NP Role Final Exam 159 Questions with Verified Answers,100% CORRECT

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NP Role Final Exam 159 Questions with Verified Answers In which specialty are most nurse practitioners educated? Peds Primary care Family Adult gerontology - CORRECT ANSWER primary care W... hich factor represents a potential barrier to Nurse Practitioner's practice in a primary care setting? Cost effectiveness Professional growth Aging baby boomers Collaboration agreements - CORRECT ANSWER Collaboration agreements Distinguish among the advanced practice registered nursing (APRN) roles recognized by the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. - CORRECT ANSWER Under the APRN model of regulation, the 4 roles recognized are Certified registered nurse anesthetist Certified nurse midwife Clinical nurse specialist Certified nurse practitioner APRNs are certified in one of the 4 roles and at least one of the six population foci: family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women's health, and/or psych Which topic is specifically addressed in outcomes designated by the AACN essentials for Master's education in nursing? physical assessment pathophysiology population health pharmacology - CORRECT ANSWER population health Which organization outlined core competencies for nurse practitioners in all tracks and specialties? American Association of Nurse Practitioners (AANP) National Organization for Nurse Practitioner Faculties (NONPF) American Association of Colleges of Nursing (AACN) National Council of State Boards of Nursing (NCSBN) - CORRECT ANSWER NONPF Differentiate between the focus of the doctor of nursing practice (DNP) and the doctor of philosophy (PhD) in nursing. - CORRECT ANSWER DNP's educational focus is on clinical practice and the PhD is more specific for research Which American Association of Colleges of Nursing (AACN) essential is unique to the doctor of nursing practice (DNP) program? a. Background for practice from sciences and humanities b. Advanced nursing practice c. Healthcare policy for advocacy in health care d. Organizational and systems leadership - CORRECT ANSWER Advanced nursing practice Describe the components of the DNP Scholarly Project as designated by the American Association of Colleges of Nursing (AACN) - CORRECT ANSWER As per the AACN, the DNP Scholarly Project must meet the following criteria: (a) focus on a change that impacts healthcare outcomes either through direct or indirect care; (b) have a systems (micro-, meso-, or macro-level) or population/aggregate focus; (c) demonstrate implementation in the appropriate arena or area of practice; (d) include a plan for sustainability (e.g. financial, systems or political realities, not only theoretical abstractions); (e) include an evaluation of processes and/or outcomes (formative or summative); (f) be designed so that processes and/or outcomes will be evaluated to guide practice and policy; and (g) provide a foundation for future practice scholarship. Discuss the scope of practice and expanded opportunities made available to the nurse practitioner who earns a doctor of nursing practice (DNP) degree - CORRECT ANSWER For the nurse practitioner who earns a DNP, the scope of practice does not change. However, by way of knowledge and skills gained in a DNP program, the nurse practitioner (NP) may have a greater impact on health outcomes for patients and populations. In addition, the DNP/NP may clinically practice in nearly any setting; including in a community health center leadership role, in larger acute care facilities, as a solo practitioner, and in nurse-managed health centers. The DNP/NP also may perform and apply research. For the DNP/NP, opportunities also include obtaining joint appointments with educational institutions and healthcare facilities, as well as serving as a leader in disease management. Explain the relevance of nursing philosophies and theories to the nurse practitioner's delivery of patient care. - CORRECT ANSWER Nursing philosophies and theories serve as the foundation for delivery of patient care by the nurse practitioner (NP). Concepts described in nursing philosophies and theories form the basis for excellence in nursing practice and serve to illustrate the NP's distinctive qualities. Nursing philosophies and theories conceptualize unique qualities; including the NP's ability to build trust, instill confidence, and create a positive patient-NP relationship. Discuss the relationship between a microsystem and a macrosystem in the context of a family unit. - CORRECT ANSWER The family microsystem comprises the nuclear family and extended family members, as well as the roles and expectations for each family member. The macrosystem represents the larger world in which the family lives and interacts, and serves as a social framework that has unintentional influences on values, attitudes, and behaviors through time. The macrosystem may impact the family's overall development and well-being across the family lifespan. Components of the macrosystem include social expectations, legal and moral perspectives, and cultural traditions that affect the ways individuals treat and are treated by others. Which step does the nurse practitioner include when applying the structural approach to family unit assessment? a. Consider normal family changes and experiences over the family members' lifetime b. Assess both individual family members and families as a whole unit c. Emphasize dimensions of time and change in the family's membership structure d. Recognize the cluster of expectations or norms for any family member's status position - CORRECT ANSWER Recognize the cluster of expectations or norms for any family member's status position The nurse practitioner considers the combined effects of both normative events and unexpected events on the family unit's health. Which family theory is most congruent with the nurse practitioner's assessment approach? a. Family stress theory b. Individual life span theory c. Family development theory d. Life course theory - CORRECT ANSWER Family stress theory Summarize the basic nature of resilience including behaviors demonstrated by resilient individuals. - CORRECT ANSWER Resilience is defined as the ability of an individual or family to function well and attain life goals despite overbearing stressors or challenges that might easily impair the person or family unit. Primary desired outcomes associated with resilience include moderating the negative effects of stress and promoting adaptation. While resilience is sometimes conceptualized as the ability to withstand a crisis that is brief in nature, in most cases, resilience is associated with how an individual or family manages a pervasive social condition such as poverty, a devastating illness, or a critical injury. Behaviors that are reflective of resilience include preserving hope;constructing a meaningful account of life events or situations; reaching out to others for help as needed; and identifying or developing resources and strengths to manage stressors flexibly and gain a positive outcome. Individual, family, and social factors that promote resilience include which characteristic? a. External locus of control b. Dependency c. Spirituality d. Upward social comparison - CORRECT ANSWER Spirituality When collecting data related to family structure, which information is needed for assessment of the family constellation? a. Identification of immediate family members b. Current level of financial support c. Strategies used for stress management d. Eligibility for financial assistance - CORRECT ANSWER Identification of immediate family members Describe family capacity including strategies that support family capacity-building. - CORRECT ANSWER Family capacity is the extent to which a family's needs, goals, strengths, capabilities, and aspirations can meet the family's ability to function to its fullest potential. Similar to resilience, family capacity may be reflective of the family's ability to adapt and change. Family capacity-building involves increasing the family members' competence in implementing strategies to enhance their development and build their problem-solving skills while increasing their confidence that they are able to do so. Which factor represents a limitation associated with use of a genogram for family health assessment? a. Data collection requires extensive interviewing b. Family members tend to be disengaged from the process. c. All information must be obtained in one sitting. d. Cultural assessment data is not included. - CORRECT ANSWER Cultural assessment data is not included. Compare and contrast the genogram and the family pedigree. - CORRECT ANSWER A genogram is an assessment tool or clinical method of taking, storing, and processing family information for the benefit of the patient and the family. Information collected for use in agenogram is displayed as a graphic representation of family members and their relations over three generations. The information collected for the genogram may include genetic, medical, social, behavioral, and cultural aspects of the family. Similar to a genogram, a family pedigree is a graphic representation of a person's medical and biological history and is often referred to as the "family tree." Like the genogram, the pedigree is a family history assessment tool developed in an interview with a patient and is displayed as a graphic representation. A pedigree can be a powerful tool for use in health risk identification, diagnosis, and intervention. However, the pedigree provides little insight into family dynamics or the complex context of the patient and family in the community. While the genogram focuses on family relationships and communication patterns, the pedigree is a collection of the family health history and an assessment of disease risk factors. Summarize the three general components of a comprehensive prioritized problem list. - CORRECT ANSWER Contents of the problem list may vary based on healthcare organizational requirements and healthcare provider preferences. In general, main components of a comprehensive prioritized problem list include (a) a list of chronic diseases or illnesses; (b) an ongoing or active problem that you are working on with the patient; and (c) a summarization of the most important things about a patient. Explain the impact of healthcare disparities and vulnerability on health outcomes. - CORRECT ANSWER Healthcare disparities comprise differences in healthcare quality among individuals or groups with regard to access, treatment options, and preventative services. Segments of the global population experience social inequalities and are at risk for poor health outcomes. While any individual can become vulnerable at any point in their life, as documented in the literature, health outcomes and vulnerability fall along a social gradient and poorer people experience poorer health. For the culturally competent nurse practitioner, the delivery of patient care is influenced by which principle? a. High-income countries are not subject to health disparities. b. Access