Posttraumatic Stress Disorder

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Discussion: Posttraumatic Stress Disorder

It is estimated that more than 6% of the U.S. population will experience posttraumatic stress disorder (PTSD) in their lifetime (National Center for PTSD, 2010). This debilitating disorder often interferes with an individual’s ability to function in daily life. Common symptoms of anxiousness and depression frequently lead to substance abuse issues and even physical ailments. For this Discussion, as you examine the Thompson Family Case Study in this week’s Learning Resources, consider how you might assess and treat clients presenting with PTSD.

· Review this week’s Learning Resources and reflect on the insights they provide.

· View the media Academic Year in Residence: Thompson Family Case Study, and assess the client in the case study.

· For guidance on assessing the client, refer to pages 137–142 of the Wheeler text in this week’s Learning Resources.

Note: To complete this Discussion, you must assess the client, but you are not required to submit a formal Comprehensive Client Assessment.

Post an explanation of your observations of the client in Thompson Family Case Study, including behaviors that align to the PTSD criteria in DSM-5. Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate. Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.

N:B REMEMBER TO INCLUDE THE INTRODUCTION, CONCLUSION AND REFERENCES LESS THAN 7 YEARS OLD

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 13, “Stabilization for Trauma and Dissociation” (pp. 469–508)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Required Media

Laureate Education (Producer). (2012a). Academic year in residence: Thompson family case study [Multimedia file]. Baltimore, MD: Author.

Ochberg, F. (2012). Psychotherapy for chronic PTSD [Video file]. Mill Valley, CA: Psychotherapy.net.

Nursing Informatics Best Practices

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Please Check the Competencies:

Overview

Write 3–5 pages in which you describe a nursing informatics best practices policy for effective and safe data use in a nursing practice setting or organization.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 2: Identify strategies and best practices for using informatics in nursing and health care.

Describe the best practices needed to promote and support data security.

Describe the ethical standards needed to promote patient confidentiality.

Describe regulatory requirements that promote and support positive patient outcomes related to a specific population.

Describe the types of behaviors and skills nurse leaders need to guide the use of information technology and research for improved patient-care outcomes.

Competency 4: Communicate in a manner that is consistent with expectations of a nursing professional.

Write coherently to support a central idea in appropriate format with correct grammar, usage, and mechanics.

To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the business community.

How do nurses develop best practice?

How does research support best practice?

What are best practices in your organization that you think are exemplars for improving patient care?

What nursing roles should be in place to support the use of evidenced-based practice?

How would you describe the concept of meaningful use and technology adoption stages: electronic health records (EHR) incentive programs, and how does this fit within the context of best practice?

What are the main points to consider as you review The Health Insurance Portability and Accountability Act (HIPAA), and why is this best practice?

How does the Patient Safety and Quality Improvement Act (PSQIA) support patient safety and improved patient outcomes?

Assessment Instructions

Imagine an organization asks you to contribute to the development of an information system best-practices policy to help maintain patient safety and patient confidentiality in their practice setting. The organization wants you to create a document to help the group better understand why an informatics policy is needed and the practices that should be included in the policy.

A nursing informatics best-practices document can serve multiple purposes, such as a handout for new-hire orientation or as a background report given to a committee tasked with creating or updating a nursing informatics best-practices policy.

Preparation

To expand your understanding of nursing informatics best practices within the industry, research the most current information about the topics of nursing best-practices documents and nursing informatics best practices.

Using different methods (Web search, for example), locate 4–6 scholarly articles related to best practices designed to support positive patient outcomes related to the following areas:

The meaning of secure data practices.

Ethical standards needed to promote and support data security.

Patient confidentiality.

Regulatory requirements.

Behaviors and skills nurse leaders need to guide the use of information technology and research for improved patient-care outcomes.

Directions

Create a description of a nursing informatics best-practices policy document designed to define and encourage effective and safe data use in a practice setting or organization.

Purpose Statement: Statement of why an organization would create the policy. Include any reasons and intent that supports the creation of an informatics best-practices policy.

Best Practices Definitions and Descriptions:

Definitions of secure practices, data security, and patient confidentiality.

Ethical standards.

Regulatory requirements.

Implementation:

Behaviors – describe the behaviors nurse leaders will need to demonstrate that will guide implementation of the policy.

Skills required – describe the skills needed to ensure policy adherence.

Format your document using the professional format and style (corporate identity) used in your organization or practice setting. Note: If you are not currently working in an organizational setting, follow the formatting instructions below.

Additional Requirements

Written communication: Ensure written communication is free of errors that detract from the overall message.

APA formatting: Format resources and citations according to current APA style and formatting guidelines.

Number of resources: Cite a minimum of four peer-reviewed resources.

Length: Submit 3–5 typed, double-spaced pages.

Font and font size: Use Times New Roman, 12 point.

Agenda Comparison Grid

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Use The Agenda Comparison Grid to compare the impact of the previous three presidential agendas on the healthcare item you selected for study

Case Study

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Complete each case study utilizing collegiate formatting (MLA or APA); typed in Cambria or New Times Roman 12 point font in ONE document. Citations required.

Case studies are case specific. Your answers should reflect the assessment and your analysis of the information in the case study… no generalized answers of all matter regarding the content.

QUESTION 1: Healthcare Delivery and Evidenced –Based Nursing Practice

The registered nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff, the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of the case manager will be included in the presentation. The nurse plans on using care of the patient with Congestive Heart Failure as a template, and prepares sample clinical pathways, care maps, and multidisciplinary action plans. (Learning Objective 3)

a. Describe how clinical pathways are used to coordinate care of caseloads of patients.

b. What is the role of the case manager in evaluating a patient’s progress?

c. What are examples of evidence-based practice tools used for planning patient care?

QUESTION 2: Community-Based Nursing Practice

Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5).

a. What would be involved in setting up the first home care visit?

b. Describe the nursing assessments and management that would occur during the visit.

QUESTION 3: Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing Process

  1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4)

What ethical dilemma exists?

Who are the stakeholders and what gains or losses do each have?

What strategies should the hospice nurse take to resolve the ethical dilemma?

QUESTION 4:

Chapter 4, Health Education and Health Promotion

he community health nurse is planning a health promotion workshop for a high school PTSO (Parent-Teacher-Student Organization). The choice of topics was suggested by the high school’s registered nurse who has observed a gradual increase in student obesity. The two nurses have collaborated to develop this workshop to provide parents, students, and teachers with information about the importance of health promotion. (Learning Objectives 6, 8, and 9)

a. Describe the importance of a focus on health promotion.

b. According to the health promotion model developed by Becker (1993), what four variables influence the selection and use of health promotion behaviors?

c. Describe four components of health promotion.

QUESTION 5: Chapter 5, Adult Health and Nutritional Assessment

The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year-old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds. (Learning Objective 8)

a. What is the rationale for computing body mass index? What is Mrs. Varner’s BMI?

b. Calculate her ideal body weight. What is your assessment of her BMI and weight?

c. Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment.

d. Mrs. Varner’s waist circumference is 38 inches. What is your assessment?

e. What laboratory values would the nurse review to evaluate Mrs. Varner’s protein levels?

QUESTION 6: Chapter 6, Individual and Family Homeostasis, Stress, and Adaptation

Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. (Learning Objective 9)

a. Describe the sequence of events that caused the local inflammation seen in Mary’s foot.

b. What is the role of histamine and kinins in the inflammatory process?

c. Which of the five cardinal signs of inflammation does Mary exhibit?

d. Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects?

