NURS 6531 Final Exam 7 2025/26 Questions and answers !% I !% I !% I !% I !% I !% I !% I !% I
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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? p. 2 a. Bonuses based
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on achievement of benchmarks
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b. Care coordination for chronic diseases !% I !% I !% I !% I
c. Standards for minimum cash reserves !% I !% I !% I !% I
d. Strict requirements for financial reporting - ANS: A !% I !% I !% I !% I !% I !% I !% I
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 !% I !% I !% I
b. Costs of ambulatory care !% I !% I !% I
c. Ease of access to care !% I !% I !% I !% I
d. The ratio of providers to patients - ANS: C !% I !% I !% I !% I !% I !% I !% I !% I
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
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home. Associations with hospitals, costs of care, and the ratio of providers to patients were
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not 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 !% I !% I !% I !% I !% I !% I !% I
a. Appraising costs per case of care for Medicare patients !% I !% I !% I !% I !% I !% I !% I !% I
b. Assessing patients' satisfaction with hospital care !% I !% I !% I !% I !% I
c. Evaluating available evidence to guide clinical care guidelines !% I !% I !% I !% I !% I !% I !% I
d. Monitoring mortality rates of all patients with pneumonia !% I !% I !% I !% I !% I !% I !% I
e. Requiring advanced IT standards and minimum cash reserves - ANS: A, B, D !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Value-based purchasing looks at five domain areas of processes of care, including efficiency of !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
care (cost per case), experience of care (patient satisfaction measures), and outcomes of care
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(mortality rates for certain conditions). Evaluation of evidence to guide clinical care is part of
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evidence-based practice. The requirements for IT standards and financial status are part of
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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 - ANS: C
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Level II research is concerned with describing the relationships among characteristics or
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variables. Level I research is conducted to define the characteristics of groups of patients.
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Level 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 a.
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Epidemiological studies
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b. Experimental design !% I
c. Qualitative studies !% I
d. Randomized clinical trials - ANS: B !% I !% I !% I !% I !% I
The experimental design is the most appropriate design for a Level III study.
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Epidemiological studies are appropriate for Level II studies. Qualitative designs are useful for !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Level I studies. 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.
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a. Adoption of interventions and clinical practices into routine clinical care !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Determination of the basis of disease and various treatment options !% I !% I !% I !% I !% I !% I !% I !% I !% I
c. Examination of safety and effectiveness of various interventions !% I !% I !% I !% I !% I !% I !% I
d. Exploration of fundamental mechanisms of biology, disease, or behavior - ANS: C Clinical !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
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
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research phase. Exploration of the fundamental mechanisms of biology, disease, or
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behavior is part of the basic research stage.
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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."
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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." - ANS: D The goal of the
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performance report is to provide guidance to staff in the areas of professional
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, development, mentoring, and leadership development. A peer review is written by others
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who perform similar skills (peers). The remaining options may be true but do not provide
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evidence of understanding of the goal of this professional requirement.
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Which assessment question would a health care provider ask when engaging in the previsit
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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?" !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
e. "Do you have any questions about the lab tests that have been ordered for you?" - ANS:
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B, C, E!% I !% I
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
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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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What is the Quadruple Aim? p. 15 - 1) Improved patient satisfaction
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2) Reduce per capita costs !% I !% I !% I
3) Improve population health !% I !% I
4) Improve patient care team experience !% I !% I !% I !% I
To reduce adverse events associated with care transitions, the Centers for Medicare and
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Medicaid Service have implemented which policy?
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a. Mandates for communication among primary caregivers and hospitalists !% I !% I !% I !% I !% I !% I !% I
b. Penalties for failure to perform medication reconciliations at time of discharge !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
c. Reduction of payments for patients readmitted within 30 days after discharge !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
d. Requirements for written discharge instructions for patients and caregivers - ANS: C As a !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
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
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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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According to multiple research studies, which intervention has resulted in lower costs and !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
fewer rehospitalizations in high-risk older patients?
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a. Coordination of posthospital care by advanced practice health care providers !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Frequent posthospital clinic visits with a primary care provider !% I !% I !% I !% I !% I !% I !% I !% I
c. Inclusion of extended family members in the outpatient plan of care !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
, d. Telephone follow-up by the pharmacist to assess medication compliance - ANS: A !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
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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1. Which advantages are provided to the chronically ill patient by personal electronic
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monitoring devices? (Select all that apply.)
