Advanced Practice Role

Question 1

If the two broad-based goals of Healthy People 2010 are met, the nation will:

a) increase quality and years of healthy life span and eliminate health disparities
b) Increase healthy life span, increase access, and improve economics related to health for all Americans
c) increase healthy life span, reduce health disparities, and improve economics related to the health of all Americans
d) reduce health disparities, increase access to healthcare services, and make life more socially acceptable for all Americans

Answer 1

a) increase quality and years of healthy life span and eliminate health disparities

Question 2

Which of the following objectives from Healthy People 2000 has not made progress towards achieving its targeted goal?

a) low birth weight
b) infant mortality
c) fetal mortality
d) screening for genetic disorders

Answer 2

a) low birth weight

Question 3

Preventive health guidelines include references to:

a) immunizations, health screening, disease prophylaxis, and education
b) Immunizations, counseling, health screening, disease prophylaxis, and education
c) health screening, disease prophylaxis, counseling, and CPR
d) health screening, disease prophylaxis, education, immunizations, and CPR

Answer 3

b) Immunizations, counseling, health screening, disease prophylaxis, and education

Question 4

Nursing’s Agenda for Health Care Reform:

a) is supportive to equal access, cost effective, high quality care
b) is a mandate to all nurses in the US
c) Is a summary of nursing research related to healthcare reform
d) is a report of the status or nursing in the 1990’s

Answer 4

a) is supportive to equal access, cost effective, high quality care

Question 5

The nurse practitioner role was initially established to:

a) improve access to care and partially solve physician shortage
b) reduce the nursing shortage and improve access to care
c) improve working conditions of nurses while improving access to care
d) improve nursing’s image through expansion of the role

Answer 5

a) improve access to care and partially solve physician shortage

Question 6

Early nursing research focused on:

a) the response of policy makers to the nursing shortage
b) the effectiveness of the NP as a primary care giver
c) an effort to demonstrate quality and cost effectiveness of NP
d) the role of the NP as a physician extender

Answer 6

c) an effort to demonstrate quality and cost effectiveness of NP

Question 7

Which of the following is not a major factor influencing healthcare delivery services?

a) provider
b) payers
c) insurers
d) agencies

Answer 7

d) agencies

Question 8

All definitions of primary healthcare include:

a) the concept of universal access and accountability
b) the concept of universal access and AIDS prevention
c) the concept of universal access and a focus on self-responsibility for health
d) the concept of universal access and a focus on reimbursement for services rendered

Answer 8

a) the concept of universal access and accountability

Question 9

Standards of practice are:

a) authoritative statements used to measure quality
b) used to measure outcome but are not authoritative
c) designed for legal purposes
d) not designed for legal purposes and cannot be used to measure quality

Answer 9

a) authoritative statements used to measure quality

Question 10

Quality improvement activities include:

a) patient satisfaction surveys only
b) peer review, patient satisfaction surveys, chart audits
c) defining four practice domains
d) systems to decrease risk of injury to patients

Answer 10

b) peer review, patient satisfaction surveys, chart audits

Question 11

Most risk management programs are based on the assumption that:

a) many injuries to patients are preventable
b) most legal liability is a result of poor documentation
c) most injuries to patients are not preventable
d) malpractice insurance is generally unnecessary

Answer 11

a) many injuries to patients are preventable

Question 12

If an APRN practices beyond his/her scope:

a) malpractice insurance will protect him/her from a charge of practicing medicine without a license
b) malpractice insurance will not protect him/her from a charge of practicing medicine without a license
c) he or she is legally accountable to the certifying body
d) the collaborating physician is legally accountable to the certifying body

Answer 12

b) malpractice insurance will not protect him/her from a charge of practicing medicine without a license

Question 13

Standards of practice may be used to:

a) establish minimal levels of performance
b) establish reimbursement schemes
c) mandate nursing practice across the nation
d) mandate nursing practice in certain states

