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Advanced Practice Nursing Essential Knowledge for the Profession 3rd Edition Denisco Test Bank

Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
Chapter1 Introduction to the Role of Advanced Practices Nursing
Multiple Choice
1. In which year did the American Association of College of Nursing (AACN) introduced the
Doctorate of Nursing Practice (DNP)?
a. 2006
b. 2004
c. 2000
d. 2002
TAhNeSA: ABCN introduced the DNP degree in 2004 to prepare advanced practice nurses (APRNs) to
meet challenges and standardize practice beyond master’s degree programs.
2. Which of the following is the best explanation for the creation of the Doctorate of Nursing
Practice (DNP) degree?
a. To compete against master’s degree programs
b. To ensure standardized curriculum ensuring independent practice
c. To validate APRN’s for financial reimbursement
d. To address increasing curriculum requirements of master’s degree programs
ANS: D
Although all answers are influenced by the DNP core competencies, the DNP program creation in
2004 bythe AACN was designed to address curriculum requirements of master’s degree programs.
3. Which of the following was the first recognized area of advanced practice nursing?
a. Clinical Nurse Specialist
b. Family nurse practitioner
c. Pediatric nurse practitioner
d. Certified Registered Nurse Anesthetist
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
ANS: D
In 1931, the National Association of Nurse Anesthetists (NANA), renamed in 1939 to the
American Association of Nurse Anesthetists (AANA) was the first recognized group promoting
advanced nursing practice. Agatha Hodgins founded the AANM at Lakeside Hospital in
Cleveland, Ohio.
4. Which factor is broadly perceived to solidify and standardize the role of the APNs over the last
25 years?
a. Lack of access to health care providers
b. Standardized curriculum development
c. Payment for services
d. Societal forces
ANS: B
As the evolution of Advanced Practice Nursing advances specific specialties and needs are
identified. Through the evolution of organization and standardization these roles have solidified
the APN’s role in today’s health care environment.
5. During the formation of early APN roles in anesthesia, which of the following increased
demand for access to health care?
a. Poverty
b. War
c. Rural access to care
d. Availability of training
ANS: B
Earliest demand for nursing-provided anesthesia spiked during periods of war when numbers of
physicians were inadequate. The earliest records date back to the American Civil War with the
administration of chloroform. During World War I in 1917 more than 1000 nurses, some trained
anesthetists, traveled into battle. Other factors such as need for rural health care came later in the
validation and need for APNs.
6. In 1889, Dr. William Worrall Mayo built and opened St. Mary’s hospital in Rochester, NY. He
is known for some of the earliest recruitment and specialized training of nurses in which of the
following roles?
a. Pediatrics
b. Anesthesia
c. Obstetrics
d. Research and statistics
e. Family nursing
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
ANS: B
In 1889, Dr. William Worrall Mayo began formally training and recognizing nurse anesthetists.
This has been regarded as the earliest training in nurse-provided anesthesia.
7. In 1893, Lillian Wald established the HenryStreet Settlement (HSS) House for which purpose?
a. Access to health care of rural areas
b. Create inner-city nursing awareness
c. Provide the disadvantaged access to care
d. Establish guidelines for advanced nursing roles
ANS: C
The HHS was established to provide nursing services to immigrants and low-income patients and
their families in Manhattan. As resistance to nurse-provided care grew, standing orders were
drafted from a group of Lower East Side physicians thereby circumventing then-existing legal
ramifications.
8. The Frontier Nursing Service (FNS) founded in Kentucky in 1925 by Mary Breckenridge
initiallyprovided Appalachia with nursing resources and which type of advanced nursing care?
a. Pediatric care
b. Anesthesia
c. Midwifery
d. Surgical services
ANS: C
The original FNS provided nursing services and obstetric services to Appalachian residents. Later
working from standard orders developed from their medical advisory committee nurses treated
patients, made diagnoses, and dispensed medications.
9. Which organization founded in 1941 under Mary Breckenridge’s leadership merged with the
American College of Nurse-Midwives (ACNM) in 1969?
a. American Association of Nurse-Midwives (AANM)
b. American Nurses Association (ANA)
c. Association for National Nurse-Midwifery (ANNM)
d. Council of Nursing Midwifery (ANM)
ANS: A
The American College of Nurse-Midwives (ACNM) formed under the leadership of Mary
Breckenridge in 1941 to provide nurse-midwife development and collaboration for midwife
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
development. In 1955, the American College of Nurse-Midwives was formed and the two
organizations merged in 1969 after the death of Mary Breckenridge.
10. In a landmark ruling by the Supreme Court as a result of Chalmers-Frances v. Nelson, 1936,
what legal precedent was established?
a. Nurse anesthesia was allowed under the nurse practice act
b. Nurse anesthesia scope of practice included anesthesia
c. Nurse anesthesia was legal, if under guidance of a supervising physician
d. Only trained nursing professionals could administer anesthesia independently
ANS: C
The landmark decision from the Chalmers-Frances v. Nelson case set national precedent for the
advanced nursing practice role. It proved to be the basis for other cases over the following few
decades and established that trained nurses could legally provide anesthesia care under supervision
of a physician.
11. The first known establishment of the nurse practitioner role occurred in 1965 at theUniversity
of Colorado. In which area of training did this role specialize?
a. Pediatrics
b. Geriatrics
c. Midwifery
d. Anesthesia
ANS: A
The establishment of the first pediatric nurse practitioner program was in 1965 at the University
of Colorado. Loretta Ford, RN and Henry Silver, MD provided a 4-month course to certified
registered nurses to provide education on managing childhood health problems.
12. The DNP program curriculum outlined which of the following clinical requirements in an
effort to standardize training?
a. 1000 supervised clinical hours and 200 unsupervised clinical hours
b. 1000 supervised clinical hours
c. 900 supervised clinical hours
d. 800 supervised clinical hours and 200 unsupervised clinical hours
ANS: B
In 2004, the AACN outlined the DNP curriculum in an effort to standardize and relieve challenges
of master’s degree programs. This includes a standardized curriculum requiring 1000 supervised
clinical hours.
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
13. Which state became the first to recognize diagnosis and treatment as part of the
scope of practice of specialty nurses?
a. Idaho
b. Oklahoma
c. South Dakota
d. Maryland
ANS: A
Idaho Governor Cecil Andrus signed HB 46 and HB 207 into law on February 11,
1971. This amended the states’ nurse practice act making it the first state to officially
recognize diagnosis and treatment of specialty nurses. The recognition of the ability
to diagnose and treat overcame an initial hurdle toward independent nursing practice.
