Chapter 2 - Professional Role Of The AGACNP

Question 1

What is certification?

Answer 1

• does not provide legal authority to practice
• shows that an NP has received the necessary education to provide care at the NP level but does not give the authority to practice

Question 2

State Licensure

Answer 2

• grants the NP authority to practice in that state

- defined by the indivudual state’s practice acts

Question 3

Prescriptive Authority

Answer 3

• in most states, need a state-based license to prescribe
• in most states, need a collaborative agreement with MD to prescribe
• need a DEA number for controlled substances

Question 4

Credentialing

Answer 4

• provides practice authority in a particular institution/health care setting
• defines hospital privileges

Question 5

What is more powerful - input or output?

Answer 5

Output - it is the evidence of the impact of NP practice on a patient population’s health outcomes

Question 6

Evidence Hierarchy - systematic review

Answer 6

• highest level of evidence

- a review of high-quality published research

Question 7

Evidence Hierarchy - randomized controlled trial

Answer 7

• second highest level of evidence
• designed to evaluate a medication or procedure in selected patients. Subjects are divided randomly into groups whose members receive treatment or placebo

Question 8

Evidence Hierarchy - cohort study

Answer 8

• third highest level of evidence
• prospective or retrospective
• a hypothesized association between a variable and outcome are tested. Observe causes of disease and investigate their relationships between risk factors and outcomes

Question 9

Evidence Hierarchy - case-controlled study

Answer 9

• fourth highest level of evidence
• retrospective
• cases (patients with particular condition) and controls (unaffected) who otherwise share specific characteristics. Compares these two groups

Question 10

What is a p-value?

Answer 10

• used for quantitative research to establish correlation
• p-value ≤ 0.5 = reject the null
• p-value > 0.5 = fail to reject the null
• null = what you are trying to disprove
• alternative = what you are trying to prove

Question 11

Evaluation of a p-value

Answer 11

• if p-value is ≤ 0.5, you reject the null and accept the alternative hypothesis
• if p-value is > 0.5, you failed to reject the null and the null hypothesis is true

Question 12

What is the definition of leadership?

Answer 12

A process by which a person influences a group of individuals to reach a common goal; look for the leader to direct activities that have the most wide-reaching influence

Question 13

The AGACNP is speaking to a group of healthcare executives to promote the NP role at a facility. Which of the following provides the strongest support for NP practice?

a. Number of academic credits earned during the NP program
b. NP practice outcomes
c. The quantity of clinical hours and type of clinical rotations in the NP program
d. The professional experience of the person prior to entering the NP program

Answer 13

b. NP practice outcomes

Question 14

Rank the following from highest to lowest level of evidence – case reports, meta-analysis, randomized controlled trials, and expert opinion

Answer 14

1. Meta-analysis
2. Randomized controlled trials
3. Case reports
4. Expert opinions

Question 15

The AGACNP is evaluating a quantitative research study on a new pharmacotherapeutic agent to prevent patients from going through acute alcohol withdrawal. The research question is: “Does this pharmacotherapeutic agent prevent acute alcohol withdrawal in hospitalized patients?” The results of the study indicate that there is a correlation between preventing acute alcohol withdrawal in hospitalized patients and the pharmacotherapeutic agent with a p-value of < 0.05. How should the AGACNP interpret these results?

a. The new agent is not effective in preventing acute alcohol withdrawal
b. The new agent is effective in preventing acute alcohol withdrawal
c. More statistical data are needed prior to reaching a conclusion
d. The research study is biased

Answer 15

b. The new agent is effective in preventing acute alcohol withdrawal

Question 16

The AGACNP is conducting a qualitative research study to evaluate the experience of pain control in patients with end-stage pancreatic cancer. The research question is: “What experiences do end-stage pancreatic cancer patients describe as being associated with their pain control?” How does the AGACNP know they have successfully completed data collection and analysis?

a. A power analysis proves there is a sufficient number of participants for the study
b. The researcher identified that common themes have emerged from the data and no new ideas are emerging
c. The researcher has gathered data from every participated recruited
d. Statistical data show a correlation between end-stage pancreatic cancer and adequate pain control

Answer 16

b. The researcher identified that common themes have emerged from the data and no new ideas are emerging

A is incorrect because: a power analysis is used for quantitative studies

Question 17

The AGACNP demonstrates fulfillment of the advanced practice nursing leadership role by participating in which of the following activities?

a. Teaching a 56-year-old man with newly-diagnosed type 2 diabetes mellitus about the importance of self-glucose monitoring
b. Volunteering to teach a class on contraceptive methods to a group of teen mothers
c. Discussing barriers to achieving BP control with a 65-year-old woman with HTN who “does not want to take any medicine”
d. Collaborating with the regional public health department on an initiative to combat obesity through a community-based exercise program

Answer 17

d. Collaborating with the regional public health department on an initiative to combat obesity through a community-based exercise program

