BOARD PRACTICE QUESTIONS - PROFESSIONAL ROLE

The nurse practitioner is reviewing evidence regarding the use of a drug used to treat Parkinson's disease. Rank the strength of evidence from strongest (1) to weakest (3). 1. 2. 3. A. An editorial that discusses how the drug may impact the advancement of Parkinson's treatment, published in the official journal of the American Academy of Neurology B. An experimental study of 300 patients with Parkinson's disease who were randomly assigned to receive either a placebo or the drug daily for 12 months C. A meta-analysis that evaluates the effectiveness of the drug, using 25 randomized controlled trials found on MEDLINE and the Cochrane database

Solution: C1, B2, A3. A meta-analysis study has the highest level of evidence and is considered the gold standard for gathering research evidence for evidence-based practice. Experimental studies are the second level of evidence, and expert opinions and editorials are the lowest level of evidence.

Which type of leader shares decisions and activities with group participants? A. Democratic B. Autocratic C. Laissez-faire D. Situational

Solution: A Democratic. Democratic leadership is characterized by equality among the leader and other participants. Decisions and activities are shared. Autocratic leadership, also known as authoritarian leadership, is a leadership style characterized by individual control over all decisions and little input from group members. Laissez-faire leadership, also known as delegative leadership, is a type of leadership style in which leaders are hands-off and allow group members to make the decisions. Situational leadership is not based on a specific skill of the leader; instead, the leader modifies the style of management to suit the requirements of the organization.

An elderly Hmong patient, who is originally from Thailand, is seen by the nurse practitioner for a follow-up visit. He is accompanied by his eldest daughter. The patient presented 6 weeks ago with complaints of a recent onset of morning headaches. He was diagnosed with stage 2 hypertension and prescribed hydrochlorothiazide, one 25-mg tablet daily. On this visit, he tells the nurse practitioner that the new medicine cured the headache, so he stopped taking it. What is the best plan to follow during this visit? A. Educate the patient about hypertension, how the medicine works on his body, and the importance of taking his pill daily B. Reassure the patient that he can resume his prescription medicine again the next morning C. Tell the patient that you will lower the dosage of hydrochlorothiazide to 12.5 mg daily D. Speak to the patient in a loud voice and confront him about his behavior

Solution: A Educate the patient about hypertension, how the medicine works on his body, and the importance of taking his pill daily. When Hmong (an ethnic group prevalent in Thailand, Myanmar, Laos, and Vietnam) see a clinician for a symptom, they expect to be treated and "cured" of their illness after one visit. When the symptoms disappear, many will stop taking the medicine. When medication is to be taken on a long-term basis, it is important to educate the patient (and the patient's family) about the disease (in this case, hypertension), how the medicine works on the body, and the reason why the patient has to take the medicine as prescribed (in this case, daily). Many Southeast Asians are very polite and consider speaking in a loud voice, staring, or confrontation to be rude behavior.

The nurse practitioner is examining a child with Down syndrome brought to the clinic with flu-like symptoms. The caregiver offers conflicting information about the source of bruises on the child's buttocks. The child is quiet and reserved. Which criterion is most important for the nurse practitioner to consider when evaluating this patient? A. Explanation of the injury is inconsistent with the presentation B. The behavior of the child during the assessment C. The hygiene of the caregiver D. Unexplained bruises are common in children with Down syndrome children

Solution: A Explanation of the injury is inconsistent with the presentation. Incompatibility between the history and the injury is the most important criterion on which to base the decision to report suspected child abuse. Children who are developmentally or physically disabled are at a higher risk for abuse. The behavior of the child may also suggest child abuse but is a less reliable indicator, since the child has a disability. The hygiene of the caregiver and the fact that the child has Down syndrome (and may have a predisposition for bruising) are less reliable indicators of abuse.

Which of the following is considered by Latinos/Hispanics to be a spiritual illness that can cause symptoms such as loss of appetite, crying, diarrhea, and weakness or death among infants and small children? A. Mal ojo (or mal de ojo) B. Chronic nightmares C. Trabajo D. Malo

Solution: A Mal ojo (or mal de ojo) Mal ojo (or mal de ojo) is a spiritual illness that can cause symptoms such as loss of appetite, crying, diarrhea, colic, fear, weakness, or death. A curandero or curandera is usually consulted and does spiritual cleansing of the patient. It may take several cleansings (limpia) to cure the patient. Trabajo means "work," and malo means "bad" in Spanish; these are included as distractors.

Patient confidentiality is breached when: A. Medical information is given to a spouse B. Records are subpoenaed C. Reports are sent to the public health department D. Records are released to insurance companies

Solution: A Medical information is given to a spouse. Patient confidentiality is breached when medical information is given to a spouse or any other individual without consent of the patient.

According to EBM experts, which of the following types of research has the highest ranking? A. Meta-analysis B. RCT C. Cohort study D. Expert opinion

Solution: A Meta-analysis Meta-analyses and systematic reviews offer the highest level of evidence. The ranking of options for this question is as follows: (1) meta-analysis, (2) randomized controlled trial (RCT), (3) cohort study, and (4) expert opinion. The best method of correctly answering this type of question is to memorize the categories for the best level of evidence (meta-analysis and/or systematic review and/or RCTs) and the lowest form of evidence (opinions, editorials).

According to evidence-based medicine (EBM) experts, which of the following types of research has the highest ranking? A. Meta-analysis B. Randomized controlled trial C. Cohort study D. Expert opinion

Solution: A Meta-analysis. Meta-analyses and systematic reviews offer the highest level of evidence. The ranking of options for this question is as follows: (1) meta-analysis, (2) randomized controlled trial, (3) cohort study, and (4) expert opinion. The best method of correctly answering this type of question is to memorize the categories for the best level of evidence (meta-analysis and/or systematic review and/or randomized controlled trials) and the lowest form of evidence (opinions, editorials). Cohort studies are used to investigate risk factors and causes of disease. An example of a cohort study is the Framingham Study.