14. The American Nursing Association (ANA) defines which requirement for the
designation of a clinical nurse specialist in any specialty?
a. Specialty training certificate
b. Successful completion of certification examination
c. Masters or doctoral degree
d. 1000 hours relevant supervised training
e. Two or more years of clinically relevant experience
ANS: C
In 1980, the ANA specifically outlined criteria for the acknowledgment of clinical
nurse specialist training programs. At that time they required graduate level training
to become an expert in a relevant specialty area of nursing. Additionally, they must
meet any requirements set forth by the specific professional society.
Chapter2 The Nurse Practitioner: Historical Perspective on the Art and Science of
NursePractitionering
1. Which of the following is the primary mission of the National Organization of Nurse
Practitioner Faculties (NONPF)?
a. Provide leadership in promoting quality NP education
b. NP Faculty training program assistance
c. Provide financial assistance to NP students
d. Lobbying legislature on behalf of NPs
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
ANS: A
The NONPF’s primary mission is to provide leadership in promoting quality NP education. The
organization has published domains and core competencies for primary care and these serve as a
framework for NP education and practice.
2. A model of competencies that are encompassed around three spheres of influence known as
patient, nurses and nursing practice, and organization and influence is known as?
a. NACNS Model of clinical nurse specialist competencies
b. Fenton’s and Brykczynski’s Expert Practice
c. Calkin’s model of Advanced Nursing Practice
d. Shuler’s Model of NP Practice
ANS: A
The NACNS’s initial 2008 statement was revised in 2004. The statement outlined competencies
that aligned to each of the three spheres of influence: patient, nurses and nursing practice, and
organization and influence.
3. Building upon Benner’s seven domains of expert nursing practice, which conceptual model
adds an additional domain “The consulting role of the nurse”?
a. Calkin’s model of Advanced Nursing Practice
b. Fenton’s and Brykczynski’s Expert Practice
c. Strong Memorial Hospital’s Model of Advanced Nursing Practice
d. Shuler’s Model of NP Practice
e. NACNS Clinical Nurse Specialists Model
ANS: B
Fenton’s and Brykczynski’s Expert Practice Domains of the CNS and NP expanded on Benner’s
seven domains adding consultation provided by CNS’s to other nurses and management of health
and illness in ambulatory care settings.
4. Which model of conceptual practice was the first to explicitly distinguish the experience level
of advanced practitioners?
a. Calkin’s model of Advanced Nursing Practice
b. Shuler’s Model of NP Practice
c. NACNS Clinical Nurse Specialists Model
d. Strong Memorial Hospital’s Model of Advanced Nursing Practice
e. Fenton’s and Brykczynski’s Expert Practice
ANS: A
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
Calkins model of Advanced Nursing Practice was the first to explicitly distinguish experience
levels of advanced practitioners for nurse administrators to differentiate advanced practice nursing
from other levels of clinical practice.
5. The circular and continuous threads of direct comprehensive patient care, support of systems,
education, research, and publication and professional leadership make up the five domains of
which advanced nursing conceptual model?
a. Strong Memorial Hospital’s Model of Advanced Nursing Practice
b. Calkin’s model of Advanced Nursing Practice
c. NACNS Clinical Nurse Specialists Model
d. Fenton’s and Brykczynski’s Expert Practice
e. Shuler’s Model of NP Practice
ANS: A
Direct and indirect activities across five domains including: direct comprehensive patient care,
support of systems, education, research, and publication and professional leadership make up the
Strong Memorial Hospital’s Model of Advanced Practice Nursing.
6. Texas Children’s Hospital Transformational Advanced Professional Practice (TAPP) APRN
Model added what unifying conceptual strand?
a. Ethics
b. Culture
c. Informatics
d. Education
ANS: A
The TAPP model added two additional domains: quality and safety, and credentialing and
regulatory practice, to the Strong model. It additionally added professional ethics as a unifying
conceptual strand.
7. Poghosyan, Boyd, and Clarke (2016) proposed a comprehensive conceptual model including
three factors: scope of practice regulations, institutional policies, and practice environments.
What was their primary purpose?
a. To discourage role ambiguity among CNS providers
b. To enhance patient education provided by the APRN
c. To maximize NP Contributions to primary care
d. To provide educational practice guidelines to enhance NP education
ANS: C
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
The 2016 model provided a comprehensive review of literature and described potential factors that
affect NP care and patient outcomes. This included scope of practice regulations that often cause
barriers for NP provided primary care.
8. Which model of practice intended to impact the NP domain at four levels: theoretical, clinical,
educational, and research in 1993?
a. Hamric’s model
b. Calkin’s model of Advanced Nursing Practice
c. Strong Memorial Hospital’s Model of Advanced Nursing Practice
d. Shuler’s Model of NP Practice
ANS: D
Shuler’s Model of NP Practice is a holistic and wellness oriented model that was designed to
impact the NP domain at four levels: theoretical, clinical, educational, and research. It is designed
to elaborate the NP’s expanded knowledge and skills into medicine including a template for
conducting a visit.
9. Which model for APRN practice addresses all four APRN roles: CNS, CRNA, CNM, and NP?
a. Calkin’s model of Advanced Nursing Practice
b. Hamric’s model
c. Strong Memorial Hospital’s Model of Advanced Nursing Practice
d. Donabedian Model
ANS: B
Many models highlight core competencies among specific APRN roles, while others emphasize
competencies for hiring managers. At the time of this writing, only the Hamric’s model
encompasses all four APRN roles.
10. Which of the following is one of the eight published essentials included in the Essentials of
Doctoral Education for Advanced Nursing Practice developed by the AACN in 2006?
a. Algorithms for advanced patient care
b. Informatics and health care technologies
c. Scientific underpinnings of practice
d. Liberal education for general nursing practice
ANS: C
The AACN publishes their national consensus to provide the core elements for nursing curriculum
creation. Currently published are Baccalaureate Essentials, Master’s Essentials, DNP Essentials,
and Clinical Resources Essentials. Although they are similar in their core approach to education,
listed first in DNP essentials is the scientific underpinnings of practice.
