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APEA 3P Exam Prep- Professional Issues/Ethics Questions
and Answers with Explanations
A nurse practitioner has agreed to participate in the Medicare health insurance program. Medicare paid 80% of the charges billed for a clinic visit. What can be done about the other 20% that is owed? The NP can bill the patient for a percentage of the remainder. The NP is prohibited from billing the patient. The NP can collect 90% if billed incident to the MD. The NP can resubmit the bill for additional payment. The NP is a “participating” provider because he agreed to accept assignments. An assignment is an agreement between Medicare and the NP to accept the Medicare Approved Amount (MAA) as payment in full and not charge Medicare recipients a higher rate. The NP can bill the patient for a percentage of the remaining bill that was not paid by Medicare. The NP may opt out of participating. The NP can be reimbursed 100% if billed incident to the MD. The name given to subjects in a research study who do not have the disease or condition being studied, but who are included in the study for comparison are: studied subjects. controls. case series. cross sectionals. Studied subjects are those members of a study who have a specific disease or condition of interest or who are receiving a specific treatment. Case series may refer to an observational study in which a group of patients with interesting characteristics are studied. Cross sectional is a type of observational study in which a particular characteristic is studied at one time rather than over time.
Controls are commonly employed in many types of research studies. The research design that provides the strongest evidence for concluding causation is:
Should not mention the possibility of HIV exposure from a dirty needle to the patient. Can offer to buy the HIV medications for $50 with their professional discount at the pharmacy next door.
The standard of care followed by the nurse practitioner should not depend on whether the patient has insurance or not. It is unethical to not properly inform the patient of risks he may have been exposed to from the puncture wound. Offering to buy the medications for the patient is noble but is not a sustainable practice. The nurse practitioner should prescribe the medications as for anyone with possible HIV exposure and refer to social services or a community referral agency that can help this patient acquire the appropriate medications. A nurse practitioner is working in a minor care clinic. She realizes that a patient with a minor laceration does not have insurance and is using his brother’s insurance information today so that his visit will be covered. How should she proceed? She should let him know that she knows what he is doing. She should ignore this and proceed to suture his wound. She should let the clinic's business office know what is happening. She should not suture his wound and ask him to leave. The nurse practitioner cannot ignore the fact that this patient is attempting to defraud the clinic and insurance company in order to receive free care. If she does not let the business office know, she is a party to the fraud. She should let the business office know what is happening and have the patient present documents verifying that he is who he states that he is. If he cannot, he can still receive care if he is willing to pay for it. An alternative care site should be offered to him. Which study listed below is considered an experimental study? Case series Cross-sectional study Cohort study Meta-analysis Observational studies are studies in which subjects are observed. No intervention takes place with them. Examples of these are found in the first three choices. A meta-analysis takes published information from other studies and combines the information to arrive at a conclusion. Although a meta-
This is a clinical judgment with an unexpected complication. The nurse practitioner’s actions followed the standard of care. The act of suturing this type of wound represents malpractice. This is poor judgment, but not malpractice. This is malpractice. Cat bites, known to be dirty bites with a high probability of infection, should not be sutured. Malpractice is usually described as having multiple elements that all must be satisfied for malpractice to occur. There must be a duty, a breach of the duty, and subsequent injury due to the breach. Comparison of performance is based on the standard of care delivered by nurse practitioners. The Medicaid health program is: funded with premiums from participants. covers an unlimited number of adult visits. funded by both state and federal governments. basically the same from state to state. Medicaid is state - run and specific to each state. The state programs are funded by a combination of state and federal funds. Most states have limits on the number of adult visits. Some states have no limits on visits for children. Participants generally do not pay premiums like Medicare recipients pay. A liability policy that pays claims only during the period that the policy is active is termed: claims made policy. tail coverage. liability protection. bobtail coverage. Liability insurance that covers the holder only during the time of the active policy is known as a claims made policy. This kind of policy is usually less expensive
than other policies that will protect the policyholder against claims not known about at the end of the policy period. Tail coverage is more expensive than other policies because it protects the healthcare provider for an extended period of time after the incident occurs. What would be the study of choice to determine the cause of a cluster of adult leukemia cases found in an isolated area of a rural state?