to primary health care services is a human right. c. Gaps in health outcomes between different groups of people are inevitable. d. Certain forms of health inequities are considered to be fair and just. - CORRECT ANSWER Access to primary health care services is a human right. The nurse practitioner explores a patient's social determinants of health. When assessing GRADESLAB.COM lifestyle and behaviors, which question does the nurse practitioner ask the patient? a. "Do you use tobacco products?" b. "Are you currently employed?" c. "Do you have sufficient food?" d. "What is your level of education?" - CORRECT ANSWER "Do you use tobacco products?" The nurse practitioner plans to advocate for improving access to health care among all populations. Which strategy does the nurse practitioner implement to advocate at the macrosystem level? a. Becoming motivated to act on the behalf of other individuals b. Developing cultural skills c. Working through the chain of command of a healthcare organization d. Gaining insight into self - CORRECT ANSWER Working through the chain of command of a healthcare organization Describe key social and environmental factors that coexist with poverty. - CORRECT ANSWER Beyond representing strictly a socioeconomic issue, poverty impacts health, well-being, and quality of life for generations to come. Key social and environmental factors that coexist with poverty include poor housing; inadequate nutrition; lack of clean water; increased exposure to violence; fragmented health care; and a higher prevalence of physical illness, mental health issues, and disabilities. Discuss factors that contribute to financial insecurity among the elderly. - CORRECT ANSWER While social security income is often identified as a protective factor against elderly poverty, increases in the life expectancy of the elderly over time mean that financial resources have to last longer. Simultaneously, healthcare and housing costs are rising and employer benefit pension plans have decreased. As a result, elderly individuals face significant insecurity about whether or not their resources are sufficient to cover the duration of their lives after retirement. Discuss transgenerational trauma and its impact on disease development. - CORRECT ANSWER Transgenerational or intergenerational trauma comprises wounding from a traumatic event that produces effects upon generations after the initial trauma. Transgenerational trauma may occur in individual families. In addition, transgenerational trauma may occur among groups who have experienced various traumatic events (such as genocide, terrorism, and natural disasters) as collective trauma. For both individuals and groups, long-lasting harmful effects on physiological processes in the body may lead to the development of chronic disease Describe the nurse practitioner's approach to assessing and assisting an individual who may be subject to human trafficking. - CORRECT ANSWER The NP must be educated on identifying victims of human trafficking, developing culturally appropriate caring patient/provider relationships, becoming knowledgeable on reporting laws, and assisting colleagues to better identify and refer potential victims. Potential indicators of trafficking include (a) being accompanied by someone who appears to be controlling the individual and the scenario; (b) fear; (c) sadness; (d) bruises and other traumatic injuries; (e) lack of documentation; (f) discrepancy of behavior and reported age; and (g) generally poor health. Recommended approaches to assessment of individuals who may be subject to human trafficking include (a) assuring safety and confidentiality as a primary step; (b) asking about the individual's living arrangements and freedom to come and go at will; (c) asking if the individual is subject to threats or harm; and (d) asking if the individual has been forced to have sex or perform sex acts. Useful laboratory testing includes complete blood count, STD testing (including HIV), ova and parasites, hepatitis B and C, and tuberculosis. By working as a team with social services and law enforcement, the NP can help get the victim to safety and into services to assist transitioning to safe housing with long-term treatment for psychological and medical issues. When discussing gender and sexuality, a patient identifies as being "gender fluid." The nurse practitioner understands the patient's gender identification to be reflective of which self- perception? a. The patient does not identify with any gender. b. The patient identifies as mixed or neutral gender. c. The patient identifies with the gender assigned at birth. d. The patient's gender is not static but shifts. - CORRECT ANSWER The patient's gender is not static but shifts. When discussing sexual orientation, the patient tells the nurse practitioner, "I view myself as being female, but I am attracted to other people regardless of how they view their gender or gender identity." Which sexual preference best describes the patient's perspective? a. Pansexual b. Homosexual c. Asexual d. Bisexual - CORRECT ANSWER Pansexual Research suggests the delivery of disparate health services is most prevalent among patients who receive mental health treatment in which setting? a. Primary care b. Psychiatric c. Community health d. Pediatric - CORRECT ANSWER Primary care The term "co-occurring diagnosis" best describes a patient who is diagnosed with which concurrent health alterations? a. Schizophrenia and opioid abuse disorder b. Emphysema and chronic bronchitis c. Hypertension and borderline personality disorder d. Bipolar depression and conduct disorder - CORRECT ANSWER Schizophrenia and opioid abuse disorder Which disorder most significantly impacts out-of-home placement for children? a. Conduct disorder b. Autism spectrum disorder c. Post-traumatic stress disorder d. Substance use disorder - CORRECT ANSWER Substance use disorder Which single intervention is most appropriate for the nurse practitioner to consider including in the plan of care for a patient who is struggling with opioid and marijuana dependencies? a. Buprenorphine b. Motivational interviewing c. Naltrexone d. Family psychotherapy - CORRECT ANSWER Motivational interviewing Discuss health outcomes associated with alterations in cortisol release secondary to chronic stress and traumatic events. - CORRECT ANSWER Systemic cortisol release enables the body to respond to stressful stimuli. However, stress and traumatic events may lead to alterations in the hypothalamic-pituitary-adrenal (HPA) axis. For example, individuals who experience chronic stress may be subject to excessive cortisol production or to cortisol release in response to nonthreatening stimuli. In animal studies, researchers found that excessive cortisol release and increased HPA axis reactivity may be linked to an increased risk for developing depression. Decreased HPA reactivity and an associated blunted cortisol response also have health implications. Lower HPA reactivity is associated with social and behavioral challenges during both childhood and adulthood. Blunted cortisol release has been studied with childhood victims of abuse and bullying. Indirect victims of trauma, such as children who witness interpersonal conflict between caregivers, have also been observed to demonstrate a low cortisol response rate. Discuss the relationship between housing instability among women and intimate partner violence. - CORRECT ANSWER Women are especially vulnerable to issues related to housing instability. A bidirectional relationship exists between housing instability and intimate partner violence. For women who are financially dependent on an abusive partner, lack of housing options represents a significant barrier to leaving the abusive relationship. In turn, future housing instability can be predicted based on having experienced intimate partner violence. The nurse practitioner (NP) identifies which personal characteristic as a potential manifestation of vicarious traumatization (VT)? a. Scheduling time off work b. Seeking peer socialization c. Empathizing with clients d. Experiencing somatization - CORRECT ANSWER Experiencing somatization Explain the bidirectional nature of dual diagnosis. - CORRECT ANSWER General risk factors are often present for both mental illness and substance use. Substance use may be secondary to a psychiatric disorder; however, a psychiatric disorder may also develop secondary to substance abuse. Commonly, dual-diagnosis is bidirectional, meaning the conditions contribute to one other. Explain the importance of including suicide screening during risk assessment for members of the general, adolescent, and geriatric populations. - CORRECT ANSWER For all risk assessments, suicide screening is a key component. In the United States, according to the Centers for Disease Control and Prevention (CDC), suicide is the 10th leading cause of death and is responsible for 1% of fatalities. The primary care setting provides the greatest opportunity for suicide screening. Recent research indicated individuals who committed suicide visited their primary care provider within a month of the suicidal act. Members of the adolescent and geriatric populations are at high risk for suicidality. Because adolescents and geriatric patients typicallysee their primary care provider at least once per year, suicide screening should be included as part of routine office visits for members of these populations. Describe two key factors that contribute to misdiagnosis of bipolar depression as unipolar depression. - CORRECT ANSWER Key factors that contribute to misdiagnosis of bipolar depression as unipolar depression include that depression is a common symptom of bipolar disorder. Without more extensive patient reporting, misdiagnosis of bipolar depression as unipolar depression is likely to occur. Additionally, patients often fail to recall manic episodes. Explain how delivering patient care based on the Golden Rule may impede cultural competence. - CORRECT ANSWER In Western culture, the Golden Rule is one of the most familiar moral values. The Golden Rule is "Do unto others as you would have them do unto you." While the Golden Rule is rooted in good intentions, in health care, this value presumes that all individuals prefer to be treated in a manner that is congruent with the healthcare provider's personal standards and beliefs without consideration of individual preferences. Beyond following the Golden rule, culturally competent care requires the nurse practitioner (NP) to consider the patient's individual preferences. Which concept centers on a belief that the culture with which the individual is most familiar represents the cultural standard? a. Polarization b. Ethnocentrism c. Acculturation d. Stereotyping - CORRECT ANSWER Ethnocentrism Differentiate between the "melting pot" and the "tossed salad" perspectives in application to cultural awareness in the United States. - CORRECT ANSWER Considering the United States as a "melting pot," or the blending together of various cultures to form one, does not take into account the unique qualities of the various