Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 19

Type: MCSA

The nurse is planning teaching for a staff seminar regarding psychiatric medication administration. The nurses teaching should be guided by the knowledge that:

1. Sedation is a desirable side effect for older adults.

2. Falls and choking risk are increased by psychiatric medications.

3. Older adults are less prone to side effects than other age groups.

4. Standard adult dosages are well tolerated by older adults.

Correct Answer: 2

Rationale 1: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking. Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Rationale 2: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking. Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Rationale 3: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking. Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Rationale 4: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking. Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 20

Type: MCSA

The nurses evaluation of the outcomes of care for an older adult mentally ill client should be guided by the knowledge that:

1. Cultural preferences that conflict with treatment goals take precedence.

2. Complete absence of psychiatric symptoms is the gold standard.

3. Clients values and preferences should be honored whenever possible.

4. Families and significant others are not routinely involved in this process.

Correct Answer: 3

Rationale 1: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Rationale 2: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Rationale 3: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Rationale 4: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 21

Type: MCSA

The nurse plans to increase self-esteem and reduce social isolation for residents living at the long-term care facility. Which one of the following strategies should the nurse include to meet these goals?

1. Reality orientation

2. Reminiscence therapy

3. Respite services

4. Restorative care

Correct Answer: 2

Rationale 1: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments. Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Rationale 2: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments. Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Rationale 3: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments. Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Rationale 4: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments. Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Develop treatment plans including reminiscence therapy, life review, reality orientation, and socialization enhancement for elders.

Question 22

Type: MCSA

Which of the following behaviors would indicate that the nurses remotivation therapy group for long-term care residents was effective?

1. Orientation to time, place, and person

2. Active discussion of dating practices in teenage years

3. Active discussion of presidential candidates in the next election

4. Orientation to the long-term care surroundings

Correct Answer: 3

Rationale 1: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Rationale 2: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Rationale 3: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Rationale 4: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Develop treatment plans including reminiscence therapy, life review, reality orientation, and socialization enhancement for elders.

Question 23

Type: MCSA

Which of the following outcomes would indicate successful reality orientation of an older adult client?

1. Ability to identify personal strengths

2. Ability to perform basic tasks and personal care activities

3. Ability to identify place and person

4. Ability to express faith and meaning in life

Correct Answer: 3

Rationale 1: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Rationale 2: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Rationale 3: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Rationale 4: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Develop treatment plans including reminiscence therapy, life review, reality orientation, and socialization enhancement for elders.

Question 24

Type: MCMA

The nurse is a case manager for several older adults living in the community. Which of the following goals are relevant for community or home based nursing care?

Standard Text: Select all that apply.

1. Educate clients and caregivers about adult daycare programs

2. Diagnose and treat psychiatric illnesses

3. Coordinate supportive services to compensate for deficits

4. Encourage relocation to assisted living or skilled nursing facilities

5. Maintain safety and optimal functional independence

Correct Answer: 1,3,5

Rationale 1: Educate clients and caregivers about adult daycare programs: Education about community-based programs such as adult daycare programs can provide respite for stressed and overwhelmed caregivers.

Rationale 2: Diagnose and treat psychiatric illnesses: Nurses need to monitor elders for signs of psychiatric illness and report them to the primary care physician, but nurses do not diagnose and treat unless they obtain advanced training and certification.

Rationale 3: Coordinate supportive services to compensate for deficits: When physical or mental deficits are present supportive services can help older adults stay in the home longer.

Rationale 4: Encourage relocation to assisted living or skilled nursing facilities: Delaying institutionalization is preferred by most elders and the nurse should support their desire to age in place unless the home environment becomes unsafe.

Rationale 5: Maintain safety and optimal functional independence: Safety and independence are key factors to remaining in the community.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living for elders and their families into your plan of care.

Question 25

Type: MCMA

Which of the following nursing interventions would be useful when caring for elders with behavioral disturbances who bite, hit, kick, or scream at caregivers during delivery of care?

Standard Text: Select all that apply.

1. Return at a later time to resume care when clients are calmer.

2. Order clients to stop biting, hitting, and screaming.

3. Continue the activity by restraining their hands and feet.

4. Allow clients to refuse bathing if no body odor is present.

5. Distract clients by encouraging them to sing with you.

Correct Answer: 1,4,5

Rationale 1: Return at a later time to resume care when clients are calmer. Research suggests that waiting and returning to resume care at a later time can be effective when dealing with resisting clients.

Rationale 2: Order clients to stop biting, hitting, and screaming. Ordering clients is ineffective. Talking and reasoning with them may be more effective.

Rationale 3: Continue the activity by restraining their hands and feet. Restraining the client unnecessarily is called battery and should only be used when someone is in imminent danger of harm.

Rationale 4: Allow clients to refuse bathing if no body odor is present. Dressing and bathing have few adverse health consequences and allow clients a form of control.

Rationale 5: Distract clients by encouraging them to sing with you. Research suggests that distracting clients with a social activity is helpful when dealing with resisting clients.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living to elders and their families into your plan of care.

