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Advanced Practice Nursing : Essentials for Role Development 4th Edition JoelTest Bank Chapter | . 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 purposeof t he HEADSS Adolescent Risk Profile when the new nurse responds that it is used to assess for needs r elated 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 assesseshome , education, activities, drugs, sex, and suicide for the purpose of identifying highrisk adolescents and then eed for anticipatory guidance. It is used to identify high- risk, not lowrisk, adolescents. Physical development is assessed with anthropometric data. Sexual develop ment is as sessed 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, theex pected stage of development for a preschooler is a. concrete operational. b. formal operational. ¢. preoperational. d. sensorimotor. ANS: C The expected stage of development for a preschooler (3 to 4 years old) is preoperational. Concreteoperat ional describes the thinking ofa school-age child (7 to 11 years old). Formal operational describes the thinking of an individual after about 11 years of age. Sensorimotor describes theearliest pattern of thinking from birth to 2 years old. REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance 3. The school nurse talking with a high school class about the difference between growth andde velopment would best describe growth as a. processes by which early cells specialize. b. psychosocial and cognitive changes. c. qualitative changes associated with aging. d. quantitative changes in size or weight. ANS: D Growth is a quantitative change in which an increase in cell number and size results in anincreasein ov erall size or weight of the body or any of its parts. The processes by which early cells specialize are ref erred to asdifferentiation. Psychosocial and cognitive changes are referred to as development. Qualita tive changes associated with aging are referred to as maturation. REF: 2 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance 4. The most appropriate response of the nurse when a mother asks what the Denver II does is that it a. can diagnose developmental disabilities. b. identifies a need for physical therapy. c. isadevelopmental screening tool. d. provides a framework for health teaching. Function is one of the concepts most significantly impacted by development. Others include sensoryperce ptual, cognition, mobility, reproduction, and sexuality. Knowledge of these concepts can help th e nurse anticipate areas that need to be addressed. Culture is a concept that is considered to significantl y affect development; the difference is the concepts that affect development are those that represent m ajor influencing factors (causes), hence determination of development and would bethe focus of preve ntive interventions. Environment is considered to significantly affect development. Nutrition is consid ered to significantly affect development. REF: 1 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance 7. Amother complains to the nurse at the pediatric clinic that her 4-yearold child always talks toher toys and makes up stories. The mother wants her child to have a psychol ogic evaluation. Thenurses 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 a ge. A referral to a psychologist would be premature based only on the complaint of the mother. Compl eting a developmental screening would be very appropriate but not the initial response. The nurse wou Id certainly want to get more information, but separating the child from themother is not necessary at th is time. REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance 8. A 17-yearold girl is hospitalized for appendicitis, and her mother asks the nurse why she is soneedy 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. wantto know everything. ANS:C Regression to an earlier stage of development is a common response to stress. Separation anxiety ismo st common in infants and toddlers. Rebellion against hospital rules is usually not an issue if the adoles cent understands the rules and would not create childlike behaviors. An adolescent may wantto know everything with their logical thinking and deductive reasoning, but that would not explain why they w ould act like a child. Chapter 2. Emerging Roles of the Advanced Practice Nurse ANS: D All of the answers may contribute to ethical dilemmas but failure ofa clinician to speak up abouta re al or potential ethical problem is commonly identified. Erosion of open and honest communication i s typically the first theme encountered in many ethical dilemmas. 4, A76- yearold patient is admitted to the hospital after suffering a spinal compression fracture. The patie nt is u nable to ambulate adequately on his or her own and requires assistance for basicneeds. Your assess ment is that the patient will recover their strength within 2 weeks. The billingdepartment at the faci lity notifies you that the patient may not stay in the hospital for more than2 days. The patient doesn ot wish to be transferred to a nursing facility and wishes to remain in the hospital for the remainin g 12 days to gain strength. Which of the following best defines this scenario? Interprofessional conflict Communication problems Legal issues Multiple commitments Beep ANS: A This ethical scenario plays out routinely in medical care as an element of interprofessional conflict.Th e clinician wishes to respect patient autonomy but must understand and express the best interestsof the patient to a multidisciplinary