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NS 660 Advanced Clinical Decision-
Making Exam 2025 - 2026 Questions
with Correct Answers and Rationales
UNH
- A nurse practitioner is evaluating a patient with poorly controlled hypertension despite adherence to medication. The nurse decides to apply Orem’s Self-Care Deficit Theory to assess the case. Which of the following actions best reflects this theory?
A. Ordering a new antihypertensive medication. B. Evaluating the patient’s ability to manage lifestyle modifications independently. C. Referring the patient to a cardiologist for advanced management. D. Scheduling more frequent follow-up visits.
Correct Answer: B
Rationale: Orem's Self-Care Deficit Theory focuses on assessing and addressing a patient's ability to perform self-care. Identifying if a patient can manage lifestyle changes is central to this theory.
- The Affordable Care Act (ACA) significantly influenced the role of advanced practice nurses. Which of the following best describes the impact?
A. Restricted scope of practice to hospital settings only. B. Reduced the number of nurse practitioners due to federal limitations. C. Expanded access to care, enabling APRNs to serve as primary care providers. D. Removed all licensure barriers for APRNs across the U.S.
Correct Answer: C
Rationale: The ACA increased the need for primary care providers, empowering APRNs to fill the gap and assume leadership roles in patient care.
- Which of the following is the most appropriate first step when applying evidence-based practice in an advanced nursing role?
A. Conducting a literature review. B. Evaluating the outcomes of previous interventions. C. Developing a clinical guideline. D. Formulating a clinical question using the PICOT format.
C. Collaborating with state nursing associations and legislators. D. Conducting private discussions with patients.
Correct Answer: C
Rationale: Policy advocacy is most effective through collaboration with established organizations and lawmakers to influence legislation and practice.
- Which nursing theorist emphasized the importance of the nurse-client relationship as central to nursing care?
A. Virginia Henderson B. Hildegard Peplau C. Dorothea Orem D. Jean Watson
Correct Answer: B
Rationale: Peplau's theory is centered on the interpersonal relationship between nurse and patient, emphasizing therapeutic communication.
- A key characteristic of a DNP-prepared nurse is the ability to:
A. Conduct original research. B. Focus solely on clinical tasks.
C. Translate evidence into practice at the systems level. D. Avoid involvement in health policy.
Correct Answer: C
Rationale: DNP-prepared nurses are trained to apply evidence at a systems level, bridging the gap between research and clinical practice.
- When using the PDSA (Plan-Do-Study-Act) model in quality improvement, which phase involves implementing the change?
A. Plan B. Do C. Study D. Act
Correct Answer: B
Rationale: The 'Do' phase of PDSA involves implementing the change or test of the process in a real setting.
- Which of the following is an example of a sentinel event in healthcare?
A. Delay in medication administration B. A patient fall without injury C. Surgery on the wrong site
B. Evaluating the patient’s ability to manage lifestyle modifications independently. C. Referring the patient to a cardiologist for advanced management. D. Scheduling more frequent follow-up visits.
Correct Answer: B
Rationale: Orem's Self-Care Deficit Theory focuses on assessing and addressing a patient's ability to perform self-care. Identifying if a patient can manage lifestyle changes is central to this theory.
- The Affordable Care Act (ACA) significantly influenced the role of advanced practice nurses. Which of the following best describes the impact?
A. Restricted scope of practice to hospital settings only. B. Reduced the number of nurse practitioners due to federal limitations. C. Expanded access to care, enabling APRNs to serve as primary care providers. D. Removed all licensure barriers for APRNs across the U.S.
Correct Answer: C
Rationale: The ACA increased the need for primary care providers, empowering APRNs to fill the gap and assume leadership roles in patient care.
- Which of the following is the most appropriate first step when applying evidence-based practice in an advanced nursing role?
A. Conducting a literature review. B. Evaluating the outcomes of previous interventions. C. Developing a clinical guideline. D. Formulating a clinical question using the PICOT format.
Correct Answer: D
Rationale: The first step in evidence-based practice is to formulate a well-structured clinical question, often using the PICOT format, to guide research.
- A nurse leader is implementing a change based on Lewin’s Change Theory. Which of the following best represents the 'refreezing' stage?
A. Introducing a new electronic medical record system. B. Reinforcing training and providing support post-implementation. C. Communicating the need for the new system to staff.
B. Hildegard Peplau C. Dorothea Orem D. Jean Watson
Correct Answer: B
Rationale: Peplau's theory is centered on the interpersonal relationship between nurse and patient, emphasizing therapeutic communication.
- A key characteristic of a DNP-prepared nurse is the ability to:
A. Conduct original research. B. Focus solely on clinical tasks. C. Translate evidence into practice at the systems level. D. Avoid involvement in health policy.
Correct Answer: C
Rationale: DNP-prepared nurses are trained to apply evidence at a systems level, bridging the gap between research and clinical practice.