Answer 13

a) establish minimal levels of performance

Question 14

Scope of practice:

a) is identical across the states
b) is determined by the federal government
c) is mandated by the federal government
d) varies from state to state

Answer 14

d) varies from state to state

Question 15

Medicaid provides health insurance coverage to:

a) certain categories of people whose personal income falls below the federal poverty level
b) anyone whose personal income falls below the federal poverty level
c) newborns, pregnant women, and those over 65 whose personal income falls below the federal poverty level
d) those who are elderly

Answer 15

a) certain categories of people whose personal income falls below the federal poverty level

Question 16

Medicaid reimbursement is available to an APRN:

a) practicing in federally designated areas
b) at a rate that is between 70% and 100% of the physician rate
c) only if the APRN is in collaborative practice with a physician
d) practicing in nursing homes only

Answer 16

b) at a rate that is between 70% and 100% of the physician rate

Question 17

Medicare reimbursement for services:

a) is not dependent on the patient’s income level
b) depends on the patient’s income level
c) is not available to APRN under any circumstances
d) is only available to APRN who is in collaborative practice with a physician

Answer 17

a) is not dependent on the patient’s income level

Question 18

Medicare Part A covers:

a) hospital, SNF, and hospice care
b) all medically necessary services
c) SNF care only
d) hospice care only

Answer 18

a) hospital, SNF, and hospice care

Question 19

Medicare Part B covers:

a) all medically necessary services
b) inpatient hospital care only
c) outpatient physician services only
d) SNF and hospice care

Answer 19

a) all medically necessary services

Question 20

To receive Medicare reimbursement, APRN must:

a) be nationally certified and maintain prescriptive privileges
b) maintain a current license in the state in which they are practicing
c) practice in a designated medially under-served area
d) practice with a physician

Answer 20

b) maintain a current license in the state in which they are practicing

Question 21

The term “incident to” refers to:

a) the occasions when an APRN practices independently but occasionally consults with a physician
b) the notion that the physician must be present in the office suite and immediately available to provide assistance in order for the APRN to bill for services rendered
c) the notion that a physician must examine the patient along with the APRN if Medicare is to be billed for services rendered
d) Medicaid only and is not pertinent to Medicare billing

Answer 21

b) the notion that the physician must be present in the office suite and immediately available to provide assistance in order for the APRN to bill for services rendered

Question 22

“Incident to” billing is specific to:

a) Medicare
b) Medicaid
c) Medicare and Medicaid
d) Private insurance companies

Answer 22

a) Medicare

Question 23

The Civilian Health and Medical Program of the United States (CHAMPUS):

a) is a federal health plan which covers health care for military personnel and their families and recognizes APRN as reimbursable provider
b) is a federal health plan which covers health care for military personnel and recognizes APRN as reimbursable provider
c) does not recognize APRN as reimbursable provider
d) only covers hospital expenses for military personnel and their families

Answer 23

a) is a federal health plan which covers health care for military personnel and their families and recognizes APRN as reimbursable provider

Question 24

The knowledge base of the APRN is based on:

a) medical content
b) theoretical content
c) scientific content and theory
d) theory and research

Answer 24

c) scientific content and theory

Question 25

The role of the APRN has traditionally focused on:

a) the delivery of primary health care to all people
b) the delivery of acute health care to all people
c) chronic care
d) the medical model

Answer 25

a) the delivery of primary health care to all people

Question 26

The nurse practitioner role began:

a) with the establishment of a pediatric nurse practitioner program in an effort to expand the role of the RN in order to meet the needs of the children of the nation
b) as a result of the new entitlement programs, Medicare and Medicaid
c) when it was evident that the medical schools across the US could not prepare enough family practitioners to meet the nation’s needs
d) as an experimental program at Duke University

Answer 26

a) with the establishment of a pediatric nurse practitioner program in an effort to expand the role of the RN in order to meet the needs of the children of the nation

Question 27

Legal authority for APRN practice is granted by:

a) federal law
b) regulations from the Department of Health and Human Services
c) state law and regulations
d) the Board of Medicine in most states

