ADVANCED PRACTICE NURSING: ESSENTIAL KNOWLEDGE FOR THE PROFESSION 3RD EDITION DENISCO TEST BANK

ADVANCED PRACTICE NURSING: ESSENTIAL KNOWLEDGE FOR THE PROFESSION 3RD EDITION DENISCO TEST BANK Chapter1 Introduction to the Role of Advanced Practices Nursing Multiple Choice 1. In which year did the American Association of College of Nursing (AACN) introduced the Doctorate of Nursing Practice (DNP)? a. 2006 b. 2004 c. 2000 d. 2002 TAhNeSA: ABCN introduced the DNP degree in 2004 to prepare advanced practice nurses (APRNs) to meet challenges and standardize practice beyond master’s degree programs. 2. Which of the following is the best explanation for the creation of the Doctorate of Nursing Practice (DNP) degree? a. To compete against master’s degree programs b. To ensure standardized curriculum ensuring independent practice c. To validate APRN’s for financial reimbursement d. To address increasing curriculum requirements of master’s degree programs ANS: D Although all answers are influenced by the DNP core competencies, the DNP program creation in 2004 bythe AACN was designed to address curriculum requirements of master’s degree programs. 3. Which of the following was the first recognized area of advanced practice nursing? a. Clinical Nurse Specialist b. Family nurse practitioner c. Pediatric nurse practitioner d. Certified Registered Nurse Anesthetist ANS: D In 1931, the National Association of Nurse Anesthetists (NANA), renamed in 1939 to the American Association of Nurse Anesthetists (AANA) was the first recognized group promoting advanced nursing practice. Agatha Hodgins founded the AANM at Lakeside Hospital in Cleveland, Ohio. 4. Which factor is broadly perceived to solidify and standardize the role of the APNs over the last 25 years? a. Lack of access to health care providers b. Standardized curriculum development c. Payment for services d. Societal forces ANS: B As the evolution of Advanced Practice Nursing advances specific specialties and needs are identified. Through the evolution of organization and standardization these roles have solidified the APN’s role in today’s health care environment. 5. During the formation of early APN roles in anesthesia, which of the following increased demand for access to health care? a. Poverty b. War c. Rural access to care d. Availability of training ANS: B Earliest demand for nursing-provided anesthesia spiked during periods of war when numbers of physicians were inadequate. The earliest records date back to the American Civil War with the administration of chloroform. During World War I in 1917 more than 1000 nurses, some trained anesthetists, traveled into battle. Other factors such as need for rural health care came later in the validation and need for APNs. 6. In 1889, Dr. William Worrall Mayo built and opened St. Mary’s hospital in Rochester, NY. He is known for some of the earliest recruitment and specialized training of nurses in which of the following roles? a. Pediatrics b. Anesthesia c. Obstetrics d. Research and statistics e. Family nursing ANS: B In 1889, Dr. William Worrall Mayo began formally training and recognizing nurse anesthetists. This has been regarded as the earliest training in nurse-provided anesthesia. 7. In 1893, Lillian Wald established the Henry Street Settlement (HSS) House for which purpose? a. Access to health care of rural areas b. Create inner-city nursing awareness c. Provide the disadvantaged access to care d. Establish guidelines for advanced nursing roles ANS: C The HHS was established to provide nursing services to immigrants and low-income patients and their families in Manhattan. As resistance to nurse-provided care grew, standing orders were drafted from a group of Lower East Side physicians thereby circumventing then-existing legal ramifications. 8. The Frontier Nursing Service (FNS) founded in Kentucky in 1925 by Mary Breckenridge initiallyprovided Appalachia with nursing resources and which type of advanced nursing care? a. Pediatric care b. Anesthesia c. Midwifery d. Surgical services ANS: C The original FNS provided nursing services and obstetric services to Appalachian residents. Later working from standard orders developed from their medical advisory committee nurses treated patients, made diagnoses, and dispensed medications. 9. Which organization founded in 1941 under Mary Breckenridge’s leadership merged with the American College of Nurse-Midwives (ACNM) in 1969? a. American Association of Nurse-Midwives (AANM) b. American Nurses Association (ANA) c. Association for National Nurse-Midwifery (ANNM) d. Council of Nursing Midwifery (ANM) ANS: A The American College of Nurse-Midwives (ACNM) formed under the leadership of Mary Breckenridge in 1941 to provide nurse-midwife development and collaboration for midwife development. In 1955, the American College of Nurse-Midwives was formed and the two organizations merged in 1969 after the death of Mary Breckenridge. 10. In a landmark ruling by the Supreme Court as a result of Chalmers-Frances v. Nelson, 1936, what legal precedent was established? a. Nurse anesthesia was allowed under the nurse practice act b. Nurse anesthesia scope of practice included anesthesia c. Nurse anesthesia was legal, if under guidance of a supervising physician d. Only trained nursing professionals could administer anesthesia independently ANS: C The landmark decision from the Chalmers-Frances v. Nelson case set national precedent for the advanced nursing practice role. It proved to be the basis for other cases over the following few decades and established that trained nurses could legally provide anesthesia care under supervision of a physician. 11. The first known establishment of the nurse practitioner role occurred in 1965 at theUniversity of Colorado. In which area of training did this role specialize? a. Pediatrics b. Geriatrics c. Midwifery d. Anesthesia ANS: A The establishment of the first pediatric nurse practitioner program was in 1965 at the University of Colorado. Loretta Ford, RN and Henry Silver, MD provided a 4-month course to certified registered nurses to provide education on managing childhood health problems. 12. The DNP program curriculum outlined which of the following clinical requirements in an effort to standardize training? a. 1000 supervised clinical hours and 200 unsupervised clinical hours b. 1000 supervised clinical hours c. 900 supervised clinical hours d. 800 supervised clinical hours and 200 unsupervised clinical hours ANS: B In 2004, the AACN outlined the DNP curriculum in an effort to standardize and relieve challenges of master’s degree programs. This includes a standardized curriculum requiring 1000 supervised clinical hours. 13. Which state became the first to recognize diagnosis and treatment as part of the scope of practice of specialty nurses? a. Idaho b. Oklahoma c. South Dakota d. Maryland ANS: A Idaho Governor Cecil Andrus signed HB 46 and HB 207 into law on February 11, 1971. This amended the states’ nurse practice act making it the first state to officially recognize diagnosis and treatment of specialty nurses. The recognition of the ability to diagnose and treat overcame an initial hurdle toward independent nursing practice. 14. The American Nursing Association (ANA) defines which requirement for the designation of a clinical nurse specialist in any specialty? a. Specialty training certificate b. Successful completion of certification examination c. Masters or doctoral degree d. 1000 hours relevant supervised training e. Two or more years of clinically relevant experience ANS: C In 1980, the ANA specifically outlined criteria for the acknowledgment of clinical nurse specialist training programs. At that time they required graduate level training to become an expert in a relevant specialty area of nursing. Additionally, they must meet any requirements set forth by the specific professional society. Chapter2 The Nurse Practitioner: Historical Perspective on the Art and Science of NursePractitionering 1. Which of the following is the primary mission of the National Organization of Nurse Practitioner Faculties (NONPF)? a. Provide leadership in promoting quality NP education b. NP Faculty training program assistance c. Provide financial assistance to NP students d. Lobbying legislature on behalf of NPs ANS: A The NONPF’s primary mission is to provide leadership in promoting quality NP education. The organization has published domains and core competencies for primary care and these serve as a framework for NP education and practice. 