Professional Nursing Concepts & Challenges 10th Edition Perry Black TEST BANK

Chapter 01: Nursing in Today’s Evolving Health Care Environment Black: Professional Nursing: Concepts and Challenges, 10th Edition

MULTIPLE CHOICE 1. Which of the following could eventually change the historical status of

nursing as a female-dominated profession? a. More men graduating from baccalaureate and higher degree

programs b. The proportion of men in nursing beginning to increase c. More male graduates of basic nursing programs entering the

workplace d. Salary compensation increasing to attract more men ANS: C

A

B C D

Feedback “More men graduating from baccalaureate and higher degree programs” is not the best answer because associate degree programs produce the majority of new graduates.

The percentage of men in nursing has increased 50% since 2000.

The more men who enter the workplace as nurses, the less nursing will be seen as a female-dominated profession.

Salary rates do not appear to relate to the recruitment of men into nursing.

PTS: 1

DIF: Cognitive Level: Comprehension

2. The racial and ethnic composition of the nursing profession will change to more accurately reflect the

population as a whole when a. the increased numbers of racial and ethnic minorities enrolled in educational programs graduate and begin to practice. b. the number of Asians or Native Hawaiian-Pacific Islanders begins to increase. c. the percentage of African American and Hispanic nurses decreases more than the percentage of White nurses. d. the non-White portion of the general population decreases.

ANS: A

A B

Feedback A larger percentage of minorities are enrolled in nursing educational programs than previously.

Asians and Native Hawaiian-Pacific Islanders are over represented in nursing compared to their percentage of the general population.

C

D

Not only would the percentage of African American and Hispanic nurses need to increase, the percentage of White nurses would have to decrease in order to more accurately reflect the population as a whole.

The non-White portion of the general population is not likely to decrease.

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DIF: Cognitive Level: Comprehension

3. Which of the following is a correct statement about the registered nurse (RN) population? a. The racial/ethnic composition of RNs closely resembles that of the general

population. b. The number of men entering nursing has decreased steadily over the last decade. c. The rate of aging of RNs has slowed for the first time in the past 30 years. d. The majority of employed RNs working full time must work a second position.

ANS: C

A B C D

Feedback The racial/ethnic composition of RNs is increasing, but does not approximate their percentage of the overall population.

The number of men entering nursing is increasing.

The average age of RNs in both 2004 and 2008 was 46.

The average age of BSN graduates is 25.

PTS: 1

DIF: Cognitive Level: Knowledge

4. Which of the following best describes trends in nursing education? a. 45% of nurses receive their degree from a university setting. b. Numbers of RNs with associate degrees are decreasing. c. Foreign-born nurses practicing in the United States are seen as less knowledgeable

because of their lesser educational preparation. d. Numbers of RNs with diploma educations are increasing.

ANS: A

A B C D

Feedback 45% of nurses report receiving their degree from a university setting.

The majority of nurses in this country get their initial nursing education in associate degree in nursing (ADN) programs.

Foreign-born nurses practicing in the United States may be viewed as less knowledgeable by their peers because of language and cultural differences.

The numbers of diploma-educated nurses are declining.

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DIF: Cognitive Level: Knowledge

5. Despite the variety of work settings available to the RN, data indicate that the primary work site for

RNs is a. ambulatory care settings. b. community health settings.

c. long-term care facilities. d. acute care hospitals.

ANS: D

A B C D

Feedback Ambulatory care settings account for about 10.5% of RNs’ places of employment.

Public health and community health settings account for 7.8% of employed RNs. Long-term care facilities account for 5.3% of RNs’ places of employment.

Statistics show that 63.2% of RNs work in acute care hospitals.

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DIF: Cognitive Level: Knowledge

6. One important advantage of clinical ladder programs for hospital-based RNs is that they a. allow career advancement for nurses who choose to remain at the bedside. b. encourage nurses to move into management positions in which they can influence

patient care on a broader scale. c. encourage RNs to become politically active and guide the profession of nursing. d. provide training to staff nurses so they can move seamlessly across departments.

ANS: A

A B C D

Feedback Clinical ladder programs allow nurses to advance professionally while remaining at the bedside.

Clinical ladder programs are designed to keep proficient nurses at the bedside.

Encouraging RNs to become politically active and guide the profession of nursing is not the goal of clinical ladder programs.

Clinical ladder programs are not designed to facilitate transfer between departments.

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DIF: Cognitive Level: Comprehension

7. Which of the following statements is correct about community health nursing (CHN)? a. Prevention and community education are the cornerstones of CHN. b. Nursing care is rapidly moving from the home setting to the institutional setting. c. High-tech care such as ventilators and total parenteral nutrition cannot be handled

in the home. d. Assessment skills are less important in CHN because patients are not acutely ill.

ANS: A

A B C

Feedback The community health nurse provides educational programs in health maintenance, disease prevention, nutrition, and child care.

Care is moving into the home setting.

Home care is increasing in complexity.

D

Community health nurses must have excellent assessment skills as they do not have the immediate backup that an acute care facility offers.

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DIF: Cognitive Level: Comprehension

8. Which of the following is true about occupational nurse roles? a. They must have the ability to work independently. b. They must have good interpersonal skills. c. They must be skilled at avoiding conflict. d. They must have a minimum of a bachelor’s degree in nursing.

ANS: B

A B C D

Feedback Occupational nurses must be able to work well independently, and with others.

Occupational nurses must have good interpersonal skills to be successful.

Occupational nurses must be able to manage conflict and stressful situations.

Occupational nurses may practice with an associates degree in nursing.

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DIF: Cognitive Level: Analysis

9. The major benefit of serving as a military nurse is a. broader responsibilities and scope of practice than civilian nurses. b. working with entirely baccalaureate-prepared peers on active duty. c. serving as an officer on active duty or in the reserves. d. the financial support to seek advanced degrees.

ANS: D

A B C D

Feedback Although military nurses do have broader responsibilities and scopes of practice than civilian nurses do, this is not the major benefit.

Although military nurses do work with entirely baccalaureate-prepared peers on active duty, this is not the major benefit.

Although military nurses serve as officers on active duty or in the reserves, this is not the major benefit.

Advanced education is supported by the military financially and also allows for promotion in rank at an accelerated pace.

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DIF: Cognitive Level: Comprehension

10. Which of the following statements explains why the school nurse of today is truly a community health

nurse? a. The school nurse may be called on to care for a student’s family members in underserved areas. b. The school nurse’s primary responsibility is centered on the well child. c. The school nurse’s primary responsibility is to maintain immunization records. d. The school nurse must be certified in CHN.

ANS: A

A B C D

Feedback In medically underserved areas a school nurse may be called on to care for members of a child’s immediate family.

Chronically ill, disabled, and physically challenged students are in regular classrooms.

School nurses detect developmental problems; counsel and educate children, parents, and teachers; and maintain immunization records.

Although school nurses are considered community health nurses, certification in community health is not required.

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DIF: Cognitive Level: Comprehension

11. What has been found about the outcomes of patients cared for in hospitals with a higher percentage of

BSN-prepared nurses as compared to patients in hospitals with a lower percentage of BSN-prepared nurses? a. Patient outcomes are more dependent on nurse-patient ratios. b. Outcomes were better in hospitals with more BSN-prepared nurses. c. Outcomes were similar in both types of hospitals. d. Medical patients had better outcomes, but surgical patients fared the same.

ANS: B

A

B C D

Feedback Nurse-patient ratio is an important determinant of patient care outcomes but has not been shown to be more or less important that the percentage of BSNprepared nurses providing direct patient care.

Research by Aiken et al. (2003) showed that patient outcomes were better in hospitals where higher percentages of BSN-prepared nurses were employed.

Research by Aiken et al. (2003) showed that patient outcomes were better in hospitals where higher percentages of BSN-prepared nurses were employed.

Aiken et al. (2003) studied orthopedic, general surgical, and vascular surgery patients and found the outcomes were improved for these patients in hospitals with a higher percentage of BSN-prepared nurses.

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DIF: Cognitive Level: Knowledge

12. Faith community nursing (FCN) was founded on which of the following premises? a. Nurses’ faith beliefs do not play a part in healing. b. The spiritual aspect takes precedence over the physical body in healing. c. Spiritual health is central to a person’s well-being. d. Faith community nurses must receive formal training as a minister or clergy.

ANS: C

Feedback

A B C D

The nurse’s spiritual journey is believed to be an essential aspect of this nursing role.

Patients are treated holistically under FCN. FCN is based on the belief that spiritual health is central to well-being.

Faith community nurses do not need to have formal training as ministers.

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DIF: Cognitive Level: Comprehension

13. One important advantage of the evolution of nursing informatics is that a. it allows any RN to become a certified informatics nurse. b. informatics nurses are best able to design systems with the needs and skills of

nurses who use them in mind. c. informatics nurses will reduce the need for direct caregivers to document care. d. benefits of informatics advancements include improved patient safety and

increased variability of care.

ANS: B

A

B C D

Feedback Although all nurses may use informatics, a nurse specializing in informatics should have a BSN and additional knowledge and experience in the field of informatics.

Informatics nurses understand how the information needs to be used and how to make the systems work for the nurses.

Direct caregivers will still need to document the care provided.

Benefits do include improved patient safety, but decreased variability of care is expected with informatics systems.

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DIF: Cognitive Level: Comprehension

14. Which of the following nursing roles is not considered an advanced practice role? a. Certified nurse-midwife (CNM) b. Community health nurse c. Certified nurse practitioner (CNP) d. Clinical nurse specialist (CNS) ANS: B

A B C D

Feedback A CNM is an advanced practice role.

The community health nurse is not an advanced practice role.

CNP is an advanced practice role.

CNS is an advanced practice role.

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DIF: Cognitive Level: Comprehension

15. NPs are advanced practice nurses who a. are required to have physician collaboration or supervision.

b. function under a set of universal advanced practitioner laws. c. cannot receive direct reimbursement for their services. d. can diagnose and treat common and chronic conditions.

ANS: D

A

B

C

D

Feedback The laws governing the practice of NPs vary from state to state, including the degree of supervision required and how they may be reimbursed for their services.

The laws governing the practice of NPs vary from state to state, including the degree of supervision required and how they may be reimbursed for their services.

The laws governing the practice of NPs vary from state to state, including the degree of supervision required and how they may be reimbursed for their services.

NPs are prepared to handle a wide range of basic health problems.

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DIF: Cognitive Level: Comprehension

16. The clinical nurse leader (CNL) is a recently proposed role. The responsibilities of the person in this

role include which of the following? a. Oversee and manage care delivery in specific settings. b. Manage and streamline operations in multiple nursing units. c. Replace the outdated CNS role. d. Provide daily care to a specific subset of patients with similar needs.

ANS: A

A

B C D

Feedback The CNL role is intended to provide the highest quality of nursing care by having master’s-prepared nurses involved in the care of a distinct group of patients.

The CNL role was not intended as a managerial or administrative role.

The CNS role is not outdated, and some controversy exists because some CNSs view this new role as possibly disenfranchising them.

CNLs may on occasion provide direct patient care, but not on a daily basis.

PTS: 1

DIF: Cognitive Level: Knowledge

MULTIPLE RESPONSE 1. Hospice and palliative care nursing is a rapidly developing specialty in nursing. Which facts have

contributed to this growth? (Select all that apply.) a. End-of-life care is largely the responsibility of nurses. b. End-of-life needs are expected to increase with the aging population. c. Nursing curricula have prepared nurses to deal effectively with dying patients and their families.

d. Palliative care is a new focus of advanced practice nurses. e. Hospice and palliative care nurses work in a variety of settings.

ANS: A, B, E Feedback Correct

Incorrect

“End-of-life care is largely the responsibility of nurses” is correct because palliative care reflects the holistic philosophy of nursing, and comfort and relief have always been nursing responsibilities. “End-of-life needs are expected to increase with the aging population” is correct because as the population ages there will be a greater demand for end-of-life care as the number of individuals needing care increases. “Hospice and palliative care nurses work in a variety of settings” is correct because palliative care takes place in hospitals, homes, hospices, skilled nursing homes, etc.

“Nursing curricula have prepared nurses to deal effectively with dying patients and their families” is incorrect because nursing educational programs have not prepared nurses well as the content related to end-oflife issues and palliative care has been limited. “Palliative care is a new focus of advanced practice nurses” is incorrect because palliative care has been a focus of many nurses, not just advanced practice nurses.

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DIF: Cognitive Level: Comprehension

2. The Clinical Nurse Specialist (CNS) may (Select all that apply.) a. manage an inpatient nursing unit. b. develop educational programs for nursing staff. c. conduct practice outcomes research. d. prescribe medications for common illnesses. e. attend or assist in the delivery of low-risk newborns.

ANS: A, B, C Feedback Correct Incorrect

CNSs are prepared with an advanced nursing degree and the skills to function in a variety of settings and functional roles.

CNSs do not have prescribing authority. CNMs attend or assist at the delivery of low-risk newborns.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 02: The History and Social Context of Nursing Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Which early nursing leader founded the first training school for nurses that would later become a

model for early nursing education? a. Dorothea Dix b. Florence Nightingale

c. Clara Barton d. Mary Ann Bickerdyke ANS: B

A

B

C D

Feedback Dorothea Dix is best known as an advocate for the mentally ill, and she created a brief training program at two New York hospitals for women who wished to serve as nurses in the Civil War. Florence Nightingale founded the first training school for nurses at St. Thomas’s Hospital in London in 1806. This became the model for nursing education in the United States.

Clara Barton is known for founding the American Red Cross.

Mary Ann Bickerdyke is best known for nursing services during the Civil War.

PTS: 1

DIF: Cognitive Level: Knowledge

2. Who was the first educated African American professional nurse? a. Linda Richards b. Phoebe Pember c. Sojourner Truth d. Mary Eliza Mahoney ANS: D

A B C D

Feedback Linda Richards was the first trained nurse in the United States.

Phoebe Pember was one of the first women placed in charge of a hospital.

Sojourner Truth was a famous abolitionist who served as a nurse for the Union forces in the Civil War. Mary Eliza Mahoney was the first African American professional nurse; she was educated at the New England Hospital for Women and Children.

PTS: 1

DIF: Cognitive Level: Knowledge

3. To which early nursing leader is attributed the founding of the American Red Cross? a. Clara Barton b. Dorothea Dix c. Florence Nightingale d. Lavinia Lloyd Dock ANS: A

A B C

Feedback Founding the American Red Cross is attributed to Clara Barton.

Dorothea Dix was superintendent of women nurses of the Union Army.

Florence Nightingale was an English pioneer in nursing.

D

Lavinia Lloyd Dock was influential in forming the National League for Nursing (NLN).

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DIF: Cognitive Level: Knowledge

4. What were some of the application requirements of nursing education programs in the 1900s? a. Male, intelligent, strong b. Female, sensitive, subservient c. Female, docile, from poor background d. Male, high breeding, independent ANS: B

A B C D

Feedback Men were not thought to be sensitive enough for nursing.

Sensitivity, breeding, intelligence, ladylike behavior, and submission to authority were highly desired personal traits for nursing students.

High breeding was desirable for nursing education program applicants.

Men were not desired nursing education program applicants.

PTS: 1

DIF: Cognitive Level: Knowledge

5. Which of the following statements best describes how the Chicago World’s Fair of 1893 became a

pivotal point in the history of nursing education in the United States? a. Florence Nightingale’s work on sanitation and its relationship to mortality rates was finally recognized. b. The organization today known as the NLN was formed to address issues in nursing education. c. The American Nurses Association (ANA) was formed to oversee nursing education in the United States. d. The International Council of Nurses (ICN) was formed to enhance collaboration between practicing nurses and educators.

ANS: B

A B C D

Feedback Florence Nightingale’s paper was on scientific training of nurses.

Several influential nursing leaders met at the Chicago World’s Fair and started the National League for Nursing Education—the precursor to the NLN. The NLN, not the ANA, was formed to oversee nursing education in the United States.

The ICN was not founded until 1899 and is not involved in U.S. education of nurses.

PTS: 1

DIF: Cognitive Level: Comprehension

6. Which early nursing organization is credited with first recommending state registration for nurses? a. ICN

b. NLN c. ANA d. National Association of Colored Graduate Nurses ANS: A

A B C D

Feedback The ICN was formed to unite all nursing organizations. The topic of the first meeting was registration for nurses by each country and state.

The NLN was formed to oversee nursing education in the United States.

The ANA was formed to enhance collaboration between practicing nurses and educators.

The National Association of Colored Graduate Nurses was formed to develop leadership among African American nurses.

PTS: 1

DIF: Cognitive Level: Knowledge

7. Which of the following nursing leaders, because of her work in the Henry Street Settlement, is

considered the founder of public health nursing? a. Margaret Sanger b. Clara Barton c. Lillian Wald d. Lavinia Lloyd Dock ANS: C

A B C D

Feedback Margaret Sanger is known for her work on birth control with immigrant women from the Lower East Side of New York City.

Clara Barton founded the American Red Cross.

Lillian Wald founded the Henry Street Settlement, the first formalized public health nursing project.

Lavinia Lloyd Dock was instrumental in the formation of the NLN.

PTS: 1

DIF: Cognitive Level: Knowledge

8. Despite the caring efforts of early public health nurses in the Henry Street Settlement, racial disparity

left many people underserved. Which of the following African American public health nurses was instrumental in providing excellent nursing care to underserved families despite these social challenges? a. Jessie Sleet Scales b. Margaret Sanger c. Lavinia Lloyd Dock d. Anita M. McGee ANS: A

Feedback

A B C D

Jessie Sleet Scales established the Stillman House, a part of the Henry Street Settlement that provided care to African Americans.

Margaret Sanger worked to provide immigrant women on the Lower East Side of New York City with birth control information.

Lavinia Lloyd Dock founded the NLN. Anita M. McGee was a physician appointed as head of the Hospital Corps, who recruited nurses for the Spanish-American War of 1898.

PTS: 1

DIF: Cognitive Level: Comprehension

9. Which one of the following events occurring during the first decade of the 20th century brought

sweeping changes to nursing? a. It was required that all practicing nurses be licensed. b. Permissive licensing laws allowed registered nurses (RNs) to practice without a license if they registered with the state. c. All states required a standardized licensing examination. d. Nurses had to pass a licensing examination to use the title RN. ANS: D

A B C D

Feedback Practicing nurses did not have to be licensed but could not use the title RN. Permissive licensing laws required all nurses using the title RN to be licensed.

Licensing examinations were not standardized until 1950.

Licensure laws were passed that required all people using the title of RN to be licensed.

PTS: 1

DIF: Cognitive Level: Comprehension

10. What was the most significant impact on the profession of nursing made by Mary Breckenridge in her

role as a frontier nurse? a. She demonstrated that nurses could provide primary care in rural settings. b. She demonstrated that female nurses could protect themselves in unsettled rural environments. c. She demonstrated that nurses were capable of teaching new mothers to care for babies. d. She demonstrated that nurses could provide care to many clients despite geographic boundaries.

ANS: A

A

B C

Feedback Mary Breckenridge established frontier nursing services. She provided primary care to women and babies and demonstrated that nurses could provide primary care.

Safety was not the primary impact of the success of frontier nursing.

Although she was a nurse-midwife, this was not the most significant impact.

D

Demonstrating that nurses could provide care to many clients despite geographic boundaries was not the most significant impact made by Mary Breckenridge.

PTS: 1

DIF: Cognitive Level: Comprehension

11. Which of the following trends in health care delivery that began in the second half of the 20th century

continues today? a. Widespread use of team nursing to address the nursing shortage b. Massive movement of nurses out of acute care and into home care c. Advent of primary care to replace specialized care d. Provision of care to the poor, elderly, and disabled through Medicare and Medicaid ANS: D

A B C D

Feedback Team nursing is rarely used today.

More nurses work in acute care today than in home care.

After World War II, specialization became popular.

Two amendments to the Social Security Act in 1965 designed to ensure access to health care for elderly, poor, and disabled Americans were the establishment of Medicare and Medicaid.

PTS: 1

DIF: Cognitive Level: Comprehension

12. A recent trend in nursing has been an increase in the number of men and women with degrees in other

fields or other careers applying to nursing programs. What is the single most important reason for this trend? a. Nursing as a career has gained increased status and prestige. b. Nursing salaries have outpaced many other fields. c. A nursing career provides both job security and meaningful employment. d. Working conditions in nursing have improved.

ANS: C

A B C

D

Feedback While true, nursing’s increased status and prestige is not a significant factor in the trend of people choosing it as a second career.

Salary is not a major factor.

The current appeal to men and women with degrees in other fields is that nursing can provide job opportunities, economic security, and the opportunity to help others.

Working conditions are not identified as a reason for choosing a second career in nursing.

PTS: 1

DIF: Cognitive Level: Knowledge

13. What specialty of nursing was considered well suited for men at a time when other areas were

excluding men from practicing?

a. b. c. d.

Obstetric nursing Pediatric nursing Psychiatric nursing Nurse educator

ANS: C

A B C D

Feedback Obstetric nursing was not considered an appropriate area for men in nursing.

Pediatric nursing was not considered an appropriate area for men in nursing.

Psychiatric nursing was considered well suited for men because it required physical stamina and strength.

Education was not a specialty considered well suited for men in nursing.

PTS: 1

DIF: Cognitive Level: Knowledge

14. When surveyed, what is the primary reason given by men for entering nursing? a. To make a difference b. High salaries c. Flexible schedules d. Opportunity for travel ANS: A

A B C D

Feedback Men who want to make a difference in peoples’ lives find nursing an appealing career choice.

Economic and job security are important factors for men entering nursing, but more significant is the opportunity to make a difference in peoples’ lives.

Flexible schedules, where provided, are an attractive incentive for employment, but that is not as significant as being able to make a difference in peoples’ lives.

Opportunity for travel is available for travel and military nurses, otherwise it is not an important aspect of nursing as a career.

PTS: 1

DIF: Cognitive Level: Knowledge

15. What was the purpose of the Hill-Burton Act? a. It established funding for the construction of hospitals. b. It provided women in the service with military rank. c. It established and funded the Frontier Nursing Service. d. It created the Cadet Nurse Corps.

ANS: A

A B C

Feedback The 1946 Hill-Burton Act provided funding for the construction of hospitals.

Congress passed a bill in 1920 that allowed women to hold military rank.

The Frontier Nursing Service, originally known as the Kentucky Committee for Mothers and Babies, was established by Mary Breckinridge.

D

The Cadet Nurse Corps was an alliance between military and collegiate nursing programs to train nurses and was funded by Congress.

PTS: 1

DIF: Cognitive Level: Knowledge

16. When surveyed, which profession was chosen by the general public as highest in honesty and ethics? a. Physician b. Pharmacist c. Nurse d. Attorney ANS: C

A B C D

Feedback Physicians were not ranked over nurses.

Pharmacists were not ranked over nurses.

Gallup polls from 1999 to 2010 rated nursing as the top profession in honesty and ethics.

Attorneys were not ranked over nurses in honesty and ethics.

PTS: 1

DIF: Cognitive Level: Knowledge

17. In 2002 which major American corporation partnered with nursing to design a media campaign to

promote the image of nursing? a. Johnson & Johnson b. Baxter c. Microsoft d. Wal-Mart ANS: A

A

B C D

Feedback In 2003 Johnson & Johnson began a $20 million campaign—Campaign for Nursing’s Future—to enhance the image of nursing, to recruit new nurses and educators, and to retain nurses.

Baxter did not launch a media campaign to promote the image of nursing.

Microsoft did not launch a media campaign to promote the image of nursing.

Wal-Mart did not launch a media campaign to promote the image of nursing.

PTS: 1

DIF: Cognitive Level: Knowledge

18. A shift in population growth is expected to place stress on nursing resources. Which age-group is

expected to experience the greatest population growth in the next decade? a. Older than 85 years of age b. 75 to 85 years of age c. 35 to 65 years of age d. 18 to 35 years of age ANS: A

A B C D

Feedback People older than 85 years, known as the “very old,” represent the fastestgrowing segment of the total population.

Although the 75 to 85 age-group is growing, it is not the fastest-growing segment of the population.

The group of individuals 35 to 65 years of age is not expected to grow as dramatically as is the group termed “very old.”

The 18 to 35 age-group is not expected to be the fastest-growing segment of the population in the next decade.

PTS: 1

DIF: Cognitive Level: Knowledge

19. Which of the following was an unsuccessful attempt by the American Medical Association (AMA) to

alleviate the nursing shortage of the time? a. Creation of the nurse manager position b. Creation of the registered care technician c. Recruitment of RNs from English-speaking countries d. Redistribution of qualified nurses to certain geographic locations ANS: B

A B C D

Feedback The nurse manager position was not created by the AMA. In response to the nursing shortage in the late 1980s, the AMA proposed a nurse extender called the registered care technician.

The recruitment of foreign nurses was not a proposal of the AMA. Travel nursing was not a proposal of the AMA.

PTS: 1

DIF: Cognitive Level: Knowledge

20. The first trained nurse in the United States graduated in 1873 and later became the supervisor of the

Boston Training School. Who was this nurse? a. Mary Ann Bickerdyke b. Dorothea Dix c. Linda Richards d. Sallie Thompkins ANS: C

A B

Feedback Mary Ann Bickerdyke was an uneducated widow who organized the camp hospital in Cairo, Illinois, during the Civil War. Dorothea Dix, a well-known advocate for the mentally ill, was instrumental in creating a month-long training program in two New York hospitals to train women wishing to serve in the Civil War.

C

D

In 1872 Linda Richards became the first student to enroll in the inaugural class of five students in the first American nurses’ training school run by Dr. Susan Dimock. She graduated 1 year later.

Sallie Thompkins established a hospital in Richmond, Virginia, and was commissioned a “captain of Cavalry, unassigned” by Confederate President Jefferson Davis.

PTS: 1

DIF: Cognitive Level: Knowledge

21. During the Great Depression, staffing of hospitals changed with an impact lasting to the current day.

What was this change? a. The employment of graduate nurses in hospitals b. The need for increased private duty nurses and rural health nurses decreased the number of nurses seeking employment in hospitals c. The opening of more schools of nursing in hospitals d. The increased number of collegiate schools of nursing, which allowed hospitals to increase the educational requirements for the staff ANS: A

A

B

C D

Feedback Hospitals were forced to close their schools of nursing; families were no longer able to afford private duty nurses in their homes; and hospitals hired the unemployed graduate nurses to care for the increased numbers of patients seeking care in hospitals.

Although there was a need for nurses in rural areas supported by the Civil Works Administration, the number of private duty nurses decreased due to the inability of families to afford them.

For economical reasons, hospitals could not afford to fund schools of nursing.

Although the number of collegiate schools increased, most nurses in hospitals were prepared in diploma programs.

PTS: 1

DIF: Cognitive Level: Comprehension

22. What was the most important influence of war on nursing? a. It allowed for the development of hospitals. b. Nurses were able to perform medical procedures during war. c. Improved medical care increased soldiers’ survival rates. d. It provided for the creation of new technology to make work easier.

ANS: B

A B

Feedback Wars allowed nurses to stretch the boundaries of their profession. Nurses have led the way in furthering their discipline by responding to needs during wartime.

Wars allowed nurses to stretch the boundaries of their profession. Nurses have led the way in furthering their discipline by responding to needs during wartime.

C D

Wars allowed nurses to stretch the boundaries of their profession. Nurses have led the way in furthering their discipline by responding to needs during wartime.

Wars allowed nurses to stretch the boundaries of their profession. Nurses have led the way in furthering their discipline by responding to needs during wartime.

PTS: 1

DIF: Cognitive Level: Comprehension

23. Florence Nightingale is often credited as being the first nurse researcher. This designation is based on a. her methods of reorganizing British hospitals. b. her use of data on the morbidity and mortality of soldiers in hospitals in Scutari. c. demonstration that trained nurses provided better nursing care. d. publication of Notes on Nursing, the first scholarly nursing publication.

ANS: B

A

B C D

Feedback Although Nightingale reformed both the British Army and British civilian hospitals on the basis of data she collected, the reformations were not researched.

Nightingale was educated in statistics and used the detailed data collected to effectively argue the case for the reform of the British Army hospital system.

Nightingale founded the first training school after she had gained fame based on the hospital reforms supported by her data collection during the Crimean War. The publication reflected Nightingale’s philosophical thoughts on nursing.

PTS: 1

DIF: Cognitive Level: Comprehension

24. The nursing profession is responsible for improving its own image. The most effective avenue for

changing the image of nursing is to a. write letters expressing concerns to those responsible for negative images on television and in films. b. have nurses as consultants to the media to ensure that the media producers have accurate information about nursing. c. have nurses appear and behave professionally and explain what nurses do in each patient interaction. d. support the Johnson & Johnson campaign by distributing their information about nursing to students interested in nursing.

ANS: C

A B C

Feedback While appropriate, writing letters to professionals in television and film is not the most effective avenue for changing the image of nursing.

While appropriate, having nursing consultants to the media is not the most effective avenue for changing the image of nursing.

The major avenue for changing the image of nursing occurs one nurse-patient encounter at a time, where nurses look and behave professionally and demonstrate what it is nurses do.

D

While supporting Johnson & Johnson’s Campaign for Nursing’s Future is appropriate, it is not the most effective avenue for changing the image of nursing.

PTS: 1

DIF: Cognitive Level: Application

25. The diversity of the population entering the health care system is a challenge for nurses because a. the portion of minorities in nursing is greater than the portion of minorities in the

general population. b. educators are culturally competent leaders for nurses and students. c. lessons about culture and cultural differences are not part of progressive education

programs. d. ethnic minority nurses do not yet meet the same proportions in the profession as in

the general population.

ANS: D

A B

C

D

Feedback Only 12% of nurses are minorities, but approximately 31% of the general population is identified as a minority.

Managers, educators, and other nursing leaders will require training so they can be culturally competent leaders for nurses and students who may have backgrounds different from their own.

Culture and cultural differences are part of progressive education programs.

However, understanding of health and illness in the context of cultural heritage is not consistently addressed in the health care system.

Minority nurses are underrepresented in nursing. This might make it difficult for patients who identify as ethnic minorities to feel comfortable or confident with the health care system.

PTS: 1

DIF: Cognitive Level: Comprehension

26. Biomedical technology involves the use of complex machines or devices in patient care situations.

Because of the highly technological environment in which nurses work, it is important that nurses a. assume total responsibility for monitoring data generated by these devices. b. use human touch and words of reassurance frequently to convey caring. c. maintain the device’s safety by assuring routine assessment by physicians. d. be careful not to frighten the patient and family with information about the device.

ANS: B

A B

Feedback The monitoring and safety of machines and devices are most often the responsibility of nurses and technicians.

The use of technology needs to be combined with caring to maintain patient and family satisfaction. Technology must never take the place of human-to-human contact.

C D

The monitoring and safety of machines and devices are most often the responsibility of nurses and technicians.

The patient and family need information about the use of the device, as well as the meaning of the information produced, to decrease stress and anxiety.

PTS: 1

DIF: Cognitive Level: Application

27. Margaret Sanger, as a nurse and activist, worked on the Lower East Side of New York City in the early

1900s with immigrant women. What was the focus of her work? a. Sanitation to prevent disease transmission b. Health education for children c. Providing nursing care to underserved African American families d. Safe contraception and family planning for women ANS: D

A

B

C

D

Feedback Sanitation to prevent disease transmission may have been part of her work in her early years, but Sanger devoted her life to the birth control movement and became a national figure in that cause.

Health education for children may have been part of her work in her early years, but Sanger devoted her life to the birth control movement and became a national figure in that cause.

Providing nursing care to underserved African American families may have been part of her work in her early years, but Sanger devoted her life to the birth control movement and became a national figure in that cause.

Margaret Sanger, inspired by the death of an immigrant woman from a selfattempted abortion, became determined to teach women about birth control.

PTS: 1

DIF: Cognitive Level: Knowledge

MULTIPLE RESPONSE 1. Nursing practices during the Civil War advanced the cause of professional nursing. The move toward

formal education and training was supported by (Select all that apply.) a. endorsement by the Catholic nursing orders (Sisters of Charity, Sisters of Mercy, and Sisters of the Holy Cross). b. a proposal by Dr. Samuel Gross in 1869 that large hospitals develop training schools for nurses. c. reports of inadequate conditions in hospitals reported by social reformers after the Civil War. d. lobbying by the United States Sanitary Commission for the creation of nursing schools. e. the appointment of Dorothea Dix as Superintendent of Women Nurses of the (Union) Army.

ANS: B, C, D, E

Feedback Correct

Incorrect

The proposal by Dr. Samuel Gross in 1869 that large hospitals develop training schools for nurses; reports of inadequate conditions in hospitals reported by social reformers after the Civil War; and lobbying by the United States Sanitary Commission for the creation of nursing schools all led toward formal education and training for nursing practices. Support for the development of schools to train nurses was given by physicians who had observed the difference training made in hospitals during the war, as well as by the United States Sanitary Commission. Social reformation that started before the Civil War identified the shocking conditions in hospitals. Dorothea Dix created a month-long training program for women who wished to serve as nurses in the Civil War. “Endorsement by the Catholic nursing orders (Sisters of Charity, Sisters of Mercy, and Sisters of the Holy Cross)” is incorrect because, although the Catholic nursing orders provided significant organized nursing care during the war, even they did not develop formal education programs until later.

PTS: 1

DIF: Cognitive Level: Comprehension

2. Historically, one solution that attempted to correct the shortage of RNs was to increase the supply of

nurses. Means of increasing the supply of nurses included (Select all that apply.) a. implementation of team nursing. b. use of “traveling nurses.” c. development of associate degree programs. d. importation of nurses from English-speaking countries. e. use of registered care technicians.

ANS: B, C, D Feedback Correct

Incorrect

“Use of traveling nurses,” “development of associate degree programs,” and “importation of nurses from English-speaking countries” are correct because all have been used to increase the numbers of practicing nurses.

“Implementation of team nursing” is incorrect because although the implementation of team nursing was intended to improve nurse availability, it did not increase the number of nurses. Registered care technicians were “nurse extenders” proposed by the AMA to ease the shortage, but this solution was quickly defeated.

PTS: 1

DIF: Cognitive Level: Comprehension

3. Provisions of the Affordable Care Act include (Select all that apply.) a. lifetime limits of catastrophic care insurance will cover. b. children up to age 26 being allowed to stay on parents’ insurance. c. disallowing denial of coverage for children and teens’ preexisting conditions. d. the right to appeal coverage decisions. e. recommended preventative services without out-of-pocket cost to consumers.

ANS: B, C, D, E

Feedback Correct

Incorrect

Provisions of the Affordable Care Act include no lifetime limits on insurance coverage, allowing children up to age 26 to stay on their parents’ insurance plan, banning the practice of denying coverage for children and teens with preexisting conditions, and a recommendation for preventative services to be covered with no out-of-pocket cost for the consumer.

The Affordable Care Act does not place lifetime limits on covering catastrophic care.

PTS: 1

DIF: Cognitive Level: Knowledge

4. Which is true regarding the Woodhull Study on Nursing? (Select all that apply.) a. This was a study on nursing on social media. b. The study represented the perception of diploma nurses. c. The study focused on 20,000 printed articles. d. 17 students and 3 faculty members ran the study.

ANS: C, D Feedback Correct

Incorrect

The study focused on 20,000 printed articles regarding nurses and the nursing profession. The study was conducted by 17 students and 3 faculty members.

The study focused on printed media. The study focused on the perception of all nurses.

PTS: 1

DIF: Cognitive Level: Knowledge

Chapter 03: Nursing’s Pathway to Professionalism Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Which of the following was recognized earliest as a true profession? a. Physic b. Teaching c. Social work d. Engineering ANS: A

A B C D

Feedback Historically only physic (medicine), law, and the divinity were accepted as professions.

Teaching was not accepted as an early profession.

Social work was not accepted as an early profession.

Engineering was not accepted as an early profession.

PTS: 1

DIF: Cognitive Level: Knowledge

2. Which of the following characteristics of a profession were listed in Flexner’s work on professions? a. Activities of professions are more physically than intellectually oriented. b. Activities of professions are based on their own body of knowledge. c. Beliefs of professions are more theoretical than practical. d. Beliefs and traditions are handed down from generation to generation.

