1. Which assessments of care providers are performed as part of the Value Based Purchasing
initiative?
Select all that apply.
a. Appraising costs per
... [Show More] case of care for Medicare patients
b. Assessing patients’ satisfaction with hospital care
c. Evaluating available evidence to guide clinical care guidelines
d. Monitoring mortality rates of all patients with pneumonia
e. Requiring advanced IT standards and minimum cash reserves
ANS: A, B, D
Value Based Purchasing looks at five domain areas of processes of care, including efficiency of
care (cost per case), experience of care (patient satisfaction measures), and outcomes of care
(mortality rates for certain conditions. Evaluation of evidence to guide clinical care is part of
evidence-based practice. The requirements for IT standards and financial status are part of
Accountable Care Organization standards. REF: Value Based Purchasing
2. What was an important finding of the Advisory Board survey of 2014 about primary care
preferences of patients?
a. Associations with area hospitals
b. Costs of ambulatory care
c. Ease of access to care
d. The ratio of providers to patients
ANS: C
As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to care,
walk-in settings and the ability to be seen within 30 minutes, and care that is close to home.
Associations with hospitals, costs of care, and the ratio of providers to patients were not part of
these results. REF: The New Look of Primary Care
3. A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated
as a Level 1 ACO. What is part of this designation?
a. Bonuses based on achievement of benchmarks
.
b. Care coordination for chronic diseases
c. Standards for minimum cash reserves
d. Strict requirements for financial reporting
ANS: A
A Level 1 ACO has the least amount of financial risk and requirements, but receives shared savings
bonuses based on achievement of benchmarks for quality measures and expenditures. Care
coordination and minimum cash reserves standards are part of Level 2 ACO requirements. Level
3 ACOs have strict requirements for financial reporting. REF: Accountable Care Organizations
Test Bank 2
Chapter 2: Transitional Care
Test Bank
Multiple Choice
1. To reduce adverse events associated with care transitions, the Centers for Medicare and
Medicaid Service have implemented which policy?
a. Mandates for communication among primary caregivers and hospitalists
b. Penalties for failure to perform medication reconciliations at time ofdischarge
c. Reduction of payments for patients readmitted within 30 days after discharge
d. Requirements for written discharge instructions for patients and caregivers
ANS: C
As a component of the Affordable Care Act, the Centers for Medicare and Medicaid Service
developed the Readmissions Reduction Program reducing payments for certain patients readmitted
within 30 days of discharge. The CMS did not mandate communication, institute penalties for
failure to perform medication reconciliations, or require written discharge instructions. REF:
Transitional Care
2. According to Naylor’s transitional care model, which intervention has resulted in lower costs
and fewer rehospitalizations in high-risk older patients?
a. Coordination of post-hospital care byadvanced practice nurses
b. Frequent post-hospital clinic visits with a primary care provider
c. Inclusion ofextended family members in the outpatient plan of care
d. Telephone follow up bythe pharmacist to assessmedication compliance
ANS: A
Naylor’s transitional care model provided evidence that high risk older patients who had posthospital care coordinated by an APN had reduced rehospitalization rates. It did not include clinic
visits with a primary care provider, inclusion of extended family members in the plan of care, or
telephone follow up by a pharmacist. REF: Transitional Care
3. Which approaches are among those recommended by the Agency for Healthcare Research
and Quality to improve health literacy in patients?
Select all that apply.
a. Empowering patients and families
b. Giving written handouts for all teaching
.
c. Highlighting no more than 7 key points
d. Repeating the instructions
e. Supplementing teaching with visual aids
ANS: A, D, E
AHRQ recommends using clear, simple language, highlighting 3 to 5 key points, using pictures or
visual aids, repeating the instructions, using Teach Back, and empowering patients. Written
communication is not part ofthe recommendations. REF: Health Literacy
Test Bank 2
Chapter 3: Translating Research Into Clinical Practice
Test Bank
Multiple Choice
1. Which is the most appropriate research design for a Level III research study?
a. Epidemiological studies
b. Experimental design
c. Qualitative studies
d. Randomized clinical trials
ANS: B
The experimental design is the most appropriate design for a Level III study. Epidemiological
studies are appropriate for Level II studies. Qualitative designs are useful for Level I studies.
