The Genetics advanced practice nurse is a specialty that requires a graduate degree. This stage IV
specialty ensures specialized training in genetics. These practitioners offer genetic counseling, case
management, consultation, and evaluation of patients and their families. An RN would only offer
information or identify the need for referral to a genetics specialist. A Pediatric nurse practitioner
or Pediatric physician would likely not have specialized training in genetic counseling.
Chapter 6. Advanced Practice Nurses and Prescriptive Authority
1. All of the following are reasons that attributed to the rise of AG-ACNP except:
a. Intensivist physician shortages
b. Rising cost of malpractice insurance for physicians
c. Changes to medical resident work hour restrictions
d. Increase in patients with complex medical conditions
ANS: B
The role of AG-ACNP rose out of an increased demand for practitioners to manage patients with
complex medical conditions, shortages of intensivist physicians, and changes to medical resident
and fellows work hour restrictions.
2. An increased spectrum of care affords the AG-ACNP the ability to provide medical care to a
broader age group. Which of the following is age-range appropriate for an AG-ACNP to
treat?
a. Age 7 and older
b. Age 13 and older
c. Age 18 and older
d. Age 21 and older
ANS: B
An AG-ACNP can provide care to patients aged 13 and older unless additional state or facility-
specific restrictions exist. The age ranges are grouped into young adults, middle-age adults, and
older adults.
3. As identified in a 2012 study by the ANCC, which of the following top work activities for the
AG-ACNP was number one when arranged by criticality?
a. Conducting history and physical examinations
b. Maintaining patient privacy and confidentiality
WWW.THENURSINGMASTERY.COM
, c. Evaluating patients for safety and efficacy of interventions
d. Assessing patients for urgent and emergent conditions
ANS: B
In 2012, the ANCC surveyed ACNP clinicians and identified top work activities for the AG-ACNP
role. These activities were organized by criticality, or importance of the skill and determined by
the requirement to perform the skill accurately each time, as a novice NP, and based on the risk of
harm by performing the skill incorrectly. Maintaining patient privacy and confidentiality scored at
the top.
4. Based on a survey of ACNPs, the following procedures are performed in a hospital-based
setting most commonly by ACNPs except:
a. Vasoactive intravenous drips
b. Lumbar puncture
c. Sutures
d. Radiologic studies
ANS: B
Based on survey data, procedures that are formed least routinely by ACNPs include lumbar
punctures, surgical first assist, thoracostomy tubes, cutdowns, paracentesis, joint aspirations, and
bladder aspirations.
5. Based on a survey of ACNPs, which of the following procedures are performed in a hospital-
based setting most commonly by ACNPs?
a. Defibrillation
b. Lumbar puncture
c. Pacemakers
d. Chest tubes
ANS: A
Based on survey data, procedures that are formed most commonly by ACNPs include radiologic
studies, vasoactive intravenous drips, resuscitative efforts, defibrillation, wound care, sutures,
incisions, and ventilation.
6. Which of the following is more commonly attributed to the AG-ACNP role versus that of a
CNS?
a. Patient-centered care
b. System change responsibilities
c. Performing procedures
d. Staff education and development
WWW.THENURSINGMASTERY.COM
,ANS: C
The AG-ACNP and CNS both focus on patient-centered care. The AG-ACNP is more likely to
spend a larger percentage of his or her time at the bedside using clinical skills to assess, diagnose,
and treat patients with complex or acute medical conditions including performing procedures. Staff
education and development and system change responsibilities are typically a larger portion of the
CNS role.
7. Which of the following locations would be most appropriate for an AG-ACNP?
a. Tertiary care management
b. Billing and coding
c. Primary care management
d. Secondary care management
ANS: A
Tertiary care management includes the intensive care unit or emergency department and would be
the best choice for this question. Although secondary care management is common, such as an
inpatient unit or hospitalist position, most acute scenarios are encountered in the ICU or ED and
more appropriate for the specialized skills of the AG-ACNP. It is important to note that any NP
should have working knowledge of all practice areas, regardless of clinical specialty.
8. Educational programs that prepare students for AG-ACNP practice adhere to which of the
following?
a. Incorporates graduate core and NP curricula and adds AG-ACNP specialty curricula
b. Incorporates graduate core but replaces NP curricula with AG-ACNP specialty curricula
c. Requires additional training that is separate and in addition to the Adult-Gerontology
curriculum and is only provided in DNP programs
d. Deviates from the graduate core allowing full specialization of the AG-ACNP specialty
curricula
ANS: A
The AG-ACNP curriculum incorporates the graduate core, advanced practice core, NP population
curricula, and AG-ACNP specialty curricula. Programs that prepare AG-ACNPs at the DNP level
do not negate the master’s core but, rather, build on it (AACN, 2006).