QUESTION 7:

Chapter 7, Overview of Transcultural Nursing

The nurse manager of an ambulatory care clinic has noted an increased number of visits by patients from different countries and cultures, including patients from Mexico and other Latin American countries. Concerned about meeting the needs of this culturally diverse population, the nurse manager convenes a staff meeting to discuss this change in patient demographics, and to query the staff about any learning needs they have related to the care of these patients. (Learning Objective 3)

a. What strategy to avoid stereotyping clients from other cultures should the nurse include in this meeting?

b. Identify culturally sensitive issues to be discussed in the staff meeting.

c. One technician on the staff complains that some patients never make eye contact, and this makes it difficult for him to complete his work. How should the nurse respond?

QUESTION 8: Chapter 8, Overview of Genetics and Genomics in Nursing

Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition. (Learning Objective 2)

a. Describe the pattern of autosomal dominant inheritance.

b. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond?

c. Explain the phenomenon of penetrance observed in autosomal dominant inheritance.

QUESTION 9: Chapter 9, Chronic Illness and Disability

Mr. Edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. Mr. Edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. He came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure-relieving cushion at home. According to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs. (Learning Objective 5)

a. What nursing considerations should be made for Mr. Edwards related to his disability?

b. What health promotion and prevention education does Mr. Edwards need?

QUESTION 10: Chapter 10, Principles and Practices of Rehabilitation

You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility.

(Learning Objective 4)

a. What assessments are indicated based on this nursing diagnosis?

b. List other major nursing diagnoses based on David’s clinical presentation.

QUESTION 11:

Chapter 11, Health Care of the Older Adult

The nurse working at the senior center notices Mrs. Jones, a 78-year-old, crying. The nurse approaches Mrs. Jones and asks if she needs help. Mrs. Jones states “I am so embarrassed. I had another accident and my pants are all wet. It’s like I’m a baby. I never should have come to the senior center.” (Learning Objectives 3 and 4)

a. What factors may be contributing to the urinary incontinence?

b. How should the nurse respond to Mrs. Jones?

QUESTION 12:

Chapter 12, Pain Management

Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning Objective 6)

What are benefits of epidural versus systemic administration of opioids?

b. The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments?

c. The nurse monitors Mr. Rogers for what other complications of epidural analgesia?

d. Mr. Rogers complains of a severe headache. What should the nurse do?

e. Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation?

QUESTION 13:

Chapter 13, Fluid and Electrolytes: Balance and Disturbance

Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. (Learning Objective 4)

a. What are possible causes of a low potassium level?

b. What action should the nurse take in relation to the serum potassium level?

c. What clinical manifestations might the nurse assess in Mrs. Dean?

Question 14:

Chapter 14, Shock and Multiple Organ Dysfunction Syndrome

Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7)

a. What predisposed the patient to develop septic shock?

b. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?

c. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?

d. Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient?

QUESTION 15:

Chapter 15, Oncology: Nursing Management in Cancer Care

The oncology clinical nurse specialist (CNS) is asked to develop a staff development program for registered nurses who will be administering chemotherapeutic agents. Because the nurses will be administering a variety of chemotherapeutic drugs to oncology patients, the CNS plans on presenting an overview of agents, classifications, and special precautions related to the safe handling and administration of these drugs. (Learning Objectives 6 and 8)

a. What does the CNS describe as the goals of chemotherapy?

b. How should the CNS respond to the following question: “Why do patients require rounds of chemotherapeutic drugs, including different drugs and varying intervals?”

c. In teaching about the administration of chemotherapeutic agents, what signs of extravasation should the nurse include?

d. What clinical manifestations of myelosuppression, secondary to chemotherapy administration, should the CNS include in this program?

QUESTION 16:

Chapter 16, End-of-Life Care

Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort. (Learning Objective 9)

a. What nursing measures should the nurse use to manage the patient’s dyspnea?

b. The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?

QUESTION 17:

Chapter 17, Preoperative Nursing Management

The nurse in a gynecology clinic is completing preoperative teaching for a patient scheduled for an abdominal hysterectomy next week. The patient states that she is currently taking 325 mg of aspirin daily for chronic joint pain, along with a multivitamin. The patient has type 2 diabetes; she closely monitors her blood glucose levels. Currently, she is taking an oral hypoglycemic agent. The nurse advises her to ask the anesthesiologist whether she should take this medication the morning of surgery. (Learning Objectives 2 and 4)

a. The nurse instructs the patient to stop taking the aspirin. What is the rationale for this action?

b. Why is it important to assess the patient for use of herbal products prior to surgery?

c. The patient asks how surgery could affect her blood glucose; how should the nurse respond?

QUESTION 18: Chapter 18, Intraoperative Nursing Management

Pearl Richards, 69 years of age, is a female patient who is in the operating room for a repair of an abdominal aortic aneurysm. The patient has a history of hypertension controlled with medications, osteoporosis, chronic obstructive pulmonary disease, and has smoked two packs of cigarettes per day for 40 years. (Learning Objectives 2, 6, and 9)

a. What nursing interventions are instituted to reduce the surgical risk factors related to the patient’s age?

b. Explain the role of the nurse in providing patient safety measures during the intraoperative period.

QUESTION 19: Chapter 19, Postoperative Nursing Management

  1. Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical unit after undergoing removal of a section of the colon for colorectal cancer. The patient does not have a colostomy. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact. There is a Jackson-Pratt drain intact with minimal serous sanguineous drainage present. The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of brown liquid. The patient has no bowel sounds. The Foley catheter has a small amount of dark amber-colored urine without sediments. The patient has sequential compression device (SCD) in place. The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O2 at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate 110 bpm; respiratory rate 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time. (Learning Objectives 4 and 7)

a. Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed.

b. What gerontological postoperative considerations should the nurse make?

  1. Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D) of an abscess on his right calf, which resulted from a farm machinery accident. The right calf has an area 3 cm × 2.5 cm, which is red, warm and hard to touch, and edematous. (Learning Objective 5)

a. Explain the wound healing process according to the phase of Mr. Smith’s wound?

b. The surgeon orders for wet-to-dry sterile saline dressing twice a day with iodoform gauze to the wound, covered with the wet-to-dry dressing. Explain how to perform this dressing change

REFERENCE TEXTBOOK:

Fundamentals of Nursing Second Edition Theory, Concepts and Applications by Judith M. Wilkinson, Leslie S Treas .

