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Nurse Practitioner Practice: Key Concepts and Applications, Exams of Nursing

A comprehensive overview of key concepts and applications related to nurse practitioner practice. It covers topics such as employment, performance evaluation, billing and coding, and collaborative practice. Multiple choice questions and true/false statements to assess understanding of the material.

Typology: Exams

2024/2025

Available from 01/19/2025

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"At |will" |employment |is |best |defined |as: |- |correct |answer |✔A |working |relationship |that |either |party |may |terminate |for |any |reason |at |any |time.

T/F: |In |most |states, |unless |there |is |a |written |contract |defining |the |duration |of |employment, |employment |is |"at |will." |- |correct |answer |✔True

A |nurse |practitioner |has |been |employed |with |a |heart |failure |clinic |for | 20 |years. |The |nurse |practitioner |resigned |from |her |position |at |the |clinic |in |order |to |open |her |own |heart |failure |clinic. |She |would |like |to |take |her |patients |with |her |to |her |new |clinic, |which |will |be |located |about | 2 |blocks |away. |Before |she |makes |any

|major |moves, |what |piece |of |advice |would |you |give |her? |- |correct |answer |✔The |NP |should |review |her |previous |contract |for |a |restrictive |covenant |in |the |contract.

T/F: |Patient |satisfaction |is |subjective, |therefore |it |cannot |be |reliably |used |to

|evaluate |performance. |- |correct |answer |✔False

A |nurse |practitioners |performance |is |most |often |evaluated |by |all |of |the |following, |EXCEPT: |- |correct |answer |✔number |of |awards |and |achievements

Nurse |practitioners |must |know |and |follow |the |standards |for |health |maintenance |recommendations |because |an |increase |in |the |demand |for |higher

|quality |healthcare |as |well |as |_________ |care, |affects |reimbursement |now |more

|than |ever. |- |correct |answer |✔Preventative

A |nurse |practitioner |has |just |been |hired |for |her |first |job |as |an |NP |at |a |diabetes |clinic. |She |is |in |a |meeting |with |the |manager |and |is |discussing |certain |aspects |of |the |contract. |While |discussing |the |structure |for |bonus-pay, |the |manager |states |that |most |reimbursement |to |the |clinic |is |capitated. |The |NP |immediately |knows |that |under |this |type |of |payment |system |a |_____________ |bonus |system |would

|work |best. |- |correct |answer |✔quality-based

Because |hospitals. |emergency |rooms, |and |specialists |are |high |cost |centers |for |health |plans, |health |plans |want |to |keep |admissions |and |referrals |to |the |emergency |room |and |specialists |at |a |minimum. |This |statement |underlines |the |concept |of: |- |correct |answer |✔utilization

In |order |to |measure |quality, |a |___________ |must |first |be |set. |- |correct |answer |✔standard

The |first |step |in |understanding |collaborative |practice |requirements |is |to: |- |correct |answer |✔Review |the |state |law |regarding |NP |scope |of |practice.

Medical |decision |making |refers |to |the |complexity |of |establishing |a |diagnosis |and/or |selecting |a |management |option. |According |to |The |Centers |for |Medicare |and |Medicaid |Services |(CMS), |the |level |of |medical |decision |making |is |determined |by |considering |all |of |these |factors, |EXCEPT:

A. |The |risk |of |significant |complications, |morbidity, |or |mortality

B. |Time |spent |triaging |the |patient |over |the |phone

A |nurse |practitioner |is |precepting |a |new |AGACNP |student |and |they |are |discussing |billing |and |coding. |The |student |asks |what |a |CPT |code |is. |The |NP |explains |that |it |is |vital |that |the |student |understands |what |a |CPT |code |is |because |they |represent:

A. |hospital |visits

B. |Office |visits

C. |procedures |and |services

D. |Medical |diagnoses |- |correct |answer |✔C. |Procedures |and |services

Evaluation |and |management |(E/M) |services |are |billed |using |multiple |aspects |of |the |patient |encounter. |Billing |Medicare |for |E/M |services |requires |the |selection |of |a |code |that |best |represents |all |of |the |following, |EXCEPT:

A. |Presence |of |a |collaborating |physician

B. |Setting |of |service

C. |Patient |type |(new |vs. |established |patient)

D. |Level |of |service |performed |- |correct |answer |✔A. |Presence |of |a |collaborating |physician

An |NP |works |in |an |outpatient |clinic |for |patients |with |advanced |heart |failure. |The |NP |has |finished |the |visit |with |Mr. |Jones |and |he |is |determining |how |he |will |bill |for |this |encounter. |His |decision |to |bill |for |an |"Incident-To" |visit |is |supported |by |all |of |the |following |statements, |EXCEPT:

A. |During |this |visit |the |NP |followed |up |on |a |plan |of |care |for |the |patient |that |was |initiated |by |the |collaborating |physician

B. |During |this |visit |the |NP |adjusted |the |heart |failure |medications |according |to |the |clinic's |standard |protocol |for |medication |adjustments.

C. |During |this |visit |the |physician |was |present |in |the |office |suite |and |available |for |assistance.

D. |During |this |visit |the |patient |complained |of |new |onset |palpitations, |which |were |investigated. |- |correct |answer |✔D. |During |this |visit |the |patient |complained |of |new |onset |palpitations, |which |were |investigated.

An |NP |works |in |an |outpatient |clinic |for |patients |with |diabetes. |The |NP |has |finished |her |visit |with |Mrs. |Jones |and |she |is |determining |how |she |will |bill |for |this |encounter. |The |NP's |decision |to |bill |Medicare |for |a |"split-shared" |visit |is |best |supported |by |the |fact |that:

A. |The |NP |called |the |physician |at |the |other |clinic |location |and |asked |for |assistance |with |decision |making |for |this |patient's |case.

B. |If |the |NP |bills |independently |she |will |only |get |reimbursed |at |85% |of |the |physician |rate

.C. |Both |the |NP |and |the |physician |performed |a |portion |of |the |visit |and |documented |those |portions.

D. |Medicare |will |reimburse |at |100% |for |this |visit |if |billed |using |the |physicians |NPI |number. |- |correct |answer |✔C. |Both |the |NP |and |the |physician |performed |a |portion |of |the |visit |and |documented |those |portions.

There |are |criteria |for |determining |if |critical |care |codes |are |appropriate. |These |include |all |of |the |following, |EXCEPT:

A. |The |patient |must |be |critically |ill.

B. |The |patient |must |be |in |an |ICU |in |order |to |bill |using |critical |care |codes.

Credentialing |is |best |defined |as: |- |correct |answer |✔the |process |of |verifying |education, |licensure, |and |certification |to |practice |as |an |APRN

T/F: |An |NP |who |is |delegated |as |a |PCP |automatically |has |privileges |to |admit |patients |to |the |hospital |- |correct |answer |✔False

An |argument |sometimes |used |by |physician |groups |against |allowing |NP's |to |become |designated |primary |care |providers |(PCP's) |is |that: |- |correct |answer

|✔NP's |do |not |commonly |have |hospital |privileges

T/F: |Traditionally, |hospital |administration |also |makes |up |the |entity |that |governs

|hospital |privileges. |- |correct |answer |✔False

A |new |NP |graduate |has |received |approval |from |the |state |to |practice |as |an |APRN. |The |graduate |has |not |yet |applied |for |a |job |anywhere. |All |of |the |following |are |true |statements, |EXCEPT: |- |correct |answer |✔The |NP |now |has |hospital |privileges.

A |new |NP |graduate |has |passed |boards. |Which |statement |is |true? |- |correct |answer |✔The |NP |is |certified.

Primary |care |providers |(PCP's) |must |apply |for |and |receive |hospital |privileges |to |best |take |care |of |their |patients |who |are |admitted |to |the |hospital. |- |correct |answer |✔False

After |accepting |a |job |offer |with |a |hospital, |the |NP |must |then |begin |the |process |for |__________ |at |the |hospital, |by |providing |proof |of |competency |to |practice. |- |correct |answer |✔credentialing

A |statute |is: |- |correct |answer |✔A |law |enacted |by |a |state |legislature |or |Congress.

