Test Bank For Hamric and Hanson's Advanced Practice Nursing, 6th Edition

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Advanced Practice Nursing, 6thEdition TESTBANKChapter 1: Highlights from the History of Advanced Practice Nursing in the United StatesTest BankMultiple Choice1.In which year did the American Association of College of Nursing (AACN) introduced theDoctorate of Nursing Practice (DNP)?a.2006b.2004c.2000d.2002ANS:BThe AACN introduced the DNP degree in 2004 to prepare advanced practice nurses (APRNs) tomeet 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 NursingPractice (DNP) degree?a.To compete against master’s degree programsb.To ensure standardized curriculum ensuring independent practicec.To validate APRN’s for financial reimbursementd.To address increasing curriculum requirements of master’s degree programsANS:DAlthough all answers are influenced by the DNP core competencies, the DNP program creation in2004 by the 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 Specialistb.Family nurse practitionerc.Pediatric nurse practitionerd.Certified Registered Nurse Anesthetist

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ANS:DIn 1931, the National Association of Nurse Anesthetists (NANA), renamed in 1939 to theAmerican Association of Nurse Anesthetists (AANA) was the first recognized group promotingadvancednursing practice.Agatha Hodginsfounded the AANM atLakeside Hospital inCleveland, Ohio.4.Which factor is broadly perceived to solidify and standardize the role of the APNs over the last25 years?a.Lack of access to health care providersb.Standardized curriculum developmentc.Payment for servicesd.Societal forcesANS:BAs the evolution of Advanced Practice Nursing advances specific specialties and needs areidentified. Through the evolution of organization and standardization these roles have solidifiedthe APN’s role in today’s health care environment.5.During the formation of early APN roles in anesthesia, which of the following increaseddemand for access to health care?a.Povertyb.Warc.Rural access to cared.Availability of trainingANS:BEarliest demand for nursing-provided anesthesia spiked during periods of war when numbers ofphysicians were inadequate. The earliest records date back to the American Civil War with theadministration of chloroform. During World War I in 1917 more than 1000 nurses, some trainedanesthetists, traveled into battle. Other factors such as need for rural health care came later in thevalidation 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 ofthe following roles?a.Pediatricsb.Anesthesiac.Obstetricsd.Research and statisticse.Family nursing

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ANS:BIn 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 Henry Street Settlement (HSS) House for which purpose?a.Access to health care of rural areasb.Create inner-city nursing awarenessc.Provide the disadvantaged access to cared.Establish guidelines for advanced nursing rolesANS:CThe HHS was established to provide nursing services to immigrants and low-income patients andtheir families in Manhattan. As resistance to nurse-provided care grew, standing orders weredrafted from a group of Lower East Side physicians thereby circumventing then-existing legalramifications.8.The Frontier Nursing Service (FNS) founded in Kentucky in 1925 by Mary Breckenridgeinitially provided Appalachia with nursing resources and which type of advanced nursing care?a.Pediatric careb.Anesthesiac.Midwiferyd.Surgical servicesANS:CThe original FNS provided nursing services and obstetric services to Appalachian residents. Laterworking from standard orders developed from their medical advisory committee nurses treatedpatients, made diagnoses, and dispensed medications.9.Which organization founded in 1941 under Mary Breckenridge’s leadership merged with theAmerican 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:AThe American College of Nurse-Midwives (ACNM) formed under the leadership of MaryBreckenridge in 1941 to provide nurse-midwife development and collaboration for midwife