ANS: B

A B C D

Feedback Flexner actually lists intellectual as opposed to physical activities.

Flexner’s characteristics of professions list a body of knowledge that can be learned. It is refreshed and refined through research.

Flexner lists practical as well as theoretical beliefs.

Flexner stressed that in professions, information is taught through a process of highly specialized professional education.

PTS: 1

DIF: Cognitive Level: Comprehension

3. Similarities exist between various ideas about what constitutes a profession. Which of the following is

believed to be a characteristic of a profession? a. Members have autonomy. b. Members are trained on the job. c. Members are motivated primarily by financial reward. d. The group lacks a code of ethics.

ANS: A

A B C D

Feedback A review of the literature on characteristics of a profession yielded these similarities: service/altruism, specialized knowledge, and autonomy/ethics.

Specialized formal education is required.

Members are motivated by altruism.

Ethics or a code of ethics is a characteristic of professions.

PTS: 1

DIF: Cognitive Level: Knowledge

4. Which of the following best describes the difference between an occupation and a profession? a. A profession requires a duty to serve. b. A profession is defined by members’ average income. c. In a profession, action is based on intuition. d. In a profession, knowledge is handed down from generation to generation.

ANS: A

Feedback

A

B C D

“Profession” is defined as a duty, vocation, or form of employment that provides a needed service to society and possesses characteristics of expertise, autonomy, long academic preparation, commitment, and responsibility.

Average income does not determine the difference between an occupation and a profession.

In a profession, action is based on long academic preparation, a body of knowledge, and instruction in techniques of the profession, not on intuition.

Knowledge is transferred in formal academic preparation, not handed down.

PTS: 1

DIF: Cognitive Level: Comprehension

5. According to the nurse’s Code of Ethics, the hallmark of nursing practice is a. autonomy. b. accountability. c. evidence-based practice. d. altruism.

ANS: B

A B

C D

Feedback Nurses do not have complete autonomy but work with other disciplines.

Individual accountability has become the hallmark of practice. Provision 4 of the Code of Ethics states, “The nurse is responsible and accountable for individual practice.”

Evidence-based practice is relatively new to nursing.

Although important to nursing, altruism is not the hallmark of nursing practice according to the Code of Ethics.

PTS: 1

DIF: Cognitive Level: Comprehension

6. The document that provides professional standards and a framework for professional decision-making

that ensures decisions are made with the highest integrity is the a. Nurse Practice Act. b. Code of Ethics. c. Nursing’s Social Policy Statement. d. bylaws of the American Nurses Association (ANA).

ANS: B

A B C D

Feedback The Nurse Practice Act defines the legal scope of practice.

The Code of Ethics in nursing guides decisions and the conduct of practitioners.

Nursing’s Social Policy Statement describes the responsibilities of nurses toward society.

Bylaws of the ANA guide the processes of the organization.

PTS: 1

DIF: Cognitive Level: Comprehension

7. A component that separates occupations from professions is commitment. Which of the following is

the best way that nurses can show commitment to each other? a. Reporting substandard practice by unlicensed personnel b. Reading the professional literature c. Mentoring nursing students and novice nurses d. Making a financial donation to a professional organization ANS: C

A B C D

Feedback Reporting substandard practice is not the best example of commitment to each other.

Reading the literature does not involve mentoring or disseminating knowledge to others.

Nurses show commitment to the profession by mentoring others entering the profession.

Donating to a professional organization is less effective than serving as an active member of the organization and disseminating knowledge through active participation.

PTS: 1

DIF: Cognitive Level: Application

8. The nursing profession has experienced barriers to professionalism. Which of the following is the

primary current barrier to nursing’s professionalism? a. Too many men in nursing b. Unquestioning obedience to doctors c. Limitations placed on practice by state legislators d. Variability of educational backgrounds of nurses ANS: D

A B C D

Feedback Although increasing, the number of men in nursing is low.

Unquestioning obedience is not a current behavior.

Currently, nurse practice acts are broader than ever before.

No other profession allows entry into practice at less than the baccalaureate level. In fact, many professions require postgraduate preparation for beginning professional practice.

PTS: 1

DIF: Cognitive Level: Comprehension

9. The process of professionalization of an occupation typically follows a pattern of developmental

stages. One of the stages is collective identity. Which of the following is an example of collective identity? a. Legal right to practice profession to protect unique skills from outsiders b. Apprenticeship programs to develop skills c. A loose association of practitioners d. Definition of the profession’s mission related to full-time work

ANS: A

A B C D

Feedback Professions will be defined legally to determine who can use the skills practiced by their members.

Professions have a formal educational process for all members.

Professions have very organized associations for their members that may set standards for practice.

To practice a profession, the work does not need to be full time only.

PTS: 1

DIF: Cognitive Level: Comprehension

10. Preparation is a component that separates occupations from professions. Which of the following is the

best way that a nurse demonstrates preparation for the profession? a. Improves nursing practice through the use of trial-and-error methods. b. Focuses on the skills needed for the practice setting. c. Articulates the values of caring and compassion in patient-centered care. d. Utilizes textbooks from college to support practice 5 years after graduation.

ANS: C

A B C

D

Feedback Professional preparation enables practitioners to act in a logical, rational manner rather than relying on intuition, tradition, or trial and error.

The preparation includes more than just practice skills.

Preparation for a profession includes more than the acquisition of knowledge and skills. Preparation includes the orientation to the beliefs, values, and attitudes expected of members of the profession.

Professions have an ever-expanding base of knowledge, which means practitioners need to use the most current information to inform practice decisions.

PTS: 1

DIF: Cognitive Level: Application

11. A barrier to professionalism attributed to nursing’s roots in altruism is illustrated when a nurse a. questions a medication order written by the physician. b. takes the time to listen to a patient’s fears about surgery. c. needs to seek approval from charge nurse to give a PRN medication. d. feels guilty for expecting to be paid well for work.

ANS: D

A B C

Feedback The nurse is serving as a patient advocate by questioning the order if it is unclear; unquestioningly following the order would violate the patient’s trust.

Listening to patients’ concerns is an important aspect of nursing.

The nurse is an independent practitioner and does not require permission to provide nursing care.

D

As with other helping professions practitioners, the value of altruism frequently makes nurses feel guilty or greedy for expecting compensation for the complex and demanding work they do.

PTS: 1

DIF: Cognitive Level: Application

12. A major challenge to full autonomy for nurses is/are a. state nurse practice acts. b. lobbyists for the American Medical Association (AMA) and hospital associations. c. the status of nurses in hospital hierarchy. d. the view of physicians as the gatekeepers in health care.

ANS: B

A

B

C D

Feedback Although nurse practice acts in many states reinforce nursing’s tenuous selfdetermination by requiring that nurses perform certain actions only when authorized by supervising physicians or hospital protocols, they are not the major challenge.

Historically at least three groups have attempted to control nursing practice, organized medicine, and health service administration, as well as organized nursing. However, both the medical profession and health services administration have attempted to control nursing because they believed it was in their best interest to keep nurses dependent on them.

Although status within the hospital may influence autonomy of practice, it is not the major challenge.

Although physician supervision or authorization is required before certain activities can occur, this is not the major challenge to nursing autonomy.

PTS: 1

DIF: Cognitive Level: Knowledge

13. One of the characteristics of a profession identified by Kelly was “there is an organization

(association) that encourages and supports high standards of practice.” Which of the following illustrates a concern for nursing meeting this characteristic? a. The ANA has existed for more than 100 years. b. Nursing specialty organizations have greater power to influence practice than a more general nursing organization. c. The membership of the ANA is less than 10% of all nurses. d. The purpose of the ANA does not address the economic and general welfare of nurses.

ANS: C

A B

Feedback Although the ANA has existed since 1896, the longevity of the organization does not assure the development of standards of practice.

Although specialty organizations may influence practice in specialty areas, the ANA addresses the needs of all nurses regardless of area of practice.

C D

Fewer than 1 in 10 nurses belong to the ANA, the official voice of nursing.

The ANA has a clear focus on the economic and general welfare of nurses historically.

PTS: 1

DIF: Cognitive Level: Comprehension

MULTIPLE RESPONSE 1. Scholars have defined “profession” through the years. Which of the following were identified as

common major characteristics according to scholars? (Select all that apply.) a. It is based on a body of knowledge that can be learned. b. It has a service orientation. c. Practice is in a single recognized setting. d. Professionals control their own practice and settings. e. Skills can be learned in a variety of settings, including through job training.

ANS: A, B, D Feedback Correct

Incorrect

“Based on a body of knowledge that can be learned,” “has a service orientation,” and “professionals control their own practice” are correct as these characteristics were identified by Flexner, Hall, and others.

“Professionals control their own practice and settings” is incorrect because a profession is not always practiced in a single setting. For example, nursing may be practiced in organized health settings, as well as in the home and community where the nurse has little, if any, control over the setting. The education and skills needed to learn a profession come from an institution of higher education.

PTS: 1

DIF: Cognitive Level: Comprehension

2. An important aspect of professionalism is collegiality. Which of the following demonstrates

collegiality? (Select all that apply.) a. Assisting a nurse researcher with data collection related to measuring stress levels in hospitalized children b. Reporting a nursing assistant to the nurse manager when heart rate was not recorded in a patient chart c. Participating in weekly patient care conferences with physicians, social workers, and other therapists d. Sharing with another nurse that you heard the nurse manager is dating the new physical therapist on the unit e. Serving as a preceptor to a nurse completing a refresher course to reactivate her nursing license ANS: A, C, E Feedback

Correct

Incorrect

“Assisting nurse researcher with data collection related to measuring stress levels in hospitalized children”; “participating in weekly patient care conferences with physicians, social workers, and other therapists”; and “serving as a preceptor to a nurse completing a refresher course to reactivate her nursing license” are correct because these actions demonstrate collegiality by sharing with, supporting, assisting, and counseling other nurses and health care providers.

“Reporting a nursing assistant to the nurse manager when heart rate was not recorded in a patient chart” is incorrect because this is not a supportive activity as everyone can make a mistake and needs to be given the opportunity to correct this behavior. “Sharing with another nurse that you heard the nurse manager is dating the new physical therapist on the unit” is incorrect because participating in gossip and rumors does not support others.

PTS: 1

DIF: Cognitive Level: Application

Chapter 04: Nursing Education in an Evolving Health Care Environment Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. In 1900, the primary reason for hospital-based nursing education programs was to a. educate nurses to care for patients in hospitals. b. provide educational opportunities for women. c. staff the hospitals that operated the education programs. d. provide standardized preparation for nurses.

ANS: C

A B C D

Feedback Most nurses worked in homes and very few worked in hospitals.

The education for women was not a value of society at the time.

In the hospitals there were few paid staff nurses, and most of the care was provided by the nursing students.

The programs of study varied in length, and each school set its standards and requirements.

PTS: 1

DIF: Cognitive Level: Knowledge

2. Which of the following nursing leaders is credited with being one of the earliest nursing educators in

the world? a. Isabel Hampton Robb b. Mary Adelaide Nutting c. Melinda Anne Richards d. Annie W. Goodrich ANS: B

A B C D

Feedback Robb studied nursing education.

Mary Adelaide Nutting was a professor at Teachers College in 1907, and she was also the first nursing professor.

Richards was the first trained nurse educated in the United States.

Goodrich became the first dean of the Yale School of Nursing in 1924.

PTS: 1

DIF: Cognitive Level: Knowledge

3. The Goldmark Report focused on what aspect of nursing? a. Consistency in length of nursing education programs b. Consistency in theory content across diploma programs c. Desirability of establishing schools of nursing within academic settings d. Increasing numbers of physicians teaching in nursing programs ANS: C

A B C

D

Feedback Consistency in length of programs was not an issue.

Content was not the issue.

The Goldmark Report focused on clinical learning experiences of students, hospital control of schools of nursing, desirability of establishing schools of nursing in universities, lack of funding for nursing education, and lack of qualified faculty.

Nursing curriculum with instruction by physicians was not encouraged.

PTS: 1

DIF: Cognitive Level: Comprehension

4. Which American university opened the first nursing school as a separate department within the

university? a. Harvard b. Teachers College c. Columbia d. Yale ANS: D

A B C D

Feedback Harvard was not the first American university to open a nursing school as its own department.

Teachers College was not the first American university to open a nursing school as its own department.

Columbia was not the first American university to open a nursing school as its own department.

In 1924, Yale University was the first American university to open a school of nursing as its own department.

PTS: 1

DIF: Cognitive Level: Knowledge

5. Which of the following recommendations resulting from the 1934 study Nursing Schools Today and

Tomorrow still has relevance today? a. Nursing students should be trained on the job. b. Nursing students should be used to staff hospitals on the weekends. c. Nurses should be highly educated. d. Nurses with highly developed instincts do not require standards of practice.

ANS: C

A B C

D

Feedback Nurses should be highly educated in a university setting.

Students should not be used to staff hospitals.

The study made five recommendations: nursing education should be established within higher education; nurses should be highly educated; students should not be used to staff hospitals; standards of practice should be established; and students should meet minimal qualifications for graduation.

Standards of practice should be established.

PTS: 1

DIF: Cognitive Level: Knowledge

6. The earliest type of formal nursing education program was the a. diploma program. b. associate degree program. c. bachelor’s degree program. d. grandfathered acceptance as registered nurse (RN).

ANS: A

A B C D

Feedback Diploma programs of nursing began in the late 1800s and were the earliest form of nursing education.

Associate nursing degree programs began in 1952.

Bachelor’s degree programs began in 1909 but became commonplace only in the mid-1900s.

Nurses are not grandfathered into licensure.

PTS: 1

DIF: Cognitive Level: Knowledge

7. The single most important reason for the decline in the number of hospital-based diploma programs

was a. shift in hospital occupancy from acute care to home care. b. increase in hospital-based medical residency programs competing for educational dollars. c. beginning of associate degree programs that were shorter in length. d. diploma education’s position outside the mainstream of higher education.

ANS: D

A B C D

Feedback The increase in complexity of health care led to the need for more advanced educational preparation for nurses.

Although it became more difficult for hospitals to fund diploma programs, this was not the most important reason for their decline.

The advent of associate degree programs led to the decline in diploma programs, because associate degree programs are located in academic settings.

The movement of nursing education into the educational mainstream, that is, colleges and universities, was responsible for the rapid decrease in diploma programs.

PTS: 1

DIF: Cognitive Level: Knowledge

8. Which of the following is a primary reason for the initial slow growth of bachelor’s degree nursing

programs in the United States? a. Belief that hands-on training received in hospital-based diploma programs was superior to the theoretical-focused content in bachelor’s degree programs b. Belief that hospital-based diploma programs were more scientifically based c. Belief that students prepared in hospital-based diploma programs were more compassionate caregivers d. Belief that hospital-based education programs facilitated career mobility ANS: A

A B C D

Feedback There was a great deal of acceptance of the hands-on teaching received in diploma programs.

Bachelor’s degree programs are more theoretically focused.

There is no difference in perception of caring between the programs.

Bachelor’s degree education facilitates career mobility.

PTS: 1

DIF: Cognitive Level: Comprehension

9. The 1948 Brown Report recommended which of the following? a. Limit enrollment of men and minorities in nursing programs. b. Students admitted to nursing programs should not be required to meet admission

requirements of the university. c. Schools of nursing should be associated with teaching hospitals. d. Schools of nursing should be located in institutions of higher learning.

ANS: D

A B

Feedback The Brown Report recommended that more men and minorities be recruited into nursing.

The Brown Report recommendations did not address admission requirements of universities.

C D

The Brown Report recommended moving nursing education into academic settings.

The Brown Report recommended that schools of nursing be moved to institutions of higher learning.

PTS: 1

DIF: Cognitive Level: Knowledge

10. Which of the following is true about bachelors of science in nursing (BSN) education? a. Faculty must be BSN prepared. b. It is recommended by professional organizations as preparation for entry into

practice. c. It requires 3 years to complete. d. Faculty are not given full faculty status in the university.

ANS: B

A B C D

Feedback Faculty in BSN programs have master’s or doctorate degrees.

Many nursing organizations have advocated for the BSN as the beginning educational preparation for the profession of nursing.

The BSN degree requires 4 years to complete.

Faculty in nursing now have full faculty status.

PTS: 1

DIF: Cognitive Level: Knowledge

11. Which recommendation made by the 1965 American Nurses Association (ANA) position paper and

other position papers of national nursing organizations is still an issue today? a. Education for nursing should take place in hospital-based programs. b. Minimum preparation for professional nursing practice should be the BSN degree. c. Minimum preparation for technical nursing practice should be the licensed practical/vocation nurse (LPN/LVN) diploma. d. Education for nursing must be evidence-based.

ANS: B

A B

C D

Feedback The ANA position paper advocated for education in colleges and universities.

The issue of minimum educational requirement for entry into practice is not likely to change until there are safeguards in place that ensure that all nurses currently in practice continue to feel that they are valued members of the profession. This provision continues to be controversial today.

The technical level of nursing was supported in community and junior colleges.

There is little evidence to support traditional educational methods used in nursing education.

PTS: 1

DIF: Cognitive Level: Comprehension

12. Which type of basic nursing education program graduates the largest number of RNs in the United

States today? a. Diploma programs b. Associate degree programs c. BSN programs d. Nurse practitioner programs ANS: B

A B C D

Feedback Diploma programs are on the decline in enrollment and number of programs operating.

Associate degree programs graduate the most nurses today.

BSN program enrollments have increased but are still lower than associate degree program enrollments.

Nurse practitioner programs are advanced practice master’s-level programs. The question refers to basic RN preparation.

PTS: 1

DIF: Cognitive Level: Knowledge

13. Which person or organization is credited with developing the model of associate degree nursing

education? a. Esther Lucille Brown b. Annie W. Goodrich c. Mildred Montag d. National League for Nursing ANS: C

A B C D

Feedback Esther Lucille Brown wrote the Brown Report.

Annie W. Goodrich was the first dean of nursing.

Mildred Montag developed a model of associate degree nursing.

The National League for Nursing did not develop the model of associate degree nursing.

PTS: 1

DIF: Cognitive Level: Knowledge

14. What is the purpose of articulated models or systems for nursing education? a. Increasing curriculum similarities in nursing programs b. Allowing nurses to work in nursing as they gain additional education c. Increasing the numbers of nursing education programs d. Facilitating opportunities for nurses to move up the educational ladder with ease ANS: D

A

Feedback Articulation has not made the programs more similar.

B

C

D

Although articulation models allow a person to move with greater ease from one level to another with less repetition of coursework, articulation systems do not address the ability to work and attend school simultaneously any more than any other nursing education program.

Articulation model educational programs have been slow to develop because of the work required to keep all the courses congruent with each other, and increased educational programs have not resulted.

Articulated models allow a nursing student/nurse to enter and leave at different points. Articulated systems provide flexibility for the nurse to gain more education.

PTS: 1

DIF: Cognitive Level: Comprehension

15. Which of the following is an important advantage of distance learning? a. It allows access to adult learners who are geographically unable to participate in a

traditional classroom setting. b. It allows students to set their own learning objectives. c. It allows a student to take courses without clinical components. d. It allows universities to offer more classes with fewer faculty.

ANS: A

A B C D

Feedback Distance education allows flexibility, particularly for working people in locations where there is no campus, and enables them to return to school.

The requirements are just as stringent as traditional courses, but the method of participation is flexible.

Distance learning does not negate the need for clinical components of courses.

Faculty requirements are the same.

PTS: 1

DIF: Cognitive Level: Comprehension

16. All levels of nursing educational programs can be accredited by which organization? a. American Association of Colleges of Nursing (AACN) b. Commission on Collegiate Nursing Education (CCNE) c. Accreditation Commission for Education in Nursing (ACEN) d. National League for Nursing Councils of Education Programs (NLNCEP) ANS: C

A B C D

Feedback The AACN does not accredit educational programs.

Although the CCNE accredits educational programs, it only accredits bachelor’s and higher degree programs.

The ACEN accredits LPN/LVN, associate degree, BSN, and MSN programs.

The NLNCEP develops accreditation programs and criteria for different levels of education but does not carry out the accreditation process.

PTS: 1

DIF: Cognitive Level: Knowledge

17. Which of the following is a part of the history of doctoral education in nursing? a. The nurse scientist program was discontinued after more universities began

offering doctoral programs in nursing. b. The first doctoral degree (PhD) was offered at the University of Pittsburgh. c. The number of doctoral programs in nursing has doubled since 1990. d. The largest numbers of doctoral programs are practice-focused.

ANS: A

A

B

C D

Feedback In the 1970s, there was a major increase in doctoral programs in nursing. This provided an education in nursing that developed research skills and provided nursing faculty. Therefore, the nurse scientist program was discontinued in 1975.

The first doctoral degree in nursing (PhD) was offered at New York University in 1934. Teachers College at Columbia had offered a degree in nursing education (EdD).

In 1990, there were 48 doctoral programs in nursing, and by 2007 there were 166, actually more than tripling the number.

Sixty-eight percent of the doctoral programs are research-focused, while 32% are practice-focused.

PTS: 1

DIF: Cognitive Level: Comprehension

18. In 2004, the AACN proposed a new doctoral degree, the doctor of nursing practice (DNP). What is the

focus of the DNP degree in nursing? a. Nursing research b. Nursing quality improvement c. Advanced clinical practice d. Nursing theory development ANS: C

A B C

D

Feedback The research degree is the PhD. There is not a nursing doctoral degree designed specifically to address quality improvement.

The DNP degree is designed to be a clinical practice degree. It would replace the master’s degree for nurse practitioners and nurse-midwives, placing them on equal footing with other disciplines.

The PhD degree is most appropriate for theory development and advancement.

PTS: 1

DIF: Cognitive Level: Knowledge

19. Which of the following is the primary distinction between licensure and certification? a. Certification is required to practice nursing.

b. Licensure is granted automatically on completion of an accredited nursing

program. c. Certification validates a high level of proficiency. d. Licensure is voluntary.

ANS: C

A B C D

Feedback Licensure, not certification, is required to practice nursing.

Licensure is not automatically granted on completion of a nursing program.

Certification validates a high level of proficiency and knowledge.

The NCLEX examination must be completed successfully. Certification is voluntary, but licensure is not.

PTS: 1

DIF: Cognitive Level: Comprehension

20. The purpose of mandatory continuing education for license renewal is to a. ensure that nurses remain up to date in knowledge. b. ensure that nurses remain competent in psychomotor skills. c. ensure that nurses attend regular staff development meetings. d. ensure consistency between states regarding continuing education requirements.

ANS: A

A B C D

Feedback Mandatory continuing education is a state government’s way of ensuring that nurses remain up to date.

Ensuring that nurses remain competent in psychomotor skills is not the rationale for continuing education.

Staff development deals with competency and institutional updates.

The number of continuing education hours required varies among states.

PTS: 1

DIF: Cognitive Level: Comprehension

MULTIPLE RESPONSE 1. Florence Nightingale established a school of nursing based on which of the following innovative

principles? (Select all that apply.) a. The nursing school should be affiliated with a teaching hospital but independent of it. b. Professional nurses should be paid for their instruction in the school. c. Students should be selected to create a diverse student body. d. The curriculum should include theory and practical experience. e. Nurses should be trained in privately funded educational institutions.

ANS: A, B, D Feedback

Correct

Incorrect

Nightingale saw the benefit to affiliation with a teaching hospital but thought that the teaching mission should be separate from the service mission. Nightingale saw instruction as a valued activity worthy of reimbursement and involving more than allowing one to learn by watching. Nightingale thought that nursing was more than just on-the-job training and required knowledge upon which to base nursing activities.

Nightingale saw nursing as a profession for women only and that the women should be selected based on certain criteria. Nightingale thought that nursing education should be publicly funded.

PTS: 1

DIF: Cognitive Level: Comprehension

2. Why is accreditation of nursing education programs important? (Select all that apply.) a. It assures students that their educational program is offering quality education. b. Acceptance into graduate programs in nursing depends on graduation from an

accredited program. c. It serves as stimulus for programs to initiate periodic self-examination and self-

improvement. d. It has established standards to allow graduates to take licensure examinations. e. Graduating from an accredited program ensures successful completion of the

licensure exam.

ANS: A, B, C Feedback Correct

Incorrect

For an educational program to be accredited, it must meet criteria that protect the quality of education. Graduate programs use the program’s accreditation status to assure the quality of education the potential student has received in preparation for graduate study. As part of the accreditation process, the educational program must complete a self-study and show how the school meets each standard.

The standards that educational programs need to meet to allow their graduates to take the licensure examination are determined by each state, not by accrediting bodies. Graduation from any program of nursing does not guarantee passage of the licensure exam.

PTS: 1

DIF: Cognitive Level: Comprehension

3. Which factors contribute to threatening the current and future supply of nurses? (Select all that apply.) a. The number of qualified applicants has decreased. b. Seventy-five percent of current faculty may retire over the next decade. c. Overall numbers of applicants to doctoral programs have decreased. d. Faculty vacancies are having an impact on large numbers of schools. e. More men are entering nursing and choosing faculty positions.

ANS: B, D Feedback

Correct Incorrect

It is projected that as many as 75% of current faculty will retire by 2019.

This will impact large numbers of schools and can limit enrollment.

The number of qualified applicants has increased, but more than 30,000 applicants were turned away from bachelor’s degree programs for “lack of capacity.” More men are entering nursing, which should help increase recruitment of other men into the field. More male faculty could also help recruitment of men into nursing. There is continued demand for doctoral education in nursing.

PTS: 1

DIF: Cognitive Level: Comprehension

4. Over the last two decades a number of organizations issued reports identifying changes needed in

nursing education to prepare nurses for practice in the 21st century. Which of the following suggestions were included in these reports? (Select all that apply.) a. Recruitment of students and faculty to reflect the multicultural nature of society b. More focus on knowledge and skills to care for acutely ill individuals c. Increased informatics training to improve access to information d. Limiting discussion of the quality improvement measures in the health care system e. Curricula emphasizing interdisciplinary teamwork and collaboration ANS: A, C, E Feedback Correct

Incorrect

The changes “recruitment of students and faculty to reflect the multicultural nature of society,” “increased informatics training to improve access to information” and “curricula emphasizing interdisciplinary teamwork and collaboration” were made in several nursing reports and in the 2003 Institute of Medicine report.

The reports stated that there should be increased focus on chronic illness and that a quality improvement process of the health care system must be included in the education of health care providers.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 05: Becoming a Professional Nurse: Defining Nursing and Socialization into Practice Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Which early nursing theorist recognized therapeutic milieu, assessment skills, and a unique body of

knowledge in her definition of nursing? a. Dorothea Orem b. Virginia Henderson c. Hildegard Peplau d. Florence Nightingale ANS: D

Feedback

A B

C D

Orem was known for her self-care theory.

Henderson was best known for her definition of nursing as assisting the sick to do those things that they would do for themselves if they were able and for her list of 14 patient problems.

Peplau is known for her theory of therapeutic nurse-patient relationships.

Nightingale was the first nurse to realize the importance of environment and assessment skills and that nursing care should be delivered by a professional nurse with a unique body of knowledge, not a layperson.

PTS: 1

DIF: Cognitive Level: Knowledge

2. Which early nursing theorist defined nursing in interpersonal terms by stating that nursing is a

significant, therapeutic, and interpersonal process? a. Virginia Henderson b. Hildegard Peplau c. Martha Rogers d. Dorothea Orem ANS: B

A B C D

Feedback Henderson’s definition of nursing did not focus on the interpersonal relationship.

Peplau defined nursing in interpersonal terms.

Rogers is known for including nursing process in her definition of nursing.

Orem is known for her theory on self-care.

PTS: 1

DIF: Cognitive Level: Knowledge

3. Which of the following is an example of Orem’s self-care theory? a. Assuring proper fresh air and ventilation b. Demonstrating good handwashing techniques c. Assisting a disoriented patient with a bath d. Performing a visual screening exam ANS: C

A B C D

Feedback Proper ventilation was described by Nightingale.

Good handwashing was described by Nightingale.

Providing adequate patient hygiene is described in Orem’s theory of nursing as providing assistance to a person because of the person’s inabilities for self-care.

Preventive services are not addressed in Orem’s theory.

PTS: 1

DIF: Cognitive Level: Application

4. Which of the following is an example of Henderson’s definition of nursing? a. Performing a hearing screening in preschool children

b. Interacting with depressed men to learn new strategies for reducing their symptoms c. Setting goals for weight loss with a patient d. Teaching a person with frequent constipation about high-fiber foods ANS: D

A B C D

Feedback Henderson’s definition does not speak to preventive services.

Henderson’s definition does not focus on interpersonal relationship.

Goal setting is part of King’s definition of nursing, not Henderson’s.

Henderson’s definition states that “the unique function of the nurse is to assist the individual in the performance of those activities contributing to health that he would perform unaided if he had the necessary knowledge.”

PTS: 1

DIF: Cognitive Level: Analysis

5. The legal definition of nursing for any particular state can be found in the a. state legislature’s official newsletter. b. state board of nursing’s bylaws. c. governor’s official papers. d. state’s nurse practice act.

ANS: D

A B C D

Feedback The legal definition of nursing is not found in the state legislature’s official newsletter.

The state board of nursing administers the nurse practice act of that state, and its bylaws govern its internal functioning.

The governor’s office does not determine the legal definition of nursing.

Each state’s nurse practice act contains the legal definition of nursing for a particular state.

PTS: 1

DIF: Cognitive Level: Comprehension

6. Which of the following is an example of formal socialization into the profession of nursing? a. Unplanned observation of a nurse comforting a child after a painful procedure b. Hearing two nurses discussing how to organize patient care more effectively c. Starting an intravenous (IV) line in the simulation laboratory under faculty

guidance d. Participating in a student nurses’ association meeting ANS: C

A B

Feedback “Unplanned observation of a nurse comforting a child after a painful procedure” is an example of an incidental learning experience.

“Hearing two nurses discussing how to organize the care of a patient more effectively” is an example of an incidental learning experience.

C D

Formal socialization includes planned activities to gain knowledge and skills needed by the nurse.

“Participating in a student nurses’ association meeting” is an example of an incidental learning experience.

PTS: 1

DIF: Cognitive Level: Application

7. Which of the following is an example of informal socialization into a profession? a. Nurses discussing a patient care issue in the presence of other nurses b. Taking an extra class for an elective c. Performing your first physical assessment in a client d. Teaching a patient about warfarin (Coumadin) ANS: A

A B C D

Feedback Informal socialization into the role of a nurse occurs when the student learns from the nurse in an informal, unplanned way.

Taking an extra class for an elective is an example of formal, planned education.

Performing your first physical assessment in a client is part of the formal learning process.

Teaching a patient about Coumadin is part of a planned clinical experience and therefore falls under the category of formal socialization.

PTS: 1

DIF: Cognitive Level: Application

8. A nursing student says to the clinical faculty, “I know I will be able to care for this patient given your

directions.” In which stage of Cohen’s model of professional socialization is this student? a. Stage I: Unilateral dependence b. Stage II: Negativity/independence c. Stage III: Dependence/mutuality d. Stage IV: Interdependence ANS: A

A B C D

Feedback In stage I, students rely on external controls and teachers, absorbing information given by the faculty.

In stage II, students begin to question authority figures versus accepting the patient assignment without questioning.

The student has developed better critical thinking skills at stage III. In stage IV, the student has learned to make decisions in collaboration with others.

PTS: 1

DIF: Cognitive Level: Application

9. A nursing student asks, “Why do I have to go to clinical in obstetrics when I know I’ll never work with

women and children?” In which stage of Cohen’s model of professional socialization is this student?

a. b. c. d.

Stage I: Unilateral dependence Stage II: Negativity/independence Stage III: Dependence/mutuality Stage IV: Interdependence

ANS: B

A B C D

Feedback Students in stage I rely on external controls and teachers.

In stage II, students begin to question authority figures and overestimate their ability to care for complex patients.

Students develop better critical thinking skills in stage III. In stage IV, students learn to make decisions in collaboration with each other.

PTS: 1

DIF: Cognitive Level: Application

10. A nursing student says, “I can now see how developing care plans helps organize my thoughts and

patient care.” In which stage of Cohen’s model of professional socialization is this student? a. Stage I: Unilateral dependence b. Stage II: Negativity/independence c. Stage III: Dependence/mutuality d. Stage IV: Interdependence ANS: C

A B C D

Feedback In stage I, students follow directions without questioning or understanding the reasoning behind the activity.

In stage II, the student would question authority figures and overestimate his or her abilities.

Students in stage III have a more reasoned evaluation of others’ ideas.

Students in stage IV learn to make decisions in collaboration with others.

PTS: 1

DIF: Cognitive Level: Application

11. A nursing student asks, “Since I work as a nurse technician in psychiatric nursing, may I spend part of

my clinical rotation with a psychiatric home visiting nurse?” In which stage of Cohen’s model of professional socialization is this student? a. Stage I: Unilateral dependence b. Stage II: Negativity/independence c. Stage III: Dependence/mutuality d. Stage IV: Interdependence ANS: D

A B C

Feedback Students in stage I are dependent on faculty.

In stage II, students begin to question authority.

In stage III, students begin to develop critical thinking skills.

D

Students in stage IV often are self-directed and seek out appropriate learning opportunities that better round out their educational experience.

PTS: 1

DIF: Cognitive Level: Application

12. Benner describes five stages of nursing proficiency as students develop into expert nurses. Which of

the following is not a stage of development described by Benner? a. Novice b. Inexpert beginner c. Competent practitioner d. Expert practitioner ANS: B

A B C D

Feedback Novice is the first stage in the theory.

The stages identified by Benner in her theory From Novice to Expert do not include inexpert beginner.

Competent practitioner is the third stage in Benner’s theory.

Expert practitioner is the fifth stage in Benner’s theory.

PTS: 1

DIF: Cognitive Level: Knowledge

13. A mother asks the nurse if her 5-year-old can visit his twin brother in the pediatric intensive care unit

(PICU) after cardiac surgery. The nurse denies the request because hospital policy states that children younger than 12 years of age are not allowed to visit the PICU. This illustrates which of Benner’s stages of nursing proficiency? a. Novice b. Advanced beginner c. Competent practitioner d. Proficient practitioner ANS: A

A B C D

Feedback At the novice stage, nurses have little background on which to base clinical behavior and therefore depend rather rigidly on established rules.

Nurses at the advanced beginner stage base decisions on both theory and principles but may have difficulty formulating priorities or alternative actions.

Nurses at the competent practitioner stage have feelings of mastery and can examine the needs of everyone in the situation before making decisions.

Nurses at the proficient practitioner stage see patient situations holistically and easily recognize priorities of care.

PTS: 1

DIF: Cognitive Level: Application

14. A mother asks the nurse if her 5-year-old can visit his twin brother in the PICU after cardiac surgery.

The nurse denies the request because hospital policy states that children younger than 12 years of age are not allowed to visit the PICU but suggests that the mother visit with the child in the visitor’s lounge and talk to him about what is happening with his brother. This illustrates which of Benner’s stages of nursing proficiency? a. Novice b. Advanced beginner c. Competent practitioner d. Proficient practitioner ANS: B

A B

C D

Feedback Nurses at the novice stage would deny the request on the basis of the established rules.

Nurses at the advanced beginner stage base their decisions on theory and principles but have difficulty viewing many nursing actions as equally important. The nurse would still likely deny the request but, knowing the needs of the mother and child, suggest an alternative means of visiting.

Nurses at the competent practitioner stage have feelings of mastery and can examine the needs of everyone in the situation before making decisions.

Nurses at the proficient practitioner stage see patient situations holistically and easily recognize priorities of care.

PTS: 1

DIF: Cognitive Level: Application

15. A mother asks the nurse if her 5-year-old can visit his twin brother in the PICU after cardiac surgery.

The nurse knows that hospital policy states that children younger than 12 years of age are not allowed to visit the PICU. After considering the needs of the patient and his brother, the nurse suggests that the brother can visit for 5 minutes. This illustrates which of Benner’s stages of nursing proficiency? a. Advanced beginner b. Competent practitioner c. Proficient practitioner d. Expert practitioner ANS: B

A

B

C

Feedback Nurses at the advanced beginner stage base their decisions on theory and principles but may have difficulty viewing many nursing actions as equally important.

