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Chapter 1: Prescriptive Authority Test Bank Multiple Choice 1. An APRN works in a urology clinic under the supervision of a physician who does not restrict the types of medications the APRN is allowed to prescribe. State law does not require the APRN to practice under physician supervision. How would the APRN’s prescriptive authority be described? a. Full authority b. Independent c. Without limitation d. Limited authority ANS: B The APRN has independent prescriptive authority because the regulating body does not require that the APRN work under physician supervision. Full prescriptive authority gives the provider the right to prescribe independently and without limitation. Limited authority places restrictions on the types of drugs that can be prescribed.DIF: Cognitive Level: ComprehensionREF: p. 1TOP: Nursing Process: I MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. Which factors increase the need for APRNs to have full prescriptive authority? a. More patients will have access to health care. b. Enrollment in medical schools is predicted to decrease. c. Physician’s assistants are being utilized less often. d. APRN education is more complex than education for physicians. ANS: A Implementation of the Affordable Care Act has increased the number of individuals with health care coverage, and thus the number who have access to health care services. The increase in the number of patients creates the need for more providers with prescriptive authority. APRNs can fill this practice gap.DIF: Cognitive Level: ComprehensionREF: p. 2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. Which factors could be attributed to limited prescriptive authority for APRNs? Select all that apply. a. Inaccessibility of patient care b. Higher health care costs c. Higher quality medical treatment d. Improved collaborative care e. Enhanced health literacy ANS: A , B Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible patient care. It may also lead to poor collaboration among providers and higher health care costs. It would not directly impact patient’s health literacy.DIF: Cognitive Level: ComprehensionREF: p. 2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. Which aspects support the APRN’s provision for full prescriptive authority? Select all that apply. a. Clinical education includes prescription of medications and disease processes. b. Federal regulations support the provision of full authority for APRNs. c. National examinations provide validation of the APRN’s ability to provide safe care. d. Licensure ensures compliance with health care and safety standards. e. Limiting provision can decrease health care affordability. ANS: A , C , D APRNs are educated to practice and prescribe independently without supervision. National examinations validate the ability to provide safe and competent care. Licensure ensures compliance with standards to promote public health and safety. Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level: ComprehensionREF: pp. 1-2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. Which aspects support the APRN’s provision for full prescriptive authority? Select all that apply. a. Clinical education includes prescription of medications and disease processes. b. Federal regulations support the provision of full authority for APRNs. c. National examinations provide validation of the APRN’s ability to provide safe care. d. Licensure ensures compliance with health care and safety standards. ANS: A , C , D APRNs are educated to practice and prescribe independently without supervision. National examinations validate the ability to provide safe and competent care. Licensure ensures compliance with standards to promote public health and safety. Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level: ComprehensionREF: pp. 1-2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. A family nurse practitioner practicing in Maine is hired at a practice across state lines in Virginia. Which aspect of practice may change for the APRN? a. The APRN will have less prescriptive authority in the new position. b. The APRN will have more prescriptive authority in the new position. c. The APRN will have equal prescriptive authority in the new position. d. The APRN’s authority will depend on federal regulations. ANS: A Virginia allows limited prescriptive authority, while Maine gives full authority to certified nurse practitioners. The federal government does not regulate prescriptive authority.DIF: Cognitive Level: ComprehensionREF: p. 3TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers, 1st Ed. Chapter 2: Rational Drug Selection and Prescription Writing Test Bank Multiple Choice 7. How can collaboration with a pharmacist improve positive outcomes for patients? Select all that apply. a. Pharmacists can suggest foods that will help with the patient’s condition. b. Pharmacists have additional information on drug interactions. c. The pharmacist can suggest adequate medication dosing. d. Pharmacists have firsthand knowledge of the facility formulary. e. Pharmacy can alter prescriptions when necessary to prevent patient harm. ANS: B , C , D Providers should collaborate with pharmacists because they will likely have additional information on formulary, drug interactions, and suggestions for adequate medication dosing. Dietitians can make foods recommendations to treat the patient’s condition. The pharmacist can contact the prescriber about questionable prescriptions, but cannot alter the prescription without notification of and approval by the provider.DIF: Cognitive Level: ComprehensionREF: p. 9TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 8. A patient presents with delirium tremens requiring Ativan administration. The provider of care is not in the facility. Which action by the nurse is most appropriate? a. Obtain a telephone order. b. Contact the on-call hospitalist. c. Obtain an order from the charge nurse. d. Wait for a written Ativan order. ANS: A In an emergency situation, such as delirium tremens with seizure activity, it is acceptable to provide a telephone order. Contacting the on-call hospitalist or waiting for a written order would take more time than available for a patient with high seizure risk. Writing an order is outside the scope of practice for the charge nurse.DIF: Cognitive Level: ApplicationREF: p. 7TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 9. A patient with chronic pain calls the provider’s office to request a refill on their oxycontin. Which action is most appropriate? a. Fax an order to the pharmacy. b. Schedule an appointment with the patient. c. Verify the patient’s adherence to drug regimen. d. Determine the patient’s current medication dosage. ANS: B Schedule II