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development. In 1955, the American College of Nurse-Midwives was formed and the twoorganizations 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 actb.Nurse anesthesia scope of practice included anesthesiac.Nurse anesthesia was legal, if under guidance of a supervising physiciand.Only trained nursing professionals could administer anesthesia independentlyANS:CThe landmark decision from the Chalmers-Frances v. Nelson case set national precedent for theadvanced nursing practice role. It proved to be the basis for other cases over the following fewdecades and established that trained nurses could legally provide anesthesia care under supervisionof a physician.11.The first known establishment of the nurse practitioner role occurred in 1965 at the Universityof Colorado. In which area of training did this role specialize?a.Pediatricsb.Geriatricsc.Midwiferyd.AnesthesiaANS:AThe establishment of the first pediatric nurse practitioner program was in 1965 at the Universityof Colorado. Loretta Ford, RN and Henry Silver, MD provided a 4-month course to certifiedregistered nurses to provide education on managing childhood health problems.12.The DNP program curriculum outlined which of the following clinical requirements in aneffort to standardize training?a.1000 supervised clinical hours and 200 unsupervised clinical hoursb.1000 supervised clinical hoursc.900 supervised clinical hoursd.800 supervised clinical hours and 200 unsupervised clinical hoursANS:BIn 2004, the AACN outlined the DNP curriculum in an effort to standardize and relieve challengesof master’s degree programs. This includes a standardized curriculum requiring 1000 supervisedclinical hours.

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13.Which state became the first to recognize diagnosis and treatment as part of the scope ofpractice of specialty nurses?a.Idahob.Oklahomac.South Dakotad.MarylandANS:AIdaho Governor Cecil Andrus signed HB 46 and HB 207 into law on February 11, 1971. Thisamended the states’ nurse practice act making it the first state to officially recognize diagnosis andtreatment of specialty nurses. The recognition of the ability to diagnose and treat overcame aninitial hurdle toward independent nursing practice.14.The American Nursing Association (ANA) defines which requirement for the designation of aclinical nurse specialist in any specialty?a.Specialty training certificateb.Successful completion of certification examinationc.Masters or doctoral degreed.1000 hours relevant supervised traininge.Two or more years of clinically relevant experienceANS:CIn 1980, the ANA specifically outlined criteria for the acknowledgment of clinical nurse specialisttraining programs. At that time they required graduate level training to become an expert in arelevant specialty area of nursing. Additionally, they must meet any requirements set forth by thespecific professional society.Tracy: Hamric & Hanson's Advanced Practice Nursing, 6thEditionChapter 2: Conceptualizations of Advanced Practice NursingTest BankMultiple Choice15.Which of the following is the primary mission of the National Organization of NursePractitioner Faculties (NONPF)?a.Provide leadership in promoting quality NP educationb.NP Faculty training program assistancec.Provide financial assistance to NP studentsd.Lobbying legislature on behalf of NPs

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ANS:AThe NONPF’s primary mission is to provide leadership in promoting quality NP education. Theorganization has published domains and core competencies for primary care and these serve as aframework for NP education and practice.16.A model of competencies that are encompassed around three spheres of influence known aspatient, nurses and nursing practice, and organization and influence is known as?a.NACNS Model of clinical nurse specialist competenciesb.Fenton’s and Brykczynski’s Expert Practicec.Calkin’s model of Advanced Nursing Practiced.Shuler’s Model of NP PracticeANS:AThe NACNS’s initial 2008 statement was revised in 2004. The statement outlined competenciesthat aligned to each of the three spheres of influence: patient, nurses and nursing practice, andorganization and influence.17.Building upon Benner’s seven domains of expert nursing practice, which conceptual modeladds an additional domain “The consulting role of the nurse”?a.Calkin’s model of Advanced Nursing Practiceb.Fenton’s and Brykczynski’s Expert Practicec.Strong Memorial Hospital’s Model of Advanced Nursing Practiced.Shuler’s Model of NP Practicee.NACNS Clinical Nurse Specialists ModelANS:BFenton’s and Brykczynski’s Expert Practice Domains of the CNS and NP expanded on Benner’sseven domains adding consultation provided by CNS’s to other nurses and management of healthand illness in ambulatory care settings.18.Which model of conceptual practice was the first to explicitly distinguish the experience levelof advanced practitioners?a.Calkin’s model of Advanced Nursing Practiceb.Shuler’s Model of NP Practicec.NACNS Clinical Nurse Specialists Modeld.Strong Memorial Hospital’s Model of Advanced Nursing Practicee.Fenton’s and Brykczynski’s Expert PracticeANS:A

