TEST BANK FOR ADVANCED PRACTICE NURSING, ESSENTIALS FOR ROLE DEVELOPMENT 4TH EDITION BY LUCILLE A. JOEL RN, PHD, FAAN CHAPTER 1-30 UPDATED GUIDE .

TEST BANK FOR ADVANCED PRACTICE NURSING, ESSENTIALS FOR ROLE DEVELOPMENT 4TH EDITION BY LUCILLE A. JOEL RN, PHD, FAAN CHAPTER 1-30 UPDATED GUIDE 2023/2024.The Evolution of Advanced Practice 1. Advanced Practice Nursing: Doing What Has to Be Done-Radicals, Renegades, and Rebels (Lynne M. Dunphy) 2. Emerging Roles of the Advanced Practice Nurse (Deborah Becker & Caroline Doherty) 3. Role Development: A Theoretical Perspective (Lucille A. Joel) 4. Educational Preparation of Advanced Practice Nurses: Looking to the Future (Phyllis Shanley Hansell) 5. Global Perspectives on Advanced Nursing Practice by (Madrean Schober & Anna Green) II. The Practice Environment 6. Advanced Practice Nurses and Prescriptive Authority (Jan Towers) 7. Credentialing and Clinical Privileges for the Advanced Practice Registered Nurse (Ann Carey & Mary Smolenski) 8. The Kaleidoscope of Collaborative Practice (Alice F. Kuehn) 9. Participation of the Advanced Practice Nurse in Health Plans and Quality Initiatives (Rita Munley Gallagher) 10. Public Policy and the Advanced Practice Registered Nurse (Marie Eileen Onieal) 11. Resource Management (Eileen D. Flaherty, Antigone Grasso, & Cindy Aiena) 12. Mediated Roles: Working With and Through Other People by (Thomas D. Smith, Maria L. Vezina, Mary E. Samost, & Kelly Reilly) III. Competency in Advanced Practice 13. Evidence-Based Practice (Deborah C. Messecar & Christine A. Tanner) 14. Advocacy and the Advanced Practice Nurse (Andrea Brassard) 15. Case Management and Advanced Practice Nursing (Denise Fessler & Irene McEachen) 16. The Advanced Practice Nurse and Research (Beth Quatrara and Dale Shaw) 17. The Advanced Practice Nurse: Holism and Complementary and Integrative Health Approaches (Carole Ann Drick) 18. Basic Skills for Teaching and the Advanced Practice Nurse (Valerie Sabol, Benjamin A. Smallheer, & Marilyn H. Oermann) 19. Culture as a Variable in Practice (Mary Masterson Germain) 20. Conflict Resolution in Advanced Practice Nursing (David M. Price & Patricia Murphy) 21. Leadership for APNs: If Not Now, When? (Edna Cadmus) 22. Information Technology and the Advanced Practice Nurse by (Robert Scoloveno) 23. Writing for Publication (Shirley Smoyak) IV. Ethical, Legal and Business Acumen 24. Measuring Advanced Practice Nurse Performance: Outcome Indicators, Models of Evaluation and the Issue of Value (Shirley Girouard, Patricia DiFusco, and Joseph Jennas) 25. Advanced Practice Registered Nurses: Accomplishments, Trends, and Future Development (Jane M. Flanagan, Allyssa Harris, & Dorothy A. Jones) 26. Starting a Practice and Practice Management (Judith Barberio) 27. The Advanced Practice Nurse as Employee or Independent Contractor: Legal and Contractual Considerations (Kathleen M. Gialanella) 28. The Law, The Courts, and the Advanced Practice Registered Nurse (David M. Keepnews) 29. Malpractice and the Advanced Practice Nurse (Carolyn T. Torres) 30. Ethics and the Advanced Practice Nurse (Gladys L. Husted, James H. Husted, & Carrie Scotto) CHAPTER1: ANSWERS AND RATIONALES 1. Which change represents the primary impetus for the end of the era of the female lay healer? 1. Perception of health promotion as an obligation 2. Development of a clinical nurse specialist position statement 3. Foundation of the American Association of Nurse-Midwives 4. Emergence of a medical establishment Page: 4 Feedback 1. This is incorrect. Lay healers traditionally viewed their role as being a function of their community obligations; however, the emerging medical establishment viewed healing as a commodity. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. 2. This is incorrect. The American Nurses Association (ANA) position statement on educational requirements for the clinical nurse specialist (CNS) was developed in 1965; the ANA’s position statement on the role of the CNS was issued in 1976. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. 3. This is incorrect. The American Association of Nurse-Midwives (AANM) was founded in 1928. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. 4. This is correct. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. Whereas lay healers viewed their role as being a function of their community obligations, the emerging medical establishment viewed healing as a commodity. The era of the female lay healer began and ended in the 19th century. The American Association of Nurse-Midwives (AANM) was founded in 1928. The American Nurses Association (ANA) position statement on educational requirements for the clinical nurse specialist (CNS) was developed in 1965; the ANA’s position statement on the role of the CNS was issued in 1976. 2. The beginning of modern nursing is traditionally considered to have begun with which event? 1. Establishment of the first school of nursing 2. Incorporation of midwifery by the lay healer 3. Establishment of the Frontier Nursing Service (FNS) 4. Creation of the American Association of Nurse-Midwives (AANM) Answer: 1 Pages: 4–5 Feedback 1. This is correct. Traditionally, modern nursing is considered to have begun in 1873, when the first three U.S. training schools for nurses opened. The role of the lay healer as a midwife is documented to have occurred in the 19th century, before the establishment of schools of nursing. The Frontier Nursing Service (FNS), which provided nurse-midwifery services, was established in 1925. In 1928, the Kentucky State Association of Midwives, which was an outgrowth of the FNS, became the American Association of Nurse-Midwives (AANM). 2. This is incorrect. The role of the lay healer as a midwife is documented to have occurred in the 19th century, before the establishment of schools of nursing. Traditionally, modern nursing is considered to have begun in 1873, when the first three U.S. training schools for nurses opened. 3. This is incorrect. The Frontier Nursing Service (FNS), which provided nursemidwifery services, was established in 1925. Traditionally, modern nursing is considered to have begun in 1873, when the first three U.S. training schools for nurses opened. 