*NURSING > TEST BANK > Test Bank Advanced Practice Nursing Essentials for Role Development Chapter 1 – Chapter 30. (All)

Test Bank Advanced Practice Nursing Essentials for Role Development Chapter 1 – Chapter 30.

Document Content and Description Below

Test Bank Advanced Practice Nursing Essentials for Role Development Chapter 1 – Chapter 30. Test Bank Advanced Practice Nursing Essentials for Role Development Chapter 1 – Chapter 30. CHAPTE... R1: ANSWERS AND RATIONALES 1. Which change represents the primary impetus for the end of the era of the female lay healer? 1. Perception of health promotion as an obligation 2. Development of a clinical nurse specialist position statement 3. Foundation of the American Association of Nurse-Midwives 4. Emergence of a medical establishment Page: 4 Feedback 1. . Lay healers traditionally viewed their role as being a function of their community obligations; however, the emerging medical establishment viewed healing as a commodity. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. 2. . The American Nurses Association (ANA) position statement on educational requirements for the clinical nurse specialist (CNS) was developed in 1965; the ANA’s position statement on the role of the CNS was issued in 1976. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. 3. . The American Association of Nurse-Midwives (AANM) was founded in 1928. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. 4. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. Whereas lay healers viewed their role as being a function of their community obligations, the emerging medical establishment viewed healing as a commodity. The era of the female lay healer began and ended in the 19th century. The American Association of Nurse-Midwives (AANM) was founded in 1928. The American Nurses Association (ANA) position statement on educational requirements for the clinical nurse specialist (CNS) was developed in 1965; the ANA’s position statement on the role of the CNS was issued in 1976. 2. The beginning of modern nursing is traditionally considered to have begun with which event? 1. Establishment of the first school of nursing 2. Incorporation of midwifery by the lay healer 3. Establishment of the Frontier Nursing Service (FNS) 4. Creation of the American Association of Nurse-Midwives (AANM) Pages: 4–5 Feedback 1. Traditionally, modern nursing is considered to have begun in 1873, when the first three U.S. training schools for nurses opened. The role of the lay healer as a midwife is documented to have occurred in the 19th century, before the establishment of schools of nursing. The Frontier Nursing Service (FNS), which provided nurse-midwifery services, was established in 1925. In 1928, the Kentucky State Association of Midwives, which was an outgrowth of the FNS, became the American Association of Nurse-Midwives (AANM). 2. . The role of the lay healer as a midwife is documented to have occurred in the 19th century, before the establishment of schools of nursing. Traditionally, modern nursing is considered to have begun in 1873, when the first three U.S. training schools for nurses opened. 3. . The Frontier Nursing Service (FNS), which provided nurse- midwifery services, was established in 1925. Traditionally, modern nursing is considered to have begun in 1873, when the first three U.S. training schools for nurses opened. 4. . In 1928, the Kentucky State Association of Midwives, which was an outgrowth of the FNS, became the American Association of Nurse- Midwives (AANM). Modern nursing is considered to have begun in 1873, at which time the first three U.S. training schools for nurses opened. 3. In 1910, which factors most significantly influenced the midwifery profession? Select all that apply. 1. Strict licensing requirements 2. Negative public perception 3. Dedicated funding for training 4. Poor maternal-child outcomes 5. Mandatory professional supervision Pages: 6–7 Feedback 1. . In 1910, the midwifery profession was significantly influenced by poor maternal-child outcomes and a public perception as unprofessional. Though legislation ultimately was passed to tighten requirements related to licensing and supervision of midwives, in the early 20th century, midwives were largely unregulated and generally perceived as unprofessional. 2. In 1910, the midwifery profession was significantly influenced by poor maternal-child outcomes and a public perception as unprofessional. At that time, approximately 50% of all U.S. births were reportedly attended by midwives. However, especially with regard to perinatal health indicators, the national population’s general health was poor. Unfavorable outcomes among both mothers and infants were attributed to midwives who, at that time, were largely unregulated and generally perceived as unprofessional. Poor maternal-child outcomes, negative perceptions of midwives, obstetricians’ targeted efforts to take control of the birthing process, and a movement away from home births prompted major changes. Legislation was passed to tighten requirements related to licensing and supervision of midwives. One aim of the Sheppard-Towner Maternity and Infancy Act involved allotting funds to train public health nurses in midwifery; however, the bill lapsed in 1929. 3. . Goals of the Sheppard-Towner Maternity and Infancy Act included allocating funds to train public health nurses in midwifery, but the bill lapsed in 1929. In 1910, poor maternal-child outcomes and a public perception as unprofessional significantly influenced the midwifery profession. 4. In 1910, the midwifery profession was significantly influenced by poor maternal-child outcomes and a public perception as unprofessional. At that time, approximately 50% of all U.S. births were reportedly attended by midwives. However, especially with regard to perinatal health indicators, the national population’s general health was poor. Unfavorable outcomes among both mothers and infants were attributed to midwives who, at that time, were largely unregulated and generally perceived as unprofessional. Poor maternal-child outcomes, negative perceptions of midwives, obstetricians’ targeted efforts to take control of the birthing process, and a movement away from home births prompted major changes. Legislation was passed to tighten requirements related to licensing and supervision of midwives. One aim of the Sheppard-Towner Maternity and Infancy Act involved allotting funds to train public health nurses in midwifery; however, the bill lapsed in 1929. 5. . In 1910, the midwifery profession was largely unregulated. Factors that influenced the profession included poor maternal-child outcomes and a public perception as unprofessional. 4. Which advanced practice nursing role is unique in that the practitioners view their role as comprising a combination of two distinct disciplines? 1. Nurse practitioner 2. Certified registered nurse anesthetist 3. Clinical nurse specialist 4. Certified nurse-midwife Page: 9 Feedback 1. . The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery. 2. . The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery. 3. . The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery. 4. The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery. 5. In the 19th century, which factors led to the administration of anesthesia by nurses? Select all that apply. 1. Surgeon entitlement to collecting anesthesia fees 2. Collaborative practice between physician-anesthetists and nurses 3. Lack of recognition of anesthesiology as a medical specialty 4. Opposition to anesthesia administration by physicians 5. Formation of a national organization by nurse anesthetists , 3 Pages: 10–11 Feedback 1. In the 19th century, anesthesia was in its early stages. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. However, physicians were not opposed to administering anesthesia; rather, anesthesia was viewed as a means by which to transform surgery into a scientific modality for treating health alterations. Collaboration between physicians and nurses did not contribute to administration of anesthesia by nurses; contentiousness is a hallmark of the relationship between nurse anesthetists and anesthesiologists even in the present day. In the 19th century, no national organization of nurse anesthetists yet existed. The National Association of Nurse Anesthetists, which was renamed the American Association of Nurse Anesthetists (AANA), was founded in 1931. 2. . With the introduction of anesthesia, collaboration between physicians and nurses did not contribute to administration of anesthesia by nurses. By contrast, contentiousness is a hallmark of the relationship between nurse anesthetists and anesthesiologists even in the present day. In the 19th century, anesthesia was in its early stages. Administration of anesthesia by nurses occurred primarily because of anesthesiology’s lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees. 3. In the 19th century, anesthesia was in its early stages. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. However, physicians were not opposed to administering anesthesia; rather, anesthesia was viewed as a means by which to transform surgery into a scientific approach to treating with health alterations. Collaboration between physicians and nurses did not contribute to administration of anesthesia by nurses; contentiousness is a hallmark of the relationship between nurse anesthetists and anesthesiologists even in the present day. In the 19th century, no national organization of nurse anesthetists yet existed. The National Association of Nurse Anesthetists, which was renamed the American Association of Nurse Anesthetists (AANA), was founded in 1931. 4. . In the 19th century, anesthesia was in its early stages. Physicians were in favor of the administration of anesthesia, viewing this advancement as a means by which to transform surgery into a scientific modality for treating health alterations. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. As such, the administration of anesthesia was assigned to nurses. 5. . The National Association of Nurse Anesthetists, which was renamed the American Association of Nurse Anesthetists (AANA), was founded in 1931. In the 19th century, anesthesia was in its early stages. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. Thus, anesthesia administration was performed by nurses. 6. Which factor contributed to expansion of the role of the clinical nurse specialist (CNS) during the 1960s? 1. Increased numbers of practicing physicians 2. Tightening of female role definitions 3. Return of nurses from military conflict 4. Lack of medical specialization Page: 17 Feedback 1. . During the 1960s, a shortage of physicians occurred. The role of the CNS was expanded in part because of the return of nurses from the Vietnam War. Nurse veterans searched for opportunities to increase their knowledge and skills, and practiced in advanced roles as well as nontraditional specialties (such as anesthesia and trauma or anesthesia). 2. . During the 1960s, role definitions for women became less restrictive. The role of the CNS was expanded in part because of the return of nurses from the Vietnam War. Nurse veterans searched for opportunities to increase their knowledge and skills, and practiced in advanced roles as well as nontraditional specialties (such as anesthesia and trauma or anesthesia). 3. Expansion of the CNS role during the 1960s occurred in part because of the return of nurse veterans from the Vietnam War who sought to increase their knowledge and skills, and to work in advanced roles and nontraditional fields, such as anesthesia and trauma. 4. . In the 1960s, medical specialization was prevalent, and the need for competent nurses who were proficient at caring for patients with complex health needs increased. Thus, the CNS role expanded. The role of the CNS also expanded because of the return of nurses from the Vietnam War. Many of these nurse veterans searched for opportunities to increase their knowledge and skills, and practiced in advanced roles as well as nontraditional specialties (such as anesthesia and trauma or anesthesia). 7. Differentiation between the role of the clinical nurse specialist (CNS) and the nurse practitioner (NP) is primarily based on which premise? 