Chapter 15. Case Management and
Advanced Practice Nursing
MULTIPLE CHOICE
1. An APRN is working in an outpatient care clinic for diabetics. He or she is responsible
for starting newly diagnosed diabetic patients on long-acting basal insulin to control their
fasting morning blood glucose levels. The APRN starts a 55-year-old obese patient 35
units of long- acting insulin nightly. The APRN chooses this dose solely based on the
weight of the patient and does not review the patient’s current medication list. The APRN
has previously used this method successfully in many patients who were admitted to the
hospital. Three days later the patient is found unconscious at home by family members,
transported to the emergency department, and expires. After an investigation the patient
had administered only the prescribed amount of insulin as directed by the APRN. Which
of the following factors most likely attributed to the patient’s poor outcome?
a. Patient education
b. Lack of knowledge
c. Thinking error
d. Lack of evidence-based practice
ANS: C
The APRN in this clinical scenario made a thinking error. While it is possible that
other factors could have influenced the poor outcome, the dose of the insulin was
unlikely individualized to this patient. Tunnel vision and treating each patient the
same are examples of thinking errors. Failing to review the patient’s medication list
for short-duration medications like steroids and antibiotics, as well as other
comorbidities, increases risks for medication side effects. Although the APRN had
administered similar doses to other patients previously, those patients were inside
medical facilities with close observation to avoid adverse events.
, 2. An APRN is treating a 44-year-old female patient with 10/10 chest pain in an emergency
department. This patient has a history of severe anxiety and has run out of her anxiety
medication. She has been seen three times in the previous month for the same pain. The
APRN discharges the patient home with a refill of her anxiety mediations but without a
full cardiac workup. The patient dies at home and an autopsy reveals a myocardial
infarction as the cause of death. Which of the following would have most likely prevented
the poor outcome of the patient?
a. Proper documentation
b. Therapeutic communication
c. Avoiding premature closure
d. Patient education
ANS: C
Avoidance of thinking errors of medical providers is imperative to excellent patient
care. While therapeutic communication may have elicited additional information
about this patient the APRN should remain constantly open to re-evaluation of
patients, be aware of personal biases and assumptions, and ensure critical data are
obtained on each patient. The use of a diagnosed “time- out” procedure sometimes is
important to review a situation with fresh eyes and to prevent assumptive diagnosis
and premature closure.
3. Use of which of the following strategies by an APRN would best prevent ethical conflicts
during end-of-life care?
a. Discussion with healthy patient during outpatient clinic
b. Use of an ethics committee
c. Discussion when life-threatening disease/accident occurs
d. Discussion upon admission of a patient to a hospital
ANS: A
Advanced Practice Nursing
MULTIPLE CHOICE
1. An APRN is working in an outpatient care clinic for diabetics. He or she is responsible
for starting newly diagnosed diabetic patients on long-acting basal insulin to control their
fasting morning blood glucose levels. The APRN starts a 55-year-old obese patient 35
units of long- acting insulin nightly. The APRN chooses this dose solely based on the
weight of the patient and does not review the patient’s current medication list. The APRN
has previously used this method successfully in many patients who were admitted to the
hospital. Three days later the patient is found unconscious at home by family members,
transported to the emergency department, and expires. After an investigation the patient
had administered only the prescribed amount of insulin as directed by the APRN. Which
of the following factors most likely attributed to the patient’s poor outcome?
a. Patient education
b. Lack of knowledge
c. Thinking error
d. Lack of evidence-based practice
ANS: C
The APRN in this clinical scenario made a thinking error. While it is possible that
other factors could have influenced the poor outcome, the dose of the insulin was
unlikely individualized to this patient. Tunnel vision and treating each patient the
same are examples of thinking errors. Failing to review the patient’s medication list
for short-duration medications like steroids and antibiotics, as well as other
comorbidities, increases risks for medication side effects. Although the APRN had
administered similar doses to other patients previously, those patients were inside
medical facilities with close observation to avoid adverse events.
, 2. An APRN is treating a 44-year-old female patient with 10/10 chest pain in an emergency
department. This patient has a history of severe anxiety and has run out of her anxiety
medication. She has been seen three times in the previous month for the same pain. The
APRN discharges the patient home with a refill of her anxiety mediations but without a
full cardiac workup. The patient dies at home and an autopsy reveals a myocardial
infarction as the cause of death. Which of the following would have most likely prevented
the poor outcome of the patient?
a. Proper documentation
b. Therapeutic communication
c. Avoiding premature closure
d. Patient education
ANS: C
Avoidance of thinking errors of medical providers is imperative to excellent patient
care. While therapeutic communication may have elicited additional information
about this patient the APRN should remain constantly open to re-evaluation of
patients, be aware of personal biases and assumptions, and ensure critical data are
obtained on each patient. The use of a diagnosed “time- out” procedure sometimes is
important to review a situation with fresh eyes and to prevent assumptive diagnosis
and premature closure.
3. Use of which of the following strategies by an APRN would best prevent ethical conflicts
during end-of-life care?
a. Discussion with healthy patient during outpatient clinic
b. Use of an ethics committee
c. Discussion when life-threatening disease/accident occurs
d. Discussion upon admission of a patient to a hospital
ANS: A