cultures that form the population. By contrast, perceiving the United States as a "tossed salad" represents a more culturally aware perspective through which the diversity of the culture is valued for what it contributes to the whole. The nurse practitioner (NP) applies Giger and Davidhizar's "transcultural assessment model" during patient assessment. Which statement by the patient is most useful for determining the patient's perception of environmental control? a. "God will decide whether or not I get well." b. "Several of my relatives have sickle cell anemia." c. "My parents think I need to drink more water." d. "I am not comfortable with strangers touching me." - CORRECT ANSWER "God will decide whether or not I get well." Which action by the nurse practitioner is most reflective of cultural humility? a. Developing competence regarding all cultures served in a specific setting b. Acknowledging limitations in understanding a patient's cultural background c. Viewing the patient's circumstances from the NP's perspective d. Learning about a specific cultural group's beliefs and preferences - CORRECT ANSWER Acknowledging limitations in understanding a patient's cultural background The nurse practitioner (NP) is preparing to assess a Native American patient. Which strategy demonstrates cultural sensitivity by the NP? a. Understanding the patient may avoid eye contact b. Anticipating that the patient may be quiet until trust is established c. Desiring to learn about the patient's use of herbal remedies d. Recognizing the patient may prefer to collaborate with a folk healer - CORRECT ANSWER Desiring to learn about the patient's use of herbal remedies Summarize the impact of cultural immersion experiences on cultural competency. - CORRECT ANSWER Research indicates cultural immersion experiences enhance cultural awareness and sensitivity. In addition, research suggests an individual's beliefs regarding a cultural group are affected by interacting with various culturally diverse groups, which prevents stereotyping. Discuss the importance of combining cultural awareness training with nurse practitioner-client partnerships to impact health outcomes for disparate populations. - CORRECT ANSWER Cultural awareness training may be helpful in increasing cultural awareness. However, simply completing cultural awareness training is not a guaranteed means by which to improve health outcomes for disparate populations. Cultural awareness becomes significant when the healthcare provider recognizes the influence of culture on a person's existence. Partnership between the NP and the client can help the NP gain a better understanding and appreciation of the client's culturally specific needs in the context of the client's population. Summarize the purpose and goals of the Office of Minority Health (OMH) Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS standards). - CORRECT ANSWER The Office of Minority Health (OMH) Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS standards) were developed for use by healthcare systems to promote delivery of the best possible care for the diverse patient populations who seek care in the United States. Goals of the CLAS standards include (a) advancing health equity; (b) improving quality; and (c) helping eliminate healthcare disparities. The 14 CLAS standards guide the nurse practitioner (NP) and other healthcare providers to the recommended language and communication processes in healthcare settings that will enhance patient care outcomes. The nurse practitioner's demonstration of cultural competence includes which intervention? a. Achieving consensus on differing values b. Using colloquial expressions when speaking c. Identifying stereotypes held by others d. Establishing boundaries for acceptable behaviors - CORRECT ANSWER Establishing boundaries for acceptable behaviors Unique aspects of a nurse practitioner (NP) preceptorship in an acute care setting include which consideration? a. Cultural competence b. Credentialing c. Clinical experience d. Collaboration - CORRECT ANSWER Credentialing Explain the role of the clinical advisor in relationship to the nurse practitioner (NP) student and the preceptor. - CORRECT ANSWER Clinical advisors are either full-time faculty or adjunct faculty who are NPs that are responsible for overseeing the clinical experiences of up to six NP students. The clinical advisor is the link for the student and the preceptor, visiting the student onsite to determine that the student is progressing in a supportive learning environment, in addition to getting to know the preceptor. This role provides the student and preceptor with someone knowledgeable about the course objectives and someone who can troubleshoot any issues that may arise. Despite excellent academic performance and favorable clinical evaluations, the nurse practitioner (NP) student thinks, "I feel like I am fooling everyone. My good grades and positive evaluations are based on luck." Which term best describes the NP student's perceptions? a. Identity crisis b. Role confusion c. Resocialization process d. Imposter phenomenon - CORRECT ANSWER Imposter phenomenon Which activity comprises a complementary form of clinical education? a. Evaluating the clinical site b. Performing a student self-evaluation c. Documenting the number of clinical hours completed d. Researching current information about a disease state - CORRECT ANSWER Researching current information about a disease state Discuss current pathways to earning a doctor of nursing practice (DNP) degree. - CORRECT ANSWER At present, several paths to the DNP are available. These academic paths include ADN to DNP, nonnursing baccalaureate degree to DNP, BSN to DNP, postmaster's DNP, and even postdoctorate DNP. Students may enter a program with experiences ranging from little to no nursing experience, several years of nursing experience, some years of nurse practitioner experience, to several years of nurse practitioner experience. According to the American Association of Colleges of Nursing (AACN), all final projects completed during the course of a doctor of nursing practice (DNP) nurse practitioner program should incorporate which component? a. Developing and implementing a research utilization project b. Evaluating a new practice model c. Using evidence to improve practice or patient outcomes d. Completing a pilot study - CORRECT ANSWER Using evidence to improve practice or patient outcomes Discuss the oral case study presentation, including its relevance to the nurse practitioner's practice and main components of the presentation. - CORRECT ANSWER The oral case presentation skill is central to healthcare providers' communication. It allows the nurse practitioner to succinctly convey a clear, organized analysis of a patient's health problem(s) to another provider in order to develop an effective management plan. The case presentation also serves as a method for clinical preceptors and peers to assess the level of expertise a practitioner has regarding a particular problem and to evaluate the assessment and management portion of that patient's care. Lastly, a clearly communicated case presentation enables the nurse practitioner to get a more experienced clinician's opinion about a patient in an efficient, cost-effective manner. The main components of an effective oral case study presentation include (1) introduction or chief complaint; (2) history of present illness; (3) physical examination; (4) diagnostic tests; (5) differential diagnosis; (6) management plan; and (7) summary. The cardiothoracic nurse practitioner (NP) is providing care to a patient who recently sustained a myocardial infarction (MI) and who may require surgical intervention. Which action by the NP best illustrates consultation? a. Asking another healthcare provider for direction on the patient's treatment plan for coronary artery disease b. Jointly communicating with another healthcare provider about the patient's ethical concerns related to blood transfusion c. Requesting that another healthcare provider accept the patient's ongoing treatment following surgery d. Working with another healthcare professional to determine the patient's need for postoperative home care - CORRECT ANSWER Asking another healthcare provider for direction on the patient's treatment plan for coronary artery disease Distinguish among collaboration, consultation, and referral of patients by the nurse practitioner. - CORRECT ANSWER Collaboration can be defined as a joint communication and decision-making process between healthcare professionals working toward a mutual goal of addressing a patient and family's medical, social, and ethical problems. Consultation can be defined as a request for direction or assistance on a diagnosis or treatment plan from another provider. Referral can be defined as another provider accepting the ongoing treatment of a patient for a specific problem and often for a limited amount of time. Explain how individual professions' isolated evidence base may create barriers for the nurse practitioner (NP) who seeks to implement effective collaborative teams. - CORRECT ANSWER When seeking to implement effective collaborative teams, barriers faced by the NP can be based on the individual professions' isolated evidence base, which results in a foundation of decision making and distinct communication patterns that can result in role confusion and turf battles. Each discipline perceives itself as having sole expertise, power, and leadership in one care aspect over the discipline. Describe the evolution of the definition of evidence-based medicine (EBM) to include patient values and preferences. - CORRECT ANSWER In the early published definitions of EBM, the areas of foci included identifying, critically appraising, and summarizing best current evidence. However, it became clear that evidence alone was not sufficient to make clinical decisions, so in 2000 the Evidence-Based Medicine Working Group presented the second fundamental principle of EBM. This principle specified that clinical decisions, recommendations, and practice guidelines must not only focus on the best available evidence, but they also must include the values and preferences of the informed patient. Summarize the four key assumptions of evidence-based practice (EBP) in nursing. - CORRECT ANSWER Key assumptions of EBP in nursing practice include (1) nursing is both a science and an applied profession; (2) knowledge is important to professional practice, and there are limits to knowledge that must be identified; (3) not all evidence is created equal, and there is a need to use the best available evidence; and (4) evidence-based practice contributes to improved outcomes When completing Step 1 of Melnyk and Fineout-Overholt's evidence-based practice (EBP) process, which action does the NP student implement? a. Cultivating a spirit of inquiry b. Formulating a clinical question c. Creating a culture of evidence-based practice d. Searching for high-quality research evidence - CORRECT ANSWER Formulating a clinical question Explain the purpose of the PICOT method. - CORRECT ANSWER Prior to