21. Transformational leadership is best defined as: A variable leadership style based on the environment, task, competency of works, or
situation
A style that is relational , driven by common goal and satisfies the leader and the
follower
An autocratic style with maximal follower input A style that allows followers to act on their own decisions.
23. Which statement best reflects King’s theory? The coping process responses constitute the outputs of the human adaptive
system which are reflected in behaviors.
A person is a system of behavior characterized by repetitive, predictable, and goal. directed behaviors that strive toward balance. Nursing goals are negotiated with the client and taking into account both the
clients and the nurses perceptions
If nurses with special knowledge and skills communicate appropriate information to
clients, mutual goal-setting and goal attainment will occur
.
24. which agency will the APN reference when seeking the current evidence- based guidelines directing standards of care? Patient Centered Outcomes Research Institute (PCORI) Agency for Health Research and Quality Centers for Disease Control and Prevention US Protective and Safety Task Force.
25. A 43-year old woman has a 12-hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever, and chills. She has had similar, milder episodes in the past. Examination reveals marked tenderness to right upper quadrant abdominal palpation. Her most likely diagnosis is: Hepatoma Acute cholecystitis Acute hepatitis Appendicitis.
22. A metaparadigm must include which of the following 3 characteristics† Identification of a domain that is similar to domains of other disciplines. • Encompass all phenomena of interest. ”
• Be perspective neutral.
•Be global in scope
.
26. what theory is used to describe the cause of endometriosis? Obstruction within the fallopian tubes prevents the endometrial tissue from Endometrial tissue passes through the fallopian tubes and into the peritoneal cavity and
remains responsive to hormones.
Inflammation of the endometrial tissue develops after recurrent sexually transmitted diseases Endometrial tissue lies dormant in the uterus until the ovaries produce sufficient hormone
to stimulate its growth .
.
27. Chronic pain, physical disability, social support, age and gender are related to perceived daily stress, which is related to depression. This is an example of which type of theory? Explanatory Predictive Descriptive Inter-relational.
28 The leadership core competency of advanced practice nursing includes which three characteristics? • Mentoring
• Innovation
• Activism Consultation Collaboration.
29. What initiative specifically focuses on the aging American, under the Affordable Care Act? Team STEPPS Multiple Chronic Conditions Shared decision making Literacy tool kit.
30. Which of the following philosophies of work view would characterize human beings as holistic; parts are viewed only in the context of the whole? Reaction Simultaneous action Holistic interaction Reciprocal interaction.
31. A difficult aspect of determining occupational exposure to disease is the: Confidentiality of the information with company records Inaccuracy of occupational exposure Long latency period between exposure and disease reporting Reliance on workers recall.
32. A novice nurse practitioner is experiencing feeling of inferiority toward more experienced clinicians in the practice. She has identified that time constraints for visits and expectations to increase productivity limits her ability to address these non-adherent issues during client visits. Which barrier to ethical practice is influencing practice? Internal to the APN Inter-professional Patient provider Organizational/environmental
.
33. Utilizing Johnson’s Behavioral systems model (JBSM), the APN discovers that a patient is not sure who he can depend on because his wife is emotionally distant. This data would be characteristic of which subsystem of the JBSM Restorative subsystem Aggressive protective subsystem Dependency subsystem Affiliative protective subsystem.
34 A purposeful, complex, dynamic, collaborative, and holistic interpersonal process aimed at supporting and facilitating patients and families through health-related experiences and transitions to achieve health-related goals (mutually determined when possible)” defines which APN role? Coach Collaborator Direct care provider Mentor.
35. A 60 year old female with a history of emphysema presents to the primary care office with complaints of cough and shortness of breath at rest. During the physical exam, the nurse practitioner recognizes clubbing, barrel chest, and prolonged expiration. The nurse practitioner understands that the patient is exhibiting symptoms resulting from which type of pulmonary disease process? Restrictive Obstructive Pleuritic Atelectatic.
