1
ISSUES/TRENDS/POLICY
You want to get more funding for your hospital’s Rapid Response Team. How
should you present this issue to the committee?
-Stress importance of the team (answer is worded as looking up evidence about how the
team affects outcomes, like a meta-analysis)
-Describe how to improve and expand the team.
What is the best way for the AGACNP to get involved in policy making?
-Attend legislative days at the state capitol -Join a hospital committee
-Write to your local congressman -Review literature and give more in-
services
What is the best way for the AGACNP to demonstrate and advocate for full scope of
practice?
-Join a hospital committee -Petition the government
-Bill for independent services -Start your own practice
Which of the following is considered a high acuity role for the AGACNP?
-Primary care clinic -Cardiology office -Community health department -Minute Clinic
What is the best way to advocate for gay and lesbian population in your area?
-Participate at a high state or national level -Join a non-profit advocacy group
-Consider lobbying the government -Start at your facility
(answers are worded differently. One of them is “decrease bias in healthcare” and another is
something like “create inservices in healthcare” and another is “obtain funding to increase
access.”
Which of the following is most important to evaluate statistical significance when
reviewing the literature?
-Consider the sample size -Make sure the confidence interval
is tight
-See if the p-value is less than the α-coefficient -Determine the error rate
(Answers are worded differently. “Ensure confounding variables were eliminated” & “P value
is less than null hypothesis” were two of them.
When closing a practice, the NP is required to do all of the following except
-Give the pt adequate time to find another provider
-Keep all of the patient’s records for a minimum of five years-
-Send a certified letter with a return receipt requested (this is for discharging/firing a
patient from your practice)
-Provide names of other providers for future care
Which of the following components of an evidenced based research process is the
most important for NP to participate in?
-Specifying methods of data collection -Formulating the hypothesis
-Carefully reviewing the literature -Formulating the
research problem
A former pt of an NP is writing blog posts, sending emails, and distributing false,
accusatory statements about the NP’s practice. Which of the following forms of
defamation is this?
-libel -slander
, 2
Can you tell the pt’s wife, for her protection, that her husband has HIV? No, not without
his permission.
How can the ANCP prepare to get involved in future mass casualty event? Pre-enroll in
disaster volunteer program
An 80-year-old male patient with dementia requires long-term care placement. To which
funding agency does the patient apply after "spending down" to qualify? Medicaid
Your pt is worried about insurance coverage and asks you for advice on Medicaid. You
instruct the patient that Medicaid: Pays after insurance and 3 party payers have paid
rd
You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night
before and wants you to say that their drug is the only one that works. What ethical
principles does this challenge? Veracity and Fidelity
Health Literacy: Average American-8th grade education level
Know your QA/QI/CPI basic definitions and goals: verbatim from Barkley’s Book
One question had Quality Assurance as one answer, then CPI as another option! It
sounded more like CPI to me.
Quality assurance-a process for evaluating the care of pts using established standards
of care to ensure quality
CPI measures what 3 measures to improve nursing? Structure, processes, and
outcomes
A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family
communication as the basis for the resulting adverse outcome. As part of the
performance improvement plan, the NP is asked to develop evidence-based polices to
establish clinician-family communication standards in the unit. These policies should
include: guidelines for having discussions with family members that are geared
toward establishing treatment goals.
Which clinical scenario does the NP evaluate for a quality improvement process
change? An increased incidence of postoperative sternal wound infections
Goals set forth in "Healthy People 2020" by the United States Department of Health
and Human Services include: elimination of health disparities. (and ↑QOL/LOL)
Based on the individual's culture, ethnicity, and personal choices, the NP can optimize
the therapeutic partnership w/the patient by: Tailoring his or her communication
style to the patient’s preference.
