Laboratory Testing and Cost Analysis, Exams of Nursing

Download Laboratory Testing and Cost Analysis and more Exams Nursing in PDF only on Docsity! 2024 MLS EDUCATION AND MANAGEMENT QUESTIONS AND ANSWERS GRADED A 1. A comparison of methods for the determination of alkaline phosphatase is categorized in which domain of educational objectives? A. Affective B. Psychomotor C. Cognitive D. Behavioral: C The cognitive domain of educational objectives deals with application, analysis, synthesis, and evaluation of information or knowledge learned to be utilized in problem solving. Harr, Robert R. Medical Laboratory Science Review (Page 523). F.A. Davis Compa- ny. Kindle Edition. 2. Attitude, judgment, and interest refer to which domain of educational objec- tives? A. Cognitive B. Affective C. Psychomotor D. Competency: B The affective domain of educational objectives includes those that emphasize val- ues, attitudes, and interests that attach a worth to an activity, situation, or phenom- enon. Harr, Robert R. Medical Laboratory Science Review (Page 523). F.A. Davis Compa- ny. Kindle Edition. 3. Criterion-referenced examinations are used in order to determine the: A. Competency of a student according to a predetermined standard B. Validity of a test C. Status of one student compared to the whole group D. Accuracy of a test: A A criterion-referenced test is used to determine the mastery of predetermined competencies, while a norm-referenced test evaluates students by comparison to the group. Criterion-referenced examinations use questions of known difficulty and can be calibrated against established criteria in order to evaluate the examinee's performance. Harr, Robert R. Medical Laboratory Science Review (Page 523). F.A. Davis Compa- ny. Kindle Edition. 4. An instructor "curved" a blood bank exam given to medical laboratory science students. The highest grade was an 85% and the lowest grade was 1 / a 60%. What type of test is this? A. Subjective B. Objective C. Norm referenced D. Criterion referenced: C This type of test compares the students to each other rather than grading the students on a set of standards or criterion that must be met. Harr, Robert R. Medical Laboratory Science Review (Page 524). F.A. Davis Compa- ny. Kindle Edition. 5. In general, academic evaluation of students depends on the ability of the instructor to create a test that reflects the stated objectives of the course material as well as making the test: A. Reliable and valid B. Normally distributed and practical C. Fair and short D. Written and oral: A A test should be based on stated, measurable objectives and contain five attributes: reliability, validity, objectivity, fairness, and practicality. Harr, Robert R. Medical Laboratory Science Review (Page 524). F.A. Davis Compa- ny. Kindle Edition. 6. When dealing with the instruction of complex instrumentation, a demonstra- tion by the instructor is necessary and should include the following: A. Detailed diagrams of the electrical system B. A blueprint of the optical system C. A step-by-step narrative with comparisons to a manual method D. A quiz as soon as the demonstration is complete: C When a demonstration of a complex instrument is necessary, a small group of stu- dents should be assembled around the instrument to permit clear visibility. A diagram with the major functioning parts should be provided, along with an assignment of a written summary or questions about the function, principle, testing done, and reagents needed. Harr, Robert R. Medical Laboratory Science Review (Page 524). F.A. Davis Compa- ny. Kindle Edition. 7. One method of learning is by giving a small group of students a topic to discuss or a problem to solve rather than a formal lecture by the 13. The four essential functions of a manager are: A. Staffing, decision making, cost analysis, evaluating B. Directing, leading, forecasting, implementing C. Planning, organizing, directing, controlling D. Innovating, designing, coordinating, problem solving: C While managing may involve all of the functions listed, the four core processes for all managers are planning, organizing, directing, and controlling. Planning in- cludes formulating of goals and objectives, organizing the tasks, and establishing schedules. Organizing includes establishing effective communication, relationships, job descriptions, and training. Directing involves oversight of the various steps and stages of the plan, including coordination and leadership. Controlling involves evaluating resource utilization and outcomes, managing costs, and modifying the process to improve quality. Harr, Robert R. Medical Laboratory Science Review (Page 526). F.A. Davis Compa- ny. Kindle Edition. 14. Direct laboratory costs for tests include which of the following? A. Equipment maintenance B. Insurance C. Depreciation D. Overtime pay: D All costs that are specifically linked to a test (e.g., personnel, overtime, chemicals, supplies) are direct costs. Harr, Robert R. Medical Laboratory Science Review (Page 526). F.A. Davis Compa- ny. Kindle Edition. 