Mock exam 1 practice questions with complete answers /graded A+/LATEST/24/25, Exams of Nursing

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Mock exam 1 practice questions with complete

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1. A 16-year-old male was treated at your facility for a closed head injury. The patient's 18-year-old wife accompanied him to the hospital and signed the consent for admission and treatment because of the patient's incapacity at the time. The patient has requested that copies of his medical records be sent to his attorney. Who should sign the authorization to release the records? the patient's wife the patient the patient's parent or legal guardian either of the patient's parents: the patient The patient must authorize the release of his records since he is an emancipated minor by marriage. 2. An 11-year-old female is brought to the emergency room with a compound, comminuted fracture of the right tibia and fibula. Her mother was very serious- ly injured in the same accident and is unconscious. What should be done? The hospital should quickly seek a court-appointed guardian for the child. Nothing, until consent can be obtained from the nearest relative. The mother can be treated under implied consent but not the child. Both patients can be treated under implied consent.: Both patients can be treated under implied consent. Even though the mother is not able to give expressed consent for treatment, permission is implied when the provider is acting in the patient's best interest to prevent death or preserve a limb. 3. The coder works 7.5 hours per day. If a time standard is determined from sample observations to be 2.50 minutes per record for coding emergency room records, what is the daily standard for the number of records coded when a 15% fatigue factor is allowed? 192 records per day 180 records

ween per day 153 records per day 200 records per day: 153 records per day Calculation:7.5 hours x 60 minutes per hour = 450 minutes per day450 x 15% = 67.5450 67.5 = 382.5382.5/2.5 = 153

4. The ER staff has collected the data on the number of visits and correspond- ing wait times in the ER. The data are displayed on the chart shown above. Based on this information, what kind of correlation do you see between the number of visits (Variable X) and the wait times (Variable Y)? a negative correlation between Variable X and Variable Y a positive correlation between Variable X and Variable Y a causative correlation between Variable X and Variable Y a conjunctive correlation between Variab: a positive correlation bet X and Variable Y Scatter diagrams display the strength of relationship between two variables. A strong relationship is seen as the data come closer to forming a straight line. When both variables increase and decrease at the same time, and the line progresses from the lower left toward the upper right corner, a positive relationship is demonstrated. 5. Mary is 6 weeks post-mastectomy for carcinoma of the breast. She is admitted for chemotherapy. What is the correct sequencing of the codes? {C50.911 Malignant neoplasm of unspecified site of right female breast Z85.3 Personal history of malignant neoplasm of breast Z51.11 Encounter for antineoplastic chemotherapy Z08 Encounter for follow-up examination after completed treatment for malig- nant neoplasm} Z08, Z51. Z51.11, Z85.3 Z85. Z51.11, C50.911: Z51.11, C50. The cancer is coded as a current condition as long as the patient is

receiving adjunct therapy.See the Official Guidelines for Coding and Reporting 2018, Section 1.c.2.d. Primary malignancy previously excised "When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy."

6. The file clerks in your department's main file area report that they are able to locate 400 out of 450 requested records during the past month. There are a total of 4,500 records in the main file. What is the area's accuracy rate? 1.1% 88.9% 8.9% 10.0%: 88.9% 400 / 450 = 0.888888 x 100 = 88.9% 7. You have received a valid patient authorization and subpoena duces tecum requesting the custodian of records to appear in court with all records kept in the normal course of business. In reviewing the request and the master patient index, you validate that the patient was treated at your facility on the date referenced in the request. When preparing the records, you must consider the organization's definition of: Hybrid Record Legal Health Record Designated Record Set Metadata: Legal Health Record The legal health record is released upon a valid request and the contents may vary based on how the organization defines it. It may include information other than clinical documents, such as radiological images, videos, or photographs. The designated record set is defined by HIPAA as a covered entity's health records and records involved in billing, insurance, enrollment, coverage and any other documents used to make decisions about individuals. All documents and data must be evaluated for designation as the legal health record and/or designated

record set.

