The Art and Science of Advanced Practice Nursing An Interprofessional Approach Sixth Edition

TEST BANK Primary Care The Art and Science of Advanced Practice Nursing An Interprofessional Approach Sixth Edition Lynne M. Dunphy • Jill E. Winland-Brown • Brian Oscar Porter • Debera J. Thomas Table of Contents I. Caring-Based Nursing: The Art 1. Primary Care in the Twenty-First Century: A Circle of Caring 3 2. Caring and the Advanced Practice Nurse 9 3. Health Promotion 15 4. The Art of Diagnosis and Treatment 21 5. Evidence-Based Practice 27 II. Caring-Based Nursing: The Science Section 1. Neurological Problems 6. Common Neurological Complaints 32 7. Seizure Disorders 38 8. Degenerative Disorders 44 9. Cerebrovascular Accident (Stroke) 50 10. Infectious and Inflammatory Neurological Disorders 56 I. CARING-BASED NURSING: THE ART Chapter 1 Primary Care in the Twenty-First Century: A Circle of Caring 1. Which combination of attributes best identifies care as "primary care" in the framework most often attributed to Starfield? A. Episodic treatment of acute illness with referral of all chronic disease B. Disease-specific management within a single organ system C. First-contact access, continuity over time, comprehensiveness, and coordination of care D. Screening services delivered exclusively in community settings Correct Answer: C Level: Moderate Rationale: Primary care is defined by first-contact access, longitudinal relationships, comprehensive scope, and coordination across settings. The other options describe fragmented, episodic, or specialty-focused models. 2. The first nurse practitioner program, developed by Loretta Ford and Henry Silver at the University of Colorado in 1965, was created primarily to address which need? A. A surplus of physicians seeking alternative roles B. A shortage of primary care providers for children and the need for greater emphasis on health promotion C. A desire to replace public health nurses D. Federal requirements for hospital-based advanced nursing Correct Answer: B Level: Moderate Rationale: The original pediatric NP program responded to a shortage of pediatric primary care providers and emphasized preventive and family-centered care, establishing the NP role in primary care. 3. A clinic director proposes evaluating performance using the Triple Aim. Which set of measures aligns with this framework? A. Patient experience of care, population health outcomes, and per capita cost of care B. Visit volume, revenue per encounter, and staff productivity C. Physician satisfaction, referral rates, and hospital census D. Number of screenings ordered, imaging utilization, and laboratory volume Correct Answer: A Level: Challenging Rationale: The Institute for Healthcare Improvement's Triple Aim targets improved patient experience, improved population health, and reduced per capita cost. Volume and revenue metrics do not capture these aims. 4. An NP practice has experienced rising burnout and turnover among clinicians and staff. Which element of the framework beyond the Triple Aim most directly addresses this problem? A. Reducing per capita cost B. Improving population health outcomes C. Improving the work life of the care team D. Enhancing patient experience Correct Answer: C Level: Challenging Rationale: The Quadruple Aim adds clinician and staff well-being as a fourth goal, recognizing that burned-out teams struggle to deliver high-quality, patient-centered care. 5. The 1978 Declaration of Alma-Ata is significant to primary care because it: A. Established licensure standards for advanced practice nurses B. Created the first insurance model for primary care C. Identified primary health care, with community participation and equitable access, as key to achieving health for all D. Mandated physician supervision of nonphysician clinicians Correct Answer: C Level: Moderate Rationale: Alma-Ata affirmed primary health care as the foundation of health systems, emphasizing accessibility, community involvement, equity, and intersectoral action. 6. A 58-year-old with diabetes, hypertension, and chronic kidney disease sees cardiology, nephrology, and endocrinology. She arrives with three medication lists containing duplicate agents and asks which doctor is in charge. Which primary care function does the NP most directly fulfill by resolving this problem? A. Health screening B. Episodic acute care C. Specialty consultation D. Coordination of care, including medication reconciliation across providers Correct Answer: D Level: Challenging Rationale: Coordination of care means integrating information and services across providers and settings. Reconciling medications and clarifying roles reduces harm from duplication and fragmentation. 7. Which of the following is NOT a core function of the patient-centered medical home? A. Fee-for-service episodic visits as the primary model of care B. Comprehensive care C. Coordinated care D. Accessible services Correct Answer: A Level: Moderate Rationale: The medical home emphasizes patient-centered, comprehensive, coordinated, accessible care with a commitment to quality and safety, rather than episodic, volume-driven visits. 