15. Which of the following accounts for the largest portion of the direct cost of a laboratory test? A. Reagents B. General supplies C. Technologist labor D. Instrument depreciation: C Labor accounts for 60%-70% of the direct cost per test in most laboratories. The cost of labor, reagents, and supplies are direct costs, but instrument depreciation is not. Harr, Robert R. Medical Laboratory Science Review (Page 526). F.A. Davis Compa- ny. Kindle Edition. 16. Using the surcharge/cost-plus method for determining test charges, de- termine the charge for an ova and parasite examination on fecal specimens, given the following information: Collection, handling, clerical, and so forth = $2.00 Reference lab charge to lab = $20.00 Lab "markup" = 100% A. $22.00 B. $32.00 C. $42.00 D. $122.00: C The "markup" factor is used to establish part of the cost of a test in order to obtain the desired profit margin. Tests sent to reference laboratories or done in-house have the added cost that is referred to as the surcharge/cost-plus method of determining test charges. Harr, Robert R. Medical Laboratory Science Review (Page 526). F.A. Davis Compa- ny. Kindle Edition. 17. In deciding whether to adopt a new test on the laboratory's automated chemistry analyzer, which parameters are needed to determine the number of tests that must be performed to break even? A. Test turnaround time B. Cost of labor per hour C. Number of other tests performed per month D.Total fixed laboratory costs: D The formula for calculating the break-even point in test volume is: No. of tests = total fixed costs ÷ (average reimbursement - variable cost per test). The total fixed costs are the expenses that are not expected to change as the workload increases (e.g., cost of the instrument). The variable cost per test includes any costs that increase as the workload increases (e.g., cost of reagents). The average reimbursement represents the expected revenue generated per billable test result. Harr, Robert R. Medical Laboratory Science Review (Page 527). F.A. Davis Compa- ny. Kindle Edition. 18. Which statement best represents the relationship between test volume and revenue or costs for batch-run tests? A. As volume increases, the fixed cost per test also increases B. As volume increases, the revenue also increases C. Revenue is approximately equal for both high- and low-volume tests D. 90% of the revenue is generated by 5% of the tests offered: B As volume increases, costs should decrease and revenues should increase. The large fixed costs such as instrumentation, labor, and management do not change with the size of the batch. As volume increases, reagent and consumable costs per test often become lower thus reducing the variable cost per test. In most laboratories, about 80% of the revenue is generated by the laboratory tests that comprise the top 20% of the test volume. Harr, Robert R. Medical Laboratory Science Review (Page 527). F.A. Davis Compa- ny. Kindle Edition. 19. A hospital submits a bill for $200.00 to the patient's insurance company for the cost of outpatient laboratory tests. The laboratory services rendered by the hospital are paid according to an agreed fee schedule. The specific laboratory procedures are billed according to which system of coding? A. Diagnosis-related group (DRG) B. Current procedural terminology (CPT) C. Medicare D. Medicaid: B The CPT code refers to Current Procedural Terminology. Codes are assigned to all medical procedures, which are grouped according to common disease character- istics. The insurance company or payer (e.g., Medicare) usually has agreed to a reimbursement amount per test or procedure. The American Medical Association publishes Current Procedural Terminology, or CPT, which is updated yearly. Harr, Robert R. Medical Laboratory Science Review (Page 527). F.A. Davis Compa- ny. Kindle Edition. 20. A hospital has a contract with a major medical insurer that reimburses the laboratory at a rate of $1.00 per insured life per year. This type of reimburse- ment is called: A. A prospective payment system B. A preferred provider discount C. Capitation D. Diagnosis-related group: C Capitation plans provide the laboratory with a fixed (known) revenue based upon a negotiated per-capita fee for the members of the group. In order to profit, the labo- ratory must manage its resources to provide covered laboratory tests to the group at a cost that does not equal or exceed its reimbursement. A prospective payment system is used by Medicare and Medicaid programs for outpatient reimbursements and is based upon projecting the cost of a laboratory test in a specific region. For inpatients, the fees for laboratory tests are incorporated into the reimbursement covering the specific diagnosis-related group rather than the type or number of laboratory procedures performed. Education and Management Harr, Robert R. Medical Laboratory Science Review (Page 528). F.A. Davis Compa- ny. Kindle Edition. 26. According to CLIA '88, satisfactory performance for ABO, Rh, and compat- ibility tests requires a score of: A. 100% B. 90% C. 80% D. 75%: A Unsatisfactory performance occurs when any challenge for ABO, Rh, or compatibil- ity testing is in error. For all other tests, a score below 80% is defined as unsatis- factory performance. Unsatisfactory performance for the same analyte for two out of two events or two out of the three most recent events constitutes unsuccessful participation. Harr, Robert R. Medical Laboratory Science Review (Page 529). F.A. Davis Compa- ny. Kindle Edition. 