Answer 27

c) state law and regulations

Question 28

Direct reimbursement to APRN has resulted in:

a) increased access to cost-effective, quality primary care
b) increased malpractice claims against APRN
c) decreased consumer choice of healthcare providers
d) proliferation of APRN in independent practice

Answer 28

a) increased access to cost-effective, quality primary care

Question 29

Malpractice insurance:

a) protects an APRN from charges of practicing medicine without a license when they are practicing outside their scope
b) does not protect an APRN from charges of practicing medicine without a license when they are practicing outside their scope
c) does not pay for legal defense if the APRN is practicing beyond the legal scope
d) is important, but should not be purchased if the facility in which the APRN is employed carries good coverage

Answer 29

b) does not protect an APRN from charges of practicing medicine without a license when they are practicing outside their scope

Question 30

Collaborative practice:

a) limits autonomy and not reasonable in current managed care environment
b) will enhance quality of care and improve patient outcomes
c) will limit consumer choice of providers
d) excludes the concept of interdisciplinary teams

Answer 30

b) will enhance quality of care and improve patient outcomes

Question 31

Case management:

a) balances quality and cost of patient care
b) has not been found to be cost effective
c) decreases the autonomy of the APRN
d) is rarely used today

Answer 31

a) balances quality and cost of patient care

Question 32

The major trend in health policy research today is:

a) outcome studies
b) primary care studies
c) studies that compare practice strategies of MD and NP
d) studies that compare patient satisfaction with care delivered by MD versus NP

Answer 32

a) outcome studies

Question 33

Current prescriptive authority for APRN:

a) varies among the states
b) is fairly consistent among the states
c) provides DEA numbers for APRN
d) allows APRN to move freely from state to state

Answer 33

a) varies among the states

Question 34

Managed care is a term that describes:

a) an established system of healthcare delivery that is mandated by the federal government
b) a network of providers who contract to provide services for a specific group of enrollees
c) a system that does not recognize APRN as a primary provider
d) a network of hospitals and nursing homes that provide care to chronically ill people

Answer 34

b) a network of providers who contract to provide services for a specific group of enrollees

Question 35

Certification is:

a) a procedure through which the government appraises and grants certification to the APRN
b) granted by the individual states
c) governed by each state’s board of nursing
d) a process in which a nongovernmental agency or group verifies that an APRN has met certain predetermined standards for specialty practice

Answer 35

d) a process in which a nongovernmental agency or group verifies that an APRN has met certain predetermined standards for specialty practice

Question 36

Licensure:

a) is a federal process that is used to standardize healthcare facilities
b) is granted by a state government agency and grants permission to engage in the practice of a given profession
c) cannot be used to prohibit anyone from practicing a given profession
d) is a federal process that is used to standardize educational programs

Answer 36

b) is granted by a state government agency and grants permission to engage in the practice of a given profession

Question 37

Reimbursement under managed care:

a) requires that the provider accept the financial risk for the care provided to a specific population of enrolled patients
b) requires that the managed care organization accept the financial risk for the care provided to a specific population of enrolled patients
c) does not reward efficient care delivery
d) is not available to APRN

Answer 37

a) requires that the provider accept the financial risk for the care provided to a specific population of enrolled patients

Question 38

An integrated delivery system:

a) is one that delivers high quality care but is often not cost effective
b) delivers a vertical integration of services with capitated payment
c) does not include rationing of resources
d) does not include a capitated payment scheme

Answer 38

b) delivers a vertical integration of services with capitated payment

Question 39

The APRN Consensus Model is:

a) a mandate from the NCSBN that defines advanced practice nursing
b) a proposed regulatory model for advanced practice nursing
c) a proposal for federal legislation for advanced practice nursing
d) approved only by the American Nurses Association

Answer 39

b) a proposed regulatory model for advanced practice nursing

Question 40

Which of the following is true with regard to advanced practice licensure?