A 70-year-old pt with a hx of DM, HTN, OAs, and a new diagnosis of coronary artery
disease, is being discharged. The adult-gerontology acute care nurse practitioner
teaches the patient that the first point of contact for health care needs is the: primary
care provider
The NP is asked to provide evidence to the hospital administration about the safety of
NP placing central lines. Which resource provides the strongest level of evidence? A
systematic review (meta-analysis is even stronger)
What legislation allowed nurse practitioners to be recognized Medicare providers in
all geographical areas with their own provider number? Balanced Budget Act
True/False: restraining an unwilling patient is grounds for malpractice? False, if
they are a danger you can restrain
Pt presents to the clinic for routine f/u and passes out. You revive the pt and admit
overnight. Which of the following would qualify as incident-to-billing? Temperature
and weight recording
The NP program initiated, primarily, because of what issue in healthcare at the time?
Pediatric physician shortage
, 3
Elderly F pt takes a turn for the worse. The husband is crying when you enter the
room and begins telling you what end-of-life care he prefers. What do you do? Ask
him to speak candidly with you
Pt calls to complain about bills and states he has Medicare, which should cover all
costs. You explain: Since you are healthy, exams are not covered.
HIPPA
Doc calls from another center asking if you can tell him what kind of orders he should
give for maintenance of patient… HIPPA.
Pt in ER not doing well, primary md calls: Give him info
NP working on ESRD research project . A colleague renal specialist asks for pt info on
your patients: HIPPA breach.
Who enforces HIPPA- Office of Civil Rights /Dept. Health and Human Services
Who ISN'T covered by HIPPA? Law enforcement/Municipal Offices, CPS/Schools,
Employers/Workman’s Comp, Life insurance
Question about an insurance company calling to verify some patient appointments.
You have to pick out that there is already a medical release signed by the patient. The
answer is to give the requested information to them.
Definitions
Root Cause Analysis – very basic question where RCA is the answer and the question is
the definition
Benchmarking-how institution compares with similar organizations
Managed Care: know what this is and how it has improved costs. Something about
putting caps on payments…
Peer review-timely, not anonymous, and NP knows how peer review will impact yearly
evaluation
Sensitivity vs specificity… sensitivity is positive and specificity is negative. Know this
backwards and forwards—like what would a high sensitivity say versus a low
sensitivity, in about 3-4 of Phil’s questions
There was a question where a patient had a multinodular goiter and wanted to know
why the NP was not going to do periodic U/S and Fine needle biopsy in montoring for
some kind of cancer or complication. The answer I picked was that these tests were
not very specific to detect the cancer. Another option was specificity.
Reliability: When implementing a new study… tested over and over. The consistency of
a measurement, or the degree to which an instrument measures the same way over
time
Validity of results in an article: P-value. Probability of falsely rejecting the null
hypothesis. Want it to be low
Statistical significance: look at sample size & p value.
Medical futility- unlikely to produce any significant good for the pt
Privileging – may be granted in full or part by the hospital. Credentialing committee is
made of physicians.
Institutional bylaws may further restrict practice (Facility limited scope of practice)
Informed Consent: a state indicating pt has received adequate instruction/information
regarding aspects of care to make a prudent, personal choice regarding such Tx.
Includes benefits and risks. Includes competence: pt. ability to CURD: communicate,
understand, reason, differentiate good and bad
Case management- Mobilize, monitor, and control resources that a pt uses during
course of an illness while balancing quality and cost (“move pts thru the system
appropriately”).
There was a 50-60’s year old patient with a new diagnosis of cancer. To appropriately
plan for discharge, what should the NP do? Options were to consult CM, consult SW,
refer to Oncology, or I think refer to hospice
Nondisclosure: not disclosing patient PHI without their permission (confidentiality)
, 4
Negligence: failure of individual to do what any reasonable person would do, resulting
in injury to the patient
When serving as a nurse researcher, the NP is guided by which ethical principle to
ensure that research participants are protected from harm or exploitation?
Nonmaleficence
Quantitative and Qualitative…. Quantitative is amount/numbers… qualitative is
descriptive, like case studies
Know difference between advanced directive and living will: Living will provides
"POA/healthcare proxy”
There was a patient who wasn’t doing well and family was at patient bedside. Answer
was to address decision making with the healthcare proxy.
