Chapter 2 Single Problem Visits Flashcards Preview

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Flashcards in Chapter 2 Single Problem Visits Deck (35):
1

1. What are date shortcuts for 2 days ago and 1 week from now?

1. t-2 and w+1

2

2. How is working in an office visit encounter different than viewing a
patient’s chart?

2. An office visit encounter offers activities such as Rooming and Plan (or
a Visit Navigator) so you can document visit-specific information. A
patient chart workspace allows you to view information in the patient’s
chart, but not to document visit-specific information.

3

3. True or False: To most efficiently completion match, enter the first few
letters of the word you want to look up and then click the Selection
button.

3. False (you should press ENTER).

4

4. In the exam room, the nurse opens Lisa’s encounter. When done
rooming the patient, what should the nurse do (assuming Dr. Lenite
will be entering the exam room soon)? Why?

4. She should leave open Lisa’s workspace and secure the workstation so
that when the provider logs in, the workstation automatically has Lisa’s
workspace open.

5

5. Can you document more than one reason for visit during a visit?

5. Yes

6

6. Nurse Memphis looks up a chief complaint by typing “twisted ankle.”
She selects that row and “ankle sprain” appears in the Reason for Visit
field. Which one was the synonym: twisted ankle or ankle sprain?

6. Twisted ankle

7

7. True or False: You should mark a medication as Not Taking if the
patient is possibly allergic to it.

7. False

8

8. What is the difference between an allergy being “Not on file” versus
“No known allergies”?

8. Not on file means we’ve never inquired. No known allergies means the
patient was asked but has no allergies.

9

9. What keyboard technique should you use to move from field to field in
the Vital Signs section?

9. TAB to go to the next field

10

10. True or False: In the Medications section, you do not have to enter the
name of a provider when documenting a patient-reported medication.

10. True

11

11. For a results message to be sent, what status must nurse Denver mark a
result in Enter/Edit Results?

11. Final

12

12. Kristi informs nurse Denver that she received a seasonal flu shot at
work last month. Explain how nurse Denver documents that fact.

12. In the Immunizations activity, open Single Historical Immunization and
document the details.

13

13. True or False: To enter dates for a series of historical immunizations,
you should use a template.

13. True

14

14. Dr. Quartz ordered a DTaP immunization. Nurse Memphis needs to
document the details after giving the shot. In the Immunizations
activity, what does the nurse click to open the details form?

14. Click Administer.

15

15. True or False: Schedule folders listed under My Schedule are created
by administrators.

15. False

16

16. Dr. Quartz entered into the Progress Notes section some detailed advice
about how the patient can take care of his lower back pain. Where
should Dr. Quartz have documented this? Explain why.

16. Dr. Quartz should have used the Patient Instructions section so it could
be printed on an After Visit Summary for the patient to take home.

17

17. True or False: To enter an LOS code for the visit, you must use an LOS
button.

17. False

18

18. Nurse Madison created a personalized schedule folder and decides that
she wants to remove a column from the display. What button should he
click: Create, Properties, or Remove?

18. Properties

19

19. What detail about a medication makes it “current”?

19. Its end date is still in the future.

20

20. Explain the difference between an expired medication and a
discontinued medication.

20. An expired medication is one that has passed its end date, whereas a
discontinued medication is one that a clinician has chosen to end by
entering a new end date of today.

21

21. In Meds & Orders, Dr. Quartz is in the Order Composer for a blood
test. He wants to change it so that the order will be released to its
destination two weeks from now. What should he do?

21. Set the Status to Future.

22

22. Complete these statements: Use the Dose field to enter how ______
medication should be taken. Use the Frequency field to document how
_______ this medication should be taken.

22. much, often

23

23. Name one possible reason a medication warning will appear.

23. One possible reason: Patient is allergic to the medication being ordered.

24

24. True or False: If nurse Denver does not have security to sign orders,
then that means she cannot look up orders.

24. False

25

25. Every time Dr. Granite orders a certain medication, a sig that she
doesn’t want is listed. Describe what she can do so that the next time
she orders it, the sig that she wants will appear.

25. Add it to her user preference list: Click the star next to the pended
medication. In the window, change details as needed and save it.

26

26. Richard needs to come in every three months for a TSH test. What
status should that order be?

26. Standing

27

27. True or False: If the order Dr. Mica selected has an advised
(recommended) question asking if the patient is pregnant, she can sign
the order without answering it.

27. True

28

28. Dr. Lenite just signed an order for a glucose test, and realized that it
was the wrong test. Describe one way she can cancel this order.

28. Find the test at the bottom of Meds & Orders, and click Cancel.

29

29. What visual cue tells you that a medication is expired?

29. It appears with a strikethrough.

30

30. Which symbol means this signed medication will be visible in the
MAR: house or bed?

30. Bed

31

31. Kristi’s asthma medication is expired, but it’s listed in the Medications
section, which should only show current medications. Why is it
appearing there?

31. It is marked long-term.

32

32. Dr. Mica is working in Meds & Orders and notices that Harold’s statin
prescription is nearing its end date. To quickly order more, what should
Dr. Mica do?

32. Click Reorder

33

33. Dr. Lenite is working in the Medications section and when she asks
Kristi about her reflux medication, Kristi says she doesn’t want to take
it anymore and she threw it away. Can Dr. Lenite discontinue that
medication in the Medications section?

33. Yes (red X)

34

34. True or False: To associate orders with diagnoses, use the Visit
Diagnoses section.

34. False

35

35. You saw a patient yesterday and wrote part of your progress note. You
exited the workspace. Now you want to finish the note. When you
attempt to open the patient’s encounter, you’re not prompted to create
an addendum. Why?

35. You had exited the workspace, so the encounter is still open. You’re
only prompted to create an addendum if the encounter is closed.