27. In order to comply with CLIA '88, calibration materials must: A. Be purchased by an authorized agency such as the College of Pathology B. Have concentration values that cover the laboratory's reportable range C. Be traceable to the National Calibration Board D. Be identical in concentration to those sold by the reagent manufacturer: B According to CLIA '88, the minimum requirement for calibration is every 6 months or more frequently if specified by the manufacturer. The calibrators must cover the reportable range of the method. A minimum of two levels of calibrant must be used (more if specified by the manufacturer). Harr, Robert R. Medical Laboratory Science Review (Page 529). F.A. Davis Compa- ny. Kindle Edition. 28. According to CLIA '88, calibration materials should be appropriate for the methodology and be: A. Of bovine origin B. Three times the normal range for the specific analyte C. Traceable to a reference method and reference material of known value D.Twice the laboratory's reference range for the analyte: C Calibrators must have an assigned concentration determined by assay using a reference method. The reference method should be calibrated using standards that are traceable to National Bureau of Standards material or acceptable primary standards. 12 / 22 Harr, Robert R. Medical Laboratory Science Review (Page 529). F.A. Davis Compa- ny. Kindle Edition. 29. Under CLIA '88, testing personnel with an associate degree and appropri- ate training in the clinical laboratory are authorized to perform: A. Waived tests only B. Tests that are qualitative or waived and some moderate-complexity tests C. Waived and moderate-complexity tests D. Waived, moderate-complexity, and highcomplexity tests: D Testing personnel with an associate degree and approved laboratory training may perform high-complexity tests as well as waived and moderate-complexity tests. However, the laboratory must be certified at all three levels. Harr, Robert R. Medical Laboratory Science Review (Page 529). F.A. Davis Compa- ny. Kindle Edition. 30. Sexual harassment is a form of discrimination and therefore is prohibited by the: A. Occupational Safety and Health Administration (OSHA) B. Civil Rights Act of 1964 (Title VII) C. Right to Privacy Act of 1974 D. Department of Health and Human Services: B The Civil Rights Act of 1964 prohibits by federal law discrimination in employment be- cause of race, color, religion, or gender. The law established the Equal Employment Opportunity Commission (EEOC) to hear complaints of discrimination by employees and initiate legal action as appropriate. Harr, Robert R. Medical Laboratory Science Review (Page 529). F.A. Davis Compa- ny. Kindle Edition. 31. Which order of events should be followed at the conclusion of a laboratory worker's shift in order to prevent the spread of bloodborne pathogens? A. Remove gloves, disinfect area, wash hands, remove lab coat B. Disinfect area, remove gloves, remove lab coat, wash hands C. Disinfect area, remove gloves, wash hands, remove lab coat D. Remove gloves, wash hands, remove lab coat, disinfect area: B According to the OSHA Bloodborne Pathogens Rule of 1992, gloves and lab coats are to be removed after disinfection of the work area. Harr, Robert R. Medical Laboratory Science Review (Page 529). F.A. Davis Compa- ny. Kindle Edition. Education and Management 32. Records of a patient's laboratory test results may not be released without his or her consent to anyone outside the clinical laboratory except to the: A. American Red Cross B. Department of Health and Human Services C. Insurance carrier D. Physician who ordered the tests: D The Privacy Act of 1974 prohibits the release of medical records without the patient's consent except to the patient's attending physician, attorney, or next of kin if deceased unless solicited by a valid subpoena. Harr, Robert R. Medical Laboratory Science Review (Page 530). F.A. Davis Compa- ny. Kindle Edition. 33. Unethical behavior by a laboratory supervisor that results in a compromise of employee safety should be: A. Reported to a higher authority B. Directly confronted C. Reported to the EEOC D. All of these options: D Direct confrontation is in order, followed by reporting the behavior to a higher authority at the clinical site. Major violations that are a threat to the safety of employees, patients, and the facility in general should be reported to the EEOC or OSHA, if the violations are not corrected in a timely fashion, and if all avenues of action have been exhausted. Harr, Robert R. Medical Laboratory Science Review (Page 530). F.A. Davis Compa- ny. Kindle Edition. 34. The most common deficiency cited during an onsite laboratory inspection by the College of American Pathologists (CAP) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is: A. Improper documentation B. Insufficient work space area C. Improper reagent storage D. Improper instrument calibration frequency: A Improper documentation accounts for the majority of laboratory deficiencies, while outdated or inadequate procedure manuals is the second most frequently cited deficiency. Harr, Robert R. Medical Laboratory Science Review (Page 530). F.A. Davis Compa- ny. Kindle Edition. 