Nurses at the competent practitioner stage will examine the needs of everyone in the situation before making a decision. The nurses may or may not allow the visit, but only after examining the needs of everyone and other exigencies involved.

Nurses at the proficient practitioner stage see patient situations holistically and easily recognize priorities of care.

D

Nurses at the expert practitioner stage have expertise that allows them to select actions based on the patient’s complete experience.

PTS: 1

DIF: Cognitive Level: Application

16. A mother asks the nurse if her 5-year-old can visit his twin brother in the PICU after cardiac surgery.

The nurse knows that hospital policy states that children younger than 12 years of age are not allowed to visit the PICU. The nurse grants the request. This illustrates which of Benner’s stages of nursing proficiency? a. Advanced beginner b. Competent practitioner c. Proficient practitioner d. Expert practitioner ANS: C

A

B C

D

Feedback Nurses at the advanced beginner stage base their decisions on theory and principles but may have difficulty viewing many nursing actions as equally important.

Nurses at the competent practitioner stage will examine the needs of everyone, as well as other exigencies involved, before making a decision.

Nurses at the proficient practitioner stage see the patient situations holistically and easily recognize the priorities of care. The nurse is more concerned about patient outcomes than institutional rules.

Nurses at the expert practitioner stage have expertise that allows them to select actions based on the patient’s complete experience.

PTS: 1

DIF: Cognitive Level: Application

17. A 5-year-old with a twin brother is admitted to the PICU after cardiac surgery. Hospital policy does

not allow individuals younger than 12 years of age to visit the PICU. The nurse recognizes the needs of the patient and his brother and suggests that the mother brings her son to visit his brother briefly in the afternoon when the unit is usually quiet. This illustrates which of Brenner’s stages of nursing proficiency? a. Advanced beginner b. Competent practitioner c. Proficient practitioner d. Expert practitioner ANS: D

A

B

Feedback Nurses at the advanced beginner stage base their decisions on theory and principles but may have difficulty viewing many nursing actions as equally important.

Nurses at the competent practitioner stage will examine the needs of everyone, as well as other exigencies involved, before making a decision.

C

D

Although nurses at the proficient practitioner stage see patient situations holistically, easily recognize the priorities of care, and allow rules to be bent, they may not suggest bending rules for the desired patient outcome.

Nurses at the expert practitioner stage have expertise that allows them to select actions based on the entire patient’s complete situation, including the needs of family members.

PTS: 1

DIF: Cognitive Level: Application

18. Which of the following illustrates an effective strategy for a registered nurse student returning for a

bachelor’s of science in nursing (BSN)? a. Get reacquainted with the library; expect to spend many hours there doing research. b. Be open to information that does not seem to be readily applicable to your current position. c. Start a program only if you have a great deal of free time to devote to classes on campus. d. Use your co-workers as a sounding board to relieve frustration.

ANS: B

A B C D

Feedback Many BSN courses use online learning and are user-friendly for working students; research today is much easier with the Internet.

Nurses returning to school for the BSN degree need to keep an open mind for information that might not seem readily applicable to their work setting.

Many courses are online or web assisted; nurses cannot wait for conditions to be perfect to return to school.

Staying positive and open to feedback from instructors will pay more dividends than complaining.

PTS: 1

DIF: Cognitive Level: Comprehension

19. A nurse observes a new graduate nurse being harassed by co-workers when asking questions or

requesting help. What action by the nurse is best? a. Do not intervene, because it will only invite more harassment. b. Ask the nursing manager to intervene on behalf of the new nurse. c. Respectfully confront the staff and explain that this behavior is not part of nursing. d. Teach the new nurse to stand up for himself or herself when harassed.

ANS: C

A B

Feedback By not getting involved, the nurse is silently accepting that this behavior is alright.

The manager may need to become involved, but not as the first step. The responsible, professional nurse would try to intervene first.

C D

Harassment and bullying is antithetical to nursing and should not be tolerated; however, colleagues should be addressed respectfully.

The new nurse may need to learn self-assertive skills; however, the nurse should intervene to stop the behavior.

PTS: 1

DIF: Cognitive Level: Application

20. A new graduate nurse is in the fifth week of working on a busy surgical unit. The nurse tells a friend

about witnessing some patient care that was “appalling.” What should the nurse do? a. Return to school to obtain a master’s of science in nursing (MSN) and leave bedside nursing. b. Talk to the other nurses involved in the situation about the concerns. c. Report the behavior to the nurse manager of the unit. d. Accept that this is the reality of nursing in a busy unit.

ANS: B

A B C D

Feedback Returning to school will not help the nurse resolve the reality of this situation.

Talking to the other nurses involved allows this nurse to take responsibility for feelings and get support.

Reporting the behavior without attempting to resolve it with the nurses involved appears to be overreacting and may appear as if the nurse is not a team player.

Disengaging mentally and emotionally may result in dropout.

PTS: 1

DIF: Cognitive Level: Analysis

21. Which of the following strategies may help to overcome reality shock in the novice nurse? a. Participating in a preceptorship b. Returning to school immediately after graduation c. Moving frequently from job to job d. Becoming emotionally involved with patients ANS: A

A B C D

Feedback Participating in a preceptor program can help a novice assimilate more smoothly into the registered nurse (RN) role.

Prematurely returning to school is often an avoidance mechanism.

Moving frequently from job to job can increase the risk of burnout.

Nurses should not become overly emotionally involved with patients.

PTS: 1

DIF: Cognitive Level: Comprehension

22. Black illustrates concepts of preventing burnout by using the example of a flight attendant instructing

persons to “put your own oxygen mask on first.” What does this statement mean? a. Oxygen is the most important element of life. b. Airway is always a priority in patient care.

c. Taking care of yourself will enable you to be a better nurse. d. Ask others for help if you feel overwhelmed by your first position as a nurse.

ANS: C

A B C D

Feedback “Putting your own oxygen mask on first” is about self-care, not oxygen.

“Putting your own oxygen mask on first” is a metaphor for self-care.

Taking care of yourself will allow you to better care for others.

Although finding a mentor is important to self-care, “putting your own oxygen mask on first” does not specifically address this concern.

PTS: 1

DIF: Cognitive Level: Comprehension

MULTIPLE RESPONSE 1. A definition of nursing is essential because it (Select all that apply.) a. differentiates nursing from other health occupations. b. guides educational preparation and theory development. c. helps state nurse practice acts reflect the changing roles of nurses. d. clarifies the purposes and functions of the nurses. e. informs potential students of exactly what nurses do.

ANS: A, B, C, D Feedback Correct

Incorrect

A definition is important because it allows nurses, other health care providers, faculty, policymakers, and others in the community to better understand what nurses do.

Although a definition clarifies the role of nursing, no definition can be so explicit that it explains everything a nurse does.

PTS: 1

DIF: Cognitive Level: Comprehension

2. Which of the following behaviors of a student indicate that the student has taken responsibility for his

or her own professional socialization? (Select all that apply.) a. Projecting a professional appearance in class b. Attending class, quietly listening to the lectures c. Taking responsibility to request alternative dates for examinations in order to work d. Taking responsibility to learn the expectations of the faculty in each course e. Accepting constructive criticism without becoming defensive ANS: A, D, E Feedback

Correct

Incorrect

Part of being a professional is to look and behave like a professional. Each teacher may have different expectations and it is the student’s responsibility to seek clarification as a professional. It is through feedback that one is able to improve as a professional. If students become defensive, they may not hear all the feedback, positive and negative.

Although class attendance is important, asking questions and initiating discussions create a dynamic learning environment. A professional is not merely an academic spectator. Taking responsibility for organizing one’s work to meet deadlines reflects professional behavior.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 06: Nursing as a Regulated Practice: Legal Issues Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Which of the following is an example of civil law? a. Possession of marijuana b. Assault and battery c. Giving alcohol to a minor d. Child custody case ANS: D

A B C D

Feedback Possession of marijuana is an example of a violation of criminal law: possession of an illegal substance.

Assault and battery comes under the purview of criminal law.

Giving alcohol to a minor is an example of a violation of criminal law.

Civil law recognizes and enforces the rights of individuals, such as disputes over legal rights or duties of individuals in relation to one another. A child custody case is an example of civil law.

PTS: 1

DIF: Cognitive Level: Comprehension

2. The nurse practice act of a state defines the scope and responsibilities of nursing practice in that state.

Which of the following is true regarding nurse practice acts? a. They determine the educational requirements for licensure. b. They describe the process for gaining membership to a professional organization. c. They regulate how many professional nursing organizations may be formed. d. They define the practice of medicine in relation to nursing.

ANS: A

A

Feedback Nurse practice acts define the minimum educational qualifications and other requirements for licensure.

B C D

Nurse practice acts do not describe the process for admission to the state board of nursing.

Nurse practice acts do not regulate nursing organizations.

Nurse practice acts have no authority over medical practice issues.

PTS: 1

DIF: Cognitive Level: Comprehension

3. Which of the following falls under the jurisdiction of the state board of nursing? a. Approving or reject applications for new nursing education programs b. Expanding the provisions of the nurse practice act c. Reducing the provisions of the nurse practice act d. Right to suspend the need for licensure of registered nurses (RNs) in times of

extreme shortage ANS: A

A B C D

Feedback Schools of nursing must have state approval from the state board of nursing to operate.

The state board of nursing can enforce the nurse practice act but cannot expand it.

The state board of nursing can enforce the nurse practice act but cannot reduce it.

The state board of nursing does not have the authority to suspend the licensure requirement for any reason.

PTS: 1

DIF: Cognitive Level: Comprehension

4. The most common reason that nurses are disciplined by the state board of nursing is a. making medication errors. b. following unsafe nursing practice. c. practicing while impaired. d. abandoning patients.

ANS: C

A B C D

Feedback Medication errors are not the most common cause of nurses having their licenses suspended.

Unsafe nursing practice is a reason to have a license suspended but not the most common reason.

The most common reason that the state board suspends a nurse’s license is for practicing while impaired.

Abandoning patients is not the most common reason for suspending nursing licenses.

PTS: 1

DIF: Cognitive Level: Knowledge

5. What is the primary function of the National Council of State Boards of Nursing (NCSBN)? a. Overseeing decisions made by state boards of nursing b. Developing the NCLEX-RN and NCLEX-PN licensing examinations c. Administering the NCLEX examination at testing centers d. Overseeing granting licensure by endorsement ANS: B

A B C D

Feedback The NCSBN does not have the authority to oversee state boards of nursing.

The NCSBN develops the test plan and items for the NCLEX examination.

States, not the NCSBN, administer the NCLEX examination.

State boards of nursing, not the NCSBN, grant licensure through endorsement.

PTS: 1

DIF: Cognitive Level: Comprehension

6. Which of the following actions by the nurse constitutes professional malpractice? a. Administering a preoperative sedative in the patient holding area instead of in the

patient’s room b. Failing to notify the physician of a potassium level of 4 mEq/L c. Placing the head of the bed flat when a patient is receiving a tube feeding, causing the patient to aspirate the mixture d. Administering a routine medication 10 minutes late because of a unit emergency ANS: C

A B C D

Feedback Administering a preoperative sedative in the patient holding area instead of in the patient’s room does no harm to the patient.

Failing to notify the physician of a potassium level of 4 mEq/L does not necessarily do harm to the patient.

The reasonable nurse would know that the head of the bed must be elevated when the patient is receiving a tube feeding.

No harm resulted from administering a routine medication 10 minutes late because of a unit emergency.

PTS: 1

DIF: Cognitive Level: Analysis

7. The nurse forgets to give the patient a dose of antibiotic. Later in the shift, the patient goes into cardiac

arrest and dies. What element is lacking to support malpractice? a. Duty of care b. Breach of duty c. Specific injury d. Proximate cause ANS: D

Feedback

A B C D

There is nothing to support that the nurse did not assume the duty of care of the patient.

Although the nurse breached her duty by not administering the antibiotic, there also has to be support that this action caused the injury.

Although one might claim injury (cardiac arrest and death), the link to the nurse’s action is not supported.

There is no support that failing to administer the antibiotic caused the cardiac arrest and death.

PTS: 1

DIF: Cognitive Level: Analysis

8. Analysis of cases of reported negligence from 1995 to 2001 demonstrated that the majority of cases

occurred in which patient care setting? a. Acute care b. Psychiatric c. Nursing homes and long-term care facilities d. Home health ANS: A

A B C D

Feedback The majority of negligence cases (60%) occurred in acute care settings.

Psychiatric settings accounted for only 8% of the cases of negligence.

Nursing homes accounted for 18% of the cases of negligence.

Home health settings accounted for only 2% of the cases of negligence.

PTS: 1

DIF: Cognitive Level: Knowledge

9. A competent resident in a long-term care facility refuses an ordered antidepressant medication. The

nurse believes the patient needs the medication because he is clearly showing signs of depression and dissolves the medication in juice without telling the patient. This illustrates negligence by failure to a. follow the standard of care. b. assess and monitor a patient. c. communicate with a patient. d. document.

ANS: C

A B C

D

Feedback The standard of care was followed as related to the giving of an ordered medication.

The nurse assessed the patient and determined he still needed the medication because he was showing signs of depression.

The nurse did not communicate with the patient to determine why he did not want to take the medication. Based on the information she gathered, further actions could have been taken.

There is no evidence that the nurse did not document the administration of the medication.

PTS: 1

DIF: Cognitive Level: Application

10. A nursing student got a thank-you card from a patient’s family and had another student take a photo of

the student with the family. The student asks the nursing instructor if it would be alright to post the photo on Facebook. Which response by the instructor is best? a. “Yes, as long as you ask the family if that would be OK.” b. “I think that would be OK, but you should check hospital policy.” c. “No, posting pictures of patients and families on social media sites is not acceptable.” d. “No, that could lead to a malpractice suit by the patient or family.”

ANS: C

A

B

C D

Feedback Confidentiality and Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations place severe restrictions on nurses’ use of social media sites. The student should not post the photo.

The hospital probably has a policy regarding the use of social media sites, but the student should also be instructed to check the nursing school’s policies as well. Most such policies prohibit or severely restrict what nurses and students can post. Even if there are no policies in place, the student should not post the photo due to ethical and HIPAA considerations.

The student would be wise to not post the photo on any social media site. Posts are neither “private” or inaccessible once deleted.

In order to prove a claim of malpractice, four elements are needed; duty, breach of duty, harm, and causation. This would most likely not be a case of malpractice.

PTS: 1

DIF: Cognitive Level: Analysis

11. The nurse giving medications to a pediatric patient notes that an order for a medication is considerably

larger than the usual dose. The nurse looks up the medication in a pharmacology book and finds the prescribed dose is too large. Which action should the nurse take? a. Documenting the findings in the chart after giving the medication b. Calling the nursing supervisor and ask what to do next c. Calling the pharmacist to obtain the usual dosage d. Notifying the physician of these findings before giving the medication ANS: D

A B

Feedback Documentation is important, but the order needs to be clarified before the medication is administered.

Although seeking advice from the supervisor is helpful, the nurse still needs to clarify the order with the physician who wrote it.

C

D

Although the pharmacist can check the dosage calculation and provide supportive information to the nurse, he or she is unable to change the order; only the physician can do that.

The nurse notifying the physician of her findings before giving the medication allows the physician to clarify the order if written incorrectly or to clarify his rationale for the increased amount.

PTS: 1

DIF: Cognitive Level: Analysis

12. Which of the following nursing responsibilities can never be delegated? a. Complex tasks b. Evaluation c. Medication administration d. Accountability ANS: D

A B

C D

Feedback Complex tasks can be delegated if the person has been trained to perform the task.

While an unlicensed assistive personnel (UAP) is not qualified to evaluate results, if the nurse delegates something to another RN, the second RN is responsible for evaluating the results and acting appropriately.

Medication administration in some states can delegated (to a limited degree) to UAPs. Professional accountability cannot be delegated.

PTS: 1

DIF: Cognitive Level: Comprehension

13. The RN asked a nursing assistant to monitor several postoperative patients. Which of the following

instructions to the nursing assistant demonstrate appropriate delegation? a. “Take vital signs every 2 hours, and report to me anything outside of the norms.” b. “Assess pain using a 10-point scale, and record the score on the chart.” c. “Record the urine output, and report to me if they have not voided within 4 hours.” d. “Record the amount of drainage on the dressing on the bedside record.”

ANS: C

A

B C D

Feedback The nursing assistant is told to report “anything outside of the norms.” An RN should not assume that the nursing assistant knows the specific norms the RN is referring to.

The nursing assistant should know if there are specific scores that the RN wishes to know about.

This is the most appropriate instruction because the nursing assistant not only knows what to do but also what specific information to report.

The RN needs to know the amount of drainage to determine whether any further actions are needed.

PTS: 1

DIF: Cognitive Level: Application

14. The RN delegates changing a sterile dressing over a central line to a licensed practical/vocational nurse

(LPN/LVN). The LPN/LVN contaminated the site during the dressing change, and an infection developed in the patient. Which of the following statements is true? a. The LPN/LVN is guilty of malpractice. b. The RN is ultimately responsible for acts he or she delegates. c. The hospital cannot be held responsible for the acts of its employees. d. A malpractice suit cannot be brought as no harm came to the patient.

ANS: B

A B C D

Feedback Guilt has to be determined in a court of law. The LPN/LVN can be held responsible for actions in relation to the LPN/LVN scope of practice in the state.

The RN is responsible for tasks delegated to both licensed and unlicensed personnel.

The hospital can be held responsible for employees not correctly following policies related to the standards of quality care.

The patient was harmed.

PTS: 1

DIF: Cognitive Level: Comprehension

15. Which of the following is a legitimate defense to a charge of assault and battery? a. Presence of a medical order b. Knowledge of what is best for the patient c. Informed consent d. Living will ANS: C

A B C D

Feedback The presence of a medical order does not negate the need for informed consent.

Even if the treatment is in the patient’s best interest, without informed consent it cannot be done.

Informed consent is a viable defense against an accusation of assault and battery.

Having a living will does not replace the need for informed consent.

PTS: 1

DIF: Cognitive Level: Knowledge

16. In which of the following situations should the legality of an informed consent be questioned? a. Patient with dementia; consent given by spouse b. Patient who received a preoperative dose of Demerol before giving consent c. Patient who is anxious and asks many questions of the physician d. Patient who expresses concern about the cost of the procedure ANS: B

A B C D

Feedback When the patient is incompetent, a spouse may give informed consent.

Patients cannot be sedated or impaired and legally give informed consent.

Patients have a right to ask questions of the health care team.

Questioning the cost does not negate the legality of the informed consent.

PTS: 1

DIF: Cognitive Level: Application

17. Which of the following is a nursing responsibility regarding informed consent? a. Canceling the procedure if the patient has questions b. Explaining the procedure, risks, and treatment alternatives c. Serving as a witness, ensuring that the patient does not feel coerced into a decision d. Ensuring that the physician has completely explained the costs of the procedure ANS: C

A B C D

Feedback The nurse does not have the responsibility to schedule or cancel medical procedures.

The physician has the responsibility of explaining the procedure, risks, and benefits.

The nurse can serve as a witness in informed consent.

The costs of the procedure are not required to be included in the physician’s explanation.

PTS: 1

DIF: Cognitive Level: Comprehension

18. Which of the following actions is acceptable as an exception to a nurse’s obligation regarding

confidentiality? a. Reporting certain diseases to public health authority b. Discussing a patient’s care with someone who does not know the patient c. Leaving printouts of lab reports on the desk in the physicians’ lounge as a convenience d. Discussing a patient’s condition in a public place as long as the patient’s name is not mentioned ANS: A

A B C D

Feedback Exceptions to confidentiality include reporting certain diseases to the appropriate public health authority.

It is inappropriate to discuss a patient with anyone outside of the treatment team.

Patient records must be kept private at all times.

Even if the patient’s name is not mentioned, discussing a patient in public is a violation of privacy because someone listening may be able to determine the patient’s identity from the discussion.

PTS: 1

DIF: Cognitive Level: Knowledge

19. Which patient rights are guaranteed by HIPAA? a. Patients are asked to sign a release of responsibility if their health care records

inadvertently become a matter of public record. b. Patients sign a release protecting the health care provider and insurance company

against computer file theft. c. Patients are protected against medical records being indiscriminately shared. d. Patients may receive a complete copy of their medical records at no cost.

ANS: C

A B C D

Feedback Patients’ health records are never to become a matter of public record.

Health care providers and insurance companies are not protected against computer theft.

HIPAA protects medical records: written, oral, and electronic.

Patients have access to their medical records through HIPAA, but they may be assessed a fee.

PTS: 1

DIF: Cognitive Level: Comprehension

20. A child is tested for genetic abnormalities. After the test results are delivered from the laboratory, a

representative of the parents’ medical insurance company calls the nurse’s station and asks for the results of the tests. The nurse’s best response to this request is to a. refuse to give the information. b. tell the representative the status of the tests is unknown. c. give the results as reported because the insurance company is paying for the tests. d. tell the representative that the test results will need to be obtained from the physician who ordered them.

ANS: A

A B C D

Feedback On the basis of HIPAA guidelines, this information is for the patient and health care providers.

Nurses should not provide false information.

Giving the test results to the insurance company would violate the HIPAA guidelines.

Nurses should not provide false information.

PTS: 1

DIF: Cognitive Level: Application

21. The Patient Self-Determination Act of 1991, as implemented today, is known as providing a. informed consent. b. advance directives. c. patient bill of rights. d. HIPAA protections.

ANS: B

A B

C D

Feedback Informed consent assures patient autonomy.

Advance directives describe an individual’s preferences in regard to medical intervention should the individual become incapacitated, which was the primary intent of the Patient Self-Determination Act of 1991.

The patient bill of rights assures patients certain basic rights unrelated to becoming incapacitated.

HIPAA protects medical records from disclosure.

PTS: 1

DIF: Cognitive Level: Comprehension

22. Which of the following puts the nurse at increased risk for legal action? a. Delegating a Foley catheter insertion to an LPN/LVN b. Documenting the exact words a patient uses when complaining c. Not assessing a patient who is complaining of pain d. Caring for a postoperative patient who has a pulmonary embolus while being

transferred to the chair ANS: C

A B C D

Feedback Proper delegation does not increase risk for legal action.

Documenting in detail, including using direct quotations when appropriate, will protect the nurse from legal liability.

Failing to assess a patient constitutes an area of risk.

The embolus may have been unavoidable, and encouraging postoperative mobility meets the standard of care.

PTS: 1

DIF: Cognitive Level: Application

23. Which of the following chart entries represents a pitfall in documentation? a. Restless and combative; SaO2 87% b. Patient demanding and difficult to please c. Discovered in bathroom; instructed to ask for assistance before ambulating d. Three-centimeter area of serosanguineous drainage noted on the dressing to the left

hip ANS: B

A B C

Feedback “Restless and combative; SaO2 87%” is an acceptable chart entry.

The chart entry is subjective and nonspecific. It also contains judgments about the patient which could be interpreted as bias.

“Discovered in bathroom; instructed to ask for assistance before ambulating” is an acceptable chart entry; it is accurate and concise.

D

“Three-centimeter area of serosanguineous drainage noted on the dressing to the left hip” is complete, accurate, and concise.

PTS: 1

DIF: Cognitive Level: Application

24. The quality of nursing care is judged by whether nursing actions meet the standard of care. Which of

the following is an example of meeting the standard of care? a. Demonstrating the use of the nursing process when charting b. Following actions consistent with local practice c. Monitoring a patient more closely if the equipment has occasionally malfunctioned d. Bypassing medication checks to save time once the nurse is experienced ANS: A

A B C D

Feedback Charting that includes assessment, planning, intervention, and evaluation must be present in the patient’s record.

National, not local, standards of practice should be used.

Nurses must use equipment properly and replace it when it is malfunctioning.

Proper medication safety checks are the standard of practice for all nurses, including those with experience.

PTS: 1

DIF: Cognitive Level: Application

25. Which of the following is an important step in preventing legal action against the nurse? a. Never make a mistake. b. Deflect blame from yourself as much as possible. c. Develop caring, therapeutic relationships with patients. d. Avoid explaining care procedures to patients.

ANS: C

A B C D

Feedback It is not reasonable to expect that nurses will never make a mistake.

Nurses must have accountability for errors.

Establishing and maintaining good communication and rapport with patients not only is an aspect of best practice but also protects the nurse from lawsuits.

Nurses should explain all procedures to patients.

PTS: 1

DIF: Cognitive Level: Knowledge

MULTIPLE RESPONSE 1. The American Nurses Association (ANA) published a guide for state nurses associations seeking to

revise their nurse practice acts. According the ANA, which of the following should be included in these revisions? (Select all that apply.) a. Differentiation between advanced and generalist nursing practice b. Authority for boards of nursing to oversee UAP

c. Specified frequency of revisions to the nurse practice acts d. Authority for boards of nursing to regulate prescription writing by advanced

practice nurses e. Nurses’ responsibility for delegating to LPN/LVNs ANS: A, B, D, E Feedback Correct

Incorrect

“Differentiation between advanced and generalist nursing practice,” “authority for boards of nursing to oversee UAP,” “specified frequency of revisions to the nurse practice acts,” “authority for boards of nursing to regulate prescription writing by advanced practice nurses,” and “nurses’ responsibility for delegating to LPN/LVNs” are identified in the ANA’s Model Practice Act published in 1996.

The frequency of revision for the nurse practice acts is not addressed.

PTS: 1

DIF: Cognitive Level: Knowledge

2. The central question in any charge of malpractice is whether the prevailing standard of care was met.

Which of the following are considered part of the standard of nursing care? (Select all that apply.) a. Basic prudent nursing care is a standard. b. Health care providers determine standards of care in health care settings. c. Standards of care are never changing. d. Standards are based on the ethical principle of nonmaleficence. e. National standards of nursing practice are standards for all nurses.

ANS: A, D, E Feedback Correct

Incorrect

The standard of care reflects a basic minimum level of prudent care for the nurse based on the ethical principle of nonmaleficence or “to do no harm,” and the national standards of nursing relevant to the situation at that time.

Nurses, not other health care providers, are responsible for determining whether the standard of nursing care was met. As nursing practice develops, the standards of care change accordingly.

PTS: 1

DIF: Cognitive Level: Comprehension

3. For a nursing malpractice action, essential characteristics of negligence must be present. Which of the

following constitute these essential characteristics? (Select all that apply.) a. The nurse assumed the responsibility for the patient’s care. b. The nurse is found to have failed to meet the standard of care. c. The harm to the patient must be shown to have been caused by the failure to meet the standard of care. d. Harm to an individual has occurred. e. The nurse’s action involves acts of commission.

ANS: A, B, C, D Feedback

Correct

Incorrect

The nurse assuming the responsibility for the patients’ care, the nurse failing to meet the standard of care, harm occurring to an individual, and the harm being shown to have been caused by the failure to meet the standard of care are the four elements that need to be present to support the charge of malpractice.

Malpractice can involve acts of either commission or omission.

PTS: 1

DIF: Cognitive Level: Comprehension

4. The nurse receives reports on the following patients at the beginning of the shift. Which of the

following care activities could be delegated to a nursing assistant? (Select all that apply.) a. Ambulating a patient who had an emergency appendectomy 8 hours ago, has stable vital signs, and needs to ambulate for the second time b. Assisting a patient who was in an automobile accident and whose right arm and leg are in traction with bathing c. Feeding a patient recovering from a stroke resulting in difficulty holding a spoon d. Taking vital signs, including blood pressure, for a patient with newly diagnosed diabetes and a history of hypertension e. Measuring a bed-bound patient’s pressure ulcer and assessing the patient’s risk for skin breakdown when turning the patient ANS: A, B, C, D Feedback Correct Incorrect

Nursing assistants can assist with hygiene and activities of daily living, especially for patients in stable conditions.

UAP cannot interpret data or assess patients, because assessment is part of the nursing process.

PTS: 1

DIF: Cognitive Level: Analysis

Chapter 07: Ethics: Basic Concepts for Professional Nursing Practice Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Which of the following situations is an example of moral distress? a. You hear nurses in the lounge making off-color jokes about a patient. You are

afraid to speak up for fear of retaliation. b. You have been late for work a couple of times in the last 2 weeks, and your co-

workers are covering for you. c. You become romantically involved with a co-worker, which is against the unit

policy, so you resign your position. d. You purposefully use vague language when explaining a patient’s condition to the

family. Staff expects that the patient may be brain-dead, but test results are not yet conclusive.

ANS: A

A

B C D

Feedback The definition of “moral distress” is distress that results from participating in a perceived moral wrongdoing due to situational constraints despite attempting to make a moral choice. Moral distress can be spiritual, emotional or behavioral anguish.

There is no breach of ethics in being late and having co-workers cover for you.

The person acts appropriately to the moral issue by resigning the position.

The person is acting appropriately under current circumstances.

PTS: 1

DIF: Cognitive Level: Analysis

2. According to Kohlberg’s stages of moral reasoning, adolescents who shoplift are operating in which

level of moral development? a. Preconventional b. Conventional c. Postconventional d. Developmental ANS: A

A B C D

Feedback In Kohlberg’s preconventional level of moral reasoning, the individual is inattentive to the norms of society and is self-centered.

In the conventional level, moral decisions conform to the norms of society.

In the postconventional level, the individual has a highly developed moral value system independent of group norms.

“Developmental” is not a level of moral reasoning identified by Kohlberg.

PTS: 1

DIF: Cognitive Level: Comprehension

3. According to Kohlberg’s stages of moral reasoning, individuals who act “because it is the rule of

society” are operating in which level of moral development? a. Preconventional b. Conventional c. Postconventional d. Developmental ANS: B

A B C D

Feedback In Kohlberg’s preconventional level of moral reasoning, the individual is inattentive to the norms of society and is self-centered.

In the conventional level, moral decisions conform to the norms of society.

In the postconventional level, the individual has a highly developed moral value system independent of group norms.

“Developmental” is not a level of moral reasoning identified by Kohlberg.

PTS: 1

DIF: Cognitive Level: Comprehension

4. Flight 93, hijacked on September 11, 2001, crashed into the Pennsylvania countryside because some of

the passengers decided to try to take control of the plane and prevent it from being used as a weapon of mass destruction against structures in Washington, D.C. They decided to act despite grave danger to themselves. This is an example of which level of Kohlberg’s stages of moral reasoning? a. Preconventional b. Conventional c. Postconventional d. Conventional phase 4 ANS: C

A B C

D

Feedback In the preconventional level, the person’s self-interest takes precedence over group norms.

In the conventional level, the person conforms to group norms.

People in the postconventional level of moral reasoning may ignore self-interest and group norms when making decisions and may sacrifice themselves for the group.

Phase 4 of the conventional level follows group and cultural norms.

PTS: 1

DIF: Cognitive Level: Analysis

5. According to Kohlberg’s theory, which of the following is true of moral development? a. Participating in decision making promotes moral reasoning. b. Intellectual development has no effect on moral development. c. Participating in debates on ethical issues decreases moral development. d. Holding people responsible for their actions does not improve moral development.

ANS: A

A B C D

Feedback Kohlberg thought that certain conditions promote moral development, such as participating in decision making.

Kohlberg thought that intellectual development was necessary for advanced moral development.

Participating in debates on ethical issues does enhance moral development.

Taking responsibility for actions promotes moral development.

PTS: 1

DIF: Cognitive Level: Comprehension

6. Gilligan’s theory on moral reasoning differed from Kohlberg’s theory because Gilligan considered

which population not addressed by Kohlberg? a. Children b. Men c. Women d. Adolescents ANS: C

A B C D

Feedback Kohlberg mostly tested his theory in men and boys.

Men were the focus of Kohlberg’s theory.

Gilligan thought that Kohlberg’s theory did not recognize the experience of women in moral development.

Gilligan’s theory did not focus on adolescents.

PTS: 1

DIF: Cognitive Level: Knowledge

7. Which of the following ethical theories is illustrated by the example of following the Golden Rule,

“Do unto others as you wish them to do unto you”? a. Deontology b. Principlism c. Utilitarianism d. Virtue ethics ANS: A

A B C

D

Feedback Deontology states that an act is moral if it originates from good will.

Principlism is the use of ethical principles in decision making.

Decisions are made based on what will do the greatest good for the greatest number of people. A main tenet of utilitarian ethics is that right or useful actions bring about the greatest good for the greatest number of people.

Virtue ethics refers to character traits of the decision maker, such as honesty, courage, kindness, and integrity.

PTS: 1

DIF: Cognitive Level: Application

8. Which of the following ethical theories is illustrated by the example of triage in disaster nursing? a. Deontology b. Principlism c. Utilitarianism d. Virtue ethics ANS: C

A B C

D

Feedback Deontology states that an act is moral if it originates from good will.

Principlism is the use of ethical principles in decision making.

Triage in disasters requires decisions to be made on how to do the greatest good for the greatest number of people. A main tenet of utilitarian ethics is that right or useful actions bring about the greatest good for the greatest number of people.

Virtue ethics refers to character traits of the decision maker, such as honesty, courage, kindness, and integrity.

PTS: 1

DIF: Cognitive Level: Application

9. Respecting the right of a patient with terminal cancer to refuse chemotherapy is based on a belief in the

ethical principle of a. justice. b. autonomy. c. nonmaleficence. d. death with dignity.

ANS: B

A B C D

Feedback “Justice” refers to the equality of the allocation of services.

Autonomy is based on the principle that patients have the right to determine their own course of action.

“Nonmaleficence” refers to the responsibility to do no harm.

Death with dignity is not an ethical principle.

PTS: 1

DIF: Cognitive Level: Application

10. Respecting an elderly woman’s decision to stay in her own home is based on a belief in the ethical

principle of a. justice. b. autonomy. c. nonmaleficence. d. death with dignity.

ANS: B

A B C D

Feedback “Justice” refers to the equality of the allocation of services.

Autonomy is based on the principle that patients have the right to determine their own course of action.

“Nonmaleficence” refers to the responsibility to do no harm.

Death with dignity is not an ethical principle.

PTS: 1

DIF: Cognitive Level: Application

11. A school nurse teaching school-aged children about water safety is an example of which ethical

principle? a. Beneficence b. Justice c. Veracity d. Autonomy ANS: A

A B

Feedback Beneficence can be seen as “the doing of good.”

“Justice” refers to the equal treatment of all.

C D

Veracity is truth telling.

“Autonomy” refers to an individual’s right to make his or her own decisions.

PTS: 1

DIF: Cognitive Level: Application

12. A nurse who advocates for a longer stay when a medically indigent patient is being prematurely

discharged to reduce hospital cost is relying on which ethical principle? a. Justice b. Beneficence c. Autonomy d. Fidelity ANS: A

A

B C D

Feedback “Justice” refers to the equal and fair allocation of services based on need.

According to this principle, the patient should receive the same care as others in the same condition, regardless of ability to pay.

“Beneficence” simply refers to doing good.

Autonomy asserts that individuals have the right to make their own decisions.

“Fidelity” is an incomplete answer, because fidelity refers to faithfulness or honoring one’s promises to patients.

PTS: 1

DIF: Cognitive Level: Application

13. The current emphasis on eliminating racially based health disparities is based on which of the

following ethical principles? a. Double effect b. Fidelity c. Justice d. Veracity ANS: C

A B C D

Feedback Double effect is the concept that justifies inflicting harm if the intent is to produce an overall good effect.

“Fidelity” refers to honoring one’s promises to patients.

The principle of justice states that equals should be treated the same.

Veracity refers to telling the truth.

PTS: 1

DIF: Cognitive Level: Application

14. A nurse is turning a bedfast patient to prevent pressure ulcers. The patient complains that the process is

painful. The nurse explains the reason for the turning schedule and completes the task. This is an example of the ethical principle of a. autonomy. b. fidelity.

c. nonmaleficence. d. veracity.

ANS: C

A B C

D

Feedback Autonomy has to do with individuals being able to make their own decisions.

“Fidelity” refers to honoring one’s commitments and promises.

“Nonmaleficence” is defined as the duty to do no harm. Although temporarily painful, not turning the patient would cause actual harm (physical damage), and so this nurse is acting on the principle of nonmaleficence.

