NCA 622 Final Exam Review Points: Key Concepts and Answers, Exams of Nursing

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What |is |a |value |based |system? |- |correct |answer |✔Value-based |healthcare |is |a |delivery |framework |that |incentivizes |providers |to |focus |on |the |quality |of |services |rendered |as |opposed |to |quantity. |It |reduces |cost |by |improving |outcomes.

Medicare |Part |A |- |correct |answer |✔Inpatient |coverage, |SNF, |nursing |home |care, |home |health, |hospice. |Also |defines |limits |of |Medicare |usage

Medicare |Part |B |- |correct |answer |✔B |covers |medically |necessary |services, |preventative |services, |clinical |research, |ambulance |services, |DME, |mental |health, |and |a |limited |number |of |preventative |or |maintenance |drugs. |

• |Medically |necessary |services |are |those |needed |to |diagnose |or |treat |a |condition |and |that |meets |accepted |standards |of |medical |practice.
• |Preventative |services |are |those |that |prevent |illness |or |detect |it |at |an |early |stage.

Medicare |Part |C |- |correct |answer |✔Medicare |Advantage |plan |is |a |program |through |which |Medicare |beneficiaries |may |have |their |benefits |administered |by |managed |healthcare |organizations |(MCOs), |similar |to |a |HMO |or |PPO. |MA |covers |vision, |hearing, |dental, |and/or |health |and |wellness |programs.

Medicare |Part |D |- |correct |answer |✔Medicare |prescription |drug |reimbursement |plans |that |cover |at |least |two |drugs |in |the |most |commonly |prescribed |categories |and |classes.

Who |qualifies |for |Medicare? |- |correct |answer |✔People |who |are | 65 |years |old |& |have |paid |in |to |Social |Security, |and |patients |younger |than | 65 |with |a |disability, |ESRD, |and |ALS.

Who |qualifies |for |Medicaid? |- |correct |answer |✔Children, |pregnant |women, |parents, |seniors, |and |individuals |with |disabilities. |Those |with |insufficient |income |up |to |133% |of |the |federal |poverty |level, |and |those |who |are |indigent, |blind, |mentally |or |physically |handicapped

What |would |you |see |on |XRs |in |a |40yo |woman |with |rheumatoid |symptoms? |-

|correct |answer |✔* |Periarticular |erosions

Decreased |bone |density

Soft |tissue |swelling

Narrowing |of |the |joint |spaces

In |the |elderly, |a |febrile |response |is |more |likely |to |indicate |and |viral |or |a

|bacterial |infection? |- |correct |answer |✔Bacterial

What |type |of |rewarming |is |most |beneficial |to |elderly |experience |hypothermia?

|- |correct |answer |✔Pulmonary |and |peritoneal

What |is |the |first |line |treatment |for |ankylosing |spondylitis? |- |correct |answer

|✔NSAIDS

Diarrhea

Confusion

What |are |the |side |effects |of |levodopa |for |Parkinson's? |- |correct |answer

|✔Nausea |and |vomiting

Hypotension

Dyskinesia

Cardiac |dysrhythmias

What |are |the |side |effects |of |dopamine |agonists |for |Parkinson's? |- |correct

|answer |✔Nausea |vomiting

Somnolence

Fatigue

Peripheral |edema

Postural |hypotension

Confusion

Dyskinesias

*rotifotine, |pramipexole, |ropinirole

What |are |the |side |effects |of |MAOIs |for |Parkinson's? |- |correct |answer |✔Nausea

Headache

Confusion

Hallucinations

• |rasagiline, |selegiline, |safinamide

What |are |the |side |effects |of |amantadine |for |Parkinson's? |- |correct |answer

|✔Restlessness

Confusion

Depression

Skin |rashes

Constipation

Anorexia

Postural |hypotension

What |is |the |confirmatory |test |for |HIV? |- |correct |answer |✔HIV |1/ |differentiation |assay