36. Which of the following statements accurately defines Hamric’s conceptual definition of advanced practice nursing? The patient-focused application of an expanded range of competencies to improve health outcomes for patients and populations within a specialized clinical area of the larger discipline of nursing. A mid-level position that incorporates advanced clinical knowledge and skills to impact patient care A nurse who has achieved education and specialized certification beyond that basic nursing education None of the above.
37. When caring for a client who presents with pain and swelling to location of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Which diagnostic test is most specific to diagnosis of rheumatoid arthritis? Elevated rheumatoid factor level Elevated uric acid level Positive antinuclear antibody titer Elevated erythrocyte sedimentation rate.
38 The Consensus Model for Advanced Practice Registered Nurse Regulations addresses which four areas? • Specialty areas
• Roles and titles to be used
• Population foci
• Preparation for emerging APRN roles
Licensure blueprints for testing.
39 Which statement best supports primary prevention of burns for geriatric clients? Douse flames with a fire extinguisher Avoid smoking in bed Install a smoke detector Use a planned emergency escape route.
40. Which of the following three complications are associated with chronic hepatitis B?
• Uncompensated cirrhosis
• Hepatocellular carcinoma
• Continued infectivity
Malignant hypertension Renal encephalopathy.
41. The central competency, direct clinical practice, is characterized by which three of the following? Uniform approach to health management • Expert clinical performance
• Formation of a therapeutic partnership with patients
• Holistic approach
Direct physician supervision.
42 Which payment system seeks Medicare reimbursement under the MACRA legislation for providing high quality patient-specific care and improved outcomes? Accountable care organization Advanced payment models Merit Incentive Based Payment Bundle payment programs.
43. What four components of advanced practice nursing (APN) are specified by the National Council for State Boards of Nursing Consensus Model for APRN regulation? • Licensure,
• Accreditation
• Education
• Certification
Competence.
44. Which learning theory would be most applicable as a guide for the development of a program to help families of patients in palliative care? Behaviorist learning theory Cognitive learning theory Psychodynamic learning theory Humanistic Learning Theory.
45. What terms indicate appropriate progression associated with the history and evolution of advance practice nursing? Specialist, Expanded Role, Advanced Practice Expanded role, advanced practice , specialist Advanced practice , specialist , expanded role Specialist, advanced practice , expanded role.
46. An experienced NP, has two separate but equally important ethical obligations that he is unfortunately unable to carry out. This is an example of which barrier to ethical practice? Moral distress Moral uncertainty Moral Dilemma Moral distraction.
47. Pre-invasive epithelial tumors of glandular or squamous cell origin describes which of the following?
Tumor in differentiation Dysplastic Cancer in situ Cancer beyond (meta) situ.
48. Which two options are barriers to the conceptualization of Advanced Practice Nursing? Lack of obscurity • Interprofessional education and practice
• Need to differentiate between advanced practice nursing and medicine
Consistency of state practice act that regulate APNs.
49. The Dreyfus Model of Skill Acquisition includes which four stages of APN performance? • Expert,
• Advanced Beginner,
• Competent
• Proficient
• Efficient.
50. The nurse practitioner is caring for a client who has undergone a recent gastrectomy who complains of fatigue, palpitations, shortness of breath, and numbness and tingling to their fingers on both hands. The nurse suspects pernicious anemia related to: Dietary deficiency of vit b 12 Deficiency of intrinsic factor production Red blood cell enzyme deficiency Multiple micronutrient deficiencies.
51. The analysis of a theory or conceptual model includes examining the origins. Which would not be considered an aspect of origin of the theory/model? The historical evolution The motivation for development The unique focus The philosophical beliefs and values about nursing that it is based on.
52. The clinical manifestations of dyskinetic cerebral palsy include: Increased muscle tone and prolonged primitive reflexes Exaggerated deep tendon reflexes, clonus, and rigidity of extremities Scoliosis, contractures, and stiffness of trunk muscles Jerky uncontrolled and abrupt fine musculoskeletal movements.
53. Which core competency incorporates assuming complex collaborative roles with stakeholders and communities? Independent practice Leadership Policy Ethics.