1. Designation as an advanced practice nurse 2. Diagnosis of patient health conditions 3. Nature of practice setting environments 4. Authority to prescribe medications Pages: 20–21 Feedback 1. . Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) are designated as advanced practice nurses (APNs). A primary differentiation between the roles of CNS and NP centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. 2. . Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) are prepared to diagnose patient health alterations. A primary differentiation between the roles of CNS and NP centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. 3. A primary differentiation between the roles of clinical nurse specialist (CNS) and nurse practitioner (NP) centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. Both the CNS and the NP are designated as advanced practice nurses (APNs), educationally prepared to diagnose patient health alterations, and eligible to apply for prescriptive authority. 4. . Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) are eligible to apply for authority to prescribe medications. A primary differentiation between the roles of CNS and NP centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. 8. The National Council of State Boards of Nursing’s Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation prompted gains related to which aspects of the role and function of the nurse practitioner (NP)? Select all that apply. 1. Legal authority 2. Reimbursement 3. Consumer recognition 4. Prescriptive privilege 5. Autonomy , 2, 4 Page: 29 Feedback 1. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 2. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 3. . At present, nurse practitioners (NPs) still face challenges related to consumer recognition in health care. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the NP, including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. 4. Adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation in 2008 by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 5. . At present, nurse practitioners (NPs) still face challenges related to autonomy. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the NP, including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 9. The doctor of nursing practice (DNP) degree was developed to support the achievement of which goal related to advanced practice nursing education? 1. Eliminating master’s degree programs 2. Promoting excellence in clinical practice 3. Replacing doctor of philosophy programs 4. Emphasizing the generation of nursing research Pages: 31, 33 Feedback 1. . Rather than seeking to eliminate master’s degree programs designed to prepare advanced practice registered nurses (APRNs), current legislation exists to preserve such programs. The doctor of nursing practice (DNP) is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. 2. The doctor of nursing practice (DNP) is not intended to replace the doctor of philosophy (PhD). Whereas the PhD emphasizes research, the DNP is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. Current legislative efforts related to nursing education do not include elimination of master’s degree programs for advanced practice registered nurses (APRNs). Rather, current legislation exists to preserve existing master’s degree programs designed to prepare APRNs. 3. . The doctor of nursing practice (DNP) is not intended to replace the doctor of philosophy (PhD). The DNP is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. 4. . Unlike the doctor of philosophy (PhD), which emphasizes research, the doctor of nursing practice (DNP) is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. 10. Among national nursing leaders, which argument serves as a basis for opposition to the requirement that advanced practice nurses (APNs) earn a doctor of nursing practice (DNP) degree? 1. Greater professionalization is needed among advanced practice nurses. 2. The number of graduate nursing programs should be limited. 3. Advanced practice nursing certification should not require a doctoral degree. 4. The need for care providers should be prioritized. Page: 33 Feedback 1. . National nursing leaders have opposed a proposition to require completion of a doctor of nursing practice (DNP) degree by advanced practice nurses (APNs) who seek certification based on a perception that the need for care providers should be prioritized above professionalization of advanced practice registered nurses (APRNs) by way of completing a DNP program. 2. . National nursing leaders have not sought to limit graduate nursing education programs for advanced practice registered nurses (APRNs). The basis for opposition among national nursing leaders related to requiring advanced practice nurses (APNs) to complete a doctor of nursing practice (DNP) degree centers on the perception that the need for care providers takes precedence over professionalization of APRNs by way of completing a DNP program. 3. . National nursing leaders have not sought to require advanced practice nurses (APNs) to complete a doctor of philosophy (PhD) degree. Rather, national nursing leaders have opposed a mandate that would require completion of a doctor of nursing practice (DNP) degree before seeking certification as an advanced practice registered nurse (APRN) based on a perception that the need for care providers should be prioritized over professionalization of APRNs. 4. National nursing leaders have opposed a mandate that would require completion of a doctor of nursing practice (DNP) degree before seeking certification as an advanced practice registered nurse (APRN) based on a perception that the need for care providers should be prioritized over professionalization of APRNs. National nursing leaders have neither sought to limit graduate nursing education programs for APRNs nor recommended that advanced practice nurses (APNs) be required to complete a doctor of philosophy (PhD) degree. Chapter 2: Emerging Roles of the Advanced Practice Nurse ANSWERS AND RATIONALES 1. Entry into which advanced practice nursing specialty will require a doctoral degree by 2022? 1. Clinical nurse specialist (CNS) 2. Certified registered nurse anesthetist (CRNA) 3. Nurse practitioner (NP) 4. Certified nurse-midwife (CNM) Page: 5 Feedback 1. . Clinical nurse specialists (CNSs) are not required to complete a doctoral degree. However, the American Association of Nurse Anesthetists (AANA) has set forth a mandate requiring all graduates to complete a doctoral degree. Beginning in 2022, a doctorate will be the minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 2. Beginning in 2022, the American Association of Nurse Anesthetists (AANA) will require a doctoral degree as a minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 3. . Nurse practitioners (NPs) are not currently required to complete a doctoral degree. Presently, only the American Association of Nurse Anesthetists (AANA) has set forth a mandate requiring all graduates to complete a doctoral degree. Beginning in 2022, a doctorate will be the minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 4. . At present, certified nurse-midwives (CNMs) are not required to obtain a doctoral degree. Only the American Association of Nurse Anesthetists (AANA) has set forth a mandate requiring all graduates to complete a doctoral degree. Beginning in 2022, a doctorate will be the minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 2. According to the Consensus Model for APRN Regulation, advanced practice nursing should abide by which recommendation? 1. Emphasizing state-based regulation of advanced practice nursing standards 2. Ensuring regulation of advanced practice registered nurses (APRNs) as a unified, collective group 3. Preparing clinical nurse specialists (CNSs) to function primarily in acute care 4. Changing the population focus of adult nurse practitioners to adult gerontology Pages: 6, 20 Feedback 1. . The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Rather than emphasizing state-based regulation of advanced practice nursing, general goals of the Consensus Model include promoting consistency of advanced practice nursing standards to increase the potential for interstate licensure reciprocity. The Consensus Model recommends shifting the population focus of adult nurse practitioners (NPs) to adult gerontology. 2. . The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Instead of ensuring regulation of advanced practice registered nurses (APRNs) as a collective group, the Consensus Model recommends regulation of APRNs in one of four accepted roles. Recommendations also include shifting the population focus of adult nurse practitioners (NPs) to adult gerontology. 3. . The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Based on the Consensus Model, the practice of clinical nurse specialist (CNS) practices occurs across both acute and primary care settings. The Consensus Model also recommends shifting the population focus of adult nurse practitioners (NPs) to adult gerontology. 4. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Per the Consensus Model, the population focus of adult nurse practitioners (NPs) has shifted to adult gerontology. As opposed to emphasizing state-based regulation of advanced practice nursing, broad goals of the Consensus Model include developing more consistent standards for advanced practice nurses (APNs) that promote eligibility for interstate licensure reciprocity. Instead of ensuring regulation of advanced practice registered nurses (APRNs) as a collective group, the Consensus Model recommends regulation of APRNs in one of four accepted roles. The Consensus Model describes the practice of clinical nurse specialists (CNSs) as including both acute and primary care settings. 3. The relationship to which aspect of the function of the clinical nurse specialist (CNS) shows the greatest need for research? 1. Patient satisfaction 2. Care outcomes 3. Income generation 4. Role adaptability Pages: 8, 10 Feedback 1. . Research has identified a correlation between clinical nurse specialist (CNS)-patient interaction and patient satisfaction. Further research is needed to examine the relationship between utilization of the CNS and income generation. 2. . Existing research studies have identified a correlation between clinical nurse specialist (CNS)-patient interaction and favorable patient care outcomes. Additional research is needed to examine the relationship between utilization of the CNS and income generation. 3. Additional research is needed to examine the relationship between utilization of the clinical nurse specialist (CNS) and income generation. Role adaptability is a central feature of the CNS. Research has identified a correlation between CNS-patient interaction and favorable patient care outcomes, as well as patient satisfaction. 4. . Role adaptability, which is a primary characteristic of the clinical nurse specialist (CNS), is regarded as contributing to role ambiguity for this advanced practice role. Available research is limited related to the economic impact of the CNS, including income generation. 4. For nurse practitioners (NPs), which issue represents a current barrier to autonomy? 1. Restrictions on reimbursement for services 2. Absence of state-based prescriptive authority 3. Limited ability to serve in acute care settings 4. Lack of authority to manage medical problems Pages: 12, 15 Feedback 1. One barrier to autonomy for nurse practitioners (NPs) stems from restrictions on reimbursement for services. Among advanced practice nurses (APRNs), NPs comprise the largest group. All 50 states, as well as the District of Columbia, grant prescriptive privileges to qualified NPs (Phillips, 2016). NPs serve in primary and acute care settings. Assessment and management of patients related to medical and nursing problems is within the NP’s scope of practice. 2. . All 50 states, as well as the District of Columbia, grant prescriptive privileges to qualified NPs (Phillips, 2016). For NPs, barriers to autonomy include restrictions on reimbursement for services. 3. . Nurse practitioners (NPs) serve in both primary and acute care settings. Barriers to autonomy for NPs include restrictions on reimbursement for services. 