Billing: NP sees a pt for HF and performs an H & P. What % is expected to be paid?
Medicare pays 80% of the total bill, Pt pays 20%. NP is reimbursed 85% of what the
MD is reimbursed for physician services, and for procedure is paid 80% of that 85%
General Tips
Several questions on d/c planning
A lot of health policy/sw/cm/pt. rights
Palliative care, end of life and advance directives
There was a question on the focus of palliative care. Answer was basic improvement in
QOL of anyone with an illness at any stage. Another answer was <6 months to live,
that one’s wrong bc its hospice
Types of research, lots of EBP, research terms, Ethical terms
LOTS of therapeutic communication- know this whole section of Barkley
Scope of practice: integration of care across the acute illness continuum with:
Collaboration*
Coordination of care
Researched based clinical practice
Clinical leadership
Family assessment
Discharge planning
Collaboration*: “true partnership” in which all players have and desire power, share
common goals, and recognize/accept separate areas of responsibility/activity
4 Roles of a Nurse Practitioner: Education, Research, Clinician,
Consultant/Collaborator
Pt is getting dc and needs wound care, pulmonary, and follow up: NP’s role is: to
coordinate services
Government is moving towards being cost effective. What is the best way? Allow NP
to treat a wider variety of pts.
Question about cutting costs by the gov’t and my answer was something primary-
preventative related
Protected health information: Conversation between the ACNP and a consultant on the
case: considered clinical relevance
How should the ACNP stay up to date with current information? Evidence based
guidelines
“Incident to” billing rules
Medicare levels and what they cover. Hospice is Medicare A
A pt presents to the ER with c/o CP and SOB. The NP misinterprets the EKG and
admits the pt for further monitoring without consulting Cardio. Later in the shift, the
pt decompensates and goes into cardiac arrest. The pt. was resuscitated but sustained
permanent brain damage. What grounds of malpractice is the NP accountable for?
Lack of skill
ISSUES/TRENDS/POLICY
You want to get more funding for your hospital’s Rapid Response Team. How
should you present this issue to the committee?
-Stress importance of the team (answer is worded as looking up evidence about how the
team affects outcomes, like a meta-analysis)
-Describe how to improve and expand the team.
What is the best way for the AGACNP to get involved in policy making?
-Attend legislative days at the state capitol -Join a hospital committee
-Write to your local congressman -Review literature and give more in-
services
What is the best way for the AGACNP to demonstrate and advocate for full scope of
practice?
-Join a hospital committee -Petition the government
-Bill for independent services -Start your own practice
Which of the following is considered a high acuity role for the AGACNP?
-Primary care clinic -Cardiology office -Community health department -Minute Clinic
What is the best way to advocate for gay and lesbian population in your area?
-Participate at a high state or national level -Join a non-profit advocacy group
-Consider lobbying the government -Start at your facility
(answers are worded differently. One of them is “decrease bias in healthcare” and another is
something like “create inservices in healthcare” and another is “obtain funding to increase
access.”
Which of the following is most important to evaluate statistical significance when
reviewing the literature?
-Consider the sample size -Make sure the confidence interval
is tight
-See if the p-value is less than the α-coefficient -Determine the error rate
(Answers are worded differently. “Ensure confounding variables were eliminated” & “P value
is less than null hypothesis” were two of them.
When closing a practice, the NP is required to do all of the following except
-Give the pt adequate time to find another provider
-Keep all of the patient’s records for a minimum of five years-
-Send a certified letter with a return receipt requested (this is for discharging/firing a
patient from your practice)
-Provide names of other providers for future care
Which of the following components of an evidenced based research process is the
most important for NP to participate in?
-Specifying methods of data collection -Formulating the hypothesis
-Carefully reviewing the literature -Formulating the
research problem
A former pt of an NP is writing blog posts, sending emails, and distributing false,
accusatory statements about the NP’s practice. Which of the following forms of
defamation is this?