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a. Helps provide more patient control their health and lifestyle !% I !% I !% I !% I !% I !% I !% I !% I
b. Eliminates need for regular medical and nursing follow-up visits !% I !% I !% I !% I !% I !% I !% I !% I
c. Helps the early identification of patient health-related problems !% I !% I !% I !% I !% I !% I !% I
d. Helps health care providers in keeping track of the patient's health status
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e. Cost is often covered by Medicare - 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
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test?
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a. Ability to calculate data, along with general knowledge about health !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Ease of using technology and understanding of graphic data
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c. Reading comprehension and reception of oral communication !% I !% I !% I !% I !% I !% I
d. Understanding of and ability to discuss health care concerns - ANS: A The "Newest Vital !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Sign" tests asks patients to look at information on an ice cream container label and answer
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questions that evaluate ability to calculate caloric data and to grasp general knowledge
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about food allergies. It does not test understanding of technology or directly measure
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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.
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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. - 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 "Ask
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Me 3" tool enhances patient-provider communication. This tool does not evaluate
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understanding of technology.
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Updated !% I
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? p. 2 a. Bonuses based
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on achievement of benchmarks
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b. Care coordination for chronic diseases !% I !% I !% I !% I
c. Standards for minimum cash reserves !% I !% I !% I !% I
d. Strict requirements for financial reporting - ANS: A !% I !% I !% I !% I !% I !% I !% I
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 !% I !% I !% I
b. Costs of ambulatory care !% I !% I !% I
c. Ease of access to care !% I !% I !% I !% I
d. The ratio of providers to patients - ANS: C !% I !% I !% I !% I !% I !% I !% I !% I
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
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home. Associations with hospitals, costs of care, and the ratio of providers to patients were
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not 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 !% I !% I !% I !% I !% I !% I !% I
a. Appraising costs per case of care for Medicare patients !% I !% I !% I !% I !% I !% I !% I !% I
b. Assessing patients' satisfaction with hospital care !% I !% I !% I !% I !% I
c. Evaluating available evidence to guide clinical care guidelines !% I !% I !% I !% I !% I !% I !% I
d. Monitoring mortality rates of all patients with pneumonia !% I !% I !% I !% I !% I !% I !% I
e. Requiring advanced IT standards and minimum cash reserves - ANS: A, B, D !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Value-based purchasing looks at five domain areas of processes of care, including efficiency of !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
care (cost per case), experience of care (patient satisfaction measures), and outcomes of care
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(mortality rates for certain conditions). Evaluation of evidence to guide clinical care is part of
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evidence-based practice. The requirements for IT standards and financial status are part of
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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 - ANS: C
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Level II research is concerned with describing the relationships among characteristics or
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variables. Level I research is conducted to define the characteristics of groups of patients.
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Level 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 a.
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Epidemiological studies
!% I !% I
b. Experimental design !% I
c. Qualitative studies !% I
d. Randomized clinical trials - ANS: B !% I !% I !% I !% I !% I
The experimental design is the most appropriate design for a Level III study.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Epidemiological studies are appropriate for Level II studies. Qualitative designs are useful for !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Level I studies. 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.
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6
a. Adoption of interventions and clinical practices into routine clinical care !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Determination of the basis of disease and various treatment options !% I !% I !% I !% I !% I !% I !% I !% I !% I
c. Examination of safety and effectiveness of various interventions !% I !% I !% I !% I !% I !% I !% I
d. Exploration of fundamental mechanisms of biology, disease, or behavior - ANS: C Clinical !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
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
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
research phase. Exploration of the fundamental mechanisms of biology, disease, or
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behavior is part of the basic research stage.
!% I !% I !% I !% I !% I !% I !% I !% I
Which statement made by a health care provider demonstrates the most appropriate
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
understanding for the goal of a performance report?
!% I !% I !% I !% I !% I !% I !% I !% I
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." - ANS: D The goal of the
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
performance report is to provide guidance to staff in the areas of professional
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
, development, mentoring, and leadership development. A peer review is written by others
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who perform similar skills (peers). The remaining options may be true but do not provide
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evidence of understanding of the goal of this professional requirement.