According |to |Carolyn |Buppert, |all |of |the |following |are |things |that |must |happen |for |NPs |to |become |PCPs, |EXCEPT: |- |correct |answer |✔NPs |should |only |bill |independently.

A |coalition |of |nursing |organizations |has |recommended |that |the |entry-level |degree |for |new |NPs |be |changed |from |an |MSN |to |a |clinical |doctorate. |- |correct |answer |✔True

A |major |component |and |concept |of |managed |care |is: |- |correct |answer |✔The |insurer |is |the |payor |and |also |has |control |over |the |quality |of |the |care |provided |and |the |utilization |of |resources.

A |regulation |is: |- |correct |answer |✔A |law |written |by |a |state |or |federal |agency |in |accordance |with |statute.

The |process |of |changing |the |law |can |be |complex. |But |changing |the |law |simply |STARTS |with: |- |correct |answer |✔Developing |a |goal

For |professional |advancement, |it |is |important |that |NPs |are |able |to |answer |questions |and |discuss |how |their |role |differs |from |that |of |a |physician |and |why |they |should |be |incorporated |into |payment |systems. |- |correct |answer |✔True

Since |the |positions |are |so |similar, |it |is |imperative |that |NPs |and |their |professional |organizations |work |closely |with |PAs |when |advocating |for

Malpractice |is: |- |correct |answer |✔the |failure |of |a |professional |to |exercise |that |degree |of |skill |and |learning |commonly |applied |by |the |average |prudent, |reputable |member |of |the |profession

If |an |NP |is |sued, |all |of |the |following |should |be |done, |EXCEPT: |- |correct |answer |✔The |NP |should |review |the |records |of |the |event |in |question |to |make |sure |they |documented |them |correctly |and |make |appropriate |changes |when |necessary |for |clarification.

The |National |Practitioner |Data |Bank |(NPDB) |was |established |by |law |for |all |of |the |following |reasons, |EXCEPT: |- |correct |answer |✔To |keep |public |record |of |damages |awarded.

John |Tucker |is |an |NP. |He |is |being |sued |for |malpractice |by |a |patient |he |saw | 2 |years |ago. |One |month |ago |John |cancelled |his |malpractice |insurance |with |Company |A |and |changed |to |a |new |policy |and |coverage |with |Company |B. |Which |type |of |insurance |policy |with |Company |A |will |cover |the |plaintiff |award |if |the |malpractice |suit |is |successful? |- |correct |answer |✔occurrence

An |NP |who |wishes |to |avoid |breaching |standard |of |care, |will |do |any/all |of |the

|following, |EXCEPT: |- |correct |answer |✔Get |certified |by |at |least |two |different |certifying |agencies.

A |plaintiff |in |a |malpractice |suit |must |prove |all |of |the |following |elements, |EXCEPT: |- |correct |answer |✔The |plaintiff |is |competent.

After |examining |a |patient |who |presented |with |fatigue, |the |provider |had |many |new |findings, |one |of |which |was |a |slightly |decreased |ejection |fraction. |This |finding |is |suggestive |of |heart |failure, |a |treatable |condition. |The |provider |failed

|to |inform |the |patient |of |the |new |finding |and |the |patient |was |admitted | 1 |month |later |with |severe |heart |failure |exacerbation. |This |scenario |is |consistent |with |which |of |the |following |concepts: |- |correct |answer |✔Risk |of |Negligent |Nondisclosure

T/F: |To |reduce |the |risk |associated |with |prescribing |controlled |substances, |the |provider |should |follow |at |least |one |current |guideline |form |an |agency |or |association. |- |correct |answer |✔True

A |young |male |presents |with |a |complaint |of |a |feeling |of |fullness |in |the |scrotum. |Physical |examination |reveals |a |round, |soft, |nontender, |nonadherent |bluish |discolored |testicular |mass |resembling |a |"bag |of |worms". |There |is |no |variation |in |size |with |respiration |or |the |Valsalva |maneuver. |The |mass |transilluminates |and |is |located |anterior |to |the |testes. |What |is |the |most |likely |diagnosis?

