive care plan Answer: 1, 3, 4 Rationale 1: Any transfers, discharges, accidents or changes in medical condition must be thoroughly documented Rationale 2: Residents must have an updated assessment upon admission and with any significant change in the resident’s condition Rationale 3: The transfer must be thoroughly documented Rationale 4: The assessment information must be updated, not just reviewed Rationale 5: The comprehensive care plan must be updated and include outcomes and target dates for needs identified in the MDS 3.0 Question 12 The RAI is used to collect information to use with 1. Standardized care plans 2. Individualized care plans 3. Discharge planning 4. Staff education Answer: 2 Rationale 1: The Resident Assessment Instrument data is used to develop individualized care plans Rationale 2: The Resident Assessment Instrument data is used to develop holistic, individualized care plans Rationale 3: The Resident Assessment Instrument data is used for comprehensive care planning, not just discharge planning Rationale 4: The Resident Assessment Data fosters an interdisciplinary approach to resident care, but is not only used for staff education Question 13 The RAI is usually completed by 1. The resident 2. The nurse 3. The interdisciplinary team 4. The resident’s family Answer: 3 Rationale 1: The RAI is usually completed with input from the resident Rationale 2: The RAI is usually completed with input from the nurse Rationale 3: The RAI is usually completed with input from the entire interdisciplinary team that includes the resident and family, the nursing staff, as well as the dietary, social services, physical and occupational therapy, speech pathology, and pharmacy departments to ensure a holistic plan of care Rationale 4: The RAI is usually completed with input from the entire interdisciplinary team that includes the resident and family, the nursing staff, as well as the dietary, social services, physical and occupational therapy, speech pathology, and pharmacy departments to ensure a holistic plan of care Question 14 The RAI consists of: Standard Text: Select all that apply. 1. A set of screening elements 2. A care area assessment process 3. Identification of residents who are at risk for developing specific functional problems and require further assessment 4. Intuitive nursing judgments 5. The MDS 3.0 Answer: 1, 2, 3, 4 Rationale 1: A core set of screening elements is included in the MDS Rationale 2: The Care Area Assessment process assists the nurse in systematically interpreting the information recorded on the MDS Rationale 3: Care Area Triggers identify residents who are at risk for developing specific functional problems and require further assessment; this is part of the CAA process Rationale 4: Intuitive nursing judgments are not included in the RAI Rationale 5: The MDS 3.o includes a core set of screening clinical and functional status elements including common definitions and coding categories, and forms the foundation of a comprehensive assessment for all residents of nursing homes Question 15 The RAI is a 1. 4 page assessment form 2. 38 page form 3. Tool used only by nursing staff 4. Tool used for billing purposes Answer: 2 Rationale 1: The RAI is a 38-page assessment form Rationale 2: The RAI is a 38-page form Rationale 3: The RAI is an interdisciplinary assessment tool Rationale 4: The RAI is not used for billing purposes; it is used to document care needed Question 16 The nurse is beginning to fill out the RAI on a newly admitted client. Information that is required includes: Standard Text: Select all that apply. 1. Type of provider 2. Resident race and ethnicity information 3. Resident sexual orientation 4. Resident medical record number 5. Date of MDS 3.0 assessment Answer: 1, 2, 4 Rationale 1: The type of providers, such as a SNF or NF is required Rationale 2: Resident race/ethnicity information is required Rationale 3: Resident sexual orientation information is not required Rationale 4: Resident medical record number is optional information Rationale 5: The date of the assessment is required Question 17 Which of the following statements about MDS 3.0 is true? 1. It is performed on a monthly basis 2. It is performed by the resident 3. Entries need to be verified as the process progresses 4. It is only required for clients over 65 Answer: 3 Rationale 1: The MDS 3.0 is not performed on a monthly basis but is reviewed at regularly mandated intervals Rationale 2: The MDS 3.0 is not performed by the resident, but includes information from the resident Rationale 3: Entries in the MDS need to be verified as correct as the process progresses so that appropriate care area triggers are identified Rationale 4: The MDS is required for all clients in a LTC facility or rehabilitative program Question 18 The MDS 3.0 assessment tool includes all of the following 1. The client’s preferences 2. A functional status assessment 3. A list of active diagnoses 4. A list of family members 5. A mood interview Answer: 4 Rationale 1: The MDS 3.0 includes assessment of the resident’s preferences for customary routines and activities Rationale 2: The MDS 3.0 includes a functional status assessment that includes ADLs Rationale 3: The MDS 3.0 includes a list of active diagnoses and health conditions Rationale 4: The MDS 3.0 does not include a list of family members Rationale 5: The MDS 3.0 includes a mood interview to assess the client’s mental status Question 19 The nurse is coding the resident’s ADL self-performance. The 1. The most independent level 2. The most dependent level 3. The Support Provided code 4. The activities that do not occur at all Answer: 2 Rationale 1: The “rule of 3” is followed to code the client’s ADL function to the most dependent level. Rationale 2: The “rule of 3” is followed to code the client’s ADL function to the most dependent level. Rationale 3: The “rule of 3” is not used to code the support provided code; there are codes to document support provided over all shifts Rationale 4: The “rule of 3” is not used to code an activity that did not occur; the ADL self-performance code in that situation is an 8 Question 20 Home health care involves which type of healthcare providers? Standard Text: Select all that apply. 1. Nurses 2. Businesses 3. Restaurants 4. Paraprofessionals 5. Children Answer: 1,2,4 Rationale 1: Nurses are typically involved in home health care Rationale 2: Business, such as those who provide oxygen, pumps, beds and wheelchairs are often involved in home health care Rationale 3: Restaurants are not usually included as home health care providers Rationale 4: Paraprofessionals such as HHAs and CNAs may be involved in home care for a client Rationale 5: Children are not providers of home health care, but may be recipients of home health care Question 21 Characteristics of the home setting include: Standard Text: Select all that apply. 1. There are rules governing visitors and pets 2. Support staff is available around the clock 3. The health care team has little control over the healing environment 4. Family members are often the ones who implement the care plan 5. The care plan’s outcome is within the nurse’s control Answer: 3, 4 Rationale 1: The hospital environment has rules governing visitors and pets Rationale 2: Support staff is available around the clock in a facility such as a hospital or SNF Rationale 3: The health care team has little control over the healing environment, including safety and hygiene standards Rationale 4: Family members often implement the plan of care Rationale 5: The outcome of the care plan is beyond the nurse’s control Question 22 Clients may be referred to home health providers by: Standard Text: Select all that apply. 