(Test Bank) Advanced Practice Nursing-Essential Knowledge for the Profession

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Nursing

Test Bank

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Test Bank for Advanced Practice Nursing-Essential Knowledge for the Profession, The downloadable file consists of 195 pages, and the total size of the file is 0.97 MB. Purchase now only for highly discounted price.

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AdvancedPracticeNursing:EssentialKnowledgefortheProfession3rd EditionDeniscoTestBank Chapter1IntroductiontotheRoleofAdvancedPracticesNursing MultipleChoice 1.InwhichyeardidtheAmericanAssociationofCollegeofNursing(AACN)introducedthe DoctorateofNursingPractice(DNP)? a.2006 b.2004 c.2000 d.2002 TAhNeSA:ABCNintroducedtheDNPdegreein2004toprepareadvancedpracticenurses(APRNs)to meetchallengesandstandardizepracticebeyondmaster’sdegreeprograms. 2.WhichofthefollowingisthebestexplanationforthecreationoftheDoctorateofNursing Practice(DNP)degree? a.Tocompeteagainstmaster’sdegreeprograms b.Toensurestandardizedcurriculumensuringindependentpractice c.TovalidateAPRN’sforfinancialreimbursement d.Toaddressincreasingcurriculumrequirementsofmaster’sdegreeprograms ANS:D AlthoughallanswersareinfluencedbytheDNPcorecompetencies,theDNPprogramcreationin 2004bytheAACNwasdesignedtoaddresscurriculumrequirementsofmaster’sdegreeprograms. 3.Whichofthefollowingwasthefirstrecognizedareaofadvancedpracticenursing? a.ClinicalNurseSpecialist b.Familynursepractitioner c.Pediatricnursepractitioner d.CertifiedRegisteredNurseAnesthetistANS:D In1931,theNationalAssociationofNurseAnesthetists(NANA),renamedin1939tothe AmericanAssociationofNurseAnesthetists(AANA)wasthefirstrecognizedgrouppromoting advancednursingpractice.AgathaHodginsfoundedtheAANMatLakesideHospitalin Cleveland,Ohio. 4.WhichfactorisbroadlyperceivedtosolidifyandstandardizetheroleoftheAPNsoverthelast 25years? a.Lackofaccesstohealthcareproviders b.Standardizedcurriculumdevelopment c.Paymentforservices d.Societalforces ANS:B AstheevolutionofAdvancedPracticeNursingadvancesspecificspecialtiesandneedsare identified.Throughtheevolutionoforganizationandstandardizationtheseroleshavesolidified theAPN’sroleintoday’shealthcareenvironment. 5.DuringtheformationofearlyAPNrolesinanesthesia,whichofthefollowingincreased demandforaccesstohealthcare? a.Poverty b.War c.Ruralaccesstocare d.Availabilityoftraining ANS:B Earliestdemandfornursing-providedanesthesiaspikedduringperiodsofwarwhennumbersof physicianswereinadequate.TheearliestrecordsdatebacktotheAmericanCivilWarwiththe administrationofchloroform.DuringWorldWarIin1917morethan1000nurses,sometrained anesthetists,traveledintobattle.Otherfactorssuchasneedforruralhealthcarecamelaterinthe validationandneedforAPNs. 6.In1889,Dr.WilliamWorrallMayobuiltandopenedSt.Mary’shospitalinRochester,NY.He isknownforsomeoftheearliestrecruitmentandspecializedtrainingofnursesinwhichofthe followingroles? a.Pediatrics b.Anesthesia c.Obstetrics d.Researchandstatistics e.FamilynursingANS:B In1889,Dr.WilliamWorrallMayobeganformallytrainingandrecognizingnurseanesthetists. Thishasbeenregardedastheearliesttraininginnurse-providedanesthesia. 7.In1893,LillianWaldestablishedtheHenryStreetSettlement(HSS)Houseforwhichpurpose? a.Accesstohealthcareofruralareas b.Createinner-citynursingawareness c.Providethedisadvantagedaccesstocare d.Establishguidelinesforadvancednursingroles ANS:C TheHHSwasestablishedtoprovidenursingservicestoimmigrantsandlow-incomepatientsand theirfamiliesinManhattan.Asresistancetonurse-providedcaregrew,standingorderswere draftedfromagroupofLowerEastSidephysicianstherebycircumventingthen-existinglegal ramifications. 8.TheFrontierNursingService(FNS)foundedinKentuckyin1925byMaryBreckenridge initiallyprovidedAppalachiawithnursingresourcesandwhichtypeofadvancednursingcare? a.Pediatriccare b.Anesthesia c.Midwifery d.Surgicalservices ANS:C TheoriginalFNSprovidednursingservicesandobstetricservicestoAppalachianresidents.Later workingfromstandardordersdevelopedfromtheirmedicaladvisorycommitteenursestreated patients,madediagnoses,anddispensedmedications. 9.Whichorganizationfoundedin1941underMaryBreckenridge’sleadershipmergedwiththe AmericanCollegeofNurse-Midwives(ACNM)in1969? a.AmericanAssociationofNurse-Midwives(AANM) b.AmericanNursesAssociation(ANA) c.AssociationforNationalNurse-Midwifery(ANNM) d.CouncilofNursingMidwifery(ANM) ANS:A TheAmericanCollegeofNurse-Midwives(ACNM)formedundertheleadershipofMary Breckenridgein1941toprovidenurse-midwifedevelopmentandcollaborationformidwifedevelopment.In1955,theAmericanCollegeofNurse-Midwiveswasformedandthetwo organizationsmergedin1969afterthedeathofMaryBreckenridge. 