1. What are the 4 settings for prescriptive authority? Describe the requirements in each
setting for physician supervision, # of NPs, chart review, and any other special
requirements in that site. correct answer- 1. Medically Underserved
2. Physician Primary Site
3. Physician Alternate Site
4....
1. What are the 4 settings for prescriptive authority? Describe the requirements in each
setting for physician supervision, # of NPs, chart review, and any other special
requirements in that site. correct answer- 1. Medically Underserved
2. Physician Primary Site
3. Physician Alternate Site
4. Facility Based Practice Site.
* General requirements per TBON rule 222.5: regular visits, chart review as determined
by APRN & physician, periodic face to face meeting of APRN & physician to discuss pt
care & improvement.
1a) Medically Underserved correct answer- *site must be official, physician must be
reachable by phone & must be provided with daily status report of any major problems
outside of the protocol.
*must have protocols.
1b) Physician Primary Practice Site correct answer- * Must have protocols.
*Sign drug orders only for pts whom the MD has/will establish a relationship.
*alternate MD may delegate.
*MD may delegate to no more than 7 APNS or PAs.
*Physician on-site visits should be 50% of the time according to BME.
1c) Facility Based Practice correct answer- *Must be physically present in facility
(hospital or long term facility).
*Physician must give prior consent.
*Delegation only at > one hospital or > 2 long term care facilities - now it is 7 FTEs.
*Long term care-only 4 APNs (APRNs) or 4 PAs or their FTE equivalent - now it is 7
FTE & approved by Chief Physician of Facility.
*Protocol signed by the Chief Physician.
1d) Physician Alternate Site correct answer- *No longer in effect.
2. The FOUR Approved Categories of APN in TX? correct answer- *CRNA, NP, CNS,
and CNM
3. NP requirements by BON for approval of license/ AP recognition each biennium.
correct answer- *Current valid RN licensure.
*400 hours of current clinical practice.
*20 hours of CEs.
*8 hours of continuing education in pharmacotherapeutics.
*Current board certification.
*Separate application for dual roles.
,4. New NP graduate requirements when applying for the board? correct answer- *Must
take and pass national certification exam.
5. What is the NP's scope of practice based on? correct answer- *Nurse practice acts
define legal scope of practice for licensed practitioners.
*Includes privileges for diagnosis, treatment, prescriptive authority and reimbursement.
11. What are clinical privileges and how are they obtained? correct answer- *autonomy
to perform expanded role functions based on the individuals licensure, educational
preparation, clinical experience, and credentials.
*Via contractual agreement with hospitals or long term care facilities.
12. Define Malpractice correct answer- *Any professional misconduct, unreasonable
lack of skill, or infidelity in professional or fiduciary duties, or illegal or immoral conduct.
*Negligence is the failure of an individual to do something that a reasonable person
would do, that results in injury to another.
*The alleged failure on the part of a professional to render services with the degree of
care, diligence, and precaution that another member of the same profession in similar
circumstances would render to prevent injury to some one else.
13. FOUR Elements of Malpractice correct answer- 1. Duty: provide some level of care,
had some contact.
2. Dereliction: reasonable, ordinary care, skill and diligence as NP's in good standing in
similar practice.
3. Damage: Must have an injury or no malpractice even if violated standard of care; cap
"pain and suffering" $250,000 to $500, 000.
4. Causation of Injury: For malpractice to have occurred, a breach of the standard of
care must have caused an injury to the patient.
15. National Practitioner Data Bank correct answer- *Receives and discloses the reports
on medical malpractice.
Who is credited to be the first advanced practice nurse role? correct answer- Nurse
Anesthesia in 1800's- perhaps the oldest advanced nursing specialty, Sister Mary
Bernard at St. Vincent's Hospital was the first anesthetist
Who is credited to be the founder of the first nurse practitioner role? correct answer-
Loretta Ford-1965- Colorado
Who is (are) the oldest primary care providers in the history of advanced practice
nurses? correct answer- Midwifes in 1700's- perhaps the oldest primary health care
provider
Martha Bullard, 1785 is the oldest noted in publication
, What are the roles of APRNs? How are they different from each other? correct answer-
To provide health care to individuals, family, groups in a variety of health care settings
(homes, hospitals, institutions, offices, clinics, etc)
APRN includes NP, nurse midwife, nurse anesthetist, and clinical nurse specialist
What states are responsible for being the first to have advanced practice language in
their nurse practice act? correct answer- Idaho (language read- "assess, diagnose,
treat")
What is NONPF? What is their influence for APRNs? correct answer- National
Organization of Nurse Practitioner Faculty
They have developed domains and competencies
Organized role competencies (policy, ethics, quality, leadership, etc)
How is the NP role different from PA role? correct answer- •PA's work directly under a
MD, NP's can function independently
•NP's focus on multiple practice and nursing models
•PA's focus on medical tasks utilizing a medical framework
What are the key elements of OTA, Brown, Safriet and Mundinger correct answer- •
OTA
NP's provide equivalent care to MD's.
Patients who receive care form an NP show decreased patient symptoms.
• Brown
Patient satisfaction and resolution of pathological conditions were greater for NP's over
MD's
NM's use less technology/ analgesia
NM's achieved equivalent neonatal outcomes
• Safreit
There is abundant data on the NP role in providing high quality, cost effective care/
There are major restrictions on the practice of NP's and these barriers should be
removed.
• Mundinger
Compared outcomes in patients who were randomly assigned to either NP's or MD's.
Results showed that patient outcomes were comparable.
How does the Texas Board of Nursing define the NP role? correct answer- A RN
approved by the board to practice as an APN based on completing an advanced
education practice program acceptable by the board. The term includes an NP, nurse
midwife, nurse anesthetist, and a CNS. The APN is prepared to practice in an expanded
role to provide health care to individuals, families, and/or groups in a variety of settings
including but not limited to homes, hospitals, institutions, offices, industry, schools,
community agencies, public/private clinics and private practice. The APN acts
independently and/or in collaboration with other health care professionals in the delivery
of health care services.
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