NRS 112 Intro to acute care nursing- Advanced Practice
Nursing in the Care of Older Adults Updated Correct
Questions and Answers_100% A+ Graded
Bundle Payments and health care expenditures - CORRECT ANSWER-- Also known as bundle
payments
- Reimburstment of health care providers on the basis of expected cost for clinically defined
episodes of care
- "middle" ground between fee-for-service and capitation
- healthcare delivery system takes on financial risk of patient
- Forces system to enhance quality and coordination of care
- Incentivizes system to deliver care that truly meets the Triple Aim
CHIP - CORRECT ANSWER-- Children's Health Insurance Program
- Health coverage to uninsured children whose families earn too much to qualify for Mediciad
but too little to afford private coverage
Role Strain - CORRECT ANSWER-Subjective feelings of frustration, tension, or anxiety
expierenced in response to role stress & can be feelings of decreased self-esteem when
performance is below expectations
Role Conflict - CORRECT ANSWER-Role expectations are percieved to be mutually exclusive or
contraditctory
Medicare Part D Billing - CORRECT ANSWER-- Prescription drug coverage
- Must join a drug place to receive coverage under part D
- Coverage is attempt to lower prescription costs
- Payment is monthly fee that varies by plan & is addition to Part B premium or inbedded in Part
C premium
Role Stress - CORRECT ANSWER-A situation of increased role performance demand (ex:
returning to school while maintaining work and family responsibilities or the expectation of
increased workload
Medicare Part B Billing - CORRECT ANSWER-- Covers medical expenses such as physician and
outpatient care
,- Direct reimbursement can only occur when submitting claim through part B
- Covers physician and nonphysical provider services, outpatient hospital services, home health
care not covered by part A (PT/OT) and other services such as diagnostic testing, durable
medical equipment and ambulance costs
- Enrollment in part B is voluntary to those receiving Part A
- Payment into system via monthly premiums that are established yearly based on system
expenses through deductibles & coinsurance programs
Advanced Practice Nurse Roles - CORRECT ANSWER-1. Nurse Practitioner
2. Clinical Nurse Specialist
3. Certified Registered Nurse Anesthetist
4. Certified Nurse Midwife
Nurse Practition - CORRECT ANSWER-- provide care through diagnosis and treatment as well as
addressing disease prevention and health management
- 1893 Lillian Wald & Henry Street Settlement (HSS) House
- HHS nurses obtained standing orders for emergency medications and treatments
- nurses considered "good enough" to care for the poor whereas physicians seen as only careing
for those who could pay
- FNS/FSA nurse practice centered around the practice autonomy in the requirement that the
patients be poor, marginalized and have little access to physician provided medical care
- NP role formally described in 1960s and was implemented in outpatient pediatric clinics in
response to a shortage of primary care physicians
- Loretta Ford in 1965 established first Pediatric NP program (PNP) & was designed to prepare
professional nurses to provide comprehensive well-child care and manage common childhood
health problems
- 1970 continue to enhance visibility in health system, and expand role while demonstrating
cost effective quality care
- role expanded/included because nurse role was essential to providing equal access to health
care for all Americans
- conflict surrounds role between other RN and NP and NP and physicians
- issues surrounding prescriptive treatment & idaho in 1971 was first state to recognize
diagnosis and treatment as part of practice
- Support DNP but does not require educational programs to be at the doctoral level
Clinical Nurse Specialist - CORRECT ANSWER-- evolved out of increasingly complexity of nursing
care
- roots in psychiatric nursing
,- psych specialists date back to 1880 & richards is credited with founding specialty of psych
nursing specialists
- Rutgers University first educational program for CNS but was for psychiatric nursing
- coronary care nurse specialists established in 1962 & CCU nurses blurred invisible boundary
separating nursing and medicine
- 1960s noted to be when clincal nurse specialist took on modern day form
- three social forces drove specialization 1. increase in specialty related information 2. new tech
advances 3. response to public need and interests
- crtical care and oncology specialty grew in 1970s
- ANA recognized CNS role 1970s defining the CNS as an expert practitioner and change agent
- master degree required
- role has postive effect on improving nursing care and patient outcomes
- view shift from direct patient care to education and organizations (seen as too valuable)
- education complex due to number of specialties involved
- can prescribe without physician supervision in 20 states now
- 1997 Balanced Budget Act identified CNS eligible for Medicare reimburstment
Certified Registered Nurse Anesthetist - CORRECT ANSWER-- history in civil war
- typically anesthesia given only when a physician was unavailable
- Dr Mayo first to recognize and formally train CRNA in 1889
-Alice Macaw mother of anesthesia (hired by mayo)
- early challenges but practice has grown
