Chapter 27. The Advanced Practice Nurse as
Employee or Independent Contractor: Legal
and Contractual Considerations
1. A 40-year-old female has smoked two packs of cigarettes per day for the past 25 years.
She has no current health issues. When questioned by the APRN if she is interested in
quitting she immediately states, “I like smoking, and I’m still healthy. I don’t want to
quit.” Which stage of change best classifies this patient’s willingness to stop smoking?
a. Contemplation
b. Precontemplation
c. Preparative
d. Action
e. Maintenance
ANS: B
The patient is in the precontemplation phase based on the information provided and is
either not ready or resistant to change. It appears she may not understand the risks of
her actions to her health, does not wish to acknowledge them, or does not believe she
is capable of quitting. Further exploring should be done by the APRN to build a
therapeutic relationship to foster change.
2. A 40-year-old female has smoked two packs of cigarettes per day for the past 25 years.
She has no current health issues. When questioned by the APRN if she is interested in
quitting she immediately states, “I like smoking, and I’m still healthy. I don’t want to
quit.” Which of the following is the next best step by the APRN?
a. Document her response
b. Assess her knowledge of smoking cessation programs
c. Educate her about the health risks of smoking
, d. Understand her level of understanding about the health risks of smoking
ANS: B
It appears the patient is in the precontemplation phase based on the information
provided. Further questioning should be done to first assess her understanding about
the health risks of smoking. After providing education an assessment of her
willingness to quit should be completed. You would not want to educate her about the
health risks if she is already aware of them, nor understand her knowledge of smoking
cessation programs if she is not ready to quit.
3. A male patient with uncontrolled diabetes visits the APRN in the health clinic. After
discussion about the patient’s uncontrolled disease the patient becomes emotional. The
patient states he has tried before and wants to do better but has never been able to afford
diabetic testing supplies. He does not currently take his prescribed insulin because he is
aware that if he administers it without being able to check his blood glucose he could
suffer serious health consequences. This patient is best classified as which stage of
change?
a. Contemplation
b. Precontemplation
c. Action
d. Preparative
e. Maintenance
ANS: D
This patient is in the action preparative stage of change. In this stage the patient is
ready to take action but previous barriers (blood glucose monitoring costs) prevented
the patient from taking action on any proposed plan previously. To move the patient
into action all barriers whether real or perceived must be overcome.
Employee or Independent Contractor: Legal
and Contractual Considerations
1. A 40-year-old female has smoked two packs of cigarettes per day for the past 25 years.
She has no current health issues. When questioned by the APRN if she is interested in
quitting she immediately states, “I like smoking, and I’m still healthy. I don’t want to
quit.” Which stage of change best classifies this patient’s willingness to stop smoking?
a. Contemplation
b. Precontemplation
c. Preparative
d. Action
e. Maintenance
ANS: B
The patient is in the precontemplation phase based on the information provided and is
either not ready or resistant to change. It appears she may not understand the risks of
her actions to her health, does not wish to acknowledge them, or does not believe she
is capable of quitting. Further exploring should be done by the APRN to build a
therapeutic relationship to foster change.
2. A 40-year-old female has smoked two packs of cigarettes per day for the past 25 years.
She has no current health issues. When questioned by the APRN if she is interested in
quitting she immediately states, “I like smoking, and I’m still healthy. I don’t want to
quit.” Which of the following is the next best step by the APRN?
a. Document her response
b. Assess her knowledge of smoking cessation programs
c. Educate her about the health risks of smoking
, d. Understand her level of understanding about the health risks of smoking
ANS: B
It appears the patient is in the precontemplation phase based on the information
provided. Further questioning should be done to first assess her understanding about
the health risks of smoking. After providing education an assessment of her
willingness to quit should be completed. You would not want to educate her about the
health risks if she is already aware of them, nor understand her knowledge of smoking
cessation programs if she is not ready to quit.
3. A male patient with uncontrolled diabetes visits the APRN in the health clinic. After
discussion about the patient’s uncontrolled disease the patient becomes emotional. The
patient states he has tried before and wants to do better but has never been able to afford
diabetic testing supplies. He does not currently take his prescribed insulin because he is
aware that if he administers it without being able to check his blood glucose he could
suffer serious health consequences. This patient is best classified as which stage of
change?
a. Contemplation
b. Precontemplation
c. Action
d. Preparative
e. Maintenance
ANS: D
This patient is in the action preparative stage of change. In this stage the patient is
ready to take action but previous barriers (blood glucose monitoring costs) prevented
the patient from taking action on any proposed plan previously. To move the patient
into action all barriers whether real or perceived must be overcome.