team. Bye An APRN is scheduled to complete his or her shift at 7 p.m. ona particular day. A new patientarri ves 5 minutes prior to the time the APRN is expected to leave. He or she is asked by a supervisor t o stay beyond their scheduled time to assess the patient and provide care. Which of the following best defines this scenario? Interprofessional conflict Multiple commitments Communication problems Legal issues pee oP ANS: B APRNs often fail to practice selfcare and it is a significant threat to ethical practice. Multiplecomm itments including obligations to multiple parties involving the patient, employer, and legalsystem may create a scenario for ethical i ssues in nursing practice. Societal issues including costcontainment pressures in health systems are likely partially responsible for development of this scenario. ee oP ANS: An APRN works ina primary care clinic. The APRN wishes to treat a patient’s disease with a spe cific medication that is far superior to other treatments. The APRN has never encountered issues prescribing this therapy as firstline treatment in the past. The APRN is informed by thisparticular patient’s insurance that they re quire proof that the APRN has tried a far less effectivetherapy for | month prior to paying for the medication. Which of the following best describes the forces at work in this scenario? Communication problems Legal issues Interprofessional conflict Societal issues D Societal issues including cost containment pressures in health systems are likely responsible for devel opment of this scenario. Interprofessional conflicts would best be involved in this scenario ifthis is app lied in a multidisciplinary team scenario. ANS: Which of the following are defined as the four elements of core competency development ineth ical decision making for APRNs? Knowledge development, knowledge application, creating an ethical environment,p romoting social justice Knowledge development, educating others, creating an ethical environment, promotings ocial justice Knowledge development, knowledge application, effective communication, promotings ocial justice Knowledge development, knowledge application, creating an ethical environment,u nderstanding legal barriers A The core competency of ethical decision making for APRNs is best organized into four keyelemen ts: knowledge development, knowledge application, creating an ethical environment, and promoting socia I justice. 8. Which of the following examples best describes the knowledge development element of core co mpetency development for ethical decision making? a. Analyzing the policymaking process b. Using self-reflection during patient case reviews c. Applying ethical decision-making model to a clinical problem d. Mentoring others to develop ethical practice ANS: B The use of knowledge development is a key element of core competency development for ethical deci sion making. It involves gaining knowledge of ethical theories and developing the ability to distinguis ANS: A Creating an ethical environment may include the use of preventative ethics and awareness ofenviro nmental barriers to ethical practice. 12. Application of existing rules and doctrine as a guide for ethical decision making is bestde scribed as which ethical approach? a. Narrative ethics b. Care-based ethics c. Casuistry d. Principle-based ethics e, Virtue-based ethics ANS: D In principlebased ethical decision making, the principles or rules in contention are balanced andinterpret ed with th e contextual elements of the situation. However, the final decision and moral justification for actions a te based on principles. 13, Which ethical approach uses comparisons of precedent-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 precedentsetting cases and currentscenarios. ANS: gana oP Which approach emphasizes the particulars of a case or story as a vehicle for discerning theme aning and values embedded in the ethical decision making? Principle-based ethics Casuistry Virtue-based ethics Care-based ethics Narrative ethics E Narrative ethics emphasizes the particulars of a case or story as a vehicle for discerning theme aning and values embedded in the ethical decision making. 15. Which ethical approach sees individuals as interdependent rather than independent andfo cuses on parties in a relationship? Principle-based ethics Care-based ethics Narrative ethics Casuistry Virtue-based ethics epeaege ANS: B Carebased ethics emphasizes creating and sustaining responsive connections with others, importan ceof contact and subjectivity in discerning ethical action, and sees individuals asinterdependent rather th an 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 CN S? Adapting to changing needs of patients, nurses, and health care systems Advanced knowledge and skills Lack of educational requirements Ability to independently practice aeoPp 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). Thisversatility allows fora CNS to transition between positions as a pri mary caregiver or educator depending on the environment. 17. Which of the following has complicated clarifying the work and core competency of allC NSs? Varying educational, competency, and practice standards Bureau of Labor Statistics’ failure to capture data Lack of interest Advancement of the nurse practitioner role Beg Pp ANS: A Varying educational, competency, and practice standards have complicated clarifying the workan d core competencies ofall CNSs, regardless of specialty. The failure of the Bureau of Labor Statis tics to track CNS providers only creates barriers when it comes to counting the number of CNSs in the United States. 