A charitable foundation plans to build a community youth center in a large urban area with a history of gang violence. What type of health prevention activity is being done in this area? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Quaternary prevention

Solution: A Primary prevention. A community youth center with good staffing can be an effective method of drawing youth out of the streets into a safer environment. It can reduce the risk of youth becoming victims of gang violence. In addition, staff members can serve as role models or mentors for adolescents.

Which of the following definitions describes the term epidemic? A. Rapid increase of a disease in a population that involves a large number of people B. Resistance to a disease in a large number of people in the population C. Baseline level of a particular disease in a population D. Rapid increase of a disease that occurs over a very large area (several countries or continents)

Solution: A Rapid increase of a disease in a population that involves a large number of people Epidemic is the rapid increase of a disease in a population that involves a large number of people. A pandemic is the rapid increase of a disease (epidemic) that occurs over a very large area (several countries or continents). Endemic is the baseline level of a particular disease in a population, and herd immunity is the resistance to a disease in a large number of people in a population.

An 87-year-old man is being seen at the health clinic. He tells the nurse practitioner that his grandson locks him in the bedroom when he leaves the house and sometimes withholds food from him if he does not give him spending money. The patient appears frail, with poor grooming, and has a strong odor of urine on his clothing. Which of the following is the best action for the nurse practitioner to take? A. Report the patient's grandson for elder abuse to the state protective health services B. Speak to the grandson and educate him about the importance of proper grooming for his grandfather C. Advise the grandson that if the patient has the same complaints the next time he is seen, the grandson will be reported for elder abuse to the state authorities D. Advise the patient that he should call his son as soon as possible to tell him about the grandson's actions

Solution: A Report the patient's grandson for elder abuse to the state protective health services. Speaking with the grandson and warning him about elder abuse and being reported to authorities may result in harm to the patient and/or refusal to return to the clinic in the future for follow-up of the patient. Advising the patient to call his son as soon as possible is vague (for what?) and may benefit the patient, but it is not the best option in this case.

Nurse practitioners and clinical nurse specialists derive their legal right to practice from: A. The nurse practice act in the state where they practice B. The laws of the state where they practice C. The Medicare statute D. The board of nursing in the state where they practice

Solution: A The nurse practice act in the state where they practice The nurse practice act is a statute enacted by the legislature of each state. The act delineates the legal scope of the practice of nursing within the geographic boundaries of the jurisdiction. The purpose of the act is to protect the public. The SBON is the agency that enforces the nurse practice act. The Medicare statute provides the funds for paying for health services at the age of 65 years and older.

Which of the following is a true statement regarding the beliefs of most patients who are Jehovah's witnesses? A. Transfusion of blood is prohibited even in cases of emergency B. Consumption of pork products is strictly prohibited C. Transfusion of blood is allowed in certain medical conditions D. Consumption of alcohol products is strictly prohibited

Solution: A Transfusion of blood is prohibited even in cases of emergency The Watch Tower Society (the governing body of the Jehovah's Witnesses) recommends that its members should not accept whole blood or its primary components in any form. Jehovah's Witnesses believe that the Bible commands them "not to eat blood," and they regard accepting transfusions as equivalent to eating blood. In 2000, a ruling stated that they can accept "minor" components of blood, but they cannot accept a "major" blood component. In the 1980s, organ transplants became acceptable. Patients who identify as Jehovah's Witness should be asked about their preferences regarding blood transfusion before surgical procedures.

The nurse practitioner discovers that a patient received an inappropriate medication due to a lab error. The nurse practitioner immediately informs the patient of the error. Which ethical principle is reflected in the nurse practitioner's behavior? A. Veracity B. Autonomy C. Confidentiality D. Fidelity

Solution: A Veracity. By presenting the information honestly and truthfully, the nurse practitioner is following the ethical principle of veracity. Autonomy is the obligation to ensure that patients have the right to make their own healthcare choices. Confidentiality is the obligation of the nurse practitioner to protect all medical and personal information of the patient. Fidelity is the process of following through with promises and maintaining trust within relationships.

A 14-year-old female is brought by her stepfather to the clinic with complaints of nausea and vomiting. Upon initial assessment, the patient states that she does not recall her last menstrual period and denies sexual activity. Blood work confirms a positive pregnancy test. The patient appears nervous when the stepfather is present and refuses to answer the nurse practitioner's questions. What guidelines will the nurse practitioner follow during the physical exam? (Select all that apply.) A. Interview the adolescent without the stepfather present B. Report the suspected abuse to the state/local authority C. Ask another healthcare professional to be present during the physical exam D. Address the findings and concern with the stepfather and mother in order to get an explanation E. Test the patient for sexually transmitted infections

Solution: A, B, C, E Interview the adolescent without the stepfather present; report the suspected abuse to the state/local authority; ask another healthcare professional to be present during the physical exam; test the patient for sexually transmitted infections. In cases of suspected abuse, the nurse practitioner should follow very specific guidelines to obtain information and assess the patient. The patient should be interviewed without the stepfather present to make the patient feel safer. If the patient feels safer, she may provide more information. Information and suspicions should be reported to the proper authorities. While assessing the patient, there should be another healthcare professional present for safety and ethical reasons. The patient should be tested not only for trauma but also for sexually transmitted infections.

A 37-year-old male presents for a follow-up visit after a recent positive HIV diagnosis. Another staff member at the clinic asks the nurse practitioner if she can read the patient's chart, as the patient is the cousin of a friend. What is the responsibility of the nurse practitioner? (Select all that apply.) A. The nurse practitioner should inform the staff member of the patient's right to privacy B. The nurse practitioner should not provide the chart to the staff member C. The nurse practitioner should remind the staff member not to share the HIV status with anyone D. The nurse practitioner should ask the staff member to sign a waiver to maintain confidentiality after reviewing the chart E. The nurse practitioner should report the incident to the supervisor

Solution: A, B, E The nurse practitioner should inform the staff member of the patient's right to privacy; the nurse practitioner should not provide the chart to the staff member; the nurse practitioner should report the incident to the supervisor. Under the Health Insurance Portability and Accountability Act (HIPAA), personal health information may not be used for purposes that are not related to healthcare. The staff member is not providing healthcare to the patient and should not have access to the chart. A supervisor should be informed, who will then report the infraction to the proper authorities. The obligation of the nurse practitioner is to protect the patient and all patient information.

