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Advanced Practice Nursing: Essential Knowledge for
the Profession 3rd Edition Denisco Test Bank Exam
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And Rationales.
Chapter1 Introduction to the Role of Advanced Practices Nursing
Multiple Choice
- 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
Ans c introduced the DNP degree in 2004 to prepare advanced practice nurses (APRNs) to meet challenges and standardize practice beyond master’s degree programs.
- 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 by the AACN was designed to address curriculum requirements of master’s degree programs.
- 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.
- 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.
- 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.
- 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.
- 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
advanced nursing practice. Agatha Hodgins founded the AANM at Lakeside Hospital in Cleveland, Ohio.
- 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.
- 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.
- 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.
- 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,
- 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.
Chapter2 The Nurse Practitioner: Historical Perspective on the Art and Science of NursePractitionering
- 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.
- 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.
- 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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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 thataffect NP care and patient outcomes. This included scope
of practice regulations that often cause barriers for NP provided primary care.
- 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
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.
- 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.
- 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, trained providers based on current estimates. The CNM role is specialized in the care of women’s health and childbearing.
- 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.
- 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).
- 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.
- 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.
- 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.
- 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
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.
- 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, trained providers based on current estimates. The CNM role is specialized in the care of women’s health and childbearing.
- 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.
- 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).
- 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.
- 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.
- 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.
- 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.
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- 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.
- 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.
- 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.
- 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).
- 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.
- 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.
- 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
