AGACNP EXAM REVIEW NEW COMPLETE SOLUTION 2022
Scope of Practice - Based on legal allowances in each state, individual state nurse practice acts
providing guidelines for nursing practice
Key elements of the NP role include - 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... - American Nurses Association which
measure quality of practice, service, or education
State Practice Acts - Authorize Boards of Nursing in each state to establish statutory authority
for licensure of RNs
State Practice Acts - authority includes: - use of title, authorization for scope of practice
including prescriptive authority, and disciplinary grounds
States vary in practice requirements, such as - certification
Prescriptive authority - Ability and extent of NPs ability to prescribe meds
DEA has ruled that nurses in advanced practice may obtain.. - registration numbers, state
practice acts dictate level of prescriptive authority allowed
Credentials encompass... - required education, licensure and certification to practice as an NP
Credentials establish... - minimal levels of acceptable performance
Credentialing is necessary to: - ensure that safe healthcare is provided by qualified individuals;
comply with federal and state laws r/t APN
Credentials also... - acknowledges the scope of practice of NP, mandates accountability, enforces
professional standards for practice
Licensure - 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 - a governmental
regulatory body (ie. state board of nursing)
Certification - Person has met certain standards that signify mastery of specialized knowledge
Certification is granted by nongovernmental agencies such as - ANCC, AANP
Admitting privileges to hospitals (non physican) were granted - 1983 by JC
Credentialing and privileging - process which an NP is granted permission to practice in an
inpt setting
,Credentialing with hospital privileges is granted by a - Hospital Credentialing Committee
Pt Medical Abandoment - 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: - 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 - 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 - 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 - incident reports
Policies regarding incident reports should address: - 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 - 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: - ppl notified after receiving complaint; ppl responsible for
responding; ppl responsible for monitoring follow up
Action taking initiatives: - Prevention, correction (corrective steps must be monitored and
audited), documentation, education, departmental coordination
Medical Futility - 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: - 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) - state that pt is able to make personal
decisions about their care
,competence implies that ability to: - understand, reason, differentiate good and bad, and
communicate
informed consent - pt has received adequate instruction or info regarding aspects of care to
make prudent, personal choice regarding such tx
Informed consent includes: - discussing benefits and risk
consent is assumed if... - pt's condition is life threatening
Danforth Amendment 1991 - 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 - study of moral conduct and behavior protecting the rights of an individual
1st priority is the - most salvagable pts. Most critically injured cared for last.
Key ethical principles are: - nonmaleficence, utilitarianism, beneficence, justice, fidelity,
veracity, autonomy
Nonmaleficence - duty to do no harm
Utilitarianism - the right act is the one that produces the greatest good for the greatest number
Beneficence - duty to prevent harm and promote good
Justice - duty to be fair
Fidelity - duty to be faithful
Veracity - duty to be truthful (tends to be in conflict with fidelity)
Autonomy - duty to respect an individual's thoughts and actions (tend to be in conflict with
beneficence)
Dismissing/discharging a pt or closing practice - NP cannot withdraw from caring for a pt
without notification
Examples of reasons for discharging a pt from practice: - abuse, refusal to pay, persistent non-
adherence to care
Steps for discharging a pt from practice: - 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 - 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... - 1960s as a result of physician shortages in the area of peds
First NP program was peds, begun in... - 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... - availability of federal
funding for preventive and primary care NP education
Movement of NPs expanded to the... - inpt setting as a result of managed care, hospital
restructuring, and decreases in medical residency programs
4 distinct roles for NPs: - clinician, consultant/collaborator, educator, researcher
Crisis/Acute Grief Communication - Acknowledge feelings
Offer self
Crisis Intervention - Boundaries
Security if necessary, NOT police
Establish trust/rapport
Advance Directive - Written statement of patient's intent regarding medical treatment
The Patient Self-Determination Act of 1990 - All patients in a hospital setting are required to
be advised of their right to execute an advance directive
Living Will - Compilation of statements that specify which life-prolonging measures one does
and does not want if they become incapacitated
Durable Power of Attourney - Individual designated in the living will that is authorized to
make medical decisions in the event patient is incapacitated
Title I of HIPPA - Protects health insurance coverage for workers and their families in the
event they change or lose their jobs
COBRA
COBRA - protects health insurance coverage for workers and their families in the event worker
loses or changes jobs
Who enforces HIPPA - Office for Civil Rights
Patient Safety Rule - Protects patient information to analyze patient safety events and improve
True or False: A patient has the right to see their medical record - True