“Veracity” refers to being truthful.

PTS: 1

DIF: Cognitive Level: Application

15. A patient who is terminally ill is experiencing great pain. To relieve the patient’s suffering, the nurse

needs to administer larger doses of morphine. This relieves the pain but also inhibits respiration.

Which principle justifies the risk of harm? a. Justice b. Fidelity c. Veracity d. Double effect ANS: D

A B C D

Feedback Justice relates to equal treatment of all.

Fidelity is faithfulness to one’s commitments.

Veracity is being truthful.

The rule of double effect addresses actions that may result in a negative effect if the end result is good. The end point justifies the risk of harm.

PTS: 1

DIF: Cognitive Level: Application

16. Taking a pediatric patient to the playroom on a promised time and day is based on the belief in the

ethical principle of a. autonomy. b. fidelity. c. justice. d. veracity.

ANS: B

A B C D

Feedback Autonomy relates to the right of individuals to make their own decisions.

Fidelity is being faithful to commitments made to others.

“Justice” refers to the equal treatment of all.

Veracity is being truthful.

PTS: 1

DIF: Cognitive Level: Application

17. When nurses receive a patient assignment and accept reports on these patients, they are committed to

providing care to those assigned to them. This is based on the ethical principle of a. beneficence. b. fidelity. c. justice. d. veracity.

ANS: B

A B

C D

Feedback Beneficence speaks to doing good.

Fidelity is being faithful or keeping commitments made to others. In accepting the assignment, the nurse has committed to caring for the patients assigned to her or him.

Justice is related to the equal treatment of all.

“Veracity” refers to one’s truthfulness.

PTS: 1

DIF: Cognitive Level: Application

18. Answering a terminally ill child’s questions about his or her condition honestly is based on a belief in

the ethical principle of a. autonomy. b. fidelity. c. justice. d. veracity.

ANS: D

A B C D

Feedback Autonomy relates to the right of an individual to make his or her own decisions.

“Fidelity” refers to being faithful to one’s commitments.

“Justice” refers to the equal treatment of all.

“Veracity” is defined as telling the truth. Truthfulness is fundamental in the development and maintenance of trust in a relationship.

PTS: 1

DIF: Cognitive Level: Application

19. A father of four is admitted after an automobile accident in which two of the children were killed.

Recognizing that he is in very serious condition, the nurse believes that it would be appropriate to avoid telling him about the death of his children unless he asks directly. This could be considered a violation of the ethical principle of a. beneficence. b. fidelity. c. justice. d. veracity.

ANS: D

A B C D

Feedback Beneficence is the expectation of doing good.

“Fidelity” refers to keeping commitments and promises.

Justice is the treatment of all equally.

Veracity is truth telling. The nurse is not lying but is not forthcoming with the information about the children.

PTS: 1

DIF: Cognitive Level: Application

20. Which of the following is the best description of a code of ethics? a. A document that describes the correct course of action and does not change

regardless of societal changes b. A document that all professions must have even if not representative of practice c. A document that permits others to know what principles guide professional

decision making d. A document widely open to interpretation by professionals in various settings ANS: C

A B C D

Feedback Codes of ethics have been revised through the years to reflect changes in society.

Codes are useful only if upheld by members of the profession in their daily practice.

The code of ethics of nursing is an implied contract through which the profession informs society of the principles and rules by which it functions.

The code of ethics should be interpreted in a similar way regardless of practice setting.

PTS: 1

DIF: Cognitive Level: Comprehension

21. A nurse is involved in an ethically challenging case. To use an ethical decision-making model, which

step should the nurse perform first? a. Gather and examine all possible solutions. b. Identify the ethical dilemma in the case. c. Identify all parties who will be impacted by the decision. d. Gather all information important to the situation.

ANS: B

A

B

Feedback The first step in many ethical decision-making models is to identify the ethical dilemma. Examining all possible solutions comes after this step and gathering information.

The first step in many ethical decision-making models is to identify the ethical dilemma.

C

D

The first step in many ethical decision-making models is to identify the ethical dilemma. Identifying parties affected is not a specific step but is part of identifying the dilemma.

The first step in many ethical decision-making models is to identify the ethical dilemma. The next step would be to gather all data related to the situation.

PTS: 1

DIF: Cognitive Level: Comprehension

MULTIPLE RESPONSE 1. Which of the following are activities in the ethical decision-making process? (Select all that apply.) a. Avoid looking at legal cases or precedents related to the situation. b. Determine if the people who are affected by the dilemma have value conflicts. c. Brainstorm with others involved to identify all possible solutions. d. Evaluate the action taken to determine whether it accomplished its purpose. e. Discuss only acceptable solutions that are practical to implement.

ANS: B, C, D Feedback Correct

Incorrect

Determining who is affected by the dilemma and identifying possible value conflicts among them, identifying all possible solutions, and evaluating the action taken to determine whether it accomplished its purpose clarify the situation and determine whether the selected action achieved its goal.

A variety of materials including legal documents may help clarify the situation or help identify possible actions. Ethical decision making is not done in isolation. It may involve others but especially must involve the patient and family. All possible solutions should be considered even if they are unusual, complex, or may be difficult to implement.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 08: Conceptual and Philosophical Foundations of Professional Nursing Practice Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Who is credited with developing the theory on systems? a. Rogers b. Maslow c. Rosenstock d. von Bertalanffy ANS: D

A

Feedback Carl Rogers developed a theory of personhood.

B C D

Abraham Maslow developed a human needs theory.

I. M. Rosenstock developed a health belief model.

Ludwig von Bertalanffy developed the theory of systems.

PTS: 1

DIF: Cognitive Level: Knowledge

2. Which of the following is true of open systems? a. They have very little interaction with the environment. b. Parts are independent of each other. c. Exchange of information is sporadic and intermittent. d. The whole is greater than the sum of all of its parts.

ANS: D

A B C D

Feedback Open systems interact with the environment.

Parts of a system are interrelated.

The exchange of information is continuous and dynamic.

In systems the whole is greater than the sum of all of its parts.

PTS: 1

DIF: Cognitive Level: Comprehension

3. Dynamic balance between systems and their parts is called a. synergy. b. homeostasis. c. inertia. d. suprasystems.

ANS: B

A B C D

Feedback Synergy occurs when all parts of the system are working collaboratively.

The dynamic balance within and between open systems and their suprasystems is homeostasis.

“Inertia” is a term in physics that describes the tendency of matter to continue in its current state, whether moving or resting.

Suprasystems are the system and all of its subsystems.

PTS: 1

DIF: Cognitive Level: Knowledge

4. A homeless man sleeps on a park bench and eats one meal a day at a shelter. Which is the lowest level

of Maslow’s basic needs he does not meet? a. Basic physiologic needs b. Safety needs c. Love and belonging needs d. Esteem needs ANS: A

A B

C D

Feedback Although he is getting food, oxygen, and rest, he does not have shelter. This is Maslow’s lowest level of needs.

Maslow identified the second level of needs as safety needs, which include physical and psychological safety. Basic physiologic needs must be met before the person can meet higher order needs.

Maslow identified the third level of needs as love and belonging. Basic physiologic needs must be met before the person can meet higher order needs.

Maslow identified the fourth level of needs as the need for self-esteem. Basic physiologic needs must be met before the person can meet higher order needs.

PTS: 1

DIF: Cognitive Level: Comprehension

5. An 18-month-old child has been in three foster homes within the past 9 months. When the child is seen

for a well-child visit, the nurse notices the child vigilantly watches everyone. This child may not have which of Maslow’s basic needs met? a. Basic physiologic needs b. Safety needs c. Love and belonging needs d. Self-actualization ANS: B

A B

C D

Feedback Maslow identified the first level of needs as those necessary for physiologic survival. The child appears to have these needs met.

Maslow identified the second level of needs as safety needs, which include physical and psychological safety, as well as security. The child does not appear to have these needs met.

Maslow identified the third level of needs as love and belonging. The safety needs must be met before a person attempts to meet higher level needs.

Maslow identified the fifth level of needs as self-actualization. The safety needs must be met before a person attempts to meet higher level needs.

PTS: 1

DIF: Cognitive Level: Comprehension

6. Which of the following describes one of the five levels of human needs identified by Maslow? a. Equilibration b. Love and belonging c. Growth and development d. Adaptation ANS: B

A B C

Feedback Equilibration is a stage of Carl Rogers’s theory of personhood.

Love and belonging is the third level of Maslow’s basic needs theory.

Growth and development is not a level of human needs according to Maslow.

D

Adaptation is from Carl Rogers’s theory of personhood.

PTS: 1

DIF: Cognitive Level: Knowledge

7. A school-aged child with spina bifida uses a wheelchair, attends school, and is actively involved in

Scouting and science club. This child is meeting which of Maslow’s basic needs? a. Safety needs b. Love and belonging needs c. Esteem needs d. Self-actualization ANS: B

A B C D

Feedback Maslow identified the second level of needs as safety needs, which include physical and psychological safety, as well as security.

Maslow identified the third level of needs as love and belonging. This child has demonstrated the social relationships and group affiliations.

Maslow identified the fourth level of needs as the need for self-esteem. Lower order needs need to be fulfilled before meeting higher order needs.

Maslow identified the fifth level of needs as self-actualization. Lower order needs need to be fulfilled before meeting higher order needs.

PTS: 1

DIF: Cognitive Level: Comprehension

8. An adult has difficulty initiating a conversation, and in working with others always agrees with them

because “My opinion is not important.” Which of Maslow’s basic needs is not being met by this person? a. Basic physiologic needs b. Love and belonging needs c. Esteem needs d. Self-actualization ANS: C

A B C D

Feedback Maslow identified the first level of needs as those necessary for physiologic survival. There is no information that this person is not meeting these needs.

Maslow identified the third level of needs as love and belonging. There is no information that this person is not meeting these needs.

Maslow identified the fourth level of needs as the need for self-esteem. This individual does not demonstrate a sense of self-worth and self-respect.

Maslow identified the fifth level of needs as self-actualization. The lower order need of self-worth and self-respect must be met before attempting to meet the needs at this level.

PTS: 1

DIF: Cognitive Level: Comprehension

9. Which of the following is true of Maslow’s basic need of self-actualization? a. Once self-actualization is achieved, it is never lost. b. Elderly people outgrow the need for self-expression and self-development. c. Most people achieve self-actualization after all other needs are met. d. People use their abilities to the fullest extent possible and are true to their nature.

ANS: D

A B C D

Feedback People do not stay in a state of self-actualization but may have peak experiences that last for some period of time.

Maslow felt that people never outgrew the innate need for self-expression and self-development, regardless of age.

Maslow believed that many people strive for self-actualization, but few consistently reach the level even if they have achieved the other levels.

Self-actualized people have realized their maximum potential.

PTS: 1

DIF: Cognitive Level: Comprehension

10. A patient’s spouse and son were recently killed in an automobile accident, and the patient’s position in

a large company has been eliminated due to corporate reorganization. The patient states, “I do not think I can handle this.” The nurse could safely assume that a. the patient will soon develop clinical depression. b. the patient needs hospitalization to foster adaptation. c. environmental factors may have a negative impact on this person’s health. d. self-care will assure the patient’s ability to readjust.

ANS: C

A B C D

Feedback Multiple changes in a person’s environment do not always result in depression.

Adaptation can be fostered without hospitalization.

Multiple changes in a person’s environment may affect health.

Self-care is important, but the patient may need further assistance.

PTS: 1

DIF: Cognitive Level: Application

11. The nurse is interviewing the mother of a school-aged child. The mother states that their family

consists of herself, her son, a female friend, and two foster children. One grandparent lives in another city, and one lives within two blocks of them. As the nurse works with this family, what implication is important to include? a. As a single parent, the mother has multiple roles to fill and will become stressed. b. As an extended family, all the children will receive attention from several adults. c. This child will lack male attention because he lives in a single-parent family. d. The quality of family life will be influenced because they are not a traditional family.

ANS: B

A B C D

Feedback Although the mother does have multiple roles to fill, she seems to have a support system to help her manage her multiple roles successfully.

The children live in a household with two adults and have a grandparent within two blocks.

There is nothing to indicate that the children will not have a male presence, especially if the grandparents are men.

Quality of family life can be achieved in a variety of family structures.

PTS: 1

DIF: Cognitive Level: Application

12. Family structures have experienced change in the second half of the 20th century. What is the most

dramatic difference seen in families today? a. Increased incidence of single-parent families b. Reemergence of large, extended families c. Increased incidence of nuclear families d. Nuclear families moving closer to extended families ANS: A

A B C D

Feedback There are more single-parent families in the United States than ever before, and most are headed by women.

With increased mobility, large extended families are decreasing.

The number of nuclear families is also decreasing.

Nuclear families are moving away from extended families.

PTS: 1

DIF: Cognitive Level: Knowledge

13. A nurse is caring for a new mother from Southeast Asia. The nurse is concerned that except for

breastfeeding, the mother allows her mother-in-law to provide all other care for the baby. The plan of care and patient teaching for this mother should include a. assessing the postpartum practices in her country of origin. b. assuming that the mother-in-law will care for the baby well since she is experienced. c. completing the teaching outlined for new mothers. d. asking the mother-in-law not to care for the baby so that the mother learns the care.

ANS: A

A B C D

Feedback The information gained will assist the nurse to plan an individualized plan of care, including cultural beliefs.

The nurse does not know how long the mother-in-law will care for the baby and what this means for the future.

Completing the routine teaching may not be appropriate for this mother.

Asking the mother-in-law not to care for the baby may be in opposition to their cultural beliefs.

PTS: 1

DIF: Cognitive Level: Application

14. A nurse is assessing a patient’s level of social support. How can the nurse best determine the adequacy

of the patient’s social support system? a. Noticing the number of visitors the patient has b. Asking for the patient’s perception of support c. Counting the number of community groups with which the patient is involved d. Assessing the patient’s family structure and roles ANS: B

A B C D

Feedback The adequacy of support can be determined only by the person himself or herself. Numbers alone do not indicate support or lack of support.

The adequacy of support can be determined only by the person himself or herself.

The number of community groups with which the patient is associated is not the best way to determine the patient’s support.

Assessing family structure and roles will provide helpful information but is not the best way to assess the adequacy of the patient’s support system.

PTS: 1

DIF: Cognitive Level: Comprehension

15. How can nurses contribute to a healthier environment? a. Supporting the purchase of polyvinyl chloride (PVC) products b. Teaching the benefits of using disposable diapers to new parents c. Recommending the purchase of nondisposable products when possible d. Leaving the computer on to reduce electrical use when rebooting ANS: C

A B C D

Feedback PVC products damage the environment.

The use of disposable diapers adds to solid waste, and they are not easily biodegradable.

The use of products that can be used again decreases the waste produced.

More energy is conserved by turning off computers.

PTS: 1

DIF: Cognitive Level: Application

16. Which of the following is the World Health Organization’s definition of “health”? a. People in harmony with environment b. A state of optimum functioning for an individual in the performance of roles and

tasks c. Physical, mental, and social well-being, not just the absence of disease or infirmity d. Functioning at maximum potential with the environment ANS: C

A B C

D

Feedback Jan Christian Smuts introduced the theory of health as man in harmony with his environment.

“The state of optimum capacity of an individual for the effective performance of his roles and tasks” is Parson’s definition of health.

The World Health Organization’s definition of health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Functioning at maximum potential with the environment is Dunn’s theory of health.

PTS: 1

DIF: Cognitive Level: Knowledge

17. What is an advantage of the holistic view of health valued by nurses? a. Altering an individual’s health beliefs to promote health b. Identifying a state of optimal role functioning c. Focusing on the interrelationship of all parts of a whole person d. Emphasizing the environment ANS: C

A B C D

Feedback Holism has nothing to do with altering health beliefs.

Holism is more than just optimal role functioning.

When viewing health holistically, individual health practices are considered, along with other aspects of the individual.

Holism sees the environment as part of the person and contributing to his or her health.

PTS: 1

DIF: Cognitive Level: Comprehension

18. Which of the following is the primary focus of Healthy People 2030? a. Improving the health of individuals b. Improving the health of children c. Improving the health of families d. Improving the health of communities ANS: D

A B C

Feedback Improving the health of individuals is only a part of the primary focus of Healthy People 2030.

Improving the health of children is only a part of the primary focus of Healthy People 2030.

Improving the health of families is only a part of the primary focus of Healthy People 2030.

D

Healthy People 2030 shifted the focus from individuals to the health of communities.

PTS: 1

DIF: Cognitive Level: Knowledge

19. An adult wears a helmet when riding a bicycle because he believes that his cycling skills might not

prevent an accident, which could result in a head injury with serious consequences. Which component of the health beliefs model is this person demonstrating? a. Knowledge that cycling is good exercise and improves health b. Perception of vulnerability to head injury from a bicycle accident c. Concern about his cycling skills d. Belief that individuals should prevent injuries ANS: B

A B C D

Feedback Knowledge of practices to improve health is not part of the health beliefs model.

The health beliefs model has as one component the evaluation of one’s vulnerability to a condition and the seriousness of that condition.

Concern about skills is not part of the health beliefs model.

The belief that individuals should prevent injuries is not part of the health beliefs model.

PTS: 1

DIF: Cognitive Level: Comprehension

20. Bandura’s theory of self-efficacy described people’s response to health-related behaviors. Which of the

following is a major premise of this theory? a. Patients will take responsibility for their health if they understand the risks and benefits. b. A “cue to action” is a powerful motivator for changing health behavior. c. Belief in self as having the ability to improve health is important in changing health behaviors. d. Health is genetically predetermined and cannot be influenced by an individual’s actions or beliefs.

ANS: C

A B C D

Feedback Understanding the risk does not always motivate patients to change their behavior.

A “cue to action” was described by Rosenstock as a motivating factor in changing behavior.

Bandura’s theory of self-efficacy states that belief in one’s self-efficacy leads to efforts to change.

Bandura believed that individuals could change their health practices if they believed they could.

PTS: 1

DIF: Cognitive Level: Comprehension

21. Which statement by an obese individual could be assessed as perceiving self-efficacy? a. “I’ve never been able to lose weight on any diet.” b. “It’s better to maintain one’s weight than lose weight and gain it all back.” c. “I’ll be all right as long as my spouse will stay on the diet with me.” d. “I believe I can stay on this diet as long as necessary.”

ANS: D

A B

C

D

Feedback The person saying “I’ve never been able to lose weight on any diet” does not reflect the belief that one is able to change his or her own behaviors.

The person saying “It’s better to maintain one’s weight than lose weight and gain it all back” does not reflect the belief that one is able to change his or her own behaviors.

The person saying “I’ll be all right as long as my spouse will stay on the diet with me” does not reflect the belief that one is able to change his or her own behaviors.

Self-efficacy is a person’s belief that he or she has the ability to modify his or her own behavior to improve health.

PTS: 1

DIF: Cognitive Level: Application

22. Which of the following is believed about the concept of locus of control? a. Internally controlled people see themselves as responsible for their health and

amenable to change. b. Externally controlled people believe health is controlled by what they do. c. Internally controlled people believe health is controlled by environmental factors. d. Externally controlled people are not likely to change their health behaviors.

ANS: A

A B C D

Feedback People with internal locus of control believe that they control their health and have the ability to change their behaviors.

Externally controlled people believe they are controlled by external forces.

Internally controlled people believe that they control health.

Externally controlled people can change health behaviors, but the stimulus to do so will come from outside of themselves.

PTS: 1

DIF: Cognitive Level: Comprehension

23. Which one of the following guiding principles helps explain nursing’s holistic approach? a. Nursing care can be provided in a variety of settings. b. Nursing care persists even in the absence of scientific research. c. Nursing care considers mind, body, and spirit. d. Nursing provides care regardless of a patient’s belief systems or culture.

ANS: C

A B C D

Feedback Holistic care can be provided in any setting.

“Nursing care persists even in the absence of scientific research” does not address the meaning of holism.

Holistic nursing considers the whole person: body, mind, and spirit.

Nursing care always strives to consider a person’s culture and belief system.

PTS: 1

DIF: Cognitive Level: Comprehension

24. The nursing process is an example of which of the following branches of philosophy? a. Aesthetics b. Ethics c. Epistemology d. Logic ANS: D

A B C D

Feedback Aesthetics is the study of what is beautiful.

Ethics deals with standards of conduct.

Epistemology deals with the nature of knowledge itself.

The nursing process is an example of ordered thinking and reasoning known as logic and reasoning.

PTS: 1

DIF: Cognitive Level: Comprehension

MULTIPLE RESPONSE 1. Which of the following are considered systems? (Select all that apply.) a. Automobile engine b. Person c. Rock d. Hospital e. Family ANS: A, B, D, E Feedback Correct

Incorrect

PTS: 1

An automobile engine, a person, a hospital, and a family exhibit the components of a system: input, output, throughput, evaluation, and feedback.

A rock does not have the characteristics of a system, such as input and output.

DIF: Cognitive Level: Comprehension

2. Nurses recognize which of the following about health? (Select all that apply.)

a. b. c. d. e.

Individuals desiring to change their behaviors are already motivated to change.

The burden of change is borne by the individual.

Health is relative and ever changing.

Multiple interventions are necessary to change health behaviors.

Unhealthy behaviors may persist in spite of increased knowledge.

ANS: C, D, E Feedback Correct

Incorrect

Nurses recognize that health is relative and ever changing, multiple interventions are necessary to change health behaviors, and that unhealthy behaviors may persist in spite of increased knowledge.

Individuals may desire change but not have the knowledge, motivation, self-efficacy, or support to change. The burden of change is shared by the patient, health care providers, and population-focused entities.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 09: Nursing Theory: The Basis for Professional Nursing Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Which of the following best describes the meaning of the term “theory”? a. A set of beliefs about the nature of how things work and how the world should be

viewed. b. A group of related concepts, definitions, and statements that describe a certain

view of nursing phenomena from which to describe or predict outcomes. c. An organizational structure that outlines concrete connections between concepts. d. Statements that describe linkages between concepts and propose a testable

outcome.

ANS: B

A B

C D

Feedback “A set of beliefs about the nature of how things work and how the world should be viewed” is the definition of “philosophy.”

“A group of related concepts, definitions, and statements that describe a certain view of nursing phenomena from which to describe or predict outcomes” is the definition of “theory.”

“An organizational structure that outlines concrete connections between concepts” is the definition of “conceptual framework.”

“Statements that describe linkages between concepts and propose a testable outcome” is the definition of “propositions.”

PTS: 1

DIF: Cognitive Level: Knowledge

2. Which component of nursing theory describes a testable outcome? a. Conceptual model

b. Proposition c. Framework d. Metaparadigm ANS: B

A B C D

Feedback A conceptual model provides an organizational structure, not a testable outcome.

A proposition describes an outcome that is testable in research or practice.

A framework is another name for conceptual model.

A metaparadigm consists of the major concepts of the discipline.

PTS: 1

DIF: Cognitive Level: Knowledge

3. A broad, general view of nursing that clarifies values and answers broad disciplinary questions for

nursing is known as a a. conceptual model. b. metaparadigm. c. philosophy. d. theory.

ANS: C

A B C D

Feedback A conceptual model is a broadly defined concept in an organized system to provide a focus for the integration and interpretation of information.

The metaparadigm is the four concepts of person, health, environment, and nursing.

A philosophy is a set of broad beliefs about the nature of how things work and how to view the world.

A theory is a group of related concepts, definitions, and statements that propose a view of phenomena to describe, explain, or predict outcomes.

PTS: 1

DIF: Cognitive Level: Comprehension

4. A specific organizational structure that makes clear connections between concepts is a a. conceptual model. b. metaparadigm. c. philosophy. d. theory.

ANS: A

A B

Feedback A conceptual model is a broadly defined concept in an organized system to provide a focus for the integration and interpretation of information.

The metaparadigm is the four concepts of person, health, environment, and nursing.

C D

A philosophy is a set of broad beliefs about the nature of how things work and how to view the world.

A theory is a group of related concepts, definitions, and statements that propose a view of phenomena to describe, explain, or predict outcomes.

PTS: 1

DIF: Cognitive Level: Comprehension

5. A group of concepts and propositions that describe linkages between the concepts is a a. conceptual model. b. metaparadigm. c. philosophy. d. theory.

ANS: D

A B C D

Feedback A conceptual model is a broadly defined concept in an organized system to provide a focus for the integration and interpretation of information.

The metaparadigm is the four concepts of person, health, environment, and nursing.

A philosophy is a set of broad beliefs about the nature of how things work and how to view the world.

A theory is a group of related concepts, definitions, and statements that propose a view of phenomena to describe, explain, or predict outcomes.

PTS: 1

DIF: Cognitive Level: Comprehension

6. An overriding principle of Nightingale’s writings on nursing dealt with which aspect of nursing? a. The relationship between nurses, physicians, and society b. The relationship between patients, health, and environment c. The relationship between illness and health practices d. The relationship between hospitals, nurses, and patients ANS: B

A B C D

Feedback The relationship between nurses, physicians, and society does not reflect Nightingale’s philosophy.

Nightingale’s philosophy was sensitive to the effect of the environment on the patient’s health and recovery.

The relationship between illness and health practices does not reflect Nightingale’s philosophy.

The relationship between hospitals, nurses, and patients does not reflect Nightingale’s philosophy.

PTS: 1

DIF: Cognitive Level: Knowledge

7. The nurse adjusts the patient’s room to allow the patient to see the sunlight out the window and checks

the patient’s diet tray to ensure a balanced diet. The nurse could be basing care on the philosophy of a. Henderson. b. Nightingale. c. Roy. d. Watson.

ANS: B

A B

C

D

Feedback Henderson identified 14 basic needs as a general focus for patient care. She proposed that these needs shaped the fundamental elements of nursing care.

Nightingale believed that the health of patients was related to their environment.

She recognized the importance of clean air and water, adequate ventilation and sunlight, a balanced diet, and cleanliness.

Roy focused on the individual as a biopsychosocial adaptive system and described nursing as a humanistic discipline that emphasized the person’s adaptive abilities.

Watson’s carative factors guide nurses who use transpersonal caring in practice.

She believes that nurses have the responsibility for creating and maintaining an environment supporting human caring while recognizing and providing for patients’ primary human requirements.

PTS: 1

DIF: Cognitive Level: Application

8. Which contemporary nursing theorist is best known for her definition of nursing that describes the

nurse’s role as a substitute for the patient and as a helper and partner to the patient? a. Orem b. Henderson c. Watson d. King ANS: B

A B C D

Feedback Orem described the self-care theory.

Henderson’s theory of nursing described the nurse’s role as that of a substitute for the patient, a helper for the patient, or a partner with the patient.

Watson’s theory was based on caring.

King’s theory was of interacting systems.

PTS: 1

DIF: Cognitive Level: Knowledge

9. Which of the following human needs was not included in Henderson’s 14 basic needs of patients? a. Need for work b. Sleep and rest c. Spirituality d. Sexuality

ANS: D

A B C D

Feedback The need for work was listed as one of the developmental needs.

Sleep and rest were listed as one of the first nine basic needs.

Spirituality was listed as one of the psychosocial needs.

Henderson did not include sexuality in the 14 basic human needs.

PTS: 1

DIF: Cognitive Level: Knowledge

10. The nurse assists the patient with a bath in the morning because the patient has a cast on one hand and

an intravenous line on the other. The nurse could be basing care on the philosophy of a. Henderson. b. Nightingale. c. Roy. d. Watson.

ANS: A

A

B

C

D

Feedback Henderson identified 14 basic needs as a general focus for patient care. She proposed that these needs shaped the fundamental elements of nursing care. One of these needs is to keep the body clean, and the nurse is assisting the patient to meet this need because the patient is unable to perform the function alone.

Nightingale believed that the health of patients was related to their environment.

She recognized the importance of clean air and water, adequate ventilation and sunlight, a balanced diet, and cleanliness.

Roy focused on the individual as a biopsychosocial adaptive system and described nursing as a humanistic discipline that emphasized the person’s adaptive abilities.

Watson’s carative factors guide nurses who use transpersonal caring in practice.

She believes that nurses have the responsibility for creating and maintaining an environment supporting human caring while recognizing and providing for patients’ primary human requirements.

PTS: 1

DIF: Cognitive Level: Application

11. Which contemporary theorist is best known for her emphasis on the caring aspect of nursing? a. Orem b. Watson c. Henderson d. King ANS: B

A B

Feedback Orem developed the self-care theory.

Watson’s theory emphasizes the caring aspect of nursing.

C D

Henderson’s theory involves assisting the patient to do those things that he or she would do for himself or herself if able.

King’s theory describes interacting systems.

PTS: 1

DIF: Cognitive Level: Knowledge

12. The nurse teaches the patient how to administer insulin. Before this the nurse and patient had

developed a trusting relationship over several days, which included sharing feelings about having to take daily medication. The patient expressed confidence in the care provided by the nurse. The nurse could be basing care on the philosophy of a. Henderson. b. Nightingale. c. Roy. d. Watson.

ANS: D

A

B

C

D

Feedback Henderson identified 14 basic needs as a general focus for patient care. The function of nurses was to assist patients if they were unable to perform any of these 14 functions themselves. Examples of the 14 basic needs include breathing, eating, and drinking (care of the physical self), communication (psychosocial needs), and the need for play (developmental needs).

Nightingale believed that the health of patients was related to their environment.

She recognized the importance of clean air and water, adequate ventilation and sunlight, a balanced diet, and cleanliness.

Roy focused on the individual as a biopsychosocial adaptive system and described nursing as a humanistic discipline that emphasized the person’s adaptive abilities.

Watson’s carative factors guide nurses who use transpersonal caring in practice.

She believes that nurses have the responsibility for creating and maintaining an environment supporting human caring while recognizing and providing for patients’ primary human requirements.

PTS: 1

DIF: Cognitive Level: Application

13. Which nursing model assumes that people want to be in control of their lives? a. Orem b. King c. Roy d. Watson ANS: A

A B

Feedback An underlying assumption of Orem’s model is that people want to be in control of their lives and to take care of themselves.

King’s model of interacting systems stresses goal attainment.

C D

Roy’s work is based on adaptation and adaptive behavior produced by changing the environment.

Watson’s theory emphasizes the caring aspect of nursing.

PTS: 1

DIF: Cognitive Level: Comprehension

14. The nurse is caring for a postoperative patient who is unable to feed himself and complete basic

activities of daily living. The nurse does catheter care and changes the surgical dressing, as well as assisting with feeding and hygiene. The nurse could be basing care on the conceptual model of a. Johnson. b. King. c. Orem. d. Roy. ANS: C

A

B

C

D

Feedback Johnson’s model describes the person as a behavioral system that is an organized and integrated whole of seven distinct behavioral subsystems.

According to Johnson, nursing is an activity that helps the person achieve and maintain an optimal state of health through the manipulation and regulation of the environment.

King focuses on goal attainment for and by the patient. King’s interacting systems form a framework to view whole people in their family and social contexts.

Orem’s model focuses on the patient’s self-care capacities and the process of designing nursing actions to meet the patient’s self-care needs. The nurse prescribes and regulates the nursing system on the basis of the patient’s self-care deficit, which is the extent to which the patient is incapable of providing effective self-care.

Roy focused on the individual as a biopsychosocial adaptive system and described nursing as a humanistic discipline that emphasizes the person’s adaptive abilities.

PTS: 1

DIF: Cognitive Level: Application

15. Which nursing theorist is best known for her emphasis on interacting systems, including nurse and

patient in goal setting and goal attainment? a. Watson b. Roy c. King d. Orem ANS: C

Feedback

A

B

C

D

Watson’s carative factors guide nurses who use transpersonal caring in practice.

She believes that nurses have the responsibility for creating and maintaining an environment supporting human caring while recognizing and providing for patients’ primary human requirements.

Roy focused on the individual as a biopsychosocial adaptive system and described nursing as a humanistic discipline that emphasizes the person’s adaptive abilities.

King focused on goal attainment for and by the patient. King’s interacting systems form a framework to view whole persons in their family and social contexts.

Orem’s model focuses on the patient’s self-care capacities and the process of designing nursing actions to meet the patient’s self-care needs. The nurse prescribes and regulates the nursing system on the basis of the patient’s self-care deficit, which is the extent to which the patient is incapable of providing effective self-care.

PTS: 1

DIF: Cognitive Level: Comprehension

16. A nurse practitioner caring for a diabetic patient thinks the patient could gain better control of the

diabetes if the patient lost weight. After assessing the patient’s perception of weight loss, role, stresses, and support systems, the nurse and patient establish the goal of losing 5 pounds in a month. The nurse could be basing care on the conceptual model of a. Johnson. b. King. c. Orem. d. Roy. ANS: B

A

B

C

D

Feedback Johnson’s model describes the person as a behavioral system that is an organized and integrated whole of seven distinct behavioral subsystems.

According to Johnson, nursing is an activity that helps the person achieve and maintain an optimal state of health through the manipulation and regulation of the environment.

King focused on goal attainment for and by the patient. King’s interacting systems form a framework to view whole persons in their family and social contexts.

Orem’s model focuses on the patient’s self-care capacities and the process of designing nursing actions to meet the patient’s self-care needs. The nurse prescribes and regulates the nursing system on the basis of the patient’s self-care deficit, which is the extent to which the patient is incapable of providing effective self-care.

Roy focused on the individual as a biopsychosocial adaptive system and described nursing as a humanistic discipline that emphasizes the person’s adaptive abilities.

PTS: 1

DIF: Cognitive Level: Application

17. Which nursing theorist based her model on the belief that adaptation to changes in the environment is

the basis of health? a. Watson b. King c. Roy d. Peplau ANS: C

A B C

D

Feedback Watson’s theory emphasizes the caring aspect of nursing.

King’s model stresses the relationship of the nurse to the patient in goal setting and goal attainment.

Roy’s model provides a comprehensive understanding of adaptation. When environmental demands are too high and patient’s adaptive mechanisms too low, behavioral responses for coping are ineffective.

Peplau’s theory of therapeutic use of self describes the therapeutic relationship in terms of phases.

PTS: 1

DIF: Cognitive Level: Comprehension

18. A patient who had a broken neck in an automobile accident and was paralyzed, but eventually went

back to college, obtained a law degree, and became a practicing lawyer could be said to be demonstrating a. adaptation. b. caring. c. self-care. d. homeostasis.

ANS: A

A

B C D

Feedback A person and the environment are sources of stimuli that require modification to promote adaptation in the person. The person is an adaptive system with physiologic, self-concept, role function, and interdependent modes.

Caring involves the development of a human-to-human relationship between nurse and patient that results in change through transpersonal caring.

Self-care is the practice of activities that individuals initiate and perform on their own behalf to maintain health and well-being.

Homeostasis is a state of equilibrium.

PTS: 1

DIF: Cognitive Level: Application

19. A patient had a significant blood loss in surgery and now has a low hemoglobin level. The patient

complains of fatigue. The nurse intervenes to facilitate adaptation by establishing periods of rest and scheduling activities throughout the day. The nurse could be basing care on the conceptual model of a. Johnson.

b. King. c. Orem. d. Roy. ANS: D

A

B

C

D

Feedback Johnson’s model describes the person as a behavioral system that is an organized and integrated whole of seven distinct behavioral subsystems.

According to Johnson, nursing is an activity that helps the person achieve and maintain an optimal state of health through the manipulation and regulation of the environment.

King focused on goal attainment for and by the patient. King’s interacting systems form a framework to view whole persons in their family and social contexts.

Orem’s model focuses on the patient’s self-care capacities and the process of designing nursing actions to meet the patient’s self-care needs. The nurse prescribes and regulates the nursing system on the basis of the patient’s self-care deficit, which is the extent to which the patient is incapable of providing effective self-care.

Roy focused on the individual as a biopsychosocial adaptive system and described nursing as a humanistic discipline that emphasizes the person’s adaptive abilities.

PTS: 1

DIF: Cognitive Level: Application

20. Peplau’s theory focuses on the therapeutic relationship as the key to successful nursing intervention.

Which of the following is correct about Peplau’s theory? a. It is a grand theory that demonstrates that defining nursing was more important than application to practice. b. Her theory developed from her work with oncology patients. c. The theory describes six key nursing roles that are flexibly used, depending on the practice setting. d. Her theory describes nursing roles as mother, technician, salesman, scholar, and advocate.