9. Which of the following organizations issue certification for AG-ACNPs?
a. American Nurses Credentialing Center and the American Association of Gerontology
b. The state where he or she intends to practice
c. American Nurses Credentialing Center and the American Association of Critical-Care
d. American Association of Critical-Care and the Emergency Nurses Association
WWW.THENURSINGMASTERY.COM
, ANS: C
American Nurses Credentialing Center and the American Association of Critical-Care issue
certification for the AG-ACNP program.
10. An AG-ACNP is part of a practice group that employs both physicians and AG-ACNPs. The
NP and a physician in the group both evaluate a patient on the same day. The NP sees the
patient first. How should the services be billed to CMS using shared service guidelines?
a. Combined and billed under the NP’s provider number
b. Billed separately under each provider’s individual number
c. Combined and billed under the physician’s provider number
d. Billed under the AG-ACNP’s provider number
ANS: C
Shared E/M services can be billed under CMS guidelines as combined services if both the NP and
the physician see the patient in a face-to-face visit on the same calendar day, regardless of order.
If the physician does not have a face-to-face encounter the services should be billed under the NP’s
provider number. Additionally, critical care time cannot be billed under shared billing.
11. How are provided critical care services billed by AG-ACNPs according to CMS?
a. Standard charge per face-to-face encounter
b. As part of DRG allocation monies bundled with hospitalist services
c. Single charge per calendar day of service
d. The number of critical care minutes spent
ANS: D
Critical care involves high-complexity decision making in the care of patients. Reimbursement is
based on the number of critical care time in minutes spent by the provider and must be billed
separately because care provided by NPs and PAs is billed at a lower rate. The first 30-74 minutes
are billed and then separate billing for each additional 30 minutes of critical care time spent with
the patient.
12. An AG-ACNP is part of a practice group that employs both physicians and AG-ACNPs. The
NP and a physician in the group both evaluate a patient in the intensive care unit. The NP
assesses and evaluates the patient first for 32 minutes followed by the physician for 20 minutes.
How should the initial critical care time be billed?
a. Combined and billed under the NP’s provider number
b. Combined and billed under the physician’s provider number
c. Billed under the AG-ACNP’s provider number
d. Billed under the physician’s provider number
WWW.THENURSINGMASTERY.COM
specialty ensures specialized training in genetics. These practitioners offer genetic counseling, case
management, consultation, and evaluation of patients and their families. An RN would only offer
information or identify the need for referral to a genetics specialist. A Pediatric nurse practitioner
or Pediatric physician would likely not have specialized training in genetic counseling.
Chapter 6. Advanced Practice Nurses and Prescriptive Authority
1. All of the following are reasons that attributed to the rise of AG-ACNP except:
a. Intensivist physician shortages
b. Rising cost of malpractice insurance for physicians
c. Changes to medical resident work hour restrictions
d. Increase in patients with complex medical conditions
ANS: B
The role of AG-ACNP rose out of an increased demand for practitioners to manage patients with
complex medical conditions, shortages of intensivist physicians, and changes to medical resident
and fellows work hour restrictions.
2. An increased spectrum of care affords the AG-ACNP the ability to provide medical care to a
broader age group. Which of the following is age-range appropriate for an AG-ACNP to
treat?
a. Age 7 and older
b. Age 13 and older
c. Age 18 and older
d. Age 21 and older
ANS: B
An AG-ACNP can provide care to patients aged 13 and older unless additional state or facility-
specific restrictions exist. The age ranges are grouped into young adults, middle-age adults, and
older adults.
3. As identified in a 2012 study by the ANCC, which of the following top work activities for the
AG-ACNP was number one when arranged by criticality?
a. Conducting history and physical examinations
b. Maintaining patient privacy and confidentiality
WWW.THENURSINGMASTERY.COM
, c. Evaluating patients for safety and efficacy of interventions
d. Assessing patients for urgent and emergent conditions
ANS: B
In 2012, the ANCC surveyed ACNP clinicians and identified top work activities for the AG-ACNP
role. These activities were organized by criticality, or importance of the skill and determined by
the requirement to perform the skill accurately each time, as a novice NP, and based on the risk of
harm by performing the skill incorrectly. Maintaining patient privacy and confidentiality scored at
the top.
4. Based on a survey of ACNPs, the following procedures are performed in a hospital-based
setting most commonly by ACNPs except:
a. Vasoactive intravenous drips
b. Lumbar puncture
c. Sutures
d. Radiologic studies
ANS: B
Based on survey data, procedures that are formed least routinely by ACNPs include lumbar
punctures, surgical first assist, thoracostomy tubes, cutdowns, paracentesis, joint aspirations, and
bladder aspirations.