finding the best current evidence for clinical decision making, the clinical problem must be identified and translated into a searchable, answerable question. The PICOT method is a widely accepted format for creating clinical questions. Discuss the primary components of a PICOT question. - CORRECT ANSWER The primary components of a PICOT question include P: Population/disease (age, gender, ethnicity, with a certain disorder); I: Intervention or variable of interest (therapy, exposure to a disease, risk behavior, prognostic factor); C: Comparison (alternate therapy, placebo or usual practice, absence of risk factor); O: Outcome (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome); and T: Time, which is the time it takes to demonstrate an outcome (i.e., the time required for the intervention to achieve an outcome or time populations are observed for outcome). When searching for the best research evidence, which step does the nurse practitioner (NP) student complete first? a. Expand the search using the explode option. b. Combine searches generated from PICOT key words. c. Establish inclusion and exclusion criteria. d. Use tools to limit the search to the topic of interest. - CORRECT ANSWER Establish inclusion and exclusion criteria. Based on the American Association of Critical Care Nurses (AACN) evidence-leveling system, which type of evidence demonstrates the greatest strength? a. Meta-analysis of multiple controlled trials b. Well-designed controlled studies c. Peer-reviewed organizational standards d. Theory-based evidence from multiple case reports - CORRECT ANSWER Meta-analysis of multiple controlled trials The nurse practitioner (NP) student is seeking to learn more about palliative care patients' perceptions of the meaning of quality of life. Based on the Oxford Centre for Evidence-Based Medicine (OCEB) 2011 Levels of Evidence, which type of evidence will be most useful to the NP student's search? a. Case-control studies b. Nonrandomized controlled trials c. Meta-synthesis of descriptive studies d. Systematic review of randomized controlled trials - CORRECT ANSWER Meta-synthesis of descriptive studies . During critical appraisal of the credibility of a research study, the nurse practitioner (NP) student considers which information? a. Evidence of conflict of interest b. Control of extraneous variables c. Clarity of reported results d. Selection of sampling procedure - CORRECT ANSWER Evidence of conflict of interest Discuss three categories of barriers to implementation of evidence-based practice (EBP) in nursing - CORRECT ANSWER Three categories of barriers to using evidence in clinical practice include limitations in EBP systems, human factors, and lack of support for clinicians who use EBP. Limitations in EBP systems may result from an overwhelming amount of evidence and sometimes contradictory findings in the research. Human factors that create barriers include lack of knowledge about EBP and skills needed to conduct EBP, nurses' negative attitudes toward research and evidence-based care, nurses' perception that research is only for medicine and is a cookbook approach, and patient expectations. Another barrier to EBP involves lack of organizational systems or infrastructure to support clinicians using EBP. Causes for barriers in this category include lack of authority for clinicians to make changes in practice, peer emphasis on practicing the way they always have practiced, lack of time during the workday, lack of administrative support or incentives, and conflicting priorities between unit work and research. Summarize the concepts of clinical prevention and population health as defined by the American Association of Colleges of Nursing (AACN). - CORRECT ANSWER As defined by the American Association of Colleges of Nursing (AACN), clinical prevention comprises health promotion and risk reduction/illness prevention for individuals and families. Population health is defined to include aggregate, community, environmental/occupational, and cultural/ socioeconomic dimensions of health. Aggregates are groups of individuals defined by a shared characteristic such as gender, diagnosis, or age. These framing definitions are endorsed by representatives of multiple disciplines including nursing. To determine the incidence rate of tuberculosis in the United States, the nurse practitioner (NP) student must obtain which data? a. The speed at which tuberculosis is occurring among individuals in the United States b. The number of new cases of tuberculosis in the United States in the past year c. The fraction of the United States population that is affected by tuberculosis d. The percentage of tuberculosis-related deaths in the United States over the past year - CORRECT ANSWER The number of new cases of tuberculosis in the United States in the past year Explain the epidemiological triangle. - CORRECT ANSWER Understanding illness and disease requires the NP to be aware first of the natural history of disease and the epidemiological triangle. As described by the Centers for Disease Control and Prevention (CDC), when considering the course of infectious diseases, this triad proposes that infections result from the interaction of agent, host, and environment. Transmission occurs when the agent leaves its reservoir or host through a portal of exit, is conveyed by some mode of transmission, and enters through an appropriate portal of entry to infect a susceptible host. The nurse practitioner (NP) student is discussing a virus that significantly impacts the global population. Which term does the nurse practitioner use to describe the virus? a. Disease outbreak b. Pandemic c. Global illness d. Epidemic - CORRECT ANSWER Pandemic Explain the relationship between population, community, and phenomenological community. - CORRECT ANSWER A population, which consists of a group of people who share common characteristics, may be large (e.g., an entire country) or small (e.g., a neighborhood). Characteristics are not limited to physical boundaries of where one may reside. A community may include members who share interpersonal and intrapersonal connections, known as a phenomenological community. Examples of characteristics held in common for a population subset or community can include age, gender, health behaviors, and exposure to a virus. The nurse practitioner (NP) is providing care to a patient who is diagnosed with obesity and osteoarthritis. When implementing secondary prevention strategies, which intervention does the NP include in the patient's care? a. Discussing low-impact exercise b. Providing education about proper nutrition c. Screening for type 2 diabetes d. Prescribing an anti-inflammatory medication - CORRECT ANSWER Screening for type 2 diabetes In the global approach to reducing HIV infection, which intervention represents a tertiary prevention strategy? a. Ensuring early detection of new cases of HIV b. Providing prompt treatment of the patient who is diagnosed with HIV c. Protecting the patient diagnosed with HIV against opportunistic infections d. Reducing the incidence of HIV transmission - CORRECT ANSWER Protecting the patient diagnosed with HIV against opportunistic infections The nurse practitioner (NP) is planning strategies to prevent HIV among a population of college students. To implement primary prevention, which strategy does the NP include in the plan? a. Increasing fellow providers' knowledge about signs of acute retroviral infection b. Requiring students to complete counseling prior to undergoing HIV testing c. Completing continuing education about HIV/AIDS d. Providing students with pre-exposure prophylaxis - CORRECT ANSWER Providing students with pre-exposure prophylaxis Summarize the responsibility of nurse practitioner (NP) with regard to reporting emergent illness and untimely or unexplained deaths. - CORRECT ANSWER The NP as a primary care provider is on the front lines of detecting emergent illness. Routine surveillance measures such as the use of health indicator data serve as baseline data. Hospitals routinely collect statistics on emergency room visits and volume, nosocomial infections, and unexplained or untimely deaths. Healthcare providers, hospitals, clinics, and public health departments must submit reports on specific communicable diseases. Nurse practitioners are expected to file communicable disease reports pending assessment findings. Describe the application of syndromic surveillance to identify potential biological terrorism. - CORRECT ANSWER Syndromic surveillance is one mechanism that can be used to detect uncommon and unusual health occurrences. This approach is based on an epidemiologic perspective and relies on the recognition of unusual patterns of illness. Biological terrorism can be expected if a set of health patterns appear that are out of the ordinary, as in the following (a) a cluster of diseases with similar clinical presentations and at a similar stage of illness; (2) a cluster of unexplained illness in a well-defined population; (3) unusually severe disease or higher mortality than expected for a given agent; (4) a cluster of cases with an unusual mode of transmission; (5) multiple or serial outbreaks; (6) a disease not typical for a specific age group; (7) a disease unusual for a season or region of the country; (8) clusters of the same illness in various locations; and (9) clusters of morbidity or mortality in animals or livestock similar to humans. Discuss the potential benefits of using an electronic health record (EHR) in relationship to care coordination. - CORRECT ANSWER Research indicated commercial ambulatory care electronic medical records (EMRs) enhance care coordination in the clinical setting by making data available at the point of care. Use of an EHR is associated with increased organization and accessibility of information, as well as increased data accuracy. Sharing of patient information among physician, therapist, and other healthcare providers, hospitals, and health systems greatly facilitates coordination of care. Summarize the main purpose of each stage of the Centers for Medicare & Medicaid Services (CMS) Meaningful Use program for adopting an electronic health record (EHR) system - CORRECT ANSWER Stage 1 of the Centers for Medicare & Medicaid Services (CMS) Meaningful Use program includes the basic functionalities for EHRs. The requirements are focused on providers capturing patient data and sharing that data either with the patient or with other healthcare professionals. Stage 2 of the Meaningful Use program focuses on advanced clinical processes. During Stage 2, the requirements emphasize health information exchange between providers and promote patient engagement by giving patients secure online access to their health information. Stage 3 of the Meaningful Use program emphasizes improved outcomes. As described by the Centers for Medicare & Medicaid Services (CMS), Stage 1 of the Meaningful Use program includes which action? a. Transmitting patient care summaries electronically across multiple settings b. Increasing requirements for e-prescribing and incorporating lab results