N5350 Roles Final Study Guide Questions With Complete
Solutions
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 Answers 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.
11. What are clinical privileges and how are they obtained?
Correct Answers *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 Answers *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 Answers 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 Answers
*Receives and discloses the reports on medical malpractice.
1a) Medically Underserved Correct Answers *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 Answers * 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 Answers *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 Answers *No longer in
effect.
2. The FOUR Approved Categories of APN in TX? Correct
Answers *CRNA, NP, CNS, and CNM
3. NP requirements by BON for approval of license/ AP
recognition each biennium. Correct Answers *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 Answers *Must take and pass national certification
exam.
, 5. What is the NP's scope of practice based on? Correct
Answers *Nurse practice acts define legal scope of practice for
licensed practitioners.
*Includes privileges for diagnosis, treatment, prescriptive
authority and reimbursement.
Are confidentiality and privacy the same? Explain. Correct
Answers •NO they are different.
•Confidentiality has to do with sharing only the information with
the patients informed consent or that is required if not disclosing
the information could result in patient harm. Or sharing with
other health care members for the purpose of providing care.
•Privacy: has to do with the patient's expectation and right to be
treated with dignity and respect. "need to know"
Are NPs in Texas allowed to prescribe controlled substances? If
so, what is required to be able to do this? What are limitations, if
present, on this kind of prescribing? Correct Answers -Must
obtain valid Rx authority number (must practice in qualifying
site, MD/DO must delegate authority per delegation protocols,
MD/DO must register name and license of APN with BME,
APN registration of Prescriptive authority form)
-Must apply for DEA number:
-Forms provided by board
-Limitations:
-Prescribe per protocols and scope
-controlled substances: schedules III, IV, and V
-Issued for only 90 day period
-Must consult with MD/DO for refills
-Not authorized for child less than 2 y/o without consulting
MD/DO
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