PRIMCAREFAM1FINALEXAM
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Questions and Answers

What is defined as continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities?

  • Secondary care
  • Tertiary care
  • Primary prevention
  • Primary care (correct)

Which of the following is NOT one of the core competencies for Advanced Practice Registered Nurses (APRNs)?

  • Population Health
  • Quality and Safety
  • Professionalism
  • Clinical Research Methods (correct)

Which aspect of nursing involves the intentional and authentic presence of the nurse with another person?

  • Clinical assessment
  • Patient education
  • Technical skills
  • Caring (correct)

What is the purpose of the 'incident to' billing in relation to APRNs?

<p>It signifies care provided under the supervision of a physician. (A)</p> Signup and view all the answers

Which factor is a common barrier to the successful implementation of Healthy People 2030?

<p>Insufficient data to evaluate progress (C)</p> Signup and view all the answers

What does the Circle of Caring Model emphasize in nursing practice?

<p>Generalized patterns of nursing care (B)</p> Signup and view all the answers

Which theme is essential for the future success of nursing practices?

<p>Full participation of nurses in practice, education, and leadership (B)</p> Signup and view all the answers

How are reimbursement standards influenced within the United States healthcare system?

<p>Primarily by insurance companies, including Medicare and Medicaid (D)</p> Signup and view all the answers

Who is eligible to be chosen as your healthcare agent?

<p>Anyone over 18, excluding your doctor (D)</p> Signup and view all the answers

What is one benefit of having a healthcare POA?

<p>Ensures care is in line with your wishes (C)</p> Signup and view all the answers

Which of the following is NOT a component that a living will can specify?

<p>Choice of attending physician (A)</p> Signup and view all the answers

What is the main purpose of a healthcare proxy?

<p>To make medical decisions on your behalf (A)</p> Signup and view all the answers

What does it mean for a POA to be durable?

<p>It continues even if the person cannot communicate (A)</p> Signup and view all the answers

Which of these statements about living wills is true?

<p>Living wills can ensure care preferences are known (B)</p> Signup and view all the answers

When considering a living will, what is important to discuss with family members?

<p>Specific medical situations and wishes (A)</p> Signup and view all the answers

Multiple agents can be appointed for a healthcare POA for which purpose?

<p>To allow for different decisions for different purposes (D)</p> Signup and view all the answers

What is a common type of Medicare Advantage plan that requires members to use a network of doctors?

<p>Health maintenance organization (HMO) plans (A)</p> Signup and view all the answers

What income eligibility method for Medicaid does the ACA use?

<p>Modified Adjusted Gross Income (MAGI) (D)</p> Signup and view all the answers

Which group of individuals is exempt from meeting the MAGI requirements for Medicaid eligibility?

<p>Citizens who are blind or disabled (C)</p> Signup and view all the answers

What happens if a Medicare Advantage plan's payout exceeds its annual fixed payment from CMS?

<p>The plan incurs a loss and may leave the market. (A)</p> Signup and view all the answers

How does Medicaid make payments for medical services?

<p>Payments are made directly to healthcare providers. (B)</p> Signup and view all the answers

What is one of the exceptions to the rule that providers must accept Medicaid payments as payment in full?

<p>Disproportionate-share hospital payments (D)</p> Signup and view all the answers

Which group of people qualifies for Medicaid assistance?

<p>Individuals with chronic disabilities (C)</p> Signup and view all the answers

What aspect of Medicaid has been a discussed focus of lawmakers?

<p>Putting more control in the hands of each state (D)</p> Signup and view all the answers

What is the first-line treatment for gonorrhea infection?

<p>IM Ceftriaxone single dose (C)</p> Signup and view all the answers

Which of the following symptoms are associated with a male gonorrhea infection?

<p>Pus-like discharge from the tip of the penis (B)</p> Signup and view all the answers

What is a common risk factor for erectile dysfunction?

<p>Diabetes (C)</p> Signup and view all the answers

How should HPV be treated in men?

<p>Cryotherapy or topical agents (D)</p> Signup and view all the answers

Which method is NOT a form of testing for Chlamydia?

<p>Physical examination for lesions (D)</p> Signup and view all the answers

What is the recommended antibiotic regimen for treating Chlamydia?

<p>Doxycycline 100 mg orally 2 times/day for 7 days (A)</p> Signup and view all the answers

Which of the following is a symptom of a yeast infection?

<p>Thick white discharge (B)</p> Signup and view all the answers

What type of testing is often used for herpes diagnosis?

<p>PCR assays for HSV DNA (A)</p> Signup and view all the answers

What is the method used to estimate the due date in pregnancy?

<p>Add one year, subtract three months, and add seven days to the LMP (A)</p> Signup and view all the answers

Which treatment is endorsed by ACOG for non-ruptured hemodynamically stable cases?

<p>Methotrexate intramuscular (D)</p> Signup and view all the answers

What is a critical sign of hypovolemic shock?

<p>Orthostatic blood pressure changes (B)</p> Signup and view all the answers

Which of the following is NOT a part of the recommended routine for managing pregnant patients?

