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1. A small, rural hospital is part of an Accountable Care Organization (ACO) and is
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designated as a Level 1 ACO. What is part of this designation?
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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
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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 vb vb vb vb vb vb vb vb vb vb vb
2 ACO requirements. Level 3 ACOs require financial reporting
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2. What was an important finding of the Advisory Board survey of 2014 about primary
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care preferences of patients?
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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
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to care, walk-in settings and the ability to be seen within 30 minutes, and care that is
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close to home. Associations with hospitals, costs of care, and the ratio of providers to
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patients were not part of these results.
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3. Which statement made by a health care provider demonstrates the most appropriate
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understanding for the goal of a performance report?
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a. "This process allows me to critique the performance of the rest of the staff." b. "Most
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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
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professional development, mentoring, and leadership development. A peer review is
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written by others who perform similar skills (peers). The remaining options may be true
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but do not provide evidence of understanding of the goal of this professional requirement.
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,4. Which assessment question would a health care provider ask when engaging in the
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previsit stage of the new model for primary care? (Select all that apply.)
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a. "Are you ready to discuss some of the community resources that are available?"
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b. "Are you experiencing any side effects from your newly prescribed medications?"
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c. "Do you anticipate any problems with adhering to your treatment plan?"
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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?" -
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Answer ANS: B, C, E
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The nursing responsibilities in the previsit stage include assessing the patient's tolerance
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of prescribed medications, understanding of existing treatment plan, and education about
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required lab testing. The primary care provider is responsible for screening lab data and
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discussing community resources during the actual visit.
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5. To reduce adverse events associated with care transitions, the Centers for Medicare
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and Medicaid Service have implemented which policy?
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a. Mandates for communication among primary caregivers and hospitalists
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b. Penalties for failure to perform medication reconciliations at time of discharge
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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
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As a component of the Affordable Care Act, the Centers for Medicare and Medicaid
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Service developed the Readmissions Reduction Program reducing payments for certain
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patients
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readmitted within 30 days of discharge. The CMS did not mandate communication,
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institute penalties for failure to perform medication reconciliations, or require written
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discharge instructions.
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6. According to multiple research studies, which intervention has resulted in lower costs
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and fewer rehospitalizations in high-risk older patients?
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a. Coordination of posthospital care by advanced practice health care providers
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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
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Research studies provided evidence that high-risk older patients who had posthospital
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care coordinated by an APN had reduced rehospitalization rates. It did not include clinic
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visits with a primary care provider, inclusion of extended family members in the plan of
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care, or telephone follow-up by a pharmacist.
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, 7. A primary care provider administers the "Newest Vital Sign" health literacy test to a
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patient newly diagnosed with a chronic disease. What information is gained by
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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
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container label and answer questions that evaluate ability to calculate caloric data and to
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grasp general knowledge about food allergies. It does not test understanding of
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technology or directly measure reading comprehension. It does not assess oral
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communication. The "Ask Me 3" tool teaches patients to ask three primary questions
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about their health care and management.
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8. What is the main reason for using the REALM-SF instrument to evaluate health
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literacy?
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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
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fast tool that measures medical word recognition. It does not evaluate numeracy. The
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"Ask Me 3" tool enhances patient-provider communication. This tool does not evaluate
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understanding of technology.
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9. A female patient who is from the Middle East schedules an appointment in a primary
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care office. To provide culturally responsive care, what will the clinic personnel do when
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meeting this patient for the first time?
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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
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care and to ask the patient about these. While certain practices are common in some
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cultural and ethnic groups, assuming that all members of those groups follow those
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norms is not culturally responsive.
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10. Which behavior is most characteristic of early adolescence?
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a. Arguing with parents and teachers
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