10.InalandmarkrulingbytheSupremeCourtasaresultofChalmers-Francesv.Nelson,1936, whatlegalprecedentwasestablished? a.Nurseanesthesiawasallowedunderthenursepracticeact b.Nurseanesthesiascopeofpracticeincludedanesthesia c.Nurseanesthesiawaslegal,ifunderguidanceofasupervisingphysician d.Onlytrainednursingprofessionalscouldadministeranesthesiaindependently ANS:C ThelandmarkdecisionfromtheChalmers-Francesv.Nelsoncasesetnationalprecedentforthe advancednursingpracticerole.Itprovedtobethebasisforothercasesoverthefollowingfew decadesandestablishedthattrainednursescouldlegallyprovideanesthesiacareundersupervision ofaphysician. 11.Thefirstknownestablishmentofthenursepractitionerroleoccurredin1965attheUniversity ofColorado.Inwhichareaoftrainingdidthisrolespecialize? a.Pediatrics b.Geriatrics c.Midwifery d.Anesthesia ANS:A Theestablishmentofthefirstpediatricnursepractitionerprogramwasin1965attheUniversity ofColorado.LorettaFord,RNandHenrySilver,MDprovideda4-monthcoursetocertified registerednursestoprovideeducationonmanagingchildhoodhealthproblems. 12.TheDNPprogramcurriculumoutlinedwhichofthefollowingclinicalrequirementsinan efforttostandardizetraining? a.1000supervisedclinicalhoursand200unsupervisedclinicalhours b.1000supervisedclinicalhours c.900supervisedclinicalhours d.800supervisedclinicalhoursand200unsupervisedclinicalhours ANS:B In2004,theAACNoutlinedtheDNPcurriculuminanefforttostandardizeandrelievechallenges ofmaster’sdegreeprograms.Thisincludesastandardizedcurriculumrequiring1000supervised clinicalhours.13.Whichstatebecamethefirsttorecognizediagnosisandtreatmentaspartofthe scopeofpracticeofspecialtynurses? a.Idaho b.Oklahoma c.SouthDakota d.Maryland ANS:A IdahoGovernorCecilAndrussignedHB46andHB207intolawonFebruary11, 1971.Thisamendedthestates’nursepracticeactmakingitthefirststatetoofficially recognizediagnosisandtreatmentofspecialtynurses.Therecognitionoftheability todiagnoseandtreatovercameaninitialhurdletowardindependentnursingpractice. 14.TheAmericanNursingAssociation(ANA)defineswhichrequirementforthe designationofaclinicalnursespecialistinanyspecialty? a.Specialtytrainingcertificate b.Successfulcompletionofcertificationexamination c.Mastersordoctoraldegree d.1000hoursrelevantsupervisedtraining e.Twoormoreyearsofclinicallyrelevantexperience ANS:C In1980,theANAspecificallyoutlinedcriteriafortheacknowledgmentofclinical nursespecialisttrainingprograms.Atthattimetheyrequiredgraduateleveltraining tobecomeanexpertinarelevantspecialtyareaofnursing.Additionally,theymust meetanyrequirementssetforthbythespecificprofessionalsociety. Chapter2TheNursePractitioner:HistoricalPerspectiveontheArtandScienceofNurse Practitionering 1.WhichofthefollowingistheprimarymissionoftheNationalOrganizationofNurse PractitionerFaculties(NONPF)? a.ProvideleadershipinpromotingqualityNPeducation b.NPFacultytrainingprogramassistance c.ProvidefinancialassistancetoNPstudents d.LobbyinglegislatureonbehalfofNPsANS:A TheNONPF’sprimarymissionistoprovideleadershipinpromotingqualityNPeducation.The organizationhaspublisheddomainsandcorecompetenciesforprimarycareandtheseserveasa frameworkforNPeducationandpractice. 2.Amodelofcompetenciesthatareencompassedaroundthreespheresofinfluenceknownas patient,nursesandnursingpractice,andorganizationandinfluenceisknownas? a.NACNSModelofclinicalnursespecialistcompetencies b.Fenton’sandBrykczynski’sExpertPractice c.Calkin’smodelofAdvancedNursingPractice d.Shuler’sModelofNPPractice ANS:A TheNACNS’sinitial2008statementwasrevisedin2004.Thestatementoutlinedcompetencies thatalignedtoeachofthethreespheresofinfluence:patient,nursesandnursingpractice,and organizationandinfluence. 3.BuildinguponBenner’ssevendomainsofexpertnursingpractice,whichconceptualmodel addsanadditionaldomain“Theconsultingroleofthenurse”? a.Calkin’smodelofAdvancedNursingPractice b.Fenton’sandBrykczynski’sExpertPractice c.StrongMemorialHospital’sModelofAdvancedNursingPractice d.Shuler’sModelofNPPractice e.NACNSClinicalNurseSpecialistsModel ANS:B Fenton’sandBrykczynski’sExpertPracticeDomainsoftheCNSandNPexpandedonBenner’s sevendomainsaddingconsultationprovidedbyCNS’stoothernursesandmanagementofhealth andillnessinambulatorycaresettings. 4.Whichmodelofconceptualpracticewasthefirsttoexplicitlydistinguishtheexperiencelevel ofadvancedpractitioners? a.Calkin’smodelofAdvancedNursingPractice b.Shuler’sModelofNPPractice c.NACNSClinicalNurseSpecialistsModel d.StrongMemorialHospital’sModelofAdvancedNursingPractice e.Fenton’sandBrykczynski’sExpertPractice ANS:ACalkinsmodelofAdvancedNursingPracticewasthefirsttoexplicitlydistinguishexperience levelsofadvancedpractitionersfornurseadministratorstodifferentiateadvancedpracticenursing fromotherlevelsofclinicalpractice. 5.Thecircularandcontinuousthreadsofdirectcomprehensivepatientcare,supportofsystems, education,research,andpublicationandprofessionalleadershipmakeupthefivedomainsof whichadvancednursingconceptualmodel? a.StrongMemorialHospital’sModelofAdvancedNursingPractice b.Calkin’smodelofAdvancedNursingPractice c.NACNSClinicalNurseSpecialistsModel d.Fenton’sandBrykczynski’sExpertPractice e.Shuler’sModelofNPPractice ANS:A Directandindirectactivitiesacrossfivedomainsincluding:directcomprehensivepatientcare, supportofsystems,education,research,andpublicationandprofessionalleadershipmakeupthe StrongMemorialHospital’sModelofAdvancedPracticeNursing. 