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Calkins model of Advanced Nursing Practice was the first to explicitly distinguish experiencelevels of advanced practitioners for nurse administrators to differentiate advanced practice nursingfrom other levels of clinical practice.19.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 ofwhich advanced nursing conceptual model?a.Strong Memorial Hospital’s Model of Advanced Nursing Practiceb.Calkin’s model of Advanced Nursing Practicec.NACNS Clinical Nurse Specialists Modeld.Fenton’s and Brykczynski’s Expert Practicee.Shuler’s Model of NP PracticeANS:ADirect and indirect activities across five domains including: direct comprehensive patient care,support of systems, education, research, and publication and professional leadership make up theStrong Memorial Hospital’s Model of Advanced Practice Nursing.20.Texas Children’s Hospital Transformational Advanced Professional Practice (TAPP) APRNModel added what unifying conceptual strand?a.Ethicsb.Culturec.Informaticsd.EducationANS:AThe TAPP model added two additional domains: quality and safety, and credentialing andregulatory practice, to the Strong model. It additionally added professional ethics as a unifyingconceptual strand.21.Poghosyan, Boyd, and Clarke (2016) proposed a comprehensive conceptual model includingthree factors: scope of practice regulations, institutional policies, and practice environments.What was their primary purpose?a.To discourage role ambiguity among CNS providersb.To enhance patient education provided by the APRNc.To maximize NP Contributions to primary cared.To provide educational practice guidelines to enhance NP educationANS:C

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The 2016 model provided a comprehensive review of literature and described potential factors thataffect NP care and patient outcomes. This included scope of practice regulations that often causebarriers for NP provided primary care.22.Which model of practice intended to impact the NP domain at four levels: theoretical, clinical,educational, and research in 1993?a.Hamric’s modelb.Calkin’s model of Advanced Nursing Practicec.Strong Memorial Hospital’s Model of Advanced Nursing Practiced.Shuler’s Model of NP PracticeANS:DShuler’s Model of NP Practice is a holistic and wellness oriented model that was designed toimpact the NP domain at four levels: theoretical, clinical, educational, and research. It is designedto elaborate the NP’s expanded knowledge and skills into medicine including a template forconducting a visit.23.Which model for APRN practice addresses all four APRN roles: CNS, CRNA, CNM, and NP?a.Calkin’s model of Advanced Nursing Practiceb.Hamric’s modelc.Strong Memorial Hospital’s Model of Advanced Nursing Practiced.Donabedian ModelANS:BMany models highlight core competencies among specific APRN roles, while others emphasizecompetencies for hiring managers. At the time of this writing, only the Hamric’s modelencompasses all four APRN roles.24.Which of the following is one of the eight published essentials included in the Essentials ofDoctoral Education for Advanced Nursing Practice developed by the AACN in 2006?a.Algorithms for advanced patient careb.Informatics and health care technologiesc.Scientific underpinnings of practiced.Liberal education for general nursing practiceANS:CThe AACN publishes their national consensus to provide the core elements for nursing curriculumcreation. 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.

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25.Which model of conceptualization identifies that health care needs are not met in a systemdominated by medical language as a basis for reimbursement?a.Donabedian Modelb.Dunphy and Winland-Brown’s Circle of Caring modelc.Shuler’s Model of NP Practiced.Calkin’s model of Advanced Nursing PracticeANS:BDunphy 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 andenhance the nursing presence in the health care system. Their model incorporates both strengthsof medicine and nursing with process of assessment, planning, intervention, and evaluation, witha feedback loop.26.Without additional application of conceptual models which model would be best chosen tomodel the skill level of beginning nurses, experienced nurses, or advanced nurse practitionerswith the appropriate level of patient care?a.Dunphy and Winland-Brown’s Circle of Caring modelb.Strong Memorial Hospital’s Model of Advanced Nursing Practicec.Donabedian Modeld.Calkin’s model of Advanced Nursing PracticeANS:DCalkin’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 careproblems.27.The 2005 Donabedian model has been used to evaluate the quality of APRN care using whichconceptual outline?a.Assessment, diagnosis, planning, intervention, and evaluationb.Structure, process, and outcomec.Diagnosis and outcomed.Diagnosis, morbidity, and mortalityANS:DThe Donabedian model encompasses structure (health care systems and facilities), process(diagnosis, treatment, education), and outcomes.

