Comparative Health Information Management 4th Edition Peden – Test Bank

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Chapter 05 Dialysis
TRUEFALSE
1. Dialysis is a procedure necessary to maintain the life of a person whose liver has failed.
(A) True
(B) False
Answer : (B)
2. ESRD networks treat patients by providing hemodialysis services.
(A) True
(B) False
Answer : (B)
3. Dialysis patients see the following caregivers at regular intervals: physicians, nurses, soci al
workers, and dietitians.
(A) True
(B) False
Answer : (A)
4. A freestanding dialysis facility that is accredited by The Joint Commission is deemed to meet
federal requirements and does not have to be surveyed by the state.
(A) True
(B) False
Answer : (B)
5. Peritoneal dialysis uses the patient’s thoracic cavity to filter out wastes.
(A) True
(B) False
Answer : (B)
6. Each dialysis patient is assigned to a primary care provider who alone is responsible for the
performing a comprehensive assessment and developing a plan of care.
(A) True
(B) False
Answer : (B)
7. The Forum of ESRD Networks has developed a medical record model outlining recommended
practices for medical record documentation in ESRD facilities.
(A) True
(B) False
Answer : (A)
8. A person with end-stage renal disease can become eligible for Medicare on the basis of the ESRD
diagnosis.
(A) True
(B) False
Answer : (A)
9. In general, dialysis facilities have been slow to adopt electronic health records.
(A) True
(B) False
Answer : (B)
10. One of the major responsibilities of an ESRD network is to evaluate and resolve patient
grievances.
(A) True
(B) False
Answer : (A)
11. The retention period for clinical information on dialysis patients, according to federal statute, is
ten years.
(A) True
(B) False
Answer : (B)
12. Both dialysis and kidney transplant are forms of renal replacement therapy (RRT).
(A) True
(B) False
Answer : (A)
13. The Kidney Disease Outcomes Quality Initiative (KDOQI) includes the development of clinical
practice guidelines; CMS has incorporated some of the outcome measures from these guidelines into
their clinical performance measures projects.
(A) True
(B) False
Answer : (A)
14. Patients who have kidney transplants generally have lower survival rates, a poorer quality of life,
and higher overall medical costs than patients on dialysis.
(A) True
(B) False
Answer : (B)
MULTICHOICE
15. In ___________, the patient’s blood circulates outside his or her body through an artificial kidney
that removes metabolic wastes and helps to maintain homeostasis.
(A) artificial renal function
(B) hemodialysis
(C) CAPD
(D) CCPD
Answer : (B)
16. In health care facilities that accept Medicare patients, a(n) __________ survey would be the only
type of survey conducted by a regional office of the Centers for Medicare and Medicaid Services.
(A) routine
(B) accreditation
(C) validation
(D) licensure
Answer : (C)
17. Which of the following has a contract with CMS to assess the quality of care rendered to ESRD
patients?
(A) ESRD network
(B) transplantation surgeon
(C) National Committee for Quality Assurance (NCQA)
(D) Accreditation Association for Ambulatory Health Care (AAAHC)
Answer : (A)
18. Although not the preferred clinical term, irreversible stage 5 chronic kidney disease is denoted
by the term _______________ in many federal publications.
(A) dialysate dependence
(B) BUN depression
(C) CAPD
(D) ESRD
Answer : (D)
19. Select the best answer or combination of answers: Renal replacement therapy (RRT) includes
______________.
(A) peritoneal dialysis
(B) hemodialysis
(C) kidney transplant
(D) a and b, but not c
(E) a, b, and c
Answer : (E)
20. Select the best answer or combination of answers: A dialysis facility is an entity that
_________________.
(A) provides outpatient maintenance dialysis services
(B) provides home dialysis training and support services
(C) performs kidney transplants
(D) a and b, but not c
(E) a, b, and c
Answer : (D)
21. Which dialysis modality is the most prevalent in the United States?
(A) in-center hemodialysis
(B) home hemodialysis
(C) continuous ambulatory peritoneal dialysis
(D) continuous cycling peritoneal dialysis
Answer : (A)
22. In ______________________________ the patient is able to perform his or her own dialysis almost
anywhere because very little special equipment is required and the patient dialyzes three or four
times a day at home or at work.
