Nursing Today Transition And Trends 9th Edition By Zerwekh TEST BANK

NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

Chapter 01: Reality Shock MULTIPLE CHOICE 1. A graduate nurse has been hired as a nurse at a local hospital. The new nurse is in the honeymoon phase of role transition when making which of the following statements? a.

“I am so nervous about being on my own as a nurse.”

b.

“This will be a great learning experience.”

c.

“I can’t wait to have a steady paycheck.”

d.

“This job is perfect. I can finally do things my own way.”

ANS: D The honeymoon phase is when the student nurse sees the world of nursing as quite rosy. Often, the new graduate is fascinated with the thrill of arriving in the profession. Reality shock occurs when one moves into the workforce after several years of educational preparation. Recovery and resolution occur when the graduate nurse is able to laugh at encountered situations. During this time, tension decreases, perception increases, and the nurse is able to grow as a person.

PTS: 1 DIF: Cognitive Level: Application REF: p. 7 OBJ: Identify the characteristics of reality shock.

TOP: Reality shock NURSINGTB.COM MSC: NCLEX®: Safe and effective care environment—management of care 2. Which of the following actions by the graduate nurse is an inappropriate methodology to recover from reality shock? a.

Networking

c.

Returning to school

b.

Obtaining a mentor

d.

Joining a support group

ANS: C The transition period is successfully managed when the graduate is able to evaluate the work situation objectively and predict effectively the actions and reactions of other staff. Nurturing the ability to see humor in a situation may be a first step. Returning to school is a positive step after the graduate has worked through role transition, has some clinical experience, and is ready to focus on a new career objective. Networking, obtaining a mentor, and joining a support group would give the graduate nurse an opportunity to talk to others experiencing the stress associated with reality shock. The nurse would benefit from ‘talking through’ issues and learning how to cope.

PTS: 1 DIF: Cognitive Level: Application REF: p. 8 OBJ: Describe four possible resolutions for reality shock. TOP: Reality shock MSC: NCLEX®: Safe and effective care environment—management of care

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3. A nurse is trying to avoid burnout. Which of the following actions is a valid way to achieve this? a.

Refusing to constantly work extra shifts

b.

Withdrawing from peer support group

c.

“Going native”

d.

Changing jobs every 6 to 12 months

ANS: A One of the quickest ways to experience burnout is to “overwork the overtime.” Set priorities with your mental and physical health being the highest priority. Learning to say “no” to extra shifts is a positive means of coping of avoiding burnout. “Going native” is the term that describes how recent graduates begin to copy and identify the reality of their role transition experience by rejecting the values from nursing school and functioning more like a team member at their place of employment. Withdrawing from peer support groups, “going native,” and changing jobs every 6 to 12 months would increase the chance of the nurse experiencing burnout. The nurse should instead focus on his/her practice and seek out support from other nurses.

PTS: 1 DIF: Cognitive Level: Application REF: p. 9 OBJ: Describe four possible resolutions for reality shock. TOP: Reality shock MSC: NCLEX®: Safe and effective care environment—management of care NURSINGTB.COM

4. Which of the following statements by the graduate nurse shows an understanding of reality shock as it applies to nursing? a.

“ Reality shock is the period when a person moves from school into the workforce.

b.

“Reality shock is the realization that practice and education are not the same.”

c.

“Reality shock is the period from graduation to becoming an experienced nurse.”

d.

“Reality shock is a transition phase that new graduates go through before changing jobs.”

ANS: A “Reality shock” is a term often used to describe the reaction experienced when one moves into the workforce after several years of educational preparation. The new graduate is caught in the situation of moving from a familiar, comfortable educational environment into a new role in the workforce where the expectations are not clearly defined or may not even be realistic. The realization that practice and nursing school are not the same is often associated with “going native.” When nurses move from one position to another, they have already experienced reality shock. Becoming an experienced nurse takes time and is not part of the definition of reality shock.

PTS: 1 DIF: Cognitive Level: Application REF: p. 6 OBJ: Compare and contrast the phases of reality shock. TOP: Reality shock MSC: NCLEX®: Not applicable

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5. A student in the last semester of nursing school has established a goal of making a successful role transition to graduate nurse. Which statement by the student indicates his/her understanding of how to achieve this goal? a.

“I should care for increased numbers of patients to enhance work organization skills.”

b.

“I will observe staff nurses as they perform nursing procedures to refine technique.”

c.

“I should seek increasingly close guidance from the nursing instructor to reduce errors.”

d.

“I will evaluate my progress every 7 weeks or more to allow time for growth.”

ANS: A It is important for the student to start taking care of increased numbers of patients to help with time management and work organization. The student should also be able to function without close guidance from the nursing instructor. Although it is good for students to observe staff, a student in the final semester should be able to perform tasks with minimal observation and should instead focus on implementing care and time management. Waiting 7 weeks to evaluate progress would not be helpful to the student. Although regular selfevaluation is an important process, it is the actual experience of taking realistic patient assignments and working typical shift hours that assists with successful role transition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 6 OBJ: Describe four possible resolutions for reality shock. TOP: Reality shock MSC: NCLEX®: Not applicable

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6. A new graduate of less than 1 year describes his/her perception of a staff nurse position, stating: “It feels great to be a nurse! In fact, it’s a snap! I can hardly believe there’s no instructor looking over my shoulder.”

What phase of reality shock is the graduate experiencing? a.

Recovery

c.

Honeymoon

b.

Shock and rejection

d.

Transition

ANS: C In the first phase of the role transition process (the honeymoon phase), the graduate nurse is thrilled with completing school and accepting the first job. Life is a bed of roses because everyone knows nursing school is much harder than nursing practice. Shock and rejection occur as the nurse tries to understand how nursing school and the “real world” come together. Transition occurs as the nurse begins the move from student to nurse and refers to the entire process, not just a particular phase. The recovery phase is when the nurse can laugh at situations that he/she is in and is able to cope with the situations that are being faced.

PTS: 1 DIF: Cognitive Level: Application REF: p. 7 OBJ: Compare and contrast the phases of reality shock. TOP: Reality shock MSC: NCLEX®: Not applicable

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7. A new graduate has worked on a busy unit for 6 months since graduating from nursing school. The graduate tells a friend, “I’ve never been so upset in all my life! The care that some of the staff give our patients is outrageously bad. There’s practically no attention to the principles of asepsis the way I learned them! The staff tells me that we have to cut corners if we’re going to get all the work done. I can’t stand it!” What phase of reality shock is this graduate experiencing? a.

Honeymoon

c.

Recovery

b.

Shock and rejection

d.

Role transformation

ANS: B The honeymoon phase for the new graduate nurse is short lived when the graduate identifies the conflicts between the way she or he was taught and the reality of what is done. Shock and rejection cause mental and emotional withdrawal, moral outrage, and a hypercritical attitude, which are just some of the symptoms of the realization that the honeymoon is over. Excessive mistrust, frequent pains and illness, a decrease in energy and fatigue, feeling like a failure and blaming oneself for every mistake, a hypercritical attitude, and feeling morally outraged are characteristics of the shock and rejection phase. The recovery phase is characterized by a beginning sense of humor (usually the first sigh), a decrease in tension, and an increase in the ability to cope with the situations that he/she is faced with. Role transformation is the process of transforming from student to nurse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 7 OBJ: Compare and contrast the phases of reality shock. TOP: Reality shock NURSINGTB.COM

MSC: NCLEX®: Not applicable 8. A graduate nurse has been out of school for 3 months and working in a staff nurse position for the past 2 months. What type of transition is the nurse experiencing? a.

A developmental transition

c.

A health-oriented transition

b.

An organizational transition

d.

A situational transition

ANS: D A situational transition is a lifestyle change that occurs because of a new situation. Most often the changes are by choice—for instance, graduations, marriages, and new jobs. Developmental transitions include becoming a parent or going through a midlife crises. An organizational transition involves a change in leadership. A health-oriented transition involves dealing with an illness or health issue, such as coping with a chronic illness.

PTS: 1 DIF: Cognitive Level: Application REF: p. 3 OBJ:Discuss concepts of transitions.TOP:Types of transitions MSC: NCLEX®: Not applicable 9. The graduate nurse understands that transitions occur throughout life. What major factor does the nurse identify as influential in a successful transition from school to practice?

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a.

Level of new knowledge and skills required in the new environment

b.

Amount of classwork required to obtain a degree

c.

Personal history of previous developmental transitions

d.

Influence of classmates and their transitional experiences

ANS: A The transition from student to practice reflects a situational transition that is most often affected by the anticipation of changes in the new work environment. Classwork no longer affects this transition. A personal history of previous developmental transitions and the influence of classmates are not as prominent as the anticipated requirements to function in the new environment of work.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 4 OBJ: Identify methods to promote successful transition. TOP: Types of transitions MSC: NCLEX®: Not applicable 10. A nurse manager is giving a presentation at a local community college. The nurse manager understands the job expectations of a new graduate when making which of the following statements? a. “A graduate nurse should be able to perform as independently as was demonstrated the last semester of nursing.”

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b. “A graduate nurse should be able to function competently as a registered nurse at the entry level.” c. “A graduate nurse should be able to function in the role that was described in the curriculum for the school of nursing.” d. “A graduate nurse should be able to be able to function independently with ability to make clinical nursing judgments.”

ANS: B The job expectations of a new graduate nurse are those of an entry-level new employee. This frequently includes an extended orientation to assist the new graduate to transition into the independent role of the nurse.

The new graduate nurse is not expected to function independently with the ability to make clinical nursing judgments. School curriculum and how one functioned the last semester of school are usually not considered in the job expectations of a new graduate.

PTS: 1 DIF: Cognitive Level: Application REF: p. 6 OBJ:Discuss concepts of transitions.TOP:Successful transitions MSC: NCLEX®: Not applicable 11. Which action by the graduate nurse shows that a successful transition to nursing has been made? a.

The nurse begins to work with the nursing team and functions as others expect.

b.

The nurse begins to objectively evaluate work experiences and enjoy the humor of clinical situations.

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c.

The nurse believes everything is great, patients are wonderful, and the new unit is so nice.

d.

The nurse meets regularly with other new graduates to compare and discuss problems.

ANS: B Objectivity and humor are two of the characteristics of a successful transition. “Going native” occurs when the graduate begins to provide care in the manner that the team or group wants it done, not necessarily the correct way. The “honeymoon phase” is when everything is going great. Meeting with other new graduates can be productive, but it is a part of the transition, not an indication of successful transition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 8 OBJ:Compare and contrast characteristics of reality shock.

TOP: Characteristics of a successful transition MSC: NCLEX®: Not applicable 12. A student nurse is in the last semester of nursing school. Which action by the nursing student indicates appropriate preparation for the transition experience? a. The nursing student requests additional experiences in performing skills and procedures. b. The nursing student maintains close contact with a nursing instructor to observe nursing procedures. c. The nursing student practices nursing assessments and care on one or two patients to become more competent.

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d. The nursing student increases communication with a nursing instructor to maintain a resource person after graduation.

ANS: A Students should get all the experience, not just observation, you can before graduation. Ask to perform procedures and skills and request feedback from staff nurses and instructors. Students should also begin to build resources that will be available after graduation. It is during the last semester that students begin to care for more complex patients (and more patient numbers) to gain experience in the “real world” of nursing management, as well as less begin to have less reliance on the nursing instructor as a resource person.

PTS: 1 DIF: Cognitive Level: Application REF: p. 8 OBJ:Identify methods to promote successful transition.

TOP:Activities to promote successful transition before graduation MSC: NCLEX®: Not applicable 13. A graduate nurse has been reviewing the NCSBN’s Transition to Practice model. The graduate nurse understands the intention of the model when making which of the following statements?

“The intention of the model is to mandate that all state boards of nursing provide a regulatory model for transition to a. practice.”

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“The intention of the model is to provide educational modules so that the new graduate does not need to work with a b. preceptor.”

“The intention of the model is to have the new graduate take and pass the NCLEX® Exam, obtain employment, and then c. enter a transition program.” d. “The intention of the model is to complete the formalized transition program within 6 weeks.”

ANS: C The NCSBN’s Transition to Practice model is a regulatory model that is designed to promote public safety by supporting the role transition experience of newly licensed nurses. The new graduate would first take and pass the NCLEX® Exam, obtain employment, and then enter the transition program. There are 5 transition modules with content focused on communication and teamwork, patient-centered care, evidence-based practice, quality improvement, and informatics. The time period for completion of the program is 6 months with an expected additional 6 months of ongoing support. Because of individual state’s rights, the NCSBN encourages states to adopt this model; however, they does not have the authority to mandate adoption of the model. This model does not act in replacement of a preceptor in the clinical practice area.

PTS: 1 DIF: Cognitive Level: Application REF: p. 17 OBJ:Identify methods to promote successful transition.

TOP:Activities to promote successful transition before graduation MSC: NCLEX®: Not applicable

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14. The nurse has an adequate understanding of transitions when making which statement about situational transitions? a.

“This type of transition can occur with leadership change.”

b.

“This type of transition occurs only when one is dealing with a chronic illness.”

c.

“This type of transition can occur when one has a career change.”

d.

“This type of transition occurs during a midlife crises.”

ANS: C A situational transition occurs from change to from one situation to another, such as a career change. Dealing with a chronic illness would be characteristic of a health–illness transition, a leadership change would be an organizational transition, and a midlife crises would be a developmental transition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 3 OBJ: Discuss the concepts of transitions. TOP: What are transitions?

MSC: NCLEX®: Health promotion and maintenance 15. A student in the last semester of nursing school wants to be sure of adequate preparation for the transition experience. Which patient should be added on to the clinical assignment to assist in this process?

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a.

A 48-year-old man with heart failure who has oral and IV medications due and needs a new IV started

b.

A 38-year-old woman who cares for herself independently and is going home later today

c.

A 25-year-old man who is leaving the hospital against medical advice

d.

A 40-year-old man who needs education on diabetes management

ANS: A To adequately prepare for role transition, the student nurse needs realistic assignments and real-life experiences. It would be most appropriate for the student to accept the “busy” patient, who requires oral and IV medications and needs to have his IV restarted. The patient who can care for themselves independently and the one who is leaving the hospital against medical advice would not provide as much skill experience.

Diabetic teaching is important but does not require the time management and work organization skills of a “busy” patient.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 13 OBJ: Describe methods to promote successful role transitions. TOP: Role transformation MSC: NCLEX®: Health promotion and maintenance 16. A student nurse is interested in improving his/her nursing skills. What action would be the best for the student nurse to take?

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Ask his/her instructor for extra skills practice during clinical hours.

b.

Watch videos on how to perform the nursing skills that he/she needs to practice.

c.

Review his/her nursing textbooks.

d.

Observe nurses perform skills in his/her clinical setting.

ANS: A The best way for the nursing student to improve skills is to get hands-on practice. The student would benefit most from requesting extra skills practice during clinical hours, where skills can be performed on real patients, with the guidance of a clinical instructor. Therefore, watching skills videos, reviewing nursing textbooks, and observing other nurses would not help the student obtain hands-on practice.

PTS: 1 DIF: Cognitive Level: Application REF: p. 13 OBJ: Describe methods to promote successful role transitions. TOP: Role transformation MSC: NCLEX®: Safe and effective care environment 17. A nursing student is nearing the end of his/her clinical experience. The student would like to care for patients who are typically challenging for students in the first year of practice. Which patient would be the best choice for this student?

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a.

A 62-year-old man with diabetes who needs outpatient care set up

b.

A 30-year old woman with a kidney stone requiring IV pain medications

c.

A 45-year old man with chest tubes recovering from a car accident

d.

A 25-year old woman who received blood yesterday

ANS: C The skills that nursing students have identified as the most challenging include code blues, chest tubes, intravenous skills, central lines, blood administration, and patient-controlled analgesia. The most appropriate patient for the student to increase his/her skill level would be the 45-year old man with chest tubes. The other patients are not considered to be a “challenging patients” for most nursing students.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 13 OBJ: Describe methods to promote successful role transitions. TOP: Role transformation MSC: NCLEX®: Health promotion and maintenance 18. Which statement by the nursing student indicates an understanding of the importance of constructive feedback? a.

“I will wait until my clinical evaluation and then make any changes to my practice that are needed.”

b.

“I will request routine feedback from my instructor so I can make any changes needed to improve my skills.”

c.

“My instructor will let me know if I need to change anything.”

d.

“I will ask my colleagues if I needed to make any changes to my practice.”

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ANS: B Students are responsible for their skills and growth as health care providers. To ensure that their nursing skills are adequate, students should request periodic feedback from their clinical instructors. Waiting for feedback or asking colleagues would be not an effective way for nursing students to obtain feedback in a timely manner.

PTS: 1 DIF: Cognitive Level: Application REF: p. 15 OBJ: Describe methods to promote successful role transitions. TOP: Role transformation MSC: NCLEX®: Not applicable 19. A graduate nurse has clocked in for his/her second shift on a busy orthopedic unit. After accepting the assignment, the graduate nurse notices a fellow nurse complaining loudly at the nurse’s station to other staff members. This fellow nurse is typically upset with floor assignments and thinks that the “new nurses get all the easy assignments.” Which action would be best for the graduate nurse to take? a.

Join the conversation and tell the fellow nurse that he/she does not care for the assignment either.

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b.

Begin a conversation with another staff member about the fellow nurse who is complaining.

c.

Steer clear of the nurse who is complaining and try to focus on the positive.

d.

Begin complaining about his/her own assignment.

ANS: C The graduate nurse would have the most success by steering clear of the complaining nurse and focus on the positive. Joining the conversation and focusing on the negative will not help the graduate nurse adjust to his/her new job.

PTS: 1 DIF: Cognitive Level: Application REF: p. 15 OBJ: Describe methods to promote successful role transitions. TOP: Role transformation MSC: NCLEX®: Safe and effective care environment 20. A new nurse is caring for five patients on a busy surgical floor. While hanging blood for a patient, the nurse receives notice that another assigned patient is being taken for surgery. The nurse has not obtained informed consent from the patient. What action should the new nurse take? a.

Immediately leave the room he/she is in and obtain informed consent from the patient.

b.

Allow the patient to go to surgery without obtaining informed consent.

c.

Delegate obtaining informed consent to another nurse while staying with the patient who is receiving blood.

d.

Ask the transporter to obtain informed consent from the patient.

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ANS: C Although the nurse must stay with the patient while hanging blood, it is important that informed consent is obtained from the other patient before going to surgery. The best action for the nurse to take would be to compromise and delegate obtaining informed consent to another nurse. The other actions would be inappropriate and possibly dangerous to the patients involved.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 16 OBJ: Describe methods to promote successful role transitions. TOP: Role transformation MSC: NCLEX®: Safe and effective care environment 21. The new graduate has an understanding of the nursing journey ahead when stating: a.

“It is not acceptable for me to make any mistakes at all.”

b.

“I am not worried about issues with transition. I am tough. I will do just fine!”

c.

“I know that I will make some mistakes, but I will learn and grow from them.”

d.

“I am going to keep studying so that I am always right.”

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ANS: C It is important for the graduate nurses to know that they will make mistakes in their nursing careers but that it is important that they learn and grow from them. It is not realistic for graduate nurses to believe that they will not make any mistakes or will not struggle with transition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 15 OBJ: Describe methods to promote successful role transitions. TOP: Role transformation MSC: NCLEX®: Safe and effective care environment 22. A nurse has worked the past 5 days in a row to make some extra money. Today is a scheduled day off.

Which of the following actions would be the best for this nurse to take? a.

Call the unit to see if they need the nurse to work.

b.

Read nursing articles and take practice quizzes to stay up to date.

c.

Take his/her small children to the zoo.

d.

Work on a continuing education requirement.

ANS: C It is important that the nurse take time to relaxNURSINGTB.COM and have fun. Taking his/her small children to the zoo is a non– work-related activity that would ease stress and be enjoyable.

PTS: 1 DIF: Cognitive Level: Application REF: p. 17 OBJ: Discuss methods that promote successful transition. TOP: Role transformation MSC: NCLEX®: Health promotion and maintenance MULTIPLE RESPONSE 1. A nurse manager is preparing a group of newly hired nurses to work on the unit. After educating them on reality shock, a student raises their hand and asks what physical and psychological symptoms the nurse may experience? The nurse manager replies: (Select all that apply.) a.

“It is not possible to experience any physical or psychological symptoms from reality shock.”

b.

“You may experience headaches.”

c.

“It is possible that you will experience gastrointestinal upset.”

d.

“You could experience insomnia.”

e.

“Women may experience menorrhagia.”

ANS: B, C, D

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Reality shock can cause physical and psychological symptoms that are important for the nurse to be aware of.

These can include headache, insomnia, feeling stressed out, gastrointestinal upset, and post-student blues.

Menorrhagia (excessive menstrual bleeding) is not a typical physical symptom of reality shock but is caused by uterine fibroids, endometriosis, or uterine polyps. Amenorrhea (absent menstrual flow) may be experienced because of stress associated with reality shock.

PTS: 1 DIF: Cognitive Level: Application REF: p. 7 OBJ:Identify the characteristics of reality shock.

TOP:What are the phases of reality shock?

MSC: NCLEX®: Health promotion and maintenance 2. A new nurse wants to make personal lifestyle changes to become a healthier individual. Which actions would help with reaching this goal? (Select all that apply.) a.

Begin an exercise routine.

b.

Eat snacks late at night.

c.

Incorporate relaxation into his/her schedule.

d.

Begin eating nutritious meals and snacks.

ANS: A, C, D

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To maintain health and wellness, the new nurse should begin an exercise routine, incorporate relaxation into his/her schedule, and begin eating nutritious meals and snacks. The nurse should consider cutting out snacks late at night.

PTS: 1 DIF: Cognitive Level: Application REF: p. 16 OBJ: Describe methods to promote successful role transitions. TOP: Role transformation MSC: NCLEX®: Health promotion and maintenance 3. Which action would greatly help the graduate nurse when seeking out employment? (Select all that apply.) a.

Plan out interviews.

b.

Ask to speak to nurses who work on the unit.

c.

Wait until the interview to gather all of the information.

d.

Find out what type of nursing care is delivered.

e.

Determine the length of orientation.

ANS: A, B, D, E

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It is important for the graduate nurse to be prepared when seeking out employment. Planning out interviews, speaking to nurses who work on the units, finding out what type of nursing care is provided, and determining the length of orientation are all actions the graduate nurse can take to prepare for employment. Waiting to gather information at the interview can leave the graduate nurse feeling frazzled and disorganized.

PTS: 1 DIF: Cognitive Level: Application REF: p. 13 OBJ: Describe methods to promote successful role transitions. TOP: Role transformation MSC: NCLEX®: Not applicable

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Chapter 02: Personal Management: Time and Self-Care Strategies MULTIPLE CHOICE 1. Which statement indicates the nurse’s understanding of effective time management?

“The purpose of effective time management is to save hours, a. minutes, and seconds.”

“The purpose of effective time management is to do as much as b. possible in as short a time as possible.”

“The purpose of effective time management is to do as little as c. possible.”

“The purpose of effective time management is to achieve personal d. and professional goals.”

ANS: D Making time to meet your individual, family, professional, and career needs and goals is vital to overall success and is the primary purpose of time management. Stating the purpose of effective time management as saving time or doing as much or as little as possible in a short time would not indicate the nurse’s understanding. Procrastinating and doing as little as possible are not characteristic of effective time management.

PTS: 1 DIF: Cognitive Level: Application REF: p. 25 NURSINGTB.COM OBJ:Identify strategies for self-care.TOP:Time management MSC: NCLEX®: Not applicable 2. A student nurse likes to sleep late and has a high-energy period in the evening. The student resists schedules and prefers to study when it “feels right” and in groups. Which of the following characteristics fit this student?

Early bird and left-brain a. dominance

Owl and left-brain c. dominance

Early bird and right-brain b. dominance

Owl and right-brain d. dominance

ANS: D The owl does its best work at night, which fits well with the right-brain–dominant person who resists schedules. People with these characteristics choose to do things in their own time and fashion. Early birds tend to do their best work earlier in the day. Left-brain–dominant people process information in a linear, sequential manner, so they would probably prefer a schedule of activities.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 26-27 OBJ: Identify your individual time styles. TOP: Time management

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MSC: NCLEX®: Not applicable 3. In 4 weeks, a student nurse will have two tests and one paper due in the same week. What is the most effective time-management strategy for this student nurse? a. Control time wasters to have more time for studying and writing. b. Delegate everything possible to create more time for studying.

Schedule specific times on a calendar to study for the tests and to c. work on the paper during the next 4 weeks.

Wait to study for the tests and to write the paper the week before d. they are due because the student nurse “works best under pressure.”

ANS: C The most effective approach to this problem would be to schedule specific time periods to prepare for the tests and write the paper. Waiting until the last minute to study and write the paper creates unnecessary stress and sets the student nurse up for failure. Creating more time for studying does not solve the problem; how that time is organized and how it is used is the key. Procrastinating by putting off assignments until the last minute can lead to extreme anxiety and stressful behavior. Although delegating some tasks is realistic and can create time for studying, it is unrealistic to delegate “everything possible.”

PTS: 1 DIF: Cognitive Level: Application REF: pp. 27-28 NURSINGTB.COM OBJ: Identify personal time management strategies.

TOP: Time management

MSC: NCLEX®: Not applicable 4. How can the student nurse increase studying efficiency?

Maintaining a supply of simple carbohydrates for a quick energy a. spurt b. Alternating mental and physical activities to increase productivity c. Working nonstop without breaks to focus concentration d. Delegating tasks of household chores to family members

ANS: B Alternating tasks that are mental with tasks that are physical can increase alertness and create a natural energy spurt to keep going. Carbohydrate-induced energy spurts are short lived and ineffective for studying efficiency.

Working nonstop without breaks leads to fatigue and burnout. Although delegating tasks would be helpful to the student nurse, it does not directly increase studying efficiency.

PTS: 1 DIF: Cognitive Level: Application REF: p. 27 OBJ: Identify personal time management strategies. TOP: Time management

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MSC: NCLEX®: Not applicable 5. The nurse has concluded that he/she is a right-brain–dominant person. Based on the nurse’s time style, which unit governance task will the nurse implement? a. Devise a plan to restructure the nursing career ladder.

Write a procedure for central line care using new equipment that b. will be available in two weeks. c. Do the unit time schedule for the next pay period.

Collate data obtained from a chart audit to report at the next unit d. staff meeting.

ANS: A Right-brain–dominant people like to brainstorm to create new ideas and approaches to old problems, so devising a restructured nursing career ladder would be an appropriate task for this person. Writing procedures, completing time schedules, and collating data are indicative of a left-brain–dominant person.

PTS: 1 DIF: Cognitive Level: Application REF: p. 27 OBJ: Identify your individual time styles. TOP: Time management MSC: NCLEX®: Not applicable

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6. What actions should a graduate nurse take in the first work experience to avoid problems with burnout? a. Cross-train to work in different areas of the hospital.

Develop a social group of nurses with whom to share work b. experiences.

Plan on several sessions with a counselor regarding managing c. stress.

Develop social contacts outside of nursing and maintain good d. nutrition and good sleep habits.

ANS: D Taking care of oneself is a primary component to preventing burnout—for example, avoiding alcohol, maintaining good nutrition, getting adequate amounts of sleep, and avoiding cigarette smoking. Developing social contacts outside the work environment also facilitates reduction of stress from work. Cross-training in different areas of the hospital, developing a social group with nurses to share work experiences, and meeting with a counselor would not be helpful to the graduate nurse in avoiding problems with burnout in the first work experience.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 37-38 OBJ: Discuss the importance of caring for yourself. TOP: Burnout

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

MSC: NCLEX®: Not applicable 7. Which action by the nurse exemplifies a sense of spiritual health? a. Belonging to a church

c. Feeling loved and cared for

Feeling purposeful and b. fulfilled

Changing religious d. affiliations

ANS: B A sense of spiritual health simply means that we have a daily awareness that there is something more to living than mere human existence. People who have a sense of spiritual being find their lives to be positive experiences and feel good about the future. Belonging to a church, feeling loved and cared for, and changing religious affiliations are not identified as ways that one exemplifies a sense of spiritual health.

PTS: 1 DIF: Cognitive Level: Application REF: p. 44 OBJ: Discuss the importance of caring for yourself. TOP: Spiritual awareness MSC: NCLEX®: Not applicable 8. Which of the following is an example of a self-defeating belief?

I must always feel loved by a. everyone.

I will get through nursing NURSINGTB.COM c. school.

b. I am a caring person.

d. I am getting better.

ANS: A Feeling as though you need to be loved by everyone is a self-defeating belief because there will always be some individuals who do not care for you. It would be unrealistic and hence self-defeating to have or express the need to be loved by everyone. There are many ways to exercise our mental potential. One of the first ways is to concentrate on removing negative thoughts or self-defeating beliefs from our minds. Affirmations or positive statements, such as being a caring person, will get through nursing school, getting better with skills or recovering from an illness, and so on are ways to avoid self-defeating comments and behaviors.

PTS: 1 DIF: Cognitive Level: Application REF: p. 39 OBJ: Identify strategies for self-care. TOP: Self-care MSC: NCLEX®: Not applicable 9. Which is an example of an effective self-care strategy for a nurse? a.

Plan time for physical recuperation after working extra hours.

b. Push feelings of sadness, joy, anger, and fear out of awareness. c.

Use alcohol to reduce tension.

d. Respond to people and opportunities reactively.

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ANS: A Taking care of ourselves physically entails getting proper nutrition and adequate sleep and exercising on a regular basis and planning for additional time to recuperate when working extra hours. Using alcohol or drugs only medicates feelings and is not considered an effective self-care strategy. Not dealing with feelings is a way to consciously suppress emotions, which can lead to a variety of anxiety disorders. Responding to people and opportunities in a reactive manner or a “knee-jerk” response, is not a good self-care strategy because the behavior can lead to poor decisions without adequate thought.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 43-44 OBJ: Identify strategies for self-care. TOP: Self-care MSC: NCLEX®: Not applicable 10. Nurse 1: “The manager told me that you and I have to change work schedules to accommodate Jim. That means we will both have to work days and nights in the same week. There’s nothing we can do about it.”

Nurse 2: “Let’s take a minute and look at the possible alternatives.” What is the best assessment of this situation?

Nurse 1 is exhibiting reactive behavior, and Nurse 2 is being a. proactive.

Nurse 1 is exhibiting a sense of empowerment, and Nurse 2 is b. behaving codependently.

Jim and the nurse manager have formed a coalition with the goal of c. dominating other staff.

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The nurse manager is evidencing good self-esteem by daring to d. take an unpopular action that will expose criticism.

ANS: A Whereas nurse 1 is reacting to the situation, nurse 2 is taking time to assess the situation more thoroughly and see what choices they might have. Many of us go through life never realizing that we have many choices. You can choose to respond to people and situations rather than react. It is important to assess the situation and see what options are available and what the consequence of the options might be. Exercising our choice potential also entails that we act responsibly toward others. Codependent behavior is a type of control or enabling behavior. Empowerment is the power to do something and acting self-confidently to do so. The question is asking about the assessment of nurse 1 and nurse 2 responses, not the nurse manager.

PTS: 1 DIF: Cognitive Level: Application REF: p. 46 OBJ: Identify strategies for self-care. TOP: Self-care—proactive response MSC: NCLEX®: Safe and effective care environment—management of care 11. A nurse has been out of school about 6 months. Which of the following would indicate that the nurse is having problems with burnout?

Having chronic fatigue, increased irritability, and feelings of a. helplessness

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Feels angry regarding the type of care being delivered and b. scheduling of staff coverage Signs up for extra courses for an advanced degree and works c. double shifts for extra money Is disorganized regarding patient care and has to stay late to finish d. shift work

ANS: A Fatigue, irritability, and feelings of helplessness are all early signs of burnout. Anger regarding care may be very appropriate; how the anger is directed is important. Overscheduling oneself is something that may promote early burnout, as are disorganization and poor time management.

PTS: 1 DIF: Cognitive Level: Application REF: p. 38 OBJ: Describe early signs of burnout. TOP: Burnout MSC: NCLEX®: Not applicable 12. The nurse would identify which of the following strategies as a means of increasing feelings of empowerment? a. Requesting an assignment to a different hospital unit b. Assisting friends to cover their shifts when they need time off Telling a coworker that a joke heard in private wasNURSINGTB.COM inconsiderate c. and thoughtless Declining to work an extra shift and going to the movies with d. friends

ANS: D Taking care of oneself is critical to preventing burnout and increasing feelings of empowerment, such as declining to work an extra shift so you can participate in activities with friends and family. Take care of yourself first; then assist others as you are able. Moving to a different hospital unit may be a type of avoidance with an issue that is unresolved. Humor and laughter are important; however, if the joke was unethical, correcting the nurse would not increase empowerment.

PTS: 1 DIF: Cognitive Level: Application REF: p. 44 OBJ:Describe early signs of burnout.TOP:Empowerment MSC: NCLEX®: Not applicable 13. What activity would most likely promote a positive feeling of well-being in a graduate nurse about 6 months after employment? a. Have a group of staff nurses over for a party. b. Participate in hospital-sponsored programs for community health.

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Spend some time with an old friend who is in the middle of a c. divorce.

Get involved in a new hobby and attend social gatherings to meet d. new people.

ANS: D Planning pleasurable activities, such as a hobby or attending a social gathering, that are not associated with nursing or other people’s problems can help you to reenergize and feel better about yourself. Having nurses over for a party or participating in hospital-sponsored programs would not give the graduate nurse the time needed away from nursing. Spending time with a friend going through a divorce would not promote a positive feeling of well-being in the graduate nurse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 44 OBJ:Identify strategies for self-care.TOP:Empowerment MSC: NCLEX®: Not applicable 14. A nurse is considering pursuing additional education in nursing and hopes to be promoted to a management position. What action should the nurse take to best achieve this?

Wait until “the time is right” and inquire about program and a. promotion opportunities.

NURSINGTB.COM Be the best nurse possible and hope a scholarship or promotion will b. be awarded.

Set long-range, mid-range, and short-range goals with specific c. related activities and time frames to meet these goals. d. Read three books on time management.

ANS: C Set goals so that you can prioritize your approach, along with identifying specific activities and time frames to work toward a management promotion are keys to success. Assess the situation and see what activities will provide the highest payoff. Waiting for the right time to achieve promotion, hoping for a scholarship or promotion, and reading books on time management are not effective; instead, the nurse must take action to achieve a goal.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 34-37 OBJ:Identify strategies for self-care.TOP:Time management MSC: NCLEX®: Not applicable 15. A student nurse is feeling stressed about the combination of nursing courses and clinical experience in the semester. What actions can the student nurse take to reduce stress level based on biological rhythms?

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a.

Schedule difficult activities at high-energy times.

b.

Shorten sleep time to accommodate increased study times.

c.

Study before bedtime to increase memorization.

d.

Only study when not feeling stressed.

ANS: A Student nurses should create schedules that work with their biological rhythms, such as scheduling difficult activities at their high-energy times. Shortening sleep, studying right before bed, and only studying when they are not feeling stressed are not advised.

PTS: 1 DIF: Cognitive Level: Application REF: p. 25 OBJ: Identify your individual time style and personal time-management strategies.

TOP: Managing your time MSC: NCLEX®: Health promotion and maintenance 16. A nurse manager is assigning additional duties to the day shift nurses to keep the unit orderly and running smoothly. Which assignment would be the best for a right-brain–dominant nurse? a. Clean up the break room by noon.

Assist with completing a unit project, based on specific rules and NURSINGTB.COM b. guidelines. c. Create a poster board in honor of Nurse’s Week. d. Take part in a meeting regarding unit policies.

ANS: C Right-brain—dominant people resist rules and schedules and prefer to complete activities on their own time.

Creating a poster board in honor of Nurse’s Week gives the right-brain–dominant nurse a chance to create in a personal way without rules and restrictions. Cleaning up the break room by noon, assisting with a unit project guided by rules and specific guidelines, and taking part in a unit policy meeting would be better suited for a left-brain–dominant nurse (structure, organization, rules, time limits, and priorities are important).

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 27 OBJ: Identify your individual time style and personal time-management strategies.

TOP: Managing your time MSC: NCLEX®: Safe and effective care environment 17. What action by student nurses indicates readiness for successful study habits? a. Combining their study area with the space that they use to pay bills b. Color coding their materials from each class

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c. Keeping all materials and papers in one bin d. Cleaning their study area at the end of each semester

ANS: B To ensure success, students should first separate the area in which they study from the area where they pay bills. Second, students should color code their materials from each class to ensure that they can find what they need during study sessions. Students should separate out materials and discard what is no longer needed.

Frequently cleaning their study area will help them maintain order.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 27-28 OBJ: Identify your individual time style and personal time-management strategies.

TOP: Managing your time MSC: NCLEX®: Not applicable 18. What actions can a student take to manage the phone calls received throughout the day?

Set a specific time during the day for business or school related a. phone calls. b. Allow phones call at any time as long as they are short.

If the student needs to leave a message, state that he/she can be c. contacted any time.

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Keep the phone turned off until all studying is completed for the d. day.

ANS: A Students should set up a time during the day for all phone calls related to business or school. If students need to leave a message, they should state when they can be contacted. Keeping the phone turned off is not a realistic option.

PTS: 1 DIF: Cognitive Level: Application REF: p. 29 OBJ: Identify your individual time style and personal time-management strategies.

TOP: Managing your time MSC: NCLEX®: Not applicable 19. A student wants to begin planning for future educational goals. Which of the following actions would NOT help the student plan?

Review a list of goals once a a. year.

c. Prioritize goals.

b. Make a master list of goals.

Cross out goals as they are d. met.

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ANS: A In planning goal-related activities, making a master list of goals and prioritizing the goal list are helpful strategies for completing activities and accomplishing goals. It is also helpful to cross off each goal, as it is completed. By doing so, provides a sense of accomplishment and immediate gratification for completing a goal. It is important to continually review the list of goals established to determine if activities or tasks need to be moved based on how quickly they need to be attended to. Reviewing a list of goals yearly would not be sufficient in helping the student plan for completing his/her educational goals.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 34-35 OBJ: Identify your individual time style and personal time-management strategies.

TOP: Managing your goals MSC: NCLEX®: Not applicable 20. Which of the following actions by the nurse helps to prevent burnout? a.

Picking up extra shifts each week

b.

Staying late to help out at the end of each shift

c.

Scheduling a massage on a day off

d.

Teaching at the local community college one day a week

ANS: C

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A fun, relaxing activity that is not work-related can help prevent burnout, such as scheduling a massage on a day off. Picking up extra shifts, staying late to help out at the end of the shift, and teaching part-time one day a week may lead to burnout if the nurse is not careful.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 35-37 OBJ:Identify strategies for self-care.TOP:Self-care strategies MSC: NCLEX®: Health promotion and maintenance 21. Which of the following statements by the nursing student is an affirmation? a.

“I must maintain As in school.”

b.

“I am human and capable of making mistakes.”

c.

“If I fail at something, the results will be catastrophic.”

d.

“If I am not liked by everyone, I am a failure.”

