ANCC IQ Domain 1-5
1. 1. You see a patient for a rou- - Up-coding
tine medication visit. At the end Rationale: Up-coding is a fraudulent practice in which
of the session, the patient asks the provider services are billed at higher procedure
questions and the session ends up codes than were actually performed, resulting in a
50 minutes in length. You normal- higher payment by Medicare or other third-party pay-
ly charge for the 30-minute ap- ers.
pointment, but instead you charge
for the 1-hour appointment. The
1-hour appointment includes a full
body assessment that you did not
perform. This violation is known
as:
- Over-coding
- Super-coding
- Down-coding
- Up-coding
2. 1. During a session, your patient - I cannot do that because Facebook does not protect
asks to be able to contact you via your Private Health Information
your Facebook page on the inter- Rationale: Using Facebook breaks patient-provider
net. You reply: confidentiality, in addition to blurring ethical bound-
- I cannot do that because I have a aries of the therapeutic relationship. Facebook does
concealed Facebook identity; and I not protect private health information. Information on
cannot reveal that to my patients the site is available for anyone to see or hack into even
- I would be happy to communicate if private messaged.
with you. It makes it easier for me
to reach you this way.
- I would be happy to use Facebook
but you will have to use a private
message so that you can be anony-
mous
- I cannot do that because Face-
, ANCC IQ Domain 1-5
book does not protect your Private
Health Information
3. 1. The Mental Health Parity and - Annual or lifetime dollar limits on mental health and
Addiction Equity Act of 2008 (MH- substance use disorder benefits are no lower than any
PAEA) insures which of the follow- such dollar limits for medical and surgical benefits of-
ing? fered by a group health plan.
- Small employers who insure 50 Rationale: The Mental Health Parity and Addiction Eq-
or fewer covered lives are exempt uity Act of 2008 (MHPAEA) provides federal legislation
from the provisions of this MH- that requires any annual or lifetime limits on medical
PAEA law. and surgical benefits be the same for mental health and
- Annual or lifetime dollar limits on substance use disorder benefits. Small employers who
mental health and substance use insure 2 to 50 employees can apply for an "opt-out"
disorder benefits are no lower than waiver, but they are not automatically exempt from
any such dollar limits for medical the MHPAEA requirements. The group health plan will
and surgical benefits offered by a be required to provide in-network and out-of-network
group health plan. mental health and substance use disorder benefits
- Mental health and substance use only if it provides both in-network and out-of-network
disorder benefits must be available medical and surgical benefits. The group health plan
through both in-network providers my obtain an exemption or waiver if the first year of
and out-of-network providers by a implementation results in 2% increase in group health
group health plan. plan costs over prior year that covers the following
- Group health plans may obtain year, and if implementation results in 1% increase in
an exemption if they can demon- group health plan costs in subsequent years. A section
strate expected cost increase re- on actuarial determination of these increased costs is
sulting from implementation of the included in the law.
parity provisions greater than a 5%
increase in the cost under existing
plan.
4. 1. A 68-year-old, retired
African-American widower who
, ANCC IQ Domain 1-5
served for 30 years as an Army of- - Respect
ficer was recently diagnosed with Rationale: Respect of cultural values and beliefs is vio-
terminal lung cancer. He made lated in this scenario.
plans to die at home with hospice
care. He was hospitalized for a bro-
ken hip and succumbed to com-
plications in the hospital. Despite
his request to be addressed as "Mr.
Baxter" the hospital staff persist-
ed in calling him by his first name,
"John." Which principle of culturally
competent care does this violate?
- Autonomy
- Advocacy
- Collaboration
- Respect
5. 1. PMHNPs seeking admitting priv- - Local hospital
ileges at a community hospital Rationale: Local PMHNPs who want admitting privi-
with inpatient psychiatric services leges will want to persuade the appropriate hospital
need to influence policymakers at decision maker, through facts, figures, and a presenta-
which of the following levels? tion of projected benefits to the hospital, of the need
- State board of nursing to change policy and allow PMHNPs to admit patients.
