Question 1

A certified registered nurse anesthetist (CRNA) is addressing a group of high school students that have expressed interest in this profession. Which information should the nurse provide?&#10;A) The fastest way to gain certification as a CRNA is through a physician's assistant program.&#10;B) Nurse anesthetists are a newly developing field.&#10;C) Currently, the entry level for this certification is a master's degree.&#10;D) Nurse anesthetists practice outside the scope of nursing by virtue of a grandfather clause in anesthesia.&#10;E) In the future, nurses wishing to become CRNAs must have a doctoral degree.&#10;

Accepted Answer

Rationale 1: CRNAs are advanced practice nurses, not physician assistants.
Rationale 2: The first "official" nurse anesthetist was administering anesthesia as early as 1877.
Rationale 3: In order to write the certificate examination, applicants must have completed a master's program.
Rationale 4: Nurse anesthetists practice within the scope of nursing for their specialty.
Rationale 5: Beginning in 2025, a Doctor of Nursing Practice (DNP) or a Doctor of Nurse Anesthesia Practice (DNAP) will be required for certification.

Question 2

The advanced nurse practitioner is routinely addressed as &#34;doctor&#34; by clinic patients. What is the best way for the nurse to handle this mistake?&#10;A) Only allow this practice if the ANP has an earned doctorate.&#10;B) Accept the mistake with good humor and ignore it.&#10;C) Be certain patients are aware that the nurse is not a physician.&#10;D) Ask the patients to address the ANP by first name.&#10;E) Wear a nametag that clearly lists the nurse's credentials as an ANP.&#10;

Accepted Answer

Rationale 1: While it is true that an ANP with an earned doctorate has the right to be addressed as "doctor," in the clinic situation, this may lead to confusion between the roles, which are sometimes confusing to patients anyway.
Rationale 2: The practice should not be ignored.
Rationale 3: The ANP must be certain that patients understand the role difference between an ANP and physician.
Rationale 4: Unless the physician is called by first name, the ANP should be addressed as Miss, Mrs., Ms., or Mr., as the situation dictates.
Rationale 5: Routinely wearing a nametag that clearly presents credentials is one method to identify the nurse's role.

Question 3

Which option reflects a change that may occur in the roles of advanced practice nurses?&#10;A) Movement to decrease the educational requirements for advanced practice nursing to the baccalaureate level&#10;B) Development of a new category to include clinical nurse specialists and advanced nurse practitioners&#10;C) Change of the doctor of nursing practice to eliminate the practice emphasis&#10;D) Elimination of nurse midwifery&#10;

Accepted Answer

Rationale 1: There is no movement to decrease the educational requirements for advanced practice nursing.
Rationale 2: Confusion exists between the roles of the CNS and the ANP. There is movement to create a category of APN that includes both of these roles. There is no movement toward the other options.
Rationale 3: By definition, the doctor of nursing practice is a practice-focused doctoral program.
Rationale 4: There is no movement to eliminate nurse midwifery.

Question 4

A nursing student's grandmother relates a time in the 1920s when medications were selected based upon the recommendation of a nurse who lived in the neighborhood. How is this possible?&#10;A) Prescriptive authority was not removed from nurse practice acts until the 1950s.&#10;B) The grandmother must be mistaken because medications have always been selected based upon physician prescription.&#10;C) Prior to 1938, most medications were over-the-counter and nurses were instrumental in their choice.&#10;D) This student's grandmother must have lived on a military base or facility where nurses were granted this privilege.&#10;

Accepted Answer

Rationale 1: The legislation limiting prescriptive authority to physicians was introduced before 1950.
Rationale 2: At one time, most medications were available over-the-counter and nurses often helped direct patients toward appropriate medications.
Rationale 3: In 1938, the federal government took control of prescriptive authority when it passed the Federal Food, Drug, and Cosmetic Act. Until that time, most medications, except narcotics, were over-the-counter and both nurses and physicians helped direct patients toward appropriate medications.
Rationale 4: There was no need to live on a military base for this to occur.

