AGACNP - Based on Frances Guide Review Materials 2023 Solved Questions

You want to get more funding for your hospital's Rapid Response Team. How should you present this issue to the committee? a. Stress importance of the team (look up evidence about how team affects outcomes) b. Describe how to improve and expand the team - ANSWER-a What is the best way for the AGACNP to get involved in policy making? a. attend legislative days at the state capitol b. join a hospital committee c. write your local congressman d. review literature and give more in-services - ANSWER-B What is the best way for the AGACNP to demonstrate and advocate for full scope of practice? a. join a hospital committee b. petition the government c. bill for independent services d. start your own practice - ANSWER-c Which of the following is considered a high acuity role for the AGACNP? a. primary care clinic b. cardiology office c. community health department d. minute clinic - ANSWER-b What is the best way to advocate for gay and lesbian population? a. participate in a high state or national level b. join a non-profit advocacy group c. consider lobbying the government d. start at your facility - ANSWER-d. start at your facility Answers are worded differently. "decrease bias in healthcare" "create in-servises in healthcare" "obtain funding to increase access" Which of the following is most important to evaluate statistical significance when reviewing the literature? a. consider the sample size b. make sure the confidence interval is tight c. see if the p-value is less than the alpha-coefficient d. determine the error rate - ANSWER-a When closing a practice, the NP is required to do all of the following except a. give the patient adequate time to find another provder b. keep all of the patient's records for a minimum of five years c. send a certified letter with a return receipt requested d. provide names of other providers for future care - ANSWER-c Which of the following components of an evidenced based research process is the most important for NP to participate in? a. specifying methods of data collection b. formulating the hypothesis c. carefully reviewing the literature d. formulating the research problem - ANSWER-d A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP's practice. Which of the following forms of defamation is this? a. libel b. slander - ANSWER-a Can you tell the patient's wife, for her protection, that her husband has HIV? - ANSWER-No, not without his permission How can the ANCP prepare to get involved in future mass casualty event? - ANSWER-Pre enroll in disaster volunteer program An 80 year old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? - ANSWER-Medicaid Your patient is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid: - ANSWER-Pays after insurance and 3rd party payers have paid You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that workds. What ethical principles does this challenge? - ANSWER-Veracity and fidelity Health literacy - ANSWER-Average american: 8th grade level Quality assurance - ANSWER-A process for evaluating the care of patients using established standards of care to ensure quality CPI - ANSWER-Measures structure, processes, and outcomes A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based policies to establish clinician-family communication standards in the unit. These policies should include: - ANSWER-Guidelines for having discussions with family members that are geared toward establishing treatment goals Which clinical scenario does the NP evaluate for a quality improvement process change? - ANSWER-An increased incidence of postoperative sternal wound infections Goals set forth in healthy people 2020 by the US department of Health and Human services include: - ANSWER-elimination of health disparities (and increased QOL/LOL) Based on the individual's culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership with the patient by: - ANSWER-Tailoring his or her communication style to the patient's preference A 70 year old patient with a history of DM, HTN, OAs, and a new diagnosis of CAD, is being discharged. The adult-gerontology acute care NP teaches the patient that the first point of contact for health care needs is the: - ANSWER-PCP The NP is asked to provide evidence to the hospital administration about the safety of NP placing central lines. Which resource provides the strongest level of evidence? - ANSWER-A systematic review (meta analysis) What legislation allowed NPs to be recognized Medicare providers in all geographical areas with their own provider number? - ANSWER-Balanced Budget act True/false: restraining an unwilling patient is grounds for malpractice? - ANSWER-False, if they are a danger you can restrain Patient presents to the clinic for routine f/u and passes out. You revive the patient and admit overnight. Which of the following would qualify as incident to billing? - ANSWER-Temperature and weight recording The NP program initiated, primarily, because of what issue in healthcare at the time? - ANSWER-Pediatric physician shortage Elderly