(A) hemodialysis
(B) self-hemodialysis
(C) continuous cycling peritoneal dialysis (CCPD)
(D) continuous ambulatory peritoneal dialysis (CAPD)
Answer : (D)
23. Which of the following types of caregivers would be most likely to see the in-center dialysis
patient at every treatment?
(A) social worker
(B) dietitian
(C) physician
(D) dialysis technicia
Answer : (D)
24. The Conditions of Coverage require that each dialysis facility implement a data-driven
performance improvement program that utilizes indicators or performance measures associated with
improved health outcomes and with the identification and reduction of medical errors. This program
is known as_______________________________ .
(A) Clinical Performance Measures (CPM) Project
(B) Renal Management Information System (REMIS)
(C) Quality Assessment and Performance Improvement (QAPI)
(D) Consolidated Renal Operations in a Web-enabled Network (CROWNWeb)
Answer : (C)
25. Which of the following is a document prepared by the interdisciplinary team that evaluates the
patient in at least thirteen required areas?
(A) Patient assessment
(B) Plan of care
(C) Interdisciplinary progress notes
(D) Clinical performance measures
Answer : (A)
26. Unstable dialysis patients should be reassessed by the interdisciplinary team at least ________.
(A) daily
(B) weekly
(C) monthly
(D) annually
Answer : (C)
27. The timeline for completion of the comprehensive patient assessment and initial implementation
of the plan of care is within _____________________.
(A) 10 calendar days after admission to the dialysis facility or 4 outpatient hemodialysis sessions
(B) 30 calendar days after admission to the dialysis facility or 13 outpatient hemodialysis sessions
(C) 90 calendar days after admission to the dialysis facility or 37 outpatient hemodialysis sessions
(D) 180 calendar days after admission to the dialysis facility or 75 outpatient hemodialysis sessions
Answer : (B)
28. Federal regulations explicitly state that the patient or designee must sign one of the following
documents or the document should explain the reason that the signature was not provided. To which
of the following documents does this regulation apply?
(A) history and physical
(B) discharge summary
(C) progress notes
(D) plan of care
Answer : (D)
29. The fundamental payment in Medicare’s reimbursement system for dialysis facilities is made on
a _______________.
(A) per diem basis
(B) per treatment basis
(C) monthly capitation basis
(D) diagnosis related group basis
Answer : (B)
30. Which of the following is NOT a case-mix adjustment factor in Medicare’s prospective payment
system for dialysis facilities for dialysis facilities?
(A) body surface area
(B) body mass index
(C) procedures
(D) age
Answer : (C)
31. Which of the following applies with regard to co-morbidity adjustments in the Medicare
prospective payment system for dialysis facilities?
(A) There are only a few (less than 20) categories of conditions that qualify as co-morbidities.
(B) There are a significant number (over 100) of categories of conditions that qualify as
co-morbidities.
(C) There are numerous (more than 1,000) categories of conditions that qualify a co-morbidities.
(D) There are no co-morbidity adjustments in the Medicare prospective payment system for dialysis
facilities.
Answer : (A)
32. When a dialysis patient is transferred to another facility, federal regulations require that all
requested medical record information be transmitted to the receiving facility within __________.
(A) one working day
(B) five working days
(C) two weeks
(D) one month
Answer : (A)
33. The best source of data on kidney transplants is available from the ______________.
(A) CROWNWeb reporting system
(B) Forum of ESRD Networks
(C) Centers for Disease Control
(D) United Network for Organ Sharing
Answer : (D)
34. One effect that the quality incentive program could have on Medicare payments to dialysis
facilities is that ______________________.