ANS: B Stating, “I am human and capable of making mistakes” is an affirmation or a positive statement concerning the ways we would like to think, feel, or behave. The other statements are self-defeating thoughts.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 45 OBJ:Identify strategies for self-care.TOP:Self-care activities MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. When taking an online or web-enhanced course, what are effective time management strategies? (Select all that apply.)

Enroll in an online or web-enhanced course that has fewer than 15 students to reduce the amount of time it takes to respond to a. everyone in the class.

Print your syllabus and create a calendar with assignment due dates b. and discussion posting requirements.

Create a directory on your computer to place assignments and c. resources specific for the course.

Determine what the best time is for logging into the course website d. and create a schedule for weekly log-in times.

Develop an online group of colleagues that meet in the chat room e. or participate in instant messaging.

ANS: B, C, D, E

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Online or web-enhanced courses can take as much, if not more, time as traditional face-to-face classes. The following are helpful strategies to improve time management involving the course: • Print the syllabus and place deadlines on your calendar before the first course meeting.

• Identify how to contact your instructor and schedule online office hours in your calendar.

• Schedule weekly times for logging into the class website.

• Schedule a time for class work and select a specific site.

• Develop collegial support groups.

• Be active in the course by participating appropriately in discussion groups.

• Establish an evidence-based file to download important articles (.pdf format).

• Bookmark websites (but before bookmarking these, review the information; do not assume all sites are up to date and evidence based).

PTS: 1 DIF: Cognitive Level: Application REF: p. 31 | p. 33 | p. 42 OBJ: Identify personal time management strategies. TOP: Time management

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MSC: NCLEX®: Not applicable 2. To achieve success in the workplace, which action by the nurse would focus on improving skills? (Select all that apply.) a.

Taking a course on communication

b.

Thinking of a way to improve time management

c.

Understanding the layout of the hospital

d.

Spending some time working on organizational skills

e.

Knowing where supplies are on the unit

ANS: B, D Employers of new graduates identify lack of organizational and time management skills as areas where new nurses need improvement and assistance. Focusing on improving these skills before employment will help the new nurse succeed.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 27-29 OBJ: Identify your individual time style and personal time-management strategies.

TOP: Managing your time MSC: NCLEX®: Not applicable

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3. What actions by the student would manage the physical environment? (Select all that apply.) a. Set up an area that is specific to school work. b. Choose a work area that has soft, dim lighting. c. Choose a work area that is free from distractions. d. Gather appropriate tools before each study session begins.

Study for 30 minutes at a time and take a 5-minute break in e. between.

ANS: A, C, D To have success when studying, students should first set up an area that is specific to school work. Students should choose a work area that is free from distractions and gather appropriate tools needed for studying.

Students should choose an area with adequate lighting and study in 50 minute sessions, taking a 10-minute break in between.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 27-29 OBJ: Identify your individual time style and personal time-management strategies.

TOP: Managing your time MSC: NCLEX®: Not applicable

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4. What actions can the nurse take to manage a habit of procrastinating? (Select all that apply.) a.

Consider the consequences of not completing each activity.

b.

Start on time and plan for the project to end on time.

c.

Break projects into small, manageable pieces.

d.

Set up a reward system for project completion.

e.

Be realistic about what can be accomplished.

ANS: A, C, D, E To avoid procrastination, the nurse should consider the consequences of not completing each activity. The nurse should break down projects into small, manageable pieces; set up a reward system; and be realistic about what can be accomplished. Projects should be started ahead of time and be planned to take 3 times as long to complete.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 31-32 OBJ: Discuss strategies that increase organizational skills and personal priority setting.

TOP: Managing tasks MSC: NCLEX®: Not applicable 5. The nurse understands stress-related illness when stating which of the following? (Select all that apply.)

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a.

“Stress can cause insomnia.”

b.

“Stress is known to cause muscle and joint pain.”

c.

“Stress can cause headaches.”

d.

“Stress is not known to cause any health problems.”

e.

“Stress can cause gastrointestinal disturbances.”

ANS: A, B, C, E Stress is known to cause a variety of physical and psychological ailments, including insomnia, muscle and joint pain, headaches, and gastrointestinal disturbances.

PTS: 1 DIF: Cognitive Level: Application REF: p. 41 OBJ:Describe early signs of burnout and how it affects nurses.

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Chapter 03: Mentorship, Preceptorship, and Nurse Residency Programs MULTIPLE CHOICE 1. The nurse manager is presenting at a conference and shows an adequate understanding of a mentoring relationship when giving the following as an example: a.

A coach and a player

c.

An intern and a resident

b.

A teacher and a learner

d.

An advisor and a partner

ANS: D In nursing, mentor is synonymous with trusted advisor, and mentoring is a partnership between two people.

Coaches help individuals find new ways to solve problems, reach goals, and design plans of action to motivate people to perform at the “top of their game.” The teacher and learner relationship involves an evaluation component (receiving a grade in a course). The intern reports to the resident, so there is more of a precepting relationship because the resident is the clinical expert, and there may also be an evaluation component in this relationship.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 50-51 OBJ: Describe the difference between mentoring, coaching, and precepting.

TOP: Mentoring relationship MSC: NCLEX®: Not applicable

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2. The nurse professor is lecturing to students in their final semester of nursing school. Which statement by the nurse professor about mentoring is accurate? a. “Mentoring involves solving an individual’s problems.” b. “Mentoring focuses on the needs of someone else.”

“Mentoring means helping someone reach his or her long-term c. goals.” d. “Mentoring requires pairing an experienced person with a novice.”

ANS: B Mentoring requires a primary focus on the needs of the mentee and an effort to fulfill the most critical of these needs. Meeting these needs first makes achievement of goals more realistic. Mentoring does not involve solving an individual’s problems, helping someone reach long-term goals, or pairing an experienced person with a novice.

PTS: 1 DIF: Cognitive Level: Application REF: p. 51 OBJ: Identify characteristics of effective mentors, mentees, and preceptors.

TOP: Description of mentoring MSC: NCLEX®: Not applicable

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3. While discussing a mentoring program with the nursing director, the nurse manager correctly states that mentoring is a a.

partnership.

c.

static relationship.

b.

one-way street.

d.

method of gaining more experience.

ANS: A Mentoring is a partnership and a two-way street with both parties freely contributing to the relationship as equals working together, based on mutual respect. Mentoring is not used as a method to gain more experience.

Mentoring is a dynamic, not a static, relationship. Gaining experience is often associated with precepting.

PTS: 1 DIF: Cognitive Level: Application REF: p. 51 OBJ: Identify characteristics of effective mentors, mentees, and preceptors.

TOP: Description of mentoring MSC: NCLEX®: Not applicable 4. You are a graduate nurse in search of a mentor. To find a good “match,” what should you look for? a. Choose an experienced nurse who is successful. b. Look for things you and the potential mentor have in common. c. Be very specific with the questions you ask of theNURSINGTB.COM possible mentor. d. Be careful not to disclose too much personal information.

ANS: B When considering establishing a mentoring relationship, look for commonalities in nursing education, areas of expertise or practice, or interests. Feeling comfortable and building trust are crucial for a successful mentoring relationship. Broad, open-ended questions stimulate discussion and offer an opportunity to assess and establish the mentor relationship. It is important to discuss yourself and be open in a light and friendly manner when talking with a potential mentor. Being an experienced nurse would be an important criterion for a preceptor.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 57-58 OBJ: Identify characteristics of effective mentors, mentees, and preceptors.

TOP: Effective mentoring relationship MSC: NCLEX®: Not applicable 5. A group of nursing students is discussing mentors. One of the students correctly states a characteristic of a successful mentor when stating: a. “They ensure that their mentees do not fail.” b. “They push the mentees to a higher level.” c. “They always ask a lot of questions of their mentees.”

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“They encourage mentees to question their skills so they can d. improve.”

ANS: B Mentors need to communicate high expectations to mentees and push them to meet or exceed these expectations. Mentors should not ensure that mentees do no fail because this is often a great learning experience for mentees. Frequently questioning mentees or encouraging mentees to question their skills is not indicative of a successful mentor. Mentors are good listeners, offer empathy and encouragement, and are generous with their time and knowledge.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 57-58 OBJ: Identify characteristics of effective mentors, mentees, and preceptors.

TOP: Successful mentorship MSC: NCLEX®: Not applicable 6. The role of the mentee needs to be understood early in the mentoring relationship. What is a characteristic or example of the mentee’s role? a. Not interrupting the mentor b. Absorbing what the mentor explains in detail c. Establishing personal short- and long-term goals

NURSINGTB.COM d. Finding out what the mentor has to offer in terms of experience

ANS: C Establishing your goals early will help you get exactly what you need from the mentoring relationship. The mentee should ask questions when clarification is needed because communication is very important. The mentor’s nursing experience is not considered part of the mentee’s role. Absorbing information may relate more to a preceptor providing information on content or skills. Finding out the experience is probably more applicable to the preceptor relationship.

PTS: 1 DIF: Cognitive Level: Application REF: p. 56 OBJ: Identify characteristics of effective mentors, mentees, and preceptors.

TOP:Role of mentee MSC: NCLEX®: Safe and effective care environment—management of care 7. Which statement indicates the student nurse’s understanding of a situational relationship? a. “A situational relationship occurs only one time.” b. “A situation relationship is established by the organization.”

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“In a situational relationship, both mentee and mentor mutually c. accept it.”

“A situational relationship is structured to ensure situational d. success.”

ANS: A Characteristically, a situational mentoring relationship is a one-time event. Organizations usually establish formal relationships. Acceptance by the mentee and mentor is characteristic of an informal relationship. A structured relationship is formal.

PTS: 1 DIF: Cognitive Level: Application REF: p. 60 OBJ:Discuss the types of mentoring relationships.

TOP: Situational mentoring relationship MSC: NCLEX®: Not applicable 8. The “honeymoon” is a specific phase of reality shock. What should the mentor do during this phase? a.

Share personal transition experiences with the mentee.

b. Reinforce the need for the mentee to problem solve. c.

Encourage the mentee to try new things.

NURSINGTB.COM d. Act as the intermediary for the mentee with all staff members.

ANS: D During the “honeymoon” phase, the mentor should be supportive (by listening and understanding), act as an intermediary with other staff members, and be a role model. Sharing feelings and experiences and the mentor’s own transition experience are appropriate in the shock and rejection phase. Trying new things and stepping outside the mentee’s comfort zone would be appropriate for the mentor to encourage during the recovery phase of reality shock.

PTS: 1 DIF: Cognitive Level: Application REF: p. 61 OBJ:Discuss the types of mentoring relationships.

TOP:Mentoring during reality shock phase MSC: NCLEX®: Safe and effective care environment—management of care 9. A new graduate is looking for a mentor. Which staff nurse would be the best choice?

Louise, a skilled clinician who appears hurried, curt, and a. occasionally sarcastic Jill, a new graduate who worked 2 years as an LPN and seems b. confident

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Juan, who has 3 years of experience, good skills, and a sense of c. humor Kim, who has 6 years of experience and is highly intellectual but is d. aloof and self-centered

ANS: C The mentor not only serves as a role model or counselor for the new graduate but also actively advises, guides, and promotes the graduate’s career. It is important to select someone who will work with you and has nursing experience as a nurse. Frequently, nurses with 3 to 5 years of experience remember their own role transition and can relate to what the new graduate is experiencing. Louise is curt and sarcastic, which would not be supportive behavior of a mentor. Jill is too recent a graduate. Kim is aloof and self-centered and would not be a good candidate for a mentor because mentors willingly are personally invested in their mentee.

PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 57-58 OBJ: Describe four possible resolutions for reality shock. TOP: Selecting a mentor MSC: NCLEX®: Not applicable 10. Which of the following statements by the nurse indicates an understanding of mentors?

“Mentors focus on fostering the mentee’s individual growth and a. development over an extended period of time.”

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b. “Mentors develop nurturing relationships during work time.”

“Mentoring is the approach of assisting an individual’s growth c. through partnership.”

“The strength of mentoring lies in the facilitation and development d. of personal qualities.”

ANS: A Mentoring involves focus on fostering the mentee’s individual growth and development over an extended period of time. Mentors develop nurturing relationships during personal time. Coaching is the approach of assisting an individual’s growth through partnership. The strength of mentoring lies in the mentor’s specific knowledge and wisdom.

PTS: 1 DIF: Cognitive Level: Application REF: p. 50 OBJ: Describe the difference between mentoring, coaching, and precepting.

TOP: What mentoring is and is not MSC: NCLEX®: Not applicable 11. A nursing student is in the mentoring process. Which action would occur if the student nurse were in the “follow” phase?

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The nursing student observes as the mentor places a urinary a. catheter.

The nursing student places a urinary catheter while the mentor b. stands nearby for guidance.

The nursing student reads the hospital policy regarding urinary c. catheter placement.

The nursing student places the urinary catheter without guidance d. from the mentor.

ANS: B In the “follow” phase, the student nurse and the mentor walk side by side down the same path, and the mentor assumes a more passive role. Therefore, the student would place the urinary catheter, with the mentor nearby for guidance. In the “lead” phase, the student would observe the mentor; in the “get out of the way” phase, the student nurse would place the urinary catheter without guidance. Reading the hospital policy on urinary catheterization does not indicate a phase of the mentoring process.

PTS: 1 DIF: Cognitive Level: Application REF: p. 56 OBJ:Examine components of a nurse residency program.

TOP: What is a nurse residency program? MSC: NCLEX®: Not applicable 12. A nursing student is in the mentoring process.

Which action would occur if the nursing student were in the NURSINGTB.COM “Get out of the way phase?”

The nursing student would assess chest tubes with the mentor a. nearby for guidance. b. The nursing student would assess chest tubes independently.

The nursing student would observe the mentor assessing chest c. tubes. d. The nursing student would read the hospital policy on chest tubes.

ANS: B In the “get out of the way” phase, the nursing student would assess chest tubes independently. In the “follow” phase, the nursing student would observe the mentor assessing chest tubes. In the “lead” phase, the nursing student would assess chest tubes with the mentor nearby for guidance. Reading hospital policy on chest tubes does not indicate a phase in the mentoring process.

PTS: 1 DIF: Cognitive Level: Application REF: p. 56 OBJ:Examine components of a nurse residency program.

TOP: What is a nurse residency program? MSC: NCLEX®: Not applicable

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13. A nursing student is meeting with a possible mentor for the last semester of nursing school. Which of the following questions would be most appropriate for the student to ask? a.

“Do you like working on this unit?”

b.

“Do you like your coworkers?”

c.

“How are things going today?”

d.

“What kind of problems are you having?”

ANS: C The nursing student should ask open-ended questions, such as, “How are things going today?” The questions “Do you like working on this unit?,” “Do you like your coworkers?,” and “What kind of problems are you having” are direct questions. Open-ended questions stimulate discussion and are less likely to make the other person feel vulnerable.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 57-58 OBJ: Implement strategies to find a mentor. TOP: How to find a mentor MSC: NCLEX®: Not applicable 14. Which statement by the nursing student best describes the characteristics of a mentee?

NURSINGTB.COM a. “The mentee should be passive and observe only.” b. “The mentee should challenge constructive feedback.” c. “The mentee should communicate clearly.”

“The mentee should let learning opportunities come to him or d. /her.”

ANS: C The mentee should always strive to communicate clearly with the mentor. Being passive, challenging constructive feedback, and not seeking out learning opportunities are not characteristics of a mentee.

PTS: 1 DIF: Cognitive Level: Application REF: p. 60 OBJ:Discuss the types of mentoring relationships.

TOP: What are the characteristics of a mentee? MSC: NCLEX®: Not applicable 15. Which action by the mentor can help reduce the impact of reality shock on the mentee during the honeymoon phase?

Listen as the mentee discusses the excitement of starting a new a. position as a nurse.

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Avoid discussions about the excitement of the mentee’s new b. position as a nurse. c. Ask the mentee not to discuss the new position during work hours. d. Tell the mentee that the excited will not last long.

ANS: A To help reduce the impact of reality shock, the mentor can listen as the mentee discusses the excitement of starting a new position as a nurse. Avoiding discussions about the new position or telling the mentee that the excitement will not last long are not ways to help reduce the impact of reality shock.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 61 OBJ:Discuss the types of mentoring relationships.

TOP: Mentoring through reality shock MSC: NCLEX®: Not applicable 16. What action can the mentor take to help reduce the impact of reality shock on the mentee during the shock or rejection phase? a. Withhold personal transition stories. b. Encourage the mentee to discuss his or her feelings.

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Encourage mentees to keep their feelings to themselves during c. work hours. d. Ignore the feelings caused by reality shock.

ANS: B During the shock or rejection phase, the mentor can encourage the mentee to discuss his or her feelings to decrease the impact of reality shock. Withholding their own personal transitions stories, encouraging the mentee to keep their feelings to themselves, or ignoring these feelings are not ways that the mentor can help the mentee through this time of transition.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 61 OBJ:Discuss the types of mentoring relationships.

TOP: Mentoring through reality shock MSC: NCLEX®: Not applicable 17. Which action by the mentor can help reduce the impact of reality shock on the mentee during the recovery phase?

Encourage the mentee to perform skills that he or she is a. comfortable with. b. Maintain a semi-open line of communication.

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c. Encourage the mentee to try new skills. d. Allow the mentee to work independently.

ANS: C During the recovery phase, the mentor should encourage the mentee to step outside of his or her comfort zone.

This can be best achieved by encouraging the mentee to try new skills. The mentee should maintain an open line of communication while working with the mentee.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 62 OBJ:Discuss the types of mentoring relationships.

TOP: Mentoring through reality shock MSC: NCLEX®: Not applicable 18. Which action by the mentor can help reduce the impact of reality shock on the mentee during the resolution phase? a. Expect the mentee to problem solve clinical issues independently. b. Continue to practicing skills that he or she is comfortable with. c. Reinforce positive qualities that the mentee possesses. d. Point out negative qualities for the mentee to change.

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ANS: C The role of the mentor during the resolution phase is to remain supportive to the mentee. Pointing out positive qualities that the mentee possess is one way to achieve this. Expecting the mentee to problem solve independently and pointing out negative characteristics will not assist in the resolution of reality shock.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 62 OBJ:Discuss the types of mentoring relationships.

TOP: Mentoring through reality shock MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. Review the following characteristics. Which best describe the role of the mentor? (Select all that apply.) a. Requires a primary focus on the needs of the new nurse b. Assists the new nurse with difficult nursing procedures c. Serves as a primary resource on the nursing unit for the new nurse d. Is assigned to the new nurse for the orientation period

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e. Is interested in the new nurse’s personal growth and nursing goals f.

Is available to the new nurse after hours to discuss problems and needs

ANS: A, E, F A mentor is more interested in a nurturing role and focuses on the needs of the new nurse and frequently shares personal time. The preceptor acts in a formal role and functions during a defined period of time. The primary focus of the preceptor is to serve as a role model during the specified period. The other options (assists the new nurse with difficult nursing procedures, serves as a primary resource on the nursing unit, and is assigned to the new nurse for the orientation period) are characteristic of a preceptor.

PTS: 1 DIF: Cognitive Level: Application REF: p. 59 OBJ: Describe the difference between mentoring, coaching, and precepting.

TOP: Characteristics of a mentor MSC: NCLEX®: Not applicable 2. A nurse manager and a nurse director are discussing e-mentoring. Which statements by the nurse director indicate an understanding of the components of e-mentoring? (Select all that apply.) a. “E-mentoring involves distance mentoring.” b. “E-mentoring is done through instant messaging.”

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“E-mentoring involves contact between mentee and mentor via c. electronic mail.”

“E-mentoring is a mentoring program for first-year nursing d. students.”

“E-mentoring uses a videoconferencing system such as Skype to e. meet virtually.” f.

“E-mentoring involves planning a meeting at a coffee shop to discuss progress of the preceptorship.”

ANS: A, B, C, E According to Knight, e-mentoring reflects mentoring that takes place over a distance (learner and faculty are not in face-to-face communication), usually by electronic communication facilitation. More recently, the use of e-mentoring can be via e-mail, smartphone, Skype, and webinars. Meeting in person (coffee shop) and the mentoring program do not describe the virtual component of e-mentoring.

PTS: 1 DIF: Cognitive Level: Application REF: p. 62 OBJ: Discuss the types of mentoring relationships. TOP: E-mentoring MSC: NCLEX®: Not applicable

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3. A group of nursing students are discussing characteristics of a successful mentor. Which of the following statements identify these characteristics? (Select all that apply.) a.

“Successful mentors are passive.”

b.

“Successful mentors communicate high expectations.”

c.

“Successful mentors are good listeners.”

d.

“Successful mentors show empathy.”

e.

“Successful mentors are nonjudgmental.”

ANS: B, C, D, E Successful mentors communicate high expectations, are good listeners, show empathy, and are nonjudgmental.

Successful mentors are not passive but are actively involved with the growth of the mentee.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 57-58 OBJ:Implement strategies to find a mentor.

TOP: What are the characteristics of a successful mentor? MSC: NCLEX®: Not applicable 4. Which statement(s) by the nursing student best describes the attributes of a mentor? (Select all that apply.)

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“A mentor actively advises, supports and promotes the mentee’s a. career.”

“A mentor is a professional who has any amount of experience as a b. nurse.” c. “Mentors have the mentee’s best interest at heart.” d. “Mentors bolster self-confidence.” e. “Mentors provide support for only a short period of time.”

ANS: A, C, D A mentor is an experienced nurse who advises, supports, and promotes the mentees career. The mentor has the mentee’s best interest at heart and bolsters self-confidence.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 57-58 OBJ: Implement strategies to find a mentor. TOP: When do we need mentors?

MSC: NCLEX®: Not applicable

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Chapter 04: Employment Considerations: Opportunities, Resumes, and Interviewing MULTIPLE CHOICE 1. Which statement by the nursing student indicates an understanding of the purpose in setting a career goal? a.

“To guarantee you will achieve your goal”

b.

“To keep you focused on your job search”

c.

“To help you define your professional identity”

d.

“To impress those part of the interview process”

ANS: C A career goal defines who or what you wish to be professionally. In addition, it will help tie together the elements of your job search—the resume writing, research, employer contacts, and interview process—by giving you direction. Setting a career goal does not guarantee achievement of that goal. It does not help focus on the job search or impress those participating in the interview process.

PTS: 1 DIF: Cognitive Level: Application REF: p. 73 OBJ: Assess trends in the job market. TOP: Career goals MSC: NCLEX®: Not applicable 2. A nursing professor correctly states the expectations of the job market for nursing as NURSINGTB.COM a. expected downsizing, decreased number of nursing positions. b. expected decrease in the number of unlicensed assistive personnel. c. expected increase in unlicensed assistive personnel: personnel. d. expected increased hiring of new graduates.

ANS: D According to the Bureau of Labor Statistics 2012–2013 Occupational Outlook Handbook, “Employment of registered nurses is expected to grow 26 percent from 2010 to 2020, which is faster than the average for all occupations.” The nursing professor would be incorrect if her or she stated the expectations to be a decreased number of nursing positions or a decrease or increase in the number of unlicensed assistive personnel.

PTS: 1 DIF: Cognitive Level: Application REF: p. 69 OBJ: Assess trends in the job market. TOP: Job trend MSC: NCLEX®: Not applicable 3. Which action by the graduate nurses shows understanding of resume writing?

Ensures that all of the dates for their employment history are a. specific

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b. Does not overstate skills c. Includes a thorough discussion of experiences as a nursing student d. Includes only last two positions

ANS: B A resume is a concise, factual presentation of a person’s educational and professional history, usually not more than two pages in length. It is important not to overstate skills. Graduate nurses should not include a thorough discussion of their experiences as a nursing student. They should include all employment positions within the past 7 years, including the months and years of employment.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 79-82 OBJ: Describe the key aspects of a resume. TOP: Resume Writing MSC: NCLEX®: Not applicable 4. The nursing professor is assisting a group of nursing students in creating resumes. The professor instructs them to include which of the following demographic data? a.

Career goal

c.

Experience

b.

Address

d.

Education

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ANS: B The student’s name, address, telephone number, and e-mail address should be at the top of the resume page.

Students should be sure to provide correct, current information so employers can easily access the contact information. Career goals, experience, and education are not considered to be demographic data.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 79-82 OBJ: Describe the key aspects of a resume. TOP: Resume Writing MSC: NCLEX®: Not applicable 5. Which statement by the graduate nurse indicates understanding of the importance of a cover letter? a. “It is optional.” b. “It is necessary only if your resume needs further explanation.” c. “It should recapitulate all of the important points of your resume.” d. “It should introduce you to the reader.”

ANS: D

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Along with your resume, the nurse should enclose a cover letter that gives a brief introduction. The cover letter should summarize important strengths or give information regarding change of specialty (after you graduate and have experience). Remember that this letter should not be longer than one page.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 79-82 OBJ: Describe the key aspects of a resume. TOP: Resume Writing MSC: NCLEX®: Not applicable 6. A graduate nurse has not heard from a prospective employer 3 days after submitting a resume. Which action should the graduate nurse take? a.

Call.

c.

Do nothing.

b.

Write a letter.

d.

Contact another employment setting.

ANS: C Only a few days have passed, so do nothing. If the graduate nurse still has not heard from the prospective employer within 7 to 10 days, give the employer a call to make sure the resume and cover letter were received and to schedule an interview.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 91-93 NURSINGTB.COM

OBJ: Review primary aspects of obtaining employment. TOP: Employment considerations MSC: NCLEX®: Not applicable 7. The nurse has an adequate understanding of employment benefits. Which of the following is not included in a benefits package? a.

Health insurance

c.

Pensions

b.

Car insurance

d.

Disability coverage

ANS: B Health insurance, pension, and disability are common in benefit packages; car insurance is not.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 79-82 OBJ: Review primary aspects of obtaining employment. TOP: Employment considerations MSC: NCLEX®: Not applicable 8. What is the best short-term objective for the resume of a new nursing graduate seeking employment on a medical-surgical unit?

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a. Obtain a position that further develops interests and skills.

Provide a basis for moving up the career ladder to a supervisory b. position within 5 years.

Acquire a staff nurse position with options to use tuition benefits to c. obtain advanced degrees.

Obtain an entry-level position as a staff nurse on a medical-surgical d. unit.

ANS: D As a new graduate, the best short-term career goal or objective would be to obtain an entry-level position as a staff nurse. Career objectives or goals are not end results (e.g., education or eventual administration positions) but steps to assist the graduate nurse to another point. The objective should be specific to what the nurse needs at the time. Obtaining a position that further develops interests and skills is a good choice, but obtaining an entry-level position on a medical-surgical unit is more specific for a recent graduate.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 79-82 OBJ: Review primary aspects of obtaining employment. TOP: Resume Writing MSC: NCLEX®: Not applicable 9. The nurse can list when of the following as information that is not routinely included in a resume?

NURSINGTB.COM a.

Age

c.

Professional memberships

b.

Education

d.

Occupational experience

ANS: A A resume is a concise, factual presentation of a nurse’s education and professional history. Age is not considered an important point in a resume, and prospective employers cannot request this information during the interviewing process. Date of birth and so on may be asked at a later time during the employment process.

Any type of occupational or work history is to be included along with membership in professional organizations.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 79-82 OBJ: Describe the important parts of a resume. TOP: Resume Writing MSC: NCLEX®: Not applicable 10. The nurse is applying for a job and is determining whether or not to submit a resume or a curriculum vitae.

What is the difference between a resume and a curriculum vitae?

A resume more accurately represents a nurse’s job and professional a. history.

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A curriculum vitae will get longer as the nurse becomes more b. professionally experienced. c. A resume will contain the nurse’s continuing education activities. d. The two are very similar and can be used interchangeably.

ANS: B A curriculum vitae will become longer as it begins to reflect the nurse’s professional activities of continuing education, positions in professional organizations, and contributions to publications. Both a resume and curriculum vitae accurately represent job and professional history and contain continuing education activities.

A curriculum vitae is used by individuals in academia.

PTS: 1 DIF: Cognitive Level: Application REF: p. 81 OBJ: Identify the important parts of a resume. TOP: Resume Writing MSC: NCLEX®: Not applicable 11. Assuming all of the following statements are true, which should be included in a resume to highlight information that would be valuable to an employer? a.

Desires annual salary of $30,000 to $32,000

b.

Is fluent in American sign language

c.

Is president of state downhill ski club

d.

Plans to move out of state after 1 year of employment

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ANS: B The ability to use American sign language is a skill that would be worthwhile to the employer because it presents to the employer an extrapersonal skill. The salary, ski club, and relocation plans are not appropriate for a resume.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 85-86 OBJ: Identify the important parts of a resume. TOP: Resume Writing MSC: NCLEX®: Not applicable 12. The knowledgeable nurse can list which strategy as one that will foster a successful interview for the interviewee? a. Demonstrate interest in what the interviewer has to say. b. Exercise the option to disagree with the interviewer. c. Check off on a list when each item is covered by the interviewer.

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d. Answer questions with as much detail as possible.

ANS: A Recruiters appreciate applicants who know some basic facts about their institution and show an interest in what the interviewer has to say. Becoming familiar with the institution before the interview will demonstrate interest. Do not contradict or argue with the interviewer. Answer questions succinctly and concisely; do not expound on ideas.

PTS: 1 DIF: Cognitive Level: Application REF: p. 88 OBJ: Describe the essential steps in the interviewing process. TOP: Phases of the interview MSC: NCLEX®: Not applicable 13. During a job interview, the interviewee is asked, “What do you believe your weaknesses to be?” What is the best reply? a. “I’ve never thought about having any weaknesses.”

“I’m looking forward to strengthening my ability to plan care for a b. group of patients.” c. “My instructors told me I was disorganized.”

“My biggest problem is in planning and implementing discharge NURSINGTB.COM d. teaching.”

ANS: B It is important to develop responses to probable interview questions. This is not an uncommon question, and the graduate nurse should prepare a positive response, such as “strengthening ability to plan for a group of patients.” Telling the interviewer that you never thought about your weaknesses or that you need help with planning and implementing discharge teaching does not indicate that you are prepared for the interview. The other option about admitting disorganization is not a positive response.

PTS: 1 DIF: Cognitive Level: Application REF: p. 86 OBJ: Discuss typical questions asked by interviewers. TOP: Phases of the interview MSC: NCLEX®: Not applicable 14. Employment for new graduate nurses is scarce in your locale. What action might help the new graduate find out about job openings before others know about them? a. Attend job fairs. b. Read the newspaper employment section. c. Read bulletin boards in health care agency personnel offices.

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Send resumes and cover letters to all health care agencies within d. the region.

ANS: C The bulletin board at the health care agency will have positions posted before they are formally advertised.

Anyone can walk into an institution and review the bulletin board in the human resources office for positions currently available. Job fairs and newspapers advertise employment opportunities to the public. Sending resumes and cover letters to health care agencies does not help the new graduate find out about job openings before the public.

PTS: 1 DIF: Cognitive Level: Application REF: p. 75 OBJ: Analyze your own priorities and needs in a job. TOP: Self-assessment MSC: NCLEX®: Not applicable 15. The graduate nurse interprets the phrase “dress for success” to mean which of the following?

Wear a casual hairstyle and clothing that reflects your off-duty a. personality or hobbies. b. Buy new, very conservative dark clothing to wear. c. Select clothing that could be worn at a cocktail party.

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Wear a neat hairstyle and well-fitting, tailored, business-like d. clothes from your existing wardrobe.

ANS: D The interviewer may judge the applicant’s professional skills by personal appearance. Does the applicant dress neatly, have clean fingernails, and have a neat hairstyle? A prospective employer may anticipate the type of employee the graduate nurse will be by observing dress and personal hygiene. Casual or inappropriate clothing (e.g., cocktail party attire) do not fulfill the phrase “dress for success.” It is not necessary to buy new clothing or wear something very dark and conservative.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 87 OBJ: Describe the essential steps in the interviewing process. TOP: The interview process MSC: NCLEX®: Not applicable 16. The interviewer says, “We are looking for a bright, interested, empathetic, hard-working person for this position in oncology nursing. Do you fit this bill?” The new graduate nurse is interested, carried a straight C average, and has worked full time while going to school. Assuming the following statements are true, what would be the best answer?

“I’m definitely interested in oncology, and I think I’m a hard worker. My instructor said I was developing empathy. My grade a. point average of C doesn’t reflect my real ability.”

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“My previous employer rated my work as excellent. It was there that I became interested in helping support oncology patients as they cope with their illness. I chose to do independent study on b. emotional reactions to the diagnosis of cancer and received an A.” “I worked full time while going to school, so my grades suffered.

I’ve had my share of life’s disappointments, so I can sympathize with cancer patients. I will work hard, but I have to make time for c. my family, too.”

“I’m interested. My parents always told me I was bright. I work as hard as the next person. I’ve learned not to get too involved with d. patients.”

ANS: B The new graduate should focus on strengths and accomplishments during the interview. The interviewee should not provide information or make excuses for a C average. The interviewee should keep it professional (avoid comments about sympathizing with patients); the interviewer does not care about the applicant family’s opinion.

PTS: 1 DIF: Cognitive Level: Application REF: p. 88 OBJ: Discuss typical questions asked by interviewers. TOP: The interview process MSC: NCLEX®: Not applicable NURSINGTB.COM

17. As the interview is drawing to a close, the interviewer asks the applicant, “What questions could I answer for you?” Which of the following questions would it be most advisable to ask to create a favorable impression?

“What will happen if I am unable to meet the outcomes for the a. competency-based orientation?”

“Do you still have tuition reimbursement for courses to obtain my b. next degree?” c. “How soon will I be responsible for supervision of other staff?”

“After completing orientation, when will the first pay raise be d. given?”

ANS: C Prepare a few questions!. This will be the applicant’s opportunity to gather important details and possibly impress the interviewer by showing interest in the position. Keep questions on the positive side and inquire about responsibilities of the position. It would be inappropriate to inquire about pay raises at this time.

Inquiries about pay and tuition reimbursement would be appropriate after the job offer has been provided.

PTS: 1 DIF: Cognitive Level: Application REF: p. 89 OBJ: Discuss typical questions asked by interviewers. TOP: The interview process MSC: NCLEX®: Not applicable

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18. A new graduate uses social networking (i.e., Facebook) as a means of communicating with family and friends. What is important for the new graduate to consider when posting information on Facebook in terms of seeking employment? a. Use a professional photo, perhaps just a headshot. b. Set the Facebook site to public so recruiters can search and find.

Provide pictures of family and friends and remove any c. inappropriate information.

Avoid using social networking sites, such as Facebook and d. LinkedIn, because employers do not like them.

ANS: A It is important to make a good impression with a potential employer; remember that the new graduate’s appearance on the social networking website will be what an employer first sees. Be sure to use a professional photo, perhaps just a headshot, and make the Facebook account private to prevent employers from searching for you if you want to use the Facebook account for family and friends. Potential employers may dismiss you as a candidate after viewing inappropriate photographs or information. LinkedIn is primarily a website for job networking.

PTS: 1 DIF: Cognitive Level: Application REF: p. 76 OBJ: Review primary aspects of obtaining employment. TOP: Social networking NURSINGTB.COM

MSC: NCLEX®: Not applicable 19. Which of the following assignments should the new nurse question before accepting? a.

A 38-year-old man with cellulitis of the right arm

b.

A 25-year-old woman with a left femur fracture

c.

A charge nurse over the unit for the day

d.

A 50-year-old man with right hip replacement

ANS: C New nurses should not be placed in the charge nurse role until the role of staff nurse has been mastered. New nurses who must accept the role of charge nurse should consider their resources in order to maintain safety for the patients. The other assignments are appropriate for the new nurse.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 75 OBJ:Identify the primary aspects of obtaining employment.

TOP:Researching prospective employers MSC: NCLEX®: Safe and effective care environment

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20. A graduate nurse is in the process of applying for a first time nursing job. What should the graduate nurse keep in mind when using social media networks?

There is no risk of potential employers searching for the nurse on a. social media websites.

Employers cannot use material found on social media websites to b. eliminate candidates.

A small percentage of recruiters have eliminated candidates based c. on material found on social media websites.

As long as no identifying patient information is provided on the social media website, recruiters can overlook any videos posted d. about the patients the nurse has cared for.

ANS: C It is important for the graduate nurse to keep in mind that recruiters search social media websites to gather information about candidates. It is reported that 35% of recruiters have eliminated candidates based on material found on social media websites. Recall that the nurse has an ethical obligation to maintain and protect patient privacy and confidentiality. The nurse should never share or post patient images, videos, or any information pertaining to a patient on any form of electronic media; this includes the use of cell phones, smartphones, cameras, and other electronic devices in the clinical setting.

PTS: 1 DIF: Cognitive Level: Application REF: p. 76 NURSINGTB.COM

OBJ: Identify the primary aspects of obtaining employment. TOP: Social networking MSC: NCLEX®: Safe and effective care environment 21. Which of the following actions by the graduate nurse would not be advised during an interview campaign? a.

Plan 3 interviews in a day,

b.

Identify a date to begin employment.

c.

Ask questions about the interview process.

d.

Research the prospective employer.

ANS: A The graduate nurse should identify a desirable date to begin employment, ask questions about the interview process, research the prospective employer, and plan no more than 2 interviews in one day.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 84-85 OBJ:Describe the essential steps involved in the interview process.

TOP: The interview process MSC: NCLEX®: Not applicable

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22. Which of the following actions would not help the graduate nurse prepare for an interview? a. Practice verbal responses to sample questions in front of a mirror. b. Ask a family member to play the role of the interviewer. c. Begin preparing for the interview the day before.

Ask for constructive feedback regarding answers to sample d. questions.

ANS: C The graduate nurse should practice verbal responses to sample questions in front of a mirror, ask a family member to play the role of the interviewer, and ask for constructive feedback regarding answers to sample questions. The graduate nurse should not begin preparing for the interview the day before; preparation should begin earlier.

PTS: 1 DIF: Cognitive Level: Application REF: p. 86 OBJ:Identify the essential steps involved in the interview process.

TOP: The interview process MSC: NCLEX®: Not applicable MULTIPLE RESPONSE NURSINGTB.COM

1. What actions should the graduate nurse take to assess an organization? (Select all that apply.) a.

Talk to those who work in the organization of interest.

b.

Read the organization’s mission statement.

c.

Evaluate the reputation of the leadership.

d.

Listen to rumors about the organization.

e.

Read and analyze the recruitment materials.

ANS: A, B, C, E To properly assess an organization, the graduate nurse should talk to those who work in the organization of interest, read the organization’s mission statement, evaluate the reputation of the leadership, and read and analyze the recruitment materials.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 74-75 OBJ:Identify the primary aspects of obtaining employment.

TOP: What do I need to know to assess the organization? MSC: NCLEX®: Not applicable 2. The graduate nurse understands information that is necessary for a resume when making which of the following statements? (Select all that apply.)

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a. “I need to include my name, address, and phone number.” b. “I should include the name of the position that I am applying for.” c. “I need to include where I received my educational training.” d. “I need to list my previous employer(s).” e. “I should include avoid putting references on my resume.” f.

“I should list my age and marital status.”