4. This is incorrect. In 1928, the Kentucky State Association of Midwives, which was an outgrowth of the FNS, became the American Association of NurseMidwives (AANM). Modern nursing is considered to have begun in 1873, at which time the first three U.S. training schools for nurses opened. 3. In 1910, which factors most significantly influenced the midwifery profession? Select all that apply. 1. Strict licensing requirements 2. Negative public perception 3. Dedicated funding for training 4. Poor maternal-child outcomes 5. Mandatory professional supervision Answer: 2, 4 Pages: 6–7 Feedback 1. This is incorrect. In 1910, the midwifery profession was significantly influenced by poor maternal-child outcomes and a public perception as unprofessional. Though legislation ultimately was passed to tighten requirements related to licensing and supervision of midwives, in the early 20th century, midwives were largely unregulated and generally perceived as unprofessional. 2. This is correct. In 1910, the midwifery profession was significantly influenced by poor maternal-child outcomes and a public perception as unprofessional. At that time, approximately 50% of all U.S. births were reportedly attended by midwives. However, especially with regard to perinatal health indicators, the national population’s general health was poor. Unfavorable outcomes among both mothers and infants were attributed to midwives who, at that time, were largely unregulated and generally perceived as unprofessional. Poor maternal-child outcomes, negative perceptions of midwives, obstetricians’ targeted efforts to take control of the birthing process, and a movement away from home births prompted major changes. Legislation was passed to tighten requirements related to licensing and supervision of midwives. One aim of the Sheppard-Towner Maternity and Infancy Act involved allotting funds to train public health nurses in midwifery; however, the bill lapsed in 1929. 3. This is incorrect. Goals of the Sheppard-Towner Maternity and Infancy Act included allocating funds to train public health nurses in midwifery, but the bill lapsed in 1929. In 1910, poor maternal-child outcomes and a public perception as unprofessional significantly influenced the midwifery profession. 4. This is correct. In 1910, the midwifery profession was significantly influenced by poor maternal-child outcomes and a public perception as unprofessional. At that time, approximately 50% of all U.S. births were reportedly attended by midwives. However, especially with regard to perinatal health indicators, the national population’s general health was poor. Unfavorable outcomes among both mothers and infants were attributed to midwives who, at that time, were largely unregulated and generally perceived as unprofessional. Poor maternal-child outcomes, negative perceptions of midwives, obstetricians’ targeted efforts to take control of the birthing process, and a movement away from home births prompted major changes. Legislation was passed to tighten requirements related to licensing and supervision of midwives. One aim of the Sheppard-Towner Maternity and Infancy Act involved allotting funds to train public health nurses in midwifery; however, the bill lapsed in 1929. 5. This is incorrect. In 1910, the midwifery profession was largely unregulated. Factors that influenced the profession included poor maternal-child outcomes and a public perception as unprofessional. 4. Which advanced practice nursing role is unique in that the practitioners view their role as comprising a combination of two distinct disciplines? 1. Nurse practitioner 2. Certified registered nurse anesthetist 3. Clinical nurse specialist 4. Certified nurse-midwife Answer: 4 Page: 9 Feedback 1. This is incorrect. The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery. 2. This is incorrect. The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery. 3. This is incorrect. The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery. 4. This is correct. The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery. 5. In the 19th century, which factors led to the administration of anesthesia by nurses? Select all that apply. 1. Surgeon entitlement to collecting anesthesia fees 2. Collaborative practice between physician-anesthetists and nurses 3. Lack of recognition of anesthesiology as a medical specialty 4. Opposition to anesthesia administration by physicians 5. Formation of a national organization by nurse anesthetists Answer: 1, 3 Pages: 10–11 Feedback 1. This is correct. In the 19th century, anesthesia was in its early stages. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. However, physicians were not opposed to administering anesthesia; rather, anesthesia was viewed as a means by which to transform surgery into a scientific modality for treating health alterations. Collaboration between physicians and nurses did not contribute to administration of anesthesia by nurses; contentiousness is a hallmark of the relationship between nurse anesthetists and anesthesiologists even in the present day. In the 19th century, no national organization of nurse anesthetists yet existed. The National Association of Nurse Anesthetists, which was renamed the American Association of Nurse Anesthetists (AANA), was founded in 1931. 2. This is incorrect. With the introduction of anesthesia, collaboration between physicians and nurses did not contribute to administration of anesthesia by nurses. By contrast, contentiousness is a hallmark of the relationship between nurse anesthetists and anesthesiologists even in the present day. In the 19th century, anesthesia was in its early stages. Administration of anesthesia by nurses occurred primarily because of anesthesiology’s lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees. 3. This is correct. In the 19th century, anesthesia was in its early stages. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. However, physicians were not opposed to administering anesthesia; rather, anesthesia was viewed as a means by which to transform surgery into a scientific approach to treating with health alterations. Collaboration between physicians and nurses did not contribute to administration of anesthesia by nurses; contentiousness is a hallmark of the relationship between nurse anesthetists and anesthesiologists even in the present day. In the 19th century, no national organization of nurse anesthetists yet existed. The National Association of Nurse Anesthetists, which was renamed the American Association of Nurse Anesthetists (AANA), was founded in 1931. 4. This is incorrect. In the 19th century, anesthesia was in its early stages. Physicians were in favor of the administration of anesthesia, viewing this advancement as a means by which to transform surgery into a scientific modality for treating health alterations. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. As such, the administration of anesthesia was assigned to nurses. 5. This is incorrect. The National Association of Nurse Anesthetists, which was renamed the American Association of Nurse Anesthetists (AANA), was founded in 1931. In the 19th century, anesthesia was in its early stages. Because of a lack of recognition as a medical specialty and the surgeon’s entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration. Thus, anesthesia administration was performed by nurses. 6. Which factor contributed to expansion of the role of the clinical nurse specialist (CNS) during the 1960s? 1. Increased numbers of practicing physicians 2. Tightening of female role definitions 3. Return of nurses from military conflict 4. Lack of medical specialization Answer: 3 Page: 17 Feedback 1. This is incorrect. During the 1960s, a shortage of physicians occurred. The role of the CNS was expanded in part because of the return of nurses from the Vietnam War. Nurse veterans searched for opportunities to increase their knowledge and skills, and practiced in advanced roles as well as nontraditional specialties (such as anesthesia and trauma or anesthesia). 2. This is incorrect. During the 1960s, role definitions for women became less restrictive. The role of the CNS was expanded in part because of the return of nurses from the Vietnam War. Nurse veterans searched for opportunities to increase their knowledge and skills, and practiced in advanced roles as well as nontraditional specialties (such as anesthesia and trauma or anesthesia). 3. This is correct. Expansion of the CNS role during the 1960s occurred in part because of the return of nurse veterans from the Vietnam War who sought to increase their knowledge and skills, and to work in advanced roles and nontraditional fields, such as anesthesia and trauma. 4. This is incorrect. In the 1960s, medical specialization was prevalent, and the need for competent nurses who were proficient at caring for patients with complex health needs increased. Thus, the CNS role expanded. The role of the CNS also expanded because of the return of nurses from the Vietnam War. Many of these nurse veterans searched for opportunities to increase their knowledge and skills, and practiced in advanced roles as well as nontraditional specialties (such as anesthesia and trauma or anesthesia). 7. Differentiation between the role of the clinical nurse specialist (CNS) and the nurse practitioner (NP) is primarily based on which premise? 1. Designation as an advanced practice nurse 2. Diagnosis of patient health conditions 3. Nature of practice setting environments 4. Authority to prescribe medications Answer: 3 Pages: 20–21 Feedback 1. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) are designated as advanced practice nurses (APNs). A primary differentiation between the roles of CNS and NP centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. 2. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) are prepared to diagnose patient health alterations. A primary differentiation between the roles of CNS and NP centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. 3. This is correct. A primary differentiation between the roles of clinical nurse specialist (CNS) and nurse practitioner (NP) centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. Both the CNS and the NP are designated as advanced practice nurses (APNs), educationally prepared to diagnose patient health alterations, and eligible to apply for prescriptive authority. 4. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) are eligible to apply for authority to prescribe medications. A primary differentiation between the roles of CNS and NP centers on the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. 8. The National Council of State Boards of Nursing’s Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation prompted gains related to which aspects of the role and function of the nurse practitioner (NP)? Select all that apply. 1. Legal authority 2. Reimbursement 3. Consumer recognition 4. Prescriptive privilege 5. Autonomy Answer: 1, 2, 4 Page: 29 Feedback 1. This is correct. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 2. This is correct. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 3. This is incorrect. At present, nurse practitioners (NPs) still face challenges related to consumer recognition in health care. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the NP, including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. 4. This is correct. Adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation in 2008 by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 5. This is incorrect. At present, nurse practitioners (NPs) still face challenges related to autonomy. The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the NP, including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. At present, NPs still face challenges related to autonomy, as well as consumer recognition in health care. 9. The doctor of nursing practice (DNP) degree was developed to support the achievement of which goal related to advanced practice nursing education? 