8. According to CPT, a biopsy of the breast that involves removal of only a portion of the lesion for pathologic examination is percutaneous. punch. excisional. incisional.: incisional. An incisional biopsy is cutting of breast tissue where a small portion or slice of a lesion is removed. 9. The Pharmacy and Therapeutics Committee has asked you to find out more about a computerized order entry system that calculates drug dosages based on patient parameters (weight, age, etc.) and even suggests the best drug

given the patient's diagnosis and current treatment. The committee is asking for information on a(n) clinical decision support system. practice parameters system. ordering system. application system.: clinical decision support system. Knowledge-based components of a clinical decision system include: (1) a knowl- edge-based system that provides facts, or evidence, concerning a domain of knowl- edge; (2) production rules that are a generic set of "if..then.." structures, or rules that draw from the knowledge base; (3) an inference engine, which is the software that controls how the rules are applied to specific facts about the patient; and (4) the user interface.

10. Four patients were discharged from Crestview Hospital yesterday. A final progress note is an appropriate discharge summary for Jackson, who had no comorbidities or complications during this admission for replacement of a pacemaker battery. Babson, who delivered a healthy 8-pound boy without complications for either mother or child, and was discharged within 36 hours of admission. Fieldstone, who was admitted for 5 days following a heart attack for the acute onset of chest pain. Howard, who died: Babson, who delivered a healthy 8-pound boy without compli- cations for either mother or child, and was discharged within 36 hours of admission. Joint Commission standards allow a final progress note to substitute for a discharge summary in the following three cases: uncomplicated OB patient, normal newborn, and a minor stay of less than 48 hours. The Babson admission is the only one that qualifies. 11. The correspondence section of your department receives an average of 50 requests per day for release of information. It takes an average of 30 minutes to fulfill each request. Using 6.5 productive hours per day as your standard, calculate the staffing needs for the correspondence section. 2.5 FTE 3.5 FTE

3 FTE

4 FTE: 4 FTE

Calculation: 50 x 30 = 1,5001,500/60 = 2525/6.5 = 3.8Round up to 4.

12. Which of the following is a voluntary process of institutional or organiza- tional review in which a quasi-independent body periodically evaluates the quality of the entity's work against pre-established criteria, such as Informa- tion Management or Environment of Care criteria? Accreditation Conditions for coverage Licensing Regulatory authorization: Accreditation Accreditation is a voluntary process or institutional or organizational review that evaluates the quality of the entity's work against preestablished criteria. Organiza- tions seek accreditation to prove that they meet the standards of legitimate and appropriate medical practice. 13. As the director of a Health Information Technology Program, you are reviewing the workforce development forecast for electronic health record specialists as outlined by ARRA and HITECH. In order to keep abreast of changes in this program, you will need to regularly access the website of which governmental agency? CMS OSHA CDC ONC: ONC The Office of the National Coordinator for Health Information Technology (ONC) produced a federal Health IT Strategic Plan that includes three major focus areas with the intent to collect patient- generated data, share information more effectively with patients, and use technology and data to improve population health. 14. The patient's family asked the attending physician to keep the patient in the hospital for a few days more until they could make arrangements for the patient's home care. Because the patient no longer meets criteria for continued stay, if the physician complies with the family's request, this would be considered

the best utilization of the hospital's resources. an underutilization of the hospital's resources

appropriate provided it is limited to a few days. an inappropriate use of hospital reso: an inappropriate use of hospital resources. The necessity for inpatient hospitalizations and continued stays are strictly regulated by intensity of service and severity of illness criteria which indicate services that can be provided only at an acute level of care. To keep a patient hospitalized for reasons not tied to these criteria would indicate an overutilization of hospital resources and likely, a denial of reimbursement.

15. Which of these conditions are always considered "present on admission" (POA)? acute conditions congenital conditions possible, probable, or suspected conditions E codes: congenital conditions As required by the Deficit Reduction Act of 2005 (DRA), the HAC-POA Indicator Reporting provision requires a quality adjustment in Medicare Severity-Diagno- sis Related Group (MS-DRG) payments for certain hospital-acquired conditions (HACs). IPPS hospitals must submit present on admission (POA) information on principal and all secondary diagnoses for inpatient discharges. IPPS hospitals do not receive the higher payment for cases when one of the selected conditions is acquired during hospitalization (i.e., the condition was not POA). The case is paid as though the secondary diagnosis is not present. Hospitals must identify the conditions that are present on admission to receive appropriate reimbursement. A congenital condition is present at birth and would therefore be present on any subsequent admission. 16. Patient was seen in the Emergency Department with lacerations on the left arm. Two lacerations, one 7 cm and one 9 cm, were closed with layered sutures. {12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet); 2.6-7.5 cm 12004 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet); 7.6-12.5 cm 12035 Repair, intermediate, of wounds of: 12035

The sizes of the layered wound repairs of the same body area are added together in order to select the correct CPT code.