4. . Nurse practitioners (NPs) are qualified to assess and manage a wide range of patient problems, including both medical and nursing issues. Barriers to the NP’s autonomy include restrictions on reimbursement for services. 5. Which changes have contributed to the evolution of the present-day nurse practitioner (NP)’s role? Select all that apply. 1. Focus on delivering care to low-income patients 2. Development of retail patient care clinics 3. Increased access to Medicaid recipients 4. Inclusion of patients from suburban areas 5. Emphasis on serving uninsured immigrants Pages: 10, 12 Feedback 1. . For the nurse practitioner (NP), the traditional patient population has included uninsured immigrants, as well as low-income individuals who receive Medicaid. Evolution of the NP’s role has been impacted by factors including an increase in the number of walk-in, retail, and urgent care clinics. A shift to providing services to patients who live in urban and suburban outpatient settings also has promoted evolution of the NP’s role. 2. The increasing number of walk-in, retail, and urgent care clinics has provided increased opportunities for patients to access nurse practitioners (NPs) who are providing primary care services. The NP’s practice has also expanded because of an increase in the provision of services to patients who live in urban and suburban outpatient settings. Traditionally, the patient population served by NPs has included low-income individuals who received Medicaid and uninsured immigrants. 3. . For the nurse practitioner (NP), the traditional patient population has included low-income individuals who receive Medicaid, as well as uninsured immigrants. Changes that have contributed to evolution of the NP’s role include an increase in the number of walk-in, retail, and urgent care clinics, as well as the provision of services to patients who live in urban and suburban outpatient settings. 4. With expansion of services to include patients who seek care in urban and suburban outpatient settings, the nurse practitioner (NP)’s practice has expanded. An increase in the number of walk-in, retail, and urgent care clinics has also increased opportunities for patients to access NPs who serve as primary care providers. 5. . Traditionally, the patient population served by nurse practitioners (NPs) has included uninsured immigrants, as well as low-income individuals who receive Medicaid. Factors that have promoted evolution of the NP’s role include an increase in the number of walk-in, retail, and urgent care clinics, as well as the provision of services to patients who live in urban and suburban outpatient settings. 6. Which consideration led to designation of the nurse practitioner (NP) rather than the clinical nurse specialist (CNS) as the advanced practice nurse (APN) who would deliver care related to psychiatric or mental health services? 1. Level of educational preparation 2. Eligibility for prescriptive authority 3. Ability to serve in community settings 4. Practice based on core competencies Page: 15 Feedback 1. . Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) may be prepared at either the master’s or doctoral level. Because of a heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health needs, the importance of prescriptive authority for this advanced practice nursing role has been underscored. At present, 40 states grant prescriptive privileges to CNSs and NPs (National Association of Clinical Nurse Specialists [NACNS], 2015). However, all 50 states grant prescriptive privileges to NPs. Therefore, the psychiatric/mental health nurse practitioner has become the sole means of educational preparation for this advanced practice role. 2. A heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health needs has underscored the importance of prescriptive authority for this advanced practice nursing role. At present, 40 states grant prescriptive privileges to clinical nurse specialists (CNSs) and nurse practitioners (NPs) (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice role. Both the CNS and the NP may be prepared at either the master’s or doctoral level. Likewise, both the CNS and the NP may practice in a community setting. Core competencies guide the practice of both the CNS and the NP. 3. . Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) may practice in a community setting. With a heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health need, the importance of prescriptive authority for this advanced practice nursing role became apparent. At present, 40 states grant prescriptive privileges to CNSs and NPs (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice role. 4. . Core competencies guide the practice of both the clinical nurse specialist (CNS) and the nurse practitioner (NP). A heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health need has highlighted the importance of prescriptive authority for this advanced practice nursing role. At present, 40 states grant prescriptive privileges to CNSs and NPs (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice specialization. 7. Which of the following defines the current practice of the acute care nurse practitioner? 1. Unit-based versus practice-based assignment 2. Participation on a specialty care team 3. Geographical setting 4. Patient population Page: 18 Feedback 1. . The acute care nurse practitioner (NP) may serve in a unit- based or practice-based capacity. This nursing specialty is defined by the patient population that is served. 2. . The acute care nurse practitioner (NP) may or may not participate as a member of a consultative team related to specialty care. The population that is served defines the acute care NP’s role. 3. . Rather than defining the acute care nurse practitioner (NP) based on the geographical setting in which care is provided, this nursing specialty is now defined by the patient population that is served. 4. Historically, the geographical setting defined the role of the acute care nurse practitioner (NP). However, the role of this nursing specialty is now defined by the patient population that is served. Acute care NPs may be practice based or unit based. The acute care NP may or may not participate as a member of a consultative team related to specialty care. 8. Certified nurse-midwives (CNMs) are most likely to practice in which setting? 1. Hospital organizations 2. Physician-owned practices 3. Nonprofit health agencies 4. Federal facilities Page: 24 Feedback 1. Most certified nurse-midwives (CNMs) practice in hospitals (29.5%) and physician-owned practices (21.7%). However, care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 2. . The majority of certified nurse-midwives (CNMs) practice in hospitals (29.5%), followed by physician-owned practices (21.7%). Additional care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 3. . Predominantly, certified nurse-midwives (CNMs) practice in hospitals (29.5%) and physician-owned practices (21.7%). However, care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 4. . Certified nurse-midwives (CNMs) most often practice in hospitals (29.5%) and physician-owned practices (21.7%). However, CNMs also may practice in a variety of other settings, including midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 9. Which function of the certified registered nurse anesthetist (CRNA) is prohibited in certain states? 1. Induction of general anesthesia 2. Pain management procedures 3. Administration of spinal anesthesia 4. Provision of post-anesthesia care Page: 27 Feedback 1. . All 50 states and the District of Columbia authorize certified registered nurse anesthetists (CRNAs) to provide induction of general anesthesia, as well as numerous other anesthesia-related services (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). However, the CRNA’s capacity to provide pain management procedures, such as epidural steroid injections, is regulated at the state level. Therefore, not all CRNAs are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). 2. Pain management procedures, such as epidural steroid injections, are regulated at the state level; therefore, not all certified registered nurse anesthetists (CRNAs) are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). All 50 states and the District of Columbia authorize CRNAs to provide induction of general anesthesia, administration of spinal anesthetics, and delivery of post- anesthesia care (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). 3. . All 50 states and the District of Columbia authorize certified registered nurse anesthetists (CRNAs) to administer spinal anesthetics, as well as to provide several other anesthesia-related services (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). However, the CRNA’s capacity to provide pain management procedures, such as epidural steroid injections, is regulated at the state level. Therefore, not all CRNAs are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). 4. . All 50 states and the District of Columbia authorize certified registered nurse anesthetists (CRNAs) to provide post-anesthesia care, as well as to deliver several other anesthesia-related services (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). However, the CRNA’s capacity to provide pain management procedures, such as epidural steroid injections, is regulated at the state level. Therefore, not all CRNAs are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). 10. Implementation of the anesthesia care team (ACT) model yielded which direct effect on anesthesia services? 1. Regulation of conditions related to reimbursable services 2. Mandatory direction of certified registered nurse anesthetists (CRNAs) by an anesthesiologist 3. Reduction in charges related to fraudulent anesthesia care 4. Increased accountability for physicians who employ CRNAs Pages: 28–29 Feedback 1. . Regulations set forth by the Tax Equity and Fiscal Responsibility Act (TEFRA) mandated conditions for reimbursable services that appeared to require physician leadership for anesthesia delivery as a standard of care. The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). 2. The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). Also in 1982, Medicare’s introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists’ accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs) (Shumway & Del Risco, 2000). Regulations set forth by the Tax Equity and Fiscal Responsibility Act (TEFRA) mandated conditions for reimbursable services that appeared to require physician leadership for anesthesia delivery as a standard of care. 3. . In 1982, Medicare’s introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists’ accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs). The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). 4. . In 1982, Medicare’s introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists’ accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs). Implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA), which also occurred in 1982, resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). Chapter 3: Role Development: A Theoretical Perspective ANSWERS AND RATIONALES 1. Nurses working in a Magnet facility have low staff turnover rates and report high job satisfaction, making others aspire to have the longevity in employment experienced by those at the Magnet facility. Which of the following reference groups is this an example of? 1. Evaluative 2. Normative 3. Comparison 4. Audience Page: 4 1. . The comparison group sets its own standards and becomes a comparison group only when an individual accepts it as such. Nurses at a Magnet facility are considered a comparison group. 2. . The normative group sets explicit standards and expects compliance, and it rewards or punishes relative to that degree of compliance. The church, community, and family are examples of normative groups. 3. The comparison group sets its own standards and becomes a comparison group only when an individual accepts it as such. Nurses at a Magnet facility are considered a comparison group. 