2. A model of competencies that are encompassed around three spheres of influence known as patient, nurses and nursing practice, and organization and influence is known as? a. NACNS Model of clinical nurse specialist competencies b. Fenton’s and Brykczynski’s Expert Practice c. Calkin’s model of Advanced Nursing Practice d. Shuler’s Model of NP Practice ANS: A The NACNS’s initial 2008 statement was revised in 2004. The statement outlined competencies that aligned to each of the three spheres of influence: patient, nurses and nursing practice, and organization and influence. 3. Building upon Benner’s seven domains of expert nursing practice, which conceptual model adds an additional domain “The consulting role of the nurse”? a. Calkin’s model of Advanced Nursing Practice b. Fenton’s and Brykczynski’s Expert Practice c. Strong Memorial Hospital’s Model of Advanced Nursing Practice d. Shuler’s Model of NP Practice e. NACNS Clinical Nurse Specialists Model ANS: B Fenton’s and Brykczynski’s Expert Practice Domains of the CNS and NP expanded on Benner’s seven domains adding consultation provided by CNS’s to other nurses and management of health and illness in ambulatory care settings. 4. Which model of conceptual practice was the first to explicitly distinguish the experience level of advanced practitioners? a. Calkin’s model of Advanced Nursing Practice b. Shuler’s Model of NP Practice c. NACNS Clinical Nurse Specialists Model d. Strong Memorial Hospital’s Model of Advanced Nursing Practice e. Fenton’s and Brykczynski’s Expert Practice ANS: A Calkins model of Advanced Nursing Practice was the first to explicitly distinguish experience levels of advanced practitioners for nurse administrators to differentiate advanced practice nursing from other levels of clinical practice. 5. The circular and continuous threads of direct comprehensive patient care, support of systems, education, research, and publication and professional leadership make up the five domains of which advanced nursing conceptual model? a. Strong Memorial Hospital’s Model of Advanced Nursing Practice b. Calkin’s model of Advanced Nursing Practice c. NACNS Clinical Nurse Specialists Model d. Fenton’s and Brykczynski’s Expert Practice e. Shuler’s Model of NP Practice ANS: A Direct and indirect activities across five domains including: direct comprehensive patient care, support of systems, education, research, and publication and professional leadership make up the Strong Memorial Hospital’s Model of Advanced Practice Nursing. 6. Texas Children’s Hospital Transformational Advanced Professional Practice (TAPP) APRN Model added what unifying conceptual strand? a. Ethics b. Culture c. Informatics d. Education ANS: A The TAPP model added two additional domains: quality and safety, and credentialing and regulatory practice, to the Strong model. It additionally added professional ethics as a unifying conceptual strand. 7. Poghosyan, Boyd, and Clarke (2016) proposed a comprehensive conceptual model including three factors: scope of practice regulations, institutional policies, and practice environments. What was their primary purpose? a. To discourage role ambiguity among CNS providers b. To enhance patient education provided by the APRN c. To maximize NP Contributions to primary care d. To provide educational practice guidelines to enhance NP education ANS: C The 2016 model provided a comprehensive review of literature and described potential factors that affect NP care and patient outcomes. This included scope of practice regulations that often cause barriers for NP provided primary care. 8. Which model of practice intended to impact the NP domain at four levels: theoretical, clinical, educational, and research in 1993? a. Hamric’s model b. Calkin’s model of Advanced Nursing Practice c. Strong Memorial Hospital’s Model of Advanced Nursing Practice d. Shuler’s Model of NP Practice ANS: D Shuler’s Model of NP Practice is a holistic and wellness oriented model that was designed to impact the NP domain at four levels: theoretical, clinical, educational, and research. It is designed to elaborate the NP’s expanded knowledge and skills into medicine including a template for conducting a visit. 9. Which model for APRN practice addresses all four APRN roles: CNS, CRNA, CNM, and NP? a. Calkin’s model of Advanced Nursing Practice b. Hamric’s model c. Strong Memorial Hospital’s Model of Advanced Nursing Practice d. Donabedian Model ANS: B Many models highlight core competencies among specific APRN roles, while others emphasize competencies for hiring managers. At the time of this writing, only the Hamric’s model encompasses all four APRN roles. 10. Which of the following is one of the eight published essentials included in the Essentials of Doctoral Education for Advanced Nursing Practice developed by the AACN in 2006? a. Algorithms for advanced patient care b. Informatics and health care technologies c. Scientific underpinnings of practice d. Liberal education for general nursing practice ANS: C The AACN publishes their national consensus to provide the core elements for nursing curriculum creation. Currently published are Baccalaureate Essentials, Master’s Essentials, DNP Essentials, and Clinical Resources Essentials. Although they are similar in their core approach to education, listed first in DNP essentials is the scientific underpinnings of practice. 11. Which model of conceptualization identifies that health care needs are not met in a system dominated by medical language as a basis for reimbursement? a. Donabedian Model b. Dunphy and Winland-Brown’s Circle of Caring model c. Shuler’s Model of NP Practice d. Calkin’s model of Advanced Nursing Practice ANS: B Dunphy and Winland-Brown’s transformative model (Dunphy, Winland-Brown, Porter, Thomas, and Gallagher, 2011; Fig. 2.12) proposed a circle of caring to encourage medical collaboration and enhance the nursing presence in the health care system. Their model incorporates both strengths of medicine and nursing with process of assessment, planning, intervention, and evaluation, with a feedback loop. 12. Without additional application of conceptual models which model would be best chosen to model the skill level of beginning nurses, experienced nurses, or advanced nurse practitioners with the appropriate level of patient care? a. Dunphy and Winland-Brown’s Circle of Caring model b. Strong Memorial Hospital’s Model of Advanced Nursing Practice c. Donabedian Model d. Calkin’s model of Advanced Nursing Practice ANS: D Calkin’s model of Advanced Nursing Practice outlines skills and knowledge of beginning nurses, experienced nurses, and advance practice nurses as they relate the patient responses for health care problems. 13. The 2005 Donabedian model has been used to evaluate the quality of APRN care using which conceptual outline? a. Assessment, diagnosis, planning, intervention, and evaluation b. Structure, process, and outcome c. Diagnosis and outcome d. Diagnosis, morbidity, and mortality ANS: D The Donabedian model encompasses structure (health care systems and facilities), process (diagnosis, treatment, education), and outcomes. 