(A) payments to high-performing facilities may be increased by as much as 5%
(B) payments to facilities that do not meet performance standards may be reduced by as much as 2%
(C) payments to facilities significantly below performance standards may be denied
(D) all of the above
Answer : (B)
SHORTANSWER
35. _____________________ is a gradual loss of kidney function classified into five stages, with mild loss
of kidney function in the early stages and severe or total loss in the later stages.Answer : Chronic
kidney disease
36. The _____________________ is an ongoing project of CMS implemented through the ESRD networks
to measure and report the quality of renal dialysis services provided under the Medicare
program.Answer : Clinical Performance Measures Project
Answer : CPM Project
37. __________________________________ is an Internet-based software application from CMS and is the
required method by which dialysis facilities submit data about patients and facility
operations.Answer : Consolidated Renal Operations in a Web-enabled Network
Answer : CROWNWeb
38. _____________________________ is a form of peritoneal dialysis in which the patient is able to dialyze
herself three or four times per day without special assistance and a minimum amount of
equipment.Answer : Continuous ambulatory peritoneal dialysis
Answer : CAPD
39. ___________________________________ is a form of peritoneal dialysis in which the patient uses a
cycler machine to dialyze once a day for nine or ten hours, generally while sleeping.Answer :
Continuous cycling peritoneal dialysis
Answer : CCPD
40. _____________________ is a solution used to filter products across a semipermeable membrane by
the process of diffusion.Answer : Dialysate
41. ________________ is the process of artificially removing metabolic end products and water across a
semipermeable membrane by diffusion.Answer : Dialysis
42. A(n) ____________________________ stimulates the bone marrow to make red blood cells and is used
to treat and prevent anemia, a common complication of chronic kidney disease in patients on
dialysis.Answer : erythropoietin stimulating agent
Answer : ESA
43. Organizations that have contracted with the Centers for Medicare and Medicaid Services (CMS)
to assess the quality of care rendered to ESRD patients and to collect and analyze ESRD data are
known as _________________.Answer : ESRD networks
44. ________________________ is a calculated value that serves as a means of measuring the adequacy
of dialysis (i.e., a way to determine whether the patient is dialyzing long enough or often enough to
remove sufficient waste and excess fluid from the body).Answer : Kt/V
45. __________________________ is the process of cleansing the blood as it circulates through an
artificial kidney machine outside the patient’s body.Answer : Hemodialysis
46. ____________________________ is a type of dialysis in which the patient’s abdominal cavity is filled
with a solution (dialysate), and the semipermeable membrane across which the products diffuse is
the patient’s own peritoneal membrane. The fluid containing the wastes is later withdrawn from the
peritoneal cavity.Answer : Peritoneal dialysis
47. _____________________________ is any treatment that replaces kidney function. The treatment may
be some type of dialysis or it may be kidney transplantation.Answer : Renal replacement therapy
Answer : RRT
48. A survey conducted by a regional office of the CMS to determine whether the surveys being
conducted by state agencies (or other groups) are appropriately assessing the facility’s operations is
known as a _______________________________.Answer : validation survey
49. With regard to frequency of reassessment, stable dialysis patients must be reassessed at least
________________.Answer : annually
ESSAY
50. Describe the difference between continuous ambulatory dialysis and continuous cycling
peritoneal dialysis?
Graders Info :
Continuous ambulatory peritoneal dialysis (CAPD):the patient is able to perform his or her own
dialysis throughout the day, because very little special equipment is required. The CAPD patient
completes an exchange of fluid three or four times a day, at home or at work. Continuous cycling
peritoneal dialysis (CCPD): uses a machine to perform peritoneal dialysis once each day while the
patient sleeps rather than three or four times throughout the day as in CAPD. Like the CAPD
patients, CCPD patients generally come to the ESRD facility only for training and for monthly
evaluations or when a complication arises.
51. Describe any three of the thirteen items that a dialysis record comprehensive assessment should
include according to federal regulations.
Graders Info :
Any three of the following:
Current health status and medical condition, including comorbid conditions.l
The appropriateness of the dialysis prescription, blood pressure, and fluid management needsl
Laboratory profile, immunization history, and medication historyl
Factors associated with anemia, such as hematocrit, hemoglobin, iron stores, and potentiall
treatment plans for anemia, including administration of erythropoiesis-stimulating agent(s)
Factors associated with renal bone diseasel
Nutritional status (evaluated by a dietitian)l
Psychosocial needs (evaluated by a social worker)l
Dialysis access type and maintenance (for example, arteriovenous fistulas, arteriovenous grafts,l
and peritoneal catheters)
The patient’s abilities, interests, preferences, and goals, including the desired level of participationl
in the dialysis care process; the preferred modality (hemodialysis or peritoneal dialysis) and setting
(for example, home dialysis); and the patient’s expectations for care outcomes
Suitability for a transplantation referral, based on criteria developed by the prospectivel
transplantation center and its surgeon(s). If the patient is not suitable for transplantation referral,
the basis for nonreferral must be documented in the patient’s medical record
Family and other support systemsl
Current patient physical activity levell
Evaluation for referral to vocational and physical rehabilitation servicesl
52. Describe three of the eight items a dialysis plan of care must include according to federal
regulation.