6.TexasChildren’sHospitalTransformationalAdvancedProfessionalPractice(TAPP)APRN Modeladdedwhatunifyingconceptualstrand? a.Ethics b.Culture c.Informatics d.Education ANS:A TheTAPPmodeladdedtwoadditionaldomains:qualityandsafety,andcredentialingand regulatorypractice,totheStrongmodel.Itadditionallyaddedprofessionalethicsasaunifying conceptualstrand. 7.Poghosyan,Boyd,andClarke(2016)proposedacomprehensiveconceptualmodelincluding threefactors:scopeofpracticeregulations,institutionalpolicies,andpracticeenvironments. Whatwastheirprimarypurpose? a.TodiscourageroleambiguityamongCNSproviders b.ToenhancepatienteducationprovidedbytheAPRN c.TomaximizeNPContributionstoprimarycare d.ToprovideeducationalpracticeguidelinestoenhanceNPeducation ANS:Che2016modelprovidedacomprehensivereviewofliteratureanddescribedpotentialfactorsthat affectNPcareandpatientoutcomes.Thisincludedscopeofpracticeregulationsthatoftencause barriersforNPprovidedprimarycare. 8.WhichmodelofpracticeintendedtoimpacttheNPdomainatfourlevels:theoretical,clinical, educational,andresearchin1993? a.Hamric’smodel b.Calkin’smodelofAdvancedNursingPractice c.StrongMemorialHospital’sModelofAdvancedNursingPractice d.Shuler’sModelofNPPractice ANS:D Shuler’sModelofNPPracticeisaholisticandwellnessorientedmodelthatwasdesignedto impacttheNPdomainatfourlevels:theoretical,clinical,educational,andresearch.Itisdesigned toelaboratetheNP’sexpandedknowledgeandskillsintomedicineincludingatemplatefor conductingavisit. 9.WhichmodelforAPRNpracticeaddressesallfourAPRNroles:CNS,CRNA,CNM,andNP? a.Calkin’smodelofAdvancedNursingPractice b.Hamric’smodel c.StrongMemorialHospital’sModelofAdvancedNursingPractice d.DonabedianModel ANS:B ManymodelshighlightcorecompetenciesamongspecificAPRNroles,whileothersemphasize competenciesforhiringmanagers.Atthetimeofthiswriting,onlytheHamric’smodel encompassesallfourAPRNroles. 10.WhichofthefollowingisoneoftheeightpublishedessentialsincludedintheEssentialsof DoctoralEducationforAdvancedNursingPracticedevelopedbytheAACNin2006? a.Algorithmsforadvancedpatientcare b.Informaticsandhealthcaretechnologies c.Scientificunderpinningsofpractice d.Liberaleducationforgeneralnursingpractice ANS:C TheAACNpublishestheirnationalconsensustoprovidethecoreelementsfornursingcurriculum creation.CurrentlypublishedareBaccalaureateEssentials,Master’sEssentials,DNPEssentials, andClinicalResourcesEssentials.Althoughtheyaresimilarintheircoreapproachtoeducation, listedfirstinDNPessentialsisthescientificunderpinningsofpractice.11.Whichmodelofconceptualizationidentifiesthathealthcareneedsarenotmetinasystem dominatedbymedicallanguageasabasisforreimbursement? a.DonabedianModel b.DunphyandWinland-Brown’sCircleofCaringmodel c.Shuler’sModelofNPPractice d.Calkin’smodelofAdvancedNursingPractice ANS:B DunphyandWinland-Brown’stransformativemodel(Dunphy,Winland-Brown,Porter,Thomas, andGallagher,2011;Fig.2.12)proposedacircleofcaringtoencouragemedicalcollaborationand enhancethenursingpresenceinthehealthcaresystem.Theirmodelincorporatesbothstrengths ofmedicineandnursingwithprocessofassessment,planning,intervention,andevaluation,with afeedbackloop. 12.Withoutadditionalapplicationofconceptualmodelswhichmodelwouldbebestchosento modeltheskilllevelofbeginningnurses,experiencednurses,oradvancednursepractitioners withtheappropriatelevelofpatientcare? a.DunphyandWinland-Brown’sCircleofCaringmodel b.StrongMemorialHospital’sModelofAdvancedNursingPractice c.DonabedianModel d.Calkin’smodelofAdvancedNursingPractice ANS:D Calkin’smodelofAdvancedNursingPracticeoutlinesskillsandknowledgeofbeginningnurses, experiencednurses,andadvancepracticenursesastheyrelatethepatientresponsesforhealthcare problems. 13.The2005DonabedianmodelhasbeenusedtoevaluatethequalityofAPRNcareusingwhich conceptualoutline? a.Assessment,diagnosis,planning,intervention,andevaluation b.Structure,process,andoutcome c.Diagnosisandoutcome d.Diagnosis,morbidity,andmortality ANS:D TheDonabedianmodelencompassesstructure(healthcaresystemsandfacilities),process (diagnosis,treatment,education),andoutcomes.14.Whichofthefollowingarethefunctionsofaconceptualizationofadvancedpracticenursing? (Selectallthatapply.) a.Basisforfurthermoredevelopmentofknowledge b.Articulateprofessionalroleidentityandfunction c.Identifyspecificprocedurestoprovide d.Deliverholisticandcollaborativecare e.Provideguidelinesonbilling ANS:A,B,D Conceptualmodelsallowforarticulationofprofessionalroleidentity,provideabasisfor furthermoredevelopmentofknowledgeandassistinclinicalpracticeforthedeliveryofholistic, comprehensive,andcollaborativecare.Modelsmayassistbutingeneraldonotprovideassistance withclinicaldecisionmakingorbilling. TestBank MultipleChoice 15.Aregisterednursecompletesaninformaleducationandtrainingcourseathisorherplaceof workauthorizinghimorhertouseultrasoundguidedimagerywhenplacingintravenouslines. Howisthisbestclassified? a.Advancedpracticenursing b.NursingSkillAdvancement c.AdvancedLicensure d.AdvancedCertification ANS:B Theadditionoradvancementofindividualskillstothenursingpracticeiscommonandencouraged butdoesnotmeettherequirementssetforthforadvancedpracticenursing.Licensureand certificationwerenotobtainedorexpressed. 