Question 1

Which of the following tests how well new systems being implemented work with exis systems?

Accepted Answer

A)  volume test 
B)  system test 
C)  unit test 
D)  integration test

Question 2

Based on the MS-DRG report above, what is the case-mix index for this facility?

Accepted Answer

A)  0.204193 
B)  2.965807 
C)  11.639 
D)  57

Question 3

Clinical manifestations of this disease include polyidpsia, polyuria, weigh loss, and hyperglycemia. Which of the following tests would be ordered to confirm the disease?

Accepted Answer

A)  fasting blood sugar. 
B)  glucagon 
C)  glucose tolerance test 
D)  postprandial blood sugar

Question 4

Alzheimer's disease with dementia

Accepted Answer

A)  331.0, 294.8 
B)  294.8 
C)  331.0, 294.10 
D)  331.0

Question 5

Still referring to the information in the table in question number 88, which area represents the greatest area of concern for Springfield Hospital's compliance with Joint Commission standards?

Accepted Answer

A)  incomplete records. 
B)  delinquent records. 
C)  delinquent H&P. 
D)  delinquent operative reports.

Question 6

The best example of point-of-care service and documentation is

Accepted Answer

A)  using an automated tracking system to locate a record. 
B)  using occurrence screens to identify adverse events. 
C)  doctors using voice recognition systems to dictate radiology reports. 
D)  nurses using bedside terminals to record vital signs.

Question 7

A histogram is a valuable tool for representing

Accepted Answer

A)  the solution to a problem. 
B)  priorities in problem solving. 
C)  a frequency distribution with continuous-interval data. 
D)  the root causes of a problem.4,

Question 8

Using the SOAP style of documenting progress notes, choose the "subjective" statement from the following.

Accepted Answer

A)  sciatica unimproved with hot pack therapy 
B)  patient moving about very cautiously, appears to be in pain 
C)  adjust pain medication; begin physical therapy tomorrow 
D)  patient states low back pain is as severe as it was on admission

Question 9

Edward is diagnosed with syndrome of inappropriate antidiuretic hormone with resultant electrolyte imbalance.

Accepted Answer

A)  276.50 
B)  276.9, 272.9 
C)  253.6, 276.9 
D)  253.6. 276.8

Question 10

The nursing staff would most likely use which of the following to facilitate aggregation of data for comparison at local, regional, national, and international levels?

Accepted Answer

A)  READ codes. 
B)  ABC codes. 
C)  SPECIALIST Lexicon. 
D)  LOINC.

Question 11

The HIM Department maintains 5000,000 records and responds to 5,000 requests for records in a given period of time. What is the record usage rate?

Accepted Answer

A)  0.01% 
B)  1% 
C)  5% 
D)  10%

Question 12

In relation to birth defects registries, active surveillance systems

Accepted Answer

A)  use trained staff to identify cases in all hospitals, clinics, and other facilities through review of patient records, indexes, vital records, and hospital logs. 
B)  are commonly used in all 50 states. 
C)  miss 10% to 30% of all cases. 
D)  rely on reports submitted by hospitals, clinics, or other sources.

Question 13

A 16-year-old male was treated at your facility for a closed head injury. The patient's 18- year-old wife accompanied him to the hospital and signed the consent for admission and treatment because of the patient's incapacity at the time. The patient has requested that copies of his medical records be sent to his attorney. Who should sign the authorization to release the records?

Accepted Answer

A)  the patient 
B)  either of the patient's parents 
C)  the patient's parent or legal guardian 
D)  the patient's wife

Question 14

An established patient was seen in her primary physician's office. The patient fell at home and came to the physician's office for an examination. Due to a possible concussion, the patient was sent to the hospital to be admitted as an observation patient. A detailed history and examination were performed and the medical decision was low complexity. The patient stayed overnight and was discharged the next afternoon.

Accepted Answer

A)  99214; 99234 
B)  99214; 99218; 99217 
C)  99218 
D)  99218; 99217

Question 15

The reference date for a cancer registry is

Accepted Answer

A)  January 1 of the year in which the registry was established. 
B)  the date when data collection began. 
C)  the date that the Cancer Committee is established. 
D)  the date that the cancer program applies for approval by the American College of Surgeons.

Question 16

Medicare rules state that the use of verbal orders should be infrequent and used only when the orders cannot be written or given electronically. In addition, verbal orders must be

Accepted Answer

A)  written within 24 hours of the patient's admission. 
B)  accepted by a charge nurses only. 
C)  co-signed by the attending physician within 12 hours of giving the order. 
D)  accepted by persons authorized by hospital regulations and procedures.

Question 17

In ICD-9-CM, when an exploratory laparotomy is performed followed by a therapeutic procedure, the coder lists

Accepted Answer

A)  therapeutic procedure first, exploratory laparotomy second. 
B)  exploratory laparotomy, therapeutic procedure, closure of wound. 
C)  therapeutic procedure only. 
D)  exploratory laparotomy first, therapeutic procedure second.

Question 18

According to current theory in the quality management field, should concurrent data collection or retrospective data collection be utilized?

Accepted Answer

A)  Concurrent and retrospective data collection methods are both necessary in order to effect meaningful interventions and contain costs. 
B)  Concurrent data collection methods alone are meaningful because they emulate health practitioner training. 
C)  Concurrent data collection methods alone are meaningful because interventions must always be immediate. 
D)  Retrospective data collection methods alone are appropriate in the reimbursement realities of this decade.

Question 19

Patient presents to the operating room where a 3.2 cm malignant lesion of the shoulder was excised and repaired with simple sutures. A 2.0 cm benign lesion of the cheek was excised and was repaired with a rotation skin graft.

Accepted Answer

A)  11604; 11442; 14040; 12001 
B)  14040; 11604 
C)  15002; 15120 
D)  17264; 17000; 12001

Question 20

A patient is undergoing hemodialysis for end-stage renal disease in the outpatient department of observation for several hours, at which time the patient is admitted to inpatient care for further workup. The cardiologist diagnoses the patient's problem as unstable angina. What is the principal diagnosis for the acute hospital stay?

Accepted Answer

A)  complications of hemodialysis. 
B)  heartburn. 
C)  unstable angina. 
D)  renal disease.

Exam 1: Registered Health Information Administrator