A. |Tumor

B. |Spermatocele

C. |Hernia

D. |Varicocele |- |correct |answer |✔D. |Varicocele

A |64-year-old |man |presents |with |a |long |history |of |nocturia. |He |now |has |some |trouble |initiating |a |urinary |stream. |Your |initial |plan |is |to:

A. |Order |a |PSA

B. |Perform |a |digital |rectal |exam

C. |Order |a |cystoscopy.

D. |Order |a |pelvic |ultrasound |- |correct |answer |✔B. |Perform |a |digital |rectal |exam

A |25-year-old-male |presents |to |the |ED |with |complaints |of |acute |onset |unilateral |scrotal |pain |that |started |one |hour |prior. |He |also |reports |nausea |without |vomiting. |Patient |is |afebrile |and |denies |urinary |frequency |or |pain |with |urination. |The |patient |reported |playing |disc |golf |the |night |before |the |pain |started |but |denies |trauma |to |the |area. |Exam |revealed |enlargement |and |edema |of |the |entire |scrotum, |more |on |the |left |side. |The |left |side |was |extremely |tender, |more |so |than |the |right |side. |No |scrotal |erythema. |Unable |to |elicit |the |cremasteric |reflex. |The |most |likely |diagnosis |is:

A. |Testicular |tumor

B. |Hydrocele

C. |Epididymitis

D. |Testicular |torsion |- |correct |answer |✔D. |Testicular |torsion

What |is |considered |a |major |contributing |factor |in |erectile |dysfunction?

A. |Drinking | 3 |beers |a |night

B. |Diabetes |mellitus

C. |Diet |high |in |vitamin |C

D. |Afib |- |correct |answer |✔B. |Diabetes |mellitus

A |25-year-old |male |with |a |history |of |sickle |cell |disease |complains |of |a |sudden |problem |with |erections |that |are |not |sexually |oriented. |He |is |currently |experiencing |a |painful |erection |and |he |is |unable |to |void. |The |best |intervention |at |this |time |is:

A. |Increased |hydration |for |sickle |cell |crisis.

B. |to |order |Meperidine |(Demerol) |and |bedrest.

C. |immediate |referral |to |a |urologist.

D. |determination |of |PSA |level |- |correct |answer |✔C. |immediate |referral |to |a |urologist.

While |examining |the |male |genitalia, |you |are |unable |to |retract |the |foreskin |of |an |uncircumcised |patient. |There |is |erythema |and |swelling |noted |to |the |distal |end |of |the |foreskin. |This |condition |is |known |as:

A. |Priapism

B. |Phimosis

C. |Paraphimosis

D. |Balanitis |- |correct |answer |✔B. |Phimosis

A |72-year-old |male |patient |presents |with |a |history |of |burning |on |urination |and |difficulty |urinating |that |has |been |increasing |over |the |past |few |days. |A |urinalysis |is |ordered |and |reveals |positive |RBCs, |+2 |leukocyte |esterase, |+2 |nitrites, |greater |then |50,000 |WBC |and |bacteria. |What |is |the |MOST |LIKELY |diagnosis?

A. |UTI

B. |Contaminated |specimen |that |may |be |benign |and |needs |repeat |testing

C. |Acute |tubular |necrosis |(ATN)

D. |BPH |- |correct |answer |✔A. |UTI

A |25-year-old |male |presents |to |the |emergency |department |with |complaints |of |scrotal |pain |and |swelling |for | 3 |days. |Upon |evaluation, |the |NP |notices |that |the |patient |has |white |penile |discharge, |a |positive |Prehn's |sign, |and |his |cremasteric

A |15-year-old |male |presents |to |the |ED |with |complaints |of |testicular |pain |that |work |him |up |while |he |was |asleep |at |5:00 |am |this |morning. |The |AGACNP |has |a |high |suspicion |that:

A. |The |patient |needs |to |be |treated |w/ |antibiotics |and |notify |their |partner(s) |to |be |treated |as |well

B. |The |patient |needs |to |be |evaluated |by |urology |for |c/f |testicular |torsion

C. |The |patient |will |need |to |be |evaluated |by |GI |surgery |for |c/f |an |inguinal |hernia |incarceration

D. |The |patient |has |spermatocele |and |will |need |to |follow |up |w/ |urology |in |clinic |- |correct |answer |✔B. |The |patient |needs |to |be |evaluated |by |urology |for |c/f |testicular |torsion

Other |potential |DDs: |varicocele, |Fournier's |gangrene, |cyst, |abscess

The |most |common |age |range |for |testicular |cancer |is:

A. |10-20yo

B. |20-35yo

C. |25-55yo

D. |55-75yo |- |correct |answer |✔B. |20-35yo

Where |is |the |most |common |origin |for |testicular |cancer?

