Family Nurse Practitioner Clinical Internship I (D122)

Correct answer: a. Attempting to understand a patient's subjective world.

Explanation:

Existential therapy focuses on exploring a person's unique perspective and subjective experiences. This approach emphasizes personal responsibility, meaning-making, and self-awareness in the face of life's uncertainties. Understanding a patient’s subjective world helps the therapist support the individual in exploring their values, choices, and existence.

Why other options are wrong:

b. Challenging a patient's irrational beliefs.

This is a core component of cognitive-behavioral therapy (CBT), not existential therapy. Existential therapy focuses on deeper philosophical concerns rather than restructuring thought patterns.

c. Developing specific plans for change.

While existential therapy encourages personal growth, it does not necessarily focus on structured behavioral plans. This approach is more about exploring meaning and choices rather than setting concrete goals.

d. Establishing general group goals.

Existential therapy is highly individualized and centered on personal meaning rather than general group objectives. While it can be applied in group settings, its primary focus is on personal exploration.

Correct answer D. tailoring their communication style to the patient’s preference.

Explanation:

Culturally competent care requires adapting communication to align with the patient’s preferences, beliefs, and values. By assessing how a patient prefers to receive information—whether through family involvement, direct discussion, or simplified explanations—the nurse practitioner fosters trust, enhances understanding, and improves health outcomes.

Why other options are wrong:

A. Assuming most patients want to rely on family members or care providers to make treatment decisions.

While some cultures place a strong emphasis on family decision-making, assuming this applies to all patients disregards individual autonomy and choice. Some patients may prefer to make independent decisions, so it is essential to assess their preference rather than make assumptions.

B. Communicating with the patient using minimal-to-no medical terminology.

While avoiding overly complex medical jargon can improve understanding, using no medical terminology at all may hinder effective communication. Instead, the nurse practitioner should assess the patient’s level of health literacy and adjust explanations accordingly, ensuring clarity without oversimplification.

C. Developing the patient’s communication skills to a more advanced level.

It is not the healthcare provider’s role to modify a patient’s communication skills but rather to adapt their own approach to meet the patient’s needs. The focus should be on clear, effective, and culturally sensitive communication rather than forcing the patient to adapt to a higher level of medical understanding.

Correct answer C. Nurse practice act

Explanation:

The nurse practice act is the document that outlines the scope of practice for Advanced Practice Registered Nurses (APRNs). It defines the roles, responsibilities, and regulations for nursing practice within a specific state or jurisdiction. The act provides the legal framework within which APRNs operate, ensuring that they practice within the boundaries set by state law.

Why other options are wrong:

A. Code of ethics – While the code of ethics provides ethical guidelines for nursing practice, it does not specifically define the scope of practice for APRNs.

B. Core competencies of the APRN – Core competencies are important in guiding the skills and knowledge required for APRNs, but they do not legally define the scope of practice.

D. Standards of practice – Standards of practice set expectations for the quality of care but do not legally outline the scope of practice, which is primarily defined by the nurse practice act.

Correct answer C. psoriasis

Explanation:

Psoriasis is a chronic inflammatory skin condition characterized by well-demarcated, erythematous plaques with silvery scales. It often presents in areas of friction such as the scalp, elbows, knees, and gluteal folds. The presence of a longstanding, intermittent, nonpruritic eruption with scaly plaques and fissuring strongly suggests psoriasis. The condition is immune-mediated and can have systemic associations, including psoriatic arthritis.

Why other options are wrong:

A. atopic dermatitis

Atopic dermatitis is an eczematous skin disorder that typically presents with pruritus, erythema, and lichenification, often affecting flexural surfaces. Unlike psoriasis, atopic dermatitis is associated with intense itching and a history of allergies or asthma. The absence of pruritus and the presence of scaling plaques make atopic dermatitis an unlikely diagnosis.

B. ichthyosis

Ichthyosis is a group of genetic disorders characterized by widespread dry, scaly skin, often present from birth or early childhood. It does not present as well-demarcated plaques and does not typically involve exacerbations and remissions. The localized nature of the lesion in this case also makes ichthyosis less likely.

D. tinea corporis

Tinea corporis is a fungal skin infection caused by dermatophytes, presenting as an annular, scaly plaque with central clearing and an advancing border. It is typically pruritic and does not exhibit the chronic, recurrent nature of psoriasis. Additionally, the lesion’s fissuring and location in the gluteal fold are more consistent with psoriasis than tinea corporis.

Correct answer: d. 88.89%

Explanation:

To calculate the pass rate, divide the number of correct answers by the total number of scored questions and multiply by 100 to get the percentage:

120 ÷ 135 = 0.8889

0.8889 × 100 = 88.89%

Therefore, the candidate's pass rate is approximately 88.89%.

Why other options are wrong:

a. 84%

This would suggest a score of around 113 out of 135, which is not the correct calculation for the score provided.

b. 80%

A score of 80% would require answering 108 out of 135 questions correctly, which is not the case here.

c. 90%

A 90% pass rate would indicate 121.5 out of 135 questions correctly answered, which is slightly higher than the actual score of 120.