15 / 22 D. An employer: D HIPAA (Health Insurance Portability and Accountability Act, 1996) provides in- creased access to health care by making it easier for providers to send medical information to insurance companies electronically. The law requires health care providers to safeguard the confidentiality of patient medical information and to provide patients with a compliance statement that defines who is entitled to receive their health information. The physician ordering the tests as well as health care workers directly involved with the patient are allowed to see laboratory results. Laboratory results may also be released to the patient's insurance provider, and to medical review officers, and public health officials. They may also be released to the patient's family provided the patient is notified of this policy beforehand, and is given the right to object. Harr, Robert R. Medical Laboratory Science Review (Page 531). F.A. Davis Compa- ny. Kindle Edition. 41. The following is (are) successful indicator(s) of Quality Assurance (QA) and Quality Improvement (QI) programs in a clinical laboratory: A. A "log" of incident report and solutions attained B. Emergency department and STAT"turnaround times" C. Positive patient identification wristbands for blood bank operations D. All of these options: D These policies, along with laboratory performances on proficiency surveys, are a part of QA, QI, and TQI (total quality improvement), which are now included in the JCAHO accreditation process. Harr, Robert R. Medical Laboratory Science Review (Page 531). F.A. Davis Compa- ny. Kindle Edition. 42. Continuous Quality Improvement (CQI) is a team effort approach for clini- cal laboratories to: A. Identify potential problems and correct them B. Set lab financial benchmarks for the year C. Make up new CPT codes D. Improve overall wages for lab employees: A The CQI team identifies problems by collecting data, analyzing it, and developing methods of correcting problems. By identifying potential problems and correcting existing problems, a high competency is achieved and potential law suits are avoided. Harr, Robert R. Medical Laboratory Science Review (Page 531). F.A. Davis Compa- ny. Kindle Edition. 43. Which of the following is not an appropriate guideline for phlebotomists to follow in order to prevent a malpractice lawsuit? A. Use one form of patient ID, such as a last name B. Keep patient confidentiality at all times C. Use aseptic venipuncture technique at all times D. Label specimens only after the blood has been drawn: A Outpatient identification through two means (name and date of birth) are standard procedures to avoid drawing the wrong patient. Other malpractice prevention mea- sures include treating people equally; securing informed consent before testing; and listening to patients' concerns. Harr, Robert R. Medical Laboratory Science Review (Page 532). F.A. Davis Compa- ny. Kindle Edition. 44. According to CLIA '88, testing personnel performing high-complexity lab- oratory tests must have at least a: A. Bachelor of Arts degree B. Bachelor of Science degree in medical laboratory science (MLS) C. Associate degree in medical laboratory science (MLT) D. High school diploma: C CLIA '88 requires personnel performing high-complexity tests to have earned at least an associate degree in medical laboratory science, or attained a level of college education and clinical laboratory training equivalent to an associate degree in medical laboratory science. Harr, Robert R. Medical Laboratory Science Review (Page 532). F.A. Davis Compa- ny. Kindle Edition. 45. During an interview, an employer may request the following from a prospective new employee: A. Marital status B. Age of children C. Arrest record for driving under the influence of alcohol D. Professional certification: D All of the questions are in violation of Title VII of the Civil Rights Act of 1964, except the request for certification. The certification is usually a requirement for job performance and is listed in the job description. Harr, Robert R. Medical Laboratory Science Review (Page 532). F.A. Davis Compa- ny. Kindle Edition. 46. Point-of-care testing (POCT) refers to: A. All testing done to the patient to save time B. All lab testing done in the central lab C. Any clinical lab testing done at the patient's bedside D. Satellite lab testing: C Point-of-care testing saves time and is invaluable for patient care. When a device is used at the bedside of a patient to produce a laboratory result, it is considered a point-of-care instrument. Many such devices are often waived by CLIA, thus allowing them to be used by personnel without laboratory training. However, the institution must have a CLIA license to perform the testing, and appropriate quality control procedures must be followed. Some devices used for point-of-care testing utilize equivalent quality control, usually electronic simulation of the measurement that takes place with disposable unit-dose reagent packs. Harr, Robert R. Medical Laboratory Science Review (Page 532). F.A. Davis Compa- ny. Kindle Edition. 