Question 26

Type: MCSA

The nurse case manager has become concerned that an older adult confused client is no longer safe at home due to wandering outside when the caregiver is not watching. Which of the following community-based programs would be most appropriate for referral?

1. Long-term care facilities

2. Assisted living communities

3. Senior citizen centers

4. Residential care facilities

Correct Answer: 1

Rationale 1: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Rationale 2: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Rationale 3: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Rationale 4: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living for elders and their families into your plan of care.

Question 27

Type: MCSA

The wife of a man with early stage Parkinsons disease expresses frustration and despair while caring for him at home because she is unable to leave him while she plays bridge with her friends twice a week. Which of the following community-based resources would be most appropriate in this situation?

1. Hospice care

2. Long-term care

3. Respite care

4. Restorative care

Correct Answer: 3

Rationale 1: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Rationale 2: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Rationale 3: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Rationale 4: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living for elders and their families into your plan of care.

Question 28

Type: MCSA

A nurse is discussing the demanding and dependent behavior of an older, depressed female client with the treatment team. Which of the following comments indicates ageism?

1. She is demanding and dependent because she is lonely and not receiving enough attention from staff members.

2. She is feeling depressed and could benefit from counseling or an antidepressant.

3. She should be encouraged to attend more activities and do as much as possible by herself.

4. She should be encouraged to spend more time with people her own age instead of trying to look or act younger.

Correct Answer: 4

Rationale 1: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Rationale 2: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Rationale 3: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Rationale 4: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Analyze personal biases, feelings, and attitudes that may be experienced in professional practice when caring for elders who suffer from mental disorders.

Question 29

Type: MCSA

Which of the following statements represents a myth about aging?

1. Advancing age does not condemn one to dependence and isolation.

2. Older adults do not benefit from supportive psychosocial services.

3. Senility and sadness are not inevitable outcomes with advancing age.

4. Aging itself is not a problem.

Correct Answer: 2

Rationale 1: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Rationale 2: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Rationale 3: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Rationale 4: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Analyze personal biases, feelings, and attitudes that may be experienced in professional practice when caring for elders who suffer from mental disorders.

Question 30

Type: MCSA

Which of the following statements is true regarding financial roadblocks to mental health care services for people over the age of 65?

1. Medicare covers inpatient but not community mental health services.

2. Medicare Part D provides simple options for prescription coverage.

3. Medicare provides little coverage for long-term care services.

4. Medicare offers low copayments for most psychotropic medications.

Correct Answer: 3

Rationale 1: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Rationale 2: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Rationale 3: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Rationale 4: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Chapter 19. Reimbursement and Documentation

1. Which of the following does not refer to the process of adding written information to a health care record?

A. Recording

B. Charting

C. Data entry

D. Documenting

2. Which of the following statements about documenting is not true?

A. Involves recording the interventions carried out to meet the patient's needs.

B. Done in a proper way, it reflect the nursing process.

C. Necessary to prove that nursing work was done.

D. Nursing documentation can be accepted in both verbal and written form

3. Which of the following are basic purposes for an accurate and complete written patient records? Select all that apply

A. Sometimes used by government agencies to evaluate patient care

B. It is a permanent record for accountability

C. It is a legal record of care

D. They are perfect sources for business and marketing

E. Can be used for research, teaching and data collection

4. This is the main basis for cost reimbursement rates by government plans

A. Critical pathway

B. Minimum data sheet

C. Diagnoses related groups

D. Patient expense documentation

5. Which of the following statements are true regarding basic rules for documentation. Select all that apply.

A. Use direct quotes for objective assessments

B. If a charting error is made, draw one line through the faulty information

C. Chart only your own care even when someone else calls you for a late entry.

D. Chart after care is provided, as soon as possible, and as often as needed

E. Sign each block of charting with full legal initials and title

6. Based upon the legal guidelines for documentation, which of the following corrective action is incorrect?

Discuss

A. Never erase entries or use correction fluid. Never right with a pencil.

B. Do not record "physician made error".

C. Be certain that entry is factual even when opinions are used

D. While logged into the computer, do not leave terminal unattended even during an emergency.

7. Which of the following statements about common forms of inadequate documentation should not be included?

A. Not charting correct time when events occurred

B.Failing to record verbal orders or failing to have them signed

C. Documentation only in hand written format even when EMR is mandated

D. Charting actions in advance to save time

E. Documenting incorrect data

8. Which of the following practices could lead to malpractice? Select all that apply

A. Charting interventions in advance to save time

B. Documenting incorrect data

C. Not charting the correct time when events took place

D. Deleting incorrect entries and crossing them out with a horizontal line.

E. Not recording verbal orders or not having them signed.

9. Charting that is divided into sections or blocks. Emphasis is placed on specific sections, or sheets of information. It also uses graphics and narrative charting

A. Traditional Chart

B. Problem-oriented medical record

C. Standard form

D. Kardex

10. Which of the following is a typical section of a traditional chart? Select all that apply

Discuss

A. Admission sheet and physician's orders

B. Progress notes and nurse's admission information

C. History and Physical Examination Data

D. Medical Administration Record

E. Care plan and nurse's notes

11. Which of the following is considered a traditional charting?

A. Narrative

B. Problem Oriented Medical Record

C. SOAPE

D. DARE

12. What is the difference between Traditional and Problem Oriented medical Record charting?

A. Traditional uses an abbreviated story form. POMR uses an outline form

B. Traditional uses SOAPE charting. Problems oriented medical record uses narrative charting

C. Traditional uses blocks. POMR uses sections.

D. Traditional focuses on interventions. POMR focuses on interventions.

13. Which of the following are considered the principal sections of a problem-oriented medical record? Select all that apply.

