AGACNP FRANCES GUIDE

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? -libel -slander

Libel -Libel = literature (written) -Slander = spoken (verbal)

35 yo 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?

Call security to ensure safety

Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserve life, but states that the patient would not want to be on a ventilator. What should you do? -Consult neurology to come interview the family -Document the situation carefully in the chart -Call a clergy member to offer support -Call the Ethics Committee

Call the Ethics Committee

Pt in ER not doing well, primary md calls:

Give him info

NP working on ESRD research project . A colleague renal specialist asks for pt info on your patients:

HIPPA breach.

Statistical significance

Look at sample size and p value

Privileging

May be granted in full or part by the hospital, credentialing committee is made of physicians

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?

Medicaid -Medicaid to help poor -Medicare to help retired -"spending down" - become poor to qualify

What is the best way for the AGACNP to get involved in policy making? -Attend legislative days at the state capitol -Join a hospital committee -Write to your local congressman -Review literature and give more in-services

Join a hospital committee -start at local level

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?

Lack of skill

Who ISN'T covered by HIPPA?

Law enforcement/Municipal Offices CPS/Schools Employers/Workman's Comp Life insurance Covered Entities: -Health Plans (health insurance) -HCP -health care clearinghouses

What is most important when assessing status?

Level of alertness or hx of symptoms

Which medicare is Hospice covered under?

Medicare A A: hospital charges B: Outpatient charges C: "Choice" choose providers (HMO plan for Medicare) D: Drugs

NP sees a patient for HF and performs an H&P. What % is expected to be paid?

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%

A code you are in does not go well, and staff members afterwards are criticizing each other. How do you deal with the situation? -Schedule an in-service to discuss common code mistakes -Meet with each team member individually -set up exercises to increase collaboration during a code -Meet with all who participated in the code and have a one-time briefing

Meet with all who participated in the code and have a one-time briefing

Case management

Mobilize, monitor, and control resources that a patient uses during course of an illness while balancing quality and cost, "move patients through the system appropriately"

Nondisclosure

Not disclosing patient PHI without permission (confidentiality)

32 yo 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?

Report to the police. ALL GSW must be reported

Quantitative and Qualitative

Quantitative: amount/numbers Qualitative: descriptive, like case studies

A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in "years." You: -Refer her to a gynecologist -Schedule her to come back next week for the PAP at another appt. -Perform the PAP today -Do a vaginal exam only, and refer the PAP to a gyno

Refer her to a gynecologist

Your 51 F patient is getting ready to discharge when she tells you she hasn't had a mammogram in 3 years. What do you do?

Refer to PCP for outpatient discharge

Discharge planning is underway for a pt who has been very debilitated after treatment for end-stage liver cancer. His wife is also debilitated and the children live out of state. What is the best choice? -Hospice -Home Health care -SNF -Private Duty RN

SNF

A patient visits your clinic for sinusitis. She requests a PAP smear since she has not had one in "years." You: -Refer her to a gynecologist -Schedule her to come back next week for the PAP at another appt. -Perform the PAP today -Do a vaginal exam only, and refer the PAP to a gyno

Schedule her to come back next week for the PAP at another appt.

What is the best way to make sure a patient will follow up as instructed? -Instruct the patient to schedule the appointment -Ask the patient the best time they can go to an appointment -Have the office manager to schedule the appointment -Schedule the appointment for the patient

Schedule the appointment for the patient

When closing a practice, the NP is required to do all of the following except: -Give the pt adequate time to find another provider (2 months) -Keep all of the patient's records for a minimum of five years -Send a certified letter with a return receipt requested -Provide names of other providers for future care

Send a certified letter with a return receipt requested -this is for discharging/firing a patient from your practice

Goals set forth in "Healthy People 2020" by the United States Department of Health and Human Services include:

elimination of health disparities. -Increase the quality of healthy life -increase the years of healthy life

Hospice

< 6 months to live

Managed Care

A health care system whose goals are to provide cost effective quality care. Putting caps on payments

Informed Consent

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

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?

A systematic review (meta-analysis is even stronger)

You notice that another NP in your group is frequently contacted by pharmacy for prescription errors. How do you handle the situation?

Address it directly with the NP

Government is moving towards being cost effective. What is the best way?

Allow NP to treat a wider variety of patients

Which clinical scenario does the NP evaluate for a quality improvement process change?

An increased incidence of postoperative sternal wound infections

Elderly female pt 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?