- State legislature
- County board of health
- Local hospital
6. 1. To demonstrate her support for - Volunteers her clinical services at the psychiatric clinic,
social justice, within her role as a run by a local mission project.
PMHNP caring for the person who Rationale: Social justice is bringing things to those who
is homeless with mental illness, the have the least means of getting them but need them
PMHNP:
, ANCC IQ Domain 1-5
- Volunteers to serve food at the the most. In this case, the homeless mentally ill need
local Home for Girls. the PMHNP's skills more.
- Teaches Sunday School.
- Volunteers to walk at the March of
Dimes walk each year.
- Volunteers her clinical services at
the psychiatric clinic, run by a local
mission project.
7. 1. You have students from local - Preceptor
psychiatric nurse practitioner pro- Rationale: The preceptor is a 1;1 relationship sustained
grams follow you in your clinical over a short time where each person brings something
practice to show them what you do to the relationship. It is a contracted, defined role with
as a PMHNP. This is called being a: goals. The preceptor is in a teaching role. Teaching is
- Preceptor completed through the observed performance, exam-
- Mentor ples, and role modeling.
- Teacher
- Professor
8. 1. As an individual advanced prac- - Process your notes and patient records in a secure
titioner, you cannot afford to have electronic system with a template for patient informa-
a standalone Electronic Health tion and interactions, supporting quick access within
Record (EHR) system to keep all your network.
of your patients' health informa- Rationale: Having an EHR system is the ideal situation
tion on a computer-based system. according to the US Health and Human Services and
How could you problem-solve this The Office of Clinical Quality and Safety. Not all offices
dilemma? have the ability to afford installation and maintenance
- Process your patient records of such systems. The US government has established
manually, in your current fashion. financial help for EHRs in rural hospitals. For single
You are keeping a full record ac- practitioner offices, doing the best possible to keep
cording to HIPAA. information ready for quick access is the best possible
- Process your notes manually and
1. 1. You see a patient for a rou- - Up-coding
tine medication visit. At the end Rationale: Up-coding is a fraudulent practice in which
of the session, the patient asks the provider services are billed at higher procedure
questions and the session ends up codes than were actually performed, resulting in a
50 minutes in length. You normal- higher payment by Medicare or other third-party pay-
ly charge for the 30-minute ap- ers.
pointment, but instead you charge
for the 1-hour appointment. The
1-hour appointment includes a full
body assessment that you did not
perform. This violation is known
as:
- Over-coding
- Super-coding
- Down-coding
- Up-coding
2. 1. During a session, your patient - I cannot do that because Facebook does not protect
asks to be able to contact you via your Private Health Information
your Facebook page on the inter- Rationale: Using Facebook breaks patient-provider
net. You reply: confidentiality, in addition to blurring ethical bound-
- I cannot do that because I have a aries of the therapeutic relationship. Facebook does
concealed Facebook identity; and I not protect private health information. Information on
cannot reveal that to my patients the site is available for anyone to see or hack into even
- I would be happy to communicate if private messaged.
with you. It makes it easier for me
to reach you this way.
- I would be happy to use Facebook
but you will have to use a private
message so that you can be anony-
mous
- I cannot do that because Face-
, ANCC IQ Domain 1-5
book does not protect your Private
Health Information
3. 1. The Mental Health Parity and - Annual or lifetime dollar limits on mental health and
Addiction Equity Act of 2008 (MH- substance use disorder benefits are no lower than any
PAEA) insures which of the follow- such dollar limits for medical and surgical benefits of-
ing? fered by a group health plan.