ANS: A, B, C, D The graduate nurse should include the following on a resume: name, address, phone number, name of position applying for, educational training, previous employer(s), and references. Age and marital status are not included on the resume. This information will be obtained by human resources after the person has been hired.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 79-82 OBJ:Describe the key aspects of a resume.

TOP: What information is necessary for a resume MSC: NCLEX®: Not applicable 3. Which of the following actions should the graduate nurse take to ensure a great first impression? (Select all that apply.)

NURSINGTB.COM a.

Arrive at the interview right on time.

b.

Establish eye contact during the interview.

c.

Minimize distracting nervous mannerisms.

d.

Show enthusiasm and body language.

e.

Smile when introduced.

ANS: B, C, D, E The graduate nurse should establish eye contact during the interview, minimize distracting nervous mannerisms, show enthusiasm and body language, and smile when introduced. The graduate nurse should arrive 10 to 15 minutes early to gather information about the organization or spend more time with the interviewer.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 85-86 OBJ:Describe the essential steps involved in the interview process.

TOP: Strategies for interview success MSC: NCLEX®: Not applicable

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Chapter 05: NCLEX-RN and New Graduate MULTIPLE CHOICE 1. The graduate nurse understands the purpose of the NCLEX-RN® exam when stating which of the following?

“The exam provides feedback to the candidate regarding areas of a. weakness in nursing practice.”

“The exam determines the candidate’s ability or inability to meet b. minimum standards for safe practice.”

“The exam gives employers an opportunity to hire graduates who c. have scored highest among first-time licensure candidates.”

“The exam prepares new graduates as efficient, effective staff d. nurses.”

ANS: B The purpose of the NCLEX-RN® Exam is to determine whether a candidate is competent to perform safe, effective, entry-level nursing care. It does not prepare nurses but rather measures their performance on a test.

Candidates who are unsuccessful receive information about their weak areas on the test, but this is not the purpose of it. Employers want to know if the person has passed because there is no specific score given other than pass or fail.

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PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 97 OBJ: Discuss the role of the National Council of State Boards of Nursing.

TOP: NCLEX® MSC: NCLEX®: Not applicable 2. Which statement by the nursing professor is accurate about the NCLEX-RN® exam? The purpose of the NCLEX-RN® test plan is to ensure that all a.

“test takers answer items of comparable difficulty.”

b. “test takers answer approximately the same number of items.” c.

“test items are job related.”

d. “clinical specialties will be equally represented.”

ANS: C The content of the NCLEX® Exam is based on a test plan that is determined by the National Council. The test plan reflects entry-level nursing practice as identified by research and the job analysis study of newly licensed registered nurses. Each candidate will receive different levels of questions in a computer adaptive format. The focus of the exam is not on clinical specialties. The test has a minimum of 75 questions and a maximum of 265 questions, so a test taker can answer any number of questions between these two numbers until they either reaches a passing standard or fails.

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PTS: 1 DIF: Cognitive Level: Application REF: pp. 98-99 OBJ: Discuss the role of the National Council of State Boards of Nursing.

TOP: NCLEX® test plan MSC: NCLEX®: Not applicable 3. In trends class, a student tells the instructor, “I don’t think I can possibly pass the NCLEX-RN®. I hated psych nursing, but now I’ve heard that a huge amount of the NCLEX® is psych related.” What is the best response from the instructor?

“Perhaps you should consider retaking the psychiatric nursing a. course.”

“There are equal numbers of questions related to each aspect of b. client needs.”

“Psychosocial integrity is the basis for 6% to 12% of the c. examination.”

“You will need to take a review course in which they teach d. psychiatric nursing principles.”

ANS: C The last detailed test plan (2013) from the National Council designated from 6% to 12% of the total questions to be from the area of psychosocial integrity. The student may not be able to retake nursing courses or a review course. Stating that content area has the same NURSINGTB.COM amount of questions would be inaccurate. Each of the categories of client needs has a different percentage, so questions are based on that percentage from the detailed test plan, not on equal numbers from each area. Students often hear incorrect information and rumors about NCLEX. PTS: 1 DIF: Cognitive Level: Application REF: pp. 98-99 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: NCLEX® MSC: NCLEX®: Not applicable 4. Which statement indicates the graduate nurses understanding of the process at the NCLEX® testing site? a.

“I will be thumbprinted and photographed.”

b.

“I will be placed in a locked testing cubicle.”

c.

“I will answer 300 test questions.”

d.

“I will be given some questions as a paper-and-pencil test.”

ANS: A Read the Candidate Bulletin and the instruction packet carefully. An Authorization to Test (ATT) will be required for admission into the testing center; however, after January 1, 2014, the NCLEX will be going paperless, so the ATT will not have to be brought to the testing center. All candidates will be thumbprinted and

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photographed and will have a palm vein reader as part of the identification process at the testing location.

Candidates are not locked in a testing cubicle or given a paper-and-pencil test. The number of questions on each candidates test may vary with a minimum of 75 questions and a maximum of 265 questions.

PTS: 1 DIF: Cognitive Level: Application REF: p. 103 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: NCLEX® MSC: NCLEX®: Not applicable 5. Which statement made by the graduate nurse indicates understanding of the NCLEX-RN® exam passing score?

“Candidates seeking licensure in California and New York must a. score higher.” b. “The passing score is the same for licensure in all states.”

“Candidates from BSN programs must score one standard c. deviation higher than the ADN graduates.”

“ADN graduates must answer 80% of the 265 questions correctly d. to pass.”

ANS: B NURSINGTB.COM

Every state has the same passing criteria. There is no percentage identified as to the number to get correct. The test has a minimum of 75 questions and a maximum of 265 questions. When the student reaches a passing level of competency or has not reached the passing competency, the test turns off. There is no differentiation in education level or state requirements.

PTS: 1 DIF: Cognitive Level: Application REF: p. 102 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: NCLEX® MSC: NCLEX®: Not applicable 6. What type of nursing position would most likely provide experience in the type of nursing situations upon which the NCLEX® Exam questions are based? a.

Home care nurse

b.

Psychiatric staff nurse

c.

Staff nurse in an ambulatory pediatric clinic

d.

Staff nurse in a medical-surgical inpatient unit

ANS: D

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The largest percentage of content on the test plan is based on physiologic integrity, which includes basic care and comfort (6%–12%), pharmacologic and parenteral therapies (12%–18%), reduction of risk potential (9%– 15%), and physiologic adaptation (11%–17%). Research also shows that the majority of new graduates begin their first job in a hospital medical-surgical environment caring for adult clients.

PTS: 1 DIF: Cognitive Level: Application REF: p. 102 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: NCLEX® MSC: NCLEX®: Not applicable 7. What is the best review strategy to use to prepare for the NCLEX-RN® Exam?

Spend about 8 hours a day on your days off until you take the a. examination. b. Study for 4 hours a night while taking a 2-week review course.

Review basic nursing content 2 to 3 hours a day 3 days a week for c. 5 to 6 weeks. d. Study 10 hours on the day and evening before the examination.

ANS: C NURSINGTB.COM Studying 2 to 3 hours a day for 2 or 3 days a week is realistic with frequent breaks during the studying. The new graduate should consider taking the exam within 2 to 3 weeks of obtaining your Authorization to Test.

Cramming before the examination will not improve your pass rate. Studying for 8 hours a day is fatiguing and does not necessarily promote retention of the information.

PTS: 1 DIF: Cognitive Level: Application REF: p. 105 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: NCLEX® MSC: NCLEX®: Not applicable 8. What are helpful strategies for dealing with test anxiety? a.

Put as much time as possible into studying.

b.

Practice relaxation techniques and positive thinking.

c.

Use review books and tapes.

d.

Focus on test-taking skills and emphasize facts less.

ANS: B Put yourself in charge of your feelings. Replace those negative thoughts and ideas with positive ones. Practice relaxation and positive thinking and picture yourself succeeding. Picture yourself succeeding. Give yourself

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permission to take some breaks; studying all of the time will increase anxiety. Review books and tapes assist with the review of important content and do not necessarily deal with test anxiety directly. They may discuss the concept and provide strategies to use, such as the two mentioned in the correct response. Test-taking skills are important for success on NCLEX but do not directly reduce test anxiety.

PTS: 1 DIF: Cognitive Level: Application REF: p. 112 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: NCLEX® MSC: NCLEX®: Not applicable 9. Which of the following statements indicate the nurses understanding of the content of the NCLEX® Exam?

“The exam is based on a practice analysis conducted by the a. National Council of State Boards of Nursing.”

“The exam is a survey of nursing faculty regarding areas of b. importance for testing.”

“The exam includes questions based on the National League of c. Nursing survey reports.”

“The exam includes contributions from all of the member boards of d. the National Council.”

ANS: A

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The National Council of State Boards of Nursing conducts a practice analysis to determine what is being required of new graduates in their place of employment. The test plan for the NCLEX® is based on this research. The test plan is not based on a survey of nursing faculty, survey reports from the National League of Nursing, or contributions from member boards of the National Council State Boards of Nursing.

PTS: 1 DIF: Cognitive Level: Application REF: p. 102 OBJ: Discuss the role of the National Council of State Boards of Nursing.

TOP: NCLEX® MSC: NCLEX®: Not applicable 10. The graduate nurse is preparing to take the NCLEX-RN® Exam. Which blueprint category is interpreted as having the highest percentage of test items?

Safe, effective care a. environment

c. Psychosocial integrity

b. Physiological integrity

Health promotion and d. maintenance

ANS: B The area of physiological integrity makes up about 50% of the test plan. This is the area that covers basic nursing care and comfort, pharmacological and parenteral therapies, reduction of risk potential, and

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physiological adaptation. Safe, effective care; psychological integrity; and health promotion and maintenance will cover less than this.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 98 OBJ: Discuss the role of the National Council of State Boards of Nursing.

TOP: NCLEX® MSC: NCLEX®: Not applicable 11. The nurse interprets “computer adaptive testing (CAT)” to mean questions are selected, and the exam is adapted to the candidate’s a. previous responses. b. the test has been “adapted” to be administered via the computer. c. the test is adapted to decrease the total number of questions. questions are adapted to meet the practice analysis survey of the d. graduates.

ANS: A Questions are selected for each candidate based on the test plan. When a candidate misses a question, the computer will present an easier question from that same category. Computer adaptive testing (CAT) does not mean that the computer has been adapted for administration via the computer. The test is not adapted to NURSINGTB.COM decrease the total number of questions. The number of questions each candidate receives and the testing time for each candidate will vary. As candidates answer questions correctly, the next question will be either a degree of difficulty equal to the previous question or a higher level of difficulty The practice analysis survey is the research basis for constructing the test plan. The test has a minimum of 75 questions and maximum number of 265 questions; it does not “decrease the total number of questions.”

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 99 OBJ:Discuss the implications of computer adaptive testing (CAT).

TOP: Computer testing MSC: NCLEX®: Not applicable 12. The graduate nurse has an adequate understanding of the Authorization to Test when stating: “The Authorization to Test arrives at the beginning of the last a. semester of nursing school.”

“The Authorization to Test arrives when the last day of clinical b. experience is complete.”

“The Authorization to Test arrives upon completion of all of the c. state and national applications.”

“The Authorization to Test arrives when all course work and d. applications have been completed and approved.”

ANS: D

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In the beginning of the semester in which the student will graduate, the school of nursing will have each student (candidate) complete an application form and send it to the state board of nursing. Upon completion of the nursing program, the school will verify the candidate’s graduate status with the state board of nursing.

After the forms have been processed, the candidate will receive an Acknowledgement of Receipt of Registration. The candidate will then receive the Authorization to Test (ATT) with instructions regarding how to schedule the examination with Pearson VUE. The candidate cannot schedule the examination until the ATT is received. Beginning January 1, 2014, the ATT process will become paperless.

PTS: 1 DIF: Cognitive Level: Application REF: p. 100 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: NCLEX® MSC: NCLEX®: Not applicable 13. The nurse interprets the Nurse Licensure Compact as an agreement between all states to recognize the license of all a. graduate nurses. an intrastate agreement for the nurse to practice in any area within b. the state. an agreement between the state boards of nursing and the National c. Council regarding foreign nurses. an agreement between compact states to recognize licensure from NURSINGTB.COM d. member states.

ANS: D Individual states must pass legislation to become members of the Nurse Licensure Compact agreement. After approval within the state legislature, a nurse may practice in one state that belongs to the compact but maintain his or her license in the state of residence.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 97 OBJ: Discuss the role of the National Council of State Boards of Nursing.

TOP: License MSC: NCLEX®: Not applicable 14. The nurse interprets the role of the individual state boards of nursing in the NCLEX® Exam as which of the following?

To coordinate with the National Council State Boards of Nursing in administering the examination and licensing candidates to practice a. in respective states To prepare a licensure examination that is reflective of entry-level b. practice in their respective states

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To grade the examination, advise students of the results, and transmit all results to the National Council State Boards of Nursing c. for their files To supervise and administer the examination to the candidates d. within their state jurisdictions

ANS: A Representatives from the state boards of nursing are members of the National Council State Boards of Nursing (NCSBN). The state boards of nursing determine the requirements to take the NCLEX® Exam in their state and serves on national committees to prepare the examination. These representatives do not grade the examination, advise students of results, or administer the examination. Pearson VUE administers the exam for the NCSBN. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 97 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: NCLEX® MSC: NCLEX®: Not applicable 15. The graduate nurse understands the process of NCLEX-RN® Exam scoring and reporting when stating: “The NCLEX-RN® Exam is scored on a pass/fail basis and is NURSINGTB.COM a. reported directly to the candidate.”

“The candidate must score 80% or higher to be considered b. competent; scores are reported to the school.”

“If the candidate must answer more than 365 questions, he or she will not pass the examination; scores are reported to the board of c. nursing.”

“Scoring is based on the level of difficulty of the questions d. presented to the candidate; scores are reported to the candidate.”

ANS: A The NCLEX-RN® Examination is scored on a pass/fail basis (competent/non–competent), and the scores are reported directly to the candidate. There is no percentage assigned to the passing score, and a candidate cannot take more than 265 questions. The level of difficulty is a component of the scoring process.

PTS: 1 DIF: Cognitive Level: Application REF: p. 102 OBJ: Discuss the role of the National Council of State Boards of Nursing.

TOP: NCLEX® scoring MSC: NCLEX®: Not applicable 16. A candidate has scheduled to take the NCLEX® Exam and has a family emergency before the scheduled date. What is the best action for the candidate to take?

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Call the respective state board of nursing and request a change in a. the testing date.

Call the Candidate Services office at least 24 hours or 1 business b. day before the scheduled testing day.

Call the school and request that someone notify the board of c. nursing regarding your change in schedule.

It is not necessary to notify anyone regarding rescheduling the d. testing date; it will be rescheduled automatically.

ANS: B A candidate must notify by either calling or go to the website of the Pearson VUE NCLEX Candidate Services office a full business day (24 hours) before the scheduled testing time to request a change in testing time. The school and respective board of nursing do not participate in the scheduling of the examination. If a candidate does not reschedule within this time frame or does not come at the scheduled testing time, the ATT is invalidated, and the candidate will be required to reregister and repay the $200 registration fee.

PTS: 1 DIF: Cognitive Level: Application REF: p. 103 OBJ: Discuss the role of the National Council of State Boards of Nursing.

TOP: Changing testing dates MSC: NCLEX®: Not applicable 17. A graduate nurse has arrived at the testingNURSINGTB.COM center when realizing that the required ATT form is missing.

Explain what events would happen next.

The testing center staff would not be able to look up his ATT a. online.

The testing center staff would not allow him to test without his b. ATT. The graduate nurse could be admitted to the testing center with a c. photo ID. The testing center staff would call the NCSBN for verbal approval d. to let the graduate nurse test.

ANS: B To test, the graduate nurse must present the ATT and photo ID to test. This process will change on January 1, 2014, when the NCLEX testing services will go paperless. The testing center staff will be able to look up the ATT online when the process is paperless. The testing center staff would not call the NCSBN for an approval to test.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 103 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: What does CAT mean?

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MSC: NCLEX®: Not applicable 18. What would happen if the graduate nurse failed the NCLEX-RN on the first testing attempt?

The graduate nurse would be required to take an additional nursing a. course before retesting. b. The graduate nurse would be required to wait 9 months to retest.

The graduate nurse would be required to wait 45 to 90 days before c. retesting. d. The graduate nurse would not be allowed to test again.

ANS: C After failing the NCLEX-RN on the first testing attempt, the graduate nurse would be required to wait 45 to 90 days before retesting. This retake time frame is determined by each state board of nursing and the NCSBN. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 102 OBJ:Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination).

TOP: What Are Some of the Other Things I Really Need to Know About the NCLEX Examination?

MSC: NCLEX®: Not applicable

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19. A graduate nurse is planning to travel to a testing site and will need to have overnight accommodations.

Which of the following is the best action for this graduate nurse to take to make the stay a success?

Share a room with the 4 other graduate nurses planning to test at a. the same testing center. b. Stay up late studying.

Room alone or with someone who is supportive of a positive c. environment. d. Room with another graduate nurse who frequently complains.

ANS: C The graduate nurse should consider rooming alone or with someone who is supportive of a positive environment. The graduate nurse will want a good night’s rest before the NCLEX-RN® examination. Staying up late studying defeats the purpose of having a restful night before taking the NCLEX-RN® examination.

PTS: 1 DIF: Cognitive Level: Application REF: p. 105 OBJ:Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination).

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TOP: Preparing for the NCLEX-RN examination MSC: NCLEX®: Not applicable 20. To adequately prepare for the NCLEX-RN® examination, which action by the graduate nurse is advised? a. Begin planning early at least 6 months ahead. b. Begin planning no more than 3 months ahead.

Wait for the state board of nursing to contact the applicant about c. filing deadlines. d. Call the state board of nursing every week to set up a testing time.

ANS: A To adequately prepare for the NCLEX-RN® examination, the graduate nurse should begin planning early, at least 6 months in advance. The graduate nurse will have received from their nursing program a listing of the filing deadlines for taking the examination. The state board of nursing does not set up the testing time because that is handled by Pearson VUE. PTS: 1 DIF: Cognitive Level: Application REF: p. 103 OBJ:Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination).

TOP: Preparing for the NCLEX-RN examination MSC: NCLEX®: Not applicable NURSINGTB.COM

MULTIPLE RESPONSE 1. A nursing professor is preparing students for the NCLEX-RN® Exam. Which of the following items should the professor inform the students to expect on the exam? (Select all that apply.) a. Multiple choice questions with one correct answer b. Drag and drop questions into an ordered response c. True/false questions d. Graphic questions with a hot spot to identify an area Questions with an audio component where you need to wear a e. headset to listen f.

Questions where you select the correct answer from the graphics presented at the end of the question

ANS: A, B, D, E, F There are, in addition to multiple-choice questions, alternate format items which consist of the following: • Fill in the blank—short answer usually requires a drug calculation, an intake and output calculation, or an assessment scoring. In these cases, only the numbers should be entered in the space provided.

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• Multiple-response item—more than four options are presented, and the question will very clearly ask you to select all of the options that correctly answer the question.

• Hot spot—presents a diagram or a graphic and requires you to select an area on the diagram to answer the question.

• Drag and drop—asked to click on each item and “drag” it to another area of the screen, placing the items, for instance, in the order in which they would be performed or in order of priority of care.

• Exhibit item—present a problem and then provide exhibit information stored in tabs. You will click on each tab to find information that will assist you in solving the problem that is presented. The tabs frequently contain information from a chart or data collection from the client.

• Audio item—presented with a question that has an audio component in which the test taker puts on the headset provided and click the “Play” button to listen to the audio for the information required to answer the question.

• Graphic options—present you with graphics instead of text for the answer options where you will be required to select the correct answer from the graphics presented at the end of the question.

Questions are selected for each candidate based on the test plan. When a candidate misses a question, the computer will present an easier question from that same category.

There are no “true/false” type questions. Questions are selected for each candidate based on the test plan.

When a candidate misses a question, the computer will present an easier question from that same category.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 113 OBJ:Discuss the implications of computer adaptive testing (CAT).

TOP: Computer testing MSC: NCLEX®: Not applicable 2. Which actions by the graduate nurse can help reduce anxiety on testing day? (Select all that apply.) a.

Drive to the testing site the day before.

b.

Evaluate traffic.

c.

Wait until testing day to drive to the testing site.

d.

Drive to the hotel the day before.

e.

Locate the parking area at the testing site.

ANS: A, B, D, E The day before the exam, the student should drive to the testing site, evaluate the traffic, find the parking area, and drive to the hotel (if required to have overnight accommodations) to ease anxiety.

PTS: 1 DIF: Cognitive Level: Application REF: p. 112

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OBJ:Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination).

TOP: Preparing for the NCLEX-RN examination MSC: NCLEX®: Not applicable 3. What actions will help prepare the graduate nurse for testing success? (Select all that apply.) a.

Dress comfortably.

b.

Stay up late for last-minute studying.

c.

Eat a balanced breakfast.

d.

Have identification needed for entrance into the exam.

e.

Celebrate your success with friends the night before.

ANS: A, C, D To prepare for a successful testing day, the graduate nurse should dress comfortably, eat a balanced breakfast, and have appropriate identification needed for entrance into the exam. Staying up late and celebrating with friends the night before could leave the graduate nurse feeling tired and not prepared for testing.

PTS: 1 DIF: Cognitive Level: Application REF: p. 106 OBJ:Identify the process and steps for preparing to take the National Council Licensure Examination for NURSINGTB.COM Registered Nurses (NCLEX-RN Examination).

TOP: Preparing for the NCLEX-RN examination MSC: NCLEX®: Not applicable 4. What questions should the graduate nurse ask themself when determining which NCLEX-RN® examination review course is right for the graduate? (Select all that apply.) a.

What review courses are easily accessible?

b.

What review courses will teach me what I need to know?

c.

How well do I study at the computer?

d.

Can I plan a study review schedule and stick to it?

e.

Can I plan study time?

ANS: A, C, D, E When choosing an NCLEX-RN® examination review courses, the graduate nurse should ask themself the following questions: What review courses are easily accessible? How well do I study at the computer? Can I plan a study review schedule and stick to it? and Can I plan study time? The purpose of the review course is not to teach the material to students but to serve as a review.

PTS: 1 DIF: Cognitive Level: Application REF: p. 109

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OBJ:Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination).

TOP: Preparing for the NCLEX-RN examination MSC: NCLEX®: Not applicable 5. What actions by the graduate nurse will assist with finding the best NCLEX-RN® review book for personal study needs? (Select all that apply.) a. Check the number of pages in various subjects in the material. b. Look up several common topics in the index.

Look for a book with information that has come out in the past c. month. d. Look for a book that focuses on nursing concepts. e. Look for a book that focuses on the delivery of safe patient care.

ANS: A, B, D, E When determining which NCLEX-RN® review book is best suited for the student, he or she should check the number of pages in various subjects in the material, look up several common topics in the index to see if information can be found in a timely manner, and look for a book that focuses on nursing concepts and the delivery of safe patient care. Information that has come out in the past month would not yet be available in review books.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 109 OBJ: Identify criteria for selecting a NCLEX examination review book and review course.

TOP:NCLEX-RN Examination books: Which one is right for you?

MSC: NCLEX®: Not applicable 6. What are acceptable forms of identification at the testing center? (Select all that apply.) a.

U.S. driver’s license

b.

U.S. state-issued identification

c.

Credit or debit card with photo identification.

d.

Passport

e.

U.S. military identification

f.

School or university picture identification

ANS: A, B, D, E A U.S. driver’s license, U.S. state-issued identification, passport, and U.S. military identification are acceptable forms of identification. (They must be in English, valid, and not expired with a photograph and a

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signature.) A credit or debit card and school or university identification (even though they have photos) are not acceptable forms of identification at the testing centers.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 103 OBJ: Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN Examination). TOP: Computer testing MSC: NCLEX®: Not applicable

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Chapter 06: Historical Perspectives MULTIPLE CHOICE 1. Which statement indicates the nurse understands the Latin origin of “nurse?” a. “The Latin word for ‘nurse’ is carena, meaning ‘caring.’” b. “The Latin word for ‘nurse’ is nimphe, meaning ‘nurture.’” c. “The Latin word for ‘nurse’ is succurus, meaning ‘relief.’” d. “The Latin word for ‘nurse’ is nutricius, meaning ‘nourishing.’”

ANS: D The word “nurse” is derived from the Latin word nutricius, meaning nourishing. It was said in Roman mythology that the goddess Fortuna, who was considered the goddess of an individual’s fate, was Jupiter’s nurse. Carena is the Latin word for “caring,” nimphe means to “nurture,” and succurus means “relief.”

PTS: 1 DIF: Cognitive Level: Application REF: p. 127 OBJ:Explain the forces that affect the role of American nurses.

TOP: Nursing history MSC: NCLEX®: Not applicable NURSINGTB.COM

2. The nursing student has an adequate grasp of nursing history when stating that after the fall of the Roman Empire, the knowledge of health practice was primarily preserved by a.

English monks in cloistered buildings.

b.

Jewish physicians who could translate into Latin.

c.

Roman priests who practiced medicine.

d.

Fortuna, who practiced midwifery.

ANS: B Any medical and health care knowledge that survived the dark period of history was preserved primarily by the Jewish physicians who translated the Greek and Roman works. English monks, Roman priests, and Fortuna did not assist in the preservation of health practice knowledge after the fall of the Roman Empire.

PTS: 1 DIF: Cognitive Level: Application REF: p. 127 OBJ: Explain the early European contributions to nursing. TOP: Nursing history MSC: NCLEX®: Not applicable 3. Which of the following is true of early Christian deaconesses and how they became responsible for caring for poor and ill people?

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The deacons relinquished this work to women (specifically, a. widows and virgins). b. The early church valued women. c. No one else would care for poor and ill people. d. The deaconesses had formal training to do the work.

ANS: A Originally, the deacons of the early Christian church cared for poor and the ill people, but they turned these duties over to widows and virgins, who were considered to be pure of heart. The early church did not value women. Formal training did not occur until much later in history.

PTS: 1 DIF: Cognitive Level: Application REF: p. 128 OBJ: Explain the early European contributions to nursing. TOP: Nursing history MSC: NCLEX®: Not applicable 4. What was the description of a nurse in the medieval times during the Holy Wars? a.

A woman who had been specially trained by a magician

b.

A man who was committed to following his Lord into battle

c.

A man who had training to care for a wounded knight

d.

A woman who had studied with an older nurse

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ANS: C During the Holy Wars, men were trained in the healing arts to care for knights during battle. These male nurses wore a red cross on their clothes for identification. During this time, women were not trained as nurses.

PTS: 1 DIF: Cognitive Level: Application REF: p. 128 OBJ: Explain the early European contributions to nursing. TOP: Nursing history MSC: NCLEX®: Not applicable 5. What was the most important contribution to nursing made during medieval times?

The Red Cross recognized the worth of nurses in caring for the a. poor.

A formal school was established to train nurses within the b. convents.

The hospital of St. John was established to train nurses and c. physicians.

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d. Society placed an increased status on caring for the ill.

ANS: D During medieval times, the altruistic ideal of providing care out of humility and love was established as the foundation of nursing. The most important contribution to nursing during medieval times was the increased status placed on caring for the ill. Nursing gained status. Convents were housing places for the deaconesses, widows, and virgins to provide physical protective shelters. The hospital of St. John was built in Jerusalem to care for Christian crusaders. The Red Cross did not come into existence until the 1880s and was founded by Clara Barton.

PTS: 1 DIF: Cognitive Level: Application REF: p. 129 OBJ: Explain the early European contributions to nursing. TOP: Nursing history MSC: NCLEX®: Not applicable 6. Which statement by the nurse shows understanding of Florence Nightingale’s status as a legend in nursing?

“Her work in improving the Institution for the Care of Sick a. Gentlewomen in Distressed Circumstances” The evaluations and recommendations she made to improve b. conditions in the hospitals in England” “Her ability to implement actions that significantly decreased NURSINGTB.COM c. mortality rates in the Crimean War” “Her work as an administrator for a women’s hospital and d. reporting conditions to the government”

ANS: C Nightingale’s contribution to the development of hospital reform and her nursing actions that significantly lowered battlefield mortality rates during the Crimean War established her as a legend in nursing. She worked as an administrator for the Institution for the Care of Sick Gentlewomen in Distressed Circumstances before the Crimean War, which provided her the experience to take to the battlefield.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 130-134 OBJ: Explain the early European contributions to nursing. TOP: Nursing history MSC: NCLEX®: Not applicable 7. Which statement by a nursing professor is true regarding Florence Nightingale’s contribution to American nursing?

“Her primary influence was organizing hospital administration and a. nursing.”

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“Her primary influence was providing a model for giving care b. during wartime.”

“Her primary influence was organizing patient care in hospital c. settings.”

“Her primary influence was developing an educational model for d. training nurses.”

ANS: D Although she was influential in many aspects of hospital administration, ministering to the sick, and early research methods to improve patient care, Nightingale’s great success prompted her to begin developing schools of nursing in both Europe and the United States based on her knowledge of what constituted effective nursing. The goals of her programs included training hospital nurses, training nurses to train others, and training nurses to work in the district with the sick poor. Her primary influence was not organizing hospital administration and nursing, providing care models, or organizing patient care.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 130-134 OBJ:Explain the forces that affect the role of American nurses.

TOP: Nursing history MSC: NCLEX®: Not applicable 8. A group of nursing students is discussing the traits of Victorian wives that crossed over to nurses. Which traits would they conclude had an early effect on the nursing profession?

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a.

Submission, harmony, and hard work

b.

Power, peace, and position

c.

Paternalism, compliance, and dullness

d.

Organized, noble, and good

ANS: A The Victorian wife was expected to “be good.” She was esteemed by her husband but had limited power within the confines of the home and society. She was expected to be hard working and able to maintain harmony while at the same time being submissive to the demands of her husband. Generally, this fostered dependence on the dominant male figure—the Victorian husband. Nurses generally were women who wanted to avoid the drudgery of a Victorian marriage. They were required to be single to make a complete commitment to their vocation. Schooled in submission, women were expected to be equally accommodating within the hospital organization. A good nurse worked for harmony within the hospital. She was expected to be hard working and submissive. The doctor and the hospital administrator were frequently the same person, usually a man who expected position and power to go hand in hand.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 135 OBJ: Explain the early European contributions to nursing. TOP: Nursing definition MSC: NCLEX®: Not applicable

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9. Nurses made many contributions to the care of Civil War soldiers. A nurse who understood this, would state which of the following? a. “Nurses established a safe haven for soldiers from the battlefield.” b. “Nurses provided a clean environment with food and water.” c. “Nurses began medication administration on the battlefield.” d. “Nurses organized the men to care for other injured soldiers.”

ANS: B During the Civil War, nurses began to see the benefit of prevention, nutrition, and clean environments for the injured soldiers. Nurses who had some formal training were recognized as being major contributors to the relative success of hospital treatments. It was in this era that the value of primary prevention, or the prevention of the occurrence of disease by measures such as immunization and the provision of a pure water supply, became understood. Volunteer nurses, mostly women, served in hospitals caring for those wounded soldiers fortunate enough to have survived the trip from the battlefield. Their patients were nursed in a clean environment and were provided with adequate nutrition. Although the other options were important to patients’ well-being, the nurses noticed that patients greatly improved with cleanliness, nutrition, and a clean water supply.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 134 OBJ:Explain the forces that affect the role of American nurses.

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TOP: Nursing definition MSC: NCLEX®: Not applicable 10. The student nurse interprets teaching as a critical role for nurses because a. health care is a complex system that requires patient education. b. not everyone has access to information about health care. the less fortunate have greater difficulty understanding treatment c. choices. understanding choices allows the patient to make informed d. decisions.

ANS: D Teaching patients about their therapy, condition, or choices is critical to the successful outcome of some prescribed treatments. Teaching does not guarantee access to health care information. Knowledge can enhance compliance with medications and can encourage healthy lifestyles and behaviors. Teaching becomes especially important when patients have to make treatment choices and decisions about their care. With the volumes of information available regarding health care, it is even more important that nurses help patients understand what they need to know to make wise decisions. The less fortunate do not necessarily have greater difficulty understanding treatment choices but often difficulty in accessing health care.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 139

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OBJ:Discuss what nurses do.TOP:Nursing definition MSC: NCLEX®: Not applicable 11. Many groups throughout the history of nursing have contributed to the profession. The student nurse recognizes which group as having promoted the development of the concept of colleagues in nursing? a.

Nurse managers

c.

Nursing educators

b.

Public health nurses

d.

Graduate students

ANS: B Public health nurses have long recognized the importance of achieving the role of colleagues in advancing the status and effectiveness of the nursing profession. The remaining groups of nurses have contributed to the profession in other ways.

PTS: 1 DIF: Cognitive Level: Application REF: p. 138 OBJ:Discuss what nurses do.TOP:Nursing definition MSC: NCLEX®: Not applicable 12. While a nurse is caring for a patient who is scheduled to have surgery in 2 hours, the patient states, “My doctor was here and told me a lot of stuff I didn’t understand. Then I signed a paper for her.” To fulfill the role NURSINGTB.COM of advocate, what is the best nursing action? a. Explain the surgery and possible outcomes to the patient. b. Call the physician to return and clarify information for the patient. c. Reassure the patient that the surgery will go as planned. d. Complete the nurse’s first priority—the preoperative teaching plan.

ANS: B Examples of nursing advocacy include questioning doctors’ orders; promoting patient comfort; and supporting patient decisions regarding health care choices, which would include the example here of informed consent. It would not be appropriate for the nurse to assume the role of the physician and explain the surgery and possible outcomes to the patient, reassure the patient that there will be no complications, or complete the preoperative teaching plan. Although important, the preoperative teaching plan is not the nurse’s first priority. Reassurance is a nontherapeutic communication strategy because it provides a false sense of security.

PTS: 1 DIF: Cognitive Level: Application REF: p. 142 OBJ:Discuss what nurses do.TOP:Nursing definition MSC: NCLEX®: Safe and effective care environment—management of care

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13. After studying nursing history on the Crusades, the nursing student can conclude that the following is the origin of the first nursing pin? a.

Nightingale’s badge

c.

Nun habit garb

b.

Maltese cross

d.

Nutricius medal

ANS: B The Maltese cross worn by the knights and nurses during the Crusades is considered the origin of the nursing pin. Nightingale is noted for the lamp. The nun’s habit is considered the origin of the nursing cap. “Nutricius medal” means “nourishing medal” PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 138 OBJ:Explain the forces that affect the role of American nurses.

TOP: Nursing history MSC: NCLEX®: Not applicable 14. A nursing student is correct when identifying which programs as having the distinction of being the first for nursing that were developed from planned research and controlled experimentation? a. Diploma programs

c. Baccalaureate programs

b. Associate degree programs

d. Master’s and doctoral programs

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ANS: B An advisory committee was established in 1952 by the American Association of Junior Colleges along with the National League for Nursing (NLN). This committee researched the development of the associate degree nursing program, evaluated associate degree graduates, and determined the future implications of the associate degree of nursing.

PTS: 1 DIF: Cognitive Level: Application REF: p. 139 OBJ: Compare and contrast the types of educational preparation for nursing.

TOP: Nursing education MSC: NCLEX®: Not applicable 15. Which of the following is true of ancient Egyptians physicians and how they used ancient medicine to treat patients? a.

They focused on finding a cure for maladies.

b.

They focused on treating maladies.

c.

Treatments were often made of antibiotics.

d.

Treatments focused on driving out evil spirits.

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ANS: D Ancient Egyptian physicians focused treatment on driving out evil spirits rather than curing or treating maladies. Ancient Egyptian physicians did not have access to antibiotics during that time period.

PTS: 1 DIF: Cognitive Level: Application REF: p. 127 OBJ:Explain the early European contributions to nursing.

TOP: Nursing history: people and places MSC: NCLEX®: Not applicable 16. Which action resulted from the command of George Washington during colonial times? a. Women were banned from providing nursing care. b. Women were hired to serve meals and provide care to the ill. c. Men were hired to serve meals to the ill.

Most of the individuals in the large hospitals providing care were d. women.

ANS: B At the command of George Washington, women were hired to serve meals and provide care to the wounded and ill. During this time, most of the individuals in the large hospitals providing care were men.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Application REF: p. 134 OBJ:Explain the forces that affect the role of American nurses.

TOP: American nursing: critical factors MSC: NCLEX®: Not applicable 17. Which of the following is a technical nurse duty, as described by Mildred Montag? a.

Changing a dressing with supervision from a nurse (RN, BSN)

b. Giving medication independently c.

Taking a radiograph

d. Prescribing medications

ANS: A Changing a dressing with supervision is a duty that a technical nurse would perform, according to Mildred Montag (1951). A technical nurse would be educated at a community college and would be eligible to become licensed as an RN. A technical nurse or bedside nurse would have a broader scope of education than a practical nurse (LPN) and a narrower scope of education than a professional nurse (BSN, RN) Giving medications independently, taking a radiograph, and prescribing medications would be inappropriate for a technical nurse (nurse technician) in this role developed by Mildred Montag.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 139 OBJ:Explain the forces that affect the role of American nurses.

TOP: History of nursing education MSC: NCLEX®: Not applicable 18. Which of the following is an example of advocacy by the nurse?

Refusing to give a patient a medication because it contradicts the a. nurse’s beliefs b. Questioning a doctor’s order that appears unsafe Giving a patient medication against their wishes because the nurse c. believes it to be in the best interest of the patient Giving out the patient’s health information to a questioning family d. member

ANS: B An example of advocacy is questioning a doctor’s order that appears unsafe. Other examples of advocacy include promoting patient comfort and supporting patient decisions regarding health care choices. Refusing to give a medication because it contradicts the nurses beliefs, giving a medication against a patient’s wishes, and giving out a patient’s health information are not examples of advocacy.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Analysis REF: p.

142

OBJ:Explain the forces that affect the role of American nurses.

TOP: The nurse’s role: the struggle for definitions MSC: NCLEX®: Not applicable 19. Which of the following depicts the charge nurse as autocratic over the student?

The student is in charge of the patient assignment while the charge a. nurse observes.

The charge nurse and the student share equal power in the patient b. assignment.

The charge nurse has absolute power over the student and the c. patient assignment.

The charge nurse passes power over the student to the attending d. physician.

ANS: C When the charge nurse is autocratic, she retains absolute power over the student and the assignment.

Autocratic leadership (also known as authoritarian leadership) is characterized by individual control over all decisions and little input from nursing staff, including students. Autocratic leaders typically make choices based on their own ideas and judgments and rarely accept advice from followers. There is a benefit to charge

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nurses being autocratic in leadership style when working with students because their decisions regarding nurse care and nursing assignments are based on experience that a student nurse would not have.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 145 OBJ:Explain the forces that affect the role of American nurses.

TOP: The nurse’s role: the struggle for definitions MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. The nurse has been studying the history of the nursing uniform and identifies which reason as the reason for the nursing cap disappearing from the student nurse uniform? (Select all that apply.) a. Unique nursing cap designs were difficult to produce b. Increase number of males in nursing profession c. Shorter haircuts worn by women Increased risk of infection by resident microorganisms on the d. nursing cap Nursing cap got in the way as more sophisticated equipment was e. used by students f.

