1. You want to get more funding for your hospital’s Rapid Response Team. How should you present this issue to the committee?
a. Stress importance of
... [Show More] the team (answer is worded as looking up evidence about how the team affects outcomes, like a
meta-analysis)
b. Describe how to improve and expand the team.
2. What is the best way for the AGACNP to get involved in policy making?
a. Attend legislative days at the state capitol
b. Join a hospital committee
c. Write to your local congressman
d. Review literature and give more in-services
3. What is the best way for the AGACNP to demonstrate and advocate for full scope of practice?
a. Join a hospital committee
b. Petition the government
c. Bill for independent services
d. Start your own practice
4. Which of the following is considered a high acuity role for the AGACNP?
a. Primary care clinic
b. Cardiology office
c. Community health department
d. Minute Clinic
5. What is the best way to advocate for gay and lesbian population in your area?
a. Participate at a high state or national level
b. Join a non-profit advocacy group
c. Consider lobbying the government
d. Start at your facility
(answers are worded differently. One of them is “decrease bias in healthcare” and another is something like “create
inservices in healthcare” and another is “obtain funding to increase access.”
6. Which of the following is most important to evaluate statistical significance when reviewing the literature?
a. Consider the sample size
b. Make sure the confidence interval is tight
c. See if the p-value is less than the α-coefficient
d. Determine the error rate
(Answers are worded differently. “Ensure confounding variables were eliminated” & “P value is less than null
hypothesis” were two of them.
7. When closing a practice, the NP is required to do all of the following except
a. Give the pt adequate time to find another provider
b. Keep all of the patient’s records for a minimum of five years
c. Send a certified letter with a return receipt requested (this is for discharging/firing a patient from your practice)
d. Provide names of other providers for future care
8. Which of the following components of an evidenced based research process is the most important for NP to participate in?
a. Specifying methods of data collection
b. Formulating the hypothesis
c. Carefully reviewing the literature
d. Formulating the research problem
9. A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP’s practice.
Which of the following forms of defamation is this?
a. libel
b. slander
10. Can you tell the pt’s wife, for her protection, that her husband has HIV? No, not without his permission.
11. How can the ANCP prepare to get involved in future mass casualty event? Pre-enroll in disaster volunteer program
12. An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply
after "spending down" to qualify? Medicaid
13. Your pt is worried about insurance coverage and asks you for advice on Medicaid. You instruct the
patient that Medicaid:
Pays after insurance and 3rd party payers have paid
14. You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that
their drug is the only one that works. What ethical principles does this challenge? Veracity and Fidelity
Health Literacy: Average American-8th grade education level
Know your QA/QI/CPI basic definitions and goals: verbatim from Barkley’s Book
One question had Quality Assurance as one answer, then CPI as another option! It sounded more
like CPI to me.
Quality assurance-a process for evaluating the care of pts using established standards of care to ensure quality
CPI measures what 3 measures to improve nursing? Structure, processes, and outcomes
A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family communication as the basis for the
resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based
polices to establish clinician-family communication standards in the unit. These policies should include: guidelines for
having discussions with family members that are geared toward establishing treatment goals.
Which clinical scenario does the NP evaluate for a quality improvement process change? An increased incidence of
postoperative sternal wound infections
Goals set forth in "Healthy People 2020" by the United States Department of Health and Human Services include: elimination
of health disparities. (and ↑QOL/LOL)
Based on the individual's culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership w/the
patient by: Tailoring his or her communication style to the patient’s preference.