1. Physicians 2. Nurses 3. Therapists 4. Family members 5. A neighbor Answer: 1, 2, 3, 4 Rationale 1: Physicians may refer clients to home health providers Rationale 2: Nurses or discharge planners may refer clients to home health providers Rationale 3: Therapists may refer clients to home health providers Rationale 4: Family members may refer clients to home health providers Rationale 5: Neighbors are not usually involved in home health referrals Question 23 Home health nursing requires the nurse to consider which of the following: Standard Text: Select all that apply. 1. Coordination of care 2. Client education 3. The nurse is required to provide the majority of the care 4. Assisting the client with problem solving 5. Unlimited time with each client Answer: 1, 2, 4, 5 Rationale 1: The nurse is responsible for coordinating home health aids and other care professionals, as well as the paperwork Rationale 2: The nurse is responsible for client and caregiver education, as the delivery of care is going to be provided by a family member or other support person Rationale 3: The nurse does not provide the majority of the care Rationale 4: The nurse assists the client and family with problem solving related to other client needs in addition to health care needs Rationale 5: Home care nurses usually have no longer than one hour with a client Question 24 The majority of the clients a home care nurse provides care for are 1. Children 2. Adults 3. Elderly 4. From nursing homes Answer: 3 Rationale 1: Children are often home care clients Rationale 2: Adults are often home care clients Rationale 3: Elderly clients make up a larger portion of the home care census Rationale 4: The majority of home care follows discharge from an acute care hospital Question 25 Which of the following is true about home care? 1. Most clients pay independently 2. Most clients have Medicaid 3. Documentation is critical to reimbursement 4. The MDS 3.0 is used to assess the client’s functional status and environment Answer: 3 Rationale 1: A third-party payer typically pays for home care Rationale 2: Most clients have a third-party payer, such as Medicare, Medicaid, Blue Cross or other health insurance Rationale 3: Accurate and complete documentation is critical to the nurse’s employer being paid for services; the nurse’s documentation also affects whether the client will be authorized for the level of care required Rationale 4: The assessment tool used in home care is OASIS-C Question 26 OASIS-C is a group of data elements that: Standard Text: Select all that apply. 1. Was developed by Blue Cross 2. Represents core items of a comprehensive assessment for an adult home care client 3. Is the basis for measuring client goals 4. Uses evidence-based tools 5. Includes several risk assessment measurements Answer: 2, 4, 5 Rationale 1: The OASIS-C was developed by the Centers for Medicare & Medicaid Services (CMS) to set standardized protocol for assessing the clinical characteristics of Home Health Agency clients Rationale 2: OASIS is a group of data elements that represent core items of a comprehensive assessment for an adult home care client Rationale 3: OASIS elements form the basis for measuring client outcomes Rationale 4: OASIS-C, the current version, added several evidence-based tools that can be considered best practices in home health care Rationale 5: The risk assessment measurements include pressure ulcer risk, falls risk, depressive symptom screening as well as vaccination tracking Question 27 The OASIS-C data is gathered: Standard Text: Select all that apply. 1. At the start of care 2. When care is terminated 3. When requested by client 4. monthly 5. When transferred to an inpatient facility Answer: 1, 2, 5 Rationale 1: The data is gathered when home care begins or resumes Rationale 2: The data is gathered when home care is terminated Rationale 3: The data is not gathered at client request Rationale 4: The data is not gathered at monthly intervals, rather at care-driven or recertification driven intervals Rationale 5: The data is gathered when the client is transferred to an inpatient facility Question 28 The nurse is completing a partial OASIS-C data collection on a client. The tabs identified as ADL/IADL, ADL/IADL 2, and ADL/IADL 3-4 are used 1. Depending on the client’s level of mobility 2. Depending on the client’s ability to meet ADLs independently 3. To provided detailed information about a variety of activities 4. To identify client outcomes Answer: 3 Rationale 1: The client’s level of mobility is included in the assessment, but all tabs are utilized Rationale 2: The client’s ability to meet ADLs independently is assessed, but all tabs are utilized Rationale 3: The use of all tabs provides detailed and comprehensive information about the client’s ability to meet ADLs Rationale 4: The tabs are not specific to outcomes; rather they are used to document the assessment stage of the home care nursing process Question 29 The nurse is reviewing a client’s nursing plan of care from the acute care facility. The nurse notes the following similarities or differences in the plan of care synopsis in the OASIS-C tool: 1. The OASIS-C is extremely detailed 2. The acute facility plan of care includes interventions from physical therapy occupational therapy, and speech pathology 3. The acute facility plan includes risk assessments 4. The OASIS-C is grouped by nursing diagnosis Answer: 3 Rationale 1: The OASIS-C plan of care synopsis is short and concise Rationale 2: The acute facility plan of care involves nursing actions, with collaboration with other providers as necessary Rationale 3: The acute facility plan of care may include at risk nursing diagnoses Rationale 4: The OASIS-C information is grouped by 7 potential common areas of need, rather than nursing diagnosis Question 30 Which of the following statements is true about the OASIS? 1. It is used to determine if the client requires care 2. OASIS summarizes the agencies plan of care 3. The nursing plan of care is included in the OASIS synopsis 4. The OASIS is performed at prescribed intervals Answer: 2 Rationale 1: The MDS 3.0 is an assessment tool used to determine if and how much care a client needs Rationale 2: The OASIS summarizes an agency’s plan of care, but does not include the nursing plan of care Rationale 3: The nursing plan of care is not included in the OASIS synopsis; that must be created separately Rationale 4: The MDS 3.0 is performed at prescribed intervals Chapter 11 Question 1 The ________ may be compared to the first automobiles because in the early stages of new technology people tend to look at things in the old way. 1. Teleradiology 2. Electronic health record 3. iPod 4. Electric car Answer: 2 Rationale 1: Teleradiology is an advanced use of technology, rather than an early use. Rationale 2: The EHR is in the early stages in most health care settings Rationale 3: The iPod is an advanced use of technology, when compared to a stereo Rationale 4: The electric care is an advanced version of the first automobiles Question 2 A client who arrives for an annual physical has brought along some information on healthy cholesterol levels he obtained from the Internet. How should the nurse handle this situation? 1. Explain that the Internet contains a lot of inaccurate information and give him a drug brochure on cholesterol. 2. Thank the client for calling that to her attention, place the information aside, and proceed with the encounter. 