Orthopaedic Nurse Test Regulatory Frameworks & Compliance 4 — Questions and Answers
Question 1: The Centers for Medicare & Medicaid Services (CMS) Surgical Care Improvement Project (SCIP) includes which orthopaedic-specific measure to reduce surgical site infections?
- Prophylactic antibiotic administered within 60 minutes before incision and discontinued within 24 hours (Correct answer)
- Universal use of laminar airflow in all operating rooms
- Preoperative beta-blocker administration for all patients
- Intraoperative blood transfusion for hemoglobin below 10 g/dL
Correct answer: Prophylactic antibiotic administered within 60 minutes before incision and discontinued within 24 hours
SCIP Inf-1 requires prophylactic antibiotics to be given within 60 minutes before incision, and SCIP Inf-3 requires discontinuation within 24 hours post-surgery (48 hours for cardiac) to reduce SSI risk.
Question 2: Under HIPAA's Minimum Necessary standard, an orthopaedic nurse sharing a patient's records with a consulting physical therapist should:
- Send the entire medical record for completeness
- Share only the information reasonably necessary for the PT to provide care (Correct answer)
- Obtain a court order before sharing any information
- Require the PT to sign a business associate agreement first
Correct answer: Share only the information reasonably necessary for the PT to provide care
The Minimum Necessary standard requires covered entities to limit PHI disclosures to the least amount needed to accomplish the intended purpose.
Question 3: Which organization publishes evidence-based clinical practice guidelines that orthopaedic nurses must be familiar with, such as VTE prophylaxis recommendations for joint replacement patients?
- American Academy of Orthopaedic Surgeons (AAOS) (Correct answer)
- National Institute of Mental Health (NIMH)
- Environmental Protection Agency (EPA)
- Bureau of Labor Statistics (BLS)
Correct answer: American Academy of Orthopaedic Surgeons (AAOS)
AAOS publishes clinical practice guidelines, including those on VTE prophylaxis after total joint arthroplasty, which inform evidence-based orthopaedic nursing care.
Question 4: A state's Nurse Practice Act is most relevant to orthopaedic nurses regarding which situation?
- Determining Medicare reimbursement rates for nursing services
- Defining the legal scope of nursing practice and required licensure (Correct answer)
- Setting national staffing ratios for orthopaedic units
- Establishing billing codes for nursing procedures
Correct answer: Defining the legal scope of nursing practice and required licensure
Each state's Nurse Practice Act defines the legal scope of nursing practice, licensure requirements, and grounds for disciplinary action within that state.
Question 5: When an orthopaedic patient is deemed a 'never event' victim due to a retained surgical sponge, CMS policy requires which of the following?
- Hospitals are prohibited from billing Medicare for the additional treatment costs (Correct answer)
- The surgeon must personally report the event to the state health department
- The patient must be transferred to a federally designated trauma center
- An automatic malpractice settlement must be offered within 30 days
Correct answer: Hospitals are prohibited from billing Medicare for the additional treatment costs
CMS does not reimburse hospitals for the additional costs of care resulting from serious reportable events (never events), including retained foreign objects after surgery.
Question 6: Which compliance requirement applies when an orthopaedic unit implements a new electronic health record system that stores patient data?
- HIPAA Security Rule safeguards for electronic PHI (ePHI) (Correct answer)
- OSHA's Hazard Communication Standard
- FDA's 510(k) clearance process
- The Affordable Care Act's essential health benefits provision
Correct answer: HIPAA Security Rule safeguards for electronic PHI (ePHI)
The HIPAA Security Rule requires covered entities to implement administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of electronic PHI.
Question 7: According to ANA standards of practice, an orthopaedic nurse who identifies a practice gap during a quality improvement audit is expected to:
- Ignore the gap if it does not affect patient outcomes immediately
- Participate in developing and implementing quality improvement initiatives to address the gap (Correct answer)
- Report the gap directly to the state board of nursing only
- Wait for a physician to identify and address the issue
Correct answer: Participate in developing and implementing quality improvement initiatives to address the gap
ANA Standards of Professional Performance require nurses to participate in quality improvement activities, including identifying practice gaps and implementing evidence-based solutions.
Orthopaedic Nurse Test Regulatory Frameworks & Compliance 4
The Centers for Medicare & Medicaid Services (CMS) Surgical Care Improvement Project (SCIP) includes which orthopaedic-specific measure to reduce surgical site infections?