Question 5

Hospital management has identified quality of care issues that center around coordination of multidisciplinary services. Which classification of advanced practice nurse would be the best choice to help address these issues?

A) Clinical nurse leader
B) Advanced nurse practitioner
C) Nurse with a doctorate of nursing practice
D) Clinical nurse specialist

Accepted Answer

Rationale 1: The role of clinical nurse leader is envisioned by the AACN to be a person who "designs, implements, and evaluates client care by coordinating, delegating, and supervising the care provided by the health care team, including licensed nurses, technicians, and other health professionals." The clinical nurse leader should have the skill set to address quality of care issues.
Rationale 2: ANPs are nurses who have specialized in one or more practice specialties. Most provide primary care to low-risk patients and may serve as the primary health care provider.
Rationale 3: DNP programs vary in focus. The nurse holding a DNP may or may not have the leadership skills needed to address this hospital's quality of care issues.
Rationale 4: Clinical nurse specialists are often practice-focused and may or may not have the skills necessary to address hospital-wide quality of care issues.

Question 6

A student nurse is contemplating seeking independent practice as a certified nurse midwife. If the nurse reaches this goal, which components of practice should the she expect to fulfill?&#10;A) Physical examinations&#10;B) PAP smears&#10;C) Management of postpartum complications&#10;D) Family planning counseling&#10;E) One-on-one management of high-risk pregnancies&#10;

Accepted Answer

Rationale 1: Physical examinations are a part of the normal prenatal, intrapartum, and gynecological care provided to women and normal newborns. This is part of the midwife role.
Rationale 2: Certified nurse midwives provide normal gynecological services such as preventive health screenings.
Rationale 3: Management of complications is not an independent practice role. The midwife may participate in this care but does not do so independently.
Rationale 4: Certified nurse midwives provide family planning counseling as part of their role.
Rationale 5: Certified nurse midwives offer an alternative childbearing experience to low-risk patients. They do not provide independent care of high-risk pregnancies.

Question 7

A group is working to increase the number of advanced nurse practitioners (ANPs) who have hospital admitting privileges. Which barriers should these nurses address?&#10;A) There is no Medicare regulation mandating medical staff membership of APNs.&#10;B) The fees associated with obtaining admitting privileges are prohibitive for ANPs.&#10;C) State laws concerning ANP admitting privileges are confusing and contradictory.&#10;D) Some state laws limit the scope of ANP practice.&#10;E) Some hospitals do not allow non-physicians to admit patients.&#10;

Accepted Answer

Rationale 1: Medicare regulations may prevent the ANP from conducting patient examinations in the hospital setting because the ANP does not have medical staff membership.
Rationale 2: There is no indication that any fees associated with admission privileges are prohibitive.
Rationale 3: Some state laws allow for ANP admitting privileges, but they also require each admitted patient to have an attending physician. This is confusing and contradictory.
Rationale 4: In some states, the ANP is required to work with a physician, so that practice is not truly autonomous.
Rationale 5: Some hospital bylaws state that non-physicians cannot have admitting privileges.

Question 8

The advanced nurse practitioner believes that he should spend as much time with each patient as the patient desires. Does this practice raise ethical challenges?&#10;A) No, patients should expect to wait in any health care provider's office.&#10;B) Yes, this practice reflects poorly on the nurse's physician colleagues.&#10;C) No, this is the way all nursing should be practiced.&#10;D) Yes, if this practice makes other patients wait past their own appointment times.&#10;

Accepted Answer

Rationale 1: Patients no longer expect to wait in the health care provider's office.
Rationale 2: The issue has nothing to do with the nurse's physician colleagues.
Rationale 3: Nurses should provide as much care as necessary, but unlimited amounts of time with patients is not realistic.
Rationale 4: The ethical dilemma arises when taking extra time with one patient requires another patient to wait past his or her appointment time. Is it ethical to let the needs of one patient supersede the needs of another?

