Advanced Practice Nursing : Essentials for Role Development 4th Edition Joel Test Bank, Exams of Nursing

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Advanced Practice Nursing : Essentials for Role Development 4th Edition Joel

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Chapter 1. Advanced Practice Nursing: Doing What Has to Be Done-Radicals, Renegades, andRebels MULTIPLE CHOICE

1. The nurse manager of a pediatric clinic could confirm that the new nurse recognized the purpose of the HEADSS Adolescent Risk Profile when the new nurse responds that it is used to assess for needs related to a. anticipatory guidance. b. low-risk adolescents. c. physical development. d. sexual development. ANS: A The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which assesses home, education, activities, drugs, sex, and suicide for the purpose of identifying high-risk adolescents and the need for anticipatory guidance. It is used to identify high-risk, not low-risk, adolescents. Physical development is assessed with anthropometric data. Sexual development is assessed using physical examination. REF: 6 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
2. The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, the expected stage of development for a preschooler is a. concrete operational. b. formal operational. c. preoperational. d. sensorimotor. ANS: C The expected stage of development for a preschooler (3 to 4 years old) is preoperational. Concrete operational describes the thinking of a school-age child (7 to 11 years old). Formal operational

REF: 4 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

5. To plan early intervention and care for an infant with Down syndrome, the nurse considers knowledge of other physical development exemplars such as a. cerebral palsy. b. failure to thrive. c. fetal alcohol syndrome. d. hydrocephaly. ANS: D Hydrocephaly is also a physical development exemplar. Cerebral palsy is an exemplar of adaptive developmental delay. Failure to thrive is an exemplar of social/emotional developmental delay. Fetal alcohol syndrome is an exemplar of cognitive developmental delay. REF: 9 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
6. To plan early intervention and care for a child with a developmental delay, the nurse would consider knowledge of the concepts most significantly impacted by development, including a. culture. b. environment. c. functional status. d. nutrition. ANS: C Function is one of the concepts most significantly impacted by development. Others include sensory-perceptual, cognition, mobility, reproduction, and sexuality. Knowledge of these concepts can help the nurse anticipate areas that need to be addressed. Culture is a concept that is considered to significantly affect development; the difference is the concepts that affect development are those that represent major influencing factors (causes), hence determination of development and would be the focus of preventive interventions. Environment is considered to significantly affect development. Nutrition is considered to significantly affect development. REF: 1 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

7. A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to her toys and makes up stories. The mother wants her child to have a psychologic evaluation. The nurses best initial response is to a. refer the child to a psychologist. b. explain that playing make believe with dolls and people is normal at this age. c. complete a developmental screening. d. separate the child from the mother to get more information. ANS: B By the end of the fourth year, it is expected that a child will engage in fantasy, so this is normal at this age. A referral to a psychologist would be premature based only on the complaint of the mother. Completing a developmental screening would be very appropriate but not the initial response. The nurse would certainly want to get more information, but separating the child from the mother is not necessary at this time. REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance
8. A 17 - year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so needy and acting like a child. The best response of the nurse is that in the hospital, adolescents a. have separation anxiety. b. rebel against rules. c. regress because of stress. d. want to know everything. ANS: C Regression to an earlier stage of development is a common response to stress. Separation anxiety is most common in infants and toddlers. Rebellion against hospital rules is usually not an issue if the adolescent understands the rules and would not create childlike behaviors. An adolescent may want to know everything with their logical thinking and deductive reasoning, but that would not explain why they would act like a child. Chapter 2. Emerging Roles of the Advanced Practice Nurse

3. Communication problems often plague ethical dilemmas, which of the following is often at the forefront of communication problems regarding clinicians? a. Poor knowledge of the situation b. Language barriers c. Poor independence d. Failure to speak up ANS: D All of the answers may contribute to ethical dilemmas but failure of a clinician to speak up about a real or potential ethical problem is commonly identified. Erosion of open and honest communication is typically the first theme encountered in many ethical dilemmas.
4. A 76 - year-old patient is admitted to the hospital after suffering a spinal compression fracture. The patient is unable to ambulate adequately on his or her own and requires assistance for basic needs. Your assessment is that the patient will recover their strength within 2 weeks. The billing department at the facility notifies you that the patient may not stay in the hospital for more than 2 days. The patient does not wish to be transferred to a nursing facility and wishes to remain in the hospital for the remaining 12 days to gain strength. Which of the following best defines this scenario? a. Interprofessional conflict b. Communication problems c. Legal issues d. Multiple commitments ANS: A This ethical scenario plays out routinely in medical care as an element of interprofessional conflict. The clinician wishes to respect patient autonomy but must understand and express the best interests of the patient to a multidisciplinary team.
5. An APRN is scheduled to complete his or her shift at 7 p.m. on a particular day. A new patient arrives 5 minutes prior to the time the APRN is expected to leave. He or she is asked by a supervisor to stay beyond their scheduled time to assess the patient and provide care. Which of the following best defines this scenario? a. Interprofessional conflict b. Multiple commitments c. Communication problems d. Legal issues ANS: B