16.ThecorefoundationsofallAPNeducationcurriculacontainadvancedcoursescoveringwhich ofthefollowing? a.Humananatomy,healthandphysicalassessment,andpharmacology b.Pathophysiology,research,andpharmacology c.Healthandphysicalassessment,pathophysiology,andobstetricsandgynecology d.Pathophysiology,healthandphysicalassessment,andpharmacologyANS:D Whilespecificspecialtiesmayfocusonindividualareasofclinicalknowledge,allaspectsof advancedpracticenursingincludeadvancedknowledgeofpathophysiology,healthandphysical assessment,andpharmacology. 17.Whichofthefollowingcriteriaisrequiredfortheattainmentofclassificationasanadvanced practicenurse(APN)? a.Practicefocusedonresearch b.Baccalaureatedegreeinareaoffocus c.Specializedskillattainment d.Graduatedegreeinareaoffocus ANS:D ThethreebasiccriteriaorqualificationsforAPNsincludegraduateeducationinadvancedpractice nursingrole,nationalcertificationinanadvancedrole,andapracticefocusedonpatientsandtheir families.Researchandskillsarecomponentsofcorecompetenciesofadvancedpracticenurses whoachieveagraduatelevelofeducation. 18.Whichofthefollowingisthecentral,corecompetencyforadvancedpracticenursing? a.Evidence-basedpractice b.Directclinicalpractice c.Leadership d.Ethicaldecisionmaking ANS:B Directclinicalpracticeisthecorecompetencythatlendsitselftoallothers.Italsoprovidesthe foundationforAPNstocarryouttheothercompetenciesadequately. 19.Thelegalauthoritygrantedtoaprofessionaltoprovideandbereimbursedforhealthcare servicesrefersto: a.Certification b.Scopeofpractice c.PracticingRole d.Education ANS:B Manythingsincludingstateandfederallawsdefinescopeofpractice.TheAPNNCSBNdefines scopeofpracticeascharacterizedbyspecialization,expansionofservicesprovided,includingdiagnosingandprescribing,andautonomytopractice.Anindividualcertificationwouldfallunder theumbrellaofscopeofpractice. 20.Whichofthefollowingmostaccuratelydescribesthecurrentfourestablishedadvanced practicenurseroles? a.RN,BSN,MSN,DNP b.CNM,FNP,CNS,CRNA c.CNM,FNP,AGNP,PNP d.CNS,CRNA,NP,CNM ANS:D ThefourestablishedadvancedpracticenurserolesincludeCNS,CRNA,CNM,andNP.FNPand AGNParespecializationsofnursepractitioners(NP). 21.Whichadvancedpracticenursingrolehasseenthelargestexpansionofgrowthandiscurrently thelargestinnumber? a.CNS b.CRNA c.CNM d.NP ANS:D NursepractitionercontinuestobethelargestinnumberofAPNroles.AccordingtotheAmerican AcademyofNursePractitionersNationalNPDatabasethereareover220,000trainedNPs. 22.Whichadvancedpracticenursingroleiscurrentlythesmallestinnumber? a.CNM b.NP c.CNS d.CRNA ANS:A TheCNMroleaccordingtotheAmericanCollegeofNurse-Midwivescurrentlyhasaround11,000 trainedprovidersbasedoncurrentestimates.TheCNMroleisspecializedinthecareofwomen’s healthandchildbearing. 23.Apracticing,certifiedCNMwishestochangerolesandworkasafamilynursepractitioner (FNP).Whichofthefollowingisrequired?a.CompleteeducationandtrainingasanNP b.TaketheFNPboardexamination c.Nothingisrequired d.Applyforimmediatereciprocity ANS:A ThefourrolesofAPN(CNS,CRNA,CNM,andNP)arenotinterchangeablewithoutadditional trainingandeducation.Althoughtherearespecificinstancesofoverlap,eachofthefourroles shouldnotbeconfusedasinterchangeable.SpecialtycertificationsundertheNProlemayallow formoreflexibilityundertoday’sregulationsandarenotstandardpractice.Scenariosareusually handledonanindividualbasis. 24.TrueorFalse.Aregisterednurseinanemergencyroomsuccessfullycompletesacriticalcare courseandmeetsallrequirementsforcertification.Heorsheisnowclassifiedasanadvanced practicenurse. a.True b.False ANS:B Thisregisterednursehascompletedadvancedtrainingthatincreasesskillandknowledgeandmay havealsoobtainedacertification;however,thisdoesnotmeetthebasiccriterionofadvanced practicenurse.Heorshemaybeexpertlyskilledbutrequiresthecompletionofagraduatedegree focusedinanareaofnursingtoappropriatelybeclassifiedasanAPN.Theacutecarenurse practitionerspecialtywouldberequiredinthisparticularsetting. Chapter3OverviewoftheDoctorofNursingPracticeDegree 1.Aregisterednursecompletesaninformaleducationandtrainingcourseathisorherplaceof workauthorizinghimorhertouseultrasoundguidedimagerywhenplacingintravenouslines. Howisthisbestclassified? a.Advancedpracticenursing b.NursingSkillAdvancement c.AdvancedLicensure d.AdvancedCertification ANS:B Theadditionoradvancementofindividualskillstothenursingpracticeiscommonandencouraged butdoesnotmeettherequirementssetforthforadvancedpracticenursing.Licensureand certificationwerenotobtainedorexpressed. 