3. Discuss the information with the client to find out if it seems accurate while also suggesting some reliable sources of online information. 4. Assume the client has done his homework and discuss the information as part of the client’s treatment plan. Answer: 3 Rationale 1: Many Internet sites provide reliable information, while others do not; it will foster a better client/provider relationship if the provider does not dismiss the information Rationale 2: Many Internet sites provide reliable information; the client’s information should be evaluated with the client Rationale 3: Discussing the information with the client will increase the client’s engagement in managing his or her own health care Rationale 4: While the client has done some homework, the nurse and client together should discuss the information, and the reliability of the source Question 3 Which of the following is not one of the ONC committee’s criteria for defining its meaningful use objectives? 1. Clients should have access to self-management tools 2. Participation on a health information exchange (HIE) 3. Providers should have access to comprehensive client data from all available sources 4. Clients should be able to correct or edit their electronic health data in real time Answer: 4 Rationale 1: The Office of the National Coordinator for Health committee included that the EHR should include client access to self-management tools Rationale 2: The ONC committee included participation in regional or national health information exchange of information in the meaningful EHR Rationale 3: The ONC included real-time access to all medical information and tools to help ensure quality and safety of the care provided Rationale 4: Client access to their EHR in real-time is not included in the ONC meaningful use objectives Question 4 Which of the following sites is considered a reliable source of information for nurses? 1. Google 2. Wikipedia 3. ANA.ORG 4. CNN Health Answer: 3 Rationale 1: Google may provide access to reliable sources, however it provides access to many sources that are unreliable, such as blogs and ‘wikis’ Rationale 2: Wikipedia is not considered a reliable source of information on most subjects, as any one who wishes to contribute to the page can add to the content Rationale 3: ANA.org, the American Nurses Association is considered a reliable nursing resource Rationale 4: CNN Health may have reliable information, however it is not considered a reliable source of information for nurses Question 5 Which of the following is an example of decision support in relation to an EHR system? 1. Links to specific protocols, case study results, or guidelines 2. An annotated bibliography of medical journals 3. Links to general online medical resources 4. A list of recommended continuing education classes Answer: 1 Rationale 1: Links to protocols or case studies provides information to the provider to guide in treatment plan decisions Rationale 2: Annotated bibliographies provide articles to read, but not specific guidelines or treatment plans Rationale 3: Links to general medical resources provide information; they do not provide the clinician with a specific evidence based plan of care that could be followed Rationale 4: Recommended classes does not assist the clinician in real-time decisions Question 6 The Internet can best be described as a (n) _________ 1. local-area network. 2. virtual private network. 3. public network. 4. wide-area network. Answer: 3 Rationale 1: A local-area network connects multiple computers together to exchange data in private networks that can be accessed only by users in that network Rationale 2: A virtual private network (VPN) uses the Internet to transport data, but encrypt and decrypts the data between the sending and receiving systems; only those who are permitted to use the system can access it Rationale 3: The Internet is a worldwide public network that can be accessed by any computer anywhere; it is a very large network of networks Rationale 4: A wide-area network (WAN) is a large group of computers connected together to exchange data in a private network that can only be accessed by the users in that network Question 7 Jorge is a home care nurse within a large geographic area; he needs real-time access to update the records of his clients while away from the home health agency. Which of the following will Jorge need to use his agency’s EHR remotely? 1. SSL 2. LAN 3. VPN 4. WAN Answer: 3 Rationale 1: An secured socket layer (SSL) is limited to data that can be used on a web page; it cannot be used to run software or view records that are on office network computers from elsewhere Rationale 2: A local area network (LAN) is a group of computers that are connected together using cables Rationale 3: A virtual private network (VPN) uses the Internet to transport data, but has software that encrypts and decrypts the data between the sending and receiving systems Rationale 4: A wide area network (WAN) is a large group of computers that are connected together by cables Question 8 The nurse is explaining the process of telemedicine to a client. Which of the following would be an example of store-and-forward telemedicine? 1. Phone teleconference 2. Video documentary on open-heart surgery 3. Voice mail message to a referring physician 4. CAT scan Answer: 3 Rationale 1: A phone teleconference is real-time telemedicine Rationale 2: A video documentary is not an example of telemedicine Rationale 3: A doctor leaving a message stating the facts of a case for a consulting physician, who then responds with a detailed response for the original physician Rationale 4: A CAT scan is not an example of telemedicine; it may be transmitted electronically, if there are secure Internet connections involved Question 9 Store-and-forward telemedicine would not be suited to which of the following situations? 1. Caring for a client with numerous comorbidities 2. Treating a high risk client 3. Performing arthroscopic surgery in real time 4. Consulting on a client with a rare disease Answer: 3 Rationale 1: Store and forward telemedicine would allow the physician to contact several specialists in order to coordinate the client’s care needs Rationale 2: The Store and forward technology would allow the physician to leave a detailed message about the client, and have the consultant respond with recommendations regarding the care plan Rationale 3: Arthroscopic knee surgery is done in real time Rationale 4: The consultant discussing a client’s plan of care can leave a detailed message regarding the client’s plan of care Question 10 A client who uses Instant Medical History when visiting her primary care provider ___________ 1. gives her symptoms to a medical assistant for entry. 2. must complete all the questions before arriving at the office. 3. has access to the EHR where her medical record resides. 4. has more face-to-face time with her provider during the visit. Answer: 4 Rationale 1: The client has already recorded her symptoms Rationale 2: The client must complete all the questions in order for the Instant Medical History to be completed Rationale 3: The client does not have access to the complete EHR; rather only the IMH and other basic demographic information Rationale 4: The client who has already answered all of the history questions related to the present illness will have more time with the provider to examine her, as well as answer other questions Question 11 Dana has sent e-mail to her provider with a question about recent blood work results. According to the HIPAA Security Rule, Dana’s provider must _________ 1. respond ASAP to his client’s question. 