Pneumocystis |jirovenci |is |a |______ |while |Mycobacterium |is |a |______. |- |correct

|answer |✔Fungus; |Bacteria

PJP: |CD4 |< |200, |dry |cough |and |dyspnea; |Bactrim, |dapsone, |clinda |+ |primaquine, |plus |corticosteroids |for |patients |with |PaO2 |< | 70

MAC: |CD4 |< |50, |fever, |night |sweats, |weight |loss, |cutaneous |nodules; |clarithromycin |or |azithromycin

A |common |cause |of |reversible |hearing |loss |in |the |elderly |is: |- |correct |answer

|✔Cerumen |impaction

• |nocturnal |awakening
• |reliever |needed |>/= |2x/week
• |activity |limitation |due |to |asthma

5: |acute |exacerbation

What |are |the |five |steps |of |therapy |for |asthma |according |to |GINA? |- |correct

|answer |✔1: |Low-dose |ICS/rapid-onset |LABA |prn |OR |low-dose |ICS/SABA |prn

2: |Low-dose |ICS/formoterol |prn |OR |low-dose |ICS |daily |with |SABA |prn

3: |Low-dose |ICS/formoterol |daily |and |prn |OR |low-dose |ICS/LABA |daily |and |SABA |prn

4: |Medium-dose |ICS/formoterol |daily |and |prn |OR |medium-dose |ICS/LABA |daily |with |SABA |prn

5: |Medium-dose |ICS/formoterol |daily |and |prn |with |LAMA |daily |OR |Medium- dose |ICS/LABA |and |LAMA |daily |with |SABA |prn

What |are |the |most |common |causes |of |CAP? |- |correct |answer |✔Strep, |Chlamydophila, |and |Mycoplasma |pneumoniae |and |H |flu

What |are |the |most |common |causes |of |HAP? |- |correct |answer |✔GNR: |E. |coli, |Klebsiells |pneumoniae, |Pseudomonas, |Enterobacter, |Acinetobacter |(PEAK-E |coli)

GPC: |Staph |aureus, |Strept |species

How |is |low- |and |high-risk |outpatient |CAP |treated? |- |correct |answer |✔Low: |Amoxicillin, |doxy, |or |macrolide

High: |Amoxicillin |or |cephalosporine |AND |a |macrolide |or |doxy |OR |a |respiratory |fluoroquinolone

How |is |non-severe |and |severe |inpatient |CAP |treated? |What |is |added |for |MRSA

|and |Pseudomonas |coverage? |- |correct |answer |✔Non-severe: |(beta-lactam |+ |macrolide) |OR |fluoroquinolone

Severe: |Beta-lactam |+ |(macrolide |or |fluoroquinolone)

MRSA: |Vancomycin, |linezolid

Pseudomonas: |Zosyn, |cefepime, |imipenem, |or |meropenem

What |antibiotics |are |used |for |lower |risk |HAP? |What |options |are |added |when

|higher |risk? |- |correct |answer |✔Zosyn, |cefepime, |imipenem, |meropenem, |and |levofloxacin

Ceftazidime, |aztreonam

What |antibiotics |are |added |for |HAP |when |at |risk |for |Pseudomonas |or |other

|GNRs? |- |correct |answer |✔Levofloxacin, |ciprofloxacin, |gentamicin, |tobramycin, |aztreonam

What |is |the |difference |between |obstructive |and |restrictive |lung |disease? |-

|correct |answer |✔Obstructive: |ventilation |failure, |leading |to |impaired |CO |elimination; |COPD, |asthma, |bronchiectasis, |and |CF

Parapneumonic:

Tuberculous:

IDSA |recommendations |for |antibiotic |management |- |correct |answer |✔

What |are |some |examples |of |beta-lactams, |macrolides, |fluoroquinolones,

|tetracyclines, |and |aminoglycoside? |- |correct |answer |✔Beta-lactams: |penicillins, |cephalosporins, |and |carbapenems