-libel -slander
, 2
Can you tell the pt’s wife, for her protection, that her husband has HIV? No, not without
his permission.
How can the ANCP prepare to get involved in future mass casualty event? Pre-enroll in
disaster volunteer program
An 80-year-old male patient with dementia requires long-term care placement. To which
funding agency does the patient apply after "spending down" to qualify? Medicaid
Your pt is worried about insurance coverage and asks you for advice on Medicaid. You
instruct the patient that Medicaid: Pays after insurance and 3 party payers have paid
rd
You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night
before and wants you to say that their drug is the only one that works. What ethical
principles does this challenge? Veracity and Fidelity
Health Literacy: Average American-8th grade education level
Know your QA/QI/CPI basic definitions and goals: verbatim from Barkley’s Book
One question had Quality Assurance as one answer, then CPI as another option! It
sounded more like CPI to me.
Quality assurance-a process for evaluating the care of pts using established standards
of care to ensure quality
CPI measures what 3 measures to improve nursing? Structure, processes, and
outcomes
A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family
communication as the basis for the resulting adverse outcome. As part of the
performance improvement plan, the NP is asked to develop evidence-based polices to
establish clinician-family communication standards in the unit. These policies should
include: guidelines for having discussions with family members that are geared
toward establishing treatment goals.
Which clinical scenario does the NP evaluate for a quality improvement process
change? An increased incidence of postoperative sternal wound infections
Goals set forth in "Healthy People 2020" by the United States Department of Health
and Human Services include: elimination of health disparities. (and ↑QOL/LOL)
Based on the individual's culture, ethnicity, and personal choices, the NP can optimize
the therapeutic partnership w/the patient by: Tailoring his or her communication
style to the patient’s preference.
A 70-year-old pt with a hx of DM, HTN, OAs, and a new diagnosis of coronary artery
disease, is being discharged. The adult-gerontology acute care nurse practitioner
teaches the patient that the first point of contact for health care needs is the: primary
care provider
The NP is asked to provide evidence to the hospital administration about the safety of
NP placing central lines. Which resource provides the strongest level of evidence? A
systematic review (meta-analysis is even stronger)
What legislation allowed nurse practitioners to be recognized Medicare providers in
all geographical areas with their own provider number? Balanced Budget Act
True/False: restraining an unwilling patient is grounds for malpractice? False, if
they are a danger you can restrain
Pt presents to the clinic for routine f/u and passes out. You revive the pt and admit
overnight. Which of the following would qualify as incident-to-billing? Temperature
and weight recording
The NP program initiated, primarily, because of what issue in healthcare at the time?
Pediatric physician shortage
, 3
Elderly F pt takes a turn for the worse. The husband is crying when you enter the
room and begins telling you what end-of-life care he prefers. What do you do? Ask
him to speak candidly with you
Pt calls to complain about bills and states he has Medicare, which should cover all
costs. You explain: Since you are healthy, exams are not covered.
HIPPA
Doc calls from another center asking if you can tell him what kind of orders he should
give for maintenance of patient… HIPPA.
Pt in ER not doing well, primary md calls: Give him info
NP working on ESRD research project . A colleague renal specialist asks for pt info on
your patients: HIPPA breach.
Who enforces HIPPA- Office of Civil Rights /Dept. Health and Human Services
Who ISN'T covered by HIPPA? Law enforcement/Municipal Offices, CPS/Schools,
Employers/Workman’s Comp, Life insurance
Question about an insurance company calling to verify some patient appointments.
You have to pick out that there is already a medical release signed by the patient. The
answer is to give the requested information to them.
Definitions
Root Cause Analysis – very basic question where RCA is the answer and the question is
the definition
Benchmarking-how institution compares with similar organizations
Managed Care: know what this is and how it has improved costs. Something about
putting caps on payments…
Peer review-timely, not anonymous, and NP knows how peer review will impact yearly
evaluation
Sensitivity vs specificity… sensitivity is positive and specificity is negative. Know this
backwards and forwards—like what would a high sensitivity say versus a low
sensitivity, in about 3-4 of Phil’s questions
There was a question where a patient had a multinodular goiter and wanted to know
why the NP was not going to do periodic U/S and Fine needle biopsy in montoring for
some kind of cancer or complication. The answer I picked was that these tests were
not very specific to detect the cancer. Another option was specificity.