8. A patient with poorly controlled asthma repeatedly misses appointments. During the visit the NP learns she lives in housing with visible mold and lacks reliable transportation. What is the best primary care response? A. Discharge the patient from the practice for nonadherence B. Increase the controller medication dose and schedule a return visit in 3 months C. Refer only to pulmonology for evaluation D. Address asthma management while screening for social needs and connecting her with community resources and social work Correct Answer: D Level: Challenging Rationale: Social determinants strongly influence outcomes. Effective primary care treats the condition while identifying and addressing housing, transportation, and other barriers through team and community resources. 9. An NP who understands her own scope and the scope of the pharmacist, social worker, and dietitian and uses them appropriately is demonstrating which interprofessional competency domain? A. Values and ethics B. Roles and responsibilities C. Interprofessional communication D. Quality improvement Correct Answer: B Level: Moderate Rationale: The roles and responsibilities domain involves knowing one's own role and those of other professions and using this knowledge to meet patient needs. 10. During a team huddle, the pharmacist reports that a patient has not filled a prescribed anticoagulant because of cost. Which NP response best reflects collaborative practice? A. Explain that cost is not a clinical concern and proceed with the plan B. Thank the pharmacist, and engage the team to identify affordable alternatives or assistance programs and follow up with the patient C. Ask the patient to resolve insurance issues independently D. Discontinue anticoagulation permanently Correct Answer: B Level: Challenging Rationale: Effective collaboration values input from all team members and uses shared problem solving to remove barriers, especially those with safety implications. 11. Which effect of the Affordable Care Act is most relevant to primary care practice? A. Elimination of all copayments for prescription drugs B. Requirement that all care be delivered in hospital outpatient settings C. Coverage of recommended preventive services without cost sharing and expanded insurance coverage D. Prohibition of nurse practitioners as primary care providers Correct Answer: C Level: Moderate Rationale: The ACA expanded coverage and required coverage of USPSTF A and B recommended preventive services without cost sharing, strengthening the preventive focus of primary care. 12. An NP relocates from a full practice authority state to a restricted practice state. Which change should she anticipate? A. A required collaborative or supervisory agreement with a physician for some aspects of practice B. Loss of prescriptive authority for all medications C. Elimination of the need for national certification D. A requirement to work only in hospitals Correct Answer: A Level: Challenging Rationale: Restricted practice states require regulated collaboration or supervision. Full practice authority allows evaluation, diagnosis, ordering tests, and prescribing under the board of nursing alone. 13. The APRN Consensus Model for regulation identifies which four APRN roles? A. Certified nurse practitioner, clinical nurse specialist, certified nurse-midwife, and certified registered nurse anesthetist B. Nurse practitioner, physician assistant, nurse educator, nurse administrator C. Family, adult, pediatric, and geriatric nurse practitioner D. Primary care, acute care, psychiatric, and women's health practitioner Correct Answer: A Level: Moderate Rationale: The Consensus Model recognizes CNP, CNS, CNM, and CRNA roles, with licensure, accreditation, certification, and education (LACE) elements. 14. Which patient is the most appropriate candidate for a synchronous video telehealth visit? A. A 62-year-old with acute chest pressure and diaphoresis B. A 45-year-old with stable hypertension who has home blood pressure readings and needs medication titration C. A 3-month-old with new fever and lethargy D. A patient needing initial evaluation of a possible fracture Correct Answer: B Level: Challenging Rationale: Telehealth is well suited to stable chronic disease follow-up with objective home data. Acute emergencies and conditions requiring hands-on examination or imaging need in-person evaluation. 15. The Institute of Medicine's definition of primary care emphasizes which feature that distinguishes it from episodic care? A. Development of a sustained partnership with patients in the context of family and community B. Use of advanced technology C. Exclusive focus on prevention D. Limitation to a single body system Correct Answer: A Level: Moderate Rationale: The IOM definition stresses accountability for most personal health needs and a sustained partnership with patients in the context of family and community. 