Scope of Practice - Based on legal allowances in each state, individual state nurse practice acts
providing guidelines for nursing practice
Key elements of the NP role include - 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... - American Nurses Association which
measure quality of practice, service, or education
State Practice Acts - Authorize Boards of Nursing in each state to establish statutory authority
for licensure of RNs
State Practice Acts - authority includes: - use of title, authorization for scope of practice
including prescriptive authority, and disciplinary grounds
States vary in practice requirements, such as - certification
Prescriptive authority - Ability and extent of NPs ability to prescribe meds
DEA has ruled that nurses in advanced practice may obtain.. - registration numbers, state
practice acts dictate level of prescriptive authority allowed
Credentials encompass... - required education, licensure and certification to practice as an NP
Credentials establish... - minimal levels of acceptable performance
Credentialing is necessary to: - ensure that safe healthcare is provided by qualified individuals;
comply with federal and state laws r/t APN
Credentials also... - acknowledges the scope of practice of NP, mandates accountability, enforces
professional standards for practice
Licensure - 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 - a governmental
regulatory body (ie. state board of nursing)
Certification - Person has met certain standards that signify mastery of specialized knowledge
Certification is granted by nongovernmental agencies such as - ANCC, AANP
Admitting privileges to hospitals (non physican) were granted - 1983 by JC
Credentialing and privileging - process which an NP is granted permission to practice in an
inpt setting
,Credentialing with hospital privileges is granted by a - Hospital Credentialing Committee
Pt Medical Abandoment - 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: - 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 - 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 - 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 - incident reports
Policies regarding incident reports should address: - 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 - 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: - ppl notified after receiving complaint; ppl responsible for
responding; ppl responsible for monitoring follow up
Action taking initiatives: - Prevention, correction (corrective steps must be monitored and
audited), documentation, education, departmental coordination
Medical Futility - 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: - 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) - state that pt is able to make personal
decisions about their care
,competence implies that ability to: - understand, reason, differentiate good and bad, and
communicate
informed consent - pt has received adequate instruction or info regarding aspects of care to
make prudent, personal choice regarding such tx
Informed consent includes: - discussing benefits and risk
consent is assumed if... - pt's condition is life threatening
Danforth Amendment 1991 - 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 - study of moral conduct and behavior protecting the rights of an individual
1st priority is the - most salvagable pts. Most critically injured cared for last.
Key ethical principles are: - nonmaleficence, utilitarianism, beneficence, justice, fidelity,
veracity, autonomy
Nonmaleficence - duty to do no harm
Utilitarianism - the right act is the one that produces the greatest good for the greatest number
Beneficence - duty to prevent harm and promote good
Justice - duty to be fair
Fidelity - duty to be faithful
Veracity - duty to be truthful (tends to be in conflict with fidelity)
Autonomy - duty to respect an individual's thoughts and actions (tend to be in conflict with
beneficence)
Dismissing/discharging a pt or closing practice - NP cannot withdraw from caring for a pt
without notification
Examples of reasons for discharging a pt from practice: - abuse, refusal to pay, persistent non-
adherence to care
Steps for discharging a pt from practice: - 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 - 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... - 1960s as a result of physician shortages in the area of peds
First NP program was peds, begun in... - 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... - availability of federal
funding for preventive and primary care NP education
Movement of NPs expanded to the... - inpt setting as a result of managed care, hospital
restructuring, and decreases in medical residency programs
4 distinct roles for NPs: - clinician, consultant/collaborator, educator, researcher
Crisis/Acute Grief Communication - Acknowledge feelings
Offer self
Crisis Intervention - Boundaries
Security if necessary, NOT police
Establish trust/rapport
Advance Directive - Written statement of patient's intent regarding medical treatment
The Patient Self-Determination Act of 1990 - All patients in a hospital setting are required to
be advised of their right to execute an advance directive
Living Will - Compilation of statements that specify which life-prolonging measures one does
and does not want if they become incapacitated
Durable Power of Attourney - Individual designated in the living will that is authorized to
make medical decisions in the event patient is incapacitated
Title I of HIPPA - Protects health insurance coverage for workers and their families in the
event they change or lose their jobs
COBRA
COBRA - protects health insurance coverage for workers and their families in the event worker
loses or changes jobs
Who enforces HIPPA - Office for Civil Rights
Patient Safety Rule - Protects patient information to analyze patient safety events and improve
True or False: A patient has the right to see their medical record - True