patient takes a turn for the worse. The husband is crying when you enter the room and begins telling you what end-of-life care he prefers. What do you do? - ANSWER-Ask him to speak candidly with you Patient calls to complain about bills and states he has Medicare, which should cover all costs. You explain: - ANSWER-Since you are healthy, exams are not covered Doc calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient... - ANSWER-No, HIPPA Patient in ER not doing well, primary MD calls: - ANSWER-Give him info NP working on ESRD research project. A colleague renal specialist asks for patient info on your patients: - ANSWER-HIPAA breach Who enforces HIPAA? - ANSWER-Office of Civil Rights/Dept Health and Human Services Who isn't covered by HIPAA? - ANSWER-Law enforcment/municipal offices, CPS/Schools, employers/workman's comp, life insurance Insurance company calling to verify some patient appointments? - ANSWER-Answer by picking out that there is already a medical release signed by the patient and give the requested information to them Benchmarking - ANSWER-How institution compares with similar organizations Managed care - ANSWER-Know what this is and how it has improved costs, something about putting caps on payments Peer review - ANSWER-Timely, not anonymous, and NP knows how peer review will impact yearly evaluation Sensitivity vs specificity - ANSWER-Sensitivity: true positives, specificity: true negatives There was a question where a patient had a multinodular goiter and wanted to know why the NP was not going to do periodic US and fine needle biopsy in monitoring for some kind of cancer or complication. The answer I picked was that these tests were not very specific to detect the cancer Reliability - ANSWER-When implementing a new study, tested over and over, the consistency of a measurement or the degree to which an instrument measures the same way over time Validity of results in an article - ANSWER-P-value, probability of falsely rejecting the null hypothesis, want it to be <0.05 Statistical significance - ANSWER-Look at sample size and p value Privileging - ANSWER-May be granted in full or part by the hospital, credentialing committee is made of physicians Who determines scope of practice? - ANSWER-State practice acts but institutional bylaws may further restrict practice (facility limited scope of practice) Informed consent - ANSWER-A state indicating patient has received adequate instruction/information regarding aspects of care to make a prudent, personal choice regarding such, includes risks and benefits, competence: ability to communicate, understand, reason, differentiate good and bad Case management - ANSWER-Mobilize, mointor, and control resources that a patient uses during course of an illness while balancing quality and cost, "move patients through the system appropriately" 50-60 year old patient ith a new diagnosis of cancer. To appropriately plan for discharge, what should the NP do? a. consult CM b. Consult SW c. refer to Oncology d. refer to Hospice - ANSWER-a Nondisclosure - ANSWER-Not disclosing patient PHI without permission Negligence - ANSWER-Failure of individual to do what any reasonable person would do, resulting in injury to the patient When serving as a nurse researcher, the NP is guided by which ethical principle to ensure that research participants are protected from harm or exploitation? - ANSWER-Nonmaleficence Living will - ANSWER-Health care proxy/POA NP sees a patient for HF and performs an H&P. What % is expected to be paid? - ANSWER-Medicare pays 80% of the total bill, pt pays 20%, NP is reimbursed 85% of what the MD is reimbursed for physician services, and for procedure 80% of that 85% Focus of palliative care - ANSWER-Basic improvement in QOL of anyone with an illness at any stage Hospice - ANSWER-<6m to live Scope of practice: integration of care across the acute illness continuum with: a. collaboration b. coordination of care c. research based clinical practice - ANSWER-a Collaboration - ANSWER-True partnership in which all players have the desire power, share common goals, and recognize/accept separate areas of responsibility/activity Patient is getting d/c'd and need wound care, pulmonary, and follow up. NP's role is to: - ANSWER-Coordinate services Government is moving towards being cost effective. What is the best way? - ANSWER-Allow NP to treat a wider variety of patients Protected health information: discussion between the NP and consultant on case - ANSWER-Considered clinical relevance How should the ACNP stay up to date with current information? - ANSWER-Evidence based guidelines Which medicare is Hospice covered under? - ANSWER-Medicare A A patient presents to the Er with c/o CP and SOB. The NP misinterprets the EKG and admits the patient fro further monitoring without consulting cardio. Later in the shift, the patient decompensates and goes into cardiac arrest. The patient was resuscitated but sustained permanent brain damage. What grounds of malpractice is the NP accountable for? - ANSWER-Lack of skill Healthcare exchange - ANSWER-Health