Chapter 01 : Advanced Practice Nursing: Doing What Has to Be Done-Radicals, Renegades, 

and Rebels

MULTIPLE CHOICE

1. The nurse manager of a pediatric clinic could confirm that the new nurse recognized the purpose

of the HEADSS Adolescent Risk Profile when the new nurse responds that it is used to assess for

needs related to

a. anticipatory guidance.

b. low-risk adolescents.

c. physical development.

d. sexual development.

ANS: A

The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which assesses

home, education, activities, drugs, sex, and suicide for the purpose of identifying high-risk

adolescents and the need for anticipatory guidance. It is used to identify high-risk, not low-risk,

adolescents. Physical development is assessed with anthropometric data. Sexual development is

assessed using physical examination.

REF: 6 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

2. The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, the

expected stage of development for a preschooler is

a. concrete operational.

b. formal operational.

c. preoperational.

d. sensorimotor.

ANS: C

The expected stage of development for a preschooler (3 to 4 years old) is preoperational. Concrete

operational describes the thinking of a school-age child (7 to 11 years old). Formal operational

describes the thinking of an individual after about 11 years of age. Sensorimotor describes the

earliest pattern of thinking from birth to 2 years old.

REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

3. The school nurse talking with a high school class about the difference between growth and

development would best describe growth as

a. processes by which early cells specialize.

b. psychosocial and cognitive changes.

c. qualitative changes associated with aging.

d. quantitative changes in size or weight.

ANS: D

Growth is a quantitative change in which an increase in cell number and size results in an increase

in overall size or weight of the body or any of its parts. The processes by which early cells

specialize are referred to asdifferentiation. Psychosocial and cognitive changes are referred to as

development. Qualitative changes associated with aging are referred to as maturation.

REF: 2 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

4. The most appropriate response of the nurse when a mother asks what the Denver II does is that it

a. can diagnose developmental disabilities.

b. identifies a need for physical therapy.

c. is a developmental screening tool.

d. provides a framework for health teaching.

ANS: C

The Denver II is the most commonly used measure of developmental status used by health care

professionals; it is a screening tool. Screening tools do not provide a diagnosis. Diagnosis requires a

thorough neurodevelopment history and physical examination. Developmental delay, which is

suggested by screening, is a symptom, not a diagnosis. The need for any therapy would be

identified with a comprehensive evaluation, not a screening tool. Some providers use the Denver II

as a framework for teaching about expected development, but this is not the primary purpose of the

tool.

REF: 4 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

5. To plan early intervention and care for an infant with Down syndrome, the nurse considers

knowledge of other physical development exemplars such as

a. cerebral palsy.

b. failure to thrive.

c. fetal alcohol syndrome.

d. hydrocephaly.

ANS: D

Hydrocephaly is also a physical development exemplar. Cerebral palsy is an exemplar of adaptive

developmental delay. Failure to thrive is an exemplar of social/emotional developmental delay.

Fetal alcohol syndrome is an exemplar of cognitive developmental delay.

REF: 9 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

6. To plan early intervention and care for a child with a developmental delay, the nurse would

consider knowledge of the concepts most significantly impacted by development, including

a. culture.

b. environment.

c. functional status.

d. nutrition.

ANS: C

Function is one of the concepts most significantly impacted by development. Others include

sensory-perceptual, cognition, mobility, reproduction, and sexuality. Knowledge of these concepts

can help the nurse anticipate areas that need to be addressed. Culture is a concept that is considered

to significantly affect development; the difference is the concepts that affect development are those

that represent major influencing factors (causes), hence determination of development and would be

the focus of preventive interventions. Environment is considered to significantly affect

development. Nutrition is considered to significantly affect development.

REF: 1 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

7. A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to

her toys and makes up stories. The mother wants her child to have a psychologic evaluation. The

nurses best initial response is to

a. refer the child to a psychologist.

b. explain that playing make believe with dolls and people is normal at this age.

c. complete a developmental screening.

d. separate the child from the mother to get more information.

ANS: B

By the end of the fourth year, it is expected that a child will engage in fantasy, so this is normal at

this age. A referral to a psychologist would be premature based only on the complaint of the

mother. Completing a developmental screening would be very appropriate but not the initial

response. The nurse would certainly want to get more information, but separating the child from the

mother is not necessary at this time.