1. Eliminating master’s degree programs 2. Promoting excellence in clinical practice 3. Replacing doctor of philosophy programs 4. Emphasizing the generation of nursing research Answer: 2 Pages: 31, 33 Feedback 1. This is incorrect. Rather than seeking to eliminate master’s degree programs designed to prepare advanced practice registered nurses (APRNs), current legislation exists to preserve such programs. The doctor of nursing practice (DNP) is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. 2. This is correct. The doctor of nursing practice (DNP) is not intended to replace the doctor of philosophy (PhD). Whereas the PhD emphasizes research, the DNP is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. Current legislative efforts related to nursing education do not include elimination of master’s degree programs for advanced practice registered nurses (APRNs). Rather, current legislation exists to preserve existing master’s degree programs designed to prepare APRNs. 3. This is incorrect. The doctor of nursing practice (DNP) is not intended to replace the doctor of philosophy (PhD). The DNP is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. 4. This is incorrect. Unlike the doctor of philosophy (PhD), which emphasizes research, the doctor of nursing practice (DNP) is focused on preparing the nurse clinician to demonstrate excellence in nursing practice. 10. Among national nursing leaders, which argument serves as a basis for opposition to the requirement that advanced practice nurses (APNs) earn a doctor of nursing practice (DNP) degree? 1. Greater professionalization is needed among advanced practice nurses. 2. The number of graduate nursing programs should be limited. 3. Advanced practice nursing certification should not require a doctoral degree. 4. The need for care providers should be prioritized. Answer: Answer: 4 Page: 33 Feedback 1. This is incorrect. National nursing leaders have opposed a proposition to require completion of a doctor of nursing practice (DNP) degree by advanced practice nurses (APNs) who seek certification based on a perception that the need for care providers should be prioritized above professionalization of advanced practice registered nurses (APRNs) by way of completing a DNP program. 2. This is incorrect. National nursing leaders have not sought to limit graduate nursing education programs for advanced practice registered nurses (APRNs). The basis for opposition among national nursing leaders related to requiring advanced practice nurses (APNs) to complete a doctor of nursing practice (DNP) degree centers on the perception that the need for care providers takes precedence over professionalization of APRNs by way of completing a DNP program. 3. This is incorrect. National nursing leaders have not sought to require advanced practice nurses (APNs) to complete a doctor of philosophy (PhD) degree. Rather, national nursing leaders have opposed a mandate that would require completion of a doctor of nursing practice (DNP) degree before seeking certification as an advanced practice registered nurse (APRN) based on a perception that the need for care providers should be prioritized over professionalization of APRNs. 4. This is correct. National nursing leaders have opposed a mandate that would require completion of a doctor of nursing practice (DNP) degree before seeking certification as an advanced practice registered nurse (APRN) based on a perception that the need for care providers should be prioritized over professionalization of APRNs. National nursing leaders have neither sought to limit graduate nursing education programs for APRNs nor recommended that advanced practice nurses (APNs) be required to complete a doctor of philosophy (PhD) degree. Chapter 2: Emerging Roles of the Advanced Practice Nurse ANSWERS AND RATIONALES 1. Entry into which advanced practice nursing specialty will require a doctoral degree by 2022? 1. Clinical nurse specialist (CNS) 2. Certified registered nurse anesthetist (CRNA) 3. Nurse practitioner (NP) 4. Certified nurse-midwife (CNM) Answer: 2 Page: 5 Feedback 1. This is incorrect. Clinical nurse specialists (CNSs) are not required to complete a doctoral degree. However, the American Association of Nurse Anesthetists (AANA) has set forth a mandate requiring all graduates to complete a doctoral degree. Beginning in 2022, a doctorate will be the minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 2. This is correct. Beginning in 2022, the American Association of Nurse Anesthetists (AANA) will require a doctoral degree as a minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 3. This is incorrect. Nurse practitioners (NPs) are not currently required to complete a doctoral degree. Presently, only the American Association of Nurse Anesthetists (AANA) has set forth a mandate requiring all graduates to complete a doctoral degree. Beginning in 2022, a doctorate will be the minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 4. This is incorrect. At present, certified nurse-midwives (CNMs) are not required to obtain a doctoral degree. Only the American Association of Nurse Anesthetists (AANA) has set forth a mandate requiring all graduates to complete a doctoral degree. Beginning in 2022, a doctorate will be the minimum requirement to enter practice as a certified registered nurse anesthetist (CRNA) (AANA, 2016). 2. According to the Consensus Model for APRN Regulation, advanced practice nursing should abide by which recommendation? 1. Emphasizing state-based regulation of advanced practice nursing standards 2. Ensuring regulation of advanced practice registered nurses (APRNs) as a unified, collective group 3. Preparing clinical nurse specialists (CNSs) to function primarily in acute care 4. Changing the population focus of adult nurse practitioners to adult gerontology Answer: 4 Pages: 6, 20 Feedback 1. This is incorrect. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Rather than emphasizing state-based regulation of advanced practice nursing, general goals of the Consensus Model include promoting consistency of advanced practice nursing standards to increase the potential for interstate licensure reciprocity. The Consensus Model recommends shifting the population focus of adult nurse practitioners (NPs) to adult gerontology. 2. This is incorrect. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Instead of ensuring regulation of advanced practice registered nurses (APRNs) as a collective group, the Consensus Model recommends regulation of APRNs in one of four accepted roles. Recommendations also include shifting the population focus of adult nurse practitioners (NPs) to adult gerontology. 3. This is incorrect. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Based on the Consensus Model, the practice of clinical nurse specialist (CNS) practices occurs across both acute and primary care settings. The Consensus Model also recommends shifting the population focus of adult nurse practitioners (NPs) to adult gerontology. 4. This is correct. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education was developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (Consensus Model, 2008). Per the Consensus Model, the population focus of adult nurse practitioners (NPs) has shifted to adult gerontology. As opposed to emphasizing state-based regulation of advanced practice nursing, broad goals of the Consensus Model include developing more consistent standards for advanced practice nurses (APNs) that promote eligibility for interstate licensure reciprocity. Instead of ensuring regulation of advanced practice registered nurses (APRNs) as a collective group, the Consensus Model recommends regulation of APRNs in one of four accepted roles. The Consensus Model describes the practice of clinical nurse specialists (CNSs) as including both acute and primary care settings. 3. The relationship to which aspect of the function of the clinical nurse specialist (CNS) shows the greatest need for research? 1. Patient satisfaction 2. Care outcomes 3. Income generation 4. Role adaptability Answer: 3 Pages: 8, 10 Feedback 1. This is incorrect. Research has identified a correlation between clinical nurse specialist (CNS)-patient interaction and patient satisfaction. Further research is needed to examine the relationship between utilization of the CNS and income generation. 2. This is incorrect. Existing research studies have identified a correlation between clinical nurse specialist (CNS)-patient interaction and favorable patient care outcomes. Additional research is needed to examine the relationship between utilization of the CNS and income generation. 3. This is correct. Additional research is needed to examine the relationship between utilization of the clinical nurse specialist (CNS) and income generation. Role adaptability is a central feature of the CNS. Research has identified a correlation between CNS-patient interaction and favorable patient care outcomes, as well as patient satisfaction. 4. This is incorrect. Role adaptability, which is a primary characteristic of the clinical nurse specialist (CNS), is regarded as contributing to role ambiguity for this advanced practice role. Available research is limited related to the economic impact of the CNS, including income generation. 4. For nurse practitioners (NPs), which issue represents a current barrier to autonomy? 1. Restrictions on reimbursement for services 2. Absence of state-based prescriptive authority 3. Limited ability to serve in acute care settings 4. Lack of authority to manage medical problems Answer: 1 Pages: 12, 15 Feedback 1. This is correct. One barrier to autonomy for nurse practitioners (NPs) stems from restrictions on reimbursement for services. Among advanced practice nurses (APRNs), NPs comprise the largest group. All 50 states, as well as the District of Columbia, grant prescriptive privileges to qualified NPs (Phillips, 2016). NPs serve in primary and acute care settings. Assessment and management of patients related to medical and nursing problems is within the NP’s scope of practice. 2. This is incorrect. All 50 states, as well as the District of Columbia, grant prescriptive privileges to qualified NPs (Phillips, 2016). For NPs, barriers to autonomy include restrictions on reimbursement for services. 3. This is incorrect. Nurse practitioners (NPs) serve in both primary and acute care settings. Barriers to autonomy for NPs include restrictions on reimbursement for services. 4. This is incorrect. Nurse practitioners (NPs) are qualified to assess and manage a wide range of patient problems, including both medical and nursing issues. Barriers to the NP’s autonomy include restrictions on reimbursement for services. 5. Which changes have contributed to the evolution of the present-day nurse practitioner (NP)’s role? Select all that apply. 1. Focus on delivering care to low-income patients 2. Development of retail patient care clinics 3. Increased access to Medicaid recipients 4. Inclusion of patients from suburban areas 5. Emphasis on serving uninsured immigrants Answer: 2, 4 Pages: 10, 12 Feedback 1. This is incorrect. For the nurse practitioner (NP), the traditional patient population has included uninsured immigrants, as well as low-income individuals who receive Medicaid. Evolution of the NP’s role has been impacted by factors including an increase in the number of walk-in, retail, and urgent care clinics. A shift to providing services to patients who live in urban and suburban outpatient settings also has promoted evolution of the NP’s role. 2. This is correct. The increasing number of walk-in, retail, and urgent care clinics has provided increased opportunities for patients to access nurse practitioners (NPs) who are providing primary care services. The NP’s practice has also expanded because of an increase in the provision of services to patients who live in urban and suburban outpatient settings. Traditionally, the patient population served by NPs has included low-income individuals who received Medicaid and uninsured immigrants. 3. This is incorrect. For the nurse practitioner (NP), the traditional patient population has included low-income individuals who receive Medicaid, as well as uninsured immigrants. Changes that have contributed to evolution of the NP’s role include an increase in the number of walk-in, retail, and urgent care clinics, as well as the provision of services to patients who live in urban and suburban outpatient settings. 