insurance marketplaces, organizations in each state through which people can purchase health insurance You notice there have been less favorable outcomes and satisfaction surveys in patients treated for sickle cell anemia. How do you approach this problem? a. ask the patients treated how care can be improved b. look back at prior treatment given to see how outcomes can be improved c. form a standardized tx plan for all patients that can be used by all healthcare staff d. form individualized tx plans that can be used by all healthcare staff - ANSWER-c You have transferred a patient to the SNF. The MD in charge at that facility calls for info about the patient's medical care, what do you do? a. direct him to look it up in the EMR b. refuse to share protected health information c. instruct him to call the department head d. share the information he requests - ANSWER-d Your patient has refused human blood products based on religious beliefs. He is now rapidly destabilizing. What do you do? a. administer PRBCs as needed b. call the ethics committee c. continue to research alternative treatments d. ask the family to give permission now that he's unconscious - ANSWER-c What is the best way to make sure a patient will follow up as instructed? a. instruct the patient to schedule the appointment b. ask the patient the best time they can go to an appointment c. have the office manager to schedule the appointment d. schedule the appointment for the patient - ANSWER-d Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserves life, but states that the patient would not want to be on a ventilator. What should you do? a. consult neurology to come interview the family b. document the situation carefully in the chart c. call a clergy member to offer support d. call the ethics committee - ANSWER-d A patient visits your clinic for sinusitis. She requests a PAP smear since she has not had one in "years". You: a. refer her to a gynecologist b. schedule her to come back next week for the PAP at another appt c. perform the pap today d. do a vaginal exam only, and refer the PAP to a gyno - ANSWER-b A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in "years." You: a. refer her to gynecologist b. schedule her to come back c. perform the PAP today d. do a vaginal exam only, and refer the PAP to a gyno - ANSWER-a Discharge planning is udnerway for a patient who has been very dehabilitated after treatment for end-stage liver cancer. His wife is also debilitated and the children live out of state. What is the best choice? a. hospice b. home health care c. SNF d. private duty RN - ANSWER-c Your patient presents to ED w/ R wrist pain. She states, "it's my fault; I should have had dinner ready on time." What do you do? a. Tell her not to go home bc it's not safe b. XR the wrist c. call the police d. consult psych - ANSWER-b Now the husband presents to the ED with drug overdose. What is your action? a. Hand him off to anothe rpractitioner b. call the police c. consult psych d. treat him without prejudice - ANSWER-d The medical resident obtained consent for an operative procedure. on your visit, the patient is confused/ refusing the procedure a. cancel the surgery b. have the wife sign another consent c. call the resident to clarify the patient was not confused when he signed the first consent d. consult neurology - ANSWER-c Your HIV positive patient is preparing to discharge when he tells you not only that he has passed the virus to his wife, but also that he plans to kill her when he gets home. How do you respond? a. call the police b. consult psych c. consult social work d. document his statements - ANSWER-b Your clinical student breaks the sterile field. HOw do you handle this situation? a. discuss it with the student b. report it to the charge nurse c. report it to the unit manager d. inform the faculty in charge of the student - ANSWER-a You are the NP on call for the night. The nurse calls you to report the patient is decompensating. Who do you direct her to call? a. the ER physician b. anesthesia c. an NP present on another unit currently d. the attending MD who is at home - ANSWER-d A code you are in does not go well, and staff members afterwards are criticizing each other. How do you deal with the situation? a. schedule an in service to discuss common code mistakes b. meet with each team member individually c. set up exercises to increase collaboration during a code d. meet with all who participated in the code and have a one-time briefing - ANSWER-d Your patient is not doing well and family/wife is at bedside crying. Yo are preparing to talk to the family. What do you do first? a. place a social work consult b. explicitly explain the situation, the outcomes and care involved c. ask if the patient has an advanced directive d. set up a family meeting in a room with a specific time and date - ANSWER-c Your patient is not conscious. HIs advance directive states he wants to be a DNR, but his family says they want him to be a full code. How do you respond? a. tell her the decision goes to the next of kin b. call the