Ask him to speak candidly with you

Your patient is not doing well and family/wife is at bedside crying. You are preparing to talk to the family. What do you do first? -Place a social work consult -Explicitly explain the situation, the outcomes, and care involved. -Ask if the patient has an advanced directive -Set up a family meeting in a room with a specific time and date

Ask if the patient has an advanced directive -Pt is decompensating; First thing to do is evaluate advanced directives

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?

Ask the patient what he wants to know about his prognosis

Health Literacy grade level

Average American-8th grade education level

What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?

Balanced Budget Act

Focus of palliative care

Basic improvement in QOL of anyone with an illness at any stage

What is the best way for the AGACNP to demonstrate and advocate for full scope of practice? -Join a hospital committee -Petition the government -Bill for independent services -Start your own practice

Bill for independent services -"demonstrate and advocate"; proving you are your own provider

The medical resident obtained consent for an operative procedure. On your visit, the pt is confused/refusing the procedure. -Cancel the surgery -Have the wife sign another consent -Call the resident to clarify the patient was not confused when he signed the first consent -Consult neurology

Call the resident to clarify the patient was not confused when he signed the first consent -rarely cancel -already obtained consent so do not need another consent

Which of the following is considered a high acuity role for the AGACNP? -Primary care clinic -Cardiology office -Community health department -Minute Clinic

Cardiology Office

Scope of practice: integration of care across the acute illness continuum with: -collaboration -coordination of care -research based clinical practice

Collaboration

A diabetic pt complains of abd pain. Which type of exam do you conduct?

Comprehensive

Which of the following is most important to evaluate statistical significance when reviewing the literature? -Consider the sample size -Make sure the confidence interval is tight -See if the p-value is less than the α-coefficient -Determine the error rate (Answers are worded differently. "Ensure confounding variables were eliminated" & "P value is less than null hypothesis" were two of them.

Consider the sample size -higher sample size; more likely to get an appropriate p-value (low p-value)

Protected health information: discussion between the NP and consultant on case

Considered clinical relevance

50-60 year old patient ith a new diagnosis of cancer. To appropriately plan for discharge, what should the NP do? -consult CM -Consult SW -refer to Oncology -refer to Hospice

Consult CM

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?

Consult case management

Your patient has refused human blood products based on religious beliefs. He is now rapidly destabilizing. What do you do? -Administer PRBCs as needed -Call the ethics committee -Continue to research alternative treatments -Ask the family to give permission now that he's unconscious

Continue to research alternative treatments -must adhere to "advanced directives"

Patient is getting d/c'd and need wound care, pulmonary, and follow up. NP's role is to:

Coordinate services

A woman of child-bearing age c/o abdominal pain. What level of exam do you document?

Detailed

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

Discuss it with the student

4 Roles of an NP

Education Research Clinician Consultant/Collaborator

How should the ACNP stay up to date with current information?

Evidence based guidelines

Negligence

Failure of individual to do what any reasonable person would do, resulting in injury to the patient

True/False: restraining an unwilling patient is grounds for malpractice?

False -if they are a danger you can restrain

What procedure does the AGACNP perform to evaluate cytology, only, in the tumor?

Fine needle biopsy

You notice there have been less favorable outcomes and satisfaction surveys in patients treated for sickle cell anemia. How do you approach this problem? -Ask the patients treated how care can be improved -Look back at prior treatment given to see how outcomes can be improved -Form a standardized Tx plans for all pts that can be used by all healthcare staff -Form individualized Tx plans that can be used by all healthcare staff .

Form a standardized Tx plans for all pts that can be used by all healthcare staff

Which of the following components of an evidenced based research process is the most important for NP to participate in? -Specifying methods of data collection -Formulating the hypothesis -Carefully reviewing the literature -Formulating the research problem

Formulating the research problem -highest level of research; develop own research problem as a Master's degree 1. identify problem 2. literature review 3. specify hypothesis 4. data collection

Healthcare exchange

Health insurance marketplaces, organizations in each state through which people can purchase health insurance

Adult child of a pt reports that her father has expressed desire to commit suicide and has a hx of EOTH and depression. The best response would be to?

Hospitalize the pt and start psychotherapy

Doc calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient...

No, HIPPA violation

Can you tell the pt's wife, for her protection, that her husband has HIV?

No, not without his permission. -HIPPA violation -reportable disease: chlamydia, gonorrhea, Syphilis, TB, HIV - report to health department only

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?

Nonmaleficence

Who enforces HIPPA?