- 1931 Lakeside hospital establishes National Association of Nurse Anesthetists
- LA medical association dues Nelson in 1934 for practicing without a license & nelson won but
in response Chalmers-Frances filed another suit and judgement was the result only to have CA
Supreme Court rule in favor of Nelson again and the practice of nurse anesthisa was legal/in
scope as long as it was done under guidance of supervision of physician
- reimburstment not clear cut
- mandatory certification
- master level education
- after 2022 must have a doctoral degree
Certified Nurse Midwife - CORRECT ANSWER-- history from start of time
- isolated communities rely on midwives
- "granny midwives"
- Fontier Nursing Service (FNS) in 1925 & was decentralized network of nurse run clinics in rural
mountains of kentucky
, - earliest school was the School of the Association for the Promotion and Standardization of
Midwifery in 1932
- combination of two disciplines nursing and midwifery
- issues with insurance coverage in 1980s because of complex delivery outcomes
- 1990s higher demand and expansion in scope of practice
- hospitals tried to limit profession and 1980s CNMs work under civilian health and medical
program of the uniformed Services for military and were first to recieve reimbursements
- 1984 recognized by all states in laws and regulations
- can get certification or master degree
- no evidence to support doctoral degree and DNP not required
Nurse Educator Role - CORRECT ANSWER-- Responsible for designing, evaluating, updating, and
implementing new and current nursing education curriculum
- advisers and role models
Nurse Administrator Role - CORRECT ANSWER-- Supervise nurses and other health care team
members
- recruit, hire, and train nurses
Role Acquisition - CORRECT ANSWER-- Anticipatory socialization to APRN roles that occurs in
graduate education
- role rehersal
- development of clinical knowledge and skills
- creation of supportive network
Medicare part A Billing - CORRECT ANSWER-- Covers hospital expenses
- Does NOT reimburs the ARPN directly because those services are already paid for as part of
the hospital expense
- Includes inpatient care recieved in hospital or skilled nursing facility
- Covers critical access hospitals, short-term care in skilled nursing facility, post institutional
home health care and hospice care
- funded through payroll taxes & beneficiary cost sharing (deductibles and coinsurance)
ICD-10-CM codes - CORRECT ANSWER-- Documentation for billing a service
- APRN use
- Diagnosis for which services are provided is what these codes represent
- forms basis as to why a service is being provided
- this is the most current version (international classification of diseases 10th revision)
Nursing in the Care of Older Adults Updated Correct
Questions and Answers_100% A+ Graded
Bundle Payments and health care expenditures - CORRECT ANSWER-- Also known as bundle
payments
- Reimburstment of health care providers on the basis of expected cost for clinically defined
episodes of care
- "middle" ground between fee-for-service and capitation
- healthcare delivery system takes on financial risk of patient
- Forces system to enhance quality and coordination of care
- Incentivizes system to deliver care that truly meets the Triple Aim
CHIP - CORRECT ANSWER-- Children's Health Insurance Program
- Health coverage to uninsured children whose families earn too much to qualify for Mediciad
but too little to afford private coverage
Role Strain - CORRECT ANSWER-Subjective feelings of frustration, tension, or anxiety
expierenced in response to role stress & can be feelings of decreased self-esteem when
performance is below expectations
Role Conflict - CORRECT ANSWER-Role expectations are percieved to be mutually exclusive or
contraditctory
Medicare Part D Billing - CORRECT ANSWER-- Prescription drug coverage
- Must join a drug place to receive coverage under part D
- Coverage is attempt to lower prescription costs
- Payment is monthly fee that varies by plan & is addition to Part B premium or inbedded in Part
C premium
Role Stress - CORRECT ANSWER-A situation of increased role performance demand (ex:
returning to school while maintaining work and family responsibilities or the expectation of
increased workload
Medicare Part B Billing - CORRECT ANSWER-- Covers medical expenses such as physician and
outpatient care
,- Direct reimbursement can only occur when submitting claim through part B
- Covers physician and nonphysical provider services, outpatient hospital services, home health
care not covered by part A (PT/OT) and other services such as diagnostic testing, durable
medical equipment and ambulance costs
- Enrollment in part B is voluntary to those receiving Part A
- Payment into system via monthly premiums that are established yearly based on system
expenses through deductibles & coinsurance programs
Advanced Practice Nurse Roles - CORRECT ANSWER-1. Nurse Practitioner
2. Clinical Nurse Specialist
3. Certified Registered Nurse Anesthetist
4. Certified Nurse Midwife
Nurse Practition - CORRECT ANSWER-- provide care through diagnosis and treatment as well as
addressing disease prevention and health management
- 1893 Lillian Wald & Henry Street Settlement (HSS) House
- HHS nurses obtained standing orders for emergency medications and treatments
- nurses considered "good enough" to care for the poor whereas physicians seen as only careing
