1. A 20-year-old female comes to the primary care clinic with clinical findings consistent with acute bronchitis. She is sexually active with a male
... [Show More] partner, although she states prior to this relationship she did have two sexual partners. Her menses comes every 28 days and is regular. An example of a primary prevention activity for this patient is:
a. Screening for a sexually transmitted disease
b. Prescribing therapies to decrease a cough
c. Obtaining a Papanicolaou (PAP) test
d. Counseling about safer sexual practices
2. A 42-year-old male presents to the clinic with the chief complaint of sinus congestion for 2 weeks associated with facial pain. He is ultimately diagnosed with acute sinusitis, and is prescribed Amoxicillin/clavulanic acid. He has not had a fever, shortness of breath, or any gastrointestinal symptoms. Upon discharge, he is requesting a “flu shot.” You inform him that:
a. He needs to return for the shot after he has completed his antibiotic therapy
b. Is not an appropriate candidate due to age for the shot
c. Is at risk of developing a reaction if the shot is given today
d. He can receive the shot in the clinic today
3. Concerning the MMR vaccine, which of the following is a correct statement?
a. The link between use of MMR vaccine and autism has been firmly supported
b. There is no scientific evidence to support MMR use increases autism risk
c. The use of the combination increases autism risk, but dividing them into separate injections minimized this
d. The injection contain thimerosal, a mercury agent
4. You are seeing a 40-year-old patient who has started varenicline (Chantix) 3 weeks ago as a tool for smoking cessation. Which of the following is the most important question to ask during this visit?
a. “How many cigarettes per day are you currently smoking?”
b. “Are you having any difficulty sleeping?”
c. “Have you noticed in your mood?”
d. “On a scale of 1-10, what is your current desire to stop smoking?”
5. A nurse practitioner is instructing a senior citizen’s group about hazards in the home. One of these is identified as burns. Which of the following would support primary prevention of this hazard?
a. Use of a fire extinguisher
b. No smoking in bed
c. Installation of a smoke detector
d. Creating a planned escape route
6. A nurse practitioner is applying for their first position. In researching different hospitals types, there are various descriptions of their type. Some of these include public, proprietary, and voluntary (not-for-profit) hospitals. What qualification would determine the hospital type?
a. The degree of reimbursement provided for nurse practitioners
b. The determination of whether or not profits are made
c. The type of specialty services offered
d. How profits are distributed
7. A Latino patient in your clinic has been perpetually late for their appointments. Which action by the nurse practitioner would be most appropriate?
a. Confront the patient and advise them the next time you will reschedule
c. Assess how the patient interprets the appointment time
d. Ignore the situation to avoid having the patient go elsewhere
8. To meet Medicare’s coverage requirements, the Nurse Practitioner’s services must be:
a. Provided subject to state restrictions and supervision requirements
b. Provided under direct supervision
c. Provided in a rural health clinic or federally qualified health center
d. Billed through a physician-directed clinic, heath agency or hospital
9. The family nurse practitioner examines a patient who has sustained a non-work-related injury that interferes with the patient’s ability to perform their job. The patient does not qualify for medical disability and has a reasonable chance of engaging in a suitable occupation with proper therapy. The nurse practitioner recommends that the patient apply for:
a. Family and Medical Leave Act benefits
b. Vocational rehabilitation services
c. Home health services
d. Social security benefits
10. A difficult aspect of determining occupational exposure to disease is the:
a. Confidentiality of the information with company records
b. Inaccuracy of occupational exposure
c. Long latency period between exposure and disease reporting
d. Reliance on worker’s recall
11. In the following patients who is at most risk for invasive pneumococcal infection?
a. A 72-year-old man with a history of COPD
b. A 32-year-old woman who underwent a splenectomy after a motor vehicle accident
c. A 45-year-old man with a 10 year history of type 2 diabetes
d. A 80-year-old female with a history of severe osteoporosis and decreased functional status
12. Risks associated with chronic hepatitis B include all the following except:
a. Continued infectivity
b. Cirrhosis
c. Hepatocellular carcinoma
d. Malignant hypertension
13. How does health policy specifically influence health care practice in the US?
a. Directs efforts by the CDC and protects Americans against population based disease.
b. Influences how health care is reimbursed and determines APN payment for services.
c. Directs specific evidence based practice guideline development and dissemination
d. All of the above
14. What specific developments have primarily occurred because of the Affordable Care Act (ACA)?
a. ACA has been appealed and no longer enacted
b. Development of patient centered outcomes, use of comparative effectiveness research, quality payment structures that impact APN reimbursement
c. Nothing has been changed by the ACA other than Medicaid Expansion and Affordable Health Care
d. None of the Above
15. The United States Protective and Safety Task Force determines specific screening requirements for age groups in the US – what agency houses the USPSTF?
a. The US Department of Health and Human Services
b. Centers for Disease Control and Prevention
c. Agency for Health, Research and Quality
d. National Clearing House Guidelines
16. The Affordable Care Act has directed the US Department of Health and Human Services and multiple agencies to develop and disseminate initiatives on meeting the care needs of patients with Multiple Chronic Conditions (MCC). What is the primary purpose for this national direction?