Nursing cap was no longer needed for pinning ceremonies

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ANS: B, C, D, E The nurse’s cap design evolved from the traditional garb of the early deaconesses or nuns who were some of the earliest nurses to care for the sick. More recently, the cap’s original use was to keep a female nurse’s hair neatly in place and present a professional appearance. The rapid growth of the number of men in nursing also necessitated a unisex uniform. Also, with the increase in nosocomial illnesses in patients, many hospital and health care agencies decided that there was an increased risk of infection by resident microorganisms on the nurse’s cap and ultimately removed the requirement of the nurse needing to wear a nurse’s cap.

PTS: 1 DIF: Cognitive Level: Application REF: p. 138 OBJ:Explain the forces that affect the role of American nurses.

TOP: Nursing history MSC: NCLEX®: Not applicable 2. During the Civil War, which actions by volunteer nurses saved the lives of soldiers injured on the battlefield? (Select all that apply.)

Volunteer nurses brought injured patients from the battlefield to the a. hospital. b. Volunteer nurses provided clean water to the patients. c. Wounds were wrapped in clean bandages.

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d. Patients were provided with adequate nutrition for healing. e. Nurses reused supplies from other patients to save money.

ANS: B, C, D During the Civil War volunteer nurses served by providing a clean environment, including water and supplies, to their patients as well providing them with adequate nutrition. Volunteer nurses did not bring injured patients from the battlefield to the hospital. Also, nurses understood the underlying principles of infection transmission and would not reuse supplies from other patients to save money.

PTS: 1 DIF: Cognitive Level: Application REF: p. 134 OBJ:Explain the forces that affect the role of American nurses.

TOP: American nursing: critical factors MSC: NCLEX®: Not applicable 3. Which actions by the reformers pushed the profession of nursing forward? (Select all that apply.) a.

Organization of the American Nurses Association

b.

Creation of the American Nurses Association’s journal

c.

Established the standards for nursing education

d.

Established the standards for nursing practice

e.

Set wages for nurses

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ANS: A, B, C, D The organization of the American Nurses Association and its journal and the establishment of standards of nursing education and practice are actions by the reformers that pushed the profession of nursing forward. The reformers did not set wages for nurses.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 135-137 OBJ:Explain the forces that affect the role of American nurses.

TOP: American nursing: critical factors MSC: NCLEX®: Not applicable 4. Which of the following shows the role of the nurse? (Select all that apply.) a.

A nurse teaching a patient preoperatively

b.

A nurse prescribing medications at discharge

c.

A nurse placing warm blankets on a patient

d.

A nurse speaking up for a patient’s wishes

e.

A nurse administering medications to a patient

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ANS: A, C, D, E The role of the nurse includes teaching patient’s preoperatively, providing care such as giving warm blankets to patients, speaking up for a patient’s wishes, and administering medications. Nurses do not prescribe medications unless they are advanced practice nurses (nurse practitioners).

PTS: 1 DIF: Cognitive Level: Application REF: p. 140 OBJ:Explain the forces that affect the role of American nurses.

TOP: The nurse’s role: the struggle for definitions MSC: NCLEX®: Not applicable 5. Imposter nurses in the 1900s inspired Dock, Palmer, and Goodrich to take which of the following actions for the safety of the public? (Select all that apply.) a.

Advocated for nurses to take an examination for licensure

b.

Required nurses to show a driver’s license to their patients

c.

Advocated for nurse training schools

d.

Pleaded for registration of nurses

e.

Fought against home-study programs for nurses

ANS: A, C, D, E

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Dock advocated for nurses to take an examination for licensure. Palmer advocated for nurse training schools and registration of nurses to protect the public from incompetent nurses. Goodrich fought against home-study programs for nurses. Nurses were not required to show a driver’s license to their patients.

PTS: 1 DIF: Cognitive Level: Application REF: p. 135 OBJ:Explain the forces that affect the role of American nurses.

TOP: The nurse’s role: the struggle for definitions MSC: NCLEX®: Not applicable 6. Which of the following actions were expected of a nurse coordinator? (Select all that apply.) a.

Improve patient care.

b.

Promote harmony within the institution.

c.

Arrange for payment of care received by patients.

d.

Motivate staff.

e.

Arrange salaries of staff.

ANS: A, B, D

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Nurse coordinators were expected to improve patient care, promote harmony within the institution, and motivate staff. Arranging for payment of care received by patients and arranging salaries of staff was not an expectation of a nurse coordinator.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 143 OBJ:Explain the forces that affect the role of American nurses.

TOP: The nurse’s role: the struggle for definitions MSC: NCLEX®: Not applicable

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Chapter 07: Nursing Education MULTIPLE CHOICE 1. Based on data, the nurse interprets which educational program as producing the most graduate nurses annually? a. Diploma program

c. Baccalaureate program

b. Associate degree program

d. Master’s and doctoral programs

ANS: B Since its beginning in 1951, the associate degree nursing program has grown to more than 900 programs, producing more graduates annually than any other program. A recent survey indicates that initial preparation in a diploma program accounted for 20.4% , the associate’s degree accounted for 45.4%, and the baccalaureate degree program accounted for 34.2% of the registered nurse educational preparation.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 151 OBJ: Compare and contrast the types of educational preparation for nursing.

TOP: Nursing education MSC: NCLEX®: Not applicable 2. The student nurse interprets which characteristic as one of graduates from a diploma school of nursing?

NURSINGTB.COM They have obtained a general education in nursing theory and a. sciences that can be applied toward an advanced degree.

They are well prepared to function in the institution in which the b. school is located.

Advanced courses in nursing management and leadership apply to c. advanced degrees in nursing.

They are prepared to practice in advanced nursing clinical d. situations.

ANS: B Hospital-based nursing programs provide extensive clinical experience in the respective hospital, so student nurses are well prepared to function at the hospital where the school is located. The diploma program may include general education subjects such as biology and physical and social sciences in addition to nursing theory and practice. Usually, the nursing courses completed cannot be transferred to an educational institution for advanced degrees. However, this is in a process of change. Many diploma programs have become degreegranting institutions. Graduates of diploma programs are prepared to function as beginning practitioners in acute, intermediate, long-term, and ambulatory health care facilities. The diploma program does not prepare students to practice or obtain courses in advanced areas of nursing as part of their basic education program.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 151 OBJ: Compare and contrast the types of educational preparation for a graduate degree.

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TOP: Nursing education MSC: NCLEX®: Not applicable 3. What type of program is designed for students who prefer to take classes on the Internet? a. Career ladder programs

c. Online degree programs

BSN completion b. programs

University-without-walls d. programs

ANS: C It is possible to earn ADN, BSN, master’s, and doctoral degrees in web-based or web-enhanced formats via online education programs. A BSN completion program is a baccalaureate program designed for students who already possess either a diploma or an associate degree in nursing and hold a current license to practice as a nurse . The career ladder concept focuses on the articulation of educational programs to permit advanced placement without loss of credit or repetition. The university-without-walls programs provide students the opportunity to obtain credit for life and professional experiences and previously acquired college-equivalent knowledge and skills to work toward a baccalaureate degree.

PTS: 1 DIF: Cognitive Level: Application REF: p. 155 OBJ:Describe the educational preparation for a graduate degree.

TOP: Nursing education MSC: NCLEX®: Not applicable 4. A new graduate wishes to select a program NURSINGTB.COM in nursing that will assist in preparation to care for individuals, families, groups, and communities. The new graduate should select a(n) a.

practical nursing school.

b. diploma program in nursing.

c.

associate degree program.

d. baccalaureate program.

ANS: D The graduate of a baccalaureate program is prepared to provide health promotion and health restoration care for individuals, families, and groups in a variety of institutional and community settings. The practical nurse would not be prepared to care for varying individuals in different settings. The diploma programs educate nurses in the hospital setting, with the end result being that the nurse will continue to work in the hospital upon graduation. Associate prepared nurses generally continue onto a higher degree upon graduation. These nurses are not as prepared as baccalaureate nurses to care for the variety of individuals in different settings.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 151 OBJ:Describe the educational preparation for a baccalaureate degree.

TOP: Nursing education MSC: NCLEX®: Not applicable 5. A master’s degree in nursing differs from a generic nursing degree in what way? A master’s degree in nursing

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a.

requires a level of specialization to be selected.

b.

prepares the nurse for nursing administration.

c.

increases the authority and responsibilities of the nurse.

d.

enables the nurse to become a nurse educator.

ANS: A A master’s nursing program requires a level of specialization to be selected—education, administration, or a specific clinical area. A nurse can be an educator without having a master’s degree; however, a master’s degree is preferred for educators in schools of nursing. A generic degree in nursing prepares the student to become a basic practitioner and allows the student to be eligible to take NCLEX upon successful graduation from a diploma, associate degree, or baccalaureate nursing program.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 156-158 OBJ: Describe the educational program for a graduate degree. TOP: Nursing education MSC: NCLEX®: Not applicable 6. The nursing student interprets the phrase “an accredited school of nursing” to mean that the nursing school is accredited by the licensing institution of the a. respective state.

NURSINGTB.COM the school has petitioned and been granted accreditation by the b. American Nurses Association. this is a voluntary process by which the school demonstrates c. meeting of standards above the legal requirements. this is a designation that allows the nursing program to confer d. advanced degrees in nursing education.

ANS: C An accreditation is a voluntary process by which a school demonstrates meeting the educational standards over and above the legal requirements. It guarantees the student the opportunity to gain a quality education.

Generic, BSN completion, and advanced degree programs obtain accreditation either through the Accreditation Commission for Education in Nursing (ACEN), which was formerly the National League for Nursing Accrediting Commission (NLNAC), or by the Commission on Collegiate Nursing Education (CCNE). The state board of nursing approves or grants the school the right to operate a school of nursing in the state. The American Nurses Association is the professional organization for graduates of nursing programs.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 162 OBJ: Describe the purpose of nursing program accreditation. TOP: Accreditation MSC: NCLEX®: Not applicable

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7. A nurse is reviewing regulations to practice in different states. Which of the following credentials is interpreted as mandatory to renew periodically in order to legally practice nursing in a particular state? a.

The nursing license

b.

The registration of the nursing license

c.

Certification in a nursing specialty organization

d.

Accreditation

ANS: A All states require a periodic renewal of the nursing license. States vary in the requirements to obtain and maintain nursing licenses. Some states may require continuing education credits to renew yearly licenses, but other states may consider continuing education as optional for professional growth. Accreditation is the voluntary process for schools to maintain educational standards. Certification is voluntarily obtained after the graduate has become licensed and meets the criteria to be certified by the respective organization, such as the Critical Care Nurse’s Association, which when certified allows nurses to use the credential CCRN after their names.

PTS: 1 DIF: Cognitive Level: Application REF: p. 161 OBJ: Describe the role of credentialing and certification. TOP: Nursing education MSC: NCLEX®: Not applicable

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8. A new graduate asks the nurse manager, “What’s the meaning of this alphabet soup that’s added after this nurse’s name: Jane Bigham, RN, CRNA?” The best explanation for the nurse manager to give would be: “It means the nurse is licensed to practice in this state and has met predetermined standards for certification set by a a. credentialing group for nurse anesthetists.” b. is also a certified rehabilitation nursing assistant.” has been licensed by the central registry for nursing assessment c. specialists.” is joking about the nurse’s age. The initials stand for Certified Real d. Nurse Antique.”

ANS: A The initials CRNA mean that the nurse is a registered nurse with a certification as a nurse anesthetist. The movement toward certification in nursing practice areas has grown significantly over the past 40 years.

Because a nursing license is recognized as indicating minimum competency, a certification credential indicates preparation beyond the minimum level. An RN would not be certified as a rehabilitation nursing assistant but as a rehabilitation registered nurse (CRRN). Registries for nursing do not provide credentials; only the state board of nursing and a certification board confer credentials to registered nurses.

PTS: 1 DIF: Cognitive Level: Application REF: p. 153

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OBJ: Describe the role of credentialing and certification in professional practice.

TOP: Nursing education MSC: NCLEX®: Not applicable 9. A distinction that can be made between nursing licensure and certification is that licensure is a. mandatory, and certification is voluntary. optional, and certification is required to practice a nursing b. specialty. c. renewed annually, and certification is renewed triannually. approved by the ANA, and certification signifies ability to give d. safe care.

ANS: A Nursing license is required or mandatory, but certification is voluntary. In nursing, the educational credentials that an individual holds indicate not only academic achievement but also a minimum level of competency.

Licensure affords protection to the public by requiring the individual to demonstrate minimum competency.

Nurses must pass an NCLEX® Exam for the state board of nursing to grant permission to practice nursing.

Nursing licensure is renewed based on the requirements of the individual’s state of residence, and certification renewal varies based on the certifying organization. Licensure is not approved by the ANA but by the State Board of Nursing, which belongs to the National Council of State Boards of Nursing. Because a nurse is certified does not signify the ability to give safe care, the initial licensure as an RN is to determine a safe, competent practitioner. Certification denotes aNURSINGTB.COM specialization in an area of nursing practice.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 161 OBJ: Describe the role of credentialing and certification in professional practice.

TOP: Nursing education MSC: NCLEX®: Not applicable 10. A nurse professor is discussing the different educational tracks for nurses. The professor interprets which track as the most popular in 1980 versus today? a.

Baccalaureate

c.

Master’s

b.

Associate

d.

Diploma

ANS: D In 1980, the diploma was the most popular educational track, but today, the associate’s degree accounts for 45.4% of nursing degrees.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 150 OBJ:Compare the various types of educational preparation for nursing.

TOP: Nursing education MSC: NCLEX®: Not applicable

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11. A nurse is comparing the diploma program with the associate’s degree program. The nurse identifies which of the following as features of the diploma program and different from that of the associate’s degree program? a. The diploma degree allows the nurse to work in specific specialties.

The diploma degree allows the nurse to earn different wages at the b. same facility.

The diploma and ADN programs each have a national licensure c. exam specific to their program.

Graduates of the diploma program are often hired into the hospital d. where they completed their program.

ANS: D Graduates of the diploma program are often hired into the hospitals where they completed their programs. This creates an easier transition for the new nurse. Graduates of both the diploma program and the associates program are not restricted in the specialties they choose to work in, wages are not limited by either degree program, and all nurses take the same licensure exam regardless of degree program.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 150-151 OBJ:Compare the various types of educational preparation for nursing.

TOP: Path of diploma education MSC: NCLEX®: Not applicable NURSINGTB.COM

12. A young parent with small children who has no prior education wants to enroll in a nursing program. The parent has very limited support and resources. Select the best program for this parent based on this above information. a.

Accelerated program

c.

Baccalaureate program

b.

Associates program

d.

Online program

ANS: B The young parent would likely be best suited for the associate’s program. With no prior education and limited support and resources, the associate’s program would be a shorter program that would allow the young parent faster access to the workforce.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 151 OBJ:Compare the various types of educational preparation for nursing.

TOP: Path of associate degree education MSC: NCLEX®: Not applicable 13. A 28-year-old individual has decided to become a nurse as quickly as possible after having worked in business management for 5 years with a master’s degree. The person is married and has 3 young children at home. The individual is motivated and has many resources and a supportive spouse. Select that best nursing program for them based on this information.

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a.

Accelerated program

c.

Associate’s program

b.

Baccalaureate program

d.

BSN completion program

ANS: A This young person would be best suited for the accelerated program. The individual is motivated; holds a graduate degree; and has life experiences, resources, and support. Although the other programs could work, the person’s statement of wanting to “become a nurse quickly,” points toward the accelerated program. In addition, the person already has a master’s degree, which indicates achievement of goals, along with college credit that may be applied to the nursing degree.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 155 OBJ:Compare the various types of educational preparation for nursing.

TOP: Other types of nursing education MSC: NCLEX®: Not applicable 14. Which action by associate degree prepared nurses indicates their understanding of the importance of higher education? a. Completing their continuing education credits early b. Attending conferences in their specialty c. Returning to college for an advanced degree

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Transferring to the education department in their place of d. employment

ANS: C Associate degree prepared nurses are recognizing the need for higher education and are choosing to return to college for an advanced degree. Continuing education is not considered higher education, which would be a baccalaureate, master’s, or doctoral degree.

PTS: 1 DIF: Cognitive Level: Application REF: p. 157 OBJ: Compare the various educational preparation for a graduate degree.

TOP: Graduate education MSC: NCLEX®: Not applicable 15. Which of the following would be the first action that a foreign nurse should take to practice in the United States? a. Apply for a hospital job in the personal desired state to practice in. b. Enroll in a community college to study “American” nursing. c. Contact NCLEX to set up a testing time.

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Contact the board of nursing in the personal desired state to d. practice nursing in.

ANS: D The first step the foreign nurse should take is to contact the board of nursing in the personal desired state to practice nursing in. The state board of nursing will provide information to the foreign nurse regarding Commission on Graduates of Foreign Nursing Schools (CGFNS) certification program, the NCLEX examination, and licensure requirements for nursing in that state.

PTS: 1 DIF: Cognitive Level: Application REF: p. 161 OBJ:Describe the purpose of nursing program accreditation.

TOP: Credentialing: licensure and certification MSC: NCLEX®: Not applicable 16. Select the following statement that describes the current student population. a.

The student population tends to be single.

b.

The student population is younger the age of 20 years.

c.

The student population tends to be older.

d.

The student population tends to be white.

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ANS: C The student population tends to be older and married and with families. Minority individuals, foreign students, and poor individuals look to nursing for career opportunities.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 163 OBJ:Describe the purpose of nursing program accreditation.

TOP: Nursing education: future trends MSC: NCLEX®: Not applicable 17. Which of the following causes is most likely to contribute to the nursing shortage? a.

The aging of the nurse faculty population

b.

General lack of interest in the nursing profession

c.

Lack of accredited nursing programs

d.

Decreased need for nursing staff

ANS: A The aging of the nurse faculty population is most likely to contribute to the nursing shortage. Approximately 75% of the current faculty population is expected to retire by 2019. Approximately 1800 full-time faculty

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members leave their positions each year. The retirement of a large number of nursing faculty will affect the ability of nursing programs to have adequate staff for their education programs.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 164 OBJ:Describe the purpose of nursing program accreditation.

TOP: Nursing education: future trends MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. A group of nurses is discussing how to choose a graduate program. Which of the following statements would be helpful to the nurses as they decide on a graduate program? (Select all that apply.) a. “Look at ACEN or CCNE publications.”

“List your career goals and decide what educational preparation b. you would need to reach these goals.” c. “Ask yourself how much time you can spend going to school.”

“Decide whether you are in a position to relocate if the programs d. you need are not offered in your area.”

“Choose a graduate program based on where your friends are going e. to school.”

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ANS: A, B, C, D Nurses looking into graduate school should focus on Accreditation Commission for Education in Nursing (ACEN) or Commission on Collegiate Nursing Education (CCNE) publications, listing career goals, determine how much time they can spend going to school, decide if they are in a position to relocate if needed, and find out which programs are accredited. Nurses should not choose a graduate program based on where their friends are going to school.

PTS: 1 DIF: Cognitive Level: Application REF: p. 158 OBJ: Describe the educational program for a graduate degree. TOP: Nursing education MSC: NCLEX®: Not applicable 2. A nurse is contemplating the concerns of nursing education in the future. The nurse concludes that the concerns are (Select all that apply.) a.

career mobility

b.

the changing student profile,

c.

the aging population,

d.

the shift from inpatient to outpatient nursing services,

e.

general interest in nursing as a profession,

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ANS: A, B, C, D The concerns of nursing education in the future include career mobility, the changing student profile, the aging population, and the shift from inpatient to outpatient nursing services. General interest in nursing as a profession is not a concern at this time.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 163 OBJ: Compare and contrast the types of educational preparation for nursing.

TOP: Nursing education MSC: NCLEX®: Not applicable 3. Which action by health care facilities show implementation of the recommendations set by the Institute of Medicine? (Select all that apply.) a. Increase the cost of outpatient services.

Set up a reward system for nurses who receive their baccalaureate b. degree. c. Encourage nurses to be lifelong learners. d. Set up a valet system to better serve patients and visitors.

Implement measures that will offer assistance to nurses who are e. pursuing doctoral degrees.

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ANS: B, C, E The Institute of Medicine has set forth recommendations that will change the future of nursing and nursing education. Health care facilities can show implementation by setting up a reward system for nurses who receive their baccalaureate degree, encourage nurses to be life-long learners, and implementing measures that will offer assistance to nurses who are pursuing a doctoral degree. Increasing the cost of outpatient services and setting up a valet system does not show implementation of these recommendations.

PTS: 1 DIF: Cognitive Level: Application REF: p. 163 OBJ:Compare the various types of educational preparation for nursing.

TOP: Nursing education MSC: NCLEX®: Safe and effective care environment 4. The Tri-Council for Nursing Policy recently stated that “every student and nurse should have access to additional nursing education “(AACN, 2012). What changes would educational institutions need to make in order to support this statement? (Select all that apply.) a. Expand nursing programs to meet the needs for health care reform Increase the cost of nursing programs to pay for additional b. instructors c. Implement distance learning d. Set up simulation labs

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Lessen the amount of work in the nursing program to accommodate e. busy professionals

ANS: A, C, D Based on the statement made by the Tri-Council for Nursing Policy, educational institutions have begun making changes to create educational systems that are more accessible. These changes include expanding nursing programs to meet the needs for health care reform, implementing distance learning and setting up simulation labs. Increasing the cost of nursing programs and lessening the amount of work in the nursing programs would not support the statement made by the Tri-Council for Nursing Policy.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 164 OBJ:Compare the various types of educational preparation for nursing.

TOP: Nursing education MSC: NCLEX®: Not applicable 5. Associate degree programs have brought a change in the type of student who enrolls in the program. Which of the following students are contributing to that change? (Select all that apply.) a. A 25-year-old Hispanic women b. A 40-year-old man who has worked in health care for 20 years An 18-year-old white woman who has just graduate from high c. school NURSINGTB.COM d. A28-year-old white man with a master’s degree in finance e. A 26-year-old African American woman with two children

ANS: A, B, D, E Associate degree programs attract a more diverse student population, including older individuals, minorities, and a variety of individuals with educational and economic experience.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 151 OBJ:Compare the various types of educational preparation for nursing.

TOP: Path of associate degree education MSC: NCLEX®: Not applicable 6. A student has been deciding between applying for nursing at the community college or a university and ultimately chooses the university. The student has an adequate understanding of the university’s baccalaureate program when making which statement(s)? (Select all that apply.)

“I can’t wait to be done with the program in 2 years and get a real a. nursing job.” b. “I am so glad that I will not have to take any liberal arts classes.”

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c. “I am excited to learn critical decision-making skills.” d. “I will develop independent nursing judgment.” e. “I am excited to be involved in research.”

ANS: C, D, E In the baccalaureate program students focus on developing critical decision-making skills, independent nursing judgment, and research skills. Baccalaureate programs are 4 to 5 years in length and involve liberal arts courses, among others.

PTS: 1 DIF: Cognitive Level: Application REF: p. 152 OBJ:Compare the various types of educational preparation for nursing.

TOP: Path of baccalaureate education MSC: NCLEX®: Not applicable 7. The nurse educator is being interviewed about the many different educational programs that allow nurses to achieve higher education. The educator states that the following educational programs were created based on the recommendation of the Institute of Medicine (Select all that apply.) a.

“BSN completion programs.”

b.

“career ladder programs.”

c.

“diploma programs.”

d.

“external degree programs.”

e.

“accelerated programs.”

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ANS: A, B, D, E BSN completion, career ladder, external degree, and accelerated programs are all created in response to the Institute of Medicine’s recommendation that all nurses should have access to higher education. Diploma programs were not created in response to these recommendations.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 151-155 OBJ:Compare the various types of educational preparation for nursing.

TOP: Other types of nursing education MSC: NCLEX®: Not applicable 8. Which statement by a nurse indicates an understanding of online nurse education programs?(Select all that apply.) a. The online programs are less work that face-to-face programs.

The online program provides education for adults who cannot b. relocate to continue their education.

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c. The online program requires no travel.

Online nurse education programs only offer an associate’s degree d. in nursing.

Online nursing education programs are only for advanced practice e. and doctoral programs.

ANS: B, C Online nurse education programs provide education for adults who cannot relocate to continue their education.

Some programs require a brief visit to the campus, but others require no travel. The online nursing programs are not less work than face-to-face programs, and they typically offer the full range of nursing programs from an RN, BSN completion programs through a doctoral degree in nursing.

PTS: 1 DIF: Cognitive Level: Application REF: p. 155 OBJ:Compare the various types of educational preparation for nursing.

TOP: Nursing education MSC: NCLEX®: Not applicable

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Chapter 08: Nursing Theories MULTIPLE CHOICE 2. A nurse wishes to incorporate Dorothea Orem’s theory into practice. Which action by the nurse encompasses this theory? a. The nurse completes the AM care for a patient. b. The patient gets dressed with help from the nurse aide.

The patient knows his or her own medication dosages and what c. time they are due.

The patient’s spouse assumes all responsibility for the patient’s d. medications.

ANS: B Dorothea Orem’s theory includes the overall theme of self-care. Nursing consists of actions to overcome or prevent self-care limitations or to provide this care for those who are unable to care for themselves. Performing care for the patient or assuming responsibility for the patient’s health care management does not put Orem’s theory into practice. Knowing medication dosages and the times they are due is a good start for the patient; the next step would be to administer the medications to themself.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 175 NURSINGTB.COM

OBJ: Describe the origins of nursing theory. TOP: Nurse theorists MSC: NCLEX®: Not applicable 3. The nurse has an adequate understanding of the four major metaparadigms when making which comment to a colleague? “The four major metaparadigms are a.

“nursing, environment, health, and illness.”

b.

“nursing, environment, person, and society.”

c.

“person, environment, health/illness, and nursing.”

d.

“person, society, wellness, and health/illness.”

ANS: C The overall theme and main ideas of nursing theory are nursing, person, health/illness, and environment. When looking at a nursing theory, the nurse looks at how the theorist defines these four metaparadigms. Society is not one of the metaparadigms. Health and illness are not separated but discussed as one metaparadigm.

Wellness is part of health/illness metaparadigm.

PTS: 1 DIF: Cognitive Level: Application REF: p. 171 OBJ:Describe some of the key words associated with nursing theory.

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TOP:Nursing metaparadigms MSC: NCLEX®: Safe and effective care environment—management of care 4. What is a common thread in the majority of definitions of a nursing theory?

Words or phrases that present a direction to how interrelated concepts can provide a reference for the study and the delivery of a. nursing care A list of the concepts and problems within the nursing profession b. and the suggested or anticipated solution of those problems A composite of the opinions and recommendations of famous, c. well-known nursing leaders An advanced role description for the study of the delivery of nursing care and the integration of nursing services with the most d. favorable economic consequences

ANS: A Theories are words or concepts that are joined together to form a theme—to describe, explain, and predict nursing care. Many theorists have various definitions regarding what a theory is, but they generally contain similar words and directions. A theory is not a list of concepts or ideas. A theory is not a composite of opinions or recommendations. Theories encompass more than just an advanced role description.

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PTS: 1 DIF: Cognitive Level: Analysis REF: p. 171

OBJ:Describe some of the key words associated with nursing theory.

TOP: Identification of nursing theory MSC: NCLEX®: Not applicable 5. Roy’s adaptation model capitalized on health and wellness based on how well one copes with stressors and the environment. Which statement by the nurse shows understanding of equilibrium? Equilibrium is reached through adaptation of our a.

“safety needs.”

c.

“physiological needs.”

b.

“self-esteem needs.”

d.

“love and belonging needs.”

ANS: C Sister Callista Roy identified six physiological needs (exercise and rest; nutrition; elimination; fluid and electrolytes; oxygenation and circulation; and regulation of temperature, senses, and the endocrine system).

Adapting and manipulating these needs successfully helps us cope with stressors. The other needs described (safety, self-esteem, and love/belonging) are associated with Maslow’s hierarchy of needs.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 179 OBJ:Discuss some of the main points of each of these theories.

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TOP: Nurse theorist’s model MSC: NCLEX®: Not applicable 6. In the system’s model of Neuman, nursing helps reduce the stressors to health through a. prevention on three levels—primary, secondary, and tertiary. b. maintenance of balance of the physiological systems. promoting a sense of inner harmony through achieving holistic c. health. repatterning the person and environment for synchrony within the d. body.

ANS: A Betty Neuman’s conceptual model focuses on prevention, or prevention as intervention, as a response to stressors. Primary prevention is what a person does to prevent illness. Secondary prevention is what is done when an illness strikes. Tertiary prevention is the rehabilitation after an illness. Physiological system balance is often associated with Roy’s theory. Inner harmony is associated with Watson’s theory on caring. Leininger’s theory discusses culture care repatterning or restructuring.

PTS: 1 DIF: Cognitive Level: Application REF: p. 180 OBJ:Discuss some of the main points of each of these theories.

TOP: Nurse theorist’s model MSC: NCLEX®:NURSINGTB.COM Not applicable 7. A nurse has been studying theory in class. Which of the following statements indicates that the nurse has an adequate understanding of theory? a.

“A theory can be used to predict something.”

b.

“A theory can measure outcomes.”

c.

“Theory can be helpful to formulate a plan of action.”

d.

“Theory is used to help evaluate interventions.”

ANS: A Theory is simply words or phrases (concepts) joined together in sentences, with an overall theme, to explain, describe, or predict something. Theory does not measure outcomes or help formulate a plan of action or interventions.

PTS: 1 DIF: Cognitive Level: Application REF: p. 171 OBJ: Identify the purposes of nursing theory. TOP: Theory definition MSC: NCLEX®: Not applicable 8. A student is in the last semester of nursing school. The student interprets nursing as

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a. knowledge of past experiences. b. the medical model of health care. c. a science based on the principles of biology and medicine. d. a science based on scientific research providing practice answers.

ANS: D As a science, nursing must be based on the principles of evidence-based scientific research that guides nursing practice. Nursing is not simply knowledge of past experiences, the medical model of health care, or based on principles of biology and medicine. Although some knowledge from past experience is incorporated into the body of nursing knowledge, the important part of nursing as a science is that it is based on sound scientific research (evidence-based practice).

PTS: 1 DIF: Cognitive Level: Application REF: p. 171 OBJ: Identify the purposes of nursing theory. TOP: Nursing science MSC: NCLEX®: Not applicable 9. A nurse is listening to a nurse manager give a presentation on nursing theory. The nurse identifies which statement as being indicative of nursing theory? a. “Team nursing to best use resources within the delivery of care” NURSINGTB.COM “Managed care focusing on conservation of the economic b. resources” “A direction as to how an individual nurse can best meet patient c. needs” “Created by nurses, for nurses, in understanding the nursing d. process”

ANS: D Nursing theory is created by nurses and for nurses who provide care to their patients, either directly or indirectly. Nursing theory is not managed care, primary nursing, team nursing, or any other more businessrelated method of delivering care.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 172 OBJ:Describe some of the key words associated with nursing theory.

TOP: Nursing theory MSC: NCLEX®: Not applicable 10. A nurse is giving a speech on the nursing theory of Madeline Leininger. Which statement by the nurse indicates an understanding of the theory? “Madeline Leininger’s theory is a theory that

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a. “considers the impact of culture on the person’s health.” b. “promotes the synchronicity between people and the universe.” “describes a dynamic state of being achieved through unity and c. harmony.” “considers nursing ‘a calling’ to work with patients in the d. reparative process.”

ANS: A The overall theme of Madeleine Leininger’s theory is culture, and it considers the impact of culture on the person’s health and caring practices. Synchronicity is most often correlated with Martha Rogers; “a calling” is most often associated with Nightingale. A dynamic state of health is often associated with Imogene King’s theory.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 184-185 OBJ:Discuss some of the main points of each of these theories.

TOP: Nurse theorist’s model MSC: NCLEX®: Not applicable 11. Systems-oriented theorists include Neuman, Roy, and a. Johnson.

Nightingale, Abdellah, and NURSINGTB.COM c. Orem.

Peplau, Watson, and b. Orlando.

Rogers, Newman, Rizzo, and d. Parse.

ANS: A Nursing theories by Betty Neuman (systems model), Sister Callista Roy (adaptation model), and Dorothy Johnson (behavioral systems model) are all considered systems oriented. All the separate components of the theory rely on one another and are interrelated. Together they make up the whole. Martha Rogers’ theory is called the Science of Unitary Human Beings. Dorothea Orem’s theory is called Self-care Nursing Theory. Jean Watson’s theory is called the Theory of Human Caring. Rosemarie Parse’s theory is called the Theory of Human Becoming. Nightingale’s theory is that the environment influences the person’s health. Faye Abdellah’s theory is a Patient-Centered Approach. Margaret Newman’s theory is called the Theory of Health as Expanding Consciousness. Rizzo is part of Rosemarie Rizzo’s Parse’s full name.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 179-180 OBJ: Identify some of the more well-known and well-developed nursing theories.

TOP: Systems-oriented nursing theories MSC: NCLEX®: Not applicable 12. A nurse is working in an Asian neighborhood of a large metropolitan city. In attempting to meet the cultural needs of this segment of the population, the nurse could apply whose nursing theory to the organization of nursing care required by these residents?

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a.

Virginia Henderson

c.

Dorothea Orem

b.

Martha Rogers

d.

Madeline Leininger

ANS: D Madeline Leininger’s theory focuses on the overall impact of culture on a person’s health and caring practices.

Dorothy Orem’s theory involves the three interwoven theories of self-care, self-care deficit, and the nursing system to help the nurse plan strategies to meet the patient’s needs. Virginia Henderson’s model focuses on the unique functions of nurses and 14 basic needs. Martha Roger’s Science of Unitary Human Beings is an abstract model addressing the complexity of the “unitary human being,” which allows for the examination of phenomena (energy fields, paranormal) that other theories do not describe, as nurses promote synchronicity between human beings and their environment/universe.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 184-185 OBJ: Discuss some of the main points of a nursing theorist. TOP: Models of nursing theory MSC: NCLEX®: Not applicable 13. A middle-aged patient has experienced a myocardial infarction that has significantly limited activities and lifestyle. The patient is exercising and working with a nurse in the cardiac rehabilitation program. This is an example of the implementation of what nursing theory? a. Martha Rogers’ examination of the phenomena of energy fields

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Dorothy Orem’s interwoven theories of self-care, self-care deficit, b. and nursing care Dorothy Johnson’s theme that the person is a behavior system and c. is orderly and balanced Sister Callista Roy’s theme of coping and adaptation to stimuli and d. stressors

ANS: B Dorothy Orem’s theory involves the three interwoven theories of self-care, self-care deficit, and the nursing system to help the nurse plan strategies to meet the patient’s needs. Martha Roger’s Science of Unitary Human Beings is an abstract model addressing the complexity of the “unitary human being,” which allows for the examination of phenomena (energy fields, paranormal); the energy being discussed regarding exercise is not what this is describing. Roy’s theory is about adapting to stressors, and in this instance, the exercising and working with the cardiac rehab nurse would not constitute adapting to stimuli and stressors. Johnson’s theory focuses on human behavior rather than the person’s state of health; hence, the activity of exercise is health related.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 175-176 OBJ: Discuss some of the main points of a nursing theorist. TOP: Models of nursing theory MSC: NCLEX®: Not applicable

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14. A nurse would like to improve personal practice by utilizing nursing theory. What action can the nurse take to begin incorporating nursing theory into practice? a.

Learn about nursing theories.

b.

Apply for a management position.

c.

Transfer to the education department.

d.

Enroll in a PhD program at the local university.

ANS: A Nursing theory can be applied to any area of nursing practice. The best first step for nurses to take is to learn about nursing theories, which they can then incorporate into their practice.

PTS: 1 DIF: Cognitive Level: Application REF: p. 173 OBJ: Identify the purposes of nursing theory. TOP: Nursing theory MSC: NCLEX®: Not applicable 15. The overall theme of Nightingale’s theory was that the person’s health is influenced by the environment.

Which of the following actions by Nightingale support this theme?

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a.

Fed the soldiers healthy food

b.

Used poor sanitation in caring for the soldiers

c.

Forced to use unclean water in caring for soldiers

d.

Shared supplies among soldiers to save money

ANS: A Florence Nightingale believed that the person is influenced by the environment. She began feeding the soldiers healthy food and cleaned the medical area. Upon doing this, the soldier’s mortality rates fell.

PTS: 1 DIF: Cognitive Level: Application REF: p. 171 OBJ:Describe the origins of theory.TOP:Nursing theory MSC: NCLEX®: Not applicable 16. Florence Nightingale believed that the environment impacts the patient’s health. Which of the following actions by the nurse incorporates Nightingale’s theory into practice today? a. Cleaning the patient’s room only at discharge b. Keeping the patient’s door closed all day

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c. Giving the patient a dinner tray of fried chicken and French fries d. Providing the patient with clean linen daily

ANS: D Florence Nightingale believed the patient’s health was directly affected by the environment. Providing the patient with clean linen daily would affect the patient’s health in a positive way. Cleaning the patient’s room only at discharge; keeping the door closed all day, preventing airflow; and feeding the patient unhealthy food do not support Nightingale’s theory.

PTS: 1 DIF: Cognitive Level: Application REF: p. 171 OBJ:Describe the origins of theory.TOP:Nursing theory MSC: NCLEX®: Not applicable 17. Which of the following would correctly evaluate the effectiveness of Nightingale’s actions to increase the health of the Crimean War soldiers? a.

Deaths continued to increase because of poor conditions.

b.

Deaths declined because of increased cleanliness.

c.

Death rates stayed consistent throughout the war.

d.

Death rates reduced to zero.

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ANS: B With Nightingale’s theory in action, death rates of the Crimean War soldiers steadily declined because of increased cleanliness.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 171 OBJ:Describe the origins of theory.TOP:Nursing theory MSC: NCLEX®: Not applicable 18. Using Betty Neuman’s conceptual model, what action by the nurse would indicate primary prevention? a.

Eating French fries and drinking a chocolate shake for lunch

b.

Taking the elevator instead of the stairs

c.

Sleeping 4 hours the night before work

d.

Exercising every other day

ANS: D

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Betty Neuman’s conceptual model focuses on prevention of disease and illness. The nurse uses primary prevention when exercising every other day. Eating unhealthy foods, lack of exercise, and sleeping only 4 hours does not support this model or a healthy lifestyle.

PTS: 1 DIF: Cognitive Level: Application REF: p. 180 OBJ: Identify some of the more well-known and well-developed nursing theories.

TOP: Nurse theorists MSC: NCLEX®: Health promotion and maintenance 19. A patient comes to the emergency department with an active myocardial infarction. Which action by the nurse indicates secondary prevention? a.

Perform an ECG to assess for damage.

b.

Check on another patient first.

c.

Enroll the patient in a cardiac rehabilitation program.

d.

Educate the patient about eating a healthy diet.