17. You have been asked to report the registry's annual caseload to adminis- tration. The most efficient way to retrieve this information would be to use patient index. patient abstracts. accession register. follow-up files.: accession register. When a case is first entered into the cancer registry, an accession number is as- signed. The unique number is assigned to the patient (not the tumor). The accession number provides a unique identifier for the patient consisting of the year in which the patient was first seen at the reporting facility and the consecutive order in which the patient was abstracted. The first four numbers specify the year, and the last five numbers are the numeric order the patient was entered into the registry database. There is only one accession number per patient, per facility, and per lifetime. A patient's accession number is never reassigned. 18. A run or line chart would be most useful for collecting data on waiting time in the Pediatrics Clinic over a 6-month period. a possible relationship between 2 variables. medication errors and their causes. patient satisfaction with the food.: waiting time in the Pediatrics Clinic over a 6-month period. Run charts are best used to track data points over time, such as wait time in a Pediatrics Clinic over several months. 19. You are the office manager at a large group practice. One of the physicians at your practice has asked you to research and supply her with information about Medicare's newest payment incentives and how to comply with the quality reporting requirements. You will bring this inquisitive physician facts from CMS regarding Merit-based Incentive Payment System (MIPS) Physician Quality Reporting System (PQRS) diagnosis related groups (DRGs) Stage 2 of meaningful use requirements: Merit-based Incentive Payment System (MIPS)

The Merit-Based Incentive Payment System (MIPS) is one of two tracks under

the Quality Payment Program, which moves Medicare Part B providers to a per- formance-based payment system. MIPS streamlines three historical Medicare pro- grams—the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM) Program, and the Medicare Electronic Health Record (EHR) Incentive Program ( Meaningful Use)—into a single payment program. All Medicare Part B providers who meet the definition of a MIPS Eligible Clinician should plan to participate in MIPS in 2017, or they will be subject to a negative 4% payment adjustment on Medicare Part B reimbursements in 2019.

20. In conducting an educational session for your staff about implementing a benchmarking program, you tell your staff that when an organization uses benchmarking, it is important to compare your facility's outcomes to nationally known facilities. larger facilities. facilities with superior performance. facilities within your corporation.: facilities with superior performance. Benchmarking occurs when an organization uses comparative data between orga- nizations to judge performance and identify improvements to be successful in other organizations. 21. Patient is admitted for elective cholecystectomy for treatment of chronic cholecystitis with cholelithiasis. Prior to administration of general anesthesia, patient suffers cerebral thrombosis. Surgery is subsequently canceled. Code and sequence the coding from the following codes. {I66.9 Occlusion and stenosis of unspecified cerebral artery K80.10 Chronic cholecystitis with chronic cholelithiasis without obstruction Z53.09 Procedure and treatment not carried out because of other contraindi- catio: K80.10, I66.9, Z53. The INCLUDES notation beneath I66 informs you that cerebral thrombosis is report- ed with a code from this code category. 22. Which of the following best describes a goal of a CDI program? -Identify and clarify missing, conflicting, or nonspecific provider documenta- tion related to diagnosis and procedures -Utilize open-ended or multiple-choice queries as a communication tool with

providers to obtain clinical clarification, documentation alert, or ask additional questions.

-Utilize computer-assisted coding (CAC) software to search and evaluate clini- cal documentation to identify potential areas for documentation integri: dentify and clarify missing, conflicting, or nonspecific provider documentation related to diagnosis and procedures The goals of a CDI program are: -Obtain specific documentation that can be used to identify the patient's severity of illness. -Identify and clarify missing, conflicting, or nonspecific provider documentation related to diagnosis and procedures. -Support accurate diagnostic and procedural coding, and Medicare Severity Diag- nosis Related Group (MS-DRG) assignment, leading to appropriate reimbursement. -Promote health record completion during the patient's course of care, which pro- motes patient safety. -Improve communication between physicians and other members of the health care team. -Provide awareness and education. -Improve documentation to reflect quality and outcome scores. -Improve coding professional's clinical knowledge.