APRNs often fail to practice self-care and it is a significant threat to ethical practice. Multiple commitments including obligations to multiple parties involving the patient, employer, and legal system may create a scenario for ethical issues in nursing practice. Societal issues including cost containment pressures in health systems are likely partially responsible for development of this scenario.

6. An APRN works in a primary care clinic. The APRN wishes to treat a patient’s disease with a specific medication that is far superior to other treatments. The APRN has never encountered issues prescribing this therapy as first-line treatment in the past. The APRN is informed by this particular patient’s insurance that they require proof that the APRN has tried a far less effective therapy for 1 month prior to paying for the medication. Which of the following best describes the forces at work in this scenario? a. Communication problems b. Legal issues c. Interprofessional conflict d. Societal issues ANS: D Societal issues including cost containment pressures in health systems are likely responsible for development of this scenario. Interprofessional conflicts would best be involved in this scenario if this is applied in a multidisciplinary team scenario.
7. Which of the following are defined as the four elements of core competency development in ethical decision making for APRNs? a. Knowledge development, knowledge application, creating an ethical environment, promoting social justice b. Knowledge development, educating others, creating an ethical environment, promoting social justice c. Knowledge development, knowledge application, effective communication, promoting social justice d. Knowledge development, knowledge application, creating an ethical environment, understanding legal barriers ANS: A The core competency of ethical decision making for APRNs is best organized into four key elements: knowledge development, knowledge application, creating an ethical environment, and promoting social justice.
8. Which of the following examples best describes the knowledge development element of core competency development for ethical decision making?

11. An APRN works at a hospital system that provides care to a large proportion of Asian- American citizens. The APRN develops a presentation for newly hired employees about the cultural belief systems held by many in this population group. This describes the use of which of the following elements of core competency development for ethical decision making? a. Creating an ethical environment b. Promoting social justice c. Knowledge application d. Knowledge development ANS: A Creating an ethical environment may include the use of preventative ethics and awareness of environmental barriers to ethical practice.
12. Application of existing rules and doctrine as a guide for ethical decision making is best described as which ethical approach? a. Narrative ethics b. Care-based ethics c. Casuistry d. Principle-based ethics e. Virtue-based ethics ANS: D In principle-based ethical decision making, the principles or rules in contention are balanced and interpreted with the contextual elements of the situation. However, the final decision and moral justification for actions are based on principles.
13. Which ethical approach uses comparisons ofprecedent-setting cases and current scenarios? a. Principle-based ethics b. Casuistry c. Care-based ethics d. Narrative ethics e. Virtue-based ethics ANS: B Casuistry is an ethical approach which uses comparisons of precedent-setting cases and current scenarios.
14. Which approach emphasizes the particulars of a case or story as a vehicle for discerning the meaning and values embedded in the ethical decision making?

a. Principle-based ethics b. Casuistry c. Virtue-based ethics d. Care-based ethics e. Narrative ethics ANS: E Narrative ethics emphasizes the particulars of a case or story as a vehicle for discerning the meaning and values embedded in the ethical decision making.

15. Which ethical approach sees individuals as interdependent rather than independent and focuses on parties in a relationship? a. Principle-based ethics b. Care-based ethics c. Narrative ethics d. Casuistry e. Virtue-based ethics ANS: B Care-based ethics emphasizes creating and sustaining responsive connections with others, importance of contact and subjectivity in discerning ethical action, and sees individuals as interdependent rather than independent and focuses on parties in a relationship. Multiple Choice
16. As defined by Kilpatrick et al. (2016), which of the following is a hallmark of the role of the CNS? a. Adapting to changing needs of patients, nurses, and health care systems b. Advanced knowledge and skills c. Lack of educational requirements d. Ability to independently practice ANS: A A hallmark of the role is the ability of the CNS to adapt to changing needs of patients, nurses, and health care systems (Kilpatrick, Tchouaket, Carter, Bryant-Lukosius, & DiCenso, 2016). This versatility allows for a CNS to transition between positions as a primary caregiver or educator depending on the environment.

a. State scope of practice and facility policy b. American Medical Association policy c. State scope of practice d. Facility policy ANS: A The scope of practice is those activities a health care individual is allowed to perform within his or her profession. It is the responsibility of the CNS to adhere to each state’s rules in which they practice. Additionally, facilities may impose additional restrictions or limitations for a CNS to perform procedures or skills.