ANS: A According to Betty Neuman’s conceptual model, secondary prevention occurs once an illness strikes. The most appropriate action for the nurse to take would be to perform an electrocardiogram (ECG) to assess for cardiac damage. Educating the patient on eating a healthy diet is an example of primary prevention, enrolling the NURSINGTB.COM patient in a cardiac rehabilitation program is tertiary prevention. The nurse should not check on another patient first because this patient is a priority.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 180-182 OBJ: Identify some of the more well-known and well-developed nursing theories.

TOP: Nursing theory MSC: NCLEX®: Safe and effective care environment 20. A 28-year-old patient is recovering from a femur repair after a traumatic car accident. The following day, lab results indicate that the hemoglobin is dangerously low and the patient needs to receive blood. The patient has identified themself as a Jehovah’s Witness and has refused to receive the blood. Which action should the nurse take? a. Notify the physician of the patient’s decision. b. Administer the blood anyway. c. Try to convince the patient to receive the blood. d. Call the patient’s family members and alert them to the situation.

ANS: A Madeleine Leininger’s Culture Care Theory states that nurses need to be mindful and respectful of each patient’s religion and cultural practices. The patient has the right to refuse the blood. The action that the nurse

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should take is to notify the physician of the patient’s decision. It would not be appropriate for the nurse to administer the blood anyway, try to convince the patient to receive the blood, or alert the family members to the situation.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 184-185 OBJ: Identify some of the more well-known and well-developed nursing theories.

TOP: Nursing theory MSC: NCLEX®: Psychosocial integrity MULTIPLE RESPONSE 1. What nursing interventions can be performed by the nurse based on Jean Watson’s Caring Theory? (Select all that apply.) a.

Assist with basic human needs.

b.

Encourage the patient to express personal feelings.

c.

Ask the patient for input regarding received care.

d.

Sit down and have a conversation with the patient.

e.

Perform care according to hospital and unit policy.

ANS: A, B, C, E

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Jean Watson’s Caring Theory involves seeing the person as a whole, which is important in the healing process.

Nursing actions that support this include assisting with basic human needs, encouraging the patient to express his feelings, asking the patient for input regarding his care, and sitting down and having a conversation with the patient. Performing care according to hospital and unit policy does not support this theory.

Cognitive Level: Application PTS: 1 DIF: Cognitive Level: Application REF: p. 183 OBJ: Identify some of the more well-known and well-developed nursing theories.

TOP: Nursing theory MSC: NCLEX®: Physiological integrity 2. Which of the following action(s) by the nursing incorporates the Culture Care Theory? (Select all that apply.) a. Becoming educated about different cultures b. Being mindful of folk practices c. Requesting that patients withhold holistic care while in the hospital d. Being respectful of different religions

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Allowing the patient to experience healing according to their e. culture

ANS: A, B, D, E Madeline Leininger believes that there can be no curing without caring. The nurse should be prepared to care for patients of different culture. These actions include becoming educated about different cultures, being mindful of folk practices, being respectful of different religions, and allowing the patient to experience healing according to their own culture if possible.

PTS: 1 DIF: Cognitive Level: Application REF: p. 183 OBJ: Identify some of the more well-known and well-developed nursing theories.

TOP: Nursing theory MSC: NCLEX®: Psychosocial integrity

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Chapter 09: Image of Nursing MULTIPLE CHOICE 1. The nurse interprets which characteristic as the forefront of discussion about nursing’s professionalism? a.

Education

c.

Social values

b.

Altruism

d.

Code of ethics

ANS: A According to Pavalko, education is one of the eight dimensions used to describe a profession, as in professional nursing. Altruism, social values and the Code of Ethics are not considered to be the forefront of discussion about nursing’s professionalism. Although the other options also are part of Pavalko’s eight dimensions, nursing still continues to debate the educational entry level for professional nursing, since the 1965 ANA position paper. There is agreement about the relevance the profession has to social values, altruism, and having a code of ethics.

PTS: 1 DIF: Cognitive Level: Application REF: p. 193 OBJ: Describe different sociological models that characterize “professionalism.”

TOP: Image of nursing MSC: NCLEX®: Not applicable NURSINGTB.COM

3. A nurse has been studying Levenstein’s characteristics of a profession. The nurse demonstrates adequate understanding when interpreting which of the following components as part of the model? a.

A code of ethics

b.

A systematic, defined progression of education

c.

An accreditation process

d.

Publications or journal for the profession

ANS: A Both Levenstein’s model and Pavalko’s model call for a code of ethics within a profession. The models do not call for a systematic, defined progression of education, an accreditation process or publications or journals.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 193 OBJ: Describe different sociological models that characterize “professionalism.”

TOP: Professionalism MSC: NCLEX®: Not applicable 4. The nurse understands the importance of the Employee Retirement Income Security Act (ERISA) of 1974, when stating which of the following?

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a. “It provided a standard of practice for nursing.”

“It allowed professional nursing organizations to act as unions on b. behalf of member nurses.”

“It established the framework for political action in legislative c. activities.” d. “It financially supports research in nursing and education.”

ANS: B The Employee Retirement Income Security Act (ERISA) opened the door for the American Nurses Association to represent nursing in collective bargaining issues. It did not provide a framework, but enacted a law. Various nursing organizations support research in nursing and education (e.g., ANA, NLN, NCSBN).

PTS: 1 DIF: Cognitive Level: Application REF: p. 195 OBJ: Identify the role that nursing organizations have in professional practice.

TOP: Professional organizations MSC: NCLEX®: Not applicable 5. In the 1950s, belonging to a professional organization was popular. What has contributed to the decline in membership of the American Nurses Association?

The ANA has increased membership dues that nurses cannot NURSINGTB.COM a. afford.

Nurses do not want to be associated with an organization that b. represents unions. c. The association does not have state and local organizations.

The increase in popularity of specialty organizations representing specific needs of members has led to a decline in nurses joining the d. ANA.

ANS: D Historically, as specialty organizations have increased their membership numbers, the membership of the ANA has decreased. The theory is that nurses are seeking a specialty area that more directly addresses their area of practice. The decrease in ANA membership is not related to increased membership dues, a desire to avoid unions, or lack of state and local organizations.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 200-201 OBJ: Identify the role that nursing organizations have in professional practice.

TOP: Professional organizations MSC: NCLEX®: Not applicable 6. What action did the Johnson and Johnson Campaign for Nursing’s Future take to promote nursing?

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a.

Identified the need for nurses in labor and delivery

b.

Raised visibility of nurses of varied races

c.

Identified the need for nurses in postpartum care

d.

Raised national starting wages for nurses

ANS: B To encourage younger adults to enter the field of nursing, Johnson and Johnson raised visibility of nurses of varied races, gender, and roles by providing numerous public announcements and campaigns.

PTS: 1 DIF: Cognitive Level: Application REF: p. 191 OBJ:Discuss the effect of image on public perception of nursing.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable 7. Which of the following predicts the outcome if the nursing profession continues to be devalued by demeaning or comical images of nurses? a.

Nurses will be able to request higher wages.

b.

The nursing shortage will end.

c.

There will not be enough jobs for new graduates.NURSINGTB.COM

d.

The nursing shortage will extend.

ANS: D If the nursing professional continues to be devalued by demeaning or comical images of nurses, the profession will suffer. The shortage will extend, and it will discourage talented individuals from entering the profession.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 191 OBJ:Discuss the effect of image on public perception of nursing.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable 8. What action can each nurse take to improve the image of nursing during his or her career? a.

Provide public education on what nurses really do.

b.

Ignore the negative image of nurses.

c.

Contribute to the negative image of nurses.

d.

Remain silent when someone speaks negatively of nursing.

ANS: A

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It is important that the nurse provide public education on what nurses really do. This, along with maintaining professionalism, will continue to improve the image of nursing.

PTS: 1 DIF: Cognitive Level: Application REF: p. 191 OBJ:Discuss the effect of image on public perception of nursing.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable 9. Which of the following assesses how nursing has relevance to social values? a.

Nurses have professional degrees.

b.

Nurses perform community service.

c.

Nursing licensure requires a baccalaureate degree.

d.

Nurses are teachers of health promotion and wellness.

ANS: D Using Pavalko’s eight dimensions to describe a profession, nursing is extremely relevant to social values. As the focus of health care shifts to primary prevention, nursing will become increasingly important because of their ability to be teachers of health promotion activities and managers of wellness, activities that have an impact on social values.

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PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 193

OBJ: Apply Pavalko’s characteristics as a framework to describe modern-day nursing practice.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable 10. Which action led to the “birth” of nursing theory? a.

Creation of baccalaureate programs

b.

Dr. Peplau’s nursing model publication

c.

Publication of Jean Watson’s Caring Theory

d.

Martha Roger’s work on nursing theory

ANS: B Dr. Peplau’s nursing model publication led to the birth of nursing theory in 1952. The work of Jean Watson and Martha Rogers occurred after Dr. Peplau’s work. Having a theoretical framework on which professional practice is one of Pavalko’s eight dimensions to describe a profession.

PTS: 1 DIF: Cognitive Level: Application REF: p. 197 OBJ: Apply Pavalko’s characteristics as a framework to describe modern-day nursing practice.

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TOP: Professional image of nursing MSC: NCLEX®: Not applicable 11. The nurse is determining which professional organizations to join. The nurse demonstrates an adequate understanding of the International Council of Nursing (ICN) when stating which of the following? a.

“The ICN handles domestic nursing issues.”

b.

“The ICN is for international nurses only.”

c.

“The ICN is focused on worldwide health care.”

d.

“The ICN is focused on foreign issues only.”

ANS: C The International Council of Nursing (ICN) is focused on worldwide health care and nursing issues. The organization represents nurses worldwide and meets every 4 years to discuss issues and trends.

PTS: 1 DIF: Cognitive Level: Application REF: p. 201 OBJ: Identify the impact that nursing organizations have on professional practice.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable 12. Which of the following organizations would the nursing advisor recommend that the nursing student join to best meet the student’s current needs?

NURSINGTB.COM National League for a. Nursing

c. International Council of Nurse

American Nurses b. Association

National Student Nurses d. Association

ANS: D The organization that would best meet the student nurse’s current needs is the National Student Nurses Association. The association mentors the professional development of future nurses and facilitates their entrance into the profession. The other associations listed are for the professional nurse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 202 OBJ: Identify the impact that nursing organizations have on professional practice.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. Throughout the 1990s, a nationwide campaign worked to strengthen the image of nurses. Which of the following action(s) during the campaign aided in this? (Select all that apply.)

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a. Worked to improve the image of nurses as depicted on television b. Reinforced the image of nurses are doctor’s personal assistants c. Reinforced the idea that nursing required little skill d. Educated the public that nurses are critical thinkers e. Reinforced that nurses have problem solving skills

ANS: A, D, E The campaign during the 1990s worked to improve the image of nurses as depicted on television, as well as to reinforce the idea that nurses are critical thinkers and have problem solving skills. Because of the campaign, the nation began to see nurses as skilled, educated health care professionals.

PTS: 1 DIF: Cognitive Level: Application REF: p. 191 OBJ:Discuss the effect of image on public perception of nursing.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable 2. What action(s) can the nurse take to continue improving the image of nursing? (Select all that apply.)

Upload inappropriate pictures to social media networks, which she a. has identified herself as a nurse,

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b. Uphold ethical standards for all patients, all the time. c. Maintain professional behavior in the workplace.

Be aware of the challenges she will face as a nurse because of d. society’s perception of nurses. e. Disregard the need to change the image of nursing.

ANS: B, C, D To change the image of nursing for the better, the nurse needs to take charge of the image. The nurse should be sure to uphold ethical standards for all patients and be aware of the challenges she will face. The nurse should present herself in an appropriate manner, both in public and online.

PTS: 1 DIF: Cognitive Level: Application REF: p. 191 OBJ:Discuss the effect of image on public perception of nursing.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable 3. Which action(s) by the nurse can help create a professional image? (Select all that apply.) a.

Maintain effective communication skills.

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b.

Maintain a positive attitude.

c.

Maintain a professional appearance.

d.

Be prepared to interact with the public.

e.

Be unprepared for work.

ANS: A, B, C, D The nurse can help create a professional image by maintaining effective communication skills, maintaining a positive attitude, maintaining a professional appearance, and being prepared to interact with the public. Being unprepared for work does not represent a professional image.

PTS: 1 DIF: Cognitive Level: Application REF: p. 191 OBJ:Discuss the effect of image on public perception of nursing.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable 4. Which of the following assesses how nurses can control their profession? (Select all that apply.) a.

Discussing issues on their lunch break

b.

Joining a professional organization

c.

Through publishing documents

d.

Being active in the state boards of nursing

e.

Keeping issues to themselves

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ANS: B, C, D Using Pavalko’s eight dimensions to describe a profession, nurses can control their profession in several ways.

They can join a professional nursing organization, publish documents, and be active in the state boards of nursing. Discussing issues on a lunch break or keeping issues to themselves are not ways to control their profession.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 196 OBJ: Apply Pavalko’s characteristics as a framework to describe modern-day nursing practice.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable 5. Which action would be consistent with the American Red Cross volunteer nurse? a.

Provide staffing for a local hospital.

b.

Provide assistance after a tornado.

c.

Teach first aide to a group of Girl Scouts.

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d.

Deliver clothing to flood victims.

e.

Educate volunteers to assist in a local hospital.

ANS: B, C, D, E The function of the American Red Cross volunteer nurse is to provide disaster relief, teach first aide, and organize volunteers for hospitals or nursing homes. The volunteer nurse would not be responsible for providing staffing for a local hospital.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 203 OBJ: Identify the impact that nursing organizations have on professional practice.

TOP: Professional image of nursing MSC: NCLEX®: Not applicable

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Chapter 10: Nursing Management and Leadership MULTIPLE CHOICE 1. What is the most consistent concern of the nurse as manager? a.

To develop long-range career goals

b.

To coordinate patient care while meeting the agency goals

c.

To maintain harmony within the agency

d.

To organize the subordinates to meet agency goals

ANS: B The role of the nurse as manager has evolved into a complex one that includes organizing patient care, directing personnel to achieve agency goals, and allocating resources. The most consistent concern of the nurse as manager is not to develop long-range career goals, maintain harmony within the agency, or organize subordinates to meet agency goals. Although having long-range career goals is a good idea for the nurse manager, it is not a day-to-day concern. Organizing subordinates in not a role of the nurse manager, but instead it is directing or supervising them to achieve patient care needs.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208 OBJ: List characteristics of an effective manager and an influential leader.

NURSINGTB.COM TOP:Nursing definition MSC: NCLEX®: Safe and effective care environment—management of care 2. What action would be an appropriate first step for the nurse to take toward becoming an effective manager? a.

Learn how to effect and direct the change process.

b.

Assess individuals’ sources of power.

c.

Develop communication and interpersonal skills.

d.

Implement effective nursing care plans.

ANS: C Effective managers have a balanced mix of management skills and leadership qualities. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). To be effective in performing these functions, a manager must develop communication and interpersonal skills.

PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: List characteristics of an effective manager and an influential leader.

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TOP:Nursing management MSC: NCLEX®: Safe and effective care environment—management of care 3. What do the responsibilities of the nurse manager include?

Planning and organizing how nursing care can most effectively be a. delivered on the nursing unit Establishing the nursing care standards to be implemented on the b. unit Developing educational programs to assist staff to meet licensure c. requirements d. Assisting staff to adhere to organizational policies and procedures

ANS: A Managers must be attentive to both dimensions of their job: the mission and goals of the organization and planning with the staff to meet the nursing care goals of the unit within the overall goals of the institution.

Both levels must be addressed—the organization as well as the needs of the individuals. Other options are not as comprehensive and could be included within the first option.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 208-210 NURSINGTB.COM OBJ: List characteristics of an effective manager and an influential leader.

TOP:Nursing management MSC: NCLEX®: Safe and effective care environment—management of care 4. The nursing staff on a busy unit enjoys autonomy and needs minimal direction for patient care. Which leadership style would be most effective on this unit? a.

Democratic

c.

Laissez-faire

b.

Authoritarian

d.

Bureaucratic

ANS: A The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. The manager is also willing to take responsibility to make decisions when staff participation is not necessary. An authoritarian leader makes decisions without the input of others. The laissez-faire manager maintains a permissive environment. The bureaucratic leader follows a close set of standards to maintain order.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 212 OBJ: Describe various types of management. TOP: Nursing management

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MSC: NCLEX®: Safe and effective care environment—management of care 5. Which statement best describes effective leadership by the nurse manager? a. Directs a staff nurse to modify his or her communication skills Fosters behavior changes in one staff member that have positive b. effects on the nurse manager and his or her peers Encourages behavior changes through the annual evaluation c. process Uses the group process to determine what behavior is distressing to d. staff

ANS: B Leadership in groups is democratic; the members feel positive about their participation and the outcomes of the group process. The other options are not examples of effective leadership. This person should be flexible enough to adapt to the changing roles of nursing staff. The nurse manager/leader should be willing and able to share power with the same people that he or she will supervise. It is important to understand that the most effective leadership style for one situation is not necessarily the most effective for another. Research indicates that the effectiveness of the leader is influenced by the situation itself. As leadership theories continue to develop, emphasis is more on what the leader does rather than on the traits the leader possesses. Effective leadership revolves around the leader focusing a group’s efforts on identifying goals and carrying out the activities needed to reach those goals, not necessarily on individual issues, such as an annual evaluation processes or working with a staff to change communication skills.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Analysis REF: p. 216 OBJ: List characteristics of an effective manager and an influential leader.

TOP: Nursing management MSC: NCLEX®: Not applicable 6. The nurse manager is beginning the process of problem solving. Which action should be taken first? a.

Define the problem.

c.

Analyze the information.

b.

Gather information.

d.

Consider the alternatives.

ANS: A The good manager will guide the process of defining or identifying the problem by asking the what, when, and where of the problem. Before the manager can perform any of the other steps of problem solving, the problem must be identified. Importance is placed on management’s ability to differentiate between facts and opinions and to attempt to break down the information to its simplest terms.

PTS: 1 DIF: Cognitive Level: Application REF: p. 224 OBJ: Apply problem-solving strategies to clinical management situations.

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TOP: Nursing management MSC: NCLEX®: Not applicable 7. A nurse is using the decision-making process. Which action should be taken first? a.

Evaluate the outcome.

c.

Set the objective.

b.

Identify and evaluate options.

d.

Implement the options.

ANS: C Decision making requires the definition of a clear objective to guide the process. The nurse must set the objective before proceeding to the other steps in the decision-making process. The second step is to identify and evaluate alternate decisions. The third step is to make the decision and implement, and the last step is to evaluate the outcome.

PTS: 1 DIF: Cognitive Level: Application REF: p. 226 OBJ: Use the decision-making process in clinical situations. TOP: Nursing management MSC: NCLEX®: Not applicable 8. Which statement by the nurse shows understanding of the primary advantage in using the group process in decision making? The process a.

“increases the time spent discussing alternatives.”NURSINGTB.COM

b.

“eliminates opposition to decisions by administrators.”

c.

“allows additional time for the planning process.”

d.

“promotes acceptance of the decision by the group.”

ANS: D When the group has input in the decision-making process, there is more acceptance of the group’s decision.

Groups can be beneficial to the decision-making process. Groups generally offer the benefits of a broader knowledge base for defining objectives and more creativity in identifying alternatives. The effectiveness of the group decision-making process is dependent on the dynamics of the group. When a group is involved in the decision-making process, there may be additional time spent discussing alternatives, and more time may be allowed for planning; however, this is not a specific advantage. It may not necessarily eliminate opposition to the decision by administration, but when the group makes a decision, it may be easier to deal with administrative opposition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: Identify characteristics of effective work groups. TOP: Nursing management MSC: NCLEX®: Not applicable 9. A nurse is interested in moving into a management position. Which action would assist with accomplishing this?

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a.

Use of reward power

c.

Use of expert power

b.

Use of coercive power

d.

Use of legitimate power

ANS: C An expert refers to someone who is knowledgeable, experienced, and respected in his or her area of nursing.

This type of expert power would assist the nurse to advance to higher positions in nursing. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Coercive power is power derived from fear of consequences.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable 10. A nurse is respected by peers for clinical skills and effective interpersonal relationships. The nurse has studied diabetic patient educational needs and consults with several units. What type of power does this nurse possess? a.

Informational

c.

Reward

b.

Legitimate

d.

Expert

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ANS: D Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others.

Those who have information that others need to perform their duties have informational power. Legitimate power is based on the person’s position within an organization. Reward power occurs when an individual has the power to give or withhold rewards.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable 11. The nurse manager on a surgical unit receives notification that multiple victims of a plane crash will arrive at the hospital momentarily. What is the most appropriate leadership style to adopt in this situation? a.

Authoritarian

c.

Laissez-faire

b.

Democratic

d.

Eclectic

ANS: A The authoritarian style of management has its emphasis on the tasks, which would be effective during an emergency or disaster situation; hence, the autocratic manager may be most effective in a crisis situation.

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The laissez-faire manager maintains a permissive climate with little direction or control exerted. This manager allows staff members to make and implement decisions independently and relinquishes most of his or her power and responsibility to them. The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. Eclectic is not a specific leadership management style.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 211 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable 12. The nurse manager tells the patient that he must eat his breakfast before getting out of bed. What type of power is the nurse manager using? a.

Legitimate power

c.

Coercive power

b.

Expert power

d.

Referent power

ANS: C Coercive power is power derived from fear of consequences. Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Referent power is power that a person has because others NURSINGTB.COM closely identify with that person’s personal characteristics; the person is liked and admired by others.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable 13. Which statement by the staff nurse shows adequate understanding of the nurse manager role? The nurse manager: a.

“is given information and power through an official position.”

b. “coordinates group activities toward a common goal.” c.

“is responsible for developing goals to be accomplished.”

d. “selects and assumes a role among a group of peers.”

ANS: B The manager coordinates the activities of the group to maintain balance and direction. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). Good leaders carefully balance job-centered and employee-centered behaviors to meet both staff and patient needs effectively and often have information and power through an official position. A good leader works toward developing goals and has a sense of purpose

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and direction. A good leader must also be aware of how her or his behavior impacts the workplace. Emotions, moods, and patterns of behavior displayed by the leader will create a lasting impression on the behavior of the team involved. A team member is a person who assumes a role among a group of peers.

PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: List characteristics of an effective manager and an influential leader.

TOP: Nursing management MSC: NCLEX®: Not applicable 14. The nurse manager is giving a presentation on the disadvantages of democratic leadership in group functioning. Which statement shows an understanding of this type of leadership?

“Requires more time and effort to make decisions and accomplish a. goals” b. “Discourages participation from quieter members of the group” “Increases the possibility of “scapegoating” or argumentative c. behavior” d. “Is difficult to control the outcomes and decisions of the group”

ANS: A Because of the encouragement of participation in decision making and the democratic leadership’s emphasis NURSINGTB.COM on group function, decision making becomes more involved with consensus and is less timely. Democratic leadership encourages group participation and works to reduce any type of scapegoating behavior among members because everyone has equal voice. The group democratically makes decisions and determines outcomes that are not controlled by management.

PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable 15. A nurse is unhappy about the way medications are being administered on the unit. What does the nurse need to do first to facilitate a change in the process? a.

Initiate a new method starting with assigned patients.

b.

Discuss concerns with fellow nurses.

c.

Develop a better method to administer the medications.

d.

Inform the charge nurse of how it can be done better.

ANS: C The nurse needs to shift into the moving phase, which incorporates taking the lead by being responsible and willing to implement change by sorting out what must be done and by facilitating an appropriate and effective

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approach. Whenever one is not happy with a situation or procedure, it is important that providing suggestions for change be incorporated into the process. Discussing concerns with fellow nurses does not actively involve the change process. For change to be effective, it must have “buy-in” from other staff and not merely inform the staff or change nurse of how there is a better way to administer the medications on the unit.

PTS: 1 DIF: Cognitive Level: Application REF: p. 229 OBJ:Discuss the change process.TOP:Nursing management MSC: NCLEX®: Not applicable 16. A nurse wants to implement a change in the work environment. Which of the following actions would be the most important thing to do? a.

Ask for suggestions from peers working in other institutions.

b. Explain to coworkers how a different plan would work better. c.

Seek input from coworkers from the beginning.

d. Incorporate all suggestions into the plan before implementing.

ANS: C Seeing the input from coworkers from the beginning is an important component of initiating change in the work environment. In the unfreezing phase, allNURSINGTB.COM of the factors that may cause resistance to change are considered. Others who may be affected by the change are sought out to determine whether they recognize that a change is needed and to determine their interest in participating in the process. It will be important to determine whether the environment of the institution is receptive to change and then convince others to work with the group initiating the change.

PTS: 1 DIF: Cognitive Level: Application REF: p. 229 OBJ:Discuss the change process.TOP:Nursing management MSC: NCLEX®: Not applicable 17. If many complaints arise about a newly developed procedure, what is the best way to handle them? a. Discontinue the change because it is not working. b. Persuade a few friends to talk positively about it.

Consider the complaints as indications that change is being c. resisted. d. Analyze the complaints and alter the plan as needed.

ANS: D In handling complaints about a new procedure, consideration should be given to bringing in a person with expert power and returning to the moving phase for analysis and adjustment of the procedure if needed.

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Because a complaint occurs does not mean that the change is being resisted. Until the complaint is investigated, the change should continue; it should not be discontinued until the issue is fully determined and resolved about the newly developed procedure PTS: 1 DIF: Cognitive Level: Application REF: pp. 226-227 OBJ:Discuss the change process.TOP:Nursing management MSC: NCLEX®: Not applicable 18. What types of changes in management can be anticipated with the introduction of generations X and Y to the nursing work force?

More flexible work time and increased personal responsibility for a. work outcomes Increased loyalty to the institution and the need for a well-defined b. work environment c. Increased interest in the goals and needs of the institution Increased structure within the nursing environment to more d. effectively predict outcomes

ANS: A NURSINGTB.COM Members of generations X and Y are more independent and place higher value on personal time. They are not characteristically team players, but they are very creative and want to be responsible for their work outcomes.

Baby Boomers are focused on building careers and are invested in organizational loyalty. The silent or veteran generation places high value on loyalty, discipline, teamwork, and respect for authority.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 218 OBJ: Identify distinguishing generational characteristics of today’s workforce.

TOP: Generations X and Y MSC: NCLEX®: Not applicable 19. The nurse understands that having a stand-up meeting versus the traditional (sitting at a conference table) meeting takes less time to come to a decision based on which of the following ideas? a.

Contingency-style leadership

b.

Evidence-based management protocols and interventions

c.

Autocratic management style

d.

Presence of a clinical nurse leader (CNL)

ANS: B Nurses are expected to practice using evidence-based protocols and interventions for clinical decision making, and managers are expected to use those management practices that are not simply based on conventional

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wisdom but on demonstrated outcomes. Evidence indicates that stand-up meetings took 34% less time to make decisions (Pfeffer & Sutton, 2006). Using this model could save an organization many hours a year that can be put to another productive use or could be eliminated from the payroll. However, very few organizations use this model for meetings even in the face of the clear evidence of the impact it would have on the organization.

The CNL is a highly prepared individual in the clinical setting whose role is to positively impact patient safety issues by identifying and managing risk while meeting standards of quality clinical care. Autocratic management style is authoritative. Contingency leadership style is a style of leading that is flexible to adapt to the situation.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 225 OBJ:Discuss the value of using evidence-based management actions.

TOP: Nursing management MSC: NCLEX®: Not applicable 20. A nurse manager has an adequate understanding of their nursing role when making which of the following statements? a.

“A manager selects or assumes a role.”

b.

“I have the same function as a floor nurse.”

c.

“I have the same authority as the director of the hospital.”

d.

“I was appointed to my role.”

ANS: D

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Whereas a manager is assigned or appointed to a role, a leader selects or assume a role. The nurse manager functions differently than a floor nurses, and although the nurse manager has some authority, it is less than the director of the hospital.

PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ:Differentiate between management and leadership.

TOP: Management versus leadership MSC: NCLEX®: Not applicable 21. Which of the following actions is consistent with a nurse leader? a.

A nurse who encourages staff to give excellent patient care

b.

A nurse who performs chart audits on her staff

c.

A nurse who writes yearly staff evaluations

d.

A nurse who gives pain medication to an assigned patient

ANS: A

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A nurse leader is someone who influences others, such as a nurse who encourages staff to give excellent patient care. A nurse who performs chart audits and writes staff evaluations is functioning as a nurse manager.

Giving pain medications is a function of the staff or bedside nurse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ:Differentiate between management and leadership.

TOP: Management versus leadership MSC: NCLEX®: Not applicable 22. A nurse manager has received a report that indicates the infection rate on the unit has gone up by 25% in the past month. The control phase of management requires that the nurse manager take action. What should the nurse manager do? a. Post the report for staff to read. b. Pull a couple of the nurses aside and discuss the issue with them.

Send an email out to the staff with information regarding upcoming c. infection prevention conference. d. Provide a mandatory handwashing in-service to all staff.

ANS: D The nurse manager has a duty to implement and mandate interventions to reduce infection rates for her unit.

NURSINGTB.COM Providing a mandatory handwashing in-service to all staff is the best way to do this and to ensure that every staff member is competent. The other options may be used in the process for the nurse manager to set up or reinforce the handwashing in-service program.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208 OBJ:Differentiate between management and leadership.

TOP: Management versus leadership MSC: NCLEX®: Safe and effective care environment 23. Which of the following actions by the nurse manager would indicate an autocratic management style? a. Allows staff members to make most of the decisions b. Makes most of the decisions without input from the staff members c. Exerts little control over staff d. Emphasizes effective group functioning

ANS: B The autocratic manager uses an authoritarian approach to direct the activities of others. This manager would make most of the decisions without input from the staff members. Allowing staff members to make most of the decisions and exerting little control over staff is a laissez-faire management style. Emphasizing effective group functioning is common for a democratic management style.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 211 OBJ:Differentiate the concepts of power and authority.

TOP: Management versus leadership MSC: NCLEX®: Not applicable 24. The nurse manager identifies which of the following as the most critical step in problem solving? a. Brainstorm all possible solutions. c. Evaluate possible solutions. b. Identify the problem.

d. Choose a solution.

ANS: B The most critical step in the problem solving process is to identify the problem. Brainstorming solutions, evaluating possible solutions, and choosing a solution occur after the problem has been identified.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 224 OBJ: Apply problem-solving strategies to clinical management situations.

TOP: Management problem solving MSC: NCLEX®: Not applicable 25. Which action by the nurse indicates placement in the unfreezing phase of Lewin’s Change Theory?

NURSINGTB.COM The nurse reconsiders what has caused themself to be resistant to a. change. b. The nurse begins the process of implementing change. c. The change has become routine. d. The change is permanent.

ANS: A Lewin’s Change Theory consists of three phases: unfreezing, moving, and refreezing. In the unfreezing phase, the nurse reconsiders what has caused her to be resistant to change. In the moving phase, the nurse begins the process of implementing change. In the refreezing phase, the change has become a permanent, routine part of the nurse’s life.

PTS: 1 DIF: Cognitive Level: Application REF: p. 230 OBJ: Discuss the change process. TOP: The challenge of change MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. Which of the following actions is consistent with a manager? (Select all that apply.)

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a. Planning the agenda for a staff meeting Directing nurse assistants in how to divide up patient care b. assignments c. Organizing a group of nurses to present a topic at a staff meeting d. Giving blood at the local hospital blood drive Assume control of the guidelines for how hourly rounding will e. work on the unit

ANS: A, B, C, E Managers plan, direct, organize. and control activities designated to their staff. Giving blood at the local hospital would not be an action that is consistent with a nurse manager role.

PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ:Differentiate between management and leadership.

TOP: Management versus leadership MSC: NCLEX®: Not applicable 2. A nurse manager is in the planning phase in a new job. Which action shows this? (Select all that apply.)

Developing goals that reflect the mission and vision of the NURSINGTB.COM a. organization Defining strategies to meet the mission and vision of the b. organization Providing direction for staff to perform the work of the c. organization d. Retaining accountability for all work completed by the staff Planning for contingencies which may interfere with the work of e. the organization

ANS: A, B, E In the planning phase, the nurse manager will develop goals, define strategies, and plan for contingencies that may interfere with the work. The next phase of management is providing direction to staff and retaining accountability for all work completed by the staff.

PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: Management versus leadership. TOP: Differentiate between management and leadership MSC: NCLEX®: Not applicable 3. Which of the following statement by the nurse reflect transformational leaders? (Select all that apply.)

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a.

Lifelong learners

b.

Courageous change agents

c.

Slow to change

d.

Value-driven visionaries

e.

Hesitant to follow

ANS: A, B, D Transformational leaders are lifelong learners, courageous change agents, and value driven visionaries. They are not slow to change or hesitant to follow.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 214 OBJ:Describe theories of management and leadership.

TOP: Management versus leadership MSC: NCLEX®: Not applicable 4. Which of the following describes reward power used by the nurse manager? (Select all that apply.) a. A nurse manager who uses fear of consequences to motivate staff b. A nurse manager who uses salary increases to motivate staff

NURSINGTB.COM A nurse manager who is perceived as an expert due to specialized c. knowledge d. A nurse manager who is well liked by the majority of staff A nurse manager who has information that others need to perform e. their jobs

ANS: A, B Reward power occurs when nurse managers provide or withhold rewards. A nurse manager who is perceived as an expert has expert power. A nurse manager who is well liked the majority of staff has referent power. A nurse manager who has information needed by others to perform their jobs has informative power.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ:Differentiate the concepts of power and authority.

TOP: Power and authority in nursing management MSC: NCLEX®: Not applicable MATCHING Match the leadership theory with the appropriate description.

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Development of trust in relationship; uses democratic concepts of management and views the tasks to be accomplished from the a. standpoint of a team member Holds power and control over followers by providing incentives when the followers respond in a positive way to the leader’s vision b. and the actions needed to reach that vision Situation is analyzed and leadership style is selected that will best c. address issues Process in which leader and followers work together in a way that changes or transforms the organization, the employees or d. followers, and the leader e. Leadership is flexible enough to address varying situations

f.

Needs to look at systems, such as those in health care organizations, as patterns of relationships and the interactions that occur among those in the system

1. Complexity theory 2. Transformational leadership 3. Contingency leadership 4. Transactional leadership NURSINGTB.COM

5. Situational leadership 6. Interactional leadership 1.ANS:FPTS:1DIF:Cognitive Level: Application REF: p. 216 OBJ: Discuss theories of management and leadership.

TOP: Nursing management MSC: NCLEX®: Not applicable 2.ANS:DPTS:1DIF:Cognitive Level: Application REF: pp. 214-215 OBJ: Discuss theories of management and leadership.

TOP: Nursing management MSC: NCLEX®: Not applicable 3.ANS:EPTS:1DIF:Cognitive Level: Application REF: p. 213 OBJ: Discuss theories of management and leadership.

TOP: Nursing management MSC: NCLEX®: Not applicable 4.ANS:BPTS:1DIF:Cognitive Level: Application

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REF: pp. 214-215 OBJ: Discuss theories of management and leadership.

TOP: Nursing management MSC: NCLEX®: Not applicable 5.ANS:CPTS:1DIF:Cognitive Level: Application REF: pp. 213-214 OBJ: Discuss theories of management and leadership.

TOP: Nursing management MSC: NCLEX®: Not applicable 6.ANS:APTS:1DIF:Cognitive Level: Application REF: p. 214 OBJ: Discuss theories of management and leadership.

TOP: Nursing management MSC: NCLEX®: Not applicable

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Chapter 11: Building Nursing Management Skills MULTIPLE CHOICE 1. During clinical experience, the student nurse is assigned a patient scheduled to undergo numerous treatments. The student decides it is not possible to complete all the needed treatments in the time scheduled for this clinical day. The student nurse consults with the clinical instructor to a.

delegate.

c.

procrastinate.

b.

prioritize.

d.

do the easiest treatment first.

ANS: B Plan your care of a patient who requires multiple treatments or complex nursing care by determining the priority of the patient’s problems or needs so that you can provide care to the patient’s highest priority needs first. Delegation would not be the most logical or appropriate choice as the student is not working over anyone.

It is not always wise to do the easiest treatment first because difficult treatments may have unexpected outcomes that may challenge time management. Procrastination is never a good approach in managing patient care.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 249 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.

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TOP:Nursing time management in clinical

MSC: NCLEX®: Safe and effective care environment—management of care 2. The instructor has suggested that the student nurse could improve organizational skills and manage time better by scheduling selected nursing activities in the daily assignment. Which activity should be scheduled? a.

Suctioning the tracheostomy tube of a patient

b.

Administering medications

c.

Assessing patient knowledge of colostomy care

d.

Assisting a patient with personal hygiene

ANS: B Medications are the most time sensitive issues in nursing care delivery. Scheduling is predetermined by the physician’s order. Assessment of a patient’s understanding of colostomy care can be done at any time.

Personal hygiene needs can be met around non–time-sensitive issues (medications, treatments) in managing the patient care. Suctioning a tracheostomy should be performed when the patient needs it; it is not scheduled.

PTS: 1 DIF: Cognitive Level: Application REF: p. 249 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.

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TOP:Time management in clinical MSC: NCLEX®: Safe and effective care environment—management of care 3. A nurse is assigned to care for five patients. The nurse is concerned about the ability to care for this many patients. The nurse needs to a. delegate one of the patients to someone else. prioritize the needs of the patients and determine the sickest b. patient. c. procrastinate and hope that someone will offer assistance. d. do the easiest patients first to allow more time for sicker patients.

ANS: B It is important to determine the least stable patient when planning care for multiple patients. Plan and complete the care for the patient who requires multiple treatments or complex nursing care. This patient is most likely to experience physiological problems if the nurse does not address his or her needs. The others are cared for in the priority order determined by their stability and needs. Procrastination and caring for the easiest patient first are not reflective of assessing patient needs and administering patient care management effectively.

PTS: 1 DIF: Cognitive Level: Application REF: p. 249 NURSINGTB.COM

OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. | Identify time-management strategies for increasing high-payoff, high-priority activities.

TOP:Time management in clinical MSC: NCLEX®: Safe and effective care environment—management of care 4. Which statement by the nurse manager shows understanding of what initiated the development of the team Strategies and Tools to Enhance Performance and Patient Safety (STEPPS)? a. “The increased need for health care coverage” b. “The need for more qualified nurses” “A need for a teamwork system focused on improving c. communication and teamwork” d. “The increased cost of health care”

ANS: C The Department of Defense (DoD) Patient Safety Program, in collaboration with the Agency for Healthcare Research and Quality (AHRQ), developed an evidence-based teamwork system focused on improving communication and teamwork skills in the health care industry to improve patient outcomes. The team was not created to solve health care coverage concerns, search for more qualified nurses or to decrease the cost of health care. The Joint Commission accredits hospitals and health care agencies. The Institute of Medicine

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provides national advice on issues relating to biomedical science, medicine, and health, and its mission to serve as adviser to the nation to improve health. The Centers for Medicare is not about patient safety but about medical insurance for people older than the age of 65 years.