The 2 certifying bodies for adult-gero and family nurse practitioners in the United States are American Nurses Credentialing Center (ANCC) and American Association of Nurse Practitioners (AANP). State boards of nursing grant a license to nurse
practitioners in the state where they practice. Most states require certification in order to become licensed. Prescriptive authority: is a right of every practicing nurse practitioner. varies from state to state. is not part of the consensus model. is dependent on certification. Prescriptive authority refers to the ability of a nurse practitioner to work and write prescriptions within the legal scope of practice in all 50 states. Although nurse practitioners are allowed to prescribe in all 50 states, there is great variability in how this occurs. Some states allow broader prescriptive authority, others much narrower authority. A nurse practitioner (NP) works in an HIV exclusive practice. In talking with a patient, the NP learns that the patient’s sister lives next door to the NP. When the NP sees her neighbor (the patient’s sister), the NP states that she met her sister in the clinic today. The neighbor replies, “Don’t you work in an HIV clinic?” How can this situation be characterized? This is negligence. This is a breach of confidentiality. This is not a breach of confidentiality. The NP has no liability. This is a breach of the patient’s confidentiality. The neighbor’s sister is the NP’s patient. The NP is bound to confidentiality regarding protected health information for any of her patients. Even though the NP did not acknowledge that her sister was a patient, she breached patient confidentiality by telling the patient’s sister that she had met her in the clinic. This is different from telling her sister she met her at the grocery store. The nurse practitioner decides to study a group of patients who are trying to quit smoking. They all will be taking the same type of medication for 42 days to help
case control study. controlled trial. A cohort study describes an observational study that is prospective in nature, such as the case with this group of smokers. Cohort studies usually ask the question, “What will happen?” A case control study looks backward in time (retrospective). Case control studies usually ask the question, “What happened?” A controlled trial is an experimental study, not observational. You are volunteering at a clinic that cares for homeless patients. What’s the most important aspect of a patient’s first visit? A complete head-to-toe exam Establish trust Take an excellent history Ask about problems with alcohol The most important aspect of the initial visit is to establish trust. Many patients will not be willing to disclose a complete history to the examiner, especially one regarding alcohol or illegal drugs. A complete head-to-toe exam might be important, but most homeless patients are driven to care based on episodic illness. They will be interested in care for the problem that brought them in on the day of the exam. Additionally, resources may be limited, which would not allow for a complete head- to-toe exam on each patient, but instead, a focused visit. How would you create a therapeutic relationship with a patient? Tell the patient that he can trust you. At the end of the visit, tell the patient you enjoyed taking care of him. Ask open-ended questions. Touch the patient during the interview. A therapeutic relationship with a patient can be established in many ways. One way is to ask open-ended questions. This allows the patient to discuss what is most important to him; personal concerns may be vocalized by the patient.
Telling the patient that he can trust you probably does little to establish trust. Actions that establish trust are more therapeutic than this statement. Touching the patient during the interview may be perceived as inappropriate by many patients. In contrast, touching the patient during the exam is different. Finally, telling the patient that you enjoyed taking care of him (if this were true) does little to establish trust.
practice. limit liability of nurse practitioners. Incorrect protect nurse practitioners from frivolous law suits. promote autonomous practice.
Standards of practice for all professionals (nurses, physicians, dentists, etc.) are established to regulate and control practice. They are intended to provide accountability for professionals and to help protect the public from unethical behavior and unsafe practice. Licensure is: used to establish a designated level of professional competence. contingent on certification. intended to limit entry into the profession. necessary for reimbursement. Licensure is used by many states to protect the public and establish a minimal level of professional competence. Licensure and competence are two distinct recognitions and are conveyed by different organizations/bodies. Licensure and reimbursement are not usually related; however, reimbursement and certification are commonly related. A liability policy that pays claims even after the policy is no longer active is termed: claims made policy. tail coverage. liability protection. “all-protect”. This is termed tail coverage because it extends beyond the time that the policy is active. This type of insurance is important for protection against claims that may come in after the healthcare provider has left the practice or retired. These are generally more expensive than claims-made policies. In a research study, the difference between the smallest and largest observation is the: absolute value. standard deviation. first degree of freedom. range.
A nurse practitioner is volunteering in a homeless clinic to gain clinical experience. Which statement is true about this? Malpractice insurance is not needed because this is volunteer work. Volunteerism negates susceptibility to lawsuits. Malpractice insurance is needed by the nurse practitioner. Coverage will be provided by the state where the clinic is located. Malpractice insurance is needed in any situation where patients are treated by a nurse practitioner. Some states have a Good Samaritan law that protects professional volunteers from being sued. Unless this is specifically provided by state law, a nurse practitioner should have professional liability insurance in the event the NP is sued A patient you are caring for in your clinic has Medicare Part B. What does this mean? The federal government will pay for his visit to your clinic today. His medicare benefit covers outpatient services. He will have a copay for his visit today. His prescriptions will be partly paid for today. Part B pays the examiner (NP, PA, MD, etc.). Part B of Medicare pays for outpatient care, ambulatory surgery services, X-rays, durable medical equipment, laboratory, and home health. Part B is an option that Medicare recipients can pay for with a monthly option. This charge is based on income. Since there is an initial copay, the federal government’s insurance plan may NOT pay for his visit to your clinic today. A nurse practitioner examined a patient who had been bitten by her husband during an assault. There were numerous bite marks and lacerations on the patient’s forearms. The nurse practitioner sutured the lacerations, but this was contraindicated because of the highly infectious nature of human bites. The patient suffered no ill effects after suturing. How can this be described? This is negligence. This was a fortunate situation for the patient.
This is malpractice. This is poor judgment and malpractice. This is not malpractice. This is negligence. Negligence occurs when one fails to exercise the care that a reasonable person would exercise. Injury does not have to