c. Incorporating decision support for national high-priority conditions d. Electronically capturing health information in a standardized format - CORRECT ANSWER Electronically capturing health information in a standardized format In comparison to an electronic medical record (EMR), the electronic health record (EHR) offers which advantage? a. Inclusion of provider generated treatment plans b. Storage of radiology imaging c. Data sharing between providers d. Accessibility of laboratory test results - CORRECT ANSWER Data sharing between providers Explain the potential benefits of electronic health records (EHRs) on population health - CORRECT ANSWER Electronic health records (EHRs) have great potential for improving public and population health through their ability to allow the aggregation of multiple sets of patient data. In addition, EHRs allow for enhanced reporting and investigation of diseases and conditions that are mandated for reporting to state and local public health agencies. Electronic health records also have the potential to provide estimates of the burden and distribution of disease among the population and population subgroups. This data could be useful for facilitating program planning, targeting, implementation, and monitoring. Members of the healthcare organization anticipate conversion to an electronic health record (EHR). During the preparation phase, as healthcare team members set the goal and vision, which question is most important to consider? a. "How much customization of the EHR is necessary?" b. What are the technologic requirements of the EHR? c. "Why are we implementing an EHR?" d. "What is the cost of the EHR?" - CORRECT ANSWER "Why are we implementing an EHR?" Explain the process of paper chart migration during implementation of an electronic health record (EHR) system. - CORRECT ANSWER Transitioning patient information recorded on paper to the EHR may involve an abstracting approach in which only pertinent pieces of the patient's record are entered into the EHR (e.g., diagnosis, medications, allergies, procedures, etc.) and only for a finite period of time in the past (approximately 7 years, depending on state laws). Creation of an electronic image of the entire patient record by scanning all of the paper pages is not recommended. Scanning the entire paper chart is time-consuming nature and uses significant technology resources. Use of paper charts for one or two visits is recommended after the go-live stage. Summarize strategies for promoting a successful go-live stage during implementation of an electronic health record (EHR) system. - CORRECT ANSWER After all preparations have been completed, the EHR software will become "active" at the time of go-live. A smooth go-live requires that a number of details are addressed. Supporting the organization is key to a successful go-live. Many organizations designate a room or space as the "command center" and house support personnel in this one location to best support the end users on go-live day. In smaller organizations, this could be a corner of the staff lunch room. It is best to also provide close support of all users on the initial days or weeks. Many software vendors can provide onsite support but the cost may be a burden for small organizations. "Super users" can be utilized for this capacity. Super users are individuals who, at an earlier point in the process, have received intense training and are then expected to train and assist other users. Many organizations find it helpful to reduce patient schedules and load during a go-live. This will allow the organization to focus on a successful rollout. An alternative is to go live with a portion of providers or all providers using limited functionality. Communication should include notifying key individuals and third parties such as other vendors (e.g., the billing company) of the intended go-live date. The electronic health record (EHR) incorporates a variety of features and functionalities, including with form of decision support? a. Clinical alerts b. Billing information c. Inpatient census d. Searchable data - CORRECT ANSWER Clinical alerts Use of an application service provider (ASP) for an electronic health record (EHR) platform is associated with which requirement? a. Large capital expenditures b. Active internet connection c. Internal IT staffing d. Required server updates - CORRECT ANSWER Active internet connection Discuss themes and goals related to of palliative care. - CORRECT ANSWER Palliative care is both a philosophy and a structure for the delivery of care. There are many definitions of palliative care; common themes through most definitions include (1) the addressing of symptoms to relieve and prevent suffering and improve one's quality of life in the face of serious illness; (2) the inclusion of the patient and family caregivers; (3) facilitation of autonomy; and (4) access to information and choice with a team approach to the delivery of care. The themes of care do not preclude treatment of the underlying condition or illness. The overall goal of palliative care is to provide symptoms management, prevent and treat suffering, and maintain or improve one's quality of life for the patient and the family members Articulate the importance of implementing a goal-oriented process in palliative care. - CORRECT ANSWER Goal-setting discussions with patients and their caregivers is a critical part of the palliative care process. Use of a goal-oriented process facilitates communication and decision making. In addition, a goal-oriented process reduces patient uncertainty and promotes the patient's identification of desired health outcomes. Discussing goals serves to encourage patients and families to identify facilitators that will help patients reach their goals and barriers that may prevent goal attainment Explain the concept of care transitions, including the role of the advanced practice nurse during transition times. - CORRECT ANSWER Care transitions represent changes in treatment approaches and philosophy due to progression or remission of a disease. Care transitions also are reflective of changes in the complexity level of healthcare services delivered to patients and their caregivers. For most patients, care transitions are associated with uncertainty, worry, and related physical, functional, and social adjustments. Advanced practice nurses play a central role in supporting patients and their caregivers through care transitions to reduce uncertainty, increase knowledge, and promote their self-management. For advanced practice nurses, transition times serve as opportunities for reassessing the goals of care, promoting key palliative care objectives of symptom management, advocating for patients and their family members, and facilitating consultation among members of the palliative care interdisciplinary team. The nurse practitioner (NP) is using the Quality of Life (QOL) model to conceptualize a patient's care. Which topic will the nurse practitioner include when addressing a primary domain of the QOL model? a. Spiritual b. Financial c. Ethical d. Moral - CORRECT ANSWER Spiritual Summarize the importance of collaboration to address the multidimensional nature of palliative care. - CORRECT ANSWER Like quality of life (QOL) issues, palliative care is multidimensional in nature. Palliative care requires inclusion of an interdisciplinary healthcare team with expertise in other areas in addition to nursing, including a variety of disciplines and professionals who attend to the spiritual needs of patients and their family members. Palliative care teams typically include nurses, physicians, social workers, and spiritual or religious professionals. Teams often also include pharmacists, psychologists, dieticians, and volunteers. When providing care to the patient diagnosed with anorexia and cachexia, which principle guides the nurse practitioner's approach to care? a. Cachexia is most commonly associated with acute illnesses. b. Research does not support the use of appetite stimulants. c. Treatment of anorexia emphasizes addressing symptoms. d. Mealtimes are often associated with cultural meaning. - CORRECT ANSWER Mealtimes are often associated with cultural meaning. The nurse practitioner (NP) provides care to a patient diagnosed with lung cancer. When assessing the patient for dyspnea, which data is most important for the NP to consider? a. The patient's respiratory rate is 24 breaths per minute. b. The patient pauses to take a breath in between sentences. c. The patient's oxygen saturation is 89% on room air. d. The patient reports feeling short of breath. - CORRECT ANSWER The patient reports feeling short of breath. The nurse practitioner (NP) assesses an adult male patient who was recently diagnosed with metastatic brain cancer. Which patient assessment data is most reflective of fatigue? a. The patient's hematocrit is 30%. b. The patient reports a decrease in functional status. c. The patient's hemoglobin level is 11 g/dL. d. The patient reports taking several naps each day. - CORRECT ANSWER The patient reports a decrease in functional status The nurse practitioner (NP) assesses a patient for physical and psychosocial health alterations. Which patient assessment data is most consistent with a diagnosis of clinical depression? a. Hopelessness one week after experiencing home foreclosure b. Difficulty sleeping three weeks after discovering a breast lump c. Helplessness five days after learning of the presence of a lung mass d. Social isolation immediately after the loss of a pet - CORRECT ANSWER Difficulty sleeping three weeks after discovering a breast lump Discuss the relationship between palliative care and hospice care. - CORRECT ANSWER Palliative care is a growing field in health care that has evolved from the earlier hospice movement. Palliative care is, at its essence, excellent symptom management at any time during a serious illness to relieve suffering and maintain or improve the quality of life for patients and their families. Similar to hospice care, excellent palliative care requires a multidisciplinary approach. Nurses play a key role in the implementation and delivery of palliative care to patients and their families. Discuss the concept of virtue ethics as described by Crigger and Godfrey (2011) in The Making of Nurse Professionals. - CORRECT ANSWER In their book The Making of Nurse Professionals, Crigger and Godfrey (2011) focused on virtue ethics as the core framework for professionalism in nursing. In this view, an individual responds to specific situations in a manner that is appropriate to that particular situation. When performed in an admirable manner, the moral message that this was "good" is reinforced so the person will conduct the action similarly in future situations. This viewpoint emphasizes that the nurse has a choice in how to interact with patients and in society at large. This experiential development process is transformational and moves toward encompassing professional ideals and ethics when good choices are reinforced. Explain how the nurse practitioner's (NP's) application of virtue ethics