2. contact Dana by phone to answer her question. 3. use decryption to verify Dana’s identity before replying. 4. not include any PHI if replying by e-mail. Answer: 4 Rationale 1: Respectful client/provider service would expect that the provider respond ASAP to a client’s query Rationale 2: The HIPAA rule does not require that the provider telephone the client Rationale 3: HIPAA does not require decryption; if a client sends an unencrypted message, the provider still has the responsibility to keep her PHI secure Rationale 4: The provider may not use an open un-encrypted email to transmit EPHI Question 12 Which of the following is not a characteristic of an e-visit? 1. It is secure. 2. It is directed to a specific provider. 3. It is free. 4. It becomes part of the client’s chart. Answer: 3 Rationale 1: An e-visit is secure; the client accesses and signs on to the clinic web site, which is secure Rationale 2: Established clients use the e-visit for non-urgent visits; e-visits can be directed to the provider on call Rationale 3: The e-visit includes provider reviewed information, and is reimbursable by the third party payers, and as such are not free Rationale 4: The e-visit includes both client and provider entered data and becomes part of the client’s EHR Question 13 An e-visit would work best in which of the following situations? 1. Screening a brand new client who has not yet been to a practice 2. Triaging a worsening condition in the middle of the night 3. Guiding a client step by step through an emergency 4. Treating a client who has seasonal allergies Answer: 4 Rationale 1: The brand new client would not be eligible for an e-visit; the client needs to be an established client Rationale 2: A worsening condition in the middle of the night would require real time assessment Rationale 3: The client in an emergency situation would require real time intervention Rationale 4: A client who has been seen in the practice with an established diagnosis of recurrent seasonal allergies is eligible for an e-visit Question 14 The nurse explains to a client that, per the HITECH Act incentives for promoting the use of an EHR system, clients must receive electronic access to lab results within _______ hours of the information being available to the provider. 1. 24 2. 36 3. 48 4. 96 Answer: 4 Rationale 1: The HITECH act established criteria for providers; the time frame for electronic access to lab results was greater than 24 hours Rationale 2: The HITECH act criteria for access to lab results was greater than 36 hours Rationale 3: The HITECH act criteria for access to lab results was greater than 48 hours Rationale 4: The HITECH act criteria for access to lab results is no greater than 96 hours Question 15 The nurse is explaining to a client the manner in which the EHR uses the Internet to enhance client health care - including which of the following applications? Standard Text: Select all that apply. 1. Use of the IMH 2. Secure client-provider messaging 3. Client access to changing the EHR 4. Client access to self-management tools 5. Provider access to client data Answer: 1, 2, 4, 5 Rationale 1: The client is able to access the practice website through a secure connection and enter registration information, as well as entering current symptoms, and other applicable history Rationale 2: Secure client-provider messaging through a secure server is able to enhance the care relationship Rationale 3: The Internet is not used to allow the client to change the EHR in real time Rationale 4: Educational and self-management tools may be available to the client to augment the care plan Rationale 5: The Internet allows the provider to access the EHR from remote locations in order to provide appropriate care Question 16 Which of the following statements about client-entered data in relation to the EHR is false? 1. The client is the best judge of what symptoms he had at the beginning of an illness, making this information more accurate when he enters it himself. 2. The clinician will spend more face-to-face time with the client if she does not need to spend the majority of the encounter entering symptoms herself. 3. Client entered data enables the clinician to ask the client more questions about the diagnosis. 4. A client who can review her medical history before she sees her provider will be more prepared for the visit. Answer: 3 Rationale 1: The client knows what symptoms are being experienced, and how they presented Rationale 2: The clinician can review the already entered information, instead of entering it during the interaction Rationale 3: The client-entered information allows the clinician to begin the interaction with a great deal of information useful to begin making the proper diagnosis, and to discuss the effects of the illness Rationale 4: A client who can review the history is better prepared to interact with the provider Question 17 Typically, an e-mail communication between a client and a provider _______ 1. becomes part of the EHR. 2. gathers symptom and HPI information. 3. allows a client to share objective health information. 4. provider is not reimbursed for treating the client. Answer: 4 Rationale 1: The e-mail communication between a client and a provider typically does not become a part of the EHR Rationale 2: The e-mail communication between a client and a provider does not gather symptomology and other history information, as it is considered PHI, and should not be communicated by the provider via an email Rationale 3: The e-mail communication does not typically include objective information Rationale 4: The e-mail communication between the provider and client does not typically get billed for or paid Question 18 Which of the following is an advantage of synchronous telemedicine? 1. It may be practiced by providers across state lines. 2. It is useful for sharing diagnostic images with specialists. 3. It gives a specialist the opportunity to research a case further. 4. It allows the provider and the client to meet in real-time. Answer: 4 Rationale 1: Telemedicine is practiced by providers across state lines Rationale 2: Synchronous medicine is not as useful for sharing diagnostic images with other specialists; it is typically difficult to get the providers together Rationale 3: Telemedicine gives the specialist the opportunity to research a case further Rationale 4: Synchronous medicine allows the provider and the client to meet in real time Question 19 Home Health nurses are using the Internet for telemedicine. Which of the following is not a valid reason for this? 1. Internet video conferencing allows the nurse to visually see the client. 2. Nurses can download data from home medical devices. 3. It gives the nurse opportunity to skip in home assessments. 4. It allows the nurse to answer client questions sooner. Answer: 3 Rationale 1: Using the Internet for videoconferencing allows the nurse to visually see the client Rationale 2: Home health nurses use the Internet to download data from home medical devices, such as fetal monitors Rationale 3: Home health nurses do not use the Internet to skip in home assessments, rather to enhance client care, and augment in home assessments Rationale 4: The speed of the Internet and email allows questions to be answered sooner Question 20 Which industry has been the last to make Internet-based transactions readily available? 