medications are not eligible for refills, and prescriptions must be handwritten. It is important to verify the patient’s adherence to the drug regimen and determine the current dosage of medication; however, this can be accomplished by scheduling an appointment and evaluating the patient in person.DIF: Cognitive Level: ApplicationREF: p. 8TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 10. A patient prescribed amoxicillin for streptococcal pharyngitis reports new onset of a flat, itchy red rash on the chest and neck. Which action is most important? a. Provide a different prescription. b. Discontinue the medication. c. Prescribe an antihistamine cream. d. Assess for respiratory compromise. ANS: B The priority action is to discontinue the medication to prevent worsening of the patient’s symptoms. A different prescription would be provided, topical antihistamine may be administered, and the patient would be assessed for respiratory involvement, but these actions would not be performed first.DIF: Cognitive Level: ApplicationREF: p. 6TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 11. A patient taking three medications for hypertension is diagnosed with COPD. Which action should be taken prior to prescribing medications to treat COPD? a. Obtain baseline laboratory values. b. Obtain a complete medication history. c. Assess liver enzyme levels. d. Determine if patient has insurance coverage. ANS: B Prior to adding medications to the treatment regimen, it is essential to assess for any potential drug- drug interactions through a complete medical history. Baseline laboratory values are not necessary for COPD treatment. Liver enzyme levels may give insight into the possibility of altered metabolism but would not be the first action. The presence of insurance coverage would affect the patient’s access to treatment but may not affect the type of medication prescribed.DIF: Cognitive Level: ApplicationREF: p. 6TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 12. A patient with diabetes reports losing their job and an inability to purchase required medications. Which action is most appropriate? a. Provide a 7-day sample pack. b. Decrease the daily dose by half. c. Contact a different pharmacy. d. Prescribe a different medication. ANS: C Providing a 7-day sample will address the patient’s immediate need, but will not help with the patient’s long-term need for medication. Decreasing the daily dose will diminish the effectiveness of the medication. Selecting a different pharmacy could decrease the cost of the medication, as costs vary based on the location and the pharmacy dispensing the medication. Prescribing a different medication would be the last option.DIF: Cognitive Level: ApplicationREF: p. 5TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 13. A patient recently prescribed hydrocodone calls to report they are unable to fill the prescription. Which factors could contribute to the inability to fill the prescription? Select all that apply. a. DEA number missing from prescription b. Prescription sent via electronic messenger c. Dose higher than typically prescribed d. Prescriber license number not included e. Patient name and date of birth were handwritten ANS: A , B , D In order to fill a hydrocodone prescription, the prescriber name, license number, DEA number, and contact information must be included. Schedule II medications, such as narcotics, must be prescribed using written prescriptions. Though the pharmacist may question the high dosing, that would not prevent filling the prescription. The patient’s name and date of birth must be included on the prescription, but there are no regulations that the name cannot be handwritten.DIF: Cognitive Level: ComprehensionREF: pp. 6-8TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers, 1st Ed. Chapter 3: Promoting Positive Outcomes of Drug Therapy Test Bank Multiple Choice 14. A patient reports that a medication prescribed for recurrent migraine headaches is not working. Which action should be taken first? a. Ask the patient about the number and frequency of tablets taken. b. Assess the patient’s headache pain on a scale from 1 to 10. c. Report the patient’s complaint to the prescriber. d. Suggest biofeedback as an adjunct to drug therapy. ANS: A When evaluating the effectiveness of a drug, it is important to determine whether the patient is using the drug as ordered. Asking the patient to tell the nurse how many tablets are taken and how often helps the nurse determine compliance. Assessing current pain does not yield information about how well the medication is working unless the patient is currently taking it. The nurse should gather as much information about compliance, symptoms, and drug effectiveness as possible before contacting the prescriber. Biofeedback may be an effective adjunct to treatment, but it should not be recommended without complete information about drug effectiveness.DIF: Cognitive Level: ApplicationREF: pp. 15-16TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 15. A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would be most concerning? a. Recent yeast infection b. Family history of cervical cancer c. Drinks two glasses of wine every night d. Patient is currently unemployed ANS: C Patients taking metronidazole should be educated not to drink alcohol to prevent adverse reactions. It would be concerning that the patient drinks wine daily. History of a yeast infection may indicate increased risk for recurrence with administration of an antimicrobial. A family history of cervical cancer is not related to administration of metronidazole. Unemployment can indicate lack of insurance coverage, which may limit the patient’s ability to purchase medications, but is not the most concerning patient finding.DIF: Cognitive Level: ApplicationREF: p. 12TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 16. A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer “two puffs every 4 hours as needed for coughing or wheezing.” The patient reports feeling jittery sometimes when taking the medication, and she doesn’t feel that the medication is always effective. Which action is most appropriate? a. Asking the patient to demonstrate use of the inhaler b. Assessing the patient’s exposure to tobacco smoke c. Auscultating lung sounds and obtaining vital signs d. Suggesting that the patient use one puff to reduce side effects ANS: C Asking the patient to demonstrate inhaler use helps to evaluate the patient’s ability to administer the medication properly and is part of the nurse’s evaluation, but is not a priority intervention based on the patient’s current report. Assessing tobacco smoke exposure helps the nurse determine whether nondrug therapies, such as smoke avoidance, can be used as an adjunct to