Office of Civil Rights /Dept. Health and Human Services

Validity of results in an article

P-value, probability of falsely rejecting the null hypothesis, want it to be <0.05

Living Will

POA/healthcare proxy

Your pt is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid:

Pays after insurance and 3rd party payers have paid

The NP program initiated, primarily, because of what issue in healthcare at the time?

Pediatric physician shortage

How can the ANCP prepare to get involved in future mass casualty event?

Pre-enroll in disaster volunteer program

Cutting costs by the gov't

Primary-prevention

You have transferred a pt to the SNF. The MD in charge at that facility calls for info about the pt's medical care. What do you do? -Direct him to look it up in the EMR -Refuse to share protected health information -Instruct him to call the department head -Share the information he requests

Share the information he requests

Pt calls to complain about bills and states he has Medicare, which should cover all costs. You explain:

Since you are healthy, exams are not covered.

What is the best way to advocate for gay and lesbian population in your area? -Participate at a high state or national level -Join a non-profit advocacy group -Consider lobbying the government -Start at your facility

Start at your facility (answers are worded differently. One of them is "decrease bias in healthcare" and another is something like "create inservices in healthcare" and another is "obtain funding to increase access.") -local level

Who determines scope of practice?

State practice acts but institutional bylaws may further restrict practice (facility limited scope of practice)

You want to get more funding for your hospital's Rapid Response Team. How should you present this issue to the committee? -Stress importance of the team -Describe how to improve and expand the team.

Stress importance of the team (answer is worded as looking up evidence about how the team affects outcomes, like a meta-analysis) -highest level of research: meta-analysis (multiple studies)

CPI measures what 3 measures to improve nursing?

Structure, processes of care outcomes

Based on the individual's culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership w/the patient by:

Tailoring his or her communication style to the patient's preference.

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 advanced directives

Tell her you can't go against the advanced directives

Pt presents to the clinic for routine f/u and passes out. You revive the pt and admit overnight. Which of the following would qualify as incident-to-billing?

Temperature and weight recording -billing outpatient services

Peer review

Timely, not anonymous, and NP knows how peer review will impact yearly evaluation

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 labor and delivery d. Consult the nurse midwife.

Transfer her to a tertiary facility -Needs neonatal ICU bc 29 weeks

Now the husband presents to ED with drug overdose. What is your action? -Hand him off to another practitioner -Call the police -Consult psych -Treat him without prejudice

Treat him without prejudice

Collaboration

True partnership in which all players have the desire power, share common goals, and recognize/accept separate areas of responsibility/activity

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 works. What ethical principles does this challenge?

Veracity and Fidelity Veracity = honest/truth Fidelity = faithful

Reliability

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

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? -Tell her not to go home bc it's not safe -XR the wrist -Call the police -Consult psych

XR the wrist -Physical domain first -Assess injury -2nd to c/s psych

Quality Assurance Quality improvement Continuous process improvement

a process for evaluating the care of pts using established standards of care to ensure quality pg 126

A 40-year-old female patient w/no PMH is admitted with bilateral pulmonary emboli. W/U reveals a positive 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 NPs most effective intervention is to:

arrange follow-up appointments for the patient at the warfarin (Coumadin) clinic and PCP after discharge.

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

consult psych -Police is usually not the answer

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:

contacts the ID MD to determine the appropriate abx duration

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 polices to establish clinician-family communication standards in the unit. These policies should include:

guidelines for having discussions with family members that are geared toward establishing treatment goals.

Benchmarking

how institution compares with similar organizations

A 70-year-old pt with a hx of DM, HTN, OAs, and a new diagnosis of coronary artery disease, is being discharged. The adult-gerontology acute care nurse practitioner teaches the patient that the first point of contact for health care needs is the:

primary care provider

Root Cause Analysis (RCA)

process to identify underlying factors that contribute to variation in outcomes in sentinel event

80-year-old 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:

provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery.

Sensitivity vs specificity

sensitivity is positive -A negative result in a test with high sensitivity is useful for ruling out disease -A positive result in a test with high sensitivity is not necessarily useful for ruling in disease specificity is negative -test's ability to correctly reject healthy patients without a condition -A positive result in a test with high specificity is useful for ruling in disease -The test rarely gives positive results in healthy patients. -A positive result signifies a high probability of the presence of disease.

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

the attending MD who is at home -Chain of command issue -NP is own provider; ED needs to stay in ED; anesthesia for codes; Another NP not appropriate

Insurance company calling to verify some patient appointments.

there is already a medical release signed by the patient. The answer is to give the requested information to them.

Medical futility

unlikely to produce any significant good for the pt