Graders Info :
Any three of the following:
Dose of dialysis. The interdisciplinary team must provide the necessary care and services to managel
the patient’s volume status; and achieve and sustain the prescribed dose of dialysis to meet a
hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an
alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis.
Nutritional status. The interdisciplinary team must provide the necessary care and counselingl
services to achieve and sustain an effective nutritional status. A patient’s albumin level and body
weight must be measured at least monthly. Additional evidence, based professionally-accepted
clinical nutrition indicators may be monitored, as appropriate.
Mineral metabolism. Provide the necessary care to manage mineral metabolism and prevent orl
treat renal bone disease.
Anemia. The interdisciplinary team must provide the necessary care and services to achieve andl
sustain the clinically appropriate hemoglobin/hematocrit level. The patient’s hemoglobin/hematocrit
must be measured at least monthly. The dialysis facility must conduct an evaluation of the patient’s
anemia management needs. For a home dialysis patient, the facility must evaluate whether the
patient can safely, aseptically, and effectively administer erythropoiesis-stimulating agents and
store this medication under refrigeration if necessary. The patient’s response to
erythropoiesis-stimulating agent(s), including blood pressure levels and utilization of iron stores,
must be monitored on a routine basis.
Vascular access. The interdisciplinary team must provide vascular access monitoring andl
appropriate, timely referrals to achieve and sustain vascular access. The hemodialysis patient must
be evaluated for the appropriate vascular access type, taking into consideration comorbid
conditions, other risk factors, and whether the patient is a potential candidate for arteriovenous
fistula placement. The patient’s vascular access must be monitored to prevent access failure,
including monitoring of arteriovenous grafts and fistulae for symptoms of stenosis.
Psychosocial status. The interdisciplinary team must provide the necessary monitoring and sociall
work interventions. These include counseling services and referrals for other social services, to
assist the patient in achieving and sustaining an appropriate psychosocial status as measured by a
standardized mental and physical assessment tool chosen by the social worker, at regular
intervals, or more frequently on an as-needed basis.
Modality, including (i) whether home dialysis is an option or why the patient is not a candidate forl
home dialysis and (ii) transplantation status, including plan for transplantation if patient accepts a
transplantation referral, the patient’s decision if the patient declines the transplantation referral,
or the reason for the patient’s non-referral as a transplantation candidate.
Rehabilitation status. The interdisciplinary team must assist the patient in achieving andl
sustaining an appropriate level of productive activity, as desired by the patient, including the
educational needs of pediatric patients, and must make rehabilitation and vocational
rehabilitation referrals as appropriate.
53. Describe what requirements must be met for a person with ESRD to be eligible for Medicare
coverage.
Graders Info :
Has worked the required amount of time under Social Security, the Railroad Retirement Board1.
(RRB), or as a government employee.
Is receiving or is eligible for Social Security or Railroad Retirement benefits.2.
Is the spouse or dependent child of a person who has worked the required amount of time to be3.
eligible for Medicare, or who is getting Social Security or Railroad Retirement benefits (How to
Sign up for Medicare).
54. Describe what a Quality Assessment and Performance Improvement (QAPI) Program should
include.
Graders Info :
The program must include, but not be limited to, an ongoing program that achieves measurable
improvement in health outcomes and reduction of medical errors by using indicators or performance
measures associated with improved health outcomes and with the identification and reduction of
medical errors. The dialysis facility must measure, analyze, and track quality indicators or other
aspects of performance that the facility adopts or develops that reflect processes of care and facility
operations. These performance components must influence or relate to the desired outcomes or be
the outcomes themselves. The program must include, but not be limited to, the following:
Adequacy of dialysis.1.
Nutritional status.2.
Mineral metabolism and renal bone disease.3.
Anemia management.4.
Vascularaccess.5.
Medical injuries and medical errors identification.6.
Hemodialyzer reuse program, if the facility reuses hemodialyzers7.
Patient satisfaction and grievances8.
Infection control9.

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