drug therapy, but does not relate to the patient’s current problem. Performing a physical assessment helps the nurse evaluate the patient’s response to the medication and identify the presence of other side effects.DIF: Cognitive Level: ApplicationREF: p. 13TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 17. A patient newly diagnosed with diabetes is to be discharged from the hospital. Which action should be taken first during medication education? a. Asking the patient to demonstrate how to measure and administer insulin b. Discussing methods of storing insulin and discarding syringes c. Giving information about how diet and exercise affect insulin requirements d. Teaching the patient about the long-term consequences of poor diabetes control ANS: A Because insulin must be given correctly to control symptoms and because an overdose can be fatal, it is most important for the patient to know how to administer it. Asking for a demonstration of technique is the best way to determine whether the patient has understood the teaching. When a patient is receiving a lot of new information, the information presented first is the most likely to be remembered. The other teaching points are important as well, but they are not as critical and can be taught later.DIF: Cognitive Level: ApplicationREF: p. 11TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 18. The drug manual states that older adult patients are at increased risk for hepatic side effects. Which action is most important when prescribing this medication to an 80-year-old patient? a. Obtain pretreatment laboratory work. b. Ensure that the drug is given in the correct dose at the correct time to minimize the risk of adverse effects. c. Discontinue the order; the drug is contraindicated for this patient. d. Give the medication intravenously so that the drug does not pass through the liver. ANS: A The drug manual indicates that this drug should be given with caution to elderly patients. Getting information about liver function before giving the drug establishes baseline data that can be compared with post-treatment data to determine whether the drug is affecting the liver. Giving the correct dose at the correct interval helps to minimize risk, but without baseline information, the effects cannot be determined. The drug is not contraindicated.DIF: Cognitive Level: AnalysisREF: p. 12TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

ractice (DNP)? a. 2006 b. 2004 c. 2000 d. 2002 TAhNeSA: ABCN introduced the DNP degree in 2004 to prepare advanced practice nurses (APRNs) to meet challenges and standardize practice beyond master’s degree programs. 2. Which of the following is the best explanation for the creation of the Doctorate of Nursing Practice (DNP) degree? a. To compete against master’s degree programs b. To ensure standardized curriculum ensuring independent practice c. To validate APRN’s for financial reimbursement d. To address increasing curriculum requirements of master’s degree programs ANS: D Although all answers are influenced by the DNP core competencies, the DNP program creation in 2004 by the AACN was designed to address curriculum requirements of master’s degree programs. 3. Which of the following was the first recognized area of advanced practice nursing? a. Clinical Nurse Specialist b. Family nurse practitioner c. Pediatric nurse practitioner d. Certified Registered Nurse Anesthetist ANS: D In 1931, the National Association of Nurse Anesthetists (NANA), renamed in 1939 to the American Association of Nurse Anesthetists (AANA) was the first recognized group promoting advanced nursing practice. Agatha Hodgins founded the AANM at Lakeside Hospital in Cleveland, Ohio. 4. Which factor is broadly perceived to solidify and standardize the role of the APNs over the last 25 years? a. Lack of access to health care providers b. Standardized curriculum development c. Payment for services d. Societal forces ANS: B As the evolution of Advanced Practice Nursing advances specific specialties and needs are identified. Through the evolution of organization and standardization these roles have solidified the APN’s role in today’s health care environment. 5. During the formation of early APN roles in anesthesia, which of the following increased demand for access to health care? a. Poverty b. War c. Rural access to care d. Availability of training ANS: B Earliest demand for nursing-provided anesthesia spiked during periods of war when numbers of physicians were inadequate. The earliest records date back to the American Civil War with the administration of chloroform. During World War I in 1917 more than 1000 nurses, some trained anesthetists, traveled into battle. Other factors such as need for rural health care came later in the validation and need for APNs. 6. In 1889, Dr. William Worrall Mayo built and opened St. Mary’s hospital in Rochester, NY. He is known for some of the earliest recruitment and specialized training of nurses in which of the following roles? a. Pediatrics b. Anesthesia c. Obstetrics d. Research and statistics e. Family nursing ANS: B In 1889, Dr. William Worrall Mayo began formally training and recognizing nurse anesthetists. This has been regarded as the earliest training in nurse-provided anesthesia. 7. In 1893, Lillian Wald established the Henry Street Settlement (HSS) House for which purpose? a. Access to health care of rural areas b. Create inner-city nursing awareness c. Provide the disadvantaged access to care d. Establish guidelines for advanced nursing roles ANS: C The HHS was established to provide nursing services to immigrants and low-income patients and their families in Manhattan. As resistance to nurse-provided care grew, standing orders were drafted from a group of Lower East Side physicians thereby circumventing then-existing legal ramifications. 8. The Frontier Nursing Service (FNS) founded in Kentucky in 1925 by Mary Breckenridge initially provided Appalachia with nursing resources and which type of advanced nursing care? a. Pediatric care b. Anesthesia c. Midwifery d. Surgical services ANS: C The original FNS provided nursing services and obstetric services to Appalachian residents. Later working from standard orders developed from their medical advisory committee nurses treated patients, made diagnoses, and dispensed medications. 9. Which organization founded in 1941 under Mary Breckenridge’s leadership merged with the American College of Nurse-Midwives (ACNM) in 1969? a. American Association of Nurse-Midwives (AANM) b. American Nurses Association (ANA) c. Association for National Nurse-Midwifery (ANNM) d. Council of Nursing Midwifery (ANM) ANS: A The American College of Nurse-Midwives (ACNM) formed under the leadership of Mary Breckenridge in 1941 to provide nurse-midwife development and collaboration for midwife development. In 1955, the American College of Nurse-Midwives was formed and the two organizations merged in 1969 after the death of Mary Breckenridge. 