Macrolides: |erythromycin, |clarithromycin, |azithromycin

Fluoroquinolones: |levo-, |cipro-, |moxi-floxacin

Tetracyclines: |doxycycline

Aminoglycosides: |gentamicin, |tobramycin, |amikacin

What |are |the |s/s |of |lung |abscess |and |the |most |common |cause? |- |correct |answer

|✔Fever, |weight |loss, |malaise

Cough |with |foul-smelling |purulent |sputum

Poor |dentition

Anaerobic

How |do |you |distinguish |between |lung |abscess, |necrotizing |pneumonia, |and

|empyema? |- |correct |answer |✔Abscess: |thick-walled |solitary |cavity |surrounded |by |consolidation |with |a |visible |air-fluid |level

Necrotizing |pneumonia: |multiple |areas |of |cavitation |within |an |area |of |consolidation

Empyema: |presence |of |pleural |fluid

What |is |the |recommended |increasing/decreasing |ventilator |management |and

|protective |lung |volumes |with |ARDS? |- |correct |answer |✔ARDSnet |indicates |stepwise |titration |alternating |10% |FiO2 |and | 2 |of |PEEP |for |a |goal |saturation |of |88-95% |or |PaO2 |55-80 |with |TV |of |6-8ml/kg |of |PBW

Normal |v |abnormal |male |genitalia |- |correct |answer |✔I |don't |know |what |to |say |for |this |one. |Normal |testicles |are |often |slightly |different |sized.

What |are |the |s/s |of |prostatodynia? |- |correct |answer |✔- |Irritative |voiding, |hesitancy, |interruption |of |flow, |or |perineal |or |suprapubic |discomfort |without |a |fever |or |history |of |UTI

• |Lifelong |history |of |voiding |difficulty |common
• |May |have |increased |anal |sphincter |tone |or |periprostatic |tenderness

What |is |the |initial |treatment |for |acute |bacterial |prostatitis? |- |correct |answer

|✔Bactrim

If |severe, |admit |for |IV |ampicillin |and |an |aminoglycoside. |Once |afebrile |for |24- |hours, |switch |to |oral |fluoroquinolone |for |4-6 |weeks.

Consulting |GI |and |urology |- |correct |answer |✔Do |your |own |assessment, |diagnostics, |and |interventions |before |consulting |a |specialty |unless |its |an |emergency

At |what |point |should |you |consult |urology |for |testicular |torsion? |- |correct

|answer |✔Urology |is |always |consulted |for |testicular |torsion. |If |surgical |intervention |is |not |immediately |available, |manual |detorsion |can |be |attempted

Cefotetan |or |cefoxitin |IV |plus |doxy |PO |or |IV |for |10-14 |days

Clinda |and |gent |IV |after |24-48 |hours |of |clinical |improvement |then |oral |clinda |or |doxy |for | 14 |days

For |tubo-ovarian |abscess, |add |metronidazole |or |clinda

What |are |the |s/s, |diagnostics, |and |treatment |for |bacterial |vaginosis? |- |correct

|answer |✔Thin, |milky |white |discharge |with |a |fishy |odor

• |clue |cells

Metronidazole |x | 5 |days |or |clinda |x | 7 |days

What |are |the |s/s, |diagnostics, |and |treatment |for |trichomoniasis? |- |correct

|answer |✔Frothy |grey/yellow/green |malodorous |discharge |with |strawberry |cervix |and |cervical |petechiae

Motile |trichomonads |and |WBCs

Metronidazole |or |tinidazole

How |is |primary |and |secondary |syphilis |distinguished? |- |correct |answer

|✔Primary: |painless |chancre |and |regional |lymphadenopathy

Secondary: |Flu-like |symptoms, |maculopapular |rash, |and |systemic |lymphadenopathy

What |is |the |first |line |treatment |for |UTI |in |pregnant |women |and |what |are |the

|alternatives? |- |correct |answer |✔- |First |line: |Nitrofurantoin/Macrobid |can |be |used |in |the |1st |and |2nd |trimester

• |2nd |line: |Cephalexin |or |amoxicillin

• |No |fluoroquinolones
• |No |sulfonamides |near |delivery

Autosomal |dominant, |autosomal |recessive, |and |x-linked |disorders |are |all |what |kind |of |genetic |disorder?