Reliability: When implementing a new study… tested over and over. The consistency of
a measurement, or the degree to which an instrument measures the same way over
time
Validity of results in an article: P-value. Probability of falsely rejecting the null
hypothesis. Want it to be low
Statistical significance: look at sample size & p value.
Medical futility- unlikely to produce any significant good for the pt
Privileging – may be granted in full or part by the hospital. Credentialing committee is
made of physicians.
Institutional bylaws may further restrict practice (Facility limited scope of practice)
Informed Consent: a state indicating pt has received adequate instruction/information
regarding aspects of care to make a prudent, personal choice regarding such Tx.
Includes benefits and risks. Includes competence: pt. ability to CURD: communicate,
understand, reason, differentiate good and bad
Case management- Mobilize, monitor, and control resources that a pt uses during
course of an illness while balancing quality and cost (“move pts thru the system
appropriately”).
There was a 50-60’s year old patient with a new diagnosis of cancer. To appropriately
plan for discharge, what should the NP do? Options were to consult CM, consult SW,
refer to Oncology, or I think refer to hospice
Nondisclosure: not disclosing patient PHI without their permission (confidentiality)
, 4
Negligence: failure of individual to do what any reasonable person would do, resulting
in injury to the patient
When serving as a nurse researcher, the NP is guided by which ethical principle to
ensure that research participants are protected from harm or exploitation?
Nonmaleficence
Quantitative and Qualitative…. Quantitative is amount/numbers… qualitative is
descriptive, like case studies
Know difference between advanced directive and living will: Living will provides
"POA/healthcare proxy”
There was a patient who wasn’t doing well and family was at patient bedside. Answer
was to address decision making with the healthcare proxy.
Billing: NP sees a pt for HF and performs an H & P. What % is expected to be paid?
Medicare pays 80% of the total bill, Pt pays 20%. NP is reimbursed 85% of what the
MD is reimbursed for physician services, and for procedure is paid 80% of that 85%
General Tips
Several questions on d/c planning
A lot of health policy/sw/cm/pt. rights
Palliative care, end of life and advance directives
There was a question on the focus of palliative care. Answer was basic improvement in
QOL of anyone with an illness at any stage. Another answer was <6 months to live,
that one’s wrong bc its hospice
Types of research, lots of EBP, research terms, Ethical terms
LOTS of therapeutic communication- know this whole section of Barkley
Scope of practice: integration of care across the acute illness continuum with:
Collaboration*
Coordination of care
Researched based clinical practice
Clinical leadership
Family assessment
Discharge planning
Collaboration*: “true partnership” in which all players have and desire power, share
common goals, and recognize/accept separate areas of responsibility/activity
4 Roles of a Nurse Practitioner: Education, Research, Clinician,
Consultant/Collaborator
Pt is getting dc and needs wound care, pulmonary, and follow up: NP’s role is: to
coordinate services
Government is moving towards being cost effective. What is the best way? Allow NP
to treat a wider variety of pts.
Question about cutting costs by the gov’t and my answer was something primary-
preventative related
Protected health information: Conversation between the ACNP and a consultant on the
case: considered clinical relevance
How should the ACNP stay up to date with current information? Evidence based
guidelines
“Incident to” billing rules
Medicare levels and what they cover. Hospice is Medicare A
A pt presents to the ER with c/o CP and SOB. The NP misinterprets the EKG and
admits the pt for further monitoring without consulting Cardio. Later in the shift, the
pt decompensates and goes into cardiac arrest. The pt. was resuscitated but sustained
permanent brain damage. What grounds of malpractice is the NP accountable for?
Lack of skill