D is correct because: this answer has the most wide-reaching influence

Question 18

A 50-year-old male is admitted to the hospital after suffering a MVC and is diagnosed with a fractured pelvis requiring surgical repair. The medical resident obtains informed consent for the surgical procedure. When the AGACNP enters the room, the patient’s wife states that she is concerned because her husband was given “a sleeping pill” and she is not sure he understood what he has signed. The most appropriate action by the AGACNP would be to:

a. Call the OR and cancel the surgery
b. Discuss the situation with the medical resident
c. Obtain a new OR consent from the patient’s wife
d. Obtain an ethics consult to determine your next action

Answer 18

b. Discuss the situation with the medical resident

Question 19

Which of the following scenarios would constitute malpractice?

a. A 32-year-old female patient who suffers a stroke while undergoing tubal ligation. The AGACNP did not identify any cerebrovascular abnormalities during the pre-op history and physical exam
b. A 16-year-old male who loses consciousness during a school-related baseball game. The patient is found to have profound anemia due to an undiagnosed condition, which is not discovered during a routine sports physical exam
c. A 54-year-old ale who presents to the ER with vague, substernal/epigastric chest pressure and states he has experienced “indigestion” for the last few weeks, which seems to get worse when he cuts his lawn and goas on his daily run. The patient’s symptoms are relieved with rest and calcium carbonate/magnesium carbonate (Mylanta). An EKG was not performed. The patient is discharged home and dies of a fatal MI 6 hours later
d. An 81-year-old female is admitted for IV antibiotic therapy for a UTI and is awake, alert, and oriented. She is instructed by the nursing staff to not get out of bed without assistance and she verbalizes understanding. She is oriented to her room, bed controls, and the call bell is placed next to her within reach. One hour later she attempts to get out of bed, falls, and fractures her hip

Answer 19

c. A 54-year-old ale who presents to the ER with vague, substernal/epigastric chest pressure and states he has experienced “indigestion” for the last few weeks, which seems to get worse when he cuts his lawn and goes on his daily run. The patient’s symptoms are relieved with rest and calcium carbonate/magnesium carbonate (Mylanta). An EKG was not performed. The patient is discharged home and dies of a fatal MI 6 hours later

C is correct because: this answer contains the 3 things that must be in play for there to be malpractice

Question 20

What 3 things must be in play for there to be malpractice?

Answer 20

1. Duty to patient
2. Violation of the standard of care
3. Injury or death happened because of the violation

Question 21

A 37-year-old female patient presents to the ER with a complaint of right foot pain. During your exam of this patient, you notice multiple bruises in various stages of hearing. The patient retracts when you reach out to touch her. When her husband appears in the waiting room, she becomes anxious. The patient reveals to you that he is physically abused by her husband and was raped by him tonight prior to coming in. During the rape, she was struggling and hit her foot. The patient does not want to press charges and wants to return home with her husband after being treated. The AGACNP’s next action is to:

a. Notify the police of the physical assault
b. Place the patient on a 24-hour psychiatric hold
c. Counsel the patient regarding her options
d. Have the patient sign out against medical advice

Answer 21

c. Counsel the patient regarding her options

Question 22

You are preparing a presentation for a local nurse practitioner conference on safe medication prescribing and administration. Which of the following must be included in your presentation as best practices for medication safety (select all that apply):

a. Prescribing using a pre-printed checklist
b. Performing a medication reconciliation at each visit
c. Calling all prescriptions into the pharmacy
d. Utilizing electronic prescribing
e. Handwriting all non-controlled substance prescriptions

Answer 22

b. Performing a medication reconciliation at each visit

d. Utilizing electronic prescribing

Question 23

10. Which of the following statements regarding competency is true?
    a. Impaired judgement deems a patient incompetent
    b. The law presumes all adult patients are competent
    c. A patient is not competent if they are unable to sign informed consent
    d. The patient is only competent if they are awake, alert, and oriented

Answer 23

b. The law presumes all adult patients are competent

B is correct because: the only way to designate someone as incompetent is through a court of law. A psychiatrist can temporarily take it away however

Question 24

11. A 35-year-old male with a 30-year history of type 1 DM presents to the ER awake, alert, and oriented with DKA. You recognize the need for aggressive fluid resuscitation and order an IV catheter to be placed with NS infused rapidly. The patient states, “No, I do not want an IV. I have been sick all of my life and I am just tired. I will drink all of the fluid you want, but I refuse to let you put an IV in me.” Which ethical principles are conflicting in this situation?
    a. Veracity and beneficence
    b. Non-malfeasance and justice
    c. Autonomy and beneficence
    d. Justice and autonomy

Answer 24

c. Autonomy and beneficence

C is correct because: autonomy is making decisions for self and beneficence is to do good/best thing for the patient

A is incorrect because: veracity is being truthful

B is incorrect because: non-malfeasance is doing no harm and justice is making sure the patient gets what they deserve

Question 25

A patient gives a healthcare facility written consent to “take their picture and use it in a billboard ad to promote healthy eating behaviors.” The facility subsequently uses the patient’s picture in another ad to promote condom use for safe sexual practices. You recognize that:

a. This is a violation of the patient’s privacy and the picture cannot be used
b. It is acceptable to use this ad since there is no name on the ad and the patient cannot be identified
c. This is a violation of confidentiality and prohibits the use of this picture
d. The previous consent allows the facility to use the picture in any advertisement