21. The National Association of Clinical Nurse Specialists has seven core competencies published for the CNS role. Which of the following is not included at the highest level? a. Coaching competency b. Professionalism competency c. Direct care competency d. Systems leadership competency ANS: B The National Association of Clinical Nurse Specialists’ Core Competencies include at the highest level seven competencies: direct care, consultation, systems leadership, collaboration, coaching, research, and ethical decision making, moral agency, and advocacy.
22. Each of the following is specifically described in the NACNS’s three spheres of influence for the CNS role except: a. Nurses/nursing practice b. Organization/system c. Leadership d. Patient ANS: C The NACNS has defined the CNS role as operating between the three spheres of influence: the patient, the organization/system, and the nurse/nursing practice. The CNS should employ Hamric’s seven competencies across the three spheres of influence.
23. According to a 2016 ruling, how has the Department of Veterans Affairs alleviated state- based practice regulations at VA facilities? a. Allows CNS to work at full practice authority b. Allows CNS to practice according to their home state’s regulation

c. Provides immediate licensures d. Provides malpractice insurance free of charge ANS: A In 2016, the Department of Veterans Affairs alleviated state-based practice regulations by allowing CNS to work at full practice authority inside VA facilities and not within a state’s scope ofpractice.

24. Which of the following is major regulatory barrier for many CNS specialties in relation to the Consensus Model? a. Poor reimbursement for services b. Lack of specialty certification examinations c. Lack of education d. Poor CNS involvement in advocacy ANS: B A lack of specialty certification examinations in some areas is a major regulatory barrier for many CNS specialties in relation to the Consensus Model.
25. With regard to prescriptive authority, how did Oregon manage CNSs whose original education curriculum did not include prescription of pharmacologic agents? a. Take a specialized state-specific examination regarding prescriptive authority b. Permanent exclusion from prescriptive authority c. An advanced pharmacology course and complete 150 supervised hours d. 2080 hours involved in a collaborative agreement ANS: C Oregon’s regulation for inclusions of CNSs whose original education curriculum did not include prescription of pharmacologic agents includes the completion of an advanced pharmacology course and a minimum of 150 hours of supervised pharmacologic management. Minnesota requires 2080 hours of practice within a collaborative agreement with a licensed CNP, CNS, or physician experienced with similar patients. Wisconsin requires advanced practice nurse prescribers to pass an examination on Wisconsin’s statutes and rules of practice.
26. States have each independently created regulation regarding advanced practice. With regard to prescriptive authority, what requirement has Wisconsin implemented regarding authorization of CNSs as advanced practice nurse prescribers? a. 2080 hours involved in a collaborative agreement b. An advanced pharmacology course and complete 150 supervised hours c. Permanent exclusion from prescriptive authority d. Take a specialized state-specific examination regarding prescriptive authority

There are several important factors that influence the stability of the CNS role in the future. These include unity around NCSBN affirmations of CNSs as APRNs, articulating contributions to patients, families, and health care systems, ensuring educational curricula are upheld and helpful, partnering with others in practice and research, and seeking national recognition for the role.

30. Which of the following is provided as part of the Consensus Model? a. Decrease educational requirements b. Collaboration among physicians c. Reimbursement for services d. Title protection ANS: D The Consensus Model provides title protection for CNSs and provides for a grandfather clause to include APRNs who graduated from accredited programs and began practicing prior to the implementation of the Consensus Model. Chapter 3. Role Development: A Theoretical Perspective Test Bank Multiple Choice
31. The federal government’s criterion to establish health professional shortage areas (HPSAs) is based on which of the following statistics? a. Average family income less than two-thirds of national poverty level b. An area in which there are less than 500 individuals for everyprimary care physician (PCMD) c. Average family income less than half of national poverty level d. An area in which there are more than 4500 individuals for every primary care physician (PCMD) e. An area in which there are more than 3500 individuals for every primary care physician (PCMD) ANS: E The federal government establishes health professional shortage areas (HPSAs) that are primarily based on the criterion that an area has more than 3500 individuals for every primary care physician (PCMD).
32. What is a downfall of the HPSA’s calculation? a. Is only recalculated every 10 years

b. Does not include other PCP designations (PAs, NPs) c. Does not adjust for inflation d. Has a lower weighted average for NP versus MD providers ANS: B The health professional shortage areas (HPSAs) are currently only calculated based on primary care physicians (PCMDs) and do not take into account other primary care providers such as PAs and NPs.