<p>Administration of live vaccines (A)</p> Signup and view all the answers

Which screening is conducted at 35-37 weeks gestation?

<p>Group B Strep screening (B)</p> Signup and view all the answers

Which of the following assessments is crucial for early detection of testicular cancer?

<p>Self-exams (C)</p> Signup and view all the answers

What is a common symptom of benign prostatic hyperplasia (BPH)?

<p>Urinary difficulty (C)</p> Signup and view all the answers

At what age should boys be referred for urologic evaluation if testicles have not descended?

<p>By the age of 6 months (C)</p> Signup and view all the answers

Which of the following conditions is associated with a risk factor of cryptorchidism?

<p>Maternal diabetes (A)</p> Signup and view all the answers

What is the typical treatment approach for testicular cancer?

<p>Surgery, chemotherapy, and/or radiation (C)</p> Signup and view all the answers

Which of the following findings is associated with inguinal hernia?

<p>Noticeable bulge in the groin area (D)</p> Signup and view all the answers

What significant family history factor increases the risk of developing testicular cancer?

<p>Cryptorchidism in the family (C)</p> Signup and view all the answers

Which symptom is NOT typically associated with testicular torsion?

<p>Painless lump (A)</p> Signup and view all the answers

Flashcards

Scope of Practice

The range of medical activities that a healthcare professional is permitted and authorized to perform.

Primary Care

Continuous, person-centered, relationship-based care that considers individual, family, and community preferences.

APRN Core Competencies

Essential skills and knowledge areas for Advanced Practice Registered Nurses (APRNs).

Caring (in Nursing)

Intentional, authentic nurse presence emphasizing compassion and understanding.

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Reimbursement for APRNs

Payment for services rendered by APRNs, often determined by insurance plans or contracts.

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Diagnostic Process Elements

Key components to consider during diagnosis, like onset, location, duration, characteristics.

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Medicare/Medicaid Reimbursement

Payment for healthcare services provided to individuals on Medicare and Medicaid.

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Incident-to Billing

Reimbursement method where a nurse is paid at a reduced rate compared to a physician.

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Healthcare Agent

A person you choose to make medical decisions for you if you become unable to communicate your wishes.

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Durable Power of Attorney

A legal document that allows your healthcare agent to make decisions even if you become incapacitated. It ensures your wishes are followed even if you can't express them.

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Living Will

A legal document that specifies your medical treatment preferences if you are unable to make decisions. Helps ensure you receive the care you want in serious illness.

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Advance Directive

A general term for legal documents that communicate your healthcare preferences in case you become unable to do so.

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Health Care Proxy

A person authorized to make medical decisions for you when you can't communicate your preferences.

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Treatment Preferences

Details about what type of medical treatment you wish to receive or avoid.

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Organ and Tissue Donation

Your wishes regarding donation of organs or tissues after death.

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End-of-Life Care

Medical care focused on providing comfort and support during the final stages of life.

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Medicare Advantage (MA) plans

Medicare plans that offer benefits beyond basic Medicare coverage, but at a potentially higher cost.

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Medicare MA plan types

Different structures within Medicare Advantage, like HMOs, PPOs, PFFS, and SNPs.

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Medicaid eligibility

Based on income, with exceptions for specific groups, determined by the Modified Adjusted Gross Income (MAGI).

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Medicaid funding

Jointly funded by federal and state governments with federal matching for qualified services.

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Medicaid payment structure

Payments to providers are made directly, with providers accepting this as full payment, apart from exceptions (e.g., disproportionate-share hospitals, hospice).

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Medicaid beneficiaries

Includes individuals and families with low income and limited resources, as well as those with chronic disabilities, children, pregnant women, parents, seniors (with dual eligibility), and people with disabilities.

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Modified Adjusted Gross Income (MAGI)

A metric used to determine income eligibility for Medicaid.

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Medicaid and CHIP coverage

In 2020, over 72.5 million Americans were covered by Medicaid and CHIP combining.

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BPH Symptoms

Symptoms of Benign Prostatic Hyperplasia (BPH) include urinary difficulty, pain, and possibly erectile dysfunction.

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BPH Risk Factors

Men over 50, African Americans, and those with a family history of BPH are at higher risk.

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BPH Diagnostics

BPH is diagnosed by checking PSA levels, conducting a Digital Rectal Exam (DRE), and sometimes performing a biopsy.

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Testicular Cancer Screening

Self-exams are crucial for early detection of testicular cancer, especially for men between 15-35.

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Testicular Cancer Risk Factors

Risk factors include undescended testicles (cryptorchidism), family history, and genetic predispositions.

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Testicular Cancer Assessment

Signs like painless lump, swelling, or heaviness in the scrotum can indicate testicular cancer.

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Cryptorchidism Assessment

Cryptorchidism is diagnosed by examining the scrotum for the absence of one or both testes, or by identifying them in a location other than the scrotum. Warm hands, frog-leg position, and supine positioning are helpful during the exam.