• |chromosomal
• |mitochondrial
• |single-gene
• |multifactorial |- |correct |answer |✔Single-gene |disorder
• |chromosomal: |extra |or |missing |chromosomes, |large-scale |deletions |or |duplications, |translocations
• |mitochondrial: |maternal |transmission
• |multifactorial: |combination |of |genetics |and |environment

How |is |genomics, |the |study |of |genes |and |their |functions, |used |in

|pharmacology? |- |correct |answer |✔Pharmacogenetics |studies |how |genes |affects |a |person's |response |to |drugs |and |is |used |to |develop |safe, |effective |medications |that |can |be |prescribed |based |on |a |person's |genetic |makeup.

How |is |an |autosomal |dominant |trait |distinguished |from |a |recessive |trait |on |a

|pedigree? |- |correct |answer |✔Dominant |traits |will |not |skip |a |generation, |every |affected |individual |will |have |an |affected |parent

Recessive |traits |can |skip |generations, |unaffected |individuals |can |have |affected |offspring

• |e |antibody |means |CHRONIC |or |PRIOR |INFECTION, |will |always |be |negative |during |the |initial |acute |phase

*** |Surface |antigen, |HBsAg, |is |ONLY |positive |during |active |infection

*** |A |positive |surface |antibody, |anti-HBs, |indicates |IMMUNITY:

• |If |recovery |from |PRIOR |INFECTION, |the |surface |AND |core |antibodies |will |be |positive
• |If |vaccinated, |ONLY |the |surface |antibody |will |be |positive |and |core |will |be |negative

"At |will" |employment |is |best |defined |as: |- |correct |answer |✔A |working |relationship |that |either |party |may |terminate |for |any |reason |at |any |time.

T/F: |In |most |states, |unless |there |is |a |written |contract |defining |the |duration |of

|employment, |employment |is |"at |will." |- |correct |answer |✔True

A |nurse |practitioner |has |been |employed |with |a |heart |failure |clinic |for | 20 |years. |The |nurse |practitioner |resigned |from |her |position |at |the |clinic |in |order |to |open |her |own |heart |failure |clinic. |She |would |like |to |take |her |patients |with |her |to |her |new |clinic, |which |will |be |located |about | 2 |blocks |away. |Before |she |makes |any

|major |moves, |what |piece |of |advice |would |you |give |her? |- |correct |answer |✔The |NP |should |review |her |previous |contract |for |a |restrictive |covenant |in |the |contract.

T/F: |Patient |satisfaction |is |subjective, |therefore |it |cannot |be |reliably |used |to

|evaluate |performance. |- |correct |answer |✔False

A |nurse |practitioners |performance |is |most |often |evaluated |by |all |of |the

|following, |EXCEPT: |- |correct |answer |✔number |of |awards |and |achievements

Nurse |practitioners |must |know |and |follow |the |standards |for |health |maintenance |recommendations |because |an |increase |in |the |demand |for |higher |quality |healthcare |as |well |as |_________ |care, |affects |reimbursement |now |more

|than |ever. |- |correct |answer |✔Preventative

A |nurse |practitioner |has |just |been |hired |for |her |first |job |as |an |NP |at |a |diabetes |clinic. |She |is |in |a |meeting |with |the |manager |and |is |discussing |certain |aspects |of |the |contract. |While |discussing |the |structure |for |bonus-pay, |the |manager |states |that |most |reimbursement |to |the |clinic |is |capitated. |The |NP |immediately |knows |that |under |this |type |of |payment |system |a |_____________ |bonus |system |would

|work |best. |- |correct |answer |✔quality-based

Because |hospitals. |emergency |rooms, |and |specialists |are |high |cost |centers |for |health |plans, |health |plans |want |to |keep |admissions |and |referrals |to |the |emergency |room |and |specialists |at |a |minimum. |This |statement |underlines |the

|concept |of: |- |correct |answer |✔utilization

In |order |to |measure |quality, |a |___________ |must |first |be |set. |- |correct |answer

|✔standard

The |first |step |in |understanding |collaborative |practice |requirements |is |to: |-

|correct |answer |✔Review |the |state |law |regarding |NP |scope |of |practice.

