CHAPTER 20- Professional Issues Flashcards Preview

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Flashcards in CHAPTER 20- Professional Issues Deck (15)
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1

The term "LACE" stands for which of the following?

  1. Licensure, accommodation, consensus, and education
  2. Licensure, accreditation, certification, and education
  3. Liberation, accommodation, consensus, and education
  4. Liberation, accreditation, certification, and education

2. Licensure, accreditation, certification, and education

The term "LACE" stands for: licensure, accreditation, certification, and education.

2

An FNP sees a patient, Mr. A, who is HIV+. After the patient is gone, the next patient to be seen mentions she knows Mr. A, and is aware he is HIV+ and is in an intimate relationship with someone who is unaware of Mr. S’s status. Of the available choices below, choose the best response for the FNP:

  1. Mr. A is not HIV+, and I am not sure where you got that information.
  2. Please report your concerns to the local public health department who can follow up on Mr. A’s inappropriate behavior.
  3. Patient confidentiality and privacy are the basis for our clinical practice, therefore I do not discuss your or any other patient’s information unless it is necessary for your health care.
  4. Thank you for the information. I will follow up on this.

3. Patient confidentiality and privacy are the basis for our clinical practice, therefore I do not discuss your or any other patient’s information unless it is necessary for your health care.

Confidentiality is keeping the patient's information private unless sharing is required by legal need to share and/or to protect children and elders from domestic violence, phychiatric violence, etc. Ethically, the FNP must follow the terms of confidentiality.

3

Ms. J is being seen for a variety of vague complaints, including malaise and mild body aches that have not gone away for several weeks. The initial workup included a complete blood count, comprehensive metabolic panel, mono-spot, and Lyme antibody. All tests were negative and/or within normal limits. Ms. J. wants a full-body magnetic resonance imaging test ordered, and a prescription for an antibiotic "just in case." While formulating an appropriate response, the FNP is aware that balancing the basis for her response will depend on which of the following ethical concepts?

  1. Non-maleficence and beneficence
  2. Virtue and action
  3. Justice and altruism
  4. Ecocentrism and procedural justice

1. Non-maleficence and beneficence

The FNP is balancing the ethical concepts of non-maleficence, which is to do no harm when the benefits outweigh the risks, and beneficence, which is doing good and helping others.

4

A 15-year-old female patient is seen in the office. She discloses she has been having unprotected sexual intercourse with a 15-year-old male she has known for many years. She would like to discuss contraceptive options but she is afraid to tell her mother. The best next step for the FNP is:

  1. Let the minor know the FNP cannot discuss contraception with her unless one parent or guardian is present.
  2. Make an appointment for the girl to go to an STD clinic.
  3. Assure the girl that the discussion will be confidential and review contraceptive options as well as possible STD testing.
  4. Make a separate appointment in 2 weeks for the girl to return and have a full gynecological examination and discussion of options at that time.

3. Assure the girl that the discussion will be confidential and review contraceptive options as well as possible STD testing.

The FNP should assure the girl that the discussion will be confidential and then review contraceptive options, as well as possible STD testing.

5

Ms. K is a 28-year-old female patient who is very shy and can be indecisive. She has a small non-tender lump on her right breast. When the FNP recommends an ultrasound and possible mammogram, Ms. K is tearful and says she needs time to decide. After a few days of not being able to make a decision, the FNP calls her and says she made the appointments for her so she has to go for testing. This concept is best described as which of the following?

  1. Aggressive medicine
  2. Non-maleficence
  3. Paternalism
  4. Distributive justice

3. Paternalism

Paternalism in the case of the health care provider, is that the provider knows better than the patient and therefore would make decisions for the patient. This directly contradicts the concept of autonomy.

6

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the use of which of the following to improve the efficiency and effectiveness of electronic records’ transmissions.

  1. National Provider Identification
  2. Medicare Provider Unique Number
  3. Healthcare Privacy Identifier
  4. Unique Insurance and Portability Number

1. National Provider Identification

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for health care producders. The use of National Provider Identification improves the efficiency and effectiveness of electronic records’ transmissions.

7

An FNP is moving from Maine to Ohio. In addition to applying for a license in the new state, he is aware of the need to know which of the following?

  1. The Consensus Model enforces each state to provide the same licensing and scope of practice for all APRNs.
  2. Although many states have incorporated portions of the Consensus Model, there are varying requirements and practice acts among states.
  3. His license from Maine will be honored in most other states.
  4. All states have some form of physician supervision in the practice act.

2. Although many states have incorporated portions of the Consensus Model, there are varying requirements and practice acts among states.

The Consensus Model was developed by the APRN Joint Dialogue Group Report in an effort to reach an agreement for the regulation of APRNs.

8

A local medical center is advertising for an APRN. The FNP requests further information prior to applying for a position. The need to ask about the role for this position is important because:

  1. APRNs are not just NPs, but also certified nurse midwives (CNMs), nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs).
  2. APRNs include NPs, as well as clinical nurse leaders (CNLs).
  3. APRNs are specifically identified in each state, which may vary.
  4. APRNs are all nurses with masters’ degrees.

1. APRNs are not just NPs, but also certified nurse midwives (CNMs), nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs).

APRNs are not just NPs, but also certified nurse midwives (CNMs), nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs).