PTS: 1 DIF: Cognitive Level: Application REF: p. 238 OBJ:Discuss Team STEPPS Tools as an evidence-based teamwork system to optimize patient outcomes.TOP:Patient management MSC: NCLEX®: Safe and effective care environment—management of care 5. The nurse manager is updating unit staff on findings by The Joint Commission. Which of the following statements shows an understanding of untoward events in the hospital setting? The primary cause of untoward events is a.

“unclear, ineffective communication.”

b.

“unclear chain of communication for reporting.”

c.

“ineffective reporting of the untoward event.”

d.

“lack of consistent supervision of nursing staff.”

ANS: A Ineffective communication was identified as the root cause for nearly 70% of all sentinel events reported. The NURSINGTB.COM majority of those untoward events involved communication failure. The other options were not identified as the majority of all sentinel events.

PTS: 1 DIF: Cognitive Level: Application REF: p. 238 OBJ:Analyze effective communication as it relates to patient safety.

TOP:Communication MSC: NCLEX®: Safe and effective care environment—management of care 6. The nurse is receiving a phone order from a health care provider. How will the nurse make sure that the provider’s order is received without error?

Advise the health care provider that the order must be written on a. the chart within the next 24 hours. b. Ask the nurse in charge to come to the phone to take the order.

Write the order without using any unclear or unapproved c. abbreviations.

Repeat the order, write the order verbatim, and read it back to the d. provider.

ANS: D

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Repeat the order, write the order verbatim, and read it back to the provider are the steps recommended to confirm that the order was understood correctly, as well as communicated correctly. The question is in regard to the receiving of the order, not specifically how it is written. The nurse will write the phone order on the chart, and later the health care provider will co-sign the order. The charge nurse does not have to take the phone order; any licensed nurse can take the phone order.

PTS: 1 DIF: Cognitive Level: Application REF: p. 239 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. | Identify current methods of transcribing physician’s orders. TOP: Communication MSC: NCLEX®: Safe and effective care environment—management of care 7. The nurse receives report on an assigned group of patients. Which patient would the nurse assess first? a. A patient 2 days postoperative who is complaining of pain An older adult patient reported to have increasing lethargy and b. confusion A newly admitted patient with a serum blood urea nitrogen (BUN) c. of 32 mg/dL d. A hypertensive patient complaining of severe midsternum pain

ANS: D NURSINGTB.COM

The patient with chest pain is at greatest risk of experiencing urgent problems and needs to be evaluated immediately. This does not mean that the nurse will not address the needs of the other patients, but the safety of the hypertensive patient is at risk if the nurse does not see him first.

PTS: 1 DIF: Cognitive Level: Application REF: p. 249 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.

TOP:Patient management MSC: NCLEX®: Safe and effective care environment—management of care 8. What are critical points to communicate during a shift report or hand-off communication?

Patient name, current physical status, activities that have contributed to current status, problems that have occurred during the shift, nursing care to address problems, and a readback or a. response Patient name, room number and date of birth, changes in current orders, provider’s visits, laboratory tests that have been completed, b. and physical activity of the patient Patient name, health care provider, diagnosis, review of all current orders, family visits and involvement in care, review of history c. leading to hospitalization, and current status of the patient

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Physician orders for past 24 hours, patient name and date of birth, medical and social history prior to hospitalization, and review of d. health problems since hospitalization

ANS: A According to the I-SBAR-R tool—Identification (patient name), Situation (current physical status), Background (activities that contributed to current status), Assessment (problems that occurred during shift), Recommendation (nursing care to address problems), Readback or Response (receiver acknowledges information)—these are critical areas. All of the other options contain items that are not critical to a shift report.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 243-244 OBJ:Utilize a standardized hand-off communication tool (I-SBAR-R) for receiving and giving change-of shiftreport.TOP:Communication MSC: NCLEX®: Safe and effective care environment—management of care 9. The charge nurse is assigning patient care activities to the nursing care team. In supervising the team, what is the most effective activity to determine that the nursing care has been completed satisfactorily?

Have hourly checks with personnel to determine how effectively a. nursing care is being completed.

NURSINGTB.COM Review with personnel at the end of the shift regarding the status of b. patients and how care was delivered.

Discuss with each person the status of their assigned patients and c. what type of nursing care each will require.

Schedule routine patient care rounds to evaluate the patients and d. the nursing care that has been completed.

ANS: A Supervision entails providing direction, evaluation, and follow-up by the nurse regarding the nursing care assigned. The only way the nurse can determine whether the care has been done satisfactorily is to monitor the task (hourly checks with personnel) and evaluate the patient. Waiting until the end of the shift could lead to problems not being assessed early to prevent complications. Discussing with the health care provider about the patient is a good practice, but determining the outcome of the care is what needs to be evaluated not just telling them what type of care is required. Scheduling rounds allows the nurse to evaluate the patient; however, communication with the nursing team is important to determine if care is administered satisfactorily.

PTS: 1 DIF: Cognitive Level: Application REF: p. 253 OBJ: Identify criteria for supervising and evaluating care provided by others.

TOP: Supervision MSC: NCLEX®: Safe and effective care environment—management of care 10. What would be a good assignment for an experienced nursing assistant?

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Help teach patients newly diagnosed with diabetes to give a. themselves injections.

Report on the quality and quantity of urine on a continuous bladder b. irrigation. c. Obtain a clean-catch urine specimen from a patient. d. Chart a diet for a patient with an eating disorder.

ANS: C The nursing assistant can be assigned activities that involve standard, unchanging procedures such as helping to obtain a clean-catch urine specimen from a patient. Charting, teaching, and assessing are not assigned to the nursing assistant.

PTS: 1 DIF: Cognitive Level: Application REF: p. 252 OBJ: Identify criteria for supervising and evaluating care provided by others.

TOP: Supervision MSC: NCLEX®: Safe and effective care environment—management of care 11. The nurse calls a physician to come to the unit to assess a patient. Which of the following is the most effective telephone communication by the nurse?

“This is the 4100 unit troublemaker again. You probably ought to NURSINGTB.COM come to the unit to see Mr. Samuels. His condition doesn’t seem a. right.”

“This is Ann Allen on 4100. I don’t quite know what to think about Mr. Samuels. I think his condition is deteriorating, and I’d like to b. have you see him.”

“Sorry to bother you. This may not be important, but I’m not completely comfortable with Mr. Samuel’s response to care. His c. blood pressure has dropped, and his pulse is elevated.”

“This is Sheila Ryan on 4100 calling regarding your patient, Mr. Samuels. His BP has dropped from 130/90 at 8 am to 100/70 at 10 am. His pulse has risen from 80 to 100, and he seems restless. He d. received his 8 am Cardizem.”

ANS: D A detailed, objective response is effective when communicating not only in person but also by telephone. Try organizing your conversation in the I-SBAR-R communication format. The other responses are subjective in nature with no descriptive assessment data to provide to the physician.

PTS: 1 DIF: Cognitive Level: Application REF: p. 247 OBJ:Analyze effective communication as it relates to patient safety.

TOP: Effective communication MSC: NCLEX®: Not applicable

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12. A nurse is working on a busy orthopedic floor and is on the phone with the floor manager when a physician comes up and gives a verbal order for pain medications on an assigned patient. The physician then leaves the unit. Which action by the nurse would be the most appropriate? a. Write down the order and administer the medication.

Put the nurse manager on hold and ask the physician to write the b. order.

Ignore the physician and continue the conversation with the nurse c. manager. d. Write down the order and document it as a telephone order.

ANS: B The most appropriate action would be for the nurse to put the nurse manager on hold and ask the physician to write the order. The Joint Commission states that there is a big difference between verbal and telephone orders.

Verbal orders should never be accepted unless there is an emergency or the physician is in a sterile environment because there is too much opportunity for a transcribing error.

PTS: 1 DIF: Cognitive Level: Application REF: p. 242 OBJ:Analyze effective communication as it relates to patient safety.

TOP: Communication and patient safety MSC: NCLEX®: Safe and effective care environment NURSINGTB.COM

13. The nurse is reviewing I-SBAR-R with a coworker at the end of the shift. Which statement indicates that they are discussing the Situation component? a. The nurse states the patient’s name using two identifiers.

The nurse states that the patient was hospitalized for a broken tibia b. and that surgery is scheduled for later today. c. The oncoming nurse acknowledges the info that has been received. d. The nurse states an opinion on what is happening with the patient.

ANS: B In the Situation component of I-SBAR-R, the nurse states what is going on with the patient. In this situation, the patient was hospitalized with a broken tibia, and surgery is planned for later today. The Identification component involves stating the patient’s name, the Assessment component involves the nurse discussing what the nurse thinks is happening with the patient, and the Read-Back or Response component involves that the oncoming nurse repeating what the nurse has heard from the nurse who is reporting at the end of the shift.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 244 OBJ: Utilize a standardized hand-off communication tool (I-SBAR-R) for receiving and giving change-of shift-report. TOP: Communication and patient safety

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MSC: NCLEX®: Safe and effective care environment 14. A nurse has received report on assigned patients and is prioritizing their care. Which of the following patients should the nurse assess first? a. A female patient who is complaining of a headache A patient who has just returned from surgery and has saturated his b. dressing c. A patient with a femur fracture that is requesting pain medications d. A male patient who needs to use the bathroom

ANS: B The nurse should assess patients using Maslow’s hierarchy of needs or the ABCD system. In the situation, the patient who has saturated his postoperative dressing should be seen first because an issue with the circulatory system makes the patient a priority over the others.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 249-250 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.

TOP:Managing time in the clinical setting NURSINGTB.COM

MSC: NCLEX®: Safe and effective care environment

15. A nurse has been assigned the following patients. Which patient is a priority to assess first? a.

A patient with abdominal pain

b.

A patient who has been NPO all morning and wants to eat

c.

A patient with pneumonia and O2 saturation of 88%

d.

A patient complaining of ear pain

ANS: C Using Maslow’s hierarchy of needs or the ABCD system, the nurse should see the patient with pneumonia and low O2 saturation first. Issues involving the airway are a priority, and these patients must be seen first. Next, the nurse should see the patient with abdominal pain followed by the patient with ear pain and then the patient who is NPO and wants to eat.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 249-250 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.

TOP:Managing time in the clinical setting

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MSC: NCLEX®: Safe and effective care environment 16. The nurse wants to anticipate patient needs in order to increase patient satisfaction and decrease the use of call bells in the assigned section. What actions can be taken to achieve this? a. Tell patients to turn on their call bells if they need something. b. Perform hourly rounding on each patient. c. Check on the patient every 2 to 3 hours.

Check on the patient only when medication needs to be d. administered.

ANS: B Performing hourly rounding encourages the nurse to anticipate the patient’s needs, thereby increasing patient satisfaction and decreasing call bell usage. Although checking on the patients every 2 to 3 hours is appropriate, it is not the best answer because hourly rounding provides increased patient satisfaction and reduction of call bells. The nurse needs to check more frequently on the patient rather than wait until the nurse sees the patient when medications are administered.

PTS: 1 DIF: Cognitive Level: Application REF: p. 250 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.

TOP:Managing time in the clinical setting

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MSC: NCLEX®: Safe and effective care environment 17. The charge nurse is determining which activities to delegate to the nursing assistant. Which of the following would not be appropriate for the charge nurse to delegate to the nursing assistant? a.

Changing soiled linen

b.

Taking a blood pressure on someone receiving blood

c.

Removing a urinary catheter

d.

Assessing a patient’s lung sounds

ANS: D When delegating care, the charge nurse must remember that she cannot delegate nursing judgment. Therefore, in this scenario, the nurse cannot delegate the task of assessing lung sounds. This is a task that must be performed by the nurse. Taking blood pressures, removing a urinary catheter, and changing bed linens are all activities that can be delegated.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 251-252 OBJ: Identify criteria for supervising and delegating care provided by others.

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TOP: Managing others MSC: NCLEX®: Safe and effective care environment 18. A nurse is working with a nurse aide to care for a group of patients. Which of the following activities would be inappropriate to delegate to the nurse aide? a.

Providing discharge instructions to a patient

b.

Refilling water containers

c.

Obtaining a lift to help a patient out of a chair

d.

Feeding a patient who is unable to feed himself

ANS: A It is the nurse’s responsibility to provide discharge instructions to patients and to assess their understanding of them. This task cannot be delegated to the nursing assistant. Refilling water containers, obtaining a lift to help a patient out of a chair, and feeding patients are all tasks that can be delegated to the nursing assistant.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 251-252 OBJ: Identify criteria for supervising and delegating care provided by others.

TOP: Managing others MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE

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1. A nurse is working on a medical-surgical unit and receives phone call from a physician who would like to give orders for a new patient. What should the nurse do to make the telephone order safer for the patient? (Select all that apply.)

Refuse to accept the telephone order and request that the physician a. come to the unit to write the order. b. Accept the order and perform a “read back.” c. Write down the telephone order as it is being given. d. Accept the telephone order, but write it down later. e. Ask another nurse to accept the telephone order.

ANS: B, C The nurse should accept the order, write it down and perform a read back. According to the Institute for Healthcare Improvement (2005), 50% of all medication errors have been directly attributed to the failure to communicate information at the point of transition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 247 OBJ:Analyze effective communication as it relates to patient safety.

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TOP: Communication and patient safety MSC: NCLEX®: Safe and effective care environment 2. A nurse is discharging a patient who primarily speaks German. Which action(s) should the nurse take to communicate effectively with the patient? (Select all that apply.)

Contact interpreter services to interpret discharge instructions to a. the patient.

Provide discharge instructions for the patient that are written in b. German.

Ask the patient to repeat the discharge instructions back to the c. interpreter as he understands them.

Forego the interpreter because you are just showing him how to d. change a dressing. e. Give the patient discharge instructions that are written in English.

ANS: A, B, C The nurse should contact interpreter services and request a German-speaking interpreter. The nurse should provide all discharge instructions with the help of the interpreter and ask the patient to repeat back what he has heard. By using a Team STEPPS strategy “check back,” the nurse can ensure that the patient understands the discharge instructions what he needs to do for himself when he leaves.

PTS: 1 DIF: Cognitive Level: Application REF: p. 240

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OBJ:Discuss Team STEPPS Tools as an evidence-based teamwork system to optimize patient outcomes.TOP:Communication and patient safety MSC: NCLEX®: Safe and effective care environment 3. A nurse has received an abnormal result on a critical test for an assigned patient. The nurse has been trying to reach the resident for 20 minutes but has been unsuccessful. What should be done to ensure the best care for the patient? (Select all that apply.)

Page the resident once and document this in the chart; he will make a. rounds soon. b. Page the attending physician.

Continue to provide care for the patient and document all actions in c. the medical record.

Wait until the resident makes rounds to review the test results with d. him.

Begin treating the patient for the test result because the nurse e. knows what the resident will likely order.

ANS: B, C

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Upon receiving the critical test result, the nurse should page the resident. The nurse should document all attempts to reach the resident and all care provided to the patient. If the resident does not call the nurse back, the nurse should page the attending physician to ensure adequate care for the patient. The nurse should not withhold the test results until the resident makes rounds or begin treating the patient without a physician’s order.

PTS: 1 DIF: Cognitive Level: Application REF: p. 243 OBJ:Analyze effective communication as it relates to patient safety.

TOP:Communicating when it is critical—what do you need to do?

MSC: NCLEX®: Safe and effective care environment 4. Which action(s) can the nurse take during report to ensure patient safety? (Select all that apply.) a. Give report at the bedside.

Give report while the nurse is finishing up charting on another b. patient, so that the new nurse doesn’t have to wait. c. Use I-SBAR-R during shift change report. d. Focus on giving report, not on answering telephones. e. Be prepared for report.

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ANS: A, C, D, E To ensure patient safety during change of shift the nurse should be prepared, give report at the bedside if possible, use I-SBAR-R, and focus on giving report and not on other distractions such as answering the telephone. The nurse should not multitask because this increases the incidence of errors.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 245-246 OBJ: Utilize a standardized hand-off communication tool (I-SBAR-R) for receiving and giving change-of shift-report. TOP: Communication and patient safety MSC: NCLEX®: Safe and effective care environment 5. A new nurse understands that organization is key to providing safe, effective care. Which of the following actions would help to achieve this? (Select all that apply.) a.

Memorize her assignment and patient reports.

b.

Create a work organization sheet.

c.

Keep info about each patient on separate sheets of paper.

d.

Write down all pertinent patient info.

e.

Minimize distractions during report.

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ANS: B, D, E To provide safe, effective care, the nurse should create a work organization sheet and write down all pertinent information regarding the patient, and minimize distractions during report. The nurse should keep all information on one sheet, so that the information does not get lost. It is unrealistic to memorize assignment and patient reports. Having patient information on separate sheets of paper can become overwhelming and is not effective work organization.

PTS: 1 DIF: Cognitive Level: Application REF: p. 249 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting.

TOP:Managing time in the clinical setting MSC: NCLEX®: Safe and effective care environment 6. A nurse has noticed that a coworker consistently has a negative attitude, criticizes others, and even shows aggression toward other members of the healthcare team. Which action(s) by the nurse would help to limit time with this individual? (Select all that apply.) a. Try to help the coworker deal with personal problems during work. b. Steer clear of the coworker. c. Use assertive communication. d. Learn to say “no.”

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e. Set clear boundaries with the coworker.

ANS: B, C, D, E To limit time with this coworker, the nurse should steer clear of this coworker, use assertive communication, learn to say “no,” and set clear boundaries. It would not be appropriate to help the coworker deal with personal problems during work.

PTS: 1 DIF: Cognitive Level: Application REF: p. 251 OBJ: Identify criteria for supervising and delegating care provided by others.

TOP: Managing others MSC: NCLEX®: Safe and effective care environment 7. The nurse manager is in charge of a busy nursing unit. Today the nurse manager is planning to evaluate the work of nurses on the unit. Which of the following actions would help complete this task in an effective manner? (Select all that apply.) a. Provide feedback as necessary to staff.

Verify the tasks are being performed according to standards of b. practice. c. Allow nurses to complete all tasks, even if performed incorrectly.

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Provide directions with clear expectations of how the task is to be d. performed. e. Evaluate the performance of the task by the staff.

ANS: A, B, D, E The nurse manager should provide directions with clear expectations, intervene if the task is being performed incorrectly, verify that the tasks are being performed according to standards of practice, evaluate the performance of the task, and provide feedback as necessary. Following these steps will help the nurse manager effectively evaluate staff.

PTS: 1 DIF: Cognitive Level: Application REF: p. 253 OBJ: Identify criteria for supervising and delegating care provided by others.

TOP:Managing time in the clinical setting MSC: NCLEX®: Safe and effective care environment

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Chapter 12: Effective Communication and Team Building MULTIPLE CHOICE 1. Which action shows the cyclical phase of forming? a.

A group dissolving

b.

Individuals coming together with a common bond

c.

Developing mutual goals

d.

A group completing tasks together

ANS: B Forming is the beginning development of a group with well-defined reasons and common directions. In the storming phase, the nurse begins to act out the roles they normally portrays in the presence of peers. Norming occurs during the development of mutual goals and guidelines that help to redefine the nurse’s behavioral roles in the group. During the performing phase, everyone knows one another, is able to work together, and trusts one another.

PTS: 1 DIF: Cognitive Level: Application REF: p. 269 OBJ: Identify different types of groups and group process. TOP: Group process NURSINGTB.COM

MSC: NCLEX®: Not applicable

2. The clinical instructor interprets the development of mutual goals and guidelines as a.

norming.

c.

storming.

b.

performing.

d.

informing.

ANS: A Norming begins with the development of guidelines and mutual goals. Successful task completion helps to redefine individual behavioral roles in the group. In the performing phase, everyone knows each other, and the group makes changes in a seamless way. The storming phase involves acting out roles normally portrayed in the presence of peers. Informing is not a phase in the group process.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 271 OBJ: Identify different types of groups and group process. TOP: Group process MSC: NCLEX®: Not applicable 3. A member of a nursing committee frequently disregards the rules of the group and feels that the rules do not apply to the member personally. The president of the committee recognizes the term that best describe this person

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a.

critical conservative.

c.

self-server.

b.

motor mouth.

d.

mouse.

ANS: C Self-servers are not willing to serve as a functioning part of the group, although they may appear to be group members when they perceive a personal benefit by the interaction. The critical conservatives typically have criticism for any suggestion other than their own. Motor mouths often interrupt others to get their points across. The mouse is known as a silent observer.

PTS: 1 DIF: Cognitive Level: Application REF: p. 272 OBJ:Analyze group member roles.TOP:Team building MSC: NCLEX®: Not applicable 4. Which term refers to the group member who watches others take the risks and responsibility for group input and agrees with everyone in the group? a.

Mouse

c.

Self-server

b.

Motor mouth

d.

Know-it-all

ANS: A

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The mouse is less confident of his or her abilities and is therefore less aggressive in the group dynamics. The motor mouth often interrupts others to get his or her point across. The self-server does not serve as a functional part of the group unless there is a benefit to them. The know-it-all is not a term used to describe group members.

PTS: 1 DIF: Cognitive Level: Application REF: p. 272 OBJ:Analyze group member roles.TOP:Team building MSC: NCLEX®: Not applicable 5. A graduate nurse is observing nurses on a busy surgical unit. The graduate nurse notices that the nurses work together as an interchangeable part of the team and have an appropriate level of skills. When questioned by the charge nurse, the graduate nurse identifies this type of team as a.

potential.

c.

basic.

b.

pseudo.

d.

real.

ANS: D Each person on a real team has the skills and abilities to be goal and group oriented. Each member has the ability to work as an interchangeable part of the team and is accountable for the team’s outcomes. The other options are not types of team.

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PTS: 1 DIF: Cognitive Level: Application REF: pp. 275-276 OBJ:Discuss team building.TOP:Team building MSC: NCLEX®: Not applicable 6. In considering the overall task of the team, what issues should be considered in the care of the patient? a. Nursing care plan, religious preference, and financial base b. Physician’s orders, nursing actions, and religious preference Family needs, physician’s orders, nursing diagnosis, and religious c. preference Physician’s treatment plan, nursing plan of care, and needs of the d. patient and family

ANS: D Nurses as individuals and as team members are advocates of the patient with a focus on the best and safest delivery of quality health care.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 275-276 OBJ:Analyze group member roles.TOP:Group process

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MSC: NCLEX®: Not applicable 7. How can the “grapevine” best be controlled?

Providing factual information in anticipation of employees’ a. questions b. Using an authoritarian communication style c. Putting everything in writing d. Having a strong union to represent employees

ANS: A Providing factual information in anticipation of employees’ questions is an effective way to reduce the “grapevine.” Most employees get secondhand information, and few employees get enough of the factual information that they need. Even if information is put in writing, it is important to communicate verbally to employees by answering their questions. A strong union does not necessarily reduce the grapevine.

PTS: 1 DIF: Cognitive Level: Application REF: p. 261 OBJ: Identify effective ways of communication with other health care workers.

TOP: Effective communication MSC: NCLEX®: Not applicable

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8. The graduate nurse has an adequate understanding of effective listening when stating which of the following? a.

“Limited level of vocabulary often affects listening skills,”

b.

“Underdeveloped attention span affects listening skills.”

c.

“External noise distractions affect listening skills.”

d.

“Emotional reactions interfere with the actual message.”

ANS: D One of the most problematic reasons for ineffective listening is that people allow their emotions to dictate what they hear or do not hear. Limited vocabulary, underdeveloped attention span, and external noise distractions are not the most problematic reason for ineffective listening.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 265-266 OBJ: Identify effective ways of communication with other health care workers. | Define basic components of communication. TOP: Effective communication MSC: NCLEX®: Not applicable 9. Which of the following actions by the nurse leader is most likely to lead to an effective meeting?

NURSINGTB.COM a.

Creating an atmosphere in which people say very little

b.

Sending out an agenda ahead of time

c.

Creating well-designed overhead transparencies

d.

Completing all the tasks of the group

ANS: B It is the leader’s responsibility to send out an agenda ahead of time and to indicate any preparations members need to make or materials they need to bring. It is important to have a meeting atmosphere where people feel as though they can respond and ask questions in a cooperative and collaborative setting. It is not necessary to have well-designed handouts for the meeting or for the leader to complete all the tasks of the group because this would indicate a lack of participation from the group members.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 273-274 OBJ: Identify effective ways of communication with other health care workers.

TOP: Effective communication MSC: NCLEX®: Not applicable 10. Which action by the nurse shows a major characteristic of aggressive behavior? a.

Achievement of personal goals at the expense of others

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b.

Indirect expression of personal feelings

c.

Communication of personal needs

d.

Ability to restrict personal rights

ANS: A All of us have a style of communication that reflects our own personality and self-concept. Achievement of the nurse’s goals at the expense of others shows an aggressive behavior. Indirect expression of one’s feelings describes passive behavior. Being able to communicate one’s own needs describes an assertive behavior.

Restricting one’s own rights does not describe an assertive style of communication. Aggression is not an indirect expression of one’s feelings but a very direct expression. Aggressive communication is angry and dominating where the person attempts to humiliate or “put down” other people.

PTS: 1 DIF: Cognitive Level: Application REF: p. 279 OBJ: Describe an assertive communication style. TOP: Effective communication MSC: NCLEX®: Not applicable 11. The nurse interprets assertive behavior as a.

apologetic.

c.

direct.

b.

coercive.

d.

self-denying.

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ANS: C A person exhibiting assertive behavior would express his or her true feelings in an honest, direct manner. An assertive person’s behavior respects others and is not coercive or self-denying or self-depreciating in any manner. Assertive persons accept compliments and criticism and are not excessively apologetic but have selfrespect for their thoughts and actions.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 OBJ: Describe an assertive communication style. TOP: Effective communication MSC: NCLEX®: Not applicable 12. The nurse is using assertive communication skills to express self rights, when stating: “I shield others from my a. anger.”

“I am avoiding direct c. confrontation.”

b. “I do not compromise.”

“I am responsible for what I d. say.”

ANS: D

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When you use an assertive communication style, you send the message that you will take responsibility for the consequences of both your words and your actions. Assertive individuals often compromise and may confront people directly about issues. Assertive individuals express anger appropriately rather than shielding others or repressing the feeling. The other statements do not express an assertive communication style.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 OBJ: Describe an assertive communication style. TOP: Effective communication MSC: NCLEX®: Not applicable 13. Dr. Jones asks you to give a medication to one of the patients, and you know the patient is allergic to it.

When you point this out, Dr. Jones says, “Give the medication or I’ll report this to your supervisor.” What is the best assertive response? a. Agree to give the medication and hope no one finds out.

Say, “I won’t give the medication, and I don’t care who you talk to b. about it.” c. Walk away and ignore Dr. Jones.

Say, “Perhaps you and I could talk this over with my supervisor d. together.”

ANS: D NURSINGTB.COM

Expressing to the physician that both of you should discuss the issue with the supervisor is an assertive response. As nurses gain experience, their judgment improves, and they are able to recognize ways to communicate needs and feelings with the goal of improving the processes and procedures used in the work setting. The patient’s safety always comes first, so you would not go ahead and give the medication. When you walk away and ignore the comment, you are denying the feelings and not dealing assertively with the situation.

Not giving the medication and stating that you don’t care who the physician talks to about the issue is a threatening, aggressive response.

PTS: 1 DIF: Cognitive Level: Application REF: p. 279 OBJ: Apply effective communication skills in common nursing activities.

TOP: Effective communication MSC: NCLEX®: Not applicable 14. Your team leader reminds you that you have forgotten to complete an assigned task. What is an assertive response? a.

“Not now; I’m busy.”

b.

“You’re right. I did forget. I’ll do it now.”

c.

“It’s not my fault. You should have reminded me sooner.”

d.

“I’m so sorry I’ve disappointed you. It won’t happen again.”

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ANS: B When using assertive communication, a person would respond to criticism by acknowledging the issue and taking direct action to correct the problem. An apologetic response is not assertively taking responsibility for the forgotten task. Telling the person “you should have reminded you sooner” is placing the responsibility of the forgotten task onto another person. Telling the person you are busy is denying the issue.

PTS: 1 DIF: Cognitive Level: Application REF: p. 279 OBJ: Apply effective communication skills in common nursing activities.

TOP: Effective communication MSC: NCLEX®: Not applicable 15. Staff nurse 1: “You’re stomping around and glaring at me. I’m wondering what’s going on.” Staff nurse 2: “I’m sick of you always going to lunch first. You don’t care about anyone but yourself.” What assessment can best be made about this exchange? a. Staff nurse 1’s remark is challenging and obstructive.

Staff nurse 1’s remark invites clarification of the meaning of the b. specific behaviors of staff nurse 2. c. Staff nurse 2’s remark will facilitate effective problem solving.

Staff nurse 2’s remark will keep anger at a minimum and give d. incentive for meeting the other’s needs.

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ANS: B Nurse 1 was assertive in her approach by giving direct descriptive feedback reflecting nurse 2’s actions with a question seeking information to explain nurse 2’s actions. Asking about what is going on allows nurse 2 to make some comment about what is bothering her. Nurse 2’s comment does not promote effective problem solving as it is judgmental (You don’t care about anyone but yourself.).

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 OBJ: Apply effective communication skills in common nursing activities.

TOP: Effective communication MSC: NCLEX®: Not applicable 16. A nurse is meeting with the nurse supervisor to discuss an issue with a coworker. Which of the following statements would help the nurse effectively communicate with the supervisor? a. “This is all my coworker’s fault. I never do anything wrong.” b. “My coworker always makes 100 excuses to get out of work.” c. “I knew you would be on their side.” d. “I feel upset that my coworker seems to have less work than I do.”

ANS: D

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When communicating with a nurse supervisor, the nurse should avoid blaming others and exaggeration. The nurse should instead focus on using “I” statements to express themself.

PTS: 1 DIF: Cognitive Level: Application REF: p. 279 OBJ:Describe the basic components of communication.

TOP: Communication in the workplace MSC: NCLEX®: Safe and effective care environment 17. Which statement made the by the nurse indicates understanding of how to control the grapevine? a.

“Grapevine rumors are generally true.”

b.

“Avoid face-to-face communication.”

c.

“Avoid spreading rumors.”

d.

“Keep rumors circulating.”

ANS: C To control the grapevine, the nurse should avoid spreading rumors. The nurse should also promote face-to-face communication, obtain information from the source, and stop the circulating of rumors by not engaging in gossip.

PTS: 1 DIF: Cognitive Level: Analysis REF: p.

261 NURSINGTB.COM OBJ: Identify effective ways of communication with other health care workers.

TOP:What does my image communicate to others?

MSC: NCLEX®: Safe and effective care environment 18. A nurse is caring for a Latino patient. The nurse is aware of the importance of cultural competency and providing the patient with culturally competent care. What can be done to enhance communication with this patient? a.

Use jargon or slang.

b.

Obtain an interpreter if needed.

c.

Give longer explanations to enhance understanding.

d.

Speak loudly to the patient.

ANS: B To communicate effectively with this patient, the nurse may need to obtain an interpreter. The nurse should also avoid jargon or slang, give shorter explanations, and speak in a normal volume and tone to the patient.

PTS: 1 DIF: Cognitive Level: Application REF: p. 262

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OBJ: Apply effective communication skills in common nursing activities.

TOP:What does my image communicate to others?

MSC: NCLEX®: Psychosocial integrity 19. A nurse manager is educating staff on how to give effective presentations. Which statement indicates an understanding of this?

“To give an effective presentation, you should always maintain a a. positive attitude.”

“You should avoid planning and should create the presentation as b. you go.” c. “Give the same presentation regardless of the audience.” d. “To reduce anxiety, avoid making eye contact with the audience.”

ANS: A To give an effective presentation the nurse should always maintain a positive attitude, plan the presentation ahead of time, spice up the presentation and make changes according to the audience, and make eye contact.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 264-265 NURSINGTB.COM

OBJ: Apply effective communication skills in common nursing activities.

TOP: Components of effective communication MSC: NCLEX®: Not applicable 20. Which statement would be most appropriate for the nurse to make when practicing assertive behavior? a. “I feel upset when Dr. Smith yells at me in front of my patients.”

“I can’t believe what a jerk Dr. Smith is; the doctor should be b. fired!” c. “Dr. Smith was right in her action.” d. “I am reporting Dr. Smith to the medical director.”

ANS: A The nurse practicing assertive behavior would state: “I feel upset when Dr. Smith yells at me in front of my patients.” The statement is direct and uses “I” statements. When the nurse says, “I can’t believe what a jerk Dr. Smith is; the doctor should be fired” and “I am reporting Dr. Smith to the medical director,” the nurse is using aggressive behavior. Statements such as: “Dr. Smith was right in her action” indicate passive/avoidant behavior.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 OBJ:Describe an assertive communication style.

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TOP: Assertive styles of communication MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE 1. Which of the following actions can the nurse take to communicate with the supervisor? (Select all that apply.) a.

Keep the supervisor informed.

b.

Focus on problem solving.

c.

Use “you” statements.

d.

Calm down before speaking.

e.

Choose words wisely.

ANS: A, B, D, E To communicate openly and effectively with the nursing supervisor, the nurse should keep the supervisor informed, focus on problem solving, use “I” statements, calm down before speaking, and choose words wisely.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 257-258 OBJ:Describe the basic components of communication.

TOP: Communication in the workplace MSC:NURSINGTB.COM NCLEX®: Safe and effective care environment 2. A nurse manager is delegating a task to another nurse. Which of the following action(s) would help the manager effectively communication with the nurse? (Select all that apply.) a.

Get the full attention of the nurse.

b.

Ask the nurse to repeat back what he or she heard.

c.

Give directions to the nurse as the nurse is walking away.

d.

Give clear, simple instructions.

e.

Give instructions while multitasking.

ANS: A, B, D The nurse manager should first get the full attention of the nurse before the nurse manager begins to communicate with the nurse. The nurse manager should give clear, simple instructions and ask the nurse to repeat back what he or she heard.

PTS: 1 DIF: Cognitive Level: Application REF: p. 259 OBJ:Describe the basic components of communication.

TOP: Communication in the workplace MSC: NCLEX®: Safe and effective care environment

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3. Which actions can the nurse take to improve personal credibility? (Select all that apply.) a.

Wear well-fitting clothes.

b.

If female, wear a reasonable amount of make-up.

c.

Be as original as possible at work.

d.

Maintain a flattering, neat haircut.

e.

Maintain a reasonable weight.

ANS: A, B, D, E To improve the nurse’s credibility, the nurse should wear well-fitting clothes and a reasonable amount of make-up (if female). The nurse should maintain a flattering, neat haircut and maintain a reasonable weight.

The nurse should reserve individuality for outside of work.

PTS: 1 DIF: Cognitive Level: Application REF: p. 259 OBJ: Identify effective ways of communication with other health care workers.

TOP: What does my image communicate to others? MSC: NCLEX®: Not applicable 4. Which of the following statements about listening indicate the nurse’s adequate understanding? (Select all that apply.)

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a.

“Listening is the hearing of words.”

b. “Listening requires most of our communication time.” c.

“We pay most attention to our listening skills.”

d. “People remember 1/3 of the messages that they have heard.” e.

“Listening requires a lot of energy.”

ANS: B, D, E The nurse has an adequate understanding of listening when the nurse states: “Listening is not just the hearing of words,” “Listening requires most of our communication time,” “We pay least attention to our listening skills,” “People remember 1/3 of the messages that they have heard” and “Listening requires a lot of energy.”

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 265-266 OBJ: Apply effective communication skills in common nursing activities.

TOP:Components of effective communication MSC: NCLEX®: Safe and effective care environment

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5. A nurse notices that a coworker has been taking longer lunch breaks. The nurse is frustrated by this and wants to use assertive communicate techniques to effectively handle the situation. Which statement(s) would be the most beneficial? (Select all that apply.)

“I feel frustrated about the length of your breaks because I am a. really busy with my patient assignment today.”

“You need to stop taking such long lunch breaks while the rest of b. us pick up your slack!”

“I am willing to compromise so that we can both get the breaks and c. help that we need.”

“I am having a hard time keeping up with both of our assignments d. today.” e. “You are putting my nursing license in jeopardy.”

ANS: A, C, D To effectively communicate, the nurse should use “I” statements and compromise with her coworker.

Statements that would be the most beneficial include “I feel frustrated about the length of your breaks because I am really busy with my patient assignment today,” “I am willing to compromise so that we can both get the breaks and help that we need,” and “I am having a hard time keeping up with both of our assignments today.”

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 NURSINGTB.COM OBJ:Describe an assertive communication style.

TOP: Assertive styles of communication MSC: NCLEX®: Safe and effective care environment

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Chapter 13: Conflict Management MULTIPLE CHOICE 1. A newborn has several congenital anomalies incompatible with living beyond 1 month. The newborn cannot retain formula, and the temperature drops when the newborn is removed from the warmer. Two nurses who alternate caring for the baby argue about whether or not to attempt bottle feedings and whether the newborn should be removed from the warmer to be held. What is the origin of the conflict described? a.

Ethical values

c.

Personal goals for advancement

b.

Nursing role concerns

d.

Personality differences

ANS: A This situation depicts personal issues based on two separate sets of ethics or values regarding the newborn’s care. One nurse places value on nutritional needs and the other on the need for bonding. This conflict is not personality driven among the two nurses. The role of the nurse is to care for the newborn. They both want to care for the newborn, so they are meeting their nursing role; however, the conflict is based on an ethical issue about feeding and bonding.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict management NURSINGTB.COM MSC: NCLEX®: Safe and effective care environment—management of care

2. Of the following common areas of conflict between nurses and their patients and families, which does the nurse interpret as the most easily resolved? a.

Issues of concern about quality of care

b.

Issues surrounding treatment decisions

c.

Issues of family involvement

d.

Issues about quality of parental care

ANS: A Families typically are concerned with how well their loved one is being attended to. Conflict often arises out of concerns related to quality of care. Whereas this is something that the nurse can directly address, issues of treatment decisions, family involvement, and quality of parental care often require more discussion and intervention.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 288 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

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3. What is the best strategy for resolving the conflict in a situation in which two staff nurses request the same vacation weeks? a.

Accommodation

c.

Competition

b.

Collaboration

d.

Avoidance

ANS: B Collaboration is the strategy that involves confrontation and problem solving. Needs, feelings, and desires of both parties are considered to create a win–win outcome. Avoidance is a lose–lose strategy for conflict resolution, which is unassertive and uncooperative. Competition is a win–lose situation in which the use of force or the use of power occurs. Accommodation is the lose–win situation in which one person accommodates the other at his or her own expense but often ends up feeling resentful and angry.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 288 | p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 4. On the unit in which you work, one nurse’s aide is usually pleasant and helpful; the other is often abrasive and angry. What is the most important basic guideline to be observed by a nurse who must resolve a conflict between the two nurse’s aides?

NURSINGTB.COM a. Deal with issues, not personalities. b. Require the aides to reach a compromise. c. Weigh the consequences of each possible solution.

Encourage ventilation of anger and use humor to minimize the d. conflict.

ANS: A Dealing with the issues and not the personalities is one of seven important key behaviors in managing conflict.