5. Based on a survey of ACNPs, which of the following procedures are performed in a hospital-
based setting most commonly by ACNPs?
a. Defibrillation
b. Lumbar puncture
c. Pacemakers
d. Chest tubes
ANS: A
Based on survey data, procedures that are formed most commonly by ACNPs include radiologic
studies, vasoactive intravenous drips, resuscitative efforts, defibrillation, wound care, sutures,
incisions, and ventilation.
6. Which of the following is more commonly attributed to the AG-ACNP role versus that of a
CNS?
a. Patient-centered care
b. System change responsibilities
c. Performing procedures
d. Staff education and development
WWW.THENURSINGMASTERY.COM
,ANS: C
The AG-ACNP and CNS both focus on patient-centered care. The AG-ACNP is more likely to
spend a larger percentage of his or her time at the bedside using clinical skills to assess, diagnose,
and treat patients with complex or acute medical conditions including performing procedures. Staff
education and development and system change responsibilities are typically a larger portion of the
CNS role.
7. Which of the following locations would be most appropriate for an AG-ACNP?
a. Tertiary care management
b. Billing and coding
c. Primary care management
d. Secondary care management
ANS: A
Tertiary care management includes the intensive care unit or emergency department and would be
the best choice for this question. Although secondary care management is common, such as an
inpatient unit or hospitalist position, most acute scenarios are encountered in the ICU or ED and
more appropriate for the specialized skills of the AG-ACNP. It is important to note that any NP
should have working knowledge of all practice areas, regardless of clinical specialty.
8. Educational programs that prepare students for AG-ACNP practice adhere to which of the
following?
a. Incorporates graduate core and NP curricula and adds AG-ACNP specialty curricula
b. Incorporates graduate core but replaces NP curricula with AG-ACNP specialty curricula
c. Requires additional training that is separate and in addition to the Adult-Gerontology
curriculum and is only provided in DNP programs
d. Deviates from the graduate core allowing full specialization of the AG-ACNP specialty
curricula
ANS: A
The AG-ACNP curriculum incorporates the graduate core, advanced practice core, NP population
curricula, and AG-ACNP specialty curricula. Programs that prepare AG-ACNPs at the DNP level
do not negate the master’s core but, rather, build on it (AACN, 2006).
9. Which of the following organizations issue certification for AG-ACNPs?
a. American Nurses Credentialing Center and the American Association of Gerontology
b. The state where he or she intends to practice
c. American Nurses Credentialing Center and the American Association of Critical-Care
d. American Association of Critical-Care and the Emergency Nurses Association
WWW.THENURSINGMASTERY.COM
, ANS: C
American Nurses Credentialing Center and the American Association of Critical-Care issue
certification for the AG-ACNP program.
10. An AG-ACNP is part of a practice group that employs both physicians and AG-ACNPs. The
NP and a physician in the group both evaluate a patient on the same day. The NP sees the
patient first. How should the services be billed to CMS using shared service guidelines?
a. Combined and billed under the NP’s provider number
b. Billed separately under each provider’s individual number
c. Combined and billed under the physician’s provider number
d. Billed under the AG-ACNP’s provider number
ANS: C
Shared E/M services can be billed under CMS guidelines as combined services if both the NP and
the physician see the patient in a face-to-face visit on the same calendar day, regardless of order.
If the physician does not have a face-to-face encounter the services should be billed under the NP’s
provider number. Additionally, critical care time cannot be billed under shared billing.
11. How are provided critical care services billed by AG-ACNPs according to CMS?
a. Standard charge per face-to-face encounter
b. As part of DRG allocation monies bundled with hospitalist services
c. Single charge per calendar day of service
d. The number of critical care minutes spent
ANS: D
Critical care involves high-complexity decision making in the care of patients. Reimbursement is
based on the number of critical care time in minutes spent by the provider and must be billed
separately because care provided by NPs and PAs is billed at a lower rate. The first 30-74 minutes
are billed and then separate billing for each additional 30 minutes of critical care time spent with
the patient.
12. An AG-ACNP is part of a practice group that employs both physicians and AG-ACNPs. The
NP and a physician in the group both evaluate a patient in the intensive care unit. The NP
assesses and evaluates the patient first for 32 minutes followed by the physician for 20 minutes.
How should the initial critical care time be billed?
a. Combined and billed under the NP’s provider number
b. Combined and billed under the physician’s provider number
c. Billed under the AG-ACNP’s provider number
d. Billed under the physician’s provider number
WWW.THENURSINGMASTERY.COM