18. Which of the following is a central competency for CNSs according to the Hamric model? ANS: B The National Association of Clinical Nurse Specialists’ Core Competencies include at the highestleve l seven competencies: direct care, consultation, systems leadership, collaboration, coaching, research, and ethical decision making, moral agency, and advocacy. 22. — Eachof the following is specifically described in the NACNS’s three spheres of influence forthe CNS role except: Nurses/nursing practice Organization/system Leadership Patient Be FP 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’sseven co mpetencies across the three spheres of influence. 23. According to a 2016 ruling, how has the Department of Veterans A ffairs alleviated statebased practice regulations at VA facilities? Allows CNS to work at full practice authority Allows CNS to practice according to their home state’s regulation Provides immediate licensures Provides malpractice insurance free of charge Beep ANS: A Tn 2016, the Department of Veterans A ffairs alleviated statebased practice regulations by allowingCNS to work at full practice authority inside VA facilities and no t within a state’s scope of practice. 24. Which of the following is major regulatory barrier for many CNS specialties in relation to theCo nsensus Model? Poorreimbursement for services Lack of specialty certification examinations Lack of education Poor CNS involvement in advocacy ee oP ANS: B A lack of specialty certification examinations in some areas is a major regulatory barrier for manyCNS specialties in relation to the Consensus Model. 25. With regard to prescriptive authority, how did Oregon manage CNSs whose originaled ucation curriculum did not include prescription of pharmacologic agents? Take a specialized state-specific examination regarding prescriptive authority Permanent exclusion from prescriptive authority An advanced pharmacology course and complete 150 supervised hours 2080 hours involved in a collaborative agreement peep ANS: C Oregon’s regulation for inclusions of CNSs whose original education curriculum did not include pre scription of pharmacologic agents includes the completion of an advanced pharmacologycours eand 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 experien ced with similar patients. Wisconsin requires advanced practice nurse prescribers to pass an exam ination on Wisconsin’s statutes and rules of practice. 26. States have each independently created regulation regarding advanced practice. With regard topr escriptive authority, what requirement has Wisconsin implemented regarding authorization of C NSs as advanced practice nurse prescribers? 2080 hours involved ina collaborative agreement An advanced pharmacology course and complete 150 supervised hours Permanent exclusion from prescriptive authority Take a specialized state-specific examination regarding prescriptive authority ae oP ANS: D Wisconsin requires advanced practice nurse prescribers to pass an examination on Wisconsin’s statut es and rules of practice. Oregon’s regulation for inclusions of CNSs whose original educationcurriculu m did not include prescription of pharmacologic agents includes the completion of an advanced phar macology 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 physic ian experienced with similar patients. 27. Which factor led to a decrease of CNSs entering CNS programs in 1990s? Repurposing CNSs into quality managers and educator roles Increased job positions Increase in facility funding for NP programs Lack of emphasis on primary care Be oP ANS: A Several forces led to the initial decline in the number of students entering CNS programs. Fiscal restrai nts of health care facilities, repurposing CNSs into other roles, increased emphasis in primary care, a nd rapid growth of NP programs have previously and continue to contribute todecreased numbers of students entering CNS programs. Test Bank Multi ple Choice 31. The federal government’s criterion to establish health professional shortage areas (HPSAs) isba sed on which of the following statistics? Average family income less than two-thirds of national poverty level Anarea in which there are less than 500 individuals for every primary care physician (PCMD) Average family income less than half of national poverty level Anarea in which there are more than 4500 individuals for every primary care physician (P CMD) e. Anarea in which there are more than 3500 individuals for every primary care physician (P CMD) Bese ANS: E The federal government establishes health professional shortage areas (HPSAs) that are primarily bas ed on the criterion that an area has more than 3500 individuals for every primary care physician (PCM D). 32. | Whatis a downfall of the HPSA’s calculation? Is only recalculated every 10 years Does not include other PCP designations (PAs, NPs) Does not adjust for inflation Has a lower weighted average for NP versus MD providers Bog Pp ANS: B The health professional shortage areas (HPSAs) are currently only calculated based on primary car e physicians (PCMDs) and do not take into account other primary care providers such as PAsand NPs. 33. Some community health centers can apply for a special designation if they are an entity that serv es a population that is medically underserved or a specially medically underserved population c omprised of migratory and seasonal agricultural workers, the homeless, andresidents of pu blic housing. What is this designation? Federally qualified health center (FQHC) Patient-centered medical home (PCMH) School-based health center (SBHC) Nurse-led health center (NLHC) Be oP ANS: A The HRSA Bureau of Primary Care enables these safety net organizations to receive a variety of enha nced federal support by applying for designation as a federally qualified health center( FQHC). 