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Capscare19Casestudies-Completeeachcasestudyutilizingcollegiateformatting.docx

CPT Medical Coding

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ANSWER ALL THE QUESTIONS -MAKE SURE THEY ARE ALL CORRECT

SEND BACK TO ME WITHIN 48 HOURS

  1. Which one of the following requirements is outlined in the guidelines established in HIPAA’s Privacy Rule? A. Hospital administrators must encrypt data within older data files. B. Managers must secure medical records immediately following patient admission. C. Patients must receive notice if their information will be used or disclosed to third parties. D. Physicians must not disclose patient information to consulting physicians.
  2. A tethered health record allows patients to A. amend the diagnoses listed in the health record. B. use a secure portal to access their own records. C. restructure insurance copayments. D. compare their health records to the records of patients with similar diagnoses.
  3. A patient sustains a fracture of the femur while playing football in a nearby park. What ICD-10-CM code would be assigned? A. S72.003A B. S72.001A C. S49.006A D. S72.009A
  4. Which one of the following structures is part of the male secondary genitalia? A. Gonads B. Urethra C. Testes D. Vulva
  5. What is the full code description for 25515? A. Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatment of distal radioulnar joint dislocation (Galeazzi fracture/dislocation), includes internal fixation, when performed, includes repair of triangular fibrocartilage complex B. Open treatment of radial shaft fracture, includes internal fixation, when performed C. Closed treatment of radial shaft fracture; without manipulation D. Closed treatment of ulnar shaft fracture; without manipulation
  6. Another name for XXY syndrome is A. Turner’s syndrome. B. Huntington’s chorea. C. Cooley’s anemia. D. Klinefelter syndrome.
  7. The hammer-shaped bone in the middle ear is called the A. cochlea. B. stapes. C. malleus. D. incus.
  8. Codes beginning with the letter K are related to the _ system. A. circulatory B. digestive C. endocrine D. sensory
  9. Which of the following statements is true of the olfactory nerve? A. It’s located in the mitral valve and helps to circulate blood throughout the heart. B. It’s found in the nose and allows the senses to detect and distinguish odors. C. It’s susceptible to erosion due to Peyronie’s disease. D. It conveys the fluid from lymph glands to other areas of the body.
  10. A patient has a Foley catheter inserted prior to a planned surgical procedure. How is this coded? A. 55520 B. 52630 C. 51702 D. 52601
  11. What is the CPT code for simple drainage of a finger abscess? A. 26010 B. 26020 C. 26034 D. 26011
  12. Usually, a comprehensive EHR includes A. secure standalone cluster controllers for hospitals in rural environments. B. software, hardware, implementation, and future program upgrades. C. coaxial cable connections between mainframe servers only. D. customizable XHRLT processes for ambulatory surgery centers.
  13. What ICD-10-CM code would be assigned for a patient with acute tubule-interstitial nephritis? A. Z02.6 B. B96.2 C. L50.0 D. N10
  14. An echocardiogram shows that the wall of a patient’s artery has dilated. The dilation has resulted in a saclike swelling. This swelling is called a/an A. aneurysm. B. cyst. C. mesenteric venous thrombosis. D. benign tumor.
  15. What is Medicare Part D? A. The component of Medicare Part A that covers outpatient surgeries B. Supplemental coverage for war veterans and their dependents C. Add-on coverage for dental procedures D. Add-on coverage for prescription drugs provided through insurance companies approved by Medicare
  16. The suffix –stasis means A. flow. B. stopping and controlling. C. breakdown. D. kinetic.
  17. The outcome of delivery code should be A. omitted from the maternal record for stillborn delivery. B. assigned to the newborn record only. C. assigned to both the maternal and newborn records. D. assigned to the maternal record when a delivery occurs.
  18. A patient who was involved in a motor vehicle accident is taken to the hospital by ambulance and admitted to the hospital in critical care. The physician sees the patient for 74 minutes in critical care. The physician leaves to attend to other patients in the ICU and the NICU of the same hospital. Five hours later, the physician returns to the patient and continues to treat the patient in critical care for an additional 30 minutes. The patient spends a total of 104 minutes in critical care. What codes are assigned? A. 99292, 99292, 99293 B. 99291, 99291 C. 99291, 99292 D. 99292, 99293
  19. The root word OBSTETR/O means A. cesarean. B. pregnancy. C. birth. D. midwife.
  20. Coders can use the Microsoft Office suite to create spreadsheets in A. Excel. B. Lotus 1-2-3. C. PowerPoint. D. Word.
  21. A patient undergoes an appendectomy and later returns to the operating room for a related procedure the same day. Which modifier should be assigned to the CPT code? A. -51 B. -AA C. -76 D. -78
  22. The concept of meaningful use pertains to A. categorization of patient information. B. medical office protocol and document organization. C. resource management in the inpatient setting. D. electronic health record implementation.
  23. The study of disease is called A. pathology. B. urology. C. physiology. D. neurology.
  24. Modifier -23 indicates that A. a procedure was performed bilaterally. B. the patient received general anesthesia for a procedure that would ordinarily be performed with local or no anesthesia. C. a physician reviewed and interpreted a radiology procedure. D. two surgeons performed a procedure.
  25. Releasing genetic information is forbidden under the terms of HIPAA because it may A. indicate susceptibility to a future illness, without the patient actually being diagnosed with the condition. B. allow immediate family members to have access to a patient’s medical records. C. not be successfully transmitted to all health care facilities. D. require physicians to fulfill contractual obligations for treatments provided in ambulatory surgery centers.
  26. Provision of security against a hurt, loss, or damage with specific cash payments is called A. protection. B. secured loss. C. copayment. D. indemnity.
  27. Physicians typically refer to anatomical locations using directional terms, which are often A. used primarily by chiropractors. B. used to describe surgical incisions. C. referenced horizontally. D. paired in opposites.
  28. The code for an ESWL would be found in the A. Digestive System of CPT. B. Urinary and Male Genital Systems of CPT. C. Chemotherapy section of HCPCS. D. Cardiovascular System of CPT.
  29. What code would be assigned for a tube pericardiostomy? A. 33015 B. 33050 C. 33026 D. 33210
  30. HCPCS modifier –E2 indicates that the patient had a surgical procedure performed on the A. upper left eyelid. B. upper right eyelid. C. lower left eyelid. D. lower right eyelid.
  31. Providers that receive reimbursement after health care services have been provided are being compensated under the _ system. A. UCR B. capitation C. retrospective payment D. prospective payment
  32. What happens when HIPAA rules conflict with state law? A. The interpretation of HIPAA rules is left to the physician’s discretion. B. The Supreme Court’s decision becomes final in binding arbitration. C. Conflicting state rules are overridden by federal law. D. State laws overrule federal law.
  33. The method that physicians use to bill for each service or visit individually rather than on a pre-paid basis is called A. pre-paid care. B. managed care. C. fee-for-service. D. capitation.
  34. The suffix -sis means A. process. B. drooping. C. inflammation. D. condition.
  35. A new patient is seen in a clinic for complaints of shortness of breath, fever, difficulty swallowing, runny nose, and cough. The physician performs a detailed history, detailed examination, and medical decision making of low complexity. The physician also obtains a chest x-ray and lab workup. Based on the results of the diagnostic tests, the physician renders a diagnosis of upper respiratory tract infection and lymphadenopathy. What ICD-10 and CPT codes are assigned? A. 99215, M19.011, R13.10 B. 99203, J06.9, R59.0 C. 99213, R06.82, F10.229 D. 99202, D63.1, J45.909
  36. A physician is called to the intensive care unit for a patient with second-degree burns sustained on 55% of his body while cooking in the kitchen where he works. The physician sees the patient in the critical care unit for two hours, leaves the unit, and returns later the same day to provide an additional hour of critical care. What ICD-10-CM and CPT codes would be assigned? A. L91.8, 99291 × 2, 99292 × 4 B. T31.50, 99291, 99292 × 4 C. Z30.09, 99293, 99294 × 2 D. R53.81, 99291, 99293 × 5
  37. A physician who cares for a patient throughout an entire pregnancy, from beginning to end, is providing A. comprehensive prenatal management. B. routine global obstetric care. C. puerperal obstetric care. D. antenatal global supervision.
