Healthcare administration and professional responsibility

During an initial evaluation of an ankle injury, the athletic trainer records: 'Anterior drawer test positive with a soft end-feel.' In which section of the SOAP note does this finding belong?

1. Objective
   A special-test result is a finding the clinician observed, so it belongs in the Objective section.
2. Plan
   Plan holds treatment, goals and follow-up, not exam results.
3. Assessment
   Assessment holds the clinician's impression drawn from the findings, not the findings themselves.
4. Subjective
   Subjective holds what the patient reports, such as symptoms and history, not test results.

BOC standards require athletic trainers to practice under the direction of, or in collaboration with, a physician. Which document puts that direction in writing for routine care?

1. The NATA Code of Ethics
   The NATA Code of Ethics sets ethical conduct and does not document physician direction.
2. The athletic trainer's BOC certificate
   BOC certification shows competence; it does not establish physician direction.
3. The venue's emergency action plan
   The emergency action plan covers emergency response, not direction for routine care.
4. Physician-signed standing orders
   Physician-signed standing orders put the physician's direction for routine care in writing.

An athletic trainer correctly selects a cold pack for an acute ankle sprain but leaves it on for more than an hour, and the patient develops a cold injury of the skin. Which type of negligence does this represent?

1. Abandonment
   The athletic trainer stayed with the patient's care throughout, so this term does not describe what happened.
2. Misfeasance
   Doing a proper act, here an indicated cold pack, in an improper way that causes harm is misfeasance.
3. Nonfeasance
   Nonfeasance is failing to act when there is a duty to act; here the athletic trainer did act.
4. Malfeasance
   Malfeasance is doing an act that should not have been done at all, but the cold pack was correctly indicated.

An athletic trainer believes the team physician's return-to-running timeline for an athlete after an ankle fracture is too aggressive. What should the athletic trainer do?

1. Follow the plan and say nothing
   Following the plan and saying nothing leaves a possible risk to the athlete unaddressed.
2. Advise the athlete to get a second opinion
   Steering the athlete to a second opinion bypasses a professional conversation with the treating physician.
3. Discuss the concern with the physician
   The athletic trainer raises the concern directly with the physician, who directs the plan of care.
4. Slow the plan without telling the physician
   Slowing the plan without telling the physician goes outside physician direction.

An athletic trainer in a clinic submits a claim for an ankle sprain evaluation. Which code set reports the patient's diagnosis on the claim?

1. NPI
   The NPI identifies the provider; it does not describe the diagnosis.
2. HCPCS Level II
   HCPCS Level II codes cover supplies, equipment and some services, not diagnoses.
3. ICD-10-CM
   ICD-10-CM codes report the patient's diagnosis on the claim.
4. CPT
   CPT codes report the procedures and services provided, not the diagnosis.

A coach asks the athletic trainer to hand out prescription pain pills from the team physician's supply to sore athletes after practice. What should the athletic trainer do?

1. Dispense if the coach signs the log
   A coach's signature does not authorize dispensing prescription medication.
2. Dispense only to athletes 18 or older
   Age does not change the rule; prescription drugs still need a prescriber and a licensed dispenser.
3. Dispense them and record each dose
   Recording each dose does not make dispensing legal.
4. Decline and refer to the physician
   Dispensing prescription drugs is outside athletic training practice, so the athletic trainer declines and refers athletes to the physician.

An athletic trainer serves on the committee choosing a new brace vendor and learns that a spouse is a paid sales representative for one of the bidding companies. What should the athletic trainer do?

1. Vote only if that company bids lowest
   Making the vote depend on price still lets a personal interest shape the decision.
2. Disclose the conflict and recuse from the vote
   Disclosing the conflict and stepping out of the vote protects the fairness of the decision.
3. Remain on the committee without mentioning it
   Staying on the committee without disclosure hides a conflict of interest.
4. Ask the spouse's company to withdraw its bid
   Asking the company to withdraw interferes with the bid process instead of managing the conflict.

An athletic training director with a fixed staff must decide which in-season teams receive an athletic trainer at practices. Which information should MOST drive this assignment?

1. Injury and catastrophic-injury risk
   Coverage is assigned by injury and catastrophic-injury risk, so the riskiest activities get an athletic trainer.
2. Coach and booster requests for coverage
   Coach or booster pressure is not a medical basis for staffing.
3. Number of home events per season
   Home-event counts ignore practice risk, where many injuries happen.
4. Number of athletes on each roster
   Roster size does not measure how likely or how serious injuries are.