47. "Six sigma" is a method used in industry and business as well as the clinical laboratory in order to: A. Allow for improved performance B. Prevent and remove defects in production C. Improve customer satisfaction D. All of these options: D Six sigma management is a method for measuring the efficiency of a process such as mass production, and it is applied in the clinical laboratory to reduce the frequency of test errors. The process consists of five steps: define, measure, analyze, improve, and control. The term "six sigma" denotes a process so precise that six times the standard deviation still results in a useful product (laboratory test result that is within acceptable limits for total allowable error). Harr, Robert R. Medical Laboratory Science Review (Page 532). F.A. Davis Compa- ny. Kindle Edition. 48. The Material Safety Data Sheets (MSDS) for hazardous materials must be reviewed by personnel per Occupational Safety and Health Administration (OSHA) regulations: A. Weekly B. Monthly C. Every 6 months technologist who did work that day failed to enter the QC results. Such an ethical dilemma falls under which behavioral domain? A. Cognitive B. Psychomotor C. Affective D. None of these options: C Ethical behavior in the laboratory falls under the affective domain of behavioral objectives. The technologist should never enter results for a test that he or she did not perform. Such false documentation could lead to dismissal of the employee, and loss of licensure for the laboratory. Harr, Robert R. Medical Laboratory Science Review (Page 534). F.A. Davis Compa- ny. Kindle Edition. 54. What documents are needed to meet the ISO-9000 standards for laboratory certification? A. Quality manual, document control, internal audits, corrective and preven- tive actions B. Work performance evaluation, maintenance, budgeting C. Inventory, quality control, customer satisfaction D. Risk prevention, quality control, personnel: A ISO refers to the International Organization for Standardization. ISO 9000 is a set of three standards—ISO 9000, 9001, and 9004 (ISO 9003 is no longer used)— for quality management that can be applied to any business or organization such as a clinical laboratory. When an organization demonstrates compliance with ISO 9000 standards, it is said to be certified. ISO certification tells an organization's customers that it adheres to quality improvement standards and guidelines that improve performance and ensure the highest quality possible. Harr, Robert R. Medical Laboratory Science Review (Page 534). F.A. Davis Compa- ny. Kindle Edition. 55. In the field of clinical laboratory testing and in vitro diagnostic test sys- tems, ISO/TC 212 is the document used for standardization and guidance in all of the following areas except: A. Quality management and quality assurance B. Scheduling, yearly evaluations, and workloads C. Pre- and postanalytical procedures D. Laboratory safety and reference systems: B TC 212 is an ISO standard written for clinical laboratory testing and manufacturing of in vitro diagnostic products. The standards deal with the analytical test process, pre- and postanalytical processes, laboratory safety, and quality assurance including personnel qualifications and accreditation. The standards committee for ISO TC 212 in the United States works under the auspices of the American National Standards Institute (ANSI), and they have designated the Clinical Laboratory Standards Insti- tute (CLSI) to oversee the standards committee. Harr, Robert R. Medical Laboratory Science Review (Page 535). F.A. Davis Compa- ny. Kindle Edition. 56. SITUATION: In the course of isolation, B. anthracis is recovered that may be implicated in an act of bioterrorism. Such an organism would fall under which Centers for Disease Control category of biological agent? A. Category A B. Category B C. Category C D. None of these options: A The CDC groups biological agents that may be used to carry out terrorist threats into one of three categories: A, B, or C. Category A agents are those that would cause the most harm because of their highly infectious nature, mode of transmission, and high mortality. This group includes Bacillus anthracis, Clostridium botulinum, Francisella tularensis, Yersinia pestis, smallpox virus, and viruses that cause hemorrhagic fever such as Ebola and Marburg viruses. Category B includes bacteria and viruses that pose a lesser threat such as the organisms that produce ricin, gangrene, and Q fever. Category C includes emergent infectious agents such as hantavirus. Harr, Robert R. Medical Laboratory Science Review (Page 535). F.A. Davis Compa- ny. Kindle Edition. 57. SITUATION: A patient refuses to have his blood drawn for a routine labora- tory test request made by his physician. What is the most appropriate course of action? A. Perform the venipuncture against the patient's will B. Do not attempt the venipuncture and file an incident report with the labora- tory manager C. Request that the patient be sedated, then collect the sample D. Request assistance from the legal department: B Patients have the right to refuse treatment, even if they signed a document upon admission giving consent for treatment. In this situation, the supervisor should be notified, the incident documented, and the physician notified. The issue of informed consent is a legal one, and the laboratory personnel should act in accordance with the laws governing their jurisdiction. For example, some courts will not admit results