Chapter 39: The Advanced Practice Nurse in the Community

Test Bank

MULTIPLE CHOICE

1. Which statement about advanced public health nurses and nurse practitioners is correct?
a. They often work in similar settings.
b. They have identical educational preparation.
c. Their practices have become more similar during the past decade.
d. The clinical nurse specialist role always involves prescriptive practice.
ANS: A
Advanced public health nurses and nurse practitioners often work in similar settings.

DIF: COG: Understanding REF: 856 OBJ: 1

2. The nurse practitioner movement began at the University of Colorado with nurses providing _____ care.
a. Maternity
b. Well-child
c. Nursing home
d. Diabetes
ANS: B
It was determined that educating community-oriented nurses could decrease morbidity among medically deprived
children.

DIF: COG: Understanding REF: 857 OBJ: 1

3. An advanced practice nurse who uses knowledge and physical, psychosocial, and environmental assessment
skills to respond to common health and illness problems is referred to as a(n):
a. Advanced practice nurse
b. Advanced public health nurse
c. Nurse practitioner
d. Clinical nurse specialist
ANS: C
A nurse practitioner applies nursing knowledge with physical, psychosocial, and environmental assessment skills.

DIF: COG: Applying REF: 856 OBJ: 1

4. A nurse practitioner is employed in a primary health care setting. Which services are most likely provided in this
setting?
a. Primary health services and prison medicine services
b. Public health and primary care services
c. Family practice and geriatrics care
d. Home health and school health services
ANS: B
Primary health includes public health and primary care services by definition.

DIF: COG: Applying REF: 857 OBJ: 1

5. Which statement accurately describes how nurse practitioner (NP) programs began?
a. Started as a physician’s assistant program
b. Were an offshoot of midwifery
c. Have not always required a master’s degree
d. Began in Europe and didn’t reach the United States until 1970
ANS: C
The early NP degree programs were often continuing education programs and certificate programs that did not
require a master’s degree or even a baccalaureate degree.
DIF: COG: Understanding REF: 858 OBJ: 2

6. A student is pursuing graduate nursing education with preparation as a generalist, functioning at the micro-
systems level, and assuming accountability for healthcare outcomes for a specific group of clients. Which
educational preparation is this student receiving?
a. Clinical nurse leader
b. Advanced public health nurse
c. Nurse practitioner
d. Doctor of Nursing Practice
ANS: A
A clinical nurse leader is defined as a nurse who is a master’s prepared generalist who functions at the micro-
system level and assumes accountability for healthcare outcomes for a specific group of clients within a unit or area.

DIF: COG: Applying REF: 857 OBJ: 2

7. A registered nurse would like to become a nurse practitioner. Which level of education is required?
a. Bachelor of science in nursing degree
b. Master’s or higher degree in nursing and NP education
c. Bachelor of science in nursing degree and completion of a formal NP program
d. Master’s degree with a specialty in public health nursing
ANS: B
As of 1992, the ANCC required a Master’s degree or higher for NP certification.

DIF: COG: Analyzing REF: 859 OBJ: 2

8. An advanced public health nurse is completing the process for certification renewal in the specialty. What time
period has passed making renewal necessary?
a. 1 year
b. 3 years
c. 5 years
d. 7 years
ANS: C
Certification for advanced public health nurses and nurse practitioners is for 5 years.

DIF: COG: Applying REF: 859 OBJ: 3

9. An advanced practice nurse is pursuing professional certification. Who will the nurse need to contact to obtain
certification?
a. American Nurses Association
b. National League for Nursing
c. State board of nursing
d. Department of Health and Human Services
ANS: A
Examinations are administered through the American Nursing Credentialing Center (ANCC), which is part of the
American Nurses Association.

DIF: COG: Analyzing REF: 858 OBJ: 3

10. Why is it necessary for nurses to obtain certification?

a. To assure competence at an advanced level
b. To verify minimal competency levels of practice
c. To create a network for nurses to collaborate
d. To make it difficult to become a nurse
ANS: A
The purpose of certification is to assure the public that nurses who claim to be competent at an advanced level have
had their credentials verified through examination.

DIF: COG: Analyzing REF: 858-859 OBJ: 3

11. In which role are the most differences seen between the advanced public health nurse and the nurse
practitioner?
a. Administrator
b. Clinician
c. Consultant
d. Educator
ANS: B
Many differences are seen between the community health clinical nurse specialist and the nurse practitioner in the
clinician role.

DIF: COG: Understanding REF: 859 OBJ: 4

12. Classes on breast self-exam are an example of which of the following levels of prevention with regard to
population-focused advanced public health nursing activities?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

DIF: COG: Applying REF: 861 OBJ: 4

13. An example of secondary prevention of a population-focused advanced public health nursing activity is:
a. Flu immunizations at churches
b. Education on need for early detection
c. Screenings for blood pressure and cholesterol
d. Follow-up clinics for diabetics
ANS: C
Flu immunizations at churches and education on need for early detection are primary preventions, and follow-up
clinics for diabetes are a tertiary prevention.

DIF: COG: Applying REF: 861 OBJ: 4

14. When an advanced public health nurse provides other nurses with information on improving client care, which
role is being performed?

a. Researcher
b. Administrator
c. Educator
d. Consultant
ANS: D
The consultant role is being practiced when an advanced public health nurse provides other nurses with information
on improving client care.