14. Which of the following are the functions of a conceptualization ofadvanced practice nursing? (Select all that apply.) a. Basis for furthermore development of knowledge b. Articulate professional role identity and function c. Identify specific procedures to provide d. Deliver holistic and collaborative care e. Provide guidelines on billing ANS: A, B, D Conceptual models allow for articulation of professional role identity, provide a basis for furthermore development of knowledge and assist in clinical practice for the delivery of holistic, comprehensive, and collaborative care. Models may assist but in general do not provide assistance with clinical decision making or billing. Test Bank Multiple Choice 15. A registered nurse completes an informal education and training course at his or her place of work authorizing him or her to use ultrasound guided imagery when placing intravenous lines. How is this best classified? a. Advanced practice nursing b. Nursing Skill Advancement c. Advanced Licensure d. Advanced Certification ANS: The addition or advancement of individual skills to the nursing practice is common and encouraged but does not meet the requirements set forth for advanced practice nursing. Licensure and certification were not obtained or expressed. 16. The core foundations of all APN education curricula contain advanced courses covering which of the following? a. Human anatomy, health and physical assessment, and pharmacology b. Pathophysiology, research, and pharmacology c. Health and physical assessment, pathophysiology, and obstetrics and gynecology d. Pathophysiology, health and physical assessment, and pharmacology ANS: D While specific specialties may focus on individual areas of clinical knowledge, all aspects of advanced practice nursing include advanced knowledge of pathophysiology, health and physical assessment, and pharmacology. 17. Which of the following criteria is required for the attainment of classification as an advanced practice nurse (APN)? a. Practice focused on research b. Baccalaureate degree in area of focus c. Specialized skill attainment d. Graduate degree in area of focus ANS: D The three basic criteria or qualifications for APNs include graduate education in advanced practice nursing role, national certification in an advanced role, and a practice focused on patients and their families. Research and skills are components of core competencies of advanced practice nurses who achieve a graduate level of education. 18. Which of the following is the central, core competency for advanced practice nursing? a. Evidence-based practice b. Direct clinical practice c. Leadership d. Ethical decision making ANS: B Direct clinical practice is the core competency that lends itself to all others. It also provides the foundation for APNs to carry out the other competencies adequately. 19. The legal authority granted to a professional to provide and be reimbursed for health care services refers to: a. Certification b. Scope of practice c. Practicing Role d. Education ANS: B Many things including state and federal laws define scope of practice. The APN NCSBN defines scope of practice as characterized by specialization, expansion of services provided, including diagnosing and prescribing, and autonomy to practice. An individual certification would fall under the umbrella of scope of practice. 20. Which of the following most accurately describes the current four established advanced practice nurse roles? a. RN, BSN, MSN, DNP b. CNM, FNP, CNS, CRNA c. CNM, FNP, AGNP, PNP d. CNS, CRNA, NP, CNM ANS: D The four established advanced practice nurse roles include CNS, CRNA, CNM, and NP. FNP and AGNP are specializations of nurse practitioners (NP). 21. Which advanced practice nursing role has seen the largest expansion of growth and is currently the largest in number? a. CNS b. CRNA c. CNM d. NP ANS: D Nurse practitioner continues to be the largest in number of APN roles. According to the American Academy of Nurse Practitioners National NP Database there are over 220,000 trained NPs. 22. Which advanced practice nursing role is currently the smallest in number? a. CNM b. NP c. CNS d. CRNA ANS: A The CNM role according to the American College of Nurse-Midwives currently has around 11,000 trained providers based on current estimates. The CNM role is specialized in the care of women’s health and childbearing. 23. A practicing, certified CNM wishes to change roles and work as a family nurse practitioner (FNP). Which of the following is required? a. Complete education and training as an NP b. Take the FNP board examination c. Nothing is required d. Apply for immediate reciprocity ANS: A The four roles of APN (CNS, CRNA, CNM, and NP) are not interchangeable without additional training and education. Although there are specific instances of overlap, each of the four roles should not be confused as interchangeable. Specialty certifications under the NP role may allow for more flexibility under today’s regulations and are not standard practice. Scenarios are usually handled on an individual basis. 24. True or False. A registered nurse in an emergency room successfully completes a critical care course and meets all requirements for certification. He or she is now classified as an advanced practice nurse. a. True b. False ANS: B This registered nurse has completed advanced training that increases skill and knowledge and may have also obtained a certification; however, this does not meet the basic criterion of advanced practice nurse. He or she may be expertly skilled but requires the completion of a graduate degree focused in an area of nursing to appropriately be classified as an APN. The acute care nurse practitioner specialty would be required in this particular setting. Chapter3 Overview of the Doctor of Nursing Practice Degree 1. A registered nurse completes an informal education and training course at his or her place of work authorizing him or her to use ultrasound guided imagery when placing intravenous lines. How is this best classified? a. Advanced practice nursing b. Nursing Skill Advancement c. Advanced Licensure d. Advanced Certification ANS: B The addition or advancement of individual skills to the nursing practice is common and encouraged but does not meet the requirements set forth for advanced practice nursing. Licensure and certification were not obtained or expressed. 2. The core foundations of all APN education curricula contain advanced courses covering which of the following? a. Human anatomy, health and physical assessment, and pharmacology b. Pathophysiology, research, and pharmacology c. Health and physical assessment, pathophysiology, and obstetrics and gynecology d. Pathophysiology, health and physical assessment, and pharmacology ANS: D While specific specialties may focus on individual areas of clinical knowledge, all aspects of advanced practice nursing include advanced knowledge of pathophysiology, health and physical assessment, and pharmacology. 3. Which of the following criteria is required for the attainment of classification as an advanced practice nurse (APN)? a. Practice focused on research b. Baccalaureate degree in area of focus c. Specialized skill attainment d. Graduate degree in area of focus ANS: D The three basic criteria or qualifications for APNs include graduate education in advanced practice nursing role, national certification in an advanced role, and a practice focused on patients and their families. Research and skills are components of core competencies of advanced practice nurses who achieve a graduate level of education. 4. Which of the following is the central, core competency for advanced practice nursing? a. Evidence-based practice b. Direct clinical practice c. Leadership d. Ethical decision making ANS: B Direct clinical practice is the core competency that lends itself to all others. It also provides the foundation for APNs to carry out the other competencies adequately. 