AGACNP Exam Review with Complete
Solutions
Scope of Practice - correct Answer-Based on legal allowances in each state, individual
state nurse practice acts providing guidelines for nursing practice
Key elements of the NP role include - correct Answer-integration of care across the
acute illness continuum with collaboration and coordination of care; research based
clinical practices, clinical leadership, family assessment, and discharge planning
Standards of Advanced Practice are delineated by... - correct Answer-American Nurses
Association which measure quality of practice, service, or education
State Practice Acts - correct Answer-Authorize Boards of Nursing in each state to
establish statutory authority for licensure of RNs
State Practice Acts - authority includes: - correct Answer-use of title, authorization for
scope of practice including prescriptive authority, and disciplinary grounds
States vary in practice requirements, such as - correct Answer-certification
Prescriptive authority - correct Answer-Ability and extent of NPs ability to prescribe
meds
DEA has ruled that nurses in advanced practice may obtain.. - correct Answer-
registration numbers, state practice acts dictate level of prescriptive authority allowed
Credentials encompass... - correct Answer-required education, licensure and
certification to practice as an NP
Credentials establish... - correct Answer-minimal levels of acceptable performance
Credentialing is necessary to: - correct Answer-ensure that safe healthcare is provided
by qualified individuals; comply with federal and state laws r/t APN
Credentials also... - correct Answer-acknowledges the scope of practice of NP,
mandates accountability, enforces professional standards for practice
Licensure - correct Answer-establishes that a person is qualified to perform in a
particular professional role
,Licensure is granted as defined by rules and regulations set forth by - correct Answer-a
governmental regulatory body (ie. state board of nursing)
Certification - correct Answer-Person has met certain standards that signify mastery of
specialized knowledge
Certification is granted by nongovernmental agencies such as - correct Answer-ANCC,
AANP
Admitting privileges to hospitals (non physican) were granted - correct Answer-1983 by
JC
Credentialing and privileging - correct Answer-process which an NP is granted
permission to practice in an inpt setting
Credentialing with hospital privileges is granted by a - correct Answer-Hospital
Credentialing Committee
Pt Medical Abandoment - correct Answer-When caregiver-pt relationship is terminated
w/o making reasonable arrangements w an appropriate person so that care can be
continued
Determination of pt abandonment depends on factors such as: - correct Answer-
Whether NP accepted pt assignment, whether NP provided reasonable notice before
termination, whether reasonable arrangements could have been made
Following do not constitute pt abandonment - correct Answer-NP refuses to accept
responsibility for pt assignment when NP has given reasonable notice to proper
authority that NP lacks competence to carry out assignment; NP refuses assignment of
a double shift or addtl hrs beyond posted work schedule when proper notification has
been given..latter phrase can be controversial
Risk Mgmt - correct Answer-Systematic effort to reduce risk begins w formal written risk
mgmt plan that includes: organizations goals, delineation of program's scope,
components, methods; delegating responsibility for implementation and enforcement;
demonstrating commitment by the board; confidentiality and immunity from retaliation
for those who report sensitive info
Most common method of documentation for risk mgmt - correct Answer-incident reports
Policies regarding incident reports should address: - correct Answer-ppl authorized to
complete report; ppl responsible for review of a report, immediate actions needed to
minimize the effects of the event; ppl responsible for follow up; plan for monitoring
aftermath; security/storage of completed report
,Risk mgmt - Satisfaction surveys - correct Answer-Important for identifying problems
before they develop into incidents or claims; for pts and employees
Risk mgmt - Complaints: Risk mgmt plan should delineate tracking, analyzing, and
managing complaints by clearly identifying: - correct Answer-ppl notified after receiving
complaint; ppl responsible for responding; ppl responsible for monitoring follow up
Action taking initiatives: - correct Answer-Prevention, correction (corrective steps must
be monitored and audited), documentation, education, departmental coordination
Medical Futility - correct Answer-Interventions that are unlikely to produce significant
benefit for pt - "Does the intervention have any reasonable prospect of helping this pt?"
Two kind of medical futility: - correct Answer-Quantitative futility: likelihood that
intervention will benefit pt is extremely poor
Qualitative futility: quality of benefit an intervention will produce is extremely poor
Informed consent - competence (decisional capability) - correct Answer-state that pt is
able to make personal decisions about their care
competence implies that ability to: - correct Answer-understand, reason, differentiate
good and bad, and communicate
informed consent - correct Answer-pt has received adequate instruction or info
regarding aspects of care to make prudent, personal choice regarding such tx
Informed consent includes: - correct Answer-discussing benefits and risk
consent is assumed if... - correct Answer-pt's condition is life threatening
Danforth Amendment 1991 - correct Answer-pts are informed at time of admission to
federally funded institution (such as hospital, nursing home, hospice, HMO, etc) that
they have the right to refuse care as long as the pt has decisional capability
(competence)
Ethics - correct Answer-study of moral conduct and behavior protecting the rights of an
individual
1st priority is the - correct Answer-most salvagable pts. Most critically injured cared for
last.
