BUTTARO TEST BANK FOR PRIMARY CARE A COLLABORATIVE PRACTICE 6TH EDITION, Exams of Nursing

Download BUTTARO TEST BANK FOR PRIMARY CARE A COLLABORATIVE PRACTICE 6TH EDITION and more Exams Nursing in PDF only on Docsity!

COLLABORATIVE PRACTICE 6

TH

EDITION

th

Buttaro: Primary Care, A Collaborative Practice, 6 Ed.

Chapter 1: The Evolving Landscape of Collaborative Practice

Test Bank

Multiple Choice

1. Which assessments of care providers are performed as part of the Value Based Purchasing initiative? Select all that apply.

a. Appraising costs per case of care for Medicare patients b. Assessing patients’ satisfaction with hospital care c. Evaluating available evidence to guide clinical care guidelines d. Monitoring mortality rates of all patients with pneumonia e. Requiring advanced IT standards and minimum cash reserves

ANS: A, B, D Value Based Purchasing looks at five domain areas of processes of care, including efficiency of care (cost per case), experience of care (patient satisfaction measures), and outcomes of care (mortality rates for certain conditions. Evaluation of evidence to guide clinical care is part of evidence-based practice. The requirements for IT standards and financial status are part of Accountable Care Organization standards. REF: Value Based Purchasing

2. What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients?

a. Associations with area hospitals b. Costs of ambulatory care c. Ease of access to care d. The ratio of providers to patients

ANS: C As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to care, walk-in settings and the ability to be seen within 30 minutes, and care that is close to home. Associations with hospitals, costs of care, and the ratio of providers to patients were not part of these results. REF: The New Look of Primary Care

3. A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation?

COLLABORATIVE PRACTICE 6

TH

EDITION

a. Bonuses based on achievement of benchmarks b. Care coordination for chronic diseases c. Standards for minimum cash reserves d. Strict requirements for financial reporting

ANS: A A Level 1 ACO has the least amount of financial risk and requirements, but receives shared savings bonuses based on achievement of benchmarks for quality measures and expenditures. Care coordination and minimum cash reserves standards are part of Level 2 ACO requirements. Level 3 ACOs have strict requirements for financial reporting. REF: Accountable Care Organizations

COLLABORATIVE PRACTICE 6

TH

EDITION

th

Buttaro: Primary Care, A Collaborative Practice, 6

Chapter 2: Translating Research Into Clinical Practice

Test Bank

Multiple Choice

Ed.

1. Which is the most appropriate research design for a Level III research study?

a. Epidemiological studies b. Experimental design c. Qualitative studies d. Randomized clinical trials

ANS: B The experimental design is the most appropriate design for a Level III study. Epidemiological studies are appropriate for Level II studies. Qualitative designs are useful for Level I studies. Randomized clinical trials are used for Level IV studies. REF: Level III Research/Experimental Design

2. What is the purpose of clinical research trials in the spectrum of translational research?

a. Adoption of interventions and clinical practices into routine clinical care b. Determination of the basis of disease and various treatment options c. Examination of safety and effectiveness of various interventions d. Exploration of fundamental mechanisms of biology, disease, or behavior

ANS: C Clinical research trials are concerned with determining the safety and effectiveness of interventions. Adoption of interventions and practices is part of clinical implementation. Determination of the basis of disease and treatment options is part of the pre-clinical research phase. Exploration of the fundamental mechanisms of biology, disease, or behavior is part of the basic research stage. REF: Translational Science Spectrum

3. What is the purpose of Level II research?

a. To define characteristics of interest of groups of patients b. To demonstrate the effectiveness of an intervention or treatment c. To describe relationships among characteristics or variables d. To evaluate the nature of relationships between two variables

COLLABORATIVE PRACTICE 6

TH

EDITION

ANS: C

Level II research is concerned with describing the relationships among characteristics or variables. Level I research is conducted to define the characteristics of groups of patients. Level II research evaluates the nature of the relationships between variables. Level IV research is conducted to demonstrate the effectiveness of interventions or treatments. REF: Level II Research

COLLABORATIVE PRACTICE 6

TH

EDITION

th

Buttaro: Primary Care, A Collaborative Practice, 6 Ed.