ANS: C

A B C

D

Feedback Most nursing theorists develop midrange theories that are applicable to practice or education.

Peplau’s work was with psychiatric patients.

Peplau’s theory focuses on the therapeutic relationship between the nurse and patient. The nurse’s role is one of six that may change with the situation or practice setting.

Peplau described the roles of nurse as counselor, resource, teacher, technical expert, surrogate, and leader.

PTS: 1

DIF: Cognitive Level: Knowledge

21. The nurse has established a relationship with a patient in whom asthma was recently diagnosed.

Through their interactions, the nurse helps the patient understand the mechanism of asthma and develop the skills to use a spacer with the inhaler. The nurse could be basing care on the theory of a. Leininger. b. Peplau. c. Orlando. d. Neuman.

ANS: B

A

B

C

D

Feedback Leininger encouraged nurses to use creativity to discover cultural aspects of human needs and use these findings to make culturally congruent therapeutic decisions.

Peplau focused on what happens between the nurse and patient in a therapeutic relationship. It is through the relationship that the patient is helped to deal with health issues.

Orlando’s theory proposes how nurses process their observations of patient behavior and how they react to patients based on inferences from patients’ behavior.

Neuman focused on the person and the environment as systems.

PTS: 1

DIF: Cognitive Level: Application

22. Which nursing theorist is best known for her emphasis on inferences based on observation of patient

behavior, confirmation by the patient, and results in effective care based on identified patient needs? a. Leininger b. Neuman c. Orlando d. Peplau ANS: C

A

B

C

D

Feedback Leininger encouraged nurses to use creativity to discover cultural aspects of human needs and use these findings to make culturally congruent therapeutic decisions.

Neuman focused on the person and the environment as systems. Within the systems, stressors are identified that result in disruption for the person, and how to maintain optimal health is explored.

Orlando’s theory proposes how nurses process their observations of patient behavior and how they react to patients based on inferences from patients’ behavior.

Peplau focused on what happens between the nurse and patient in a therapeutic relationship. It is through the relationship that the patient is helped to deal with health issues.

PTS: 1

DIF: Cognitive Level: Comprehension

23. The nurse observes a patient pacing around the room. The patient expresses concern that being

hospitalized will cause lost wages and create economic problems. The nurse infers that the patient is anxious, which the patient confirms. The nurse could be basing care on the theory of a. Leininger. b. Neuman. c. Orlando. d. Peplau.

ANS: C

A

B C

D

Feedback Leininger encouraged nurses to use creativity to discover cultural aspects of human needs and use these findings to make culturally congruent therapeutic decisions.

Neuman focused on the person and the environment as systems.

Orlando’s theory proposes how nurses process their observations of patient behavior and how they react to patients on the basis of inferences from patients’ behavior.

Peplau focused on what happens between the nurse and patient in a therapeutic relationship. It is through the relationship that the patient is helped to deal with health issues.

PTS: 1

DIF: Cognitive Level: Comprehension

24. Leininger’s theory uses the sunrise model. What is the major premise of Leininger’s theory? a. Nursing care should be culturally congruent. b. Nursing care is based on personal, interpersonal, and social systems. c. Nursing care is a deliberate action based on observation. d. Nursing care is only possible after scientific evaluation.

ANS: A

A B C D

Feedback Nursing care is focused on culture care preservation.

Nursing care based on personal, interpersonal, and social systems is from King’s theory.

Nursing care as a deliberate action based on observation is a premise of Orlando’s theory.

Much nursing care tradition has not been empirically tested.

PTS: 1

DIF: Cognitive Level: Knowledge

25. The nurse is caring for a young Hispanic patient after surgery. The patient hesitates when the nurse

asks about meal selections from the menu. When the parents return, the nurse asks the patient what foods are eaten when one is ill. The nurse could be basing care on the theory of

a. b. c. d.

Leininger.

Neuman.

Orlando.

Peplau.

ANS: A

A

B C

D

Feedback Leininger encouraged nurses to use creativity to discover cultural aspects of human needs and use these findings to make culturally congruent therapeutic decisions.

Neuman focused on the person and the environment as systems.

Orlando’s theory proposes how nurses process their observations of patient behavior and how they react to patients on the basis of inferences from patients’ behavior.

Peplau focused on what happens between the nurse and patient in a therapeutic relationship. It is through the relationship that the patient is helped to deal with health issues.

PTS: 1

DIF: Cognitive Level: Application

26. A nurse conducts theory testing and theory development research to develop nursing science. This

nurse is prepared at which level of nursing education? a. Associate degree b. Bachelor’s degree c. Master’s degree d. Doctoral degree ANS: D

A B

C

D

Feedback Nurses prepared with an associate degree may have experienced nursing-model or theory-guided curricula or courses.

The baccalaureate nurse is introduced to the research process and the use of theory to guide research. These nurses are informed consumers of research relevant to evidence-based nursing practice.

Master’s-prepared nurses use theoretical perspectives focused on the patient for specific nursing outcomes. They may use theory to frame patient care and guide research with practice questions.

At the doctoral level, nurses are concerned about the nature of knowledge and how it is known. It is through nursing research that new, discipline-specific knowledge is generated.

PTS: 1

DIF: Cognitive Level: Comprehension

27. Which of the following best describes a middle-range theory? a. They are very limited in scope and are confined to one to three concepts. b. They do not incorporate the elements of nursing’s metaparadigm in use.

c. They usually blend nursing practice with nursing research. d. They do not borrow concepts from other disciplines.

ANS: C

A B C D

Feedback Middle-range theories are considered neither broad nor narrow.

While limited to a few concepts, the middle-range theories do not exclude the concepts from the metaparadigm.

Middle-range theories usually merge research and nursing practice.

Theories from other disciplines are often incorporated into middle-range theories.

PTS: 1

DIF: Cognitive Level: Comprehension

28. A nurse has been introduced to theory as a guide to research and practice. This nurse is prepared at

which level of nursing education? a. Associate degree b. Bachelor’s degree c. Master’s degree d. Doctoral degree ANS: B

A B

C

D

Feedback Nurses prepared with an associate degree may have experienced nursing-model or theory-guided curricula or courses.

The baccalaureate nurse is introduced to the research process and the use of theory to guide research. These nurses are informed consumers of research relevant to evidence-based nursing practice.

Master’s-prepared nurses use theoretical perspectives focused on the patient for specific nursing outcomes. They may use theory to frame patient care and guide research with practice questions.

At the doctoral level, nurses are concerned about the nature of knowledge and how it is known. It is through nursing research that new, discipline-specific knowledge is generated.

PTS: 1

DIF: Cognitive Level: Comprehension

29. Nursing theory provides a foundation for theory-based practice and curriculum development. Which is

a primary reason for incorporating theory into education? a. Nursing theory helps nurses explain their practice to members of other disciplines. b. Nursing theory helps transmit knowledge to new professional nurses. c. Nursing theory contributes to professional autonomy, an important characteristic of all professions. d. Nursing theory is taught as a guide to nursing practice and to teach students care within the unique perspective of nursing.

ANS: D

A B C D

Feedback Nursing theory does help nurses explain their practice to members of other disciplines.

Nursing theory does help transmit knowledge to new professional nurses.

Nursing theory does contribute to professional autonomy, an important characteristic of all professions.

Nursing theory is important in a curriculum because it serves as a guide to nursing practice and enhances patient care within the unique perspective of the discipline.

PTS: 1

DIF: Cognitive Level: Comprehension

MULTIPLE RESPONSE 1. What are the reasons nursing theory is important to the profession? (Select all that apply.) a. Nursing theory is used to guide research but not practice. b. The goal of nursing theory is to support excellence in practice. c. Nursing as a profession becomes stronger when nursing knowledge is built on

sound theory. d. Theory is a useful tool for reasoning, critical thinking, and decision making. e. Nursing theory is used by other disciplines.

ANS: B, C, D Feedback Correct

Incorrect

As a profession, nursing uses theory to guide practice, has a distinct body of knowledge that needs to be built on sound theory, and theories assist in organizing information and provide a framework to look at situations.

Theory is important to nursing to guide not only research and the development of knowledge but also practice decisions. Nursing theory has not been used by other disciplines; however, with the increase of interdisciplinary research, this may change.

PTS: 1

DIF: Cognitive Level: Comprehension

2. The metaparadigm of nursing consists of which concepts? (Select all that apply.) a. Environment b. Health c. Caring d. Nursing e. Person ANS: A, B, D, E Feedback Correct

Environment, health, nursing, and the person are the concepts contained in most nursing philosophies, models, and theories.

Incorrect

Caring is not a concept in the metaparadigm.

PTS: 1

DIF: Cognitive Level: Knowledge

3. Which of the following are included in Henderson’s 14 basic needs of patients? (Select all that apply.) a. The need to eliminate body wastes b. The need for interdependence c. The need to communicate d. The need for self-concept e. The need for work and sense of accomplishment ANS: A, C, E Feedback Correct Incorrect

The needs to eliminate body wastes, communicate, and work are part of the 14 basic needs identified by Henderson.

The need for interdependence and self-concept are not part of the 14 basic needs identified by Henderson.

PTS: 1

DIF: Cognitive Level: Comprehension

4. Watson’s 10 caritas processes include which of the following? (Select all that apply.) a. The promotion of interpersonal teaching-learning b. The participation in recreation c. The instillation of faith-hope d. Avoidance of injuring others e. Assistance with the gratification of human needs ANS: A, C, E Feedback Correct

Incorrect

The promotion of interpersonal teaching-learning, the instillation of faithhope, and assistance with the gratification of human needs are part of the 10 carative factors identified by Watson.

The participation in recreation and avoidance of injuring others are not included in the 10 carative factors identified by Watson.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 10: The Science of Nursing and Evidence-Based Practice Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. The discovery of oxygen would be called pure science because this information a. was obtained for the sake of obtaining new knowledge of the world. b. had an immediate use for humans. c. would be useful in curing, managing, or preventing disease. d. could direct further research at the bedside.

ANS: A

A B C D

Feedback Pure science or pure research summarizes and explains the world without regard to whether this information is immediately useful.

Pure science does not address the immediate use of the information or its relationship to diseases or bedside research.

Pure science does not address the immediate use of the information or its relationship to diseases or bedside research.

Pure science does not address the immediate use of the information or its relationship to diseases or bedside research.

PTS: 1

DIF: Cognitive Level: Comprehension

2. What is meant by the term “evidence-based practice”? a. Using nursing research findings to develop nursing theory b. Integrating the research process into nursing administration c. Studying research from the social sciences and applying it to practice d. Applying research findings; patient care data, preferences, and values; and nursing

expertise to nursing practice ANS: D

A B C D

Feedback Evidence-based practice is for the purpose of clinical practice, not theory development.

The goal of evidence-based practice is to integrate research into clinical practice, not necessarily into nursing administration.

Research from nursing applied to practice is evidence-based practice.

Evidence based practice is defined as practice that “integrates the best evidence from [research] studies and patient care data with clinician expertise and patient preferences and values.”

PTS: 1

DIF: Cognitive Level: Knowledge

3. To build the body of knowledge of nursing, a problem amenable to study should be a. able to ensure participants that the intervention is a “good idea.” b. based on published research findings and fit logically with what is already known. c. an original area of study never researched previously. d. able to produce results that are applicable to a variety of situations.

ANS: B

A B

Feedback An intervention being a “good idea” does not mean it will build the body of knowledge unless it relates to what we already know.

To build a body of knowledge, one needs to extend what one already knows.

C D

Although original research is excellent, to build the body of knowledge, the foundational work must be expanded.

Not all problems occur in a variety of settings.

PTS: 1

DIF: Cognitive Level: Comprehension

4. Which of the following is not a necessary step in the research process? a. Review of the literature b. Review of best practice guidelines c. Design of the study d. Dissemination of results ANS: B

A B C D

Feedback Review of the literature is a primary step in the research process.

Review of best practice guidelines is not a step in the research process.

Design of the study is an essential step in the research process.

Dissemination is a step of the research process and a responsibility of the researcher.

PTS: 1

DIF: Cognitive Level: Comprehension

5. Which of the following are the three most common sources of research questions? a. Study of clinical problems, anecdotal stories, requests by the National Institutes of

Health (NIH) b. Requests by drug companies, doctoral students, review of the literature c. Clinical problems, replication of prior research, testing nursing theory d. Review of existing research, NIH grants, request by state board of nursing ANS: C

A B C D

Feedback Clinical problems are a source of research, but anecdotal stories and NIH requests are not.

Drug companies conduct their own studies.

The three most common sources of research questions are clinical situations, the literature, and theory.

Most research questions do not come from the state board of nursing.

PTS: 1

DIF: Cognitive Level: Comprehension

6. Which of the following is an example of a research question based on a clinical problem? a. Published observations of a nurse who practiced many years in elder care b. Nursing intuition about what measures are most useful with anxious patients

before surgery c. Stories of a flight nurse’s experiences with posttraumatic stress disorder d. Relationship between hours of bright light and irritability of preterm infants

ANS: D

A B C D

Feedback Published observations about elder care do not meet the criteria of a research question.

Nursing intuition does not meet the criteria of a research question.

Stories of flight nurses’ experiences do not meet the criteria of a research question.

The relationship between hours of bright light and irritability in preterm infants is a research question based on a clinical problem that can be studied.

PTS: 1

DIF: Cognitive Level: Comprehension

7. A nursing manager wants the unit staff to become more involved in research. The staff nurses say they

are not qualified to conduct research. Which response by the manager is best? a. “You need a basic understanding of the research process because you should be good consumers of research.” b. “At the staff nurse level, you can assist with clinical studies by doing data collection.” c. “A baccalaureate-prepared nurse should be able to design simple studies.” d. “If we all work on this together, we can design and implement good research studies.”

ANS: A

A B C D

Feedback Nurses at all levels of basic preparation become consumers of research when they enter practice, so they need a good understanding of the process.

Staff nurses might be asked to assist in data collection, but this option does not fully explain why they should be involved in research.

The masters-prepared nurse should be able to design replication studies.

Without the educational background that prepares a nurse to conduct research, even a team effort will probably not yield high-quality studies.

PTS: 1

DIF: Cognitive Level: Application

8. An intensive care unit (ICU) nurse notices that patients seem to have more normal vital signs when

they are being visited by their family members, especially when the visitors seem to be more “caring.”

However, the hospital has strict visiting hours of 10 minutes every other hour. What would be the most appropriate research question to ask at this time? a. What is patient and family satisfaction with visitation time? b. What is the relationship between length of visitation and vital signs? c. What are the vital signs of ICU patients when visited by caring visitors in comparison with when they are alone? d. Do ICU patients have vital signs in the normal range more frequently when they are being visited by family members?

ANS: D

A B C

D

Feedback Satisfaction is the issue the nurse is interested in.

At this point the length of visitation is similar and is not the issue.

Although this is an interesting question, the nurse needs to first discover whether the vital signs are in the normal range more often during family visitation.

The nurse has only subjective data and needs to determine whether the vital signs are truly more often in the normal range with visitation.

PTS: 1

DIF: Cognitive Level: Application

9. Which research design has the goal of determining a cause-and-effect relationship? a. Experimental design b. Nonexperimental design c. Pure research d. Applied research ANS: A

A B C D

Feedback A true experimental design should prove a cause-and-effect relationship.

Nonexperimental studies do not necessarily include cause-and-effect controls.

Pure research is research conducted without regard for whether the information is immediately useful.

Applied research seeks to develop a practical use for research findings.

PTS: 1

DIF: Cognitive Level: Knowledge

10. Which research design would be used to determine the relationship between self-concept, physical

fitness, and health habits in school-aged children? a. Experimental design b. Nonexperimental design c. Applied research design d. Pretest and posttest design ANS: B

A B C D

Feedback Experimental designs look for differences between groups on certain variables.

Nonexperimental designs will allow the researcher to look for relationships among the variables and are described as descriptive or exploratory.

Designs used in applied research take various forms, including experimental and nonexperimental.

An experimental design addresses differences, not relationships.

PTS: 1

DIF: Cognitive Level: Comprehension

11. Which research design should be used to determine whether there is a difference in the effectiveness of

two preoperative preparation methods on length of stay? a. Survey design b. Experimental design c. Nonexperimental design d. Descriptive comparison design ANS: B

A B C D

Feedback A survey design will describe but not address differences.

Experimental designs will allow the researcher to look for differences between the outcomes of the two different preparation methods.

Nonexperimental designs will not allow the researcher to answer questions about differences between groups.

As a nonexperimental design, it addresses relationships among variables in groups.

PTS: 1

DIF: Cognitive Level: Comprehension

12. For data collection to be valid, what must occur? a. The tool must be thorough. b. The tool must be unbiased. c. The tool must measure what it is supposed to measure. d. The tool must be accurate all of the time.

ANS: C

A B C D

Feedback Thoroughness of the tool does not make it valid.

A tool should be unbiased, but it will not make it valid.

For a tool to be valid, it must measure what it is supposed to measure.

The accuracy of the tool is referred to as reliability.

PTS: 1

DIF: Cognitive Level: Comprehension

13. A data collection protocol calls for a questionnaire to be administered to patients having knee

replacement surgery after the third physical therapy appointment. Errors can be introduced into the study by a. giving the questionnaire to all participants. b. reading the questionnaire to the participants with poor reading skills. c. giving the questionnaire to all participants when they arrive for their appointment. d. giving the questionnaire to the participants after the appointment to be completed while they have a snack.

ANS: C

A

Feedback Giving a questionnaire to all participants follows the timing of the protocol.

B C

D

Reading the questionnaire to participants with poor reading skills follows the timing of the protocol.

Giving the questionnaire to all participants when they arrive for their appointment does not follow the protocol; the participant could fill out the questionnaire before experiencing the therapy session.

Giving the questionnaire to the participants after the appointment to be completed while they have a snack follows the timing of the protocol.

PTS: 1

DIF: Cognitive Level: Application

14. Which of the following must be included in the informed consent in research? a. Participants relinquish the right to privacy. b. Once participants agree to participate, they must complete the study. c. Participants need to know the funding source for the research. d. Participants must be informed of risks associated with participation.

ANS: D

A B C D

Feedback Participants must be guaranteed privacy.

Participants may withdraw their consent at any time.

Participants do not need to know the funding source for the study.

Participants must be informed of any risk involved while participating.

PTS: 1

DIF: Cognitive Level: Knowledge

15. What body has been established to protect participants of research? a. Institutional review board b. State board of nursing c. Nursing research board d. Peer review panel ANS: A

A B C D

Feedback An institutional review board has the purpose of protection of human subjects.

The state board of nursing has no jurisdiction over research.

The nursing research board is not a recognized entity.

The peer review process is not used to protect participants of research studies.

PTS: 1

DIF: Cognitive Level: Knowledge

16. What is the current name of the agency that serves as an important source of funding for nursing

research? a. NIH b. National Institute of Nursing Research c. National Center for Nursing Research d. National Nursing Research Agenda

ANS: B

A B C D

Feedback The National Institute of Nursing Research is the part of the NIH charged with nursing research.

The name of the agency that primarily funds nursing research is the National Institute of Nursing Research.

The National Center for Nursing Research was the original name for the National Institute of Nursing Research before 1992.

The National Nursing Research Agenda determines priorities for funding of nursing research but does not directly fund nursing research.

PTS: 1

DIF: Cognitive Level: Knowledge

MULTIPLE RESPONSE 1. Translational research/science will do which of the following? (Select all that apply.) a. Result in biomedical research becoming less flexible in response to the needs of b. c. d. e.

society.

Limit interdisciplinary research because this does not enhance patient care.

Take laboratory findings for development for use with patients at the bedside.

Use clinical research findings to ask new questions for research in the laboratory.

Discover practical applications for scientific theories and laws.

ANS: C, D Feedback Correct Incorrect

PTS: 1

Translational research serves as the conduit between the “bench and the bedside.

Translational research will result in more flexibility in taking biomedical research findings to practical applications. Interdisciplinary research is expected to increase as multiple disciplines involved in clinical concerns can use the findings of the bench scientists. Discovering practical applications for scientific knowledge is applied science.

DIF: Cognitive Level: Comprehension

2. Quantitative research methods may be somewhat less useful in nursing because of which of the

following? (Select all that apply.) a. Qualitative methods are the preferred method to study nursing phenomena. b. Nursing ethics require more stringent controls than are required by quantitative methods. c. Many phenomena of interest to nurses are not amenable to study in tightly controlled circumstances. d. The complexity of human beings makes it difficult to break problems into statements that can be tested. e. Patient perceptions of experiences may have significant effects on their health behaviors.

ANS: C, D, E Feedback Correct

Incorrect

Nursing problems of interest often cannot be studied in laboratory settings.

The view of human beings as holistic makes it difficult to dissect them into problem statements to be tested. The meaning of the experience to the patient may be as significant to his or her response as the objective events that occurred.

Quantitative methods have had stature as the method of inquiry. However, both qualitative and quantitative methods have much to offer to the study of nursing phenomena. Quantitative methods are the most stringent but are not required to study all phenomena of interest to nursing.

PTS: 1

DIF: Cognitive Level: Comprehension

3. Evidence-based nursing practice involves which of the following? (Select all that apply.) a. The use of the best evidence available supporting the interventions b. The use of randomized controlled trials only versus qualitative studies c. The expertise of the professional nurse d. Resources to identify practices that have traditionally been used in nursing practice e. The preferences of the individual patients and their families ANS: A, C, E Feedback Correct

Incorrect

Focusing on the evidence of the effectiveness of the intervention prevents the nurse from basing care on tradition or routine. Expertise of the nurse allows the nurse to question the best way to do something and to seek information to answer the question. Patient preference is still important if the intervention is to be successful.

Randomized controlled trials may be the “gold standard” for providing evidence of effectiveness, but they are not the only method to study patient problems. Resources should be used to find the best evidence to support nursing practice, not what nurses have done traditionally.

PTS: 1

DIF: Cognitive Level: Comprehension

4. A nurse wants to examine the accuracy of child and parent perceptions of asthma symptoms and their

decision making based on their understanding of the symptoms. What specific factors would identify participants? (Select all that apply.) a. Children 5 to 18 years of age b. Mothers of the children c. Children with a history of pneumonia d. Families living in rural areas e. Ethnicity ANS: A, B Feedback

Correct Incorrect

Children 5 to 18 years of age and their mothers address the participants identified in the problem.

There is no mention that the children needed to have had pneumonia.

Although a researcher could limit participants based on geographic location and ethnicity, these are not mentioned in the description of the participants needed for this study.

PTS: 1

DIF: Cognitive Level: Application

5. Dissemination of findings may involve which of the following activities? (Select all that apply.) a. Manuscript reviewed by peers b. Oral presentation of findings at annual conference of the Society of Pediatric

Nurses c. Poster presentation at regional conference of Sigma Theta Tau International d. Publication of findings in Western Journal of Nursing Research e. PowerPoint slides developed showing charts and graphs of the statistical results ANS: A, B, C, D Feedback Correct Incorrect

The dissemination of findings involves the publication and/or presentation of the results so that they are available to others.

A PowerPoint presentation may be part of preparation for publication or presentation, but it does not disseminate the findings in itself unless shown or discussed with other professionals.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 11: Developing Nursing Judgment Through Critical Thinking Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Critical thinking in nursing needs to include which of the following important variables? a. Consideration of ethics and responsible decision making b. Ability to act quickly, often on impulse c. Ability to determine the best nursing interventions regardless of patient’s values

and beliefs d. Flexible thinking that rarely follows a pattern or considers standards ANS: A

A B C D

Feedback Critical thinking in nursing is based on ethics and standards of the profession.

Critical thinking is consciously developed, complex, and purposeful, never impulsive.

Critical thinking and decision making are based on patient’s values and beliefs.

Critical thinking is based on a decision-making model and nursing standards.

PTS: 1

DIF: Cognitive Level: Comprehension

2. A nursing student asks a faculty member how to improve critical thinking. Which response by the

faculty is best? a. “Don’t worry too much; it will come with time and experience.” b. “Pay close attention to how you solve problems; assess your own style of thinking.” c. “Spend time shadowing an experienced nurse to see how it is done.” d. “Use ethical standards to guide how you approach patient situations.”

ANS: B

A

B C D

Feedback Although time and experience are important in developing critical thinking, people actually must actively consider how they think in order to improve critical thinking.

Making thinking a focus of concern and actively thinking about it is the best advise the faculty can give.

While observing an experienced nurse may be helpful, the student needs to be an active participant to improve critical thinking.

Using ethical and professional standards is a part of critical thinking, but that is only a portion of what makes a good critical thinker.

PTS: 1

DIF: Cognitive Level: Analysis

3. Which of the following is a characteristic of an accomplished critical thinker? a. Inquisitiveness b. Narrow focus c. Unaffected by other arguments d. Quick decision making ANS: A

A B C D

Feedback The accomplished critical thinker needs to ask questions when things do not seem quite right.

The accomplished critical thinker thinks broadly, considering all possibilities.

The accomplished critical thinker considers all information and all arguments before deciding on a course of action.

The accomplished critical thinker considers the facts, fits them into known patterns, considers all aspects of the problem, and makes decisions based on knowledge, not on instinct.

PTS: 1

DIF: Cognitive Level: Comprehension

4. Which of the following statements describes the purpose of the nursing process? a. Process of documentation designed to decrease liability

b. Process designed to maximize reimbursement potential c. A sophisticated time-management strategy d. Process used to identify and solve patient problems ANS: D

A B C D

Feedback Although proper documentation is part of the nursing process, it is a problemsolving process, not a documentation process.

The nursing process is not used with reimbursement potential in mind.

The nursing process is not a time-management strategy.

The purpose of the nursing process is to identify and solve patient problems.

PTS: 1

DIF: Cognitive Level: Knowledge

5. Which of the following is considered subjective data in information gathering from the patient? a. Pulse and blood pressure measurements b. ECG pattern c. Diaphoresis d. Pain ANS: D

A B C D

Feedback Pulse rate and blood pressure measurements are signs or objective data that can be confirmed by observation.

The ECG pattern is objective data.

Diaphoresis is objective data.

Subjective data are the patient’s perceptions, sometimes called “symptoms.”

PTS: 1

DIF: Cognitive Level: Comprehension

6. A nursing student is complaining about writing care plans. Which response by the faculty is best to

help the student see the importance of this activity? a. “Using the nursing process will help nurses get reimbursement for their services.” b. “You need a written plan of care so everyone is on the same page as you are.” c. “The nursing process is a way to systematically think about and use patient data.” d. “Most state nurse practice acts require them, so you need to learn how to do them.”

ANS: C

A

B C

Feedback Demonstrating use of the nursing process may be important in obtaining reimbursement, but it is not the primary reason for using the nursing process (and writing care plans).

Having a detailed plan that other nurses can follow is important, but it is not the primary reason for using the nursing process (and writing care plans).

Writing care plans teaches students to use the nursing process, which is a systematic way of thinking about and processing patient data.

D

State nurse practice acts do require that nurses demonstrate the use of the nursing process, but this statement does not describe why the process itself is important.

PTS: 1

DIF: Cognitive Level: Comprehension

7. Which of the following is considered objective data obtained from the patient? a. “I can’t catch my breath.” b. Patient expresses concern about missing work. c. Patient nods, indicating an affirmative answer to a question. d. Blood pressure is 110/70 at 8 p.m.

ANS: D

A B C D

Feedback A patient’s expression of a problem is subjective data.

The patient expressing concern about missing work is an inference based on what a patient has said.

“Patient nods, indicating an affirmative answer to a question” is interpretation of a movement.

Objective data are measurable and observable.

PTS: 1

DIF: Cognitive Level: Comprehension

8. The nurse observes a patient lying rigidly in bed and taking shallow breaths. The patient reports a pain

score of 4 out of 5 and says, “My leg hurts.” The nurse determines that the objective and subjective data are a. incongruent and require more assessment. b. insufficient to make any conclusions. c. congruent and support that the patient is in pain. d. unclear; the nurse needs to talk to the patient’s family for more information.

ANS: C

A B C D

Feedback The statement and behaviors observed indicate that the patient is experiencing pain.

One can make a conclusion because there is sufficient information available.

The patient states he/she is in pain and the rigid positioning and shallow breathing are behaviors found when individuals experience pain.

The subjective nature of pain requires obtaining the information from the patient if at all possible. The family can be an excellent source of information if the patient is unable to cooperate with the nurse’s assessment.

PTS: 1

DIF: Cognitive Level: Analysis

9. A nurse is admitting a non-English speaking patient to the hospital unit. Which is the best method of

obtaining data from the patient?

a. b. c. d.

Asking the other family members to help interpret Performing a physical examination on the patient Interviewing the patient using a professional interpreter Attempting to obtain past medical records for this patient

ANS: C

A

B

C D

Feedback While tempting, the nurse should not use family members to interpret. They may insert cultural biases, may be embarrassed to translate certain topics, or may misunderstand the nurses’ question. Professional interpreters must be used.

A physical examination yields important data, but the patient interview is the primary method of obtaining information. The nurse needs to use an interpreter to gain this information from the patient.

A professional interpreter has been trained to convey medical information without cultural biases and in an objective fashion.

Past medical records may provide useful information but obtaining them does not replace the need to conduct a patient interview with the assistance of a professional interpreter.

PTS: 1

DIF: Cognitive Level: Application

10. What is the primary method of obtaining patient data? a. Medical record b. Speaking with family c. Interview with patient d. Physical examination ANS: C

A B C D

Feedback The medical record is the third source, along with consultation.

The presence of others, even family, can obstruct the interview process.

The patient interview is the primary method of obtaining information.

The examination is the second process.

PTS: 1

DIF: Cognitive Level: Knowledge

11. What does the process of analysis of patient data directly result in? a. Validating actual problems or diagnoses b. Determining the nursing interventions of importance c. Identifying actual or potential problems amenable to nursing intervention d. Confirming the medical diagnosis ANS: C

A

Feedback Analysis identifies both actual and potential problems.

B

C D

Analysis identifies problems. The most important interventions are determined by identifying the most important problems and the interventions related to them.

Analysis will identify both actual and potential problems. These problems can be addressed through nursing interventions.

The identification of patient problems that nursing can intervene with is not related only to the medical diagnosis.

PTS: 1

DIF: Cognitive Level: Knowledge

12. Which of the following describes the primary difference between nursing diagnoses and medical

diagnoses? a. Nursing diagnoses identify simple instead of complex problems. b. Nursing diagnoses must be verified by a physician. c. Nursing diagnoses, like medical diagnoses, identify medical diseases. d. Nursing diagnoses identify problems that can be treated with independent nursing actions.

ANS: D

A B C D

Feedback Nursing diagnoses are not simple versus complex problems but the human response to disease.

Nursing diagnoses are identified by nurses and do not need to be verified by any other professional.

Nursing diagnoses identify the human effect of disease on the person.

Nursing diagnoses identify problems that nurses can treat within their scope of practice.

PTS: 1

DIF: Cognitive Level: Knowledge

13. Which of the following is a correctly stated nursing diagnosis? a. Fluid volume deficit b. Hypovolemia related to vomiting c. Fluid volume deficit related to vomiting as evidenced by increased heart rate and

decreased urine output d. Hypovolemia related to nausea as evidenced by restlessness and anxiety ANS: C

A B C

Feedback “Fluid volume deficit” is incomplete; it contains only the diagnostic label.

“Hypovolemia related to vomiting” is incomplete; it contains only the diagnostic label and the etiology.

“Fluid volume deficit related to vomiting as evidenced by increased heart rate and decreased urine output” contains the diagnostic label, the etiology, and the defining characteristics.

D

The etiology of “hypovolemia related to nausea as evidenced by restlessness and anxiety” is incorrect.

PTS: 1

DIF: Cognitive Level: Comprehension

14. A patient is admitted with the diagnosis of bronchitis, congestive heart failure, and fever. The nurse’s

assessment finds a temperature of 101° F, peripheral edema, and rhonchi. Which of the following is the best etiology to support the nursing diagnosis of ineffective airway clearance? a. Peripheral edema b. Retained secretions c. Bronchitis d. Congestive heart failure ANS: B

A B C D

Feedback Peripheral edema is related to the accumulation of fluid in the feet and legs but has nothing to do with the airway.

The nursing diagnosis indicates that “something” may be blocking the airway.

Respiratory secretions are the only choice that could block the airway.

Bronchitis is a medical diagnosis.

Congestive heart failure is a medical diagnosis.

PTS: 1

DIF: Cognitive Level: Analysis

15. Why is the etiology of the nursing diagnosis statement important? a. If the etiology is incorrect, the nursing interventions are likely to be ineffective. b. The etiology will be the same each time the nursing diagnosis is identified. c. The etiology is necessary to identify the defining characteristics. d. The etiology determines whether the problem can be solved.

ANS: A

A B

C D

Feedback On the basis of the etiology, different interventions would be selected; for example, anxiety versus fatigue.

The etiology can vary although the same diagnosis is identified. For example, the etiology of the nursing diagnosis of ineffective breathing pattern could be either fatigue or anxiety.

The etiology is not necessary to identify the defining characteristics that are the signs and symptoms of the nursing diagnosis.

The resolution of the problem is not determined by the etiology.

PTS: 1

DIF: Cognitive Level: Comprehension

16. A patient is admitted with asthma. The nurse’s assessment finds a temperature of 99° F, wheezing,

speaking in three-word phrases, and respiratory rate of 16 breaths per minute. Which of the following is the best defining characteristic to support the diagnosis of ineffective airway clearance related to inflammation and constriction of the bronchial tree? a. Elevated temperature and respiratory rate b. Diagnosis of asthma with wheezing c. Wheezing and speaking in three-word phrases d. Limited vocalization and fever ANS: C

A B C D

Feedback Neither the temperature nor the respiratory rate is outside of the norms of an adult.

The medical diagnosis is not a defining characteristic.

The constriction causes wheezing and difficulty vocalizing.

There is no fever.

PTS: 1

DIF: Cognitive Level: Analysis

17. Which of the following patient problems is given the highest priority by the nurse? a. Anxiety related to hospitalization as manifested by hyperactive state b. Impaired tissue perfusion, cerebral, related to hypoxia as manifested by decreased

level of consciousness c. Impaired skin integrity related to surgical incision d. Risk for fluid volume overload related to imbalance in antidiuretic hormone as manifested by peripheral edema and decreased sodium ANS: B

A B C D

Feedback Anxiety is a psychological, not a physical or life-threatening, problem.

Impaired tissue perfusion, cerebral, is life threatening and would take priority.

Impaired skin integrity has a potential for harm but does not take priority over cerebral tissue perfusion problems.

Risk for fluid volume overload related to imbalance in antidiuretic hormone as manifested by peripheral edema and decreased sodium is a potential problem and does not take priority over actual problems.

PTS: 1

DIF: Cognitive Level: Analysis

18. Which of the following patient problems is given the highest priority by the nurse using Maslow’s

hierarchy of needs? a. Anxiety related to fear of the hospital b. Ineffective airway clearance related to retained secretions c. Fluid volume excess related to third spacing of fluid (edema) d. Ineffective thermoregulation related to fever ANS: B

A B C D

Feedback Psychological safety is a not higher-level need than oxygenation.

The need for oxygen is one of the most basic needs according to Maslow’s hierarchy.

Although fluid volume excess related to third spacing of fluid (edema) concerns a basic need, it is not as life threatening as lack of oxygen.

Although ineffective thermoregulation related to fever concerns a basic need, it is not as life threatening as lack of oxygen.

PTS: 1

DIF: Cognitive Level: Analysis

19. The identification of nursing diagnosis and goal setting should ideally be a collaborative process

between the nurse and which other party? a. Physician b. Nurse manager c. Patient’s family d. Patient ANS: D

A B C D

Feedback The physician does not set nursing goals.

The nurse manager does not set nursing goals.

The family does not set goals for the patient.

Nursing goals should be agreed on jointly by the nurse and the patient.