5. The legal authority granted to a professional to provide and be reimbursed for health care services refers to: a. Certification b. Scope of practice c. Practicing Role d. Education ANS: B Many things including state and federal laws define scope of practice. The APN NCSBN defines scope of practice as characterized by specialization, expansion of services provided, including diagnosing and prescribing, and autonomy to practice. An individual certification would fall under the umbrella of scope of practice. 6. Which of the following most accurately describes the current four established advanced practice nurse roles? a. RN, BSN, MSN, DNP b. CNM, FNP, CNS, CRNA c. CNM, FNP, AGNP, PNP d. CNS, CRNA, NP, CNM ANS: D The four established advanced practice nurse roles include CNS, CRNA, CNM, and NP. FNP and AGNP are specializations of nurse practitioners (NP). 7. Which advanced practice nursing role has seen the largest expansion of growth and is currently the largest in number? a. CNS b. CRNA c. CNM d. NP ANS: D Nurse practitioner continues to be the largest in number of APN roles. According to the American Academy of Nurse Practitioners National NP Database there are over 220,000 trained NPs. 8. Which advanced practice nursing role is currently the smallest in number? a. CNM b. NP c. CNS d. CRNA ANS: A The CNM role according to the American College of Nurse-Midwives currently has around 11,000 trained providers based on current estimates. The CNM role is specialized in the care of women’s health and childbearing. 9. A practicing, certified CNM wishes to change roles and work as a family nurse practitioner (FNP). Which of the following is required? a. Complete education and training as an NP b. Take the FNP board examination c. Nothing is required d. Apply for immediate reciprocity ANS: A The four roles of APN (CNS, CRNA, CNM, and NP) are not interchangeable without additional training and education. Although there are specific instances of overlap, each of the four roles should not be confused as interchangeable. Specialty certifications under the NP role may allow for more flexibility under today’s regulations and are not standard practice. Scenarios are usually handled on an individual basis. 10. True or False. A registered nurse in an emergency room successfully completes a critical care course and meets all requirements for certification. He or she is now classified as an advanced practice nurse. a. True b. False ANS: B This registered nurse has completed advanced training that increases skill and knowledge and may have also obtained a certification; however, this does not meet the basic criterion of advanced practice nurse. He or she may be expertly skilled but requires the completion of a graduate degree focused in an area of nursing to appropriately be classified as an APN. The acute care nurse practitioner specialty would be required in this particular setting. Chapter4 Emerging Roles for the DNP Nurse Educator Test Bank Multiple Choice 25. In 1990, Cooper and Sparacino postulate than an APRN’s maximum potential may not be attained until: a. After 1 year b. After 7 years c. After 3 years d. After 5 years ANS: D Studies have shown that the first-year position of an APRN is one of transition, and Cooper and Sparacino estimate that an APRN’s maximum potential may not be attained until after 5 years or more in practice. 26. An NP student is performing a thorough neurologic examination for the first time in the clinical setting. This is an example of: a. Role implementation b. Role acquisition c. Role confusion d. Role conflict ANS: B The changes occurring during role transitions experienced during the educational component of an APN role are classified as role acquisition. Additionally, role transition is described as when an APRN begins to practice for the first time in a new role. 27. A new NP student is completing a rotation at an outpatient urgent care clinic and completes an examination on a patient with chest pain. The nursing assistant hands a 12-lead ECG to the NP student and asks: “What should we do?” The NP student’s preceptor did not provide clear instructions on the role of the NP student at this time even though the student is capable of interpreting ECGs. This is an example of: a. Role ambiguity b. Role transition c. Role strain d. Role supplementation ANS: A Role ambiguity is created by unclear expectations, diffuse responsibilities, and uncertainty of subroles. The NP student’s preceptor did not provide clear roles to the NP student about what he or she should do in the absence of the preceptor. If the NP student was placed in a role where he or she was unaware of how to interpret ECGs this would be an example of role incongruity. 28. An NP is completing the first month in his or her first job. He or she receives a phone call from an administrator telling him or her that he or she will need to see 30% more patients starting next week. He or she is told that this is the minimum requirement of all NPs in the same position. The NP has difficulty using the electronic health record (EHR) software efficiently and feels overwhelmed. This is an example of: a. Role supplementation b. Role ambiguity c. Role conflict d. Role insufficiency ANS: D Role insufficiency is often seen as APRN graduates’ transition to the workforce or change positions. This may include feelings of inadequacy or slow speed due to the new role or barriers such as electronic health record documentation requirements. 29. Which of the following is an example of role acquisition? a. NP student learning leadership roles in the classroom b. NP student on graduation day from his or her program c. NP student beginning a new job as a family nurse practitioner d. A practicing NP advancing central line skills ANS: A The changes occurring during role transitions experienced during the educational component of an APN role are classified as role acquisition. All of the others are examples of role implementation. 30. The changes occurring as an APRN performs procedures during job duties are classified as? a. Role supplementation b. Role transition c. Role implementation d. Role acquisition ANS: C The job duties and responsibilities performed by the APRN are an example of role implementation. Role transition is the transition from student to practicing NP. 31. Which of the following is best classified as roll stress? a. Maintaining family responsibilities while in school b. An APN’s feelings of poor self-esteem c. Starting a first job as an NP d. Multiple failed attempts to master a procedure during education ANS: A There are many examples of role stress. Role stress may include any situation that requires increased performance above and beyond the expectation of others. This is easily classified as examples of things that require additional demand in addition to school or work such as work/family responsibilities or keeping up with new and advancing technologies. Starting a first job as an NP is an example of role transition. 32. Which of the following is best classified as role strain? a. A difficult disagreement with a physician b. An APN’s feelings of poor self-esteem after failing two examinations c. Maintaining family responsibilities while in school d. Starting a first job as an NP ANS: B Role strain is defined as the subjective feeling of frustration, tension, or anxiety in response to role stress. Examples of role strain typically include subjective feelings of decreased self-esteem when performance is below the expectations of self or others. A difficult disagreement with a physician is an example of role conflict. Starting a first job as an NP is an example of role transition. Maintaining family responsibilities while in school is an example of role stress. 33. Which of the following is an example of role conflict? a. Difficult work-life balance b. A difficult disagreement with a physician c. Starting a first job as an NP d. Maintaining family responsibilities while in school ANS: B Role conflict occurs when role expectations are perceived to be mutually exclusive or contradictory. Role conflict does not have to be with superiors but can occur between APRNs and nurses, other APRNs, or physicians. Starting a first job as an NP is an example of role transition. Maintaining family responsibilities while in school is an example of role stress. 