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ASHRM Certified Professional in Health Care Risk Management (CPHRM) Sample Questions (Q72-Q77):
NEW QUESTION # 72
What is the difference between a deductible and a self-insured retention?
- A. A self-insured retention is paid from operational fund.
- B. A deductible is subtracted from any amounts paid by a commercial carrier.
- C. A self-insured retention pays after carrier limits are exhausted.
- D. A deductible has to be paid before coverage is available.
Answer: B
Explanation:
According to Health Care Risk Management principles outlined by ASHRM and the American Hospital Association Certification Center, both deductibles and self-insured retentions are mechanisms used in risk financing to allocate a portion of loss to the insured organization. However, they function differently in relation to the insurer's obligation.
A deductible is typically subtracted from the amount paid by the commercial carrier. In many policies, the insurer may pay the full claim amount and then seek reimbursement of the deductible from the insured, or the insured may pay the deductible portion while the insurer handles defense and indemnity payments above that amount. The key distinction is that coverage attaches immediately, but the insured ultimately bears the deductible portion.
A self-insured retention differs in that the insured must satisfy the retention amount before the insurer's coverage is triggered. Until the retention is exhausted, the insured is responsible for payment and often for defense management.
Option B incorrectly describes a deductible as operating like a self-insured retention. Option C does not distinguish between the two mechanisms. Option D is incorrect because self-insured retention applies before, not after, carrier limits.
Therefore, the correct distinction is that a deductible is subtracted from amounts paid by the commercial carrier.
NEW QUESTION # 73
The source of many medication errors is:
- A. Elevator delays
- B. Radiology scheduling
- C. Verbal/telephone orders (when avoidable and not properly verified)
- D. Patient wristbands
Answer: C
Explanation:
Verbal/telephone orders are widely recognized aserror-pronebecause they can be misheard, misunderstood, or transcribed incorrectly-especially with sound-alike drug names, confusing numerals (15 vs 50), background noise, accents, and interruptions. ISMP and patient safety advisories recommend minimizing verbal orders whenever possible and using safeguards such as read-back/confirm-back, spelling drug names, stating digits individually, and documenting promptly. Risk management objectives include reducing reliance on memory and imperfect communication by prioritizing written or electronic orders (CPOE), standardizing when verbal orders are permitted (true emergencies), and auditing compliance to prevent unsafe normalization. Because medication errors can cause severe harm, controlling verbal order risk is a high-yield safety intervention and improves legal defensibility by aligning practice with recognized safety recommendations.
NEW QUESTION # 74
All of the following are examples of an adverse drug event EXCEPT
- A. controlled substance inventory discrepancy.
- B. a drug reaction experienced by the patient.
- C. an error in ordering or dispensing a drug.
- D. administration of a drug by the wrong route.
Answer: A
Explanation:
Under Health Care Risk Management principles defined by ASHRM and the American Hospital Association Certification Center, an adverse drug event refers to patient harm or potential harm related to the use of medication. This includes medication errors and adverse drug reactions that directly affect patient safety.
Administration of a drug by the wrong route is a medication error that may result in patient harm and therefore qualifies as an adverse drug event. A drug reaction experienced by the patient is, by definition, an adverse drug reaction and falls within the broader category of adverse drug events. Similarly, an error in ordering or dispensing a drug represents a medication error that may cause or has the potential to cause harm to a patient.
In contrast, a controlled substance inventory discrepancy relates to regulatory compliance, diversion risk, or financial accountability, not direct patient injury. While such discrepancies are serious and fall under legal, regulatory, and operational risk domains, they do not constitute an adverse drug event unless patient harm occurs.
Clinical and patient safety objectives emphasize distinguishing between medication-related patient harm and regulatory or operational issues. Therefore, the controlled substance inventory discrepancy is not an adverse drug event.
NEW QUESTION # 75
When a hospital notes that most errors are occurring at the "sharp end," what does that mean?
- A. Errors occur during direct caregiver-patient interaction (frontline care)
- B. Errors are exclusively leadership decisions
- C. Errors occur only in device manufacturing
- D. Errors are occurring in billing and contracting
Answer: A
Explanation:
The "sharp end" refers to the point in a system where clinicians directly interact with patients and deliver care-nurses administering medications, physicians performing procedures, therapists mobilizing patients, and so on. Errors at the sharp end are typicallyactive failuresthat are immediately visible, but they are often shaped by "blunt end" factors-staffing levels, training, equipment design, policies, and workflow constraints. Risk management objectives discourage blaming the sharp end alone; instead, they use incident analysis (RCA) to identify latent system conditions that make frontline errors more likely. Improving sharp- end safety includes standardization, teamwork tools (SBAR/TeamSTEPPS), human factors engineering, and reducing hazardous variability in processes. This systems approach helps prevent repeat events and supports a just culture where learning is prioritized while accountability is preserved for reckless conduct.
NEW QUESTION # 76
An unstable patient in the emergency department needs transfer to another hospital. Which of the following statements is true regarding the refusal of an on-call physician to treat this patient?
- A. The on-call physician may refuse to participate in the care of a patient, as long as that refusal is not based on insurance status or other financial concerns.
- B. The on-call physician is relieved of duty only if unavailable because of caring for another patient, or because of other circumstances outside the physician's control.
- C. The on-call physician may refuse to participate in the care of any patient, for any reason.
- D. The on-call physician is never relieved of duty to accept a patient needing specialized services.
Answer: B
Explanation:
Under Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, obligations under the Emergency Medical Treatment and Labor Act EMTALA govern on-call physician responsibilities. When a hospital maintains an on-call roster to provide specialty services for emergency department patients, physicians listed on call are required to respond and participate in the evaluation and stabilization of patients with emergency medical conditions.
An on-call physician may only be relieved of duty if legitimately unavailable due to circumstances beyond their control, such as actively caring for another patient or being otherwise unable to respond in accordance with hospital policy. Refusal to treat for convenience or non-clinical reasons may constitute an EMTALA violation and expose both the hospital and physician to regulatory penalties.
A blanket right to refuse care is inconsistent with EMTALA requirements. While financial discrimination is prohibited, refusal for other non-justifiable reasons may still violate federal law. Conversely, stating that a physician is never relieved of duty is inaccurate, as legitimate unavailability may excuse performance under specific circumstances.
Legal and regulatory objectives emphasize compliance with EMTALA, proper on-call coverage policies, and documentation of availability. Therefore, the correct statement is that relief occurs only when the physician is unavailable due to circumstances outside their control.
NEW QUESTION # 77
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