10. In a landmark ruling by the Supreme Court as a result of Chalmers-Frances v. Nelson, 1936, what legal precedent was established? a. Nurse anesthesia was allowed under the nurse practice act b. Nurse anesthesia scope of practice included anesthesia c. Nurse anesthesia was legal, if under guidance of a supervising physician d. Only trained nursing professionals could administer anesthesia independently ANS: C The landmark decision from the Chalmers-Frances v. Nelson case set national precedent for the advanced nursing practice role. It proved to be the basis for other cases over the following few decades and established that trained nurses could legally provide anesthesia care under supervision of a physician. 11. The first known establishment of the nurse practitioner role occurred in 1965 at theUniversity of Colorado. In which area of training did this role specialize? a. Pediatrics b. Geriatrics c. Midwifery d. Anesthesia ANS: A The establishment of the first pediatric nurse practitioner program was in 1965 at the University of Colorado. Loretta Ford, RN and Henry Silver, MD provided a 4-month course to certified registered nurses to provide education on managing childhood health problems. 12. The DNP program curriculum outlined which of the following clinical requirements in an effort to standardize training? a. 1000 supervised clinical hours and 200 unsupervised clinical hours b. 1000 supervised clinical hours c. 900 supervised clinical hours d. 800 supervised clinical hours and 200 unsupervised clinical hours ANS: B In 2004, the AACN outlined the DNP curriculum in an effort to standardize and relieve challenges of master’s degree programs. This includes a standardized curriculum requiring 1000 supervised clinical hours. 13. Which state became the first to recognize diagnosis and treatment as part of the scope of practice of specialty nurses? a. Idaho b. Oklahoma c. South Dakota d. Maryland ANS: A Idaho Governor Cecil Andrus signed HB 46 and HB 207 into law on February 11, 1971. This amended the states’ nurse practice act making it the first state to officially recognize diagnosis and treatment of specialty nurses. The recognition of the ability to diagnose and treat overcame an initial hurdle toward independent nursing practice. 14. The American Nursing Association (ANA) defines which requirement for the designation of a clinical nurse specialist in any specialty? a. Specialty training certificate b. Successful completion of certification examination c. Masters or doctoral degree d. 1000 hours relevant supervised training e. Two or more years of clinically relevant experience ANS: C In 1980, the ANA specifically outlined criteria for the acknowledgment of clinical nurse specialist training programs. At that time they required graduate level training to become an expert in a relevant specialty area of nursing. Additionally, they must meet any requirements set forth by the specific professional society. Chapter2 The Nurse Practitioner: Historical Perspective on the Art and Science of Nurse Practitionering 1. Which of the following is the primary mission of the National Organization of Nurse Practitioner Faculties (NONPF)? a. Provide leadership in promoting quality NP education b. NP Faculty training program assistance c. Provide financial assistance to NP students d. Lobbying legislature on behalf of NPs ANS: A The NONPF’s primary mission is to provide leadership in promoting quality NP education. The organization has published domains and core competencies for primary care and these serve as a framework for NP education and practice. 2. A model of competencies that are encompassed around three spheres of influence known as patient, nurses and nursing practice, and organization and influence is known as? a. NACNS Model of clinical nurse specialist competencies b. Fenton’s and Brykczynski’s Expert Practice c. Calkin’s model of Advanced Nursing Practice d. Shuler’s Model of NP Practice ANS: A The NACNS’s initial 2008 statement was revised in 2004. The statement outlined competencies that aligned to each of the three spheres of influence: patient, nurses and nursing practice, and organization and influence. 3. Building upon Benner’s seven domains of expert nursing practice, which conceptual model adds an additional domain “The consulting role of the nurse”? a. Calkin’s model of Advanced Nursing Practice b. Fenton’s and Brykczynski’s Expert Practice c. Strong Memorial Hospital’s Model of Advanced Nursing Practice d. Shuler’s Model of NP Practice e. NACNS Clinical Nurse Specialists Model ANS: B Fenton’s and Brykczynski’s Expert Practice Domains of the CNS and NP expanded on Benner’s seven domains adding consultation provided by CNS’s to other nurses and management of health and illness in ambulatory care settings. 4. Which model of conceptual practice was the first to explicitly distinguish the experience level of advanced practitioners? a. Calkin’s model of Advanced Nursing Practice b. Shuler’s Model of NP Practice c. NACNS Clinical Nurse Specialists Model d. Strong Memorial Hospital’s Model of Advanced Nursing Practice e. Fenton’s and Brykczynski’s Expert Practice ANS: A Calkins model of Advanced Nursing Practice was the first to explicitly distinguish experience levels of advanced practitioners for nurse administrators to differentiate advanced practice nursing from other levels of clinical practice. 5. The circular and continuous threads of direct comprehensive patient care, support of systems, education, research, and publication and professional leadership make up the five domains of which advanced nursing conceptual model? a. Strong Memorial Hospital’s Model of Advanced Nursing Practice b. Calkin’s model of Advanced Nursing Practice c. NACNS Clinical Nurse Specialists Model d. Fenton’s and Brykczynski’s Expert Practice e. Shuler’s Model of NP Practice ANS: A Direct and indirect activities across five domains including: direct comprehensive patient care, support of systems, education, research, and publication and professional leadership make up the Strong Memorial Hospital’s Model of Advanced Practice Nursing. 6. Texas Children’s Hospital Transformational Advanced Professional Practice (TAPP) APRN Model added what unifying conceptual strand? a. Ethics b. Culture c. Informatics d. Education ANS: A The TAPP model added two additional domains: quality and safety, and credentialing and regulatory practice, to the Strong model. It additionally added professional ethics as a unifying conceptual strand. 