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Cryptorchidism Referral

Referral to a urologist is recommended for boys with undescended testicles, especially those not descended by six months of age or older boys with newly diagnosed cryptorchidism.

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Ectopic Pregnancy

A pregnancy that occurs outside the uterus, commonly in the fallopian tube. It is a serious condition that can lead to internal bleeding and requires immediate medical attention.

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Ectopic Pregnancy Symptoms

Common symptoms include abdominal pain, vaginal bleeding, dizziness, weakness, and fever. Other symptoms may include breast fullness, nausea, vomiting, syncope, and cardiac arrest.

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Emergency Signs of Ectopic Pregnancy

These warning signs include abdominal rigidity, involuntary guarding, severe tenderness, and evidence of hypovolemic shock (low blood pressure, rapid heart rate).

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Ectopic Pregnancy Treatment

Treatment options for ectopic pregnancy include methotrexate (a medication that stops cell growth), which is often used for non-ruptured pregnancies, and surgery if the pregnancy is unstable or ruptured.

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Naegele's Rule

A commonly used formula for estimating a woman's due date. To apply it, add one year to the first day of her last menstrual period (LMP), subtract three months, and add seven days.

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Gonorrhea Testing

Usually done with a NAAT test using the first urine of the day or a vaginal/cervical swab.

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Gonorrhea Treatment

A single dose of IM Ceftriaxone.

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HPV Testing

Often visually detected, many men are asymptomatic.

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HPV Treatment

Most cases resolve within a year. Topical treatments include Imiquimond cream, Podofilox solution, Sinecatechins ointment, or cryotherapy.

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Chlamydia Testing

Typically done with a NAAT test using the first urine of the day or a vaginal/cervical swab.

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Chlamydia Treatment

Standard treatment is Doxycycline 100 mg twice daily for 7 days. Alternatives include a single dose of Azithromycin 1 g or Levofloxacin 500 mg daily for 7 days.

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Herpes Testing

Can be done with PCR assays for HSV DNA or IGG testing, often included in an STI panel.

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Erectile Dysfunction Risk Factors

Common risk factors include smoking, obesity, lack of physical activity, and psychological stressors.

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Study Notes

Primary Care of the Family Reading Notes

  • The scope of practice for nurses isn't consistent across all states.
  • Three themes for future success in nursing include the need for nurses to play a full role in practice, education, and leadership; the need for diversity in the nursing workforce; and the need for improved data to track progress.
  • Healthy People 2030 needs significant improvement.
  • Primary care is defined as continuous, person-centered, relationship-based care that addresses the needs and preferences of individuals, families, and communities.
  • Core competencies for Advanced Practice Registered Nurses (APRNs) include:
    • Domain 1: Knowledge for Nursing Practice
    • Domain 2: Person-Centered Care
    • Domain 3: Population Health
    • Domain 4: Scholarship for Nursing Practice
    • Domain 5: Quality and Safety
    • Domain 6: Interprofessional Partnerships
    • Domain 7: Systems-Based Practice
    • Domain 8: Information and Healthcare Technologies
    • Domain 9: Professionalism
    • Domain 10: Personal, Professional, and Leadership Development
  • The APRN role is based on knowledge of skills and caring.
  • Caring, in nursing, is characterized by the intentional presence of the nurse with another living being, with general nursing patterns represented by the Circle of Caring Model: Courage, Authentic presence, and Advocacy.

Chapter Five: Elements of the Diagnostic Process

  • Onset, duration, characteristics, location, aggravating and relieving factors, and treatment are elements of the diagnostic process.

Reimbursement

  • Payment standards in the U.S. are primarily driven by insurance companies, particularly Medicare and Medicaid.
  • APRNs are receiving third-party reimbursement in more settings, but payments often vary by contract and state regulations.
  • Reimbursement for NPs is sometimes based on "incident to" billing, paying the supervising physician 100% of the charged amount rather than the 85% rate for independent NPs.
  • This method makes it difficult for Medicare to identify and support NP clinicians providing primary care.
  • Efforts are underway to eliminate incident to billing and establish a more unified reimbursement system.

Third-Party Payer Rules

  • Medicare, Medicaid, indemnity insurance companies, managed care organizations (MCOs), workers' compensation, veterans' administration, and auto liability are the seven primary categories of third-party payers.
  • Each payer source has specific policies and fee schedules.
  • CMS guidelines serve as a foundation for most payer policies.
  • Medicare has four parts (A, B, C and D) associated with inpatient hospital coverage, physician services, Medicare Advantage (a single plan combining Parts A & B) and prescription drug coverage.
  • Medicare Part A (hospital services) deductible was $1,484 in 2021.

Additional Information

  • Detailed information on Medicare part A and Part B requirements is provided and discussed.
  • Medicare Part D is a prescription drug coverage component.
  • Medicare Advantage plans combine Medicare A & B coverage, additional benefits (drug, dental, etc.), and offer lower co-pays.
  • The ACA influenced the role of APRNs and expanded services.
  • HIPAA (Health Insurance Portability and Accountability Act) regulations manage aspects of electronic health care.

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