- When using the PDSA (Plan-Do-Study-Act) model in quality improvement, which phase involves implementing the change?
A. Plan B. Do
C. Study D. Act
Correct Answer: B
Rationale: The 'Do' phase of PDSA involves implementing the change or test of the process in a real setting.
- Which of the following is an example of a sentinel event in healthcare?
A. Delay in medication administration B. A patient fall without injury C. Surgery on the wrong site D. High patient readmission rates
Correct Answer: C
Rationale: A sentinel event is a serious, unexpected occurrence involving death or serious injury, such as wrong-site surgery.
- In evidence-based practice, the highest level of evidence typically comes from:
A. Expert opinion B. Case reports
- The Affordable Care Act (ACA) significantly influenced the role of advanced practice nurses. Which of the following best describes the impact?
A. Restricted scope of practice to hospital settings only. B. Reduced the number of nurse practitioners due to federal limitations. C. Expanded access to care, enabling APRNs to serve as primary care providers. D. Removed all licensure barriers for APRNs across the U.S.
Correct Answer: C
Rationale: The ACA increased the need for primary care providers, empowering APRNs to fill the gap and assume leadership roles in patient care.
- Which of the following is the most appropriate first step when applying evidence-based practice in an advanced nursing role?
A. Conducting a literature review. B. Evaluating the outcomes of previous interventions. C. Developing a clinical guideline. D. Formulating a clinical question using the PICOT format.
Correct Answer: D
Rationale: The first step in evidence-based practice is to formulate a well-structured clinical question, often using the PICOT format, to guide research.
- A nurse leader is implementing a change based on Lewin’s Change Theory. Which of the following best represents the 'refreezing' stage?
A. Introducing a new electronic medical record system. B. Reinforcing training and providing support post-implementation. C. Communicating the need for the new system to staff. D. Allowing staff to give feedback during the transition.
Correct Answer: B
Rationale: In Lewin’s Change Theory, 'refreezing' solidifies the change into the system by reinforcing behaviors and providing ongoing support.
- In developing a policy proposal to increase APRN autonomy in your state, which of the following would be the most effective advocacy strategy?
A. Posting opinions on social media. B. Holding internal hospital meetings.
C. Translate evidence into practice at the systems level. D. Avoid involvement in health policy.
Correct Answer: C
Rationale: DNP-prepared nurses are trained to apply evidence at a systems level, bridging the gap between research and clinical practice.
- When using the PDSA (Plan-Do-Study-Act) model in quality improvement, which phase involves implementing the change?
A. Plan B. Do C. Study D. Act
Correct Answer: B
Rationale: The 'Do' phase of PDSA involves implementing the change or test of the process in a real setting.
- Which of the following is an example of a sentinel event in healthcare?
A. Delay in medication administration B. A patient fall without injury
C. Surgery on the wrong site D. High patient readmission rates
Correct Answer: C
Rationale: A sentinel event is a serious, unexpected occurrence involving death or serious injury, such as wrong-site surgery.
- In evidence-based practice, the highest level of evidence typically comes from:
A. Expert opinion B. Case reports C. Randomized controlled trials D. Cohort studies
Correct Answer: C
Rationale: Randomized controlled trials are considered the gold standard for clinical evidence due to their ability to minimize bias.
- A nurse practitioner is evaluating a patient with poorly controlled hypertension despite adherence to medication. The nurse decides to apply Orem’s Self-Care Deficit Theory to assess the case. Which of the following actions best reflects this theory?
Rationale: The ACA increased the need for primary care providers, empowering APRNs to fill the gap and assume leadership roles in patient care.
- Which of the following is the most appropriate first step when applying evidence-based practice in an advanced nursing role?
A. Conducting a literature review. B. Evaluating the outcomes of previous interventions. C. Developing a clinical guideline. D. Formulating a clinical question using the PICOT format.
Correct Answer: D
Rationale: The first step in evidence-based practice is to formulate a well-structured clinical question, often using the PICOT format, to guide research.
- A nurse leader is implementing a change based on Lewin’s Change Theory. Which of the following best represents the 'refreezing' stage?
A. Introducing a new electronic medical record system. B. Reinforcing training and providing support post-implementation. C. Communicating the need for the new system to staff.
D. Allowing staff to give feedback during the transition.
Correct Answer: B
Rationale: In Lewin’s Change Theory, 'refreezing' solidifies the change into the system by reinforcing behaviors and providing ongoing support.
- In developing a policy proposal to increase APRN autonomy in your state, which of the following would be the most effective advocacy strategy?
A. Posting opinions on social media. B. Holding internal hospital meetings. C. Collaborating with state nursing associations and legislators. D. Conducting private discussions with patients.
Correct Answer: C
Rationale: Policy advocacy is most effective through collaboration with established organizations and lawmakers to influence legislation and practice.
- Which nursing theorist emphasized the importance of the nurse-client relationship as central to nursing care?
A. Virginia Henderson