34. The four-stage process to NP role development first identified by Anderson, Leonard, and Yates (1974) and validated by Roberts et al. (1997) included which four components? a. Finding a niche, coping with pressures, feeling competent, internalizing the role b. Complete dependence, developing competence, independence, interdependence c. Novice, developing competence, competent, advanced d. Developing competence, partial independence, complete independence, interdependence e. Dependence, independence, interdependence, role model ANS: B Complete dependence, developing competence, independence, and interdependence are the four- stage process of NP development outlined by Anderson, Leonard, and Yates in 1974 and validated by Roberts et al. (1997). 35. A trained nurse enters the first semester of an NP training program. He or she is required to learn new and more advanced techniques beginning with conducting an advanced physical examination. The overwhelming feeling and stress of learning additional skills is most likely classified by the studies of Anderson, Leonard, and Yates in 1974 as: a. Independence b. Developing competence c. Interdependence d. Complete dependence ANS: D The initial learning of skills and additional techniques experienced by NPs in the beginning of their training has been described as complete dependence. 36. A trained NP is working at an outpatient care clinic. He or she encounters a difficult patient, is unaware of treatment options, and consults one of his or her colleagues for advice. This is best classified as: a. Independence b. Interdependence c. Developing competence d. Complete dependence ANS: B As initially defined by Anderson, Leonard, and Yates in 1974, NP roles as they transition to the workplace as seasoned practitioners transition to interdependence as they work with colleagues to enhance patient care. 37. Fleming and Carberry’s research in 2011 studied two cohorts of critical care nurse advanced practice trainees in Scotland. They found that transition occurred in which four areas? a. Complete dependence, developing competence, independence, interdependence b. Developing competence, partial independence, complete independence, interdependence c. Coping with pressures, feeling competent, internalizing the role, leading others d. Finding a niche, overcoming obstacles, advanced practice, interdependence e. Finding a niche, coping with pressures, feeling competent, internalizing the role ANS: E Fleming and Carberry’s research in 2011 studied two cohorts of critical care nurse advanced practice trainees in Scotland showing transition occurred in four areas: finding a niche, coping with pressures, feeling competent, internalizing the role. 38. A strategy to promote role acquisition in school that involves a ceremony at the beginning of the NP students training is the best example of: a. Role rehearsal b. Creating a support network c. Role development d. Developing clinical knowledge of skills ANS: A Role rehearsal may include many facets including a rite of passage such as a ceremony to mark the beginning of a new training program. 39. Which initial strategy would provide the best role acquisition for a student or potential student about to begin a new NP program? a. Provide case scenarios of patients that may be encountered b. Preadmission testing c. Provide a handout detailing the APRN curriculum d. Clinical faculty mentoring by preceptors ANS: C An initial strategy for role acquisition includes components for role rehearsal. Providing the overall framework for the APRN curriculum would allow for the best-case scenario of role acquisition. Clinical faculty mentoring by preceptors is an example of role acquisition but is best suited to develop clinical knowledge and skills. 40. Which of the following is the best strategy for transition of an APRN into a new position? a. Ensuring adequate pre-position training b. Development of a structured orientation plan c. Scheduling time-based evaluations d. Providing immediate feedback from supervisors ANS: B APRNs in new roles regardless of previous experience benefit most from structured orientation plans, networking with peers, appropriate mentors and preceptors, and an understanding of appropriate expectations. 41. Which three major purposes are categorized and can be utilized to facilitate role acquisition of NPs in school? a. Knowledge expansion, skill practice, creation of a supportive network b. Role rehearsal, development of clinical knowledge and skills, creation of a supportive network c. Role acquisition, role rehearsal, creation of a supportive network d. Knowledge foundation development, development of clinical skills, tracking outcomes ANS: B An adaptation of Brykczynski’s (2000) “Strategies to promote NP role acquisition in school” allows for specific strategies for role acquisition to be categorized into three major purposes: role rehearsal, development of clinical knowledge and skills, and creation of a supportive network. 42. Which of the following examples would best enhance the development of clinical knowledge and skills as part of role acquisition of the NP? a. Establishment of a peer support system b. Clinical conferences c. Identifying a role model d. Subscription to APRN journals and conferences ANS: B Role acquisition strategies include three major purposes: role rehearsal, development of clinical knowledge and skills, and creation of a supportive network. Establishment of clinical conferences to discuss clinical experiences with faculty and peers can promote clinical understanding and enhance the development of clinical knowledge and skills. Subscription to APRN journals and conferences would establish a pattern for continuing education and help create a support network. Establishment of a peer support system would also help create a support network. Identifying a role model or mentor would facilitate role rehearsal. 43. A faculty member at an NP education program has identified that students are experiencing difficulty with role rehearsal during the first few semesters of the program. Which of the following strategies would likely enhance role rehearsal and facilitate role acquisition? a. Subscription to APRN journals and conferences b. Identifying a role model c. Clinical conferences d. Establishment of a peer support system ANS: B Role acquisition strategies include three major purposes: role rehearsal, development of clinical knowledge and skills, and creation of a supportive network. Identification of a role model or mentor and developing a mentee relationship that can be maintained throughout an APRN programis an excellent strategy to promote role rehearsal and support role acquisition while in school. Clinical conferences support developing clinical knowledge and skills. Establishment of a peer support system or subscriptions to APRN journals help create a support network. 44. In 2010, researchers Sullivan-Bentz et al. used Brown and Olshansky’s four-stage transition model to study recent NP graduates as they undergo role transition to practicing NPs. What did the study demonstrate? a. New NPs transitioned from feeling overwhelmed to feeling confident in 6 months only with support networks b. New NPs did not transition from feeling overwhelmed to feeling confident in the study c. New NPs transitioned from feeling overwhelmed to feeling confident in 1 year only with support networks d. New NPs transitioned from feeling overwhelmed to feeling confident in 1 year e. New NPs transitioned from feeling overwhelmed to feeling confident in 6 months ANS: D APRN role development processes have been supported by a number of studies identifying that the first year is most likely to be observed as the transition from feeling overwhelmed to feeling confident. 