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Which assessment question would a health care provider ask when engaging in the previsit
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
stage of the new model for primary care? (Select all that apply.)
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
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?"
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
d. "Are you ready to discuss the results of your laboratory tests?" !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
e. "Do you have any questions about the lab tests that have been ordered for you?" - ANS:
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
B, C, E!% I !% I
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
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
required lab testing. The primary care provider is responsible for screening lab data and
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
discussing community resources during the actual visit.
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What is the Quadruple Aim? p. 15 - 1) Improved patient satisfaction
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
2) Reduce per capita costs !% I !% I !% I
3) Improve population health !% I !% I
4) Improve patient care team experience !% I !% I !% I !% I
To reduce adverse events associated with care transitions, the Centers for Medicare and
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Medicaid Service have implemented which policy?
!% I !% I !% I !% I !% I !% I
a. Mandates for communication among primary caregivers and hospitalists !% I !% I !% I !% I !% I !% I !% I
b. Penalties for failure to perform medication reconciliations at time of discharge !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
c. Reduction of payments for patients readmitted within 30 days after discharge !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
d. Requirements for written discharge instructions for patients and caregivers - ANS: C As a !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
component of the Affordable Care Act, the Centers for Medicare and Medicaid Service
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
developed the Readmissions Reduction Program reducing payments for certain patients
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
readmitted within 30 days of discharge. The CMS did not mandate communication,
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
institute penalties for failure to perform medication reconciliations, or require written
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
discharge instructions.
!% I !% I
According to multiple research studies, which intervention has resulted in lower costs and !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
fewer rehospitalizations in high-risk older patients?
!% I !% I !% I !% I !% I !% I
a. Coordination of posthospital care by advanced practice health care providers !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Frequent posthospital clinic visits with a primary care provider !% I !% I !% I !% I !% I !% I !% I !% I
c. Inclusion of extended family members in the outpatient plan of care !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
, d. Telephone follow-up by the pharmacist to assess medication compliance - ANS: A !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
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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1. Which advantages are provided to the chronically ill patient by personal electronic
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
monitoring devices? (Select all that apply.)
!% I !% I !% I !% I !% I !% I
a. Helps provide more patient control their health and lifestyle !% I !% I !% I !% I !% I !% I !% I !% I
b. Eliminates need for regular medical and nursing follow-up visits !% I !% I !% I !% I !% I !% I !% I !% I
c. Helps the early identification of patient health-related problems !% I !% I !% I !% I !% I !% I !% I
d. Helps health care providers in keeping track of the patient's health status
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
e. Cost is often covered by Medicare - ANS: A, C, D, E
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
A primary care provider administers the "Newest Vital Sign" health literacy test to a patient
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
newly diagnosed with a chronic disease. What information is gained by administering this
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
test?
!% I
a. Ability to calculate data, along with general knowledge about health !% I !% I !% I !% I !% I !% I !% I !% I !% I
b. Ease of using technology and understanding of graphic data
!% I !% I !% I !% I !% I !% I !% I !% I
c. Reading comprehension and reception of oral communication !% I !% I !% I !% I !% I !% I
d. Understanding of and ability to discuss health care concerns - ANS: A The "Newest Vital !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Sign" tests asks patients to look at information on an ice cream container label and answer
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
questions that evaluate ability to calculate caloric data and to grasp general knowledge
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
about food allergies. It does not test understanding of technology or directly measure
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
reading comprehension. It does not assess oral communication. The "Ask Me 3" tool
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
teaches patients to ask three primary questions about their health care and management.
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
What is the main reason for using the REALM-SF instrument to evaluate health literacy? p.
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27
!% I
a. It assesses numeracy skills.
!% I !% I !% I
b. It enhances patient-provider communication.
!% I !% I !% I
c. It evaluates medical word recognition.
!% I !% I !% I !% I
d. It measures technology knowledge. - ANS: C
!% I !% I !% I !% I !% I !% I
The Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) is an easy and
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
fast tool that measures medical word recognition. It does not evaluate numeracy. The "Ask
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
Me 3" tool enhances patient-provider communication. This tool does not evaluate
!% I !% I !% I !% I !% I !% I !% I !% I !% I !% I !% I
understanding of technology.
!% I !% I !% I