REF: 5 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

8. A 17-year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so

needy and acting like a child. The best response of the nurse is that in the hospital, adolescents

a. have separation anxiety.

b. rebel against rules.

c. regress because of stress.

d. want to know everything.

ANS: C

Regression to an earlier stage of development is a common response to stress. Separation anxiety is

most common in infants and toddlers. Rebellion against hospital rules is usually not an issue if the

adolescent understands the rules and would not create childlike behaviors. An adolescent may want

to know everything with their logical thinking and deductive reasoning, but that would not explain

why they would act like a child.

Chapter 02: Emerging Roles of the Advanced Practice Nurse

Test Bank

Multiple Choice

1. An APRN is about to examine a patient in the emergency department. A colleague states to the

APRN “This patient is probably just seeking pain medication.” Regardless of his or her

colleague’s comment he or she enter the examination room and treat the patient as if he or she

is trustworthy and has good motives. Which of the ten essential elements of dignity is the

APRN utilizing?

a. Inclusion

b. Benefit of the doubt

c. Acceptance of identity

d. Recognition

ANS: B

Treating others as if they are trustworthy, starting with the premise that they have good motives

and are acting with integrity are all key points of benefit of the doubt. Benefit of the doubt is one

of the ten essential elements of dignity.

2. An APRN approaches his or her patients as neither inferior nor superior and gives others the

freedom to express their authentic selves without being judged. Which of the ten essential

elements of dignity is the APRN utilizing?

a. Safety

b. Accountability

c. Acceptance of identity

d. Benefit of doubt

ANS: C

The acceptance of identity is one of the ten essential elements of dignity. Approaching people as

neither inferior nor superior to you, giving others the freedom to express their authentic selves

without fear of being negatively judged, interacting without prejudice or bias, accepting how race,

religion, gender, class, sexual orientation, age, disability, and so on are at the core of someone’s

identities, and assuming they have integrity are all included in the essential elements of acceptance

of identity.

3. Communication problems often plague ethical dilemmas, which of the following is often at the

forefront of communication problems regarding clinicians?

a. Poor knowledge of the situation

b. Language barriers

c. Poor independence

d. Failure to speak up

ANS: D

All of the answers may contribute to ethical dilemmas but failure of a clinician to speak up about

a real or potential ethical problem is commonly identified. Erosion of open and honest

communication is typically the first theme encountered in many ethical dilemmas.

4. A 76-year-old patient is admitted to the hospital after suffering a spinal compression fracture.

The patient is unable to ambulate adequately on his or her own and requires assistance for basic

needs. Your assessment isthat the patient will recover their strength within 2 weeks. The billing

department at the facility notifies you that the patient may not stay in the hospital for more than

2 days. The patient does not wish to be transferred to a nursing facility and wishes to remain in

the hospital for the remaining 12 days to gain strength. Which of the following best defines

this scenario?

a. Interprofessional conflict

b. Communication problems

c. Legal issues

d. Multiple commitments

ANS: A

This ethical scenario plays out routinely in medical care as an element of interprofessional conflict.

The clinician wishes to respect patient autonomy but must understand and express the best interests

of the patient to a multidisciplinary team.

5. An APRN is scheduled to complete his or her shift at 7 p.m. on a particular day. A new patient

arrives 5 minutes prior to the time the APRN is expected to leave. He or she is asked by a

supervisor to stay beyond their scheduled time to assess the patient and provide care. Which

of the following best defines this scenario?

a. Interprofessional conflict

b. Multiple commitments

c. Communication problems

d. Legal issues

ANS: B

APRNs often fail to practice self-care and it is a significant threat to ethical practice. Multiple

commitments including obligations to multiple parties involving the patient, employer, and legal

system may create a scenario for ethical issues in nursing practice. Societal issues including cost

containment pressures in health systems are likely partially responsible for development of this

scenario.