- Small employers who insure 50 Rationale: The Mental Health Parity and Addiction Eq-
or fewer covered lives are exempt uity Act of 2008 (MHPAEA) provides federal legislation
from the provisions of this MH- that requires any annual or lifetime limits on medical
PAEA law. and surgical benefits be the same for mental health and
- Annual or lifetime dollar limits on substance use disorder benefits. Small employers who
mental health and substance use insure 2 to 50 employees can apply for an "opt-out"
disorder benefits are no lower than waiver, but they are not automatically exempt from
any such dollar limits for medical the MHPAEA requirements. The group health plan will
and surgical benefits offered by a be required to provide in-network and out-of-network
group health plan. mental health and substance use disorder benefits
- Mental health and substance use only if it provides both in-network and out-of-network
disorder benefits must be available medical and surgical benefits. The group health plan
through both in-network providers my obtain an exemption or waiver if the first year of
and out-of-network providers by a implementation results in 2% increase in group health
group health plan. plan costs over prior year that covers the following
- Group health plans may obtain year, and if implementation results in 1% increase in
an exemption if they can demon- group health plan costs in subsequent years. A section
strate expected cost increase re- on actuarial determination of these increased costs is
sulting from implementation of the included in the law.
parity provisions greater than a 5%
increase in the cost under existing
plan.
4. 1. A 68-year-old, retired
African-American widower who
, ANCC IQ Domain 1-5
served for 30 years as an Army of- - Respect
ficer was recently diagnosed with Rationale: Respect of cultural values and beliefs is vio-
terminal lung cancer. He made lated in this scenario.
plans to die at home with hospice
care. He was hospitalized for a bro-
ken hip and succumbed to com-
plications in the hospital. Despite
his request to be addressed as "Mr.
Baxter" the hospital staff persist-
ed in calling him by his first name,
"John." Which principle of culturally
competent care does this violate?
- Autonomy
- Advocacy
- Collaboration
- Respect
5. 1. PMHNPs seeking admitting priv- - Local hospital
ileges at a community hospital Rationale: Local PMHNPs who want admitting privi-
with inpatient psychiatric services leges will want to persuade the appropriate hospital
need to influence policymakers at decision maker, through facts, figures, and a presenta-
which of the following levels? tion of projected benefits to the hospital, of the need
- State board of nursing to change policy and allow PMHNPs to admit patients.
- State legislature
- County board of health
- Local hospital
6. 1. To demonstrate her support for - Volunteers her clinical services at the psychiatric clinic,
social justice, within her role as a run by a local mission project.
PMHNP caring for the person who Rationale: Social justice is bringing things to those who
is homeless with mental illness, the have the least means of getting them but need them
PMHNP:
, ANCC IQ Domain 1-5
- Volunteers to serve food at the the most. In this case, the homeless mentally ill need
local Home for Girls. the PMHNP's skills more.
- Teaches Sunday School.
- Volunteers to walk at the March of
Dimes walk each year.
- Volunteers her clinical services at
the psychiatric clinic, run by a local
mission project.
7. 1. You have students from local - Preceptor
psychiatric nurse practitioner pro- Rationale: The preceptor is a 1;1 relationship sustained
grams follow you in your clinical over a short time where each person brings something
practice to show them what you do to the relationship. It is a contracted, defined role with
as a PMHNP. This is called being a: goals. The preceptor is in a teaching role. Teaching is
- Preceptor completed through the observed performance, exam-
- Mentor ples, and role modeling.
- Teacher
- Professor
8. 1. As an individual advanced prac- - Process your notes and patient records in a secure
titioner, you cannot afford to have electronic system with a template for patient informa-
a standalone Electronic Health tion and interactions, supporting quick access within
Record (EHR) system to keep all your network.
of your patients' health informa- Rationale: Having an EHR system is the ideal situation
tion on a computer-based system. according to the US Health and Human Services and
How could you problem-solve this The Office of Clinical Quality and Safety. Not all offices
dilemma? have the ability to afford installation and maintenance
- Process your patient records of such systems. The US government has established
manually, in your current fashion. financial help for EHRs in rural hospitals. For single
You are keeping a full record ac- practitioner offices, doing the best possible to keep
cording to HIPAA. information ready for quick access is the best possible
- Process your notes manually and
