Advanced Practice Nursing : Essentials for Role Development 4th Edition Test Bank 2022/202, Exams of Public Health

Download Advanced Practice Nursing : Essentials for Role Development 4th Edition Test Bank 2022/202 and more Exams Public Health in PDF only on Docsity! Advanced Practice Nursing : Essentials for Role Development 4th Edition Test Bank 2022/2023 Updated questions and answers guaranteed success A+ Chapter 1 . Advanced Practice Nursing: Doing What Has to Be Done-Radicals, Renegades, and Rebels MULTIPLE CHOICE 1. The nurse manager of a pediatric clinic could confirm that the new nurse recognized the purpose of the HEADS 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 describes the thinking of an individual after about 11 years of age. Sensorimotor describes the earliest 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 and development 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 an increase in overall size or weight of the body or any of its parts. The processes by which early cells specialize are referred to asdifferentiation. Psychosocial and cognitive changes are referred to as development. Qualitative 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. is a developmental screening tool. d. provides a framework for health teaching. ANS: C 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 Test Bank Multiple Choice 1. An APRN is about to examine a patient in the emergency department. A colleague states to the APRN “This patient is probably just seeking pain medication.” Regardless of his or her colleague’s comment he or she enter the examination room and treat the patient as if he or she is trustworthy and has good motives. Which of the ten essential elements of dignity is the APRN utilizing? a. Inclusion b. Benefit of the doubt c. Acceptance of identity d. Recognition ANS: B Treating others as if they are trustworthy, starting with the premise that they have good motives and are acting with integrity are all key points of benefit of the doubt. Benefit of the doubt is one of the ten essential elements of dignity. 2. An APRN approaches his or her patients as neither inferior nor superior and gives others the freedom to express their authentic selves without being judged. Which of the ten essential elements of dignity is the APRN utilizing? a. Safety b. Accountability c. Acceptance of identity d. Benefit of doubt ANS: C The acceptance of identity is one of the ten essential elements of dignity. Approaching people as neither inferior nor superior to you, giving others the freedom to express their authentic selves without fear of being negatively judged, interacting without prejudice or bias, accepting how race, religion, gender, class, sexual orientation, age, disability, and so on are at the core of someone’s identities, and assuming they have integrity are all included in the essential elements of acceptance of identity. 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 ethicalscenario plays out routinely in medical care as an element of interprofessional conflict. The clinician wishes to respect patient autonomy but must understand and expressthe 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 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 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 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. 17. Which of the following has complicated clarifying the work and core competency of all CNSs? a. Varying educational, competency, and practice standards b. Bureau of Labor Statistics’ failure to capture data c. Lack of interest d. Advancement of the nurse practitioner role ANS: A Varying educational, competency, and practice standards have complicated clarifying the work and core competencies of all CNSs, regardless of specialty. The failure of the Bureau of Labor Statistics 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? a. Indirect care of patients and families b. Ethical decision making c. Direct care of patients and families d. Systems leadership e. Conduct of research ANS: C Direct care of patients or clients is the central core competency of the Hamric model and links each of the other competencies. 19. According to the NACNS model, emphasis on which of the following competencies is largest? a. Indirect care of patients and families b. Ethical decision making c. Conduct of research d. Direct care of patients and families e. Systems leadership ANS: D Direct care of patients or clients is the largest competency of the three spheres according to the NACNS model and encompasses the other two. 20. A CNS relocatesto another state and begins a new job. Which ofthe following would guide his or her ability to practice certain procedures or skills? 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. a. Repurposing CNSs into quality managers and educator roles b. Increased job positions c. Increase in facility funding for NP programs d. Lack of emphasis on primary care ANS: A Several forces led to the initial decline in the number of students entering CNS programs. Fiscal restraints of health care facilities, repurposing CNSs into other roles, increased emphasis in primary care, and rapid growth of NP programs have previously and continue to contribute to decreased numbers of students entering CNS programs. 28. Which of the following is an important defining characteristic of the difference of the CNS role from an NP? a. Time spent among three spheres of influence b. Primarily involved in direct care c. Does not provide consultations d. Time spent primarily as patient advocate ANS: A One key defining difference of the CNS role is that the time spent performing competencies is across three spheres of influence. In the NP role, most time is spent in direct care management of patients. Both may provide consultations and all clinicians should act as a patient advocate. 29. Which of the following is most important to stabilize the future of the CNS role? a. Decreased educational requirements b. CNS conducted independent research c. Unity around NCSBN affirmation of CNSs being APRNs d. NP restrictions of roles ANS: C 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 professionalshortage 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 every primary 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 school grounds 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 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 In 2014, the American Academy of Pediatrics had questions regarding CCCs and their possible incentives to overprescribe, lack of longitudinal relationships with providers, and uneven EHR interoperability with community primary care providers that may negatively impact the health care system. 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 effectively as an advanced practice registered nurse? a. Clinical credibility b. Appropriate education c. Years of experience d. Age ANS: A All of the options may attribute to effectively leading clinical staff and programs as an APRN. Direct care is the central competency of advanced practice nursing and excellence in direct care requires clinical credibility to lead other clinical staff. Years of experience or age may or may not be related to direct care. Appropriate education is important for clinical leadership, but clinical credibility requires experience combined with direct care. 46. An advanced practice registered nurse in an outpatient clinic has a phone conference with a cardiologist regarding a patient’s condition. This is an example of: a. Social services b. Point-of-care encounter c. Indirect care d. Direct care ANS: C This is an example of indirect care of clinical practice. Direct care or direct clinical practice refers to those activities and functions that the APRN performs within the patient-nurse interface. 