6. An APRN works in a primary care clinic. The APRN wishes to treat a patient’s disease with a

specific medication that is far superior to other treatments. The APRN has never encountered

issues prescribing this therapy as first-line treatment in the past. The APRN is informed by this

particular patient’s insurance that they require proof that the APRN has tried a far less effective

therapy for 1 month prior to paying for the medication. Which of the following best describes

the forces at work in this scenario?

a. Communication problems

b. Legal issues

c. Interprofessional conflict

d. Societal issues

ANS: D

Societal issues including cost containment pressures in health systems are likely responsible for

development of this scenario. Interprofessional conflicts would best be involved in this scenario if

this is applied in a multidisciplinary team scenario.

7. Which of the following are defined as the four elements of core competency development in

ethical decision making for APRNs?

a. Knowledge development, knowledge application, creating an ethical environment,

promoting social justice

b. Knowledge development, educating others, creating an ethical environment, promoting

social justice

c. Knowledge development, knowledge application, effective communication, promoting

social justice

d. Knowledge development, knowledge application, creating an ethical environment,

understanding legal barriers

ANS: A

The core competency of ethical decision making for APRNs is best organized into four key

elements: knowledge development, knowledge application, creating an ethical environment, and

promoting social justice.

8. Which of the following examples best describes the knowledge development element of core

competency development for ethical decision making?

a. Analyzing the policymaking process

b. Using self-reflection during patient case reviews

c. Applying ethical decision-making model to a clinical problem

d. Mentoring others to develop ethical practice

ANS: B

The use of knowledge development is a key element of core competency development for ethical

decision making. It involves gaining knowledge of ethical theories and developing the ability to

distinguish a true ethical dilemma from a situation of moral distress or other clinically problematic

situation. Becoming sensitive to ethical dimensions of clinical practice and fidelity conflicts,

developing values clarification (self-reflection), and interpreting reactions and emotions of others

are all elements of knowledge development and moral sensitivity.

9. An APRN joins a group promoting awareness about abuse in long-term nursing care facilities.

He or she advocates for policies that protect the health care rights of individuals who are not

able to care for themselves independently. The APRN most likely employed which of the

following elements of core competency development for ethical decision making?

a. Promoting social justice

b. Knowledge development

c. Creating an ethical environment

d. Knowledge application

ANS: A

Skills or behaviors for promoting social justice within a health care system include the ability to

analyze the policy process and advocacy, communication, and leadership skills that promote

involvement in health policy initiatives supporting social justice.

10. An APRN interacts with a patient and another colleague to achieve the best outcome ofan

ethical dilemma. The APRN most likely used which of the following elements of core

competency development for ethical decision making?

a. Knowledge application

b. Creating an ethical environment

c. Promoting social justice

d. Knowledge development

ANS: A

Applying ethical decision-making models to clinical problems, using skilled communication

regarding ethical issues, and facilitating decision making by using select strategies are involved in

the use of knowledge application.

11. An APRN works at a hospital system that provides care to a large proportion of AsianAmerican citizens. The APRN develops a presentation for newly hired employees about the

cultural belief systems held by many in this population group. This describes the use of which

of the following elements of core competency development for ethical decision making?

a. Creating an ethical environment

b. Promoting social justice

c. Knowledge application

d. Knowledge development

ANS: A

Creating an ethical environment may include the use of preventative ethics and awareness of

environmental barriers to ethical practice.

12. Application of existing rules and doctrine as a guide for ethical decision making is best

described as which ethical approach?

a. Narrative ethics

b. Care-based ethics

c. Casuistry

d. Principle-based ethics

e. Virtue-based ethics

ANS: D

In principle-based ethical decision making, the principles or rules in contention are balanced and

interpreted with the contextual elements of the situation. However, the final decision and moral

justification for actions are based on principles.

13. Which ethical approach uses comparisons ofprecedent-setting cases and current scenarios?

a. Principle-based ethics

b. Casuistry

c. Care-based ethics

d. Narrative ethics

e. Virtue-based ethics

ANS: B

Casuistry is an ethical approach which uses comparisons of precedent-setting cases and current

scenarios.

14. Which approach emphasizes the particulars of a case or story as a vehicle for discerning the

meaning and values embedded in the ethical decision making?

a. Principle-based ethics

b. Casuistry

c. Virtue-based ethics

d. Care-based ethics

e. Narrative ethics

ANS: E

Narrative ethics emphasizes the particulars of a case or story as a vehicle for discerning the

meaning and values embedded in the ethical decision making.