a. Medicare reimbursement must meet quality payment standards under MACRA legislation
b. Advanced Practice Nurses are responsible for addressing the multiple issues associated with this patient population
c. Patients with MCCs represent the largest, fastest growing and costliest US patient population
d. None of the above
17. As an APN seeking the best evidence to ensure optimal patient-centered outcomes, which agency will you refer to when seeking the current evidence based guidelines directing standard of care?
a. Patient Centered Outcomes Research Institute (PCORI)
b. Agency for Health Research and Quality
c. Centers for Disease Control and Prevention
d. US Protective and Safety Task Force
18. When seeking specific epidemiology information on disease statistics and prevention of deadly conditions. What specific agency under the US Department of Health and Human Services would you rely upon?
a. National Institutes of Health
b. American Cancer Society
c. Centers for Disease Control and Prevention
d. All of the above
19. Advanced Practice Nurses (APNs) committed to ensuring the safety of an aging society and reducing escalations in mental health disorders will require the following practice to promote wellness in this patient population:
a. Certification as a Psychiatry Nurse Practitioner
b. Understanding the current health policy directing clinical practice recommendations
c. Seek ongoing continuing education credits in mental health and aging
d. All of the above
20. Currently, 10,000 Baby Boomers are entering the Medicare system daily. The Affordable Care Act was designed to improve health care delivery through prevention and promotion programs. What initiative specifically focuses on the aging American?
a. Team STEPPS
b. Multiple Chronic Conditions
c. Shared Decision Making
d. Literacy Tool Kit
21. How can the APN influence the development and passage of a specific health policy issue?
a. Develop a health policy proposal and present it to the House of Representatives?
b. Partner with a legislator who is a sponsor of a bill despite his or her specific assigned committee work.
c. Determine what the specific legislative agenda is for the nursing organization that you belong – so that your expertise can be used to push the agenda with your specific legislator.
d. None of the above
22. How has the Quality Chasm Report been used to direct US health care?
a. Is not used to direct health care in the US
b. IOM designed this document to direct medical practices in the US
c. This report has been used as the framework and foundation for multiple health policy initiatives since its release in 2001
d. None of the above
23. Medicare Access and Summary CHIP Reauthorization Act of 2015, (MACRA) legislation is:
a. Bipartisan
b. Replaces the 1997 Sustainable Growth Index
c. Requires measurement of quality metrics
d. All of the Above
24. Team STEPPS training through the Agency for Health, Research and Quality is focused on patient safety. The primary tenets of this training are focused specifically on:
a. Interdisciplinary collaboration
b. Communication
c. Teamwork
d. All of the above
25. As an APN providing patient-specific care and seeking Medicare reimbursement under MACRA legislation demonstrating value and quality. You will bill under which payment system?
a. Accountable Care Organization
b. Advanced Payment Models
c. Merit Incentive Based Payment
d. All of the above
26. Observational study designs are primarily used in public health data collection and help to determine efficacy of specific interventions. What is an example of a public health concern that is frequently evaluated by the CDC to ensure population-based health and wellness?
a. Drug safety and efficacy
b. Pasteurization
c. Environmental toxins
d. Vaccinations
32. For nursing to be considered a discipline which statement is true?
a. Defining the knowledge base of nursing is essential and straightforward.
b. The discipline of nursing consists of a well-defined knowledge base.
c. The human component of the knowledge base of the discipline cannot influence or change the existing knowledge base.
d. Context has considerable influence on the development of the knowledge base.
33. Which statements must be present to be considered a metaparadigm? It should (Select all that apply)
a. identify a domain that is similar to domains of other disciplines.
b. encompass all phenomena of interest
c. be perspective –neutral.
d. be global in scope.
e. Identify all reasonable paradigms
34. A philosophy differs from a metaparadigm because it communicates what the members of a discipline believe to be true about the phenomena of interest to the discipline, what they believe about the development of knowledge and the value assigned to their actions and practices. Which of the following philosophies would be characterized as “human beings are holistic; parts are viewed only in the context of the whole”?
a. Reaction World View
b. Simultaneous Action World View
c. Holistic interaction World View
d. Reciprocal Interaction World View
35. Scientific theories should be complex, contain clearly outlines characteristics and have a defined purpose. The components that are essential in a theory is the set of: ?
a. interrelated concepts, definitions and propositions.
b. interrelated statements which assume all the relationships to be true.
c. statements that are based on the author’s opinions and experience only.
d. propositions and constructs that are not necessarily tied together.
36. Theory attributes meaning, provides explanation, imposes order and organizes logically the events that that healthcare professionals come into contact with. Which is an example of the steps that practitioners take in theorizing?
a. Ask certain questions, research the topic, implement what is developed, evaluate the implementation
b. Ask certain questions, Question the status Quo, Seek the most plausible answer, Build a narrative for the questions and answers
c. Question the status quo, Seek a meaningful answer, Build a program to answer the question and evaluate the program
d. Question the status quo, seek a meaningful answer, build a logical structure for the questions and answers, Review other theories about the situation
37. Which of the following statements best addresses how theory can guide and direct practice?
a. Nursing theories will guide the way of relating with the person, and direct the goals of practice with the person.
b. Research studies are the associated methods, procedures and empirical indicators that guide practice.
c. Nursing theory is essential to the continuing evolution of the discipline of nursing.
d. Nursing theories are required when an organization is applying for magnet status.