A physician is referring one of his patients to a nurse practitioner. What type of relationship will exist between the physician and nurse practitioner? A. Consultative B. Collaborative C. Professional D. Advocate

Solution: B Collaborative. A collaborative relationship exists when a health caregiver refers a patient to others (e.g., physicians, specialists, physical therapy) to help with patient treatment and management. Consult reports and progress reports are sent to the primary caregiver to report the patient's progress. Consultative relationships are informal, such as talking to a colleague about a patient's treatment.

The nurse practitioner is performing an assessment on an elderly patient who lives in a long-term care facility that has recently been investigated for elder abuse. All of the following physical findings are suggestive of potential abuse, except: A. Faded bruises on the arms and legs B. Incontinence C. Signs of malnutrition D. Stage II pressure injury

Solution: B Incontinence. Bruises are a result of ruptured vessels under the skin. Unless the patient is receiving antiplatelet medication, they may be a sign of physical abuse. Signs of malnutrition that are not due to a physical illness may indicate that the patient is not receiving adequate nutrition or being fed. A pressure injury is indicative of inadequate positioning or movement and may indicate the patient is being isolated in a chair or bed. These observations must be evaluated by the nurse practitioner. A combination of these signs is suggestive of elder abuse. Incontinence is common in older adult clients and is not a direct indicator of abuse.

What is the median? A. It is the number that occurs most frequently B. It is the middle number in a group of numbers C. It is the average number in a group of numbers D. It a measure of central tendency

Solution: B It is the middle number in a group of numbers. The median is the middle value in a given set of numbers (arranged from lowest to highest). For example, for a group of numbers that consists of 2, 3, 6, 7, 7, 8, and 10, the number 7 is the median value.

A nurse practitioner is conducting a study on a group of subjects over 5 years, looking at the variables of blood pressure, body mass index (BMI), and presence of cardiovascular disease. This is a: A. Retrospective study B. Longitudinal study C. Case study study D. Cross-sectional study

Solution: B Longitudinal study. A longitudinal study examines a group of subjects with the same variables over a long period of time. A retrospective study examines that have already occurred. A case study examines a single person, event, or phenomena. A cross-sectional study compares the similarities and differences between two or more groups of people at one given point in time.

The research term/symbol that is used to indicate the "total population" in a research study is: A. n B. N C. p D. α

Solution: B N The correct symbol to indicate total number of subjects in a study (total population) is N. For example, a research study has a total number of subjects or total population of 100 (N = 100). The small letter n is used to indicate a subpopulation. For example, a study uses a total population of N = 100 that is divided into two groups of 50 subjects (n = 50). The letter p is used to indicate p -value. The symbol α denotes the significance level.

A 17-year-old female patient tells the nurse practitioner that she is sexually active with her long-term boyfriend and asks for contraception information and a prescription. What is the responsibility of the nurse practitioner? A. Call the parent and obtain consent B. Prescribe the contraceptive after educating the patient about the medication C. Counsel the patient on the dangers of early sexual activity D. Ask the patient to include the boyfriend in the contraceptive decision

Solution: B Prescribe the contraceptive after educating the patient about the medication. A 17-year-old patient has the right to consent for the use of contraceptives. She may give full consent without the involvement of her parents or boyfriend. The nurse practitioner should provide all necessary education regarding safe sexual practices and choice of contraception. The patient is due all confidentiality in this matter.

Medicare Part D reimburses for which of the following services? A. Preventive healthcare such as routine Pap smears and physical exams B. Prescription drugs C. Alcohol misuse/abuse counseling D. Over-the-counter drugs and vitamins

Solution: B Prescription drugs Medicare Part D is a voluntary program that charges a premium. Like all Medicare services, patients need to enroll during the "open enrollment" periods during the year (there is a penalty for late enrollment). There is a drug formulary, and not all drugs are available or reimbursed. Use of generic drugs is preferred, as there is a spending limit. Medicare Part B will reimburse for alcohol misuse/abuse treatment.

The most important job of an IRB is to: A. Protect the interests of the hospital or the research institution B. Protect the rights of the human subjects who participate in research done at the institution C. Protect the researcher and research team from lawsuits D. Evaluate research protocols and methodology for appropriateness and safety

Solution: B Protect the rights of the human subjects who participate in research done at the institution Every research institution has an IRB, whose job is to review all the research that is conducted in that institution. The IRB's most important role is to protect the rights of the human subjects who participate in research done at the institution of which the IRB is a part (e.g., research hospitals, universities).

The most important job of an institutional review board (IRB) is: A. Protecting the interests of the hospital or the research institution B. Protecting the rights of the human subjects who participate in research done at the institution C. Protecting the researcher and research team from lawsuits D. Evaluating research protocols and methodology for appropriateness and safety

Solution: B Protecting the rights of the human subjects who participate in research done at the institution. Every research institution has an IRB whose job is to review all the research that is conducted in that institution. The IRB's most important role is to protect the rights of the human subjects who participate in research done at the institution of which the IRB is a part (e.g., research hospitals, universities).

The nurse practitioner completes a physical assessment for a 45-year-old Hispanic female and prescribes an antihypertensive medication. The patient refuses the prescription and tells the nurse practitioner that she would prefer to take a family-prepared herbal medication to lower her blood pressure. What is the appropriate response by the nurse practitioner? A. Inform the patient that herbal substances are not always effective B. Respect the patient's choice and ask her to return weekly for blood-pressure monitoring C. Implore the patient try the conventional medication for 3 months D. Place the patient on a restricted low-sodium, low-fat diet and monitor blood pressure monthly

Solution: B Respect the patient's choice and ask her to return weekly for blood-pressure monitoring. The nurse practitioner should respect the patient's right to refuse and support her cultural beliefs. Cultural practices influence a person's interpretation of illness. Asking the patient to return for frequent assessment of her blood pressure can help determine the effectiveness of the patient's regimen, as well as allow adaptations to be made. Some herbal medications and treatments may have beneficial effects, but any other medications taken by the patient must be assessed to avoid an adverse combination.