23. Which of the following is coded as an adverse effect in ICD-10-CM? rejection of transplanted kidney nonfunctioning pacemaker due to defective soldering mental retardation due to intracranial abscess tinnitus due to allergic reaction after administration of eardrops: tinnitus due to allergic reaction after administration of eardrops An allergic reaction is an adverse effect to medication properly administered. 24. You are conducting an educational session on benchmarking.You tell your audience that the key to benchmarking is to use the comparison to implement your QI process. compare your department with another. improve your department's processes. make recommendations for improvement.: improve your department's

process- es. Benchmarking involves comparing your department to other departments or organi- zations known to be excellent in one or more areas. The success of benchmarking

involves finding out how the other department functions and then incorporating their ideas into your department.

25. A patient with lung cancer and bone metastasis is seen for complex treatment planning by a radiation oncologist. {77263 Therapeutic radiology treatment planning; complex 77290 Therapeutic radiology simulation-aided field setting; complex 77315 Teletherapy, isodose plan (whether hand or computer calculated); com- plex (mantle or inverted Y, tangential ports, the use of wedges, compensators, complex blocking, rotational beam, or special beam considerations) 77334 Treatment devices, design and const: 77263 Code 77263 for complex therapeutic radiology treatment planning. No indication of simulation-aided field, teletherapy, or treatment devices. 26. Patient was seen for excision of two interdigital neuromas from the left foot. 28080 Excision, interdigital (Morton) neuroma, single, each 64774 Excision of neuroma; cutaneous nerve, surgically identifiable 64776 Excision of neuroma; digital nerve, one or both, same digit 64774 28080 64776 28080, 28080: 28080, 28080 Look up in CPT codebook index under foot, neuroma. 27. An HIM Department Budget Report for May shows a payroll budget of $25,000 and an actual payroll expense of $22,345. The percentage of budget variance for the month is $265. $2,655. 11%. 0.9%.: 11%. A budget variance is the difference between the budgeted amount and

the amount actually spent. To determine the percent variance, subtract the budgeted amount from the actual amount and then divide the difference by the budgeted amount.

Calculation: 25,000 - 22,345 = 2, 2,655 / 25,000 = 0.1062 x 100 = 10.62%, rounds to 11%

28. As the information security officer at your facility, you have been asked to provide examples of technical security safeguards as required of HIPAA Security Rule. Which of the following would you provide? audit controls surge protectors workstation use and location evidence of security awareness training: audit controls Under the Security Rule, technical safeguards include automatic log off and unique user identification to protect access and control of ePHI. 29. Your HMO manager has requested a report on the number of patient visits per year for preschool children. Which of the age groupings below will you use for your report? 0-2 years 3-4 years 5 years

12 months 12-24 months 25-37 months 38-50 months <51 months 0-1 year 1-2 years 2-3 years 3-4 years 4-5 years <12 months 12-24 months 25-37 months 38-50 months 51-63 months: <12 months 12-24 months 25-37 months 38-50 months 51-63 months A grouped frequency distribution shows the values that a variable can take and the number of observations associated with each value. The data are sorted and separated into groups called classes. There are typically 5 to 20 classes are used, but in any case, make sure that you use enough classes to give a good description of the data. The classes must be mutually exclusive (non-overlapping). This means that there is no way that any of the data could fall into two different classes at once. The classes must be continuous—this means that there

can be no gaps in the classes. The classes must be exhaustive, meaning that there must be a class for every data value in the data set. Lastly, the classes must be of equal width, otherwise

the distribution would give a distorted view of the data. This frequency distribution is mutually exclusive, continuous, exhaustive, and equal.

