2022 Two Midnight Rule – Post Test

Quiz Summary

0 of 10 Questions completed

Questions:

You have already completed the quiz before. Hence you can not start it again.

Quiz is loading…

You must sign in or sign up to start the quiz.

You must first complete the following:

Results

Quiz complete. Results are being recorded.

Results

0 of 10 Questions answered correctly

You have reached 0 of 0 point(s), (0)

Current
Review
Answered
Correct
Incorrect

Question 1 of 10

1. Question
1. The Two Midnight Rule
- a. Requires all patients be in-house for two midnights before inpatient status is ordered
- b. Follows the Medical Inpatient Only (MIO) listing which is updated each year
- c. States that documentation for inpatient far exceeds that for observation status
- d. States that active management of a clinical condition should be expected to transcend two midnights to be considered inpatient
Correct

Incorrect
Question 2 of 10

2. Question
2. Exclusions for the Two Midnight Rule include:
- a. Death before two midnights have passed
- b. Leaving AMA or being transferred to another facility
- c. Unexpected ventilator use
- d. All of the above are exclusions
Correct

Incorrect
Question 3 of 10

3. Question
3. You expected a COPD exacerbation patient to stay more than two midnights based on presentation and prior history and so you ordered for inpatient care. The patient responded more quickly than expected and on the evening rounds of day two, asked to go home. Clinically, you agree with his request. Because the patient did not pass two midnights, you should
- a. Change the admit order to Observation AFTER you discharge the patient
- b. Change the admit order to Observation BEFORE you discharge the patient
- c. Leave the Inpatient order in place, but document that the clinical condition responded more rapidly than expected
- d. Keep the patient until after midnight so secure the “two midnight” criteria for inpatient admission
Correct

Incorrect
Question 4 of 10

4. Question
4. Medical admissions (CHF, pneumonia, etc.) have a specific inpatient only list that gets updated each year by CMS.
- a. True
- b. False
Correct

Incorrect
Question 5 of 10

5. Question
5. Correct statements for the “Two Midnight Rule” include:
- a. It is mandated by CMS that this “rule” be followed
- b. Two Midnights of active clinical management are needed to be documented to show the medical necessity of the condition and “inpatient” care needed
- c. Weekends and holidays are not counted
- d. There are no exclusions for the “Two Midnight Rule”
Correct

Incorrect
Question 6 of 10

6. Question
6. On day two of a hospital stay where the patient was admitted as inpatient, what would help secure this on day two?
- a. Occasional PACs on overnight monitor
- b. Noting a slight increased work of breathing on ambulation to the toilet (no accessory muscle use and RR 13) and RA saturation 96%
- c. Continued shortness of breath (sat 95% off supplemental O2) at rest. RR11.
- d. Shortness of breath on ambulation with O2 saturation 86% in a patient not on home O2
Correct

Incorrect
Question 7 of 10

7. Question
7. Which of the following COPD scenarios would most likely merit INPATIENT hospitalization from initial presentation?
- a. COPD patient with mild confusion exacerbation on day one
- b. COPD exacerbation with RR 15, cough w/ thick increased phlegm, sat 96% on RA
- c. COPD with 2 liters home O2, presents with sat 81% and bumped to 4 liters. CXR with LLL pneumonia. On 4 liters saturation is 91%.
- d. COPD patient who still smokes AMA, has 3d of wheezing and has used MDI 2x/day for 3d without relief
Correct

Incorrect
Question 8 of 10

8. Question
8. A 82 year old with HFrEF (31%) presents with a 2 day history of weight gain, DOE, LE edema of +3, and a RA saturation of 92% (baseline is 95%). His labs are stable with K+ 4.2, Hgb 9.9, and a Cr of 1.4 (baseline 0.9). CXR shows increased lung markings and a slight effusion. You order inpatient, but the Physician Advisor has requested a reconsideration for placement in Observation. What are some clinical indicators on day TWO that would confirm a need for continued care beyond two midnights and merit an inpatient admission? Choose ALL that are correct:
- a. The saturation drops to 88% and the 2 liters of oxygen is titrated to 3 liters with a sat of 93%
- b. The renal numbers increase on day two and you document a concern that further diuresis is needed and as such, the renal status may worsen
- c. When removing the oxygen (2 liters), the saturation drops to 85% on ambulation to the bathroom, requiring a re-institution of oxygen therapy to maintain baseline saturations
- d. The Hgb drops to 9.2. All other conditions are improving.
Correct

Incorrect
Question 9 of 10

9. Question
9. A 68 year old DM patient with ASCVD and HFrEF (40% EF), presents with Acute HF exacerbation. The patient, on day two has a Cr of 1.15, down from 1.16 (baseline 1.13). There are still crackles in the bases, but weight is down 11 pounds and O₂ sats are better overall at 96% off of supplemental oxygen. On ambulation, sats remain > 95% on RA. He was admitted as inpatient by your colleague yesterday. You decide the patient is stable to go home. You feel…
- a. Inpatient care is appropriate because of the O2 sat and crackles
- b. The patient can be discharged to home, but the inpatient order cannot be changed
- c. Observation is appropriate, so a new order needs to be written and case management notified before discharge
- d. Inpatient care is appropriate because of the Cr is still above baseline
Correct

Incorrect
Question 10 of 10

10. Question
10. A 71 year old with HFrEF (41%) presents with a 2 day history of weight gain, DOE, LE edema of +3, and a RA saturation of 92% (baseline is 95%). His labs are normal with K+ 4.2, Hgb 9.9, and a Cr of 1.4 (baseline 0.9). CXR shows increased lung markings and a slight effusion. His prior admission 2 months ago was 6 days and was complicated by acute kidney injury (Cr max was 2.8) after diuresis. This patient is best served by
- a. Inpatient admission due to the low hemoglobin, low oxygen saturation and HFrEF
- b. Inpatient admission due to the prior renal response and the assumption that a similar path will be taken given this presentation
- c. Outpatient observation because of the stable oxygenation on room air
- d. Outpatient observation because the Cr is only slightly elevated
Correct

Incorrect

2022 Two Midnight Rule – Post Test

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

Need Help Accessing the Site?

We're Here To Assist You