Chapter 3: The Patient, the Provider, and Primary Care: An Integrated Perspective

Test Bank

Multiple Choice

1. A patient takes glucosamine chondroitin to help control osteoarthritis pain. Which medications, taken in conjunction with this medication, are of concern?

a. Anticholinergic drugs b. Beta blocker medications c. Blood-thinning agents d. Narcotic analgesics

ANS: C Glucosamine chondroitin can prolong bleeding if taken with other blood-thinning agents. It does not have anticholinergic effects, cardiac effects or analgesic effects. REF: Alternative Therapies for Common Chronic Conditions/Joint Pain

2. The provider learns that a patient is taking herbal supplements for a variety of reasons. What is an important point to discuss with this patient about taking such supplements?

a. Because they are not FDA approved, they are not safe b. Dietary supplements are safer than most prescription medications c. Many supplements lack clear clinical evidence of efficacy d. Supplements should not be taken with prescription medications

ANS: C Many dietary supplements lack clinical evidence to support their use. Even though they are not FDA approved, federal law mandates that the products are safe and cannot make misleading claims about use. Supplements are not necessarily safer than prescription drugs. Supplements may be taken with prescription medications as long as the effects, side effects, and drug interactions are known. REF: Alternative Therapies for Common Chronic Conditions

3. Which dietary supplements have shown some effectiveness in reducing blood pressure in patients with hypertension? Select all that apply.

a. Chromium picolinate b. Cinnamon

COLLABORATIVE PRACTICE 6

TH

EDITION

c. CoQ d. Garlic extract e. L-arginine

ANS: C, D, E CoQ10, garlic extract, and L-arginine have demonstrated effectiveness in reducing blood pressure in some studies. Chromium picolinate and cinnamon have been studied for effects on glucose tolerance and fasting glucose. REF: Alternative Therapies for Common Chronic Conditions/Prehypertension and Hypertension

COLLABORATIVE PRACTICE 6

TH

EDITION

th

Buttaro: Primary Care, A Collaborative Practice, 6

Chapter 16: Lifestyle Management

Test Bank

Multiple Choice

Ed.

1. A 60-year-old patient who leads a sedentary lifestyle has expressed an interest in beginning an aerobic exercise program. What will the provider include when counseling this patient about this program?

a. Begin with a 45 to 60 minute workout b. Include a 1 to 2 minute warm up before exercise c. Maintain a heart rate between 80 and 128 beats per minute d. Stretching should be performed prior to activity

ANS: D The heart rate should be kept between 50% and 80% of the maximum heart rate (220 minus the patient’s age = 160), which is 80 to 128 beats per minute. Patients who are not conditioned should begin with a 20 minute workout; conditioned individuals may increase up to 60 minutes. The warm up should be 3 to 6 minutes and longer if it is cold. Stretching is performed after the activity when the muscles are warm. REF: Exercise

2. Routine screening blood tests at an annual physical exam reveal a fasting glucose level of 125 mg/dL and a hemoglobin A1C of 6.2%. What will the provider do, based on these results?

a. Evaluate the patient for impaired glucose tolerance b. Reassure the patient that these are normal values c. Suggest that the patient begin an exercise program d. Tell the patient that these results indicate diabetes

ANS: A The fasting blood glucose level is normal, but the HgA1C indicates impaired glucose tolerance. If the HgA1C were greater than 6.4%, the patient would be diagnosed with diabetes. Until the results are evaluated, suggestions for treatment are not indicated. REF: Diabetes

3. The primary care provider is screening a patient using the CAGE criteria. What will the provider include in this assessment? Select all that apply.

COLLABORATIVE PRACTICE 6

TH

EDITION

a. Number of times per week eaten in restaurants b. Sodium and sugar intake c. Sources of daily dairy intake d. Total number of servings of fruits and vegetables e. Types of meats and proteins

ANS: A, C, E The CAGE questionnaire is designed to evaluate the intake of saturated fat and cholesterol, so the provider will ask about sources of dairy, the number of times eating foods not made at home, and the types of meats and proteins eaten. The questionnaire does not evaluate for sodium, sugar, fruits, or vegetables. REF: Box 16-1: Dietary CAGE Questions for Assessment of Intake of Saturated Fat and Cholesterol

COLLABORATIVE PRACTICE 6

TH

EDITION

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

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 HEADSS Adolescent Risk Profile when the new nurse responds that it is used to assess for

needs related to

a. anticipatory guidance.

b. low-risk adolescents.

c. physical development.

d. sexual development.

ANS: A

The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which assesses

home, education, activities, drugs, sex, and suicide for the purpose of identifying high-risk

adolescents and the need for anticipatory guidance. It is used to identify high-risk, not low-risk,

adolescents. Physical development is assessed with anthropometric data. Sexual development is

assessed using physical examination.

REF: 6 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

2. The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, the

expected stage of development for a preschooler is

a. concrete operational.

b. formal operational.

c. preoperational.

d. sensorimotor.

ANS: C

The expected stage of development for a preschooler (3 to 4 years old) is preoperational. Concrete

COLLABORATIVE PRACTICE 6

TH

EDITION

operational describes the thinking of a school-age child (7 to 11 years old). Formal operational

COLLABORATIVE PRACTICE 6

TH

EDITION

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 as differentiation. 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

The Denver II is the most commonly used measure of developmental status used by health care

professionals; it is a screening tool. Screening tools do not provide a diagnosis. Diagnosis requires a

thorough neurodevelopment history and physical examination. Developmental delay, which is

suggested by screening, is a symptom, not a diagnosis. The need for any therapy would be

identified with a comprehensive evaluation, not a screening tool. Some providers use the Denver II

as a framework for teaching about expected development, but this is not the primary purpose of the

COLLABORATIVE PRACTICE 6

TH

EDITION

tool.

COLLABORATIVE PRACTICE 6

TH

EDITION

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

5. To plan early intervention and care for an infant with Down syndrome, the nurse considers

knowledge of other physical development exemplars such as

a. cerebral palsy.

b. failure to thrive.

c. fetal alcohol syndrome.

d. hydrocephaly.

ANS: D

Hydrocephaly is also a physical development exemplar. Cerebral palsy is an exemplar of adaptive

developmental delay. Failure to thrive is an exemplar of social/emotional developmental delay.

Fetal alcohol syndrome is an exemplar of cognitive developmental delay.

REF: 9 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

6. To plan early intervention and care for a child with a developmental delay, the nurse would

consider knowledge of the concepts most significantly impacted by development, including

a. culture.

b. environment.

c. functional status.

d. nutrition.

ANS: C

Function is one of the concepts most significantly impacted by development. Others include

sensory-perceptual, cognition, mobility, reproduction, and sexuality. Knowledge of these concepts

can help the nurse anticipate areas that need to be addressed. Culture is a concept that is considered

to significantly affect development; the difference is the concepts that affect development are those

that represent major influencing factors (causes), hence determination of development and would be

the focus of preventive interventions. Environment is considered to significantly affect

development. Nutrition is considered to significantly affect development.

REF: 1 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

COLLABORATIVE PRACTICE 6

TH

EDITION

7. A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to

her toys and makes up stories. The mother wants her child to have a psychologic evaluation. The

nurses best initial response is to

a. refer the child to a psychologist.

b. explain that playing make believe with dolls and people is normal at this age.

c. complete a developmental screening.

d. separate the child from the mother to get more information.

ANS: B

By the end of the fourth year, it is expected that a child will engage in fantasy, so this is normal at

this age. A referral to a psychologist would be premature based only on the complaint of the

mother. Completing a developmental screening would be very appropriate but not the initial

response. The nurse would certainly want to get more information, but separating the child from the

mother is not necessary at this time.

REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

8. A 17-year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so

needy and acting like a child. The best response of the nurse is that in the hospital, adolescents

a. have separation anxiety.

b. rebel against rules.

c. regress because of stress.

d. want to know everything.

ANS: C

Regression to an earlier stage of development is a common response to stress. Separation anxiety is

most common in infants and toddlers. Rebellion against hospital rules is usually not an issue if the

adolescent understands the rules and would not create childlike behaviors. An adolescent may want

to know everything with their logical thinking and deductive reasoning, but that would not explain

why they would act like a child.

Chapter 2. Emerging Roles of the Advanced Practice Nurse

COLLABORATIVE PRACTICE 6

TH

EDITION

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.

COLLABORATIVE PRACTICE 6

TH

EDITION

3. Communication problems often plague ethical dilemmas, which of the following is often at the forefront of communication problems regarding clinicians?

a. Poor knowledge of the situation b. Language barriers c. Poor independence d. Failure to speak up

ANS: D All of the answers may contribute to ethical dilemmas but failure of a clinician to speak up about a real or potential ethical problem is commonly identified. Erosion of open and honest communication is typically the first theme encountered in many ethical dilemmas.