4. . The audience group is a collective group whose attention an individual wishes to attract. The audience group holds certain values but does not demand compliance from the person for whom they serve as a referent. 2. Which action should the advanced practice nurse (APN) take to be successful in socialization? 1. Be better at multitasking. 2. Develop a rapport with colleagues. 3. Develop skills in empathic communication. 4. Practice sympathetic listening. Page: 6 1. . Better multitasking does not lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 2. . Developing a rapport does not lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 3. Developing skill in empathic communication does lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 4. . Practicing sympathetic listening does not lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 3. An advanced practice nurse (APN) consistently identifies each client by the five rights upon every encounter. This behavior is an example of which of the following? 1. First-order change 2. Second-order change 3. Role-making 4. Subrole internalization Page: 6 1. . First-order changes are behavioral shifts that do not permanently achieve a desired result. Old preferences keep resurfacing. 2. Second-order change leads to permanent change. Old behaviors and patterns are gone and are not replaced by a new version. 3. . Role-making is bidirectional and interactive, with both actors presenting behaviors that are interpreted reciprocally for the purpose of creating and modifying their own roles. 4. . Second-order change leads to permanent change. Old behaviors and patterns are gone and are not replaced by a new version. 4. Which action by the advanced practice nurse (APN) demonstrates role-making? 1. Practicing autonomy when working in a busy practice 2. Suggesting a change in treatment to the supervising physician 3. Changing a client’s medication to a lower dosage 4. Teaching a client how to self-administer insulin Page: 7 1. . Although important, this does not demonstrate role-making. 2. This demonstrates role-making, which is bidirectional and interactive. 3. . Although part of the advanced practice nurse (APN)’s role, this is not a demonstration of role-making. 4. . Although part of the advanced practice nurse (APN)’s role, this is not a demonstration of role-making. 5. The advanced practice nurse (APN) is mentoring an APN student. The APN recognizes that the student is having a hard time adjusting to the new role. Which action should the mentor take? 1. Allow the student to work through the process. 2. Listen sympathetically to the student. 3. Refer the student to a colleague with similar experiences. 4. Treat each failure as a learning opportunity. Page: 10 1. . Although the student should be allowed to work through the process, the advanced practice nurse (APN) should be present as a guide. 2. . The advanced practice nurse (APN) should listen empathetically to the student. 3. . The advanced practice nurse (APN) should work closely with the client to overcome obstacles. 4. The advanced practice nurse (APN) should treat each failure as a learning opportunity. 6. The advanced practice nurse (APN) is working with a colleague in a busy surgical center and becomes concerned with the colleague’s change in behavior. Which sign indicates that the colleague might be experiencing burnout? 1. Empathic behavior 2. Short attention span 3. Sensitivity 4. Intolerance Page: 14 1. . Empathic behavior is not a sign of burnout. 2. . Short attention span is not a sign of burnout. 3. . Insensitivity is a sign of burnout. 4. Intolerance is a sign of burnout, and should be treated appropriately. 7. The advanced practice nurse (APN) is working in a busy emergency room. Which action can the APN take to reduce role strain? 1. Own the problem and work through it. 2. Find a quiet place to retreat. 3. Focus on helping others. 4. Become more involved in the work environment. Page: 17 1. . The advanced practice nurse (APN) should determine who owns each problem, and allow others to work through theirs. 2. The advanced practice nurse (APN) should manage role strain by finding a quiet place to retreat. 3. . The advanced practice nurse (APN) should focus on self and reducing stress and strain. 4. . The advanced practice nurse (APN) should take adequate time away from the work environment to regroup. 8. The advanced practice nurse (APN) is experiencing burnout and recognizes the need for self-care. Which action should the APN avoid? 1. Work through stressful situations and then take a break. 2. Plan self-care as seriously as client care. 3. Determine who owns each problem. 4. Examine the quality of peer support. Page: 17 1. The advanced practice nurse (APN) should schedule breaks during stressful situations. 2. . The advanced practice nurse (APN) should plan self-care as seriously as client care. 3. . The advanced practice nurse (APN) should determine who owns each problem. 4. . Part of managing role strain involves examining the quality of peer support. 9. The advanced practice nurse (APN) is working with a new nurse. Which action by the nurse does the APN interpret as the social integration phase of resocialization? 1. Working well with others in the profession 2. Mastering skills 3. Integrating values into work setting 4. Displaying competency in routine Page: 15 1. Working well in the profession is an example of the social integration phase of resocialization. 2. . Mastery of skills occurs in the skills and routine mastery phase. 3. . Integrating values into the work setting occurs in the conflict resolution phase. 4. . Competence in routine occurs in the skills and routine mastery phase. 10. Which action should the advanced practice nurse (APN) avoid when attempting to resolve role strain? 1. Using alcohol to escape stress 2. Taking meditation breaks during a shift 3. Talking with coworkers 4. Voicing opinions at a staff meeting Page: 15 1. The advanced practice nurse (APN) should avoid the use of drugs and alcohol when trying to resolve role strain. 2. . The advanced practice nurse (APN) should use meditation as a means to reduce role strain. 3. . The advanced practice nurse (APN) should talk with trusted friends when trying to resolve role strain. 4. . The advanced practice nurse (APN) should voice opinions at a staff meeting when trying to resolve role strain. Chapter 4: Educational Preparation of Advanced Practice Nurses: Looking to the Future ANSWERS AND RATIONALES 1. Which activity does the advanced practice nurse (APN) anticipate when completing a doctor of philosophy (PhD) research residency? 1. Literature review in nursing science 2. Participation in quality improvement 3. Presentation at practice conferences 4. Development of capstone with mentors Page: 16 Feedback 1. When completing a doctor of philosophy (PhD) research residency, the advanced practice nurse (APN) anticipates completing a literature review in nursing science. 2. . This activity is anticipated for a doctor of nursing practice (DNP) degree, not a doctor of philosophy (PhD). 3. . This activity is anticipated for a doctor of nursing practice (DNP) degree, not a doctor of philosophy (PhD). 4. . This activity is anticipated for a doctor of nursing practice (DNP) degree, not a doctor of philosophy (PhD). 2. Which activity is completed for both a doctor of nursing practice (DNP) and doctor of philosophy (PhD) program? 1. Interprofessional education (IPE) collaborative experiences 2. Participation in full scope research 3. Presentation at practice conferences 4. Submission of research grant proposals Page: 16 Feedback 1. Both the doctor of nursing practice (DNP) and doctor of philosophy (PhD) candidate will participate in interprofessional education (IPE) collaborative experiences. 2. . This activity is anticipated during a doctor of philosophy (PhD) research residency. 3. . This activity is anticipated during a doctor of nursing practice (DNP) residency. 4. . This activity is anticipated during a doctor of philosophy (PhD) research residency. 3. Which type of grant proposal does the advanced practice nurse (APN) submit when completing a doctor of philosophy (PhD) residency? Select all that apply. 1. Practice 2. Business 3. Research 4. Leadership Page: 16 Feedback 1. . A practice research proposal is completed when pursing a doctor of nursing practice (DNP) degree. 2. . A business proposal is not completed when pursing a doctor of philosophy (PhD) degree. 3. The advanced practice nurse (APN) will complete a research proposal when pursing a doctor of philosophy (PhD) degree. 4. . A leadership research proposal is completed when pursing a doctor of nursing practice (DNP) degree. 4. Which activity does the advanced practice nurse (APN) complete when participating in a doctor of nursing practice (DNP) residency? 1. Participate in quality improvement 2. Present at research conferences 3. Pilot research projects for dissertation 4. Submit research grant proposals Page: 16 Feedback 1. When completing a doctor of nursing practice (DNP) residency, the advanced practice nurse (APN) anticipates participation in quality improvement. 2. . The advanced practice nurse (APN) participates in this activity when completing a doctor of philosophy (PhD) research residency. 3. . The advanced practice nurse (APN) participates in this activity when completing a doctor of philosophy (PhD) research residency. 4. . The advanced practice nurse (APN) participates in this activity when completing a doctor of philosophy (PhD) research residency. 5. Which is the predominant route to certification for the advanced practice nurse (APN)? 1. Doctor of philosophy (PhD) 2. Doctor of nursing practice (DNP) 3. Master of science in nursing (MSN) 4. Bachelor of science in nursing (BSN) Page: 3 Feedback 1. . The doctor of philosophy (PhD) degree is not the predominant route of certification for the advanced practice nurse (APN). 2. . The doctor of nursing practice (DNP) degree is not the predominant route of certification for the advanced practice nurse (APN). 3. The master of science in nursing (MSN) degree continues to be the predominant route of certification for the advanced practice nurse (APN). 4. . The bachelor of science in nursing (BSN) degree is one route of certification for entry-level nursing. 6. Which doctoral degree may be inappropriate for the nurse educator who seeks a tenure track position in the university setting? 1. Doctor of medicine (MD) 2. Doctor of philosophy (PhD) 3. Educational doctorate (EdD) 4. Doctor of nursing practice (DNP) Page: 11 Feedback 1. . A nurse educator is unlikely to have a doctor of medicine (MD) degree; however, this degree is not inappropriate for tenure track positions in the university setting. 2. . A doctor of philosophy (PhD) is an acceptable doctoral degree for the nurse educator who is seeking a tenure track position in the university setting. 3. . An educational doctorate (EdD) is an acceptable doctoral degree for the nurse educator who is seeking a tenure track position in the university setting. 4. Most universities do not accept the doctor of nursing practice (DNP) for tenure track positions. 7. The doctor of nursing practice (DNP) student will complete a final project referred to as a requirement. capstone Page: 13 Feedback: The advanced practice nurse (APN) completing a doctor of nursing practice (DNP) program will complete a final project that is often referred to as a capstone requirement. 8. The doctor of philosophy student will complete a as part of the educational process. dissertation Page: 13 Feedback: The doctor of philosophy (PhD) student will complete a research-based dissertation as part of the educational process. Chapter 5: Global Perspectives on Advanced Nursing Practice ANSWERS AND RATIONALES 1. Which is a factor contributing to the international growth in advanced practice nursing? 1. Decreased inpatient acuity 2. Ignorance of health-care consumers 3. Escalated disease burden worldwide 4. General global excess of health-care workers Page: 1 Feedback 1. . Increased, not decreased, inpatient acuity is a factor contributing to the international growth in advanced practice nursing. 2. . Better informed, not ignorant, health-care consumers is a factor contributing to the international growth in advanced practice nursing. 