A 70-year-old pt with a hx of DM, HTN, OAs, and a new diagnosis of coronary artery disease, is being discharged. The adultgerontology
acute care nurse practitioner teaches the patient that the first point of contact for health care needs is the:
primary care provider
The NP is asked to provide evidence to the hospital administration about the safety of NP placing central lines. Which resource
provides the strongest level of evidence? A systematic review (meta-analysis is even stronger)
What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own
provider number? Balanced Budget Act
True/False: restraining an unwilling patient is grounds for malpractice? False, if they are a danger
you can restrain
Pt presents to the clinic for routine f/u and passes out. You revive the pt and admit overnight. Which
of the following would qualify as incident-to-billing? Temperature and weight recording
The NP program initiated, primarily, because of what issue in healthcare at the time? Pediatric
physician shortage
Elderly F pt takes a turn for the worse. The husband is crying when you enter the room and begins
telling you what end-of-life care he prefers. What do you do? Ask him to speak candidly with you
Pt calls to complain about bills and states he has Medicare, which should cover all costs. You explain:
Since you are healthy, exams are not covered.
HIPPA
Doc calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient… HIPPA.
Pt in ER not doing well, primary md calls: Give him info
NP working on ESRD research project . A colleague renal specialist asks for pt info on your patients: HIPPA breach.
Who enforces HIPPA- Office of Civil Rights /Dept. Health and Human Services
Who ISN'T covered by HIPPA? Law enforcement/Municipal Offices, CPS/Schools, Employers/Workman’s Comp, Life insurance
Question about an insurance company calling to verify some patient appointments. You have to pick out that there is already a
medical release signed by the patient. The answer is to give the requested information to them.
Definitions
Root Cause Analysis – very basic question where RCA is the answer and the question is the definition
Benchmarking-how institution compares with similar organizations
Managed Care: know what this is and how it has improved costs. Something about putting caps on payments…
Peer review-timely, not anonymous, and NP knows how peer review will impact yearly evaluation
Sensitivity vs specificity… sensitivity is positive and specificity is negative. Know this backwards and
forwards—like what would a high sensitivity say versus a low sensitivity, in about 3-4 of Phil’s
questions
There was a question where a patient had a multinodular goiter and wanted to know why the NP was
not going to do periodic U/S and Fine needle biopsy in montoring for some kind of cancer or
complication. The answer I picked was that these tests were not very specific to detect the cancer.
Another option was specificity.
Reliability: When implementing a new study… tested over and over. The consistency of a measurement, or the degree to which
an instrument measures the same way over time
Validity of results in an article: P-value. Probability of falsely rejecting the null hypothesis. Want it to be low
Statistical significance: look at sample size & p value.
Medical futility- unlikely to produce any significant good for the pt
Privileging – may be granted in full or part by the hospital. Credentialing committee is made of physicians.
Institutional bylaws may further restrict practice (Facility limited scope of practice)
Informed Consent: a state indicating pt has received adequate instruction/information regarding aspects of care to make a
prudent, personal choice regarding such Tx. Includes benefits and risks. Includes competence: pt. ability to CURD:
communicate, understand, reason, differentiate good and bad
Case management- Mobilize, monitor, and control resources that a pt uses during course of an illness while balancing quality
and cost (“move pts thru the system appropriately”).
There was a 50-60’s year old patient with a new diagnosis of cancer. To appropriately plan for discharge, what should the NP
do? Options were to consult CM, consult SW, refer to Oncology, or I think refer to hospice
Nondisclosure: not disclosing patient PHI without their permission (confidentiality)
Negligence: failure of individual to do what any reasonable person would do, resulting in injury to the patient
When serving as a nurse researcher, the NP is guided by which ethical principle to ensure that research participants are
protected from harm or exploitation? Nonmaleficence
Quantitative and Qualitative…. Quantitative is amount/numbers… qualitative is descriptive, like case studies
Know difference between advanced directive and living will: Living will provides "POA/healthcare proxy”
There was a patient who wasn’t doing well and family was at patient bedside. Answer was to address decision making with the
healthcare proxy.