47. Which of the following is considered indirect care? a. Forming a therapeutic relationship during patient examination b. Discharge planning c. Consideration of which medication to prescribe a patient d. Patient education regarding medication side effects ANS: B Indirect care or indirect clinical practice refers to those activities and responsibilities that occur outside of the patient-nurse interface. They may include consultation with other health care providers, discharge planning, care coordination, communication with insurance companies, education or supervision of other medical staff, or billing and coding for services rendered. The other options are examples of direct care. 48. Which of the following is considered direct care? a. Forming a therapeutic relationship during patient examination b. Increasing knowledge of a disease process to better care for a complex patient c. Prior authorization of prescriptions d. Consultant phone call about patient condition ANS: A Direct care or direct clinical practice refers to those activities and functions that the APRN performs within the patient-nurse interface. Examples of direct care include physical acts of diagnosis, monitoring, treatment, or direct patient education that occur in the patient-nurse interface. It can be with the patient or family members. The other options are examples of indirect care. 49. An APRN is preparing a patient to be discharged from an emergency department. Which of the following activities is considered direct care? a. Speaking with the patient’s primary care provider b. Electronically transmitting prescriptions to pharmacy c. Discharge planning documentation d. Discharge patient education ANS: D 55. An APRN encounters an angry and combative patient during his or her shift. The next day he or she begins analyzing patient outcomes as they correlate with different treatment modalities. Which characteristic of advanced direct care practice is the APRN utilizing? a. Expert clinical performance b. Use of evidence as a guide for practice c. Use of reflective practice d. Diverse approaches to and interventions for Health and Illness Management ANS: B Systematic reviews of existing journals, health care statistics, and working with colleagues in an attempt to improve outcomes and understand clinical scenarios are examples of excellent use of evidence as a guide for practice. In this scenario the other options are incorrect; the APRN had not just discussed his or her personal beliefs, nor was specifically reviewing patient data for his or her personal knowledge development. 56. An APRN is working in a rural community health center providing community health services to poverty-stricken families He or she works at government agencies and regional medical centers to coordinate care for patients who cannot afford it. At these facilities the APRN gains experience using lower cost strategies to provide effective care. Which characteristic of advanced direct care practice is the APRN utilizing? a. Expert clinical performance b. Use of reflective practice c. Diverse approaches to and interventions for Health and Illness Management d. Use of evidence as a guide for practice ANS: C Diverse approaches to and interventions for health and illness management include the interpersonal interventions to guide or coach patients, acquiring new ways to treat patients, providing preventative services, coordinating services among care sites and multiple providers, and acquiring knowledge about complementary therapies. 57. An APRN in an emergency department is utilizing a new type of IV catheter for the first time. He or she seeks out a colleague more familiar with the device for supervision. Which characteristic of advanced direct care practice is the APRN utilizing? a. Expert clinical performance b. Use of reflective practice c. Formation of therapeutic partnerships with patients d. Use of a holistic perspective ANS: A Expert clinical practice includes more than just providing excellent care at your current level. It also includes having an understanding of scenarios, situations, and procedures where you may be overwhelmed or less confident and then seeking out expert assistance or guidance. This provides the best outcomes for the patient and furthers the clinical understanding. 58. A female patient is undergoing an elective surgery that has a risk of blood loss. She is a Jehovah’s Witness and due to her religious beliefs does not want blood transfusions to be administered. The APRN delays the patient’s surgery and recommends she donate her own blood to be administered during the surgery if needed. Which characteristic of advanced direct care practice is the APRN utilizing? a. Use of evidence as a guide for practice b. Expert clinical performance c. Use of a holistic perspective d. Formation of therapeutic partnerships with patients ANS: C Understanding the patient’s spiritual and life values, additional context of the patient’s life, possible life changes, and the effects of their disease or treatments are all factors that must be considered when using a holistic perspective. 59. Which of the following will most likely enhance the patient-APRN relationship and increase communication? a. Longer appointment duration b. Printed education guides c. Having a caregiver present at the time of examination d. Active listening ANS: D A foundation of excellent communication begins with listening to the patient. Each of the other options may improve the outcome of the patient but establishing effective therapeutic relationships with patients involves listening to their concerns to establish trust, increase patient satisfaction, increase adherence to treatment plans, and improve patient outcomes. 60. With which of the following types of patients would it be most difficult to establish a therapeutic partnership? a. Mentally disabled patient b. Toddler c. Elderly patient d. A patient with tonal hearing loss ANS: A While all of the patients in this question may be more challenging, only the mentally disabled patient has expressed limitations in communication. A mentally disabled patient may not be able to comprehend instructions, and the level of understanding may not be able to be fully expressed. An elderly patient, a patient with hearing loss, and a toddler are still able to effectively communicate their level of understanding. Modifications in communication strategies may be required in all of the patients. 61. Which of the following techniques should be utilized when communicating with all elderly patients who have hearing loss? a. Administer testing for understanding b. Face the patient c. Use verbal aids d. Write down instructions ANS: B During the initial encounter with a patient with a communication barrier, the level of the barrier should first be assessed. Additional therapies may not be needed if simply sitting directly facing the patient can achieve effective communication. The same methods for ensuring understanding should be used in patients with hearing loss, such as having them repeat instructions or voice their level of understanding. 62. An elderly male patient is being seen by the APRN. Which of the following techniques for effective communication should be initially avoided? a. Speaking in a louder voice b. Appropriate touch c. Maintain eye contact d. Face the patient ANS: A Remember that assumptions should never be initially made about any patient and always speaking in a louder voice may be considered offensive. An elderly patient does not always have hearing loss or dementia, and strategies to assess the level of understanding should be used if suspicions exist. 63. An APRN is working in an outpatient care clinic for diabetics. He or she is responsible for starting newly diagnosed diabetic patients on long-acting basal insulin to control their fasting morning blood glucose levels. The APRN starts a 55-year- old obese patient 35 units of long acting insulin nightly. The APRN chooses this dose solely based on the weight of the patient and does not review the patient’s current medication list. The APRN has previously used this method successfully in many patients who were admitted to the hospital. Three days later the b. Use of evidence as a guide for practice c. Formation of therapeutic partnerships with patients d. Adequate supervision of others e. Use of a holistic perspective ANS: A, B, C, E The six characteristics of direct clinical care are use of a holistic perspective, formation of therapeutic partnerships with patients, expert clinical performance, use of reflective practice, use of evidence as a guide to practice, and use of diverse approaches to health and illness management. Adequate supervision of others is an example of indirect care. 69. A newly licensed APRN is working in a busy outpatient clinic. He or she continually runs late and cannot adequately gather all of the pertinent patient information during each patient encounter. This has caused the APRN to misdiagnose multiple patients. Which of the following may best alleviate the time pressures experienced by the APRN? (Select all that apply.) a. Avoid interruptions b. Increase visit