  38. A patient is seen in the emergency room complaining of abdominal pain in the left lower quadrant. It’s determined that the patient is experiencing inflammation of the pancreas, which is also called A. pancreaticoduodonal arcade. B. pancreatonia. C. pancreatolysis. D. pancreatitis.
  39. The covering on the brain and spinal cord in the dorsal cavity is called the A. sheath. B. peritoneum. C. ganglia. D. meninges.
  40. The regulations in HIPAA apply to three groups of individual and corporate entities, each involved in electronic medical records transfer. These groups are collectively referred to as A. health care administrators. B. protected personnel. C. provisional health care data collectors. D. covered entities.
  41. The retention period is the amount of time that A. insurance billing documents must be retained in filing cabinets. B. medications must be kept in the medical office. C. records must be kept. D. HIM employee files must be retained upon termination or resignation.
  42. A physician has a meeting with a pharmaceutical sales representative. During the course of the conversation, the physician reveals the diagnosis and past family, medical, and social history of a patient currently being treated with one of the medications that the sales representative is selling. In this situation, the doctor could be sued for A. invasion of privacy. B. undue harm and fraud. C. malice. D. malfeasance.
  43. Epithelial tissue that secretes its products directly into the bloodstream is made of A. endoplasmic reticulum. B. endocrine gland cells. C. extracellular matrix. D. columnar epithelial cells.
  44. A physician obtains cells from the bone marrow cavity using a needle and a syringe. How would this procedure be coded? A. 38220 B. 36575 C. 35092 D. 37328
  45. The vitreous humor can be found in the A. eye. B. nose. C. tongue. D. ear.
  46. The study of tissue disease using macroscopic or microscopic analysis is called A. microbiology. B. histopathology. C. immunology. D. cytopathology.
  47. Placing a catheter into the aorta or directly into an artery or vein is called A. selective catheter placement. B. brachiocephalic manipulation. C. third order placement. D. nonselective catheter placement.
  48. A patient is diagnosed with acne. What ICD-10-CM code would be assigned? A. L74.2 B. L70.0 C. L72.3 D. L73.1
  49. Members of the uniformed services, their families and survivors, and retired members and their families qualify for A. OIG Recovery. B. Medicaid. C. Medicare. D. TRICARE.
  50. A 35-year-old male is brought to the emergency department with memory disturbance after being accidentally exposed to lead paint. What ICD-10-CM codes should be assigned? A. T42.4X1A, R40.0 B. T23.009A, R23.8 C. T56.0X1A, R41.3 D. T57.0X1A, R10.9
  51. Health care practitioners who submit fraudulent bills to increase reimbursement may A. be listed in the Coding Directory of Fraudulent Billing published annually by the Department of Health and Human Services. B. be reported to the Office of the Attorney General. C. be blacklisted according to geographic location. D. face financial penalties or, in some cases, imprisonment.
  52. A patient comes to the ambulatory surgery center for a fusion of the cervical spine. Prior to the beginning of the surgery, the patient suffers an allergic reaction to the anesthesia shortly after it’s administered. Because of this reaction, the surgery is not performed. What code would be assigned as the first-listed diagnosis? A. The anesthesia administration B. The allergy code C. The reason that the surgery was scheduled to be performed D. The observation code
  53. The root word ENTER/O means A. secretion. B. intestine. C. stomach. D. tooth.
  54. When coding burns, coders should A. assign separate codes for each burn site. B. assign the code for chronic burns. C. classify all burns as acute burns. D. assign the code for third-degree burns.
  55. Which of the following forms is used to bill outpatient charges? A. CMS-1500 or UCF-1500. B. AMA-14 or UCF-1250 C. HCFA-1400 or CMS-1540 D. HCFA-1350 or CMS-650
  56. A significant, separately identifiable E/M service performed by the same physician in conjunction with another service performed on the same day would be reported using what modifier? A. -TC B. -47 C. -90 D. -25
  57. Which of the following modifiers would be assigned for a moribund patient? A. P5 B. P1 C. P4 D. P3
  58. Taking certain steps to protect PHI from being accidentally released to individuals who don’t need to know the information is called the A. minimum necessary standard. B. information provision standard. C. privacy management statute. D. health information guardianship guideline.
  59. Codes for plastic repair of the perineum are found in which code range? A. 57000–57426 B. 57000–57010 C. 57150–57180 D. 56800–56810
  60. A coder overhears a confidential statement made outside of the court, and then, when called to testify, repeats the statement as being truth. This is an example of A. speculation. B. hearsay. C. a direct quote. D. cross-examination.
  61. A nurse sustains an accidental needle pinprick to the right third finger while administering an injection. If an employee has an occupational exposure, what must happen? A. An in-service meeting should be held for all employees who may potentially be exposed to the same occupational hazard. B. The employee should contact the proper authorities. C. Hospital administrators must maintain the nurse’s medical record for the remainder of her employment plus an additional 30 years. D. The guidelines for OSHA should be included in the employment file.
  62. Another name for third-party contractors who have access to medical information is A. healthcare vendors. B. insurance administrators. C. covered entities. D. business associates.
  63. A patient receives two venous pressure clamps for hemodialysis. What HCPCS Level II code is assigned? A. A4751 B. A4918 × 2 C. A4751 × 2 D. A4918
  64. The anatomical location of the calyx is the A. arm. B. kidney. C. spine. D. brain.
  65. A patient comes to the clinic complaining of ongoing headaches. The headaches began one week prior and have persisted ever since. A lumbar spinal tap is performed to pinpoint the source of the patient’s headaches. What CPT and ICD-10-CM codes are assigned? A. 62270, G74.3 B. 62270, G44.1 C. 62141, G46.8 D. 62272, G46.9
  66. A coder assigns a HCPCS Level II code to a patient’s medical record. The code description reads as follows: Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape. Based on this description, which HCPCS Level II code was assigned? A. B4278 B. B4125 C. B4072 D. B4034
  67. To conform to the HIPAA Privacy Rule, which of the following safeguards must be maintained in health care facilities? A. ICD-7 provisional safeguards B. Immunization and injection safeguards C. Reasonable administrative, technical, and physical safeguards D. Hazardous waste protection safeguards
  68. A patient receives a blood glucose monitor. What HCPCS Level II code would be assigned? A. E0976 B. E0562 C. E4752 D. E0607
  69. Alternative dispute resolution (ADR) allows A. lawyer-to-lawyer mediation during trial recess. B. mediating disputes with a judge in the presence of the bailiff. C. resolving medical malpractice suits by submitting pretrial depositions. D. litigants to resolve disputes prior to or after the start of litigation.
  70. A 65-year-old patient is admitted to the hospital for 48 hours to receive treatment from her physician. This patient would be covered under A. Medicare Part B. B. Medicare Part A. C. Medicare Part D. D. Medicare Part C.
  71. Another term for disease evolution is A. remission. B. pathogenesis. C. morphology. D. exacerbation.
  72. In relation to HIPAA regulations regarding the manner in which information can be disclosed, which of the following statements is true? A. Protected health information must be disclosed only when the patient is unable to testify in a court proceeding. B. Protected health information may never be disclosed. C. Protected health information may be disclosed in a judicial or administrative proceeding if the request is made through an order from a court or administrative tribunal. D. Protected health information may be disclosed only within a deposition.
  73. The gatekeeper concept refers to the operation of A. ambulatory payment surgery centers. B. prospective payment organizations. C. retrospective payment organizations. D. health maintenance organizations.
  74. Which of the following procedures would be performed to treat prostate cancer? A. Transurethral resection of the prostate (TURP) B. Meniscectomy C. Vasoconstriction D. Arthroscopy
  75. What diagnosis code would be assigned for a patient diagnosed with Type 2 diabetes mellitus with diabetic nephropathy? A. E11.21 B. E11.01 C. E11.22 D. E11.9
  76. Another name for Medicare Advantage is A. Medicare Part A. B. Medicare Part C. C. Medicare Part B. D. Medicare Part D.
  77. The codes for pacemakers and implantable defibrillators would be found in what section of CPT? A. 33200–33205 B. 33437–33537 C. 33202–33273 D. 33533–33799