Key ethical principles are: - correct Answer-nonmaleficence, utilitarianism, beneficence,
justice, fidelity, veracity, autonomy
Nonmaleficence - correct Answer-duty to do no harm
, Utilitarianism - correct Answer-the right act is the one that produces the greatest good
for the greatest number
Beneficence - correct Answer-duty to prevent harm and promote good
Justice - correct Answer-duty to be fair
Fidelity - correct Answer-duty to be faithful
Veracity - correct Answer-duty to be truthful (tends to be in conflict with fidelity)
Autonomy - correct Answer-duty to respect an individual's thoughts and actions (tend to
be in conflict with beneficence)
Dismissing/discharging a pt or closing practice - correct Answer-NP cannot withdraw
from caring for a pt without notification
Examples of reasons for discharging a pt from practice: - correct Answer-abuse, refusal
to pay, persistent non-adherence to care
Steps for discharging a pt from practice: - correct Answer-send a certified letter with
return receipt (copy for chart), provide general healthcare coverage for 1st 15-30 days
post termination deadline, obtain release of info to provide copies of all needed records
for next care provider
Obligations in closing practice d/t relocation, retirement - correct Answer-give pt
adequate time to find another provider, keep all files for min 5 years, provide timely
notification and names of other providers and resources for future care
Role of NP developed in the early... - correct Answer-1960s as a result of physician
shortages in the area of peds
First NP program was peds, begun in... - correct Answer-1964 by Dr. Loretta Ford and
Dr. Henry Silver at CU Health Sciences mainly focusing on ambulatory and outpt care
Historical service of NPs in primary care resulted in part from the... - correct Answer-
availability of federal funding for preventive and primary care NP education
Movement of NPs expanded to the... - correct Answer-inpt setting as a result of
managed care, hospital restructuring, and decreases in medical residency programs
4 distinct roles for NPs: - correct Answer-clinician, consultant/collaborator, educator,
researcher
Crisis/Acute Grief Communication - correct Answer-Acknowledge feelings
Offer self
Solutions
Scope of Practice - correct Answer-Based on legal allowances in each state, individual
state nurse practice acts providing guidelines for nursing practice
Key elements of the NP role include - correct Answer-integration of care across the
acute illness continuum with collaboration and coordination of care; research based
clinical practices, clinical leadership, family assessment, and discharge planning
Standards of Advanced Practice are delineated by... - correct Answer-American Nurses
Association which measure quality of practice, service, or education
State Practice Acts - correct Answer-Authorize Boards of Nursing in each state to
establish statutory authority for licensure of RNs
State Practice Acts - authority includes: - correct Answer-use of title, authorization for
scope of practice including prescriptive authority, and disciplinary grounds
States vary in practice requirements, such as - correct Answer-certification
Prescriptive authority - correct Answer-Ability and extent of NPs ability to prescribe
meds
DEA has ruled that nurses in advanced practice may obtain.. - correct Answer-
registration numbers, state practice acts dictate level of prescriptive authority allowed
Credentials encompass... - correct Answer-required education, licensure and
certification to practice as an NP
Credentials establish... - correct Answer-minimal levels of acceptable performance
Credentialing is necessary to: - correct Answer-ensure that safe healthcare is provided
by qualified individuals; comply with federal and state laws r/t APN
Credentials also... - correct Answer-acknowledges the scope of practice of NP,
mandates accountability, enforces professional standards for practice
Licensure - correct Answer-establishes that a person is qualified to perform in a
particular professional role
,Licensure is granted as defined by rules and regulations set forth by - correct Answer-a
governmental regulatory body (ie. state board of nursing)
Certification - correct Answer-Person has met certain standards that signify mastery of
specialized knowledge
Certification is granted by nongovernmental agencies such as - correct Answer-ANCC,
AANP
Admitting privileges to hospitals (non physican) were granted - correct Answer-1983 by
JC
Credentialing and privileging - correct Answer-process which an NP is granted
permission to practice in an inpt setting
Credentialing with hospital privileges is granted by a - correct Answer-Hospital
Credentialing Committee
Pt Medical Abandoment - correct Answer-When caregiver-pt relationship is terminated
w/o making reasonable arrangements w an appropriate person so that care can be
continued
Determination of pt abandonment depends on factors such as: - correct Answer-
Whether NP accepted pt assignment, whether NP provided reasonable notice before
termination, whether reasonable arrangements could have been made
Following do not constitute pt abandonment - correct Answer-NP refuses to accept
responsibility for pt assignment when NP has given reasonable notice to proper