3. Escalated disease burden for both communicable and noncommunicable disease is a factor contributing to the international growth in advanced practice nursing. 4. . A shortage, not general excess, of health-care workers is a factor contributing to the international growth in advanced practice nursing. 2. Which action from the International Council of Nurses (ICN) establishes title protection when regulating the advanced practice nurse? 1. Rule making 2. Criminal legislation 3. Assessment processes 4. Fitness to practice procedures Page: 10 Feedback 1. The International Council of Nurses (ICN) establishes title protection for the advanced practice nurse (APN) through rule making and civil legislation. 2. . Establishing civil, not criminal, legislation established title protection for the advanced practice nurse (APN). 3. . The International Council of Nurses (ICN) establishes assessment processes as a minimal standard for regulating the advanced practice nurse (APN); however, this action does not establish title protection. 4. . The International Council of Nurses (ICN) establishes fitness to practice procedures as a minimal standard for regulating the advanced practice nurse (APN); however, this action does not establish title protection. 3. A nurse is considering pursuing an advanced degree while practicing in the Republic of South Africa. Which must occur before beginning this journey? 1. Military service 2. Practice abroad 3. Two years of clinical practice 4. Two years of community service Page: 17 Feedback 1. . Military service is not a prerequisite for an advanced practice degree in the Republic of South Africa. 2. . Practicing abroad is not a prerequisite for an advanced practice degree in the Republic of South Africa. 3. Two years of clinical practice is a prerequisite for an advanced practice degree in the Republic of South Africa. 4. . One, not two, years of community service is a prerequisite for an advanced practice degree in the Republic of South Africa. 4. Which level of prescribing is required for the specialist nurse in the Republic of South Africa? 1. Level one 2. Level two 3. Level three 4. Level four Page: 17 Feedback 1. . Level one is the prescribing requirement for the staff nurse. 2. . Level two is the prescribing requirement for the professional nurse. 3. Level three is the prescribing requirement for the specialist, or advanced practice, nurse. 4. . This level is not used in the Republic of South Africa. 5. Which is considered an obstacle by the World Health Organization's Eastern Mediterranean Region (WHO-EMR) Consensus on factors that influence advanced practice nursing development? 1. Desire in the region to improve access to care 2. An increase in the community need for health-care services 3. Research studies that don’t support advanced nursing practice 4. Lack of feasibility studies for advanced practice nursing needs Page: 29 Feedback 1. . This is not considered an obstacle that influences advanced practice nursing development. 2. . This is not considered an obstacle that influences advanced practice nursing development. 3. . This is not considered an obstacle that influences advanced practice nursing development. 4. The lack of feasible studies for advanced practice nursing needs is an obstacle that influences advanced practice nursing development. 6. Which is supportive, per the World Health Organization's Eastern Mediterranean Region (WHO-EMR) Consensus, on factors influencing advanced practice nursing development? 1. Role ambiguity 2. Absence of regulatory systems 3. Lack of feasibility studies for needs 4. Commitment to the development of nursing roles Page: 29 Feedback 1. . This is a noted obstacle on factors influencing advanced practice nursing development. 2. . This is a noted obstacle on factors influencing advanced practice nursing development. 3. . This is a noted obstacle on factors influencing advanced practice nursing development. 4. This is a noted support on factors influencing advanced practice nursing development. 7. Which is considered an obstacle by the World Health Organization's Eastern Mediterranean Region (WHO-EMR) Consensus on factors that influence advanced practice nursing development? Select all that apply. 1. Desire in the region to improve access to care 2. An increase in the community need for health-care services 3. An absence of nursing leadership at the policy level 4. Research studies that don’t support advanced nursing practice 5. Lack of feasibility studies for advanced practice nursing needs , 5 Page: 29 Feedback 1. . This is a noted support factor that influences the development of advanced practice nursing. 2. . This is a noted support factor that influences the development of advanced practice nursing. 3. This is a noted obstacle for the development of advanced practice nursing. 4. . This is a noted support factor that influences the development of advanced practice nursing. 5. This is a noted obstacle for the development of advanced practice nursing. 8. Which is supportive, per the World Health Organization's Eastern Mediterranean Region (WHO-EMR) Consensus, on factors influencing the advanced practice nursing development? 1. Role ambiguity 2. Absence of regulatory systems 3. Lack of feasibility studies for needs 4. Research studies from outside the region 5. Commitment to the development of nursing roles , 5 Page: 29 Feedback 1. . Role ambiguity is not a supportive factor influencing the development of advanced practice nursing. This is a noted obstacle. 2. . The absence of regulatory development is not a supportive factor influencing the development of advanced practice nursing. This is a noted obstacle. 3. . The lack of feasibility studies for needs is not a supportive factor influencing the development of advanced practice nursing. This is a noted obstacle. 4. This is a supportive factor that influences the development of advanced practice nursing. 5. This is a supportive factor that influences the development of advanced practice nursing. 9. Which is an example of the educational preparation needed for an advanced practice nurse (APN) according to the International Council of Nurses (ICN)? 1. Right to diagnose 2. Case management 3. Formal system of licensure 4. Authority to refer to other professionals Page: 4 Feedback 1. . The right to diagnose is an example of a regulatory mechanism, not educational preparation, for the advanced practice nurse (APN) according to the International Council of Nurses (ICN). 2. . Case management is an example of the nature of practice, not educational preparation, for the advanced practice nurse (APN) according to the International Council of Nurses (ICN). 3. 4. . The authority to refer to other professionals is an example of a regulatory mechanism, not educational preparation, for the advanced practice nurse (APN) according to the International Council of Nurses (ICN). 10. According to the International Council of Nurses (ICN), the nature of practice includes the ability of the advanced practice nurse (APN) to integrate research, , and clinical management. education Page: 4 Feedback: According to the International Council of Nurses (ICN), the nature of practice includes the ability of the advanced practice nurse (APN) to integrate research, education, and clinical management. Chapter 6: Advanced Practice Nurses and Prescriptive Authority ANSWERS AND RATIONALES 1. Which of the following changed the ability of all advanced practice nurses (APNs) to prescribe medications? 1. Risk of harm to patients 2. Lack of a physician on site 3. Nurse practitioner (NP) practice in primary care 4. Interruption of patient flow Page: 2 Feedback 1. . When a physician was not on site to sign nurse practitioner (NP) prescriptions, patients had to wait for prescriptions to be signed before they could be filled. If a physician was not available for a day or more, the implications for patient safety and health care were serious. Though certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs) practiced in advanced roles for some time before the birth of NPs, the impetus for all advanced practice nurses (APNs) to obtain authorization to prescribe medications was the advent of NP practice in primary care. 2. . Nurse practitioners (NPs) assessed and diagnosed patients who needed prescription medications and treatments for their care. Depending on physicians to prescribe medications created problems in the areas of patient access to care, continuity of care, and patient flow. Though certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs) practiced in advanced roles for some time before the birth of NPs, the impetus for all advanced practice nurses (APNs) to obtain authorization to prescribe medications was the advent of NP practice in primary care. 3. Though certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs) practiced in advanced roles for some time before the birth of NPs, the impetus for all advanced practice nurses (APNs) to obtain authorization to prescribe medications was the advent of NP practice in primary care. 4. . Nurse practitioners (NPs) assessed and diagnosed patients who needed prescription medications and treatments for their care. Depending on physicians to prescribe medications created problems in the areas of patient access to care, continuity of care, and patient flow. Though certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs) practiced in advanced roles for some time before the birth of NPs, the impetus for all advanced practice nurses (APNs) to obtain authorization to prescribe medications was the advent of NP practice in primary care. 2. Which of the following has been the main source of barriers limiting advanced practice registered nurses’ (APRNs’) prescriptive authority? 1. Limitations in state legislation and regulations 2. Concerns about patient safety and quality of care 3. Requirement for Drug Enforcement (DEA) number 4. Organized lobbying by medical organizations Page: 13 Feedback 1. . Though some legislators and governors have set limitations in statutes and administrative rules governing advanced practice registered nurses (APRNs), the majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of APRNs. 2. . Though opposition to prescriptive authority has often been couched in the language of “protecting public safety,” the majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs). 3. . Though the requirement of a Drug Enforcement Administration (DEA) number by insurance companies to pay for prescriptions is still problematic, the majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs). 4. The majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs). 3. Which of the following was found to be the most practical formulary for regulating prescriptive authority? 1. Open 2. Exclusionary 3. Collaborative 4. Regulator established Page: 11 Feedback 1. . The open formulary is the most flexible framework for prescriptive authority. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority. 2. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority. 3. . A collaborative formulary allows the advanced practice registered nurse (APRN) to create a formulary most useful to his or her practice in collaboration with an identified physician who serves as a collaborator. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority. 4. . An established formulary was used in the early days of advanced practice registered nurse (APRN) prescribing activity to determine an agreed-on list of drugs APRNs could prescribe. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority. 4. Which of the following is a main reason a clinical nurse specialist (CNS) would refrain from obtaining prescriptive authority? 1. Lack of title recognition 2. Preservation of autonomy 3. Educational requirements 4. Required physician oversight Page: 17 Feedback 1. . The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable. 2. The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable. 3. . The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable. 4. . The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable. 5. Which of the following increased certified registered nurse anesthetists’ (CRNAs’) involvement with other advanced practice registered nurses (APRNs) to obtain prescriptive authority? 