APRN Problem Solving Exam Questions and
With Distinction level Marking scheme
updated 2023/2024
Hamric's APRN Model - correct answer Conceptual definition of
advanced practice nursing and defining characteristics that
include primary criteria (graduate education, certification in
specialty, and focus on clinical practice with patients) and set of
core competencies (direct clinical practice, collaboration,
guidance and coaching, evidence-based practice, ethical
decision-making, consultation, and leadership).
Critical environmental elements affecting advanced practice
nursing include - regulatory and credentialing requirements,
business aspects, health policy, payment mechanisms, outcome
evaluation and performance improvement, marketing and
contracting, and organizational structure and culture.
Standards of Care - correct answer Did the clinician do the
right thing at the right time?
Was effective care provided to the patient?
Was care provided safely and in an appropriate time frame?
Was the outcome as good as expected, given the patient's
condition and personal characteristics and the current state of
medical science?
Standards are set by the National Committe of Quality Assurance
(NCQA), Joint Commission, Medicare, and the Agency for
Healthcare Research and Quality (AHRQ).
,AANP - Standards of Care
1. Assessment of health status (health history, PE, identifying
risks, ordering appropriate testing)
2. Diagnosis (critical thinking, analyzing data, differential
diagnosis, establishing priorities)
3. Development of treatment plan (ordering additional tests,
prescribing appropriate interventions, developing education
plan, appropriate consults/referrals)
4. Implementation of plan (individualized, consistent with care
plan, consistent with teaching and learning opportunities)
5. Follow up/Evaluation (determination of effectiveness of
treatment plan with documentation of outcomes, modifying plan
as necessary)
HEDIS - correct answer Health Plan Employer Data and
Information Set
Set of performance measures set by the NCQA.
Barriers to Advanced Practice Nursing - correct answer
Inconsistent state-by-state regulations
Physician "supervision" or "collaboration" requirements
Invisible provider status through "incident to" billing
Inability to order hospice, home health care, or skilled nursing
services
, Unable to practice NP principles of care that is patient-centered,
health-focused, and holistic within a particular setting due to role
fulfillment constraints.
In many clinical settings the medical model dominates leading to
restricted nursing aspects of care. Lack of recognition of nursing
diagnoses as billable conditions.
Language difference and confusion about the APN role.
Lack of collective voice.
In some states, state board of nursing does not have sole power
to govern nursing practice in the state (Missouri).
(Internal barriers relate to the role of the nurse practitioner.
External barriers are primarily related to public policy. )
APRN Scope of Practice in Missouri - correct answer APRNs
must obtain their right to administer, dispense, or prescribe
drugs through a collaborative practice agreement. Also, APRNs
are not allowed to prescribe controlled substances unless
specifically outlined in the collaborative practice agreement
(however, APRNs are NOT allowed to prescribe schedule II meds,
and no more than a 5 day supply of schedule III meds).
With Distinction level Marking scheme
updated 2023/2024
Hamric's APRN Model - correct answer Conceptual definition of
advanced practice nursing and defining characteristics that
include primary criteria (graduate education, certification in
specialty, and focus on clinical practice with patients) and set of
core competencies (direct clinical practice, collaboration,
guidance and coaching, evidence-based practice, ethical
decision-making, consultation, and leadership).
Critical environmental elements affecting advanced practice
nursing include - regulatory and credentialing requirements,
business aspects, health policy, payment mechanisms, outcome
evaluation and performance improvement, marketing and
contracting, and organizational structure and culture.
Standards of Care - correct answer Did the clinician do the
right thing at the right time?
Was effective care provided to the patient?
Was care provided safely and in an appropriate time frame?
Was the outcome as good as expected, given the patient's
condition and personal characteristics and the current state of
medical science?
Standards are set by the National Committe of Quality Assurance
(NCQA), Joint Commission, Medicare, and the Agency for
Healthcare Research and Quality (AHRQ).
,AANP - Standards of Care
1. Assessment of health status (health history, PE, identifying
risks, ordering appropriate testing)
2. Diagnosis (critical thinking, analyzing data, differential
diagnosis, establishing priorities)
3. Development of treatment plan (ordering additional tests,
prescribing appropriate interventions, developing education
plan, appropriate consults/referrals)
4. Implementation of plan (individualized, consistent with care
plan, consistent with teaching and learning opportunities)
5. Follow up/Evaluation (determination of effectiveness of
treatment plan with documentation of outcomes, modifying plan
as necessary)
HEDIS - correct answer Health Plan Employer Data and
Information Set
Set of performance measures set by the NCQA.
Barriers to Advanced Practice Nursing - correct answer
Inconsistent state-by-state regulations
Physician "supervision" or "collaboration" requirements
Invisible provider status through "incident to" billing
Inability to order hospice, home health care, or skilled nursing
services
, Unable to practice NP principles of care that is patient-centered,
health-focused, and holistic within a particular setting due to role
fulfillment constraints.
In many clinical settings the medical model dominates leading to
restricted nursing aspects of care. Lack of recognition of nursing
diagnoses as billable conditions.
Language difference and confusion about the APN role.
Lack of collective voice.
In some states, state board of nursing does not have sole power
to govern nursing practice in the state (Missouri).
(Internal barriers relate to the role of the nurse practitioner.
External barriers are primarily related to public policy. )
APRN Scope of Practice in Missouri - correct answer APRNs
must obtain their right to administer, dispense, or prescribe
drugs through a collaborative practice agreement. Also, APRNs
are not allowed to prescribe controlled substances unless
specifically outlined in the collaborative practice agreement
(however, APRNs are NOT allowed to prescribe schedule II meds,
and no more than a 5 day supply of schedule III meds).