A. Database

B. Problem list

C. Care plan

D. Physical examination and diagnostic tests

E. Referral form

14. Active, inactive potential and resolved problems that serve as the index for charting documentation

A. Problem assessments

B. Problem List

C. Database

D. Traditional Chart

15.Which insurance company will only reimburse 4 units per visit?

A. Aetna

B. Medicare

C. United

D. Cigna

16. Which of the following insurance companies will reimburse for physical performance test (PPT)?

Discuss

A. PC

B. BCBS

C. MVA

D. A & B

E. All of the above

17. For Medicare, when must progress reports be completed?

A. 40 days or 15 visits, whichever comes first

B. 30 days or 15 visits, whichever comes first

C. 30 days or 10 visits, whichever comes first

D. 40 days or 10 visits, whichever comes first

18. Aetna will only reimburse evaluations once every 180 days, even if it's a new injury.

A.True

B. False

19. A patient with Keystone HMO health insurance has been to the clinic for 20 visits. What is the total reimbursement the clinic will receive from insurance?

A. Only the deductible

B. Only the co-pay and the capitated rate per patient per month.

C.$1,000

D. Nothing until the insurance company holds a manual review

20. A patient with Align insurance was injured at work. Which of the following statements is/are true?

A. The work ready script must be signed by the referring physician as soon as possible

B. Authorization is not needed to perform FPN

C. Align is not a third party administrator insurance

D. There is reimbursement of 5 individual codes along with WH/WC

E. A & C

F. A, C & D

Chapter 20. Termination and Outcome Evaluation

Question 1

Type: MCSA

When does the psychiatrist decide to terminate treatment?

Global Rationale: Termination optimally occurs when coping and functioning have improved, symptoms are reduced, and the goals of treatment are met. Achievement of goals depends on the collaborative goals set with the patient at the outset of treatment and on the type of approach or model used. For example, supportive psychodynamic psychotherapy criteria for termination would include the strengthening of the ego, reversal of regression, and symptom improvement.

In contrast, more expressive psychoanalytic psychotherapy criteria for termination would involve the resolution of the transference neurosis, an acceptance of the futility of perfectionist strivings and childhood fantasies, a reduction in the intensity of core conflicts, and the development of a self-analytic capacity.

Question 2

Type: MCSA

When does termination begin for cognitive behavioral therapy?

Global Rationale:

For cognitive-behavioral psychotherapy, termination begins in the first session, and the expected duration is usually discussed at that time, when issues and goals for treatment are clarified. The therapist usually sets a specific number of sessions, sets a predetermined date to end, or informs the patient that the treatment will not go longer than a few weeks or months without specifying an exact date.

Question 3

Type: MCSA

What does the Self Analytic Capacity reflect in psychotherapy?

Global Rationale:

Self-analytic capacity means that the person has learned to be reflective and to become his/her own therapist. The advanced practice psychiatric nurse (APPN) can usually detect that this has been achieved by what the patient says and does. For example, the person may say, “I thought about what you would say when I was in that situation” or “I had a whole conversation in my head with you before I talked to him.” These kinds of statements reflect the patient’s internalization of the therapist’s reflective function. Sometimes, nothing is said, but the person’s functioning has greatly improved, and it is obvious to the therapist from what the person says about how s/he has handled various situations that a newfound ability to self-reflect or self-soothe is operating.

Question 4

Type: MCSA

What are the major goals in the interpersonal psychotherapy (IPT)?

Global Rationale:

In interpersonal psychotherapy (IPT), major goals of treatment relate to resolution of interpersonal problems in the “here and now.” To that end, alternative strategies for interpersonal relationships are identified, new relational patterns are practiced, and old ways of relating are grieved. Once the patient is successfully implementing the new ways of being, goals of therapy are met. Termination begins as early as the middle phase of treatment and is embedded in the work of that phase, working with the sadness about the loss of the relationship with the therapist and addressing issues of relapse prevention. As with CBT, there is a finite number of sessions delineated (16), and this provides incentive for the person to do the work within a circumscribed parameters of the treatment. The therapy does not really end at the last session in that the work continues with the person working independently.

Question 4

Type: MCSA

What are some ways a therapist decides on how to terminate?

Global Rationale:

From a psychodynamic viewpoint, all requests from the patient to terminate should be explored. Often, the patient’s desire to end treatment is thought to reflect resistance. Gabbard (2004) states that underlying motives should always be explored with these questions in mind: Is the patient anxious and afraid and running from something? Angry at the therapist? Enacting a flight into health? Discouraged about the therapy? Feeling judged by the therapist? If the goals of treatment have not been met, it is likely that anxiety is underlying the wish to terminate. The person may