Randomized clinical trials are used for Level IV studies. REF: Level III Research/Experimental
Design
2. What is the purpose of clinical research trials in the spectrum oftranslational research?
a. Adoption of interventions and clinical practices into routine clinical care
b. Determination ofthe basis of disease and various treatment options
c. Examination ofsafety and effectiveness of various interventions
d. Exploration offundamental mechanisms of biology, disease, or behavior
ANS: C
Clinical research trials are concerned with determining the safety and effectiveness of
interventions. Adoption of interventions and practices is part of clinical implementation.
Determination of the basis of disease and treatment options is part of the pre-clinical research phase.
Exploration of the fundamental mechanisms of biology, disease, or behavior is part of the basic
research stage. REF: Translational Science Spectrum
3. What is the purpose ofLevel II research?
a. To define characteristics of interest of groups of patients
b. To demonstrate the effectiveness of an intervention ortreatment
c. To describe relationships among characteristics or variables
d. To evaluate the nature ofrelationships between two variables
ANS: C
.
Level II research is concerned with describing the relationships among characteristics or variables.
Level I research is conducted to define the characteristics of groups of patients. LevelII research
evaluates the nature of the relationships between variables. Level IV research is conducted to
demonstrate the effectiveness of interventions or treatments. REF: Level II Research
Test Bank 2
Chapter 4: The Patient, the Provider, and Primary Care: An Integrated Perspective
Test Bank
Multiple Choice
1. A patient takes glucosamine chondroitin to help control osteoarthritis pain. Which
medications, taken in conjunction with this medication, are of concern?
a. Anticholinergic drugs
b. Beta blocker medications
c. Blood-thinning agents
d. Narcotic analgesics
ANS: C
Glucosamine chondroitin can prolong bleeding if taken with other blood-thinning agents. It does
not have anticholinergic effects, cardiac effects or analgesic effects. REF: Alternative Therapies for
Common Chronic Conditions/Joint Pain
2. The provider learns that a patient is taking herbal supplements for a variety of reasons. What
is an important point to discuss with this patient about taking such supplements?
a. Because they are not FDA approved, they are not safe
b. Dietary supplements are safer than most prescription medications
c. Many supplements lack clear clinical evidence ofefficacy
d. Supplements should not be taken with prescription medications
ANS: C
Many dietary supplements lack clinical evidence to support their use. Even though they are not
FDA approved, federal law mandates that the products are safe and cannot make misleading claims
about use. Supplements are not necessarily safer than prescription drugs. Supplements may be
taken with prescription medications as long as the effects, side effects, and drug interactions are
known. REF: Alternative Therapies for Common Chronic Conditions
3. Which dietary supplements have shown some effectiveness in reducing blood pressure in
patients with hypertension?
Select all that apply.
a. Chromium picolinate
b. Cinnamon
c. CoQ10
.
d. Garlic extract
e. L-arginine
ANS: C, D, E
CoQ10, garlic extract, and L-arginine have demonstrated effectiveness in reducing blood pressure
in some studies. Chromium picolinate and cinnamon have been studied for effects on glucose
tolerance and fasting glucose. REF: Alternative Therapies for Common Chronic
Conditions/Prehypertension and Hypertension
Test Bank 2
Chapter 5: Population-Based Care for Primary Care Providers
Test Bank
Multiple Choice
1. Which are key components ofthe Patient-Centered Medical Home?
Select all that apply.
a. Access to care
b. Comprehensive care
c. Coordination of care
d. Provision of care by a single provider
e. Storage ofmedical records
ANS: A, B, C
The Patient-Centered Medical Home is a team-based approach to providing care that is accessible,
comprehensive, coordinated, longitudinal and high quality. It is not provided by a single provider,
but is managed as a team. The original concept had to do with where medical records are stored,
but this is not the working definition today. REF: The Patient-Centered Medical Home
2. The chronic care model (CCM) was developed to manage patients with complicated chronic
conditions because the traditional acute care model
a. could not provide efficient and cost-effective chronic care.
b. did not meet longitudinal health careneedsfor this population.
c. did not offer ambulatory care services for these patients.
d. put patients and families at the center of care.