38. To implement a theory/conceptual model into practice, the nurse would identify the purpose of the practice, general nature of the practice problem, the setting of the practice, and the characteristics of participants in the practice. What would be the next step for the nurse?
a. Decide on the timeframe for implementing the theory/ model.
b. Enlist nursing staff and physicians in the practice who would be involved.
c. Determine the process and technology used as well as assessment and evaluation of outcomes.
d. Review several models to decide on the best approach for the practice.
39. Which theorist identifies carative factors as a value system, and faith-hope and sensitivity to self and others?
a. Dorothea Orem
b. Paterson’s and Zderad
c. Jean Watson
d. Margaret Newman
40. Which statement below best reflects Imogene King’s theory?
a. The coping process responses constitute the outputs of the human??? adaptive system.
b. A person is a system of behavior characterized by repetitive, predictable, and goal –directed behaviors that strive toward balance.
c. Nursing goals are negotiated with the client and take into account both the client’s and the nurse’s perceptions.
d. If nurses with special knowledge and skills communicate appropriate information to clients, mutual goal-setting and goal attainment will occur.
41. The APN wants to develop a community educational program for hypertension and stroke prevention. She recognizes that the individual’s lifestyle and pattern of behavior need to be addressed for the program to be successful. Which theory would be most appropriate to guide the program development?
a. Theory of health as expanding consciousness.
b. Theory of Human Caring.
c. Theory of culture care.
d. Theory of interpersonal nursing.
42. According to Madeline Leininger, cultural care/accomodation/negotiation refers to actions or decisions that help a particular culture:
a. retain and preserve care values
b. adapt to or negotiate with others for satisfying healthcare outcomes.
c. change or modify behaviors affecting their lifestyles.
d. work with each other to set up goals for improved health outcomes.
43. What are the three major categories of Nola Pender’s Health promotion model? (Select all that apply)
a. *Individual characteristics/ experience
b. *health outcome
c. Individual health measures;
d. *behavior –specific cognitions
e. measureable health outcomes
44. The APN wants to evaluate the effectiveness of a protocol change that has lessened the waiting time for patients with acute symptoms of an exacerbation of COPD to be seen in a primary care practice. He is interested in whether the change reflects an improvement in prevention of hospitalization for COPD as well as the patient’s quality of life. What does he need to consider if he wants to utilize the Health-related quality of life (HRQOL) theory to guide his evaluation?
a. There are multiple frameworks and models to choose from
b. Only biological and physiological variables and symptoms are included
c. An individual’s perceptions are not addressed in the theory
d. Quality of life and HRQOL are interchangeable concepts
45. Which learning theory would be most applicable as a guide for the development of an educational program for families of patients in palliative care?
a. Behaviorist Learning Theory
b. Cognitive Learning Theory
c. Psychodynamic Learning theory
d. Humanistic Learning theory
46. To analyze and evaluate a theory/ model for potential use in guiding practice, the APN should consider what internal factors? (Select all that apply)
a. Clarity
b. Consistency
c. Logical development
d. Adequacy
e. Level of theory development
47. The analysis of a theory or conceptual model includes examining the origins. Which would not be considered an aspect of origin of the theory/model?
a. The historical evolution of the theory/ cmodel
b. The motivation to develop the theory/model
c. The unique focus of the theory/model
d. The philosophical beliefs and values about the theory/ model
48. After thoroughly researching the topic of interest, what is the next step an APN should take in selecting a theory/ model for use in practice or research?
a. Decide if the theory/model fits with the purpose/ topic of interest.
b. Examine major concepts of the theory/model to determine how they relate to each other.
c. Consider several different theories / models for possible use.
d. Decide if the assumptions, rationale and suppositions in the theory/model can be accepted by the APN.
49. Fawcett’s Conceptual-Theoretical-Empirical Structure (CTE) involve what linkage?
a. Parsimony
b. Testability
c. Adequacy
d. Legitimacy
50. Once a practice problem / research question has been identified the next step would be to use the PPICOT format to define the question. PICOT means:
a. P --population, I-- intervention, C-- Concepts, O--operational definitions, T –Time
b. P—precision instrument, I—intervention, C—control, O—operational definitions, T—Time
c. P—population, I – internal validity, C –Comparisons, O –outcome, T – time
d. P—population, I – intervention, C – comparisons, O – outcome, T – time
51. The APN is using Johnson’s Behavioral systems model (JBSM) to guide the assessment process for a patient who is being treated for lung cancer and presents to the emergency department with fever and neutropenia. Some of the assessment included that the patient realized his ability to care for himself and his family is decreasing as his health worsens. He is not sure who he can depend on because his wife is emotionally distant. This data would be characteristic of which subsystem of the JBSM?
a. Restorative subsystem
b. Aggressive protective subsystem
c. Dependency subsystem
d. Affiliative protective subsystem [Show Less]