Billing: NP sees a pt for HF and performs an H & P. What % is expected to be paid? Medicare pays 80% of the total bill, Pt pays
20%. NP is reimbursed 85% of what the MD is reimbursed for physician services, and for procedure is paid 80% of that 85%
General Tips
Several questions on d/c planning
A lot of health policy/sw/cm/pt. rights
Palliative care, end of life and advance directives
There was a question on the focus of palliative care. Answer was basic improvement in QOL of anyone with an illness at any
stage. Another answer was <6 months to live, that one’s wrong bc its hospice
Types of research, lots of EBP, research terms, Ethical terms
LOTS of therapeutic communication- know this whole section of Barkley
Scope of practice: integration of care across the acute illness continuum with:
o Collaboration*
o Coordination of care
o Researched based clinical practice
o Clinical leadership
o Family assessment
o Discharge planning
Collaboration*: “true partnership” in which all players have and desire power, share common goals, and recognize/accept
separate areas of responsibility/activity
4 Roles of a Nurse Practitioner: Education, Research, Clinician, Consultant/Collaborator
Pt is getting dc and needs wound care, pulmonary, and follow up: NP’s role is: to coordinate services
Government is moving towards being cost effective. What is the best way? Allow NP to treat a wider variety of pts.
Question about cutting costs by the gov’t and my answer was something primary-preventative related
Protected health information: Conversation between the ACNP and a consultant on the case: considered clinical relevance
How should the ACNP stay up to date with current information? Evidence based guidelines
“Incident to” billing rules
Medicare levels and what they cover. Hospice is Medicare A
A pt presents to the ER with c/o CP and SOB. The NP misinterprets the EKG and admits the pt for further monitoring without
consulting Cardio. Later in the shift, the pt decompensates and goes into cardiac arrest. The pt. was resuscitated but sustained
permanent brain damage. What grounds of malpractice is the NP accountable for? Lack of skill
Healthcare exchange: = health insurance marketplaces = orgs. in each state thru which pple can purchase health insurance,
DECISION MAKING
1. You notice there have been less favorable outcomes and satisfaction surveys in patients treated for sickle cell anemia. How do
you approach this problem?
a. Ask the patients treated how care can be improved
b. Look back at prior treatment given to see how outcomes can be improved
c. Form a standardized Tx plans for all pts that can be used by all healthcare staf
d. Form individualized Tx plans that can be used by all healthcare staff .
2. You have transferred a pt to the SNF. The MD in charge at that facility calls for info about the pt’s medical care. What do you do?
a. Direct him to look it up in the EMR
b. Refuse to share protected health information
c. Instruct him to call the department head
d. Share the information he requests
3. Your patient has refused human blood products based on religious beliefs. He is now rapidly destabilizing. What do you do?
a. Administer PRBCs as needed
b. Call the ethics committee
c. Continue to research alternative treatments
d. Ask the family to give permission now that he’s unconscious
4. What is the best way to make sure a patient will follow up as instructed?
a. Instruct the patient to schedule the appointment
b. Ask the patient the best time they can go to an appointment
c. Have the office manager to schedule the appointment
d. Schedule the appointment for the patient
5. Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserve life, but states
that the patient would not want to be on a ventilator. What should you do?
a. Consult neurology to come interview the family
b. Document the situation carefully in the chart
c. Call a clergy member to offer support
d. Call the Ethics Committee
6. A patient visits your clinic for sinusitis. She requests a PAP smear since she has not had one in “years.” You:
a. Refer her to a gynecologist
b. Schedule her to come back next week for the PAP at another appt.
c. Perform the PAP today
d. Do a vaginal exam only, and refer the PAP to a gyno
7. A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in “years.” You:
a. Refer her to a gynecologist
b. Schedule her to come back next week for the PAP at another appt.
c. Perform the PAP today
d. Do a vaginal exam only, and refer the PAP to a gyno
8. Discharge planning is underway for a pt who has been very debilitated after treatment for end-stage liver cancer. His wife is also
debilitated and the children live out of state. What is the best choice?
a. Hospice
b. Home Health care
c. SNF
d. Private Duty RN
9. Your patient presents to ED w/R wrist pain. She states, “It’s my fault; I should have had dinner ready on time.” What do you do?
a. Tell her not to go home bc it’s not safe
b. XR the wrist
c. Call the police
d. Consult psych
10. Now the husband presents to ED with drug overdose. What is your action?
a. Hand him off to another practitioner
b. Call the police
c. Consult psych
d. Treat him without prejudice
11. The medical resident obtained consent for an operative procedure. On your visit, the pt is confused/refusing the procedure.
a. Cancel the surgery
b. Have the wife sign another consent
c. Call the resident to clarify the patient was not confused when he signed the first consent
d. Consult neurology
12. Your HIV positive patient is preparing to discharge when he tells you not only that he has passed the virus to his wife, but also
that he plans to kill her when he gets home. How do you respond?
a. call the police
b. consult psych
c. consult social work
d. document his statements
13. Your clinical student breaks the sterile field. How do you handle this situation?
a. Discuss it with the student
b. report it to the charge nurse
c. report it to the unit manager
d. inform the faculty in charge of the student
14. You are the NP on call for the night. The nurse calls you to report the patient is decompensating. Who do you direct her to call?
a. the ER physician
b. anesthesia
c. an NP present on another unit currently
d. the attending MD who is at home
15. A code you are in does not go well, and staff members afterwards are criticizing each other. How do you deal with the situation?
a. Schedule an in-service to discuss common code mistakes
b. Meet with each team member individually
c. set up exercises to increase collaboration during a code
d. Meet with all who participated in the code and have a one-time briefing
16. Your patient is not doing well and family/wife is at bedside crying. You are preparing to talk to the family. What do you do first?
a. Place a social work consult
b. Explicitly explain the situation, the outcomes, and care involved.
c. Ask if the patient has an advanced directive
d. Set up a family meeting in a room with a specific time and date
17. Your patient is not conscious. His advance directive states he wants to be a DNR, but his family says they want him to be a full
code. How do you respond?
a. Tell her the decision goes to the next of kin
b. Call the ethics committee
c. Comply with her wishes and make him a full code
d. Tell her you can’t go against the advanced directives
18. A patient comes to the ED at a community hospital who is 29 weeks pregnant. She says her water has broken. Her VS are stable.
What do you do?
a. Transfer her to a tertiary facility
b. Contact her OB/GYN for treatment advice
c. Admit to labor and delivery
d. Consult the nurse midwife.
19. Your 51F patient is getting ready to discharge when she tells you she hasn’t had a mammogram in 3 years. What do you do?
Refer to PCP for outpatient discharge
20. Your patient’s imaging reveals he has metastatic cancer. The family, in accordance with their culture, request that you not share
the test results to spare him distress. How do you respond? Ask the patient what he wants to know about his prognosis
21. 35 yo F presents with c/o bilateral wrist pain. You suspect spouse abuse. You notice a handgun in her purse. What would be your
next action? Call security to ensure safety
22. Adult child of a pt reports that her father has expressed desire to commit suicide and has a hx of EOTH
and depression. The best response would be to? Hospitalize the pt and start psychotherapy
23. You notice that another NP in your group is frequently contacted by pharmacy for prescription errors. How do you handle the
situation? Address it directly with the NP
24. Your patient voices concerns because he has lost his insurance and worries his children will no longer have coverage for medical
expenses. What do you do? Consult case management
25. 80-year-old patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture.
To prepare the patient for discharge, the NP: provides verbal reinforcement to the patient on how to keep proper body
alignment following hip surgery.
26. A 40-year-old female patient w/no PMH is admitted with bilateral pulmonary emboli. W/U reveals a positive result for lupus
anticoagulant, and anticoagulant therapy is planned. The patient verbalizes concern about her ability to manage the
appointments and the follow-up care. The NPs most effective intervention is to: arrange follow-up appointments for the patient
at the warfarin (Coumadin) clinic and PCP after discharge.
27. What procedure does the AGACNP perform to evaluate cytology, only, in the tumor? Fine needle biopsy [Show Less]