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?

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 "doctor" by clinic patients. What is the best way for the nurse to handle this mistake?

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?

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?

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?

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?

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?

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?

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?

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?

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?

Accepted Answer

Rationale 1: The primary driving factor was a shortage of primary physicians that occurred in the late 1960s and early 1970s.
Rationale 2: The situation driving the development of this role was not limited to primary care settings.
Rationale 3: The situation driving the development of this role was not limited to rural health care.
Rationale 4: There is no indication that physicians were refusing to care for rural patients.

Question 12

The advanced nurse practitioner wishes to obtain admitting privileges at an area hospital. To whom should this nurse apply for these privileges?

Accepted Answer

Rationale 1: The state board of medicine may recommend guidelines for credentialing but does not grant privileges to specific hospitals.
Rationale 2: Institutions grant the privileges for individuals to practice in their facility. This privilege granting is governed by the institution based on a set of credentials that are determined by a designated peer group practicing in that institution.
Rationale 3: The Joint Commission specifies that standards for privileging must be present and followed, but this organization does not grant privileges to individual practitioners.
Rationale 4: The state board of health may have guidelines for granting privileges but does not grants privileges to individuals.

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?

Accepted Answer

Rationale 1: Decreased autonomy does not protect the staff nurses from litigation.
Rationale 2: The fact that this nurse makes more money would not be likely to play into the decision to sue.
Rationale 3: Nurses who hold specialty credentials are assumed to be experts in their role. This increases the likelihood of suit if an unexpected outcome occurs.
Rationale 4: The seriousness of the patient's illness is not a major determining factor in unexpected outcomes. When a person who is not seriously ill has a poor treatment outcome, litigation is often considered.

Question 14

The advanced nurse practitioner is considering changing malpractice insurance carriers. What should the nurse consider prior to making this change?

Accepted Answer

Rationale 1: As the role of the ANP has expanded, so has the frequency with which these nurses are sued.
Rationale 2: Advanced nurse practitioners are nurses and should carry nursing malpractice specific to their role.
Rationale 3: ANPs are not less likely to be sued than nurses holding a DNP.
Rationale 4: There is no indication that ANPs are more likely to be sued than physicians.
Rationale 5: APRNs have seen the severity of malpractice claims rise in the past few years.

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?

Accepted Answer

Rationale 1: There is no information to support this statement.
Rationale 2: Using the physician's reimbursement codes ensures that reimbursement is billed at 100% rather than the 80-85% rate for ANPs.
Rationale 3: Efficiency is not the most likely reason for this suggestion.
Rationale 4: Medicare does accept billing from advanced practice nurses.

Quiz 12: Advanced Nursing Practice Roles