1. Limited authority 2. Legislative restrictions 3. Role in pain management 4. Required physician supervision Page: 8 Feedback 1. . The authority of certified registered nurse anesthetists (CRNAs) to select and administer anesthesia has long been recognized. Until recently, CRNAs have been less involved in the struggle to obtain prescriptive authority than the other three disciplines. CRNAs have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve. 2. . Limitations set in state statutes and regulations affect the practice of all advanced practice registered nurses (APRNs). Certified registered nurse anesthetists (CRNAs) have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve. 3. Certified registered nurse anesthetists (CRNAs), particularly in rural areas, suffer from similar problems. CRNAs have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve. 4. . Requirements for formalized collaborative agreements with physicians to practice and receive reimbursement have been most challenging for nurse practitioners (NPs) and certified nurse-midwives (CNMs). Certified registered nurse anesthetists (CRNAs) have supervising or cooperating physicians in most states (AANA, 2016), whereas clinical nurse specialists (CNSs), in the states in which they have prescriptive authority, tend to have the same requirements as NPs. CRNAs have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve. 6. Which of the following describes the historical progression of advanced practice registered nurses’ (APRNs’) attainment of prescriptive authority? Select all that apply. 1. Standardization of educational programs 2. Lack of primary care in underserved areas 3. Complexity of the federal legislation process 4 Persuasion of legislators and state governors 5. Lack of title recognition in nurse practice acts , 2, 4, 5 Page: 4 Feedback 1. Many nurse practice acts prohibited the prescribing of medication by nurses regardless of specialty or status. Changing state statutes and regulations gave title recognition and prescriptive authority to advanced practice registered nurses (APRNs). The form of regulatory rules depended largely on the persuasiveness of nurse practitioners (NPs) and the attitudes of the legislators and governors of those states. In the early days, NPs did not have title recognition other than that of registered nurse (RN) in their state regulatory systems. Except for certified nurse- midwives (CNMs) and certified registered nurse anesthetists (CRNAs) in several states, no APRNs had title recognition in statutory or regulatory language in the state nurse practice acts or administrative rules. 2. The movement toward attainment of prescriptive authority was enhanced in the early days by an acute shortage of primary care physicians, and some states with higher primary care needs moved forward more rapidly. Rural states were more likely to initiate statutory and regulatory adjustments than states with large urban populations. 3. . Licensure for all professions occurs at the state rather than the federal level. 4. In the early days, nurse practitioners (NPs) did not have title recognition other than that of registered nurse (RN) in their state regulatory systems. Except for certified nurse-midwives (CNMs) and certified registered nurse anesthetists (CRNAs) in several states, no advanced practice registered nurses (APRNs) had title recognition in statutory or regulatory language in the state nurse practice acts or administrative rules. 5. Educational programs had to demonstrate that their curriculums prepared nurse practitioners (NPs) for an independent prescribing role. Advanced pathophysiology and pharmacology and the development of differential diagnosis and clinical decision-making skills needed to be visible in the programs. With the advent of federal grants to prepare NPs, the content and quality of the preparatory programs was increasingly standardized. 7. Which of the following contributes to the increase in the likelihood of advanced practice registered nurses (APRNs) attaining nationwide prescriptive authority? 1. Quality of care 2. Cost-effectiveness 3. Uniform nurse practice acts 4. Designation as a midlevel practitioner 5. Endorsement of APRN Consensus Model , 2, 5 Page: 18 Feedback 1. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. 2. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. 3. . Because licensure for all professions occurs at the state rather than the federal level, the movement to achieve prescriptive authority does not progress equally. States with the most need make legislative changes most rapidly. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. . Confusion about the role and scope of practice of an advanced practice registered nurse (APRN) through the grouping of nurse practitioners (NPs), certified nurse-midwives (CNMs), and physician assistants (PAs) as “midlevel practitioners” has created problems for APRNs. Though totally unfettered authority by all APRNs has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. 5. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. 8. The medications most frequently prescribed by nurse practitioners (NPs) in the Department of Veterans Affairs (VA) are and . antihypertensives and cardiac or cardiac and antihypertensives. Page: 16 Feedback: The majority of nurse practitioners (NPs) in the Department of Veterans Affairs (VA) hospital setting most frequently prescribe antihypertensives and cardiovascular drugs. 9. The primary document that supports advanced practice registered nurses’ (APRNs’) unrestricted prescriptive authority and provides recommendations for APRNs’ education and certification is . APRN Consensus Model Page: 17 Feedback: The APRN Consensus Model (2016) includes recommendations for the education and certification of advanced practice registered nurses (APRNs) and reinforces the authorization of APRNs to function at their full educational scope, which includes unrestricted prescriptive authority for APRNs. 10. Reorder the steps for changing a state’s nurse practice act (first to last). 1. Hearing to give testimony 2. Introduction of legislation 3. Sent to floor of both chambers 4. Referral to committee of jurisdiction 5. Passage through appropriate committees , 1, 5, 3 Page: 9 This is the correct order. 2. Legislation must be introduced that amends or adds to current law. 4. Once legislation is introduced, it is referred to a committee of jurisdiction (usually a professional licensure committee) for consideration. 1. Once the legislation is in committee, the chair of that committee generally calls for a hearing to allow proponents and opponents of the legislation to give testimony regarding the introduced legislation. 5. After passing through all appropriate committees, the legislation, at the discretion of the majority party leadership, is taken to the floor of the voting chamber for a vote. In some states, proposed legislation must also go through the appropriations committee of at least one of the voting chambers to determine cost and evaluate fiscal impact on the state. 3. After passing through all appropriate committees, the legislation is taken to the floor of the voting chambers. Sometimes this is done simultaneously in both chambers of the state legislature; in others, the legislation passes through one chamber at a time. Chapter 7: Credentialing and Clinical Privileges for the Advanced Practice Registered Nurse ANSWERS AND RATIONALES 1. Which of the following justifies the rigor of the credentialing process for advanced practice registered nurses (APRNs)? 1. Scope of practice 2. Quality assurance 3. Regulatory oversight 4. Autonomous practice Page: 2 Feedback 1. . The independence and autonomy of advanced practice registered nurse (APRN) services necessitates the same degree of attention to the processes of credentialing and privileging as accorded to physicians and other providers. 2. . The independence and autonomy of advanced practice registered nurse (APRN) services necessitates the same degree of attention to the processes of credentialing and privileging as accorded to physicians and other providers. 3. . The independence and autonomy of advanced practice registered nurse (APRN) services necessitates the same degree of attention to the processes of credentialing and privileging as accorded to physicians and other providers. 4. The independence and autonomy of advanced practice registered nurse (APRN) services necessitates the same degree of attention to the processes of credentialing and privileging as accorded to physicians and other providers. 2. An advanced practice registered nurse (APRN) determines that the implementation of the Consensus Model for APRN Regulation accomplishes which of the following? 1. Scope of practice standardization 2. Joint Commission accreditation 3. Uniformity of national standards 4. Consistent provider standards Page: 3 Feedback 1. . Scope of practice is legislated by individual states. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (NCSBN, 2008) or LACE (Licensure, Accreditation, Certification, Education of advanced practice registered nurses [APRNs]) promotes uniformity of national standards and regulation by the states to promote mobility of APRNs and access to APRN care. 2. . The Joint Commission sets its own standards for accreditation of health-care institutions. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (NCSBN, 2008) or LACE (Licensure, Accreditation, Certification, Education of advanced practice registered nurses [APRNs]) promotes uniformity of national standards and regulation by the states to promote mobility of APRNs and access to APRN care. 3. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (NCSBN, 2008) or LACE (Licensure, Accreditation, Certification, Education of advanced practice registered nurses [APRNs]) promotes uniformity of national standards and regulation by the states to promote mobility of APRNs and access to APRN care. 4. . Regulations were changed to ensure uniform processes and allowances for the credentialing and privileging of medical and allied health professionals. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (NCSBN, 2008) or LACE (Licensure, Accreditation, Certification, Education of advanced practice registered nurses [APRNs]) promotes uniformity of national standards and regulation by the states to promote mobility of APRNs and access to APRN care. 3. Which of the following directs legislative requirements for the advanced practice registered nurse (APRN) credentialing process? 1. Educational institutions 2. Nursing licensing boards 3. Organizational medical staff 4. Federal and state regulations Page: 7 Feedback 1. . The types of data gathered during the credentialing process are directed by federal and state regulations; professional standards; facility requirements, policies, and procedures; and voluntary oversight bodies. 2. . The types of data gathered during the credentialing process are directed by federal and state regulations; professional standards; facility requirements, policies, and procedures; and voluntary oversight bodies. 3. . The types of data gathered during the credentialing process are directed by federal and state regulations; professional standards; facility requirements, policies, and procedures; and voluntary oversight bodies. 4. The types of data gathered during the credentialing process are directed by federal and state regulations; professional standards; facility requirements, policies, and procedures; and voluntary oversight bodies. 4. An advanced practice registered nurse (APRN) is reviewing medical staff standards. Which of the following are used to determine whether hospital privileges are granted? 1. Institutional policies 2. Protection of the public 3. Broadened medical scope of practice 4. Provision of medical level care Page: 15 Feedback 1. . The decision to grant privileges is guided by institutional policies and procedures related to the structure of the decision-making body. Advanced practice registered nurses (APRNs) and physician assistants (PAs) who provide "medical level of care" must be credentialed and privileged through the medical staff standards process. 