Free ACHPN Education and Professionalism Questions and Answers — Questions and Answers
Question 1: When the advanced practice registered nurse stays with a patient and holds the patient's hand when the physician delivers bad news about the patient's prognosis, the APRN is acting on the ethical principle of:
- nonmaleficence.
- beneficence. (Correct answer)
- autonomy.
- veracity.
Correct answer: beneficence.
Explanation: <br> When the advanced practice registered nurse stays with a patient and holds the patient's hand when the physician delivers bad news about the patient's prognosis, the APRN is acting on the ethical principle of beneficence. Beneficence is acting to benefit another person, and this can include providing comfort in times of distress as well as ensuring that treatments should ultimately benefit the patient even though they may result in adverse effects.
Question 2: If the advanced practice registered nurse is using the Palliative Performance Scale (PPS) to assess a patient with severe heart disease and finds the patient is now completely bedridden, requires total care, oral intake of both food and fluids is reduced, and the patient is responsive but very drowsy, the PPS score would be:
- 60.
- 50.
- 40.
- 30. (Correct answer)
Correct answer: 30.
Explanation: <br> If the advanced practice registered nurse is using the Palliative Performance Scale to assess a patient with severe heart disease and finds the patient is now completely bedridden, requires total care, oral intake of both food and fluids is reduced, and the patient is responsive but very drowsy, the PPS would be 30. Once a patient becomes bedridden, the highest possible score is 30. Scores of 50 and below indicate that the disease is extensive and the condition deteriorating.
Question 3: If a patient with metastatic breast cancer has informed healthcare providers that she wants a DNR order and no heroic measures to prolong life but the patient's son and daughter insist that all life-prolonging measures be carried out, the best response is to:
- tell the son and daughter that the patient has a right to make this decision.
- arrange a family meeting so that the patient and children can discuss this issue. (Correct answer)
- tell the son and daughter that they have no legal standing since the patient is alert.
- urge the patient to tell her children not to interfere.
Correct answer: arrange a family meeting so that the patient and children can discuss this issue.
Explanation: <br> If a patient with metastatic breast cancer has informed healthcare providers that she wants a DNR order and no heroic measures to prolong life but the patient's son and daughter insist that all life-prolonging measures be carried out, the best response is to arrange a family meeting so that the patient and children can discuss this issue. Both the patient and her children need to express their reasoning and their feelings about the patient's condition and treatment.
Question 4: If using the ask-tell-ask framework to educate a patient about self-care, the advanced practice registered nurse would begin by:
- waiting for the patient to ask a question.
- providing information and asking the patient to repeat it back.
- asking the patient to write down a number of questions.
- asking the patient what he/she knows and wants to know. (Correct answer)
Correct answer: asking the patient what he/she knows and wants to know.
Explanation: <br> If using the ask-tell-ask framework to educate a patient about self-care, the advanced practice registered nurse would begin by asking the patient what the patient already knows about the condition and needs and what the patient wants to know. When the patient responds, the APRN tells the patient the information needed or wanted and then asks if the patient still has more questions or needs more information, continuing the cycle of ask-tell-ask.
Question 5: A 69-year-old patient with severe cognitive impairment has fallen and fractured her elbow. Which of the following pain assessment methods is most appropriate?
- PAINAD (Correct answer)
- FACES
- 1-10 scale
- LANSS
Correct answer: PAINAD
Explanation: <br> If a 69-year-old patient with severe cognitive impairment has fallen and fractured her elbow, the pain assessment method that is most appropriate is PAINAD (Pain Assessment in Advanced Dementia). This scale assesses 5 elements: respirations (hyperventilation, tachypnea, Cheyne-Stokes), vocalization (silence, moan, groan, cry), facial expression (sad, frightened, grimacing), body language (tense, fidgeting, fist clinched, fetal position, combative), and consolability (inability to distract or console).
Question 6: The advanced practice registered nurse is conducting the timed-up-and-go test as part of the gait assessment of a patient. The patient is able to stand from a chair with arrests, walk 3 meters, and turn and sit down. Which of the following times required to carry out these activities first indicates an increased risk for falls?
- 7 seconds
- 10 seconds
- 14 seconds (Correct answer)
- 16 seconds
Correct answer: 14 seconds
Explanation: <br> If the advanced practice registered nurse is conducting the timed-up-and-go test as part of the gait assessment of a patient and the patient is able to stand from a chair with armrests, walk 3 meters, and turn and sit down, the time that indicates a risk for falls is equal to or greater than 14 seconds. The normal time needed to carry out the activities ranges from 7-10 seconds. Gait speed is also a consideration with gait speed of less than 0.6 m/second when walking 5 meters predicting limitations in mobility.