length time c. Limit patient complaints allowed for each visit d. Use a systematic approach e. Set a timer to end each patient encounter ANS: A, B, D Time pressures are experienced at an even higher frequency in novice APRNs. Avoiding interruptions and increasing visit length time are the best options to alleviate time pressures. Setting a timer to end each patient encounter or limiting patient complaints would be inappropriate strategy for a novice APRN. Rushed or truncated encounters often lead to lack of therapeutic communication, incomplete physical examinations, and withholding of patient questions. Development of a systematic approach to each patient encounter is one of the best strategies to implement to increase APRN efficiency and is usually paramount as an APRN develops experience. Chapter 5. Global Perspectives on Advanced Nursing Practice 70. A nurse develops an interest in more effective medication management and seeks additional training to enhance his or her daily care of patients and for peers at the facility for which he or she works. This is an example of: a. Specialization b. Subspecialty c. Specialty d. Advanced practice nursing ANS: A Specialization involves focusing on practice in a specific area derived fromthe field of professional nursing. Specialties can be further characterized as nursing practice that intersects with another body of knowledge, has a direct impact on nursing practice, and is supportive of the direct care provided to patients by other registered nurses (American Nurses Association [ ANA], 2010a). If the nurse changed his or her focus of practice this could be considered a specialty. 71. A nurse develops an interest in effective medication management and seeks additional training. The nurse then focuses the majority of his or her time on medication management aspects of nursing. This is an example of: a. Advanced practice nursing b. Subspecialty c. Specialization d. Specialty ANS: D The termspecialty suggeststhat the focus of practice is limited to parts ofthe whole ( ANA, 2010b). Since this nurse has refocused his or her care entirely on medication management as part of the nursing role it is considered a specialty. 72. A registered nurse is planning to extend his or her education beyond baccalaureate education into an advanced practice role. When choosing between CRNA, CNM, and NP these are delineations of which type? a. Reasoning b. Subspecialty c. Specialty d. Specialization ANS: C The termspecialty suggeststhat the focus of practice is limited to parts ofthe whole ( ANA, 2010b). Deciding on advanced practice nursing among CRNA, CNM, and NP requires knowledge that they are independent specialties. Specialties of NP at the highest level are psychiatric and mental health, pediatrics, and adult-gerontology. Subspecialties further differentiate the focus of practice such as family practice nurse practitioner, adult-gerontology nurse practitioner, and acute care among others. 73. A student is evaluating a program to attend. He or she finds an adult-gerontology nurse practitioner program that will also prepare him or her as a hospitalist. How is the hospitalist training best defined? a. Specialty b. Subspecialty c. Reasoning d. Specialization ANS: B Subspecialization further delineates the focus of practice. In subspecialty practice, knowledge and skill in a delimited clinical area is expanded further. Examples of subspecialties include diabetes care, acute care, pain management, and clinical transplant coordinator. 74. Which of the following most accurately describes the four stages in the evolution ofadvanced practice nursing? a. Interest occurs, specialty begins, specialty organizes, and pressures mount for standardization b. Specialty begins, specialty organizes, laws require standardization, maturity, and growing interprofessionalism c. Specialty begins, specialty organizes, pressures mount for standardization, maturity, and growing interprofessionalism d. Interest occurs, specialty begins, specialty organizes, and specialty matures ANS: C The four stages in the evolution of advanced practice nursing include: stage I: specialty begins, stage II: specialty organizes, stage III: pressures mount for standardization, and stage IV: maturity and growing interprofessionalism. 75. An adult-gerontology nurse practitioner works to enhance education for polypharmacy in elderly patients through the creation ofstandardized education tools. The NP works with other professionals at his or her facility to research and develop criteria for education and practice. This example is best classified as which stage? a. Specialty organizes b. Specialty standardizes c. Specialty begins d. Specialty matures and grows interprofessionally ANS: C Specialty stages are not concrete, but specialties that are in the beginning of development are in stage I: specialty beginning. Stage II: specialty organization is typically considered when a professional organization of like-minded individuals is officially formed. ANS: C The WOCNS offers four levels of WOC specialty nurse training and has been developing curricula and education that are offered in postbaccalaureate and some graduate-level programs. 83. Although not required for practice, the AAPM offers a credentialing examination requiring at least 2 years of pain management experience prior to examination for Interventional Pain Practice. This organization’s efforts to standardize care classify as what stage of evolution of advanced practice nursing? a. Stage I b. Stage II c. Stage IV d. Stage III ANS: D The AAPM offers two credentialing examinations: diplomate and fellow. This allows for initial standardization of practice in chronic pain management and paves for care as the organization begins to mature along with the Interventional Pain Specialist specialty. 84. What specialty hastwo levels of certification available, focused on the management of diabetes and prescribing medications? a. Diabetes and Wellness Specialty b. Endocrine Specialty c. Advanced Diabetes Manager d. Diabetes Clinical Specialist ANS: C The American Association of Diabetes Education (AADE) offers two levels for the specialty of Advanced Diabetes Manager: Certified Diabetes Educator (CDE) and Board Certified Advanced Diabetes Manager (BC-ADM). Specifically, the BC-ADM focuses less on education and moreon the management of diabetes and prescribing of medications. 85. A father and mother have been identified as carriers of cystic fibrosis, a genetic disease. Their primary care provider suggests they obtain genetic counseling prior to starting a family. Which provider is the best for this couple? a. Pediatric nurse practitioner b. Pediatric Physician c. Genetics Specialty RN d. Genetics advanced practice nurse ANS: D The Genetics advanced practice nurse is a specialty that requires a graduate degree. This stage IV specialty ensures specialized training in genetics. These practitioners offer genetic counseling, case management, consultation, and evaluation of patients and their families. An RN would only offer information or identify the need for referral to a genetics specialist. A Pediatric nurse practitioner or Pediatric physician would likely not have specialized training in genetic counseling. Chapter 6. Advanced Practice Nurses and Prescriptive Authority 1. All of the following are reasons that attributed to the rise of AG-ACNP except: a. Intensivist physician shortages b. Rising cost of malpractice insurance for physicians c. Changes to medical resident work hourrestrictions d. Increase in patients with complex medical conditions ANS: B The role of AG-ACNP rose out of an increased demand for practitioners to manage patients with complex medical conditions, shortages of intensivist physicians, and changes to medical resident and fellows work hour restrictions. 2. An increased spectrum of care affords the AG-ACNP the ability to provide medical care to a broader age group. Which of the following is age-range appropriate for an AG-ACNP to treat? a. Age 7 and older b. Age 13 and older c. Age 18 and older d. Age 21 and older ANS: B An AG-ACNP can provide care to patients aged 13 and older unless additional state or facility specific restrictions exist. The age ranges are grouped into young adults, middle-age adults, and older adults. 3. As identified in a 2012 study by the ANCC, which of the following top workactivities for the AG-ACNP was number one when arranged by criticality? a. Conducting history and physical examinations b. Maintaining patient privacy and confidentiality c. Evaluating patients for safety and efficacy of interventions d. Assessing patients for urgent and emergent conditions ANS: B In 2012, the ANCC surveyed ACNP clinicians and identified top work activities for the AG- ACNP role. These activities were organized by criticality, or importance of the skill and determined by the requirement to perform the skill accurately each time, as a novice NP, and based on the risk of harm by performing the skill incorrectly. Maintaining patient privacy and confidentiality scored at the top. 4. Based on a survey of ACNPs, the following procedures are performed in a hospital-based setting most commonly by ACNPs except: a. Vasoactive intravenous drips b. Lumbar puncture c. Sutures d. Radiologic studies ANS: B Based on survey data, procedures that are formed least routinely by ACNPs include lumbar punctures, surgical first assist, thoracostomy tubes, cutdowns, paracentesis, joint aspirations, and bladder aspirations. 5. Based on a survey of ACNPs, which of the following procedures are performed in a hospital based setting most commonly by ACNPs? a. Defibrillation b. Lumbar puncture c. Pacemakers d. Chest tubes ANS: A Based on survey data, procedures that are formed most commonly by ACNPs include radiologic studies, vasoactive intravenous drips, resuscitative efforts, defibrillation, wound care, sutures, incisions, and ventilation. 6. Which of the following is more commonly attributed to the AG-ACNP role versus that of a CNS? a. Patient-centered care b. System change responsibilities c. Performing procedures d. Staff education and development ANS: C Billing of critical care time for the initial 30 minutes is billed under the provider number of whoever provided the service. It cannot be combined. Subsequent critical care minutes should be billed separately and also cannot be combined or linked. 13. Which of the following is a specialization opportunity most appropriate for an AG-ACNP? a. Rapid response ream b. Advanced diabetes manager c. Outpatient clinic supervisor d. Wound ostomy nurse ANS: A Although the AG-ACNP may be eligible to specialize in all of the areas, he or she would best be suited for a specialization that utilizes the acute care nature of his or her skills. Chapter 7. Credentialing and Clinical Privileges for the Advanced Practice Registered Nurse 1. Which of the following is the primary mission of the National Organization of Nurse Practitioner Faculties (NONPF)? a. Provide leadership in promoting quality NP education b. NP Faculty training program assistance c. Provide financial assistance to NP students d. Lobbying legislature on behalf of NPs ANS: A The NONPF’s primary mission is to provide leadership in promoting quality NP education. The organization has published domains and core competencies for primary care and these serve as a framework for NP education and practice. 2. A model of competencies that are encompassed around three spheres of influence known as patient, nurses and nursing practice, and organization and influence is known as? a. NACNS Model of clinical nurse specialist competencies b. Fenton’s and Brykczynski’s Expert Practice c. Calkin’s model of Advanced Nursing Practice d. Shuler’s Model of NP Practice ANS: A The NACNS’s initial 2008 statement was revised in 2004. The statement outlined competencies that aligned to each of the three spheres of influence: patient, nurses and nursing practice, and organization and influence. 3. Building upon Benner’s seven domains of expert nursing practice, which conceptual model adds an additional domain “The consulting role of the nurse”? a. Calkin’s model of Advanced Nursing Practice b. Fenton’s and Brykczynski’s Expert Practice c. Strong Memorial Hospital’s Model of Advanced Nursing Practice d. Shuler’s Model of NP Practice e. NACNS Clinical Nurse Specialists Model ANS: B Fenton’s and Brykczynski’s Expert Practice Domains of the CNS and NP expanded on Benner’s seven domains adding consultation provided by CNS’s to other nurses and management of health and illness in ambulatory care settings. 4. Which model of conceptual practice was the first to explicitly distinguish the experience level of advanced practitioners? a. Calkin’s model of Advanced Nursing Practice b. Shuler’s Model of NP Practice c. NACNS Clinical Nurse Specialists Model d. Strong Memorial Hospital’s Model of Advanced Nursing Practice e. Fenton’s and Brykczynski’s Expert Practice ANS: A Calkins model of Advanced Nursing Practice was the first to explicitly distinguish experience levels of advanced practitioners for nurse administratorsto differentiate advanced practice nursing from other levels of clinical practice. 5. The circular and continuous threads of direct comprehensive patient care, support of systems, education, research, and publication and professional leadership make up the five domains of which advanced nursing conceptual model? a. Strong Memorial Hospital’s Model of Advanced Nursing Practice b. Calkin’s model of Advanced Nursing Practice c. NACNS Clinical Nurse Specialists Model d. Fenton’s and Brykczynski’s Expert Practice e. Shuler’s Model of NP Practice ANS: A Direct and indirect activities across five domains including: direct comprehensive patient care, support of systems, education, research, and publication and professional leadership make up the Strong Memorial Hospital’s Model of Advanced Practice Nursing. 6. Texas Children’s Hospital Transformational Advanced Professional Practice (TAPP) APRN Model added what unifying conceptual strand? a. Ethics b. Culture c. Informatics d. Education ANS: A The TAPP model added two additional domains: quality and safety, and credentialing and regulatory practice, to the Strong model. It additionally added professional ethics as a unifying conceptual strand. 7. Poghosyan, Boyd, and Clarke (2016) proposed a comprehensive conceptual model including three factors: scope of practice regulations, institutional policies, and practice environments. What was their primary purpose? a. To discourage role ambiguity among CNS providers b. To enhance patient education provided by the APRN c. To maximize NP Contributions to primary care d. To provide educational practice guidelines to enhance NP education ANS: C ANS: D The Donabedian model encompasses structure (health care systems and facilities), process ( diagnosis, treatment, education), and outcomes. 14. Which of the following are the functions of a conceptualization ofadvanced practice nursing? (Select all that apply.) a. Basis for furthermore development of knowledge b. Articulate professional role identity and function c. Identify specific procedures to provide d. Deliver holistic and collaborative care e. Provide guidelines on billing ANS: A, B, D Conceptual models allow for articulation of professional role identity, provide a basis for furthermore development of knowledge and assist in clinical practice for the delivery of holistic, comprehensive, and collaborative care. Models may assist but in general do not provide assistance with clinical decision making or billing. Chapter 8. The Kaleidoscope of Collaborative Practice 1. A 45-year-old female is being prepared for elective surgery. A registered nurse goes over the patient’s medication list and allergies and then the patient is seen by a CRNA prior to surgery who also goes over the patient’s medication list. The registered nurse and the CRNA do not work together to form a medication list for the patient. This is best defined as: a. Collaboration b. Parallel communication c. Parallel functioning d. Faux collaboration e. Information exchange ANS: B Parallel communication occurs when two clinicians do not talk together prior to seeing the patient, see the patient separately, and have no expectation of joint interactions. If the two made separate plans of care for the same aspect of the patient’s care this could be defined as parallel functioning. 2. Which of the following has the highest likelihood for medical errors and decrease patient outcomes? a. Collaboration b. Parallel functioning c. Referral d. Consultation ANS: B Parallel functioning is when providers are caring for patients and address the same clinical problems without joint or collaborative planning. This could lead to additional interventions, confusion for the patient, medication errors, and poor outcomes. 3. Two APRNs work together to evaluate a patient, develop a plan of care, and implement different aspects of care while communicating about the patient’s overall clinical course.This is an example of: a. Parallel communication b. Collaboration c. Coordination d. Referral e. Parallel functioning ANS: B Collaboration with other team members involves the facilitation of teamwork to ensure the delivery of safe, effective, high-quality care leading to positive outcomes. 4. A novice APRN begins working at a cardiovascular outpatient clinic with a more senior APRN. The novice APRN always goes along with recommendations of the other APRN due to a feeling of a lack of skill to engage in conversations about the patient’s care. Which of the following is the novice APRN experiencing? a. Information exchange b. Faux collaboration c. One-sided compromise d. Parallel functioning e. Parallel communication ANS: C One-sided compromise is communication where one side consistently yields to other health care providers and senses a personal lack of integrity in the care. The compromise may occur when there is a lack of will or skill to engage in collaborative negotiation. 5. A novice APRN begins working at a cardiovascular outpatient clinic with a more senior APRN. The novice APRN always goes along with recommendations of the senior APRN. The senior APRN does not feelthe need for meaningful dialogue since the novice APRN has agreed with all of the plans of care. Which of the following best describes this situation? a. Parallel communication b. One-sided compromise c. Parallel functioning d. Coordination e. Faux collaboration ANS: E Faux collaboration can be subtle and difficult to identify. It occurs when a person in a position of authority believes he or she is being collaborative because those around him or her are agreeable and there is no meaningful dialogue. 6. Two providers are caring for the same patient and address the same clinical problems without joint or collaborative planning. Which of the following is the best example of this scenario? a. Parallel functioning b. Faux collaboration c. Parallel communication d. Referral e. One-sided compromise ANS: A Parallel functioning is when providers caring for patients address the same clinical problems without joint or collaborative planning. 7. An APRN suspects a patient has tuberculosis and has the patient placed in isolation in a negative pressure room. The APRN notifies the nurse caring for the patient that anyone entering the room must wear a special mask. This example is best defined by which of the following? a. Collaboration b. Comanagement c. Information exchange d. Faux collaboration 13. Which of the following are restraining forces on interprofessional practice, education, or research? (Select all that apply.) a. Shared competencies b. Culturalsilos c. Lack of expertise d. Physician-based reimbursement e. Care of older adults and their families ANS: B, C, D Restraining forces for interprofessional practice, education, and research include lack of expertise, cultural silos, existing infrastructure, and reimbursement. Driving forces for interprofessional practice, education, and research include older adults and their families, professions (shared competencies), business (workforce shortages), and policy (health care reform). 14. Which of the following are driving forces on interprofessional practice, education, or research? (Select all that apply.) a. Lack of expertise b. Workforce shortages c. Shared competencies d. Care of older adults and their families e. Physician-based reimbursement ANS: B, C, D Driving forces for interprofessional practice, education, and research include older adults and their families, professions (shared competencies), business (workforce shortages), and policy (health care reform). Restraining forces for interprofessional practice, education, and research include lack of expertise, cultural silos, existing infrastructure, and reimbursement. Chapter 9. Participation of the Advanced Practice Nurse in Health Plans and Quality Initiatives 86. In 1990, Cooper and Sparacino postulate than an APRN’s maximum potential may not be attained until: a. After 1 year b. After 7 years c. After 3 years d. After 5 years ANS: D Studies have shown that the first-year position of an APRN is one of transition, and Cooper and Sparacino estimate that an APRN’s maximum potential may not be attained until after 5 years or more in practice. 87. An NP student is performing a thorough neurologic examination for the first time in the clinical setting. This is an example of: a. Role implementation b. Role acquisition c. Role confusion d. Role conflict ANS: B The changes occurring during role transitions experienced during the educational component of an APN role are classified as role acquisition. Additionally, role transition is described as when an APRN begins to practice for the first time in a new role. 88. A new NP student is completing a rotation at an outpatient urgent care clinic and completes an examination on a patient with chest pain. The nursing assistant hands a 12-lead ECG to the NP student and asks: “What should we do?” The NP student’s preceptor did not provide clear instructions on the role of the NP student at this time even though the student is capable of interpreting ECGs. This is an example of: a. Role ambiguity b. Role transition c. Role strain d. Role supplementation ANS: A Role ambiguity is created by unclear expectations, diffuse responsibilities, and uncertainty of subroles. The NP student’s preceptor did not provide clear roles to the NP student about what he or she should do in the absence of the preceptor. If the NP student was placed in a role where he or she was unaware of how to interpret ECGs this would be an example of role incongruity. 89. An NP is completing the first month in his or her first job. He or she receives a phone call from an administrator telling him or her that he or she will need to see 30% more patients starting next week. He or she is told that this is the minimum requirement of all NPs in the same position. The NP has difficulty using the electronic health record (EHR) software efficiently and feels overwhelmed. This is an example of: a. Role supplementation b. Role ambiguity c. Role conflict d. Role insufficiency ANS: D Role insufficiency is often seen as APRN graduates’ transition to the workforce or change positions. This may include feelings of inadequacy or slow speed due to the new role or barriers such as electronic health record documentation requirements. 96. A trained nurse enters the first semester of an NP training program. He or she is required to learn new and more advanced techniques beginning with conducting an advanced physical examination. The overwhelming feeling and stress of learning additional skills is most likely classified by the studies of Anderson, Leonard, and Yates in 1974 as: a. Independence b. Developing competence c. Interdependence d. Complete dependence ANS: D The initial learning of skills and additional techniques experienced by NPs in the beginning of their training has been described as complete dependence. 97. A trained NP is working at an outpatient care clinic. He or she encounters a difficult patient, is unaware of treatment options, and consults one of his or her colleagues for advice. This is best classified as: a. Independence b. Interdependence c. Developing competence d. Complete dependence ANS: B As initially defined by Anderson, Leonard, and Yates in 1974, NP roles as they transition to the workplace as seasoned practitioners transition to interdependence as they work with colleagues to enhance patient care. 98. Fleming and Carberry’s research in 2011 studied two cohorts of critical care nurse advanced practice trainees in Scotland. They found that transition occurred in which four areas? a. Complete dependence, developing competence, independence, interdependence b. Developing competence, partial independence, complete independence, interdependence c. Coping with pressures, feeling competent, internalizing the role, leading others d. Finding a niche, overcoming obstacles, advanced practice, interdependence e. Finding a niche, coping with pressures, feeling competent, internalizing the role ANS: E Fleming and Carberry’s research in 2011 studied two cohorts of critical care nurse advanced practice trainees in Scotland showing transition occurred in four areas: finding a niche, coping with pressures, feeling competent, internalizing the role. 99. A strategy to promote role acquisition in school that involves a ceremony at the beginning of the NP students training is the best example of: a. Role rehearsal b. Creating a support network c. Role development d. Developing clinical knowledge of skills ANS: A Role rehearsal may include many facets including a rite of passage such as a ceremony to mark the beginning of a new training program. 