1. Healthcare 2. Banking 3. Travel 4. Brokerage/investing Answer: 1 Rationale 1: Healthcare as a whole has not made Internet transactions such as personal health records, e-visits readily available to consumers Rationale 2: Banking has made Interned-based transactions readily available to consumers; bank accounts can be accessed on the Internet Rationale 3: The travel industry has made many types of transactions available to consumers; tickets and reservations can be made for many types of travel and accommodations Rationale 4: Brokerage services are readily available on the Internet Question 21 The nurse know that the Internet has a lot of potential for healthcare, including: 1. Remote access to client charts 2. Transmission of PHI via email 3. Transmission of medical reports 4. Consultation with specialists 5. Ability to care for clients remotely Answer: 1 Rationale 1: The Internet allows the provider to access EHRs from remote locations Rationale 2: Providers do not transmit PHI via email Rationale 3: Medical reports and images can be transmitted over the Internet Rationale 4: Providers can consult with specialists vial the Internet Rationale 5: Providers can provide care to clients remotely, utilizing e-visits, and video technology Question 22 The client can utilize the Internet to: Standard Text: Select all that apply. 1. locate providers. 2. research diseases. 3. see physicians for the initial visit. 4. self diagnose. 5. participate in on-line discussion groups. Answer: 1, 2, 5 Rationale 1: The client can use the Internet to search for providers, both by looking for the individual provider, as well as searching the insurance company’s provider directory Rationale 2: Clients use the Internet to research diseases and medications Rationale 3: Clients cannot use the Internet for e-visits for the initial visit with a provider Rationale 4: Clients are not able to self-diagnose Rationale 5: On-line support group are common for clients with different types of conditions Question 23 The nurse and client are discussing criteria to use when evaluating information available on the Internet, including: Standard Text: Select all that apply. 1. Checking the date of the information 2. The information is provided by a drug company 3. The article lists an organization as the author 4. The website is from a trusted medical institution 5. The article lists the author and credentials Answer: 1, 4, 5 Rationale 1: It is important to check the date the information was last updated Rationale 2: Information provided by a drug company may have a bias toward selling the drug Rationale 3: The article or information should include the author’s name and credentials Rationale 4: The web site should be from a reliable or trusted medical institution, such as a university, hospital or the client’s regular doctor Rationale 5: The article should list the author and credentials Question 24 The nurse is caring for a client who is unfamiliar with a prescribed medication. An example of a reliable source for information is: 1. www.wikipedia.com 2. www.ana.org 3. www.drugstore.com 4. www.medicine.com Answer: 2 Rationale 1: Wikipedia is not a reliable source of information; the contributors are often unknown Rationale 2: www.ana.org is the website of the American Nurses Association, and is a reliable source of information Rationale 3: www.drugstore.com is not an academic source of information Rationale 4: www.medicine.com is an online pharmacy interested in selling medication Question 25 Useful resources for the nurse to use at the client’s bedside include 1. Websites 2. Journals 3. Integrated decision support resources 4. Continuing education courses Answer: 3 Rationale 1: Websites are not always at hand in the exam room or at the bedside Rationale 2: Current nursing journals are not always immediately available Rationale 3: Decision support resources that are integrated within the EHR system are the most useful at the bedside or in the exam room Rationale 4: Continuing education courses are not immediately available at the bedside Question 26 The nurse is caring for a client in an acute care facility. The EHR is accessible on the nurse’s tablet pc via: 1. a LAN 2. a VPN 3. The World Wide Web 4. a WAN Answer: 2 Rationale 1: A LAN is a group of computers connected by cables; the tablet pc is a wireless device Rationale 2: The VPN is used to transmit data, with encryption and decryption between the sending and receiving systems; the VPN verifies the identity of the person signing on Rationale 3: The World Wide Web is a network of networks, and is typically not used Rationale 4: The WAN is a large group of computers connected by cables; the table pc is wireless Question 27 A client is being seen at the health care office for the first time. The office utilizes an IMH. The client will input this information: 1. Prior to registering at the reception desk 2. After seeing the nurse 3. Upon checkout from the office 4. Prior to seeing the nurse Answer: 4 Rationale 1: The client will typically enter the information after arrival for his or appointment Rationale 2: The client will typically enter the information prior to seeing the nurse Rationale 3: The client will typically enter his or her medical history prior to seeing the nurse, provider, and checkout from the office Rationale 4: The client will enter the information before being seen by the nurse, so the nurse can review the data prior to the client being seen by the provider Question 28 The IMH allows the client to enter the following information in the EHR: 1. Vital signs 2. HPI 3. The current encounter note 4. Comprehensive physical exam information Answer: 2 Rationale 1: The client does not typically enter the vital signs in the EHR Rationale 2: The client accesses the EHR to enter the history of the present illness Rationale 3: The provider enters the encounter note Rationale 4: The provider enters the examination information, and gives the client a copy of the encounter note after the visit has been completed Question 29 The nurse explains the main benefit of the IMH is: 1. to save money. 2. to save the receptionist time. 3. to evaluate the client’s ability to read. 4. to allow the provider more time to spend with the client. Answer: 4 Rationale 1: Saving money is not the main benefit of the client inputting the HPI information Rationale 2: The receptionist’s workflow is not the main benefit of the IMH Rationale 3: The client’s literacy can be evaluated in other ways Rationale 4: The IMH allows the provider to spend more time talking with the client Question 30 The nurse needs to let the client know about some lab results. The appropriate method of communicating with the client with the EHR is: 1. e-mail 2. Secure messaging 3. Telephone 4. Text message Answer: 2 Rationale 1: e-mail is not a secure method of transmitting PHI Rationale 2: Secure messaging is the method of choice with the client; there is a clear line of communication that both know is secure and timely Rationale 3: Telephone may not be the easiest way to get in touch Rationale 4: The text message is not a secure communication Chapter 12 Question 1 The nurse explains to the client that an EHR can create specific preventive screening or health maintenance guidelines based on all of the following information about a client except: 1. Past medical history 2. Gender 3. Personal preferences 4. Social history Answer: 3 Rationale 1: The EHR uses codified information from the client’s past medical history to develop guidelines for screening, counseling and preventive measures Rationale 2: The EHR uses the client’s gender to generate