  78. A patient comes to the emergency room complaining of abdominal pain. She was previously diagnosed with type I diabetes. She also complains of watery eyes, congestion, pressure in the sinuses, and difficulty breathing. Her final diagnoses are right lower quadrant abdominal pain, type I diabetes, acute sinusitis, and asthma. What CPT and ICD-10-CM codes are assigned? A. 99222, R18.91, E16.9, J01.91, J45.919 B. 99221, R17.41, E17.9, J01.90, J45.909 C. 99223, R14.31, E15.9, J01.90, J45.929 D. 99221, R10.31, E10.9, J01.90, J45.909
  79. What is considered to be protected health information (PHI)? A. Any health information that can identify the individual to whom it refers B. Records pertaining to ancestry C. Statistical data compiled for research purposes only D. Census data
  80. In what CPT code range is Surgical Pathology found? A. 88515–88598 B. 88300–88309 C. 88400–80499 D. 88000–80299
  81. The federal law that requires a patient’s written consent prior to disclosure of certain medical information by government agencies is called the A. Health Care Amendment of 1976. B. Privacy Act of 1974. C. Health Information Law of 2002. D. Medical Consent Act of 1965.
  82. Data stored in a health care facility must A. be organized in accordance with state standards for electronic data interchange. B. adhere to OIG policies and procedures. C. conform to the physician’s expectations for data storage. D. comply with HIPAA rules and must be maintained securely.
  83. Under HIPAA, health care facilities must A. maintain a clean, safe working environment. B. choose a privacy officer in accordance with HIPAA policies and procedures. C. keep records of patients who refill prescriptions more than once within a three-month timeframe. D. follow up with patients who repeatedly miss scheduled appointments for mandatory services.
  84. What CPT code would be assigned for a colpocentesis? A. 57135 B. 57859 C. 57600 D. 57020
  85. A patient is prescribed a medication that narrows the blood vessels and raises her blood pressure. The medication is most likely a A. tranquilizer. B. vasoconstrictor. C. cardiotonic. D. cardiogenic.
  86. If patients choose to obtain copies of their medical records, under the terms of HIPAA, providers can A. complete employee paperwork. B. charge a reasonable fee for providing copies of those records. C. reschedule office visits to allow time to update medical records. D. also fulfill requests for prescription data.
  87. According to the CMS National Physician Fee Schedule, what is the conversion factor for basic life support mileage? A. $34.5741 B. $32.4726 C. $28.8457 D. $36.0666
  88. According to HIPAA, a patient’s information may be released for A. determining premiums based on a patient’s past medical history. B. paternity testing. C. research. D. transferring electronic medical records to remote locations.
  89. A patient comes to the clinic complaining of fever, diarrhea, nausea, and vomiting. The patient is diagnosed with salmonella meningitis. What ICD-10-CM code would be assigned? A. A07.21 B. A02.21 C. A05.26 D. A23.24
  90. Which of the following anatomical locations would contain the diaphysis? A. Metatarsal B. Tibia C. Septum D. Diaphragm
  91. A patient comes to the clinic complaining of nausea, vomiting, fever, dizziness, and intermittent confusion. The physician conducts a detailed history and examination and reviews the patient’s lab results. The patient is diagnosed with pyelonephritis and is scheduled for an ultrasound to review the state of the kidneys and other organs. What CPT and ICD-10-CM codes are assigned? A. 76775-TC, N15 B. 71010-26, B12 C. 76775-26, N10 D. 73256-TC, M11
  92. A female patient is diagnosed with breast cancer of the lower-inner quadrant of the right breast. The patient undergoes a modified radical mastectomy of the right breast in an attempt to circumvent the spread of the cancer to any secondary anatomical sites. The procedure was performed in three stages. In addition to the radical mastectomy, the physician also performed a right breast biopsy to treat the breast tumor in the lower-inner quadrant. What ICD-10-CM and CPT codes are assigned? A. 15852-58, Z48.01 B. 19307-58-RT, 19101-59-RT, C50.311 C. 19307-RT, 19101-RT, C50.211 D. 11602, 15240, C50.312
  93. The concept of confidentiality can be substantiated based on the right of A. easement. B. constitutionality. C. totality. D. privacy.
  94. The abbreviation INH indicates what route of drug administration? A. Inhaled and intrathecal administration B. Intrathecal injection C. Inhalant solution D. Inhaled and intravenous administration
  95. A patient is seen in the physician’s office after the results of an earlier mammogram demonstrated microcalcification in the right breast as well as a breast lesion. The lesion is excised using needle localization. The patient’s final diagnosis is fibrosclerosis of the right breast. What CPT and ICD-10-CM codes are assigned? A. 19123-RT, H16.11 B. 19126-LT, M25.1 C. 19125-RT, N60.31 D. 19120-RT, L10.11
  96. What is the code description for 65101-LT? A. Removal of ocular implant performed laterally B. Biopsy of cornea performed on the lower third of the cornea C. Enucleation of eye, without implant, performed on the left side of the body D. Fine needle aspiration of orbital contents on the left third of the orbit
  97. The foramen ovale is found in which anatomical location? A. Fibula B. Heart C. Liver D. Pancreas
  98. During a routine examination, a patient indicates that she is taking an antihypertensive medication that causes her kidneys to excrete more urine. These antihypertensive medications are called A. calcium-channel blockers. B. anticoagulants. C. diuretics. D. beta blockers.
  99. Code range 99231–99233 pertains to A. initial hospital care. B. hospital discharge services. C. consultation services. D. subsequent hospital care.
  100. A 7-year-old patient is seen in follow-up after an earlier diagnosis of excessive daytime sleepiness. The physician obtains a sleep study and then reviews and interprets the results. What CPT and ICD-10-CM codes are assigned? A. 95810-26, R40.0 B. 95811-TC, J14.0 C. 95815-TC, G45.0 D. 95812-26, H40.0
  101. If a physician provides preoperative management only to a patient prior to surgery, which modifier would be added to the surgery code? A. -56 B. -44 C. -32 D. -91
  102. The HIPAA Privacy Rule indicates that A. restrictions on information disclosure exist only for patients with life-threatening illnesses. B. the level of information disclosure permitted is based on the nature of the procedure. C. practitioners should disclose only the minimum amount of health information necessary for the purpose of the disclosure. D. physicians may release medical information at their own discretion.
  103. The atrioventricular (tricuspid) valve is located in the A. fibula. B. lung. C. heart. D. brain.
  104. A physician is analyzing specific organs in a particular region of the patient’s body. In her notes, she refers to the transverse or cross-sectional plane, which divides the body A. horizontally. B. vertically. C. inferiorly. D. bilaterally.
  105. A health care practitioner who knowingly submits false statements to obtain federal health care reimbursement is guilty of A. Medicare fraud. B. DHS claim misrepresentation. C. Health Insurance Privacy and Portability misuse. D. Medicaid omission.
  106. According to the guidelines for medical records outlined in the Health Insurance Portability and Accountability Act (HIPAA), patients A. have the right to have errors reviewed by a hospital administrator. B. do not have the right to have errors corrected, as the data has been previously verified by the physician. C. have the right to have errors in their medical records corrected. D. have the right to correct errors in identification data only.
  107. The Health Insurance Portability and Accountability Act (HIPAA) standards were developed to A. ensure that coders could easily access each medical record. B. determine the structure of insurance carrier payments for health care practitioners. C. protect patient confidentiality when health information is transferred electronically. D. define XLTM standards for health records management.
  108. A coder would assign modifier -53 to report A. procedures cancelled due to the patient’s condition. B. anesthesia administration. C. dental procedures. D. repeat procedures.
  109. A patient is diagnosed with breast cancer and undergoes a partial mastectomy. What CPT code would be assigned? A. 19305 B. 19301 C. 19304 D. 19307
  110. Which of the following anesthesia modifiers indicates a normal, healthy patient? A. P1 B. P4 C. P3 D. P2
  111. A coder searching for codes pertaining to tissue expanders would find them in what section of CPT? A. 16200–16799 B. 12000–12300 C. 11960–11971 D. 15000–15999
  112. A patient comes to the emergency room complaining of abdominal pain, nausea, and intractable vomiting. Unable to pinpoint the source of the patient’s complaints, the physician decides to admit the patient to the hospital. After conducting a complete history and examination, the patient’s final diagnosis is determined to be chronic duodenal ulcer. The patient remains hospitalized for three days. The physician sees the patient on the day of discharge. What ICD-10 and CPT codes are assigned? A. 99223, I48.91 B. 99238, K26.7 C. 99234, N17.9 D. 99291, D63.1
  113. What is the code for excision of Meckel’s diverticulum? A. 44820 B. 44700 C. 44800 D. 44850