PTS: 1

DIF: Cognitive Level: Knowledge

20. Which of the following statements has all of the necessary criteria for a well-written outcome? a. Patient will consume 50% of meals with no nausea and vomiting by 24 hours

postsurgery. b. Therapist will report improvement in patient’s range of motion on a daily basis. c. Patient will ambulate in the halls a little today. d. Patient’s condition will improve before discharge.

ANS: A

A B C D

Feedback “Patient will consume 50% of meals with no nausea and vomiting by 24 hours postsurgery” is specific, measurable, and has a specific time frame.

Outcomes should be patient focused.

“Patient will ambulate in the halls a little today” is nonspecific and not measurable.

“Patient’s condition will improve before discharge” is nonspecific, is nonmeasurable, and has no time frame.

PTS: 1

DIF: Cognitive Level: Application

21. A patient is in respiratory distress and placed on oxygen. Which is the most appropriate short-term

goal? a. Nasal cannula remains in place. b. Patient completes morning care and eats breakfast. c. Patient verbalizes that he is breathing better after lunch. d. Patient maintains an oxygen saturation of 90% during the shift.

ANS: D

A B C D

Feedback “Nasal cannula remains in place” is not a patient goal, and there is no time frame.

“Patient completes morning care and eats breakfast” is broad, and there is no time frame.

Although there is a short time frame, the goal “patient verbalizes that he is breathing better after lunch” lacks specificity.

“Patient maintains an oxygen saturation of 90% during the shift” involves a specific goal for the patient in a short time frame.

PTS: 1

DIF: Cognitive Level: Application

22. Which of the following is an appropriate long-term goal to measure diabetes control for a patient in

whom diabetes has been newly diagnosed? a. Patient will inject insulin twice daily. b. Patient will keep appointments with physician over the next 6 months. c. Patient’s A1c will be 5% at 1 year postdiagnosis. d. Patient’s recorded blood glucose will be between 60 and 120 mg/dL each day.

ANS: C

A B C

D

Feedback Taking the insulin is important but does not indicate how well blood glucose was controlled.

Although keeping appointments is important for diabetes management, this does not indicate blood glucose control.

“Patient’s A1c will be 5% at 1 year postdiagnosis” reflects the best indicator of long-term control of blood glucose level and therefore diabetes management.

This goal is specific and easily measurable.

“Patient’s recorded blood glucose will be between 60 and 120 mg/dL each day” is a short-term measure of blood glucose control.

PTS: 1

DIF: Cognitive Level: Application

23. Which of the following is an independent nursing intervention? a. Teaching a patient with congestive heart failure to weigh herself daily b. Recommending an extra dose of diuretic to the patient whose weight has increased

2 pounds overnight

c. Changing the first surgical dressing on a patient after surgery d. Transferring a patient out of the intensive care unit 2 days after vascular surgery ANS: A

A B C D

Feedback Teaching requires no supervision, and nurses can carry out teaching interventions independently.

Prescribing medication is not a nursing intervention.

“Changing the first surgical dressing on a patient after surgery” is a dependent nursing action.

“Transferring a patient out of the intensive care unit 2 days after vascular surgery” is a dependent nursing intervention.

PTS: 1

DIF: Cognitive Level: Comprehension

24. Which of the following represents an interdependent nursing action? a. Giving the patient an ordered medication b. Bathing the patient c. Inserting a Foley catheter d. Participating in a “code” (cardiac arrest response) ANS: D

A B C D

Feedback “Giving the patient an ordered medication” is a dependent nursing action.

“Bathing the patient” is an independent nursing action.

“Inserting a Foley catheter” is a dependent nursing action.

“Participating in a ‘code’ (cardiac arrest response)” is an example of an action that involves collaboration with other health care professionals before and during implementation. It requires a protocol.

PTS: 1

DIF: Cognitive Level: Comprehension

25. The use of standardized plans of care for different patient populations has a. facilitated the use of critical paths as interdisciplinary plans of care. b. required the nurse to individualize the plan of care to the patient. c. eliminated the need for the nurse to develop a plan of care for an individual. d. increased the time the nurse has to document the plan of care.

ANS: B

A B C

Feedback Standardized plans of care are not always critical paths and/or interdisciplinary.

Although plans for frequent patient problems can be easily produced, the plan of care still may need to be modified to meet the needs of the patient.

The use of standardized plans of care has not eliminated the need for an individualized plan.

D

The use of the standardized plans of care has decreased the time required of the nurse to update and document the plan of care.

PTS: 1

DIF: Cognitive Level: Comprehension

26. The nurse instructs the patient about incentive spirometry as preoperative teaching. Which phase of the

nursing process does this illustrate? a. Assessment b. Planning c. Implementation d. Evaluation ANS: C

A B C D

Feedback The example in the question is an intervention, not an assessment.

The example in the question is an intervention, not a plan.

Implementation is the phase of the nursing process when interventions are carried out.

The example of incentive spirometry is not an evaluation.

PTS: 1

DIF: Cognitive Level: Comprehension

27. In the nursing process, the evaluation phase is used to determine the a. value of the nursing intervention. b. accuracy of problem identification. c. the quality of the plan of care. d. degree of outcome achievement.

ANS: D

A B C D

Feedback Evaluation does not measure the value of the intervention.

Evaluation does not measure the accuracy of problem identification.

While it is an indicator of the effectiveness of the plan of care, evaluation is far more than that.

The evaluation phase of the nursing process is used to evaluate patient progress related to goals and outcome achievement to determine whether a problem is resolved.

PTS: 1

DIF: Cognitive Level: Knowledge

28. A nurse reviewing a patient’s care plan notes a goal of “Patient will ambulate 50 feet, three times in

the hallway today.” According to Bloom, what taxonomic category is this goal? a. Affective domain b. Physical domain c. Psychomotor domain d. Cognitive domain

ANS: C

A B C D

Feedback The affective domain involves feelings, emotions, values, and attitudes. This goal is not in the affective domain.

Bloom’s taxonomy does not include “physical” domain.

The psychomotor involves movement and motor skills. An ambulation goal would be part of this domain.

The cognitive domain includes knowledge and cognitive skills. Ambulating would not be part of the cognitive domain.

PTS: 1

DIF: Cognitive Level: Comprehension

MULTIPLE RESPONSE 1. A “well-cultivated critical thinker” is an individual who does which of the following? (Select all that

apply.) a. Raises questions. b. Recognizes alternative ways to see problems. c. Uses only logic to determine relevance of information. d. Implements solutions to complex problems only as an individual. e. Criticizes solutions and alternatives suggested by others.

ANS: A, B Feedback Correct Incorrect

PTS: 1

A critical thinker identifies clear and precise questions and is open-minded to alternative ways to see problems.

A critical thinker gathers and assesses all relevant information and will communicate with others as he or she formulates solutions. Critical thinking does not involve criticism of others’ solutions and ideas, although it does include questioning and arriving at one’s own conclusions.

DIF: Cognitive Level: Comprehension

2. The nurse is admitting a patient for surgery. The patient is twisting a handkerchief over and over while

saying, “I’m going to have a little mole removed. I’m not worried. The surgery will take only an hour, and then I will go home. I’ve never been sick a day in my life, so I’ll be fine.” The nurse finds the following during her physical assessment: blood pressure is 150/90; temperature is 98.6° F; pulse is 88 beats per minute; respiration is 20 breaths per minute; black, brown, and red pigmented pea-sized raised area on her shoulder. Which of the above information would be considered objective data?

(Select all that apply.) a. Twisting handkerchief b. Blood pressure 150/90 c. “I’m having this little mole removed.” d. Patient is worried. e. Patient is exhibiting denial.

ANS: A, B Feedback Correct Incorrect

Twisting handkerchief and blood pressure 150/90 are measurable or observable data.

“Patient is worried” is subjective data, and “I’m having this little mole removed” is the patient’s description of what is going to occur. “Patient is worried” is incorrect because this is a conclusion the nurse might make based on the subjective and objective data. “Patient is exhibiting denial” is incorrect because this is a conclusion or inference that the nurse might make based on the data.

PTS: 1

DIF: Cognitive Level: Application

3. The nurse is admitting a patient for surgery. The patient is twisting a handkerchief over and over while

saying, “I’m going to have a little mole removed. I’m not worried. The surgery will take only an hour, and then I will go home. I’ve never been sick a day in my life, so I’ll be fine.” The nurse finds the following during her physical assessment: blood pressure is 150/90; temperature is 98.6° F; pulse is 88 beats per minute; respiration is 20 breaths per minute; black, brown, and red pigmented pea-sized raised area on her shoulder. Which of the above information would be considered subjective data?

(Select all that apply.) a. Pigmented mole on shoulder. b. “I’m not worried… I’ll be fine.” c. Patient is anxious. d. Heart rate is increased. e. “The surgery will take only an hour and then I will go home.”

ANS: B, E Feedback Correct

Incorrect

“I’m not worried… I’ll be fine” and “The surgery will take only an hour and then I will go home” are statements made by the patient describing feelings or events.

“Pigmented mole on shoulder” is a conclusion based on objective data.

“Patient is anxious” is incorrect because this is a conclusion the nurse might make based on the subjective and objective data. “Heart rate is increased” is incorrect because this is a conclusion the nurse might make based on objective data.

PTS: 1

DIF: Cognitive Level: Application

4. Several methods have been developed to assist nurses in organizing patient data. They include (Select

all that apply.) a. Henderson’s 14 nursing problems. b. Gordon’s 11 functional health patterns. c. Nightingale’s ecological framework. d. Abdellah’s 21 nursing problems.

ANS: A, B, D

Feedback Correct Incorrect

Henderson’s 14 nursing problems, Gordon’s 11 functional health patterns, and Abdellah’s 21 nursing problems help sort patient data into categories.

Nightingale did not provide a method of organizing patient data.

PTS: 1

DIF: Cognitive Level: Comprehension

5. Developing sound clinical judgment is a professional responsibility of the nurse. Which statements

indicate behaviors that improve clinical judgment? (Select all that apply.) a. “I always assess before acting and make changes as needed.” b. “I only work the shifts I am assigned and usually refuse to float to other units.” c. “I look for research findings to support my nursing actions.” d. “I believe that every patient deserves my very best efforts.” e. “I have read the professional nursing standards.”

ANS: A, C, D, E Feedback Correct

Incorrect

“I always assess before acting and make changes as needed,” “I look for research findings to support my nursing actions,” “I believe that every patient deserves my very best efforts,” and “I have read the professional nursing standards” are behaviors that demonstrate the use of resources and the nursing process to give the patient quality care. These activities facilitate the development of clinical judgment.

The nurse is not taking opportunities to extend herself or himself and potentially learn from other situations. This would not show sound clinical judgment.

PTS: 1

DIF: Cognitive Level: Application

Chapter 12: Communication and Collaboration in Professional Nursing Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Which of the following best describes Peplau’s theory on therapeutic use of self? a. Putting patients’ needs ahead of your own b. Providing excellent clinical skills to improve patients’ health status c. Using excellent interpersonal skills to help patients improve their health status d. Self-protection through avoidance of a relationship with the patient ANS: C

A

Feedback “Putting patients’ needs ahead of your own” is not the best answer because although it is true that the patient’s needs, not the nurse’s, are met during the therapeutic relationship, nurses should not necessarily put all patient needs ahead of their own.

B C D

The theory focuses on therapeutic communication, not clinical skills.

Peplau’s theory described “using one’s personality and communication skills to help patients improve their health status” as therapeutic use of self.

The focus is the patient, not the nurse.

PTS: 1

DIF: Cognitive Level: Comprehension

2. Therapeutic use of self involves a. forming a relationship based on the nurse’s knowledge, attitudes, and skills to

communicate effectively. b. providing a safe environment based on the use of environmental manipulation and

verbal limit setting. c. evaluation of nurse-patient interactions and the creation of social alliances. d. determining whether it is necessary to listen to the patient and provide feedback.

ANS: A

A B C D

Feedback Therapeutic use of self as defined by Peplau included using communication skills to help patients.

Therapeutic use of self does not involve the manipulation of the environment.

Therapeutic use of self does not involve the creation of social alliances.

Therapeutic use of self involves listening and providing feedback to the patient.

PTS: 1

DIF: Cognitive Level: Comprehension

3. What is the most important information the nurse should share with the patient during the orientation

phase? a. Name, credentials, extent of responsibility b. Plan for the day, times the nurse will be unavailable, how to contact the nurse c. Nurse’s name, physician’s name, possible discharge date d. Plan for discharge, teaching needs, goals for the day ANS: A

A B

C D

Feedback During the orientation phase the nurse shares his or her name, credentials, and extent of responsibilities.

Sharing information about the plan for the day, times the nurse will be unavailable and how to contact the nurse is not primary during the orientation phase.

Determining a discharge date would be the responsibility of the entire treatment team.

The nurse does not share the plan for discharge and teaching needs during the orientation phase.

PTS: 1

DIF: Cognitive Level: Knowledge

4. One of the most important outcomes of the orientation phase of the nurse-patient relationship is the

development of mutual a. communication. b. understanding. c. acceptance. d. trust.

ANS: D

A B C D

Feedback The entire relationship requires excellent communication, not just the orientation phase.

All phases of the therapeutic relationship require understanding.

All phases require nonjudgmental acceptance.

The purpose of the orientation phase is to establish trust.

PTS: 1

DIF: Cognitive Level: Comprehension

5. Which behaviors help patients develop trust in the nurse? a. Answering questions with authority b. Sharing personal information to indicate openness c. Conveying acceptance of the patient and a nonjudgmental attitude d. Meeting with the patient spontaneously because that indicates caring ANS: C

A

B C D

Feedback Although answering questions as fully as possible and admitting the limits of knowledge facilitates trust, answering questions with authority implying that this is the entire answer does not help develop trust.

The sharing of personal information does not help develop trust.

Accepting the patient’s thoughts and feelings without judgment helps develop trust in the nurse.

Meeting at designated times helps the patient develop trust that the nurse will follow through with what is promised.

PTS: 1

DIF: Cognitive Level: Comprehension

6. The nurse says to a newly diagnosed diabetic patient, “I will be working with you during your 3-day

stay to help you practice insulin injections and to review your new diet. I’m wondering if we could find a time of day to begin the teaching sessions that is good for us.” This conversation would occur in which phase of the nurse-patient relationship? a. Acquaintance phase b. Orientation phase c. Working phase d. Termination phase ANS: B

A B C D

Feedback The phases of the nurse-patient relationship do not include an acquaintance phase.

During the orientation phase the time frame of the relationship is established, the problems to be worked on are identified, and a time to meet is established.

The working phase is when the nurse and patient address the problems.

The termination phase is when the relationship is ending.

PTS: 1

DIF: Cognitive Level: Application

7. Which of the following suggests that a successful contract has been established between the nurse and

patient in the orientation phase of the nurse-patient relationship? a. Patient has agreed to learn to change his colostomy bag. b. Patient ambulates in the hall without assistance. c. Patient allows the nurse to inject his daily insulin. d. Patient asks the charge nurse to verify that the staff nurse’s teaching is correct.

ANS: A

A B C D

Feedback The successful completion of a planned intervention signifies the successful establishment of the therapeutic relationship.

The patient is acting independently of the nurse’s instructions.

The patient is not moving toward goals of independence.

Trust has not been established.

PTS: 1

DIF: Cognitive Level: Application

8. A newly diagnosed diabetic patient states “I have very definite likes and dislikes when it comes to

food. Am I going to have to eat only certain foods, or will I have some choice?” The nurse responds, “Why don’t you give me a list of your likes and dislikes? I will consult with the dietitian about how to include your preferences and still come up with a good diet for you.” What phase of the nurse-patient relationship is this? a. Relationship phase b. Orientation phase c. Working phase d. Termination phase ANS: C

A B C D

Feedback The phases of the nurse-patient relationship do not include a relationship phase.

The orientation phase is when the relationship is established, the problems to be worked on are identified, and a time to meet is established.

The working phase is when the nurse and patient address the problems that have been identified.

The termination phase is when the relationship is ending.

PTS: 1

DIF: Cognitive Level: Comprehension

9. A patient demonstrates obvious regression in ability to perform self-care during the working phase.

Which response by the nurse is most appropriate? a. Frustration because the patient does not appear to be motivated to achieve goals b. Persistence in demonstrating the importance of achieving goals c. Patience and understanding because regression is a defense mechanism d. Ignoring it because the nurse realizes the patient is exhibiting childlike behavior ANS: C

A B C

D

Feedback The nurse needs to show patience and maturity, not frustration.

Regression may be a necessary defense mechanism against stress, and the nurse needs patience during this time.

Patience and understanding are necessary because the patient’s progress toward goal achievement may not be smooth. Regression is a defense mechanism that may precede positive outcomes.

Understanding of regression is needed during this time.

PTS: 1

DIF: Cognitive Level: Analysis

10. When should the preparation for the termination phase of the nurse-patient relationship begin? a. In the orientation phase b. During the working phase c. As part of the termination phase d. Right before termination ANS: A

A B C D

Feedback During the orientation phase, the nurse gives the patient an estimated time frame for their relationship. This begins the preparation for termination.

Preparation for termination of the nurse-patient relationship begins in the orientation phase.

Preparation for termination of the nurse-patient relationship begins in the orientation phase.

Preparation for termination of the nurse-patient relationship begins in the orientation phase.

PTS: 1

DIF: Cognitive Level: Knowledge

11. The nurse and patient may experience sadness during the termination phase. How can the nurse help

the patient be successful in the termination phase of the nurse-patient relationship? a. Providing personal contact information so the patient can contact the nurse if needed b. Visiting the patient at home during off-duty time to help the transition to self-care

c. Emphasizing the achievements the patient has made, including the ability for self-

care d. Exchanging goodbye gifts as a sign that the relationship is terminated ANS: C

A B C D

Feedback Nurses should not maintain personal communication with patients after discharge.

The nurse respects professional boundaries.

Emphasizing the patient’s achievement of goals and the reasons he or she does not need the nurse anymore is effective in the termination process.

Nurses should not exchange gifts with patients but should instead respect professional boundaries.

PTS: 1

DIF: Cognitive Level: Comprehension

12. A patient is being discharged from the hospital. Which statement by the nurse is appropriate for the

termination phase of the nurse-patient relationship? a. “You must be happy to be going home. Here are the written diet and medication instructions.” b. “It has been wonderful getting to know you. The best of luck when you get home.” c. “During the past 3 days, you have learned how to inject insulin and how to make appropriate food choices. Remember that you have the unit telephone number if you have any questions.” d. “You have done well learning a lot of new material and should be able to do well at home.”

ANS: C

A B C D

Feedback This response does not summarize what has occurred, which is an important part of the termination phase.

This response does not include a summary of the progress the patient has made, which is an important part of the termination phase.

Summarizing the gains the patient has made is important during the termination phase.

This response gives false reassurance about success at home.

PTS: 1

DIF: Cognitive Level: Application

13. Which of the following is an effective way to maintain safe professional boundaries? a. Never accepting small gifts from patients b. Finding ways to satisfy your needs through personal relationships outside of

nursing c. Avoiding caring for patients who ask personal questions about you d. Sharing your personal stories so that patients will feel understood and trusting ANS: B

A

B

C D

Feedback There are many other possibilities for violating professional boundaries; gifts are only one small way and, on occasions when the gift is not valuable and can be shared with the entire staff, may be accepted.

Respecting professional boundaries means that the nurse recognizes the vulnerability of the patient and the power that comes from the nurse’s personal knowledge about the patient. Finding ways to satisfy personal needs outside of the professional relationship will prevent the nurse from becoming inappropriately involved with the patient.

Avoidance is not a helpful response to any nurse-patient problem.

The nurse should stay focused on the patient.

PTS: 1

DIF: Cognitive Level: Comprehension

14. Which of the following is most important in order for a new staff nurse to communicate therapeutically

with patients? a. Focusing interactions on educating patients about their treatments b. Becoming aware of own feelings about illness and death c. Sharing information about the intimate details of one’s own life d. Presenting himself or herself as a knowledgeable and experienced clinician ANS: B

A B C D

Feedback Although education is important for patients, this does not help the nurse understand his or her feeling and responses.

Reflection will allow the nurse to develop self-awareness, which will help him or her become a better advocate for the patients.

Sharing intimate personal information is not therapeutic.

As a new nurse, knowledge and experience may be limited; portraying more knowledge and experience than one has is deceitful.

PTS: 1

DIF: Cognitive Level: Application

15. During report, a nurse complains about a 3-year-old boy, saying “He sure knows when to pour on the

tears. There’s nothing wrong until he sees you; then the tears start, but they stop as soon as you leave or his mother comes. He’s just spoiled because they have a nanny at home who waits on him hand and foot.” This is an example of a. lack of understanding of child development. b. frustration that the mother is not present. c. assessment of the child’s behavior. d. stereotyping because the child has a nanny.

ANS: D

Feedback

A B C D

The response does not reflect lack of knowledge about child development, assessment of the behavior, or a response to the mother’s not being present.

The response does not reflect lack of knowledge about child development, assessment of the behavior, or a response to the mother’s not being present.

The response does not reflect lack of knowledge about child development, assessment of the behavior, or a response to the mother’s not being present.

Stereotypes are simplistic and illogical images used to describe groups of people.

PTS: 1

DIF: Cognitive Level: Analysis

16. A nurse comments in private about a patient: “That lady with six kids is pregnant again! It makes me

sick to see these people on welfare taking away from our tax dollars. I don’t know how she can continue to do this.” The best response by a nurse peer is to a. ignore the biased statements. b. accept the comments as self-disclosure. c. offer neutral responses. d. convey acceptance of the patient.

ANS: D

A B C D

Feedback To ignore the statements will not help this nurse become aware of stereotypes.

These statements do not qualify as self-disclosure.

Offering neutral responses will not help the nurse become aware of stereotyping.

Acceptance conveys neither approval nor disapproval of personal beliefs.

Nonjudgmental acceptance means that the nurse acknowledges that all people have rights to be different and to express their differences. Nurses should convey acceptance of people as they are even if they disagree with specific beliefs and/or practices.

PTS: 1

DIF: Cognitive Level: Application

17. Which of the following best illustrates nonjudgmental acceptance by the nurse? a. Using professional influence to change a patient’s morality to be more in keeping

with societal norms b. Changing your assignment if you discover that you have negative feelings toward

your patient’s lifestyle c. Demonstrating caring behavior in spite of negative feelings d. Avoiding all negative feelings about the patient ANS: C

A B C

Feedback The nurse should not attempt to change a patient’s belief system or morality.

We cannot control our feelings but need to be able to control our behaviors.

Acceptance indicates neither approval nor disapproval of patient’s beliefs, behaviors, or lifestyles.

D

Prejudices are strong, and we may be unaware of them. It is impossible to control all negative feelings, but it is professional to acknowledge them and continue to provide safe and effective care.

PTS: 1

DIF: Cognitive Level: Analysis

18. Using Hagerty and Patusky’s theory of human relatedness (2003), the nurse-patient relationship has

been reconceptualized by approaching a. each patient contact as one step in a lengthy relationship-building process. b. patients with a sense of the patient’s autonomy, choice, and participation. c. the relationship as one in which the nurse has the power. d. the nurse-patient contact as an opportunity to streamline caregiving.

ANS: B

A B C D

Feedback Each contact should be approached as an opportunity for connection and goal achievement and not a lengthy process.

The relationship between the nurse and the patient is on a more equitable basis than the traditional nurse-patient relationship.

The relationship should be equitable.

The reconceptualization does not streamline caregiving.

PTS: 1

DIF: Cognitive Level: Comprehension

19. Which is true of verbal and nonverbal communication? a. Verbal messages are more important than nonverbal cues. b. Individuals can exercise more control over nonverbal communication. c. Verbal and nonverbal communication always match. d. The nonverbal communication may be a more reliable message.

ANS: D

A B C D

Feedback The nonverbal message may tell much more than the verbal one.

Individuals can exercise more control over verbal communication than nonverbal communication.

Verbal and nonverbal communication are not always congruent.

Nonverbal communication includes gestures, posture, facial expressions, eye contact, and actions, among other things. Although the verbal message using words may be short, the nonverbal message can tell much more about the person’s feelings.

PTS: 1

DIF: Cognitive Level: Comprehension

20. Which of the following could be considered congruent communication? a. The nurse manager states, “Come by my office anytime.” Then she keeps her door

closed and does not answer phone calls.

b. As a co-worker hurries down the hall, he asks, “Is there anything you need help

with?” c. As she drops a stack of charts loudly on the desk, a co-worker states, “This is

going to be a wonderful day.” d. The nurse manager sits with you in the nurse’s lounge and asks, “Is there anything

you would like to talk about?”

ANS: D

A B C

D

Feedback The verbal message is that she is available, but the closed door indicates otherwise.

The verbal message is willingness to help; the nonverbal message is, “I hope you do not ask.”

The dropping of the charts loudly indicates frustration and is incongruent with the message “This is going to be a wonderful day.” Sarcasm is incongruent communication.

The nurse manager’s verbal message matches the nonverbal message. This is the definition of congruent communication.

PTS: 1

DIF: Cognitive Level: Application

21. A nurse is irrigating pressure ulcers on a patient’s coccyx. When the patient asks how they are healing,

the nurse grimaces and says, “Oh, they’re doing just fine.” This is a. incongruence between verbal and nonverbal messages. b. a confirming statement. c. objectivity in responding to the question. d. the therapeutic use of humor.

ANS: A

A B C D

Feedback The words say, “It’s OK,” but the facial grimaces say it is not.

The verbal and nonverbal messages do not match.

Objectivity is not found in the statement.

There is no use of humor.

PTS: 1

DIF: Cognitive Level: Application

22. Context is one of the five major elements of communication identified by Ruesch. Which of the

following is part of the context of communication? a. Information about the sender b. Attitude of the receiver c. Response of the receiver d. Content of the message ANS: B

Feedback

A B C D

Information about the sender is not part of the context of the communication.

Context refers to the environment in which the interaction occurs. This includes the mood and the relationship between the sender and receiver.

The response of the receiver is not part of the context of communication.

The content of the message is not part of the context of communication.

PTS: 1

DIF: Cognitive Level: Comprehension

23. A new mother says to the nurse, “It really hurts me to breastfeed. I think I should wean my baby.” The

most appropriate response by the nurse is, a. “It is good to wean the baby early because it is easier on you.” b. “If I understand you, it hurts when you breastfeed. Tell me how and when it hurts.” c. “It is your decision to make whether you breastfeed.” d. “You should continue to breastfeed because it is much better for the baby.”

ANS: B

A

B C D

Feedback Saying “It is good to wean the baby early because it is easier on you” gives a response before the situation is clarified and closes off continued communication.

The nurse is gaining feedback that helps the nurse understand more about the situation from the patient’s perspective and keeps communication open.

Saying “It is your decision to make whether you breastfeed” gives a response before the situation is clarified and closes off continued communication.

Saying “You should continue to breastfeed because it is much better for the baby” gives a response before the situation is clarified and closes off continued communication.

PTS: 1

DIF: Cognitive Level: Application

24. A new mother says to the nurse, “It really hurts me to breastfeed. I think I should wean my baby.” The

nurse responds, “If I understand you, it hurts when you breastfeed. Tell me how and when it hurts.”

This response best represents which criterion of successful communication? a. Appropriateness b. Efficiency c. Feedback d. Flexibility ANS: C

A B C

Feedback Appropriateness relates to whether the reply fits the circumstances and matches the message.

Efficiency means using simple, clear words that are timed at a pace suitable to the patient.

The nurse seeks to clarify the hurt before intervening further.

D

Flexibility means the message is based on the immediate situation and not preconceived expectations.

PTS: 1

DIF: Cognitive Level: Application

25. When a co-worker tells the nurse, “I am not sure I will be able to give the right answers in the job

interview,” the nurse replies, “I know what you mean. Interviews have always been a problem for me, too.” This response can be evaluated as lacking a. appropriateness. b. efficiency. c. feedback. d. flexibility.

ANS: A

A

B C D

Feedback Appropriateness relates to whether the reply fits the circumstances and matches the message. The nurse’s response related to his own issue does not deal with the co-worker’s issue, which should be the focus of the interaction.

Efficiency means using simple, clear words that are timed at a pace suitable to the patient.

Feedback means the nurse seeks to clarify what the patient has said and gain understanding.

Flexibility means the message is based on the immediate situation and not preconceived expectations.

PTS: 1

DIF: Cognitive Level: Application

26. A new mother says, “My baby is being kept in the nursery. I’m really worried about him. I’m also

worried that the separation will interfere with breastfeeding.” The most appropriate response by the nurse is, a. “Well, that’s not my territory. You’ll have to deal with the nursery staff about breastfeeding.” b. “As a nurse on this unit, I can assure you that we will do all we can to help you.” c. “I can see you’re upset about this, but to be honest with you, I’m a new nurse here, and I’m not sure how I can help you.” d. “I can see this is a problem for you. I will go to the nursery and see if I can get some answers for you.”

ANS: D

A B C

Feedback Telling the mother that she will need to deal with the nursery staff does not address the concern of the mother.

Saying that the staff of the hospital will do all they can to help does not address the concern of the mother.

The nurse telling the mother that he is new and does not know how to help does not address the concern of the mother.

D

The nurse’s response fits the circumstances and matches the mother’s message of being concerned about the separation and breastfeeding.

PTS: 1

DIF: Cognitive Level: Application

27. Using simple, clear words to explain the details of a colonoscopy procedure shows sensitivity to which

successful communication criterion? a. Appropriateness b. Efficiency c. Feedback d. Flexibility ANS: B

A B C D

Feedback Appropriateness relates to whether the reply fits the circumstances and matches the message.

Efficiency means using simple, clear words that are timed at a pace suitable to the patient.

Feedback means the nurse seeks to clarify what the patient has said and gain understanding.

Flexibility means the message is based on the immediate situation and not preconceived expectations.

PTS: 1

DIF: Cognitive Level: Application

28. A 4-year-old child is going to have an abdominal x-ray examination. The child asks, “Why do they

have to do this? Will it hurt?” Which of the following is the most appropriate response by the nurse? a. “The doctor needs you to have the x-ray so she knows what is wrong with you.” b. “You will go to the x-ray department so they can take pictures of your tummy to find out why you have a tummy ache. The bed you lie on may be cool, but you will have a blanket to keep you warm. The test will not hurt.” c. “You will go downstairs on a stretcher. You will need to lie very still on a hard table while the x-ray machine goes over you. It will not take very long.” d. “X-rays do not hurt. The machine takes a picture but will not touch you.”

ANS: B

A B C

D

Feedback Telling the child that he will need an x-ray to determine what is wrong with him does not provide a clear explanation that addresses the child’s concerns.

The nurse’s response explains the procedure in clear and simple words that are suitable to a 4-year-old child.

Explaining the x-ray procedure in terms that may not be easy to understand for a 4-year-old does not provide a clear explanation that addresses the child’s concerns.

Telling the child that x-rays do not hurt and that they take pictures does not provide a clear explanation that addresses the child’s concerns.

PTS: 1

DIF: Cognitive Level: Application

29. Which of the following examples illustrates the nurse’s failure to use flexibility effectively in

professional communication? a. Asking on the admission assessment, “You don’t smoke, do you?” b. When updating a family member on a patient’s condition stating, “Your wife’s ABG report indicates significant hypoxia.” c. Continuing to follow the agenda in a staff meeting when people are obviously upset by a recent death on the unit d. Requiring nurses to read back phone orders to physicians ANS: C

A B C D

Feedback “You don’t smoke, do you?” is an example of value judgment.

This is an example of poor communication, because the message is not geared to the receiver’s level of understanding.

Continuing to follow an established agenda when the emotional state of the group needs to be addressed indicates inflexibility on the part of the leader.

Requiring nurses to read back phone orders to physicians is an example of feedback.

PTS: 1

DIF: Cognitive Level: Analysis

30. The nurse plans to teach a patient about the care of her mastectomy site. The nurse finds the patient

crying. The best response by the nurse is, a. “It is time to discuss how to care for the surgical site.” b. “You seem upset. You should start looking forward to going home and being a wife and mother again.” c. “I see you are upset. Is there something on your mind you’d like to talk about?” d. “Dr. Abrams said you can go home tomorrow, and we need to talk about the care of your surgical site.”

ANS: C

A B C

D

Feedback This statement follows the established agenda and does not respond to the emotional state of the patient.

This statement follows the established agenda and does not respond to the emotional state of the patient.

The nurse’s response demonstrates flexibility. The response identifies the emotional state of the patient and requires deviation from the established agenda.

This statement follows the established agenda and does not respond to the emotional state of the patient.

PTS: 1

DIF: Cognitive Level: Application

31. The patient says to the nurse, “The staff treats me like I’m a child. Everyone tells me what to do. No

one ever asks my opinion. After all, it is my body.” Which response by the nurse indicates active listening? a. “Well, you’re sick. Don’t you think you should let us take care of you?” b. “I don’t think I can help you with this. This is a personal matter between you and the rest of the staff.” c. “It makes you angry not to be included in your health care decisions. Let’s talk about how you can vent your anger appropriately.” d. “Let me see if I understand. It bothers you not to be recognized for your abilities to handle your life. I can discuss this with the staff if you wish so that everyone involves you in planning your care.”

ANS: D

A B C D

Feedback This statement indicates a lack of interest in what the patient was saying and is paternalistic.

This statement indicates a lack of interest in what the patient was saying and an unwillingness to help the patient.

This statement shows an assumption by the nurse that should be verified.

The nurse’s response recognizes the patient’s feelings and concerns. The nurse verifies the patient’s feelings and suggests an action which gives the patient the desired control.

PTS: 1

DIF: Cognitive Level: Application

32. In which of the following examples is the nurse demonstrating empathy for the postoperative

mastectomy patient? a. “With today’s advanced reconstruction techniques, you’ll quickly forget you ever had surgery.” b. “You’ll be back to your busy routine sooner than you think.” c. “This must be a very difficult time for you.” d. “I know how you feel; I also had breast cancer.”

ANS: C

A B C D

Feedback Saying “With today’s advanced reconstruction techniques, you’ll quickly forget you ever had surgery” discounts the patient’s feelings and is false reassurance.

The nurse is making an assumption that the patient wants to return to a busy routine. This is false reassurance based on a faulty assumption about the patient.

The nurse acknowledges the patient’s feelings and uses an open-ended statement to encourage the patient to verbalize further.

The nurse should never assume to know how the patient feels. The focus should be on the patient, not the nurse. The nurse’s experience is not germane to the nurse-patient relationship.

PTS: 1

DIF: Cognitive Level: Application

33. Which of the following demonstrates giving information versus opinion? a. “Mrs. Khan, let’s practice together the breathing techniques you learned in Lamaze

classes. That will help us to work together more effectively later when your labor is stronger.” b. “You learned breathing techniques in Lamaze classes. I really believe the breathing techniques make labor easier.” c. “Mrs. Khan, have you been practicing the breathing techniques you learned? It is very important to practice if you wish to use them effectively in labor.” d. “Using breathing techniques in labor is really to your benefit because you feel in control.”

ANS: A

A

B

C

D

Feedback Saying “Mrs. Khan, let’s practice together the breathing techniques you learned in Lamaze classes. That will help us to work together more effectively later when your labor is stronger” does not offer an opinion.

Saying “You learned breathing techniques in Lamaze classes. I really believe the breathing techniques make labor easier” offers the nurse’s opinion regarding the breathing techniques.

Saying “Mrs. Khan, have you been practicing the breathing techniques you learned? It is very important to practice if you wish to use them effectively in labor” offers the nurse’s opinion regarding the breathing techniques.

Saying “Using breathing techniques in labor is really to your benefit because you feel in control” offers the nurse’s opinion regarding the breathing techniques.

PTS: 1

DIF: Cognitive Level: Application

34. How would a nurse’s use of the technique of reflection help a person? a. Showing an awareness of the person’s feelings b. Causing the person to answer more fully than yes or no c. Showing knowledge the person is not expected to know d. Encouraging the person to think through problems for himself or herself ANS: D

A B C D

Feedback Reflection may involve the person becoming aware of his or her feelings but does not require the nurse’s awareness.

Reflection is not related to the answers provided by the patient.

Reflection is related to the insight the person gains, not information provided to him or her.

Reflection implies respect for the patient and his or her ability to solve his or her problems.