ANS: B
The chronic care model was developed based on the recognition that the traditional acute care
model did not meet longitudinal health care needs of patients with chronic and complicated
conditions, not because of inefficiencies or costs. The traditional model does include ambulatory
care, but that is not the focus. The traditional model does not typically place patients at the center
of care. REF: Chronic Care Model
3. What are functions ofpatient registries in the chronic care model?
Select all that apply.
a. Alerting providers to medication interactions
.
b. Identifying appropriate specialists for referral
c. Recommending routine screenings
d. Reminding providers about immunizations
e. Transmitting clinical dataabout patients
ANS: A, C, D, E
Patient registries are used to help manage patients at risk and include alerting providers about
medication interactions, recommending routine screenings, reminders for immunizations, and
transmitting clinical data. They are not used to identify or recommend providers or specialists.
REF: Chronic Care Model/Clinical Information Systems
Test Bank 2
Chapter 6: Health Literacy, Health Care Disparities, and Culturally Responsive Primary
Care
Test Bank
Multiple Choice
1. A primary care provider administers the ―Newest Vital Sign‖ health literacy test to a patient
newly diagnosed with a chronic disease. What information is gained by administering this test?
a. Ability to calculate data, along with general knowledge about health
b. Ease ofusing technology and understanding of graphic data
c. Reading comprehension and reception oforal communication
d. Understanding of and ability to discuss health care concerns
ANS: A The ―Newest Vital Sign‖ tests asks patients to look at information on an ice cream container
label and answer questions that evaluate ability to calculate caloric data and to grasp general
knowledge about food allergies. It does not test understanding of technology or directly measure
reading comprehension. It does not assess oral communication. The ―Ask Me 3‖ tool teaches
patients to ask three primary questions about their health care and management. REF: Health
Literacy Assessment
2. A female patient who is from the Middle East schedules an appointment in a primary care
office. To provide culturally responsive care, what will the clinic personnel do when meeting
this patient for the first time?
a. Ensure that she is seen by a female provider
b. Include a male family member in discussions about health care
c. Inquire about the patient’s beliefs about health and treatment
d. Research middle eastern cultural beliefs about health care
ANS: C
It is important not to make assumptions about beliefs and practices associated with health care and
to ask the patient about these. While certain practices are common in some cultural and ethnic
groups, assuming that all members of those groups follow those norms is not culturally responsive.
REF: Address Cultural Variations Among Diverse Patient Groups
3. What is the main reason for using the REALM-SF instrument to evaluate health literacy?
a. It assesses numeracy skills.
.
b. It enhances patient-provider communication.
c. It evaluates medical word recognition.
d. It measures technology knowledge.
ANS: C
The REALM-SF is an easy and fast tool that measures medical word recognition. It does not
evaluate numeracy. The ―Ask Me 3‖ tool enhances patient-provider communication. This tool
does not evaluate understanding oftechnology. REF: Health Literacy Assessment
Test Bank 2
Chapter 7: Genetic Considerations in Primary Care
Test Bank
Multiple Choice
1. A patient expresses concern that she is at risk for breast cancer. To best assess the risk for
this patient, what is the best initial action?
a. Ask if there is a family history of breast cancer
b. Gather and record a three-generation pedigree
c. Ordera genetic test for the breast cancer gene
d. Recommend direct-to-consumer genetic testing
ANS: B
The three-generation pedigree is the best way to evaluate genetic risk. Asking about a family history
is not a systematic risk assessment and doesn’t specify who in the family has the historyor whether
there is a pattern. Genetic testing and DTC genetic testing are not the initial actions when assessing
genetic risk. REF: Gathering a Family History
2. A patient asks about direct-to-consumer (DTC) genetic testing. What will the provider tell
the patient?
a. It is not useful for identifying genetic diseases.
b. Much ofthe information does not predict disease risk.
c. The results are shared with the patient’s insurance company.
d. The results must be interpreted by a provider.
ANS: B
DTC testing gives a lot of information, but much of it does not contribute to disease prediction,
since mutations are not necessarily related to specific diseases. The tests are useful, but must be
interpreted accurately. The results are confidential and do not have to be i [Show Less]