A university assigns a full-time athletic trainer to every football and men's basketball practice, while women's soccer and softball share one graduate assistant who attends games only. Which federal law is MOST directly implicated?

1. Americans with Disabilities Act
   The ADA covers disability discrimination, not unequal coverage by sex.
2. Title IX of the Education Amendments
   Unequal medical coverage between men's and women's teams is a sex-based disparity in benefits, which Title IX addresses.
3. Family Educational Rights and Privacy Act
   FERPA governs education records, not how medical coverage is allocated.
4. Title VII of the Civil Rights Act
   Title VII covers employment discrimination, not services to student-athletes.

The father of a 19-year-old university soccer player calls the university-employed athletic trainer to ask about his daughter's knee MRI results. The athlete has not signed a release. What should the athletic trainer do?

1. Obtain the athlete's written consent first
   The athlete is an adult, so the athletic trainer needs the athlete's written authorization before sharing health results with a parent.
2. Refer him to the physician to share them
   Sending the father to the physician moves the problem; the physician also needs the athlete's consent.
3. Share them, as parents hold FERPA rights
   FERPA rights pass to the student at 18, so a parent does not hold them.
4. Share them verbally but not in writing
   Sharing verbally is still a disclosure and needs the same authorization.

An athletic training director is reviewing plans for a new facility's hydrotherapy area, which will house two whirlpools. Which electrical feature is MOST important for patient safety in this area?

1. A separate breaker panel for the whirlpools
   A separate breaker panel organizes circuits but does not trip on the small leaks a GFCI detects.
2. Heavy-duty extension cords rated for outdoor use
   Extension cords near water are a hazard, whatever their rating.
3. Ground-fault circuit interrupters on outlets
   Ground-fault circuit interrupters cut power at a current leak, preventing electrocution near water.
4. Surge protectors on each whirlpool outlet
   Surge protectors guard equipment against voltage spikes, not patients against ground faults.

An athletic training clinic averages 11 visits per ankle-sprain episode of care, while a regional database of similar clinics reports an average of 7. Which quality-improvement activity is the clinic performing by making this comparison?

1. Peer review
   Peer review evaluates individual clinicians' care, not the clinic against a database.
2. Root cause analysis
   Root cause analysis investigates why a specific adverse event happened.
3. Failure mode and effects analysis
   Failure mode and effects analysis looks ahead at how a process could fail.
4. Benchmarking
   Comparing the clinic's results with an external average is benchmarking.

An athletic trainer employed by a high school and covered by the district's liability policy plans to provide paid weekend services to a private club team. What should the athletic trainer do before starting?

1. Obtain individual liability coverage
   Paid outside work is not covered by the employer's policy, so the athletic trainer needs individual liability coverage.
2. Rely on Good Samaritan protection
   Good Samaritan laws cover unpaid emergency aid, not paid services.
3. Rely on the club's participant waivers
   Participant waivers do not protect against negligence claims the way insurance does.
4. Rely on the district's liability policy
   The district's policy covers duties done for the district, not private paid work.

During a tournament, an athletic trainer begins evaluating a wrestler with a suspected shoulder dislocation, then leaves for lunch without handing off care; the wrestler waits unattended for 40 minutes. Which legal concept BEST applies?

1. Comparative negligence
   Comparative negligence apportions fault between parties and is not the act of leaving a patient.
2. Misfeasance
   The athletic trainer's error was leaving the patient, which this term does not describe.
3. Abandonment
   Starting care and then leaving without handing off to a qualified provider is abandonment.
4. Malfeasance
   Malfeasance is doing an act that should not have been done, but no improper act occurred here.

A high school athlete fractures her wrist in a game. Her family's health plan pays 80% after the deductible, and the school carries athletic accident insurance written as excess coverage. How are the claims processed?

1. The school policy pays everything alone
   An excess policy does not pay the whole claim alone while primary coverage exists.
2. The school policy first, then the family plan
   The school's excess policy does not pay first; it waits for the primary plan.
3. Only the family plan pays; excess never does
   Excess coverage does pay remaining eligible costs after the primary plan.
4. Family plan first, then the school policy
   Excess coverage pays only after the primary policy, so the family plan pays first and the school policy covers what remains.