Question 9

The patient requires a controlled substance for the treatment of pain. What is true of the advanced nurse practitioner's role in independently prescribing this medication?&#10;A) Some states allow advanced nurse practitioners to prescribe controlled substances.&#10;B) There are no states in which any advanced nurse practitioner can prescribe controlled substances.&#10;C) Prescriptive authority allows all advanced practice nurses to prescribe any medication necessary for the treatment of their patients.&#10;D) Prescriptive authority is limited to nurse anesthetists.&#10;

Accepted Answer

Rationale 1: Laws about prescriptive authority vary from state to state.
Rationale 2: The APN may have prescriptive authority for some controlled substances, depending upon the state of licensure.
Rationale 3: The vast majority of states still require some degree of physician involvement or delegation in the area of prescriptive authority, including direct supervision or use of a formulary.
Rationale 4: Prescriptive authority is not limited to CRNAs.

Question 10

The advanced practice nurse would like to move to a large metropolitan area. How will this move impact the advanced practice nurse's practice?&#10;A) There is no problem as the practice requirements are the same.&#10;B) There would be no problem as the move is to an area that is primarily minority.&#10;C) This would be an unwise move for the nurse, as advanced practice is limited to rural areas.&#10;D) There would be no problem if the move is to a medically underserved area.&#10;

Accepted Answer

Rationale 1: All 50 states recognize the advanced practice nurse role.
Rationale 2: There is no requirement that APNs restrict their practice to minority areas.
Rationale 3: There is no requirement that APNs restrict their practice to rural areas.
Rationale 4: There is no requirement that APNs restrict their practice to medically underserved areas.

Question 11

A nurse discussing the establishment of today's advanced nurse practitioner role would discuss which factor as the primary driving force?&#10;A) The physician shortage of the late 1960s&#10;B) The need for providers to work in primary care settings&#10;C) The need for more rural health care by qualified providers&#10;D) The refusal of physicians to see rural patients&#10;

Accepted Answer

The answer of A nurse discussing the establishment of today's...

Question 12

The advanced nurse practitioner wishes to obtain admitting privileges at an area hospital. To whom should this nurse apply for these privileges?&#10;A) The state board of medicine&#10;B) The individual hospital&#10;C) The Joint Commission&#10;D) The state board of health&#10;

Accepted Answer

The answer of The advanced nurse practitioner wishes to obtain...

Question 13

A nurse working as a clinical nurse specialist (CNS) in a hospital is aware of a greater risk for being sued for malpractice than that of the staff nurses' co-workers. What rationale would the CNS give for this difference?

A) "I have greater autonomy in my work."
B) "Since I make more money, I am a better litigation target."
C) "I assume greater legal liability because of my specialty credentials."
D) "The patients I work with are sicker and more likely to develop treatment related complications."

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Accepted Answer

The answer of A nurse working as a clinical nurse...

Question 14

The advanced nurse practitioner is considering changing malpractice insurance carriers. What should the nurse consider prior to making this change?&#10;A) The expanding role of the advanced nurse practitioner has increased the number of lawsuits filed.&#10;B) The advanced nurse practitioner should carry medical malpractice, just as the physician does.&#10;C) Advanced nurse practitioners are less likely to be sued than nurses holding a doctorate of nursing practice.&#10;D) The advanced nurse practitioner is more likely to be sued than a physician.&#10;E) The severity of malpractice claims against some ANP roles has increased in the last few years.&#10;

Accepted Answer

The answer of The advanced nurse practitioner is considering changing...

Question 15

The office director of a medical practice has recommended that the advanced practice nurses bill for service under the name of one of the group's physicians. What is the probable rationale for this suggestion?

A) Patients are more likely to pay physician bills than nurse bills.
B) Typically physicians are reimbursed at a higher rate than ANPs.
C) Having a smaller number of names under which billing is submitted is more efficient.
D) Nurses are not permitted to bill government payers.

Accepted Answer

The answer of The office director of a medical practice...

Deck 12: Advanced Nursing Practice Roles