A 15-year-old girl who attends a public school is referred to the nurse practitioner by one of her teachers. The teen's parents are recently divorced. The teen has been missing school and is falling behind in her schoolwork. After closing the exam room door, the nurse practitioner starts to interview the teen, asking about her moods, her appetite, her sleep, whether she has any plan of hurting herself or others, and other questions. In what type of health prevention activity is the nurse practitioner engaging? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Dropout prevention program

Solution: B Secondary prevention. The nurse practitioner is evaluating the teenager for major depression. Secondary prevention includes detecting disease at an early stage to halt or slow its progress. All screening tests and lab tests (e.g., mammography, Pap smears) are secondary prevention activities.

Some American Indians may view illness or disease as being caused by which of the following? A. Poor blood circulation in the body B. Spiritual problems manifesting as physical disease of the body C. An imbalance of the flow of energy in the body D. An imbalance of the hot and cold energy forces in the body

Solution: B Spiritual problems manifesting as physical disease of the body. American Indians traditionally believe that spiritual problems can manifest as physical disease of the body. Some illnesses are believed to come from angry spirits, and special rituals are used by healers to appease the angered spirits. The use of herbs and botanicals are used by traditional healers (i.e., shamans) in the form of salves, tinctures, or teas. A sweat lodge (heated by fire on hot stones) may be used for cleansing and purification of a person or place. This practice is called "smudging."

A 22-year-old Muslim woman is seen for a complaint of recurrent abdominal pain. A female NP gives the patient a paper gown with instructions for disrobing and leaves the room. When the NP returns, the patient is still clothed and refuses to undress. The NP's best action is to: A. Ask the patient whether she prefers to be seen by a male physician B. Tell the patient what to expect and perform a modified physical exam C. Instruct the patient to go to the closest ED for an abdominal sonogram D. Lecture the patient about the importance of performing an abdominal exam without clothin

Solution: B Tell the patient what to expect and perform a modified physical exam In Muslim culture, modesty is paramount. Garments of adolescent females and women should cover arms, legs, and head. As a result, Muslim women may refuse to undress for a physical examination. The NP should patiently explain to the patient what to expect and perform a modified exam over her clothing.

A nurse expert is called to testify in a malpractice lawsuit. The nurse will: A. Testify about the actions she would have taken in a similar situation B. Testify about the standards of nursing care as they apply to the facts in the case C. Testify about the laws that govern healthcare in the area D. Provide an expert opinion of the other nurse's actions

Solution: B Testify about the standards of nursing care as they apply to the facts in the case. An expert nurse may testify about the laws and standards of practice as they apply to nursing. An expert nurse is not a legal expert. A nurse expert can testify for the prosecution or the defense. As an expert witness, the nurse would provide only facts and would not provide an opinion about the other nurse's actions.

A 14-year-old girl with amenorrhea is tested for pregnancy and has a positive result. The patient tells the nurse practitioner (NP) that she is seriously considering terminating the pregnancy. She tells the NP that she wants to be referred to a Planned Parenthood clinic. The NP's personal beliefs and religious beliefs are pro-life. Which of the following is the best action for the NP? A. The NP should tell the patient about her personal beliefs and advise her against getting an abortion B. The NP should advise the patient that a peer who is working with the NP can help answer the patient's questions more thoroughly C. The NP should excuse herself from the case D. The NP should refer the patient to an obstetrician

Solution: B The NP should advise the patient that a peer who is working with the NP can help answer the patient's questions more thoroughly. In general, discussing personal beliefs is considered unprofessional behavior. Respecting the patient's right to choose is an example of supporting patient autonomy.

The Patient Protection and Affordable Care Act, enacted into law under President Obama, sought to expand health insurance coverage for Americans. All of the following are true statements about this law, except: A. Preexisting health conditions cannot be used to exclude individuals from obtaining coverage B. The health plan ensures that all Americans have health insurance coverage C. Young adults up to the age of 26 years who live with their parents are covered under their parents' health insurance plan D. Employers who choose not to participate in the national health insurance plan are fined

Solution: B The health plan ensures that all Americans have health insurance coverage. The national health insurance plan, officially known as the Patient Protection and Affordable Care Act and unofficially nicknamed Obamacare, was enacted in March 2010 with the goal of expanding health insurance for the millions of Americans who were uninsured. It prohibits an insurance company from rejecting people with preexisting health conditions. There is also a penalty for employers (and individuals) who choose not to participate in the national health plan. Although increased numbers of Americans gained insurance as a result of the law's passage, many millions more still lack coverage.

The major difference between the quasi-experimental design and the experimental design is which of the following? A. The quasi-experimental design is a type of observational study B. The quasi-experimental design uses convenience sampling instead of random sampling to recruit subjects C. The quasi-experimental design is also known as a survey D. The quasi-experimental design does not have an intervention group

Solution: B The quasi-experimental design uses convenience sampling instead of random sampling to recruit subjects. The quasi-experimental design uses an intervention (it is not an observational study or a survey). It has many similarities to an experimental study except that the human subjects are recruited by convenience and not at random (as in an experimental study).

Which of the following is an example of how the "utilitarian" principle is applied? A. Helping a patient decide the type of treatment that they want B. Using limited societal financial resources on programs that will positively affect the largest number of people and have the lowest possible negative outcomes C. Minimizing the bad outcome when offering treatment choices to a patient D. Being more careful when using healthcare financial resources for any purpose

Solution: B Using limited societal financial resources on programs that will positively affect the largest number of people and have the lowest possible negative outcomes. Generally, the utilitarian principle refers to societal programs that will affect or benefit the largest number of people in a positive manner. It is not used to refer to an individual person.

A nurse practitioner working in a community health clinic sees a male patient who expresses concern about starting a homosexual relationship with a new partner. Which of the following is the best plan to follow during this visit? (Select all that apply.) A. Contact the patient's partner to schedule HIV testing B. Educate the patient about using barrier devices during sex C. Prescribe daily oral PrEP D. Draw a blood sample for a combination HIV antigen/antibody test E. Schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP

Solution: B, D, E Educate the patient about using barrier devices during sex; draw a blood sample for a combination HIV antigen/antibody test; schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP Education on using barriers during sexual activity (e.g., condom/dental dams) is important. Daily oral preexposure prophylaxis (PrEP), such as tenofovir emtricitabine, is recommended for sexually active persons who are at risk for HIV. PrEP is used in HIV-negative persons, so the nurse practitioner must wait for the test results before prescribing. It is appropriate to schedule a 1-month follow-up to review the test results and discuss PrEP options (if test is negative). It is not appropriate ethically or legally to contact the partner; however, it would be appropriate for the patient to encourage his partner to get tested.