Question 7: A male patient is being admitted for advanced cirrhosis of the liver and is hostile and angry, lashing out verbally at caregivers and refusing to cooperate. The best approach when conducting the history and physical exam is to:
- ask the patient to lower the voice and cooperate.
- tell the patient that he cannot receive care unless he cooperates.
- ask security personnel to stand by during the examination.
- remain calm and patient, responding to the patient as appropriate. (Correct answer)
Correct answer: remain calm and patient, responding to the patient as appropriate.
Explanation: <br> If a male patient is being admitted for advanced cirrhosis of the liver and is hostile and angry, lashing out verbally at caregivers and refusing to cooperate, the best approach when conducting the history and physical exam is to remain calm and patient, responding to the patient as appropriate. Cirrhosis is often associated with some degree of confusion, and the patient may be frightened and anxious, so speaking calmly and remaining empathetic and supportive is important.
Question 8: The advanced practice registered nurse has begun to overly identify with the pain and suffering of patients and frequently finds that concerns about patients are interfering with their personal lives. The APRN often skips lunch and breaks in order to spend more time with patients and is beginning to have nightmares and trouble concentrating. The APRN is likely experiencing:
- depression
- compassion fatigue (Correct answer)
- anxiety
- empathy
Correct answer: compassion fatigue
Explanation: <br> If the advanced practice registered nurse has begun to overly identify with the pain and suffering of patients and frequently finds that concerns about patients are interfering with personal life, and the APRN often skips lunch and breaks in order to spend more time with patients and is beginning to have nightmares and trouble concentrating, the APRN is likely experiencing compassion fatigue. The APRN may need to take a break from work and participate in a stress management program.
Question 9: When collaborating with a patient and family in developing the plan of care, it's important for the patient and family to understand:
- their rights and responsibilities. (Correct answer)
- their limitations.
- the organization's philosophy.
- the difference between goals and objectives.
Correct answer: their rights and responsibilities.
Explanation: <br> When collaborating with a patient and family in developing the plan of care, it's important for the patient and family to understand their rights and responsibilities. The advanced practice registered nurse should ask them what their goals and expectations are and what is most important to them. The APRN may ask the patient and family members to separately list those things that are important to them and then compare and discuss the lists because they may not always be in agreement.
Question 10: A Native American patient has stage IV multiple myeloma and is under hospice care in an extended care facility. A staff nurse tells the advanced care registered nurse that, despite the diagnosis, the patient seems to have little pain. The patient does not complain or request pain medication although the patient has been lying in a fetal position and refusing most food and drink. The advanced care registered nurse should advise the staff nurse that:
- the patient is probably comfortable without pain medication.
- the patient may avoid outward expressions of pain. (Correct answer)
- the staff nurse should be more aware of patient needs.
- the patient probably prefers to suffer rather than take pain medication.
Correct answer: the patient may avoid outward expressions of pain.
Explanation: <br> If a Native American patient has stage IV multiple myeloma and is under hospice care in an extended care facility and a staff nurse tells the advanced care registered nurse that, despite the diagnosis, the patient seems to have little pain; and the patient does not complain or request pain medication although the patient has been lying in fetal position and refusing most food and drink, the advanced care registered nurse should advise the staff nurse that Native Americans often avoid an outward expression of pain. However, the patient's body language indicates discomfort.
Question 11: A family reports that the patient who was raised Catholic has not attended Mass for 50 years. The patient is nearing death but remains responsive and has not requested a priest. The advanced care registered nurse should:
- assume the patient will not want to see a priest.
- ask the priest on call to visit the patient.
- ask the patient if he or she wants to see a priest. (Correct answer)
- ask the family if a priest should be called.
Correct answer: ask the patient if he or she wants to see a priest.
Explanation: <br> If a patient was raised Catholic but has not attended Mass for 50 years and is nearing death but remains responsive, the advanced care registered nurse should ask the patient directly if the patient wants to see a priest. Even lapsed Catholics who have not been active in the church may obtain spiritual comfort from the sacraments commonly referred to as last rites. The advanced care registered nurse should never make assumptions about a patient's spirituality.
Free ACHPN Education and Professionalism Questions and Answers
When the advanced practice registered nurse stays with a patient and holds the patient's hand when the physician delivers bad news about the patient's prognosis, the APRN is acting on the ethical principle of: