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CHAPTER1: ANSWERS AND RATIONALES 1. Which change represents the primary impetus for the end of the era of the female lay healer? 2. The beginning of modern nursing is traditionally considered... to have begun with which event? 3. In 1910, which factors most significantly influenced the midwifery profession? Select all that apply. 4. Which advanced practice nursing role is unique in that the practitioners view their role as comprising a combination of two distinct disciplines? Answer: 4 Page: 9 1. In the 19th century, which factors led to the administration of anesthesia by nurses? Select all that apply. nurses. By contrast, contentiousness is a hallmark of the relationship between nurse anesthetists and anesthesiologists even in the present day. In the 19th century, anesthesia was in its early stages. Administration of anesthesia by nurses occurred primarily because of anesthesiology’s lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees. 3. This is correct. In the 19th century, anesthesia was in its early stages. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. However, physicians were not opposed to administering anesthesia; rather, anesthesia was viewed as a means by which to transform surgery into a scientific approach to treating with health alterations. Collaboration between physicians and nurses did not contribute to administration of anesthesia by nurses; contentiousness is a hallmark of the relationship between nurse anesthetists and anesthesiologists even in the present day. In the 19th century, no national organization of nurse anesthetists yet existed. The National Association of Nurse Anesthetists, which was renamed the American Association of Nurse Anesthetists (AANA), was founded in 1931. 4. This is incorrect. In the 19th century, anesthesia was in its early stages. Physicians were in favor of the administration of anesthesia, viewing this advancement as a means by which to transform surgery into a scientific modality for treating health alterations. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. As such, the administration of anesthesia was assigned to nurses. 5. This is incorrect. The National Association of Nurse Anesthetists, which was renamed the American Association of Nurse Anesthetists (AANA), was founded in 1931. In the 19th century, anesthesia was in its early stages. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. Thus, anesthesia administration was performed by nurses. 1. Which factor contributed to expansion of the role of the clinical nurse specialist (CNS) during the 1960s? 1. Increased numbers of practicing physicians 2. Tightening of female role definitions 3. Return of nurses from military conflict 4. Lack of medical specialization Answer: 3 Page: 17 Feedback 1. This is incorrect. During the 1960s, a shortage of physicians occurred. The role of the CNS was expanded in part because of the return of nurses from the Vietnam War. Nurse veterans searched for opportunities to increase their knowledge and skills, and practiced in advanced roles as well as nontraditional specialties (such as anesthesia and trauma or anesthesia). 2. This is incorrect. During the 1960s, role definitions for women became less restrictive. The role of the CNS was expanded in part because of the return of nurses from the Vietnam War. Nurse veterans searched for opportunities to increase their knowledge and skills, and practiced in advanced roles as well as nontraditional specialties (such as anesthesia and trauma or anesthesia). 3. This is correct. Expansion of the CNS role during the 1960s occurred in part because of the return of nurse veterans from the Vietnam War who sought to increase their knowledge and skills, and to work in advanced roles and nontraditional fields, such as anesthesia and trauma. 4. This is incorrect. In the 1960s, medical specialization was prevalent, and the need for competent nurses who were proficient at caring for patients with complex health needs increased. Thus, the CNS role expanded. The role of the CNS also expanded because of the return of nurses from the Vietnam War. Many of these nurse veterans searched for opportunities to increase their knowledge and skills, and practiced in advanced roles as well as nontraditional specialties (such as anesthesia and trauma or anesthesia). 7. Differentiation between the role of the clinical nurse specialist (CNS) and the nurse practitioner (NP) is primarily based on which premise? 1. Designation as an advanced practice nurse 2. Diagnosis of patient health conditions 3. Nature of practice setting environments 4. Authority to prescribe medications Answer: 3 Pages: 20–21 Feedback 1. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) are designated as advanced practice nurses (APNs). A primary differentiation between the roles of CNS and NP centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. 2. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) are prepared to diagnose patient health alterations. A primary differentiation between the roles of CNS and NP centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. 3. This is correct. A primary differentiation between the roles of clinical nurse specialist (CNS) and nurse practitioner (NP) centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. Both the CNS and the NP are designated as advanced practice nurses (APNs), educationally prepared to diagnose patient health alterations, and eligible to apply for prescriptive authority. 4. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) are eligible to apply for authority to prescribe medications. A primary differentiation between the roles of CNS and NP centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. 8. The National Council of State Boards of Nursing’s Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation prompted gains related to which aspects of the role and function of the nurse practitioner (NP)? Select all that apply. 1. Legal authority 2. Reimbursement 3. Consumer recognition 4. Prescriptive privilege 5. Autonomy Answer: 1, 2, 4 Page: 29 Feedback 1. This is correct. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 2. This is correct. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 3. This is incorrect. At present, nurse practitioners (NPs) still face challenges related to consumer recognition in health care. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the NP, including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. 4. This is correct. Adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation in 2008 by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 5. This is incorrect. At present, nurse practitioners (NPs) still face challenges related to autonomy. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the NP, including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 9. The doctor of nursing practice (DNP) degree was developed to support the achievement of which goal related to advanced practice nursing education? 1. Eliminating master’s degree programs 2. Promoting excellence in clinical practice 3. Replacing doctor of philosophy programs 4. Emphasizing the generation of nursing research Answer: 2 Pages: 31, 33 Feedback 1. This is incorrect. Rather than seeking to eliminate master’s degree programs designed to prepare advanced practice registered nurses (APRNs), current legislation exists to preserve such programs. The doctor of nursing practice (DNP) is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. 2. This is correct. The doctor of nursing practice (DNP) is not intended to replace the doctor of philosophy (PhD). Whereas the PhD emphasizes research, the DNP is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. Current legislative efforts related to nursing education do not include elimination of master’s degree programs for advanced practice registered nurses (APRNs). Rather, current legislation exists to preserve existing master’s degree programs designed to prepare APRNs. 3. This is incorrect. The doctor of nursing practice (DNP) is not intended to replace the doctor of philosophy (PhD). The DNP is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. 4. This is incorrect. Unlike the doctor of philosophy (PhD), which emphasizes research, the doctor of nursing practice (DNP) is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. 10. Among national nursing leaders, which argument serves as a basis for opposition to the requirement that advanced practice nurses (APNs) earn a doctor of nursing practice (DNP) degree? 1. Greater professionalization is needed among advanced practice nurses. 2. The number of graduate nursing programs should be limited. 3. Advanced practice nursing certification should not require a doctoral degree. 4. The need for care providers should be prioritized. Answer: Answer: 4 Page: 33 Feedback 1. This is incorrect. National nursing leaders have opposed a proposition to require completion of a doctor of nursing practice (DNP) degree by advanced practice nurses (APNs) who seek certification based on a perception that the need for care providers should be prioritized above professionalization of advanced practice registered nurses (APRNs) by way of completing a DNP program. 2. This is incorrect. National nursing leaders have not sought to limit graduate nursing education programs for advanced practice registered nurses (APRNs). The basis for opposition among national nursing leaders related to requiring advanced practice nurses (APNs) to complete a doctor of nursing practice (DNP) degree centers on the perception that the need for care providers takes precedence over professionalization of APRNs by way of completing a DNP program. 3. This is incorrect. National nursing leaders have not sought to require advanced practice nurses (APNs) to complete a doctor of philosophy (PhD) degree. Rather, national nursing leaders have opposed a mandate that would require completion of a doctor of nursing practice (DNP) degree before seeking certification as an advanced practice registered nurse (APRN) based on a perception that the need for care providers should be prioritized over professionalization of APRNs. 4. This is correct. National nursing leaders have opposed a mandate that would require completion of a doctor of nursing practice (DNP) degree before seeking certification as an advanced practice registered nurse (APRN) based on a perception that the need for care providers should be prioritized over professionalization of APRNs. National nursing leaders have neither sought to limit graduate nursing education programs for APRNs nor recommended that advanced practice nurses (APNs) be required to complete a doctor of philosophy (PhD) degree. Chapter 2: Emerging Roles of the Advanced Practice Nurse ANSWERS AND RATIONALES 1. Entry into which advanced practice nursing specialty will require a doctoral degree by 2022? 1. Clinical nurse specialist (CNS) 2. Certified registered nurse anesthetist (CRNA) 3. Nurse practitioner (NP) 4. Certified nurse-midwife (CNM) Answer: 2 Page: 5 Feedback 1. This is incorrect. Clinical nurse specialists (CNSs) are not required to complete a doctoral degree. However, the American Association of Nurse Anesthetists (AANA) has set forth a mandate requiring all graduates to complete a doctoral degree. Beginning in 2022, a doctorate will be the minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 2. This is correct. Beginning in 2022, the American Association of Nurse Anesthetists (AANA) will require a doctoral degree as a minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 3. This is incorrect. Nurse practitioners (NPs) are not currently required to complete a doctoral degree. Presently, only the American Association of Nurse Anesthetists (AANA) has set forth a mandate requiring all graduates to complete a doctoral degree. Beginning in 2022, a doctorate will be the minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 4. This is incorrect. At present, certified nurse-midwives (CNMs) are not required to obtain a doctoral degree. Only the American Association of Nurse Anesthetists (AANA) has set forth a mandate requiring all graduates to complete a doctoral degree. Beginning in 2022, a doctorate will be the minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 2. According to the Consensus Model for APRN Regulation, advanced practice nursing should abide by which recommendation? 1. Emphasizing state-based regulation of advanced practice nursing standards 2. Ensuring regulation of advanced practice registered nurses (APRNs) as a unified, collective group 3. Preparing clinical nurse specialists (CNSs) to function primarily in acute care 4. Changing the population focus of adult nurse practitioners to adult gerontology Answer: 4 Pages: 6, 20 Feedback 1. This is incorrect. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Rather than emphasizing state-based regulation of advanced practice nursing, general goals of the Consensus Model include promoting consistency of advanced practice nursing standards to increase the potential for interstate licensure reciprocity. The Consensus Model recommends shifting the population focus of adult nurse practitioners (NPs) to adult gerontology. 2. This is incorrect. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Instead of ensuring regulation of advanced practice registered nurses (APRNs) as a collective group, the Consensus Model recommends regulation of APRNs in one of four accepted roles. Recommendations also include shifting the population focus of adult nurse practitioners (NPs) to adult gerontology. 3. This is incorrect. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Based on the Consensus Model, the practice of clinical nurse specialist (CNS) practices occurs across both acute and primary care settings. The Consensus Model also recommends shifting the population focus of adult nurse practitioners (NPs) to adult gerontology. 4. This is correct. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Per the Consensus Model, the population focus of adult nurse practitioners (NPs) has shifted to adult gerontology. As opposed to emphasizing state-based regulation of advanced practice nursing, broad goals of the Consensus Model include developing more consistent standards for advanced practice nurses (APNs) that promote eligibility for interstate licensure reciprocity. Instead of ensuring regulation of advanced practice registered nurses (APRNs) as a collective group, the Consensus Model recommends regulation of APRNs in one of four accepted roles. The Consensus Model describes the practice of clinical nurse specialists (CNSs) as including both acute and primary care settings. 3. The relationship to which aspect of the function of the clinical nurse specialist (CNS) shows the greatest need for research? 1. Patient satisfaction 2. Care outcomes 3. Income generation 4. Role adaptability Answer: 3 Pages: 8, 10 Feedback 1. This is incorrect. Research has identified a correlation between clinical nurse specialist (CNS)-patient interaction and patient satisfaction. Further research is needed to examine the relationship between utilization of the CNS and income generation. 2. This is incorrect. Existing research studies have identified a correlation between clinical nurse specialist (CNS)-patient interaction and favorable patient care outcomes. Additional research is needed to examine the relationship between utilization of the CNS and income generation. 3. This is correct. Additional research is needed to examine the relationship between utilization of the clinical nurse specialist (CNS) and income generation. Role adaptability is a central feature of the CNS. Research has identified a correlation between CNS-patient interaction and favorable patient care outcomes, as well as patient satisfaction. 4. This is incorrect. Role adaptability, which is a primary characteristic of the clinical nurse specialist (CNS), is regarded as contributing to role ambiguity for this advanced practice role. Available research is limited related to the economic impact of the CNS, including income generation. 4. For nurse practitioners (NPs), which issue represents a current barrier to autonomy? 1. Restrictions on reimbursement for services 2. Absence of state-based prescriptive authority 3. Limited ability to serve in acute care settings 4. Lack of authority to manage medical problems Answer: 1 Pages: 12, 15 Feedback 1. This is correct. One barrier to autonomy for nurse practitioners (NPs) stems from restrictions on reimbursement for services. Among advanced practice nurses (APRNs), NPs comprise the largest group. All 50 states, as well as the District of Columbia, grant prescriptive privileges to qualified NPs (Phillips, 2016). NPs serve in primary and acute care settings. Assessment and management of patients related to medical and nursing problems is within the NP’s scope of practice. 2. This is incorrect. All 50 states, as well as the District of Columbia, grant prescriptive privileges to qualified NPs (Phillips, 2016). For NPs, barriers to autonomy include restrictions on reimbursement for services. 3. This is incorrect. Nurse practitioners (NPs) serve in both primary and acute care settings. Barriers to autonomy for NPs include restrictions on reimbursement for services. 4. This is incorrect. Nurse practitioners (NPs) are qualified to assess and manage a wide range of patient problems, including both medical and nursing issues. Barriers to the NP’s autonomy include restrictions on reimbursement for services. 5. Which changes have contributed to the evolution of the present-day nurse practitioner (NP)’s role? Select all that apply. 1. Focus on delivering care to low-income patients 2. Development of retail patient care clinics 3. Increased access to Medicaid recipients 4. Inclusion of patients from suburban areas 5. Emphasis on serving uninsured immigrants Answer: 2, 4 Pages: 10, 12 Feedback 1. This is incorrect. For the nurse practitioner (NP), the traditional patient population has included uninsured immigrants, as well as low-income individuals who receive Medicaid. Evolution of the NP’s role has been impacted by factors including an increase in the number of walk-in, retail, and urgent care clinics. A shift to providing services to patients who live in urban and suburban outpatient settings also has promoted evolution of the NP’s role. 2. This is correct. The increasing number of walk-in, retail, and urgent care clinics has provided increased opportunities for patients to access nurse practitioners (NPs) who are providing primary care services. The NP’s practice has also expanded because of an increase in the provision of services to patients who live in urban and suburban outpatient settings. Traditionally, the patient population served by NPs has included low-income individuals who received Medicaid and uninsured immigrants. 3. This is incorrect. For the nurse practitioner (NP), the traditional patient population has included low-income individuals who receive Medicaid, as well as uninsured immigrants. Changes that have contributed to evolution of the NP’s role include an increase in the number of walk-in, retail, and urgent care clinics, as well as the provision of services to patients who live in urban and suburban outpatient settings. 4. This is correct. With expansion of services to include patients who seek care in urban and suburban outpatient settings, the nurse practitioner (NP)’s practice has expanded. An increase in the number of walk-in, retail, and urgent care clinics has also increased opportunities for patients to access NPs who serve as primary care providers. 5. This is incorrect. Traditionally, the patient population served by nurse practitioners (NPs) has included uninsured immigrants, as well as low-income individuals who receive Medicaid. Factors that have promoted evolution of the NP’s role include an increase in the number of walk-in, retail, and urgent care clinics, as well as the provision of services to patients who live in urban and suburban outpatient settings. 6. Which consideration led to designation of the nurse practitioner (NP) rather than the clinical nurse specialist (CNS) as the advanced practice nurse (APN) who would deliver care related to psychiatric or mental health services? 1. Level of educational preparation 2. Eligibility for prescriptive authority 3. Ability to serve in community settings 4. Practice based on core competencies Answer: 2 Page: 15 Feedback 1. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) may be prepared at either the master’s or doctoral level. Because of a heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health needs, the importance of prescriptive authority for this advanced practice nursing role has been underscored. At present, 40 states grant prescriptive privileges to CNSs and NPs (National Association of Clinical Nurse Specialists [NACNS], 2015). However, all 50 states grant prescriptive privileges to NPs. Therefore, the psychiatric/mental health nurse practitioner has become the sole means of educational preparation for this advanced practice role. 2. This is correct. A heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health needs has underscored the importance of prescriptive authority for this advanced practice nursing role. At present, 40 states grant prescriptive privileges to clinical nurse specialists (CNSs) and nurse practitioners (NPs) (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice role. Both the CNS and the NP may be prepared at either the master’s or doctoral level. Likewise, both the CNS and the NP may practice in a community setting. Core competencies guide the practice of both the CNS and the NP. 3. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) may practice in a community setting. With a heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health need, the importance of prescriptive authority for this advanced practice nursing role became apparent. At present, 40 states grant prescriptive privileges to CNSs and NPs (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice role. 4. This is incorrect. Core competencies guide the practice of both the clinical nurse specialist (CNS) and the nurse practitioner (NP). A heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health need has highlighted the importance of prescriptive authority for this advanced practice nursing role. At present, 40 states grant prescriptive privileges to CNSs and NPs (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice specialization. 7. Which of the following defines the current practice of the acute care nurse practitioner? 1. Unit-based versus practice-based assignment 2. Participation on a specialty care team 3. Geographical setting 4. Patient population Answer: 4 Page: 18 Feedback 1. This is incorrect. The acute care nurse practitioner (NP) may serve in a unit- based or practice-based capacity. This nursing specialty is defined by the patient population that is served. 2. This is incorrect. The acute care nurse practitioner (NP) may or may not participate as a member of a consultative team related to specialty care. The population that is served defines the acute care NP’s role. 3. This is incorrect. Rather than defining the acute care nurse practitioner (NP) based on the geographical setting in which care is provided, this nursing specialty is now defined by the patient population that is served. 4. This is correct. Historically, the geographical setting defined the role of the acute care nurse practitioner (NP). However, the role of this nursing specialty is now defined by the patient population that is served. Acute care NPs may be practice based or unit based. The acute care NP may or may not participate as a member of a consultative team related to specialty care. 8. Certified nurse-midwives (CNMs) are most likely to practice in which setting? 1. Hospital organizations 2. Physician-owned practices 3. Nonprofit health agencies 4. Federal facilities Answer: 1 Page: 24 Feedback 1. This is correct. Most certified nurse-midwives (CNMs) practice in hospitals (29.5%) and physician-owned practices (21.7%). However, care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 2. This is incorrect. The majority of certified nurse-midwives (CNMs) practice in hospitals (29.5%), followed by physician-owned practices (21.7%). Additional care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 3. This is incorrect. Predominantly, certified nurse-midwives (CNMs) practice in hospitals (29.5%) and physician-owned practices (21.7%). However, care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 4. This is incorrect. Certified nurse-midwives (CNMs) most often practice in hospitals (29.5%) and physician-owned practices (21.7%). However, CNMs also may practice in a variety of other settings, including midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 9. Which function of the certified registered nurse anesthetist (CRNA) is prohibited in certain states? 1. Induction of general anesthesia 2. Pain management procedures 3. Administration of spinal anesthesia 4. Provision of post-anesthesia care Answer: 2 Page: 27 Feedback 1. This is incorrect. All 50 states and the District of Columbia authorize certified registered nurse anesthetists (CRNAs) to provide induction of general anesthesia, as well as numerous other anesthesia-related services (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). However, the CRNA’s capacity to provide pain management procedures, such as epidural steroid injections, is regulated at the state level. Therefore, not all CRNAs are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). 2. This is correct. Pain management procedures, such as epidural steroid injections, are regulated at the state level; therefore, not all certified registered nurse anesthetists (CRNAs) are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). All 50 states and the District of Columbia authorize CRNAs to provide induction of general anesthesia, administration of spinal anesthetics, and delivery of post- anesthesia care (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). 3. This is incorrect. All 50 states and the District of Columbia authorize certified registered nurse anesthetists (CRNAs) to administer spinal anesthetics, as well as to provide several other anesthesia-related services (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). However, the CRNA’s capacity to provide pain management procedures, such as epidural steroid injections, is regulated at the state level. Therefore, not all CRNAs are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). 4. This is incorrect. All 50 states and the District of Columbia authorize certified registered nurse anesthetists (CRNAs) to provide post-anesthesia care, as well as to deliver several other anesthesia-related services (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). However, the CRNA’s capacity to provide pain management procedures, such as epidural steroid injections, is regulated at the state level. Therefore, not all CRNAs are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). 10. Implementation of the anesthesia care team (ACT) model yielded which direct effect on anesthesia services? 1. Regulation of conditions related to reimbursable services 2. Mandatory direction of certified registered nurse anesthetists (CRNAs) by an anesthesiologist 3. Reduction in charges related to fraudulent anesthesia care 4. Increased accountability for physicians who employ CRNAs Answer: 2 Pages: 28–29 Feedback 1. This is incorrect. Regulations set forth by the Tax Equity and Fiscal Responsibility Act (TEFRA) mandated conditions for reimbursable services that appeared to require physician leadership for anesthesia delivery as a standard of care. The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). 2. This is correct. The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). Also in 1982, Medicare’s introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists’ accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs) (Shumway & Del Risco, 2000). Regulations set forth by the Tax Equity and Fiscal Responsibility Act (TEFRA) mandated conditions for reimbursable services that appeared to require physician leadership for anesthesia delivery as a standard of care. 3. This is incorrect. In 1982, Medicare’s introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists’ accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs). The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). 4. This is incorrect. In 1982, Medicare’s introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists’ accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs). Implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA), which also occurred in 1982, resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). Chapter 3: Role Development: A Theoretical Perspective ANSWERS AND RATIONALES 1. Nurses working in a Magnet facility have low staff turnover rates and report high job satisfaction, making others aspire to have the longevity in employment experienced by those at the Magnet facility. Which of the following reference groups is this an example of? 1. Evaluative 2. Normative 3. Comparison 4. Audience Answer: 3 Page: 4 1. This is incorrect. The comparison group sets its own standards and becomes a comparison group only when an individual accepts it as such. Nurses at a Magnet facility are considered a comparison group. 2. This is incorrect. The normative group sets explicit standards and expects compliance, and it rewards or punishes relative to that degree of compliance. The church, community, and family are examples of normative groups. 3. This is correct. The comparison group sets its own standards and becomes a comparison group only when an individual accepts it as such. Nurses at a Magnet facility are considered a comparison group. 4. This is incorrect. The audience group is a collective group whose attention an individual wishes to attract. The audience group holds certain values but does not demand compliance from the person for whom they serve as a referent. 2. Which action should the advanced practice nurse (APN) take to be successful in socialization? 1. Be better at multitasking. 2. Develop a rapport with colleagues. 3. Develop skills in empathic communication. 4. Practice sympathetic listening. Answer: 3 Page: 6 1. This is incorrect. Better multitasking does not lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 2. This is incorrect. Developing a rapport does not lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 3. This is correct. Developing skill in empathic communication does lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 4. This is incorrect. Practicing sympathetic listening does not lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 3. An advanced practice nurse (APN) consistently identifies each client by the five rights upon every encounter. This behavior is an example of which of the following? 1. First-order change 2. Second-order change 3. Role-making 4. Subrole internalization Answer: 2 Page: 6 1. This is incorrect. First-order changes are behavioral shifts that do not permanently achieve a desired result. Old preferences keep resurfacing. 2. This is correct. Second-order change leads to permanent change. Old behaviors and patterns are gone and are not replaced by a new version. 3. This is incorrect. Role-making is bidirectional and interactive, with both actors presenting behaviors that are interpreted reciprocally for the purpose of creating and modifying their own roles. 4. This is incorrect. Second-order change leads to permanent change. Old behaviors and patterns are gone and are not replaced by a new version. 4. Which action by the advanced practice nurse (APN) demonstrates role-making? 1. Practicing autonomy when working in a busy practice 2. Suggesting a change in treatment to the supervising physician 3. Changing a client’s medication to a lower dosage 4. Teaching a client how to self-administer insulin Answer: 2 Page: 7 1. This is incorrect. Although important, this does not demonstrate role-making. 2. This is correct. This demonstrates role-making, which is bidirectional and interactive. 3. This is incorrect. Although part of the advanced practice nurse (APN)’s role, this is not a demonstration of role-making. 4. This is incorrect. Although part of the advanced practice nurse (APN)’s role, this is not a demonstration of role-making. 5. The advanced practice nurse (APN) is mentoring an APN student. The APN recognizes that the student is having a hard time adjusting to the new role. Which action should the mentor take? 1. Allow the student to work through the process. 2. Listen sympathetically to the student. 3. Refer the student to a colleague with similar experiences. 4. Treat each failure as a learning opportunity. Answer: 4 Page: 10 1. This is incorrect. Although the student should be allowed to work through the process, the advanced practice nurse (APN) should be present as a guide. 2. This is incorrect. The advanced practice nurse (APN) should listen empathetically to the student. 3. This is incorrect. The advanced practice nurse (APN) should work closely with the client to overcome obstacles. 4. This is correct. The advanced practice nurse (APN) should treat each failure as a learning opportunity. 6. The advanced practice nurse (APN) is working with a colleague in a busy surgical center and becomes concerned with the colleague’s change in behavior. Which sign indicates that the colleague might be experiencing burnout? 1. Empathic behavior 2. Short attention span 3. Sensitivity 4. Intolerance Answer: 4 Page: 14 1. This is incorrect. Empathic behavior is not a sign of burnout. 2. This is incorrect. Short attention span is not a sign of burnout. 3. This is incorrect. Insensitivity is a sign of burnout. 4. This is correct. Intolerance is a sign of burnout, and should be treated appropriately. 7. The advanced practice nurse (APN) is working in a busy emergency room. Which action can the APN take to reduce role strain? 1. Own the problem and work through it. 2. Find a quiet place to retreat. 3. Focus on helping others. 4. Become more involved in the work environment. Answer: 2 Page: 17 1. This is incorrect. The advanced practice nurse (APN) should determine who owns each problem, and allow others to work through theirs. 2. This is correct. The advanced practice nurse (APN) should manage role strain by finding a quiet place to retreat. 3. This is incorrect. The advanced practice nurse (APN) should focus on self and reducing stress and strain. 4. This is incorrect. The advanced practice nurse (APN) should take adequate time away from the work environment to regroup. 8. The advanced practice nurse (APN) is experiencing burnout and recognizes the need for self-care. Which action should the APN avoid? 1. Work through stressful situations and then take a break. 2. Plan self-care as seriously as client care. 3. Determine who owns each problem. 4. Examine the quality of peer support. Answer: 1 Page: 17 1. This is correct. The advanced practice nurse (APN) should schedule breaks during stressful situations. 2. This is incorrect. The advanced practice nurse (APN) should plan self-care as seriously as client care. 3. This is incorrect. The advanced practice nurse (APN) should determine who owns each problem. 4. This is incorrect. Part of managing role strain involves examining the quality of peer support. 9. The advanced practice nurse (APN) is working with a new nurse. Which action by the nurse does the APN interpret as the social integration phase of resocialization? 1. Working well with others in the profession 2. Mastering skills 3. Integrating values into work setting 4. Displaying competency in routine Answer: 1 Page: 15 1. This is correct. Working well in the profession is an example of the social integration phase of resocialization. 2. This is incorrect. Mastery of skills occurs in the skills and routine mastery phase. 3. This is incorrect. Integrating values into the work setting occurs in the conflict resolution phase. 4. This is incorrect. Competence in routine occurs in the skills and routine mastery phase. 10. Which action should the advanced practice nurse (APN) avoid when attempting to resolve role strain? 1. Using alcohol to escape stress 2. Taking meditation breaks during a shift 3. Talking with coworkers 4. Voicing opinions at a staff meeting Answer: 1 Page: 15 1. This is correct. The advanced practice nurse (APN) should avoid the use of drugs and alcohol when trying to resolve role strain. 2. This is incorrect. The advanced practice nurse (APN) should use meditation as a means to reduce role strain. 3. This is incorrect. The advanced practice nurse (APN) should talk with trusted friends when trying to resolve role strain. 4. This is incorrect. The advanced practice nurse (APN) should voice opinions at a staff meeting when trying to resolve role strain. Chapter 4: Educational Preparation of Advanced Practice Nurses: Looking to the Future ANSWERS AND RATIONALES 1. Which activity does the advanced practice nurse (APN) anticipate when completing a doctor of philosophy (PhD) research residency? 1. Literature review in nursing science 2. Participation in quality improvement 3. Presentation at practice conferences 4. Development of capstone with mentors Answer: 1 Page: 16 Feedback 1. This is correct. When completing a doctor of philosophy (PhD) research residency, the advanced practice nurse (APN) anticipates completing a literature review in nursing science. 2. This is incorrect. This activity is anticipated for a doctor of nursing practice (DNP) degree, not a doctor of philosophy (PhD). 3. This is incorrect. This activity is anticipated for a doctor of nursing practice (DNP) degree, not a doctor of philosophy (PhD). 4. This is incorrect. This activity is anticipated for a doctor of nursing practice (DNP) degree, not a doctor of philosophy (PhD). 2. Which activity is completed for both a doctor of nursing practice (DNP) and doctor of philosophy (PhD) program? 1. Interprofessional education (IPE) collaborative experiences 2. Participation in full scope research 3. Presentation at practice conferences 4. Submission of research grant proposals Answer: 1 Page: 16 Feedback 1. This is correct. Both the doctor of nursing practice (DNP) and doctor of philosophy (PhD) candidate will participate in interprofessional education (IPE) collaborative experiences. 2. This is incorrect. This activity is anticipated during a doctor of philosophy (PhD) research residency. 3. This is incorrect. This activity is anticipated during a doctor of nursing practice (DNP) residency. 4. This is incorrect. This activity is anticipated during a doctor of philosophy (PhD) research residency. 3. Which type of grant proposal does the advanced practice nurse (APN) submit when completing a doctor of philosophy (PhD) residency? Select all that apply. 1. Practice 2. Business 3. Research 4. Leadership Answer: 3 Page: 16 Feedback 1. This is incorrect. A practice research proposal is completed when pursing a doctor of nursing practice (DNP) degree. 2. This is incorrect. A business proposal is not completed when pursing a doctor of philosophy (PhD) degree. 3. This is correct. The advanced practice nurse (APN) will complete a research proposal when pursing a doctor of philosophy (PhD) degree. 4. This is incorrect. A leadership research proposal is completed when pursing a doctor of nursing practice (DNP) degree. 4. Which activity does the advanced practice nurse (APN) complete when participating in a doctor of nursing practice (DNP) residency? 1. Participate in quality improvement 2. Present at research conferences 3. Pilot research projects for dissertation 4. Submit research grant proposals Answer: 1 Page: 16 Feedback 1. This is correct. When completing a doctor of nursing practice (DNP) residency, the advanced practice nurse (APN) anticipates participation in quality improvement. 2. This is incorrect. The advanced practice nurse (APN) participates in this activity when completing a doctor of philosophy (PhD) research residency. 3. This is incorrect. The advanced practice nurse (APN) participates in this activity when completing a doctor of philosophy (PhD) research residency. 4. This is incorrect. The advanced practice nurse (APN) participates in this activity when completing a doctor of philosophy (PhD) research residency. 5. Which is the predominant route to certification for the advanced practice nurse (APN)? 1. Doctor of philosophy (PhD) 2. Doctor of nursing practice (DNP) 3. Master of science in nursing (MSN) 4. Bachelor of science in nursing (BSN) Answer: 3 Page: 3 Feedback 1. This is incorrect. The doctor of philosophy (PhD) degree is not the predominant route of certification for the advanced practice nurse (APN). 2. This is incorrect. The doctor of nursing practice (DNP) degree is not the predominant route of certification for the advanced practice nurse (APN). 3. This is correct. The master of science in nursing (MSN) degree continues to be the predominant route of certification for the advanced practice nurse (APN). 4. This is incorrect. The bachelor of science in nursing (BSN) degree is one route of certification for entry-level nursing. 6. Which doctoral degree may be inappropriate for the nurse educator who seeks a tenure track position in the university setting? 1. Doctor of medicine (MD) 2. Doctor of philosophy (PhD) 3. Educational doctorate (EdD) 4. Doctor of nursing practice (DNP) Answer: 4 Page: 11 Feedback 1. This is incorrect. A nurse educator is unlikely to have a doctor of medicine (MD) degree; however, this degree is not inappropriate for tenure track positions in the university setting. 2. This is incorrect. A doctor of philosophy (PhD) is an acceptable doctoral degree for the nurse educator who is seeking a tenure track position in the university setting. 3. This is incorrect. An educational doctorate (EdD) is an acceptable doctoral degree for the nurse educator who is seeking a tenure track position in the university setting. 4. This is correct. Most universities do not accept the doctor of nursing practice (DNP) for tenure track positions. 7. The doctor of nursing practice (DNP) student will complete a final project referred to as a requirement. Answer: capstone Page: 13 Feedback: The advanced practice nurse (APN) completing a doctor of nursing practice (DNP) program will complete a final project that is often referred to as a capstone requirement. 8. The doctor of philosophy student will complete a as part of the educational process. Answer: dissertation Page: 13 Feedback: The doctor of philosophy (PhD) student will complete a research-based dissertation as part of the educational process. Chapter 5: Global Perspectives on Advanced Nursing Practice ANSWERS AND RATIONALES 1. Which is a factor contributing to the international growth in advanced practice nursing? 1. Decreased inpatient acuity 2. Ignorance of health-care consumers 3. Escalated disease burden worldwide 4. General global excess of health-care workers Answer: 3 Page: 1 Feedback 1. This is incorrect. Increased, not decreased, inpatient acuity is a factor contributing to the international growth in advanced practice nursing. 2. This is incorrect. Better informed, not ignorant, health-care consumers is a factor contributing to the international growth in advanced practice nursing. 3. This is correct. Escalated disease burden for both communicable and noncommunicable disease is a factor contributing to the international growth in advanced practice nursing. 4. This is incorrect. A shortage, not general excess, of health-care workers is a factor contributing to the international growth in advanced practice nursing. 2. Which action from the International Council of Nurses (ICN) establishes title protection when regulating the advanced practice nurse? 1. Rule making 2. Criminal legislation 3. Assessment processes 4. Fitness to practice procedures Answer: 1 Page: 10 Feedback 1. This is correct. The International Council of Nurses (ICN) establishes title protection for the advanced practice nurse (APN) through rule making and civil legislation. 2. This is incorrect. Establishing civil, not criminal, legislation established title protection for the advanced practice nurse (APN). 3. This is incorrect. The International Council of Nurses (ICN) establishes assessment processes as a minimal standard for regulating the advanced practice nurse (APN); however, this action does not establish title protection. 4. This is incorrect. The International Council of Nurses (ICN) establishes fitness to practice procedures as a minimal standard for regulating the advanced practice nurse (APN); however, this action does not establish title protection. 3. A nurse is considering pursuing an advanced degree while practicing in the Republic of South Africa. Which must occur before beginning this journey? 1. Military service 2. Practice abroad 3. Two years of clinical practice 4. Two years of community service Answer: 3 Page: 17 Feedback 1. This is incorrect. Military service is not a prerequisite for an advanced practice degree in the Republic of South Africa. 2. This is incorrect. Practicing abroad is not a prerequisite for an advanced practice degree in the Republic of South Africa. 3. This is correct. Two years of clinical practice is a prerequisite for an advanced practice degree in the Republic of South Africa. 4. This is incorrect. One, not two, years of community service is a prerequisite for an advanced practice degree in the Republic of South Africa. 4. Which level of prescribing is required for the specialist nurse in the Republic of South Africa? 1. Level one 2. Level two 3. Level three 4. Level four Answer: 3 Page: 17 Feedback 1. This is incorrect. Level one is the prescribing requirement for the staff nurse. 2. This is incorrect. Level two is the prescribing requirement for the professional nurse. 3. This is correct. Level three is the prescribing requirement for the specialist, or advanced practice, nurse. 4. This is incorrect. This level is not used in the Republic of South Africa. 5. Which is considered an obstacle by the World Health Organization's Eastern Mediterranean Region (WHO-EMR) Consensus on factors that influence advanced practice nursing development? 1. Desire in the region to improve access to care 2. An increase in the community need for health-care services 3. Research studies that don’t support advanced nursing practice 4. Lack of feasibility studies for advanced practice nursing needs Answer: 4 Page: 29 Feedback 1. This is incorrect. This is not considered an obstacle that influences advanced practice nursing development. 2. This is incorrect. This is not considered an obstacle that influences advanced practice nursing development. 3. This is incorrect. This is not considered an obstacle that influences advanced practice nursing development. 4. This is correct. The lack of feasible studies for advanced practice nursing needs is an obstacle that influences advanced practice nursing development. 6. Which is supportive, per the World Health Organization's Eastern Mediterranean Region (WHO-EMR) Consensus, on factors influencing advanced practice nursing development? 1. Role ambiguity 2. Absence of regulatory systems 3. Lack of feasibility studies for needs 4. Commitment to the development of nursing roles Answer: 4 Page: 29 Feedback 1. This is incorrect. This is a noted obstacle on factors influencing advanced practice nursing development. 2. This is incorrect. This is a noted obstacle on factors influencing advanced practice nursing development. 3. This is incorrect. This is a noted obstacle on factors influencing advanced practice nursing development. 4. This is correct. This is a noted support on factors influencing advanced practice nursing development. 7. Which is considered an obstacle by the World Health Organization's Eastern Mediterranean Region (WHO-EMR) Consensus on factors that influence advanced practice nursing development? Select all that apply. 1. Desire in the region to improve access to care 2. An increase in the community need for health-care services 3. An absence of nursing leadership at the policy level 4. Research studies that don’t support advanced nursing practice 5. Lack of feasibility studies for advanced practice nursing needs Answer: 3, 5 Page: 29 Feedback 1. This is incorrect. This is a noted support factor that influences the development of advanced practice nursing. 2. This is incorrect. This is a noted support factor that influences the development of advanced practice nursing. 3. This is correct. This is a noted obstacle for the development of advanced practice nursing. 4. This is incorrect. This is a noted support factor that influences the development of advanced practice nursing. 5. This is correct. This is a noted obstacle for the development of advanced practice nursing. 8. Which is supportive, per the World Health Organization's Eastern Mediterranean Region (WHO-EMR) Consensus, on factors influencing the advanced practice nursing development? 1. Role ambiguity 2. Absence of regulatory systems 3. Lack of feasibility studies for needs 4. Research studies from outside the region 5. Commitment to the development of nursing roles Answer: 4, 5 Page: 29 Feedback 1. This is incorrect. Role ambiguity is not a supportive factor influencing the development of advanced practice nursing. This is a noted obstacle. 2. This is incorrect. The absence of regulatory development is not a supportive factor influencing the development of advanced practice nursing. This is a noted obstacle. 3. This is incorrect. The lack of feasibility studies for needs is not a supportive factor influencing the development of advanced practice nursing. This is a noted obstacle. 4. This is correct. This is a supportive factor that influences the development of advanced practice nursing. 5. This is correct. This is a supportive factor that influences the development of advanced practice nursing. 9. Which is an example of the educational preparation needed for an advanced practice nurse (APN) according to the International Council of Nurses (ICN)? 1. Right to diagnose 2. Case management 3. Formal system of licensure 4. Authority to refer to other professionals Answer: 3 Page: 4 Feedback 1. This is incorrect. The right to diagnose is an example of a regulatory mechanism, not educational preparation, for the advanced practice nurse (APN) according to the International Council of Nurses (ICN). 2. This is incorrect. Case management is an example of the nature of practice, not educational preparation, for the advanced practice nurse (APN) according to the International Council of Nurses (ICN). 3. This is correct. 4. This is incorrect. The authority to refer to other professionals is an example of a regulatory mechanism, not educational preparation, for the advanced practice nurse (APN) according to the International Council of Nurses (ICN). 10. According to the International Council of Nurses (ICN), the nature of practice includes the ability of the advanced practice nurse (APN) to integrate research, , and clinical management. Answer: education Page: 4 Feedback: According to the International Council of Nurses (ICN), the nature of practice includes the ability of the advanced practice nurse (APN) to integrate research, education, and clinical management. Chapter 6: Advanced Practice Nurses and Prescriptive Authority ANSWERS AND RATIONALES 1. Which of the following changed the ability of all advanced practice nurses (APNs) to prescribe medications? 1. Risk of harm to patients 2. Lack of a physician on site 3. Nurse practitioner (NP) practice in primary care 4. Interruption of patient flow Answer: 3 Page: 2 Feedback 1. This is incorrect. When a physician was not on site to sign nurse practitioner (NP) prescriptions, patients had to wait for prescriptions to be signed before they could be filled. If a physician was not available for a day or more, the implications for patient safety and health care were serious. Though certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs) practiced in advanced roles for some time before the birth of NPs, the impetus for all advanced practice nurses (APNs) to obtain authorization to prescribe medications was the advent of NP practice in primary care. 2. This is incorrect. Nurse practitioners (NPs) assessed and diagnosed patients who needed prescription medications and treatments for their care. Depending on physicians to prescribe medications created problems in the areas of patient access to care, continuity of care, and patient flow. Though certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs) practiced in advanced roles for some time before the birth of NPs, the impetus for all advanced practice nurses (APNs) to obtain authorization to prescribe medications was the advent of NP practice in primary care. 3. This is correct. Though certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs) practiced in advanced roles for some time before the birth of NPs, the impetus for all advanced practice nurses (APNs) to obtain authorization to prescribe medications was the advent of NP practice in primary care. 4. This is incorrect. Nurse practitioners (NPs) assessed and diagnosed patients who needed prescription medications and treatments for their care. Depending on physicians to prescribe medications created problems in the areas of patient access to care, continuity of care, and patient flow. Though certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs) practiced in advanced roles for some time before the birth of NPs, the impetus for all advanced practice nurses (APNs) to obtain authorization to prescribe medications was the advent of NP practice in primary care. 2. Which of the following has been the main source of barriers limiting advanced practice registered nurses’ (APRNs’) prescriptive authority? 1. Limitations in state legislation and regulations 2. Concerns about patient safety and quality of care 3. Requirement for Drug Enforcement (DEA) number 4. Organized lobbying by medical organizations Answer: 4 Page: 13 Feedback 1. This is incorrect. Though some legislators and governors have set limitations in statutes and administrative rules governing advanced practice registered nurses (APRNs), the majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of APRNs. 2. This is incorrect. Though opposition to prescriptive authority has often been couched in the language of “protecting public safety,” the majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs). 3. This is incorrect. Though the requirement of a Drug Enforcement Administration (DEA) number by insurance companies to pay for prescriptions is still problematic, the majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs). 4. This is correct. The majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs). 3. Which of the following was found to be the most practical formulary for regulating prescriptive authority? 1. Open 2. Exclusionary 3. Collaborative 4. Regulator established Answer: 2 Page: 11 Feedback 1. This is incorrect. The open formulary is the most flexible framework for prescriptive authority. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority. 2. This is correct. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority. 3. This is incorrect. A collaborative formulary allows the advanced practice registered nurse (APRN) to create a formulary most useful to his or her practice in collaboration with an identified physician who serves as a collaborator. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority. 4. This is incorrect. An established formulary was used in the early days of advanced practice registered nurse (APRN) prescribing activity to determine an agreed-on list of drugs APRNs could prescribe. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority. 4. Which of the following is a main reason a clinical nurse specialist (CNS) would refrain from obtaining prescriptive authority? 1. Lack of title recognition 2. Preservation of autonomy 3. Educational requirements 4. Required physician oversight Answer: 2 Page: 17 Feedback 1. This is incorrect. The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable. 2. This is correct. The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable. 3. This is incorrect. The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable. 4. This is incorrect. The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable. 5. Which of the following increased certified registered nurse anesthetists’ (CRNAs’) involvement with other advanced practice registered nurses (APRNs) to obtain prescriptive authority? 1. Limited authority 2. Legislative restrictions 3. Role in pain management 4. Required physician supervision Answer: 3 Page: 8 Feedback 1. This is incorrect. The authority of certified registered nurse anesthetists (CRNAs) to select and administer anesthesia has long been recognized. Until recently, CRNAs have been less involved in the struggle to obtain prescriptive authority than the other three disciplines. CRNAs have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve. 2. This is incorrect. Limitations set in state statutes and regulations affect the practice of all advanced practice registered nurses (APRNs). Certified registered nurse anesthetists (CRNAs) have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve. 3. This is correct. Certified registered nurse anesthetists (CRNAs), particularly in rural areas, suffer from similar problems. CRNAs have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve. 4. This is incorrect. Requirements for formalized collaborative agreements with physicians to practice and receive reimbursement have been most challenging for nurse practitioners (NPs) and certified nurse-midwives (CNMs). Certified registered nurse anesthetists (CRNAs) have supervising or cooperating physicians in most states (AANA, 2016), whereas clinical nurse specialists (CNSs), in the states in which they have prescriptive authority, tend to have the same requirements as NPs. CRNAs have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve. 6. Which of the following describes the historical progression of advanced practice registered nurses’ (APRNs’) attainment of prescriptive authority? Select all that apply. 1. Standardization of educational programs 2. Lack of primary care in underserved areas 3. Complexity of the federal legislation process 4 Persuasion of legislators and state governors 5. Lack of title recognition in nurse practice acts Answer: 1, 2, 4, 5 Page: 4 Feedback 1. This is correct. Many nurse practice acts prohibited the prescribing of medication by nurses regardless of specialty or status. Changing state statutes and regulations gave title recognition and prescriptive authority to advanced practice registered nurses (APRNs). The form of regulatory rules depended largely on the persuasiveness of nurse practitioners (NPs) and the attitudes of the legislators and governors of those states. In the early days, NPs did not have title recognition other than that of registered nurse (RN) in their state regulatory systems. Except for certified nurse- midwives (CNMs) and certified registered nurse anesthetists (CRNAs) in several states, no APRNs had title recognition in statutory or regulatory language in the state nurse practice acts or administrative rules. 2. This is correct. The movement toward attainment of prescriptive authority was enhanced in the early days by an acute shortage of primary care physicians, and some states with higher primary care needs moved forward more rapidly. Rural states were more likely to initiate statutory and regulatory adjustments than states with large urban populations. 3. This is incorrect. Licensure for all professions occurs at the state rather than the federal level. 4. This is correct. In the early days, nurse practitioners (NPs) did not have title recognition other than that of registered nurse (RN) in their state regulatory systems. Except for certified nurse-midwives (CNMs) and certified registered nurse anesthetists (CRNAs) in several states, no advanced practice registered nurses (APRNs) had title recognition in statutory or regulatory language in the state nurse practice acts or administrative rules. 5. This is correct. Educational programs had to demonstrate that their curriculums prepared nurse practitioners (NPs) for an independent prescribing role. Advanced pathophysiology and pharmacology and the development of differential diagnosis and clinical decision-making skills needed to be visible in the programs. With the advent of federal grants to prepare NPs, the content and quality of the preparatory programs was increasingly standardized. 7. Which of the following contributes to the increase in the likelihood of advanced practice registered nurses (APRNs) attaining nationwide prescriptive authority? 1. Quality of care 2. Cost-effectiveness 3. Uniform nurse practice acts 4. Designation as a midlevel practitioner 5. Endorsement of APRN Consensus Model Answer: 1, 2, 5 Page: 18 Feedback 1. This is correct. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. 2. This is correct. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. 3. This is incorrect. Because licensure for all professions occurs at the state rather than the federal level, the movement to achieve prescriptive authority does not progress equally. States with the most need make legislative changes most rapidly. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. This is incorrect. Confusion about the role and scope of practice of an advanced practice registered nurse (APRN) through the grouping of nurse practitioners (NPs), certified nurse-midwives (CNMs), and physician assistants (PAs) as “midlevel practitioners” has created problems for APRNs. Though totally unfettered authority by all APRNs has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. 5. This is correct. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. 8. The medications most frequently prescribed by nurse practitioners (NPs) in the Department of Veterans Affairs (VA) are and . Answer: antihypertensives and cardiac or cardiac and antihypertensives. Page: 16 Feedback: The majority of nurse practitioners (NPs) in the Department of Veterans Affairs (VA) hospital setting most frequently prescribe antihypertensives and cardiovascular drugs. 9. The primary document that supports advanced practice registered nurses’ (APRNs’) unrestricted prescriptive authority and provides recommendations for APRNs’ education and certification is . Answer: APRN Consensus Model Page: 17 Feedback: The APRN Consensus Model (2016) includes recommendations for the education and certification of advanced practice registered nurses (APRNs) and reinforces the authorization of APRNs to function at their full educational scope, which includes unrestricted prescriptive authority for APRNs. 10. Reorder the steps for changing a state’s nurse practice act (first to last). 1. Hearing to give testimony 2. Introduction of legislation 3. Sent to floor of both chambers 4. Referral to committee of jurisdiction 5. Passage through appropriate committees Answer: 2, 4, 1, 5, 3 Page: 9 This is the correct order. 2. Legislation must be introduced that amends or adds to current law. 4. Once legislation is introduced, it is referred to a committee of jurisdiction (usually a professional licensure committee) for consideration. 1. Once the legislation is in committee, the chair of that committee generally calls for a hearing to allow proponents and opponents of the legislation to give testimony regarding the introduced legislation. 5. After passing through all appropriate committees, the legislation, at the discretion of the majority party leadership, is taken to the floor of the voting chamber for a vote. In some states, proposed legislation must also go through the appropriations committee of at least one of the voting chambers to determine cost and evaluate fiscal impact on the state. 3. After passing through all appropriate committees, the legislation is taken to the floor of the voting chambers. Sometimes this is done simultaneously in both chambers of the state legislature; in others, the legislation passes through one chamber at a time. Chapter 7: Credentialing and Clinical Privileges for the Advanced Practice Registered Nurse ANSWERS AND RATIONALES 1. Which of the following justifies the rigor of the credentialing process for advanced practice registered nurses (APRNs)? 1. Scope of practice 2. Quality assurance 3. Regulatory oversight 4. Autonomous practice Answer: 4 Page: 2 Feedback 1. This is incorrect. The independence and autonomy of advanced practice registered nurse (APRN) services necessitates the same degree of attention to the processes of credentialing and privileging as accorded to physicians and other providers. 2. This is incorrect. The independence and autonomy of advanced practice registered nurse (APRN) services necessitates the same degree of attention to the processes of credentialing and privileging as accorded to physicians and other providers. 3. This is incorrect. The independence and autonomy of advanced practice registered nurse (APRN) services necessitates the same degree of attention to the processes of credentialing and privileging as accorded to physicians and other providers. 4. This is correct. The independence and autonomy of advanced practice registered nurse (APRN) services necessitates the same degree of attention to the processes of credentialing and privileging as accorded to physicians and other providers. 2. An advanced practice registered nurse (APRN) determines that the implementation of the Consensus Model for APRN Regulation accomplishes which of the following? 1. Scope of practice standardization 2. Joint Commission accreditation 3. Uniformity of national standards 4. Consistent provider standards Answer: 3 Page: 3 Feedback 1. This is incorrect. Scope of practice is legislated by individual states. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (NCSBN, 2008) or LACE (Licensure, Accreditation, Certification, Education of advanced practice registered nurses [APRNs]) promotes uniformity of national standards and regulation by the states to promote mobility of APRNs and access to APRN care. 2. This is incorrect. The Joint Commission sets its own standards for accreditation of health-care institutions. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (NCSBN, 2008) or LACE (Licensure, Accreditation, Certification, Education of advanced practice registered nurses [APRNs]) promotes uniformity of national standards and regulation by the states to promote mobility of APRNs and access to APRN care. 3. This is correct. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (NCSBN, 2008) or LACE (Licensure, Accreditation, Certification, Education of advanced practice registered nurses [APRNs]) promotes uniformity of national standards and regulation by the states to promote mobility of APRNs and access to APRN care. 4. This is incorrect. Regulations were changed to ensure uniform processes and allowances for the credentialing and privileging of medical and allied health professionals. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (NCSBN, 2008) or LACE (Licensure, Accreditation, Certification, Education of advanced practice registered nurses [APRNs]) promotes uniformity of national standards and regulation by the states to promote mobility of APRNs and access to APRN care. 3. Which of the following directs legislative requirements for the advanced practice registered nurse (APRN) credentialing process? 1. Educational institutions 2. Nursing licensing boards 3. Organizational medical staff 4. Federal and state regulations Answer: 4 Page: 7 Feedback 1. This is incorrect. The types of data gathered during the credentialing process are directed by federal and state regulations; professional standards; facility requirements, policies, and procedures; and voluntary oversight bodies. 2. This is incorrect. The types of data gathered during the credentialing process are directed by federal and state regulations; professional standards; facility requirements, policies, and procedures; and voluntary oversight bodies. 3. This is incorrect. The types of data gathered during the credentialing process are directed by federal and state regulations; professional standards; facility requirements, policies, and procedures; and voluntary oversight bodies. 4. This is correct. The types of data gathered during the credentialing process are directed by federal and state regulations; professional standards; facility requirements, policies, and procedures; and voluntary oversight bodies. 4. An advanced practice registered nurse (APRN) is reviewing medical staff standards. Which of the following are used to determine whether hospital privileges are granted? 1. Institutional policies 2. Protection of the public 3. Broadened medical scope of practice 4. Provision of medical level care Answer: 4 Page: 15 Feedback 1. This is incorrect. The decision to grant privileges is guided by institutional policies and procedures related to the structure of the decision-making body. Advanced practice registered nurses (APRNs) and physician assistants (PAs) who provide "medical level of care" must be credentialed and privileged through the medical staff standards process. 2. This is incorrect. Public protection is one of the purposes of cerdentialing. Advanced practice registered nurses (APRNs) and physician assistants (PAs) who provide "medical level of care" must be credentialed and privileged through the medical staff standards process. 3. This is incorrect. Limitations to advanced practice registered nurses’ (APRNs’) scope of practice continue to be a barrier to APRNs executing their full scope of practice. APRNs and physician assistants (PAs) who provide "medical level of care" must be credentialed and privileged through the medical staff standards process. 4. This is correct. Advanced practice registered nurses (APRNs) and physician assistants (PAs) who provide "medical level of care" must be credentialed and privileged through the medical staff standards process. 5. According to Medicare Conditions of Participation (CoP), which governing body grants privileges to a telemedicine practitioner? 1. Distant site 2. Originating site 3. State review board 4. State licensing board Answer: 2 Page: 16 Feedback 1. This is incorrect. Medicare Conditions of Participation (CoP) require the governing body of the originating site to grant privileges to a distant site independent practitioner. 2. This is correct. Medicare Conditions of Participation (CoP) require the governing body of the originating site to grant privileges to a distant site independent practitioner. 3. This is incorrect. Medicare Conditions of Participation (CoP) require the governing body of the originating site to grant privileges to a distant site independent practitioner. 4. This is incorrect. Medicare Conditions of Participation (CoP) require the governing body of the originating site to grant privileges to a distant site independent practitioner. 6. Which is a minimum requirement of the Joint Commission for an advanced practice registered nurse (APRN) to be granted disaster privileges? 1. Continuing education 2. Oversight of treatment 3. Occurrence of a disaster 4. Professional practice evaluation Answer: 2 Page: 16 Feedback 1. This is incorrect. At a minimum, the Joint Commission requires verification of license and oversight of care treatment and services (TJC, 2016). 2. This is correct. When a disaster management plan has been activated and/or when the organization is unable to meet immediate patient care needs, an advanced practice registered nurse (APRN) may be granted disaster privileges. At a minimum, the Joint Commission requires verification of license and oversight of care treatment and services (TJC, 2016). 3. This is incorrect. When a disaster management plan has been activated and/or when the organization is unable to meet immediate patient care needs, an advanced practice registered nurse (APRN) may be granted disaster privileges. At a minimum, the Joint Commission requires verification of license and oversight of care treatment and services (TJC, 2016). 4. This is incorrect. When a disaster management plan has been activated and/or when the organization is unable to meet immediate patient care needs, an advanced practice registered nurse (APRN) may be granted disaster privileges. At a minimum, the Joint Commission requires verification of license and oversight of care treatment and services (TJC, 2016). 7. A credentialed advanced practice registered nurse (APRN) advises an APRN student on the advantages of establishing a professional portfolio. Which of the following is an advantage to this practice? 1. Justifies patient care therapeutics 2. Archives documents in one database 3. Receives higher status and compensation 4. Describes core competencies of APRN specialty Answer: 3 Page: 23 Feedback 1. This is incorrect. Evidence-based practice provides a scientific, justifiable rationale for patient care therapeutics. A professional credentialing portfolio provides “practice-based evidence” for credentialing. Establishing a portfolio at the beginning of the advanced practice registered nurse’s (APRN’s) advanced practice education may assist the APRN to be more adequately compensated by allowing him or her to achieve a higher status within a health-care facility because of practice-based evidence. 2. This is incorrect. Establishing a portfolio at the beginning of the advanced practice registered nurse’s (APRN’s) advanced practice education may assist the APRN to be more adequately compensated by allowing him or her to achieve a higher status within a health-care facility because of practice-based evidence. 3. This is correct. Establishing a professional credentialing portfolio as the advanced practice registered nurse (APRN) begins his or her advanced practice education may assist the APRN to be more adequately compensated by allowing him or her to achieve a higher status within a health-care facility because of practice-based evidence. 4. This is incorrect. Description of core competencies is included in the practice-based evidence component of a professional credentialing portfolio. Establishing a portfolio at the beginning of the advanced practice registered nurse’s (APRN’s) advanced practice education may assist the APRN to be more adequately compensated by allowing him or her to achieve a higher status within a health-care facility because of practice-based evidence. 8. Which of the following may limit an advanced practice registered nurse’s (APRN’s) scope of practice within a health-care institution? 1. Excessive patient lengths of stay 2. Performance improvement strategies 3. Redundant credentialing requirements 4. Governance representation on medical staff Answer: 1 Page: 28 Feedback 1. This is correct. An advanced practice registered nurse’s (APRN’s) scope of practice may be limited when an institution finds the APRN’s clinical performance falls outside established benchmarks, such as excessive lengths of stay, repeated and lengthy delays in appointments, quality of care issues, and exposure to liability related to variations in performance. 2. This is incorrect. Performance improvement strategies initiated by advanced practice registered nurses (APRNs) are likely to enhance the APRN’s ability to achieve full scope of practice in a health-care institution. An APRN’s scope of practice may be limited when an institution finds the APRN’s clinical performance falls outside established benchmarks, such as excessive lengths of stay, repeated and lengthy delays in appointments, quality of care issues, and exposure to liability related to variations in performance. 3. This is incorrect. Redundant credentialing processes are time consuming. An advanced practice registered nurse’s (APRN’s) scope of practice may be limited when an institution finds the APRN’s clinical performance falls outside established benchmarks, such as excessive lengths of stay, repeated and lengthy delays in appointments, quality of care issues, and exposure to liability related to variations in performance. 4. This is incorrect. Governance representation on medical staff assures full advanced practice registered nurse (APRN) representation in medical staff bylaws. An APRN’s scope of practice may be limited when an institution finds the APRN’s clinical performance falls outside established benchmarks, such as excessive lengths of stay, repeated and lengthy delays in appointments, quality of care issues, and exposure to liability related to variations in performance. 9. The application for credentialing should include which of the following? Select all that apply. 1. Proof of liability insurance 2. Primary source verification 3. Evaluations of clinical performance 4. Professional licenses and certifications 5. Professional organization memberships Answer: 1, 3, 4 Pages: 25–26 Feedback 1. This is correct. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 2. This is incorrect. Primary source verification is part of the application review process. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 3. This is correct. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 4. This is correct. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 5. This is incorrect. Professional organization memberships are not required. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 10. An advanced practice registered nurse (APRN) is compiling the practice-based evidence component of the professional career portfolio. Which of the following documentation should the APRN include? Select all that apply. 1. Employment history 2. Insurance liability history 3. Performance outcome data 4. Current and completed research 5. Core competencies for APRN specialization Answer: 1, 3, 5 Pages: 25–26 Feedback 1. This is correct. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. 2. This is incorrect. Insurance liability history is included in the credentials component of the professional career portfolio. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. 3. This is correct. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. 4. This is incorrect. Current and completed research are included in the credentials component of the professional career portfolio. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. 5. This is correct. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. Chapter 8: The Kaleidoscope of Collaborative Practice ANSWERS AND RATIONALES 1. A nurse is presenting a workshop on the history of nursing and discusses the long-standing perception that nurses are under a physician’s supervision. Which of the following explanations would the nurse give for this perception? 1. Physicians’ hierarchical role structure 2. Reliance on physicians to make decisions 3. Medical domination over nursing practice 4. Separation of the physician and nursing roles Answer: 1 Page: 4 Feedback 1. This is correct. In 2009, the American Medical Association (AMA) House of Delegates issued a statement supporting that the hierarchical role structure called for physician supervision of nurses, noting that, although the nurse role is important, it must be supervised. Placing the nurse as a care provider subservient to the physician established and formalized a role structure that, after nearly 150 years, continues to define society’s general sense of the nurse role as within the role of the physician (Partin, 2009; Workman, 1986). 2. This is incorrect. In 2009, the American Medical Association (AMA) House of Delegates issued a statement supporting that the hierarchical role structure called for physician supervision of nurses, noting that, although the nurse role is important, it must be supervised. Placing the nurse as a care provider subservient to the physician established and formalized a role structure that, after nearly 150 years, continues to define society’s general sense of the nurse role as within the role of the physician (Partin, 2009; Workman, 1986). 3. This is incorrect. In 2009, the American Medical Association (AMA) House of Delegates issued a statement supporting that the hierarchical role structure called for physician supervision of nurses, noting that, although the nurse role is important, it must be supervised. Placing the nurse as a care provider subservient to the physician established and formalized a role structure that, after nearly 150 years, continues to define society’s general sense of the nurse role as within the role of the physician (Partin, 2009; Workman, 1986). 4. This is incorrect. In 2009, the American Medical Association (AMA) House of Delegates issued a statement supporting that the hierarchical role structure called for physician supervision of nurses, noting that, although the nurse role is important, it must be supervised. Placing the nurse as a care provider subservient to the physician established and formalized a role structure that, after nearly 150 years, continues to define society’s general sense of the nurse role as within the role of the physician (Partin, 2009; Workman, 1986). 2. A team of nurses and physicians is planning a continuing education program during which physicians and nurses will lecture about the care of patients with diabetes. Which of the following terms is this an example of? 1. Multidisciplinary practice 2. Interprofessional discipline 3. Transdelivery collaboration 4. Interdisciplinary relationship Answer: 4 Page: 23 Feedback 1. This is incorrect. An interdisciplinary relationship develops as two or more members of different professions begin to coalesce their roles toward a common goal. Each professional shares discipline-specific expertise, resulting in cross-fertilization of ideas and group ownership of the practice. Multidisciplinary practice refers to shared responsibilities and information exchange between professionals. An interdisciplinary relationship exists within the multidisciplinary framework. 2. This is incorrect. An interdisciplinary relationship develops as two or more members of different professions begin to coalesce their roles toward a common goal. Each professional shares discipline-specific expertise, resulting in cross-fertilization of ideas and group ownership of the practice. Interprofessional describes unique disciplinary knowledge applied in the service each discipline offers in a specific health situation. 3. This is incorrect. An interdisciplinary relationship develops as two or more members of different professions begin to coalesce their roles toward a common goal. Each professional shares discipline-specific expertise, resulting in cross-fertilization of ideas and group ownership of the practice. Transdisciplinary collaboration refers to a peak level of shared collaboration among professionals in which they act as one and do not have to think about it. Everyone, including the patient, owns the plan of care and the goal of high-quality patient care transcends any “turf” issues. 4. This is correct. An interdisciplinary relationship develops as two or more members of different professions begin to coalesce their roles toward a common goal. Each professional shares discipline-specific expertise, resulting in cross-fertilization of ideas and group ownership of the practice. 3. A nurse practitioner (NP) is moving to a different state to establish a private practice. Which of the following defines the collaborative practice protocols in each state? 1. Federal law 2. Standards of care 3. Legal precedents 4. Legislative requirements Answer: 4 Page: 12 Feedback 1. This is incorrect. Federal law does not vary between states. Legal and legislative requirements for collaboration and the parameters of required collaborative practice protocols vary from state to state. 2. This is incorrect. Standards of care are established by professional nursing organizations. Legal and legislative requirements for collaboration and the parameters of required collaborative practice protocols vary from state to state. 3. This is incorrect. A legal precedent is a legal case that establishes a rule. Legal and legislative requirements for collaboration and the parameters of required collaborative practice protocols vary from state to state. 4. This is correct. Legal and legislative requirements for collaboration and the parameters of required collaborative practice protocols vary from state to state. 4. Which of the following actions reduce elitism? 1. Explain pathophysiology 2. Acknowledge roles of registered nurses (RNs) 3. Demonstrate nursing skills 4. Provide timely orders Answer: 2 Page: 28 Feedback 1. This is incorrect. Explaining pathophysiology may be perceived as elitism. Acknowledging registered nurse (RN) roles and responsibilities reduces elitism. Nursing has been guilty of elitism and of exhibiting professional dominance both in relating to nurses with different levels of education and in working with other health-care professionals. Lack of understanding, failure to acknowledge roles and responsibilities of other professionals, and the very isolated nature of health professional education is the basis for much of the elitism still prevalent today (Glasgow, Dunphy, & Mainous, 2010; Rice et al., 2010). 2. This is correct. Acknowledging registered nurse (RN) roles and responsibilities reduces elitism. Nursing has been guilty of elitism and of exhibiting professional dominance both in relating to nurses with different levels of education and in working with other health-care professionals. Lack of understanding, failure to acknowledge roles and responsibilities of other professionals, and the very isolated nature of health professional education is the basis for much of the elitism still prevalent today (Glasgow, Dunphy, & Mainous, 2010; Rice et al., 2010). 3. This is incorrect. Demonstrating nursing skills may imply the registered nurse (RN) does not perform skills adequately and may be perceived as professional dominance. Acknowledging RN roles and responsibilities reduces elitism. Nursing has been guilty of elitism and of exhibiting professional dominance both in relating to nurses with different levels of education and in working with other health-care professionals. Lack of understanding, failure to acknowledge roles and responsibilities of other professionals, and the very isolated nature of health professional education is the basis for much of the elitism still prevalent today (Glasgow, Dunphy, & Mainous, 2010; Rice et al., 2010). 4. This is incorrect. Providing timely orders facilitates nurses’ efficiency. Acknowledging registered nurse (RN) roles and responsibilities reduces elitism. Nursing has been guilty of elitism and of exhibiting professional dominance both in relating to nurses with different levels of education and in working with other health-care professionals. Lack of understanding, failure to acknowledge roles and responsibilities of other professionals, and the very isolated nature of health professional education is the basis for much of the elitism still prevalent today (Glasgow, Dunphy, & Mainous, 2010; Rice et al., 2010). 5. Which of the following is vital to the attainment of transdisciplinary collaboration? 1. Dialogue 2. Discipline 3. Discussion 4. Partnership Answer: 1 Page: 24 Feedback 1. This is correct. The key to the success of transdisciplinary collaboration is communication through dialogue as it allows for free exploration of ideas, issues, and innovations, and the ability to suspend personal viewpoints without a sense of defensiveness. 2. This is incorrect. Discipline refers to the body of scientific knowledge that is the basis of that profession’s practice. The key to the success of transdisciplinary collaboration is communication through dialogue as it allows for free exploration of ideas, issues, and innovations, and the ability to suspend personal viewpoints without a sense of defensiveness. 3. This is incorrect. Discussion implies a hard exchange of ideas bouncing back and forth, presented and defended with the need to come to a decision. The key to the success of transdisciplinary collaboration is communication through dialogue as it allows for free exploration of ideas, issues, and innovations, and the ability to suspend personal viewpoints without a sense of defensiveness. 4. This is incorrect. The key to the success of transdisciplinary collaboration is communication through dialogue as it allows for free exploration of ideas, issues, and innovations, and the ability to suspend personal viewpoints without a sense of defensiveness. 6. A group of advanced practice registered nurses (APRNs) is developing a proposal to present to the board of trustees outlining strategies to improve collaboration and patient care. Which of the following is the priority to include in the proposal? 1. Patient autonomy 2. Shared knowledge 3. Institutional support 4. Multidisciplinary practice Answer: 2 Page: 62 Feedback 1. This is incorrect. Including patients in their health-care decisions is important, but is not the priority. Shared knowledge and the free flow of information is the priority to include in the proposal. Clinicians and patients should communicate effectively and share information. 2. This is correct. Shared knowledge and the free flow of information is the priority to improve collaboration. Clinicians and patients should communicate effectively and share information. 3. This is incorrect. Institutional support is required to implement the strategies. Shared knowledge and the free flow of information is the priority to include in the proposal. Clinicians and patients should communicate effectively and share information. 4. This is incorrect. Multidisciplinary practice is a level of information exchange, with no presumption of shared planning. Shared knowledge and the free flow of information is the priority to include in the proposal. Clinicians and patients should communicate effectively and share information. 7. Which of the following is a primary reason for medical opposition to the nurse practitioner (NP) role? 1. Patient safety 2. Lack of knowledge 3. Prescriptive authority 4. Competition for patients Answer: 1 Page: 15 Feedback 1. This is correct. Medical opposition, which existed from the beginning, is often couched in terms of patient safety, despite the fact that it often is more related to issues of control and competition in practice. 2. This is incorrect. Medical opposition, which existed from the beginning, is often couched in terms of patient safety, despite the fact that it often is more related to issues of control and competition in practice. 3. This is incorrect. Medical opposition, which existed from the beginning, is often couched in terms of patient safety, despite the fact that it often is more related to issues of control and competition in practice. 4. This is incorrect. Medical opposition, which existed from the beginning, is often couched in terms of patient safety, despite the fact that it often is more related to issues of control and competition in practice. 8. The APRN Consensus Model indicates which of the following decreases obstacles to establishing collaborative practice? Select all that apply. 1. Role clarity 2. Advanced education 3. Consumer satisfaction 4. Common practice elements 5. Clearly delineated scope of practice Answer: 1, 4, 5 Page: 8 Feedback 1. This is correct. The challenges advanced practice registered nurses (APRNs) face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 2. This is incorrect. Advanced education and experience are among factors contributing to growth and acceptance of the advanced practice registered nurse (APRN) role. The challenges APRNs face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 3. This is incorrect. “Consumer satisfaction and physician advocacy have proved to be powerful stimuli” for operationalizing the advanced practice registered nurse (APRN) role (Stanley 2005, p. 34). The challenges APRNs face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 4. This is correct. The challenges advanced practice registered nurses (APRNs) face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 5. This is correct. The challenges advanced practice registered nurses (APRNs) face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 9. Which of the following are key attributes of collaborative practice? Select all that apply. 1. Clinical skills 2. Parity between providers 3. Conflict management 4. Mutually defined goals 5. Decision making by consensus Answer: 2, 4, 5 Pages: 19–21 Feedback 1. This is incorrect. Clinical skills are a competency of collaborative practice. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 2. This is correct. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 3. This is incorrect. Conflict management is a competency of collaborative practice. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 4. This is correct. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 5. This is correct. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 10. An advanced practice registered nurse (APRN) is a guest speaker for a class of nurse practitioner (NP) students. Which of the following represents the focus on evolving collaborative practice? Select all that apply. 1. Primary care model 2. Functional care model 3. Advanced care organization 4. Patient navigator program 5. Patient-centered medical home Answer: 3, 4, 5 Pages: 53–55 Feedback 1. This is incorrect. The primary care model is a traditional model which refers to medical care that is provided by a general practitioner. 2. This is incorrect. The functional care model is a traditional model of nursing care delivery focused on nursing tasks and activities. 3. This is correct. An advanced care organization (ACO) is an example of an emerging collaborative practice model. ACOs are a facet of Medicare’s cost-saving plan and members share in any bonuses received from meeting cost-saving targets. 4. This is correct. The patient navigator program is an example of emerging collaborative practice. A patient navigator “works with patients and families to help them at many points along the health care continuum” to eliminate barriers to obtaining screening, diagnosis, treatment, and ongoing health care. 5. This is correct. The patient-centered medical home (PCMH) model is an example of emerging collaborative practice. The PCMH model seeks to provide coordinated care through an interprofessional team of health-care providers. Chapter 9: Participation of the Advanced Practice Nurse in Health Plans and Quality Initiatives ANSWERS AND RATIONALES 1. The nurse educator is presenting a lecture on health-care costs to a group of nursing students. Which statement indicates that the teaching has been effective? 1. “Fee-for-service is the primary source of pricing.” 2. “The approach to health-care delivery has undergone significant changes in health-care reimbursement.” 3. “Providers no longer take liability for service costs.” 4. “Financial risk to the provider has decreased.” Answer: 2 Page: 2 Feedback 1. This is incorrect. Fee-for-service is no longer the primary source of pricing. Common methods are global pricing, capitation, and value-based purchasing. 2. This is correct. Health-care delivery has undergone significant changes in reimbursement and contracting in order to decrease overall health-care costs. 3. This is incorrect. Providers have taken on a role of liability for service costs and levels of care. 4. This is incorrect. Financial risks to the provider have increased. 2. A nurse manager is working with a group of advanced practice nurses (APNs) in a busy surgical center. Which interpretation of the role of the APN is the most accurate? 1. APNs are important for the client to see, in addition to the physician. 2. Fewer APNs are needed now that the physician shortage is resolving. 3. APNs are somewhat cost effective. 4. APNs are responsible for decreased hospital admission rates. Answer: 4 Page: 3 Feedback 1. This is incorrect. Advanced practice nurses (APNs) function as an equivalent to the physician. 2. This is incorrect. The physician shortage is not resolving. More advanced practice nurses (APNs) are filling in this role. 3. This is incorrect. Advanced practice nurses (APNs) are highly cost-effective. 4. This is correct. Advanced practice nurses (APNs) are responsible for decreased hospital admission rates. 3. The nurse is listening to a lecture on the mechanisms of managed care costs. How should the nurse interpret the benefit of managed care costs? 1. Decreased beneficiary cost sharing helps manage costs. 2. Flexible hospital stays decrease costs. 3. The denial of high-cost care cases reduces care costs. 4. Economic incentives to physicians assist in managing care costs. Answer: 4 Page: 4 Feedback 1. This is incorrect. Increased beneficiary cost sharing helps manage costs. 2. This is incorrect. Controls on inpatient admissions and length of stay assist in managing costs. 3. This is incorrect. Close management of high-cost care cases assists in managing care costs. 4. This is correct. Economic incentives for physicians who choose low-cost care options assist in managing care. 4. An advanced practice nurse (APN) is working with a client who needs a procedure to correct blood flow. Upon reviewing the health plan, which should the nurse expect before the procedure takes place? 1. The client may need preauthorization for this procedure. 2. The client needs the administration of an antihypertensive. 3. The client will avoid use of a hot tub or swimming pool. 4. The client will initiate an exercise plan. Answer: 1 Page: 4 Feedback 1. This is correct. The client may need preauthorization for this procedure. 2. This is incorrect. There is no indication that the client would need an antihypertensive. Clients are kept NPO before procedures. 3. This is incorrect. The client will be instructed to avoid use of hot tubs and swimming pools after the procedure has been completed. 4. This is incorrect. The nurse would not expect this after reviewing the health plan. 5. An advanced practice nurse (APN) is explaining the benefit of managed care to a health-care provider. Which information should the nurse include? 1. “The burden of risk is shared in managed care.” 2. “The most common type of health plan is point-of-service.” 3. “The main goal of managed care is to improve quality of care.” 4. “Managed care decreases the use of preventative medicine.” Answer: 1 Page: 5 Feedback 1. This is correct. In managed care, the burden of risk is shared. 2. This is incorrect. The most common types of health plans are HMOs and PPOs. 3. This is incorrect. The initial main goal of managed care was to improve quality of care. 4. This is incorrect. Managed care increases the use of preventative medicine as cost saving. 6. Which skill should the advanced practice nurse (APN) incorporate in order to be successful? 1. Ask staff nurses to follow through on client requests. 2. Follow rules and protocols without question. 3. Take on the case manager role effectively. 4. Enhance communication methods with other health-care personnel. Answer: 4 Page: 7 Feedback 1. This is incorrect. The advanced practice nurse (APN) should follow through with commitments, delegating to other staff when necessary. 2. This is incorrect. The advanced practice nurse (APN) should be creative and flexible, and adapt care to each client’s needs. 3. This is incorrect. The advanced practice nurse (APN) should work closely with the case manager to provide quality care to each client. 4. This is correct. The advanced practice nurse (APN) should enhance communication methods with other health-care personnel. 7. Which of the following has been a barrier to advanced practice nurses (APNs)? 1. Inclusion of APNs on provider panels 2. Full Medicare reimbursement for services 3. Denial of claims from third-party payers 4. Decreased employment of APNs Answer: 3 Page: 10 Feedback 1. This is incorrect. Exclusion of advanced practice nurses (APNs) on provider panels has been a barrier. 2. This is incorrect. Lack of full Medicare reimbursement has been a barrier. 3. This is correct. Denial of claims from third-party payers has been a barrier for advanced practice nurses (APNs) and is based upon misinformation. 4. This is incorrect. Employment of advanced practice nurses (APNs) has increased, not decreased. 8. An advanced practice nurse (APN) is caring for an elderly client with mildly elevated blood pressure. Focusing on health promotion and prevention, which initial intervention should the nurse suggest? 1. Cardiac stress test 2. Low sodium diet 3. Amlodipine 5mg daily 4. Increased fluid intake Answer: 2 Page: 23 Feedback 1. This is incorrect. A cardiac stress test is a focus of health promotion, because this test assesses for a problem. 2. This is correct. The advanced practice nurse (APN) would recommend changing the client’s diet to a low sodium diet. This action aims to prevent a problem from occurring. 3. This is incorrect. The advanced practice nurse (APN) would not order an antihypertensive for this client as an initial action. 4. This is incorrect. Increased fluid intake would not help this client, and would likely increase blood pressure further. 9. Using marketing principles, which nursing action displays an understanding of promotion? 1. Focusing on the physical assessment of the client 2. Having full knowledge of the costs of care 3. Calling attention to safe, effective client care 4. Making a decision to work as an independent practitioner Answer: 3 Page: 24 Feedback 1. This is incorrect. Focusing on the physical assessment of the client shows product. 2. This is incorrect. Having full knowledge of the costs of care shows price. 3. This is correct. Calling attention to safe, effective client care shows promotion. 4. This is incorrect. Making a decision to work as an independent practitioner shows place. 10. The advanced practice nurse (APN) recognizes that certain aspects of practice will ultimately push the profession forward. Which action should the APN focus on providing? 1. High-quality care 2. Fast, efficient care 3. Moderate cost care 4. Diversity in care Answer: 1 Page: 25 Feedback 1. This is correct. High-quality, cost-effective care pushes the profession forward. 2. This is incorrect. Fast, efficient care does not push the profession forward. 3. This is incorrect. Moderate cost care does not push the profession forward. 4. This is incorrect. Diversity in care does not push the profession forward. Chapter 10: Public Policy and the Advanced Practice Registered Nurse ANSWERS AND RATIONALES 1. Upon moving to a new city, an advanced practice registered nurse (APRN) notices there are many county regulations that expand children’s access to health-care services. Which of the following influenced the development of the regulations? Select all that apply. 1. A significant percentage of children in the county lacked health insurance. 2. Community members developed policies to provide accessible health care. 3. The incidence of vaccine-preventable illness among children was increasing. 4. Key stakeholders and policy makers viewed children as a vulnerable population. 5. The county board held a town hall meeting to discuss children’s health-care services. Answer: 1, 3, 4, 5 Pages: 1–2 Feedback 1. This is correct. Public policy is about communities trying to achieve something as a community. 2. This is incorrect. Public policy is made in the legislative, executive, or judicial branches of government, at either the state or federal level, within the jurisdiction of those entities. 3. This is correct. Public policy is for the good and/or protection of the community. Access to health care for children and requiring vaccines increase immunization rates. 4. This is correct. Policy development reflects the values of those making the policy. 5. This is correct. Public policy is about communities trying to achieve something. A component of the policy making process is the formulation of the problem and the identification of viable solutions. 2. Which of the following best explains an advanced practice registered nurse’s (APRN’s) decision to ask a legislator to support a bill that eliminates the requirement for collaborative agreements? 1. Limited scope of practice 2. Obligation to social contract 3. Responsibility to lead others 4. Ability to influence health policy Answer: 4 Page: 2 Feedback 1. This is incorrect. Advanced practice registered nurses (APRNs) recognize the responsibility to contribute to the development of health policy through political action. 2. This is incorrect. Advanced practice registered nurses (APRNs) recognize the responsibility to contribute to the development of health policy through political action. 3. This is incorrect. Advanced practice registered nurses (APRNs) recognize the responsibility to contribute to the development of health policy through political action. 4. This is correct. Advanced practice registered nurses (APRNs) recognize the responsibility to contribute to the development of health policy through political action. 3. A nurse practitioner (NP) is moving to a state that requires physician supervision of all advanced practice registered nurses (APRNs) and has a strong medical lobbying group. The lobbying group’s influence represents which of the following? 1. Barriers to independent practice 2. Physician resistance to APRN autonomy 3. Effect of political processes on health-care policy 4. Legislators’ lack of understanding of APRN roles Answer: 4 Page: 6 Feedback 1. This is incorrect. The process of health policy development includes the ability to influence policy makers and influences the delivery of care. 2. This is incorrect. The process of health policy development includes the ability to influence policy makers and influences the delivery of care. 3. This is incorrect. The process of health policy development includes the ability to influence policy makers and influences the delivery of care. 4. This is correct. The process of health policy development includes the ability to influence policy makers and influences the delivery of care. 4. Which requirement of the Affordable Care Act (ACA) improves access to health-care services provided by nurse practitioners (NPs)? 1. Face-to-face certification 2. Medicare reimbursement 3. Collaborative agreements 4. Nondiscrimination provision Answer: 4 Page: 11 Feedback 1. This is incorrect. Though advanced practice registered nurses (APRNs) have been authorized Part B Medicare providers since 1998, patients needing home health-care services must have a physician to certify the APRN has conducted the required face-to-face certification examination. 2. This is incorrect. Advanced practice registered nurses (APRNs) have been recognized Part B Medicare providers since 1998. 3. This is incorrect. The Affordable Care Act (ACA) does not mandate collaborative agreements. Each state legislates whether APRNs must have a collaborative agreement, which limits APRNs’ ability to practice to the full extent of their preparation. 4. This is correct. The nondiscrimination provision of the Affordable Care Act (ACA) acknowledged advanced practice registered nurses (APRNs) as primary care providers. 5. An advanced practice registered nurse (APRN) is talking with a legislator about the need for a primary care clinic in an underserved area. Which of the following points should the APRN include to gain the legislator’s support? Select all that apply. 1. Access to a regular primary care provider improves chronic disease management. 2. Primary care reduces costs related to complications of untreated health conditions. 3. APRNs are educated to provide the same level of care as primary care physicians. 4. Direct reimbursement of APRNs by third-party payers reduces costs to the state. 5. Improved access to care enables APRNs to address environmental causes of disease. Answer: 1, 2, 5 Pages: 9–12 Feedback 1. This is correct. Advanced practice registered nurses (APRNs) increase availability of primary care, which is associated with more effective provision of preventive services and better management of chronic disease. 2. This is correct. Advanced practice registered nurses (APRNs) increase availability of primary care, which is associated with more effective provision of preventive services and better management of chronic disease. 3. This is incorrect. Advanced practice registered nurses (APRNs) are mid-level care providers and practice within the limits of their nurse practice act. 4. This is incorrect. Though advanced practice registered nurses (APRNs) are recognized as qualified health-care providers, differences in the reimbursement and coverage policies, restrictions within states and policies related to direct reimbursement, and supervisory requirements by another health-care provider create challenges in reimbursement. 5. This is correct. Advanced practice registered nurses (APRNs) increase access to care for underserved populations and are educated to address social, economic, and environmental factors that influence health. 6. An advanced practice registered nurse (APRN) working in a primary care clinic identifies the need for an additional health-care provider. Which of the following indicates the reason the APRN recommends hiring a nurse practitioner (NP) over other providers? 1. NPs are reimbursed at a higher rate. 2. NPs have a broader scope of practice. 3. NPs expand access to care at a lower cost. 4. NPs’ malpractice insurance is less expensive. Answer: 3 Page: 9 Feedback 1. This is incorrect. Increased use of advanced practice registered nurses (APRNs) expands the availability of health care at a lower price. 2. This is incorrect. Increased use of advanced practice registered nurses (APRNs) expands the availability of health care at a lower price. 3. This is correct. Increased use of advanced practice registered nurses (APRNs) expands the availability of health care at a lower price. 4. This is incorrect. Increased use of advanced practice registered nurses (APRNs) expands the availability of health care at a lower price. 7. A nurse practitioner (NP) identifies advanced practice registered nurses (APRNs) in the state have reduced practice authority. The NP recognizes full practice authority includes which of the following? Select all that apply. 1. Title recognition 2. Prescriptive authority 3. Physician supervision 4. Collaborative agreement 5. Ability to diagnose patients Answer: 2, 5 Page: 13 Feedback 1. This is incorrect. A full practice license allows the advanced practice registered nurse (APRN) to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications. 2. This is correct. The right to full practice is under the exclusive licensure authority of the state board of nursing, not a regulated collaborative agreement or supervision by another health discipline. A full practice license allows the advanced practice registered nurse (APRN) to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatment, including prescribing medications. 3. This is incorrect. The right to full practice is under the exclusive licensure authority of the state board of nursing, not a regulated collaborative agreement or supervision by another health discipline. A full practice license allows the advanced practice registered nurse (APRN) to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatment, including prescribing medications. 4. This is incorrect. The right to full practice is under the exclusive licensure authority of the state board of nursing, not a regulated collaborative agreement or supervision by another health discipline. A full practice license allows the advanced practice registered nurse (APRN) to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications. 5. This is correct. A full practice license allows the advanced practice registered nurse (APRN) to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications. 8. An advanced practice registered nurse (APRN) is attending a provider roundtable to discuss the Centers for Medicare and Medicaid Services’s (CMS’s) proposed changes in reimbursement policies. Which of the following indicates the APRN understands that participation in the discussion is essential? 1. APRNs are morally obligated to protect the health of the public. 2. Health-care policies impact APRN practice and quality of patient care. 3. The American Nurses Association (ANA) Code of Ethics requires nurses to advocate for health policies. 4. APRNs are responsible for setting health-care policies in practice settings. Answer: 2 Page: 5 Feedback 1. This is incorrect. Advanced practice registered nurses (APRNs) must participate in health policy making processes to ensure their input regarding the effect of legislation on APRN practice, patient care, and other health-care issues is provided and heard. 2. This is correct. Advanced practice registered nurses (APRNs) must participate in health policy making processes to ensure their input regarding the effect of legislation on APRN practice, patient care, and other health-care issues is provided and heard. 3. This is incorrect. Advanced practice registered nurses (APRNs) must participate in health policy making processes to ensure their input regarding the effect of legislation on APRN practice, patient care, and other health-care issues is provided and heard. 4. This is incorrect. Advanced practice registered nurses (APRNs) must participate in health policy making processes to ensure their input regarding the effect of legislation on APRN practice, patient care, and other health-care issues is provided and heard. 9. Collaborative agreements for advanced practice registered nurses (APRNs) limit which of the following? 1. Political competence 2. Self-governing licensure 3. Reimbursement from third-party payers 4. Accreditation of advanced practice nursing programs Answer: 2 Page: 14 Feedback 1. This is incorrect. Collaborative agreements directly limit the advanced practice registered nurse’s (APRN’s) ability to have a self-governing license. 2. This is correct. Collaborative agreements directly limit the advanced practice registered nurse’s (APRN’s) ability to have a self-governing license. 3. This is incorrect. Collaborative agreements directly limit the advanced practice registered nurse’s (APRN’s) ability to have a self-governing license. 4. This is incorrect. Collaborative agreements directly limit the advanced practice registered nurse’s (APRN’s) ability to have a self-governing license. 10. Which of the following may limit a nurse practitioner’s (NP’s) ability to establish a practice? 1. Scope of practice 2. Reimbursement policies 3. Accreditation requirements 4. Access to sufficient patient volume Answer: 2 Page: 15 Feedback 1. This is incorrect. Advanced practice registered nurse (APRN) practice increases accessibility for patient populations. 2. This is correct. Full practice authority allows for independent practice in the state. 3. This is incorrect. Accreditation requirements focus on nursing and certification programs. 4. This is incorrect. Reimbursement policies make it difficult for nurse practitioners (NPs) to serve as primary care providers (PCPs) because of differences in coverage policies, state regulatory restrictions, and supervisory requirements by another health-care provider. Chapter 11: Resource Management ANSWERS AND RATIONALES 1. When reviewing a client’s medical record, which hospital-acquired condition (HAC) would be considered Medicare reimbursable? 1. Air embolism 2. Stage II pressure ulcer 3. Surgical infection post bariatric surgery 4. Catheter-associated urinary tract infection Answer: 2 Page: 6 Feedback 1. This is incorrect. An air embolism is a hospital-acquired condition (HAC) that is not reimbursable by Medicare. 2. This is correct. A stage II pressure ulcer is reimbursable by Medicare. Stage III and Stage IV pressure ulcers, however, are hospital-acquired conditions (HACs) that are not reimbursable by Medicare. 3. This is incorrect. A surgical infection post bariatric surgery is a hospital-acquired condition (HAC) that is not reimbursable by Medicare. 4. This is incorrect. A catheter-associated urinary tract infection is a hospital-acquired condition (HAC) that is not reimbursable by Medicare. 2. The nurse practitioner (NP) is reviewing the medical records for several clients who are diagnosed with hospital-acquired conditions (HACs). Which HAC diagnoses are ineligible for Medicare reimbursement? Select all that apply. 1. Blood incompatibility 2. Diabetic ketoacidosis 3. Stage I pressure ulcer 4. Deep vein thrombosis post hip replacement 5. Peripherally inserted central catheter infection Answer: 1, 2, 4, 5 Page: 6 Feedback 1. This is correct. Blood incompatibility is a hospital-acquired condition (HAC) that is ineligible for Medicare reimbursement. 2. This is correct. Diabetic ketoacidosis, a manifestation of poor glycemic control, is a hospital- acquired condition (HAC) that is ineligible for Medicare reimbursement. 3. This is incorrect. A stage I pressure injury is eligible for Medicare reimbursement. Stage III and Stage IV pressure injuries, however, are hospital-acquired conditions (HACs) that are ineligible for Medicare reimbursement. 4. This is correct. A deep vein thrombosis post hip replacement is a hospital-acquired condition (HAC) that is ineligible for Medicare reimbursement. 5. This is correct. A peripherally inserted central catheter infection is a hospital-acquired condition (HAC) that is ineligible for Medicare reimbursement. 3. Which is categorized as an account code when tracking and managing the health-care facility’s financial systems? 1. Blood bank 2. Cancer care center 3. Treatment hemodialysis 4. Nurse practitioner (NP) salary Answer: 4 Pages: 1–2 Feedback 1. This is incorrect. The blood bank is an activity, an example of the cost, revenue, or responsibility center, not an account code. 2. This is incorrect. The cancer care center is a service line, an example of the cost, revenue, or responsibility center, not an account code. 3. This is incorrect. Hemodialysis is a treatment, an example of the cost, revenue, or responsibility center, not an account code. 4. This is correct. The nurse practitioner (NP) salary is an example of an account code or a type of transaction. 4. Which is an example of a third-party payer that provides the health-care facility with operating revenue? 1. Medicare 2. Medicaid 3. Veteran affairs benefits 4. Health maintenance organizations Answer: 4 Page: 4 Feedback 1. This is incorrect. Medicare is an example of reimbursement from the federal government. 2. This is incorrect. Medicaid is an example of reimbursement from the state government. 3. This is incorrect. Veteran affairs benefits are an example of reimbursement from the federal government. 4. This is correct. Health maintenance organizations are an example of reimbursement from a third party. 5. Which is an example of a federal government payer that provides the health-care facility with operating revenue? Select all that apply. 1. Medicare 2. Medicaid 3. Veteran affairs benefits 4. Fee-for-service insurance plan 4. Health maintenance organizations Answer: 1, 3 Page: 4 Feedback 1. This is correct. Medicare is an example of payer reimbursement from the federal government. 2. This is incorrect. Medicaid is an example of reimbursement from the state government. 3. This is correct. Veteran affairs benefits are an example of payer reimbursement from the federal government. 4. This is incorrect. A fee-for-service insurance plan is an example of reimbursement from a third party. 5. This is incorrect. Health maintenance organizations are an example of reimbursement from a third party. 6. Which is an example of a state government payer that provides the health-care facility with operating revenue? 1. Medicare 2. Medicaid 3. Veteran affairs benefits 4. Fee-for-service insurance plan Answer: 2 Page: 4 Feedback 1. This is incorrect. Medicare is an example of reimbursement from the federal government. 2. This is correct. Medicaid is an example of reimbursement from the state government. 3. This is incorrect. Veteran affairs benefits are an example of reimbursement from the federal government. 4. This is incorrect. A fee-for-service insurance plan is an example of reimbursement from a third party. 7. Which health-care provider incurs direct costs when providing patient care? 1. Unit secretary 2. Nurse manager 3. Nurse practitioner (NP) 4. Clinical nurse specialist (CNS) Answer: 3 Page: 10 Feedback 1. This is incorrect. Leadership and support staff, including a unit secretary, incur indirect costs when providing patient care. 2. This is incorrect. Leadership and support staff, including a nurse manager, incur indirect costs when providing patient care. 3. This is correct. The nurse practitioner (NP) incurs direct costs when providing patient care. 4. This is incorrect. Leadership and support staff, including a clinical nurse specialist, incur indirect costs when providing patient care. 8. Which health-care provider incurs indirect costs when providing patient care? Select all that apply. 1. Unit secretary 2. Nurse manager 3. Nurse practitioner (NP) 4. Respiratory therapist 5. Clinical nurse specialist (CNS) Answer: 1, 2, 5 Page: 10 Feedback 1. This is correct. Leadership and support staff, including a unit secretary, incur indirect costs when providing patient care. 2. This is correct. Leadership and support staff, including a nurse manager, incur indirect costs when providing patient care. 3. This is incorrect. The nurse practitioner (NP) incurs direct costs when providing patient care. 4. This is incorrect. The respiratory therapist incurs direct costs when providing patient care. 5. This is correct. Leadership and support staff, including a clinical nurse specialist, incur indirect costs when providing patient care. 9. planning is likely to be translated into a long-range budget that addresses the direction of the organization during the next 3 to 5 years or more Answer: strategic Page: 12 Feedback: Strategic planning is likely to be translated into a long-range budget that addresses the direction of the organization during the next 3 to 5 years or more. 10. The measurement for identifying the individual practitioner’s contribution to the organization most frequently is based on billed. Answer: services Page: 23 Feedback: The measurement for identifying the individual practitioner’s contribution to the organization most frequently is based on services billed. Chapter 12: Mediated Roles: Working With and Through Other People ANSWERS AND RATIONALES 1. When acting as a mentor, which core competency is the nurse practitioner (NP) exemplifying? 1. Research 2. Coaching 3. Consultation 4. Collaboration Answer: 2 Pages: 5–6 Feedback 1. This is incorrect. Acting as a mentor does not exemplify the core competency of research. 2. This is correct. Acting as a mentor exemplifies the core competency of coaching. 3. This is incorrect. Acting as a mentor does not exemplify the core competency of consultation. 4. This is incorrect. Acting as a mentor does not exemplify the core competency of collaboration. 2. Which interpersonal attributes must the advanced practice nurse (APN) possess in order for successful collaboration to occur with other health-care providers? Select all that apply. 1. Trust 2. Empathy 3. Optimism 4. Knowledge 5. Cooperation Answer: 1, 3, 4, 5 Page: 8 Feedback 1. This is correct. Trust is an interpersonal attribute the advanced practice nurse (APN) must possess for successful collaboration to occur. 2. This is incorrect. Empathy is not an interpersonal attribute the advanced practice nurse (APN) must possess for successful collaboration to occur. 3. This is correct. Optimism is an interpersonal attribute the advanced practice nurse (APN) must possess for successful collaboration to occur. 4. This is correct. Knowledge is an interpersonal attribute the advanced practice nurse (APN) must possess for successful collaboration to occur. 5. This is correct. Cooperation is an interpersonal attribute the advanced practice nurse (APN) must possess for successful collaboration to occur. 3. When implementing the Parallel Model of collaborative practice, which action by the advanced practice nurse (APN) is most appropriate? 1. Diagnosing patients 2. Managing stable patients 3. Performing intake assessments 4. Managing medically complex patients Answer: 2 Page: 11 Feedback 1. This is incorrect. This action is appropriate by the physician when implementing the Sequential Model of collaborative practice. 2. This is correct. Managing stable patients is the advanced practice nurse’s (APN’s) role when implementing the Parallel Model of collaborative practice. 3. This is incorrect. This action exemplifies the advanced practice nurse (APN) implementing the Sequential Model of collaborative practice. 4. This is incorrect. This is the physician’s role when implementing the Parallel Model of collaborative practice. 4. When implementing the Sequential Model of collaborative practice, which action by the advanced practice nurse (APN) is appropriate? 1. Diagnosing patients 2. Managing stable patients 3. Performing intake assessments 4. Managing medically complex patients Answer: 3 Page: 11 Feedback 1. This is incorrect. This action is appropriate by the physician when implementing the Sequential Model of collaborative practice. 2. This is incorrect. Managing stable patients is the advanced practice nurse’s (APN’s) role when implementing the Parallel Model of collaborative practice. 3. This is correct. This action exemplifies the advanced practice nurse (APN) implementing the Sequential Model of collaborative practice. 4. This is incorrect. This is the physician’s role when implementing the Parallel Model of collaborative practice. 5. An advanced practice nurse (APN) wants to implement interdisciplinary team relationships. Which of the following is an example of a skill that the APN would need? 1. Group dynamics 2. Conflict resolution 3. Respect for other disciplines 4. Awareness of outcomes-based practice Answer: 2 Page: 17 Feedback 1. This is incorrect. This is not a skill needed to implement interdisciplinary team relationships. This is an example of knowledge that is needed to implement interdisciplinary team relationships. 2. This is correct. Conflict resolution is a skill needed to implement interdisciplinary team relationships. 3. This is incorrect. This is not a skill needed to implement interdisciplinary team relationships. This is an example of the attitude that is needed to implement interdisciplinary team relationships. 4. This is incorrect. This is not a skill needed to implement interdisciplinary team relationships. This is an example of the attitude that is needed to implement interdisciplinary team relationships. 6. An advanced practice nurse (APN) wants to implement interdisciplinary team relationships. Which of the following is an example of knowledge that the APN would need? 1. Group dynamics 2. Conflict resolution 3. Respect for other disciplines 4. Awareness of outcomes-based practice Answer: 1 Page: 17 Feedback 1. This is correct. Knowledge of group dynamics is needed by the advanced practice nurse (APN) to implement interdisciplinary team relationships. 2. This is incorrect. Conflict resolution is a skill needed to implement interdisciplinary team relationships. 3. This is incorrect. Respect of other disciplines is an attitude needed to implement interdisciplinary team relationships. 4. This is incorrect. Awareness of outcomes-based practice is a skill needed to implement interdisciplinary team relationships. 7. An advanced practice nurse (APN) wants to implement interdisciplinary team relationships. Which of the following are examples of the attitudes that the APN would need? Select all that apply. 1. Group dynamics 2. Conflict resolution 3. Outcomes-focused care 4. Respect for other disciplines 5. Awareness of outcomes-based practice Answer: 4, 5 Page: 17 Feedback 1. This is incorrect. The advanced practice nurse (APN) must have knowledge of group dynamics to implement interdisciplinary team relationships. This is not an example of an attitude needed to implement these relationships. 2. This is incorrect. The advanced practice nurse (APN) must have conflict resolution skills to implement interdisciplinary team relationships. This is not an example of an attitude needed to implement these relationships. 3. This is incorrect. Outcome-focused care is a skill needed by the advanced practice nurse (APN) to implement interdisciplinary team relationships. 4. This is correct. Respect for other disciplines is an attitude needed by the advanced practice nurse (APN) to implement interdisciplinary team relationships. 5. This is correct. Awareness of outcomes-based practice is a skill needed to implement interdisciplinary team relationships. 8. Which is an example of an appropriate question to ask when interviewing an advanced practice nurse (APN) to assess roles, expectations, and influences on practice? Select all that apply. 1. What does referral mean to you? 2. How would you describe your role? 3. What does consultation mean to you? 4. How important is empathy in your role? 5. Where did you obtain your graduate degree? Answer: 1, 2, 3 Pages: 21–22 Feedback 1. This is correct. This is an example of a question to ask when interviewing an advanced practice nurse (APN) to assess roles, expectations, and influences on practice. 2. This is correct. This is an example of a question to ask when interviewing an advanced practice nurse (APN) to assess roles, expectations, and influences on practice. 3. This is correct. This is an example of a question to ask when interviewing an advanced practice nurse (APN) to assess roles, expectations, and influences on practice. 4. This is incorrect. This is not an example of a question to ask when interviewing an advanced practice nurse (APN) to assess roles, expectations, and influences on practice. 5. This is incorrect. This is not an example of a question to ask when interviewing an advanced practice nurse (APN) to assess roles, expectations, and influences on practice. 9. Successful outcomes imply that at least four conditions are met: The task is suitable for teamwork, the team must include the right clinical skills to perform the task, team members must combine their effectively, and the organization must provide a supportive context for the team. Answer: resources Page: 19 Feedback: Successful outcomes imply that at least four conditions are met: The task is suitable for teamwork, the team must include the right clinical skills to perform the task, team members must combine their resources effectively, and the organization must provide a supportive context for the team. 10. Clinical nurse specialists (CNSs) categorize their role into two primary domains: clinical and . Answer: professional Page: 22 Feedback: Clinical nurse specialists (CNSs) categorize their role into two primary domains: clinical and professional. Chapter 13: Evidence-Based Practice ANSWERS AND RATIONALES 1. Which phase of Tanner’s clinical judgment model involves the integration of evidence-based practice, clinical knowledge, and knowledge of the patient? 1. Noticing 2. Reflecting 3. Responding 4. Interpreting Answer: 1 Page: 16 Feedback 1. This is correct. During the “noticing” phase, the clinician’s expectations of the situation are formed using knowledge of the patient, clinical or practical knowledge of similar patients, and textbook- and research-based knowledge. 2. This is incorrect. During the “reflecting” phase, the clinician observes the patient’s responses to the action taken. 3. This is incorrect. During the “responding” phase, the clinician may act or choose not to act depending on the situation. 4. This is incorrect. During the “interpreting” phase, the clinician forms an understanding of the situation by using one or more reasoning patterns. 2. Which knowledge enables the advanced practice registered nurse (APRN) to recognize phenomena associated with specific health problems? 1. Practical 2. Scientific 3. Theoretical 4. Research-based Answer: 4 Page: 9 Feedback 1. This is incorrect. Practical knowledge, also known as knowledge from clinical experience, is acquired through working with many patients. 2. This is incorrect. Scientifically derived knowledge is a component of theoretical knowledge. 3. This is incorrect. Theoretical knowledge is acquired through understanding of scientifically derived knowledge and theory and is used in a situation as a specific application of an abstract rule or principle. 4. This is correct. Research-based knowledge is directed toward describing phenomena which can contribute to the clinician’s overall knowledge base for assessing risks. 3. An advanced practice registered nurse (APRN) is reviewing the literature for current treatment guidelines of hypertension. Which of the following should the APRN use to develop a client’s treatment plan? 1. Clinical experience 2. Local practice data 3. Research evidence 4. Patient preferences Answer: 3 Page: 7 Feedback 1. This is incorrect. Advanced practice registered nurses (APRNs) use clinical experience and research evidence to inform their clinical judgment and make patient care decisions. Review of the literature for current guidelines represents use of research evidence. 2. This is incorrect. Local practice data are not part of a literature review that informs advanced practice registered nurses’ (APRNs’) clinical judgment. 3. This is correct. Advanced practice registered nurses (APRNs) are expected to utilize conscientious, explicit, and judicious use of research evidence to inform their clinical judgment and make decisions that maximize the well-being of their patients. 4. This is incorrect. Though the advanced practice registered nurse (APRN) considers patient preferences, these are not part of a literature review. 4. Which of the following are included in the revised definition of evidence-based practice? Select all that apply. 1. Clinical expertise 2. Standards of care 3. Practical knowledge 4. Outcomes management 5. Systematic research evidence Answer: 1, 4, 5 Page: 5 Feedback 1. This is correct. The definition of evidence-based medicine was revised to be more comprehensive. Clinicians must integrate their personal clinical expertise with the best available evidence from systematic research, the local context of care, and the internal evidence generated there such as patient assessment, outcomes management, and quality improvement data and apply this within the context of their patient’s unique values and circumstances. 2. This is incorrect. The definition of evidence-based medicine was revised to be more comprehensive. Clinicians must integrate their personal clinical expertise with the best available evidence from systematic research, the local context of care, and the internal evidence generated there such as patient assessment, outcomes management, and quality improvement data and apply this within the context of their patient’s unique values and circumstances. 3. This is incorrect. The definition of evidence-based medicine was revised to be more comprehensive. Clinicians must integrate their personal clinical expertise with the best available evidence from systematic research, the local context of care, and the internal evidence generated there such as patient assessment, outcomes management, and quality improvement data and apply this within the context of their patient’s unique values and circumstances. 4. This is correct. The definition of evidence-based medicine was revised to be more comprehensive. Clinicians must integrate their personal clinical expertise with the best available evidence from systematic research, the local context of care, and the internal evidence generated there such as patient assessment, outcomes management, and quality improvement data and apply this within the context of their patient’s unique values and circumstances. 5. This is correct. The definition of evidence-based medicine was revised to be more comprehensive. Clinicians must integrate their personal clinical expertise with the best available evidence from systematic research, the local context of care, and the internal evidence generated there such as patient assessment, outcomes management, and quality improvement data and apply this within the context of their patient’s unique values and circumstances. 5. Which of the following would an advanced practice nurse (APN) use to create topics for key articles related to clinical practice? 1. MEDLINE 2. PICOT format 3. CATmaker critical appraisal tool 4. Cochrane Database of Systematic Reviews Answer: 3 Page: 24 Feedback 1. This is incorrect. MEDLINE is an electronic database used to identify relevant citations in the clinical literature. 2. This is incorrect. The PICOT format (the population/problem, intervention, comparison, outcome, time) is a useful framework to help novice searchers organize electronic database searches. 3. This is correct. The CATmaker critical appraisal tool can be downloaded from the Center for Evidence-Based Medicine (CEBM) to help the APN create Critically Appraised Topics (CATs) for key articles about therapy, diagnosis, prognosis, etiology/harm, and systematic reviews of therapy. 4. This is incorrect. The Cochrane Database of Systematic Reviews is an electronic database comprised of evidence summaries, which takes the user directly to primary or secondary publications of the relevant clinical evidence. 6. An advanced practice registered nurse (APRN) is providing care for patients with type 2 diabetes. Which criteria would an APRN use to evaluate research articles related to diabetes? Select all that apply. 1. Randomization 2. Narrative review 3. Treatment effect 4. Outcome variation 5. Clarity of research question Answer: 1, 3, 5 Page: 32 Feedback 1. This is correct. Considerations for appraising therapy articles include: (a) randomization of treatment groups, (b) size of the treatment effect, and (c) presence of a clearly defined research question. 2. This is incorrect. A narrative review article provides a summary of an area or topic written by an expert in the field. 3. This is correct. Considerations for appraising therapy articles include: (a) randomization of treatment groups, (b) size of the treatment effect, and (c) presence of a clearly defined research question. 4. This is incorrect. Consideration of outcome variations is among the four steps which focus on the use of outcomes to make medical decisions. 5. This is correct. Considerations for appraising therapy articles include: (a) randomization of treatment groups, (b) size of the treatment effect, and (c) presence of a clearly defined research question. 7. An advanced practice registered nurse (APRN) is developing a treatment plan for a 57-year-old patient who reports shortness of breath and palpitations. Which resource was the first major attempt to provide up-to-date, evidence-based information that the APRN can consult? 1. MEDLINE 2. BMJ Clinical Evidence 3. Evidence-Based Medicine Toolkit 4. Online Journal of Knowledge Synthesis for Nursing Answer: 2 Page: 28 Feedback 1. This is incorrect. MEDLINE is the best-known bibliographic database of indexed medical literature. 2. This is correct. Clinical Evidence was the first major attempt of The British Medical Journal (BMJ) publishing group and the American College of Physicians–American Society of Internal Medicine to provide an up-to-date, evidence-based textbook. 3. This is incorrect. The Evidence-Based Medicine Toolkit provides a guide for evaluating therapy articles and has questions for appraising articles on diagnosis, prognosis, and harm (risks for certain diseases or conditions). 4. This is incorrect. The Online Journal of Knowledge Synthesis for Nursing is a peer-reviewed online journal which presents current scientific evidence to inform clinical decisions and ongoing discussions on issues, methods, clinical practice, and teaching strategies for evidence- based practice. 8. Which of the following resources can the advanced practice registered nurse (APRN) utilize to receive the newest online updates from multiple journals in one location? 1. Mendeley 2. Electronic database 3. Regular alert notifications 4. Real Simple Syndication (RSS) feeds Answer: 4 Page: 23 Feedback 1. This is incorrect. Mendeley is a free application that can store references and articles and then be retrieved and be accessible by several types of devices. 2. This is incorrect. An electronic database is a search tool that enables users to locate evidence summaries and publications of the relevant clinical evidence. 3. This is incorrect. Regular alert notifications can be sent by a journal or library to a subscriber when a new article or summary appears on an identified topic or author. 4. This is correct. Real Simple Syndication (RSS) feeds are files Web sites update with their newest content and are used by many databases, several journals, and news sites. A RSS feed aggregator allows the user to open an RSS reader to see what is new at many sites all in one location. 9. Which of the following would be most useful to an advanced practice registered nurse (APRN) who wishes to discuss practice implications of treating osteoporosis with other APRNs? 1. BMJ Clinical Evidence 2. Cochrane Database of Systematic Reviews 3. Online Journal of Knowledge Synthesis for Nursing 4. Cumulative Index to Nursing and Allied Health Literature Answer: 3 Page: 29 Feedback 1. This is incorrect. The British Medical Journal’s Clinical Evidence is an up-to-date, evidence- based textbook. 2. This is incorrect. The Cochrane Database of Systematic Reviews is a structured, exhaustive electronic database of high-quality systematic reviews of randomized clinical trials. 3. This is correct. The Online Journal of Knowledge Synthesis for Nursing is a peer-reviewed online journal in which each article offers a synthesis of research studies on a single topic and concludes with practice implications. 4. This is incorrect. The Cumulative Index to Nursing and Allied Health Literature is an electronic bibliographic database, which permits users to identify relevant citations in the clinical literature. 10. Which of the following should an advanced practice registered nurse (APRN) consider when deciding to apply the results of a research study to a patient in the APRN’s clinical setting? 1. Validity 2. Protocols 3. Demographics 4. Incidence rate Answer: 3 Page: 29 Feedback 1. This is incorrect. Validity indicates whether a study’s findings truly represent the phenomenon being measured. 2. This is incorrect. Research studies establish evidence for protocols and guidelines. 3. This is correct. The clinician must determine whether a patient is similar enough to a study’s participants for the results to be applicable. Demographics such as race, age, and gender assist the clinician to assess generalizability of a study’s findings. 4. This is incorrect. The incidence rate reflects the number of new cases in a specified period. Incidence rates are used to (a) compare the development of disease in different population groups; and/or (b) determine whether a relationship exists between a possible causal factor and a disease. Chapter 14: Advocacy and the Advanced Practice Registered Nurse ANSWERS AND RATIONALES 1. Which action shows the advanced practice nurse (APN) effectively coaching a client? 1. Teaching the client self-advocacy 2. Referring the client to a specialist 3. Telling the client to talk to a pharmacist about new medications 4. Requesting the visiting nurse set up a medication box for a client Answer: 1 Page: 3 Feedback 1. This is correct. The nurse who teaches the client to advocate for himself or herself is effectively coaching. 2. This is incorrect. Referring the client to a specialist is not an example of coaching. Coaching enables the client to be independent with care. 3. This is incorrect. Referring the client to a pharmacist is not an example of coaching. Coaching enables the client to be independent with care. 4. This is incorrect. Requesting a nurse to set up a medication box is not an example of coaching. Coaching enables the client to be independent with care. 2. Which action by the advanced practice nurse (APN) shows public policy advocacy? 1. Encouraging clients to speak up for their needs 2. Teaching clients how to self-administer insulin 3. Meeting with a lawmaker to discuss current practices 4. Discussing a concern in practices with a manager Answer: 3 Page: 3 Feedback 1. This is incorrect. Public policy involves influencing legislators and lawmakers to change policies affecting health care. Encouraging clients to speak up for themselves is autonomy. 2. This is incorrect. Public policy involves influencing legislators and lawmakers to change policies affecting health care. Encouraging clients to self-administer insulin is autonomy. 3. This is correct. Meeting with a lawmaker to influence change is an example of public policy advocacy. 4. This is incorrect. Discussing client needs with a manager reflects client advocacy. 3. Which skill should the advanced practice nurse (APN) master in order to successfully advocate for clients? 1. Clinical experience 2. Communication 3. Medication dosing 4. Referral practices Answer: 2 Page: 5 Feedback 1. This is incorrect. Although important in decision making, clinical experience does not increase the advanced practice nurse’s (APN’s) ability to advocate for clients. 2. This is correct. Communication is imperative to the advanced practice nurse (APN) when advocating for clients. 3. This is incorrect. Medication dosing does not help the advanced practice nurse (APN) advocate for the client. 4. This is incorrect. Referral practices do not help the advanced practice nurse (APN) advocate for the client. 4. Which action by the advanced practice nurse (APN) is an example of systems-level advocacy? 1. Working with a company to obtain free diabetic testing supplies 2. Discussing the importance of diabetic monitoring and care with a client 3. Teaching a client how to self-administer insulin 4. Assisting a client in signing up for a free diabetes education class Answer: 1 Page: 9 Feedback 1. This is correct. System-level advocacy occurs at a population of community level. 2. This is incorrect. This is one-on-one care of a client. System-level advocacy occurs at a population of community level. 3. This is incorrect. This is one-on-one care of a client. System-level advocacy occurs at a population of community level. 4. This is incorrect. This is one-on-one care of a client. System-level advocacy occurs at a population of community level. 5. During systems-level advocacy, which action occurs in the final stages? 1. Implementing a program 2. Creating action agendas 3. Identifying a problem 4. Developing policy options Answer: 1 Page: 10 Feedback 1. This is correct. Program implementation and evaluation occur in the final stages. 2. This is incorrect. Creating action agendas occurs in the beginning stages. 3. This is incorrect. Identifying a problem occurs in the beginning stages. 4. This is incorrect. Developing policy concerns occurs in the beginning stages. 6. The advanced practice nurse (APN) is working with a nursing student who has been assigned to the surgical unit for the day. Which action by the APN would be most beneficial to help the student learn about advocacy? 1. Lecture the student on the benefits of advocacy. 2. Have the nursing student read an article on the topic. 3. Ask the nursing student to discuss advocacy with a client. 4. Engage in a discussion about advocacy with the nursing student. Answer: 4 Page: 14 Feedback 1. This is incorrect. Providing a lecture on the topic will not assist the student in gaining new knowledge in the clinical setting. The advanced practice nurse (APN) should model advocacy in the clinical setting. 2. This is incorrect. The advanced practice nurse (APN) should model advocacy in the clinical setting. 3. This is incorrect. The clinical setting is ideal for seeing and participating in learning experiences, such as seeing advocacy in action. 4. This is correct. Discussing advocacy with the nursing student, and other positive experiences, enhance learning. 7. Which action by the advanced practice nurse (APN) is an example of advocacy? 1. Teaching the client’s wife how to prepare a cardiac diet 2. Educating a client and family why it is important to monitor glucose levels 3. Requesting that a physician meet with a client to discuss concerns before surgery 4. Repeating discharge education to a client Answer: 3 Page: 9 Feedback 1. This is incorrect. Although educating clients is important, this is not an example of advocacy. 2. This is incorrect. Although educating clients and their families are important, this is not an example of advocacy. 3. This is correct. Requesting the physician to clarify information on the client’s behalf is an example of advocacy. 4. This is incorrect. Although educating clients and ensuring the understanding of discharge information is important, this is not an example of advocacy. 8. The advanced practice nurse (APN) is working on a busy pediatric unit, caring for a child who was injured by a parent. The child is now in custody of the grandmother. Which action by the APN demonstrates advocacy for the welfare of the child? 1. Assisting the grandmother in navigating the health-care system 2. Setting up an appointment with the child’s pediatrician 3. Obtaining laboratory reports for the grandmother 4. Allowing the child to go to the playroom Answer: 1 Page: 9 Feedback 1. This is correct. Advocacy includes helping clients navigate the health-care system. 2. This is incorrect. This does not involve the client’s grandmother in the process of navigating the health-care system. 3. This is incorrect. This does not include the grandmother in the care of the client. 4. This is incorrect. This is not an example of advocacy. 9. While working in a surgical center the advanced practice nurse (APN) notices that a client has not had all questions answered before the scheduled procedure. Which action should the nurse take? 1. Have the client sign the consent. 2. Inform the client that questions can be completed with the surgeon in the operating room. 3. Hold the consent until the surgeon can speak with the client. 4. Explain the procedure in detail to the client and sign the consent form. Answer: 3 Page: 9 Feedback 1. This is incorrect. The client should have the opportunity for informed consent. 2. This is incorrect. The client should have the opportunity for informed consent. 3. This is correct. The client should have the chance to speak with the surgeon before the procedure, and have all questions answered. 4. This is incorrect. The client should have the opportunity for informed consent. 10. The nurse is working with a client who speaks English as a second language. The client appears to be confused, and answers “Yes” to all questions. Which action should the nurse take? 1. Call an interpreter to the room. 2. Ask the client’s wife to interpret. 3. Write down a straightforward list of what was discussed. 4. Ask the physician to come back and speak with the client again. Answer: 1 Page: 9 Feedback 1. This is correct. This is an example of advocating on behalf of the client. 2. This is incorrect. The nurse should use a professional interpreter to ensure that the intended message is being relayed. 3. This is incorrect. This does not help the client unless it is in the client’s preferred language. 4. This is incorrect. This does not help the client unless it is in the client’s preferred language. Chapter 15: Case Management and the Advanced Practice Nurse ANSWERS AND RATIONALES 1. Place the following historical events of nursing case management in chronological order from past [1] to present [5]. 1. Public health nurses provided case management services for immigrants and the poor. 2. The Veterans Administration established the first model for “one-stop” health care for veterans. 3. Health insurance companies initiated case management services and care coordination. 4. The U.S. Public Health Service developed a case management system for “community as client.” 5. The Centers for Medicaid and Medicare Services (CMS) created Accountable Care Organizations. Answer: 1, 4, 2, 3, 5 Pages: 2–5 Feedback 1. Beginning in the 1860s, public health nurses used the case management process to respond to health and social needs of high risk populations, such as new immigrants living in tenement housing. 4. In the early 1900s, as an expansion of the role of the community-based public health nurse caring for individuals, the federal government mandated the United States Public Health Service to develop a system of case management with the “community as the client.” 2. After World War II, the Veterans Administration established a center in Los Angeles for veterans’ benefits, which was its first model for “one-stop” health care. This was the inception of its ongoing model for a continuum of care. 3. In the 1980s, health insurance companies initiated case management to shorten hospital stays, as well as to coordinate and manage services for participants with high costs or catastrophic illnesses. 5. As a provision of the Patient Protection and Affordable Care Act of 2010, the Centers for Medicare and Medicaid Services (CMS) created Accountable Care Organizations. An ACO is a concept contained within a corporate structure which consists of care settings (including hospitals) and professional care providers, including physicians, nurse practitioners (NPs), and physician assistants (PAs). 2. Which of the following differentiates the advanced practice registered nurse (APRN) case manager’s role from the baccalaureate level case manager role? 1. Assessment skills 2. Clinical experience 3. Nursing knowledge 4. Outcome accountability Answer: 4 Page: 7 Feedback 1. This is incorrect. Baccalaureate registered nurses have assessment skills, clinical experience, and nursing knowledge. Advanced practice registered nurses (APRNs) have expert knowledge regarding the specific clinical populations for which standards and pathways are written, understand clients’ needs on a continuum-of-care basis, and have the additional requirement of outcome accountability. 2. This is incorrect. Baccalaureate registered nurses have assessment skills, clinical experience, and nursing knowledge. Advanced practice registered nurses (APRNs) have expert knowledge regarding the specific clinical populations for which standards and pathways are written, understand clients’ needs on a continuum-of-care basis, and have the additional requirement of outcome accountability. 3. This is incorrect. Baccalaureate registered nurses have assessment skills, clinical experience, and nursing knowledge. Advanced practice registered nurses (APRNs) have expert knowledge regarding the specific clinical populations for which standards and pathways are written, understand clients’ needs on a continuum-of-care basis, and have the additional requirement of outcome accountability. 4. This is correct. Advanced practice registered nurses (APRNs) have expert knowledge regarding the specific clinical populations for which standards and pathways are written, understand clients’ needs on a continuum-of-care basis, and have the additional requirement of outcome accountability. 3. Community-based case managers are experiencing an increased need for which of the following skills and knowledge? Select all that apply. 1. Cost containment 2. Discharge planning 3. Reimbursement systems 4. Extensive clinical expertise 5. Chronic disease management Answer: 3, 4 Page: 17 Feedback 1. This is incorrect. Community-based models have experienced an increasing need for a high level of clinical expertise in their case managers, as well as the traditional knowledge of community resources and health-care reimbursement methodologies. 2. This is incorrect. Hospital-based case managers have an increased need for an intense discharge planning model. 3. This is correct. Community-based models have experienced an increasing need for a high level of clinical expertise in their case managers, as well as the traditional knowledge of community resources and health-care reimbursement methodologies. 4. This is correct. Community-based models have experienced an increasing need for a high level of clinical expertise in their case managers, as well as the traditional knowledge of community resources and health-care reimbursement methodologies. 5. This is incorrect. Community-based models have experienced an increasing need for a high level of clinical expertise in their case managers, as well as the traditional knowledge of community resources and health-care reimbursement methodologies. 4. Which of the following best addresses the needs of older adults? Select all that apply. 1. Predictive Model 2. Guided Care Model 3. Transitional Care Model 4. Patient-Centered Medical Home 5. Accountable Care Organizations Answer: 2, 3, 4 Pages: 16, 19 Feedback 1. This is incorrect. Predictive modeling is used to manage the health risk of the small percentage of individuals who drive a significant percentage of health-care expenditures. 2. This is correct. The Johns Hopkins Bloomberg School of Public Health designed the Guided Care Model for the better care of older people with chronic conditions. 3. This is correct. The Transitional Care Model has improved care for older adults at risk for readmission within the 30-day post discharge window. 4. This is correct. The Patient-Centered Medical Home (PCMH) Model focuses on providing health care to older adults by combining skills of the multidisciplinary team, family, caregivers, and patient. 5. This is incorrect. Accountable Care Organizations address the needs of chronically ill members. 5. Which of the following is essential to document financial outcomes of value-based purchasing agreements? 1. Predictive models 2. Risk management 3. Shared systems data 4. Reimbursement methods Answer: 3 Page: 15 Feedback 1. This is incorrect. Sharing data between disparate systems has become a major emphasis for health-care providers and payers as they assume accountability for financial outcomes in value-based purchasing agreements with the Centers for Medicaid and Medicare Services (CMS). 2. This is incorrect. Sharing data between disparate systems has become a major emphasis for health-care providers and payers as they assume accountability for financial outcomes in value-based purchasing agreements with the Centers for Medicaid and Medicare Services (CMS). 3. This is correct. Sharing data between disparate systems has become a major emphasis for health-care providers and payers as they assume accountability for financial outcomes in value-based purchasing agreements with the Centers for Medicaid and Medicare Services (CMS). 4. This is incorrect. Sharing data between disparate systems has become a major emphasis for health-care providers and payers as they assume accountability for financial outcomes in value-based purchasing agreements with the Centers for Medicaid and Medicare Services (CMS). 6. An advanced practice registered nurse (APRN) is providing care for a client with diabetes who is having difficulty adhering to the proposed plan of care. A successful APRN should possess which skill to procure the necessary items or services that will enable this patient to manage an illness? 1. Negotiation 2. Fiscal advocacy 3. Follow through 4. Use management Answer: 1 Page: 28 Feedback 1. This is correct. Negotiation is necessary to procure what a patient requires for health purposes. 2. This is incorrect. Fiscal advocacy is the ability to demonstrate the monetary effect of case management on care. Negotiation is necessary to procure what a patient requires for health purposes. 3. This is incorrect. Follow through is necessary to ensure optimum care within available resources. Negotiation is necessary to procure what a patient requires for health purposes. 4. This is incorrect. Use management is the appropriate use of resources. Negotiation is necessary to procure what a patient requires for health purposes. 7. What knowledge would be most beneficial for an advanced practice registered nurse (APRN) leading a primary care practice? 1. Discharge planning 2. Reimbursement methods 3. Population health management 4. Electronic medical record system Answer: 3 Page: 23 Feedback 1. This is incorrect. Knowledge of discharge planning is most beneficial for advanced practice registered nurse (APRN) case managers working in a hospital setting. The primary care APRN works with specific populations within a community. The APRN would be most involved in chronic disease management among specific populations, health promotion, and disease prevention. 2. This is incorrect. All advanced practice registered nurse (APRN) case managers benefit from knowledge of reimbursement methods. The primary care APRN works with specific populations within a community. The APRN would be most involved in chronic disease management among specific populations, health promotion, and disease prevention. 3. This is correct. The primary care advanced practice registered nurse (APRN) works with specific populations within a community. The APRN would be most involved in chronic disease management among specific populations, health promotion, and disease prevention. 4. This is incorrect. All advanced practice registered nurse (APRN) case managers benefit from knowledge of electronic medical record systems. The primary care APRN works with specific populations within a community. The APRN would be most involved in chronic disease management among specific populations, health promotion, and disease prevention. 8. Which of the following is a result of the increase in use of case management services? 1. Increased patient risk 2. Lack of accountability 3. Lack of care coordination 4. Decreased patient adherence Answer: 3 Page: 25 Feedback 1. This is incorrect. A down-side to the popularity and use of case management solutions across the continuum of care has been the lack of coordination of case management services. 2. This is incorrect. A down-side to the popularity and use of case management solutions across the continuum of care has been the lack of coordination of case management services. 3. This is correct. A down-side to the popularity and use of case management solutions across the continuum of care has been the lack of coordination of case management services. 4. This is incorrect. A down-side to the popularity and use of case management solutions across the continuum of care has been the lack of coordination of case management services. 9. Case management services are looking to add an additional staff member to work directly with a population of migrant farm workers and their families. Which of the following would be the most appropriate to address the needs of this community? 1. Diploma registered nurse 2. Master’s-APRN case manager 3. Baccalaureate nurse case manager 4. Master’s level functional case manager Answer: 2 Page: 27 Feedback 1. This is incorrect. Similar to baccalaureate nurse case managers, nurses with diploma/associate degrees have foundational theoretical and clinical knowledge in nursing, and can manage the care of patients who are less complex and more predictable, often with the assistance of critical paths. Master’s-APRN case managers can manage patients in high-risk, vulnerable populations. 2. This is correct. Master’s-APRN case managers have clinical expertise and advanced knowledge in health and wellness promotion and illness intervention models for specific patient populations. Master’s-APRN case managers can manage patients in high-risk, vulnerable populations. 3. This is incorrect. Baccalaureate registered nurse (RN) case managers have foundational theoretical and clinical knowledge in nursing and can manage the care of patients who are less complex and more predictable, often with the assistance of critical paths. Master’s-APRN case managers can manage patients in high-risk, vulnerable populations. 4. This is incorrect. Nurses with master’s level preparation specifically for the functional role of case manager possess expert knowledge and skill in case management models, processes and tools, health-care financing, reimbursement, outcome monitoring, and measurement. 10. An office wants to add a staff member with expert knowledge of health-care financing and reimbursement methods. Which of the following roles would be best suited to fill this position? 1. Diploma registered nurse 2. Master’s-APRN case manager 3. Baccalaureate nurse case manager 4. Master’s level functional case manager Answer: 4 Page: 27 Feedback 1. This is incorrect. Similar to baccalaureate nurse case managers, nurses with diploma/associate degrees have foundational theoretical and clinical knowledge in nursing, and can manage the care of patients who are less complex and more predictable, often with the assistance of critical paths. 2. This is incorrect. Master’s-APRN case managers have clinical expertise and advanced knowledge in health and wellness promotion and illness intervention models for specific patient populations. Master’s-APRN case managers manage patients in high-risk, vulnerable populations. 3. This is incorrect. Baccalaureate nurse case managers have foundational theoretical and clinical knowledge in nursing, and can manage the care of patients who are less complex and more predictable, often with the assistance of critical paths. 4. This is correct. Nurses with master’s level preparation specifically for the functional role of case manager possess expert knowledge and skill in case management models, processes and tools, health-care financing, reimbursement, outcome monitoring, and measurement. Chapter 16: The Advanced Practice Nurse and Research ANSWERS AND RATIONALE 1. The advanced practice registered nurse (APRN) identifies a hospital unit’s readmission rates as higher than national rates. How would an APRN demonstrate an understanding of the use of research in the clinical setting? 1. Search the literature to identify causes of frequent readmission rates. 2. Review financial ramifications of high readmission rates with unit nurses. 3. Conduct a survey of unit nurses to identify possible causes for the increase. 4. Ensure nurses provide thorough discharge teaching to decrease risk for readmission. Answer: 3 Page: 1 Feedback 1. This is incorrect. A literature search provides the advanced practice registered nurse (APRN) with evidence-based practices and scientific information. Identification of a clinical problem using research outcomes (readmission data) and data collection in the clinical area where the problem exists demonstrates the use of research in the clinical setting. 2. This is incorrect. Identification of a clinical problem using research outcomes (readmission data) and data collection in the clinical area where the problem exists demonstrates the use of research in the clinical setting. 3. This is correct. Identification of a clinical problem using research outcomes (readmission data) and data collection in the clinical area where the problem exists demonstrates the use of research in the clinical setting. 4. This is incorrect. Identification of a clinical problem using research outcomes (readmission data) and data collection in the clinical area where the problem exists demonstrates the use of research in the clinical setting. 2. Which of the following occurs during the second research competency phase? 1. Defining outcome measures 2. Implementing research outcomes 3. Generating new nursing knowledge 4. Teaching methods to critique research Answer: 1 Page: 4 Feedback 1. This is correct. The second research competency phase includes defining outcome measures to evaluate effectiveness of interventions. 2. This is incorrect. The first research competency phase focuses on interpreting and implementing research outcomes. 3. This is incorrect. The third research competency phase incorporates the collaborative generation of new knowledge. 4. This is incorrect. The first research competency phase includes teaching nurses how to critique research. 3. An advanced practice registered nurse (APRN) is compiling data to evaluate the effectiveness of his or her role. Which of the following is most useful for this evaluation? 1. Patient outcomes 2. Patient satisfaction 3. Revenue generation 4. Number of research studies Answer: 1 Page: 5 Feedback 1. This is correct. Patient outcomes demonstrate advanced practice registered nurse (APRN) role efficacy by validating APRNs’ contribution to patient care. 2. This is incorrect. Patient outcomes demonstrate advanced practice registered nurse (APRN) role efficacy by validating APRNs’ contribution to patient care. 3. This is incorrect. Patient outcomes demonstrate advanced practice registered nurse (APRN) role efficacy by validating APRNs’ contribution to patient care. 4. This is incorrect. Patient outcomes and research competency demonstrate advanced practice registered nurses’ (APRNs’) role efficacy by validating APRNs’ contribution to patient care. 4. An advanced practice registered nurse (APRN) is tracking the effectiveness of a new intravenous access device 6 weeks after its implementation. Which is the most important outcome measure? 1. Cost 2. Proper use 3. Infection rate 4. Provider satisfaction Answer: 3 Page: 8 Feedback 1. This is incorrect. Patient safety, evidenced by the infection rate, is the priority outcome. 2. This is incorrect. Patient safety, evidenced by the infection rate, is the priority outcome. 3. This is correct. Patient safety, evidenced by the infection rate, is the priority outcome. 4. This is incorrect. Patient safety, evidenced by the infection rate, is the priority outcome. 5. Which of the following are benefits of advanced practice registered nurse (APRN) participation in collaborative research? Select all that apply. 1. Administrative support 2. Efficient data collection 3. Manuscript preparation 4. Promotion of scholarship 5. Professional presentations Answer: 2, 4, 5 Page: 5 Feedback 1. This is incorrect. Administrative support is needed to conduct research. Benefits of collaborative advanced practice nurse (APN) research include shared expertise, academic influence, access to clinical populations, efficient data collection, improved research relevance, and the creation of an environment that promotes the application of scholarship in patient care. 2. This is correct. Benefits of collaborative advanced practice nurse (APN) research include shared expertise, academic influence, access to clinical populations, efficient data collection, improved research relevance, and the creation of an environment that promotes the application of scholarship in patient care. 3. This is incorrect. Manuscript preparation may occur independently. Benefits of collaborative advanced practice nurse (APN) research include shared expertise, academic influence, access to clinical populations, efficient data collection, improved research relevance, and the creation of an environment that promotes the application of scholarship in patient care. 4. This is correct. Benefits of collaborative advanced practice nurse (APN) research include shared expertise, academic influence, access to clinical populations, efficient data collection, improved research relevance, and the creation of an environment that promotes the application of scholarship in patient care. 5. This is correct. Benefits of collaborative advanced practice nurse (APN) research include shared expertise, academic influence, access to clinical populations, efficient data collection, improved research relevance, and the creation of an environment that promotes the application of scholarship in patient care. 6. An advanced practice registered nurse (APRN) research team is designing a study to examine the effectiveness of clinical nurse specialists (CNSs) in the intensive care unit (ICU). Which of the following is a priority to ensure the study moves forward? 1. Time frame 2. Funding sources 3. Clinician interest 4. Subject participation Answer: 3 Page: 10 Feedback 1. This is incorrect. The study is unlikely to move forward without clinician interest. 2. This is incorrect. The study is unlikely to move forward without clinician interest. 3. This is correct. The study is unlikely to move forward without clinician interest. 4. This is incorrect. The study is unlikely to move forward without clinician interest. 7. A new advanced practice registered nurse’s (APRN’s) research has been selected for presentation at Sigma Theta Tau’s Annual Research Congress. Which of the following actions is most important to prepare for the presentation? 1. Obtaining a mentor 2. Submitting the abstract 3. Designing the presentation 4. Selecting supplemental materials Answer: 1 Page: 10 Feedback 1. This is correct. Learning to present research-based practice changes or research studies may be difficult for a beginning advanced practice registered nurse (APRN); therefore, a new APRN should seek a mentor who is experienced in presenting and publishing. 2. This is incorrect. Learning to present research-based practice changes or research studies may be difficult for a beginning advanced practice registered nurse (APRN); therefore, a new APRN should seek a mentor who is experienced in presenting and publishing. 3. This is incorrect. Learning to present research-based practice changes or research studies may be difficult for a beginning advanced practice registered nurse (APRN); therefore, a new APRN should seek a mentor who is experienced in presenting and publishing. 4. This is incorrect. Learning to present research-based practice changes or research studies may be difficult for a beginning advanced practice registered nurse (APRN); therefore, a new APRN should seek a mentor who is experienced in presenting and publishing. 8. An advanced practice registered nurse (APRN) wants to conduct clinical research on the care of patients with chronic illnesses. Which of the following will support the APRN’s goal? Select all that apply. 1. Access to patients 2. Formal framework 3. Multidisciplinary team 4. Adherence to care protocols 5. Evidence-based nursing care Answer: 1, 2, 5 Pages: 15–17 Feedback 1. This is correct. When clinical research is considered unimportant, the advanced practice registered nurse (APRN) may be denied access to patients. 2. This is correct. A formal framework for research enhances the advanced practice registered nurse’s (APRN’s) opportunity to lead or participate in some aspect of clinical research. 3. This is incorrect. Multidisciplinary teams design, implement, and evaluate patient care. Support from a multidisciplinary team is necessary for successful clinical research. 4. This is incorrect. Adherence to care protocols is an expectation of nurses and other care providers. 5. This is correct. Hospitals that utilize evidence-based nursing care demonstrate commitment and support of nursing research. 9. Which of the following would be the best employer for an advanced practice registered nurse (APRN) who plans to engage in nursing research? 1. Magnet hospital 2. University hospital 3. Family practice clinic 4. Nursing organization Answer: 1 Page: 17 Feedback 1. This is correct. Hospitals with Magnet Recognition from the American Nurses Credentialing Center expect nurses to conduct clinical research. 2. This is incorrect. Though nursing research may be conducted in any clinical setting, hospitals with Magnet Recognition from the American Nurses Credentialing Center expect nurses to conduct clinical research. 3. This is incorrect. Though nursing research may be conducted in any clinical setting, hospitals with Magnet Recognition from the American Nurses Credentialing Center expect nurses to conduct clinical research. 4. This is incorrect. Though nursing research is conducted in many settings, hospitals with Magnet Recognition from the American Nurses Credentialing Center expect nurses to conduct clinical research. 10. An advanced practice registered nurse (APRN) can develop a culture of clinical research by training . Answer: selected clinicians Page: 23 Feedback: An advanced practice registered nurse (APRN) can develop a research-based nursing culture by training selected clinicians. Chapter 17: The Advanced Practice Nurse: Holism and Complementary and Integrative Health Approaches ANSWERS AND RATIONALES 1. Which definition should the advanced practice nurse (APN) share with a patient when providing education about holistic care? 1. “It is a practice used together with conventional medicine.” 2. “It involves the coordination of conventional and complementary approaches.” 3. “It refers to a non-mainstream practice used in place of conventional medicine.” 4. “It includes approaches and interventions that address the needs of the whole body.” Answer: 4 Page: 2 Feedback 1. This is incorrect. This is the definition of complementary approaches. 2. This is incorrect. This is the definition of integrative health care. 3. This is incorrect. This is the definition of alternative approaches. 4. This is correct. This is the definition the advanced practice nurse (APN) uses when providing patient education regarding holistic care. 2. A student wants to be certified in holistic nursing after obtaining a registered nurse (RN) license. Which of the following programs would provide this student with eligibility for certification upon graduation? Select all that apply. 1. Capital University 2. Florida Atlantic University 3. Metropolitan State University 4. Virginia Commonwealth University 5. Eastern University College of Nursing Answer: 1, 2, 3, 5 Page: 44 Feedback 1. This is correct. Graduates from Capital University are eligible for certification in holistic nursing after obtaining their registered nurse (RN) license. 2. This is correct. Graduates from Florida Atlantic University are eligible for certification in holistic nursing after obtaining their registered nurse (RN) license. 3. This is correct. Graduates from Metropolitan State University are eligible for certification in holistic nursing after obtaining their registered nurse (RN) license. 4. This is incorrect. Graduates from Virginia Commonwealth University are not eligible for certification in holistic nursing after obtaining their registered nurse (RN) licensure. 5. This is correct. Graduates from Eastern University College of Nursing are eligible for certification in holistic nursing after obtaining their registered nurse (RN) license. 3. Which definition should the advanced practice nurse (APN) share with a patient when providing education about complementary approaches? 1. “It is a practice used together with conventional medicine.” 2. “It involves the coordination of conventional and complementary approaches.” 3. “It refers to a non-mainstream practice used in place of conventional medicine.” 4. “It includes approaches and interventions that address the needs of the whole body.” Answer: 1 Page: 2 Feedback 1. This is correct. This is the definition of complementary approaches and is appropriate for the nurse to share with the patient. 2. This is incorrect. This is the definition of integrative health care. 3. This is incorrect. This is the definition of alternative approaches. 4. This is incorrect. This is the definition of holistic care. 4. Which is an approved resource from the American Holistic Nurse Association (AHNA) that the advanced practice nurse (APN) can use to research information for a patient inquiring about holistic health-care options? Select all that apply. 1. Beginnings 2. Monthly eNews 3. Nursing Research 4. Pediatric Nursing 5. Dr. Mercola Answer: 1, 2 Page: 42 Feedback 1. This is correct. This is the newsletter published by the American Holistic Nurse Association (AHNA); therefore, it is an appropriate resource for the advanced practice nurse (APN) to use. 2. This is correct. This is an appropriate resource for the advanced practice nurse (APN) to use when researching information regarding holistic health-care options. 3. This is incorrect. This journal is not an approved resource from the American Holistic Nurse Association (AHNA). 4. This is incorrect. This journal is not an approved resource from the American Holistic Nurse Association (AHNA). 5. This is incorrect. Dr. Mercola is not an approved resource from the American Holistic Nurse Association (AHNA). 5. Which definition should the advanced practice nurse (APN) share with a patient when providing education about integrative health care? 1. “It is a practice used together with conventional medicine.” 2. “It involves the coordination of conventional and complementary approaches.” 3. “It refers to a non-mainstream practice used in place of conventional medicine.” 4. “It includes approaches and interventions that address the needs of the whole body.” Answer: 2 Page: 2 Feedback 1. This is incorrect. This is the definition of complementary approaches. 2. This is correct. This is the definition of integrative health care and is appropriate for the advanced practice nurse (APN) to share with the patient during the teaching session. 3. This is incorrect. This is the definition of alternative approaches. 4. This is incorrect. This is the definition of holistic care. 6. Which term does the advanced practice nurse (APN) substitute for botanicals when providing education to a patient regarding natural products? 1. Herbs 2. Vitamins 3. Minerals 4. Probiotics Answer: 1 Page: 7 Feedback 1. This is correct. Herbs is another term for botanicals, a natural product. Natural products are often sold as dietary supplements. 2. This is incorrect. Vitamins are an example of a natural product; however, it is not another term for botanicals. 3. This is incorrect. Minerals are an example of a natural product; however, it is not another term for botanicals. 4. This is incorrect. Probiotics are an example of a natural product; however, it is not another term for botanicals. 7. Which definition should the advanced practice nurse (APN) share with a patient when providing education about alternative approaches? 1. “It is a practice used together with conventional medicine.” 2. “It involves the coordination of conventional and complementary approaches.” 3. “It refers to a non-mainstream practice used in place of conventional medicine.” 4. “It includes approaches and interventions that address the needs of the whole body.” Answer: 3 Page: 2 Feedback 1. This is incorrect. This is the definition of complementary approaches. 2. This is incorrect. This is the definition of integrative health care. 3. This is correct. This is the definition of alternative approaches and is appropriate for the advanced practice nurse (APN) to share with the patient during the teaching session. 4. This is incorrect. This is the definition of holistic care. 8. Which does the advanced practice nurse (APN) include when teaching a patient about mind and body practices? Select all that apply. 1. Probiotics 2. Meditation 3. Acupuncture 4. Healing touch 5. Guided imagery Answer: 2, 3, 4, 5 Page: 7 Feedback 1. This is incorrect. Probiotics is an example of a natural product, not a mind and body practice. 2. This is correct. Meditation is an example of a mind and body practice. 3. This is correct. Acupuncture is an example of a mind and body practice. 4. This is correct. Healing touch is an example of a mind and body practice. 5. This is correct. Guided imagery is an example of a mind and body practice. 9. Most health approaches fall into one of two subgroups: natural products or mind and body practices. Answer: complementary Page: 7 Feedback: Most complementary health approaches fall into one of two subgroups: natural products or mind and body practices. 10. A patient can have the unexpected benefit mind-body response of the that results from a person’s anticipation that an intervention will help. Answer: placebo effect Page: 7 Feedback: A patient can have the unexpected benefit mind-body response of the placebo effect that results from a person’s anticipation that an intervention will help. Chapter 18: Basic Skills for Teaching and the Advanced Practice Registered Nurse ANSWERS AND RATIONALES 1. How would the advanced practice nurse (APN) exemplify the quality of expert knowledge, one of the five predominant qualities of effective teaching? 1. Provides support for students. 2. Uses sound clinical judgments. 3. Translates current research findings into clinical practice. 4. Effectively demonstrates procedures and technical skills. Answer: 3 Page: 4 Feedback 1. This is incorrect. This detail is required to have positive relationships. 2. This is incorrect. This detail is required for clinical competence. 3. This is correct. Translating current research findings into clinical practice is a detail the advanced practice nurse (APN) must exemplify to have expert knowledge. 4. This is incorrect. This detail is required for teaching skills. 2. For effective patient teaching, which of the following personal characteristics should the advanced practice nurse (APN) possess? Select all that apply. 1. Admits mistakes 2. Explains ideas clearly 3. Possesses a sense of humor 4. Portrays an enthusiasm for teaching 5. Demonstrates technical skills effectively Answer: 1, 3, 4 Page: 4 Feedback 1. This is correct. This is a personal characteristic the advanced practice nurse (APN) must possess to provide effective patient teaching. 2. This is incorrect. This is a teaching skill the advanced practice nurse (APN) must possess to provide effective patient teaching. 3. This is correct. This is a personal characteristic the advanced practice nurse (APN) must possess to provide effective patient teaching. 4. This is correct. This is a personal characteristic the advanced practice nurse (APN) must possess to provide effective patient teaching. 5. This is incorrect. This is a teaching skill the advanced practice nurse (APN) must possess to provide effective patient teaching. 3. How would the advanced practice nurse (APN) exemplify the quality of clinical competence, one of the five predominant qualities of effective teaching? 1. Communicates clearly 2. Knows how to care for patients 3. Is up-to-date with interventions 4. Evaluates learners fairly Answer: 2 Page: 4 Feedback 1. This is incorrect. This detail is required to have positive relationships. 2. This is correct. This detail is required for clinical competence. 3. This is incorrect. This detail is required for expert knowledge. 4. This is incorrect. This detail is required for teaching skills. 4. An advanced practice nurse (APN) is planning patient education activities. Which question should the APN use to guide the assessment of learning needs? 1. What is the learner’s occupation? 2. What does the educator know about the content? 3. What competencies does the learner already have? 4. What should be taught based on the goals and objectives? Answer: 3 Page: 5 Feedback 1. This is incorrect. This question does not guide the advanced practice nurse’s (APN’s) assessment of learning needs when planning patient education activities. 2. This is incorrect. This question does not guide the advanced practice nurse’s (APN’s) assessment of learning needs when planning patient education activities. 3. This is correct. Determining the learner’s competencies is an important part of the assessment of learning needs when planning patient education activities. 4. This is incorrect. This question does not guide the advanced practice nurse’s (APN’s) assessment of learning needs when planning patient education activities. 5. How would the advanced practice nurse (APN) exemplify the quality of teaching skills, one of the five predominant qualities of effective teaching? 1. Communicates clearly 2. Knows how to care for patients 3. Is up-to-date with interventions 4. Evaluates learners fairly Answer: 4 Page: 4 Feedback 1. This is incorrect. This detail is required to have positive relationships. 2. This is incorrect. This detail is required for clinical competence. 3. This is incorrect. This detail is required for expert knowledge. 4. This is correct. This detail is required for teaching skills. 6. The advanced practice nurse (APN) is educating a patient who is newly diagnosed with type 2 diabetes mellitus. Which is an example of positive reinforcement that the APN could use? 1. Offering praise after successfully testing blood glucose levels 2. Explaining why monitoring blood glucose levels is important 3. Allowing adequate time for practice with monitoring blood glucose levels 4. Reviewing the procedure for monitoring blood glucose over several sessions Answer: 1 Page: 6 Feedback 1. This is correct. This is an example of positive reinforcement. 2. This is incorrect. Although this is a strategy for motivating learners, it is not an example of positive reinforcement. 3. This is incorrect. Although this is a strategy for motivating learners, it is not an example of positive reinforcement. 4. This is incorrect. Although this is a strategy for motivating learners, it is not an example of positive reinforcement. 7. How would the advanced practice nurse (APN) exemplify the quality of positive relationships, one of the five predominant qualities of effective teaching? 1. Provides support for students 2. Uses sound clinical judgments 3. Translates current research findings into clinical practice 4. Effectively demonstrates procedures and technical skills Answer: 1 Page: 4 Feedback 1. This is correct. This detail is required to have positive relationships. 2. This is incorrect. This detail is required for clinical competence. 3. This is incorrect. This detail is required for expert knowledge. 4. This is incorrect. This detail is required for teaching skills. 8. Which teaching skill should the advanced practice nurse (APN) possess to provide effective patient education? Select all that apply. 1. Admits mistakes 2. Explains ideas clearly 3. Possesses a sense of humor 4. Portrays an enthusiasm for teaching 5. Demonstrates technical skills effectively Answer: 2, 5 Page: 4 Feedback 1. This is incorrect. This is a personal characteristic the advanced practice nurse (APN) must possess to provide effective patient teaching. 2. This is correct. This is a teaching skill the advanced practice nurse (APN) must possess to provide effective patient teaching. 3. This is incorrect. This is a personal characteristic the advanced practice nurse (APN) must possess to provide effective patient teaching. 4. This is incorrect. This is a personal characteristic the advanced practice nurse (APN) must possess to provide effective patient teaching. 5. This is correct. This is a teaching skill the advanced practice nurse (APN) must possess to provide effective patient teaching. 9. When preparing a teaching session for a group of novice nurses, the advanced practice nurse (APN) must know the learners and their . Answer: backgrounds Page: 17 Feedback: When preparing a teaching session for a group of novice nurses, the advanced practice nurse (APN) must know the learners and their backgrounds. 10. When evaluating print materials and Web sites for use in patient education, the advanced practice nurse (APN) should consider variety of media and . Answer: readability Pages: 23–24 Feedback: When evaluating print materials and Web sites for use in patient education, the advanced practice nurse (APN) should consider variety of media and readability. Chapter 19: Culture as a Variable in Practice ANSWERS AND RATIONALES 1. The advanced practice nurse (APN) administers a health literacy assessment asking the middle-age patient to pronounce words in ascending order of difficulty. Which assessment is the APN administering? Select all that apply. 1. Rapid Estimate of Adult Literacy in Medicine (REALM) 2. Test of Functional Health Literacy in Adults (TOFHLA) 3. Rapid Estimate of Adult Literacy in Medicine–Short Form (REALM-SF) 4. Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) 5. Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen) Answer: 1, 3 Page: 40 Feedback 1. This is correct. REALM (Rapid Estimate of Adult Literacy in Medicine) is a health literacy assessment tool. The advanced practice nurse (APN) asks the individual to pronounce words in ascending order of difficulty. 2. This is incorrect. TOFHLA (Test of Functional Health Literacy in Adults) is a health literacy assessment tool where the advanced practice nurse (APN) asks the patient to replace the missing words in a paragraph from four multiple-choice answer options for each missing word. 3. This is correct. REALM-SF (Rapid Estimate of Adult Literacy in Medicine–Short Form) is a health literacy assessment tool. The advanced practice nurse (APN) asks the individual to pronounce words in ascending order of difficulty. 4. This is incorrect. SAHLSA-50 (Short Assessment of Health Literacy for Spanish Adults) measures the ability of the Spanish-speaking adults to read and understand commonly used medical terms. The advanced practice nurse (APN) asks the patient to read the medical term aloud and to select the word that is similar in meaning. 5. This is incorrect. REALM-Teen (Rapid Estimate of Adolescent Literacy in Medicine) is a health literacy assessment tool. Although the advanced practice nurse (APN) does ask the individual to pronounce words in ascending order of difficulty, this assessment is appropriate for the adolescent, not middle-age adult, patient. 2. The advanced practice nurse (APN) administers a health literacy assessment asking the patient to replace missing words in paragraphs from multiple-choice options for each missing word. Which assessment is the APN administering? 1. Rapid Estimate of Adult Literacy in Medicine (REALM) 2. Test of Functional Health Literacy in Adults (TOFHLA) 3. Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) 4. Newest Vital Sign (NVS) Answer: 2 Page: 40 Feedback 1. This is incorrect. REALM (Rapid Estimate of Adult Literacy in Medicine) is a health literacy assessment tool. This tool does require the advanced practice nurse (APN) to ask the patient to pronounce words in ascending order; however, this tool is appropriate for adult, not adolescent, patients. 2. This is correct. TOFHLA (Test of Functional Health Literacy in Adults) is a health literacy assessment tool where the advanced practice nurse (APN) asks the patient to replace the missing words in a paragraph from four multiple-choice answer options for each missing word. 3. This is incorrect. SAHLSA-50 (Short Assessment of Health Literacy for Spanish Adults) measures the ability of the Spanish-speaking adults to read and understand commonly used medical terms. The advanced practice nurse (APN) asks the patient to read the medical term aloud and to select the word that is similar in meaning. 4. This is incorrect. The NVS (Newest Vital Sign) is a health literacy assessment tool that asks the individual to read a label to test both reading comprehension and numeracy skills. 3. Which assessment tool is appropriate for the advanced practice nurse (APN) to use when assessing the health literacy of a Spanish-speaking patient? Select all that apply. 1. Newest Vital Sign (NVS) 2. Rapid Estimate of Adult Literacy in Medicine (REALM) 3. Test of Functional Health Literacy in Adults (TOFHLA) 4. Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) 5. Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen) Answer: 1, 2, 3, 4 Page: 40 Feedback 1. This is correct. The NVS (Newest Vital Sign) is a health literacy assessment tool that is available in Spanish; therefore, this is an appropriate tool for the advanced practice nurse (APN) to use. 2. This is correct. REALM (Rapid Estimate of Adult Literacy in Medicine) is a health literacy assessment tool that is available in Spanish; therefore, this is an appropriate tool for the advanced practice nurse (APN) to use. 3. This is correct. TOFHLA (Test of Functional Health Literacy in Adults) is a health literacy assessment tool that is available in Spanish; therefore, this is an appropriate tool for the advanced practice nurse (APN) to use. 4. This is correct. SAHLSA-50 (Short Assessment of Health Literacy for Spanish Adults) is a health literacy assessment tool for Spanish-speaking individuals; therefore, this is an appropriate tool for the advanced practice nurse (APN) to use. 5. This is incorrect. REALM-Teen (Rapid Estimate of Adolescent Literacy in Medicine) is a health literacy assessment tool; however, this tool is not available in Spanish. 4. Which tool does the advanced practice nurse (APN) use when assessing both reading comprehension and numeric ability when conducting a health literacy assessment? 1. Newest Vital Sign (NVS) 2. Rapid Estimate of Adult Literacy in Medicine (REALM) 3. Test of Functional Health Literacy in Adults (TOFHLA) 4. Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) Answer: 3 Page: 40 Feedback 1. This is incorrect. Although this is a health literacy assessment tool, it is not used for both reading comprehension and numeric ability. 2. This is incorrect. Although this is a health literacy assessment tool, it is not used for both reading comprehension and numeric ability. 3. This is correct. TOFHLA (Test of Functional Health Literacy in Adults) is a health literacy assessment tool that assesses both reading comprehension and numeric ability; therefore, this is the appropriate tool for the APN to use when conducting the assessment. 4. This is incorrect. Although this is a health literacy assessment tool, it is not used for both reading comprehension and numeric ability. 5. The advanced practice nurse (APN) is conducting an assessment for a patient of a different cultural background. Which question is appropriate for the APN to ask the patient to assess perceptions? 1. “How do you define health and illness?” 2. “Do you use folk medicine to treat your condition?” 3. “Who makes health-care decisions within your family?” 4. “How do your spiritual beliefs affect your health-care choices? Answer: 1 Page: 57 Feedback 1. This is correct. This is an appropriate question for the advanced practice nurse (APN) to ask the patient when assessing cultural perception. 2. This is incorrect. This question is appropriate when assessing the patient’s use or beliefs related to complementary medicine. 3. This is incorrect. This question is appropriate when assessing decision making. 4. This is incorrect. This question is appropriate when assessing religion. 6. The advanced practice nurse (APN) is conducting an assessment for a patient of a different cultural background. Which question is appropriate for the APN to ask the patient to assess interpersonal behavior? 1. “How do you define health and illness?” 2. “Do you use folk medicine to treat your condition?” 3. “Do you have any particular norms related to eye contact?” 4. “How do your spiritual beliefs affect your health-care choices?” Answer: 3 Page: 57 Feedback 1. This is incorrect. This question is appropriate when assessing perceptions, not interpersonal behavior. 2. This is incorrect. This question is appropriate when assessing the patient’s use or beliefs related to complementary medicine, not interpersonal behavior. 3. This is correct. This question is appropriate when assessing interpersonal behavior for a patient who is from a culture that is different than the advanced practice nurse (APN). 4. This is incorrect. This question is appropriate when assessing religion, not interpersonal behavior. 7. The advanced practice nurse (APN) conducts an assessment for a patient from a different culture. Which question is appropriate for the APN to ask to elicit beliefs and treatment expectations for the patient who is seeking illness care? Select all that apply. 1. “What do you think caused your problem?” 2. “What kind of treatment should you receive?” 3. “What do you fear most about your sickness?” 4. “Who makes health-care decisions in your family?” 5. “What are your folk medicine beliefs and practices?” Answer: 1, 2, 3 Page: 51 Feedback 1. This is correct. This question is appropriate for the advanced practice nurse (APN) to ask to elicit beliefs and treatment expectations for the patient of a different culture who seeks care for an illness. 2. This is correct. This question is appropriate for the advanced practice nurse (APN) to ask to elicit beliefs and treatment expectations for the patient of a different culture who seeks care for an illness. 3. This is correct. This question is appropriate for the advanced practice nurse (APN) to ask to elicit beliefs and treatment expectations for the patient of a different culture who seeks care for an illness. 4. This is incorrect. This is a key question used to explore cultural groups, not to elicit beliefs and treatment expectations for the patient of a different culture who seeks care for an illness. 5. This is incorrect. This is a key question used to explore cultural groups, not to elicit beliefs and treatment expectations for the patient of a different culture who seeks care for an illness. 8. When working with a population within a community, which racial group does the advanced practice nurse (APN) identify as being at the greatest risk for health disparity related to poverty? 1. Blacks 2. Asians 3. Hispanics 4. Non-Hispanic whites Answer: 1 Page: 10 Feedback 1. This is correct. The poverty rate for blacks is 26.2%, indicating a great risk for health disparity. Blacks have the greatest risk for health disparity related to poverty when compared with Asians, Hispanics, and non-Hispanic whites. 2. This is incorrect. The poverty rate for Asians is 12%. Blacks have a greater risk for health disparity when compared with Asians. 3. This is incorrect. The poverty rate for Hispanics is 23.6%. Blacks have a greater risk for health disparity when compared with Hispanics. 4. This is incorrect. The poverty rate for non-Hispanic whites is 10.1%. Blacks have a greater risk for health disparity when compared with non-Hispanic Whites. 9. A valuable tool for assessing the cultural and Conducting a Cultural Competence Self-Assessment. Answer: linguistic Page: 20 competency of a health-care organization is Feedback: A valuable tool for assessing the cultural and linguistic competency of a health-care organization is Conducting a Cultural Competence Self-Assessment. 10. The advanced practice nurse (APN) uses the Field Guide to assess five domain areas identified by the community. Answer: LGBT Pages: 30–31 Feedback: The advanced practice nurse (APN) uses the Field Guide to assess five domain areas identified by the LGBT community. Chapter 20: Conflict Resolution in Advanced Practice Nursing ANSWERS AND RATIONALES 1. Which health-care provider must commit to a career-long effort to develop conflict resolution skills? Select all that apply. 1. Nurse anesthetist 2. Certified nurse-midwife (CNM) 3. Registered nurse (RN) 4. Nurse practitioner (NP) 5. Nursing assistive personnel (NAP) Answer: 1, 2, 4 Page: 1 Feedback 1. This is correct. All advanced practice nurses (APNs) must commit to a career-long effort to develop conflict resolution skills. The nurse anesthetist is an APN. 2. This is correct. All advanced practice nurses (APNs) must commit to a career-long effort to develop conflict resolution skills. The certified nurse-midwife (CNM) is an APN. 3. This is incorrect. The registered nurse (RN) should develop conflict resolution skills; however, the RN is not an APN. 4. This is correct. All advanced practice nurses (APNs) must commit to a career-long effort to develop conflict resolution skills. The nurse practitioner (NP) is an APN. 5. This is incorrect. The nursing assistive personnel (NAP) should develop conflict resolution skills; however, the NAP is not an APN. 2. Which conflict is the advanced practice nurse (APN) likely to experience in practice? Select all that apply. 1. Conflict with patients 2. Conflict with a surgeon 3. Conflict with own family 4. Conflict with procedures 5. Conflict with the nurse manager Answer: 1, 2, 4, 5 Page: 5 Feedback 1. This is correct. Advanced practice nurses (APNs) will deal with conflicts with their patients in practice. 2. This is correct. Advanced practice nurses (APNs) will deal with conflicts with other health-care providers, including surgeons, in practice. 3. This is incorrect. Although personal conflict with family occurs, it is unlikely the advanced practice nurse (APN) will experience this in practice. 4. This is correct. Advanced practice nurses (APNs) will deal with conflicts with institutional policies and procedures in practice. 5. This is correct. Advanced practice nurses (APNs) will deal with conflicts with administrative leaders, including nurse managers, in practice. 3. Which does the advanced practice nurse (APN) identify as a distinct response to conflict when referring to the Thomas-Kilmann Index (TKI)? Select all that apply. 1. Trusting 2. Avoiding 3. Competing 4. Collaborating 5. Compromising 6. Accommodating Answer: 2, 3, 4, 5, 6 Page: 5 Feedback 1. This is incorrect. Trusting is not a distinct response to conflict per the Thomas-Kilmann Index (TKI). 2. This is correct. Avoiding is a distinct response to conflict per the Thomas-Kilmann Index (TKI). 3. This is correct. Competing is a distinct response to conflict per the Thomas-Kilmann Index (TKI). 4. This is correct. Collaborating is a distinct response to conflict per the Thomas-Kilmann Index (TKI). 5. This is correct. Compromising is a distinct response to conflict per the Thomas-Kilmann Index (TKI). 6. This is correct. Accommodating is a distinct response to conflict per the Thomas-Kilmann Index (TKI). 4. Which conflict management modes are nurses most likely to use? Select all that apply. 1. Avoiding 2. Competing 3. Collaborating 4. Compromising 5. Accommodating Answer: 1, 4, 5 Page: 5 Feedback 1. This is correct. Avoiding, compromising, and accommodating are the conflict management skills that nurses are likely to use. 2. This is incorrect. Competing is not a conflict management skill the nurse is likely to use. This response causes the nurse to be disadvantaged. 3. This is incorrect. Collaborating is not a conflict management skill the nurse is likely to use. This response causes the nurse to be disadvantaged. 4. This is correct. Avoiding, compromising, and accommodating are the conflict management skills that nurses are likely to use. It is important to note that compromising, although used frequently by nurses, leads all parties to the conflict being equally disadvantaged. 5. This is correct. Avoiding, compromising, and accommodating are the conflict management skills that nurses are likely to use. 5. Which response to conflict is likely to cause the advanced practice nurse (APN) to be discouraged and frustrated? Select all that apply. 1. Avoiding 2. Competing 3. Collaborating 4. Compromising 5. Accommodating Answer: 1, 5 Page: 7 Feedback 1. This is correct. Avoiding conflict often causes the advanced practice nurse (APN) to be discouraged and frustrated. 2. This is incorrect. This response to conflict is not likely to cause the advanced practice nurse (APN) to be discouraged and frustrated. 3. This is incorrect. This response to conflict is not likely to cause the advanced practice nurse (APN) to be discouraged and frustrated. 4. This is incorrect. This response to conflict is not likely to cause the advanced practice nurse (APN) to be discouraged and frustrated. 5. This is correct. Accommodating conflict often causes the advanced practice nurse (APN) to be discouraged and frustrated. 6. Which is a justification that many advanced practice nurses (APNs) use when hesitating to directly confront peers? 1. “Maybe it won’t happen again.” 2. “I don’t have time to address the issue.” 3. “I am not trained to confront this person.” 4. “We are not responsible for the physicians.” Answer: 1 Pages: 16–17 Feedback 1. This is correct. This is a common justification used by advanced practice nurses (APNs) when hesitating to directly confront peers. 2. This is incorrect. This is not a common justification used by advanced practice nurses (APNs) when hesitating to directly confront peers. 3. This is incorrect. This is not a common justification used by advanced practice nurses (APNs) when hesitating to directly confront peers. 4. This is incorrect. This is not a common justification used by advanced practice nurses (APNs) when hesitating to directly confront peers. 7. Which action by the advanced practice nurse (APN) is appropriate when confronting a conflict with another member of the health-care team? 1. Using subjective opinions 2. Presenting a written record 3. Proposing punitive solutions 4. Reminding self the goal is retribution Answer: 2 Pages: 17–18 Feedback 1. This is incorrect. The use of facts, versus opinions, is best when confronting conflict with another member of the health-care team. 2. This is correct. Presenting a written record is an appropriate action when confronting conflict with another member of the health-care team. 3. This is incorrect. Proposals should be rehabilitative, not punitive. 4. This is incorrect. The goal is a reduction of toxic behavior, not retribution. 8. Which action by the advanced practice nurse (APN) is inappropriate when confronting a conflict with another member of the health-care team? Select all that apply. 1. Using subjective opinions 2. Presenting a written record 3. Proposing punitive solutions 4. Reminding self the goal is retribution 5. Avoiding emotionally charged adjectives Answer: 1, 3, 4 Pages: 17–18 Feedback 1. This is correct. This is an inappropriate action by the advanced practice nurse (APN) when confronting conflict with another member of the health-care team. 2. This is incorrect. This is an appropriate action by the advanced practice nurse (APN) when confronting conflict with another member of the health-care team. 3. This is correct. This is an inappropriate action by the advanced practice nurse (APN) when confronting conflict with another member of the health-care team. 4. This is correct. This is an inappropriate action by the advanced practice nurse (APN) when confronting conflict with another member of the health-care team. 5. This is incorrect. This is an appropriate action by the advanced practice nurse (APN) when confronting conflict with another member of the health-care team. 9. When participating in conflict resolution, the advanced practice nurse (APN) must describe what happened rather than how you felt about it or how you it. Answer: interpret Page: 18 Feedback: When participating in conflict resolution, the advanced practice nurse (APN) must describe what happened rather than how you felt about it or how you interpret it. 10. When asked to propose solutions during conflict resolution, the advanced practice nurse proposes rehabilitative solutions, making it about the and effectiveness of the hospital and not about you. Answer: integrity Page: 18 Feedback: When asked to propose solutions during conflict resolution, the advanced practice nurse (APN) proposes rehabilitative solutions, making it about the integrity and effectiveness of the hospital and not about you. Chapter 21: Leadership for APNs: If Not Now, When? ANSWERS AND RATIONALES 1. Which characteristic must the advanced practice nurse (APN) possess to implement servant leadership? Select all that apply. 1. Empathy 2. Charisma 3. Awareness 4. Stewardship 5. Active listening Answer: 1, 3, 4, 5 Pages: 6–7 Feedback 1. This is correct. Empathy is a characteristic the advanced practice nurse (APN) must possess to implement servant leadership. 2. This is incorrect. Charisma is needed for transformational or transactional leadership, not servant leadership. 3. This is correct. Awareness is a characteristic the advanced practice nurse (APN) must possess to implement servant leadership. 4. This is correct. Stewardship is a characteristic the advanced practice nurse (APN) must possess to implement servant leadership. 5. This is correct. Active listening is a characteristic the advanced practice nurse (APN) must possess to implement servant leadership. 2. Which characteristic must the advanced practice nurse (APN) possess to implement transformational leadership? 1. Empathy 2. Charisma 3. Awareness 4. Stewardship Answer: 2 Pages: 6–7 Feedback 1. This is incorrect. Empathy is a characteristic associated with servant, not transformational, leadership. 2. This is correct. Charisma is a characteristic associated with transformational leadership. 3. This is incorrect. Awareness is a characteristic associated with servant, not transformational, leadership. 4. This is incorrect. Stewardship is a characteristic associated with servant, not transformational, leadership. 3. Which is an advantage the advanced practice nurse (APN) includes when presenting information about servant leadership? 1. Builds trust and collaboration 2. Introduces the concept of caring 3. Enables adaptation to complexity 4. Creates an independent environment Answer: 2 Page: 7 Feedback 1. This is incorrect. This is not an advantage the advanced practice nurse (APN) includes in a presentation about servant leadership. This is an advantage of clinical/congruent leadership. 2. This is correct. Servant leadership introduces the concept of caring. This is an advantage the advanced practice nurse (APN) should include in the presentation. 3. This is incorrect. This is not an advantage the advanced practice nurse (APN) includes in a presentation about servant leadership. This is an advantage of relational leadership. 4. This is incorrect. This is not an advantage the advanced practice nurse (APN) includes in a presentation about servant leadership. 4. Which type of leadership is considered most effective in turbulent markets because leaders elevate the interest of their followers and look beyond their own self-interest? 1. Clinical 2. Servant 3. Relational 4. Transformational Answer: 4 Page: 7 Feedback 1. This is incorrect. Clinical leadership is not considered most effective in turbulent markets. 2. This is incorrect. Servant leadership is not considered most effective in turbulent markets. 3. This is incorrect. Relational leadership is not considered most effective in turbulent markets. 4. This is correct. Transformational leadership is considered the most effective type of leadership in turbulent markets. 5. Which concept is included in Kouzes’ and Posner’s definition of leadership? Select all that apply. 1. Title 2. Power 3. Actions 4. Authority 5. Credibility 6. Relationships Answer: 3, 5, 6 Page: 8 Feedback 1. This is incorrect. Kouzes’ and Posner’s definition of leadership does not include title. 2. This is incorrect. Kouzes’ and Posner’s definition of leadership does not include power. 3. This is correct. Kouzes’ and Posner’s definition of leadership includes actions. 4. This is incorrect. Kouzes’ and Posner’s definition of leadership does not include authority. 5. This is correct. Kouzes’ and Posner’s definition of leadership includes credibility. 6. This is correct. Kouzes’ and Posner’s definition of leadership includes relationships. 6. Which attribute exemplifies credibility as defined by Kouzes and Posner? Select all that apply. 1. Honesty 2. Confidence 3. Stimulating 4. Competency 5. Inspirational Answer: 1, 4, 5 Page: 8 Feedback 1. This is correct. This attribute exemplifies credibility as defined by Kouzes and Posner. 2. This is incorrect. This attribute is not noted to exemplify credibility as defined by Kouzes and Posner. 3. This is incorrect. This attribute is not noted to exemplify credibility as defined by Kouzes and Posner. 4. This is correct. This attribute exemplifies credibility as defined by Kouzes and Posner. 5. This is correct. This attribute exemplifies credibility as defined by Kouzes and Posner. 7. Which of the following are clusters of cognitive intelligence? Select all that apply. 1. Self-awareness 2. Self-management 3. Social intelligence 4. Self-assertiveness 5. Relationship management Answer: 1, 2, 3, 5 Page: 13 Feedback 1. This is correct. Self-awareness is a cluster of cognitive intelligence. 2. This is correct. Self-management is a cluster of cognitive intelligence. 3. This is correct. Social intelligence is a cluster of cognitive intelligence. 4. This is incorrect. Self-assertiveness is not a cluster of cognitive intelligence. 5. This is correct. Relationship management is a cluster of cognitive intelligence. 8. Which is a subconcept that is explored with self-management? 1. Empathy 2. Influence 3. Teamwork 4. Adaptability Answer: 4 Page: 13 Feedback 1. This is incorrect. Empathy is a subconcept of social intelligence, not self-management. 2. This is incorrect. Influence is a subconcept of relationship management, not self- management. 3. This is incorrect. Teamwork is a subconcept of relationship management, not self- management. 4. This is correct. Adaptability is a subconcept of self-management. 9. requires the leader to be honest with him- or herself and with others about his or her strengths and weaknesses. Answer: self-awareness Page: 13 Feedback: Self-awareness requires the leader to be honest with him- or herself and with others about his or her strengths and weaknesses. 10. Social awareness requires the leader to be , a good listener, and attuned to the needs of others. Answer: empathetic Page: 13 Feedback: Social awareness requires the leader to be empathetic, a good listener, and attuned to the needs of others. Chapter 22: Information Technology and the Advanced Practice Nurse ANSWERS AND RATIONALES 1. The nurse is educating a new registered nurse (RN) on the electronic health record. Which statement by the RN indicates that learning has been effective? 1. “The electronic health record allows only health-care providers to access client records.” 2. “Clients can designate individuals who can access their medical information.” 3. “Health-care providers pay a small fee for each client who signs up to use the electronic health record.” 4. “The electronic health record does not include past medical records.” Answer: 2 Page: 3 Feedback 1. This is incorrect. The electronic health record allows clients to access their health-care records. 2. This is correct. Clients can designate individuals who can access their medical information. 3. This is incorrect. There is no fee for clients to sign up for the health-care record. 4. This is incorrect. The health-care record includes all the client’s health-care information. 2. Which of the following is a central objective of the meaningful use of the electronic health record incentive program? 1. Low-cost health-care provisions 2. General education 3. Paper prescription reintegration 4. Public health reporting Answer: 4 Page: 3 Feedback 1. This is incorrect. Providing low-cost health care is not an objective. 2. This is incorrect. Providing specific education is an objective. 3. This is incorrect. Electronic prescribing is an objective. 4. This is correct. Public health reporting is an objective. 3. Which of the following is a benefit of the electronic health record? 1. Reduction in medical errors 2. Costs related to implementation 3. Workflow reorganization 4. Health information safety Answer: 1 Page: 4 Feedback 1. This is correct. A benefit of the electronic health record is reduction in medical errors. 2. This is incorrect. A disadvantage of the health record is costs related to implementation. 3. This is incorrect. A disadvantage of the health record is disruption in workflow. 4. This is incorrect. A disadvantage of the health record is safety of health information. 4. When using the electronic health record, which of the following is a disadvantage? 1. Increased medical errors 2. Adherence to evidence-based guidelines 3. Ongoing training 4. Clinical decision support Answer: 3 Page: 4 Feedback 1. This is incorrect. The electronic medical record has led to a decrease in medical errors. 2. This is incorrect. Adherence to evidence-based guidelines is an advantage. 3. This is correct. A disadvantage is ongoing training. 4. This is incorrect. Clinical decision support is an advantage. 5. Which action can the advanced practice nurse (APN) take to reduce threats to privacy when using the electronic health record? 1. Create a secure login and password for staff use. 2. Attend a local seminar on electronic health record safety. 3. Send protected health information by secure attachment via e-mail. 4. Follow up on erroneous information. Answer: 4 Page: 4 Feedback 1. This is incorrect. Each staff member should have an individual login and password. 2. This is incorrect. Continued education provides the most privacy safety. 3. This is incorrect. Protected health information should only be sent via e-mail or text when there is known to be only one recipient. 4. This is correct. The nurse should follow up on erroneous information. 6. The advanced practice nurse (APN) is listening to a lecture on health information exchange. Which statement indicates that learning has occurred? 1. “Query-based exchange involves sending client care summaries.” 2. “Direct exchange allows the provider to discover health information.” 3. “Query-based exchange allows clients to access their own health information.” 4. “Direct exchange allows health-care providers to receive laboratory data.” Answer: 4 Page: 5 Feedback 1. This is incorrect. Direct exchange involves sending client care summaries. 2. This is incorrect. Query-based exchange allows the provider to discover health information. 3. This is incorrect. Consumer-mediated exchange allows the client to access personal health information. 4. This is correct. Direct exchange allows health-care providers to receive laboratory data. 7. The advanced practice nurse (APN) manager is working in a busy primary care office. Which benefit does the manager see in regards to the use of health information exchanges? 1. Cost reductions 2. Improvement in employee teamwork 3. Improvement in physician-client communication 4. Increased client satisfaction Answer: 1 Page: 5 Feedback 1. This is correct. A benefit of health information exchanges is cost reduction. 2. This is incorrect. Improved employee teamwork is not a proven benefit. 3. This is incorrect. Improved physician-client communication is not a proven benefit. 4. This is incorrect. Increased client satisfaction is not a proven benefit. 8. The nurse is discussing the benefits of computerized provider order entry. Which benefit should the nurse mention? 1. Alert fatigue no longer occurs. 2. Medical errors are reduced by 95%. 3. Physicians can still hand write prescriptions. 4. Orders are transmitted directly to the pharmacy. Answer: 4 Page: 6 Feedback 1. This is incorrect. Alert fatigue is still a concern. 2. This is incorrect. Medical errors are reduced by up to 80%. 3. This is incorrect. Physicians no longer hand write prescriptions in this system. 4. This is correct. Orders are transmitted directly to the pharmacy. 9. Which action by the advanced practice nurse (APN) shows the use of clinical decision support? 1. Creating workplace guidelines for caregiver support 2. Using general diagnosis treatment guidelines 3. Reporting an alert regarding duplicate testing to the health-care provider 4. Referring a client to a specialist Answer: 3 Page: 6 Feedback 1. This is incorrect. Creating workplace guidelines for caregiver support does not show the use of clinical decision support. 2. This is incorrect. Diagnosis-specific treatment guidelines show the use of clinical decision support. 3. This is correct. Reporting duplicate testing is an example of using clinical decision support. 4. This is incorrect. Referring a client to a specialist does not show the use of clinical decision support. 10. Which change in care should the nurse expect with the expanse of health information technology? 1. Remains focused in large hospitals 2. Increases in primary care facilities 3. Shifts to the home 4. Increases in specialist offices Answer: 3 Page: 7 Feedback 1. This is incorrect. With the expanse of health information technology, care will transition away from large hospitals. 2. This is incorrect. With the expanse of health information technology, care will transition away from primary care facilities. 3. This is correct. Care will shift toward the home. 4. This is incorrect. With the expanse of health information technology, care will transition away from specialist offices. Chapter 23: Writing for Publication ANSWERS AND RATIONALES 1. An experienced advanced practice registered nurse (APRN) is helping a new APRN create a plan to develop scholarly writing skills. Which should the APRN include in the plan? Select all that apply. 1. Start with the first sentence. 2. Close the door when writing. 3. Write 15 to 30 minutes each day. 4. Write what first comes to mind. 5. Co-author an article for publication. Answer: 2, 3, 4 Pages: 2–3 Feedback 1. This is incorrect. Never attempt to write your first sentence first. 2. This is correct. Assure a space where you will not be interrupted. Choose a place at home where a closed door indicates to others you are not to be disturbed. 3. This is correct. Limit your writing to 30 minutes at a time when you are most sharp. 4. This is correct. Write what comes to your mind. Develop sentences from the rambling thoughts that go around in your head. 5. This is incorrect. Do not attempt to write an article for a professional journal when learning to write professionally. 2. Which of the following is required when an advanced practice registered nurse (APRN) is writing about an innovation in the agency where he or she is employed? 1. Timeliness 2. Peer review 3. Agency approval 4. Source citation Answer: 3 Page: 4 Feedback 1. This is incorrect. Before writing about new clinical ideas or innovations, the management of the unit, agency, or hospital must agree they want the information disclosed. 2. This is incorrect. Before writing about new clinical ideas or innovations, the management of the unit, agency, or hospital must agree they want the information disclosed. 3. This is correct. Before writing about new clinical ideas or innovations, the management of the unit, agency, or hospital must agree they want the information disclosed. 4. This is incorrect. Before writing about new clinical ideas or innovations, the management of the unit, agency, or hospital must agree they want the information disclosed. 3. An advanced practice registered nurse (APRN) was a major presenter at a professional conference. Which of the following is the expanded synopsis that the APRN prepares about the presentation? 1. Report 2. Monograph 3. Journal article 4. Report of Proceedings Answer: 2 Page: 5 Feedback 1. This is incorrect. A report describes areas or issues that are not systematic studies or actual research. 2. This is correct. A monograph requires that the keynote and major presenters submit an expanded synopsis of their talks or workshops. 3. This is incorrect. Journal articles present research studies, meta-analyses, and/or scholarly discussion of topics of interest which are related to the journal’s specialty and readership. 4. This is incorrect. Reports of proceedings of a convention or conference include short synopses of keynote addresses or major presentations. 4. Which is an advanced practice registered nurse’s (APRN’s) first consideration when writing a journal article? 1. Audience 2. Study design 3. Literature review 4. Guidelines for authors Answer: 1 Page: 6 Feedback 1. This is correct. Identifying the journal’s audience is the first step when writing an article. 2. This is incorrect. Study design is reported in journal articles. Identifying the journal’s audience is the first step when writing an article. 3. This is incorrect. A thorough search of the literature must be done to determine whether your topic is new to you alone (you have just discovered this), or the topic/issue is new to others as well. Identifying the journal’s audience is the first step when writing an article. 4. This is incorrect. Guidelines for authors inform authors of a journal’s requirements for preparing an article’s manuscript before submission. Identifying the journal’s audience is the first step when writing an article. 5. Which is the best source for an advanced practice registered nurse (APRN) searching for summaries of randomized controlled trials and meta-analyses? 1. MEDLINE 2. National Library of Medicine 3. Cochrane Database of Systematic Reviews 4. Cumulative Index to Nursing and Allied Health Literature (CINAHL) Answer: 3 Page: 14 Feedback 1. This is incorrect. MEDLINE is an electronic database which includes all biomedical literature sources. 2. This is incorrect. The National Library of Medicine developed the MEDLINE electronic database. 3. This is correct. Cochrane Database of Systematic Reviews contains systematic summaries of the research literature on health-care studies, many of them randomized controlled trials and meta-analyses. 4. This is incorrect. The Cumulative Index to Nursing and Allied Health Literature (CINAHL) is a comprehensive database of nursing and allied health literature. 6. While conducting an extensive literature review, which of the following would lead an advanced practice registered nurse (APRN) to conclude that some of the studies are flawed? 1. Only positive findings were reported. 2. Hypotheses and theories were tested. 3. Descriptions of data analyses were brief. 4. Randomized clinical trials were conducted. Answer: 1 Page: 12 Feedback 1. This is correct. A study which reports only positive or significant findings is flawed. 2. This is incorrect. Proper studies test theories completely. 3. This is incorrect. A brief description of data analyses is acceptable, as long as data are not misrepresented. 4. This is incorrect. Randomized clinical trials contribute to medical practice as they are based on scientific evidence. 7. An advanced practice registered nurse (APRN) is writing a manuscript for the American Journal of Nurse Practitioners. Which of the following should the APRN use when writing in expository style? Select all that apply. 1. Second person 2. Editorialization 3. Clear and concise sentences 4. Controversial statements 5. Transitions between paragraphs Answer: 3, 5 Page: 9 Feedback 1. This is incorrect. Second person is informal. Third person is used in expository writing because it is objective and professional. 2. This is incorrect. Editorialization refers to writing an opinion. Expository writing is objective. 3. This is correct. Concise sentences use the most effective words and maintain clarity. 4. This is incorrect. Controversial statements are not necessary in expository writing but they must be documented when used. 5. This is correct. When transitions between paragraphs are used, the key points are maintained from beginning to end. 8. Which of the following is most helpful to an advanced practice registered nurse (APRN) who is designing a comprehensive literature review? 1. Citations 2. Key words 3. Spreadsheets 4. Academic librarian Answer: 4 Page: 13 Feedback 1. This is incorrect. Academic librarians are excellent sources for how to access databases and are willing to share their favorite search engines and methods. 2. This is incorrect. Key words are helpful to narrow a database search to specific topics. Academic librarians are excellent sources for how to access databases and are willing to share their favorite search engines and methods. 3. This is incorrect. Spreadsheets are used to organize references. 4. This is correct. Academic librarians are excellent sources for how to access databases and are willing to share their favorite search engines and methods. 9. An advanced practice registered nurse (APRN) is writing a chapter on physical assessment in a clinical nursing book. Which of the following should the APRN use to communicate key ideas throughout? 1. Conciseness 2. Third person 3. Proper grammar 4. Transitions between paragraphs Answer: 4 Page: 10 Feedback 1. This is incorrect. Concise writing uses the most effective and strongest words. Transitions between paragraphs ensure main points are maintained from beginning to end. The end of each paragraph should signal what will follow. 2. This is incorrect. Third person is the most objective. Transitions between paragraphs ensure main points are maintained beginning to end. The end of each paragraph should signal what will follow. 3. This is incorrect. Proper grammar maintains professionalism. Transitions between paragraphs ensure main points are maintained from beginning to end. The end of each paragraph should signal what will follow. 4. This is correct. Transitions between paragraphs ensure main points are maintained from beginning to end. The end of each paragraph should signal what will follow. 10. An advanced practice registered nurse (APRN) understands journal reviewers use which questions to evaluate a manuscript? Select all that apply. 1. Are the references relevant and up-to-date? 2. Is the expository writing style consistently used? 3. Are clinical implications clear, practical, and useful? 4. Is there evidence for conclusions or recommendations? 5. Are research methods clearly and adequately described? Answer: 1, 3, 4, 5 Page: 17 Feedback 1. This is correct. Manuscript reviewers evaluate whether references are relevant and up-to-date. 2. This is incorrect. Reviewers are evaluating the content of a manuscript, not the writing style. 3. This is correct. Manuscript reviewers evaluate whether clinical implications are clear, practical, and useful. 4. This is correct. Manuscript reviewers evaluate whether there is evidence for conclusions or recommendations. 5. This is correct. Manuscript reviewers evaluate whether research methods are described clearly and adequately. Chapter 24: Measuring Advanced Practice Nurse Performance: Outcome Indicators, Models of Evaluation, and the Issue of Value ANSWERS AND RATIONALES 1. What action can the advanced practice nurse (APN) take to be an effective leader and advocate for value issues associated with clients? 1. Know what the stakeholders want. 2. Attend seminars and training events. 3. Work longer hours to see more clients. 4. Focus on recruiting skilled nurses. Answer: 1 Page: 8 Feedback 1. This is correct. The advanced practice nurse (APN) should know what the stakeholders want in order to be a leader and advocate. 2. This is incorrect. Attending seminars does not help the advanced practice nurse (APN) with value issues associated with the patient. 3. This is incorrect. Working longer hours does not help the advanced practice nurse (APN) with value issues associated with the patient. 4. This is incorrect. Recruiting skilled nurses does not help the advanced practice nurse (APN) with value issues associated with the patient. 2. Using the Donabedian framework, how can the nurse affect quality of care at the micro level? 1. Assess outcomes. 2. Assess client satisfaction. 3. Review cost-effectiveness. 4. Discuss clinical research findings. Answer: 2 Page: 10 Feedback 1. This is incorrect. Assessing outcomes is an example of the macro level. 2. This is correct. Assessing client care is an example of the micro level. 3. This is incorrect. This is an example of the macro level. 4. This is incorrect. This is an example of the macro level. 3. What areas of care does the advanced practice nurse (APN) identify as difficult for clients to access? 1. Primary care 2. Mental health care 3. Orthopedic care 4. Urgent care Answer: 2 Page: 11 Feedback 1. This is incorrect. Primary care is not an area that is difficult for clients to access. 2. This is correct. Mental health has been identified as an area that is difficult for clients to access. 3. This is incorrect. Orthopedic care is not an area that is difficult for clients to access. 4. This is incorrect. Urgent care is not an area that is difficult for clients to access. 4. What should the advanced practice nurse (APN) keep in mind when treating each client? 1. Ordering the highest level of testing for ailments 2. Treating the clients with high-cost medication to ensure best results 3. Justifying the need for the considered treatment before prescribing 4. Encouraging the client to change diet and lifestyle being Answer: 3 Page: 11 Feedback 1. This is incorrect. Ordering the highest level of testing is not cost-effective. 2. This is incorrect. Treating clients with high-cost medication is not cost-effective. 3. This is correct. The advanced practice nurse (APN) should justify the need for each considered treatment. 4. This is incorrect. The advanced practice nurse (APN) should choose the most appropriate, and cost-effective, treatment. 5. The advanced practice nurse (APN) is trying to maintain a more cost-effective practice. Which global expenditures should the APN consider? 1. Pharmaceutical costs 2. Insurance costs 3. Price of services 4. Good and supplies Answer: 4 Page: 11 Feedback 1. This is incorrect. Pharmaceutical costs are considered by consumers, and are not global expenditures. 2. This is incorrect. Insurance costs are considered by consumers, and are not global expenditures. 3. This is incorrect. Price of services is considered by employers, and are not global expenditures. 4. This is correct. 6. The advanced practice nurse (APN) wishes to determine quality at the individual, societal, and organizational level. Which should the APN take into consideration? 1. Access and cost issues 2. Cancellation frequency per client 3. Client satisfaction scores 4. Number of client visits per day Answer: 1 Page: 12 Feedback 1. This is correct. Issues with access and costs reflect outcomes and quality. 2. This is incorrect. Cancellation frequency does not reflect outcomes and quality. 3. This is incorrect. Client satisfaction scores do not reflect outcomes and quality. 4. This is incorrect. The number of client visits per day does not reflect outcomes and quality. 7. The nurse is educating another practitioner about the Institute of Medicine’s (IOM’s) National Health Care Quality Roundtable. Which statement by the practitioner indicates that teaching has been effective? 1. “The objectives include assessing the health-care needs of communities.” 2. “The objectives include providing low-cost health-care to the elderly.” 3. “The objectives include keeping hospitals staffed with quality health-care providers.” 4. “The objectives include assessing hospitals for areas of growth.” Answer: 1 Page: 12 Feedback 1. This is correct. One of the objectives is to assess the health-care needs of communities. 2. This is incorrect. This is not an objective to assess the health-care needs of communities. 3. This is incorrect. This is not an objective to assess the health-care needs of communities. 4. This is incorrect. This is not an objective to assess the health-care needs of communities. 8. What action can the advanced practice nurse (APN) take to provide high-quality care to clients? 1. Create general care guidelines for clients based on disease process. 2. Make decisions on behalf of the client about treatment. 3. Discuss options for medical treatment with the client’s family. 4. Respect clients in their decision making. Answer: 4 Page: 18 Feedback 1. This is incorrect. The advanced practice nurse (APN) should create specific care guidelines based on each client’s needs and diagnosis. 2. This is incorrect. The advanced practice nurse (APN) should allow the client to make medical decisions. 3. This is incorrect. The advanced practice nurse (APN) should not discuss the client’s medical care with anyone except for the client without permission. 4. This is correct. The advanced practice nurse (APN) should respect clients in their decision making. 9. Which action by the advanced practice nurse (APN) is an Institute of Medicine (IOM) aim for quality improvement in order to promote safety? 1. Providing services based on scientific knowledge 2. Providing respectful care 3. Preventing waste 4. Preventing infection Answer: 4 Page: 19 Feedback 1. This is incorrect. This is identified as the Institute of Medicine (IOM) aim: Effective. 2. This is incorrect. This is identified as the Institute of Medicine (IOM) aim: Patient-Centered. 3. This is incorrect. This is identified as the Institute of Medicine (IOM) aim: Efficient. 4. This is correct. This is the Institute of Medicine (IOM) aim: Safe. 10. Which action by the advanced practice nurse (APN) is an Institute of Medicine (IOM) aim for quality improvement in order to promote efficiency? 1. Increasing the number of clients seen per day 2. Preventing accidental waste of materials 3. Providing care that does not vary based on characteristics 4. Refraining from providing services to those who will not benefit Answer: 2 Page: 19 Feedback 1. This is incorrect. This is not an Institute of Medicine (IOM) aim. 2. This is correct. This is the Institute of Medicine (IOM) aim: Efficient. 3. This is incorrect. This is the Institute of Medicine (IOM) aim: Equitable. 4. This is incorrect. This is the Institute of Medicine (IOM) aim: Effective. Chapter 25: Advanced Practice Nurses: Accomplishments, Trends, and Future Developments ANSWERS AND RATIONALES 1. Which of the following accounts for the shift in nurse practitioners’ (NPs’) and certified nurse-midwives’ (CNMs’) practice settings? 1. Population-driven needs 2. Expansion in scope of practice 3. Fragmentation in health care 4. Physician residency education Answer: 4 Page: 4 Feedback 1. This is incorrect. The scope of advanced practice registered nurses’ (APRNs’) practice is not setting-specific; it is determined by the needs of a population. Changes in physician residency education and the use of nurse practitioners (NPs) and certified nurse-midwives (CNMs) as physician substitutes in disease-based specialty has led to a shift in practice settings. 2. This is incorrect. The expansion of advanced practice registered nurses’ (APRNs’) scope of practice can be attributed to outcomes evaluation research, poor access to care in underserved and rural areas, and APRNs’ political activism. Changes in physician residency education and the use of nurse practitioners (NPs) and certified nurse-midwives (CNMs) as physician substitutes in disease-based specialty has led to a shift in practice settings. 3. This is incorrect. Fragmentation in health care creates an increased need for advanced practice registered nurses (APRNs). Changes in physician residency education and the use of nurse practitioners (NPs) and certified nurse-midwives (CNMs) as physician substitutes in disease-based specialty has led to a shift in practice settings. 4. This is correct. Changes in physician residency education and the use of nurse practitioners (NPs) and certified nurse-midwives (CNMs) as physician substitutes in disease-based specialty has led to a shift in practice settings. 2. Certified registered nurse anesthetists (CRNAs) have more autonomy in providing anesthesia care in which of the following settings? 1. Rural hospitals 2. Critical care units 3. Skilled care facilities 4. Outpatient surgery centers Answer: 1 Page: 6 Feedback 1. This is correct. Though physician anesthetists continue to regulate certified registered nurse anesthetist (CRNA) practice and limit their work as independent providers of anesthesia care, the CRNA role has prevailed, especially in underserved and rural settings. 2. This is incorrect. Though physician anesthetists continue to regulate certified registered nurse anesthetist (CRNA) practice and limit their work as independent providers of anesthesia care, the CRNA role has prevailed, especially in underserved and rural settings. 3. This is incorrect. Though physician anesthetists continue to regulate certified registered nurse anesthetist (CRNA) practice and limit their work as independent providers of anesthesia care, the CRNA role has prevailed, especially in underserved and rural settings. 4. This is incorrect. Though physician anesthetists continue to regulate certified registered nurse anesthetist (CRNA) practice and limit their work as independent providers of anesthesia care, the CRNA role has prevailed, especially in underserved and rural settings. 3. Which of the following works directly with patients and is an expert in an area such as wound care, pain management, or diabetes care? 1. Clinical nurse specialist (CNS) 2. Certified nurse-midwife (CNM) 3. Family nurse practitioner (FNP) 4. Certified registered nurse anesthetist (CRNA) Answer: 1 Page: 8 Feedback 1. This is correct. The clinical nurse specialist (CNS) is recognized as a clinical expert in a specialized area of patient care such as wound care, pain management, or diabetes care. Most CNSs work directly with patients. 2. This is incorrect. Certified nurse-midwives (CNMs) provide gynecological care to healthy women and low-risk obstetrical care in the home and the hospital setting. 3. This is incorrect. Nurse practitioners (NPs) have traditionally provided primary care for underserved populations within the inner city, rural areas, and other nonhospital settings and continue to deliver patient care in settings in which traditional physician providers are unavailable. 4. This is incorrect. Certified registered nurse anesthetists (CRNAs) provide anesthesia care to patients primarily in hospital settings, outpatient surgical centers, and practices where anesthesia is needed. 4. Which of the following provides primary care to the poor or elderly in urban, rural, and underserved areas? 1. Clinical nurse specialist (CNS) 2. Certified nurse-midwife (CNM) 3. Family nurse practitioner (FNP) 4. Certified registered nurse anesthetist (CRNA) Answer: 3 Page: 7 Feedback 1. This is incorrect. The majority of primary care nurse practitioners (NPs) practice in urban primary care settings providing care to elderly, poor, and ethnically diverse populations with limited or no access to health care. 2. This is incorrect. The majority of primary care nurse practitioners (NPs) practice in urban primary care settings providing care to elderly, poor, and ethnically diverse populations with limited or no access to health care. 3. This is correct. The majority of primary care nurse practitioners (NPs) practice in urban primary care settings providing care to elderly, poor, and ethnically diverse populations with limited or no access to health care. 4. This is incorrect. The majority of primary care nurse practitioners (NPs) practice in urban primary care settings providing care to elderly, poor, and ethnically diverse populations with limited or no access to health care. 5. Which of the following facilitated direct Medicare reimbursement for nurse practitioners (NPs)? 1. The Federal Register 2. Balanced Budget Act of 1997 3. American Nurses Association 4. American Academy of Family Physicians Answer: 2 Page: 10 Feedback 1. This is incorrect. The Balanced Budget Act of 1997 facilitated direct Medicare reimbursement for the nurse practitioner (NP). 2. This is correct. The Balanced Budget Act of 1997 facilitated direct Medicare reimbursement for the nurse practitioner (NP). 3. This is incorrect. The Balanced Budget Act of 1997 facilitated direct Medicare reimbursement for the nurse practitioner (NP). 4. This is incorrect. The Balanced Budget Act of 1997 facilitated direct Medicare reimbursement for the nurse practitioner (NP). 6. Which of the following is thought to have had the greatest influence on advanced practice registered nurses’ (APRNs’) salaries? 1. Gender 2. Education 3. Specialty area 4. Practice setting Answer: 4 Page: 9 Feedback 1. This is incorrect. Although gender can play a role in salary determinations, practice settings have been suggested to be the greatest determinant of advanced practice registered nurses’ (APRNs’) salaries. 2. This is incorrect. Although education is important in the determination of salary or compensation, practice settings have been suggested to be the greatest determinant of advanced practice registered nurses’ (APRNs’) salaries. 3. This is incorrect. Practice settings have been suggested to be the greatest determinant of advanced practice registered nurses’ (APRNs’) salaries. 4. This is correct. Practice settings have been suggested to be the greatest determinant of advanced practice registered nurses’ (APRNs’) salaries. 7. An advanced practice registered nurse (APRN) is developing a report describing patient conditions which have responded positively to nurse practitioner (NP) care. Which nurse-sensitive indicators delineated by the Agency for Healthcare Research and Quality (AHRQ) as responsive to nursing care should the APRN include? Select all that apply. 1. Pain 2. Pressure ulcers 3. Congestive heart failure 4. Ventilator-associated pneumonia 5. Catheter-associated urinary tract infections Answer: 2, 4, 5 Page: 11 Feedback 1. This is incorrect. The Agency for Healthcare Research and Quality (AHRQ) outlines nurse- sensitive indicators such as falls, skin ulcerations, and hospital-acquired infections (including ventilator-associated pneumonia and catheter-associated urinary tract infections) as conditions responsive to nursing care. 2. This is correct. The Agency for Healthcare Research and Quality (AHRQ) outlines nurse- sensitive indicators such as falls, skin ulcerations, and hospital-acquired infections (including ventilator-associated pneumonia and catheter-associated urinary tract infections) as conditions responsive to nursing care. 3. This is incorrect. The Agency for Healthcare Research and Quality (AHRQ) outlines nurse- sensitive indicators such as falls, skin ulcerations, and hospital-acquired infections (including ventilator-associated pneumonia and catheter-associated urinary tract infections) as conditions responsive to nursing care. 4. This is correct. The Agency for Healthcare Research and Quality (AHRQ) outlines nurse- sensitive indicators such as falls, skin ulcerations, and hospital-acquired infections (including ventilator-associated pneumonia and catheter-associated urinary tract infections) as conditions responsive to nursing care. 5. This is correct. The Agency for Healthcare Research and Quality (AHRQ) outlines nurse- sensitive indicators such as falls, skin ulcerations, and hospital-acquired infections (including ventilator-associated pneumonia and catheter-associated urinary tract infections) as conditions responsive to nursing care. 8. An advanced practice registered nurse (APRN) is examining quality indicators that generate revenue. Which of the following has linked reimbursement to quality indicators? 1. American Hospital Association (AHA) 2. Centers for Medicare and Medicaid Services (CMS) 3. Agency for Healthcare Research and Quality (AHRQ) 4. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Answer: 2 Page: 11 Feedback 1. This is incorrect. Quality indicators are now linked to Medicare reimbursement through the Centers for Medicare and Medicaid Services (CMS). 2. This is correct. Quality indicators are now linked to Medicare reimbursement through the Centers for Medicare and Medicaid Services (CMS). 3. This is incorrect. Quality indicators are now linked to Medicare reimbursement through the Centers for Medicare and Medicaid Services (CMS). 4. This is incorrect. Quality indicators are now linked to Medicare reimbursement through the Centers for Medicare and Medicaid Services (CMS). 9. Which of the following influenced blended nursing education programs to distinguish advanced practice registered nurse (APRN) roles? 1. Consensus Model (LACE) 2. Institute of Medicine (IOM) 3. American Nurses Credentialing Center (ANCC) 4. American Association of Colleges of Nursing (AACN) Answer: 1 Page: 15 Feedback 1. This is correct. The Consensus Model (2008) affects blended education programs that have attempted to merge rather than distinguish advanced practice registered nurse (APRN) roles. 2. This is incorrect. The Institute of Medicine (IOM) 2010 report calls for initiatives that focus on changes that will enhance the potential of nurses to have a positive impact on the future of health care. 3. This is incorrect. The American Nurses Credentialing Center (ANCC) developed Magnet Status to recognize excellence and innovation in nursing practice related to quality outcomes. 4. This is incorrect. The American Association of Colleges of Nursing (AACN) recommended the doctorate in nursing practice (DNP) should be the minimum degree for advanced practice registered nurses (APRNs) to enter practice. 10. Which of the following has the most significant impact on an advanced practice registered nurse’s (APRN’s) professional identity? 1. Practice settings 2. Disciplinary focus 3. Physician shortages 4. Doctoral preparation Answer: 2 Page: 17 Feedback 1. This is incorrect. Loss of disciplinary focus related to lack of distinction between nursing domains and medical knowledge jeopardizes advanced practice registered nurses’ (APRNs’) professional identity. 2. This is correct. Loss of disciplinary focus related to lack of distinction between nursing domains and medical knowledge jeopardizes advanced practice registered nurses’ (APRNs’) professional identity. 3. This is incorrect. Loss of disciplinary focus related to lack of distinction between nursing domains and medical knowledge jeopardizes advanced practice registered nurses’ (APRNs’) professional identity. 4. This is incorrect. Loss of disciplinary focus related to lack of distinction between nursing domains and medical knowledge jeopardizes advanced practice registered nurses’ (APRNs’) professional identity. Chapter 26: Starting a Practice and Practice Management ANSWERS AND RATIONALES 1. The advanced practice nurse (APN) is considering opening an independent practice. Which of the following does the APN consider an advantage? 1. Need for direct reimbursement from third parties 2. Cost-effective health care for the community 3. Limited hospital privileges 4. Ability to provide care within the APN’s scope of practice Answer: 2 Pages: 2–3 Feedback 1. This is incorrect. A disadvantage is the need for direct reimbursement from third parties. 2. This is correct. An advantage to independent practice is that it is cost effective to the community. 3. This is incorrect. A disadvantage to independent practice is little or no hospital privileges. 4. This is incorrect. A disadvantage is that the advanced practice nurse (APN) is limited by his or her scope of practice. 2. The advanced practice nurse (APN) is listening to a lecture on how to start an independent practice. Which statement by the APN indicates that learning has occurred? 1. “Financing is often a one-time occurrence.” 2. “Start-up costs are often waived for APNs.” 3. “Malpractice insurance is not necessary for the APN.” 4. “Compliance with federal regulations can be an obstacle.” Answer: 4 Page: 4 Feedback 1. This is incorrect. Financing is not a one-time occurrence, and can be a major obstacle for the advanced practice nurse (APN). 2. This is incorrect. Start-up costs are not waived, and can be an obstacle for advanced practice nurses (APNs). 3. This is incorrect. Malpractice insurance is necessary to protect the advanced practice nurse (APN). There are different types of malpractice insurance available. 4. This is correct. Compliance with regulations can be a major obstacle. 3. The advanced practice nurse (APN) is considering opening an independent practice. Which should the APN first consider? 1. Scope of practice within the APN’s state 2. Cost of start-up 3. Hiring competent, enthusiastic workers 4. Cost of malpractice insurance Answer: 1 Page: 5 Feedback 1. This is correct. The advanced practice nurse (APN) should first consider the scope of practice within the APN’s state. 2. This is incorrect. The nurse should consider the cost of start-up, but this is not the first consideration. 3. This is incorrect. The nurse should consider hiring competent, enthusiastic workers, but this is not the first consideration. 4. This is incorrect. The nurse should consider the cost of malpractice insurance, but this is not the first consideration. 4. The advanced practice nurse (APN) is interested in the pay-for-performance service model for a small clinic. Which feature should the APN understand about this model? 1. Focuses on payment for services and procedures 2. Focuses on collaborating with and receiving reimbursements from hospitals 3. Reimburses based on clinical and cost-saving outcomes 4. Reimburses based on client satisfaction Answer: 3 Page: 4 Feedback 1. This is incorrect. This is not the pay-for-performance model. Pay-for-performance focuses on clinical and cost-saving outcomes. 2. This is incorrect. This is not the pay-for-performance model. Pay-for-performance focuses on clinical and cost-saving outcomes. 3. This is correct. Pay-for-performance models focus on reimbursement based on clinical and cost-saving outcomes. 4. This is incorrect. This is not the pay-for-performance model. Pay-for-performance focuses on clinical and cost-saving outcomes. 5. The advanced practice nurse (APN) is listening to a lecture on developing strategy for opening a new business. Which statement indicates that learning has occurred? 1. “I should see all clients, regardless of ailments.” 2. “I can help my practice bloom if I offer to see clients for a discounted rate.” 3. “I should consider offering same-day appointments.” 4. “I should develop a niche and grow my practice from there.” Answer: 4 Page: 8 Feedback 1. This is incorrect. The advanced practice nurse (APN) should choose a specialization and focus on that specific client population. 2. This is incorrect. The advanced practice nurse (APN) should set standards and regulations for practice. 3. This is incorrect. The advanced practice nurse (APN) should set standards and regulations for practice. 4. This is correct. The advanced practice nurse (APN) should develop a niche and grow the practice from there. 6. Which statement indicates that the advanced practice nurse (APN) understands new business start-up? 1. “I should designate a colleague as the project leader.” 2. “I should allow a minimum of 6 months for start-up.” 3. “I should anticipate that start-up costs will likely be waived.” 4. “I should create a timeline to keep myself on track.” Answer: 4 Page: 9 Feedback 1. This is incorrect. The advanced practice nurse (APN) should be the project leader. 2. This is incorrect. The advanced practice nurse (APN) should allow approximately 9 months for start-up, because 6 months is not enough time for adequate start-up. 3. This is incorrect. The advanced practice nurse (APN) should not anticipate that costs will be waived. 4. This is correct. The advanced practice nurse (APN) should create a timeline to stay on track. 7. The advanced practice nurse (APN) is opening a new clinic and is interested in providing care to Medicare clients. Which action should the APN take? 1. Apply through the national plan and provider enumeration system. 2. Determine who the carrier is for the state of practice. 3. Apply for admission to the panel of providers. 4. Begin accepting Medicaid clients and bill using the provided billing steps. Answer: 2 Page: 11 Feedback 1. This is incorrect. This action applies for the national provider identifier. 2. This is correct. The advanced practice nurse (APN) must determine who the carrier is for the state of practice before applying. 3. This is incorrect. The advanced practice nurse (APN) would apply to the panel of providers for Medicaid if denied. 4. This is incorrect. The advanced practice nurse (APN) must first be accepted by Medicare and given a provider number. 8. Which of the following statements about insurance options is accurate? 1. Occurrence will cover the advanced practice nurse (APN) only when active. 2. Claims made will cover the APN for any incident. 3. Tail coverage protects the APN from events that happen before joining a group practice. 4. Consider taking on the minimal coverage allowed by the state. Answer: 3 Page: 15 Feedback 1. This is incorrect. Claims made will only cover the advanced practice nurse (APN) while the insurance is active. 2. This is incorrect. Occurrence will cover the advanced practice nurse (APN) for any incident. 3. This is correct. Tail coverage protects the advanced practice nurse (APN) from events that happen before joining a group practice. 4. This is incorrect. The advanced practice nurse (APN) should consider taking on additional coverage. 9. Which benefit should the nurse consider as a sole proprietorship? 1. Personal liability for debt 2. Flexibility 3. Losses deducted from business income 4. Business manager is responsible for employees Answer: 2 Page: 19 Feedback 1. This is incorrect. Debt is taken from the advanced practice nurse’s (APN’s) personal income. 2. This is correct. Flexibility for practice is a benefit. 3. This is incorrect. Losses are deducted from the advanced practice nurse’s (APN’s) personal income. 4. This is incorrect. The advanced practice nurse (APN) is the sole individual responsible for staff. 10. The advanced practice nurse (APN) is considering a partnership in the start-up of a new clinic. What benefit should the APN consider? 1. Unlimited personal liability of each partner 2. Payment of taxes by each business partner 3. Flexible decision making 4. Shared authority over the practice Answer: 3 Page: 20 Feedback 1. This is incorrect. This advanced practice nurse (APN) would be, to some degree, responsible for the decisions of the other party. 2. This is incorrect. The advanced practice nurse (APN) must rely on the partner to pay business taxes. 3. This is correct. Flexible decision making is a benefit. 4. This is incorrect. The advanced practice nurse (APN) is not the sole decision maker. Chapter 27: The Advanced Practice Nurse as Employee or Independent Contractor: Legal and Contractual Considerations ANSWERS AND RATIONALES 1. What professional liability should the advanced practice nurse (APN) consider as an employee? 1. Taxes are not withheld and will need to be paid in full by the APN. 2. The employer is ultimately responsible for the actions of the APN. 3. The APN is responsible for filing a W-2 with the government. 4. The employer must have the APN fill out a 1099-MISC. Answer: 2 Page: 3 Feedback 1. This is incorrect. When the advanced practice nurse (APN) is an employee, taxes are automatically withheld. 2. This is correct. The employer is responsible for the actions of the advanced practice nurse (APN). 3. This is incorrect. The employer is responsible for filing a W-2 with the government. 4. This is incorrect. The advanced practice nurse (APN) must fill out a 1099-MISC when working as an independent contractor. 2. What should the advanced practice nurse (APN) consider as an independent contractor? 1. The APN can qualify for paid time off. 2. The APN can request a pension at the time of employment. 3. The APN can sign up for health insurance 1 month after employment begins. 4. The APN can deduct any amount of business expenses. Answer: 4 Page: 3 Feedback 1. This is incorrect. The independent contractor is not guaranteed paid time off. 2. This is incorrect. The independent contractor cannot request a pension. 3. This is incorrect. The independent contractor is responsible for his or her own insurance. 4. This is correct. The independent contractor can deduct any amount of business expenses. 3. The advanced practice nurse (APN) is listening to a lecture on independent contracting versus being an employee. Which statement indicates that learning has occurred? 1. “If the APN has significant fixed unreimbursed business expenses, the APN is an independent contractor.” 2. “If the APN has his or her own set of practices and protocols in place, the APN is an employee.” 3. “If the APN is instructed on how to perform job duties and provides supplies, the APN is an independent contractor.” 4. “If the APN advertises for services, the APN is an employee.” Answer: 1 Page: 5 Feedback 1. This is correct. This advanced practice nurse (APN) is an independent contractor. 2. This is incorrect. This advanced practice nurse (APN) is an employee. 3. This is incorrect. This advanced practice nurse (APN) is an independent contractor. 4. This is incorrect. This advanced practice nurse (APN) is an employee. 4. The advanced practice nurse (APN) is listening to a lecture on the public policy exception. Which statement indicates that learning has been effective? 1. “The public policy exception means that employees will be treated fairly.” 2. “The public policy exception means that employees can pursue a wrongful termination claim against an employer.” 3. “The public policy exception means that an employee can expect equal pay.” 4. “The public policy exception means that an employee has the right to health insurance.” Answer: 2 Page: 8 Feedback 1. This is incorrect. This policy does not mean that employees will be treated fairly. 2. This is correct. This policy means that employees can pursue a wrongful termination claim against an employer. 3. This is incorrect. This policy does not mean that an employee can expect equal pay. 4. This is incorrect. This policy does not mean that the employee has the right to health insurance. 5. The advanced practice nurse (APN) is working as an independent contractor. After being injured on the job, which action is not an option for the APN? 1. Obtain emergency medical care at the local hospital. 2. Initiate paperwork for workers’ compensation. 3. Work shorter hours during the week. 4. Begin outpatient physical therapy. Answer: 2 Page: 10 Feedback 1. This is incorrect. The advanced practice nurse (APN) can obtain emergency medical care. 2. This is correct. The advanced practice nurse (APN) who is an independent contractor is not entitled to the benefits that an organization would provide to employees. 3. This is incorrect. The advanced practice nurse (APN) is able to change scheduling. 4. This is incorrect. The advanced practice nurse (APN) can choose to attend outpatient physician therapy. 6. The nurse manager is hiring an advanced practice nurse (APN) on contract to work for a large hospital. Which action should the nurse manager take? 1. Understand basic contract law. 2. Request the APN to work directly with the hospital’s attorneys. 3. Discuss the company’s policy on Family and Medical Leave Act (FMLA) usage. 4. Ask the hospital director to brief the APN on job expectations. Answer: 1 Page: 10 Feedback 1. This is correct. The nurse manager should have a basic understanding of contract law. 2. This is incorrect. The nurse manager should be knowledgeable about contracts. 3. This is incorrect. The nurse manager should focus on discussing the contract with the advanced practice nurse (APN). 4. This is incorrect. The nurse manager should brief the advanced practice nurse (APN) on job expectations. 7. The nurse is researching the different types of contracts and the implications of each. Which should the nurse expect in an implied contract? 1. A contract derived from the conduct of the parties 2. Sets of promises expressed in writing 3. A contract to provide equitable relief 4. A contract that would not be enforced in court Answer: 1 Pages: 12–13 Feedback 1. This is correct. An implied contract is derived from the conduct of both parties. 2. This is incorrect. Express contracts are those that are expressed in writing. 3. This is incorrect. Quasi-contracts provide equitable relief. 4. This is incorrect. An invalid contract would not be enforced in court. 8. What action does the advanced practice nurse expect during contract negotiations when mutual assent has been reached? 1. Declination of an offer, with no counteroffer 2. Making a counteroffer, and discussing consideration 3. Accepting an offer and discussing consideration 4. Revising the contract to meet specific needs Answer: 3 Page: 13 Feedback 1. This is incorrect. This is a declination of the offer, not mutual assent. 2. This is incorrect. This is a counteroffer, not mutual assent. 3. This is correct. Making an offer and discussing consideration is mutual assent. 4. This is incorrect. Revising the contract is not mutual assent. 9. The advanced practice nurse (APN) has recently discovered a conflict of interest with a health-care entity. Which action should the APN take? 1. Report the conflict of interest to the other party. 2. Work through the conflict of interest as fairly as possible. 3. Work with an attorney to neutralize the conflict. 4. Seek another party to obtain a contract with. Answer: 1 Page: 20 Feedback 1. This is correct. The advanced practice nurse (APN) has a duty to report the conflict with the party involved. 2. This is incorrect. The advanced practice nurse (APN) should not attempt working through the conflict without notifying the other party that there is a conflict. 3. This is incorrect. This may be needed down the road, but the nurse should first notify the other party that there is a conflict. 4. This is incorrect. The nurse should first notify the other party of the conflict of interest. Then, the nurse can consider other options. 10. The advanced practice nurse (APN) is signing a contract with an indemnification clause. Based on this, which action should the APN take? 1. Obtain malpractice insurance. 2. Request a clause seeking bonuses. 3. Plan to worked varied shifts. 4. See clients regardless of their ability to pay. Answer: 1 Page: 20 Feedback 1. This is correct. The advanced practice nurse (APN) should expect to obtain malpractice insurance, as this clause means that the APN is responsible for all actions. 2. This is incorrect. The advanced practice nurse (APN) should expect to obtain and maintain malpractice insurance. Seeking bonus pay does not help the APN with the need for malpractice insurance. 3. This is incorrect. This clause does not mean that the nurse would need to work varied shifts. 4. This is incorrect. This clause does not indicate that the nurse should need to see clients regardless of their ability to pay. Chapter 28: The Law, the Courts, and the Advanced Practice Registered Nurse ANSWERS AND RATIONALES 1. Which action can the advanced practice nurse (APN) take to avoid malpractice? 1. Understand and practice within the scope of practice. 2. Understand how laws work. 3. Ensure that each client receives medical care as needed. 4. See clients within a specific specialty. Answer: 1 Page: 10 Feedback 1. This is correct. In order to avoid malpractice, the advanced practice nurse (APN) should understand and practice within the scope of practice for an APN. 2. This is incorrect. The advanced practice nurse (APN) should understand and work within a scope of practice. Understanding how laws work does not protect the APN from malpractice. 3. This is incorrect. Although important, this does not protect the advanced practice nurse (APN) from malpractice. 4. This is incorrect. This action by the advanced practice nurse (APN) does not prevent malpractice. 2. The advanced practice nurse (APN) has been newly hired as an independent contractor in New York State for a busy cardiac practice. Which action would violate the state’s practice act? 1. Referring the client for a dobutamine stress test. 2. Prescribing narcotics for a broken wrist. 3. Initiating a consult for open-heart surgery. 4. Placing the client on a beta-blocker. Answer: 2 Page: 10 Feedback 1. This is incorrect. Referring the client for a dobumatine stress test is not outside of the scope of practice. 2. This is correct. Advanced practice nurses (APNs) in New York State can only prescribe medications related to their area of specialty. The nurse would be prescribing inappropriately. 3. This is incorrect. The nurse is acting within the scope of practice in the state. 4. This is incorrect. This action does not violate the prescribing rights in this state. 3. The advanced practice nurse (APN) has been accused of violating a state’s practice act. What can the APN expect first? 1. Restriction of license for 1 year 2. The opportunity to respond 3. A fine of $200 4. An investigation into the nurse’s work history Answer: 2 Page: 16 Feedback 1. This is incorrect. The nurse must first have due process and be given the right to respond to the complaint. 2. This is correct. The nurse has the right to respond and be meaningfully heard. 3. This is incorrect. The nurse must first have the right to respond. If found negligent, the court will determine the next steps. 4. This is incorrect. The nurse must first be notified and have the chance to respond to the complaint. 4. As a provider for Medicare clients, which action is important for the advanced practice nurse to take in order to prevent legal action? 1. Understand the expectations as a provider. 2. Document thoroughly and legibly. 3. Ensure that each client receives adequate time with a provider at each visit. 4. Be aware of new technology and application to the practice setting. Answer: 1 Page: 17 Feedback 1. This is correct. Ignorance does not excuse legal action. The advanced practice nurse (APN) should understand the expectations as a provider. 2. This is incorrect. Although important, this does not protect the advanced practice nurse (APN) from legal action. 3. This is incorrect. This is important to build rapport and properly care for the client, but does not prevent legal action. 4. This is incorrect. This does not prevent the advanced practice nurse (APN) from being subject to legal action. 5. Which action do enforcement agencies take to stop fraud and abuse? 1. Routinely assess all advanced practice nurses (APNs) for fraudulent activity. 2. Enforce license suspension for each suspected fraudulent activity. 3. Look for patterns of abuse. 4. Require yearly education on fraud prevention for all APNs. Answer: 3 Page: 18 Feedback 1. This is incorrect. Enforcement agencies are concerned with patterns of abuse, and look for those. 2. This is incorrect. Enforcement agencies look for patterns of abuse. License suspension does not automatically occur. 3. This is correct. Enforcement agencies look for patterns of abuse. 4. This is incorrect. Enforcement agencies do not require yearly education on fraud prevention. 6. Which action should the advanced practice nurse (APN) take to ensure that clients are billed appropriately? 1. Request an audit to ensure that billing is correct. 2. Bill partially for each client interaction. 3. Become certified as a billing specialist. 4. Hire a billing specialist. Answer: 4 Page: 16 Feedback 1. This is incorrect. Requesting audits is not an appropriate way to ensure that billing is correct. 2. This is incorrect. This would not be realistic for the advanced practice nurse (APN). Hiring a billing specialist would ensure that clients are billed appropriately. 3. This is incorrect. This would not be realistic for the advanced practice nurse (APN). Hiring a billing specialist would ensure that clients are billed appropriately. 4. This is correct. To ensure that clients are billed appropriately, the advanced practice nurse (APN) should hire a billing specialist. 7. When billing under “incident to,” what action should the advanced practice nurse (APN) take? 1. Ensure that the physician is available to the APN. 2. Work as an independent contractor. 3. Bill the client for the highest level of services. 4. Ensure that the client is seen intermittently by another APN. Answer: 1 Page: 20 Feedback 1. This is correct. The advanced practice nurse (APN) should ensure that the physician is available to assist, in order to bill as “incident to.” 2. This is incorrect. In order to bill as “incident to,” the advanced practice nurse (APN) needs to work as an independent contractor of the physician whose services the actions are billed under. 3. This is incorrect. The client should be billed for services provided. 4. This is incorrect. The physician whose services are being billed under should see the client intermittently. 8. What should the advanced practice nurse (APN) keep in mind when billing services as “incident to”? 1. Billing shows that services were provided by the APN. 2. Billing shows that services were provided by the physician. 3. Billing shows that services were provided by the health system or clinic. 4. Billing shows that services were provided by both the APN and physician. Answer: 2 Page: 21 Feedback 1. This is incorrect. Billing shows that services were provided by the physician only. 2. This is correct. Billing shows that services were provided by the physician. 3. This is incorrect. Billing does not show that services were provided by the health system or clinic; billing shows services provided by the physician. 4. This is incorrect. Billing shows that services were provided by the physician only. 9. What action can the advanced practice nurse (APN) take to influence nursing practice? 1. Ensure that policies are followed to avoid disciplinary action. 2. Support the purchase of malpractice insurance. 3. Advocate for policies that expand access to health care. 4. Become self-sufficient as an independent contractor. Answer: 3 Page: 26 Feedback 1. This is incorrect. Following policies to avoid disciplinary action does not influence nursing practice. 2. This is incorrect. Advocating for the purchase of malpractice insurance does not influence nursing practice. 3. This is correct. Advocating for policies that expand access to health care influences nursing practice. 4. This is incorrect. Becoming self-sufficient does not influence nursing practice. 10. What action should the advanced practice nurse (APN) take before choosing to bill as “incident to” or directly for services provided? 1. Learn the rate at which services are reimbursed. 2. Hire a billing specialist to handle office billing concerns. 3. Understand licensure restrictions. 4. Determine what services can be billed for. Answer: 1 Page: 21 Feedback 1. This is correct. The advanced practice nurse (APN) should learn the rate at which services are reimbursed. 2. This is incorrect. Hiring a billing specialist is important, but the advanced practice nurse (APN) should still understand the rate at which services are reimbursed. 3. This is incorrect. Understanding licensure restrictions is important, but understanding licensure restrictions helps the advanced practice nurse (APN) determine how to bill. 4. This is incorrect. The advanced practice nurse (APN) should determine what rate services will be reimbursed. Chapter 29: Malpractice and the Advanced Practice Nurse ANSWERS AND RATIONALES 1. The nurse should be aware of limitations to the employer’s insurance policy. Which might the nurse not be protected from? 1. Complaints of wrongful injury 2. Complaints of negligence 3. Complaints reported to the board of nursing 4. Complaints reported to the facility administration Answer: 3 Page: 2 Feedback 1. This is incorrect. The nurse would be protected against complaints of wrongful injury. 2. This is incorrect. The nurse would be protected against complaints of negligence. 3. This is correct. The nurse may not be protected against reports sent to the board of nursing. 4. This is incorrect. The nurse would be protected against complaints reported to the facility administration. 2. The nurse manager of an urgent care clinic is evaluating the impact of advanced practice nurses (APNs) on health care. How does the nurse manager interpret the benefits of employing APNs? 1. Projected shortfall of primary care providers 2. Increased cost of employing APNs 3. Easier client accessibility to APNs 4. Broader skill sets Answer: 1 Page: 3 Feedback 1. This is correct. The projected primary care provider shortfall, without advanced practice nurses (APNs), is projected to be 20,400 by 2020. 2. This is incorrect. Advanced practice nurses (APNs) reduce overall health-care costs. 3. This is incorrect. There is no data to suggest that advanced practice nurses (APNs) are more readily accessible to the client. 4. This is incorrect. Advanced practice nurses (APNs) are trained with a specific skill set, just as primary care providers are. 3. The nurse is interested in becoming an advanced practice nurse (APN). How does the nurse interpret the limitations of practice authority? 1. Serves as a safeguard to the client. 2. Decreases client access to health care. 3. Increases health-care costs. 4. Leads to a decrease in APNs in the workplace. Answer: 2 Page: 6 Feedback 1. This is incorrect. Limiting practice authority does not serve as a safeguard to clients. 2. This is correct. Limiting practice authority is associated with decreased client access to health care. 3. This is incorrect. Denying independent reimbursement leads to increased health-care costs. 4. This is incorrect. The nurse would be protected against complaints reported to the facility administration. 4. Which action can the advanced practice nurse (APN) take to prevent negligence? 1. Disclose essential information to the client. 2. Follow privacy laws. 3. Closely follow laws of regulation programs. 4. Keep licensure up-to-date. Answer: 1 Page: 7 Feedback 1. This is correct. To prevent negligence, the advanced practice nurse (APN) should disclose essential information. 2. This is incorrect. This action does not prevent negligence. 3. This is incorrect. This action does not prevent negligence. 4. This is incorrect. This action does not prevent negligence. 5. Which action should the advanced practice nurse (APN) expect with program exclusion? 1. Loss of federal reimbursement 2. Loss of licensure to practice 3. Restrictions on autonomy for a year 4. Close federal monitoring on prescription writing Answer: 1 Page: 8 Feedback 1. This is correct. Program exclusion involves a loss of federal reimbursement. 2. This is incorrect. Program exclusion does not involve a loss of licensure. 3. This is incorrect. Program exclusion does not involve restrictions on practice. 4. This is incorrect. Program exclusion does not involve close federal monitoring on prescription writing. 6. The advanced practice nurse (APN) is using telemedicine to care for a large group of clients both in and outside of the APN’s state of practice. What action can the APN take to ensure that laws are not being violated? 1. Become familiar with local ordinances. 2. Require staff to keep clients’ personal information up-to-date. 3. Carefully select which clients to admit into telemedicine. 4. Remain up-to-date on federal regulations. Answer: 4 Page: 8 Feedback 1. This is incorrect. The advanced practice nurse (APN) should become familiar with ordinances in all states where clients are using telemedicine. 2. This is incorrect. Although this is important, this does not lead to violation of laws when using telemedicine. 3. This is incorrect. This action does not prevent violation of laws. 4. This is correct. The advanced practice nurse (APN) should remain up-to-date on federal regulations. 7. The advanced practice nurse (APN) wants to see tort reform passed. Which action would this law take to protect health-care professionals? 1. Stop clients from being able to sue health-care professionals. 2. Make it less profitable to file claims against health-care professionals. 3. Encourage health-care professionals to increase education levels. 4. Enforce stricter guidelines for health-care professionals. Answer: 2 Page: 17 Feedback 1. This is incorrect. Tort reforms make it less profitable for clients to file claims against health- care professionals. 2. This is correct. Tort reforms make it less profitable to file claims against health-care professionals. 3. This is incorrect. Tort reforms do not encourage health-care professionals to increase education levels. 4. This is incorrect. Tort reforms do not enforce stricter guidelines for health-care professionals. 8. Which step should the advanced practice nurse (APN) take first in securing professional liability coverage? 1. Determine policy settlement provisions. 2. Select level of coverage. 3. Identify a carrier. 4. Select type of coverage. Answer: 3 Page: 26 Feedback 1. This is incorrect. Determining policy settlement provisions is the fourth step. 2. This is incorrect. Selecting level of coverage is the second step. 3. This is correct. The first step in securing professional coverage is to identify a carrier. 4. This is incorrect. Selecting type of coverage is the third step. 9. Which action should the advanced practice nurse (APN) take when a lawsuit has been filed? 1. Activate the professional liability coverage within a week of the trial. 2. Retain both copies of the summons for the APN’s records. 3. Discuss the suit with the supervising physician. 4. Prepare anecdotal documentation. Answer: 4 Page: 29 Feedback 1. This is incorrect. The advanced practice nurse (APN) should activate professional liability immediately. 2. This is incorrect. The advanced practice nurse (APN) should submit copies to management and the insurer as required. 3. This is incorrect. The advanced practice nurse (APN) should refrain from discussing the lawsuit with others. 4. This is correct. The advanced practice nurse (APN) should prepare anecdotal documentation. 10. Which action should the advanced practice nurse (APN) take when being assigned a lawyer for interview? 1. Ask for the lawyer’s credentials. 2. Request to choose a lawyer. 3. Decline the interview until personal representation has been obtained. 4. Ask to waive the interview. Answer: 1 Page: 30 Feedback 1. This is correct. The advanced practice nurse (APN) should ask for the lawyer’s credentials, in an effort to become familiar with the lawyer. 2. This is incorrect. The advanced practice nurse (APN) should accept the lawyer that has been assigned. 3. This is incorrect. The advanced practice nurse (APN) should not decline the interview. 4. This is incorrect. The advanced practice nurse (APN)should not waive the interview. Chapter 30: Ethics and the Advanced Practice Nurse ANSWERS AND RATIONALES 1. What action should the nurse take to practice nursing in the practice-based ethical system? 1. Assess whether or not the client can perform independently. 2. Prescribe medication according to the weight-based dosing formula. 3. Strengthen the client’s confidence in recovery. 4. Provide the client with written education on glucose monitoring. Answer: 3 Page: 5 Feedback 1. This is incorrect. Practice-based ethical systems strive to encourage clients and health-care providers to work together. 2. This is incorrect. Practice-based ethical systems strive to encourage clients and health-care providers to work together. 3. This is correct. Strengthen the client’s confidence in recovery is a way to encourage clients and health-care providers to work together. 4. This is incorrect. Practice-based ethical systems strive to encourage clients and health-care providers to work together. 2. What action does the advanced practice nurse (APN) interpret as the client regaining power through the use of practice-based ethical systems? 1. Taking all medication as prescribed most of the time 2. Following a cardiac diet during the weekdays 3. Administering insulin according to a sliding scale 4. Discussing missed daily weights with the health-care provider Answer: 3 Page 3 Feedback 1. This is incorrect. The client regains power through initiating and sustaining actions. 2. This is incorrect. The client regains power through initiating and sustaining actions. 3. This is correct. The client regains power through initiating and sustaining actions. 4. This is incorrect. The client regains power through initiating and sustaining actions. 3. The nurse has made a medication error. Which action shows moral courage? 1. Refrain from reporting the medication error. 2. Report the medication error anonymously. 3. Assess the client and ensure that no harm comes to the client. 4. Discuss the medication error with the manager. Answer: 4 Page: 13 Feedback 1. This is incorrect. Moral courage is the ability to do what is right or moral, which this action does not represent. 2. This is incorrect. Moral courage is the ability to do what is right or moral. The nurse cannot report the error anonymously. 3. This is incorrect. The nurse should follow protocol and report the error, as well as assess the client. 4. This is correct. The nurse should discuss the medication error with the manager. This demonstrates moral courage. 4. The advanced practice nurse (APN), who follows a utilitarian ethical system, is orienting a new nurse. Which action should the new nurse expect? 1. Encouraging equal consequences for all 2. Promoting the greatest good for the greatest number 3. Following the rules, regardless of outcome 4. Expressing that certain beliefs are paramount Answer: 2 Page: 38 Feedback 1. This is incorrect. The utilitarianism ethical system believes in doing the greatest good for the greatest number. 2. This is correct. The utilitarianism ethical system believes in doing the greatest good for the greatest number. 3. This is incorrect. The utilitarianism ethical system believes in doing the greatest good for the greatest number. Following the rules regardless of outcomes is characteristic of deontology. 4. This is incorrect. The utilitarianism ethical system believes in doing the greatest good for the greatest number. Expressing that certain beliefs are paramount follows the social relativism ethical system. 5. Which action by the advanced practice nurse (APN) demonstrates deontology? 1. Administering medications outside of parameters 2. Helping as many clients as possible 3. Connecting with clients who hold the same beliefs 4. Picking up a client to help a coworker Answer: 1 Page: 38 Feedback 1. This is correct. Deontology does not view consequences as important. 2. This is incorrect. Deontology does not view consequences as important. Helping as many clients as possible follows the utilitarian ethical system. 3. This is incorrect. Deontology does not view consequences as important. If the nurse holds certain belief systems as superior, then the nurse is demonstrating social relativism. 4. This is incorrect. Deontology does not view consequences as important. 6. The advanced practice nurse (APN) is caring for a client on a busy cardiac unit with minimal staff. The client recently had open-heart surgery and requires increased monitoring and administration of multiple medications. Which factor does the nurse interpret as potential for moral distress? 1. Cost containment 2. Increased workload 3. Client satisfaction 4. Inadequate staffing Answer: 4 Page: 13 Feedback 1. This is incorrect. Cost containment does not prevent the nurse from acting in an ethical manner. 2. This is incorrect. Increased workload does not prevent the nurse from acting in an ethical manner. 3. This is incorrect. This does not prevent the nurse from acting in an ethical manner. 4. This is correct. Moral distress occurs when the nurse is unable to act in an ethical manner. 7. The advanced practice nurse (APN) is admitting a client into a home-care agency. The client is in a wheelchair and is in need of a home health aide to assist with bathing and other personal needs. The client’s insurance does not cover the home health aide. Which factor does the nurse recognize as potential for moral distress? 1. Inadequate staffing 2. Health policy constraints 3. Lack of community resources 4. Need for education Answer: 2 Page: 13 Feedback 1. This is incorrect. Inadequate staffing would not create moral distress in this scenario. 2. This is correct. Health policy constraints have the potential to create moral distress in this scenario. 3. This is incorrect. A lack of community resources does not create moral distress in this scenario. 4. This is incorrect. A need for education would not create moral distress. 8. The nurse administers an IV antibiotic to the client, who shows signs and symptoms of an allergic reaction. The nurse immediately initiates treatment. Which action by the nurse shows context of awareness? 1. Initiating treatment for the allergic reaction 2. Administering the antibiotic for infection 3. Recognizing the allergic reaction 4. Stopping the IV infusion Answer: 1 Page: 16 Feedback 1. This is correct. Initiating treatment for allergic reaction shows context of awareness. 2. This is incorrect. Administering the antibiotic does not show context of awareness. 3. This is incorrect. Recognizing the allergic reaction does not show context of awareness. 4. This is incorrect. Stopping the infusion does not show context of awareness. 9. Which action by the advanced practice nurse (APN) demonstrates autonomy? 1. Encouraging the client to direct the course of treatment 2. Respecting the client’s decisions 3. Remaining faithful to the terms of an agreement 4. Judging the benefits and harm for the client Answer: 2 Page: 40 Feedback 1. This is incorrect. This demonstrates freedom. 2. This is correct. This demonstrates autonomy. 3. This is incorrect. This demonstrates fidelity. 4. This is incorrect. This demonstrates beneficence. 10. Which action by the advanced practice nurse (APN) promotes freedom for the client? 1. Allowing the client to choose a method of exercise 2. Respecting the client as a unique individual 3. Keeping promises made to the client 4. Helping the client choose a therapy that provides the most benefit Answer: 1 Page: 40 Feedback 1. This is correct. This demonstrates freedom. 2. This is incorrect. This demonstrates autonomy. 3. This is incorrect. This demonstrates fidelity. 4. This is incorrect. This demonstrates beneficence. [Show More]

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