45. A questionnaire study conducted by Hart and Macnee (2007) at two national NP conferences found that 51% of NPs perceived that they were only somewhat or minimally prepared for actual practice. Which of the following would most likely facilitate the role transition issues for a beginning NP? a. Clinical NP residency program b. Additional time requirement as a practicing registered nurse c. Longer NP education program d. Additional NP clinical training hours ANS: A As many studies have shown the role transition issues of APRN graduates, clinical residency programs have been developed to address these issues. Clinical residency programs ease new graduate transition into practice and increase NP retention and overall satisfaction. Chapter5 Influencing and Leading Change in the Complex Health Environment : The Role of theAdvanced Practice Nurse Multiple Choice 46. A nurse develops an interest in more effective medication management and seeks additional training to enhance his or her daily care of patients and for peers at the facility for which he or she works. This is an example of: a. Specialization b. Subspecialty c. Specialty d. Advanced practice nursing ANS: A Specialization involves focusing on practice in a specific area derived from the field of professional nursing. Specialties can be further characterized as nursing practice that intersects with another body of knowledge, has a direct impact on nursing practice, and is supportive of the direct care provided to patients by other registered nurses (American Nurses Association [ANA], 2010a). If the nurse changed his or her focus of practice this could be considered a specialty. 47. A nurse develops an interest in effective medication management and seeks additional training. The nurse then focuses the majority of his or her time on medication management aspects of nursing. This is an example of: a. Advanced practice nursing b. Subspecialty c. Specialization d. Specialty ANS: D The term specialty suggests that the focus of practice is limited to parts of the whole (ANA, 2010b). Since this nurse has refocused his or her care entirely on medication management as part of the nursing role it is considered a specialty. 48. A registered nurse is planning to extend his or her education beyond baccalaureate education into an advanced practice role. When choosing between CRNA, CNM, and NP these are delineations of which type? a. Reasoning b. Subspecialty c. Specialty d. Specialization ANS: C The term specialty suggests that the focus of practice is limited to parts of the whole (ANA, 2010b). Deciding on advanced practice nursing among CRNA, CNM, and NP requires knowledge that they are independent specialties. Specialties of NP at the highest level are psychiatric and mental health, pediatrics, and adult-gerontology. Subspecialties further differentiate the focus of practice such as family practice nurse practitioner, adult-gerontology nurse practitioner, and acute care among others. 49. A student is evaluating a program to attend. He or she finds an adult-gerontology nurse practitioner program that will also prepare him or her as a hospitalist. How is the hospitalist training best defined? a. Specialty b. Subspecialty c. Reasoning d. Specialization ANS: B Subspecialization further delineates the focus of practice. In subspecialty practice, knowledge and skill in a delimited clinical area is expanded further. Examples of subspecialties include diabetes care, acute care, pain management, and clinical transplant coordinator. 50. Which of the following most accurately describes the four stages in the evolution ofadvanced practice nursing? a. Interest occurs, specialty begins, specialty organizes, and pressures mount for standardization b. Specialty begins, specialty organizes, laws require standardization, maturity, and growing interprofessionalism c. Specialty begins, specialty organizes, pressures mount for standardization, maturity, and growing interprofessionalism d. Interest occurs, specialty begins, specialty organizes, and specialty matures ANS: C The four stages in the evolution of advanced practice nursing include: stage I: specialty begins, stage II: specialty organizes, stage III: pressures mount for standardization, and stage IV: maturity and growing interprofessionalism. 51. An adult-gerontology nurse practitioner works to enhance education for polypharmacy in elderly patients through the creation of standardized education tools. The NP works with other professionals at his or her facility to research and develop criteria for education and practice. This example is best classified as which stage? a. Specialty organizes b. Specialty standardizes c. Specialty begins d. Specialty matures and grows interprofessionally ANS: C Specialty stages are not concrete, but specialties that are in the beginning of development are in stage I: specialty beginning. Stage II: specialty organization is typically considered when a professional organization of like-minded individuals is officially formed. 52. A clinical transplant coordinator works with many aspects of the patient transplant process. Two national organizations currently provide education and preparation for certification of nurses. Which stage of organization is this specialty? a. Stage IV b. Stage II c. Stage I d. Stage III ANS: B The clinical transplant coordinator is currently a stage II specialty as it organizes and begins plans for standardization of care. 53. A national specialty committee is formed for a specific nursing specialty. This is an example of what stage of evolution of advanced practice nursing? a. Stage II: specialty organizes b. Stage I: specialty begins c. Stage IV: specialty matures d. Stage III: specialty standardizes ANS: A As national organizations form around specific specialties they are considered to be in stage II of the evolution of advanced practice nursing. 54. Two organizations are formed for a specific advanced practice nursing specialty. As interest in the specialty grows, legislation is required to govern aspects of care. To answer this call, the organizations must meet what stage of evolution of advanced practice nursing? a. Stage I: specialty begins b. Stage IV: specialty matures c. Stage III: specialty standardizes d. Stage II: specialty organization ANS: C As pressures mount for standardization, often for curriculum development or legislative pressure, standardization of practice must be obtained. This is often a difficult and lengthy process of stage III of the evolution of advanced practice nursing. 55. Hospitalist practice by advanced practice nurses are in significant need. What stage of development is hospitalist practice? a. Specialty standardizes b. Specialty begins c. Specialty matures and grows interprofessionally d. Specialty organizes ANS: B Hospitalist practice is a relatively new field for advanced practice nursing and has yet to be organized. Hospitalist practice is a stage I specialty. 56. Which of the following specialties is classified as stage II, organized but yet to be standardized? a. Wound and Ostomy Nursing b. Interventional Pain Specialist c. Advanced Diabetes Manager d. Clinical Transplant Coordinator ANS: D The clinical transplant coordinator is currently a stage II specialty as it organizes and begins plans for standardization of care. Wound and Ostomy nursing and Interventional Pain Practice are both stage III specialties. Advanced Diabetes manager and Genetics Advanced Practice are stage IV specialties. 57. As first addressed in 1985 at Surgeon General’s workshop on Violence and Public Health, the need for which specialty began? a. CRNA b. Forensic Nursing c. Public Health Nursing d. Wound and Ostomy Nursing ANS: B The need for Forensic Nursing specialty was first addressed in 1985 at Surgeon General’s workshop on Violence and Public Health. 