for those who could pay
- FNS/FSA nurse practice centered around the practice autonomy in the requirement that the
patients be poor, marginalized and have little access to physician provided medical care
- NP role formally described in 1960s and was implemented in outpatient pediatric clinics in
response to a shortage of primary care physicians
- Loretta Ford in 1965 established first Pediatric NP program (PNP) & was designed to prepare
professional nurses to provide comprehensive well-child care and manage common childhood
health problems
- 1970 continue to enhance visibility in health system, and expand role while demonstrating
cost effective quality care
- role expanded/included because nurse role was essential to providing equal access to health
care for all Americans
- conflict surrounds role between other RN and NP and NP and physicians
- issues surrounding prescriptive treatment & idaho in 1971 was first state to recognize
diagnosis and treatment as part of practice
- Support DNP but does not require educational programs to be at the doctoral level
Clinical Nurse Specialist - CORRECT ANSWER-- evolved out of increasingly complexity of nursing
care
- roots in psychiatric nursing
,- psych specialists date back to 1880 & richards is credited with founding specialty of psych
nursing specialists
- Rutgers University first educational program for CNS but was for psychiatric nursing
- coronary care nurse specialists established in 1962 & CCU nurses blurred invisible boundary
separating nursing and medicine
- 1960s noted to be when clincal nurse specialist took on modern day form
- three social forces drove specialization 1. increase in specialty related information 2. new tech
advances 3. response to public need and interests
- crtical care and oncology specialty grew in 1970s
- ANA recognized CNS role 1970s defining the CNS as an expert practitioner and change agent
- master degree required
- role has postive effect on improving nursing care and patient outcomes
- view shift from direct patient care to education and organizations (seen as too valuable)
- education complex due to number of specialties involved
- can prescribe without physician supervision in 20 states now
- 1997 Balanced Budget Act identified CNS eligible for Medicare reimburstment
Certified Registered Nurse Anesthetist - CORRECT ANSWER-- history in civil war
- typically anesthesia given only when a physician was unavailable
- Dr Mayo first to recognize and formally train CRNA in 1889
-Alice Macaw mother of anesthesia (hired by mayo)
- early challenges but practice has grown
- 1931 Lakeside hospital establishes National Association of Nurse Anesthetists
- LA medical association dues Nelson in 1934 for practicing without a license & nelson won but
in response Chalmers-Frances filed another suit and judgement was the result only to have CA
Supreme Court rule in favor of Nelson again and the practice of nurse anesthisa was legal/in
scope as long as it was done under guidance of supervision of physician
- reimburstment not clear cut
- mandatory certification
- master level education
- after 2022 must have a doctoral degree
Certified Nurse Midwife - CORRECT ANSWER-- history from start of time
- isolated communities rely on midwives
- "granny midwives"
- Fontier Nursing Service (FNS) in 1925 & was decentralized network of nurse run clinics in rural
mountains of kentucky
, - earliest school was the School of the Association for the Promotion and Standardization of
Midwifery in 1932
- combination of two disciplines nursing and midwifery
- issues with insurance coverage in 1980s because of complex delivery outcomes
- 1990s higher demand and expansion in scope of practice
- hospitals tried to limit profession and 1980s CNMs work under civilian health and medical
program of the uniformed Services for military and were first to recieve reimbursements
- 1984 recognized by all states in laws and regulations
- can get certification or master degree
- no evidence to support doctoral degree and DNP not required
Nurse Educator Role - CORRECT ANSWER-- Responsible for designing, evaluating, updating, and
implementing new and current nursing education curriculum
- advisers and role models
Nurse Administrator Role - CORRECT ANSWER-- Supervise nurses and other health care team
members
- recruit, hire, and train nurses
Role Acquisition - CORRECT ANSWER-- Anticipatory socialization to APRN roles that occurs in
graduate education
- role rehersal
- development of clinical knowledge and skills
- creation of supportive network
Medicare part A Billing - CORRECT ANSWER-- Covers hospital expenses
- Does NOT reimburs the ARPN directly because those services are already paid for as part of
the hospital expense
- Includes inpatient care recieved in hospital or skilled nursing facility
- Covers critical access hospitals, short-term care in skilled nursing facility, post institutional
home health care and hospice care
- funded through payroll taxes & beneficiary cost sharing (deductibles and coinsurance)
ICD-10-CM codes - CORRECT ANSWER-- Documentation for billing a service
- APRN use
- Diagnosis for which services are provided is what these codes represent
- forms basis as to why a service is being provided
- this is the most current version (international classification of diseases 10th revision)