  114. The Health Insurance Portability and Accountability Act (HIPAA) was created for the purpose of A. modifying legal and ethical issues surrounding medical records retention. B. stabilizing administrative costs and productivity. C. decreasing employee turnover and reducing the volume of new hire paperwork. D. streamlining claims processing and reducing paperwork through electronic transmission.
  115. The voluntary program that’s financed through a combination of payments from general federal revenues and premiums paid by beneficiaries who elect to participate is called A. CHAMPVA. B. Medicare Part B. C. Medicaid. D. TRICARE.
  116. The I-10 helps coders classify patient A. management information. B. morbidity and mortality. C. evaluation files. D. reimbursement data.
  117. A patient recently became eligible for health insurance through her employer. Her health insurance is considered to be an 80-20 policy. Under the terms of an 80-20 policy, the insurer pays 80 percent and the insured pays 20 percent of expenses. This 80-20 policy is an example of A. coinsurance. B. capitation. C. prospective payment. D. case management.
  118. Performing a daily check for viruses and malware is one of the A. requirements of the Help Desk. B. routine aspects of software maintenance. C. sensible guidelines for Internet use in health care facilities. D. functions of HIM encoders.
  119. Bones inside the nose are called A. septal mucosa. B. maxillae. C. turbinates. D. ethmoids.
  120. A group of doctors who belong to the same network and provide discounted services to enrollees is called a/an A. Managed Care Organization (MCO). B. Individual Practice Association (IPA). C. Health Maintenance Organization (HMO). D. Preferred Provider Organization (PPO).
  121. A female patient is seen for her annual gynecological examination. During the examination, the physician performs a test to detect cervical cancer. This test is called a/an A. Pap smear. B. carcinoembryonic antigen test. C. mycobacterial culture. D. immunoassay test.
  122. Businesses that provide support services, like administration, to individual physicians are called A. integrated provider organizations. B. medical foundations. C. management services organizations. D. physician-hospital organizations
  123. What is the full code description for 33536? A. Repair of double outlet right ventricle with intraventricular tunnel repair B. Repair of postinfarction ventricular septal defect, with or without myocardial resection C. Closure of atrioventricular valve (mitral or tricuspid) by suture or patch D. Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts
  124. The CPT code for thrombolysis is A. 93000. B. 92920. C. 93797. D. 92975.
  125. Which of the following statements is true of the Affordable Care Act? A. It offers parents supplementary coverage for dependents with chronic illness. B. It makes it mandatory for patients to carry health insurance. C. It includes a provision for military service members who served in Afghanistan. D. It requires health care facilities to maintain health records for at least 10 years.
  126. A qualifying circumstance indicates a A. situation that makes anesthesia administration more difficult. B. condition that reduces the average recovery time for a particular type of surgery. C. situation that may extend a patient’s length of stay in the hospital setting. D. condition that impacts the outcome of surgery.
  127. The portion of health insurance that an insured pays before he or she is entitled to receive benefits from an insurance plan is called the A. capitation. B. OPPS reimbursement. C. coinsurance. D. deductible.
  128. A good compliance program in the health care setting includes A. regular audit consultations with trustees of the AAPC. B. HHS surveillance. C. meetings with compliance officers. D. regular tracking and monitoring of coding activities.
  129. A 55-year-old patient was injured while working as a carpenter on a construction site. While framing the roof of a two-story house, he fell and hit his head. He was diagnosed with a concussion to the left side of his head, and underwent a right frontal parietal craniotomy with removal of a subdural hematoma. During the patient’s period of recovery, he was given a medication that resulted in a rash on his abdomen. The physician conducted an expanded problem focused history and exam, with straightforward medical decision making. What CPT code(s) should be assigned? A. 99253 B. 99252 C. 99292, 99291 D. 99251
  130. During a routine examination, a male patient is diagnosed with an elevated PSA. The physician performs a biopsy of the prostate with a rectal ultrasound to pinpoint the source of the problem. Which CPT and ICD-10-CM codes would be assigned? A. 55720, 74000-26, R97.3 B. 55700, 76872-26, R97.2 C. 55734, 73200-26, R97.2 D. 55725, 76000-26, R93.6
  131. When is code 58120 assigned? A. The code is assigned for a patient undergoing dilatation and curettage. B. The code has been deleted and cannot be assigned. C. The code is assigned for permanent pacemaker insertion. D. The code is assigned as an add-on code.
  132. A patient is seen for 167 minutes of critical care. What CPT codes would be assigned? A. 99291, 99292 × 4 B. 99291, 99292 × 2 C. 99291, 99292 × 3 D. 99291, 99292 × 5
  133. The prefix endo- means A. outside of. B. within. C. beneath. D. adjacent to.
  134. A patient comes to the emergency room after having dinner at a restaurant, where she began to experience chest tightness during the meal. She is seen for a cardiology consultation in the outpatient setting for a diagnosis of chest tightness. Which CPT and ICD-10-CM codes would be assigned? A. 99243, R25.96 B. 99242, R17.52 C. 99244, R07.59 D. 99245, R07.89
  135. The prefix sub- means A. above. B. horizontal. C. under. D. lateral.
  136. What CPT code range is used to code for a limited lymphadenectomy? A. 38700–38780 B. 38562–38564 C. 39501–39599 D. 37501–37650
  137. The process of removing tissue for histopathology is called A. excision. B. shaving. C. debridement. D. biopsy.
  138. Which of the following anatomical locations would contain the superior vena cava? A. Heart B. Nose C. Hip D. Lungs
  139. A patient is seen in the office for complaints of dizziness and insomnia. The physician records a chronological description of specific elements of the patient’s condition. This chronological description is called the A. chief complaint. B. review of systems. C. examination. D. history of present illness.
  140. A patient comes to the physician’s office complaining of neck irritation. The physician examines her neck and notes that she has a 15 cm neck scar. Upon further examination, the physician notes that the neck scar requires extensive debridement and retention sutures. The physician performs a dermabrasion to treat the neck scar and then closes the complex wound with the sutures. What ICD-10 and CPT codes are assigned? A. 13132, 13133 × 3, H81.09, L92.9 B. 13133-51, 13131-79, L60.0 C. 13132, 13133 × 2, L90.5 D. 13132, L76.82
  141. The first step in EHR implementation is A. analyzing the content of the traditional medical record. B. conducting an assessment of the goals, needs, and financial stability of the health care practice. C. structuring the timeline for EHR implementation. D. reviewing the list of established patients currently being seen in the practice.
  142. A patient is seen in follow-up two weeks after undergoing cholecystectomy. During the follow-up examination, the physician notes that the abdominal wound has not yet healed. The patient undergoes a split-thickness autograft due to a nonhealing left lower abdominal wound that’s 10 square centimeters. Which CPT and ICD-10-CM codes would be assigned? A. 15200, L85.64 B. 15250, L34.74 C. 15350, L52.64 D. 15100, L76.82
  143. A patient is diagnosed with severe sepsis and septic shock after experiencing a severe drop in blood pressure. What ICD-10-CM code would be assigned? A. T79.4 B. T81.12 C. R65.21 D. R65.10
  144. A patient has a disorder in which the bone marrow produces an overabundance of white blood cells. What is this disorder called? A. Septicemia B. Coagulation C. Leukemia D. Hemophilia
  145. Which modifier indicates a staged or related procedure performed during the postoperative period? A. -59 B. -54 C. -57 D. -58
  146. The Female Genital System subsection covers which CPT code range? A. 56203–56303 B. 56405–58999 C. 56607–56809 D. 56300–56499
  147. A patient with numerous symptoms is seen in the laboratory for a general health panel to gauge her overall physical well-being. What CPT code would be assigned for a general health panel? A. 82136 B. 84135 C. 80051 D. 80050
  148. A patient undergoes a sigmoidoscopy. The coder would assign CPT code A. 45919. B. 45852. C. 45330. D. 45397.
  149. Code 71030-TC indicates a/an A. complete chest x-ray, four views, technical component only. B. incomplete chest x-ray, three views, technical and professional component. C. complete chest x-ray, two views, technical component only. D. incomplete chest x-ray, two views, technical and professional component.
  150. Health care practitioners must maintain records of privacy policy practices and procedures for A. 2 years. B. 20 years. C. 6 years. D. 10 months.