2.ThecorefoundationsofallAPNeducationcurriculacontainadvancedcoursescoveringwhich ofthefollowing? a.Humananatomy,healthandphysicalassessment,andpharmacology b.Pathophysiology,research,andpharmacology c.Healthandphysicalassessment,pathophysiology,andobstetricsandgynecology d.Pathophysiology,healthandphysicalassessment,andpharmacologyANS:D Whilespecificspecialtiesmayfocusonindividualareasofclinicalknowledge,allaspectsof advancedpracticenursingincludeadvancedknowledgeofpathophysiology,healthandphysical assessment,andpharmacology. 3.Whichofthefollowingcriteriaisrequiredfortheattainmentofclassificationasanadvanced practicenurse(APN)? a.Practicefocusedonresearch b.Baccalaureatedegreeinareaoffocus c.Specializedskillattainment d.Graduatedegreeinareaoffocus ANS:D ThethreebasiccriteriaorqualificationsforAPNsincludegraduateeducationinadvancedpractice nursingrole,nationalcertificationinanadvancedrole,andapracticefocusedonpatientsandtheir families.Researchandskillsarecomponentsofcorecompetenciesofadvancedpracticenurses whoachieveagraduatelevelofeducation. 4.Whichofthefollowingisthecentral,corecompetencyforadvancedpracticenursing? a.Evidence-basedpractice b.Directclinicalpractice c.Leadership d.Ethicaldecisionmaking ANS:B Directclinicalpracticeisthecorecompetencythatlendsitselftoallothers.Italsoprovidesthe foundationforAPNstocarryouttheothercompetenciesadequately. 5.Thelegalauthoritygrantedtoaprofessionaltoprovideandbereimbursedforhealthcare servicesrefersto: a.Certification b.Scopeofpractice c.PracticingRole d.Education ANS:B Manythingsincludingstateandfederallawsdefinescopeofpractice.TheAPNNCSBNdefines scopeofpracticeascharacterizedbyspecialization,expansionofservicesprovided,includingdiagnosingandprescribing,andautonomytopractice.Anindividualcertificationwouldfallunder theumbrellaofscopeofpractice. 6.Whichofthefollowingmostaccuratelydescribesthecurrentfourestablishedadvanced practicenurseroles? a.RN,BSN,MSN,DNP b.CNM,FNP,CNS,CRNA c.CNM,FNP,AGNP,PNP d.CNS,CRNA,NP,CNM ANS:D ThefourestablishedadvancedpracticenurserolesincludeCNS,CRNA,CNM,andNP.FNPand AGNParespecializationsofnursepractitioners(NP). 7.Whichadvancedpracticenursingrolehasseenthelargestexpansionofgrowthandiscurrently thelargestinnumber? a.CNS b.CRNA c.CNM d.NP ANS:D NursepractitionercontinuestobethelargestinnumberofAPNroles.AccordingtotheAmerican AcademyofNursePractitionersNationalNPDatabasethereareover220,000trainedNPs. 8.Whichadvancedpracticenursingroleiscurrentlythesmallestinnumber? a.CNM b.NP c.CNS d.CRNA ANS:A TheCNMroleaccordingtotheAmericanCollegeofNurse-Midwivescurrentlyhasaround11,000 trainedprovidersbasedoncurrentestimates.TheCNMroleisspecializedinthecareofwomen’s healthandchildbearing. 9.Apracticing,certifiedCNMwishestochangerolesandworkasafamilynursepractitioner (FNP).Whichofthefollowingisrequired?a.CompleteeducationandtrainingasanNP b.TaketheFNPboardexamination c.Nothingisrequired d.Applyforimmediatereciprocity ANS:A ThefourrolesofAPN(CNS,CRNA,CNM,andNP)arenotinterchangeablewithoutadditional trainingandeducation.Althoughtherearespecificinstancesofoverlap,eachofthefourroles shouldnotbeconfusedasinterchangeable.SpecialtycertificationsundertheNProlemayallow formoreflexibilityundertoday’sregulationsandarenotstandardpractice.Scenariosareusually handledonanindividualbasis. 10.TrueorFalse.Aregisterednurseinanemergencyroomsuccessfullycompletesacriticalcare courseandmeetsallrequirementsforcertification.Heorsheisnowclassifiedasanadvanced practicenurse. a.True b.False ANS:B Thisregisterednursehascompletedadvancedtrainingthatincreasesskillandknowledgeandmay havealsoobtainedacertification;however,thisdoesnotmeetthebasiccriterionofadvanced practicenurse.Heorshemaybeexpertlyskilledbutrequiresthecompletionofagraduatedegree focusedinanareaofnursingtoappropriatelybeclassifiedasanAPN.Theacutecarenurse practitionerspecialtywouldberequiredinthisparticularsetting. Chapter4EmergingRolesfortheDNPNurseEducator TestBank MultipleChoice 25.In1990,CooperandSparacinopostulatethananAPRN’smaximumpotentialmaynotbe attaineduntil: a.After1year b.After7years c.After3years d.After5years ANS:DStudieshaveshownthatthefirst-yearpositionofanAPRNisoneoftransition,andCooperand SparacinoestimatethatanAPRN’smaximumpotentialmaynotbeattaineduntilafter5yearsor moreinpractice. 26.AnNPstudentisperformingathoroughneurologicexaminationforthefirsttimeintheclinical setting.Thisisanexampleof: a.Roleimplementation b.Roleacquisition c.Roleconfusion d.Roleconflict ANS:B Thechangesoccurringduringroletransitionsexperiencedduringtheeducationalcomponentofan APNroleareclassifiedasroleacquisition.Additionally,roletransitionisdescribedaswhenan APRNbeginstopracticeforthefirsttimeinanewrole. 