30. Establishing a data strategy and policies for managing structured and unstructured data within the organization are a component of: Information Governance EHR Governance Documentation Governance Data Governance: Data Governance Information Governance is the framework to manage information through its life-cy- cle within an organization. This framework focuses on the proper use and application of information. Data governance is the overarching authority that ensures the cohe- sive operation and integration of all information. This includes the formal structure with the authority and responsibility to establish a data structure and policies for managing structured and unstructured data within the organization. 31. The decision makers in the HIM department have decided to use the decision analysis matrix method to select coding software. Use of this method will help ensure the level of software support will be considered in the decision. consistent criteria are used to evaluate the alternatives/vendors. the personalities of individual vendors will not influence the decision. all alternatives/vendors are evaluated subjectively.: consistent criteria are used to evaluate the alternatives/vendors. A data matrix analysis helps organize information to make a decision by listing options as rows in a table and the factors as columns. Then a ratings scale is established to assess the value of each option/factor combination to determine a score for each option. 32. A union campaign is being conducted at your facility. As a department manager, it is appropriate for you to tell employees that you need the names of those involved in union activities. you are opposed to the union. wages will increase if the union is defeated. a strike is inevitable if the union wins.: you are opposed to the union.

Management has both the right and obligation to tell employees that the organi-

zation does not believe that union representation is in their best interest and to encourage them to vote no on the ballot. They also should answer employee's questions honestly and assure the commitment of the organization to provide high quality care in a desirable working environment and culture for employees. They should also explain that if they choose to recognize the union, any improvements in wages, benefits, and working conditions will be subject to negotiation and are not guaranteed. Management is not permitted to interrogate individual employees about their union activities. They cannot threaten, coerce, or intimidate employees because of their union support. They may not make specific promises contingent on the outcome of the election or offer unilateral improvements in wages, benefits, or working conditions during the election campaign.Management has both the right

33. You stop by the office to meet a friend for lunch. Looking on her desk, you see the grid above. Your friend is trying to design a system. plan a conversion. make a decision. analyze a workflow.: make a decision. A data matrix analysis helps organize information to make a decision by listing options as rows in a table and the factors as columns. Then a ratings scale is established to assess the value of each option/factor combination to determine a score for each option. 34. Incomplete abortion complicated by excessive hemorrhage; dilation and curettage performed. Code the diagnoses using ICD-10-CM and procedures using ICD-10-PCS. {D62 Acute posthemorrhagic anemia O03.1 Delayed or excessive hemorrhage following incomplete spontaneous abortion O03.6 Delayed or excessive hemorrhage following complete or unspecified spontaneous abortion O03.4 Incomplete spontaneous abortion without complication 10D17ZZ Extraction, retained products of conception, via natural

opening 0: O03.1, 10D17ZZ O03 is reported for a spontaneous abortion. A spontaneous abortion may be complete or incomplete. The coding manual needs to be referenced for the assigning codes according to the types of complications.

35. RHIT Mock Examination (Untimed) Your Score: 58%87 Correct out of 150Question 35 of 150 The Chief of Staff, Chief of Medicine, President of the Governing Body, and most departmental managers have already completed CQI training. Unfor- tunately, the hospital administrator has not been to training, refuses to get involved with CQI, and refuses to let the administrative departmental staff get training. If you can talk him into training his staff, you can let him skip the training. This level of invol: This will not do because it violates Joint Commission standards and CQI philosophy Acceptance of the CQI philosophy must funnel down from the top to truly permeate the organization's culture. Executive leadership must communicate a clear vision and mission statement that every employee can understand and share. 36. A Clinical Documentation Specialist performs many duties. These include reviewing the data, and looking for trends or patterns over time, as well as noting any variances that require further investigation. In this role, the CDS professional is acting as a(n) ambassador. reviewer. educator. analyst.: analyst. The CDS professional may act as a reviewer and educator, but the duties described are most representative of his or her role as an analyst. Ambassador is a distractor. A CDI analyst conduct ongoing analyses of clinical documentation while providing extensive collaboration with physicians, nursing staff, other patient caregivers, and medical records coding staff to improve quality and completeness of documentation of care provided and coded. 37. You are creating an inventory of all template forms within the electronic health record. You come across an unnamed template in the OB section that includes a checklist for assessing an obstetric patient's lochia, fundus, and perineum. The document type you give to this form is