100. Which initial strategy would provide the best role acquisition for a student or potential student about to begin a new NP program? a. Provide case scenarios of patients that may be encountered b. Preadmission testing c. Provide a handout detailing the APRN curriculum d. Clinical faculty mentoring by preceptors ANS: C An initialstrategy for role acquisition includes components for role rehearsal. Providing the overall framework for the APRN curriculum would allow for the best-case scenario of role acquisition. Clinical faculty mentoring by preceptors is an example of role acquisition but is best suited to develop clinical knowledge and skills. 101. Which of the following is the best strategy for transition of an APRN into a new position? a. Ensuring adequate pre-position training b. Development of a structured orientation plan c. Scheduling time-based evaluations d. Providing immediate feedback from supervisors ANS: B APRNs in new roles regardless of previous experience benefit most from structured orientation plans, networking with peers, appropriate mentors and preceptors, and an understanding of appropriate expectations. 102. Which three major purposes are categorized and can be utilized to facilitate role acquisition of NPs in school? a. Knowledge expansion, skill practice, creation of a supportive network b. Role rehearsal, development of clinical knowledge and skills, creation of a supportive network c. Role acquisition, role rehearsal, creation of a supportive network d. Knowledge foundation development, development of clinical skills, tracking outcomes ANS: B An adaptation of Brykczynski’s (2000) “Strategies to promote NP role acquisition in school” allows for specific strategies for role acquisition to be categorized into three major purposes: role rehearsal, development of clinical knowledge and skills, and creation of a supportive network. 103. Which of the following examples would best enhance the development of clinical knowledge and skills as part of role acquisition of the NP? a. Establishment of a peer support system b. Clinical conferences c. Identifying a role model d. Subscription to APRN journals and conferences ANS: B Role acquisition strategies include three major purposes: role rehearsal, development of clinical knowledge and skills, and creation of a supportive network. Establishment of clinical conferences to discuss clinical experiences with faculty and peers can promote clinical understanding and enhance the development of clinical knowledge and skills. Subscription to APRN journals and conferences would establish a pattern for continuing education and help create a support network. Establishment of a peer support system would also help create a support network. Identifying a role model or mentor would facilitate role rehearsal. 104. A faculty member at an NP education program has identified that students are experiencing difficulty with role rehearsal during the first few semesters of the program. Which of the following strategies would likely enhance role rehearsal and facilitate role acquisition? a. Subscription to APRN journals and conferences b. Identifying a role model c. Clinical conferences d. Establishment of a peer support system ANS: B Role acquisition strategies include three major purposes: role rehearsal, development of clinical knowledge and skills, and creation of a supportive network. Identification of a role model or mentor and developing a mentee relationship that can be maintained throughout an APRN program is an excellent strategy to promote role rehearsal and support role acquisition while in school. Clinical conferences support developing clinical knowledge and skills. Establishment of a peer support system or subscriptions to APRN journals help create a support network. 105. In 2010, researchers Sullivan-Bentz et al. used Brown and Olshansky’s four-stage transition model to study recent NP graduates as they undergo role transition to practicing NPs. What did the study demonstrate? b. Accreditation c. Credentialing d. Certification e. Licensure ANS: C Credentialing is an umbrella term that refers to regulatory mechanisms that can be applied broadly to individuals, programs, or organizations (Styles, 1998). 112. An APRN has recently graduated from his or her program of choice, obtained national certification, and is applying for licensure in his or her home state. Which of the following is true regarding prescriptive authority? a. Requires additional CE requirements to maintain b. Provided in all states with APRN licensure c. Requires separate licensure d. Varies among individual states and regulating agencies ANS: D Prescriptive authority remains as a regulatory hurdle for APRNs. Requirements for obtaining prescriptive authority vary among states and have various requirements to maintain licensure. 113. An APRN has obtained prescriptive authority in his or her state and obtained Drug Enforcement Administration (DEA) number. All of the following pertain to controlled substances except: a. An APRN individually cannot prescribe controlled substances without a DEA number b. DEA numbers are site-specific and an APRN must obtain a DEA number for each site where he or she prescribes controlled substances c. Obtaining a DEA number authorizes the prescription of controlled substances without additional regulation d. An APRN who does not prescribe controlled substances is not required to obtain a DEA number e. A DEA number authorizes prescription of controlled substances as it pertains to state regulation ANS: C DEA numbers authorize the prescription of controlled substances but are still regulated by both federal and state regulations. APRNs may be subjected to additional regulation in the state where he or she practices. 114. All of the factors must be present for a malpractice case to demonstrate negligence by an APRN except: a. Direct causation must be linked to the APRN b. The patient must be under the direct care of the APRN c. A duty of care must be owed to the injured party d. Damages or sustained injuries to the patient e. The accepted standard of care was breached ANS: B Four factors must be established for the basis of a malpractice claim including a duty of care being owed, a breach of accepted standards of care, resulting damages or injury to the patient, and direct causation that is linked to the APRN. The patient does not have to be under the direct care of the provider to be included in a malpractice suit. 115. Which of the following requires compliance with HIPAA while functioning as an APRN? a. Transmission of health information for payment of medical claims b. All of the above c. Transmission of health information in any form d. Regular care of patients e. Discussion of patient conditions with consultants ANS: B The Health Insurance Portability and Accountability Act (HIPPA) originally became law in 1996 and mandates all medical professionals adhere to patient privacy standards when pertaining to personally identifiable patient information, regardless of transmission method. Chapter 11 . Resource Management 1. After teaching a group of students about the various types of advanced practice nurses, the instructor determines that the teaching was successful when the students state which of the following as the most common type? A) B) Important parties who would be involved did not have an opportunity to engage in a discussion about the recommendation. C) There is agreement among those in nursing education about the core competencies to be included in a typical program. D) DNP graduates may not be able to obtain tenure and equal status in the educational field like their PhD counterparts. Ans: C 9. Which of the following best reflects the position of the AACN related to DNP and PhD graduates who want to teach at the collegiate level? PhD graduates are better prepared to teach as the collegiate level than DNP graduates. B) Both graduates must pursue additional coursework that focuses on teaching. C) DNP and PhD graduates can apply research findings that focus on educational settings. D) PhD graduates understand curriculum development while DNP graduates do not. Ans: B 10. A nurse is preparing to become a clinical nurse leader. At which level would this nurse expect to practice? A) Microsystems level B) Population-based level C) Community-based level D) Macrosystem level Ans: A 11. Which of the following would be the most appropriate response to critics of the DNP who are concerned that the curriculum does not include theory? A) DNP programs focus primarily on nursing theories, which are essential to advanced practice nurses. B) Since nurses work as part of an interdisciplinary team, they need to understand many types of theories. C) DNP programs focus on using appropriate research methodologies to generate new nursing theories. D) The DNP graduate would be able to make decisions based on expertise and practice rather than on theory. Ans: B A) 12. A group of nursing students are reviewing the two types of doctoral degrees for nursing. The students demonstrate a need for additional study when they identify which of the following as a research-focused doctorate? A) PhD B) DNS C) DNP D) DNSc Ans: C 13. After teaching a class about the views of medicine and the DNP, the instructor determines that additional teaching is necessary when the students identify which of the following as a current belief supported by the American Medical Association? A) The physician has the final authority for the patient. B) Doctors of nursing practice can practice independently. C) Medicine has the right to regulate advanced practice nurses. D) Medicine can identify the roles and functions of a DNP. Ans: B 14. Which of the following would best characterize the clinical nurse leader (CNL) role? A) Masters-prepared advanced practice specialist nurse B) Focus on management systems for institutional health care delivery C) Integration of the care provided by each of the disciplines involved in patient care D) Limited focus on health promotion with greater emphasis on population-based care Ans: C 15. A group of students is reviewing information about the clinical nurse leader role (CNL) and how it differs from other advanced practice roles. The students demonstrate understanding of the information when they state which of the following about the CNL role? A) Focuses on a specific group of patients in a particular setting B) Picks up care where the role of the clinical nurse specialist ends C) Participates in care before admission and after discharge D) Is a consistent figure to act as a point person for those involved Ans: D 16. When describing the functions of the nurse practitioner ( NP), which of the following would be included? A) Prescribing medications for treatment B) Administering anesthesia during labor C) Providing care during pregnancy D) Providing expert consultation for nursing staffs Ans: A 17. According to the AACN, which role would assume guardianship for the nursing profession? A) Nurse practitioners B) Clinical nurse leaders While specific specialties may focus on individual areas of clinical knowledge, all aspects of advanced practice nursing include advanced knowledge of pathophysiology, health and physical assessment, and pharmacology. 3. Which of the following criteria is required for the attainment of classification as an advanced practice nurse (APN)? a. Practice focused on research b. Baccalaureate degree in area of focus c. Specialized skill attainment d. Graduate degree in area of focus ANS: D The three basic criteria or qualifications for APNs include graduate education in advanced practice nursing role, national certification in an advanced role, and a practice focused on patients and their families. Research and skills are components of core competencies of advanced practice nurses who achieve a graduate level of education. 4. Which of the following is the central, core competency for advanced practice nursing? a. Evidence-based practice b. Direct clinical practice c. Leadership d. Ethical decision making ANS: B Direct clinical practice is the core competency that lends itself to all others. It also provides the foundation for APNs to carry out the other competencies adequately. 5. The legal authority granted to a professional to provide and be reimbursed for health care services refers to: a. Certification b. Scope of practice c. Practicing Role d. Education ANS: B Many things including state and federal laws define scope of practice. The APN NCSBN defines scope of practice as characterized by specialization, expansion of services provided, including diagnosing and prescribing, and autonomy to practice. An individual certification would fall under the umbrella of scope of practice. 6. Which of the following most accurately describes the current four established advanced practice nurse roles? a. RN, BSN, MSN, DNP b. CNM, FNP, CNS, CRNA c. CNM, FNP, AGNP, PNP d. CNS, CRNA, NP, CNM ANS: D The four established advanced practice nurse roles include CNS, CRNA, CNM, and NP. FNP and AGNP are specializations of nurse practitioners (NP). 7. Which advanced practice nursing role hasseen the largest expansion of growth and is currently the largest in number? a. CNS b. CRNA c. CNM d. NP ANS: D Nurse practitioner continues to be the largest in number of APN roles. According to the American Academy of Nurse Practitioners National NP Database there are over 220,000 trained NPs. 8. Which advanced practice nursing role is currently the smallest in number? a. CNM b. NP c. CNS d. CRNA ANS: A The CNM role according to the American College of Nurse-Midwives currently has around 11,000 trained providers based on current estimates. The CNM role is specialized in the care of women’s health and childbearing. 9. A practicing, certified CNM wishes to change roles and work as a family nurse practitioner (FNP). Which of the following is required? a. Complete education and training as an NP b. Take the FNP board examination c. Nothing is required d. Apply for immediate reciprocity ANS: A The four roles of APN (CNS, CRNA, CNM, and NP) are not interchangeable without additional training and education. Although there are specific instances of overlap, each of the four roles should not be confused as interchangeable. Specialty certifications under the NP role may allow for more flexibility under today’s regulations and are not standard practice. Scenarios are usually handled on an individual basis. 10. True or False. A registered nurse in an emergency room successfully completes a critical care course and meets all requirements for certification. He or she is now classified as an advanced practice nurse. a. True b. False ANS: B This registered nurse has completed advanced training that increases skill and knowledge and may have also obtained a certification; however, this does not meet the basic criterion of advanced practice nurse. He or she may be expertly skilled but requires the completion of a graduate degree focused in an area of nursing to appropriately be classified as an APN. The acute care nurse practitioner specialty would be required in this particular setting. Chapter 13. Evidence-Based Practice a. Tradition-based practice b. Rationale-based practice c. Evidence-based practice d. Nursing-based research ANS: A Tradition-based research is based on clinical and anecdotal experience, combined with received wisdom, often provided by instructors or clinical preceptors and expert opinion from those perceived as experts or expert clinicians in a given area of care. 123. Which of the following is the overall goal of a research study? a. Enhance quality of care by evaluating the effect of a specific action b. Application of best evidence to clinical decision making c. Combine the wisdom of experts in a given area of care d. Produce generalizable new knowledge ANS: D The overall goal of a research study is to produce generalizable new knowledge using various methods. The unit ofstudy typically varies but is often an aggregate of individual patients, families, or communities. A research study typically involves a review and approval from an Institutional Review Board (IRB) and is produced into a research report that may be presented in many modalities. 124. Which of the following is the overall goal of evidence-based practice? a. Produce generalizable new knowledge b. Combine the wisdom of experts in a given area of care c. Enhance quality of care by evaluating the effect of a specific action d. Application of best evidence to clinical decision making ANS: D The overall goal of evidence-based practice isto applythe current best evidence to clinical decision making for an individual patient, facility, or large group. 