DIF: COG: Applying REF: 861 OBJ: 4

15. As an administrator, the advanced public health nurse:

a. Engages in consultation and problem solving with individuals, families, and the community
b. Is often responsible for and has direct authority and supervision over the staff and client care
c. Works with doctorally prepared nurses on research projects
d. Educates the public on current health care practices
ANS: B
The APHN or NP functioning in the role of administrator is often responsible for and has direct authority and
supervision over the staff and client care.

DIF: COG: Applying REF: 861 OBJ: 4

16. An advanced public health nurse is more likely than a nurse practitioner to be involved with:
a. Diagnosing health problems
b. Managing chronic disease
c. Limiting disability
d. Conducting community assessments
ANS: D
Diagnosing health problems, managing chronic disease, and limiting disability are roles of an NP.

DIF: COG: Analyzing REF: 859-860 OBJ: 4

17. Which activity is more likely to be performed by a nurse practitioner than by an advanced public health nurse?
a. Disease prevention activities
b. Deciding on a treatment plan
c. Identifying needs of populations at risk
d. Identifying health needs of the community
ANS: B
Disease prevention activities, identifying needs of populations at risk, and identifying health needs of the community
are roles of a CNS.

DIF: COG: Analyzing REF: 860 OBJ: 4

18. An advanced public health nurse has been working with multiple agencies to establish a nursing center in the
community. What is the purpose of creating a nursing center?
a. To provide opportunities for collaborative relationships
b. To offer specialized care for certain medical conditions
c. To promote the autonomy of nurse practitioners
d. To focus on primary prevention for the community
ANS: A
Nursing centers provide opportunities for collaborative practice among APHNs, NPs, baccalaureate-prepared
nurses, and community members.

DIF: COG: Analyzing REF: 863 OBJ: 5

19. A nurse practitioner (NP) recently began employment in an emergency department. What would the primary role
of the NP be in this setting?
a. To triage clients
b. To manage non-emergent client problems
c. To assess medically uninsured clients
d. To provide health education about preventive health care
ANS: B
The primary role of the nurse practitioner in emergency departments is usually to manage non-emergent uninsured
clients.

DIF: COG: Analyzing REF: 863 OBJ: 5

20. Which is an example of a population-focused intervention?

a. Setting up a health fair with nursing students at a local university
b. Teaching a new mother how to breastfeed
c. Doing physical examinations on preschool children at the clinic one at a time
d. Contacting local officials about the rise in crime in one area of the city
ANS: A
Setting up a health fair with nursing students at a local university is an example of a population-focused intervention.

DIF: COG: Analyzing REF: 860 OBJ: 5

21. An advanced public health nurse wants to establish an independent practice. Which is the best method to
achieve this goal?
a. Act as a legal expert.
b. Learn complex assessment skills.
c. Market a service package.
d. Serve as a liaison for community programs.
ANS: C
One of the best ways for an advanced public health nurse to establish an independent practice is to market a
service package, providing certain services for a specific population.

DIF: COG: Analyzing REF: 862 OBJ: 5

22. A nurse practitioner is investigating regulations for third-party reimbursement. Which information will the nurse
practitioner most likely discover?
a. Nurse practitioners are reimbursed when directly supervised by a physician.
b. Nurse practitioners only receive reimbursement when working in rural areas.
c. Nurse practitioners are reimbursed at 85% of the physician rate.
d. Nurse practitioners are unable to be reimbursed by Medicare and Medicaid.
ANS: C
In 1997, with the passage of the national reconciliation spending bill, NPs can be directly reimbursed, regardless of
geographic setting, at 85% of what a physician would have been paid (if the service is covered under Medicare part
B).

DIF: COG: Analyzing REF: 865 OBJ: 6

23. A nurse practitioner recently obtained licensure and certification as an advanced practice registered nurse.
Where would the nurse find information about prescriptive privileges?
a. Reimbursement policies
b. Certification requirements
c. Educational preparation
d. Nurse practice acts
ANS: D
The scope and practice of the nurse practitioner, including prescriptive authority, is defined by the state’s nurse
practice act.

DIF: COG: Analyzing REF: 865 OBJ: 6

24. Which is most likely to be a major stressor for an advanced public health nurse?
a. Autonomy of practice
b. Professional isolation
c. Long work hours
d. Collaboration
ANS: B
The major stressor for an advanced public health nurse is likely to be professional isolation, because they are likely
to be hired in remote practice employment sites.

DIF: COG: Understanding REF: 866 OBJ: 7

MULTIPLE RESPONSE

1. Which functions are shared by advanced public health nurses and nurse practitioners? Select all that apply.
a. Leadership
b. Research
c. Comprehensive assessment
d. Systems focus
ANS: A, B, C
Leadership, research, and comprehensive assessment are functions that are completed by both advanced public
health nurses and nurse practitioners. The advanced public health nurse is more systems focused, whereas the
nurse practitioner has an individual/family focus.

DIF: COG: Understanding REF: 857 OBJ: 4

2. Which factors cause stress for advanced practice nurses? Select all that apply.
a. Legal issues
b. Professional isolation
c. Conflicting expectations
d. Role confusion
ANS: A, B, C
Legal issues, professional isolation, conflicting expectations, liability, collaborative practice, and professional
responsibilities all may cause stress for advanced practice nurses. Role confusion is not a factor causing stress for
advanced practice nurses.

DIF: COG: Understanding REF: 866 OBJ: 7