27.AnewNPstudentiscompletingarotationatanoutpatienturgentcareclinicandcompletesan examinationonapatientwithchestpain.Thenursingassistanthandsa12-leadECGtotheNP studentandasks:“Whatshouldwedo?”TheNPstudent’spreceptordidnotprovideclear instructionsontheroleoftheNPstudentatthistimeeventhoughthestudentiscapableof interpretingECGs.Thisisanexampleof: a.Roleambiguity b.Roletransition c.Rolestrain d.Rolesupplementation ANS:A Roleambiguityiscreatedbyunclearexpectations,diffuseresponsibilities,anduncertaintyof subroles.TheNPstudent’spreceptordidnotprovideclearrolestotheNPstudentaboutwhathe orsheshoulddointheabsenceofthepreceptor.IftheNPstudentwasplacedinarolewherehe orshewasunawareofhowtointerpretECGsthiswouldbeanexampleofroleincongruity. 28.AnNPiscompletingthefirstmonthinhisorherfirstjob.Heorshereceivesaphonecallfrom anadministratortellinghimorherthatheorshewillneedtosee30%morepatientsstarting nextweek.HeorsheistoldthatthisistheminimumrequirementofallNPsinthesame position.TheNPhasdifficultyusingtheelectronichealthrecord(EHR)softwareefficiently andfeelsoverwhelmed.Thisisanexampleof: a.Rolesupplementation b.Roleambiguity c.Roleconflictd.Roleinsufficiency ANS:D RoleinsufficiencyisoftenseenasAPRNgraduates’transitiontotheworkforceorchange positions.Thismayincludefeelingsofinadequacyorslowspeedduetothenewroleorbarriers suchaselectronichealthrecorddocumentationrequirements. 29.Whichofthefollowingisanexampleofroleacquisition? a.NPstudentlearningleadershiprolesintheclassroom b.NPstudentongraduationdayfromhisorherprogram c.NPstudentbeginninganewjobasafamilynursepractitioner d.ApracticingNPadvancingcentrallineskills ANS:A Thechangesoccurringduringroletransitionsexperiencedduringtheeducationalcomponentofan APNroleareclassifiedasroleacquisition.Alloftheothersareexamplesofroleimplementation. 30.ThechangesoccurringasanAPRNperformsproceduresduringjobdutiesareclassifiedas? a.Rolesupplementation b.Roletransition c.Roleimplementation d.Roleacquisition ANS:C ThejobdutiesandresponsibilitiesperformedbytheAPRNareanexampleofroleimplementation. RoletransitionisthetransitionfromstudenttopracticingNP. 31.Whichofthefollowingisbestclassifiedasrollstress? a.Maintainingfamilyresponsibilitieswhileinschool b.AnAPN’sfeelingsofpoorself-esteem c.StartingafirstjobasanNP d.Multiplefailedattemptstomasteraprocedureduringeducation ANS:A Therearemanyexamplesofrolestress.Rolestressmayincludeanysituationthatrequires increasedperformanceaboveandbeyondtheexpectationofothers.Thisiseasilyclassifiedas examplesofthingsthatrequireadditionaldemandinadditiontoschoolorworksuchas work/familyresponsibilitiesorkeepingupwithnewandadvancingtechnologies.Startingafirst jobasanNPisanexampleofroletransition.32.Whichofthefollowingisbestclassifiedasrolestrain? a.Adifficultdisagreementwithaphysician b.AnAPN’sfeelingsofpoorself-esteemafterfailingtwoexaminations c.Maintainingfamilyresponsibilitieswhileinschool d.StartingafirstjobasanNP ANS:B Rolestrainisdefinedasthesubjectivefeelingoffrustration,tension,oranxietyinresponsetorole stress.Examplesofrolestraintypicallyincludesubjectivefeelingsofdecreasedself-esteemwhen performanceisbelowtheexpectationsofselforothers.Adifficultdisagreementwithaphysician isanexampleofroleconflict.StartingafirstjobasanNPisanexampleofroletransition. Maintainingfamilyresponsibilitieswhileinschoolisanexampleofrolestress. 33.Whichofthefollowingisanexampleofroleconflict? a.Difficultwork-lifebalance b.Adifficultdisagreementwithaphysician c.StartingafirstjobasanNP d.Maintainingfamilyresponsibilitieswhileinschool ANS:B Roleconflictoccurswhenroleexpectationsareperceivedtobemutuallyexclusiveor contradictory.RoleconflictdoesnothavetobewithsuperiorsbutcanoccurbetweenAPRNsand nurses,otherAPRNs,orphysicians.StartingafirstjobasanNPisanexampleofroletransition. Maintainingfamilyresponsibilitieswhileinschoolisanexampleofrolestress. 34.Thefour-stageprocesstoNProledevelopmentfirstidentifiedbyAnderson,Leonard,and Yates(1974)andvalidatedbyRobertsetal.(1997)includedwhichfourcomponents? a.Findinganiche,copingwithpressures,feelingcompetent,internalizingtherole b.Completedependence,developingcompetence,independence,interdependence c.Novice,developingcompetence,competent,advanced d.Developingcompetence,partialindependence,completeindependence,interdependence e.Dependence,independence,interdependence,rolemodel ANS:B Completedependence,developingcompetence,independence,andinterdependencearethefour- stageprocessofNPdevelopmentoutlinedbyAnderson,Leonard,andYatesin1974andvalidated byRobertsetal.(1997).35.AtrainednurseentersthefirstsemesterofanNPtrainingprogram.Heorsheisrequiredto learnnewandmoreadvancedtechniquesbeginningwithconductinganadvancedphysical examination.Theoverwhelmingfeelingandstressoflearningadditionalskillsismostlikely classifiedbythestudiesofAnderson,Leonard,andYatesin1974as: a.Independence b.Developingcompetence c.Interdependence d.Completedependence ANS:D TheinitiallearningofskillsandadditionaltechniquesexperiencedbyNPsinthebeginningoftheir traininghasbeendescribedascompletedependence. 