What is the pedigree symbol for a diseased male? A. An empty square B. An empty circle C. A filled-in square D. A filled-in circle

Solution: C A filled-in square. A filled-in square is a diseased or affected male, and a filled-in circle is a diseased or affected female. An empty square is a healthy male, and an empty circle is a healthy female.

A patient has a past medical history of chickenpox (childhood), which provided what type of immunity? A. Herd immunity B. Passive immunity C. Active immunity D. No immunity

Solution: C Active immunity. Active immunity is acquired by vaccination administration or by infection. Passive immunity is when the antibodies are obtained from another host. Herd immunity occurs when large numbers of the population are resistant to a disease.

All of the following are considered emancipated minors, except: A. 16-year-old who is married B. 15-year-old who obtained a declaration of emancipation from a state court C. 17-year-old who is enlisted in the U.S. Army D. 13-year-old being treated for a sexually transmitted disease

Solution: D 13-year-old being treated for a sexually transmitted disease There are three primary ways for a minor to become emancipated: marriage, court order, and military service. A minor can be treated for a sexually transmitted disease without parental permission in most states.

Sources of legal risk for the nurse practitioner include all of the following, except: A. Invasive procedures B. Electronic medical record entries C. Prescribing medication D. In-service training

Solution: D In-service training. Legal risks for the nurse practitioner include invasive procedures, electronic medical record entries, and prescribing of medications. In-service training does not directly affect the patient; therefore, legal risks are not a problem.

A patient who is a member of the Jehovah's Witnesses faith refuses a blood transfusion based on religious beliefs. In which manner would the nurse practitioner support the patient's beliefs and practices, while also ensuring that the patient understands the components of informed consent? A. Ask the patient and their family to explain the cultural reasoning behind the decision B. Tell the patient that it is understandable to stand by their beliefs and ask them to complete advance directive paperwork C. Ask a hospital liaison from the patient's faith to counsel them on options and decision-making D. Contact social services to petition the court to obtain temporary guardianship to make decisions for the patient

Solution: C Ask a hospital liaison from the patient's faith to counsel them on options and decision-making. The right to refuse treatment is grounded in the ethical principle of respect for autonomy of the individual. The patient has the right to refuse treatment as long as they are competent and are made aware of the risks and complications associated with refusal of treatment. Therefore, asking a hospital liaison to counsel the patient on decision-making not only will demonstrate support of the cultural practices but also will allow the information to be conveyed by someone they trust. While it is always good practice to demonstrate earnestness by asking about cultural practices, this is not a method of supporting beliefs and gaining an informed consent. Although inquiring about advance directives is standard practice, it is not the primary focus when developing a trusting relationship and demonstrating support. Social services should not petition the court unless the patient is deemed incompetent to make decisions for themselves.

During an assessment of a child with flu-like symptoms, the nurse practitioner notes several deep bruises on the child's buttocks. Which ethical concept does the nurse practitioner follow in reporting the findings? A. Utilitarianism B. Justice C. Beneficence D. Autonomy

Solution: C Beneficence. The ethical concept of beneficence is the obligation to help the patient—to remove or prevent harm and promote good. The reporting of suspected abuse is acting in the child's best interest and being a patient advocate. Utilitarianism is the obligation to be useful or beneficial to the majority. Justice is the quality of being fair and acting without bias. Autonomy refers to the obligation to ensure that mentally competent patients have the right to make their own health decisions.

The spouse of an elderly patient with Alzheimer's disease tells the nurse practitioner that she is exhausted and cannot continue to be the sole caregiver. The couple have no children. They both have healthcare coverage with Medicare, but no supplemental insurance. The nurse practitioner will initially do which of the following to support the caregiver? A. Refer to home health services B. Provide a list of qualified in-home caregivers C. Contact an agency that provides skilled respite care D. Provide a brochure for "meals on wheels"

Solution: C Contact an agency that provides skilled respite care. Contacting an agency that provides skilled respite care is the best intervention because respite care is reimbursed by Medicare and will provide the caregiver some "break" time. Nurse practitioners should be knowledgeable regarding resources for patients with needs. Home health services are not the appropriate level of intervention, as the patient does not need skilled nursing services. Providing a list of qualified in-home caregivers would be helpful if the family has the financial ability to incur the steep costs of private caregivers, but this would not be the best action initially in helping with the problem. Providing a brochure for "meals on wheels" could be useful, but the service would not provide the caregiver with needed rest.

All of the following services are covered under Medicare Part A, except: A. Inpatient hospital care B. Inpatient psychiatric hospital care C. Custodial care D. SNF care

Solution: C Custodial care Medicare Parts A and B do not cover custodial care or nursing home care (help with bathing, dressing, using bathroom, and eating). Medicare Part A coverage includes inpatient hospitalization, inpatient psychiatric hospitalization, and skilled care given in a certified SNF (Skilled Nursing Facility).

All of the following are phases of a medical malpractice trial, except: A. Discovery occurs B. Judgment is given C. Defendant has "burden of proof" D. Case is dismissed, or damages are awarded

Solution: C Defendant has "burden of proof" In a medical malpractice trial, the plaintiff has the "burden of proof," not the defendant. The phases of the trial: lawsuit filed, discovery occurs, court trial (plaintiff has burden of proof), judgment given, and case dismissed or damages awarded.

All of the following groups are classified as "vulnerable populations" and have additional protections as human subjects, except: A. Prisoners B. Pregnant women, fetuses, and children C. Elderly D. Those with intellectual disability

Solution: C Elderly Elderly who are mentally competent are not considered a vulnerable population group.