Whereas issues tend to be more concrete, personalities involve emotional issues. Although weighing the consequences is one of the seven key behaviors, it does not apply to this situation which involves the behaviors of the nurse’s aides. Asking parties to compromise may not always be the best approach in resolving the conflict. Although encouraging ventilation of anger and using humor are successful approaches, it is important to always deal with the issue at hand and not the personality of the person.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 288 | p. 290 OBJ:Discuss techniques to use in dealing with difficult people.

TOP:Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

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5. One of your peers, a staff nurse, is a “potshot artist.” This nurse often makes you the butt of innuendo or teasing digs. You are fed up and decide to take action the next time it happens. What strategy should be considered as an effective way of dealing with a “sniper?” a. Clam up and allow the individual to fully ventilate her concern. b. Confront and tell the individual he or she is wrong. c. Coldly withdraw from the individual.

Obtain group confirmation or denial of criticism raised by the d. individual.

ANS: D When confronting the sniper, it is important to involve the rest of the staff to get a group consensus of denial or confirmation. Remember to always expose the sniper’s attack by saying, “That sounded like a put-down to me.” Clams tend to withdraw from the individual. Confronting the individual and telling them they are wrong is how a Sherman tank would approach the situation because they have a strong need to be right.

PTS: 1 DIF: Cognitive Level: Application REF: p. 294 OBJ:Discuss techniques to use in dealing with difficult people.

TOP:Conflict management NURSINGTB.COM

MSC: NCLEX®: Safe and effective care environment—management of care 6. A staff nurse who has worked on the unit for 6 months voices the following concerns to another nurse: “The clinical nurse leader of the unit often follows me into the supply room and stands blocking the doorway and chats. The nurse leader makes opportunities to mention my good looks, muscular physique, or strength in the context of daily work, saying things like: ‘You’re so handsome; no wonder your patients like you.’ The nurse leader frequently touches me on the arm, the shoulder, chest, or the hair, and if I’m sitting, touches my leg.

Yesterday, the nurse leader patted my arm and said, ‘You know, if we were dating, I might be able to give you lighter assignments.’ I don’t want to date the nurse leader. I just want to be left alone! What should I do?”

What is the best reply?

“Don’t be quite so honorable. Go on a date and see if you get better a. assignments.”

“Confront the nurse leader with a description of the behavior and b. state that you want the behavior to stop.”

“Go directly to the human relations office at the agency and tell c. them what you just told me.”

“Contact your lawyer and get advice ASAP in case the nurse leader d. decides to turn the tables and accuse you of advances.”

ANS: B There are two ways to deal with sexual harassment in the workplace: informally by confrontation and formally through a grievance procedure, keeping a record of all confrontations and statements in writing. The best first

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step is to confront the person directly. Then, if there is no stopping of the behavior, go to the human relations office and explain the situation. At this point, there is no need to contact a lawyer because the human relations office can handle the sexual harassment issue.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 300 OBJ: Identify situations of sexual harassment in the workplace and discuss possible solutions.

TOP:Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 7. To resolve a scheduling conflict, a nurse manager is using employment seniority. The nurse manager interprets this as a.

a win–win strategy.

c.

a lose–lose strategy.

b.

a win–lose strategy.

d.

a compromise.

ANS: B This is an example of a win–lose strategy, which underpins competition as the method of resolving the conflict. The person with the more seniority wins, and the one with the lesser seniority loses the scheduling issue. Compromise or bargaining is a modified win–lose strategy. In this instance, there is no compromise as the nurse manager uses seniority to resolve the conflict. Avoidance is a lose–lose strategy for conflict NURSINGTB.COM resolution, which is unassertive and uncooperative.

Win–win strategies involve collaboration and problem solving, which lead to cooperation and objectivity.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 289 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 8. The nurse manager is attempting to resolve an interpersonal conflict between two nurses. Which action below should be done first? a.

Determine the facts related to the situation.

b.

Schedule a meeting time for resolution.

c.

Have an accurate understanding of the problem or conflict.

d.

Have the determination to resolve the conflict.

ANS: C The first step is to make sure that the nurse manager has an accurate understanding of the problem of conflict.

The quality of the outcome of resolving a problem depends on proper recognition and identification of the problem or issue. This assessment is best addressed by determining the nature of the differences and the

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reasons for them. After this has been achieved, the next steps would be identifying the conflicting facts and developing ways to implement a plan for resolution.

PTS: 1 DIF: Cognitive Level: Application REF: p. 288 | p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 9. During a staff meeting, an upset nursing assistant tells the group that the other nursing assistants are given easier patient assignments and are always given their choice of days off. What approach by the nurse manager would be effective to resolve this conflict? a. Attempt to persuade the upset nursing assistant to calm down.

Tell the group that this type of conversation needs to be handled b. privately. c. Consider transferring the upset nursing assistant to another unit.

Acknowledge the feelings of the upset nursing assistant and make a d. plan to meet with her.

ANS: D Acknowledging the nursing assistant’s feelings is the first step in conflict resolution. This process requires NURSINGTB.COM dealing with issues, not personalities, by communicating openly, listening actively to the complaints, sorting out the issues, identifying key themes of the discussion, and weighing the consequences and options to resolve the conflict. Transferring the upset person avoids dealing with the conflict.

PTS: 1 DIF: Cognitive Level: Application REF: p. 288 | p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 10. Considering the following terms used to label different styles of handling anger—the Sherman tank, the sniper, the constant complainer, and the clam. Which of the following comments would you expect a Sherman tank to make? a.

“That sure sounded like a put-down to me.”

b.

“How dare you accuse me of not putting away the linen!”

c.

“So, you think you know everything, eh?”

d.

“Why do we always have to rotate shifts?”

ANS: B Sherman tanks attack individuals and have a strong need to prove to themselves and to others that their view of a situation is right. Their comments are abusive and abrupt and can be intimidating. Snipers take “potshots” at

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others and are not as openly aggressive as Sherman tanks. Constant complainers do just that—they complain but offer no solution. Clams also behave like their name—they clam up and refuse to respond when you need an answer or want to talk.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 292 OBJ: Discuss solutions and alternatives in dealing with anger. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 11. Which action by the nurse has a potential for creating role conflict?

Arguing that the nurse on the next shift is responsible for weighing a. a patient Failing to discuss differences with a coworker the nurse is angry b. with c. Placing the nurse’s personal achievement over that of coworkers d. Trying to change another nurse’s personality

ANS: A Arguing with another nurse about whose responsibility it is to weigh a patient is an example of a role conflict.

Failing to discuss differences is a communication conflict. Placing personal achievements about those of others NURSINGTB.COM is goal conflict. Trying to change another nurse’s personality is personality conflict.

PTS: 1 DIF: Cognitive Level: Application REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Not applicable 12. Which of the following scenarios shows an ethical conflict?

A nurse who consistently speaks poorly of another nurse for always a. being “grumpy” A nurse who has a hard time respecting ‘no codes’ on young b. patients A nurse who refuses to run a systems check on the glucometers c. because “it’s night shift’s duty” A nurse who forgets to alert family members to a change in visiting d. hours

ANS: B A nurse who has a hard time respecting “no codes” on young patients is experiencing an ethical conflict. A nurse who speaks poorly of another nurse has a personality conflict. A nurse who refuses to run controls on a

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glucometer has a role conflict. A nurse who forgets to alert family members to a change in visiting hours has a communication conflict.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment 13. A nurse is aware that an area of conflict between nurses and patient’s families is quality of parental care.

Which action would not help the nurse reduce conflict? a. Become frustrated with the parents for lack of participation in care b. Model positive parenting techniques c. Encourage parents to meet other parents d. Give out information about parenting classes

ANS: A To reduce conflict that nurse can model positive parenting techniques, encourage parents to meet other parents and give out information about parenting classes. The nurse should avoid becoming frustrated with parents because this will likely cause conflict.

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PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290

OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment 14. What can staff nurses do to reduce conflict with patients and families? a. Allow nurses to enforce what they feel comfortable with.

Keep treatment decisions between the patient and health care team b. only. c. Do not allow family to participate in patient care. d. Maintain consistency in enforcing rules and policies.

ANS: D To reduce conflict with patients and families, the nurse can maintain consistency in enforcing rules and policies. Allowing each nurse to enforce rules they are comfortable with, keeping treatment decisions between the patient and the health care team, and not allowing family to participate in care may increase conflict.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290

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OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment 15. A nurse is frustrated about being scheduled on a holiday that had been requested off, but a new nurse with less seniority was given the holiday off. Which action by the nurse shows accommodation? a. The nurse works out a schedule change with the new nurse.

The nurse doesn’t bring the issue to the attention of the new nurse b. but feels angry and frustrated. c. The nurse works the holiday while the new nurse has the day off. d. The nurse requests to have the day before the holiday off.

ANS: C Accommodation occurs when the nurse decides to work the holiday while the new nurse has the holiday off.

Collaboration occurs when the nurses work out a schedule change. Avoidance occurs when the nurse doesn’t bring the issue to the attention of the new nurse but feels angry and frustrated. Compromise occurs when the nurse requests to have the day before the holiday off.

PTS: 1 DIF: Cognitive Level: Application REF: p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict resolution NURSINGTB.COM

MSC: NCLEX®: Safe and effective care environment 16. A nurse feels angry over a patient assignment and feels that assignments always include the “bad ones.”

What is the best way to control this anger? a.

Ignore the negative feelings.

b.

Talk about other coworkers behind their backs.

c.

Face this anger and determine what is being felt.

d.

Refuse to speak to any coworkers for fear of lashing out.

ANS: C The nurse should face the anger and determine what is being felt. Ignoring angry feelings, talking about coworkers behind their backs, and ignoring others will not help to resolve the anger.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 297-300 OBJ:Discuss techniques to use in dealing with difficult people.

TOP: Dealing with difficult people MSC: NCLEX®: Safe and effective care environment

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17. Which statement by the nurse is true regarding sexual harassment? a. “Sexual harassment no longer occurs in the workplace.” b. “Sexual harassment is only caused by men.”

“The most common sexual harassment complaint is inappropriate c. remarks and touching.” d. “Nothing can be done to prove sexual harassment.”

ANS: C The most common sexual harassment complaint is inappropriate remarks and touching. The statements that “sexual harassment no longer occurs in the workplace,” “sexual harassment is only caused by men,” and “nothing can be done to prove sexual harassment” are false.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 300-302 OBJ: Identify situations of sexual harassment in the workplace and discuss possible solutions.

TOP:Sexual harassment in the workplace MSC: NCLEX®: Safe and effective care environment 18. A female nurse is experiencing sexual harassment in the workplace by a male nurse. Which action should NURSINGTB.COM this nurse take to stop the sexual harassment? a.

Ignore the comments made by the male nurse.

b.

Laugh about the comments.

c.

Tell the male nurse to stop.

d.

Begin to sexually harass the male nurse.

ANS: C The nurse should take the most direct route and tell the male nurse to stop. Ignoring the comments, laughing at them, or sexually harassing the male nurse will not stop the harassment.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 300-302 OBJ: Identify situations of sexual harassment in the workplace and discuss possible solutions.

TOP:Sexual harassment in the workplace MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE

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1. What action(s) by the staff nurse is an effective way to deal with a sexual harassment issue in the workplace? (Select all that apply.) a.

Tell the person to stop.

b.

Tell your best friend about the incident.

c.

File a formal grievance.

d.

Explain the situation to your spouse.

e.

Play along with the person and document the activities.

f.

Threaten the person with a sexual harassment lawsuit.

ANS: A, B, C, D There are two ways to deal with sexual harassment workplace conflict, informally and formally through a grievance procedure. Start with the most direct measure. Ask the person to STOP! Tell the harasser in clear terms that the behavior makes you uncomfortable and that you want it to stop immediately. In addition, put your statement in writing to the person, keeping a copy for yourself. It is also important to tell other people (e.g., family members, friends, your personal physician, your minister) that this is happening and how you are dealing with it.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 300-302 OBJ: Discuss five methods to resolve conflict.NURSINGTB.COM TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 2. Which of the following are common factors of conflict encountered in nursing? (Select all that apply.) a. Ambiguous boundaries around work responsibilities b. Unclear communication to family members about visiting hours c. Nursing assistant placing personal achievement above everything Chief of medicine demanding that the nurse/patient ratio be d. increased Consideration of 26-week termination of pregnancy by a physician e. because of mother’s health f.

Vacation schedules posted with new staff members having to work at least one day during all holidays

ANS: A, B, C, D, E, F All of these areas are potential factors that can precipitate conflict in a nursing situation—roles, communication, goals, personalities, and conflicting ethics and values.

PTS: 1 DIF: Cognitive Level: Application REF: p. 287

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OBJ: Identify common factors that lead to conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 3. What is important for the nurse manager to understand about resolving conflict in the workplace? (Select all that apply.)

Realize that most new graduates use competition as a form of a. conflict response.

Effective role socialization reduces negative conflict behaviors b. among nursing staff.

Use of collaboration to solve conflict issues is an important c. strategy to encourage.

Thinking like a nurse promotes role socialization and reduces d. conflict.

Nurse managers need to create working environments that facilitate e. professional practice. f.

High self-esteem fosters entitlement-type behavior that promotes conflict.

ANS: B, C, D, E New graduates use compromise and avoidanceNURSINGTB.COM as primary means of conflict resolution based on current research. High self-esteem is often found in empowering workplace environments where successful positive conflict resolution occurs. Effective role socialization, positive professional practice environments, using collaboration, and thinking like a nurse are noted in effective conflict resolution situations.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290 OBJ: Identify common factors that lead to conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care 4. What are some positive results that can come from conflict? (Select all that apply.)

Disturbing issues are brought out, which may lead to more serious a. conflict. b. Groups cohesiveness may increase as individuals resolve issues. c. Results of conflict can be constructive. d. Groups can learn from each other. e. Talking about issues can avert serious conflict.

ANS: B, C, D, E

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Positive aspects of conflict include group cohesiveness may increase as individuals resolve issues, results of conflict can be constructive, and groups can learn from each other and talking about issues can avert serious conflict.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 288-289 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment 5. A nurse is caring for an older adult patient when conflict regarding treatment arises between the family and the health care provider. What can the nurse do to resolve this conflict? (Select all that apply.)

Defend the health care provider’s treatment and try to explain it to a. the family.

Try to convince the family that the health care provider knows b. what is best for the patient.

Allow the family to participate in the decision-making process for c. their loved one.

Encourage the family to speak directly to the health care provider d. regarding treatments. e. Clarify the health care provider’s order with the family.

ANS: C, D, E

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The nurse should avoid defending the health care provider’s treatment and convincing the family that the health care provider knows what is best. Instead the nurse should allow the family to participate in the decision-making process, encourage the family to speak directly to the health care provider regarding treatments, and clarify orders with the family.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 288-290 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment 6. Which of the following statements by the nurse about unresolved conflict is true? (Select all that apply.) a.

“Conflict makes nursing staff more productive.”

b.

“Conflict reduces productivity among staff.”

c.

“Conflicts wastes time.”

d.

“Conflict waste energy.”

e.

“Conflict increases teamwork.”

ANS: B, C, D

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Unresolved conflict reduces productivity, decreases teamwork, and wastes time and energy. Nursing staff are not more productive with unresolved conflict, and this type of conflict does not increase team work.

PTS: 1 DIF: Cognitive Level: Application REF: p. 288 OBJ: Discuss five methods to resolve conflict. TOP: Conflict resolution MSC: NCLEX®: Safe and effective care environment 7. What actions can a nurse implement into daily practice to reduce conflict? (Select all that apply.) a.

Deal with issues and not personalities.

b.

Worry about themselves and no one else.

c.

Communicate openly.

d.

Listen actively.

e.

Sort out issues.

ANS: A, C, D, E To reduce conflict, nurses can implement the following actions into their daily practice: deal with issues and not personalities, communicate openly, listen actively, and sort out issues.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290

OBJ: Discuss five methods to resolve conflict. TOP: Conflict resolution MSC: NCLEX®: Safe and effective care

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Chapter 14: Delegation in the Clinical Setting MULTIPLE CHOICE 1. Which task could a staff nurse delegate to a certified nursing assistant (CNA)? a.

Evaluating a patient’s response to pain

b.

Making rounds with a physician

c.

Feeding a stroke patient who has minimal dysphagia

d.

Assessing a patient’s central venous line site

ANS: C Feeding a stroke patient who has minimal dysphagia is an appropriate delegation of a nursing intervention to a CNA. The majority of state boards have addressed the issue of delegation and have developed rules that offer specific guidelines regarding who can do what. The scope of practice for each level of care provider usually includes a description of the tasks that may be performed at that level. The nurse cannot delegate the task of assessing the patient or making rounds with the physician to the CNA. Nursing interventions such as assessment and evaluation of pain, management of central line sites, or performing tracheotomy or colostomy care are within the scope of professional nursing, as is making rounds with a physician.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-310 NURSINGTB.COM

OBJ: Select the right person for the task. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 2. The nurse has just given a patient a narcotic for pain relief. Because the nurse must leave the unit for lunch and a 1-hour meeting, the task of evaluating the patient’s response to the pain medication must be delegated.

To whom should the nurse delegate this responsibility? a.

Nursing assistant

c.

Licensed practical nurse

b.

Student nurse

d.

Nurse manager

ANS: D Evaluating the patient’s response to pain medication is an activity within the scope of the registered professional nurse (who in this situation is the nurse manager). Many states are very specific in their description of what cannot be delegated and belongs only to the nurse’s scope of practice. The licensed practical nurse can administer the pain medication. The student nurse could assist the professional nurse in the evaluation of the patient’s response to the pain medication; however, the nurse leaving the unit cannot delegate this responsibility to a student. This nursing intervention is outside the scope of practice of the nursing assistant.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 311 OBJ: Select the right person for the task. TOP: Delegation in the clinical setting

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MSC: NCLEX®: Safe and effective care environment—management of care 3. The nurse has a full assignment. The charge nurse adds a newly admitted patient who will require close monitoring. Which task can the nurse delegate to the CNA who is co-assigned to the same patients? a. Teaching Mr. Z insulin self-administration b. Updating Mrs. W’s care plan Evaluating goal attainment for Mr. Y, who is learning to walk with c. a below-the-knee prosthesis d. Bathing Miss X, an unconscious patient

ANS: D Bathing a patient is an appropriate nursing intervention within the role and responsibilities and scope of practice of the CNA. The nurse must determine what needs to be done and then identify whether this is a task that can be delegated to someone else. The role of the nurse involves the coordination and planning of care, with the primary focus on identifying with the patient and the physician the desired outcomes for the patients.

Teaching clients, updating nursing care plans, and evaluating patient responses to treatment plans are within the scope of practice of the registered professional nurse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 310 OBJ:Delegate tasks successfully based on outcomes.

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TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 4. Based on the goal of making optimal use of the level of preparation of the licensed practical nurse (LPN), which task should the nurse (RN) delegate to the LPN? a.

Assisting with a lumbar puncture

b.

Transporting a patient to the radiology department

c.

Restocking the sterile supplies

d.

Distributing afternoon nutrition supplements

ANS: A Assisting with procedure, such as a lumbar puncture, is within the scope of practice of the LPN. The nurse must select the right task for a competent person in a selected situation. Transporting clients, restocking supplies, and passing nutrition supplement are nursing interventions that can be carried out by a certified nursing assistant (CNA).

PTS: 1 DIF: Cognitive Level: Application REF: p. 310 OBJ: Select the right person for the task. TOP: Delegation in the clinical setting

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MSC: NCLEX®: Safe and effective care environment—management of care 5. There is a temporary agency registered nurse assigned to the nursing unit. You have no knowledge of this nurse’s skills, and you want to assign the nurse to a patient who has a fresh tracheostomy. How should you handle this situation?

Assign the nurse to the patient with the tracheostomy and hope for a. the best.

Ask the nurse about his or her competency to care for the patient b. with the tracheostomy.

Assign the patient to another nurse and use the temporary agency c. nurse to do simple care tasks.

Call the agency and ask for a nurse skilled in the care of a patient d. with a tracheostomy.

ANS: B Float and temporary nurses should be asked about their competency at the beginning of a shift or assignment.

Never assume that an individual knows something; be sure and ask. Delegation of an activity should always be followed by an anticipated response from that nurse as to whether or not he or she feels capable of performing the task. It is important to determine the competency of the nurse as well as to make sure the nurse indicates he or she is competent to carry out the delegated activity. It would be appropriate to check on this nurse frequently to evaluate their delivery of care or to offer assistance. It would be okay to call the agency and verify the nurse’s skilled competencies, but talking with the nurse would still be the first action.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 314 OBJ: Select the right person for the task. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 6. What would be the best example of delegation?

Transferring to another nurse the responsibility of caring for a a. patient requiring a blood transfusion b. Providing guidance to an LPN to hang blood on a patient Assigning a series of nursing unit tasks to the certified nursing c. assistant Assisting a new nurse to understand the rules and regulations of the d. Nurse Practice Act

ANS: A Transferring to another nurse the responsibility of caring for a patient requiring a blood transfusion is the best example of delegation. Delegation involves transferring to a competent nurse a specific task or responsibility for nursing care. The person who delegated the responsibility maintains responsibility for following guidelines for appropriate delegation. Providing guidance to an LPN and explaining to a new nurse about the Nurse

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Practice Act would be teaching and/or supervision rather than delegating a specific task or responsibility.

Assigning to a CNA certain tasks is not delegation because there is no transferring of a specific task or responsibility of nursing care to that person.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 305 OBJ: Define the operational terms delegation, supervision, and accountability.

TOP:Definition of delegation MSC: NCLEX®: Safe and effective care environment—management of care 7. What would be the best example of supervision? a. Assigning nursing care for a group of five patients to a nurse Following up with a CNA on the assigned task of ambulation and b. feeding of two patients Assigning a urinary catheterization and collection of sterile culture c. to an LPN Scheduling the LPN to administer medications on the unit for the d. afternoon

ANS: B NURSINGTB.COM

Supervision is the provision of guidance, direction, and follow-up for the accomplishment of an assigned task.

The nurse would follow up with the CNA to determine whether the tasks were completed and whether any problems occurred. Assigning nursing care for a group of patients or a specific procedure are examples of delegation, as is scheduling an LPN to administer medications.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 305 OBJ: Define the operational terms delegation, supervision, and accountability.

TOP:Definition of supervision MSC: NCLEX®: Safe and effective care environment—management of care 8. What are potential causes of performance inadequacies?

The person to whom the task was assigned had appropriate a. educational qualifications to complete the task.

The task was assigned to a person capable of carrying out the b. assignment.

The person who delegated the task confirmed the recipient’s ability c. to perform the task.

The person to whom the task was assigned did not understand what d. the task involved.

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ANS: D When a person who was assigned a task and did not understand it, this would be a potential cause of a performance inadequacy. A principle of delegation, the person to whom the task is assigned, should verify that they understand and can perform the task. If the person is capable, has appropriate educational qualifications, and the nurse has confirmed that they are able to perform the task, then there should not be performance inadequacy.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 319 OBJ: Select the right person for the task. TOP: Evaluating performance MSC: NCLEX®: Safe and effective care environment—management of care 9. Which of the following represents appropriate feedback for an assignment to an LPN? “Did you understand the assignment that you received in the staff a. report?”

“Have you completed the urinary catheterization and care of the b. new patient?”

“The patient in Room 430 looks much better, and you did a good c. job of making the patient comfortable.”

“I know you are busy; however, you need to get caught up with d. your pain medications.”

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ANS: C Telling the LPN that they did a good job of making a patient comfortable is appropriate feedback on an assignment. Feedback is a process of informing someone of how well or how poorly a delegated task was performed. Asking understanding of an assignment or whether a procedure was performed is not giving feedback but determining if what is supposed to be done is understand or whether the task (urinary catheterization) has been completed. The pain medications may have been delegated; however, if this task was delegated, the feedback does not tell the LPN what her or she is doing right or wrong.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 316-317 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP:Providing feedback MSC: NCLEX®: Safe and effective care environment—management of care 10. The nurse needs to discuss a problem with the nursing assistant. The nursing assistant has left several rooms cluttered with trash and not cleaned appropriately. Which comment by the nurse would be the best way to approach the problem?

“I checked on the four rooms you were assigned, and they are a. really a mess.”

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“Have you had a problem completing your work assignment b. today?”

“All four of the patient rooms assigned to you today are messy with c. a lot of trash in them.”

“Family members have been really upset today. Why have you not d. cleaned up the rooms assigned to you?”

ANS: B Providing an open-ended question to determine if there was some difficulty with an assignment is an appropriate method to assess this situation. When correcting or telling a person that they did something wrong, it is best to start by giving that person an opportunity to provide some input into the situation. This can be accomplished by asking the nursing assistant if there were any problems completing the assignment today.

Asking “why” type questions can put the person on defensive and does not allow the CNA to provide an explanation of why the rooms were cluttered. Telling the CNA that the rooms were cluttered and messy does not address the issue of how it occurred.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 321-322 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP:Providing feedback MSC: NCLEX®: Safe and effective care environment—management of care NURSINGTB.COM

11. Which of the following task can the nurse safely delegate to the nursing assistant? a.

Assessing the patients who are being discharge later today

b.

Give discharge instructions to a patient

c.

Help a patient select food according to their diet

d.

Educating the patient on what foods to eat for his diet plan

ANS: C The nurse can safely delegate the job of helping the patient select food according to his diet. The nurse is responsible for assessing patients, giving discharge instructions, and educating the patient on what foods to eat for his diet plan.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 316 OBJ: Understand and apply the five rights of delegation in nursing practice.

TOP: What does delegation mean? MSC: NCLEX®: Safe and effective care environment 12. Determine how the nurse’s role is different from that of the LPN in assessment of the patient.

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a.

Collects data during the health history and physical exam

b.

Contributes to the development of the care plan

c.

Assist in updating the care plan

d.

Uses findings from the assessment to create a care plan

ANS: D The nurse differs from the LPN in that the nurse uses assessment findings to create a care plan for the patient.

The LPN focuses on collecting data during the health history and exam, contributes to the development of the care plan, and assists in updating the care plan.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 318 OBJ: Understand and apply the five rights of delegation in nursing practice.

TOP: Delegation MSC: NCLEX®: Safe and effective care environment 13. A nurse is feeling overwhelmed and has determined to delegate some of the tasks to the LPN he//she is working with. Which of the following would be most appropriate for the nurse to delegate? a.

An initial assessment on a new patient

b.

Educational teaching on diabetes management

c.

Creating a care plan for a patient

d.

Updating the care plan for a patient who is postop day 2

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ANS: D The nurse could delegate updating the care plan for a patient who is postop day 2. The nurse should not delegate an initial assessment, educational teaching, or creating a care plan for a patient. These responsibilities are not within the scope of practice for the LPN and must be completed by the nurse.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 318 OBJ: Understand and apply the five rights of delegation in nursing practice.

TOP: Delegation MSC: NCLEX®: Safe and effective care environment 14. A day shift nurse has come into work and notices that the glucometers were not tested overnight as they typically are. What is the best way for the nurse to question the nurse assistant, in order to give feedback? a. “Why didn’t you test the glucometers?” b. “What did you do last night?” c. “How was your night? I noticed the glucometers weren’t tested.”

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“Couldn’t you have asked one of the nurses to check the d. glucometers if you were busy?”

ANS: C When giving an individual negative feedback, the nurse should also ask for the nurse assistant’s feedback. If the nurse becomes accusatory, the nursing assistant may become defensive, which does not help solve the issue of the glucometers not being tested. Asking, “How was your night? I noticed the glucometers weren’t tested” gives the nursing assistant a chance to responds and explain what happened.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 321 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP:The right supervision and delegation MSC: NCLEX®: Safe and effective care environment 15. A nurse is reviewing delegation with a graduate nurse. The nurse knows that the teaching has been successful when the graduate nurse states which of the following? a. “The nurse can delegate assessments to the nurse assistants.”

“The nurse must create the care plan based on assessment b. findings.”

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“The nursing assistants cannot perform bed baths on postsurgical c. patients.” d. “The LPN can perform discharge teaching.”

ANS: B The teaching has been successful when the graduate nurse states: “The nurse must create the care plan based on assessment findings.” The nurse is solely responsible for this action. The nurse cannot delegate assessments to the nursing assistants; this must be completed by the nurse. Performing discharge teaching is a requirement of the nurse, not the LPN. Nursing assistants can perform bed baths on postsurgical patients.

PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 309-310 OBJ: Understand and apply the five rights of delegation in nursing practice.

TOP: The right task MSC: NCLEX®: Safe and effective care environment 16. What should the nurse do to assess competence before delegating a task to an LPN? a.

Ask if the LPN has previous experience performing the task.

b.

Ask if the LPN is willing to perform the task.

c.

Ask another nurse if the LPN is competent.

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d.

Assume the LPN is competent due to her years of service.

ANS: A In order to assess competence, the nurse should ask the LPN if he or she has experience performing the task.

Based on the answer, the nurse can then ask more questions if needed to determine competency.

PTS: 1 DIF: Cognitive Level: Application REF: p. 314 OBJ: Understand and apply the five rights of delegation in nursing practice.

TOP: The right circumstances MSC: NCLEX®: Safe and effective care environment 17. Which of the following statements indicate the nurses understanding of accountability in the delegation process? a. “I am solely accountable for the actions of the delagetee.”

“I am accountable for assessing the delegatee’s competency before b. delegation.”

“The delegate is responsible for telling them if they are c. competent.”

“The manager is responsible for providing feedback to the d. delegate.”

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ANS: B The nurse is accountable for assessing the delegatee’s competency before delegation and providing feedback after the task has been completed. The delegate is solely responsible for his or her actions, not the nurse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 307 OBJ: Define the operational terms delegation, supervision, and accountability.

TOP: Accountability MSC: NCLEX®: Safe and effective care environment 18. To optimally use the level of preparation of the LPN, which task should the nurse delegate to the LPN? a.

Transporting a patient to the laboratory

b.

Assisting with a thoracentesis

c.

Restocking and counting the sterile supplies

d.

Passing afternoon nutrition supplements and waters

ANS: B

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Although the LPN/LVN could be delegated appropriately to do all of these tasks, assisting with procedures (e.g., the thoracentesis) would make best use of the LPN’s emergency department educational preparation. The other activities would be appropriate to delegate to a nursing assistant.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 19. The charge nurse is assigning patients for care. There are two nurses, a LPN, and a certified nursing assistant (CNA). The charge nurse would assign which of the following patients to the LPN? An older adult who is receiving IV chemotherapy through a central a. line and will need a dressing change An adult patient diagnosed with insulin-dependent diabetes who will need dressing changes on several stasis ulcers on the lower b. extremities An adult patient with a right fractured femur and right arm in a cast c. who needs to urinate An older patient with terminal cancer who will be transferred to d. hospice

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ANS: B The patient with diabetes will need stasis ulcer care, which is within the scope of practice of the LPN. The patient receiving chemotherapy through a central line would be assigned to the nurse. The nursing assistant would help the female patient with the fractures with the bedpan. The nurse should facilitate the transfer of the hospice patient.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 20. The nurse is making assignments for the team. There are 2 LPNs and a nursing assistant on the team.

Which of the following assignments would the nurse choose for themself?

A patient who had a cerebrovascular accident (CVA) with lefta. sided paralysis who will need help with bathing b. A patient with a chest tube who is ambulating in the hall c. A patient receiving chemotherapy for bone cancer

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d. A patient receiving tube feedings with a J-tube

ANS: C The patient with the highest acuity would be the patient receiving chemotherapy for bone cancer. The nurse would be managing delivery of chemotherapy drugs and pain control with narcotics as ordered. The other patients are within the scope of care for the LVN and the nursing assistant.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 311 OBJ:Select the right person for the task.TOP:Selecting right person MSC: NCLEX®: Safe and effective care environment—management of care 21. A female patient in the medical-surgical unit is diagnosed with anemia and complains of weakness. Which of the following assignments could be given to the nursing assistant? a.

Organize the patient’s meal tray for dinner.

b.

Talk with the patient about managing her rest and activities.

c.

Get a diet history and list of the patient’s favorite foods.

d.

Take an apical pulse and listen to the lungs for crackles.

ANS: A

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The only assignment that fits the scope of practice for the nursing assistant would be to organize the patient’s tray. Talking with the patient and obtaining a diet history would be nurse functions, as would listening to the lungs for crackles.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 22. An experienced nursing assistant could be assigned by the nurse to do which of the following?

Help in the teaching of new diabetic clients to give themselves a. injections.

Report on quality and quantity of urine and adjust drip rate on b. continuous bladder irrigation. c. Assist the client to obtain a clean-catch urine specimen. d. Chart the dietary intake for a client with an eating disorder.

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ANS: C The nursing assistant can be assigned activities that involve standard, unchanging procedures, such as helping to obtain a clean-catch urine specimen from a client. Teaching, working with complicated procedures (continuous bladder irrigation), and monitoring dietary intake with a person having an eating disorder would need to be assigned to the nurse because they involve assessment and evaluation.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care 23. The nurse is preparing assignments in a pediatric unit for the night shift. Which of the following would be appropriate to assign the LPN/LVN? a. A 5-year-old child who had an appendectomy about 6 hours ago A 4-year-old child admitted for severe epiglottis who is running a b. fever of 102° F A 6-year-old child admitted with dehydration and receiving IV c. therapy A 7-year-old child who has inhalation burns 2 days ago and has a NURSINGTB.COM d. tracheostomy

ANS: A The child who is postoperative for the appendectomy would be an appropriate assignment for the LVN/LPV. This child’s problem has a predictable outcome. The question doesn’t mention any unstable symptoms that would have to be handled outside the LVN/LPN’s scope of practice. The children with epiglottis, dehydration, and burns will need to be evaluated and monitored for complications, which is the scope of practice and responsibility of the nurse.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care MULTIPLE RESPONSE 1. Which of the following statements made by the charge nurse indicates appropriate delegation? (Select all that apply.) a. The LPN can delegate dressing changes to the nursing assistant.

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b. The LPN can administer a DPT immunization to a child. c. The LPN can add a dose of Bleomycin to an existing IV infusion.

The nursing assistant can transfer a paraplegic patient from a wheelchair to the bed using a lift, as long as the nursing assistant d. has received training and demonstrated competency.

The nursing assistant can assess vital signs on a patient 15 minutes e. after the transfusion has been started.

ANS: B, D Only nurses can delegate to other personnel. LPNs can administer routine medications, such as immunization, but not chemotherapy drugs (Bleomycin). A nursing assistant can transfer patients, provide basic hygiene measures, and assess vital signs. (The patient has been receiving blood, so the nurse needs to monitor the first 50 mL that is given because this is when a transfusion reaction is most likely to occur.)

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ:Select the right person for the task.TOP:Providing feedback MSC: NCLEX®: Safe and effective care environment—management of care 2. The Delegation Decision Tree, which was prepared and adopted by ANA and NCSBN, has specific steps.

Identify the steps in this Decision Tree. (Select all that apply.)

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Monitoring

b.

Surveillance and supervision

c.

Readback and response

d.

Assessment and planning

e.

Evaluation

f.

Communication

ANS: B, D, E, F There are four steps to the ANA and NCSBN Delegation Decision Tree. They are in order as follows: Step 1: Assessment and planning.

Step 2: Communication: Must be a two-way process involving the nurse who assesses the nursing assistive personnel’s understanding of the delegated task and the nursing assistive person who asks questions regarding the delegation and seeks clarification of expectations if needed.

Step 3: Surveillance and supervision: The purpose of surveillance and monitoring is related to nurse’s responsibility for patient care within the context of a patient population. The nurse supervises the delegation by monitoring the performance of the task or function and assures compliance with standards of practice, policies,

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and procedures. Frequency, level, and nature of monitoring vary with needs of patient and experience of assistant.

Step 4: Evaluation and feedback: Evaluation is often the forgotten step in delegation and should include a determination if the delegation was successful and discussion of parameters to determine the effectiveness of the delegation. (ANA & NCSBN, 2006, pp. 7-9) PTS: 1 DIF: Cognitive Level: Application REF: p. 306 OBJ: Delegate tasks successfully based on outcomes and define the operational terms delegation, supervision, and accountability. TOP: Delegation decision tree MSC: NCLEX®: Safe and effective care environment—management of care 3. Which actions by the nurse show an understanding of what the nurse is accountable for? (Select all that apply.) a. Assessing patients according to priority b. Determining the need to delegate a task to a nursing assistant Deciding that the nursing assistant is competent to perform the task c. delegated Following up to determine completion of the task that was d. delegated

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Delegating assessments of low-acuity patients to the nursing e. assistant

ANS: A, B, C, D Nurses show understanding of what they are accountable for by assessing patients according to priority, determining the need to delegate, deciding whether the nursing assistant is competent to perform that task, and following up to determine completion of the task that was delegated. Nurses should not delegate assessment of any patient to a nursing assistant. Assessment must be completed by the nurse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 306 OBJ: Understand and apply the five rights of delegation in nursing practice.

TOP: Delegation MSC: NCLEX®: Safe and effective care environment 4. The charge nurse is determining tasks that can be delegated to keep the unit running smoothly. What factors should the charge nurse consider before delegating? (Select all that apply.) a.

Staff who are working

b.

Acuity of patients

c.

Community needs

d.

Teaching obligations of the nurses

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e.

How many patients are waiting for beds on the unit

ANS: A, B, C, D The charge nurse should consider other factors such as the staff that are working, acuity of patients, community needs, and teaching obligations of the nurses before beginning to delegate. These factors will determine what kind of delegation can be safely handled by the staff.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 308 OBJ: Understand and apply the five rights of delegation in nursing practice.

TOP: Delegation MSC: NCLEX®: Safe and effective care environment 5. The nurse is preparing to delegate work to the nurse aide. What can be done to ensure that work is delegated in a manner that is understood by the nurse aide? (Select all that apply.) a. Determine if the nurse aide understands what is being asked b. Ensure that the directions giving are in accordance with policy c. Delegate more difficult tasks because the nurse aide is experienced Ask the nurse aide if he or she has the info needed to complete the d. task

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e. Refrain from delegating and complete the tasks themself

ANS: A, B, D The nurse should determine if the nurse aide understands what is being asked. The nurse can do this by asking the nurse aide to repeat the directions back or read-back. The nurse should also ensure that the directions given are in accordance with policy and ask the nurse aide if her or she has the info needed to complete the task. The nurse should not delegate more difficult tasks because the nurse aide is experienced or refrain from delegating and completing all tasks by themself.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 319 OBJ: Apply the “four C’s” of initial direction for clear understanding of your expectations TOP: Delegation MSC: NCLEX®: Safe and effective care environment 6. Which statement(s) will help the nurse give feedback to a coworker? (Select all that apply.) a. “Can you tell me what happened?” b. “You did a great job positioning the postoperative patient.”

“What do you think can be done to ensure that the blood pressures c. are charted?” d. “I don’t understand why you didn’t do what I asked you to do.”

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e. “I only gave you one job to complete.”