a) It is granted by some states based on specialty certification
b) it will guarantee reimbursement
c) it may be obtained on a national basis
d) it is a federal process verifying that a PNP has met standards for specialty practice

Answer 40

a) It is granted by some states based on specialty certification

Question 41

A PNP may obtain certification from the PNCB and which other association?

a) American College of Nurse Practitioners
b) American Academy of Nurse Practitioners
c) American Nurses Credentialing Center
d) American Nurses Association

Answer 41

c) American Nurses Credentialing Center

Question 42

According to the Consensus Model for APRN regulation, which of the following is most consistent with the definition of Advanced Practice Registered Nursing?

a) optional national certification
b) a significant component of education and practice focuses on direct care of individuals
c) accountability excludes prescription of pharmacologic and nonpharmacologic intervention
d) level of role autonomy is unchanged

Answer 42

b) a significant component of education and practice focuses on direct care of individuals

Question 43

The granting of authority to practice is known as:

a) credentialing
b) accreditation
c) licensure
d) regulation

Answer 43

c) licensure

Question 44

Payment by capitation means that:

a) financial risk is shifted from payers to providers
b) care is provided on a fee-for-service basis
c) care resources are rationed
d) target populations have unlimited access to health care

Answer 44

a) financial risk is shifted from payers to providers

In capitation, providers are responsible for a target population for which they receive and age and gender adjusted budget.

Question 45

Which of the following is the purpose of certification?

a) to review and approve educational degree programs in nursing
b) to assure the public that an individual has mastered a body of knowledge and acquired skills in a particular body of knowledge
c) all of the above
d) none of the above

Answer 45

b) to assure the public that an individual has mastered a body of knowledge and acquired skills in a particular body of knowledge

Question 46

The mobilization, monitoring, and control of resources used by a patient over the course of an illness is called:

a) case management
b) quality improvement
c) quality assurance
d) risk management

Answer 46

a) case management

Question 47

Managed care plans may be certified by which of the following?

a) centers for Medicare and Medicaid services
b) department of health and human services
c) national institutes of health
d) national committee for quality assurance

Answer 47

d) national committee for quality assurance

The NCQA certifies managed care plans utilizing a set of performance measures known as Health Plan Employer Data and Information Sets (HEDIS)

Question 48

Prescriptive writing privileges:

a) require a formal collaborative relationship with a physician
b) are regulated by both boards of nursing and medicine
c) vary according to state statutes
d) are granted upon certification

Answer 48

c) vary according to state statutes

Question 49

Systematically developed statements to assist practitioner and patient about appropriate care for specific clinical outcomes are called:

a) clinical practice guidelines
b) benchmarking
c) protocol requirements
d) written collaborative agreement

Answer 49

a) clinical practice guidelines

Question 50

A main goal of continuous quality improvement is to:

a) incorporate norms, criteria, and standards as evaluative measures
b) emphasize outcome measures in addition to structure and process
c) promote evaluation based on peer review, audits, and chart reviews
d) inform that quality assurance is more than a periodic evaluation of performance

Answer 50

d) inform that quality assurance is more than a periodic evaluation of performance

Continuous quality improvement is considered to be an integral (not just periodic) part of the organization.

Question 51

In documenting quality care, patient satisfaction is considered to be what type of measure?

a) structural
b) process
c) outcome
d) cost containment

Answer 51

c) outcome

Question 52

Political activism through lobbying is an example of what type of change strategy?

a) normative reeducative
b) empirical rational
c) power-coercive
d) confrontational

Answer 52

c) power-coercive

Question 53

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program describes a comprehensive set of healthcare services provided by:

a) private insurance
b) state child protection teams
c) Medicaid
d) most managed care organizations

Answer 53

c) Medicaid

Question 54

Scope of practice statements:

a) are prepared by national professional organizations
b) provide the basis for reimbursement policies
c) are written by employers
d) may vary from state to state

Answer 54

d) may vary from state to state

Scope of practice statements are prepared by national professional organizations and may go beyond what is legally allowable in a given state.