16. A clinic serves a growing refugee population with high rates of missed follow-up. Which approach best reflects caring-based, community-oriented primary care? A. Shorten visits to see more patients B. Partner with community leaders, use professional interpreters, and tailor services to cultural and logistical needs C. Require patients to arrange their own interpreters D. Refer all patients to a public health department Correct Answer: B Level: Challenging Rationale: Community engagement, professional interpretation, and culturally tailored services build trust and improve access, reflecting caring-based practice. 17. The term "primary health care" differs from "primary care" in that primary health care: A. Refers only to physician services B. Is a broader approach that includes population health, community participation, and action across sectors C. Is limited to treatment of acute illness D. Excludes preventive services Correct Answer: B Level: Moderate Rationale: Primary health care is a broader strategy addressing determinants of health and community needs, while primary care refers to the clinical services delivered at first contact. 18. An NP practice receives a bonus for the proportion of patients with diabetes achieving an HbA1c below 8%. Which strategy best fits this value-based payment model? A. Increase the number of visits scheduled per hour B. Refer all patients with diabetes to endocrinology C. Maintain a diabetes registry and conduct proactive outreach and team-based management of patients above goal D. Limit enrollment of patients with complex disease Correct Answer: C Level: Challenging Rationale: Value-based models reward outcomes across a defined population. Registry-driven outreach and team management improve performance and patient health. 19. Continuity of care with a consistent primary care clinician is most consistently associated with which outcome? A. Lower rates of hospitalization and emergency department use B. Higher rates of medication errors C. Increased specialist referral D. Reduced patient satisfaction Correct Answer: A Level: Moderate Rationale: Continuity is associated with better trust, adherence, satisfaction, and fewer hospitalizations and emergency visits. 20. Which statement best reflects the "circle of caring" concept in primary care? A. Caring is limited to the clinician-patient encounter B. Caring extends among patients, families, teams, and communities, and is sustained when clinicians also care for themselves and each other C. Caring is a skill that is separate from clinical competence D. Caring applies only to terminally ill patients Correct Answer: B Level: Challenging Rationale: A circle of caring recognizes reciprocal relationships and the need for clinician self-care and team support to sustain caring practice. 21. Research comparing NP and physician primary care generally shows that NP-delivered care results in: A. Consistently poorer outcomes for chronic disease B. Higher costs without improved outcomes C. Lower access to care D. Comparable outcomes for patient satisfaction and many quality measures Correct Answer: D Level: Moderate Rationale: Multiple studies show NPs provide primary care with outcomes comparable to physicians on satisfaction and many quality indicators, supporting their role in expanding access. 22. An NP reviews her panel of 1,200 patients and finds that 40% of women aged 50 to 74 years are overdue for mammography. Outreach is planned for all of them. This activity is best described as: A. Diagnostic reasoning B. Tertiary prevention C. Case management D. Population health management Correct Answer: D Level: Challenging Rationale: Using panel data to identify gaps and reach out proactively to a defined group is population health management, a core function of modern primary care. 23. Which model is best supported by evidence for managing depression in primary care? A. Referral to inpatient psychiatry for all patients B. Treatment by the primary care provider without follow-up C. Watchful waiting for all cases D. Collaborative care with a care manager and psychiatric consultant Correct Answer: D Level: Moderate Rationale: Collaborative care integrates a behavioral care manager, systematic follow-up, and psychiatric consultation, improving depression outcomes in primary care. 24. An uninsured patient with heart failure cannot afford a brand-name medication. The NP's best response reflects advocacy at which levels? A. Individual only, by dropping the prescription B. System only, by writing to legislators C. Individual (generic alternatives, assistance programs, sliding-scale resources) and system (policy and practice advocacy) D. Neither, because cost is outside the NP role Correct Answer: C Level: Challenging Rationale: Caring-based practice includes advocating for the individual patient through practical solutions and, over time, addressing structural barriers through policy and practice change. 25. Which intervention is the best example of an upstream approach to improving health? A. Prescribing insulin for a patient with newly diagnosed diabetes B. Ordering a chest radiograph for a patient with cough C. Referral to cardiology after a myocardial infarction D. A medical-legal partnership that addresses substandard housing contributing to childhood asthma Correct Answer: D Level: Challenging Rationale: Upstream interventions address root social and environmental causes of disease rather than treating downstream consequences.