54. A critical environmental element that affects the authority of advanced practice nurses to practice to their fullest/maximum scope, according to Hamric’s model, is: Direct clinical practice Consultation Health policy Certification.
55. For nursing to be considered a discipline, which statement is true? Defining the knowledge base of nursing is essential and straightforward. The discipline of nursing consists of a well-defined knowledge base. The human component of the knowledge base of the discipline does not influence or change the existing knowledge base Context has considerable influence on the development of the knowledge base.
56. The APN wants to develop a community educational program for hypertension and stroke prevention. She recognizes that the individual’s lifestyle and pattern of behavior need to be addressed for the program to be successful. Which theory would be most appropriate to guide the program development? Health as Expanding consciousness Science of unitary human beings Human becoming school of thought interpersonal based nursing.
57. When considering a theory for use in guiding practice, the APN should examine the onceptual-Theoretical-Empirical (C-T-E) linkages by for which criteria? Internal consistency Specification adequacy Parsimony Empirical adequacy.
58. In septic shock, which mediators are anti-inflammatory? Interleukin (IL-4, IL-10, IL13) Tumor necrosis factor -alpha (tnf-a) and granulocyte cell stimulating factor IL-1, IL2and IL6 Prostaglandin ,leukotrienes and brady kinin.
59. The link between major depression and cortisol secretion is that individuals with depression: Show suppression of plasma cortisol when given dexamethasone Have a decreased plasma cortisol level, despite the administration of exogenous
corticosteroids
Show that persistently elevated plasma cortisol levels can result in inflammation that is
believed to trigger depression
Have normal plasma cortisol levels throughout the day when they take antidepressant
medication as prescribed
.
60. Which three primary criteria for advanced practice nursing are identified in Hamric’s Integrative Model of Advanced Practice Nursing? • Guidance,
• Graduate education,
• Patient-focused practice,
• Certification
Ethical decision making.
61. Which advance practice nursing was developed to facilitate delivery of high quality, patient centered primary care? Certified nurse midwife(CNM) Certified nurse practitioner (CNP) Certified registered nurse anesthetist (CRNA) Clinical nurse specialist CNS).
62. An adult-gerontology nurse practitioner is employed in a rural practice that is initiating a school-based primary healthcare program. All nurse practitioners in the practice are required to initiate preparations to facilitate conducting patient visits in the new setting. Which role concepts best describes what the adult-gerontology nurse practitioner is experiencing? Role transition role incongruity role ambiguity role stress.
63. A MSN student is noting challenges related to attending school while attempting to balance other work, family, and social responsibilities. Which of the following role concepts illustrates the MSN student’s experience? Role stress Role strain Role transition Role conflict.
64. A 24 year old female presents to the primary care office with complaints of dysuria. Urinalysis lab results indicated positive nitrites. The nurse practitioner plans to initiate antibiotic coverage for the most likely causative organism which is: Escherichia coli Staphylococcus aureus Neisseria gonorrhoeae Ureaplasma urealyticum.
65. Place the following four steps of APN core competency of evidence based practice in order.
Critically appraise and extract evidence 1 . Formulate a measurable clinical question 2 Review literature for relevant studies 3 Implement useful findings in clinical decision making 4.
66. A 12 year old male is diagnosed with Klinefelter syndrome. His karyotype would reveal which of the following? XY XX XYY XXY.
Concerning the MMR vaccine, which of the following is a correct statement? The link between use of MMR vaccine and autism has been firmly supported There is no scientific evidence to support MMR use increases autism risk The use of the combination increases autism risk, but dividing them into separate injections minimized this The injection contain thimerosal, a mercury agent.
68. You are seeing a 40-year-old patient who has started varenicline (Chantix) 3 weeks ago as a tool for smoking cessation. What is the most important question to ask during the visit? How many cigarettes per day are you currently smoking?" Are you having any difficulty sleeping?" Have you noticed change in your mood?" "On a scale of 1-10, what is your current desire to stop smoking?".