may produce actions that are incongruent with a patient's definition of "doing good." - CORRECT ANSWER Occasionally, "doing good" for the patient may not be what the patient believes is best, and this is when the integrity of the nurse professional, based on an ethical code, must prevail. For NPs, such situations occur fairly frequently in daily practice; e.g., patients who want narcotics for prolonged periods of time without a known etiology of pain, the neighbor who calls and asks for an antibiotic prescription without being evaluated as a patient of that practitioner's practice setting, and so forth. Many examples serve to illustrate how the patient view and the NP view of "doing good" may collide. Describe Adams and Miller's (2001) wheel of professionalism. - CORRECT ANSWER Adams and Miller (2001) developed a wheel of professionalism that has at its base education in a university setting, and the spokes of the wheel include publication and communication; adherence to a code of ethics for nurses; theory development, use, and evaluation; community service orientation; continuing education/competence; research development, use, and evaluation; self-regulation (autonomy); and professional organization participation. As described by Keenan (1999), which characteristic is essential to the concept of professional autonomy for the nurse practitioner (NP)? a. Practicing independently b. Functioning without collaboration requirements c. Effecting a desirable outcome d. Participating in administrative policy making - CORRECT ANSWER Effecting a desirable outcome Which behavior by the nurse practitioner (NP) is most reflective of the professional attribute of autonomy? a. Developing an evidence-based practice project b. Maintaining accountability for patient outcomes c. Participating in a research study d. Engaging in community service - CORRECT ANSWER Maintaining accountability for patient outcomes Which term best describes the American Nurses Association (ANA) Code of Ethics for Nurses? a. Personal philosophy b. Moral guidelines c. Professional recommendations d. Social contract - CORRECT ANSWER Social contract . According to a 2009 study by Bahadori & Fitzpatrick, the nurse practitioner's (NP's) perceived professional autonomy is most significantly impacted by which factor? a. Outpatient clinical productivity b. Scope of practice c. Accountability level d. Geographical location - CORRECT ANSWER Accountability leve Discuss the importance of research related to applied ethics and nurse practitioners (NPs), including topics that warrant further investigation. - CORRECT ANSWER An area that lacks significant study is related to applied ethics and nurse practitioners, particularly outside of the acute care setting. In daily interactions with patients, families, colleagues, institutions, and even our sociopolitical world, dilemmas are often presented to the NP who needs to respond in an ethical and culturally sensitive manner. Studies have identified issues that are frustrating and can cause moral distress and/or ethical dilemmas for NPs. These include topics around the constraints from patients' lack of adequate healthcare coverage, unrealistic demands by patients, limited time to spend with patients due to scheduling pressures, restrictive drug formularies, allocation of resources, and abortion. Education for the student nurse practitioner (NP) includes a variety of didactic and clinical educational experiences. During the student NP's educational journey, which strategy most effectively promotes development and increases understanding of the new professional role? a. Using reflective processes b. Applying decision making skills c. Joining professional organizations d. Understanding practice models - CORRECT ANSWER Using reflective processes Discuss Florence Nightingale's accomplishments as a foundation to healthcare advocacy. - CORRECT ANSWER The foundation of nurse practitioner healthcare advocacy can be linked to Florence Nightingale, a visionary of public policy on numerous healthcare issues: promoting clean water, good nutrition, decent lodging, and adequate ventilation to reduce infection rates. Nightingale impacted healthcare reform issues through leadership, innovative thought, and perseverance. She lobbied the British Parliament to educate nurses who would serve in public workhouses and was passionate in her opinion that individuals who were sick should avoid hospitalization, advocating for home health services provided by nurses and physicians. By way of careful preparation and attention to detail, Nightingale obtained the support of high-level medical experts, cabinet ministers, and senior governmental officials. The most prominent sanitarians of the time, statisticians, engineers, and water experts alike were willing to work with her to advance health policies because they shared her vision and respected her methods. The first nurse practitioner (NP) program in the United States prepared NPs to practice in which specialty? a. Pediatrics b. Family c. Women's health d. Psychiatric mental health - CORRECT ANSWER Pediatrics Which legislation granted provider status to nurse practitioners and authorized NPs to bill Medicare directly for providing services to its recipients, regardless of setting? a. Social Security Act b. Balanced Budget Act c. Affordable Care Act d. American Health Care Act - CORRECT ANSWER Balanced Budget Act Members of the American Association of Nurse Practitioners (AANP) are advocating for introduction of a bill related to healthcare advocacy. To help determine whether the timing is right to introduce the bill, which individual is most appropriate for the AANP to consult? a. A state representative b. A member of congress c. A lobbyist d. A senator - CORRECT ANSWER A lobbyist In 2008, which organization partnered with the Robert Wood Johnson Foundation (RWJF) to launch a 2-year initiative to promote advancement of the nursing profession? a. Office of Minority Health (OMH) b. Institutes of Medicine (IOM) c. U.S. Department of Health and Human Services (DHHS) d. Centers for Medicare and Medicaid Services (CMS) - CORRECT ANSWER Institutes of Medicine (IOM) Discuss use of the American Association of Nurse Practitioners (AANP) website to ensure understanding of the nurse practitioner's (NP's) scope of practice - CORRECT ANSWER To date, each state has been able to define advanced practice registered nurse (APRN) legal scope of practice, recognize the APRN roles and titles, as well as define the criteria for entry into practice, and the certification examinations that are acceptable. The scope of practice for NPs across the nation, by state, can be found on the American Association of Nurse Practitioners (AANP) website. Because each state can define the scope of practice in statutes, some of which are detailed and others more general, it is essential that NPs review the most current scope of practice legislated by the state in which they practice. Summarize the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Quality Payment Program on reimbursement for nurse practitioner (NP) services. - CORRECT ANSWER As part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medicare billing and reimbursement have been transformed from a fee-for-service schedule to a pay-for-performance program that focuses on quality, value, and accountability. The Quality Payment Program framework is intended to reward providers for better care, rather than the delivery of more services. The Merit-Based Incentive Payment System (MIPS) provides a performance score (rated from 0-100) for providers based on four categories (quality, resource use, clinical practice improvement activities, and meaningful use of electronic health records) which will be used to determine the provider's Medicare reimbursement for each payment year. The nurse practitioner (NP) reviews regulations related to Medicare reimbursement. Based on current regulations, which action is reimbursable and appropriate for implementation by the NP? a. Performing the admission examination for a skilled nursing facility (SNF) patient who is a Medicare recipient b. Providing the initial certification of a Medicare patient's eligibility for hospice care c. Completing the first monthly examination for a skilled nursing facility (SNF) patient who is a Medicare recipient d. Serving as the attending provider for a Medicare patient who requires hospice care - CORRECT ANSWER Serving as the attending provider for a Medicare patient who requires hospice care Explain how the use of provider neutral language could increase the nurse practitioner's (NP's) eligibility for Medicare reimbursement. - CORRECT ANSWER Several regulatory barriers to NP practice could easily be addressed by simply using provider neutral language (i.e., "provider" rather than "physician") or correcting the interpretation of the term "physician" to be consistent with current Medicare payment policies that authorize Part B payment to NPs for services within their scope of practice. This minor change would enable NPs to certify Medicare beneficiaries for hospice and home health services and to conduct admission examinations for skilled nursing facilities (SNFs). Describe two events hosted by the American Association of Nurse Practitioners (AANP) that promote political advocacy. - CORRECT ANSWER The AANP offers two major events that promote political advocacy. The Annual Health Policy Conference is held late winter in Washington, D.C. The conference includes an introduction to Capitol Hill, a government affairs update, presentations by the organization's health policy committee, interactions with NP elected officials representing various states across the nation, presentations on key legislative issues, and a day-long visit to Capitol Hill. The AANP also provides a Health Policy Fellowship program, a 4-week onsite experience at the AANP Government Affairs office in Alexandria, Virginia. Selected fellows provide support for health policy leadership development activities. Research activities may include reviewing literature, gathering information, collecting and analyzing data, and preparing reports. Fellows also attend relevant congressional briefings, political fundraisers, and policy meetings. Describe achievements by Florence Nightingale that serve to establish her position as the first quality improvement expert in the healthcare field. - CORRECT ANSWER Achievements by Florence Nightingale that support her position as the first quality improvement expert in the healthcare field include tracking hospital death rates, which included a depiction of unnecessary military deaths caused by unsanitary conditions. Nightingale was also an innovator in the collection, tabulation, interpretation, and graphical display of descriptive statistics. The nurse practitioner develops a quality assurance (QA) program related to hand hygiene protocols. Which outcome best describes a central aim of the QA program? a. Demonstrating healthcare team members' adherence to hand hygiene protocols b. Motivating healthcare team members to learn about updated standards related to