Medical |decision |making |refers |to |the |complexity |of |establishing |a |diagnosis |and/or |selecting |a |management |option. |According |to |The |Centers |for |Medicare

D. |ICD-10 |codes |are |made |up |of |a |maximum |of | 7 |alphanumeric |digits |and

|include |aspects |of |etiology, |location, |and |laterality. |- |correct |answer |✔D. |ICD- 10 |codes |are |made |up |of |a |maximum |of | 7 |alphanumeric |digits |and |include |aspects |of |etiology, |location, |and |laterality.

A |nurse |practitioner |is |precepting |a |new |AGACNP |student |and |they |are |discussing |billing |and |coding. |The |student |asks |what |a |CPT |code |is. |The |NP |explains |that |it |is |vital |that |the |student |understands |what |a |CPT |code |is |because |they |represent:

A. |hospital |visits

B. |Office |visits

C. |procedures |and |services

D. |Medical |diagnoses |- |correct |answer |✔C. |Procedures |and |services

Evaluation |and |management |(E/M) |services |are |billed |using |multiple |aspects |of |the |patient |encounter. |Billing |Medicare |for |E/M |services |requires |the |selection |of |a |code |that |best |represents |all |of |the |following, |EXCEPT:

A. |Presence |of |a |collaborating |physician

B. |Setting |of |service

C. |Patient |type |(new |vs. |established |patient)

D. |Level |of |service |performed |- |correct |answer |✔A. |Presence |of |a |collaborating |physician

An |NP |works |in |an |outpatient |clinic |for |patients |with |advanced |heart |failure. |The |NP |has |finished |the |visit |with |Mr. |Jones |and |he |is |determining |how |he |will

|bill |for |this |encounter. |His |decision |to |bill |for |an |"Incident-To" |visit |is |supported |by |all |of |the |following |statements, |EXCEPT:

A. |During |this |visit |the |NP |followed |up |on |a |plan |of |care |for |the |patient |that |was |initiated |by |the |collaborating |physician

B. |During |this |visit |the |NP |adjusted |the |heart |failure |medications |according |to |the |clinic's |standard |protocol |for |medication |adjustments.

C. |During |this |visit |the |physician |was |present |in |the |office |suite |and |available |for |assistance.

D. |During |this |visit |the |patient |complained |of |new |onset |palpitations, |which

|were |investigated. |- |correct |answer |✔D. |During |this |visit |the |patient |complained |of |new |onset |palpitations, |which |were |investigated.

An |NP |works |in |an |outpatient |clinic |for |patients |with |diabetes. |The |NP |has |finished |her |visit |with |Mrs. |Jones |and |she |is |determining |how |she |will |bill |for |this |encounter. |The |NP's |decision |to |bill |Medicare |for |a |"split-shared" |visit |is |best |supported |by |the |fact |that:

A. |The |NP |called |the |physician |at |the |other |clinic |location |and |asked |for |assistance |with |decision |making |for |this |patient's |case.

B. |If |the |NP |bills |independently |she |will |only |get |reimbursed |at |85% |of |the |physician |rate

.C. |Both |the |NP |and |the |physician |performed |a |portion |of |the |visit |and |documented |those |portions.

D. |Medicare |will |reimburse |at |100% |for |this |visit |if |billed |using |the |physicians

|NPI |number. |- |correct |answer |✔C. |Both |the |NP |and |the |physician |performed |a |portion |of |the |visit |and |documented |those |portions.