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
11. Which model of conceptualization identifies that health care needs are not met in a system
dominated by medical language as a basis for reimbursement?
a. Donabedian Model
b. Dunphy and Winland-Brown’s Circle of Caring model
c. Shuler’s Model of NP Practice
d. Calkin’s model of Advanced Nursing Practice
ANS: B
Dunphy and Winland-Brown’s transformative model (Dunphy, Winland-Brown, Porter, Thomas,
and Gallagher, 2011; Fig. 2.12) proposed a circle of caring to encourage medical collaboration and
enhance the nursing presence in the health care system. Their model incorporates both strengths
of medicine and nursing with process of assessment, planning, intervention, and evaluation, with
a feedback loop.
12. Without additional application of conceptual models which model would be best chosen to
model the skill level of beginning nurses, experienced nurses, or advanced nurse practitioners
with the appropriate level of patient care?
a. Dunphy and Winland-Brown’s Circle of Caring model
b. Strong Memorial Hospital’s Model of Advanced Nursing Practice
c. Donabedian Model
d. Calkin’s model of Advanced Nursing Practice
ANS: D
Calkin’s model of Advanced Nursing Practice outlines skills and knowledge of beginning nurses,
experienced nurses, and advance practice nurses as they relate the patient responses for health care
problems.
13. The 2005 Donabedian model has been used to evaluate the quality of APRN care using which
conceptual outline?
a. Assessment, diagnosis, planning, intervention, and evaluation
b. Structure, process, and outcome
c. Diagnosis and outcome
d. Diagnosis, morbidity, and mortality
ANS: D
The Donabedian model encompasses structure (health care systems and facilities), process
(diagnosis, treatment, education), and outcomes.
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
14. Which of the following are the functions of a conceptualization ofadvanced practice nursing?
(Select all that apply.)
a. Basis for furthermore development of knowledge
b. Articulate professional role identity and function
c. Identify specific procedures to provide
d. Deliver holistic and collaborative care
e. Provide guidelines on billing
ANS: A, B, D
Conceptual models allow for articulation of professional role identity, provide a basis for
furthermore development of knowledge and assist in clinical practice for the delivery of holistic,
comprehensive, and collaborative care. Models may assist but in general do not provide assistance
with clinical decision making or billing.
Test Bank
Multiple Choice
15. A registered nurse completes an informal education and training course at his or her place of
work authorizing him or her to use ultrasound guided imagery when placing intravenous lines.
How is this best classified?
a. Advanced practice nursing
b. Nursing Skill Advancement
c. Advanced Licensure
d. Advanced Certification
ANS:
The addition or advancement of individualskills to the nursing practice is common and encouraged
but does not meet the requirements set forth for advanced practice nursing. Licensure and
certification were not obtained or expressed.
16. The core foundations of all APN education curricula contain advanced courses covering which
of the following?
a. Human anatomy, health and physical assessment, and pharmacology
b. Pathophysiology, research, and pharmacology
c. Health and physical assessment, pathophysiology, and obstetrics and gynecology
d. Pathophysiology, health and physical assessment, and pharmacology
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
ANS: D
While specific specialties may focus on individual areas of clinical knowledge, all aspects of
advanced practice nursing include advanced knowledge of pathophysiology, health and physical
assessment, and pharmacology.
17. Which of the following criteria is required for the attainment of classification as an advanced
practice nurse (APN)?
a. Practice focused on research
b. Baccalaureate degree in area of focus
c. Specialized skill attainment
d. Graduate degree in area of focus
ANS: D
The three basic criteria or qualifications for APNs include graduate education in advanced practice
nursing role, national certification in an advanced role, and a practice focused on patients and their
families. Research and skills are components of core competencies of advanced practice nurses
who achieve a graduate level of education.
18. Which of the following is the central, core competency for advanced practice nursing?
a. Evidence-based practice
b. Direct clinical practice
c. Leadership
d. Ethical decision making
ANS: B
Direct clinical practice is the core competency that lends itself to all others. It also provides the
foundation for APNs to carry out the other competencies adequately.
19. The legal authority granted to a professional to provide and be reimbursed for health care
services refers to:
a. Certification
b. Scope of practice
c. Practicing Role
d. Education
ANS: B
Many things including state and federal laws define scope of practice. The APN NCSBN defines
scope of practice as characterized by specialization, expansion of services provided, including
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
diagnosing and prescribing, and autonomy to practice. An individual certification would fall under
the umbrella of scope of practice.
20. Which of the following most accurately describes the current four established advanced
practice nurse roles?
a. RN, BSN, MSN, DNP
b. CNM, FNP, CNS, CRNA
c. CNM, FNP, AGNP, PNP
d. CNS, CRNA, NP, CNM
ANS: D
The four established advanced practice nurse roles include CNS, CRNA, CNM, and NP. FNP and
AGNP are specializations of nurse practitioners (NP).
21. Which advanced practice nursing role has seen the largest expansion of growth and is currently
the largest in number?
a. CNS
b. CRNA
c. CNM
d. NP
ANS: D
Nurse practitioner continues to be the largest in number of APN roles. According to the American
Academy of Nurse Practitioners National NP Database there are over 220,000 trained NPs.
22. Which advanced practice nursing role is currently the smallest in number?
a. CNM
b. NP
c. CNS
d. CRNA
ANS: A
The CNM role according to the American College of Nurse-Midwives currently has around 11,000
trained providers based on current estimates. The CNM role is specialized in the care of women’s
health and childbearing.
23. A practicing, certified CNM wishes to change roles and work as a family nurse practitioner
(FNP). Which of the following is required?
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
a. Complete education and training as an NP
b. Take the FNP board examination
c. Nothing is required
d. Apply for immediate reciprocity
ANS: A
The four roles of APN (CNS, CRNA, CNM, and NP) are not interchangeable without additional
training and education. Although there are specific instances of overlap, each of the four roles
should not be confused as interchangeable. Specialty certifications under the NP role may allow
for more flexibility under today’s regulations and are not standard practice. Scenarios are usually
handled on an individual basis.
24. True or False. A registered nurse in an emergency room successfully completes a critical care
course and meets all requirements for certification. He or she is now classified as an advanced
practice nurse.
a. True
b. False
ANS: B
This registered nurse has completed advanced training that increases skill and knowledge and may
have also obtained a certification; however, this does not meet the basic criterion of advanced
practice nurse. He or she may be expertly skilled but requires the completion of a graduate degree
focused in an area of nursing to appropriately be classified as an APN. The acute care nurse
practitioner specialty would be required in this particular setting.
Chapter3 Overview of the Doctor of Nursing Practice Degree
1. A registered nurse completes an informal education and training course at his or her place of
work authorizing him or her to use ultrasound guided imagery when placing intravenous lines.
How is this best classified?
a. Advanced practice nursing
b. Nursing Skill Advancement
c. Advanced Licensure
d. Advanced Certification
ANS: B
The addition or advancement of individualskills to the nursing practice is common and encouraged
but does not meet the requirements set forth for advanced practice nursing. Licensure and
certification were not obtained or expressed.
2. The core foundations of all APN education curricula contain advanced courses covering which
of the following?
a. Human anatomy, health and physical assessment, and pharmacology
b. Pathophysiology, research, and pharmacology
c. Health and physical assessment, pathophysiology, and obstetrics and gynecology
d. Pathophysiology, health and physical assessment, and pharmacology
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
ANS: D
While specific specialties may focus on individual areas of clinical knowledge, all aspects of
advanced practice nursing include advanced knowledge of pathophysiology, health and physical
assessment, and pharmacology.
3. Which of the following criteria is required for the attainment of classification as an advanced
practice nurse (APN)?
a. Practice focused on research
b. Baccalaureate degree in area of focus
c. Specialized skill attainment
d. Graduate degree in area of focus
ANS: D
The three basic criteria or qualifications for APNs include graduate education in advanced practice
nursing role, national certification in an advanced role, and a practice focused on patients and their
families. Research and skills are components of core competencies of advanced practice nurses
who achieve a graduate level of education.
4. Which of the following is the central, core competency for advanced practice nursing?
a. Evidence-based practice
b. Direct clinical practice
c. Leadership
d. Ethical decision making
ANS: B
Direct clinical practice is the core competency that lends itself to all others. It also provides the
foundation for APNs to carry out the other competencies adequately.
5. The legal authority granted to a professional to provide and be reimbursed for health care
services refers to:
a. Certification
b. Scope of practice
c. Practicing Role
d. Education
ANS: B
Many things including state and federal laws define scope of practice. The APN NCSBN defines
scope of practice as characterized by specialization, expansion of services provided, including
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
diagnosing and prescribing, and autonomy to practice. An individual certification would fall under
the umbrella of scope of practice.
6. Which of the following most accurately describes the current four established advanced
practice nurse roles?
a. RN, BSN, MSN, DNP
b. CNM, FNP, CNS, CRNA
c. CNM, FNP, AGNP, PNP
d. CNS, CRNA, NP, CNM
ANS: D
The four established advanced practice nurse roles include CNS, CRNA, CNM, and NP. FNP and
AGNP are specializations of nurse practitioners (NP).
7. Which advanced practice nursing role has seen the largest expansion of growth and is currently
the largest in number?
a. CNS
b. CRNA
c. CNM
d. NP
ANS: D
Nurse practitioner continues to be the largest in number of APN roles. According to the American
Academy of Nurse Practitioners National NP Database there are over 220,000 trained NPs.
8. Which advanced practice nursing role is currently the smallest in number?
a. CNM
b. NP
c. CNS
d. CRNA
ANS: A
The CNM role according to the American College of Nurse-Midwives currently has around 11,000
trained providers based on current estimates. The CNM role is specialized in the care of women’s
health and childbearing.
9. A practicing, certified CNM wishes to change roles and work as a family nurse practitioner
(FNP). Which of the following is required?
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
a. Complete education and training as an NP
b. Take the FNP board examination
c. Nothing is required
d. Apply for immediate reciprocity
ANS: A
The four roles of APN (CNS, CRNA, CNM, and NP) are not interchangeable without additional
training and education. Although there are specific instances of overlap, each of the four roles
should not be confused as interchangeable. Specialty certifications under the NP role may allow
for more flexibility under today’s regulations and are not standard practice. Scenarios are usually
handled on an individual basis.
10. True or False. A registered nurse in an emergency room successfully completes a critical care
course and meets all requirements for certification. He or she is now classified as an advanced
practice nurse.
a. True
b. False
ANS: B
This registered nurse has completed advanced training that increases skill and knowledge and may
have also obtained a certification; however, this does not meet the basic criterion of advanced
practice nurse. He or she may be expertly skilled but requires the completion of a graduate degree
focused in an area of nursing to appropriately be classified as an APN. The acute care nurse
practitioner specialty would be required in this particular setting.
Chapter4 Emerging Roles for the DNP Nurse Educator
Test Bank
Multiple Choice
25. In 1990, Cooper and Sparacino postulate than an APRN’s maximum potential may not be
attained until:
a. After 1 year
b. After 7 years
c. After 3 years
d. After 5 years
ANS: D
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
Studies have shown that the first-year position of an APRN is one of transition, and Cooper and
Sparacino estimate that an APRN’s maximum potential may not be attained until after 5 years or
more in practice.
26. An NP student is performing a thorough neurologic examination for the first time in the clinical
setting. This is an example of:
a. Role implementation
b. Role acquisition
c. Role confusion
d. Role conflict
ANS: B
The changes occurring during role transitions experienced during the educational component of an
APN role are classified as role acquisition. Additionally, role transition is described as when an
APRN begins to practice for the first time in a new role.
27. A new NP student is completing a rotation at an outpatient urgent care clinic and completes an
examination on a patient with chest pain. The nursing assistant hands a 12-lead ECG to the NP
student and asks: “What should we do?” The NP student’s preceptor did not provide clear
instructions on the role of the NP student at this time even though the student is capable of
interpreting ECGs. This is an example of:
a. Role ambiguity
b. Role transition
c. Role strain
d. Role supplementation
ANS: A
Role ambiguity is created by unclear expectations, diffuse responsibilities, and uncertainty of
subroles. The NP student’s preceptor did not provide clear roles to the NP student about what he
or she should do in the absence of the preceptor. If the NP student was placed in a role where he
or she was unaware of how to interpret ECGs this would be an example of role incongruity.
28. An NP is completing the first month in his or her first job. He or she receives a phone call from
an administrator telling him or her that he or she will need to see 30% more patients starting
next week. He or she is told that this is the minimum requirement of all NPs in the same
position. The NP has difficulty using the electronic health record (EHR) software efficiently
and feels overwhelmed. This is an example of:
a. Role supplementation
b. Role ambiguity
c. Role conflict
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
d. Role insufficiency
ANS: D
Role insufficiency is often seen as APRN graduates’ transition to the workforce or change
positions. This may include feelings of inadequacy or slow speed due to the new role or barriers
such as electronic health record documentation requirements.