hand hygiene c. Improving healthcare team members' adherence to hand hygiene protocols d. Capturing lessons learned about healthcare team members and barriers to effective hand hygiene - CORRECT ANSWER Demonstrating healthcare team members' adherence to hand hygiene protocols The nurse practitioner (NP) delivers a presentation about Quality and Safety Education for Nurses (QSEN) competencies related to safety. To illustrate knowledge-based competencies related to safety, which information does the NP discuss? a. Valuing one's own role in preventing errors b. Appreciating the cognitive and physical limits of human performance c. Using organizational error reporting systems d. Examining human factors and other basic safety design principles - CORRECT ANSWER Examining human factors and other basic safety design principles Discuss the origin and central tenets of the Planetree Model for promoting patient-centered care. - CORRECT ANSWER The Planetree Model provides a comprehensive approach to patient-centered care. Founded in 1978, the Planetree Model was developed by Angelica Thieriot after she experienced the depersonalized effects of being a patient as well as a care provider for her spouse and son. The model encompasses mind, body, and spirit for healing the patient. The focus of the health care in this model centers on the patient. Family members, caregivers, professionals—anyone in contact with the patient—must be sensitive to the patient's needs. Patient-centered care takes place in the office, clinic, and even during volunteer activities. The nurse practitioner (NP) implements a quality improvement (QI) initiative aimed at enhancing staff nurses' ability to recognize signs and symptoms of substance abuse among patients. Staff nurses are given a pretest and post-test to evaluate learning. During which stage of the Plan-Do-Study-Act (PDSA) framework does the NP analyze pre-test data? a. Plan b. Do c. Study d. Act - CORRECT ANSWER Study Summarize the role of The Joint Commission in promoting patient safety - CORRECT ANSWER In 2002, The Joint Commission established its National Patient Safety Goals (NPSGs) program. The NPSGs were developed to assist accredited organizations with focusing on specific areas of concern in regard to patient safety. The Joint Commission Is also responsible, with the help of the safety advisory board made up of multiple healthcare specialties, for determining the highest priority patient safety issues. Explain the nature and purpose of TeamSTEPPS. - CORRECT ANSWER TeamSTEPPS was developed by the Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality (AHRQ). TeamSTEPPS is a comprehensive, evidence-based teamwork system created for use by healthcare organizations to develop a culture of safety. Central aims of TeamSTEPPS include improving communication and teamwork skills among healthcare professionals. The TeamSTEPPS approach uses assessment and training tools to develop teams that work to improve patient outcomes. Clear roles and responsibilities are emphasized, as well as methods to improve communication, thereby reducing conflicts. Barriers to achieving and maintaining a culture of safety and quality are addressed. When writing medication prescriptions, the nurse practitioner (NP) refrains from using certain abbreviations as specified by which organization? a. The Joint Commission b. U.S. Food and Drug Administration c. Robert Wood Johnson Foundation d. Agency for Healthcare Research and Quality - CORRECT ANSWER The Joint Commission The nurse practitioner prescribes opioid analgesia for an adult patient who undergoes surgical repair of an ankle fracture. Which data is acceptable for inclusion in the medication order? a. 5.0 mg b. qd c. MSO4 d. IV - CORRECT ANSWER IV Discuss patient adherence to a medication treatment plan including risks of inadequate adherence and strategies for assessing compliance. - CORRECT ANSWER The definition of patient adherence to a medication treatment plan is the extent to which the patient continues the agreed-upon mode of treatment under limited supervision when faced with conflicting demands, as distinguished from compliance or maintenance. Inadequate adherence to medications can cause inaccurate assessment of the drug's utility, toxicity when given incorrectly, disease exacerbations and progression, and increased acute care admissions. Methods to assess for compliance to the prescribed plan include (1) medications being refilled as prescribed; (2) patient self-report; (3) patient diaries; (4) patient contracts; (5) measurement of drug titers found in body fluids; and (6) electronic medication monitors. Describe selection criteria for use by the nurse practitioner (NP) student when choosing a preceptor who is not an NP. - CORRECT ANSWER Preceptors should have at least 1 year of experience with a solid skill set in whatever clinical setting the experience will take place. Beyond their clinical expertise, the preceptor should have knowledge of the NP role in order to be a role model for the preceptee. For the NP student, the preceptor is not always another NP. Rather, the preceptor could be a physician's assistant, a certified nurse-midwife, or a physician. The nurse practitioner (NP) student is assigned an experienced NP who will provide guidance and direction related to all aspects of transitioning into the role of an advanced practice registered nurse (APRN). The short-term relationship will be limited to the practice setting and will require adherence to goals prescribed by the experienced NP. Which term best describes the experienced NP? a. Guide b. Role model c. Mentor d. Preceptor - CORRECT ANSWER Preceptor Differentiate between a coach and a role model in the context of the nurse practitioner (NP) student's development. - CORRECT ANSWER A role model serves as an example of desirable behavior for another individual. Role models include those people in whom we find qualities that are admirable or appealing. We can choose one or more role models. Engagement with a role model may or may not include direct contact or a relationship. In the context of the nurse practitioner (NP) student's development, the role model could be a person who is from the same discipline, such as a current NP leader or faculty member, or the role model may not be from the same profession. NP students can identify what qualities they feel are important and would like to emulate. A rewarding experience with a role model can lead the NP student to set professional self-expectations and goals. By contrast, a coach helps move an individual forward to where he or she wants to be with regard to a specific goal or issue; for example, achieving a desired weight or writing an article for publication. Specific goals could be set by the coach, the individual, or mutually set depending on the context. Coaches may be assigned or chosen The nurse practitioner (NP) provides care to a patient diagnosed with obesity. During the course of treatment, the NP inspires and empowers the patient to lose weight through exercise and improved nutrition. Which term best describes the NP's role? a. Teacher b. Coach c. Mentor d. Guide - CORRECT ANSWER Coach Differentiate between a mentor and a preceptor. - CORRECT ANSWER A mentor is an individual with whom the mentee desires to engage in a supportive relationship for an extended period of time. Mentoring may be a formal relationship, where a mentor is assigned by an organization, or an informal agreement made between a mentor and mentee who have chosen each other. The mentorship relationship lasts for a mutually agreed upon time and is typically long lasting. In the ideal mentoring relationship, both parties experience personal and professional development within the context of a relationship that emphasizes caring, respect, and collaboration. The mentor and mentee may engage with one another both in and away from the professional setting. By contrast, a preceptor is typically assigned to a preceptee. Compared to the role of the mentor, the preceptor's role is more limited. Typically, the NP student is assigned a preceptor for clinical experiences. The relationship is usually a prescribed length of time—typically a short duration—and the relationship is usually confined to the work environment. Summarize key aspects of the stages of mentoring. - CORRECT ANSWER In stage 1, initiation, the mentee and mentor are becoming acquainted. The experienced person believes that the novice can be successful and is willing to mentor the novice. The novice finds the mentor admirable and is willing to be guided and coached by the mentor. During stage 2, cultivation, mutual goals should be set. A contract clearly identifying what achievements are desired, and how the mentor will guide the mentee to reach those achievements, a note articulating the frequency and mode of meetings, as well as confidentiality, and a clause written about openness and conflict resolution should be included. At this time the mentee is becoming more confident that her or his professional and personal goals can be met. Dependence on the mentor can be strong during these early stages. In stage 3, separation, the mentee has become self-confident and is not as dependent on the mentor. At this point, the mentee will start the separation process. The final stage, which is stage 4, is redefinition. Application of mentorship principles established by the American Academy of Nurse Practitioners (AANP) Fellows includes which strategy? a. Establishing a mutually beneficial relationship b. Emphasizing achievement of personal goals c. Avoiding the use of defined objectives d. Minimizing time and energy expenditures - CORRECT ANSWER Establishing a mutually beneficial relationship During a mentorship relationship, which action by the mentor best illustrates the competency of surrendering? a. Aiming to rid the relationship of anxiety related to the mentor's authority b. Realizing when to end the current relationship c. Pushing the mentee beyond the boundaries of comfort d. Offering valuable opportunities with no expectation of reciprocation - CORRECT ANSWER Aiming to rid the relationship of anxiety related to the mentor's authority When applying the Barker-Sullivan Model of Mentor Partnerships, which factor serves as the basis for selection of a mentor by the nurse practitioner (NP) student? a. Existing competencies b. Mutual attraction c. Discreet communication d. Self-reflection - CORRECT ANSWER Mutual attraction Discuss the value of peer mentoring for the nurse practitioner (NP) who has recently completed a doctor of nursing practice (DNP) program. - CORRECT ANSWER Peer mentoring is mentoring relationship format that may be useful as the increased number of NP/DNP graduates seeking experienced NP/DNPs is mismatched. Identification of a peer mentor that can help in areas where she or he has expertise that the NP needs further growth in, and where the NP can offer her or his own expertise in an area the other person needs to grow in, can be a very rewarding experience. It can also be beneficial and practical to have a group of peer mentors that can offer