4. This is correct. With expansion of services to include patients who seek care in urban and suburban outpatient settings, the nurse practitioner (NP)’s practice has expanded. An increase in the number of walk-in, retail, and urgent care clinics has also increased opportunities for patients to access NPs who serve as primary care providers. 5. This is incorrect. Traditionally, the patient population served by nurse practitioners (NPs) has included uninsured immigrants, as well as low-income individuals who receive Medicaid. Factors that have promoted evolution of the NP’s role include an increase in the number of walk-in, retail, and urgent care clinics, as well as the provision of services to patients who live in urban and suburban outpatient settings. 6. Which consideration led to designation of the nurse practitioner (NP) rather than the clinical nurse specialist (CNS) as the advanced practice nurse (APN) who would deliver care related to psychiatric or mental health services? 1. Level of educational preparation 2. Eligibility for prescriptive authority 3. Ability to serve in community settings 4. Practice based on core competencies Answer: 2 Page: 15 Feedback 1. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) may be prepared at either the master’s or doctoral level. Because of a heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health needs, the importance of prescriptive authority for this advanced practice nursing role has been underscored. At present, 40 states grant prescriptive privileges to CNSs and NPs (National Association of Clinical Nurse Specialists [NACNS], 2015). However, all 50 states grant prescriptive privileges to NPs. Therefore, the psychiatric/mental health nurse practitioner has become the sole means of educational preparation for this advanced practice role. 2. This is correct. A heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health needs has underscored the importance of prescriptive authority for this advanced practice nursing role. At present, 40 states grant prescriptive privileges to clinical nurse specialists (CNSs) and nurse practitioners (NPs) (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice role. Both the CNS and the NP may be prepared at either the master’s or doctoral level. Likewise, both the CNS and the NP may practice in a community setting. Core competencies guide the practice of both the CNS and the NP. 3. This is incorrect. Both the clinical nurse specialist (CNS) and the nurse practitioner (NP) may practice in a community setting. With a heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health need, the importance of prescriptive authority for this advanced practice nursing role became apparent. At present, 40 states grant prescriptive privileges to CNSs and NPs (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice role. 4. This is incorrect. Core competencies guide the practice of both the clinical nurse specialist (CNS) and the nurse practitioner (NP). A heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health need has highlighted the importance of prescriptive authority for this advanced practice nursing role. At present, 40 states grant prescriptive privileges to CNSs and NPs (National Association of Clinical Nurse Specialists [NACNS], 2015). However, as all 50 states grant prescriptive privileges to NPs, the psychiatric/mental health NP has become the sole means of educational preparation for this advanced practice specialization. 7. Which of the following defines the current practice of the acute care nurse practitioner? 1. Unit-based versus practice-based assignment 2. Participation on a specialty care team 3. Geographical setting 4. Patient population Answer: 4 Page: 18 Feedback 1. This is incorrect. The acute care nurse practitioner (NP) may serve in a unitbased or practice-based capacity. This nursing specialty is defined by the patient population that is served. 2. This is incorrect. The acute care nurse practitioner (NP) may or may not participate as a member of a consultative team related to specialty care. The population that is served defines the acute care NP’s role. 3. This is incorrect. Rather than defining the acute care nurse practitioner (NP) based on the geographical setting in which care is provided, this nursing specialty is now defined by the patient population that is served. 4. This is correct. Historically, the geographical setting defined the role of the acute care nurse practitioner (NP). However, the role of this nursing specialty is now defined by the patient population that is served. Acute care NPs may be practice based or unit based. The acute care NP may or may not participate as a member of a consultative team related to specialty care. 8. Certified nurse-midwives (CNMs) are most likely to practice in which setting? 1. Hospital organizations 2. Physician-owned practices 3. Nonprofit health agencies 4. Federal facilities Answer: 1 Page: 24 Feedback 1. This is correct. Most certified nurse-midwives (CNMs) practice in hospitals (29.5%) and physician-owned practices (21.7%). However, care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 2. This is incorrect. The majority of certified nurse-midwives (CNMs) practice in hospitals (29.5%), followed by physician-owned practices (21.7%). Additional care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 3. This is incorrect. Predominantly, certified nurse-midwives (CNMs) practice in hospitals (29.5%) and physician-owned practices (21.7%). However, care settings for the CNM also may include midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 4. This is incorrect. Certified nurse-midwives (CNMs) most often practice in hospitals (29.5%) and physician-owned practices (21.7%). However, CNMs also may practice in a variety of other settings, including midwife-owned practices, educational institutions, community health centers, birthing centers, nonprofit health agencies, and military or federal government agencies (Schuiling, Sipe, & Fullerton, 2013). 9. Which function of the certified registered nurse anesthetist (CRNA) is prohibited in certain states? 