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28.Which of the following are the functions of a conceptualization of advanced practice nursing?(Select all that apply.)a.Basis for furthermore development of knowledgeb.Articulate professional role identity and functionc.Identify specific procedures to provided.Deliver holistic and collaborative caree.Provide guidelines on billingANS:A, B, DConceptual models allow for articulation of professional role identity, provide a basis forfurthermore 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 assistancewith clinical decision making or billing.Tracy: Hamric & Hanson's Advanced Practice Nursing, 6thEditionChapter 3: A Definition of Advanced Practice NursingTest BankMultiple Choice29.A registered nurse completes an informal education and training course at his or her place ofwork authorizing him or her to use ultrasound guided imagery when placing intravenous lines.How is this best classified?a.Advanced practice nursingb.Nursing Skill Advancementc.Advanced Licensured.Advanced CertificationANS:BThe addition or advancement of individual skills to the nursing practice is common and encouragedbut does not meet the requirements set forth for advanced practice nursing. Licensure andcertification were not obtained or expressed.30.The core foundations of all APN education curricula contain advanced courses covering whichof the following?a.Human anatomy, health and physical assessment, and pharmacologyb.Pathophysiology, research, and pharmacologyc.Health and physical assessment, pathophysiology, and obstetrics and gynecologyd.Pathophysiology, health and physical assessment, and pharmacology

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ANS:DWhile specific specialties may focus on individual areas of clinical knowledge, all aspects ofadvanced practice nursing include advanced knowledge of pathophysiology, health and physicalassessment, and pharmacology.31.Which of the following criteria is required for the attainment of classification as an advancedpractice nurse (APN)?a.Practice focused on researchb.Baccalaureate degree in area of focusc.Specialized skill attainmentd.Graduate degree in area of focusANS:DThe three basic criteria or qualifications for APNs include graduate education in advanced practicenursing role, national certification in an advanced role, and a practice focused on patients and theirfamilies. Research and skills are components of core competencies of advanced practice nurseswho achieve a graduate level of education.32.Which of the following is the central, core competency for advanced practice nursing?a.Evidence-based practiceb.Direct clinical practicec.Leadershipd.Ethical decision makingANS:BDirect clinical practice is the core competency that lends itself to all others. It also provides thefoundation for APNs to carry out the other competencies adequately.33.The legal authority granted to a professional to provide and be reimbursed for health careservices refers to:a.Certificationb.Scope of practicec.Practicing Roled.EducationANS:BMany things including state and federal laws define scope of practice. The APN NCSBN definesscope of practice as characterized by specialization, expansion of services provided, including

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diagnosing and prescribing, and autonomy to practice. An individual certification would fall underthe umbrella of scope of practice.34.Which of the following most accurately describes the current four established advancedpractice nurse roles?a.RN, BSN, MSN, DNPb.CNM, FNP, CNS, CRNAc.CNM, FNP, AGNP, PNPd.CNS, CRNA, NP, CNMANS:DThe four established advanced practice nurse roles include CNS, CRNA, CNM, and NP. FNP andAGNP are specializations of nurse practitioners (NP).35.Which advanced practice nursing role has seen the largest expansion of growth and is currentlythe largest in number?a.CNSb.CRNAc.CNMd.NPANS:DNurse practitioner continues to be the largest in number of APN roles. According to the AmericanAcademy of Nurse Practitioners National NP Database there are over 220,000 trained NPs.36.Which advanced practice nursing role is currently the smallest in number?a.CNMb.NPc.CNSd.CRNAANS:AThe CNM role according to the American College of Nurse-Midwives currently has around 11,000trained providers based on current estimates. The CNM role is specialized in the care of women’shealth and childbearing.37.A practicing, certified CNM wishes to change roles and work as a family nurse practitioner(FNP). Which of the following is required?

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a.Complete education and training as an NPb.Take the FNP board examinationc.Nothing is requiredd.Apply for immediate reciprocityANS:AThe four roles of APN (CNS, CRNA, CNM, and NP) are not interchangeable without additionaltraining and education. Although there are specific instances of overlap, each of the four rolesshould not be confused as interchangeable. Specialty certifications under the NP role may allowfor more flexibility under today’s regulations and are not standard practice. Scenarios are usuallyhandled on an individual basis.38.True or False. A registered nurse in an emergency room successfully completes a critical carecourse and meets all requirements for certification. He or she is now classified as an advancedpractice nurse.a.Trueb.FalseANS:BThis registered nurse has completed advanced training that increases skill and knowledge and mayhave also obtained a certification; however, this does not meet the basic criterion of advancedpractice nurse. He or she may be expertly skilled but requires the completion of a graduate degreefocused in an area of nursing to appropriately be classified as an APN. The acute care nursepractitioner specialty would be required in this particular setting.Tracy: Hamric & Hanson's Advanced Practice Nursing, 6thEditionChapter 4: Role Development of the Advanced Practice NurseTest BankMultiple Choice39.In 1990, Cooper and Sparacino postulate than an APRN’s maximum potential may not beattained until:a.After 1 yearb.After 7 yearsc.After 3 yearsd.After 5 yearsANS:D

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Studies have shown that the first-year position of an APRN is one of transition, and Cooper andSparacino estimate that an APRN’s maximum potential may not be attained until after 5 years ormore in practice.40.An NP student is performing a thorough neurologic examination for the first time in the clinicalsetting. This is an example of:a.Role implementationb.Role acquisitionc.Role confusiond.Role conflictANS:BThe changes occurring during role transitions experienced during the educational component ofan APN role are classified as role acquisition. Additionally, role transition is described as when anAPRN begins to practice for the first time in a new role.41.A new NP student is completing a rotation at an outpatient urgent care clinic and completes anexamination on a patient with chest pain. The nursing assistant hands a 12-lead ECG to the NPstudent and asks: “What should we do?” The NP student’s preceptor did not provide clearinstructions on the role of the NP student at this time even though the student is capable ofinterpreting ECGs. This is an example of:a.Role ambiguityb.Role transitionc.Role straind.Role supplementationANS:ARole ambiguity is created by unclear expectations, diffuse responsibilities, and uncertainty ofsubroles. The NP student’s preceptor did not provide clear roles to the NP student about what heor she should do in the absence of the preceptor. If the NP student was placed in a role where heor she was unaware of how to interpret ECGs this would be an example of role incongruity.42.An NP is completing the first month in his or her first job. He or she receives a phone call froman administrator telling him or her that he or she will need to see 30% more patients startingnext week. He or she is told that this is the minimum requirement of all NPs in the sameposition. The NP has difficulty using the electronic health record (EHR) software efficientlyand feels overwhelmed. This is an example of:a.Role supplementationb.Role ambiguityc.Role conflict

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d.Role insufficiencyANS:DRole insufficiency is often seen as APRN graduates’ transition to the workforce or changepositions. This may include feelings of inadequacy or slow speed due to the new role or barrierssuch as electronic health record documentation requirements.43.Which of the following is an example of role acquisition?a.NP student learning leadership roles in the classroomb.NP student on graduation day from his or her programc.NP student beginning a new job as a family nurse practitionerd.A practicing NP advancing central line skillsANS:AThe changes occurring during role transitions experienced during the educational component ofanAPNroleareclassifiedasroleacquisition.Alloftheothersareexamplesofroleimplementation.44.The changes occurring as an APRN performs procedures during job duties are classified as?a.Role supplementationb.Role transitionc.Role implementationd.Role acquisitionANS:CThe job duties and responsibilities performed by the APRN are an example of role implementation.Role transition is the transition from student to practicing NP.45.Which of the following is best classified as roll stress?a.Maintaining family responsibilities while in schoolb.An APN’s feelings of poor self-esteemc.Starting a first job as an NPd.Multiple failed attempts to master a procedure during educationANS:AThere are many examples of role stress. Role stress may include any situation that requiresincreased performance above and beyond the expectation of others. This is easily classified asexamples of things that require additional demand in addition to school or work such aswork/family responsibilities or keeping up with new and advancing technologies. Starting a firstjob as an NP is an example of role transition.

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