58. Wound and Ostomy nursing, through the WOCNS, offers four levels of care providers. This organization is currently in what stage of evolution of advanced practice nursing? a. Specialty organizes b. Specialty begins c. Specialty standardizes d. Specialty matures and grows interprofessionally ANS: C The WOCNS offers four levels of WOC specialty nurse training and has been developing curricula and education that are offered in postbaccalaureate and some graduate-level programs. 59. Although not required for practice, the AAPM offers a credentialing examination requiring at least 2 years of pain management experience prior to examination for Interventional Pain Practice. This organization’s efforts to standardize care classify as what stage of evolution of advanced practice nursing? a. Stage I b. Stage II c. Stage IV d. Stage III ANS: D The AAPM offers two credentialing examinations: diplomate and fellow. This allows for initial standardization of practice in chronic pain management and paves for care as the organization begins to mature along with the Interventional Pain Specialist specialty. 60. What specialty has two levels of certification available, focused on the management of diabetes and prescribing medications? a. Diabetes and Wellness Specialty b. Endocrine Specialty c. Advanced Diabetes Manager d. Diabetes Clinical Specialist ANS: C The American Association of Diabetes Education (AADE) offers two levels for the specialty of Advanced Diabetes Manager: Certified Diabetes Educator (CDE) and Board Certified Advanced Diabetes Manager (BC-ADM). Specifically, the BC-ADM focuses less on education and moreon the management of diabetes and prescribing of medications. 61. A father and mother have been identified as carriers of cystic fibrosis, a genetic disease. Their primary care provider suggests they obtain genetic counseling prior to starting a family. Which provider is the best for this couple? a. Pediatric nurse practitioner b. Pediatric Physician c. Genetics Specialty RN d. Genetics advanced practice nurse ANS: D The Genetics advanced practice nurse is a specialty that requires a graduate degree. This stage IV specialty ensures specialized training in genetics. These practitioners offer genetic counseling, case management, consultation, and evaluation of patients and their families. An RN would only offer information or identify the need for referral to a genetics specialist. A Pediatric nurse practitioner or Pediatric physician would likely not have specialized training in genetic counseling. Chapter6 Interprofessional Collaboration for Improving Patient and Population HealthKnowledge Multiple Choice 62. Which metric is key for validating the need for the role of the Nurse-Midwife (NM) worldwide? a. Infant mortality b. Number of OBGYN Physicians c. Average distance to nearest obstetric center d. Number of births per capita ANS: A Infant morbidity and mortality is a statistic of countries worldwide and is a key driver of expansion of the nurse-midwife role into developing countries. Low- and middle-income countries often have the highest rates of infant morbidity and mortality. Another factor increasing the expansion of the NM’s role is the increasing costs of medical care. 63. Which organization’s primary goal is aiming to become an international resource for APNs and NPs on a global scale? a. ICN’s International Nurse Practitioner/APN Network (INP/APNN) b. American Nurses Association (ANA) c. World Health Organization (WHO) d. Bill & Melinda Gates Foundation ANS: A The INP/APNN’s primary goal is to provide resources to advanced practitioners on a global scale. This includes providing resources to countries and organizations that are forming NP programs. 64. Which three countries were the first to officially establish the NP role? a. Canada, United States, and China b. Canada, United States, and United Kingdom c. United States, Canada, and Australia d. United States, Canada, and Jamaica ANS: D The United States was the first country to establish the NP role in 1965, followed by Canada and Jamaica in the mid-1970s. 65. According to a 2014 study, nurse-midwives who obtain the appropriate education and who are regulated to meet ICM competencies for practice and care can deliver what percentage of midwifery care? a. 87% b. 79% c. 73% d. 93% ANS: A The UNFPA 2014 study showed that nurse-midwives who obtain the appropriate education and who are regulated to meet ICM competencies for practice and care can deliver 87% of midwifery care. 66. Which three countries were the first to officially establish the clinical nurse specialist (CNS) role? a. United States, Canada, and Netherlands b. Canada, United States, and China c. United States Canada, and United Kingdom d. United States, Canada, and Australia ANS: C The CNS role was first introduced in the United States, Canada, and the United Kingdom in the 1960s due to increasing complexity and specialization of health care as well as increased demand for clinical expertise, education, and leadership. 67. Which role was first developed in Australia in 1986 and was formed from the United States’ model of the CNS role? a. Advanced Nurse Practitioner b. Clinical Nurse Advanced Specialist c. Clinical Nurse Practitioner d. Nurse Consultant ANS: D The Nurse Consultant role exists in Australia, the United Kingdom, and Hong Kong. It was first introduced in Australia in 1986 and was modeled after the CNS role in the United States. 68. A nurse in Australia obtains clinical experience and expands his or her knowledge and experience with a master’s degree with a focus on education and training in a specialty area of medicine. He or she most likely obtains which role? a. Clinical nurse specialist b. Advanced Registered Nurse c. Nurse Consultant d. Nursing physician assistant ANS: C In Australia, the Nurse Consultant role varies in requirements from a hospital certificate to a master’s degree. The role has different grade levels and increases responsibilities across five domains. 69. As of the writing of this text, which of the following regions is considered the “next frontier” of APN role development? a. China b. Europe c. Latin America d. Africa ANS: C Latin America is considered the next frontier of APN role development. This region is an area of the world where few such roles exist as of the writing of this text. Development of APN roles in this region is driven by the policies that include: primary health care reform, access to health care, and universal health care coverage. 70. Which of the following strategies is best to support the development of APN roles at the international level? a. Create communities of practice to develop APNs b. Using evidence-based approaches to role development c. Build consensus among stakeholders on health systems solutions utilizing APN roles d. Leverage and share resources for APN education with another country ANS: D While all approaches may be beneficial to support role development, leveraging and sharing resources with another country are most likely to benefit role development internationally. The other options are most beneficial in the development of APN roles at the country level. 