29. Which of the following is an example of role acquisition?
a. NP student learning leadership roles in the classroom
b. NP student on graduation day from his or her program
c. NP student beginning a new job as a family nurse practitioner
d. A practicing NP advancing central line skills
ANS: A
The changes occurring during role transitions experienced during the educational component of an
APN role are classified as role acquisition. All of the others are examples of role implementation.
30. The changes occurring as an APRN performs procedures during job duties are classified as?
a. Role supplementation
b. Role transition
c. Role implementation
d. Role acquisition
ANS: C
The job duties and responsibilities performed by the APRN are an example of role implementation.
Role transition is the transition from student to practicing NP.
31. Which of the following is best classified as roll stress?
a. Maintaining family responsibilities while in school
b. An APN’s feelings of poor self-esteem
c. Starting a first job as an NP
d. Multiple failed attempts to master a procedure during education
ANS: A
There are many examples of role stress. Role stress may include any situation that requires
increased performance above and beyond the expectation of others. This is easily classified as
examples of things that require additional demand in addition to school or work such as
work/family responsibilities or keeping up with new and advancing technologies. Starting a first
job as an NP is an example of role transition.
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
32. Which of the following is best classified as role strain?
a. A difficult disagreement with a physician
b. An APN’s feelings of poor self-esteem after failing two examinations
c. Maintaining family responsibilities while in school
d. Starting a first job as an NP
ANS: B
Role strain is defined as the subjective feeling of frustration, tension, or anxiety in response to role
stress. Examples of role strain typically include subjective feelings of decreased self-esteem when
performance is below the expectations of self or others. A difficult disagreement with a physician
is an example of role conflict. Starting a first job as an NP is an example of role transition.
Maintaining family responsibilities while in school is an example of role stress.
33. Which of the following is an example of role conflict?
a. Difficult work-life balance
b. A difficult disagreement with a physician
c. Starting a first job as an NP
d. Maintaining family responsibilities while in school
ANS: B
Role conflict occurs when role expectations are perceived to be mutually exclusive or
contradictory. Role conflict does not have to be with superiors but can occur between APRNs and
nurses, other APRNs, or physicians. Starting a first job as an NP is an example of role transition.
Maintaining family responsibilities while in school is an example of role stress.
34. The four-stage process to NP role development first identified by Anderson, Leonard, and
Yates (1974) and validated by Roberts et al. (1997) included which four components?
a. Finding a niche, coping with pressures, feeling competent, internalizing the role
b. Complete dependence, developing competence, independence, interdependence
c. Novice, developing competence, competent, advanced
d. Developing competence, partial independence, complete independence, interdependence
e. Dependence, independence, interdependence, role model
ANS: B
Complete dependence, developing competence, independence, and interdependence are the fourstage process of NP development outlined by Anderson, Leonard, and Yates in 1974 and validated
by Roberts et al. (1997).
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
35. A trained nurse enters the first semester of an NP training program. He or she is required to
learn new and more advanced techniques beginning with conducting an advanced physical
examination. The overwhelming feeling and stress of learning additional skills is most likely
classified by the studies of Anderson, Leonard, and Yates in 1974 as:
a. Independence
b. Developing competence
c. Interdependence
d. Complete dependence
ANS: D
The initial learning of skills and additional techniques experienced by NPs in the beginning of their
training has been described as complete dependence.
36. A trained NP is working at an outpatient care clinic. He or she encounters a difficult patient, is
unaware of treatment options, and consults one of his or her colleagues for advice. This is best
classified as:
a. Independence
b. Interdependence
c. Developing competence
d. Complete dependence
ANS: B
As initially defined by Anderson, Leonard, and Yates in 1974, NP roles as they transition to the
workplace as seasoned practitioners transition to interdependence as they work with colleagues to
enhance patient care.
37. Fleming and Carberry’s research in 2011 studied two cohorts of critical care nurse advanced
practice trainees in Scotland. They found that transition occurred in which four areas?
a. Complete dependence, developing competence, independence, interdependence
b. Developing competence, partial independence, complete independence, interdependence
c. Coping with pressures, feeling competent, internalizing the role, leading others
d. Finding a niche, overcoming obstacles, advanced practice, interdependence
e. Finding a niche, coping with pressures, feeling competent, internalizing the role
ANS: E
Fleming and Carberry’s research in 2011 studied two cohorts of critical care nurse advanced
practice trainees in Scotland showing transition occurred in four areas: finding a niche, coping
with pressures, feeling competent, internalizing the role.
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
38. A strategy to promote role acquisition in school that involves a ceremony at the beginning of
the NP students training is the best example of:
a. Role rehearsal
b. Creating a support network
c. Role development
d. Developing clinical knowledge of skills
ANS: A
Role rehearsal may include many facets including a rite of passage such as a ceremony to mark
the beginning of a new training program.
39. Which initial strategy would provide the best role acquisition for a student or potential student
about to begin a new NP program?
a. Provide case scenarios of patients that may be encountered
b. Preadmission testing
c. Provide a handout detailing the APRN curriculum
d. Clinical faculty mentoring by preceptors
ANS: C
An initialstrategy for role acquisition includes components for role rehearsal. Providing the overall
framework for the APRN curriculum would allow for the best-case scenario of role acquisition.
Clinical faculty mentoring by preceptors is an example of role acquisition but is best suited to
develop clinical knowledge and skills.
40. Which of the following is the best strategy for transition of an APRN into a new position?
a. Ensuring adequate pre-position training
b. Development of a structured orientation plan
c. Scheduling time-based evaluations
d. Providing immediate feedback from supervisors
ANS: B
APRNs in new roles regardless of previous experience benefit most from structured orientation
plans, networking with peers, appropriate mentors and preceptors, and an understanding of
appropriate expectations.
41. Which three major purposes are categorized and can be utilized to facilitate role acquisition of
NPs in school?
a. Knowledge expansion, skill practice, creation of a supportive network
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
b. Role rehearsal, development of clinical knowledge and skills, creation of a supportive
network
c. Role acquisition, role rehearsal, creation of a supportive network
d. Knowledge foundation development, development of clinical skills, tracking outcomes
ANS: B
An adaptation of Brykczynski’s (2000) “Strategies to promote NP role acquisition in school”
allows for specific strategies for role acquisition to be categorized into three major purposes: role
rehearsal, development of clinical knowledge and skills, and creation of a supportive network.