Some NPs bill directly for their services. Regarding reimbursement, who is considered a third-party payer? A. Patient B. Healthcare provider C. Health insurance companies, health plans, Medicare, and Medicaid D. Federal government

Solution: C Health insurance companies, health plans, Medicare, and Medicaid Third-party payers are health insurance companies, health plans (HMOs or PPOs), Medicare, and Medicaid. The "first party" is the patient. The "second party" is the healthcare provider.

Some nurse practitioners bill directly for their services. Regarding reimbursement, who is considered a third-party payer? A. Patient B. Healthcare provider C. Health insurance companies, health plans, Medicare, and Medicaid D. Federal government

Solution: C Health insurance companies, health plans, Medicare, and Medicaid. Third-party payers are health insurance companies, health plans (HMOs or PPOs), Medicare, and Medicaid. The "first party" is the patient. The "second party" is the healthcare provider.

he nurse practitioner does not need to obtain parental consent from all of the following patients, except: A. A 17-year-old who wants to be treated for a sexually transmitted infection B. A 12-year-old who wants a serum pregnancy test C. A 15-year-old who wants birth control pills D. A 14-year-old who wants to be treated for dysmenorrhea

Solution: D A 14-year-old who wants to be treated for dysmenorrhea. Treatment for teenagers may be done without parental consent for sexually transmitted infections, pregnancy testing, and contraception counseling and treatment. Parental consent is required for any type of physical exam or for other problems that require more invasive testing.

A middle-aged man who is homeless reports to the local public health clinic complaining of a painless and shallow ulcer on the penile shaft for the past 2 weeks. He is sexually active and had unprotected intercourse with two male partners over the past few months. The patient is tested for HIV, syphilis, gonorrhea, hepatitis B, and herpes types 1 and 2. The syphilis and HIV tests are both positive. The gonorrhea, hepatitis B, and herpes tests are negative. The nurse practitioner is aware of the nationally notifiable infectious conditions. Which of the following is true regarding the reporting of any of these sexually transmitted infections? A. Healthcare providers must obtain the patient's permission before reporting the positive HIV and syphilis test results to the local public health department B. The nurse practitioner should obtain the patient's and sexual partner's permission before reporting the positive test results to the local health department C. Healthcare providers are mandated by law to report certain types of diseases to the local health department even if the patient does not give permission D. The nurse practitioner should consult with the supervising physician about this issue

Solution: C Healthcare providers are mandated by law to report certain types of diseases to the local health department even if the patient does not give permission. Physicians and laboratories are legally mandated to report certain types of diseases. Sexually transmitted diseases, HIV infection/ AIDS, gonorrhea, and syphilis must be reported to the local health department even if the patient does not give permission. Partner tracing and notification are done by the local health department. The Centers for Disease Control and Prevention (CDC) website contains a list of nationally reportable diseases. Reportable diseases include tuberculosis; diphtheria; hepatitis A, B, and C; measles; mumps; pertussis; Lyme disease; and Rocky Mountain spotted fever.

A 22-year-old female presents at the urgent care clinic with signs of a broken arm, stating that she fell at home. Upon assessment, the nurse practitioner observes numerous bruises in various stages of healing, and the patient's live-in boyfriend responds aggressively to all questions posed to the patient. Which of the following interventions is most appropriate? A. Call security and have the boyfriend removed from the examination room. B. Ask the boyfriend why he will not let the patient answer the questions. C. Inform the boyfriend that the rest of the exam must be private, show him to the waiting area, and tell him you will retrieve him as soon as you finish. D. State your suspicions to the couple and ask them to provide a truthful answer to the injuries.

Solution: C Inform the boyfriend that the rest of the exam must be private, show him to the waiting area, and tell him you will retrieve him as soon as you finish. The boyfriend is demonstrating dominant and controlling behavior. This behavior is characteristic in intimate partner violence and abuse. Excuses are being made for injuries, and the victim demonstrates fear of the partner and will not answer truthfully in his presence. Examining the victim privately allows for free therapeutic conversation and truth telling. Challenging the partner with threats or confronting him could escalate violent behavior.

A research participant tells the nurse practitioner that he wants to withdraw from the study. Regarding this case, the nurse practitioner is aware that all research study consent forms should contain which of the following information? A. The patient's demographic information B. The possible risks of the study C. Information that a research subject can voluntarily withdraw from the study at any time without any penalties or adverse consequences D. The benefits from the study

Solution: C Information that a research subject can voluntarily withdraw from the study at any time without any penalties or adverse consequences It should be written on the consent forms that the research subject can voluntarily withdraw from the study at any time without any penalties or adverse consequences. In addition, the human subject should be verbally informed of this right.

HIPAA was passed by Congress in 2003. All of the following statements about HIPAA are correct, except: A. It provides federal protections for personal health information B. It is applicable to all healthcare providers and payers who bill electronically and transmit health information over the internet C. Patients have the right to view their mental health-related and psychotherapy-related health information D. It gives patients the right to view and correct errors in their medical records

Solution: C Patients have the right to view their mental health-related and psychotherapy-related health information Mental health and psychotherapy/psychiatric records do not have to be released to patients even if they request those records. Otherwise, any type of medical records can be released if requested by the health insurance or health plan for billing purposes and reimbursement. HIPAA applies to all healthcare providers, health plans, health insurance companies, medical clearinghouses, and others who bill electronically and transmit health information over the internet.

Which type of evidence identifies, selects, and analyzes multiple research articles concerning a health condition, disease, or other health-related topic? A. Meta-analysis B. Cohort study C. Systematic review D. Case series

Solution: C Systematic review A systematic review is a literature review that identifies, selects, and analyzes multiple research articles concerning a health condition, disease, or other health-related topic. A meta-analysis is a statistical method that combines data from multiple studies (systematic review), resulting in higher statistical power and a single conclusion. A case series is a collection of case reports (report of one patient with a disease or an unusual condition) that feature multiple individuals who are given similar treatment. A cohort study is used to investigate risk factors and causes of disease. An example of a cohort study is the Framingham Study.

Swim therapy (aqua therapy) for a 13-year-old with cerebral palsy is an example of: A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Health prevention

Solution: C Tertiary prevention. Tertiary prevention is any type of rehabilitation for a particular condition. Examples include physical rehab (swimming), cardiac rehab, and/or speech therapy.