a pool of expertise to help the NPs that form this group. Which aspect of the nurse practitioner's (NP's) reimbursement eligibility requirements is typically fulfilled by the practice manager? a. Applying for a national provider number b. Completing a third-party credentialing process c. Requesting an employer provider number d. Filling out an attestation form - CORRECT ANSWER Completing a third-party credentialing process For the nurse practitioner (NP), reduced practice authority requires which action on the part of a fellow provider? a. Collaboration agreement b. Supervision c. Delegation d. Team management - CORRECT ANSWER Collaboration agreement Discuss the nature and purpose of medical coding using International Classification of Diseases (ICD) codes and Current Procedural Terminology (CPT) codes. - CORRECT ANSWER Medical coding is best defined as the translation of the original medical record documentation regarding patient diagnoses and procedures into a series of code numbers that describe the information in a standard manner. Coded medical information is used for patient care, research, reimbursement, and evaluation of services. International Classification of Diseases (ICD) codes, developed by the World Health Organization, are used to identify the patient's diagnoses or reasons for seeking care. These codes cover specific illnesses or diseases as well as signs and symptoms resulting in the patient encounter. ICD codes are also useful for classifying morbidity and mortality data from inpatient and outpatient records and most National Center for Health Statistics (NCHS) surveys. Another component of medical billing is the Current Procedural Terminology (CPT), which describes the services and/or procedures for which reimbursement is sought. CPT codes are used for specific types of patient encounters, including procedures and diagnostic studies. Incorporate the use of Current Procedural Terminology (CPT) codes and International Classification of Diseases (ICD) codes to explain medical necessity. - CORRECT ANSWER Medical necessity is defined as medical items and services that are "reasonable and necessary" for a variety of purposes. Medical necessity represents the combination of "what was done" with "why it was done." The formula for determining medical necessity may be expressed as CPT + ICD-10 = medical necessity. A patient is transported to the emergency department by ambulance for treatment of respiratory distress related to asthma. The nurse practitioner (NP) orders administration of nebulized albuterol. The Healthcare Common Procedure Coding System (HCPCS) Level II code set must be used for identification of which aspect of the patient's care? a. Ambulance transport b. History of asthma c. Diagnosis of respiratory distress d. Albuterol administration - CORRECT ANSWER Ambulance transport Discuss the most important document in the reimbursement process. - CORRECT ANSWER The medical record is the most important document in the reimbursement process. Any information provided to the patient on a particular date of service must be recorded in the record. If it was not documented, it was not done. The resourced-based relative value scale (RBRVS) is directly relevant to which aspect of the nurse practitioner's (NP) practice? a. Coordination of care b. Credentialing c. Medical record documentation d. Reimbursement - CORRECT ANSWER Reimbursement Which component of the patient history must be present in order to classify the patient interaction as Level 2/problem focused? a. Detailed history of present illness (HPI) b. Pertinent past family and social history (PFSH) c. Brief history of present illness (HPI) d. Complete past family and social history (PFSH) - CORRECT ANSWER Brief history of present illness (HPI) Summarize medical decision making as a key component of reimbursement for services provided by the nurse practitioner (NP). - CORRECT ANSWER Medical decision making takes into account the diagnosis, the information required to make the diagnosis, and the risks and complications associated with the diagnosis. Medical decision making is the point at which the NP obtains credit for the decision regarding diagnosing and treatment options. The evaluation and management documentation guidelines describe four levels of medical decision making: Level 2 is straightforward; Level 3 is low complexity; Level 4 is moderate complexity; and Level 5 is high complexity. Discuss the use of modifiers in the context of medical coding for reimbursement - CORRECT ANSWER Modifiers are a way to show the evaluation and management code has changed. The service or procedure is altered. Modifiers can increase or decrease a value. It can indicate bilateral or multiple procedures. It can indicate additional work was performed in rendering the service. The two-digit modifier is always attached to the evaluation and management code. Most modifiers are used in the surgical arena. Upon graduation from a neonatal nurse practitioner (NP) program, which step is most appropriate for the NP candidate to implement? a. Applying to the American Nurses Credentialing Center (ANCC) b. Practicing completion of short-answer essay questions c. Taking an official competency-based examination d. Requesting a national provider identifier (NPI) for each state of practice - CORRECT ANSWER Taking an official competency-based examination The American Academy of Nurse Practitioners Certification Board (AANPCB) examination covers content related to which domain? a. Professional Practice b. Implementation c. Independent Practice d. Evaluation - CORRECT ANSWER Evaluation Discuss the use of a résumé and a curriculum vitae when applying for employment as a nurse practitioner (NP). - CORRECT ANSWER While a résumé and a curriculum vitae are similar in some regards, there are some significant differences. A résumé is typically an abbreviated document that gives an overview of education, employment history, and achievements in one to two pages. Curricula vitae, on the other hand, are typically longer and more detailed. Curricula vitae are used when seeking positions in an academic setting, but often nursing professionals will use them if seeking a leadership role in the healthcare field. As a new NP, highlighting clinical education and hours spent in each specialty area is important, as the individual does not yet have formal work experience as an NP. Whether using a résumé or a curriculum vitae, the NP must have a wellorganized and coherent document that highlights personal abilities, skills, and accomplishments to promote his or her career. For the nurse practitioner who is seeking employment, recommendations related to résumé preparation include which practice? a. Highlighting past nonmedical jobs b. Using 12 point Times New Roman font c. Omitting discussion of any gaps in the work history d. Providing the email address used at the current workplace - CORRECT ANSWER Using 12 point Times New Roman font Discuss the collaborative nature of the nurse practitioner's (NP's) role. - CORRECT ANSWER Collaboration is an important component for NP practice, and one that is inherent to nursing in general. Collaborative care may be defined as "an arrangement whereby an NP and a physician provide primary health care to a group of patients, with the professionals sharing authority for providing care within their scope of practice" (Bellini & Shea, 2006, p. 233). Resnick and Bonner (2003) defined collaboration as "a joint and cooperative enterprise that integrates the individual perspectives and expertise of various team members" (p. 344), and they identified collaboration as a foundation for successful practice. Discuss strategies implemented by the nurse practitioner (NP) to promote a successful interview by telephone and in person. - CORRECT ANSWER For many candidates, the first step in the interview process may be a telephone interview. The telephone interview is used as a mechanism to screen candidates in order to decide if they warrant a face-to-face interview. The NP should not take a casual approach to the telephone interview, and should be prepared with questions as if conducting an in-person interview. Some experts believe that standing while being interviewed will make you stronger and increase your confidence. NPs who make it past the initial telephone interview should not assume that they have the position. If called in for a face-to-face interview, the NP must prepare by dressing professionally, having several copies of his or her résumé in hand, and have a list of questions for the employer. Researching the company's mission and goals shows interest and initiative on the part of the NP. The nurse practitioner (NP) is interviewing for a new position. Which question is most appropriate for the NP to ask the potential employer? a. "What is the expected patient volume?" b. "Is health insurance provided?" c. "What is the salary range? d. "How will vacation time be accrued?" - CORRECT ANSWER "What is the expected patient volume?" Summarize key advantages to finalizing the nurse practitioner's (NP's) employment contract with a written agreement. - CORRECT ANSWER Key advantages associated with a written employment contract include increased job security and control over professional practice, as well as legal protection in relation to finances and job responsibilities. The written employment contract also serves as an upfront agreement on potential problems and professional issues and provides protection from termination. Following graduation from a nurse practitioner (NP) program, the NP candidate prepares to seek employment. When seeking authorization to practice as an NP in a healthcare setting, which step does the NP candidate complete first? a. Credentialing b. Peer review c. Clinical privileging d. Licensure - CORRECT ANSWER Licensure Discuss state governance of the legal scope of practice for the nurse practitioner (NP). - CORRECT ANSWER The nurse practitioner must be familiar with the legal scope of practice in the state she or he wishes to practice in. Each state has regulations that define the scope of practice; some statutes are governed by state legislature and other states give the board of nursing the authority to enforce the scope of practice law (Buppert, 2018). Each state must define the legal requirement for physician involvement in the nurse practitioner's practice. This involvement, if any, is depicted as "supervision" or "collaboration" and further explains the details of the terms of the involvement. Some state laws give tremendous detail in regard to the specifics of the level of involvement, ranging from prescribing controlled substances to establishing a referral and consultation arrangement between the physician and NP. When entering an employment contract in a state where the scope of practice statute mandates a "collaborative" agreement between an advanced practice nurse and a physician, it is important to draft a mutually agreeable collaborative practice agreement that will support the scope of practice law in your state. [Show More]

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