9

In most states, adolescents (under age 18 years) would not have the right to refuse medical treatment if a parent decided it was necessary for that teenager to be healthy. Which one of the following scenarios is true?

  1. All states allow a female adolescent to obtain abortion services if desired.
  2. Fifty states require an adolescent to co-sign medical treatment forms.
  3. At least one state allows adolescents to request abortion services without parental permission but has not allowed refusal of chemotherapy for a curable cancer.
  4. The majority of states do not allow adolescents to get treated for sexually transmitted diseases without parental or guardian approval.

3. At least one state allows adolescents to request abortion services without parental permission but has not allowed refusal of chemotherapy for a curable cancer.

At least one state allows adolescents to request abortion services without parental permission but has not allowed refusal of chemotherapy for a curable cancer. The FNP must be aware of the laws pertaining to minors and health care in the state in which he/she practices as they are all regulated a bit differently.

10

A 45-year-old male and a 52-year-old male are seeking treatment options for increased prostate-specific antigen levels. One of these men has no health insurance and the other has very comprehensive coverage. The FNP knows that they must both be offered the same options/recommendations based on which ethical principle?

  1. Maternalism
  2. Non-maleficence
  3. Deontology
  4. Justice

4. Justice

Justice is a complex term, but it means that equals should be treated equally. 

11

A newly graduated, certified, and licensed FNP has taken a position in a large medical practice. The physicians repeatedly refer to him as a "mid-level provider" when introducing him to patients and the office staff. What is an appropriate next step to help inform the physicians and staff about the use of the term "mid-level"?

  1. Make copies of the position paper on the use of the term "mid-level" from AANP and leave it on the physicians’ desks.
  2. Ask for a meeting with the lead physician of the practice to discuss some positive feedback about the role and also discuss the negative use of the term "mid-level" and offer other terms that would reflect a more positive image to patients and staff, such as "primary care or health care provider" and/or "clinician."
  3. Plan to discuss this at the next full staff meeting with the intention of letting everyone know how insulting this has been and threaten to quit if it continues.
  4. Since this is the FNP’s first job, it would be better to let them continue calling him a mid-level and address this in a year or so when they realize how competent he is.

2. Ask for a meeting with the lead physician of the practice to discuss some positive feedback about the role and also discuss the negative use of the term "mid-level" and offer other terms that would reflect a more positive image to patients and staff, such as "primary care or health care provider" and/or "clinician."

The Term "mid-level" implied an inaccurate hierarchy within clinical practice. Nurse Practitioners practice at the highest level of professional nursing practice. 

12

Two examples of the FNP role as it relates to health policy and practice would be (choose two numbers):

  1. Joining the local community center’s board of directors.
  2. Serving as a leader in the local Girl Scout troop.
  3. Volunteering to work on increasing access to care for the local homeless shelter.
  4. Advocating for concussion evaluations and best-fit helmets for the local youth football league.

3 and 4. Volunteering to work on increasing access to care for the local homeless shelter and Advocating for concussion evaluations and best-fit helmets for the local youth football league.

The Affordable Care Act became a law in 2010. Having FNPs utlizing their skills in the community to offer care to those in the community who may not be given the chance is a huge way the FNP can contribute to Health Policy.

13

The newly licensed FNP is seeing a patient who has acute pain related to a severe ankle strain. The collaborating physician recommends that she write the patient a prescription for Tylenol #3 (acetaminophen with codeine). The FNP is aware of her state’s law that she needs which of the following to be able to prescribe this medication?

  1. A state controlled-substances license and a DEA registration certificate for schedule III drugs
  2. A state license and NPI registration number
  3. A federal license to practice and a state license allowing her to prescribe Schedule I and II drugs.
  4. A state controlled-substances license and a state registration license for Schedule II–IV drugs.

1. A state controlled-substances license and a DEA registration certificate for schedule III drugs

The FNP must apply for the State Controlled-Substances Licensure and the DEA licensure.

14

An FNP is deciding what state to move to in an effort to expand her practice. The easiest and best option is to look up the latest:

  1. Pearson Report.
  2. LACE Report.
  3. Consensus Report.
  4. Federal Scope of Practice Report.

1. Pearson Report.

The Pearson Report provides and annual state-by-state national overview of nurse practitioner legistlation and helath care issues. It will provide the FNP with the definition of the legal scope of practice for each individual state.

15

An FNP is completing paperwork for a new position in a large hospital-based outpatient center. Forms to be signed include strict guidelines about physician supervision of the FNP and patient care. Which of the following statements is true?

  1. The institution can dictate whatever restrictions on physician oversight they prefer, even if FNPs are allowed to practice without supervision in that state.
  2. The institution cannot dictate that the FNP must be supervised when providing care in an outpatient setting if that state allows full unsupervised practice.
  3. The FNP will need to report to the supervising physician on each patient seen prior to the end of the patient medical visit.
  4. The FNP can sign the forms and then make an agreement with the chief medical officer about which patients can be seen without any supervision.

1. The institution can dictate whatever restrictions on physician oversight they prefer, even if FNPs are allowed to practice without supervision in that state.

The institution can dictate whatever restrictions on physician oversight that they prefer, even if FNPs are allowed to practice without supervision in that state.