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