Answer 25

a. This is a violation of the patient’s privacy and the picture cannot be used

Question 26

An 80-year-old female presents to the ER and is unresponsive. The patient’s living will indicates she wants to artificial food or fluid, no IV infusions, no blood products, no CPR or intubation. In addition, the directive states she wants comfort cares only. There is no family or healthcare proxy available. The appropriate course of action would be to:

a. Perform a full history and physical evaluation
b. Admit for neuro checks every shift
c. Order an emergency CT scan of the brain without contrast
d. Refer to hospice care for comfort care measures to be instituted

Answer 26

a. Perform a full history and physical evaluation

D is incorrect because: the patient’s living will is only enacted when the patient has been determined to have terminal illness

Question 27

Which research study would be appropriate to test a medication in a group of carefully-selected patients?

a. Cohort study
b. Case-control study
c. Randomized controlled trial
d. Meta-analysis

Answer 27

c. Randomized controlled trial

A is incorrect because: a cohort study determines associations between variables and outcomes

B is incorrect because: a case-control study compares for risk factors

Question 28

An AGACNP recently accepted a position at a local hospital on the general medicine service. As part of the terms of employment, the hospital offers participation in their claims-made malpractice insurance policy. The AGACNP understands that this type of insurance:

a. Covers a claim only if the insurance policy is in effect when the claim is made
b. Covers any incident that occurs while the policy is in effect
c. Covers any incident that occurs up until the end of the statute of limitations
d. Is the most expensive form of malpractice insurance

Answer 28

a. Covers a claim only if the insurance policy is in effect when the claim is made

B is incorrect because: it is describing an Occurrence Based Policy (if the policy was in effect when the claim took place, you’re covered even if the policy is no longer active)

D is incorrect because: Claims-made policies are the cheapest

Question 29

An AGACNP who was working at FHEA Regional Medical Center has decided to relocate to another state and has resigned from this facility. During their employment, the AGACNP had a claims-made malpractice insurance policy. Which type of coverage will protect the AGACNP from any incidents filed from their time at this facility until the end of the statute of limitations?

a. A new occurrence-based policy
b. A new extended-agreement policy
c. A new claims-made policy
d. A new tail coverage policy

Answer 29

d. A new tail coverage policy

D is correct because: this type of policy extends the life of a claims-made policy up until the end of the statue of limitations (also the most expensive)

B is incorrect because: this policy type doesn’t exist

C is incorrect because: it must be the same policy as when the claim took place

Question 30

The AGACNP is caring for a 75-year-old male patient who was admitted to the hospital with intractable lower back pain. The patient was subsequently diagnosed with end-stage pancreatic cancer. The patient’s son asks you to not tell the patient about the diagnosis. He is afraid this information will hasten his death and cause him too much anxiety. He would rather his father die peacefully. When you enter the patient’s room, the patient asks you to tell him what the results of the testing concluded. The most appropriate action would be to tell the patient:

a. He will need to speak with the attending physician
b. You are still evaluating his results
c. He has end-stage pancreatic cancer
d. He has a lump on his pancreas, but it is nothing to worry about right now

Answer 30

c. He has end-stage pancreatic cancer

C is correct because: you are upholding the ethical principle of veracity (to tell the truth)

Question 31

Which of the following nurse practitioners would be eligible to obtain a DEA number?

a. A certified AGACNP by the ANCC or AACN
b. A licensed AGACNP in a state granting controlled substance prescriptive authority
c. Any AGACNP who has a national provider identification (NPI) number
d. Any AGACNP who has completed 30 hours of controlled substance training in their state

Answer 31

b. A licensed AGACNP in a state granting controlled substance prescriptive authority

B is correct because: you have to be licensed in a state that grants you authority to prescribe controlled substances to receive a DEA number

Question 32

The nurse educator of the cardiovascular ICU asks the unit’s AGACNP to provide a monthly educational session for the registered nurses on the unit. Which of the following is the most effective method of determining the topics for these educational sessions?

a. Perform a survey of the registered nurses to determine the topics they are most interested in learning about
b. Review quality indicators of patient care and develop topics based on quality indicators in need of improvement
c. Develop topics based on commonly performed procedures by registered nurses on the unit
d. Randomly select topics based on the content outline for the cardiovascular nurse certification exam

Answer 32

b. Review quality indicators of patient care and develop topics based on quality indicators in need of improvement

Question 33

Which of the following practice settings best reflects the role and population of the AGACNP?

a. A family medicine-based practice
b. A rural health care clinic
c. A cardiology office
d. A long-term care facility

Answer 33

c. A cardiology office

C is correct because: this is most reflective of the population the AGACNP would be taking care of

Question 34

A particular state is introducing legislation to allow nurse practitioners full practice autonomy. Which of the following would be the most effective method for the NP to advocate for this legislation?

a. Writing a letter to the local legislator
b. Attending a public rally promoting nurse practitioner autonomy
c. Joining a state level professional nurse practitioner association
d. Meeting with the state legislators and providing evidence of NP-based outcomes

Answer 34

d. Meeting with the state legislators and providing evidence of NP-based outcomes

D is correct because: it is all about outcomes