7. Poghosyan, Boyd, and Clarke (2016) proposed a comprehensive conceptual model including three factors: scope of practice regulations, institutional policies, and practice environments. What was their primary purpose? a. To discourage role ambiguity among CNS providers b. To enhance patient education provided by the APRN c. To maximize NP Contributions to primary care d. To provide educational practice guidelines to enhance NP education ANS: C he 2016 model provided a comprehensive review of literature and described potential factors that affect NP care and patient outcomes. This included scope of practice regulations that often cause barriers for NP provided primary care. 8. Which model of practice intended to impact the NP domain at four levels: theoretical, clinical, educational, and research in 1993? a. Hamric’s model b. Calkin’s model of Advanced Nursing Practice c. Strong Memorial Hospital’s Model of Advanced Nursing Practice d. Shuler’s Model of NP Practice ANS: D Shuler’s Model of NP Practice is a holistic and wellness oriented model that was designed to impact the NP domain at four levels: theoretical, clinical, educational, and research. It is designed to elaborate the NP’s expanded knowledge and skills into medicine including a template for conducting a visit. 9. Which model for APRN practice addresses all four APRN roles: CNS, CRNA, CNM, and NP? a. Calkin’s model of Advanced Nursing Practice b. Hamric’s model c. Strong Memorial Hospital’s Model of Advanced Nursing Practice d. Donabedian Model ANS: B Many models highlight core competencies among specific APRN roles, while others emphasize competencies for hiring managers. At the time of this writing, only the Hamric’s model encompasses all four APRN roles. 10. Which of the following is one of the eight published essentials included in the Essentials of Doctoral Education for Advanced Nursing Practice developed by the AACN in 2006? a. Algorithms for advanced patient care b. Informatics and health care technologies c. Scientific underpinnings of practice d. Liberal education for general nursing practice ANS: C The AACN publishes their national consensus to provide the core elements for nursing curriculum creation. Currently published are Baccalaureate Essentials, Master’s Essentials, DNP Essentials, and Clinical Resources Essentials. Although they are similar in their core approach to education, listed first in DNP essentials is the scientific underpinnings of practice. 11. Which model of conceptualization identifies that health care needs are not met in a system dominated by medical language as a basis for reimbursement? a. Donabedian Model b. Dunphy and Winland-Brown’s Circle of Caring model c. Shuler’s Model of NP Practice d. Calkin’s model of Advanced Nursing Practice ANS: B Dunphy and Winland-Brown’s transformative model (Dunphy, Winland-Brown, Porter, Thomas, and Gallagher, 2011; Fig. 2.12) proposed a circle of caring to encourage medical collaboration and enhance the nursing presence in the health care system. Their model incorporates both strengths of medicine and nursing with process of assessment, planning, intervention, and evaluation, with a feedback loop. 12. Without additional application of conceptual models which model would be best chosen to model the skill level of beginning nurses, experienced nurses, or advanced nurse practitioners with the appropriate level of patient care? a. Dunphy and Winland-Brown’s Circle of Caring model b. Strong Memorial Hospital’s Model of Advanced Nursing Practice c. Donabedian Model d. Calkin’s model of Advanced Nursing Practice ANS: D Calkin’s model of Advanced Nursing Practice outlines skills and knowledge of beginning nurses, experienced nurses, and advance practice nurses as they relate the patient responses for health care problems. 13. The 2005 Donabedian model has been used to evaluate the quality of APRN care using which conceptual outline? a. Assessment, diagnosis, planning, intervention, and evaluation b. Structure, process, and outcome c. Diagnosis and outcome d. Diagnosis, morbidity, and mortality ANS: D The Donabedian model encompasses structure (health care systems and facilities), process (diagnosis, treatment, education), and outcomes. 14. Which of the following are the functions of a conceptualization ofadvanced practice nursing? (Select all that apply.) a. Basis for furthermore development of knowledge b. Articulate professional role identity and function c. Identify specific procedures to provide d. Deliver holistic and collaborative care e. Provide guidelines on billing ANS: A, B, D Conceptual models allow for articulation of professional role identity, provide a basis for furthermore development of knowledge and assist in clinical practice for the delivery of holistic, comprehensive, and collaborative care. Models may assist but in general do not provide assistance with clinical decision making or billing. Test Bank Multiple Choice 15. A registered nurse completes an informal education and training course at his or her place of work authorizing him or her to use ultrasound guided imagery when placing intravenous lines. How is this best classified? a. Advanced practice nursing b. Nursing Skill Advancement c. Advanced Licensure d. Advanced Certification ANS: B The addition or advancement of individual skills to the nursing practice is common and encouraged but does not meet the requirements set forth for advanced practice nursing. Licensure and certification were not obtained or expressed. 16. The core foundations of all APN education curricula contain advanced courses covering which of the following? a. Human anatomy, health and physical assessment, and pharmacology b. Pathophysiology, research, and pharmacology c. Health and physical assessment, pathophysiology, and obstetrics and gynecology d. Pathophysiology, health and physical assessment, and pharmacology ANS: D While specific specialties may focus on individual areas of clinical knowledge, all aspects of advanced practice nursing include advanced knowledge of pathophysiology, health and physical assessment, and pharmacology. 17. Which of the following criteria is required for the attainment of classification as an advanced practice nurse (APN)? a. Practice focused on research b. Baccalaureate degree in area of focus c. Specialized skill attainment d. Graduate degree in area of focus ANS: D The three basic criteria or qualifications for APNs include graduate education in advanced practice nursing role, national certification in an advanced role, and a practice focused on patients and their families. Research and skills are components of core competencies of advanced practice nurses who achieve a graduate level of education. 