4. A 76-year-old patient is admitted to the hospital after suffering a spinal compression fracture. The patient is unable to ambulate adequately on his or her own and requires assistance for basic needs. Your assessment is that the patient will recover their strength within 2 weeks. The billing department at the facility notifies you that the patient may not stay in the hospital for more than 2 days. The patient does not wish to be transferred to a nursing facility and wishes to remain in the hospital for the remaining 12 days to gain strength. Which of the following best defines this scenario?

a. Interprofessional conflict b. Communication problems c. Legal issues d. Multiple commitments

ANS: A This ethical scenario plays out routinely in medical care as an element of interprofessional conflict. The clinician wishes to respect patient autonomy but must understand and express the best interests of the patient to a multidisciplinary team.

5. An APRN is scheduled to complete his or her shift at 7 p.m. on a particular day. A new patient arrives 5 minutes prior to the time the APRN is expected to leave. He or she is asked by a supervisor to stay beyond their scheduled time to assess the patient and provide care. Which of the following best defines this scenario?

a. Interprofessional conflict b. Multiple commitments c. Communication problems d. Legal issues

ANS: B

COLLABORATIVE PRACTICE 6

TH

EDITION

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

6. An APRN works in a primary care clinic. The APRN wishes to treat a patient’s disease with a specific medication that is far superior to other treatments. The APRN has never encountered issues prescribing this therapy as first-line treatment in the past. The APRN is informed by this particular patient’s insurance that they require proof that the APRN has tried a far less effective therapy for 1 month prior to paying for the medication. Which of the following best describes the forces at work in this scenario?

a. Communication problems b. Legal issues c. Interprofessional conflict d. Societal issues

ANS: D Societal issues including cost containment pressures in health systems are likely responsible for development of this scenario. Interprofessional conflicts would best be involved in this scenario if this is applied in a multidisciplinary team scenario.

7. Which of the following are defined as the four elements of core competency development in ethical decision making for APRNs?

a. Knowledge development, knowledge application, creating an ethical environment, promoting social justice b. Knowledge development, educating others, creating an ethical environment, promoting social justice c. Knowledge development, knowledge application, effective communication, promoting social justice d. Knowledge development, knowledge application, creating an ethical environment, understanding legal barriers

ANS: A The core competency of ethical decision making for APRNs is best organized into four key elements: knowledge development, knowledge application, creating an ethical environment, and promoting social justice.

8. Which of the following examples best describes the knowledge development element of core competency development for ethical decision making?

COLLABORATIVE PRACTICE 6

TH

EDITION

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 decision making. It involves gaining knowledge of ethical theories and developing the abilit y to distinguish a true ethical dilemma from a situation of moral distress or other clinically problematic situation. Becoming sensitive to ethical dimensions of clinical practice and fidelity conflicts, developing values clarification (self-reflection), and interpreting reactions and emotions of others are all elements of knowledge development and moral sensitivity.

9. An APRN joins a group promoting awareness about abuse in long-term nursing care facilities. He or she advocates for policies that protect the health care rights of individuals who are not able to care for themselves independently. The APRN most likely employed which of the following elements of core competency development for ethical decision making?

a. Promoting social justice b. Knowledge development c. Creating an ethical environment d. Knowledge application

ANS: A Skills or behaviors for promoting social justice within a health care system include the ability to analyze the policy process and advocacy, communication, and leadership skills that promote involvement in health policy initiatives supporting social justice.

10. An APRN interacts with a patient and another colleague to achieve the best outcome ofan ethical dilemma. The APRN most likely used which of the following elements of core competency development for ethical decision making?

a. Knowledge application b. Creating an ethical environment c. Promoting social justice d. Knowledge development

ANS: A Applying ethical decision-making models to clinical problems, using skilled communication regarding ethical issues, and facilitating decision making by using select strategies are involved in the use of knowledge application.

COLLABORATIVE PRACTICE 6

TH

EDITION

11. An APRN works at a hospital system that provides care to a large proportion of Asian- American citizens. The APRN develops a presentation for newly hired employees about the cultural belief systems held by many in this population group. This describes the use of which of the following elements of core competency development for ethical decision making?

a. Creating an ethical environment b. Promoting social justice c. Knowledge application d. Knowledge development

ANS: A Creating an ethical environment may include the use of preventative ethics and awareness of environmental barriers to ethical practice.

12. Application of existing rules and doctrine as a guide for ethical decision making is best described as which ethical approach?

a. Narrative ethics b. Care-based ethics c. Casuistry d. Principle-based ethics e. Virtue-based ethics

ANS: D In principle-based ethical decision making, the principles or rules in contention are balanced and interpreted with the contextual elements of the situation. However, the final decision and moral justification for actions are based on principles.

13. Which ethical approach uses comparisons 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?

COLLABORATIVE PRACTICE 6

TH

EDITION

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.