ethics committee c. comply with her wishes and make him a full code d. tell her you can't go against the advance directive - ANSWER-d A patient comes to the ED at a community hospital who is 29 weeks pregnant. She says her water has broken. Her VS are stable. What do you do? a. transfer her to a tertiary facility b. contact her OB/GYN for treatment advice c. admit to l/d d. consult the nurse midwife - ANSWER-a Your 51F patient is getting ready to discharge when she tells you she hasn't had a mammogram in 3 years. What do you do? - ANSWER-Refer to PCP for outpatient discharge Your patient's imaging reveals he has metastatic cancer. The family, in accordance with their culture, request that you not share the test results to spare him distress. How do you respond? - ANSWER-Ask the patient what he wants to know about his prognosis 35yo F presents with c/o bilateral wrist pain. You suspect spouse abuse. You notice a handgun in her purse. What would be your next action? - ANSWER-Call security to ensure safety Adult child of a patient reports that her father has expressed desire to commit suicide and has a hx of ETOH and depression. The best response would be to? - ANSWER-Hospitalize the patient and start pscyhotherapy You notice that another NP in your group is frequently contact by pharmacy for prescription errors. How do you handle the situation? - ANSWER-Address it directly with the NP Your patient voices concerns because he has lost his insurance and worries his children will no longer have coverage for medical expenses. What do you do? - ANSWER-Consult case management 80yo patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture. To prepare the patient for discharge, the NP: - ANSWER-Provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery A 40yo female patient with no PMH is admitted with bilateral PE. W/u reveals a psoitive result for lupus anticoagulant, and anticoagulant therapy is planned. The patient verbalizes concern about her ability to manage the appointments and the follow up care. The NP's most effective intervention si to: - ANSWER-Arrange follow up appointments for the patient at the warfarin (Coumadin) clinic and PCP after discharge What procedure does the AGACNP perform to evaluate cytology, only, in the tumor? - ANSWER-Fine needle biopsy A patient has fully recovered from septic shock due to bacteremia and has been accepted to a LTC facility for continuation of abx. ID has not seen the patient in two days. The NP: - ANSWER-Contacts the ID MD to determine the appropriate abx duration 32yo M presented with a gunshot wound (GSW) to the FA. Injuries are negligible and pt is stable. Pt reports the shot was an accident during hunting. What should the NP do? - ANSWER-Report to the police. All GSW must be reported What is the most important when assessing status? - ANSWER-Level of alertness or hx of symptoms A woman of child bearing age c/o abdominal pain. What level of exam do you document? - ANSWER-Detailed A diabetic patient complains of abd pain. Which type of exam do you conduct? - ANSWER-Comprehenzive What qualifies patient for HHC - ANSWER-Home bound, has a prescription, requires care services, wound care, select care Patient is refusing care? - ANSWER-Let them refuse, educate, and search for alternatives Guy in ER needs refill on ritalin - ANSWER-research alternatives Knowledge deficit in ICU, what would you do for nurses? - ANSWER-In services A patient has advanced dementia, ESRD, and HF, what do you do for him? - ANSWER-Transfer from acute to palliative care Your 24m patient has been out hiking on vacation. He shows you the following rash, and thinks he has Rocky Mountain Spotted Fever. What is his diagnoses? - ANSWER-Lyme disease (Erythema migrans/bullseye rash), both are treated with doxycycline Your patient is a Chinese female immigrant living in the US. You notice she is avoiding eye contact. What is this due to? a. shame because she feels the illness is her fault b. embarrassment from the examination c. a sign of respect d. a normal response - ANSWER-c Your patient speaks only spanish and you need to evaluate his pain. What do you do? a. ask a family member to translate for you b. utilize the hospital's interpreter service c. call over the Hispanic housekeeper and ask her to translate d. Use a visual pain scale - ANSWER-d 58yo Japanese male with CP 4/10 for 3 hours, reluctant to answer questions. Which of the following in the Ed warrant admission? a. age b. gender c. pain level d. ethnicity - ANSWER-d A 77yo male patient's wife cares for him at home .Which statement by the wife indicates a need for a SNF? a. my husband needs more help with his ADLs b. I can't lift him out of bed anymore c. he has lost 20 pounds d. he has trouble swallowing and I'm worried he will choke on his food - ANSWER-a Which psychiatric disorder is most commonly diagnosed, yet least commonly treated? a. bipolar disorder b. alzheimer disease c. depression d. dementia - ANSWER-c Your patient with PNA is noted to have a heavy drinking habit. 