authority that NP lacks competence to carry out assignment; NP refuses assignment of
a double shift or addtl hrs beyond posted work schedule when proper notification has
been given..latter phrase can be controversial
Risk Mgmt - correct Answer-Systematic effort to reduce risk begins w formal written risk
mgmt plan that includes: organizations goals, delineation of program's scope,
components, methods; delegating responsibility for implementation and enforcement;
demonstrating commitment by the board; confidentiality and immunity from retaliation
for those who report sensitive info
Most common method of documentation for risk mgmt - correct Answer-incident reports
Policies regarding incident reports should address: - correct Answer-ppl authorized to
complete report; ppl responsible for review of a report, immediate actions needed to
minimize the effects of the event; ppl responsible for follow up; plan for monitoring
aftermath; security/storage of completed report
,Risk mgmt - Satisfaction surveys - correct Answer-Important for identifying problems
before they develop into incidents or claims; for pts and employees
Risk mgmt - Complaints: Risk mgmt plan should delineate tracking, analyzing, and
managing complaints by clearly identifying: - correct Answer-ppl notified after receiving
complaint; ppl responsible for responding; ppl responsible for monitoring follow up
Action taking initiatives: - correct Answer-Prevention, correction (corrective steps must
be monitored and audited), documentation, education, departmental coordination
Medical Futility - correct Answer-Interventions that are unlikely to produce significant
benefit for pt - "Does the intervention have any reasonable prospect of helping this pt?"
Two kind of medical futility: - correct Answer-Quantitative futility: likelihood that
intervention will benefit pt is extremely poor
Qualitative futility: quality of benefit an intervention will produce is extremely poor
Informed consent - competence (decisional capability) - correct Answer-state that pt is
able to make personal decisions about their care
competence implies that ability to: - correct Answer-understand, reason, differentiate
good and bad, and communicate
informed consent - correct Answer-pt has received adequate instruction or info
regarding aspects of care to make prudent, personal choice regarding such tx
Informed consent includes: - correct Answer-discussing benefits and risk
consent is assumed if... - correct Answer-pt's condition is life threatening
Danforth Amendment 1991 - correct Answer-pts are informed at time of admission to
federally funded institution (such as hospital, nursing home, hospice, HMO, etc) that
they have the right to refuse care as long as the pt has decisional capability
(competence)
Ethics - correct Answer-study of moral conduct and behavior protecting the rights of an
individual
1st priority is the - correct Answer-most salvagable pts. Most critically injured cared for
last.
Key ethical principles are: - correct Answer-nonmaleficence, utilitarianism, beneficence,
justice, fidelity, veracity, autonomy
Nonmaleficence - correct Answer-duty to do no harm
, Utilitarianism - correct Answer-the right act is the one that produces the greatest good
for the greatest number
Beneficence - correct Answer-duty to prevent harm and promote good
Justice - correct Answer-duty to be fair
Fidelity - correct Answer-duty to be faithful
Veracity - correct Answer-duty to be truthful (tends to be in conflict with fidelity)
Autonomy - correct Answer-duty to respect an individual's thoughts and actions (tend to
be in conflict with beneficence)
Dismissing/discharging a pt or closing practice - correct Answer-NP cannot withdraw
from caring for a pt without notification
Examples of reasons for discharging a pt from practice: - correct Answer-abuse, refusal
to pay, persistent non-adherence to care
Steps for discharging a pt from practice: - correct Answer-send a certified letter with
return receipt (copy for chart), provide general healthcare coverage for 1st 15-30 days
post termination deadline, obtain release of info to provide copies of all needed records
for next care provider
Obligations in closing practice d/t relocation, retirement - correct Answer-give pt
adequate time to find another provider, keep all files for min 5 years, provide timely
notification and names of other providers and resources for future care
Role of NP developed in the early... - correct Answer-1960s as a result of physician
shortages in the area of peds
First NP program was peds, begun in... - correct Answer-1964 by Dr. Loretta Ford and
Dr. Henry Silver at CU Health Sciences mainly focusing on ambulatory and outpt care
Historical service of NPs in primary care resulted in part from the... - correct Answer-
availability of federal funding for preventive and primary care NP education
Movement of NPs expanded to the... - correct Answer-inpt setting as a result of
managed care, hospital restructuring, and decreases in medical residency programs
4 distinct roles for NPs: - correct Answer-clinician, consultant/collaborator, educator,
researcher
Crisis/Acute Grief Communication - correct Answer-Acknowledge feelings
Offer self