34. ae fp ANS: Which of the following is not a common characteristic of a school-based health center (SBHC)? No parental requirement for consent for treatment Close integration with the school Comprised of a multidisciplinary team Located in schools or on school grounds A Nearly all SBHCs require parental consent for full treatment of adolescents, except in states where suc h adolescents can consent for certain treatments like contraception, pregnancy, drug abuse, and/o t sexually transmitted infections. 35. ee oP ANS: A nurse practitioner provides care at a veteran’s clinic managed by the Department of Veterans A f fairs. The state in which he or she practices prohibits many procedures. Which of thefollo wing is most accurate regarding the care the NP provides? Additional licensure is required to practice in VA systems by the state NP must be supervised for all skills State practice regulations override VA regulations Full practice authority is allowed inside the VA system D In 2016, The Department of Veterans A ffairs granted full practice authority to NPs, CNSs, and CNMs . This allows these providers to work at full practice authority inside VA facilities and notconfined —_ wit hin a state’s scope of practice. 36. ao oP Medical care provided by primary care providers (PCMD, PCNP) as part of the patientcentered medical home (PCMH) model encompasses the full spectrum of primary care including standards of accessibility, continuity, comprehensiveness, integrated care, and interprofessional c¢ are. This model was first defined for what population group? Geriatrics Gynecology Pediatrics Mental health ANS: C The patient- centered medical home (PCMH) model was first developed for the pediatric medicalcommunity for de velopment of children with complex medical conditions. sae erPp ANS: Pediatrics Acute care Psychiatric/mental health Primary care Tertiary Care D About 89.2% of NPs are certified in an area of primary care as of 2017 including Adult, AdultGerontolo gy, Al. ANS: sao oP Family, Gerontology, Pediatric-Primary Care, and Women’s Health. According to the American Association of Nurse Practitioners: 2017 NP Fact Sheet and the A ANP National Nurse Practitioners Database, approximately how many NPs are licensed inthe United States? 1,26,000 2,34,000 3,18,000 3,81,000 4,08,000 B As of 2017, there are more than 2,34,000 NPs licensed to practice in the United States. 42. snoop ANS: Which of the following has shown promising outcomes for NPs in achievement of co mpetence, confidence, and mastery as well as increased levels of NP satisfaction? NP Postgraduate Residency Programs Work in Underserved population areas Increased NP Pay Decreased malpractice claims Advancement of NP care practices A NP Postgraduate Residency Programs still need additional research on outcomes, policy considerat ions, and academic arrangements. Early studies have suggested that NPs who completea residency program acquire higher achievement of competence, confidence, and mastery as wellas increased le vels of NP satisfaction. 43. a. The Triple Aim Initiative was launched in 2007 by the Institute for Healthcare Improvement (HI T) which focused on three dimensions of health care: experience of care, per capita cost, and pop ulation health. Which fourth aim was proposed in 2014 by Bodenheimer and Sinsky ina call to re design the initiative? Tmproved 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 tolight the facts that the “joy” has gone out of practicing medicine. Other studies have shown that patient oute omes suffer if providers feel overwhelmed, overworked, or powerless. 44. The American Academy of Pediatrics questioned which of the following negative outcomesof Community Care Clinics (CCCs)? (Select all that apply.) Uneven ERR interoperability with community primary care providers Lack of longitudinal relationships with providers Incentives to overprescribe Increased patient satisfaction Decreased wait times eaogp ANS: A, B,C In 2014, the American Academy of Pediatrics had questions regarding CCCs and their possible incent ives to overprescribe, lack of longitudinal relationships with providers, and uneven EHR interoperabil ity with community primary care providers that may negatively impact the health caresystem. Chapter 4. Educational Preparation of Advanced Practice Nurses: Looking to the Future 45. | Which of the following is the most essential component to lead clinical staff and programs eff ectively as an advanced practice registered nurse? Clinical credibility Appropriate education Years of experience Age et ANS: A All of the options may attribute to effectively leading clinical staffand programs as an APRN. Direc tcare is the central competency of advanced practice nursing and excellence in direct care requires c linical credibility to lead other clinical staff. Years of experience orage may ormaynotbe __ related to direct care. Appropriate education is important for clinical leadership, but clinical credibility requir es experience combined with direct care. 46. An advanced practice registered nurse in an outpatient clinic has a phone conference with acar diologist regarding a patient’s condition. This is an example of: 