69. A primary care nurse practitioner (NP) is seeking additional support from ancillary health services for a diabetic client who is noncompliant with nutrition, exercise, and medication. Which barrier to ethical practice is influencing the NP's practice?
Interprofessional Patient-provider Internal to the APN Organizational / Environmental.
70. Which hospital ownership classification best describes an organization whose excess income is distributed to its shareholders?
Public Not for profir For profit Commercial.
72. A 12-year-old female is newly diagnosed with type 1 DM. When the parents ask what causes this, what is the nurse practitioner's best response? A familial, autosomal dominant gene defect Obesity and lack of exercise Immune destruction of the pancreas Hyperglycemia from eating too many sweets.
73. Which patient below is at most risk for invasive pneumococcal infection?
A 72-year-old man with a history of COPD A 32-year-old woman who underwent a splenectomy after a motor vehicle accident A 45-year-old man with a 10 year history of type 2 diabetes A 80-year-old female with a history of severe osteoporosis and decreased functional status.
71. How has the Quality Chasm Report been used to direct US health care? The report integrates international directives for provision of quality health care. The Institute of edicine (IOM) designed this document to direct medical practices in the US. As a framework for safe, effective, efficient, equitable, timely, and pațient centered care It outlines processes for determining interdisciplinary root cause etiologies.
74. A Latino patient in your clinic has been perpetually late for his appointment. Which action by the nurse practitioner would be most appropriate?
Advise the patient that he should have called to reschedule Adjust the appointments to allow for this lateness Assess how the patient interprets the appointment time Ignore the situation to avoid having the patient go elsewhere .
75. What specific developments have primarily occurred because of the Affordable Care Act (ACA)?
ACA has been appealed and no longer enacted Development of patient centered outcomes, use of comparative effectiveness research, quality payment structures that impact APN reimbursement Nothing has been changed by the ACA other than Medicaid Expansion and Affordable Health Care ACA has provided limited access to care.
76. Hamric's Integrative Model of Advanced Practice Nursing identify the central competency of advance practice nursing that directs the other six core competencies. Evidence-based practice Guidance and Coaching Ethical decision making Direct clinical practice.
77. A public health nurse is teaching the community about health promotion. When explaining immunity, the APN discusses that innate immunity is: acquired following an illness present at birth obtained by IV administration acquired during adulthood.
78. According to Madeline Leininger, cultural care/accommodation/negotiation refers to actions/ decisions that help a particular culture: retain and preserve care values adapt to or negotiate with others for satisfying healthcare outcomes change or modify behaviors affecting their lifestyles. work with each other to set up goals for improved health outcomes.
79. The nurse practitioner is conducting annual physical exam on a 62 year old male. Which of the following risk factors will prompt the nurse practitioner to screen the patient for development of benign prostatic hypertrophy (BPH)? High fat diet Recurrent prostatitis Increased age Cigarette smoking .
80. The family nurse practitioner examines a patient who has sustained a non-work- related injury that interferes with his ability to perform his job. The patient does not qualify for medical disability and has a reasonable chance of engaging in a suitable proper therapy. What type of services or benefits should the nurse practitioner recommend?
Family and Medical Leave Act benefits Vocational rehabilitation services Public unemployment services Social security benefits.
1. Which statement provides the most accurate information regarding the transmission of herpes simplex virus (HSV)? HSV is transmitted only when vesicles are present HSV is transmitted only while lesions are present The use of condoms prevents the transmission of HSV The risk of transmission is present even during latent periods.
2. What practice by Advanced Practice Nurses (APNS) best promotes safety and reduced escalations in mental health disorders among an aging population? Obtaining certification as a psychiatric nurse practitioner Implementing current clinical practice mental health guidelines YESSSSSS Seeking continuing education regarding mental health among the aging Performing a mental health screening based on age and history.
3. How does health policy specifically influence health care practice in the United States? Health Policy directs efforts by the CDC and protects Americans against population based diseases. Health policy does not directly influence how health care is reimbursed and determines APN payment for services. Health policy does not direct specific evidence based practice guideline development and dissemination Health policy is broad and does specifically focus on population based disease efforts.