36.AtrainedNPisworkingatanoutpatientcareclinic.Heorsheencountersadifficultpatient,is unawareoftreatmentoptions,andconsultsoneofhisorhercolleaguesforadvice.Thisisbest classifiedas: a.Independence b.Interdependence c.Developingcompetence d.Completedependence ANS:B AsinitiallydefinedbyAnderson,Leonard,andYatesin1974,NProlesastheytransitiontothe workplaceasseasonedpractitionerstransitiontointerdependenceastheyworkwithcolleaguesto enhancepatientcare. 37.FlemingandCarberry’sresearchin2011studiedtwocohortsofcriticalcarenurseadvanced practicetraineesinScotland.Theyfoundthattransitionoccurredinwhichfourareas? a.Completedependence,developingcompetence,independence,interdependence b.Developingcompetence,partialindependence,completeindependence,interdependence c.Copingwithpressures,feelingcompetent,internalizingtherole,leadingothers d.Findinganiche,overcomingobstacles,advancedpractice,interdependence e.Findinganiche,copingwithpressures,feelingcompetent,internalizingtherole ANS:E FlemingandCarberry’sresearchin2011studiedtwocohortsofcriticalcarenurseadvanced practicetraineesinScotlandshowingtransitionoccurredinfourareas:findinganiche,coping withpressures,feelingcompetent,internalizingtherole.38.Astrategytopromoteroleacquisitioninschoolthatinvolvesaceremonyatthebeginningof theNPstudentstrainingisthebestexampleof: a.Rolerehearsal b.Creatingasupportnetwork c.Roledevelopment d.Developingclinicalknowledgeofskills ANS:A Rolerehearsalmayincludemanyfacetsincludingariteofpassagesuchasaceremonytomark thebeginningofanewtrainingprogram. 39.Whichinitialstrategywouldprovidethebestroleacquisitionforastudentorpotentialstudent abouttobeginanewNPprogram? a.Providecasescenariosofpatientsthatmaybeencountered b.Preadmissiontesting c.ProvideahandoutdetailingtheAPRNcurriculum d.Clinicalfacultymentoringbypreceptors ANS:C Aninitialstrategyforroleacquisitionincludescomponentsforrolerehearsal.Providingtheoverall frameworkfortheAPRNcurriculumwouldallowforthebest-casescenarioofroleacquisition. Clinicalfacultymentoringbypreceptorsisanexampleofroleacquisitionbutisbestsuitedto developclinicalknowledgeandskills. 40.WhichofthefollowingisthebeststrategyfortransitionofanAPRNintoanewposition? a.Ensuringadequatepre-positiontraining b.Developmentofastructuredorientationplan c.Schedulingtime-basedevaluations d.Providingimmediatefeedbackfromsupervisors ANS:B APRNsinnewrolesregardlessofpreviousexperiencebenefitmostfromstructuredorientation plans,networkingwithpeers,appropriatementorsandpreceptors,andanunderstandingof appropriateexpectations. 41.Whichthreemajorpurposesarecategorizedandcanbeutilizedtofacilitateroleacquisitionof NPsinschool? a.Knowledgeexpansion,skillpractice,creationofasupportivenetworkb.Rolerehearsal,developmentofclinicalknowledgeandskills,creationofasupportive network c.Roleacquisition,rolerehearsal,creationofasupportivenetwork d.Knowledgefoundationdevelopment,developmentofclinicalskills,trackingoutcomes ANS:B AnadaptationofBrykczynski’s(2000)“StrategiestopromoteNProleacquisitioninschool” allowsforspecificstrategiesforroleacquisitiontobecategorizedintothreemajorpurposes:role rehearsal,developmentofclinicalknowledgeandskills,andcreationofasupportivenetwork. 42.Whichofthefollowingexampleswouldbestenhancethedevelopmentofclinicalknowledge andskillsaspartofroleacquisitionoftheNP? a.Establishmentofapeersupportsystem b.Clinicalconferences c.Identifyingarolemodel d.SubscriptiontoAPRNjournalsandconferences ANS:B Roleacquisitionstrategiesincludethreemajorpurposes:rolerehearsal,developmentofclinical knowledgeandskills,andcreationofasupportivenetwork.Establishmentofclinicalconferences todiscussclinicalexperienceswithfacultyandpeerscanpromoteclinicalunderstandingand enhancethedevelopmentofclinicalknowledgeandskills.SubscriptiontoAPRNjournalsand conferenceswouldestablishapatternforcontinuingeducationandhelpcreateasupportnetwork. Establishmentofapeersupportsystemwouldalsohelpcreateasupportnetwork.Identifyinga rolemodelormentorwouldfacilitaterolerehearsal. 43.AfacultymemberatanNPeducationprogramhasidentifiedthatstudentsareexperiencing difficultywithrolerehearsalduringthefirstfewsemestersoftheprogram.Whichofthe followingstrategieswouldlikelyenhancerolerehearsalandfacilitateroleacquisition? a.SubscriptiontoAPRNjournalsandconferences b.Identifyingarolemodel c.Clinicalconferences d.Establishmentofapeersupportsystem ANS:B Roleacquisitionstrategiesincludethreemajorpurposes:rolerehearsal,developmentofclinical knowledgeandskills,andcreationofasupportivenetwork.Identificationofarolemodelor mentoranddevelopingamenteerelationshipthatcanbemaintainedthroughoutanAPRNprogram isanexcellentstrategytopromoterolerehearsalandsupportroleacquisitionwhileinschool. Clinicalconferencessupportdevelopingclinicalknowledgeandskills.Establishmentofapeer supportsystemorsubscriptionstoAPRNjournalshelpcreateasupportnetwork.44.In2010,researchersSullivan-Bentzetal.usedBrownandOlshansky’sfour-stagetransition modeltostudyrecentNPgraduatesastheyundergoroletransitiontopracticingNPs.Whatdid thestudydemonstrate? a.NewNPstransitionedfromfeelingoverwhelmedtofeelingconfidentin6monthsonly withsupportnetworks b.NewNPsdidnottransitionfromfeelingoverwhelmedtofeelingconfidentinthestudy c.NewNPstransitionedfromfeelingoverwhelmedtofeelingconfidentin1yearonlywith supportnetworks d.NewNPstransitionedfromfeelingoverwhelmedtofeelingconfidentin1year e.NewNPstransitionedfromfeelingoverwhelmedtofeelingconfidentin6months ANS:D APRNroledevelopmentprocesseshavebeensupportedbyanumberofstudiesidentifyingthat thefirstyearismostlikelytobeobservedasthetransitionfromfeelingoverwhelmedtofeeling confident. 