PTS: 1

DIF: Cognitive Level: Comprehension

35. Within nurse-patient communication, the use of silence can a. block further therapeutic communication. b. allow the patient to not feel pressured to provide information. c. demonstrate trust. d. provide the nurse with an opportunity to complete the patient’s care.

ANS: B

A B C D

Feedback Using silence actually encourages communication because it allows the patient to organize his or her thoughts.

Using silence means allowing periods of quiet thought during the nurse-patient interaction when the patient does not feel pressure to provide conversation.

Using silence does not relate to trust.

Using silence is not a requirement for completing patient care.

PTS: 1

DIF: Cognitive Level: Comprehension

36. A patient states, “The harder I try to get along with my son, the more I feel he just wants to be left

alone,” and the nurse responds, “I guess parents have to expect these problems as children get older.”

The nurse’s response is an example of a communication breakdown known as a. failing to see the uniqueness of the individual. b. failing to recognize levels of meaning. c. using value statements. d. failing to clarify unclear messages.

ANS: A

A B C D

Feedback The nurse’s response has put the patient into a group, parents, and therefore does not respond to the patient as a unique individual.

There is no meaning under the surface content in the patient’s remark.

There are no value statements in the nurse’s response.

The patient’s remark was not unclear.

PTS: 1

DIF: Cognitive Level: Application

37. A patient states, “The thing that scares me the most about surgery is the spinal anesthesia. I’m afraid

it’ll leave me paralyzed,” and the nurse responds, “Everything will be fine. The anesthesiologists are very skilled in administering spinal anesthesia.” The nurse’s response is an example of a communication breakdown known as a. failing to see the uniqueness of the individual. b. failing to recognize levels of meaning. c. using value statements. d. using false assurance.

ANS: D

A B C D

Feedback The nurse does not fail to respond to the patient as a unique individual.

The nurse does not fail to consider the meaning under the surface content.

The nurse does not use value statements.

The nurse offers false assurance.

PTS: 1

DIF: Cognitive Level: Application

38. Collaboration in health care settings involves a. professionals respected for their unique knowledge and abilities. b. professionals educated in a collaborative model of education. c. recognition of individual professional accomplishments. d. a multitiered system hierarchy.

ANS: A

A B C D

Feedback Collaboration implies working jointly with other professionals, all of whom are respected for their unique knowledge and skills in the situation.

Currently most professionals are not educated in a collaborative model of education, although they are expected to work in collaboration.

In collaboration the accomplishments of the total group are recognized, not individuals.

Collaboration implies that everyone on the interdisciplinary team can make valuable contributions.

PTS: 1

DIF: Cognitive Level: Comprehension

39. Collaboration among health care professionals most importantly results in a. the development of esprit de corps. b. benefits to the organization alone. c. positive patient outcomes. d. maintenance of employee satisfaction.

ANS: C

A B C D

Feedback Although esprit de corps develops, the ultimate result is for positive patient outcomes.

Collaboration benefits the individuals involved, as well as the organization.

Making the most of collaborative opportunities enhances positive patient outcomes.

Employee satisfaction is greater with more collaboration, but the ultimate value of collaboration is positive patient outcomes.

PTS: 1

DIF: Cognitive Level: Comprehension

MULTIPLE RESPONSE 1. Which behaviors foster active listening? (Select all that apply.) a. Encouraging the speaker by saying, “Tell me more” b. Limiting verbal ventilation because it is not focused c. Sitting in an open posture such as leaning forward d. Engagement in a task e. Good eye contact at eye level and nodding of the head ANS: A, C, E Feedback Correct

Incorrect

Active listening is a method of communicating interest and attention.

Encouraging the speaker, using an open posture, eye contact, and nodding the head all communicate interest and attention.

Limiting verbal expression is likely to decrease the sharing of information by the patient. A task may serve as a distraction for the nurse and patient and may limit active listening.

PTS: 1

DIF: Cognitive Level: Comprehension

2. Which of the following are examples of open-ended questions? (Select all that apply.) a. “Ms. Goode, did you have a productive therapy session?” b. “How are you?” c. “How do you feel about staying with your daughter?” d. “What would you like to discuss today while we take a walk?” e. “Are you having that problem with arthritis in your hand again?”

ANS: B, C, D Feedback Correct

Incorrect

The questions “How are you?” “How do you feel about staying with your daughter?” and “What would you like to discuss today while we take a walk?” require the patient to answer by providing data and not just a yes or no answer.

The statements “Ms. Goode, did you have a productive therapy session?” and “Are you having that problem with arthritis in your hand again?” do not require more than yes or no answers.

PTS: 1

DIF: Cognitive Level: Analysis

Chapter 13: Nurses, Patients, and Families: Caring at the Intersection of Health, Illness, and Culture Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. Which illness has the characteristics of an acute illness? a. Exercise-induced asthma

b. Type 2 diabetes c. Influenza d. Cleft palate ANS: C

A B C D

Feedback Exercise-induced asthma is a chronic condition because it requires ongoing health care services and affects the person for his or her entire life.

Type 2 diabetes is a chronic condition because it requires ongoing health care services and affects the person for his or her entire life.

Influenza symptoms are short-lived, and the person returns to his or her previous level of wellness.

Cleft palate is a chronic condition because it requires ongoing health care services and affects the person for his or her entire life.

PTS: 1

DIF: Cognitive Level: Comprehension

2. Which illness has the characteristics of a chronic illness? a. Lupus b. Bronchitis c. Chickenpox d. Gastroenteritis ANS: A

A

B C

D

Feedback Lupus requires long-term treatment and impacts a person for his or her entire life. Previously, the life expectancy was as short as a few months after diagnosis.

Bronchitis is an acute illness with symptoms that are short-lived, and the person returns to his or her previous level of wellness once he or she is no longer ill.

Chickenpox is an acute illness with symptoms that are short-lived, and the person returns to his or her previous level of wellness once he or she is no longer ill.

Gastroenteritis is an acute illness with symptoms that are short-lived, and the person returns to his or her previous level of wellness once he or she is no longer ill.

PTS: 1

DIF: Cognitive Level: Comprehension

3. Which statement about acute illness is true? a. Most people with acute illness develop chronic illness. b. Most people with acute illness return to their previous level of wellness. c. All people with an acute illness need medical care. d. Acute illnesses are usually catastrophic in nature.

ANS: B

A

B C D

Feedback Some people do go on to develop a chronic illness after an acute one, but unless there are complications, most people with acute illness return to their previous level of wellness.

Most people with acute illness return to their previous level of wellness.

Many acute illnesses do not require medical intervention.

While some acute illnesses are catastrophic in nature, not all acute illnesses are.

PTS: 1

DIF: Cognitive Level: Knowledge

4. What is the primary difference between acute illness and chronic illness? a. In acute illness, symptoms begin suddenly, progress quickly, and subside quickly. b. In acute illness, symptoms begin suddenly, progress gradually, and do not subside. c. In chronic illness, symptoms begin gradually, progress suddenly, and subside

quickly. d. In chronic illness, symptoms begin suddenly, require ongoing management, and

subside quickly.

ANS: A

A B C D

Feedback Acute illness is defined as severe symptoms that appear suddenly, progress steadily, and subside quickly.

Chronic illness symptoms progress gradually and generally do not subside.

Chronic illness symptoms progress gradually and generally do not subside.

Chronic illness symptoms begin gradually.

PTS: 1

DIF: Cognitive Level: Comprehension

5. A patient with diabetes who refuses to change eating patterns may be in which stage of adjustment? a. Denial and disbelief b. Irritability and anger c. Attempting to gain control d. Acceptance and participation ANS: A

A

B

C D

Feedback Denial and disbelief is the first stage in adjustment to an illness. It is characterized by belief that the symptoms do not really represent illness and will go away.

Irritability and anger are characteristics of the second stage of illness acceptance. It is characterized by anger at the body for not functioning properly or by anger displaced onto others.

The person in the “attempting to gain control” stage usually seeks help and knowledge as ways to gain control.

The “acceptance and participation” stage occurs when the patient is ready to participate in decisions about treatment.

PTS: 1

DIF: Cognitive Level: Comprehension

6. A patient states, “I am so upset that I need a knee replacement. I should have done those exercises that

the physical therapist told me to do years ago.” In which stage of illness is the patient? a. Disbelief and denial b. Irritability and anger c. Attempting to gain control d. Depression and despair ANS: B

A B C D

Feedback The person in the “disbelief and denial” stage believes that the symptoms do not really represent illness and will go away.

Irritability and anger is the second stage of illness acceptance. It is characterized by anger at the body for not functioning properly or by anger at self or others.

The person in the “attempting to gain control” stage usually seeks help and knowledge as ways to gain control.

At the “depression and despair” stage, the patient may experience many losses, and depression is the response.

PTS: 1

DIF: Cognitive Level: Comprehension

7. A patient states, “I do not understand why I keep getting these headaches. I have seen a nurse

practitioner and two specialists. I have taken several medications, but the headaches keep coming back.” In which stage of illness is the patient? a. Disbelief and denial b. Irritability and anger c. Attempting to gain control d. Acceptance and participation ANS: C

A B C D

Feedback The person in the first stage believes that the symptoms do not really represent illness and will go away.

At the second stage the person is angry at the body for not functioning properly or displaces anger onto self or others.

Attempting to gain control is the third stage in adjustment to an illness. The person in this stage usually seeks help and knowledge as ways to gain control.

The fifth stage occurs when the patient is ready to participate in decisions about treatment.

PTS: 1

DIF: Cognitive Level: Comprehension

8. A patient states, “There is no hope. They’re going to keep me here until I die. Can’t you give me my

medication more often? I’m going to die anyway.” In which stage of illness is this patient?

a. b. c. d.

Disbelief and denial Irritability and anger Attempting to gain control Depression and grief

ANS: D

A B C D

Feedback The person in the first stage believes that the symptoms do not really represent illness and will go away.

At the second stage the person is angry at the body for not functioning properly or displaces anger onto self or others.

The person in the third stage usually seeks help and knowledge as ways to gain control.

Depression and grief is the fourth stage in the adjustment to an illness. The person at this stage may experience many losses, and depression is the response.

PTS: 1

DIF: Cognitive Level: Comprehension

9. A patient states, “I have knowledge about my diet and how to do my insulin injections, so I can get on

with my life.” In which stage of illness is this patient? a. Disbelief and denial b. Irritability and anger c. Attempting to gain control d. Acceptance and participation ANS: D

A B C D

Feedback The person in the first stage believes that the symptoms do not really represent illness and will go away.

At the second stage the person is angry at the body for not functioning properly or displaces anger onto self or others.

The person in the third stage usually seeks help and knowledge as ways to gain control.

Acceptance and participation is the final stage in the adjustment to an illness. A person in this stage is ready to participate in decisions about treatment.

PTS: 1

DIF: Cognitive Level: Comprehension

10. A contemporary view of the sick role includes a. patient as partner with the health care provider. b. patient as submissive to the health care provider. c. patient noncompliant with the health care provider. d. moving away from cultural values when making health care decisions.

ANS: A

Feedback

A B C D

A contemporary view of the sick role includes partnering with patients in making health care decisions.

Patient as submissive to health care provider is a paternalistic perspective.

Patients are expected to want to get well, and the patient who wants to get well will comply with the prescribed treatment.

All health care needs to be culturally sensitive.

PTS: 1

DIF: Cognitive Level: Comprehension

11. A patient tells the nurse, “I’ll let you do whatever you think is best for me.” The patient does very little

independently without calling for assistance. The nurses conclude that the patient is demonstrating which personality characteristic? a. Acceptance b. Sense of control c. Coping d. Dependence ANS: D

A B C D

Feedback The person demonstrating acceptance will acknowledge the situation.

The person demonstrating sense of control would be actively seeking ways to manage the situation.

The person who is coping is looking to decrease the threat in the situation or to increase his or her resources to deal with the threat.

Some people assume a passive attitude and rely on others to care for them. This can occur with or without illness.

PTS: 1

DIF: Cognitive Level: Comprehension

12. A patient diagnosed with breast cancer responded by gathering information about treatment options

and becoming involved in a self-help group. The nurse assesses that the patient is demonstrating which personality characteristic? a. Independence b. Hardiness c. Self-control d. Tolerance ANS: B

A B

C D

Feedback Independence is not requiring or needing to rely on someone else.

Hardiness is the ability to feel capable of handling stressful life events. Hardy people are likely to perceive themselves as having some control over a situation even when they are ill.

Self-control is the ability to manage oneself in the situation.

Tolerance is the capacity to endure or adapt to a situation.

PTS: 1

DIF: Cognitive Level: Application

13. A patient was diagnosed with ovarian cancer 5 years ago. She underwent chemotherapy and

radiotherapy, but cancer returned 2 years ago with metastases to the bone and possibly the lung. She says the cancer is “no longer curable, but treatable.” During this time the patient’s daughter was critically injured in a car accident and now lives with a traumatic brain injury, needing round-the-clock care. Her husband had an affair. She continues to work and volunteers with various community groups.

Which phenomenon is the patient demonstrating? a. Resourcefulness b. Independence c. Acceptance d. Resilience ANS: D

A B C D

Feedback The patient has not demonstrated that her ability to continue work and activities is due to her use of resources.

Independence is not requiring or needing to rely on someone else.

Acceptance means the person acknowledges the situation for what it is.

Resilience is the successful adaptation despite challenging or threatening circumstances. The patient has faced difficult, adverse, and traumatic events in her life but continues to participate and contribute.

PTS: 1

DIF: Cognitive Level: Comprehension

14. A patient in whom metastatic cancer is diagnosed tells the nurse, “God has never let me down before.

I’ll pray for strength.” This patient’s illness behavior is being influenced by a. resiliency. b. sense of control. c. spirituality. d. depression.

ANS: C

A B C D

Feedback Resiliency is survival under trying circumstances.

Sense of control is feeling that one can control a situation.

Spirituality is an inner strength related to a belief in and connectedness to a higher power.

Depression involves feelings of loss, grief, and despair.

PTS: 1

DIF: Cognitive Level: Application

15. A patient in whom cancer has just been diagnosed tells the nurse, “Just get out of here and leave me

alone! Let me suffer alone. God is punishing me.” The nurse determines that the most appropriate nursing diagnosis for this patient is a. risk for loneliness.

b. powerlessness. c. dysfunctional grieving. d. spiritual distress.

ANS: D

A B

C D

Feedback The risk for loneliness is when a person may experience a vague sense of unpleasantness.

Powerlessness is a perceived lack of control in the current situation. This patient may feel powerless, but the reference to God’s punishment makes spiritual distress a more likely diagnosis.

Dysfunctional grieving is the unsuccessful use of intellectual and emotional responses to deal with a loss.

Spiritual distress is the inability to experience and integrate meaning and purpose in life through connectedness with self, others, or a power greater than oneself.

PTS: 1

DIF: Cognitive Level: Application

16. Which of the following is an appropriate intervention for the nursing diagnosis of spiritual distress? a. Never pray with patients or share readings that can have a religious connection. b. Inform patients of the prevalent religious beliefs that exist in the locale where they

are being treated. c. Consider patients’ religious beliefs when planning care. d. Reassure patients that they should not blame God for their illness.

ANS: C

A B C D

Feedback It is acceptable to pray with patients or share readings with them if requested by the patient and the nurse is comfortable doing so.

The nurse should help the patient to tap into his or her own spirituality, not create one for them or influence the patient.

Helping patients engage spiritually assures holistic care.

Nurses should recognize that blaming God is a sign of spiritual distress.

PTS: 1

DIF: Cognitive Level: Comprehension

17. A patient is in the intensive care unit after a myocardial infarction and refuses to stay in bed, saying, “I

have to be up and walking around. When I stayed in bed after having my babies 40 years ago, I got so weak I could hardly move.” This patient’s illness behavior is being influenced by a. hardiness. b. past experiences. c. culture. d. role expectations.

ANS: B

A B C D

Feedback Hardiness is the resistance to stressful events.

The patient is basing what she thinks she needs to do on experiences she had 40 years ago after she had delivered her children.

She does not say she bases her need to get up on cultural beliefs.

She does not base her need to be up on an expectation that she should be.

PTS: 1

DIF: Cognitive Level: Application

18. A Caucasian nurse is caring for a Native American after a stroke. The nurse finds the patient sleeping

while holding several small feathers bound by a beaded leather thong. The nurse should consider the possibility that this is a. an interesting trinket to brighten the environment. b. a gift from his grandchildren to make him feel closer to the family. c. an important item used in native healing practices. d. an item that might introduce microorganisms into the hospital environment.

ANS: C

A B C

D

Feedback Although the object’s meaning is unknown, the implication is that it is not important.

Although the object’s meaning is unknown, the implication is that it is not important.

Because the patient is of a different culture than the nurse, the nurse should clarify with either the patient or family what the meaning and importance of the item is and how it should be treated.

Although the object’s meaning is unknown, the implication is that it is not important.

PTS: 1

DIF: Cognitive Level: Application

19. A young girl from a Middle Eastern country is in the process of dying. Her parents ask the nurses to

allow her to be prepared for death by being dressed in a specific garment and headdress every day. The parents cannot be there every day to do this and ask the nurses to apply the attire. Which actions by the nurses demonstrate culturally competent care? a. Allowing the parents to dress the patient in the garment and headdress when they are by her side b. Consulting the chaplain as to the meaning of the ritual in the Middle East c. Informing the parents that hospital policy requires all patients to wear hospital garments d. Learning how to apply the garment and headdress properly ANS: D

A

Feedback Allowing the parents to dress the child when they are by her side does not assure the daily cultural expectations of the family.

B

C D

While the meaning of the ritual would be nice to know, whether the nurses know the meaning does not make the ritual any less culturally important to the family.

Informing the parents that hospital policy requires all patients to wear hospital garments totally disregards the desires of the family.

By learning how to dress the patient, the nurses are acknowledging the importance of culture for this family.

PTS: 1

DIF: Cognitive Level: Application

20. An English-speaking nurse gave a non–English-speaking Asian patient instructions about preparing an

abdominal surgical site. The nurse showed the patient how the bottle of povidone-iodine was to be used in cleansing the area. The patient smiled and nodded throughout the instructions. The patient did not respond when asked if he had any questions. When the nurse left the room, the patient promptly drank the bottle of povidone-iodine. Which action would be most effective in preventing this error? a. Giving the patient written instructions in his language b. Using a medical interpreter to give the preoperative instructions c. Having the patient sign a statement that he understood the instructions d. Using illustrations to show the patient the procedure ANS: B

A B C D

Feedback The patient may not be able to read in his language but may not indicate that to the nurse.

The use of the interpreter assures that the patient has received the correct information in a manner he can understand.

Having the patient sign a statement does not indicate that he understood. He may sign because he feels that this is expected.

Although illustrations may help, the use of an interpreter is still the best action to ensure understanding.

PTS: 1

DIF: Cognitive Level: Analysis

21. Why is a basic understanding of ethnopharmacology part of being a culturally competent nurse? a. Significant differences among ethnic groups have been found in relation to the

effects of medications. b. Ethnopharmacology is a new area of study important to all nurses. c. Nurses should know how medications may affect individual patients to properly administer the medication. d. Pharmacology is a significant aspect of nursing practice.

ANS: A

A

Feedback The absorption, metabolism, distribution, and elimination of medications have been demonstrated to differ among ethnic groups. Nurses need to be aware of these ethnic differences to provide quality care.

B C

D

The importance is not that it is new, but that ethnopharmacology is significant to the care nurses provide.

Although nurses should know how to administer medication properly to any patient, the nurse also needs to understand the different responses including those based on ethnicity.

Although the understanding of pharmacology is significant, the nurse needs to understand ethnopharmacology to be culturally competent.

PTS: 1

DIF: Cognitive Level: Comprehension

22. The best definition of ethnocentrism is a. a tendency to compare the behavior of others with your own cultural values. b. an astute awareness of your own personal biases regarding other cultures. c. a tendency to view your own culture as superior to others. d. the ability to incorporate patients’ cultural beliefs and values into health teaching.

ANS: C

A B C D

Feedback A tendency to compare the behavior of others with one’s own cultural beliefs describes cultural relativism.

Ethnocentrism implies a lack of awareness of one’s own biases.

Ethnocentrism describes a tendency to view your own culture as superior to others.

The ability to incorporate patients’ cultural beliefs and values into health teaching describes culturally sensitive care, not ethnocentrism.

PTS: 1

DIF: Cognitive Level: Comprehension

23. The nurse finds a patient sitting in bed, rocking back and forth, wringing her hands, and repeating

rapidly, “I can’t breathe. My heart is pounding. I think I’m going to die.” Her physician is called to the bedside and tells the nurse, “She is having an anxiety attack.” What assessment can be made by the nurse? a. Severe anxiety is present in this patient. b. Cultural factors control anxiety levels. c. Focusing on discharge instruction will ease the anxiety. d. The level of anxiety cannot be determined at this point.

ANS: A

A B C

Feedback With increased anxiety, one observes rapid speech, increased purposeless body movements, and subjective statements of discomfort.

Although cultural factors may influence how anxiety is expressed, they do not control anxiety.

If a person is experiencing anxiety, he or she will not be able to focus on receiving information, including discharge instructions.

D

The level of anxiety can be determined on the basis of the observation of the patient’s behavior.

PTS: 1

DIF: Cognitive Level: Application

24. A patient has been diagnosed with angina. As he talks with the nurse, he asks several good questions

about angina and seems able to concentrate on the explanations. He seems eager to learn how to manage his condition. What assessment can be made by the nurse? a. Severe anxiety is present. b. Mild anxiety is present. c. Moderate anxiety is present. d. The level of anxiety cannot be determined.

ANS: B

A B C D

Feedback When severe anxiety is present, the person’s thoughts are scattered and attention to learning is decreased.

With mild anxiety, the person is able to focus attention, and there is an increased capacity for learning.

When moderate anxiety is present, the person is only able to concentrate on one thing at a time and would not be asking questions.

The level of anxiety can be determined from the patient’s behaviors.

PTS: 1

DIF: Cognitive Level: Application

25. Nurses can best help patients deal with stress by a. helping patients eliminate all stress from their lives. b. helping patients communicate their stress better to friends and family. c. helping patients evaluate their lifestyles for areas of potential stress. d. intervening in the family system to reduce family stress.

ANS: C

A B C D

Feedback It is not possible or desirable to eliminate all stress from one’s life.

Having someone to talk to may be helpful in reducing stress, but problem solving and planning are more effective plans for management.

Nurses can assist patients to restructure the stressful aspects of their lives to reduce or minimize stress.

It is not reasonable to expect the nurse to solve the patient’s problems.

PTS: 1

DIF: Cognitive Level: Comprehension

26. When planning for patient teaching, the nurse is aware that which of the following factors create(s) a

barrier to learning? a. Mild anxiety b. Pain and fatigue

c. Family presence d. Patient autonomy ANS: B

A B C D

Feedback Mild anxiety can improve learning.

Pain and fatigue create barriers to learning.

Family presence does not necessarily impede learning.

Patient autonomy does not impede learning, and patient learning facilitates development of autonomy.

PTS: 1

DIF: Cognitive Level: Knowledge

27. The parents of a 4-year-old diabetic have become increasingly argumentative especially about whether

the father helps enough with child care and housekeeping. He works two jobs which leaves little time to help his stay-at-home wife. Which nursing intervention is most appropriate for this family? a. Referring the parents to a marriage counselor b. Discussing with the parents the stresses they perceive in the situation c. Suggesting that the father give up one of his jobs d. Identifying a way to reallocate the child’s diabetes care between the parents ANS: B

A B C

D

Feedback It may be premature to refer the parents to a marriage counselor until the situation is assessed further.

Before changes are suggested and/or made, everyone involved should have identified what the perceived stressors are for all members of the family.

Suggesting that the father give up his part-time job may be premature until it is known what the stressors are, as well as determining whether the income is required to provide for the needs of the family.

The nurse should not be the one determining how to reallocate the child’s care within the family. The decision rests with the parents.

PTS: 1

DIF: Cognitive Level: Application

MULTIPLE RESPONSE 1. Which questions will aid the nurse in planning culturally congruent care? (Select all that apply.) a. “What do smiles, nods, and hand gestures mean?” b. “How are you usually addressed?” c. “How many health care professionals have you seen?” d. “What is eaten when one is sick?” e. “Who is involved in making decisions about health care?”

ANS: A, B, D, E Feedback

Correct Incorrect

The questions allow the nurse to learn about the specific cultural expectations of the patient.

While it is important to know how many providers the patient has been seeing, this information is not related to culturally competent care.

PTS: 1

DIF: Cognitive Level: Comprehension

2. A patient recently lost a job as a salesperson. Which behaviors would indicate that the patient is

experiencing stress? (Select all that apply.) a. Patient describes the desire to sleep a great deal due to fatigue. b. Patient states a decrease in participating in usual church activities. c. Patient seems to have difficulty selecting items from a menu. d. Patient is reading the newspaper and online job listings daily. e. Patient continues to spend time with her dog at the dog park.

ANS: A, B, C Feedback Correct

Incorrect

Excessive sleepiness/fatigue, decrease in social activities and participation in usual events, and difficulty making decisions are correct because stress affects a person physically, emotionally, and cognitively.

Reading the job listings and spending time with the dog at the park indicate the patient is managing the situation.

PTS: 1

DIF: Cognitive Level: Comprehension

3. Which of the following are characteristic of compassion fatigue? (Select all that apply.) a. Increased energy b. Burnout c. Being prone to accidents d. Poor judgment e. Increased interest in reflection ANS: B, C, D Feedback Correct

Incorrect

Loss of physical energy, burnout, accident proneness, emotional breakdowns, apathy, indifference, poor judgment, and disinterest in introspection are all signs of compassion fatigue.

Increased energy and increased interest in reflection are not signs of compassion fatigue.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 14: Health Care in the United States Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE

1. Which of the following is not included as an overarching goal of Healthy People 2030? a. Eliminating health disparities b. Creating environments that promote good health c. Lengthening the average life span by a decade d. Attaining longer lives free of preventable diseases and injury ANS: C

A B C D

Feedback Eliminating health disparities is part of the overarching goals of Healthy People 2030.

Creating social and physical environments that promote good health is part of the overarching goals of Healthy People 2030.

Lengthening the average life span by itself is not one of the overarching goals of Healthy People 2030.

Attaining longer lives free of preventable disease and injury is part of the overarching goals of Healthy People 2320.

PTS: 1

DIF: Cognitive Level: Knowledge

2. Which of the following is an example of health promotion and maintenance? a. Talking to a women’s church group about having an annual mammogram b. Establishing an exercise program for postmenopausal women to reduce bone loss c. Providing colonoscopy examinations for high-risk individuals d. Talking to a state legislator about supporting a motorcycle helmet law ANS: A

A

B C D

Feedback Health promotion and maintenance involves activities to assist individuals to remain healthy, prevent diseases and injuries, detect diseases early, and promote healthier lifestyles. Mammograms can detect disease early.

Establishing an exercise group to reduce bone loss is illness prevention based on the presence of risk factors.

Having a colonoscopy examination is illness prevention based on risk factors.

Speaking to a state legislator about supporting a helmet law may or may not lead to changes in the law.

PTS: 1

DIF: Cognitive Level: Comprehension

3. Which of the following is an example of illness prevention? a. Viewing a program on television about the increased incidence of heart disease b. Speaking to a high school group about the value of exercise c. Encouraging women at a health fair to have an annual mammogram d. Counseling people recently experiencing death of a spouse about signs and

symptoms of depression ANS: D

A

B C D

Feedback At best this is an example of health promotion, although health promotion requires active participation. Watching a program on television is passive but could provide health-promoting education.

Speaking to high school groups about exercise is an example of health promotion.

Health promotion includes early detection, and the goal of screening for breast cancer is early detection, not prevention.

Illness prevention is used when a person is already at risk for development of a health problem because of behavior or circumstance.

PTS: 1

DIF: Cognitive Level: Comprehension

4. Health promotion differs from illness prevention in that health promotion a. addresses identified health problems. b. occurs before the identification of disease risk factors. c. identifies and ameliorates a health problem. d. returns an individual to optimal functioning after an illness.

ANS: B

A B C D

Feedback Health promotion is focused on helping prevent health problems.

The goal of health promotion is to keep the person healthy and involved in healthy lifestyles to prevent the development of risk factors.

Health promotion does not identify health problems.

Returning to optimal function occurs with rehabilitation.

PTS: 1

DIF: Cognitive Level: Comprehension

5. Which of the following is an example of diagnosis and treatment? a. Attending smoking cessation classes b. Computerized tomography (CT) scan to rule out gallbladder inflammation c. Screening in the workplace for tuberculosis d. Prenatal classes ANS: B

A B C D

Feedback Attending smoking cessation classes is illness prevention based on the known risks of smoking.

The CT scan will diagnose disease that may then be treated.

Screenings are examples of early detection activities.

Prenatal classes are health promotion activities.

PTS: 1

DIF: Cognitive Level: Comprehension

6. Which of the following is an example of rehabilitation and disease management?

a. Prompt treatment for hypertension b. Attending weight loss classes c. Teaching patients with newly diagnosed diabetes the signs of hypoglycemia and

hyperglycemia d. Taking an antibiotic for a sinus infection ANS: C

A B C D

Feedback Prompt treatment of hypertension is an example of diagnosis and treatment.

Attending weight loss classes is illness prevention because of the risk for disease development.

Knowing the signs of hypoglycemia and hyperglycemia will help the person manage the disease of diabetes.

Taking medication is treatment of a disease.

PTS: 1

DIF: Cognitive Level: Comprehension

7. Which of the following is characteristic of public agencies? a. They are supported by donations from the public. b. Most only provide primary care services. c. They are not involved in the education of health care providers. d. They provide health care services at the national, state, and local levels.

ANS: D

A B C D

Feedback Public agencies are supported by taxes from the community they serve.

Public agencies offer all levels of health care services, although not all agencies offer all levels.

Many public agencies provide educational opportunities or funding for education.

Public agencies can serve the nation, state, or local community.

PTS: 1

DIF: Cognitive Level: Comprehension

8. Which of the following is not a public agency? a. National Institute of Nursing Research b. American Red Cross c. Centers for Disease Control and Prevention d. State Board of Nursing ANS: B

A

Feedback The National Institute of Nursing Research is a governmental (public) agency.

B

C D

The American Red Cross is an organization that is supported by private donations to provide health services. Originally all services were provided by volunteers; this is why this type of agency is frequently called a voluntary agency.

The Centers for Disease Control and Prevention is a governmental (public) agency.

The State Board of Nursing is a governmental (public) agency.

PTS: 1

DIF: Cognitive Level: Knowledge

9. Governmental agencies differ from voluntary agencies in which way? a. Level of community served b. Administrative structure c. Funding source d. How the profits are used ANS: C

A B C D

Feedback Both types of agencies can provide services at the national, state, or local levels.

The administrative structures can be very similar in the two types of agencies.

Governmental agencies are funded through tax dollars, whereas voluntary agencies are funded by donations.

All governmental agencies are also nonprofit as are most voluntary agencies.

PTS: 1

DIF: Cognitive Level: Comprehension

10. A health care agency that uses its profits to better the institution rather than paying stockholders would

be classified as a a. for-profit agency. b. not-for-profit agency. c. voluntary agency. d. private agency.

ANS: B

A B

C D

Feedback For-profit agencies distribute profits earned to partners or stockholders.

Not-for-profit agencies use their income to pay personnel, improve services, advertise services, provide educational programs, or otherwise contribute to the mission of the agency.

Voluntary agencies can be for-profit agencies.

Private agencies can also be for-profit agencies.

PTS: 1

DIF: Cognitive Level: Comprehension

11. The school health clinic treats common health problems, as well as conducting health promotion and

illness prevention activities. The clinic provides which level of health care?

a. b. c. d.

Subacute care Primary care Secondary care Tertiary care

ANS: B

A B

C D

Feedback Subacute care is inpatient care that lies between hospital care and long-term care.

Care provided at the point at which a person first enters the health care system is considered primary care. Care provided can include emergency care, health maintenance, and chronic care, as well as health promotion.

Secondary care involves the prevention of complications from disease. This level of care may occur in hospitals as well as other types of agencies.

Tertiary care is provided to the acutely ill, those requiring long-term care, those requiring rehabilitation services, and terminally ill patients.

PTS: 1

DIF: Cognitive Level: Comprehension

12. An agency that treats temporary health dysfunction requiring intervention to prevent complications is

providing which level of health care? a. Subacute care b. Primary care c. Secondary care d. Tertiary care ANS: C

A B

C D

Feedback Subacute care is inpatient care that lies between hospital care and long-term care.

Primary care is provided at the point at which a person first enters the health care system. Care provided can include emergency care, health maintenance, and chronic care, as well as health promotion.

Secondary care involves the prevention of complications from disease. This level of care may occur in hospitals as well as other types of agencies.

Tertiary care is provided to the acutely ill, those requiring long-term care, those requiring rehabilitation services, and terminally ill patients.

PTS: 1

DIF: Cognitive Level: Comprehension

13. Hospices that provide care to terminally ill patients and their families in hospitals, in the home, or in

special hospice facilities provide which level of health care? a. Subacute care b. Primary care c. Secondary care d. Tertiary care

ANS: D

A B

C D

Feedback Subacute care is inpatient care that lies between hospital care and long-term care.

Primary care is provided at the point at which a person first enters the health care system. Care provided can include emergency care, health maintenance, and chronic care, as well as health promotion.

Secondary care involves the prevention of complications from disease. This level of care may occur in hospitals as well as other types of agencies.

Tertiary care is provided to the acutely ill, those requiring long-term care, those requiring rehabilitation services, and terminally ill patients.

PTS: 1

DIF: Cognitive Level: Comprehension

14. An agency that provides inpatient care related to less complex conditions and does not require high-

technology monitoring or complex diagnostic procedures is providing which level of care? a. Subacute care b. Primary care c. Secondary care d. Tertiary care ANS: A

A B

C D

Feedback Subacute care is inpatient care that lies between hospital care and long-term care.

Primary care is provided at the point at which a person first enters the health care system. Care provided can include emergency care, health maintenance, and chronic care, as well as health promotion.

Secondary care involves the prevention of complications from disease. This level of care may occur in hospitals as well as other types of agencies.

Tertiary care is provided to the acutely ill, those requiring long-term care, those requiring rehabilitation services, and terminally ill patients.

PTS: 1

DIF: Cognitive Level: Comprehension

15. Which of the following is a responsibility of many health care agencies’ chief executive officers

(CEOs)? a. Managing the budgets of each department in the agency b. Recruiting and hiring of staff c. Overall operation of the agency on a daily basis d. Establishing policies governing the operation for the agency ANS: C

Feedback

A B C D

Although the CEO is concerned about the cost-effectiveness of the institution as a whole, he or she does not deal with individual department budgets.

The CEO is not responsible for staffing.

The CEO makes sure that the institution runs efficiently and cost-effectively and carries out policies established by the board.

The CEO carries out the policies established by the board.

PTS: 1

DIF: Cognitive Level: Knowledge

16. Which of the following is a responsibility of many nurse executives (chief nursing officers)? a. Recruiting, hiring, and training new staff b. Managing day-to-day staff scheduling c. Managing budget for assigned unit d. Participating as a member of the board of directors ANS: D

A B C D

Feedback Recruiting, hiring, and training new staff is a function of middle management.

Managing day-to-day staff scheduling is a function of middle management.

Managing budget for assigned unit is a function of middle management.

The chief nurse executive is often a member of the board of directors.

PTS: 1

DIF: Cognitive Level: Knowledge

17. Within a nursing shared governance model, the role of the clinical nursing staff is to a. determine the expectations and goals for the unit. b. manage the budget for the unit to be cost-effective. c. focus on the unit activities related to nurses only. d. adhere to standards and quality benchmarks to ensure professional practice.

ANS: D

A B C D

Feedback Determining the expectations and goals for the unit is a function of the nurse manager.

Managing the budget for the unit to be cost-effective is a function of the nurse manager.

Depending on the organization of the institution, unit governance may involve other personnel besides just nurses.

Shared governance is based on the philosophy that nurses have both the right and responsibility to govern their own work.