2 days post admit he becomes combative/agitated. What is tx? a. IV valium b. IV ativan c. PO librium d. lasix - ANSWER-c Your patient has developed a fever of unknown origin. What is the next step? a. PO abx b. IV abx c. do nothing until diagnosis is confirmed d. tylenol - ANSWER-c How long will it take to begin to see healing in a pressure ulcer that has a clean, well-vascularized bed? a. 7 days b. 2-4 weeks c. 2 days d. 4-6 weeks - ANSWER-c The patient has been in a bar fight and has a human bite on his hand. What should you do next? a. order PO abx b. order wound culture c. order IV abx d. measure the wound depth and width - ANSWER-a Your patient has a chronic, nonhealing decubitus ulcer. He c/o pain when he moves his leg. What is a potential complication? a. compartment syndrome b. decrease in ROM ability c. septic shock d. osteomyelitis - ANSWER-d What is the strongest predictor of functional impairment prior to discharge of the elderly patient? a. advanced age b. incontinence c. cognitive impairment d. poor balance - ANSWER-c Your patient has been taking Thorazine and now has fever, sweating, lethargy, and a temp of 39.4 (102.2) a. give IVF b. antipyretic c. abx d. ice packs to groin and axilla - ANSWER-a You suspect your patient on TPN with a PICC has a CLABSI. What is the first intervention? a. stop the TPN, remove the line, and place a new line for TPN b. start abx c. send cx d. change the guidewire - ANSWER-a Your patient has a fever 3 days post op, WBC are 15k, blood cultures negative, and Eos 9%. What is the diagnosis? a. viral infection b. bacterial infection c. malignant hyperthermia d. drug fever - ANSWER-d (eos=allergic reaction, normal is 1-4%) What are protein supplements best used for? a. eliminate the need for lipids b. prevent anasarca (peripheral edema) c. aid in post op healing - ANSWER-c Which macronutrient of TPN significantly increases the osmolality of the solution? a. lipids b. dextrose c. mutivitamin d. potassium - ANSWER-b Protein in nutrition for what reason? - ANSWER-maintain nitrogen balance along with metabolic needs, adjust protein weekly by measuring urinary urea nitrogen Which electrolyte are you most concerned about monitoring in cachexic patient? a. mag b. ca c. na d. k - ANSWER-d. refeeding syndrome, hypokalemia and hypophosphatemia Which electrolyte do you monitor in refeeding syndrome? - ANSWER-Phosphorous (or potassium) Which lab do you monitor daily in a patient on nutritional supplements? a. BMP b. cbc c. abg d. blood culture - ANSWER-a (LFTs weekly) What alternative therapy can you order to relax the patient prior to procedure? a. massage b. aromatherapy c. music d. muscle relaxant - ANSWER-c What alternative therapy can you use to help/distract them from their pain during the procedure? - ANSWER-Guided imagery Which alternative therapy helps Parkinson's patients with coordination? a. acupuncture b. tai chi c. relaxation techniques d. hypnotherapy - ANSWER-b (also helps prevent falls in elderly) Which 2 headaches are treated with triptans? - ANSWER-Migraines and cluster What kind of dressing do you use on a decubitus ulcer with necrotic tissue? - ANSWER-Hydrocolloid 45yo s/p double mastectomy 2 months ago. Now is c/o pain at the incision site - ANSWER-Neuropathic pain What does the leg/foot look like in a hip fracture - ANSWER-Internally or externally rotated Pt has a post op fever... - ANSWER-Give fluids WHO pain ladder... - ANSWER-Fentanyl patch for breakthrough cancer pain Best pain indicator... - ANSWER-Patient self report Best alternative therapy to decrease pain in clavicle fracture: - ANSWER-Therapeutic touch/reiki (hand or palm healing that transfers 'universal energy' has been used for cancer, emotional, or physical healing) Picture of gunshot wound to the R lung area - ANSWER-The answer is to allow the dressing to be sucked to the chest wall during the negative pressure of expiration Another answer was to let air blow out during inhalation Cocaine induced psychosis - ANSWER-s/s parnoia, delusions, hallucinations, 'cocaine bugs' under skin, mydriasis Pt comes in tachycardic, hallucinating, all kinds of other crazy symptoms with dilated pupils - ANSWER-Sympathomimetic (cocaine or meth) Antidepressant OD - ANSWER-s/s hallucinations, confusion, tachy/dysrhythmias, hypothermia, blurred vision, urinary retention, hypotension (can't see, can't pee, can't spit, can't shit) Antidepressant OD treatment - ANSWER-ICU if CNS or cardio toxic, activated charcoal NaHCO3 for dysrhythmias and maintain pH, benzos (valium) for seizure (if serotonin syndrome: dantrium/dantrolene sodium) ASA overdose - ANSWER-s/s n/v, tinnitus, dehydration, hyperthermia, apnea, cyanosis, metabolic acidosis ASA overdose treatment - ANSWER-activated charcoal, NaHCO3 for severe acidosis of <7.1, monitor ABGs How do you treat group A strep on skin - ANSWER-TMP/SMX or Doxy/mino + beta lactam (1st generation cephalosporin, PCN, or amoxil) Pt has cellulitis of lower extremity with a wound, what do you treat with? - ANSWER-Based on the hospital sensitivity Mallampati grades for visualization of oral cavity: - ANSWER-1. complete soft palate