45.AquestionnairestudyconductedbyHartandMacnee(2007)attwonationalNPconferences foundthat51%ofNPsperceivedthattheywereonlysomewhatorminimallypreparedfor actualpractice.Whichofthefollowingwouldmostlikelyfacilitatetheroletransitionissues forabeginningNP? a.ClinicalNPresidencyprogram b.Additionaltimerequirementasapracticingregisterednurse c.LongerNPeducationprogram d.AdditionalNPclinicaltraininghours ANS:A AsmanystudieshaveshowntheroletransitionissuesofAPRNgraduates,clinicalresidency programshavebeendevelopedtoaddresstheseissues.Clinicalresidencyprogramseasenew graduatetransitionintopracticeandincreaseNPretentionandoverallsatisfaction. Chapter5InfluencingandLeadingChangeintheComplexHealthEnvironment:TheRoleofthe AdvancedPracticeNurse MultipleChoice 46.Anursedevelopsaninterestinmoreeffectivemedicationmanagementandseeksadditional trainingtoenhancehisorherdailycareofpatientsandforpeersatthefacilityforwhichheor sheworks.Thisisanexampleof:a.Specialization b.Subspecialty c.Specialty d.Advancedpracticenursing ANS:A Specializationinvolvesfocusingonpracticeinaspecificareaderivedfromthefieldofprofessional nursing.Specialtiescanbefurthercharacterizedasnursingpracticethatintersectswithanother bodyofknowledge,hasadirectimpactonnursingpractice,andissupportiveofthedirectcare providedtopatientsbyotherregisterednurses(AmericanNursesAssociation[ANA],2010a).If thenursechangedhisorherfocusofpracticethiscouldbeconsideredaspecialty. 47.Anursedevelopsaninterestineffectivemedicationmanagementandseeksadditionaltraining. Thenursethenfocusesthemajorityofhisorhertimeonmedicationmanagementaspectsof nursing.Thisisanexampleof: a.Advancedpracticenursing b.Subspecialty c.Specialization d.Specialty ANS:D Thetermspecialtysuggeststhatthefocusofpracticeislimitedtopartsofthewhole(ANA,2010b). Sincethisnursehasrefocusedhisorhercareentirelyonmedicationmanagementaspartofthe nursingroleitisconsideredaspecialty. 48.Aregisterednurseisplanningtoextendhisorhereducationbeyondbaccalaureateeducation intoanadvancedpracticerole.WhenchoosingbetweenCRNA,CNM,andNPtheseare delineationsofwhichtype? a.Reasoning b.Subspecialty c.Specialty d.Specialization ANS:C Thetermspecialtysuggeststhatthefocusofpracticeislimitedtopartsofthewhole(ANA,2010b). DecidingonadvancedpracticenursingamongCRNA,CNM,andNPrequiresknowledgethatthey areindependentspecialties.SpecialtiesofNPatthehighestlevelarepsychiatricandmentalhealth, pediatrics,andadult-gerontology.Subspecialtiesfurtherdifferentiatethefocusofpracticesuchas familypracticenursepractitioner,adult-gerontologynursepractitioner,andacutecareamong others.49.Astudentisevaluatingaprogramtoattend.Heorshefindsanadult-gerontologynurse practitionerprogramthatwillalsopreparehimorherasahospitalist.Howisthehospitalist trainingbestdefined? a.Specialty b.Subspecialty c.Reasoning d.Specialization ANS:B Subspecializationfurtherdelineatesthefocusofpractice.Insubspecialtypractice,knowledgeand skillinadelimitedclinicalareaisexpandedfurther.Examplesofsubspecialtiesincludediabetes care,acutecare,painmanagement,andclinicaltransplantcoordinator. 50.Whichofthefollowingmostaccuratelydescribesthefourstagesintheevolutionofadvanced practicenursing? a.Interestoccurs,specialtybegins,specialtyorganizes,andpressuresmountfor standardization b.Specialtybegins,specialtyorganizes,lawsrequirestandardization,maturity,andgrowing interprofessionalism c.Specialtybegins,specialtyorganizes,pressuresmountforstandardization,maturity,and growinginterprofessionalism d.Interestoccurs,specialtybegins,specialtyorganizes,andspecialtymatures ANS:C Thefourstagesintheevolutionofadvancedpracticenursinginclude:stageI:specialtybegins, stageII:specialtyorganizes,stageIII:pressuresmountforstandardization,andstageIV:maturity andgrowinginterprofessionalism. 51.Anadult-gerontologynursepractitionerworkstoenhanceeducationforpolypharmacyin elderlypatientsthroughthecreationofstandardizededucationtools.TheNPworkswithother professionalsathisorherfacilitytoresearchanddevelopcriteriaforeducationandpractice. Thisexampleisbestclassifiedaswhichstage? a.Specialtyorganizes b.Specialtystandardizes c.Specialtybegins d.Specialtymaturesandgrowsinterprofessionally ANS:C Specialtystagesarenotconcrete,butspecialtiesthatareinthebeginningofdevelopmentarein stageI:specialtybeginning.StageII:specialtyorganizationistypicallyconsideredwhena professionalorganizationoflike-mindedindividualsisofficiallyformed.