A 27-year-old male patient reports a strong desire to dress and be treated as a woman, telling the nurse practitioner that they have never been comfortable with their assigned sex. The nurse practitioner will: (Select all that apply.) A. Refer the patient to a psychiatric-mental health professional B. Tell the patient that they may be experiencing a hormonal imbalance C. Maintain respect for the patient's process of disclosure D. Ask for the patient's preferred gender pronouns and use gender-neutral language in communications and on patient forms E. Inform the patient that he is experiencing gender dysphoria, which can be treated

Solution: C, D Maintain respect for the patient's process of disclosure; ask for the patient's preferred gender pronouns and use gender-neutral language in communications and on patient forms. The patient's gender preferences should be acknowledged and respected by the nurse practitioner. Suggesting that the patient has medical or psychological disorders is not an appropriate action.

Which of the following situations is considered emergent? A. A laceration on the lower leg of a patient who has been taking aspirin (Bayer) 81 mg every other day B. Rapid breathing and tachycardia in a patient with a fever C. An elderly man with abdominal pain whose vital signs appear stable D. A 37-year-old male biker with a concussion due to a fall who is slightly agitated and does not appear to understand instructions given by the medical assistant checking his vital signs

Solution: D A 37-year-old male biker with a concussion due to a fall who is slightly agitated and does not appear to understand instructions given by the medical assistant checking his vital signs. The biker who has the concussion is the emergent situation because of his agitation and his inability to follow directions, which could mean he has some type of brain trauma. A concussion is a traumatic brain injury (TBI) that may result in a bad headache, altered levels of alertness, or unconsciousness. The following are emergency symptoms for which immediate medical care should be sought: changes in alertness and consciousness, seizures, muscle weakness on one or both sides, persistent confusion, repeated vomiting, unequal pupils, unusual eye movements, problems with walking, or coma. The patient on aspirin who has a laceration can be treated with pressure to stop the bleeding until help arrives. The elderly man with abdominal pain has apparently normal vital signs. Tachycardia is common in patients with fever.

Which of the following definitions describes the term specificity? A. Ability of a screening test to correctly identify a person with a disease B. Probability that a person with a negative test result does not have the disease C. Degree of certainty in a sampling method D. Ability of a screening test to correctly identify a person without a disease

Solution: D Ability of a screening test to correctly identify a person without a disease Specificity measures the ability of a screening test to correctly identify a person without a disease. It is often confused with sensitivity, which measures the ability of a screening test to correctly identify a person with a disease. Negative predictive value is the probability that a person with a negative test result does not have the disease, and confidence interval measures the degree of certainty in a sampling method.

All of the following are covered under Medicare Part B, except: A. Persons age 65 years or older B. Durable medical equipment C. Mammograms annually starting at age 50 D. Anesthesia services during emergency appendicitis surgery performed in a hospital

Solution: D Anesthesia services during emergency appendicitis surgery performed in a hospital According to the Medicare.gov website, Medicare Part A covers anesthesia that is received while in an inpatient hospital. Medicare Part B covers outpatient care, durable medical equipment, home health services, and other medical services, including some preventive services such as annual physical exams and mammograms (baseline age 50 years).

Which is a true statement regarding claims-based malpractice insurance policies? A. If the insurance company's lawyer finds the NP negligent, it is the nurse's responsibility to pay for the claim B. Claims against the NP are covered as long as the nurse had an active malpractice policy at the time of the incident C. Claims against the NP are usually paid if the nurse is found not to be negligent D. Claims against the NP are covered if both the incident and claim happen when the policy is still active

Solution: D Claims against the NP are covered if both the incident and claim happen when the policy is still active When the NP stops paying the premiums for this type of policy, it is no longer active.

A nurse practitioner discusses the condition of a patient with acute myeloid leukemia in the hallway with another nurse. Which of the following statements is correct? A. The dignity of the patient has been compromised B. Patient autonomy has been infringed upon C. The patient's right to know has been neglected D. Confidentiality has been breached

Solution: D Confidentiality has been breached. Discussing the patient's condition in the hallway jeopardizes the patient's right to confidentiality. This action should not jeopardize the dignity of the patient, nor would it neglect the patient's right to know. Discussing the patient's condition in the hallway does not jeopardize the patient's autonomy.

How would the nurse practitioner ensure explanations of treatment and medications are correctly translated to a patient who does not speak English? A. Ask a family member to interpret the medications and treatment plan to the patient B. Ask the patient to repeat information back C. Ask a family member to write down the directions for the patient to follow at home D. Contact language access services for additional assistance

Solution: D Contact language access services for additional assistance. Language barriers can pose a real challenge to the clinician and may result in miscommunication of a patient's care. It is best to contact language access services for additional assistance. This can be done virtually, over the telephone, or in person. Untrained staff or family should not provide this service, because medical information can be interpreted incorrectly.

According to EBM experts, which of the following types of research has the lowest ranking? A. RCT B. Experimental study C. Cohort study D. Editorial

Solution: D Editorial Editorials and professional society opinions are considered the lowest level of evidence because they are subjective and not based on research. The ranking of options for this question is as follows: (1) randomized controlled trial (RCT), (2) experimental study, (3) cohort study, and (4) editorial. The best method of correctly answering this type of question is to memorize the categories for the best level of evidence (meta-analysis and/or systematic review and/or RCTs) and the lowest form of evidence (opinions, editorials).

All of the following are classified as activities of daily living (ADL), except: A. Ability to feed self (self-feeding) B. Ability to manage bladder and bowel elimination C. Personal hygiene and grooming D. Grocery shopping

Solution: D Grocery shopping. Grocery shopping, housework, and managing one's fi nances are considered instrumental activities of daily living (IADLs).

Which of the following statements is false regarding the HITECH Act of 2009? A. It encouraged healthcare providers to adopt electronic health records (EHR) B. It improved the security protections for healthcare data C. It provided financial incentives for adoption of EHRs D. Healthcare providers are not required to use EHRs if a hard copy of the chart is available

Solution: D Healthcare providers are not required to use EHRs if a hard copy of the chart is available Option D is a false statement. After 2015, HITECH began to issue financial penalties (e.g., reductions of Medicare and Medicaid reimbursement) for providers and entities who had not adopted EHR technologies.