IOM Future Of Nursing

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In a reflection of 450-600 words, explain how you see yourself fitting into the following IOM Future of Nursing recommendations:

  1. Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80% by 2020.
  2. Recommendation 5: Double the number of nurses with a doctorate by 2020.
  3. Recommendation 6: Ensure that nurses engage in lifelong learning.

Identify your options in the job market based on your educational level. (I have Associate degree in nursing (ADN) and this a Bachelor science in nursing program, (BSN) so you can have based it on BSN, because I will be done soon)

  1. How will increasing your level of education affect how you compete in the current job market?
  2. How will increasing your level of education affect your role in the future of nursing?

A minimum of Four scholarly references are required for this assignment. solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, an abstract is not required, CITE WEBSITE SOURCE.

Nursing Decision-making

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Question 1

A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct?

A) Infectious

B) Inflammatory

C) Hematologic

D) Traumatic

Question 2

A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient?

A) Age

B) Hair color

C) Actinic lentigines

D) Heavy sun exposure

Question 3

A 15-year-old high school sophomore and her mother come to your clinic because the mother is concerned about her daughter’s weight. You measure her daughter’s height and weight and obtain a BMI of 19.5 kg/m2. Based on this information, which of the following is appropriate?

A) Refer the patient to a nutritionist and a psychologist because the patient is anorexic.

B) Reassure the mother that this is a normal body weight.

C) Give the patient information about exercise because the patient is obese.

D) Give the patient information concerning reduction of fat and cholesterol in her diet because she is obese.

Question 4

A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months.They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do?

A) Reassure him that there is nothing to worry about.

B) Do laboratory work to check for platelet problems.

C) Obtain an extensive history regarding blood problems and bleeding disorders.

D) Do a skin biopsy in the office.

Question 5

Jacob, a 33-year-old construction worker, complains of a “lump on his back” over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely?

A) An enlarged lymph node

B) A sebaceous cyst

C) An actinic keratosis

D) A malignant lesion

Question 6

A patient comes to you for the appearance of red patches on his forearms that have been present for several months. They remain for several weeks. He denies a history of trauma. Which of the following is likely?

A) Actinic keratoses

B) Pseudoscars

C) Actinic purpura

D) Cherry angiomas

Question 7

A 19-year old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn’t been. Which of the following physical examination descriptions is most consistent with meningitis?

A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of motion

B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right

C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion

D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full range of motion

Question 8

A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis?

A) Actinic keratosis

B) Seborrheic keratosis

C) Basal cell carcinoma

D) Squamous cell carcinoma

Question 9

A patient presents for evaluation of a cough. Which of the following anatomic regions can be responsible for a cough?

A) Ophthalmologic

B) Auditory

C) Cardiac

D) Endocrine

Question 10

A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing loss. He has noticed some decreased ability to hear what his wife and grandchildren are saying to him. He admits to lip-reading more. He has a history of noise exposure in his young adult years: He worked as a sound engineer at a local arena and had to attend a lot of concerts. Based on this information, what is the most likely finding regarding his hearing acuity?

A) Loss of acuity for middle-range sounds

B) Increase of acuity for low-range sounds

C) Loss of acuity for high-range sounds

D) Increase of acuity for high-range sounds

Question 11

Mrs.Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash?

A) Insect bites

B) Urticaria, or hives

C) Psoriasis

D) Purpura

Question 12

A new mother is concerned that her child occasionally “turns blue.” On further questioning, she mentions that this is at her hands and feet. She does not remember the child’s lips turning blue. She is otherwise eating and growing well. What would you do now?

A) Reassure her that this is normal

B) Obtain an echocardiogram to check for structural heart disease and consult cardiology

C) Admit the child to the hospital for further observation

D) Question the validity of her story

Question 13

An 89-year-old retired school principal comes for an annual check-up. She would like to know whether or not she should undergo a screening colonoscopy. She has never done this before. Which of the following factors should not be considered when discussing whether she should go for this screening test?

A) Life expectancy

B) Time interval until benefit from screening accrues

C) Patient preference

D) Current age of patient

Question 14

You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?