4. What are the primary tenets of Team STEPPS training?
Interdisciplinary collaboration, communication, teamwork Individualized training, continuing education, safety Autonomous monitoring, team building, communication Interdisciplinary knowledge, skills, attitude.
5. In order to develop theory-type questions, the practitioner would take which of the following initial series of steps?
Ask certain questions, research the topic, implement what is developed, and evaluate the implementation Ask certain questions, question the status quo, seek the most plausible answer, and build a narrative for the questions and answers Question the status quo, seek a meaningful answer, Build a program to answer the question and evaluate the program Question the status quo, seek a meaningful answer, build a logical structure for the questions and answers, and Review other theories about the situation.
6. Utilizing Fawcett's evaluation of the Conceptual-Theoretical-Empirical Structure (CTE) of a theory the APN knows that the empirical indicators of a theory are examined for ---? Internal consistency Parsimony Operational adequacy Empirical adequacy.
7. A newborn is in respiratory distress and requires ventilation, Tests reveal that he does not produce surfactant due to the absence of: Mucus-producing cells Type Il alveolar cells Alveolar macrophages Goblet cells.
8. What statement concerning the pathogenetic mechanisms of polycystic ovarian syndrome (POS) is true? POS causes a decrease in leptin levels; this decrease reduces the hypothalamic pulsatility of gonadotropin-releasing hormone, which reduces the number of follicles that mature. POS is a result of a disorder in the anterior pituitary that increases the follicle-stimulating hormone, which reduces the luteinizing hormone released. POS is a result of a combination of conditions that include oligo-ovulatign or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries. POS inhibits testosterone, which stimulates androgen secretion by the ovarian stroma and indirectly reduces sex hormone-binding globulin.
9. Which agency under the US Department of Health and Human Services would you rely on when seeking specific epidemiology information on disease statistics and prevention of deadly conditions? National Institutes of Health American Cancer Society Centers for DiseaselControl and Prevention Agency for Healthcare and Research Quality.
10. Which leadership style involves development of unity between the leader and followers to achieve a collective purpose?
Laissez-Faire Transactional Transformational Democratic.
11. 42-year-old male presents to the clinic with the chief complaint of sinus congestion for 2 weeks associated with facial pain. He is diagnosed with acute sinusitis, and is prescribed Amoxicillin/clavulanic acid. He has not had a fever, shortness of breath, or any gastrointestinal symptoms. Upon discharge, he is requesting a "flu shot." The most appropriate response is that, he "needs to return for the shot after he has completed his antibiotic therapy." "is not an appropriate candidate for the shot due to his age." "is at risk of developing a reaction if the shot is given today." "can receive the shot in the clinic today.
12. Which of the following best describes the function of the clinical nurse specialist (CNS) as an advanced practice nurse (APN)? Provide expert consultation and direct care to clients with complex health problems, educate and support nursing staff, and lead change within organizations Provide expert, prevention and wellness focused direct care for acute and chronic conditions Provide specialized care and intervention related to women's health and childbearing.
13. What is the purpose of a conceptual model for advance practice nursing? To articulate professional role identity and function, competencies, and population foci To offer a systemic approach to nursing research, education, administration, and To promote communication, resolve conflict, and ensure consistency of advance nursing practice .
14. Which of the following statements best describes a middle range theory?
A conceptual model of nursing that guides patient care of the elderly. A theory of caring that can be incorporated into a program for RN's in a hospital setting LA theory of health promotion to guide a smoking cessation program.
15. The APN wants to evaluate the effectiveness of a protocol change that has lessened the waiting time for patients with acute symptoms of an exacerbation of COPD to be seen in a primary care practice. He is interested in whether the change reflects an improvement in prevention of hospitalization for COPD as well as the patient's quality of life. What does he need to consider if he wants to utilize the Health related quality of life (HRQOL) theory to guide his evaluation?
There are multiple frameworks and models to choose from Only blological and physiological variables and symptoms are included An individual's perceptions are not addressed in the theory .
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