guidelines based on sex that include variations for other additional risk factors Rationale 3: The client’s personal preferences are not a factor in the development of screening and preventive guidelines; these guidelines are based on evidence-based research Rationale 4: A client’s codified social history, for example alcohol use or tobacco use, is used to generate preventive screening guidelines Question 2 Janice made an appointment for her regular mammogram after receiving an email from her provider’s office. This is an example of: 1. Acute care 2. Coordinating 3. Counseling 4. Preventive screening Answer: 4 Rationale 1: Acute care involves care of a client during an active illness or injury Rationale 2: Coordinating care is involved with the client who has multiple active health problems that require the services of many specialists Rationale 3: Counseling is emotion of psychological treatment for a situational stressor Rationale 4: Preventive screening is done to determine if a client has a condition, or a risk factor for developing a condition Question 3 In which of the following ways would an EHR form that was created for a well-baby check be different from a form used for an adult client? 1. It has check boxes to record findings. 2. It is intended for a narrowly defined age group. 3. It includes selected findings related to the client. 4. It does not include vital sign information. Answer: 2 Rationale 1: All EHR created forms use check boxes to speed data entry Rationale 2: The form for a well-baby encounter is intended for a 12-month age span; the adult encounter form will cover clients from 18 to 100 years old Rationale 3: All EHR created forms will include findings related to that specific client; the checklist will be based on data collected from the client Rationale 4: The EHR well-baby visit form, as well as the adult visit, will include vital signs, height and weight measurements Question 4 Which of the following is an example of FS Hx and to whom does this relate? 1. Tobacco; parents 2. Enrolled in day-care; parents 3. Exposure to second-hand smoke; caregivers 4. Living with parents; client Answer: 1 Rationale 1: In the Family and Social History, the parents’ social habits are included in the pediatric visit Rationale 2: With the pediatric client, the Family and Social History includes the parents’ habits and environment; the child is the client in the day care situation Rationale 3: The caregiver’s exposure to secondhand smoke is not applicable to the child’s health or health care Rationale 4: If the client is a child, this is appropriate information to ask, but the client would not be the appropriate response; it would be parents Question 5 The nurse is preparing to measure and record (in the EHR) the vital signs of a 7-month-old baby during a wellness check. Which of the following is incorrect? 1. You will assess the baby’s temperature tympanic ally. 2. You will assess baby’s growth by measuring his height. 3. You do not need to take the baby’s blood pressure. 4. You will need to include a measurement of the baby’s head circumference. Answer: 2 Rationale 1: The baby’s temperature will be measured in the ear (tympanic ally) Rationale 2: Infant growth is measured in length not height Rationale 3: Blood pressure readings are not typically taken in healthy children under the age or 3 Rationale 4: The circumference of the head is measured in children under the age of one Question 6 The CDC provides a weight-for-stature clinical growth chart for people in which of the following age categories? 1. Birth to 36 months 2. Children and adolescents, 2 to 20 years 3. Preschoolers, 2 to 5 years 4. Teenagers, 13 to 20 years Answer: 3 Rationale 1: The birth to 36 month growth chart provided by the CDC is a length-for-age and weight for age Rationale 2: The CDC provides clinical growth charts for children and adolescents, 2 to 20 years as follows: stature for age and weight-for-age, and BMI-for age Rationale 3: The CDC provides a weight-for-stature growth chart for preschoolers, 2 to 5 years Rationale 4: The CDC growth charts do not include one specific to the13 to 20-year-old, weight for stature Question 7 Jeremy’s pediatrician notes that he is in the 75th percentile for his height. What does this mean? 1. Jeremy weighs the same as more than 25% of the reference population for girls and boys. 2. Jeremy is shorter than 25% of the reference population for boys. 3. Jeremy’s height and weight are normal for a child of his age. 4. Jeremy has been following a consistent curve in terms of his height. Answer: 2 Rationale 1: The 75th eight; he is taller than 75 % of the boys his age Rationale 2: Jeremy is the same height or shorter than 25% of the boys his age Rationale 3: Jeremy’s height is within the normal range for children his age; his weight is not determined at this time Rationale 4: The single measurement does not indicate the growth curve Question 8 Molly is an obese 8-year-old. How might a pediatric growth chart generated by an EHR system be useful in educating Molly’s parents about Molly’s condition? 1. The growth chart illustrates Molly’s risks of developing juvenile diabetes. 2. The growth chart proves Molly needs more regular physical exercise. 3. The growth chart places Molly’s measurements in context with other 8-year-old girls. 4. The growth chart teaches Molly’s parents the importance of a healthier diet. Answer: 3 Rationale 1: Other educational material would be useful in helping the parents understand the risks of childhood obesity Rationale 2: The growth chart does not prove a need for exercise; it provides information in context with other children the same age Rationale 3: The growth chart will illustrate Molly’s measurements in context with other girls her age; the illustration on a graph will be a visual tool to assist in the client education process Rationale 4: The growth chart is a tool that the provider can use during nutrition teaching Question 9 The nurse is reviewing the use of the BMI for age charts. Which of the following statements about BMI is incorrect? 1. BMI is used primarily for overweight children. 2. BMI in childhood is related to a person’s BMI in adulthood. 3. The BMI number shows body weight adjusted for height. 4. BMI-for-age is a relatively new screening tool. Answer: 1 Rationale 1: Everybody has a BMI that can be evaluated Rationale 2: BMI in childhood is a determinant of adult BMI Rationale 3: BMI is a number that shows body weight adjusted for height Rationale 4: BMI for age is being used to replace the use of weight for stature charts; it is consistent with the adult index, and can be used continuously from two years of age to adulthood Question 10 At which point do both males and females begin using the same BMI chart? 1. Up to age 2 2. Before age 12 3. After age 20 4. Beginning at age 65 Answer: 3 Rationale 1: The BMI is not used for children under age 2; the length for age, and weight for age charts are used Rationale 2: BMI is gender specific and age specific for children ages 2 to 20 years Rationale 3: Adults of both genders age 20 years or older share the same BMI chart Rationale 4: Adults of both genders age 20 years or older share the same BMI chart Question 11 Which of the following is not an example of an adult BMI category? 