D220 CPT Questions and Answers Review Guide

D220 CPT Questions and Answers Review Guide

How did the data in the electronic medical record (EMR) inform the decision to place a patient with a history of methicillin-resistant Staphylococcus aureus (MRSA) on contact precautions?

The decision to implement contact precautions for a patient with a history of MRSA is primarily based on specific and confirmatory information within the EMR. The most critical evidence is the laboratory report from the patient’s prior hospital stay that shows a positive culture for MRSA. This confirmation of colonization or infection justifies the use of contact precautions to prevent transmission of this resistant bacterium.

Other documentation, such as notes on wet-to-dry dressing changes or antibiotic administration, does not specifically indicate MRSA management. Dressing notes are nonspecific, and antibiotic records do not confirm whether treatment was for MRSA or another infection. Similarly, nursing documentation of symptoms like a swollen elbow with drainage may reflect unrelated issues.

Which EMR data would prompt a nurse to implement droplet precautions for a patient reporting shortness of breath, productive cough, and fatigue?

The radiology report showing lung consolidation is the key finding that prompts droplet precautions. Consolidation in the lungs is commonly associated with pneumonia, which can spread via respiratory droplets, necessitating precautions to protect healthcare workers and other patients.

Other findings, such as a history of asthma, elevated white blood cell counts, or wheezing noted in nursing flowsheets, do not specifically indicate an infectious process requiring droplet precautions. Asthma is a chronic, non-infectious condition; an elevated white blood cell count is a general marker of infection but not specific to droplet transmission; and wheezing alone does not confirm contagious illness.

What EMR data supports an influenza diagnosis in a patient with fever, chills, and muscle aches?

Definitive confirmation of influenza comes from laboratory testing results documented in the EMR. Rapid antigen detection tests or polymerase chain reaction (PCR) assays can identify the presence of the influenza virus, enabling clinicians to initiate appropriate treatments and isolation protocols.

While radiology reports, nursing observations, and patient history may describe symptoms consistent with influenza, they do not confirm the diagnosis.

What is the purpose of a clinical decision support (CDS) alert in the EMR warning of high risk for obstructive sleep apnea before surgery?

The primary purpose of a CDS alert identifying high risk for obstructive sleep apnea (OSA) preoperatively is to enhance patient safety. OSA poses increased risks during surgery, such as airway obstruction and anesthetic complications. The alert serves to prompt healthcare providers to take preventive steps, including adjusting anesthesia plans and increasing perioperative monitoring.

Though compliance with safety regulations and reduction of reportable incidents are important benefits, the foremost goal remains the prevention of patient harm.

What should a nurse assess to evaluate a newly diagnosed heart failure patient’s ability to engage in care and education?

To assess a heart failure patient’s ability to participate in care and education, the nurse should identify potential barriers such as cognitive deficits, language differences, health literacy challenges, and socioeconomic factors that could interfere with understanding and adherence to treatment recommendations. While the patient’s willingness and family support are important, they do not fully determine the ability to engage. Access to educational resources alone is insufficient without addressing these underlying barriers.

Which low-cost marketing method should a rural hospital use to educate its community and promote patient engagement?

Social media platforms represent the most cost-effective and efficient marketing tool for rural hospitals aiming to educate the community and encourage patient engagement. These platforms allow for rapid, broad-reaching communication and interactive dialogue. Traditional methods such as radio, newspapers, and billboards tend to be more expensive, less targeted, and generally have lower impact in rural settings.

What is the first action an informatics nurse should take when staff use printed information from a new electronic health record (EHR) as a “worklist,” creating unsafe practice?

The initial step for an informatics nurse is to conduct interviews or discussions with staff members to understand why they rely on printed reports. This investigative approach helps uncover workflow difficulties or usability problems within the EHR system. Addressing these root causes through collaboration and education is more effective than immediately restricting printing privileges or escalating the issue.

Who should be included in a committee tasked with reviewing and updating hospital order sets?

A multidisciplinary team is essential for reviewing and updating hospital order sets to ensure clinical relevance and operational feasibility. The team should include:

How should an informatics nurse determine the best mobile workstation device for nursing staff?

The informatics nurse should observe nursing staff directly during their workflow to assess device preferences, technical requirements, and practical challenges. This user-centered approach ensures that the selected workstation enhances efficiency and supports clinical tasks. While factors like disinfectability, budget, and security are important, they should be considered after understanding user needs.

Which nurse comment about hospital information systems (HIS) indicates a misunderstanding needing correction?

A nurse’s statement such as “With automated machines and computers, the number of nurses who encounter errors has increased” reflects a misunderstanding. Hospital information systems are designed to reduce errors by automating routine tasks, standardizing documentation, and supporting clinical decision-making. Other comments that highlight HIS benefits—such as improved inventory control, real-time access to data, and better coordination of care—are accurate.

What is the top priority security concern when using virtualized storage in clinical trial matching tools at an ambulatory oncology facility?

The main security concern is protecting sensitive patient medical data from breaches when stored in virtualized environments. Maintaining confidentiality and preventing unauthorized access is critical due to the sensitivity of oncology patient information. Issues like user resistance or workflow delays are secondary and can be addressed with appropriate training.

What is the advantage of using standardized terminology in healthcare data reporting?

Standardized terminology allows for consistent benchmarking and comparison of performance across healthcare organizations. It enables quality improvement initiatives, regulatory compliance, and efficient data sharing, all contributing to enhanced patient outcomes. Although visual data presentation tools help communicate findings, the core advantage lies in the ability to perform meaningful comparisons and track progress over time.

How can an informatics nurse specialist appropriately use knowledge discovery in databases (KDD) within healthcare?

An informatics nurse specialist utilizes KDD to analyze large clinical datasets to identify patterns, trends, and areas requiring improvement in nursing practice. This supports evidence-based care and enhances patient outcomes. However, KDD is a data analysis tool and does not replace clinical judgment necessary for decisions such as treatment limitations or care planning.

What time frame does CMS use to define repeat patient admissions under the Hospital Readmissions Reduction Program (HRRP)?

CMS defines repeat admissions within a 30-day window. This metric is used to measure hospital readmission rates and incentivize hospitals to reduce avoidable readmissions, thereby improving care quality.

What is the scope of practice for nursing informatics?

Nursing informatics combines nursing science with information and analytical sciences to manage data, information, knowledge, and wisdom related to nursing practice. It supports clinical decision-making, optimizes information systems, and improves patient outcomes. Its scope excludes specialized roles like data engineering or behavioral health sciences but focuses on applying informatics principles within nursing contexts.

References

Centers for Disease Control and Prevention. (2023). Infection control guidance for healthcare professionals about coronavirus (COVID-19). https://www.cdc.gov/infectioncontrol/guidelines/index.html

HealthIT.gov. (2023). Clinical decision support. https://www.healthit.gov/topic/safety/clinical-decision-support

Institute of Medicine. (2011). Health IT and patient safety: Building safer systems for better care. The National Academies Press.

National Institute of Nursing Research. (2022). Nursing informatics: The intersection of nursing science, computer science, and information science. https://www.ninr.nih.gov/researchandfunding/spotlight-on-nursing-research/nursing-informatics

U.S. Centers for Medicare & Medicaid Services. (2023). Hospital Readmissions Reduction Program (HRRP). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program

World Health Organization. (2023). Standardization of terminology in health data. https://www.who.int/standards/classifications