What is the best description of a variable? A. It is an important part of every research study B. It is the probability that a factor is important for the research data C. It is the value or number that occurs the most frequently D. It is a condition, characteristic, or factor that is being measured

Solution: D It is a condition, characteristic, or factor that is being measured A variable is a condition, characteristic, or factor that is being measured. An independent variable is the one being manipulated that is not affected by the others. A dependent variable changes depending on the manipulation of the independent variable.

All of the following statements are correct regarding licensure for NPs, except: A. It ensures a minimum level of professional competency B. It grants permission for an individual to practice in a profession C. It requires verification of educational training from an accredited graduate program D. It reviews information via a nongovernmental agency

Solution: D It reviews information via a nongovernmental agency The SBON is a regulatory agency created by the state government and is devoted to monitoring nurses' personal and professional behaviors. SBONs have the legislative power to initiate, regulate, and enforce provisions of the nurse practice act.

All of the following are covered under Medicare Part B, except: A. Persons aged 65 years or older B. Durable medical equipment C. Mammograms annually starting at age 50 D. Outpatient anesthesiologist's services

Solution: D Outpatient anesthesiologist's services. Medicare Part A covers anesthesia that is received while in an inpatient hospital. Medicare Part B covers outpatient care, durable medical equipment, home health services, and other medical services, including some preventive services such as annual physical exams, and mammograms (baseline age 50 years).

Which of the following is a true statement regarding the beliefs of many patients who are Hindu? A. Blood loss worsens illness B. Life energy (chi or qi) imbalance or blockage is the cause of disease C. "Temple garments" should be worn under hospital gown D. Pain is a means of progressing spiritually

Solution: D Pain is a means of progressing spiritually Hinduism encourages the acceptance of pain and suffering as part of the consequences of karma. Hindu patients may not be forthcoming about pain and may prefer to accept it as a means of progressing spiritually. Vietnamese patients may fear blood tests and surgery because of a belief that blood loss worsens illness. Mormons may wear "temple garments" under their clothes or hospital gown as a symbol of covenant they made in the temple. Practitioners of traditional Chinese medicine believe that life energy (chi or qi) imbalance or blockage is the cause of disease.

A 13-year-old girl is brought by her mother to the health clinic because the girl is complaining of vaginal discharge and pain. The mother tells the nurse practitioner that her daughter is not sexually active yet. The mother is divorced, lives with her boyfriend, and works full time. During the exam, the nurse practitioner notes that the vaginal introitus is red, with tears and a torn hymen. The cervix is covered with green discharge. The nurse practitioner suspects that the child has been sexually abused by the mother's boyfriend. Which is the best action for the nurse practitioner to take during this visit? A. Ask the mother questions about her boyfriend's behaviors B. Advise the mother to watch how her boyfriend interacts with her daughter and to call within 1 week to discuss his behavior with her C. Advise the mother that you suspect that her daughter has been sexually abused D. Report the child abuse to the department of child protective services (CPS)

Solution: D Report the child abuse to the department of child protective services (CPS). There are several "helping" professions (nurses, teachers, mental health) that are required to report suspected or actual child/elderly abuse to authorities. The nurse practitioner is legally required to report the case to CPS. If the child is in danger, CPS may ask for a court order to take the child away for protection until the investigation is completed. Talking about the boyfriend's behavior will not be effective and may put the child and/or mother in danger if the boyfriend suspects that he is being watched.

All of the following statements about common health beliefs of many traditional Asian cultures are true, except: A. An imbalance of the hot and cold (yin/yang) vital forces can cause illness, and treating a hot disease with a "cold" treatment (e.g., certain foods/herbs) can help to restore balance and cure the illness B. If the patient is very ill or dying, immediate family and extended family members will visit the patient daily in shifts to provide emotional support C. Infants and small children may wear an amulet such as a red string on the wrist or a piece of cloth on the neck or the wrist D. Surgical procedures are regarded as important treatment for many illnesses

Solution: D Surgical procedures are regarded as important treatment for many illnesses. Some Asian cultures regard surgery as a last resort and consider loss of blood as depleting the vital forces of the body and causing illness. Western medicine is considered to be "hot," and patients may discontinue or reduce the doses of their medicine without asking. An imbalance of the hot and cold (yin/yang) is believed to cause illness. Treating a "yin" disease (common cold) means avoiding eating yin foods (melons, cucumbers) because they will worsen it. Instead, yin diseases are treated with yang foods (meat, spicy foods) so that the body becomes more balanced.

A nurse practitioner's right to practice is regulated under: A. Medicare regulations B. The board of medicine C. The federal government D. The board of nursing

Solution: D The board of nursing. APRN practice is typically defined by the state nurse practice act and governed by the state board of nursing, but other laws and regulations may affect practice, and other boards may play a role. For instance, in some states nurse-midwives are regulated by a board of midwifery or public health. In other states, both the board of medicine and the board of nursing regulate nursing practice.

An adult patient is being evaluated for tuberculosis (TB) infection with a Mantoux test. The purified protein derivative (PPD) result is 10.5 mm. The patient denies weight loss, cough, and night sweats, and the results of a chest x-ray are negative. The patient reports that he is in the United States illegally and is fearful about discovery. What is the most appropriate action for the nurse practitioner? A. The nurse practitioner has a legal duty to report the patient to the local federal agency responsible for illegal migrants B. The nurse practitioner is legally mandated to report illegal migrants to state authorities C. The nurse practitioner should call the state health department to report that the patient has a TB infection D. The nurse practitioner has an ethical duty to provide quality healthcare to patients

Solution: D The nurse practitioner has an ethical duty to provide quality healthcare to patients. Currently, health caregivers are not legally required to report illegal migrants to the state or local authorities. This patient does not have the signs and symptoms of active TB disease (cough, weight loss, night sweats) and has a negative chest x-ray. Therefore, he has latent TB infection and is not contagious. Only patients with active TB disease (has signs/symptoms) must be reported to the state public health department.