COLLABORATIVE PRACTICE 6

TH

EDITION

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 relocates to another state and begins a new job. Which of the following would guide his or her ability to practice certain procedures or skills?

COLLABORATIVE PRACTICE 6

TH

EDITION

a. State scope of practice and facility policy b. American Medical Association policy c. State scope of practice d. Facility policy

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

21. The National Association of Clinical Nurse Specialists has seven core competencies published for the CNS role. Which of the following is not included at the highest level?

a. Coaching competency b. Professionalism competency c. Direct care competency d. Systems leadership competency

ANS: B The National Association of Clinical Nurse Specialists’ Core Competencies include at the highest level seven competencies: direct care, consultation, systems leadership, collaboration, coaching, research, and ethical decision making, moral agency, and advocacy.

22. Each of the following is specifically described in the NACNS’s three spheres of influence for the CNS role except:

a. Nurses/nursing practice b. Organization/system c. Leadership d. Patient

ANS: C The NACNS has defined the CNS role as operating between the three spheres of influence: the patient, the organization/system, and the nurse/nursing practice. The CNS should employ Hamric’s seven competencies across the three spheres of influence.

23. According to a 2016 ruling, how has the Department of Veterans Affairs alleviated state- based practice regulations at VA facilities?

a. Allows CNS to work at full practice authority b. Allows CNS to practice according to their home state’s regulation

COLLABORATIVE PRACTICE 6

TH

EDITION

c. Provides immediate licensures d. Provides malpractice insurance free of charge

ANS: A In 2016, the Department of Veterans Affairs alleviated state-based practice regulations by allowing CNS to work at full practice authority inside VA facilities and not within a state’s scope of practice.

24. Which of the following is major regulatory barrier for many CNS specialties in relation to the Consensus Model?

a. Poor reimbursement for services b. Lack of specialty certification examinations c. Lack of education d. Poor CNS involvement in advocacy

ANS: B A lack of specialty certification examinations in some areas is a major regulatory barrier for many CNS specialties in relation to the Consensus Model.

25. With regard to prescriptive authority, how did Oregon manage CNSs whose original education curriculum did not include prescription of pharmacologic agents?

a. Take a specialized state-specific examination regarding prescriptive authority b. Permanent exclusion from prescriptive authority c. An advanced pharmacology course and complete 150 supervised hours d. 2080 hours involved in a collaborative agreement

ANS: C Oregon’s regulation for inclusions of CNSs whose original education curriculum did not include prescription of pharmacologic agents includes the completion of an advanced pharmacology course and a minimum of 150 hours of supervised pharmacologic management. Minnesota requires 2080 hours of practice within a collaborative agreement with a licensed CNP, CNS, or physician experienced with similar patients. Wisconsin requires advanced practice nurse prescribers to pass an examination on Wisconsin’s statutes and rules of practice.

26. States have each independently created regulation regarding advanced practice. With regard to prescriptive authority, what requirement has Wisconsin implemented regarding authorization of CNSs as advanced practice nurse prescribers?

a. 2080 hours involved in a collaborative agreement b. An advanced pharmacology course and complete 150 supervised hours c. Permanent exclusion from prescriptive authority d. Take a specialized state-specific examination regarding prescriptive authority

COLLABORATIVE PRACTICE 6

TH

EDITION

ANS: D

Wisconsin requires advanced practice nurse prescribers to pass an examination on Wisconsin’s statutes and rules of practice. Oregon’s regulation for inclusions of CNSs whose original education curriculum did not include prescription of pharmacologic agents includes the completion of an advanced pharmacology course and a minimum of 150 hours of supervised pharmacologic management. Minnesota requires 2080 hours of practice within a collaborative agreement with a licensed CNP, CNS, or physician experienced with similar patients.

27. Which factor led to a decrease of CNSs entering CNS programs in 1990s?

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

COLLABORATIVE PRACTICE 6

TH

EDITION

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

30. Which of the following is provided as part of the Consensus Model?

a. Decrease educational requirements b. Collaboration among physicians c. Reimbursement for services d. Title protection

ANS: D The Consensus Model provides title protection for CNSs and provides for a grandfather clause to include APRNs who graduated from accredited programs and began practicing prior to the implementation of the Consensus Model.

Chapter 3. Role Development: A Theoretical Perspective

Test Bank

Multiple Choice

31. The federal government’s criterion to establish health professional shortage areas (HPSAs) is based on which of the following statistics?

a. Average family income less than two-thirds of national poverty level b. An area in which there are less than 500 individuals for 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