18. Which of the following is the central, core competency for advanced practice nursing? a. Evidence-based practice b. Direct clinical practice c. Leadership d. Ethical decision making ANS: B Direct clinical practice is the core competency that lends itself to all others. It also provides the foundation for APNs to carry out the other competencies adequately. 19. The legal authority granted to a professional to provide and be reimbursed for health care services refers to: a. Certification b. Scope of practice c. Practicing Role d. Education ANS: B Many things including state and federal laws define scope of practice. The APN NCSBN defines scope of practice as characterized by specialization, expansion of services provided, including diagnosing and prescribing, and autonomy to practice. An individual certification would fall under the umbrella of scope of practice. 20. Which of the following most accurately describes the current four established advanced practice nurse roles? a. RN, BSN, MSN, DNP b. CNM, FNP, CNS, CRNA c. CNM, FNP, AGNP, PNP d. CNS, CRNA, NP, CNM ANS: D The four established advanced practice nurse roles include CNS, CRNA, CNM, and NP. FNP and AGNP are specializations of nurse practitioners (NP). 21. Which advanced practice nursing role has seen the largest expansion of growth and is currently the largest in number? a. CNS b. CRNA c. CNM d. NP ANS: D Nurse practitioner continues to be the largest in number of APN roles. According to the American Academy of Nurse Practitioners National NP Database there are over 220,000 trained NPs. 22. Which advanced practice nursing role is currently the smallest in number? a. CNM b. NP c. CNS d. CRNA ANS: A The CNM role according to the American College of Nurse-Midwives currently has around 11,000 trained providers based on current estimates. The CNM role is specialized in the care of women’s health and childbearing. 23. A practicing, certified CNM wishes to change roles and work as a family nurse practitioner (FNP). Which of the following is required? a. Complete education and training as an NP b. Take the FNP board examination c. Nothing is required d. Apply for immediate reciprocity ANS: A The four roles of APN (CNS, CRNA, CNM, and NP) are not interchangeable without additional training and education. Although there are specific instances of overlap, each of the four roles should not be confused as interchangeable. Specialty certifications under the NP role may allow for more flexibility under today’s regulations and are not standard practice. Scenarios are usually handled on an individual basis. 24. True or False. A registered nurse in an emergency room successfully completes a critical care course and meets all requirements for certification. He or she is now classified as an advanced practice nurse. a. True b. False ANS: B This registered nurse has completed advanced training that increases skill and knowledge and may have also obtained a certification; however, this does not meet the basic criterion of advanced practice nurse. He or she may be expertly skilled but requires the completion of a graduate degree focused in an area of nursing to appropriately be classified as an APN. The acute care nurse practitioner specialty would be required in this particular setting. Chapter3 Overview of the Doctor of Nursing Practice Degree 1. A registered nurse completes an informal education and training course at his or her place of work authorizing him or her to use ultrasound guided imagery when placing intravenous lines. How is this best classified? a. Advanced practice nursing b. Nursing Skill Advancement c. Advanced Licensure d. Advanced Certification ANS: B The addition or advancement of individual skills to the nursing practice is common and encouraged but does not meet the requirements set forth for advanced practice nursing. Licensure and certification were not obtained or expressed. 2. The core foundations of all APN education curricula contain advanced courses covering which of the following? a. Human anatomy, health and physical assessment, and pharmacology b. Pathophysiology, research, and pharmacology c. Health and physical assessment, pathophysiology, and obstetrics and gynecology d. Pathophysiology, health and physical assessment, and pharmacology ANS: D While specific specialties may focus on individual areas of clinical knowledge, all aspects of advanced practice nursing include advanced knowledge of pathophysiology, health and physical assessment, and pharmacology. 3. Which of the following criteria is required for the attainment of classification as an advanced practice nurse (APN)? a. Practice focused on research b. Baccalaureate degree in area of focus c. Specialized skill attainmen d. Graduate degree in area of focus ANS: D The three basic criteria or qualifications for APNs include graduate education in advanced practice nursing role, national certification in an advanced role, and a practice focused on patients and their families. Research and skills are components of core competencies of advanced practice nurses who achieve a graduate level of education. 4. Which of the following is the central, core competency for advanced practice nursing? a. Evidence-based practice b. Direct clinical practice c. Leadership d. Ethical decision making ANS: B Direct clinical practice is the core competency that lends itself to all others. It also provides the foundation for APNs to carry out the other competencies adequately. 5. The legal authority granted to a professional to provide and be reimbursed for health care services refers to: a. Certification b. Scope of practice c. Practicing Role d. Education ANS: B Many things including state and federal laws define scope of practice. The APN NCSBN defines scope of practice as characterized by specialization, expansion of services provided, including diagnosing and prescribing, and autonomy to practice. An individual certification would fall under the umbrella of scope of practice. 6. Which of the following most accurately describes the current four established advanced practice nurse roles? a. RN, BSN, MSN, DNP b. CNM, FNP, CNS, CRNA c. CNM, FNP, AGNP, PNP d. CNS, CRNA, NP, CNM ANS: D The four established advanced practice nurse roles include CNS, CRNA, CNM, and NP. FNP and AGNP are specializations of nurse practitioners (NP). 7. Which advanced practice nursing role has seen the largest expansion of growth and is currently the largest in number? a. CNS b. CRNA c. CNM d. NP ANS: D Nurse practitioner continues to be the largest in number of APN roles. According to the American Academy of Nurse Practitioners National NP Database there are over 220,000 trained NPs. 8. Which advanced practice nursing role is currently the smallest in number? a. CNM b. NP c. CNS d. CRNA ANS: A The CNM role according to the American College of Nurse-Midwives currently has around 11,000 trained providers based on current estimates. The CNM role is specialized in the care of women’s health and childbearing. 9. A practicing, certified CNM wishes to change roles and work as a family nurse practitioner (FNP). Which of the following is required? a. Complete education and training as an NP b. Take the FNP board examination c. Nothing is required d. Apply for immediate reciprocity ANS: A The four roles of APN (CNS, CRNA, CNM, and NP) are not interchangeable without additional training and education. Although there are specific instances of overlap, each of the four roles should not be confused as interchangeable. Specialty certifications under the NP role may allow for more flexibility under today’s regulations and are not standard practice. Scenarios are usually handled on an individual basis. 10. True or False. A registered nurse in an emergency room successfully completes a critical care course and meets all requirements for certification. He or she is now classified as an advanced practice nurse. a. True b. False ANS: B This registered nurse has completed advanced training that increases skill and knowledge and may have also obtained a certification; however, this does not meet the basic criterion of advanced practice nurse. He or she may be expertly skilled but requires the completion of a graduate degree focused in an area of nursing to appropriately be classified as an APN. The acute care nurse practitioner specialty would be required in this particular setting. Chapter4 Emerging Roles for the DNP Nurse Educator Test Bank Multiple Choice 25. In 1990, Cooper and Sparacino postulate than an APRN’s maximum potential may not be attained until: a. After 1 year b. After 7 years c. After 3 years d. After 5 years ANS: D Studies have shown that the first-year position of an APRN is one of transition, and Cooper and Sparacino estimate that an APRN’s maximum potential may not be attained until after 5 years or more in practice. 26. An NP student is performing a thorough neurologic examination for the first time in the clinical setting. This is an example of: a. Role implementation b. Role acquisition c. Role confusion d. Role conflict ANS: B 27. A new NP student is completing a rotation at an outpatient urgent care clinic and completes an examination on a patient with chest pain. The nursing assistant hands a 12-lead ECG to the NP student and asks: “What should we do?” The NP student’s preceptor did not provide clear instructions on the role of the NP student at this time even though the student is capable of interpreting ECGs. This is an example of: a. Role ambiguity b. Role transition c. Role strain d. Role supplementation ANS: A Role ambiguity is created by unclear expectations, diffuse responsibilities, and uncertainty of subroles. The NP student’s preceptor did not provide clear roles to the NP student about what he or she should do in the absence of the preceptor. If the NP student was placed in a role where he or she was unaware of how to interpret ECGs this would be an example of role incongruity. 28. An NP is completing the first month in his or her first job. He or she receives a phone call from an administrator telling him or her that he or she will need to see 30% more patients starting next week. He or she is told that this is the minimum requirement of all NPs in the same position. The NP has difficulty using the electronic health record (EHR) software efficiently and feels overwhelmed. This is an example of: a. Role supplementation b. Role ambiguity c. Role conflict d. Role insufficiency ANS: D Role insufficiency is often seen as APRN graduates’ transition to the workforce or change positions. This may include feelings of inadequacy or slow speed due to the new role or barriers such as electronic health record documentation requirements. 29. Which of the following is an example of role acquisition? a. NP student learning leadership roles in the classroom b. NP student on graduation day from his or her program cd.. ANPprsatuctdiecnintgbeNgPinandinvganacinnegwcejonbtral lainfeamskiliyllsnurse practitioner ANS: A The changes occurring during role transitions experienced during the educational component of an APN role are classified as role acquisition. All of the others are examples of role implementation. 30. The changes occurring as an APRN performs procedures during job duties are classified as? a. Role supplementation b. Role transition c. Role implementation d. Role acquisition ANS: C The job duties and responsibilities performed by the APRN are an example of role implementation. Role transition is the transition from student to practicing NP. 31. Which of the following is best classified as roll stress? a. Maintaining family responsibilities while in school b. An APN’s feelings of poor self-esteem c. Starting a first job as an NP d. Multiple failed attempts to master a procedure during education ANS: A There are many examples of role stress. Role stress may include any situation that requires increased performance above and beyond the expectation of others. This is easily classified as examples of things that require additional demand in addition to school or work such as work/family responsibilities or keeping up with new and advancing technologies. Starting a first job as an NP is an example of role transition. 32. Which of the following is best classified as role strain? a. A difficult disagreement with a physician b. An APN’s feelings of poor self-esteem after failing two examinations c. Maintaining family responsibilities while in school d. Starting a first job as an NP ANS: B Role strain is defined as the subjective feeling of frustration, tension, or anxiety in esponse to role stress. Examples of role strain typically include subjective feelings of decreased self-esteem when performance is below the expectations of self or others. A difficult disagreement with a physician is an example of role conflict. Starting a first job as an NP is an example of role transition. Maintaining family responsibilities while in school is an example of role stress. 33. Which of the following is an example of role conflict? a. Difficult work-life balance b. A difficult disagreement with a physician c. Starting a first job as an NP d. Maintaining family responsibilities while in school ANS: B Role conflict occurs when role expectations are perceived to be mutually exclusive or contradictory. Role conflict does not have to be with superiors but can occur between APRNs and nurses, other APRNs, or physicians. Starting a first job as an NP is an example of role transition. Maintaining family responsibilities while in school is an example of role stress. 