1. Malnourished 2. Underweight 3. Overweight 4. Obese Answer: 1 Rationale 1: Adult BMI categories include underweight, normal, overweight, or obese Rationale 2: Adult BMI categories include underweight, normal, overweight, or obese Rationale 3: Adult BMI categories include underweight, normal, overweight, or obese Rationale 4: Adult BMI categories include underweight, normal, overweight, or obese Question 12 The nurse is discussing immunizations with the parents of a newborn who have decided to breast feed the child. Which of the following statements is not true? 1. Neonates are born with a natural immunity. 2. Newborns receive antibodies from their mothers. 3. Babies who are breastfed do not require immunization. 4. Childhood immunization prevents many serious diseases from occurring. Answer: 3 Rationale 1: Neonates are born with a natural immunity that last for a month to a year Rationale 2: Newborns have antibodies that they obtain from their mothers in utero Rationale 3: All babies require immunizations to prevent contracting many infectious diseases that can cause serious consequences or death Rationale 4: Childhood immunizations prevent diseases such as polio, measles, diphtheria, pertussis, rubella, mumps, tetanus and Haemophilus influenza type b Question 13 The nurse explains that the acronym DTaP stands for 1. Rotavirus 2. Inactivated Poliovirus 3. Meningococcal 4. Diphtheria, Tetanus and Pertussis Answer: 4 Rationale 1: Rotavirus is not abbreviated as DTaP, but as RV Rationale 2: Inactivated Poliovirus is not abbreviated as DTaP, but as IPV Rationale 3: Meningococcal vaccine is not abbreviated as DTaP Rationale 4: DTaP stands for Diphtheria, Tetanus, and Pertussis Question 14 Which of the following is true about childhood immunizations? 1. Not all children in the U.S. need to be vaccinated. 2. In some regions of the U.S. vaccines are administered all at once. 3. Some vaccines must be given more than one time. 4. The CDC is the sole authority that recommends childhood immunizations. Answer: 3 Rationale 1: All children need to be vaccinated Rationale 2: Vaccinations are administered over a period of years Rationale 3: Some vaccines, such as Hepatitis B, DTaP, HiB requires series of vaccinations Rationale 4: CDC and state health departments have a schedule that is approved by the CDC Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians Question 15 Which of the following vaccines is recommended to be given at birth? 1. RV 2. HepB 3. DTaP 4. IPV Answer: 2 Rationale 1: RV (rotavirus) is recommended to be given every two months starting at 2 months of age for three doses Rationale 2: HepB vaccinations are given at birth, age 1-2 months, and between ages 6-18 months Rationale 3: DTaP is given as four doses, at 2 months, 4 months, 6 months and between 15-18 months Rationale 4: IPV (inactivated poliovirus) is given as 4 doses at 2 months, 4 months, and 6-18 months and between 4-6 years Question 16 Which of the following is not true of a PHR? 1. Its use by clients is encouraged by the ONC. 2. It requires a secure web site. 3. It is must be maintained by a client’s healthcare provider. 4. It is available to a client anywhere with Internet access. Answer: 3 Rationale 1: Using a Personal Health Record allows clients to create and update their records Rationale 2: The Personal Health Record allows clients to log on to a secure web site and to create and update their records Rationale 3: The Personal Health Record can be maintained by the provider, but would only have information from that facility; the record maintained by the client can contain data from visits at multiple practices Rationale 4: The online PHR is available everywhere, and the client can access the records and share them with the provider Question 17 Joyce has been keeping a graph of her blood pressure at home for a few months. This means that Joyce: 1. can adjust her medication as necessary. 2. e-mails a graph to her physician each day. 3. needs to see her physician far less often. 4. is better able to tell if her current treatment is effective. Answer: 4 Rationale 1: The physician does medication adjustment Rationale 2: The client would not need to email a graph to her physician daily; trending is done over time, and if the client adds the information to the PHR, the physician will be able to see the information Rationale 3: The client will need to see the physician at the same intervals, regardless of home monitoring Rationale 4: The client will be able to see if the medication is having the desired effect Question 18 All of the following are true about “evidence-based guidelines” except: 1. They are mainly useful for dealing with demographic groups in general. 2. They represent an analysis of current scientific research. 3. They offer guidelines both for and against taking certain measures. 4. They serve as the basis for recommendations based on age, sex, and risk factors for disease. Answer: 1 Rationale 1: Evidence-based guidelines can recommend certain screening, counseling and preventive medications; the guidelines can vary by age and sex, but also change at recommended intervals based on the individual client Rationale 2: Evidence-based guidelines are created by analyzing scientific evidence from current research and studies to determine the effectiveness of preventive services Rationale 3: Evidence-based guidelines can recommend actions to take and actions to avoid Rationale 4: Evidence-based guidelines serve as the basis for recommendations based on age and sex, but also based on the individual client’s risk factors Question 19 Ideally, a client’s personal health record (PHR) contains information for the person’s _______. 1. family 2. lifetime 3. provider 4. chronic diseases Answer: 2 Rationale 1: The PHR will contain family history information, and much more Rationale 2: The PHR will contain information about the client from birth to the current time frame Rationale 3: The PHR ideally will contain information from all the client’s providers, past and present Rationale 4: The PHR will contain information about all of the client’s past and present conditions, acute and chronic Question 20 To make sure preventive care services are delivered appropriately, __________ should be available at the point of care. 1. CDC recommendations 2. risk assessment data 3. evidence-based information 4. screening and testing Answer: 3 Rationale 1: CDC recommendations are part of the library of information that should be available at the point of care Rationale 2: The risk assessment data is included in the EHR Rationale 3: Evidence-based information should be available in the library of information at the point of service EHR Rationale 4: Guidelines and evidence-based information should be available at the point of service Question 21 The nurse is reviewing the birth and medical and surgical history for a pediatric client at a 6-month well-baby visit. Appropriate data to collect includes information about: Standard Text: Select all that apply. 1. Type of birth 2. Smoking history of parents 3. History of previous illnesses 4. Type of pregnancy 5. Head circumference Answer: 1, 3, 4 Rationale 1: The type of birth is part of the infant’s birth and med/surg history Rationale 2: The smoking history of the parents would be entered when collecting data on the Family and Social history portion of the encounter Rationale 3: Any history of previous illness, such as anemia, would be determined at this point in the encounter Rationale 4: The pediatric client’s pregnancy history, such as single or twin birth or pregnancy would be entered at this point of the encounter Rationale 5: The head circumference measurement would be entered during the physical exam portion of the encounter Question 22 The nurse is reviewing the mother’s educational needs during a well-baby checkup. Items that would be included in this portion of the encounter include: Standard Text: Select all that apply. 