71. Which of the following strategies is best to support the initial development of APN roles at the country level? a. Showing support for policies of world organizations to prevent out-migration of nursing leaders and educators b. Collaborating with another country to understand policy decisions c. Joining policy discussions to advocate for the APN role d. Obtaining an advanced nursing practice degree in another country ANS: C The initial development of APN roles at country level is multifaceted. The importance of advocacy for the role to key stakeholders and policymakers is often the first step. The other options are best suited for development at the international level. Chapter7 An Overview of U.S. Healthcare Delivery 72. Which of the following is the most essential component to lead clinical staff and programs effectively as an advanced practice registered nurse? a. Clinical credibility b. Appropriate education c. Years of experience d. Age ANS: A All of the options may attribute to effectively leading clinical staff and programs as an APRN. Direct care is the central competency of advanced practice nursing and excellence in direct care requires clinical credibility to lead other clinical staff. Years of experience or age may or may not be related to direct care. Appropriate education is important for clinical leadership, but clinical credibility requires experience combined with direct care. 73. An advanced practice registered nurse in an outpatient clinic has a phone conference with a cardiologist regarding a patient’s condition. This is an example of: a. Social services b. Point-of-care encounter c. Indirect care d. Direct care ANS: C This is an example of indirect care of clinical practice. Direct care or direct clinical practice refers to those activities and functions that the APRN performs within the patient-nurse interface. 74. Which of the following is considered indirect care? a. Forming a therapeutic relationship during patient examination b. Discharge planning c. Consideration of which medication to prescribe a patient d. Patient education regarding medication side effects ANS: B Indirect care or indirect clinical practice refers to those activities and responsibilities that occur outside of the patient-nurse interface. They may include consultation with other health care providers, discharge planning, care coordination, communication with insurance companies, education or supervision of other medical staff, or billing and coding for services rendered. The other options are examples of direct care. 75. Which of the following is considered direct care? a. Forming a therapeutic relationship during patient examination b. Increasing knowledge of a disease process to better care for a complex patient c. Prior authorization of prescriptions d. Consultant phone call about patient condition ANS: A Direct care or direct clinical practice refers to those activities and functions that the APRN performs within the patient-nurse interface. Examples of direct care include physical acts of diagnosis, monitoring, treatment, or direct patient education that occur in the patient-nurse interface. It can be with the patient or family members. The other options are examples of indirect care. 76. An APRN is preparing a patient to be discharged from an emergency department. Which of the following activities is considered direct care? a. Speaking with the patient’s primary care provider b. Electronically transmitting prescriptions to pharmacy c. Discharge planning documentation d. Discharge patient education ANS: D The decision to discharge a stable patient requires that the APRN evaluated the patient and his or her clinical condition and determined it to be stable; this most likely required direct clinical care including a physical examination and medical decision making and discharge-related patient education. 77. An APRN evaluates and modifies his or her clinical practice routines by reading and following updates and recommendations from various journals and organizations such as the United States Preventative Task Force (USPSTF). Which characteristic of advanced direct care practice is the APRN utilizing? a. Use of reflective practice b. Use of a holistic perspective c. Expert clinical performance d. Use of evidence as a guide for practice ANS: D Using evidence as a guide for practice is one of six characteristics for advanced direct care practice. Reading research reports, searching health care databases, acquiring skills to analyze evidence, and working with colleagues regarding evidence-based improvements in care are all examples of using evidence as a guide for practice. 78. During a patient encounter the APRN remembers the patient mentioned during a previous visit that the patient’s child was applying to colleges. The APRN asks which college the patient’s child chose to attend. Discussing this at the beginning of the patient encounter utilizes what characteristic of advanced direct care practice? a. Formation of therapeutic partnerships with patients b. Expert clinical performance c. Use of a holistic perspective d. Use of reflective practice ANS: A The formation of therapeutic partnerships with patients is one of six characteristics for advanced direct care practice. The APRN is effectively using good conversational style to create a strong therapeutic relationship with the patient. Use of a holistic perspective would only be correct if this conversation was used in relation to the patient’s care. 79. An APRN starts a patient on a specific medication chosen over a compatible medication due to a decreased risk of sedation. The medication was chosen because the patient has an occupation driving a truck. Which characteristic of advanced direct care practice is the APRN utilizing? a. Formation of therapeutic partnerships with patients b. Use of a holistic perspective c. Expert clinical performance d. Use of reflective practice ANS: B Using a holistic perspective includes identifying patterns of symptoms combined with the effect of the individual patient. This may include the patient’s view of his or her own health or the impact that his or her disease or treatments may affect his or her overall quality of life. Expert clinical performance is incorrect because the medication was chosen solely based on the effect of medication side effects on the patient’s social life. 80. An APRN encounters an angry and combative patient during his or her shift. The next day he or she meets and speaks with a colleague involved with the patient to discuss how the department handled the incident as well as his or her personal beliefs regarding the care of combative patients. Which characteristic of advanced direct care practice is the APRN utilizing? a. Use of evidence as a guide for practice b. Expert clinical performance c. Diverse approaches to and interventions for Health and Illness Management d. Use of reflective practice ANS: D The use of reflective practice is an important characteristic of advanced direct practice care. Meeting with colleagues and teachers regarding clinical scenarios are important aspects of reflective practice as you explore personal values, social beliefs, and behaviors. Since the meeting was not regarding evidence-based improvements of care or strategies to improve the outcome of similar patients the other options are incorrect. 81. An APRN works in a critical care environment. He or she identifies a patient he or she believes to be at risk for decompensation and intervenes quickly. Which characteristic of advanced direct care practice is the APRN utilizing? a. Use of evidence as a guide for practice b. Expert clinical performance c. Use of reflective practice d. Diverse approaches to and interventions for Health and Illness Management ANS: B Expert clinical performance is the development of specialized knowledge, experience, and complex situations the APRN will encounter during patient care. Deeply understanding clinical knowledge and interpretation of data are aspects of expert clinical performance. 82. An APRN encounters an angry and combative patient during his or her shift. The next day he or she begins analyzing patient outcomes as they correlate with different treatment modalities. Which characteristic of advanced direct care practice is the APRN utilizing? a. Expert clinical performance b. Use of evidence as a guide for practice c. Use of reflective practice d. Diverse approaches to and interventions for Health and Illness Management ANS: B Systematic reviews of existing journals, health care statistics, and working with colleagues in an attempt to improve outcomes and understand clinical scenarios are examples of excellent use of evidence as a guide for practice. In this scenario the other options are incorrect; the APRN had not just discussed his or her