33. Some community health centers can apply for a special designation if they are an entity that serves a population that is medically underserved or a specially medically underserved population comprised of migratory and seasonal agricultural workers, the homeless, and residents of public housing. What is this designation? a. Federally qualified health center (FQHC) b. Patient-centered medical home (PCMH) c. School-based health center (SBHC) d. Nurse-led health center (NLHC) ANS: A The HRSA Bureau of Primary Care enables these safety net organizations to receive a variety of enhanced federal support by applying for designation as a federally qualified health center (FQHC).
34. Which of the following is not a common characteristic of a school-based health center (SBHC)? a. No parental requirement for consent for treatment b. Close integration with the school c. Comprised of a multidisciplinary team d. Located in schools or on schoolgrounds ANS: A Nearly all SBHCs require parental consent for full treatment of adolescents, except in states where such adolescents can consent for certain treatments like contraception, pregnancy, drug abuse, and/or sexually transmitted infections.
35. A nurse practitioner provides care at a veteran’s clinic managed by the Department of Veterans Affairs. The state in which he or she practices prohibits many procedures. Which of the following is most accurate regarding the care the NP provides? a. Additional licensure is required to practice in VA systems by the state b. NP must be supervised for all skills

c. Shared medical appointments d. Group therapy ANS: C Shared medical appointments are a reimbursable type of visit that may include a multidisciplinary team where patients with similar conditions discuss their health status, therapeutic regimes, behavioral modifications, and how to handle them in a group setting.

39. According to the American Association of Nurse Practitioners: 2017 NP Fact Sheet, NPs have been in practice an average of how many years? a. 9 years b. 14 years c. 7 years d. 11 years ANS: D In 2017, the average NP has been in practice for 11 years.
40. According to the American Association of Nurse Practitioners: 2017 NP Fact Sheet, which of the following is the largest area of certification? a. Pediatrics b. Acute care c. Psychiatric/mental health d. Primary care e. Tertiary Care ANS: D About 89.2% of NPs are certified in an area of primary care as of 2017 including Adult, Adult- Gerontology, Family, Gerontology, Pediatric-Primary Care, and Women’s Health.
41. According to the American Association of Nurse Practitioners: 2017 NP Fact Sheet and the AANP National Nurse Practitioners Database, approximately how many NPs are licensed in the United States? a. 1,26, b. 2,34, c. 3,18, d. 3,81, e. 4,08, ANS: B

As of 2017, there are more than 2,34,000 NPs licensed to practice in the United States.

42. Which of the following has shown promising outcomes for NPs in achievement of competence, confidence, and mastery as well as increased levels of NP satisfaction? a. NP Postgraduate Residency Programs b. Work in Underserved population areas c. Increased NP Pay d. Decreased malpractice claims e. Advancement of NP care practices ANS: A NP Postgraduate Residency Programs still need additional research on outcomes, policy considerations, and academic arrangements. Early studies have suggested that NPs who complete a residency program acquire higher achievement of competence, confidence, and mastery as well as increased levels of NP satisfaction.
43. The Triple Aim Initiative was launched in 2007 by the Institute for Healthcare Improvement (HIT) which focused on three dimensions of health care: experience of care, per capita cost, and population health. Which fourth aim was proposed in 2014 by Bodenheimer and Sinsky in a call to redesign the initiative? a. Improved clinician experience b. Prevention c. Increased reimbursements d. Decreased adverse events ANS: A Bodenheimer and Sinsky proposed a fourth aim “improved clinician experience” which brings to light the facts that the “joy” has gone out of practicing medicine. Other studies have shown that patient outcomes suffer if providers feel overwhelmed, overworked, or powerless.
44. The American Academy of Pediatrics questioned which of the following negative outcomes of Community Care Clinics (CCCs)? (Select all that apply.) a. Uneven EHR interoperability with community primary care providers b. Lack of longitudinal relationships with providers c. Incentives to overprescribe d. Increased patient satisfaction e. Decreased wait times ANS: A, B, C