1. Nutrition 2. Child safety 3. Vital signs 4. Teething 5. Motor tone Answer: 1, 2, 4 Rationale 1: Nutrition is an important educational need for the parents of a baby Rationale 2: Child safety is an important educational need to review, and document, for the parents of the well baby Rationale 3: Vital signs are documented in the physical exam portion of the encounter Rationale 4: Teething information is important to review with the parents of an infant, including normal and abnormal teething symptoms Rationale 5: Motor tone is assessed and documented within the physical exam portion of the encounter Question 23 The nurse is checking the calculations of a client’s BMI. The correct formula is: 1. ht2/wt 2. wt2/ht *703 3. wt/ht2 4. lbs/kg Answer: 3 Rationale 1: The correct formula is the weight divided by the height squared when using kilograms and meters Rationale 2: The correct formula is the weight divided by the height squared when using kilograms and meters Rationale 3: The correct formula is the weight divided by the height squared times 703 when using pounds and inches Rationale 4: The correct formula is wt/ht2 using the weight in kilograms and the height in meters Question 24 The nurse is calculating a client’s BMI. The client weighs 102 pounds and is 5 feet tall. The client’s BMI is 1. 19.2 2. 20 3. 199 4. 19.9 Answer: 4 Rationale 1: The formula is: weight (lb) * 703 = 19.9 / Height2 (in2) Rationale 2: The formula is: weight (lb) * 703 = 19.9 / Height2 (in2) Rationale 3: The formula is: weight (lb) * 703 = 19.9 / Height2 (in2) Rationale 4: The formula is: weight (lb) * 703 = 19.9 / Height2 (in2) Question 25 The nurse is reviewing a pediatric client’s immunization record. The family was traveling immediately after the child’s birth, and he did not receive any immunizations at 2 and 4 months. The nurse explains that the immunizations: Standard Text: Select all that apply. 1. can all be given at the current encounter to ‘catch up’. 2. need to be given over time. 3. cannot be given and the child will be unprotected. 4. generally have a range that is considered appropriate for administration. 5. will be administered according to a catcher-up schedule. Answer: 2, 4, 5 Rationale 1: Immunizations cannot be given all at once; immunizations need to be given over time Rationale 2: Immunizations need to be given over time; many immunizations require several doses to be effective Rationale 3: The immunizations can be given, over time, and the child will be protected Rationale 4: The immunization schedule has generally accepted intervals between doses Rationale 5: A catch-up schedule will be set up to ensure the child receives all recommended immunizations Question 26 The nurse practitioner is reviewing the pediatric client’s immunization schedule. By clicking the ‘Y’ on form next to the appropriate vaccine the following occurs: 1. The provider documents the immunization 2. The provider sends an order to the pharmacy for the vaccine 3. The provider writes a prescription 4. The provider sets up the catch-up schedule Answer: 1 Rationale 1: By marking the box on the form, the provider documents the immunization Rationale 2: The provider will generally have the vaccine in the office and will not be required to order the vaccines from a pharmacy Rationale 3: The provider is not writing a prescription when the boxes on the form are checked Rationale 4: The provider is not setting up a catch-up schedule by checking the vaccine boxes Question 27 The diabetic client is discussing her care plan with her provider. Potential actions that the client should take to be engaged in her own care includes: Standard Text: Select all that apply. 1. Calling the provider’s office with all the blood sugar measurements 2. Recording the measurements in a notebook 3. Calling the provider when the blood sugar measurements are not within normal limits 4. Monitoring and recording vital signs 5. Reviewing the logs with the provider on monitoring visits Answer: 2, 3, 4, 5 Rationale 1: The client does not need to call the provider’s office with all blood sugar measurements; normal measurements do not need to be called to the provider Rationale 2: Recording the measurements in a notebook or computer program will enable the client and provider to determine effectiveness of the medication regimen Rationale 3: Calling the provider when blood sugar measurements are not within normal limits assist the client in controlling the condition Rationale 4: Monitoring and recording vital signs will allow the client and provider to keep track of trends in the client’s condition Rationale 5: Reviewing the logs with the provider will keep the client actively engaged in her own health care Question 28 The nurse is explaining the concept of the patient-centered medical home to a client, stating: 1. The client stays with the provider for years at a time 2. The client sees specialists in one facility 3. The client uses paper-based records 4. The client is seen in a primary healthcare setting that facilitates partnerships Answer: 4 Rationale 1: The client is seen in a primary care setting that facilitates partnerships between individual clients, and their personal physician, within a set of PCMH standards Rationale 2: The client is seen in a primary care setting Rationale 3: The practice is general an electronic based practice Rationale 4: The PCMH is an approach to providing comprehensive primary care for children, youth and adults, facilitating a partnership between the clients, physicians, and when appropriate, the client’s family Question 29 A client is transferring from one provider to another. This is facilitated with the EHR by: Standard Text: Select all that apply. 1. Providing clients with electronic access to their health information within hours 2. Providing clients with printouts of their EHR 3. Providing clients with electronic copies of discharge instructions 4. Mailing the client reminders for preventive or follow up care 5. Emailing the new provider all the client’s information Answer: 1, 3, 4 Rationale 1: The client’s health information, such as test results, should be available to the client within 96 hours of it becoming available to the provider Rationale 2: The EHR is not used to provide printouts for the client Rationale 3: The EHR allows the client to have electronic copies of discharge instructions, and procedures, and this can also be provided to the new provider Rationale 4: Reminders can be generated by the EHR and either emailed or mailed to the client for preventive or follow-up care Rationale 5: Email is not used to send protected health information Question 30 The basics that the client should look for when evaluating a PHR include: Standard Text: Select all that apply. 1. The data is managed by the provider 2. The provider or company controls who can have access 3. The client can see who entered the data 4. The data is secure and private 5. The PHR is universally accessible via the internet Answer: 3, 4, 5 Rationale 1: The client should manage the data Rationale 2: The client should control who can have access to the PHR Rationale 3: The client should be able to see who entered each data record and when Rationale 4: The data is secure and private Rationale 5: The PHR is universally accessible via the Internet Test Bank for Electronic Health Records and Nursing Richard Gartee, Sharyl Beal 9780131383722, 9780132885522
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