2. . Public protection is one of the purposes of cerdentialing. Advanced practice registered nurses (APRNs) and physician assistants (PAs) who provide "medical level of care" must be credentialed and privileged through the medical staff standards process. 3. . Limitations to advanced practice registered nurses’ (APRNs’) scope of practice continue to be a barrier to APRNs executing their full scope of practice. APRNs and physician assistants (PAs) who provide "medical level of care" must be credentialed and privileged through the medical staff standards process. 4. Advanced practice registered nurses (APRNs) and physician assistants (PAs) who provide "medical level of care" must be credentialed and privileged through the medical staff standards process. 5. According to Medicare Conditions of Participation (CoP), which governing body grants privileges to a telemedicine practitioner? 1. Distant site 2. Originating site 3. State review board 4. State licensing board Page: 16 Feedback 1. . Medicare Conditions of Participation (CoP) require the governing body of the originating site to grant privileges to a distant site independent practitioner. 2. Medicare Conditions of Participation (CoP) require the governing body of the originating site to grant privileges to a distant site independent practitioner. 3. . Medicare Conditions of Participation (CoP) require the governing body of the originating site to grant privileges to a distant site independent practitioner. 4. . Medicare Conditions of Participation (CoP) require the governing body of the originating site to grant privileges to a distant site independent practitioner. 6. Which is a minimum requirement of the Joint Commission for an advanced practice registered nurse (APRN) to be granted disaster privileges? 1. Continuing education 2. Oversight of treatment 3. Occurrence of a disaster 4. Professional practice evaluation Page: 16 Feedback 1. . At a minimum, the Joint Commission requires verification of license and oversight of care treatment and services (TJC, 2016). 2. When a disaster management plan has been activated and/or when the organization is unable to meet immediate patient care needs, an advanced practice registered nurse (APRN) may be granted disaster privileges. At a minimum, the Joint Commission requires verification of license and oversight of care treatment and services (TJC, 2016). 3. . When a disaster management plan has been activated and/or when the organization is unable to meet immediate patient care needs, an advanced practice registered nurse (APRN) may be granted disaster privileges. At a minimum, the Joint Commission requires verification of license and oversight of care treatment and services (TJC, 2016). 4. . When a disaster management plan has been activated and/or when the organization is unable to meet immediate patient care needs, an advanced practice registered nurse (APRN) may be granted disaster privileges. At a minimum, the Joint Commission requires verification of license and oversight of care treatment and services (TJC, 2016). 7. A credentialed advanced practice registered nurse (APRN) advises an APRN student on the advantages of establishing a professional portfolio. Which of the following is an advantage to this practice? 1. Justifies patient care therapeutics 2. Archives documents in one database 3. Receives higher status and compensation 4. Describes core competencies of APRN specialty Page: 23 Feedback 1. . Evidence-based practice provides a scientific, justifiable rationale for patient care therapeutics. A professional credentialing portfolio provides “practice-based evidence” for credentialing. Establishing a portfolio at the beginning of the advanced practice registered nurse’s (APRN’s) advanced practice education may assist the APRN to be more adequately compensated by allowing him or her to achieve a higher status within a health-care facility because of practice-based evidence. 2. . Establishing a portfolio at the beginning of the advanced practice registered nurse’s (APRN’s) advanced practice education may assist the APRN to be more adequately compensated by allowing him or her to achieve a higher status within a health-care facility because of practice-based evidence. 3. Establishing a professional credentialing portfolio as the advanced practice registered nurse (APRN) begins his or her advanced practice education may assist the APRN to be more adequately compensated by allowing him or her to achieve a higher status within a health-care facility because of practice-based evidence. 4. . Description of core competencies is included in the practice-based evidence component of a professional credentialing portfolio. Establishing a portfolio at the beginning of the advanced practice registered nurse’s (APRN’s) advanced practice education may assist the APRN to be more adequately compensated by allowing him or her to achieve a higher status within a health-care facility because of practice-based evidence. 8. Which of the following may limit an advanced practice registered nurse’s (APRN’s) scope of practice within a health-care institution? 1. Excessive patient lengths of stay 2. Performance improvement strategies 3. Redundant credentialing requirements 4. Governance representation on medical staff Page: 28 Feedback 1. An advanced practice registered nurse’s (APRN’s) scope of practice may be limited when an institution finds the APRN’s clinical performance falls outside established benchmarks, such as excessive lengths of stay, repeated and lengthy delays in appointments, quality of care issues, and exposure to liability related to variations in performance. 2. . Performance improvement strategies initiated by advanced practice registered nurses (APRNs) are likely to enhance the APRN’s ability to achieve full scope of practice in a health-care institution. An APRN’s scope of practice may be limited when an institution finds the APRN’s clinical performance falls outside established benchmarks, such as excessive lengths of stay, repeated and lengthy delays in appointments, quality of care issues, and exposure to liability related to variations in performance. 3. . Redundant credentialing processes are time consuming. An advanced practice registered nurse’s (APRN’s) scope of practice may be limited when an institution finds the APRN’s clinical performance falls outside established benchmarks, such as excessive lengths of stay, repeated and lengthy delays in appointments, quality of care issues, and exposure to liability related to variations in performance. 4. . Governance representation on medical staff assures full advanced practice registered nurse (APRN) representation in medical staff bylaws. An APRN’s scope of practice may be limited when an institution finds the APRN’s clinical performance falls outside established benchmarks, such as excessive lengths of stay, repeated and lengthy delays in appointments, quality of care issues, and exposure to liability related to variations in performance. 9. The application for credentialing should include which of the following? Select all that apply. 1. Proof of liability insurance 2. Primary source verification 3. Evaluations of clinical performance 4. Professional licenses and certifications 5. Professional organization memberships , 3, 4 Pages: 25–26 Feedback 1. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 2. . Primary source verification is part of the application review process. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 3. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 4. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 5. . Professional organization memberships are not required. Liability insurance and claims history, clinical performance, state(s) licensure history (including state-controlled substance licenses), and certifications are among required data for credentialing. 10. An advanced practice registered nurse (APRN) is compiling the practice-based evidence component of the professional career portfolio. Which of the following documentation should the APRN include? Select all that apply. 1. Employment history 2. Insurance liability history 3. Performance outcome data 4. Current and completed research 5. Core competencies for APRN specialization , 3, 5 Pages: 25–26 Feedback 1. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. 2. . Insurance liability history is included in the credentials component of the professional career portfolio. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. 3. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. 4. . Current and completed research are included in the credentials component of the professional career portfolio. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. 5. The practice-based evidence component of the professional career portfolio should include: (a) employment history, identifying significant responsibilities; (b) performance outcome data that may have been collected at places of employment (e.g., number of patients seen per day, revenue generated, patient satisfaction); and (c) core competencies for the advanced practice registered nurse (APRN) specialty. Chapter 8: The Kaleidoscope of Collaborative Practice ANSWERS AND RATIONALES 1. A nurse is presenting a workshop on the history of nursing and discusses the long-standing perception that nurses are under a physician’s supervision. Which of the following explanations would the nurse give for this perception? 1. Physicians’ hierarchical role structure 2. Reliance on physicians to make decisions 3. Medical domination over nursing practice 4. Separation of the physician and nursing roles Page: 4 Feedback 1. In 2009, the American Medical Association (AMA) House of Delegates issued a statement supporting that the hierarchical role structure called for physician supervision of nurses, noting that, although the nurse role is important, it must be supervised. Placing the nurse as a care provider subservient to the physician established and formalized a role structure that, after nearly 150 years, continues to define society’s general sense of the nurse role as within the role of the physician (Partin, 2009; Workman, 1986). 2. . In 2009, the American Medical Association (AMA) House of Delegates issued a statement supporting that the hierarchical role structure called for physician supervision of nurses, noting that, although the nurse role is important, it must be supervised. Placing the nurse as a care provider subservient to the physician established and formalized a role structure that, after nearly 150 years, continues to define society’s general sense of the nurse role as within the role of the physician (Partin, 2009; Workman, 1986). 3. . In 2009, the American Medical Association (AMA) House of Delegates issued a statement supporting that the hierarchical role structure called for physician supervision of nurses, noting that, although the nurse role is important, it must be supervised. Placing the nurse as a care provider subservient to the physician established and formalized a role structure that, after nearly 150 years, continues to define society’s general sense of the nurse role as within the role of the physician (Partin, 2009; Workman, 1986). 4. . In 2009, the American Medical Association (AMA) House of Delegates issued a statement supporting that the hierarchical role structure called for physician supervision of nurses, noting that, although the nurse role is important, it must be supervised. Placing the nurse as a care provider subservient to the physician established and formalized a role structure that, after nearly 150 years, continues to define society’s general sense of the nurse role as within the role of the physician (Partin, 2009; Workman, 1986). 2. A team of nurses and physicians is planning a continuing education program during which physicians and nurses will lecture about the care of patients with diabetes. Which of the following terms is this an example of? 1. Multidisciplinary practice 2. Interprofessional discipline 3. Transdelivery collaboration 4. Interdisciplinary relationship Page: 23 Feedback 1. . An interdisciplinary relationship develops as two or more members of different professions begin to coalesce their roles toward a common goal. Each professional shares discipline-specific expertise, resulting in cross-fertilization of ideas and group ownership of the practice. Multidisciplinary practice refers to shared responsibilities and information exchange between professionals. An interdisciplinary relationship exists within the multidisciplinary framework. 