Correct answer C: creating a task force to address scope-of-practice concerns

Explanation:

Professional leadership in nursing involves advocating for policy improvements, fostering collaboration, and addressing systemic challenges within healthcare. By creating a task force to address scope-of-practice concerns, the family nurse practitioner (FNP) takes an active role in shaping the professional landscape and ensuring that nurse practitioners (NPs) can practice to the full extent of their education and training. Task forces provide a structured way to assess limitations, propose solutions, and collaborate with stakeholders, reinforcing the FNP’s role as a leader in healthcare policy and professional advocacy.

Why other options are wrong:

A. adding clinical protocols to the nurse practitioner's scope of practice

While establishing clinical protocols is important, individual NPs cannot unilaterally expand their scope of practice. Scope of practice is regulated by state laws, national guidelines, and professional organizations. Leadership involves working within these regulations to advocate for appropriate changes rather than independently altering protocols.

B. comparing the workplace roles of the registered nurse and the nurse practitioner

While role differentiation is essential for professional identity and collaboration, merely comparing roles does not constitute leadership. Leadership involves action, such as advocating for professional recognition, improving policies, or addressing barriers to practice. A comparison of roles alone does not actively contribute to resolving scope-of-practice concerns.

D. lobbying to eliminate continuing education requirements

Eliminating continuing education (CE) requirements would be counterproductive to professional growth and competency. CE is essential for maintaining up-to-date clinical knowledge, ensuring patient safety, and adapting to advancements in healthcare. Advocating for the removal of CE requirements would not be seen as a leadership initiative but rather as a step away from professional responsibility.

Correct answer:

A. Credentialing ensures that APRNs meet the necessary qualifications and standards for safe and effective practice.

Explanation:

Credentialing is crucial because it ensures that APRNs meet the qualifications and standards necessary for delivering safe and effective care. It involves verifying that an APRN has the appropriate education, training, and licensure to practice in their specialty area. This process helps maintain high standards of care and patient safety.

Why other options are wrong:

B. Credentialing is primarily focused on continuing education requirements.

While continuing education may be part of the credentialing process, credentialing itself is broader and focuses on verifying qualifications, training, licensure, and professional experience. Continuing education is one aspect but not the sole focus.

C. Credentialing is a way to increase the number of nurses in the workforce.

Credentialing does not directly impact the number of nurses in the workforce. Instead, it ensures that nurses who are practicing have the necessary qualifications and competencies for their role.

D. Credentialing allows APRNs to prescribe medications without supervision.

Credentialing verifies qualifications, but the ability to prescribe medications depends on licensure and state laws. Credentialing itself does not automatically grant prescribing authority, especially without adherence to state regulations and practice agreements.

Correct answer A. add gabapentin (Neurontin) to the treatment regimen.

Explanation:

Duloxetine (Cymbalta) is commonly prescribed for both major depressive disorder and neuropathic pain, but in some cases, it may not provide full relief for neuropathic pain. If the patient's depression is well-controlled but pain persists, the nurse practitioner may add a medication like gabapentin (Neurontin), which is specifically used to treat neuropathic pain. This combination is a standard approach to managing both conditions effectively.

Why other options are wrong:

B. conduct additional diagnostic tests – The patient has already been diagnosed with diabetes and major depressive disorder, and the ongoing neuropathic pain is a known complication of diabetes. Further diagnostic tests may not be necessary unless there is suspicion of a different condition.

C. contact the patient's endocrinologist – Although it's important to collaborate with other specialists when needed, there is no immediate indication that the endocrinologist needs to be involved for the management of the patient's neuropathic pain. Treatment with gabapentin or another medication is appropriate first-line care.

D. increase the dosage of duloxetine (Cymbalta) – Increasing the dosage of duloxetine may help with pain to some extent, but it is not the most effective approach to neuropathic pain specifically. Gabapentin is a more appropriate choice for this particular symptom.

Correct answer:

B. Consult state laws, collaborate with a physician, and adhere to employer policies.

Explanation:

To ensure compliance when prescribing controlled substances, an FNP must follow state laws, collaborate with a physician if required, and adhere to their employer’s policies. States with restrictive regulations may have specific guidelines for prescribing controlled substances, and FNPs must ensure they follow these rules. Collaboration with a physician may be necessary in some jurisdictions, and employer policies can provide additional guidance.

Why other options are wrong:

A. Prescribe without consulting anyone since they are licensed. 

This is incorrect. Even though an FNP is licensed, controlled substance prescribing is often governed by specific state laws and employer policies. Failing to follow these can result in legal or professional consequences.

C. Consult only with colleagues and disregard formal regulations.

This is highly unprofessional and potentially illegal. State laws and regulations supersede informal consultations, and disregarding them can lead to serious consequences for licensure and patient safety.

D. Only follow employer policies and ignore state laws. 

This is incorrect because state laws are legally binding, and an FNP must always follow state regulations regarding prescribing controlled substances. Employer policies must also be followed, but they cannot override state law.