42. Which of the following examples would best enhance the development of clinical knowledge
and skills as part of role acquisition of the NP?
a. Establishment of a peer support system
b. Clinical conferences
c. Identifying a role model
d. Subscription to APRN journals and conferences
ANS: B
Role acquisition strategies include three major purposes: role rehearsal, development of clinical
knowledge and skills, and creation of a supportive network. Establishment of clinical conferences
to discuss clinical experiences with faculty and peers can promote clinical understanding and
enhance the development of clinical knowledge and skills. Subscription to APRN journals and
conferences would establish a pattern for continuing education and help create a support network.
Establishment of a peer support system would also help create a support network. Identifying a
role model or mentor would facilitate role rehearsal.
43. A faculty member at an NP education program has identified that students are experiencing
difficulty with role rehearsal during the first few semesters of the program. Which of the
following strategies would likely enhance role rehearsal and facilitate role acquisition?
a. Subscription to APRN journals and conferences
b. Identifying a role model
c. Clinical conferences
d. Establishment of a peer support system
ANS: B
Role acquisition strategies include three major purposes: role rehearsal, development of clinical
knowledge and skills, and creation of a supportive network. Identification of a role model or
mentor and developing a mentee relationship that can be maintained throughout an APRN program
is an excellent strategy to promote role rehearsal and support role acquisition while in school.
Clinical conferences support developing clinical knowledge and skills. Establishment of a peer
support system or subscriptions to APRN journals help create a support network.
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
44. In 2010, researchers Sullivan-Bentz et al. used Brown and Olshansky’s four-stage transition
model to study recent NP graduates as they undergo role transition to practicing NPs. What did
the study demonstrate?
a. New NPs transitioned from feeling overwhelmed to feeling confident in 6 months only
with support networks
b. New NPs did not transition from feeling overwhelmed to feeling confident in the study
c. New NPs transitioned from feeling overwhelmed to feeling confident in 1 year only with
support networks
d. New NPs transitioned from feeling overwhelmed to feeling confident in 1 year
e. New NPs transitioned from feeling overwhelmed to feeling confident in 6 months
ANS: D
APRN role development processes have been supported by a number of studies identifying that
the first year is most likely to be observed as the transition from feeling overwhelmed to feeling
confident.
45. A questionnaire study conducted by Hart and Macnee (2007) at two national NP conferences
found that 51% of NPs perceived that they were only somewhat or minimally prepared for
actual practice. Which of the following would most likely facilitate the role transition issues
for a beginning NP?
a. Clinical NP residency program
b. Additional time requirement as a practicing registered nurse
c. Longer NP education program
d. Additional NP clinical training hours
ANS: A
As many studies have shown the role transition issues of APRN graduates, clinical residency
programs have been developed to address these issues. Clinical residency programs ease new
graduate transition into practice and increase NP retention and overall satisfaction.
Chapter5 Influencing and Leading Change in the Complex Health Environment : The Role
of theAdvanced Practice Nurse
Multiple Choice
46. A nurse develops an interest in more effective medication management and seeks additional
training to enhance his or her daily care of patients and for peers at the facility for which he or
she works. This is an example of:
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
a. Specialization
b. Subspecialty
c. Specialty
d. Advanced practice nursing
ANS: A
Specialization involves focusing on practice in a specific area derived from the field of professional
nursing. Specialties can be further characterized as nursing practice that intersects with another
body of knowledge, has a direct impact on nursing practice, and is supportive of the direct care
provided to patients by other registered nurses (American Nurses Association [ANA], 2010a). If
the nurse changed his or her focus of practice this could be considered a specialty.
47. A nurse develops an interest in effective medication management and seeks additional training.
The nurse then focuses the majority of his or her time on medication management aspects of
nursing. This is an example of:
a. Advanced practice nursing
b. Subspecialty
c. Specialization
d. Specialty
ANS: D
The term specialty suggests that the focus of practice islimited to parts of the whole (ANA, 2010b).
Since this nurse has refocused his or her care entirely on medication management as part of the
nursing role it is considered a specialty.
48. A registered nurse is planning to extend his or her education beyond baccalaureate education
into an advanced practice role. When choosing between CRNA, CNM, and NP these are
delineations of which type?
a. Reasoning
b. Subspecialty
c. Specialty
d. Specialization
ANS: C
The term specialty suggests that the focus of practice is limited to parts of the whole (ANA, 2010b).
Deciding on advanced practice nursing among CRNA, CNM, and NP requires knowledge that they
are independent specialties. Specialties of NP at the highest level are psychiatric and mental health,
pediatrics, and adult-gerontology. Subspecialties further differentiate the focus of practice such as
family practice nurse practitioner, adult-gerontology nurse practitioner, and acute care among
others.
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
49. A student is evaluating a program to attend. He or she finds an adult-gerontology nurse
practitioner program that will also prepare him or her as a hospitalist. How is the hospitalist
training best defined?
a. Specialty
b. Subspecialty
c. Reasoning
d. Specialization
ANS: B
Subspecialization further delineates the focus of practice. In subspecialty practice, knowledge and
skill in a delimited clinical area is expanded further. Examples of subspecialties include diabetes
care, acute care, pain management, and clinical transplant coordinator.
50. Which of the following most accurately describes the four stages in the evolution ofadvanced
practice nursing?
a. Interest occurs, specialty begins, specialty organizes, and pressures mount for
standardization
b. Specialty begins, specialty organizes, laws require standardization, maturity, and growing
interprofessionalism
c. Specialty begins, specialty organizes, pressures mount for standardization, maturity, and
growing interprofessionalism
d. Interest occurs, specialty begins, specialty organizes, and specialty matures
ANS: C
The four stages in the evolution of advanced practice nursing include: stage I: specialty begins,
stage II: specialty organizes, stage III: pressures mount for standardization, and stage IV: maturity
and growing interprofessionalism.
51. An adult-gerontology nurse practitioner works to enhance education for polypharmacy in
elderly patients through the creation of standardized education tools. The NP works with other
professionals at his or her facility to research and develop criteria for education and practice.
This example is best classified as which stage?
a. Specialty organizes
b. Specialty standardizes
c. Specialty begins
d. Specialty matures and grows interprofessionally
ANS: C
Specialty stages are not concrete, but specialties that are in the beginning of development are in
stage I: specialty beginning. Stage II: specialty organization is typically considered when a
professional organization of like-minded individuals is officially formed.
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
52. A clinical transplant coordinator works with many aspects of the patient transplant process.
Two national organizations currently provide education and preparation for certification of
nurses. Which stage of organization is this specialty?
a. Stage IV
b. Stage II
c. Stage I
d. Stage III
ANS: B
The clinical transplant coordinator is currently a stage II specialty as it organizes and begins plans
for standardization of care.
53. A national specialty committee is formed for a specific nursing specialty. This is an example
of what stage of evolution of advanced practice nursing?
a. Stage II: specialty organizes
b. Stage I: specialty begins
c. Stage IV: specialty matures
d. Stage III: specialty standardizes
ANS: A
As national organizations form around specific specialties they are considered to be in stage II of
the evolution of advanced practice nursing.
54. Two organizations are formed for a specific advanced practice nursing specialty. As interest in
the specialty grows, legislation is required to govern aspects of care. To answer this call, the
organizations must meet what stage of evolution of advanced practice nursing?
a. Stage I: specialty begins
b. Stage IV: specialty matures
c. Stage III: specialty standardizes
d. Stage II: specialty organization
ANS: C
As pressures mount for standardization, often for curriculum development or legislative pressure,
standardization of practice must be obtained. This is often a difficult and lengthy process of stage
III of the evolution of advanced practice nursing.
55. Hospitalist practice by advanced practice nurses are in significant need. What stage of
development is hospitalist practice?
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
a. Specialty standardizes
b. Specialty begins
c. Specialty matures and grows interprofessionally
d. Specialty organizes
ANS: B
Hospitalist practice is a relatively new field for advanced practice nursing and has yet to be
organized. Hospitalist practice is a stage I specialty.
56. Which ofthe following specialties is classified asstage II, organized but yet to be standardized?
a. Wound and Ostomy Nursing
b. Interventional Pain Specialist
c. Advanced Diabetes Manager
d. Clinical Transplant Coordinator
ANS: D
The clinical transplant coordinator is currently a stage II specialty as it organizes and begins plans
for standardization of care. Wound and Ostomy nursing and Interventional Pain Practice are both
stage III specialties. Advanced Diabetes manager and Genetics Advanced Practice are stage IV
specialties.
57. As first addressed in 1985 at Surgeon General’s workshop on Violence and Public Health, the
need for which specialty began?
a. CRNA
b. Forensic Nursing
c. Public Health Nursing
d. Wound and Ostomy Nursing
ANS: B
The need for Forensic Nursing specialty was first addressed in 1985 at Surgeon General’s
workshop on Violence and Public Health.
58. Wound and Ostomy nursing, through the WOCNS, offers four levels of care providers. This
organization is currently in what stage of evolution of advanced practice nursing?
a. Specialty organizes
b. Specialty begins
c. Specialty standardizes
d. Specialty matures and grows interprofessionally
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
ANS: C
The WOCNS offers four levels of WOC specialty nurse training and has been developing curricula
and education that are offered in postbaccalaureate and some graduate-level programs.
59. Although not required for practice, the AAPM offers a credentialing examination requiring at
least 2 years of pain management experience prior to examination for Interventional Pain
Practice. This organization’s efforts to standardize care classify as what stage of evolution of
advanced practice nursing?
a. Stage I
b. Stage II
c. Stage IV
d. Stage III
ANS: D
The AAPM offers two credentialing examinations: diplomate and fellow. This allows for initial
standardization of practice in chronic pain management and paves for care as the organization
begins to mature along with the Interventional Pain Specialist specialty.
60. What specialty hastwo levels of certification available, focused on the management of diabetes
and prescribing medications?
a. Diabetes and Wellness Specialty
b. Endocrine Specialty
c. Advanced Diabetes Manager
d. Diabetes Clinical Specialist
ANS: C
The American Association of Diabetes Education (AADE) offers two levels for the specialty of
Advanced Diabetes Manager: Certified Diabetes Educator (CDE) and Board Certified Advanced
Diabetes Manager (BC-ADM). Specifically, the BC-ADM focuses less on education and moreon
the management of diabetes and prescribing of medications.
61. A father and mother have been identified as carriers of cystic fibrosis, a genetic disease. Their
primary care provider suggests they obtain genetic counseling prior to starting a family. Which
provider is the best for this couple?
a. Pediatric nurse practitioner
b. Pediatric Physician
c. Genetics Specialty RN
d. Genetics advanced practice nurse
ANS: D
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
The Genetics advanced practice nurse is a specialty that requires a graduate degree. This stage IV
specialty ensures specialized training in genetics. These practitioners offer genetic counseling, case
management, consultation, and evaluation of patients and their families. An RN would only offer
information or identify the need for referral to a genetics specialist. A Pediatric nurse practitioner
or Pediatric physician would likely not have specialized training in genetic counseling.
Chapter6 Interprofessional Collaboration for Improving Patient and Population
HealthKnowledge
Multiple Choice
62. Which metric is key for validating the need for the role of the Nurse-Midwife (NM)
worldwide?
a. Infant mortality
b. Number of OBGYN Physicians
c. Average distance to nearest obstetric center
d. Number of births per capita
ANS: A
Infant morbidity and mortality is a statistic of countries worldwide and is a key driver of expansion
of the nurse-midwife role into developing countries. Low- and middle-income countries often have
the highest rates of infant morbidity and mortality. Another factor increasing the expansion of the
NM’s role is the increasing costs of medical care.
63. Which organization’s primary goal is aiming to become an international resource for APNs
and NPs on a global scale?
a. ICN’s International Nurse Practitioner/APN Network (INP/APNN)
b. American Nurses Association (ANA)
c. World Health Organization (WHO)
d. Bill & Melinda Gates Foundation
ANS: A
The INP/APNN’s primary goal is to provide resources to advanced practitioners on a global scale.
This includes providing resources to countries and organizations that are forming NP programs.
64. Which three countries were the first to officially establish the NP role?
a. Canada, United States, and China
b. Canada, United States, and United Kingdom
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
c. United States, Canada, and Australia
d. United States, Canada, and Jamaica
ANS: D
The United States was the first country to establish the NP role in 1965, followed by Canada and
Jamaica in the mid-1970s.
65. According to a 2014 study, nurse-midwives who obtain the appropriate education and who are
regulated to meet ICM competencies for practice and care can deliver what percentage of
midwifery care?
a. 87%
b. 79%
c. 73%
d. 93%
ANS: A
The UNFPA 2014 study showed that nurse-midwives who obtain the appropriate education and
who are regulated to meet ICM competencies for practice and care can deliver 87% of midwifery
care.
66. Which three countries were the first to officially establish the clinical nurse specialist (CNS)
role?
a. United States, Canada, and Netherlands
b. Canada, United States, and China
c. United States Canada, and United Kingdom
d. United States, Canada, and Australia
ANS: C
The CNS role was first introduced in the United States, Canada, and the United Kingdom in the
1960s due to increasing complexity and specialization of health care as well as increased demand
for clinical expertise, education, and leadership.
67. Which role was first developed in Australia in 1986 and was formed from the United States’
model of the CNS role?
a. Advanced Nurse Practitioner
b. Clinical Nurse Advanced Specialist
c. Clinical Nurse Practitioner
d. Nurse Consultant
ANS: D
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
The Nurse Consultant role exists in Australia, the United Kingdom, and Hong Kong. It was first
introduced in Australia in 1986 and was modeled after the CNS role in the United States.
68. A nurse in Australia obtains clinical experience and expands his or her knowledge and
experience with a master’s degree with a focus on education and training in a specialty area of
medicine. He or she most likely obtains which role?
a. Clinical nurse specialist
b. Advanced Registered Nurse
c. Nurse Consultant
d. Nursing physician assistant
ANS: C
In Australia, the Nurse Consultant role varies in requirements from a hospital certificate to a
master’s degree. The role has different grade levels and increases responsibilities across five
domains.
69. As of the writing of this text, which of the following regions is considered the “next frontier”
of APN role development?
a. China
b. Europe
c. Latin America
d. Africa
ANS: C
Latin America is considered the next frontier of APN role development. This region is an area of
the world where few such roles exist as of the writing of this text. Development of APN roles in
this region is driven by the policies that include: primary health care reform, access to health care,
and universal health care coverage.
70. Which of the following strategies is best to support the development of APN roles at the
international level?
a. Create communities of practice to develop APNs
b. Using evidence-based approaches to role development
c. Build consensus among stakeholders on health systems solutions utilizing APN roles
d. Leverage and share resources for APN education with another country
ANS: D
While all approaches may be beneficial to support role development, leveraging and sharing
resources with another country are most likely to benefit role development internationally. The
other options are most beneficial in the development of APN roles at the country level.
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
71. Which of the following strategies is best to support the initial development of APN roles at the
country level?
a. Showing support for policies of world organizations to prevent out-migration of nursing
leaders and educators
b. Collaborating with another country to understand policy decisions
c. Joining policy discussions to advocate for the APN role
d. Obtaining an advanced nursing practice degree in another country
ANS: C
The initial development of APN roles at country level is multifaceted. The importance of advocacy
for the role to key stakeholders and policymakers is often the first step. The other options are best
suited for development at the international level.
Chapter7 An Overview of U.S. Healthcare Delivery
72. Which of the following is the most essential component to lead clinical staff and programs
effectively as an advanced practice registered nurse?
a. Clinical credibility
b. Appropriate education
c. Years of experience
d. Age
ANS: A
All of the options may attribute to effectively leading clinical staff and programs as an APRN.
Direct care is the central competency of advanced practice nursing and excellence in direct care
requires clinical credibility to lead other clinical staff. Years of experience or age may or may not
be related to direct care. Appropriate education is important for clinical leadership, but clinical
credibility requires experience combined with direct care.
73. An advanced practice registered nurse in an outpatient clinic has a phone conference with a
cardiologist regarding a patient’s condition. This is an example of:
a. Social services
b. Point-of-care encounter
c. Indirect care
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
d. Direct care
ANS: C
This is an example of indirect care of clinical practice. Direct care or direct clinical practice refers
to those activities and functions that the APRN performs within the patient-nurse interface.
74. Which of the following is considered indirect care?
a. Forming a therapeutic relationship during patient examination
b. Discharge planning
c. Consideration of which medication to prescribe a patient
d. Patient education regarding medication side effects
ANS: B
Indirect care or indirect clinical practice refers to those activities and responsibilities that occur
outside of the patient-nurse interface. They may include consultation with other health care
providers, discharge planning, care coordination, communication with insurance companies,
education or supervision of other medical staff, or billing and coding for services rendered. The
other options are examples of direct care.
75. Which of the following is considered direct care?
a. Forming a therapeutic relationship during patient examination
b. Increasing knowledge of a disease process to better care for a complex patient
c. Prior authorization of prescriptions
d. Consultant phone call about patient condition
ANS: A
Direct care or direct clinical practice refers to those activities and functions that the APRN
performs within the patient-nurse interface. Examples of direct care include physical acts of
diagnosis, monitoring, treatment, or direct patient education that occur in the patient-nurse
interface. It can be with the patient or family members. The other options are examples of indirect
care.
76. An APRN is preparing a patient to be discharged from an emergency department. Which of
the following activities is considered direct care?
a. Speaking with the patient’s primary care provider
b. Electronically transmitting prescriptions to pharmacy
c. Discharge planning documentation
d. Discharge patient education
ANS: D
Advanced Practice Nursing: Essential Knowledge for the Profession 3rd Edition Denisco Test Bank
The decision to discharge a stable patient requires that the APRN evaluated the patient and his or
her clinical condition and determined it to be stable; this most likely required direct clinical care
including a physical examination and medical decision making and discharge-related patient
education.
77. An APRN evaluates and modifies his or her clinical practice routines by reading and following
updates and recommendations from various journals and organizations such as the United
States Preventative Task Force (USPSTF). Which characteristic of advanced direct care
practice is the APRN utilizing?
a. Use of reflective practice
b. Use of a holistic perspective
c. Expert clinical performance
d. Use of evidence as a guide for practice
ANS: D
Using evidence as a guide for practice is one ofsix characteristics for advanced direct care practice.
Reading research reports, searching health care databases, acquiring skills to analyze evidence,
and working with colleagues regarding evidence-based improvements in care are all examples of
using evidence as a guide for practice.
78. During a patient encounter the APRN remembers the patient mentioned during a previous visit
that the patient’s child was applying to colleges. The APRN asks which college the patient’s
child chose to attend. Discussing this at the beginning of the patient encounter utilizes what
characteristic of advanced direct care practice?
a. Formation of therapeutic partnerships with patients
b. Expert clinical performance
c. Use of a holistic perspective
d. Use of reflective practice
ANS: A
The formation of therapeutic partnerships with patients is one of six characteristics for advanced
direct care practice. The APRN is effectively using good conversational style to create a strong
therapeutic relationship with the patient. Use of a holistic perspective would only be correct if this
conversation was used in relation to the patient’s care.
79. An APRN starts a patient on a specific medication chosen over a compatible medication due
to a decreased risk of sedation. The medication was chosen becau

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