1. Induction of general anesthesia 2. Pain management procedures 3. Administration of spinal anesthesia 4. Provision of post-anesthesia care Answer: 2 Page: 27 Feedback 1. This is incorrect. All 50 states and the District of Columbia authorize certified registered nurse anesthetists (CRNAs) to provide induction of general anesthesia, as well as numerous other anesthesia-related services (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). However, the CRNA’s capacity to provide pain management procedures, such as epidural steroid injections, is regulated at the state level. Therefore, not all CRNAs are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). 2. This is correct. Pain management procedures, such as epidural steroid injections, are regulated at the state level; therefore, not all certified registered nurse anesthetists (CRNAs) are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). All 50 states and the District of Columbia authorize CRNAs to provide induction of general anesthesia, administration of spinal anesthetics, and delivery of postanesthesia care (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). 3. This is incorrect. All 50 states and the District of Columbia authorize certified registered nurse anesthetists (CRNAs) to administer spinal anesthetics, as well as to provide several other anesthesia-related services (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). However, the CRNA’s capacity to provide pain management procedures, such as epidural steroid injections, is regulated at the state level. Therefore, not all CRNAs are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). 4. This is incorrect. All 50 states and the District of Columbia authorize certified registered nurse anesthetists (CRNAs) to provide post-anesthesia care, as well as to deliver several other anesthesia-related services (Department of Health and Human Services [DHHS], Public Health Service [PHS] Division of Acquisition Management, 1995). However, the CRNA’s capacity to provide pain management procedures, such as epidural steroid injections, is regulated at the state level. Therefore, not all CRNAs are authorized to provide pain management services (American Association of Nurse Anesthetists [AANA], 2014). 10. Implementation of the anesthesia care team (ACT) model yielded which direct effect on anesthesia services? 1. Regulation of conditions related to reimbursable services 2. Mandatory direction of certified registered nurse anesthetists (CRNAs) by an anesthesiologist 3. Reduction in charges related to fraudulent anesthesia care 4. Increased accountability for physicians who employ CRNAs Answer: 2 Pages: 28–29 Feedback 1. This is incorrect. Regulations set forth by the Tax Equity and Fiscal Responsibility Act (TEFRA) mandated conditions for reimbursable services that appeared to require physician leadership for anesthesia delivery as a standard of care. The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). 2. This is correct. The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). Also in 1982, Medicare’s introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists’ accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs) (Shumway & Del Risco, 2000). Regulations set forth by the Tax Equity and Fiscal Responsibility Act (TEFRA) mandated conditions for reimbursable services that appeared to require physician leadership for anesthesia delivery as a standard of care. 3. This is incorrect. In 1982, Medicare’s introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists’ accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs). The 1982 implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA) resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). 4. This is incorrect. In 1982, Medicare’s introduction of an insurance reimbursement regulation policy aimed to reduce charges of fraud for anesthesia care by delineating specific conditions that maintained anesthesiologists’ accountability for services they claimed to provide when working with or employing certified registered nurse anesthetists (CRNAs). Implementation of the anesthesia care team (ACT) model by the American Society of Anesthesiologists (ASA), which also occurred in 1982, resulted in mandatory direction of anesthetic administration by an anesthesiologist (Shumway & Del Risco, 2000). Chapter 3: Role Development: A Theoretical Perspective ANSWERS AND RATIONALES 1. Nurses working in a Magnet facility have low staff turnover rates and report high job satisfaction, making others aspire to have the longevity in employment experienced by those at the Magnet facility. Which of the following reference groups is this an example of? 1. Evaluative 2. Normative 3. Comparison 4. Audience Answer: 3 Page: 4 1. This is incorrect. The comparison group sets its own standards and becomes a comparison group only when an individual accepts it as such. Nurses at a Magnet facility are considered a comparison group. 2. This is incorrect. The normative group sets explicit standards and expects compliance, and it rewards or punishes relative to that degree of compliance. The church, community, and family are examples of normative groups. 3. This is correct. The comparison group sets its own standards and becomes a comparison group only when an individual accepts it as such. Nurses at a Magnet facility are considered a comparison group. 4. This is incorrect. The audience group is a collective group whose attention an individual wishes to attract. The audience group holds certain values but does not demand compliance from the person for whom they serve as a referent. 2. Which action should the advanced practice nurse (APN) take to be successful in socialization? 1. Be better at multitasking. 2. Develop a rapport with colleagues. 3. Develop skills in empathic communication. 