A. |Prostate

B. |Lung

C. |Colon

D. |Thyroid |- |correct |answer |✔A. |Prostate

What |is |Stage | 3 |of |the |TNM |staging |system? |- |correct |answer |✔when |there |are |signs |of |distance |metastasis

What |is |Stage | 2 |of |the |TNM |staging |system? |- |correct |answer |✔When |regional |lymph |node |involvement |is |seen |in |the |retroperitoneum

What |is |Stage | 1 |of |the |TNM |staging |system? |- |correct |answer |✔When |lesions |are |confined |to |the |testis

A |male |patient |presents |to |the |urgent |care |with |complaints |of |penile |discharge |and |lesions. |What |are |your |differential |diagnoses? |(6) |- |correct |answer |✔Gonorrhea/chlamydia

Acute |bacterial |prostatitis

HSV

Syphilis

Neoplasm

HIV

A | 19 |year |old |male |patient |presents |to |the |ED |with |complaints |of |dysuria |and |denies |any |other |complaints. |What |diagnostics |will |the |AGACNP |order? |(select |all |that |apply)

A | 45 |year |old |male |presents |to |the |urgent |care |and |states |that |he |is |unable |to |maintain |an |erection |for |sexual |intercourse. |As |the |AGACNP, |you |are |aware |that:

A. |Over |1/2 |of |all |men |aged |40-70 |will |have |erectile |dysfunction

B. |It |will |need |to |be |treated |with |Rocephin |and |doxycycline

C. |It |will |need |to |be |treated |w/ |2gm |metronidazole

D. |Erectile |dysfunction |affects |more |men |below |50yo |than |men |above |70yo |-

|correct |answer |✔A. |Over |1/2 |of |all |men |aged |40-70 |will |have |erectile |dysfunction

A | 23 |year |old |male |patient |with |a |history |of |sickle |cell |presents |to |the |ED |with |complaints |of |an |erect |penis |for |five |(5) |hours |in |which |it |has |become |painful. |The |AGACNP |suspects |the |patient |is |exhibiting:

A. |Peyronie's |disease

B. |Priapism

C. |Loss |of |libido

D. |Problems |w/ |penile |implant |- |correct |answer |✔B. |Priapism

Priapism |is |a |surgical |emergency |and |the |most |appropriate |initial |intervention |is:

A. |Conservative |measures |such |as |applying |ice |to |the |penis

B. |Aspirate |blood |from |the |corpus |cavernosum

C. |Inject |phenylephrine |intracavernosally

D. |Consult |urology |and |prep |for |OR |- |correct |answer |✔A. |Conservative |measures |such |as |applying |ice |to |the |penis

T/F: |Males |have |a |higher |risk |for |prostate |cancer |if |they |are |diagnosed |with |benign |prostate |hyperplasia |- |correct |answer |✔False

A |male |patient |presents |for |an |urgent |care |visit. |What |symptoms |would |bring |concern |for |BPH? |(Select |all |that |apply)

A. |Post-void |dripping

B. |Urinary |frequency

C. |Increased |caliber |of |urine |stream

D. |Hesitancy

E. |Burning |with |urination |- |correct |answer |✔A, |B, |D

What |differentials |would |you |consider |for |this |patient |who |presents |with |symptoms |of |hesitancy, |decreased |stream, |double |voiding, |post-void |dribble, |urinary |frequency |other |than |BPH? |(8) |- |correct |answer |✔UTI

STI

Prostate |cancer

Bladder |cancer

Neurogenic |bladder

Urethritis

Urethral |trauma

Urethral |stricture