PTS: 1

DIF: Cognitive Level: Comprehension

18. The purpose of continuous quality improvement (CQI) is to a. monitor processes involved in the provision of safe, effective care for patients. b. restructure hospital departments to initiate cost savings.

c. provide an opportunity for staff members to participate in self-governance. d. deliver appropriate nursing care to patients.

ANS: A

A

B C D

Feedback CQI focuses on using groups of employees to decide how care will be delivered, decide on the desired outcomes, and design systems to create those outcomes.

Every effort is made to anticipate potential problems and prevent their occurrence.

CQI may involve restructuring to improve patient care, but it may not relate to cost-effectiveness.

CQI may or may not be part of self-governance.

The goal of CQI is quality care, not appropriate care.

PTS: 1

DIF: Cognitive Level: Comprehension

19. Differences between treatment outcomes for different populations are known as a. health care outcomes. b. population variability. c. treatment choices. d. health care disparities.

ANS: D

A B C D

Feedback Health care outcomes are measurable results of the health care system.

Population variability relates to the variation of characteristics of the population.

Treatment choices are options offered for care of the patient.

The differences in disease management and treatment outcomes have been found in different ethnic and racial groups as well as in different gender and age groups.

PTS: 1

DIF: Cognitive Level: Knowledge

20. A contributing factor to health care disparities may be a. genetic factors. b. provider bias. c. standard treatment options. d. diagnostic differences.

ANS: B

A B

Feedback Genetic factors may influence disease occurrence; however, once the disease is found, all occurrences should be treated in a similar manner.

The health care disparities could be the result of the options offered or care provided on the basis of ethnicity, gender, or age.

C D

Standard treatment options available for specific diseases or injuries should not affect disparities.

Disparities have been shown to exist among patients with the same diagnosis.

PTS: 1

DIF: Cognitive Level: Knowledge

21. Which of the following is not recognized as part of the role of the nurse as a member of the health care

team? a. Patient advocate and educator b. Collaborator and provider of care c. Manager of care and resources for a group of patients d. Performance of physician functions under direct supervision of a physician ANS: D

A B C D

Feedback Advocate and educator are roles of the nurse.

Collaborator and provider of care is the role of the nurse.

Manager of care and resources for a group of patients is the role of the nurse.

The physician’s assistant performs many functions of the physician under the direct supervision of the physician.

PTS: 1

DIF: Cognitive Level: Comprehension

22. A nurse recognizes that the strict visiting hours policy on the pediatric unit is outmoded and begins to

gather data to support a new policy liberalizing visiting hours based on evidence of better patient care is taking on the role of a. provider of care. b. patient advocate. c. counselor. d. educator.

ANS: B

A B C D

Feedback The nurse as the provider of care provides nursing care to patients.

A nurse advocate knows how to work through bureaucracy to provide for the patients’ best interest at all times.

The nurse as a counselor provides basic counseling and support to patients in relation to their emotional responses to health and illness.

The nurse as an educator provides information to patients and their families related to health and illness issues.

PTS: 1

DIF: Cognitive Level: Application

23. A nurse caring for a preoperative patient is told by the patient, “The doctor just had me sign a paper. I

wish I knew what it was all about.” The nurse goes to report this to the physician. The nursing role adopted by the nurse is

a. b. c. d.

provider of care. counselor. change agent. patient advocate.

ANS: D

A B C D

Feedback The nurse as the provider of care provides nursing care to patients.

The nurse as a counselor provides basic counseling and support to patients in relation to their emotional responses to health and illness.

The nurse as a change agent is involved in making changes in the health care system or in the provision of patient care.

A nurse advocate works to provide for the best interest of patients at all times.

PTS: 1

DIF: Cognitive Level: Application

24. A nurse places high priority on working with patients and families, including them in planning care

and in establishing goals. Which nursing role has this nurse assumed? a. Patient advocate b. Provider of care c. Change agent d. Collaborator ANS: D

A B C D

Feedback A nurse advocate works to provide for the best interest of patients at all times.

The nurse as the provider of care provides nursing care to patients.

The nurse as a change agent is involved in making changes in the health care system or in the provision of patient care.

The nurse who works collaboratively with patients and families includes them in planning care and outcomes.

PTS: 1

DIF: Cognitive Level: Comprehension

25. Which of the following is a characteristic of the team model of nursing care delivery? a. Each member of the team uses his or her abilities to the fullest in patient care. b. Communication among the team saves time, so the model is cost-efficient. c. Team nursing emphasizes holistic care for the patients and their families. d. This model increases continuity of care for the patients.

ANS: A

A

Feedback Both the professional and nonprofessional members of the team provide the level of care they are best prepared to offer. The team members are utilized to their fullest.

B C D

Communicating patient information to all involved in patient care is time consuming.

Team nursing fragments the care for the patients because multiple people are involved.

The continuity of care can be fragmented because of the multiple providers over the time the patient is in the hospital.

PTS: 1

DIF: Cognitive Level: Comprehension

26. The care delivery model in which a registered nurse provides direct care and also has 24-hour

responsibility for updating the patient’s plan of care is known as a. functional care. b. team nursing. c. primary care. d. case management.

ANS: C

A B C D

Feedback Functional nursing divides tasks among care team members.

Team nursing uses different skill levels to provide care in teams.

The primary care nurse retains accountability for care outcomes 24 hours a day while the patient is on the unit.

Case management coordinates care and resources.

PTS: 1

DIF: Cognitive Level: Knowledge

27. Which care delivery model uses critical pathways and continuous quality improvement to guide care

practices? a. Managed care b. Primary care c. Case management d. Care redesign ANS: C

A B C

D

Feedback Managed care uses health maintenance organizations and preferred provider organizations for prospective reimbursement.

Primary care identifies one nurse as responsible for the patient’s care and evaluation of outcomes the entire time the patient is on the unit.

Case management uses critical pathways as guides to care and outcomes and continuous quality improvement to assess the cause of variances in the critical pathway.

Care redesign was an attempt during the 1990s to reintroduce team nursing.

PTS: 1

DIF: Cognitive Level: Knowledge

28. Which of the following patients is likely to benefit most from referral for case management? a. Child injured in a playground accident b. Elderly patient with total hip replacement c. A 49-year-old man in the emergency department with chest pain d. A 20-year-old with appendectomy ANS: B

A

B

C D

Feedback Injuries sustained to a child on a playground are likely to be different from many other childhood injuries and thus outcomes will be less predictable. The injury may also be minor in nature and not need the involvement of a case manager.

The best referral to case management is a patient who falls within a specific diagnostic group and whose outcomes can be reasonably predicted within a set period of time.

A middle-aged man with chest pain does not yet have a diagnosis that would put him in a diagnostic group benefiting from case management.

A young person with an acute illness requiring surgery is likely to have an uncomplicated recovery.

PTS: 1

DIF: Cognitive Level: Application

29. A nursing case manager requests a meeting with the nursing staff after discovering variances from

critical pathways related to timely discharge of patients having hip replacement. Patients are not being discharged on time because they are refusing their physical therapy as a result of poor pain control.

Meeting with the staff to discuss potential improvements in pain management is an example of a. performance improvement. b. continuous quality improvement. c. team building. d. The Joint Commission compliance.

ANS: B

A B C D

Feedback Performance improvement is designed to address individual employee performance and manager performance.

Continuous quality improvement focuses on establishing procedures for ensuring high-quality care.

Team building is about building professional relationships.

The Joint Commission compliance is adherence to a set of criteria established by The Joint Commission.

PTS: 1

DIF: Cognitive Level: Comprehension

30. Which of the following is a characteristic of the patient-centered care model of nursing care delivery? a. It is easily explained to patients because it is based on traditional models of

nursing care. b. Communication among team members is not required to make the model work.

c. A multidisciplinary team emphasizes continuum of care and focuses on the

patient’s right to individualized care. d. It decreases the number of registered nurses required to provide care.

ANS: C

A B C D

Feedback The patient-care model is complex, and it is difficult to explain all the roles of the team members.

For the patient-care model to work, there has to be a high degree of collaboration and communication between the team members.

The patient-care model is a contemporary model that is implemented by a multidisciplinary team that focuses on the patient’s right to individualized care.

The patient-care model actually requires more registered nurses to provide the best patient-centered care.

PTS: 1

DIF: Cognitive Level: Comprehension

31. What is the relevance of the concepts of supply and demand, free market, and price sensitivity with

regard to health care costs? a. The undersupply of available health care has driven up costs. b. In a free market, increased numbers of people are able to pay for health care. c. Consumer insensitivity to costs has increased demand for health care services. d. Third-party payers have demanded more health care services.

ANS: C

A B C D

Feedback There is an oversupply of health care services, so costs should decrease.

In a free market, the consumption of health care services would be based on the individual’s ability to pay.

Because more consumers have health insurance, they pay only a small portion of the cost and, therefore, request more services.

The demand for services has come from consumers not third-party payers.

PTS: 1

DIF: Cognitive Level: Comprehension

32. An impact of health care cost-containment measures on nursing has been a. adding more registered nurses to the skill mix of the nursing team. b. the concern about the assurance of quality care. c. large annual salary increases for nurses. d. development of standards of nursing practice.

ANS: B

A

Feedback Frequently the solution to increased costs is to reduce nursing personnel, not increase the numbers.

B C D

Frequently the solution to increased costs is to reduce nursing personnel, raising the concern that the quality of care will be affected.

Salaries have not increased significantly for nurses as a result of costcontainment measures.

Cost-containment measures have not influenced the development of nursing standards.

PTS: 1

DIF: Cognitive Level: Comprehension

33. What service is covered by Medicare, part D? a. Home health care b. Prescription drug costs c. Inpatient hospital stays d. Physician office visits ANS: B

A B C D

Feedback Some home health care is covered under part A. Prescription drugs costs are covered under part D. Inpatient hospital stays are covered under part A. Physician office visits are covered under part B.

PTS: 1

DIF: Cognitive Level: Knowledge

MULTIPLE RESPONSE 1. Which of the following areas experience serious disparities in health care access and outcomes for

minorities? (Select all that apply.) a. Infant mortality b. Arthritis c. Cardiovascular disease d. Oral health e. Immunizations ANS: A, C, E Feedback Correct

Incorrect

PTS: 1

The African American infant mortality rate is 2.5 times that of White infants. The incidence of heart disease is 29% higher among African American adults than among White adults. Hispanics and African Americans, aged 65 years and over, were less likely than Whites to report receiving influenza and pneumococcal vaccines.

Differences in arthritis and oral health have not been thoroughly studied.

DIF: Cognitive Level: Comprehension

2. To whom does the nurse provide information when working in the role of educator? (Select all that

apply.) a. Families about illnesses and treatments b. Community groups about injury prevention c. Student nurses about nursing standards and ideals d. Health care team members about the patient e. Physician assistants about invasive procedures ANS: A, B, C, D Feedback Correct Incorrect

Nurses can be key educators for many different groups and on a variety of health and professional topics.

The physician supervises physician assistants and should provide information to them about invasive procedures they are doing.

PTS: 1

DIF: Cognitive Level: Comprehension

3. How can staff nurses play an important role in controlling health care costs? (Select all that apply.) a. Becoming aware of cost of supplies b. Questioning the need for unnecessary or repetitive tests c. Suggesting the use of brand-name medications to support the economy d. Handwashing to prevent infections e. Assuring that the payment method is identified on admission ANS: A, B, D Feedback Correct

Incorrect

Knowing the cost of supplies will help the nurse select the most appropriate supply, as well as the amount used. The numbers of laboratory tests and/or other diagnostic tests increase the costs to the institution, the patient, and the payer. The prevention of hospital-caused infections will decrease length of stay and need for antibiotic treatment.

Brand-name medications are generally more expensive than generic forms. The identification of the payment method will not influence the cost of the care.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 15: Political Activism in Nursing: Communities, Organizations, Government Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. The area of philosophy that deals with the regulation and control of people living in society to preserve

prosperity, defend rights, and augment resources is known as a. policy. b. politics. c. political power.

d. power.

ANS: B

A B

C D

Feedback Policy is a plan of action intended to influence and determine decisions, actions, and other matters.

One definition of politics is it is “that part of ethics which has to do with the regulation and government of a nation or state, the preservation of its safety, peace, and prosperity, the defense of its existence and rights against foreign control or conquest, the augmentation of its strength and resources, and the protection of its citizens in their rights, with the preservation and improvement of their morals.”

Political power is used by individuals and groups to influence policy development and implementation.

Power is strength of influence.

PTS: 1

DIF: Cognitive Level: Comprehension

2. A nurse who lobbies state legislators to support a change in the scope of practice in nursing is

engaging in a. power sharing. b. setting policy. c. politics. d. legislative power.

ANS: C

A B C

D

Feedback Power sharing is not part of lobbying for causes.

Setting policy is the process of determining the decision to govern actions.

Politics has to do with the conduct and contests of parties with reference to political measures or the administration of public affairs. Lobbying for a change in the scope of practice relates to the administration of public affairs.

Legislative power is the influence of the legislature.

PTS: 1

DIF: Cognitive Level: Application

3. The principles and values that govern actions directed at influencing and determining decisions,

actions, and other matters are known as a. policy. b. politics. c. political power. d. power.

ANS: A

Feedback

A B

C D

Policy is a plan of action intended to influence and determine decisions, actions, and other matters.

Politics is that part of ethics that has to do with the regulation of a nation or state for the preservation of its safety and prosperity, the defense of its existence, the augmentation of its strength and resources, and the protection of its citizens’ rights.

Political power is used by individuals and groups to influence policy development and implementation.

Power is strength of influence.

PTS: 1

DIF: Cognitive Level: Comprehension

4. Which of the following is an effective method for the practicing nurse to achieve leadership skills? a. Becoming active in professional organizations b. Changing jobs frequently to improve skills c. Learning about collective bargaining d. Avoiding involvement in politics ANS: A

A B C D

Feedback Becoming active in professional organizations helps nurses acquire leadership skills.

Changing jobs frequently does not build leadership skills.

Engaging in collective bargaining does not enhance leadership skills.

Involvement in politics can build leadership skills.

PTS: 1

DIF: Cognitive Level: Comprehension

5. The American Nurses Association (ANA) serves as the a. clearinghouse of standards set by clinical specialty organizations. b. regulatory agency setting the guidelines for the scope of practice. c. source of dissemination of nursing research. d. professional organization for all nurses regardless of practice setting or level of

practice.

ANS: D

A B C D

Feedback The ANA does not establish standards for specialty organizations.

State boards of nursing are the regulatory agencies that set the guidelines for the scope of practice.

The ANA’s purpose is not to disseminate research information.

The ANA is an example of a broad-purpose association. It serves the needs of all nurses.

PTS: 1

DIF: Cognitive Level: Comprehension

6. A nurse has applied for a job and during the interview was told that the health care facility is a “closed

shop.” What does that phrase mean to the nurse? a. The nurse must join a union to be employed there. b. The nurse can join the union if desired, but it is not required. c. This facility is closed to all union activities. d. The facility is negotiating with several unions for control of the employees.

ANS: A

A B C D

Feedback Union membership is a requirement of employment in a closed shop.

Union membership is a requirement of employment in a closed shop.

A closed shop already has a union in existence, and membership is a condition of employment there.

Union membership is a requirement of employment in a closed shop where a union is already in existence.

PTS: 1

DIF: Cognitive Level: Comprehension

7. A nurse is contemplating a political leadership position and wonders if she/he has the desired

characteristics to make a good leader. Which of the following traits is inconsistent with a good leader? a. Has a developed sense of systems thinking. b. Solves problems methodically using a strict model. c. Holds high moral and ethical standards. d. Adapts quickly to new situations.

ANS: B

A B C D

Feedback A sense of systems thinking is a desired trait in a nurse leader.

The ability to solve problems creatively, not using a rigid model, is a desired trait.

Having high moral and ethical standards is a desired trait.

Being able to adapt quickly in new situations is a desired trait.

PTS: 1

DIF: Cognitive Level: Knowledge

8. The most critical aspect of nurses becoming personally “political” is a. financially supporting political action committees (PACs). b. being informed of social and political issues. c. communicating with legislators. d. running for office.

ANS: B

A

Feedback Financially supporting political action committees is an activity more involved in the world of politics.

B

C D

The basis for all political involvement is understanding broader social and political issues to gain insight into what needs to be changed in society and how nurses could help bring about the change.

Communicating with legislators is an activity more involved in the world of politics.

Running for office is an activity more involved in the world of politics.

PTS: 1

DIF: Cognitive Level: Comprehension

9. A nurse has registered to vote, voted in primary and regular elections, and participated in public

forums related to budget reductions that could result in the reduction of the numbers of school nurses.

The nurse is known as a a. nurse citizen. b. nurse activist. c. nurse politician. d. nurse clinician.

ANS: A

A

B

C D

Feedback A nurse citizen brings the perspective of health care to the voting booth, to public forums that advocate for health and human services, and to involvement in community activities.

A nurse activist takes a more active role in politics than the nurse citizen by joining politically active nursing organizations; contacting public officials through letters, e-mails, and in person; and/or working in the campaign of a candidate supporting nursing issues.

A nurse politician realizes and experiences the empowerment that can come from political activism and chooses to run for office.

A nurse clinician is a nurse with advanced skills in a particular area of nursing practice.

PTS: 1

DIF: Cognitive Level: Application

10. A nurse has held a media event to publicize the need for funding for immunizations and lobbied

decision makers by providing pertinent statistical information about the risks and benefits of immunizations. The nurse is known as a a. nurse citizen. b. nurse activist. c. nurse politician. d. nurse clinician.

ANS: B

A

Feedback A nurse citizen brings the perspective of health care to the voting booth, to public forums that advocate for health and human services, and to involvement in community activities.

B

C D

A nurse activist takes a more active role in politics than the nurse citizen by joining politically active nursing organizations; contacting public officials through letters, e-mails, and in person; and/or working in the campaign of a candidate supporting nursing issues.

A nurse politician realizes and experiences the empowerment that can come from political activism and chooses to run for office.

A nurse clinician is a nurse with advanced skills in a particular area of nursing practice.

PTS: 1

DIF: Cognitive Level: Application

11. A nurse was appointed to a governing board of a governmental agency and then ran for an elective

office. The nurse is known as a a. nurse citizen. b. nurse activist. c. nurse politician. d. nurse clinician.

ANS: C

A

B

C D

Feedback A nurse citizen brings the perspective of health care to the voting booth, to public forums that advocate for health and human services, and to involvement in community activities.

A nurse activist takes a more active role in politics than the nurse citizen by joining politically active nursing organizations; contacting public officials through letters, e-mails, and in person; and/or working in the campaign of a candidate supporting nursing issues.

A nurse politician realizes and experiences the empowerment that can come from political activism and chooses to run for office.

A nurse clinician is a nurse with advanced skills in a particular area of nursing practice.

PTS: 1

DIF: Cognitive Level: Application

MULTIPLE RESPONSE 1. A variety of benefits result from membership in professional organizations, including (Select all that

apply.) a. availability of practice guidelines to influence policy development. b. discount on licensure fees. c. continuing education opportunities. d. opportunities to develop personal leadership skills. e. increased pay and prestige in the work setting.

ANS: A, C, D Feedback

Correct

Incorrect

Availability of practice guidelines to influence policy development, continuing education opportunities, and opportunities to develop personal leadership skills are all benefits offered by professional organizations such as the ANA. Professional organizations may offer discounts on many services, but licensure fees are not one of those services. Increased pay is not an advertised benefit of joining a professional organization.

PTS: 1

DIF: Cognitive Level: Comprehension

Chapter 16: Nursing’s Challenge: To Continue to Evolve Black: Professional Nursing: Concepts and Challenges, 10th Edition MULTIPLE CHOICE 1. A tired, stressed nurse complains about being part of the “Sandwich Generation.” What does that

phrase mean? a. People who care for both children and aging parents b. Employees who are stuck in jobs they wish to quit c. A person who is tired and stressed from a job d. A group of people squeezed by the need for continued work ANS: A

A

B

C

D

Feedback The “Sandwich Generation” refers to people between 40 and 60 years of age who face both caring for their own children and providing care for their elderly parents.

The “Sandwich Generation” refers to people between 40 and 60 years of age who face both caring for their own children, and providing care for their elderly parents.

The “Sandwich Generation” refers to people between 40 and 60 years of age who face both caring for their own children, and providing care for their elderly parents.

The “Sandwich Generation” refers to people between 40 and 60 years of age who face both caring for their own children, and providing care for their elderly parents.

PTS: 1

DIF: Cognitive Level: Knowledge

2. According to Cooper, what is one important measure nurses can take to reduce burnout? a. Being aware of stressors and acting on them b. Refusing to work in a nonproductive environment c. Reporting bullying when it is noticed in the workplace d. Keeping a diary of unhealthy behaviors one indulges in ANS: A

A B C D

Feedback Being aware of the environment enables nurses to identify their stressors and then act on them. This is a healthy response to stress.

Refusing to work in a nonproductive environment was not included by Cooper.

Reporting bullying when noticed is an important action, but not as important as identifying and acting on stressors.

Keeping a diary was not mentioned by Cooper.

PTS: 1

DIF: Cognitive Level: Comprehension

3. A new graduate medical-surgical nurse is interested in joining a professional organization. Which

organization should the nurse’s manager recommend? a. National Student Nurses Association (NSNA) b. American Nurses Association (ANA) c. The unit-based journal club d. A national political action committee ANS: B

A B C

D

Feedback As a new graduate, the NSNA would not be a good fit.

The ANA is the voice for professional nurses and represents nurses working in all areas. This would be the best choice for the new nurse.

A unit-based journal club would be good to join; however, the nurse will not get access to statements and position papers on ethics, standards of care, and political positions that are available from the ANA. A political action committee would be a good fit if the nurse is interested in political activity; however, the nurse will not get access to statements and position papers on ethics, standards of care, and political positions that are available from the ANA.

PTS: 1

DIF: Cognitive Level: Comprehension

4. A nurse sees an advertisement for work shoes that include a sexualizing image of a nurse wearing

them. Which action by the nurse is best? a. Buying the shoes and complaining to the store manager b. Refusing to buy the shoes and writing a letter of complaint to the company c. Looking around to see if there are other shoes that fit and are appropriate for work d. Asking co-workers what they think about this advertisement campaign ANS: B

A

Feedback Nurses need to be aware of nursing images in the public and respond appropriately. The best response is to refuse to buy the shoes and write a letter of complaint to the company that manufactures them.

B

C

D

Nurses need to be aware of nursing images in the public and respond appropriately. The best response is to refuse to buy the shoes and write a letter of complaint to the company that manufactures them.

Nurses need to be aware of nursing images in the public and respond appropriately. The best response is to refuse to buy the shoes and write a letter of complaint to the company that manufactures them.

Nurses need to be aware of nursing images in the public and respond appropriately. The best response is to refuse to buy the shoes and write a letter of complaint to the company that manufactures them.

PTS: 1

DIF: Cognitive Level: Application

5. What is meant by “workplace incivility”? a. A setting in which there are poor relationships among different professional

specialties. b. A setting in which different professions vie to take over the functions of other

professional groups. c. A setting in which the manager is unreceptive, hostile, and creates dissention. d. A setting where colleagues bully, intimidate, or use aggression toward each other.

ANS: D

A

B

C

D

Feedback Incivility in the workplace is described as a continuum of behaviors toward coworkers including taunting, using racial/ethnic slurs, intimidating, bullying, or using aggression against another person.

Incivility in the workplace is described as a continuum of behaviors toward coworkers including taunting, using racial/ethnic slurs, intimidating, bullying, or using aggression against another person.

Incivility in the workplace is described as a continuum of behaviors toward coworkers including taunting, using racial/ethnic slurs, intimidating, bullying, or using aggression against another person.

Incivility in the workplace is described as a continuum of behaviors toward coworkers including taunting, using racial/ethnic slurs, intimidating, bullying, or using aggression against another person.

PTS: 1

DIF: Cognitive Level: Comprehension

6. A nursing manager has noticed increasing incidents of rudeness and lack of cooperation among co-

workers. Which action by the manager is best? a. Holding a staff meeting and reminding the staff of policies regarding behavior b. Disciplining the “ringleaders” in order to make an example for the other staff c. Having informal meetings to solicit staff opinions on the workplace d. Announcing that raises will be withheld from staff members engaging in this behavior ANS: C

A

B

C

D

Feedback Workplace incivility leads to poor patient outcomes and cannot be tolerated.

However, people engage in this type of behavior because they feel stressed and powerless. Simply reminding staff members of behavioral expectations would make them feel more powerless.

Workplace incivility leads to poor patient outcomes and cannot be tolerated.

However, people engage in this type of behavior because they feel stressed and powerless. Simply disciplining the “ringleaders” would increase their sense of powerlessness and would not solve the root problem.

Workplace incivility leads to poor patient outcomes and cannot be tolerated.

However, people engage in this type of behavior because they feel stressed and powerless. Obtaining opinions about the working conditions could help the staff and manager pinpoint areas leading to the stress and powerlessness, which could then be addressed, increasing staff power and decreasing stress. This should lead to decreased incivility. The other options might need to be employed as well, but this option would hold the best chance of solving the root problem.

Workplace incivility leads to poor patient outcomes and cannot be tolerated.

However, people engage in this type of behavior because they feel stressed and powerless. Simply withholding raises would increase feelings of powerlessness, hostility, and resentment.

PTS: 1

DIF: Cognitive Level: Application

7. How could changes in world population affect health? a. Decreasing populations in third world countries frees up limited resources for the

remaining population’s needs. b. Feeding, immunizing, and providing clean water will become an overwhelming

task. c. Massive population increases in some areas will lead to abundant health care in

countries with smaller populations. d. More health care resources can be utilized fighting regional problems based on

shifting population dynamics.

ANS: B

A

B

C

Feedback As the world’s populations increase to a projected 8.8 billion by 2025, feeding, immunizing, providing potable water, and caring for this many human beings threaten to overwhelm the environmental, economic, social, and medical systems of the entire world.

As the world’s populations increase to a projected 8.8 billion by 2025, feeding, immunizing, providing potable water, and caring for this many human beings threaten to overwhelm the environmental, economic, social, and medical systems of the entire world.

As the world’s populations increase to a projected 8.8 billion by 2025, feeding, immunizing, providing potable water, and caring for this many human beings threaten to overwhelm the environmental, economic, social, and medical systems of the entire world.

D

As the world’s populations increase to a projected 8.8 billion by 2025, feeding, immunizing, providing potable water, and caring for this many human beings threaten to overwhelm the environmental, economic, social, and medical systems of the entire world.

PTS: 1

DIF: Cognitive Level: Comprehension

8. A nurse manager wants to cut costs and eliminate expensive latex-free gloves. Which response by the

chief nursing officer (CNO) is best? a. Allowing the change because it will save substantial money b. Allowing the change because the manager is in charge of the unit’s budget c. Not allowing the change because latex allergy is fairly common d. Not allowing the change until the next vendor bidding cycle occurs ANS: C

A B

C D

Feedback Of frequent glove users, 8% to 12% have latex allergies, so regardless of the possible cost savings, the CNO should not approve the change.

While the unit manager is in charge of the unit’s budget, latex allergy is fairly common (8% to 12% of frequent glove users), so the manager will need to find a different cost-cutting measure.

The CNO should not allow the change because 8% to 12% of frequent glove users report latex allergies.

Of frequent glove users, 8% to 12% have latex allergies, so regardless of where the facility is in the bidding cycle, the CNO should not approve the change.

PTS: 1

DIF: Cognitive Level: Application

9. A new manager is hired and is reviewing unit records. The manager finds a list of accidents, errors,

and interpersonal problems on the staff. Which action by the manager is best? a. Investigating the educational credentials and experience of the staff b. Hiring more registered nurses and assistive personnel c. Comparing this unit’s records with similar units in the hospital d. Researching alternative staffing patterns and the effects of shift work ANS: D

A

B

Feedback Because the staff has already been hired, their credentials should already be established and are likely not the cause of the problem. Shift work has been shown to increase depression, exhaustion, accidents, and interpersonal problems, and the manager should investigate this aspect of the work environment.

The unit may indeed need more staff, but this alone will not solve the problem.

Shift work has been shown to increase depression, exhaustion, accidents, and interpersonal problems, and the manager should investigate this aspect of the work environment.

C

D

Comparing units is a helpful strategy but not the best option. Shift work has been shown to increase depression, exhaustion, accidents, and interpersonal problems, and the manager should investigate this aspect of the work environment.

Shift work has been shown to increase depression, exhaustion, accidents, and interpersonal problems, and the manager should investigate this aspect of the work environment. The manager should investigate problems associated with shift work and find alternative patterns of staffing in order to propose a change.

PTS: 1

DIF: Cognitive Level: Application

10. A patient asks a nurse to explain pharmacogenetics. Which response by the nurse is best? a. “It is the effect of pharmaceutical agents on a person’s genes.” b. “It uses genetic information to determine if particular drugs will work in a person.” c. “It is the science of using a person’s genes to help create new medications.” d. “It was the project that mapped and sequenced human genes.”

ANS: C

A

B

C

D

Feedback Pharmacogenetics is a developing field in which genetic variants that affect drug metabolism can help providers determine the correct dose of a particular drug and possibly even whether a particular drug will work at all.

Pharmacogenetics is a developing field in which genetic variants that affect drug metabolism can help providers determine the correct dose of a particular drug and possibly even whether a particular drug will work at all.

Pharmacogenetics is a developing field in which genetic variants that affect drug metabolism can help providers determine the correct dose of a particular drug, and possibly even whether a particular drug will work at all.

Pharmacogenetics is a developing field in which genetic variants that affect drug metabolism can help providers determine the correct dose of a particular drug, and possibly even whether a particular drug will work at all. Mapping and sequencing human genes was the Human Genome Project.

PTS: 1

DIF: Cognitive Level: Comprehension

11. What is the most important action a nurse can take to help further the profession of nursing? a. Joining a professional organization like the ANA b. Running for political office and helping create health-related legislation c. Maintaining a sense of well-being and taking care of oneself in the workplace d. Developing leadership skills and increasing professional education ANS: A

Feedback

A

B C D

Nurses comprise the largest group of health care professionals, with over 3 million members. Uniting in a professional organization would help nurses’ voices to be heard, would influence health care policy and legislation, and would help improve health for all people.

Running for office is a good idea but will only be appealing to a minority of nurses.

Taking care of oneself is certainly important, but it will not help advance the profession.

Developing leadership skills and advancing one’s education are good ideas, but they are not as important as uniting in a professional organization.

PTS: 1

DIF: Cognitive Level: Knowledge

12. What is true about genetics and nursing practice? a. In the future, all drugs will be genetically based. b. Nurses will need competence in genetics. c. Genetic diseases will become more prevalent. d. All genetic conditions can be identified prenatally.

ANS: B

A B C D

Feedback Having all medications be genetically based is not a goal of genetics in health care.

In the future, nurses will need increasing competence in the area of genetics.

Genetic diseases may or may not become more prevalent.

Some but not all genetic conditions can be identified in the prenatal period.

PTS: 1

DIF: Cognitive Level: Knowledge

13. Approximately what percentage of today’s nurses belong to the ANA? a. 10% b. 20% c. 25% d. 30% ANS: A

A B C D

Feedback Only about 10% of the nation’s 3 million nurses belong to the ANA. Only about 10% of the nation’s 3 million nurses belong to the ANA. Only about 10% of the nation’s 3 million nurses belong to the ANA. Only about 10% of the nation’s 3 million nurses belong to the ANA.

PTS: 1

DIF: Cognitive Level: Comprehension

14. What is the focus of The Truth About Nursing Campaign? a. Educating high school students about the nature of nursing

b. Increasing interdisciplinary collaboration by highlighting nursing achievements c. Changing how the world thinks of nursing and protecting its image d. Defending nurses against malpractice by supplying expert witnesses at trial ANS: C

A B C D

Feedback The Truth About Nursing is a watchdog organization that strives to change the public perception of nursing and to protect its public image.

The Truth About Nursing is a watchdog organization that strives to change the public perception of nursing and to protect its public image.

The Truth About Nursing is a watchdog organization that strives to change the public perception of nursing and to protect its public image.

The Truth About Nursing is a watchdog organization that strives to change the public perception of nursing and to protect its public image.

PTS: 1

DIF: Cognitive Level: Comprehension

MULTIPLE RESPONSE 1. Which factors will lead to a continuing nursing shortage in the future? (Select all that apply.) a. Aging of the workforce b. Decreasing pay for nurses c. Increased unionization d. Increased need for nurses e. Recent economic downturn ANS: A, D Feedback Correct Incorrect

Aging of the workforce and an ever-increasing need for nurses will continue to contribute to the nursing shortage.

Decreasing pay, increased unionization, and the recent economic downturn are not projected to be contributing factors in the continuing nursing shortage.

PTS: 1

DIF: Cognitive Level: Comprehension

2. Which medical conditions can be linked to decreases in environmental quality? (Select all that apply.) a. Chronic respiratory diseases b. Allergies c. Cancers d. Mental illness e. Inflammatory bowel disease ANS: A, B, C Feedback

Correct Incorrect

Chronic respiratory ailments, allergies, and cancers of all types have been linked to deterioration in the environment.

Mental illness and inflammatory bowel disease have not been linked to changes in the environment.

PTS: 1

DIF: Cognitive Level: Comprehension

3. What are some recommendations for self-care for nurses in the workplace? (Select all that apply.) a. Wash hands consistently. b. Use sharps disposal containers. c. Use adequate help or mechanical devices for lifting. d. Demand mental health screening for all visitors and patients. e. Reduce the need for working double shifts.

ANS: A, B, C Feedback Correct

Incorrect

Self-protection measures nurses should take as part of self-care at work include handwashing, properly using sharps containers, having adequate resources for lifting, and reducing or eliminating shift rotations and double shifts.

Providing mental health screening for all patients and visitors would not be feasible or reasonable.

PTS: 1

DIF: Cognitive Level: Comprehension

4. What are the roles of the Occupational Safety and Health Administration (OSHA) in the workplace?

(Select all that apply.) a. They provide protection for people who report workplace safety problems. b. They inspect all equipment to ensure it is safe before the staff uses it. c. The regulate workplace safety. d. They provide health screenings for all new employees. e. They administer the employee health program.

ANS: A, C Feedback Correct

Incorrect

PTS: 1

OSHA regulates safety in the workplace and operates a whistleblower protection program that protects people who have reported safety violations in their workplace from retribution.

OSHA does not inspect all equipment, provide health screenings, or operate the employee health program in facilities.

DIF: Cognitive Level: Comprehension

5. Which of the following are important for successful implementation of health care reform set by the

ANA? (Select all that apply.) a. Health care is a basic human right for all citizens and residents. b. Health policies should be based on outcomes research.

c. Government should be the only health care insurer. d. Health care should provide more balance by including preventive and community

care. e. All people should have access to an all-inclusive package of health care.

ANS: A, D Feedback Correct

Incorrect

According to this document, the ANA believes that health care is a basic human right that should be provided to all citizens and residents, and that more balance is needed by providing community and preventive services.

The ANA believes that a single-payer health care system is best but does not specify that the government has to take on this role. They also believe that all people should have universal access to a standard package of essential health services.

PTS: 1

DIF: Cognitive Level: Comprehension

6. Which of the following is true regarding the requirement that entry to nursing practice should require a

bachelor’s of science in nursing (BSN)? (Select all that apply.) a. With increased complexity in health care, this is being debated again. b. Many ADN nurses are returning to school to complete this degree. c. The BSN will be required for practice in all 50 states by 2025. d. The master’s of science in nursing (MSN) will replace the BSN for bedside nurses. e. The need for BSN-prepared nurses will decrease with increased unlicensed staff.

ANS: A, B Feedback Correct

Incorrect

PTS: 1

With the increased complexity of today’s health care environment, the subject of the BSN as entry to practice is being heavily debated again and will probably gain more favor. Many ADN prepared nurses are returning to school to finish this degree.

There is no mandate for all-BSN entry to practice by 2025; the MSN will not replace the BSN for bedside practice; and the need for registered nurses will only continue to increase in the future.

DIF: Cognitive Level: Comprehension