4. Practice sympathetic listening. Answer: 3 Page: 6 1. This is incorrect. Better multitasking does not lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 2. This is incorrect. Developing a rapport does not lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 3. This is correct. Developing skill in empathic communication does lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 4. This is incorrect. Practicing sympathetic listening does not lead to successful socialization. The individual must project him- or herself into the circumstances of another and then step back to imagine how he or she would feel in the other’s situation. If there is accurate determination of the motives and feelings of the other, the actor can modify his or her own behavior to sustain or alter the other’s response. 3. An advanced practice nurse (APN) consistently identifies each client by the five rights upon every encounter. This behavior is an example of which of the following? 1. First-order change 2. Second-order change 3. Role-making 4. Subrole internalization Answer: 2 Page: 6 1. This is incorrect. First-order changes are behavioral shifts that do not permanently achieve a desired result. Old preferences keep resurfacing. 2. This is correct. Second-order change leads to permanent change. Old behaviors and patterns are gone and are not replaced by a new version. 3. This is incorrect. Role-making is bidirectional and interactive, with both actors presenting behaviors that are interpreted reciprocally for the purpose of creating and modifying their own roles. 4. This is incorrect. Second-order change leads to permanent change. Old behaviors and patterns are gone and are not replaced by a new version. 4. Which action by the advanced practice nurse (APN) demonstrates role-making? 1. Practicing autonomy when working in a busy practice 2. Suggesting a change in treatment to the supervising physician 3. Changing a client’s medication to a lower dosage 4. Teaching a client how to self-administer insulin Answer: 2 Page: 7 1. This is incorrect. Although important, this does not demonstrate role-making. 2. This is correct. This demonstrates role-making, which is bidirectional and interactive. 3. This is incorrect. Although part of the advanced practice nurse (APN)’s role, this is not a demonstration of role-making. 4. This is incorrect. Although part of the advanced practice nurse (APN)’s role, this is not a demonstration of role-making. 5. The advanced practice nurse (APN) is mentoring an APN student. The APN recognizes that the student is having a hard time adjusting to the new role. Which action should the mentor take? 1. Allow the student to work through the process. 2. Listen sympathetically to the student. 3. Refer the student to a colleague with similar experiences. 4. Treat each failure as a learning opportunity. Answer: 4 Page: 10 1. This is incorrect. Although the student should be allowed to work through the process, the advanced practice nurse (APN) should be present as a guide. 2. This is incorrect. The advanced practice nurse (APN) should listen empathetically to the student. 3. This is incorrect. The advanced practice nurse (APN) should work closely with the client to overcome obstacles. 4. This is correct. The advanced practice nurse (APN) should treat each failure as a learning opportunity. 6. The advanced practice nurse (APN) is working with a colleague in a busy surgical center and becomes concerned with the colleague’s change in behavior. Which sign indicates that the colleague might be experiencing burnout? 1. Empathic behavior 2. Short attention span 3. Sensitivity 4. Intolerance Answer: 4 Page: 14 1. This is incorrect. Empathic behavior is not a sign of burnout. 2. This is incorrect. Short attention span is not a sign of burnout. 3. This is incorrect. Insensitivity is a sign of burnout. 4. This is correct. Intolerance is a sign of burnout, and should be treated appropriately. 7. The advanced practice nurse (APN) is working in a busy emergency room. Which action can the APN take to reduce role strain? 1. Own the problem and work through it. 2. Find a quiet place to retreat. 3. Focus on helping others. 4. Become more involved in the work environment. Answer: 2 Page: 17 1. This is incorrect. The advanced practice nurse (APN) should determine who owns each problem, and allow others to work through theirs. 2. This is correct. The advanced practice nurse (APN) should manage role strain by finding a quiet place to retreat. 3. This is incorrect. The advanced practice nurse (APN) should focus on self and reducing stress and strain. 4. This is incorrect. The advanced practice nurse (APN) should take adequate time away from the work environment to regroup. 8. The advanced practice nurse (APN) is experiencing burnout and recognizes the need for self-care. Which action should the APN avoid? 1. Work through stressful situations and then take a break. 2. Plan self-care as seriously as client care. 3. Determine who owns each problem. 4. Examine the quality of peer support. Answer: 1 Page: 17 1. This is correct. The advanced practice nurse (APN) should schedule breaks during stressful situations. 2. This is incorrect. The advanced practice nurse (APN) should plan self-care as seriously as client care. 3. This is incorrect. The advanced practice nurse (APN) should determine who owns each problem. 4. This is incorrect. Part of managing role strain involves examining the quality of peer support. 9. The advanced practice nurse (APN) is working with a new nurse. Which action by the nurse does the APN interpret as the social integration phase of resocialization? 1. Working well with others in the profession 2. Mastering skills 3. Integrating values into work setting 4. Displaying competency in routine Answer: 1 Page: 15 1. This is correct. Working well in the profession is an example of the social integration phase of resocialization. 2. This is incorrect. Mastery of skills occurs in the skills and routine mastery phase. 3. This is incorrect. Integrating values into the work setting occurs in the conflict resolution phase. 4. This is incorrect. Competence in routine occurs in the skills and routine mastery phase. 10. Which action should the advanced practice nurse (APN) avoid when attempting to resolve role strain? 1. Using alcohol to escape stress 2. Taking meditation breaks during a shift 3. Talking with coworkers 4. Voicing opinions at a staff meeting