Adult-Gerontology Primary Care Nurse Practitioner Exam Technology & Digital Applications 3 — Questions and Answers
Question 1: Under the 21st Century Cures Act information blocking rule, which action by a healthcare provider would constitute information blocking?
- Charging a nominal fee for paper records
- Delaying patient access to test results for 90 days without a permitted exception (Correct answer)
- Releasing records to the patient after identity verification
- Using a standardized FHIR API for data exchange
Correct answer: Delaying patient access to test results for 90 days without a permitted exception
Delaying or restricting patient access to health data without a recognized exception constitutes information blocking under the Cures Act.
Question 2: An AGPCNP is evaluating a remote patient monitoring (RPM) program for hypertensive older adults. Which CMS billing code set is MOST relevant for reimbursing RPM services?
- CPT 99213-99215 (office visit E/M)
- CPT 99453, 99454, 99457, 99458 (RPM setup and management) (Correct answer)
- CPT 90837 (psychotherapy)
- CPT 93000 (ECG)
Correct answer: CPT 99453, 99454, 99457, 99458 (RPM setup and management)
CPT codes 99453, 99454, 99457, and 99458 specifically cover device setup, supply, and clinical management time for Medicare RPM programs.
Question 3: A 70-year-old patient with COPD is enrolled in a telemonitoring program. Which physiologic parameter, when trended remotely, is MOST predictive of a COPD exacerbation requiring intervention?
- Fasting blood glucose
- Oxygen saturation (SpO2) decline combined with increased respiratory rate (Correct answer)
- Daily step count only
- Blood pressure elevation
Correct answer: Oxygen saturation (SpO2) decline combined with increased respiratory rate
Declining SpO2 combined with elevated respiratory rate are early physiologic signals of impending COPD exacerbation captured by home telemonitoring.
Question 4: When documenting a telehealth encounter in the EHR, the AGPCNP must include which element to satisfy Medicare billing requirements?
- The patient's insurance card number
- Notation of the communication technology used and the patient's location at the time of service (Correct answer)
- A photograph of the patient
- Signature of a supervising physician
Correct answer: Notation of the communication technology used and the patient's location at the time of service
Medicare requires documentation of the telehealth modality and the patient's originating site to support billing and eligibility requirements.
Question 5: A practice implements a chatbot to conduct pre-visit symptom screening. The AGPCNP should ensure the chatbot:
- Replaces the intake nurse entirely to reduce staffing costs
- Is validated for accuracy, has clear escalation pathways, and discloses it is not a human clinician (Correct answer)
- Collects financial information before health information
- Operates without any clinical oversight
Correct answer: Is validated for accuracy, has clear escalation pathways, and discloses it is not a human clinician
Validated symptom-screening chatbots must be transparent about their nature, accurate, and integrated with human clinical oversight for safety.
Question 6: Which interoperability standard is required by CMS and ONC for patient data exchange through certified EHR technology as of 2023?
- HL7 v2 messaging only
- HL7 FHIR R4 APIs (Correct answer)
- SOAP web services
- Direct secure messaging exclusively
Correct answer: HL7 FHIR R4 APIs
ONC's 21st Century Cures Act Final Rule mandates FHIR R4-based APIs for certified health IT to enable standardized patient data access.
Question 7: A 65-year-old patient uses a smartwatch that detected an irregular heart rhythm and generated an ECG strip. The AGPCNP should:
- Dismiss the finding as consumer devices are never clinically relevant
- Review the strip, correlate with clinical history, and order a formal 12-lead ECG if atrial fibrillation is suspected (Correct answer)
- Refer immediately to cardiology without evaluating the strip
- Advise the patient to stop using the device
Correct answer: Review the strip, correlate with clinical history, and order a formal 12-lead ECG if atrial fibrillation is suspected
FDA-cleared single-lead smartwatch ECGs can detect AFib and should be reviewed in clinical context, with formal 12-lead ECG follow-up when indicated.
Adult-Gerontology Primary Care Nurse Practitioner Exam Technology & Digital Applications 3
Under the 21st Century Cures Act information blocking rule, which action by a healthcare provider would constitute information blocking?