2. . An interdisciplinary relationship develops as two or more members of different professions begin to coalesce their roles toward a common goal. Each professional shares discipline-specific expertise, resulting in cross-fertilization of ideas and group ownership of the practice. Interprofessional describes unique disciplinary knowledge applied in the service each discipline offers in a specific health situation. 3. . An interdisciplinary relationship develops as two or more members of different professions begin to coalesce their roles toward a common goal. Each professional shares discipline-specific expertise, resulting in cross-fertilization of ideas and group ownership of the practice. Transdisciplinary collaboration refers to a peak level of shared collaboration among professionals in which they act as one and do not have to think about it. Everyone, including the patient, owns the plan of care and the goal of high-quality patient care transcends any “turf” issues. 4. An interdisciplinary relationship develops as two or more members of different professions begin to coalesce their roles toward a common goal. Each professional shares discipline-specific expertise, resulting in cross-fertilization of ideas and group ownership of the practice. 3. A nurse practitioner (NP) is moving to a different state to establish a private practice. Which of the following defines the collaborative practice protocols in each state? 1. Federal law 2. Standards of care 3. Legal precedents 4. Legislative requirements Page: 12 Feedback 1. . Federal law does not vary between states. Legal and legislative requirements for collaboration and the parameters of required collaborative practice protocols vary from state to state. 2. . Standards of care are established by professional nursing organizations. Legal and legislative requirements for collaboration and the parameters of required collaborative practice protocols vary from state to state. 3. . A legal precedent is a legal case that establishes a rule. Legal and legislative requirements for collaboration and the parameters of required collaborative practice protocols vary from state to state. 4. Legal and legislative requirements for collaboration and the parameters of required collaborative practice protocols vary from state to state. 4. Which of the following actions reduce elitism? 1. Explain pathophysiology 2. Acknowledge roles of registered nurses (RNs) 3. Demonstrate nursing skills 4. Provide timely orders Page: 28 Feedback 1. . Explaining pathophysiology may be perceived as elitism. Acknowledging registered nurse (RN) roles and responsibilities reduces elitism. Nursing has been guilty of elitism and of exhibiting professional dominance both in relating to nurses with different levels of education and in working with other health-care professionals. Lack of understanding, failure to acknowledge roles and responsibilities of other professionals, and the very isolated nature of health professional education is the basis for much of the elitism still prevalent today (Glasgow, Dunphy, & Mainous, 2010; Rice et al., 2010). 2. Acknowledging registered nurse (RN) roles and responsibilities reduces elitism. Nursing has been guilty of elitism and of exhibiting professional dominance both in relating to nurses with different levels of education and in working with other health-care professionals. Lack of understanding, failure to acknowledge roles and responsibilities of other professionals, and the very isolated nature of health professional education is the basis for much of the elitism still prevalent today (Glasgow, Dunphy, & Mainous, 2010; Rice et al., 2010). 3. . Demonstrating nursing skills may imply the registered nurse (RN) does not perform skills adequately and may be perceived as professional dominance. Acknowledging RN roles and responsibilities reduces elitism. Nursing has been guilty of elitism and of exhibiting professional dominance both in relating to nurses with different levels of education and in working with other health-care professionals. Lack of understanding, failure to acknowledge roles and responsibilities of other professionals, and the very isolated nature of health professional education is the basis for much of the elitism still prevalent today (Glasgow, Dunphy, & Mainous, 2010; Rice et al., 2010). 4. . Providing timely orders facilitates nurses’ efficiency. Acknowledging registered nurse (RN) roles and responsibilities reduces elitism. Nursing has been guilty of elitism and of exhibiting professional dominance both in relating to nurses with different levels of education and in working with other health-care professionals. Lack of understanding, failure to acknowledge roles and responsibilities of other professionals, and the very isolated nature of health professional education is the basis for much of the elitism still prevalent today (Glasgow, Dunphy, & Mainous, 2010; Rice et al., 2010). 5. Which of the following is vital to the attainment of transdisciplinary collaboration? 1. Dialogue 2. Discipline 3. Discussion 4. Partnership Page: 24 Feedback 1. The key to the success of transdisciplinary collaboration is communication through dialogue as it allows for free exploration of ideas, issues, and innovations, and the ability to suspend personal viewpoints without a sense of defensiveness. 2. . Discipline refers to the body of scientific knowledge that is the basis of that profession’s practice. The key to the success of transdisciplinary collaboration is communication through dialogue as it allows for free exploration of ideas, issues, and innovations, and the ability to suspend personal viewpoints without a sense of defensiveness. 3. . Discussion implies a hard exchange of ideas bouncing back and forth, presented and defended with the need to come to a decision. The key to the success of transdisciplinary collaboration is communication through dialogue as it allows for free exploration of ideas, issues, and innovations, and the ability to suspend personal viewpoints without a sense of defensiveness. 4. . The key to the success of transdisciplinary collaboration is communication through dialogue as it allows for free exploration of ideas, issues, and innovations, and the ability to suspend personal viewpoints without a sense of defensiveness. 6. A group of advanced practice registered nurses (APRNs) is developing a proposal to present to the board of trustees outlining strategies to improve collaboration and patient care. Which of the following is the priority to include in the proposal? 1. Patient autonomy 2. Shared knowledge 3. Institutional support 4. Multidisciplinary practice Page: 62 Feedback 1. . Including patients in their health-care decisions is important, but is not the priority. Shared knowledge and the free flow of information is the priority to include in the proposal. Clinicians and patients should communicate effectively and share information. 2. Shared knowledge and the free flow of information is the priority to improve collaboration. Clinicians and patients should communicate effectively and share information. 3. . Institutional support is required to implement the strategies. Shared knowledge and the free flow of information is the priority to include in the proposal. Clinicians and patients should communicate effectively and share information. 4. . Multidisciplinary practice is a level of information exchange, with no presumption of shared planning. Shared knowledge and the free flow of information is the priority to include in the proposal. Clinicians and patients should communicate effectively and share information. 7. Which of the following is a primary reason for medical opposition to the nurse practitioner (NP) role? 1. Patient safety 2. Lack of knowledge 3. Prescriptive authority 4. Competition for patients Page: 15 Feedback 1. Medical opposition, which existed from the beginning, is often couched in terms of patient safety, despite the fact that it often is more related to issues of control and competition in practice. 2. . Medical opposition, which existed from the beginning, is often couched in terms of patient safety, despite the fact that it often is more related to issues of control and competition in practice. 3. . Medical opposition, which existed from the beginning, is often couched in terms of patient safety, despite the fact that it often is more related to issues of control and competition in practice. 4. . Medical opposition, which existed from the beginning, is often couched in terms of patient safety, despite the fact that it often is more related to issues of control and competition in practice. 8. The APRN Consensus Model indicates which of the following decreases obstacles to establishing collaborative practice? Select all that apply. 1. Role clarity 2. Advanced education 3. Consumer satisfaction 4. Common practice elements 5. Clearly delineated scope of practice , 4, 5 Page: 8 Feedback 1. The challenges advanced practice registered nurses (APRNs) face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 2. . Advanced education and experience are among factors contributing to growth and acceptance of the advanced practice registered nurse (APRN) role. The challenges APRNs face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 3. . “Consumer satisfaction and physician advocacy have proved to be powerful stimuli” for operationalizing the advanced practice registered nurse (APRN) role (Stanley 2005, p. 34). The challenges APRNs face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 4. The challenges advanced practice registered nurses (APRNs) face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 5. The challenges advanced practice registered nurses (APRNs) face in establishing collaborative practice will be greatly minimized once the role is clarified, scopes of practice are delineated, common practice elements of APRNs are made known, and support from professional colleagues and consumers is ongoing (APRN Joint Dialogue Group, 2008). 9. Which of the following are key attributes of collaborative practice? Select all that apply. 1. Clinical skills 2. Parity between providers 3. Conflict management 4. Mutually defined goals 5. Decision making by consensus , 5 Pages: 19–21 Feedback 1. . Clinical skills are a competency of collaborative practice. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 2. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 3. . Conflict management is a competency of collaborative practice. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 4. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 5. Key attributes of collaborative practice include: consensus-driven decision making, mutually defined goals for the practice, and parity between providers. 10. An advanced practice registered nurse (APRN) is a guest speaker for a class of nurse practitioner (NP) students. Which of the following represents the focus on evolving collaborative practice? Select all that apply. 1. Primary care model 2. Functional care model 3. Advanced care organization 4. Patient navigator program 5. Patient-centered medical home , 4, 5 Pages: 53–55 Feedback 1. . The primary care model is a traditional model which refers to medical care that is provided by a general practitioner. 2. . The functional care model is a traditional model of nursing care delivery focused on nursing tasks and activities. 3. An advanced care organization (ACO) is an example of an emerging collaborative practice model. ACOs are a facet of Medicare’s cost-saving plan and members share in any bonuses received from meeting cost-saving targets. 4. The patient navigator program is an example of emerging collaborative practice. A patient navigator “works with patients and families to help them at many points along the health care continuum” to eliminate barriers to obtaining screening, diagnosis, treatment, and ongoing health care. 5. The patient-centered medical home (PCMH) model is an example of emerging collaborative practice. The PCMH