125. Which of the following is the overall goal of a quality improvement project? a. Combine the wisdom of experts in a given area of care b. Application of best evidence to clinical decision making c. Produce generalizable new knowledge d. Enhance quality of care by evaluating the effect of a specific action ANS: D The overall goal of a quality improvement project is to enhance quality of care by evaluating the effect of a specific action plan on a local unit, clinic, facility, or health system. 126. Which of the following would best help a nurse formulate a measurable question that can be meaningfully addressed using evidence-based clinical decision strategies? a. PICO(T) b. ROPI c. IRB d. GRADE ANS: A The PICO(T) model is the best model for a nurse to formulate a measurable question that can be meaningfully addressed using evidence-based clinical decision strategies. PICO(T) stands for patient/population and problem, intervention, comparison, outcome, and time. 127. Based on the pyramid of evidence, which of the following studies has the highest potential to contribute to evidence based on its design? a. Systematic reviews b. Cohort study c. Randomized controlled trial d. Case study e. Meta-analysis ANS: E A meta-analysis has the highest potential contribution to evidence based on design. Case studies and in vivo and in vitro studies have the least potential contribution due to their limited size. 128. Based on the pyramid of evidence, which of the following studies has the lowest potential to contribute to evidence based on its design? a. Meta-analysis b. Randomized controlled trial c. Cohort study d. Case study e. Systematic reviews ANS: D Case studies and in vivo and in vitro studies have the least potential contribution due to their limited size. A meta-analysis has the highest potential contribution to evidence based on design. 129. Which of the following rankings of recommendations for clinical practice as provided by the US Preventative Services Task Force (USPSTF) should always be offered or provided by the APRN when indicated? a. A, B, and C b. A c. A and B d. All recommendations e. B ANS: C Rankings A and B should be offered or provided when indicated. 130. Which of the following rankings of recommendations for clinical practice as provided by the US Preventative Services Task Force (USPSTF) should be offered or provided by the APRN only when other considerations support offering or providing the service? a. C b. D c. B d. All recommendations e. B and C ANS: A A USPSTF ranking ofC statesthat evidence suggeststhat the service only provides a small benefit and should be provided only when other considerations support offering or providing this service. 131. Which of the following rankings of recommendations for clinical practice as provided by the US Preventative Services Task Force (USPSTF) should the APRN discourage use of? a. D b. I c. B d. C e. C and D The Nurse Consultant role exists in Australia, the United Kingdom, and Hong Kong. It was first introduced in Australia in 1986 and was modeled after the CNS role in the United States. 138. A nurse in Australia obtains clinical experience and expands his or her knowledge and experience with a master’s degree with a focus on education and training in a specialty area of medicine. He or she most likely obtains which role? a. Clinical nurse specialist b. Advanced Registered Nurse c. Nurse Consultant d. Nursing physician assistant ANS: C In Australia, the Nurse Consultant role varies in requirements from a hospital certificate to a master’s degree. The role has different grade levels and increases responsibilities across five domains. 139. As of the writing of this text, which of the following regions is considered the “next frontier” of APN role development? a. China b. Europe c. Latin America d. Africa ANS: C Latin America is considered the next frontier of APN role development. This region is an area of the world where few such roles exist as of the writing of this text. Development of APN roles in this region is driven by the policies that include: primary health care reform, access to health care, and universal health care coverage. 140. Which of the following strategies is best to support the development of APN roles at the international level? a. Create communities of practice to develop APNs b. Using evidence-based approaches to role development c. Build consensus among stakeholders on health systems solutions utilizing APN roles d. Leverage and share resources for APN education with another country ANS: D While all approaches may be beneficial to support role development, leveraging and sharing resources with another country are most likely to benefit role development internationally. The other options are most beneficial in the development of APN roles at the country level. 141. Which of the following strategies is best to support the initial development of APN roles at the country level? a. Showing support for policies of world organizations to prevent out-migration of nursing leaders and educators b. Collaborating with another country to understand policy decisions c. Joining policy discussions to advocate for the APN role d. Obtaining an advanced nursing practice degree in another country ANS: C The initial development of APN roles at country level is multifaceted. The importance of advocacy for the role to key stakeholders and policymakers is often the first step. The other options are best suited for development at the international level. Chapter 15. Case Management and Advanced Practice Nursing Multiple Choice 142. Which of the following is the most essential component to lead clinical staff and programs effectively as an advanced practice registered nurse? a. Clinical credibility b. Appropriate education c. Years of experience d. Age ANS: A All of the options may attribute to effectively leading clinical staff and programs as an APRN. Direct care is the central competency of advanced practice nursing and excellence in direct care requires clinical credibility to lead other clinical staff. Years of experience or age may or may not be related to direct care. Appropriate education is important for clinical leadership, but clinical credibility requires experience combined with direct care. 143. An advanced practice registered nurse in an outpatient clinic has a phone conference with a cardiologist regarding a patient’s condition. This is an example of: a. Social services b. Point-of-care encounter c. Indirect care d. Direct care ANS: C This is an example of indirect care of clinical practice. Direct care or direct clinical practice refers to those activities and functions that the APRN performs within the patient-nurse interface. 144. Which of the following is considered indirect care? a. Forming a therapeutic relationship during patient examination b. Discharge planning c. Consideration of which medication to prescribe a patient d. Patient education regarding medication side effects ANS: B Indirect care or indirect clinical practice refers to those activities and responsibilities that occur outside of the patient-nurse interface. They may include consultation with other health care providers, discharge planning, care coordination, communication with insurance companies, education or supervision of other medical staff, or billing and coding for services rendered. The other options are examples of direct care. 145. Which of the following is considered direct care? a. Forming a therapeutic relationship during patient examination b. Increasing knowledge of a disease process to better care for a complex patient c. Prior authorization of prescriptions d. Consultant phone call about patient condition ANS: A Direct care or direct clinical practice refers to those activities and functions that the APRN performs within the patient-nurse interface. Examples of direct care include physical acts of diagnosis, monitoring, treatment, or direct patient education that occur in the patient-nurse interface. It can be with the patient or family members. The other options are examples of indirect care. 146. An APRN is preparing a patient to be discharged from an emergency department. Which of the following activities is considered direct care? a. Speaking with the patient’s primary care provider b. Electronically transmitting prescriptions to pharmacy c. Discharge planning documentation d. Discharge patient education ANS: D