34. The four-stage process to NP role development first identified by Anderson, Leonard, and Yates (1974) and validated by Roberts et al. (1997) included which four components? a. Finding a niche, coping with pressures, feeling competent, internalizing the role b. Complete dependence, developing competence, independence, interdependence c. Novice, developing competence, competent, advanced d. Developing competence, partial independence, complete independence, interdependence e. Dependence, independence, interdependence, role model ANS: B Complete dependence, developing competence, independence, and interdependence are the four- stage process of NP development outlined by Anderson, Leonard, and Yates in 1974 and validated by Roberts et al. (1997). 35. A trained nurse enters the first semester of an NP training program. He or she is required to learn new and more advanced techniques beginning with conducting an advanced physical examination. The overwhelming feeling and stress of learning additional skills is most likely classified by the studies of Anderson, Leonard, and Yates in 1974 as: a. Independence b. Developing competence c. Interdependence d. Complete dependence ANS: D The initial learning of skills and additional techniques experien ed by NPs in the beginning of their training has been described as complete dependence. 36. A trained NP is working at an outpatient care clinic. He or she encounters a difficult patient, is unaware of treatment options, and consults one of his or her colleagues for advice. This is best classified as: a. Independence b. Interdependence c. Developing competence d. Complete dependence ANS: B As initially defined by Anderson, Leonard, and Yates in 1974, NP roles as they transition to the workplace as seasoned practitioners transition to interdependence as they work with colleagues to enhance patient care. 37. Fleming and Carberry’s research in 2011 studied two cohorts of critical care nurse advanced practice trainees in Scotland. They found that transition occurred in which four areas? a. Complete dependence, developing competence, independence, interdependence b. Developing competence, partial independence, complete independence, interdependence c. Coping with pressures, feeling competent, internalizing the role, leading others d. Finding a niche, overcoming obstacles, advanced practice, interdependence e. Finding a niche, coping with pressures, feeling competent, internalizing the role ANS: E Fleming and Carberry’s research in 2011 studied two cohorts of critical care nurse advanced practice trainees in Scotland showing transition occurred in four areas: finding a niche, coping with pressures, feeling competent, internalizing the role. 38. A strategy to promote role acquisition in school that involves a ceremony at the beginning of the NP students training is the best example of: a. Role rehearsal b. Creating a support network c. Role development d. Developing clinical knowledge of skills ANS: A Role rehearsal may include many facets including a rite of passage such as a ceremony to mark the beginning of a new training program. 39. Which initial strategy would provide the best role acquisition for a student or potential student about to begin a new NP program? a. Provide case scenarios of patients that may be encountered b. Preadmission testing c. Provide a handout detailing the APRN curriculum d. Clinical faculty mentoring by preceptors ANS: C An initial strategy for role acquisition includes components for role rehearsal. Providing the overall framework for the APRN curriculum would allow for the best-case scenario of role acquisition. Clinical faculty mentoring by preceptors is an example of role acquisition but is best suited to develop clinical knowledge and skills. 40. Which of the following is the best strategy for transition of an APRN into a new position? a. Ensuring adequate pre-position training b. Development of a structured orientation plan c. Scheduling time-based evaluations d. Providing immediate feedback from supervisors ANS: B APRNs in new roles regardless of previous experience benefit most from structured orientation plans, networking with peers, appropriate mentors and preceptors, and an understanding of appropriate expectations. 41. Which three major purposes are categorized and can be utilized to facilitate role acquisition of NPs in school? a. Knowledge expansion, skill practice, creation of a supportive network

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Comprehensive Musculoskeletal System and Disorder Study Guide| Fractures|Injuries| Nursing school study guide| 18 pages printable pdf| Digital download -> A 18-page comprehensive covering all the important aspects of Musculoskeletal System and Disorder -> EachMusculoskeletal comes with Causes, Signs and Symptoms, Prevention, Diagnosis, Treatment, Nursing Intervention and more** -> Everything is explained in easy to memorize graphics and elements -> Digital instant download pdf -> Perfect guide for your NCLEX prep! What's Included Musculoskeletal System And Disorders | 18 pages | Digital Download -Musculoskeletal system Overview -Types of Bones -Types of Joints - Skeletal Muscle -Terminology -Assessment -Injuries -Types of Fractures -Osteoporosis -Osteoarthritis -Rheumatoid Arthritis -Stages Of RA -RA and OA Comparison -Gout * Content Updated: 2022 based on several textbooks and lectures Check back soon as I am adding new study sheets often! This is a Digital Download PDF. No physical product will be shipped. PURCHASE PROCESS ================== 1. Once payment is received AND completed by ETSY, you will receive an instant download link to access your purchased files. This is a DIGITAL FILE. - No physical items will be sent to you. 2. Download your files and save them to your computer. Files can be opened in Adobe Acrobat Reader, if your computer does not already contain a PDF Viewer. 3. Print the files as many times as you need. DOWNLOAD PROCESS ================== After receiving payment, your digital files will be available to download in your account and you will receive an email. Confirmation may take a few minutes. You’ll see a notice at the top of the page, if your payment is still processing. LICENCING ================== ➭ These files are FOR PERSONAL USE ONLY. You are not authorised to resell for a profit or hand out these files in any format, including DIGITAL or PRINTED. ➭ Prints made from these files are licensed to the purchaser only | If you require extended print licences please contact our store directly. RETURNS ================== No physical products will be sent. As this is a digital product we cannot offer refunds. However, should there be any problems in downloading the files or with the files themselves, please send us a message, and we will help you find a solution. *Please Message me if you have any other issues or concerns - Happy to help anytime:)*

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