A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution

B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution

C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution

D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution

Question 15

A 79-year-old retired banker comes to your office for evaluation of difficulty with urination; he gets up five to six times per night to urinate and has to go at least that often in the daytime. He does not feel as if his bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or hematuria. This problem has been present for several years but has worsened over the last 8 months. You palpate his prostate. What is your expected physical examination finding, based on this description?

A) Normal size, smooth

B) Normal size, boggy

C) Enlarged size, smooth

D) Enlarged size, boggy

Question 16

A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small “pits” in his nails. What would account for these findings?

A) Eczema

B) Pityriasis rosea

C) Psoriasis

D) Tinea infection

Question 17

A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most likely pathologic process?

A) Infection

B) Inflammation

C) Allergic

D) Vascular

Question 18

A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs.Based on this description, what is your most likely diagnosis?

A) Actinic keratosis

B) Seborrheic keratosis

C) Basal cell carcinoma

D) Squamous cell carcinoma

Question 19

An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling or inflammation. There are no hair shafts visible. Based on this description, what is your most likely diagnosis?

A) Alopecia areata

B) Trichotillomania

C) Tinea capitis

D) Traction alopecia

Question 20

A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis?

A) Pityriasis rosea

B) Tinea versicolor

C) Psoriasis

D) Atopic eczema

Question 21

Which of the following booster immunizations is recommended in the older adult population?

A) Tetanus

B) Diphtheria

C) Measles

D) Mumps

Question 22

A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to?

A) Musculoskeletal

B) Reproductive

C) Urinary

D) Endocrine

Question 23

Ms.Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do?

A) Conclude that these are lesions she has had for a long time.

B) Wait for her to mention them before asking further questions.

C) Ask how she acquired them.

D) Conduct the visit as usual for the patient.

Question 24

You have recently returned from a medical missions trip to sub-Saharan Africa, where you learned a great deal about malaria. You decide to use some of the same questions and maneuvers in your “routine” when examining patients in the midwestern United States. You are disappointed to find that despite getting some positive answers and findings, on further workup, none of your patients has malaria except one, who recently emigrated from Ghana. How should you next approach these questions and maneuvers?

A) Continue asking these questions in a more selective way.

B) Stop asking these questions, because they are low yield.

C) Question the validity of the questions.

D) Ask these questions of all your patients.

Question 25

On routine screening you notice that the cup-to-disc ratio of the patient’s right eye is 1:2. What ocular condition should you suspect?

A) Macular degeneration

B) Diabetic retinopathy

C) Hypertensive retinopathy

D) Glaucoma

Question 26

Mrs.Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn’t blanch. What would you tell her regarding her rash?

A) It is likely to be related to her lupus.

B) It is likely to be related to an exposure to a chemical.

C) It is likely to be related to an allergic reaction.

D) It should not cause any problems.

Question 27

A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several years. He normally takes over-the-counter medications to ease the pain, but this time they haven’t worked as well and he still has discomfort. He recently wallpapered the entire second floor in his house, which caused him great discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic process?

A) Infectious

B) Neoplastic

C) Degenerative

D) Traumatic

Question 28

A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis?

A) Pityriasis rosea

B) Tinea versicolor

C) Psoriasis

D) Atopic eczema

Question 29

Which of the following changes are expected in vision as part of the normal aging process?

A) Cataracts

B) Glaucoma

C) Macular degeneration

D) Blurring of near vision

Question 30

You are examining an unconscious patient from another region and notice Beau’s lines, a transverse groove across all of her nails, about 1 cm from the proximal nail fold. What would you do next?

A) Conclude this is caused by a cultural practice.

B) Conclude this finding is most likely secondary to trauma.

C) Look for information from family and records regarding any problems which occurred 3 months ago.

D) Ask about dietary intake.

Professional Capstone And Practicum Reflective Journal And Scholarly Activities

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Throughout the course, students will engage in weekly reflection and scholarly activities. These assignments are presented in Topic 1 to allow students to plan ahead, and incorporate the deliverables into the Individual Success Plan if they so choose.

The weekly reflective journals and scholarly activities will not be submitted in LoudCloud each week; a final, culminating submission will be due in Topic 10. No submission is required until Topic 10.

Professional Capstone and Practicum Reflective Journal

Students are required to maintain weekly reflective narratives throughout the course to combine into a final, course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course. This course-long journal assignment will be due in Topic 10.

In each week’s entry, you should reflect on the personal knowledge and skills gained throughout the Professional Capstone and Practicum course. Your entry should address a variable combination of the following, dependent on the specific practice immersion clinical experiences you encountered that week:

New practice approaches

Intraprofessional collaboration

Health care delivery and clinical systems

Ethical considerations in health care

Population health concerns

The role of technology in improving health care outcomes

Health policy

Leadership and economic models

Health disparities

In the Topic 10 submission, each of the areas should be addressed in one or more of the weekly entries.

This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how they met competencies and course objectives.

Scholarly Activities

Throughout the RN-to-BSN program, students are required to participate in scholarly activities outside of clinical practice or professional practice. Examples of scholarly activities include attending conferences, seminars, journal club, grand rounds, morbidity and mortality meetings, interdisciplinary committees, quality improvement committees, and any other opportunities available at your site, within your community, or nationally.

You are required to post one scholarly activity while you are in the BSN program, which should be documented by the end of this course. In addition to this submission, you are required to be involved and contribute to interdisciplinary initiatives on a regular basis.

In Topic 10, you will submit a summary report of your scholarly activity. You may use the “Scholarly Activity Summary” resource to help guide this assignment.

Practicum – Journal Entry

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Practicum – Week 5 Journal Entry

                                  Learning Objectives

Students will:

· Develop diagnoses for clients receiving psychotherapy*

· Evaluate the efficacy of therapeutic approaches for clients*

· Analyze legal and ethical implications of counseling clients with psychiatric

disorders*

                                         The Assignment

Select a client whom you observed or counseled that suffers from a disorder related to trauma. Then, address the following in your Practicum Journal:

· Describe the client (without violating HIPAA regulations) and identify any

pertinent history or medical information, including prescribed medications.

· Using the DSM-5, explain and justify your diagnosis for this client.

· Explain whether any of the therapeutic approaches in this week’s Learning

Resources would be effective with this client. Include expected outcomes based

on these therapeutic approaches. Support your approach with evidence-based

literature.

· Explain any legal and/or ethical implications related to counseling this client.

                                              Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 13, “Stabilization for Trauma and Dissociation” (pp. 469–508)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Required Media

Laureate Education (Producer). (2012a). Academic year in residence: Thompson family case study [Multimedia file]. Baltimore, MD: Author.

Ochberg, F. (2012). Psychotherapy for chronic PTSD [Video file]. Mill Valley, CA: Psychotherapy.net.

Health Research

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Details:/ Research a health care organization or a network that spans several states within the U.S

Research a health care organization or a network that spans several states within the U.S. (Example: United Healthcare, Vanguard, Banner Healthcare, etc.).

Harvard Business Review Online and Hoover’s Company Records, found in the GCU Library, are useful sources. You may also find pertinent information on your organization’s webpage.

Review “Singapore Airlines Case Study.”

Prepare a 1,000-1250-word paper that focuses on the organization or network you have selected.

Your essay should assess the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade, and include a strategic plan that addresses issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction. Provide a comparison to the health care organization or network and the Singapore Airlines. Include any cultural issues that may influence the practices listed above.

 Solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, use at least SIX References. Prepare this assignment according to the APA STYLE, an abstract is not required.