ANS: A, B, C When giving feedback, the nurse should practice using the feedback formula. This includes asking for the other person’s input (“Can you tell me what happened?”), giving credit for accomplishments (“You did a great job positioning the postoperative patient”), and asking for the others person’s thoughts on resolutions (“What do you think can be done to ensure that the blood pressures are charted?”). The statements “I don’t understand why you didn’t do what I asked you to do “ and “I only gave you one job to complete” would not be helpful in providing feedback to the coworker because they could cause the coworker to become defensive.

PTS: 1 DIF: Cognitive Level: Application REF: p. 321 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP:The right supervision and evaluation MSC: NCLEX®: Safe and effective care environment 7. The nurse manager understands the causes of performance weaknesses when making which of the following statements? (Select all that apply.) a.

“The employee does not know what is expected.”

b.

“The employee is getting adequate feedback.” NURSINGTB.COM

c.

“The employee requires additional education.”

d.

“The employee lacks motivation.”

e.

”The employee needs additional supervision.”

ANS: A, C, D, E There are several causes of performance weaknesses, including not knowing what the expectations are, not getting adequate feedback, not having enough education to perform the job, lack of motivation, and requiring additional supervision.

PTS: 1 DIF: Cognitive Level: Application REF: p. 315 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate’s performance.

TOP: The right circumstances MSC: NCLEX®: Safe and effective care environment 8. A nurse manager is discussing the “five rights of clinical delegation?” Which statement indicates understanding? (Select all that apply.) a. “The nurse should determine if the task can safely be delegated.”

“The nurse should determine if this is a task that will fit into b. schedule.”

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c. “The nurse should delegate the task to the right person.”

“The nurse should determine whether this is a task that would d. enhance learning.” e. “The nurse should provide feedback to the delegate.”

ANS: A, C, E To safely delegate, the nurse manager should determine the following: The right task—determining whether the task can be delegated The right circumstance—according to the NCSBN, the appropriate client setting, available resources, and consideration of other relevant factors The right person—matching the task to the right (qualified) person The right direction and communication—clear expectations of what needs to be done The right supervision and evaluation—acknowledgment that the person understands the information and is capable of completing the task and giving them feedback and evaluation PTS: 1 DIF: Cognitive Level: Application REF: p. 308 NURSINGTB.COM OBJ: Delegate tasks successfully based on outcomes.

TOP: Definition of delegation

MSC: NCLEX®: Safe and effective care environment—management of care

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Chapter 15: The Health Care Organization and Patterns of Nursing Care Delivery MULTIPLE CHOICE 1. How does managed care affect the economics of health care delivery? a.

Provides incentives for smaller private or individual hospitals

b. Increases the tax bases for the community c.

Uses corporate economics to achieve a profit

d. Decreases duplicate processes and redundant facilities

ANS: D The corporatization of health care amalgamates the smaller health care operations into the larger organizations to decrease duplicate and redundant health care provisions. For example, one hospital would provide a high level of cardiac care, and another hospital would focus on oncology. Managed care does not increase community tax base because the costs are paid by the patients and their insurance. Managed care is more of an incentive for larger hospitals and corporations. The focus is to reduce duplication of services, not to use corporate economics to achieve a profit.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 328 OBJ: Differentiate between a centralized and aNURSINGTB.COM decentralized organizational structure.

TOP: Organizational structure MSC: NCLEX®: Not applicable 2. Which statement regarding characteristics of clinical pathways shows the nurses understanding? a. “Clinical pathways focus on patient outcomes.” b. “Clinical pathways use a timeline with sequenced interventions.”

“Clinical pathways collaborate efforts by health care c. professionals.” d. “Clinical pathways involve nurse-centered orientation.”

ANS: D Clinical pathways help reduce expensive variations in care. Clinical pathways are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for patients with a particular diagnosis, procedure, or symptom. Clinical pathways are not a nurse-centered orientation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 322 OBJ:Discuss patterns of nursing care delivery systems.

TOP:Patterns of nursing care delivery

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MSC: NCLEX®: Safe and effective care environment—management of care 3. Which statement shows the nurses understanding of patient-focused care? a. “Patient-focused care is a nursing care delivery system.” b. “Patient-focused care is a model for a health care organization.” c. “Patient-focused care is a clinical pathway within an institution.” d. “Patient-focused care is an institutional value and philosophy.”

ANS: A Patient-focused care is another type of delivery system. The level of productivity is increased through centralization of functions (e.g., phlebotomy, diet instruction, respiratory therapy) on the unit under the direction of the nurse and cross-training ancillary workers to do more than one function. The patient comes into contact with fewer people under this organizational framework.

PTS: 1 DIF: Cognitive Level: Application REF: p. 344 OBJ: Identify trends affecting the health care delivery system. TOP: Trends in health care MSC: NCLEX®: Safe and effective care environment—management of care 4. Which statement by the nurse manager is accurate regarding case management? The two tools that support NURSINGTB.COM case management are a.

“clinical pathways and patient classifications.”

b.

“clinically oriented and business-oriented pathways.”

c.

“clinical pathways and disease management protocols.”

d.

“centralized and decentralized system models.”

ANS: C Both of these tools (clinical pathways and disease management protocols) support case management by coordination and delivery of high-quality care. Clinical pathways (also known as care maps) are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for patients with a particular diagnosis, procedure, or symptom. Disease management protocols involve a system of coordinated health care interventions and communications for persons with conditions in which self-care is important in controlling the disease.

PTS: 1 DIF: Cognitive Level: Application REF: p. 330 OBJ:Discuss patterns of nursing care delivery systems.

TOP: Patterns of nursing care delivery MSC: NCLEX®: Not applicable

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5. A nurse manager is training a new hire. Which statement shows an understanding of functional nursing? a.

“Functional nursing is organized around tasks.”

b.

“Functional nursing is patient led.”

c.

“Functional nurses is physician led.”

d.

“Functional nursing is unorganized.”

ANS: A Functional nursing is where nursing care is broke into a series of tasks performed by many people, which results in a fragmented, impersonal kind of care. Fragmentation of care caused patient problems to be overlooked because they did not fit into a defined assignment. Aides, vocational nurses, and licensed practical nurses are allowed to perform functions such as administration of medication and treatments. This functional kind of nursing results in a fragmented, impersonal kind of care. In team nursing, groups of patients are assigned to a team headed by a team leader, usually a nurse, who coordinates the care for a designated group of patients. In primary nursing, a nurse plans and directs the care of a patient over a 24-hour period. This approach is designed to reduce or eliminate the fragmentation of care between shifts and nurses because one nurse is accountable for planning the care of the patient around the clock. In a patient-focused care system, the patient comes into contact with fewer people, and the nurse, who is familiar with the patient’s plan of care, supervises the delivery of care. This model also moves nurses to a higher level of functioning because they are now accountable for a fuller range of services for the patient.

PTS: 1 DIF: Cognitive Level: Application REF: p. 342 NURSINGTB.COM

OBJ:Discuss patterns of nursing care delivery systems.

TOP: Patterns of nursing care delivery MSC: NCLEX®: Not applicable 6. Which of the following statements shows the nurses understanding of primary nursing?

“Primary nursing involves planning and directing of patient care a. over 24 hours.” b. “Primary nursing involves care for 48 hours or more.” c. “Primary nursing involves one nurse planning care for the patient.” d. “Primary nursing is the only method of care used today.”

ANS: C In primary nursing, the fragmentation between shifts and nurses is eliminated because one nurse is accountable for planning the care of the patient around the clock. Primary nursing is not the only method of care used today. Functional nursing is when nursing care is broke into a series of tasks performed by many people, which results in a fragmented, impersonal kind of care. Fragmentation of care caused patient problems to be overlooked because they did not fit into a defined assignment. In team nursing, groups of patients are assigned to a team headed by a team leader, usually an RN, who coordinates the care for a designated group of patients.

In primary nursing, a nurse plans and directs the care of a patient over a 24-hour period. This approach is designed to reduce or eliminate the fragmentation of care between shifts and nurses because one nurse is

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accountable for planning the care of the patient around the clock. In a patient-focused care system, the patient comes into contact with fewer people, and the RN, who is familiar with the patient’s plan of care, supervises the delivery of care. This model also moves RNs to a higher level of functioning because they are now accountable for a fuller range of services for the patient.

PTS: 1 DIF: Cognitive Level: Application REF: p. 342 OBJ:Discuss patterns of nursing care delivery systems.

TOP: Patterns of nursing care delivery MSC: NCLEX®: Not applicable 7. Which statement is true about case management? a. There are two models—traditional and full immersion. b. It is used to reduce resource utilization only.

To be effective, it requires case managers to provide direct patient c. care.

It eliminates the need for other caregivers (LPN, LVNs, nursing d. assistants).

ANS: A Case management is one of the strategies to reduce costs while ensuring coordination of care. The first is the traditional model, which focuses on dischargeNURSINGTB.COM planning and determining if the care planned throughout the patient’s hospital stay is necessary and appropriate (utilization review) so that the insurer will pay for the services. The full immersion model of case management requires the case manager to review the chart and communicate with physicians and nurses caring for the patients on their case load daily. Case managers do not provide direct patient care, and it does not eliminate the need for other health care workers (LPN, CNA).

Resource utilization is the examining of resources to ensure optimal allocation, such as restructuring shifts so that nurses work fewer overtime hours is an example of resource utilization.

PTS: 1 DIF: Cognitive Level: Application REF: p. 342 OBJ:Discuss patterns of nursing care delivery systems.

TOP:Patterns of nursing care delivery MSC: NCLEX®: Safe and effective care environment—management of care 8. A nurse is interested in case management. Which statement indicates an understanding of the primary work environment of case manager? a. “They work most often in acute care institutions.”

“Their work is focused on community activities and is based within b. the community.”

“They typically work for insurance companies, providing c. coordination of care.”

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“All types of health care organizations, as well as organizations d. with health-related functions, hire case managers.”

ANS: D Nurses who are case managers work in all types of health care institutions. They may also work for insurance or utilization review companies or in health-related areas of various types of large businesses. Registered nurses, social workers, and therapists may all be case managers, but how they perform their role depends on the scope of practice of their discipline. All case managers must be skilled at communication, critical thinking, negotiation, and collaboration. They must be knowledgeable about resources available to patients. The case manager not only deals with individual patients but also with family and other support systems of the patient; however, a case manager’s work is not focused on just the community.

PTS: 1 DIF: Cognitive Level: Application REF: p. 342 OBJ: Describe challenges facing health care that impact the delivery of nursing care.

TOP: Case managers MSC: NCLEX®: Not applicable 9. Which statement is true about patient classification systems? a. They measure all the needs of patients. b. They provide an absolute formula for unit staffing.

NURSINGTB.COM They should not be used to make patient care assignments because c. acuity systems are more accurate.

They provide historical data of the usage of nursing time, which is d. helpful when developing the department budget.

ANS: D A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. This system does not measure the needs of all patients, is not used an as absolute formula for unit staffing, and is not used to make patient assignments. Patient acuity is the measure of categorizing patients based on their nursing care requirements. Patient classification systems, particularly with increased computerization and the ability to access the system online, provide many benefits.

Specifically, they can be used to improve patient care outcomes, identify appropriate staffing, track budget compliance and costs, and maintain nurse retention through their ability to impact staffing through assessment of patients’ conditions.

PTS: 1 DIF: Cognitive Level: Application REF: p. 348 OBJ:Describe strategies to coordinate care and reduce costs.

TOP:Coordination of care and cost control MSC: NCLEX®: Safe and effective care environment—management of care 10. Which of the following best describes the concept of evidence-based practice?

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It is a method of improving nursing care and effectively a. maintaining cost containment.

Insurance companies review the evidence of the health care b. practice for reimbursement.

It achieves large-scale economics while providing cost-effective c. care.

It provides for the use of recent research in current nursing d. practice.

ANS: D The IOM reported that it took 17 years for research to be reflected into daily practice. Evidence-based practice is the use of the current best evidence to provide care and make decisions regarding patient care. Evidencebased practice is not a method of improving nursing care and maintaining costs containment. Insurance companies do not review the evidence of health care practice for reimbursement. Evidence-based practice does not achieve large-scale economics while providing cost-effective care.

PTS: 1 DIF: Cognitive Level: Application REF: p. 333 OBJ: Describe evidence-based care. TOP: Evidence-based practice MSC: NCLEX®: Not applicable 11. A female patient is admitted to the labor and delivery unit, where she is assigned a registered nurse who NURSINGTB.COM will manage her care for the duration of her hospitalization. What type of nursing care delivery model is represented in this nursing unit? a.

Functional care

c.

Patient-focused care

b.

Primary care

d.

Case management

ANS: B This is an example of primary care nursing, in which the nurse is the principal or primary person to manage and coordinate the patient’s care around the clock. Patient-focused care is an interdisciplinary approach to patient care. Functional care is the provision of care by nursing and nursing ancillary staff rather than by an allnursing staff as seen in primary care nursing. Case management is a model of care delivery in which a nurse case manager coordinates and collaborates with other health services when a patient has complicated health care needs, but the case manager may not be involved in the daily care activities of the patient.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 336 OBJ:Discuss patterns of nursing care delivery systems.

TOP:Patterns of nursing care delivery MSC: NCLEX®: Safe and effective care environment—management of care 12. The nurse is reviewing upcoming discharges. Which patient would a case manager be assigned to?

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A 55-year-old woman post hysterectomy, who has adequate a. support from family A 42-year-old man post appendectomy, who is able to change his b. own dressing c. A 60-year-old man post sepsis, in need of nursing home placement A 38-year-old woman, post shoulder repair, who needs to follow d. up with the orthopedic surgeon

ANS: C Case managers become involved when patients have complicated health care needs are receiving care that is expensive or are receiving care from multiple providers. The patient that is post sepsis is likely to be seeing a team of doctors and will need that care transferred over to the nursing home setting. The case manager can bridge that care so that the transition is smooth for the patient. The other patients need minimal support and therefore would not qualify for case management.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 330 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost.TOP:Case management MSC: NCLEX®: Safe and effective care environment NURSINGTB.COM 13. Which action by the case manager would be required under the full immersion model?

The case manager would see only the patients with the most a. extensive health care needs.

The case manager would see all patients that come into the b. hospital.

The case manager would only see the patients with health c. insurance.

The case manager would conduct a daily chart review of patients d. he or she is assigned to.

ANS: D Under the full immersion model, the case manager would be required to conduct a daily chart review on all patients he or she is assigned to. The nurse would then meet with the health care providers and nurses caring for these patients to discuss their care. The purpose of this model is to enhance communication and decrease cost of care by shortening hospital stays.

PTS: 1 DIF: Cognitive Level: Application REF: p. 330 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost.TOP:Case management MSC: NCLEX®: Safe and effective care environment

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14. Which of the following statements about evidence-based practice shows that the nurse has an adequate understanding?

“Evidence-based practice is the hospital’s protocol for providing a. care.” b. “Evidence-based practice is based on community need.”

“Evidence-based practice is a set of guidelines determined by each c. hospital unit.”

“Evidence-based practice is the use of current best evidence in d. making decisions about patient care.”

ANS: D The statement “Evidence-based practice is the use of current best evidence in making decision about patient care” shows that the nurse has an adequate understanding. The other statements about evidence-based practice are false.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 330 OBJ: Describe challenges facing health care that impact the delivery of nursing care, including evidence-based care. TOP: Evidence-based practice MSC: NCLEX®: Safe and effective care environment NURSINGTB.COM

15. A new nurse is determining which hospital to apply for. The nurse has heard a lot about magnet hospitals from friends that are nurses and knows that working for a magnet hospital would mean a. the nurse would likely experience high job satisfaction. b. the nurse would likely experience poor job satisfaction. c. the nurse would have to have a BSN before being able to apply. d. the nurse would be hired after having a year of nursing experience.

ANS: A Magnet hospitals are known for attracting and retaining nurses because of their high satisfaction rates among nurses. These hospitals have low job turnover and low nurse vacancy even when the hospital is in an area experiencing a nursing shortage.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 335 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including shortage of health care professionals.TOP:Magnet hospitals MSC: NCLEX®: Not applicable

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16. A nurse is covering for a coworker who is on a lunch break. While administering medications, the nurse notices a bag of antibiotic hanging with another patient’s name on it. The nurse immediately stops the infusion.

What should the next step be? a. Say nothing about the error because the patient is fine.

Speak with the coworker about the error and fill out the proper b. paperwork for documentation. c. Tell the other coworkers about the error. d. Tell the patient about the error.

ANS: B The next step that the nurse should take is to speak to the coworker about the error and then fill out paperwork for documentation. The nurse needs to have a “crucial conversation” with this coworker to alert him or her about the error. This allows for a decrease in the number of errors and a safer health care environment.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 337 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including patient safety.TOP:Patient safety MSC: NCLEX®: Safe and effective care environment NURSINGTB.COM

17. The nurse assesses the quality of patient care to be higher in the Total Patient Care model because: a.

Patients are able to perform the majority of their own care.

b.

Nurses are required to perform less care.

c.

Nurses are able to focus all of their care on one patient.

d.

Nurses are hired to care for two patients.

ANS: C The quality of care is higher in the Total Patient Care model because nurses are able to focus all of their care on one patient instead of juggling the care of two or more.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 341 OBJ:Trace the history of the use of nursing care delivery models.

TOP: The effects of various patterns of nursing care delivery: a historical perspective MSC: NCLEX®: Safe and effective care environment 18. A nurse has been assigned as team leader for the day and is working with two LPNs and two unlicensed personnel. What should the nurse do to ensure success in caring for patients?

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Give the assignments for the day out to the team and plan to meet a. right before the end of shift.

Continuously communicate with the members of the team b. throughout the entire day.

Report changes in a patient’s condition to the health care provider c. only. d. Revise each patient’s plan of care once a shift.

ANS: B To ensure success for the day, the nurse should continuously communicate with the members of the team throughout the entire day. The nurse should be sure to update all members of the team on any change in patient status. The LPN can also report changes in a patient’s condition to a health care provider because it doesn’t have to be the team leader. Revisions of each patient’s plan of care should be done continuously has changes arise and not just once a shift.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 337 OBJ:Trace the history of the use of nursing care delivery models.

TOP: Team nursing MSC: NCLEX®: Safe and effective care environment 19. The nurse has an adequate understanding of patient-focused care when stating which of the following?

NURSINGTB.COM a. “Patient-focused care includes the physician, who supervises care.” b. “Patient-focused care decreases productivity.” c. “In patient-focused care, the nurse supervises delivery of care.” d. “The patient is not an active participant in patient-focused care.”

ANS: C In patient-focused care, the nurse (not a physician) supervises delivery of care. This system increases productivity and encourages the patient to be an active member of the health care team. Patients are encouraged to be active participants in the planning of their care.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 344 OBJ:Trace the history of the use of nursing care delivery models.

TOP: Patient-focused care MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE 1. Which type of nursing delivery models would be appropriate in a rural area that would require fewer numbers of registered nurses? (Select all that apply.)

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a.

Functional nursing

b.

Team nursing

c.

Primary care nursing

d.

Patient-focused care

e.

Transitional care

ANS: A, B, D When you have a limited number of nurses, then functional nursing, team nursing, and patient-focused care are useful because you can deliver quality care by using more ancillary staff. Primary care is usually 24-hour nurse coverage, and transitional care is when advanced practice nurses (APRNs) conduct assessments and—with physicians—design and coordinate patient care and discharge plans.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 342-343 OBJ:Discuss patterns of nursing care delivery systems.

TOP:Patterns of nursing care delivery MSC: NCLEX®: Safe and effective care environment—management of care 2. The nurse understands cost containment when stating which of the following? Major elements of the law NURSINGTB.COM that support cost containment include (Select all that apply.) a.

“increased governmental regulation of insurers.”

b.

“less use of technology.”

c.

“increasing incentives for coordination of care.”

d.

“emphasis on physician centered care.”

e.

“decreasing consumer out of pocket costs.”

ANS: A, C Major elements of the law that supports cost containment include increased governmental regulation of insurers, increased use of technology, increasing incentives for coordination of care, emphasis on patientcentered care, and increased consumer out-of-pocket costs. These measures are in an effort to reduce the overall cost of health care.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 328 OBJ: Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost. TOP: Cost of health care MSC: NCLEX®: Not applicable 3. Which action can the hospital administrator take to reduce health care costs? (Select all that apply.)

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Hire case managers to see all patients who have extensive medical a. needs. b. Reduce the number of patients the hospital can accommodate. c. Ensure that appropriate staff is available. d. Encourage the use of evidence-based practice. e. Accept only patients with health insurance.

ANS: A, C, D To reduce health care costs, the hospital administrator can take different actions. The hospital administrator can hire case managers to see all patients with extensive medical needs, ensure that appropriate is available, and encourage the use of evidence based practice. It is not realistic for the hospital administrator to reduce the number of patients that the hospital can accommodate. It is illegal to turn away patients without health insurance.

PTS: 1 DIF: Cognitive Level: Application REF: p. 328 OBJ: Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost. TOP: Strategies to control costs MSC: NCLEX®: Not applicable 4. Which statement by the nurse indicates understanding of the case manager’s role? The case manager (Select all that apply.)

NURSINGTB.COM a.

“guides patients through the health care delivery process.”

b. “ensures quicker discharge for patients without insurance.” c.

“coordinates care for the patient.”

d. “assists patients in achieving goals effectively and efficiently.” e.

“collaborates with the health care team.”

ANS: A, C, D, E The role of the nurse case manager includes guiding patients through the health care delivery process, coordinating care for the patient, assisting patients in achieving goals effectively, and efficiently and collaborating with the health care team. Patients without insurance do not necessarily have a quicker discharge process.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 330 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost.TOP:Case management MSC: NCLEX®: Safe and effective care environment 5. The nurse judges that the disease management program has been successful when the patient (Select all that apply.)

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a.

assumes responsibility for their own health.

b.

learns how to maintain good health.

c.

can state how to manage their chronic condition.

d.

relies on the health care team for maintenance of health.

e.

can state how to avoid worsening of health.

ANS: A, B, C, E The disease management program has been successful when the patient assumes responsibility for their own health, learns how to maintain good health, can state how to manage their chronic condition, and can state how to avoid worsening of health.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 331 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including reduction of cost.TOP:Case management MSC: NCLEX®: Safe and effective care environment 6. The nursing shortage is projected to reach 1.2 million by 2020. Which actions can hospitals take to retain nurses? (Select all that apply.)

NURSINGTB.COM

a. Create a health care system that supports nursing advancement.

b. Encourage a work environment that fosters workgroup cohesion. c. Allow nurses to have autonomy. d. Reduce the number of managers within the health care system. e. Allow nurses a variety of specialties to choose from.

ANS: A, B, C, E To retain nurses, hospitals must take actions that will attract nurses to their institutions. These actions can include creating a health care system that supports nursing advancement, encouraging a work environment that fosters workgroup cohesion, allowing nurses to have autonomy, and allowing nurses a variety of specialties to choose from.

PTS: 1 DIF: Cognitive Level: Application REF: p. 334 OBJ:Describe challenges facing health care that impact the delivery of nursing care, including shortage of health care professionals.TOP:Shortage of nurses MSC: NCLEX®: Safe and effective care environment

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Chapter 16: Economics of the Health Care Delivery System MULTIPLE CHOICE 1. Which statement by the nurse indicates understanding of the major factors influencing the increase in health care costs?

“Health care expenditures are exceeding the cost of the gross a. domestic product (GDP) in excess of 14%.”

“Older adult patients consume more of the health care product than b. they can afford to finance.”

“The cost of prescription drugs is soaring so rapidly that the c. majority of people cannot afford them.”

“Because of the limited payment of Medicare, institutions are not d. being reimbursed at the same level of expenditures.”

ANS: A Health care expenditures consume more than 16% of the GDP—the amount of money being spent exceeds the amount of money recompensed. The older adult population contributes to this situation because they require more health care as a result of chronic conditions. The cost of prescription drugs and the level of Medicare reimbursements also contribute to this problem.

PTS: 1 DIF: Cognitive Level: Application REF: p. 356 NURSINGTB.COM OBJ: Compare the market of health care with the normal market for goods and services.

TOP: Cost of health care MSC: NCLEX®: Not applicable 2. A nurse is educating a coworker on the intrinsic factors and cost of health care. The nurse knows that the teaching has been effective when the coworker lists the following intrinsic factor as the major cause of increased cost: Almost 10% of Americans over 65 years old are considered at or a. below the poverty level.

The new medical technology available has increased the cost of b. health care.

There are increasing labor costs in the total hospital spending c. budget.

The staff nurse does not understand the responsibility of economics d. and money management.

ANS: A A major intrinsic factor contributing to the high cost of health care is that an increasing number of Americans are over 65 years old, and a significant portion of this age group does not have the funds to obtain medical care. The US Census Bureau’s 2011 Supplemental Poverty Measure reports an even higher percentage, 15.1%.

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The other options listed are extrinsic factors—new medical technology, increasing labor costs, and lack of staff nurse understanding of fiscal responsibilities of the organization.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 356 OBJ:Use basic knowledge of health care economics to analyze trends in the health care delivery system.TOP:Intrinsic factors for health care costs MSC: NCLEX®: Not applicable 3. A nurse manager is preparing a presentation on health care economics for unit staff. How would the nurse manager explain the definition of economics as it relates to health care to the staff?

Economics refers to how the health care system is going to care for a. the older segment of the population.

Health care is a limited resource; economics refers to how this b. resource is going to be allocated.

Health care economics refers to the budgeting and financial c. management of the institution providing the care.

Economics is the balance of the utilization of health care services d. and the monies obtained for the services provided.

ANS: B NURSINGTB.COM

Economics is the allocation of scarce resources. Health care economics is the distribution of the limited resource of health care. Economics includes not only the older adult segment but all age groups. Economics is not about using health care services and the monies obtained but instead how they will be distributed.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 358 OBJ: Define economics and health care economics. TOP: Health care economics MSC: NCLEX®: Not applicable 4. The nurse would identify which of the following as an example of a strategy that represents fiscally responsible clinical nursing practice?

Begin discharge planning as soon as it is evident when a patient a. will be discharged.

Encourage patients to consider being admitted the evening before a b. major surgical procedure.

Use unlicensed personnel as much as possible in the delivery of c. nursing care.

Accurately document the current status of a patient with regard to d. the patient’s ongoing needs.

ANS: D

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Documentation that accurately reflects the current status of the patient is critical to the institution obtaining reimbursement for the care of the patient. For example, if there are “no problems” with a patient, then perhaps the patient could be cared for in a less expensive environment. Use of unlicensed personnel is important but only to the extent of their training, and this is not a relevant factor in a great deal of nursing care. Discharge planning considerations should begin when the patient is admitted and not left until the patient is about to be discharged. It would be unnecessary and costly to have the patient admitted the evening before surgery because this would cost an extra day of hospitalization.

PTS: 1 DIF: Cognitive Level: Application REF: p. 372 OBJ: Discuss strategies you will use to achieve fiscal responsibility in clinical practice.

TOP: Fiscal responsibilities of nursing MSC: NCLEX®: Not applicable 5. The nurse manager receives the budget variance report for the assigned nursing unit. What other critical information must the nurse manager consider to evaluate this report? a.

Projection of costs in the operating budget

b.

The amount of money allocated to meet expected costs

c.

Figures on which a zero-based budget were determined

d.

Planning needs for unit staffing based on patient acuity

ANS: A

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The operating or budget costs are guidelines by which the nurse manager determines whether the unit has operated within allowable expenses. This is often called an expense or operating budget. The other options are not considered critical information that the nurse manager would need to consider when evaluating the report.

The operating budget also includes all of the items necessary for care on the unit. These are called line items in a budget and include such things as supplies, telephones, small equipment (e.g., wheelchairs, nurse pagers, fax machines), postage, and copying costs. Some of these are variable costs—that is, costs that change with the volume of patients cared for in a year. Zero-based budgeting is the efficient allocation of resources because it is based on needs and benefits where all expenditures have to be approved.

PTS: 1 DIF: Cognitive Level: Application REF: p. 365 OBJ: Describe what is meant by an operating budget. TOP: Budgeting MSC: NCLEX®: Not applicable 6. Which statement by the nurse shows understanding of the Rand Health Insurance Experiment?

“When consumers were required to pay 25% co-payment, there a. was a considerable decline in the use of health care services.”

“There was an increase in the use of health care services when b. consumers were required to make a co-payment.”

“If the health care cost is being paid by insurance companies, the c. consumer is not concerned about the cost.”

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“The implementation of the Oregon Health Policy for reimbursement of the cost of health care services led to the Rand d. Health Insurance Experiment.”

ANS: A Participants in the Rand study either received free care or paid co-payments of 25%, 50%, or 95%. Economic theory would predict that as price increases, the purchase of goods or services would decline. That is exactly what happened. With a co-payment of 25%, there was a decline in utilization of health care of 19% compared with a free plan. There were even greater declines in utilization of health care services at the higher rates of copayments.

PTS: 1 DIF: Cognitive Level: Application REF: p. 362 OBJ: Use basic knowledge of health care economics to analyze trends in the health care delivery system. TOP: Budgeting MSC: NCLEX®: Not applicable 7. What is the nurse’s fiscal responsibility to the patient? a. To provide the best health care that the patient can afford To provide the best health care that the insurance company will b. allow To use the most cost-efficient resources to provide maximum c. health care to the patient

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To use the most efficient method of providing nursing care to d. patients whose resources are limited

ANS: C The fiscal responsibility of nursing is to maximize the health benefits within the most cost-efficient combination of resources. In clinical practice, fiscal responsibility does not relate to insurance or how the patient is paying for service. The fiscal responsibility of nursing is to maximize the health benefits within the most cost-efficient combination of resources. Providing the best health care is about quality improvement.

PTS: 1 DIF: Cognitive Level: Application REF: p. 368 OBJ: Describe what is meant by the term fiscal responsibility in clinical practice.

TOP: Fiscal responsibility in clinical practice MSC: NCLEX®: Not applicable 8. What is the most important way that a nurse can be fiscally responsible to the employing institution? a. By providing quality, safe nursing care b. By considering patient needs and prioritizing appropriately c. By accurately documenting the patient’s condition d. By maintaining accurate charges for supplies used in patient care

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ANS: A Quality nursing care includes using fiscal resources wisely, but most important is the provision of quality nursing care—preventing falls, controlling the spread of infection, providing care to prevent complications, for example. All of these situations increase the length of stay for a patient and ultimately the costs of the institution. The other options are ways to be fiscally responsible but not the most important.

PTS: 1 DIF: Cognitive Level: Application REF: p. 370 OBJ: Describe what is meant by the term fiscal responsibility in clinical practice.

TOP: Fiscal responsibility in clinical practice MSC: NCLEX®: Not applicable 9. Which statement is true about patient classification systems? a. The systems measure all the needs of patients. b. The systems provide an absolute formula for unit staffing.

The systems should not be used to make patient care assignments c. because acuity systems are more accurate.

The systems provide historical data of the usage of nursing time, d. which is helpful when developing the department budget.

ANS: D

NURSINGTB.COM

A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. It is helpful for developing a department budget. It is not a formula for unit staffing and does not measure all the needs of the patients.

PTS: 1 DIF: Cognitive Level: Application REF: p. 367 OBJ:Describe strategies to coordinate care and reduce costs.

TOP: Coordination of care and cost control MSC: NCLEX®: Not applicable 10. The case manager is educating the nurse about health care costs. The case manager knows that the education has been effective when the nurse states: a. “Health care costs are increasing because demand is decreasing.” b. “Health care costs are steadily decreasing.”

“The aging population is requiring more health care services, c. causing the costs to increase.”

“The aging population is requiring less health care services, d. causing the costs to decrease.”

ANS: C

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

The case manager would know that the teaching was effective if the nurse states: “Health care costs are continuing to increase because the aging population requires more health care services.” The other statements are false regarding health care costs.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 357 OBJ: Define economics and health care economics. TOP: Intrinsic factors MSC: NCLEX®: Not applicable 11. A nurse is educating a group of students about health care economics. Which statement would the students make if the teaching were effective? a.

“Extrinsic factors include the cost of prescription drugs.”

b.

“Extrinsic factors include the age of the population.”

c.

“Extrinsic factors include the demand for health care.”

d.

Extrinsic factors include employer-paid health insurance.”

ANS: A The nurse would know that the teaching was effective when the students states: “Extrinsic factors include the cost of prescription drugs.” The other statements about health care economics are false.

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PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 357

OBJ: Define economics and health care economics. TOP: Intrinsic factors MSC: NCLEX®: Not applicable 12. To provide quality care, the Affordable Care Act of 2010 a.

reduced the number of patients accepted into Medicaid.

b. kept the Medicaid system the same. c.

made changes to slow growth in spending.

d. increased Medicaid spending to ensure adequate patient care.

ANS: C To provide quality care, the Affordable Care Act of 2010 made changes to slow growth in spending. Other changes were aimed at improving Medicaid benefits and improving delivery of care.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 359 OBJ: Define economics and health care economics. TOP: Intrinsic factors

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MSC: NCLEX®: Not applicable 13. What action can nurses take to be fiscally responsible?

Give patients their discharge instructions and let them determine if a. the cost of their medications fit into their budget. b. Allow nurses to work on the unit when the census drops. c. Use proper hand hygiene. d. Document minimally on each patient.

ANS: C Nurses can be fiscally responsible in many different ways. This includes fiscal responsibility to the patient, such as assessing the patient’s resources for purchasing medication. The nurse is also expected to have fiscal responsibility for the organization. This includes sending nurses home or to another unit when the census drops and using proper hand hygiene to prevent infections, which would result in increased health care spending to treat. The nurse should also consider fiscal responsibility to the payer of care and practice documenting thoroughly to show the patients need for the care given.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 368-372 OBJ: Describe what is meant by the term fiscal responsibility in clinical practice.

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TOP: Fiscal responsibility MSC: NCLEX®: Not applicable

14. A case manager is educating a patient on health care insurance. Which statement by the patient shows that the teaching has been effective? a. “All health care is covered by insurance.” b. “Insurance does not cover inpatient hospital stays.” c. “All health care coverage is the same.”

All health insurance companies have rules about what services will d. be covered.”

ANS: D The case manager will know that teaching has been effective when the patients states: “All health insurance companies have rules about what services will be covered.” Each insurance company is different and will provide different coverage depending on the plan and the patient’s preexisting conditions.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 357 OBJ: Use basic knowledge of health care economics to analyze trends in the health care delivery system. TOP: Payer allocation decisions MSC: NCLEX®: Not applicable 15. The nurse has an adequate understanding of capital budget when stating:

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a. “A capital budget is part of the expected expenses of the unit.”

“A capital budget is used to purchase or replace equipment costing b. more than $5000.” c. “A capital budget is used to pay for nurses to work in the hospital.” d. “A capital budget is used to purchase lunch for employees.”

ANS: B The nurse has an adequate understanding of capital budget when the nurse states that the budget “is used to purchase or replace equipment costing more than $5000.” The capital budget is the beginning point of the budget cycle. It is not used to pay for nurses to work in the hospital and is not used to purchase lunch for employees. The capital budget is not part of the expected expenses of the unit.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 364 OBJ: Describe what is meant by operating budget, personnel budget, and capital budget.

TOP: Types of budgets MSC: NCLEX®: Not applicable 16. The nurse has an adequate understanding of productive time when stating: “Productive time is the amount of time the nurse is available to a. give care to patients.”

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“Productive time is the amount of time the nurse is attending a b. continuing education activity.”

“Productive time is counted when the nurse is not directly giving c. bedside care, such as going to lunch and taking a break.”

“Productive time is counted when the physician is at the patient’s d. bedside.”

ANS: A The nurse has an adequate understanding of productive time when stating that “productive time is the amount of time the nurse is available to give care to patients.” One work day (8 hours) is usually considered to be 7.5 productive hours. Nonproductive time reflects the amount of time that is not available for direct care, such as vacations, days off, holidays, continuing education, committee work, breaks, and lunch.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 367 OBJ: Describe what is meant by operating budget, personnel budget, and capital budget.

TOP: Productive time MSC: NCLEX®: Not applicable 17. Which of the following statements indicates the nurse’s understanding of fiscal responsibility? a. “Fiscal responsibility should be a concern for all nurses.”

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

“Fiscal responsibility is only a concern for the department b. manager.”

“Fiscal responsibility is only a concern for the hospital c. administrators.” d. “Fiscal responsibility is not a concern for the nursing staff.”

ANS: A The nurse has an adequate understanding of fiscal responsibility when stating: “Fiscal responsibility should be a concern for all nurses.” Fiscal responsibility affects everyone in the health care system. The nurse, as well as the entire hospital staff and administration, needs to have an understanding of the costs of care.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 368-372 OBJ: Describe what is meant by operating budget, personnel budget, and capital budget.

TOP: Types of budgets MSC: NCLEX®: Not applicable 18. Which statement by the nurse is accurate regarding the current health care American’s receive? a. “The distribution of services is efficient across the population.” b. “The distribution of care is even across the population.” c. “Access to care related to income is improving.” NURSINGTB.COM d. “Many Americans receive care that causes harm.”

ANS: D The nurse with an adequate understanding of current health care would state that many Americans receive care that causes harm. The distribution of services is inefficient and uneven across the population, and access to care related to income is worsening.

PTS: 1 DIF: Cognitive Level: Application REF: p. 358 OBJ:Define economics and health care economics.

TOP: Economics of the health care delivery system MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. It is important for the nurse to understand strategies that promote a fiscally responsible clinical practice.

From the following listing, select those strategies that would achieve a fiscally responsible clinical practice. (Select all that apply.)

Completes charge slips or scans bar code of nursing supplies used a. when changing a surgical dressing

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b. Participates in the annual hospital fund-raising activity Visits the Centers for Medicare & Medicaid Services to understand c. what services are provided during an inpatient visit Immediately reports any development of a patient medical d. complication to the health care provider Volunteers to participate in a hospital program initiative to reduce e. central line associated bloodstream infection (CLABSI) f.

Completes a patient’s discharge plan on the morning of discharge

ANS: A, C, D, E The following is a listing of strategies to promote a fiscally responsible clinical practice: • Provides quality nursing care that prevents complications and documents condition accurately • Makes conscious decisions about the allocation of professional nursing time • Understands Medicare and Medicaid insurance coverage • Engages in evidence-based practice and follows best practice guidelines • Shares information with patients and families about the costs of care and alternatives NURSINGTB.COM

• Assigns assistive personnel (nurse aides, certified medical assistants) appropriately to help with care • Works with the members of other health care professions to promote fiscal responsibility for clinical practice • Begins discharge planning on admission; otherwise, if not available or prepared until the day of discharge, there may be confounding factors (lack of transportation) that require the patient to stay an additional hospital day • Completes charge slips for patient supplies if required (Answer A) • Avoids burnout by taking scheduled breaks, meal times, and vacations • Engages in safe clinical practice that will avoid personal injuries The participation in a fund-raising activity does not directly impact the clinical practice. It does build a sense of camaraderie among staff.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 368-372 OBJ: Describe what is meant by the term fiscal responsibility in clinical practice.

TOP: Fiscal responsibility in clinical practice MSC: NCLEX®: Not applicable 2. Which action by the nurse demonstrates fiscal responsibility to the patient? (Select all that apply.)

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Discharging a patient home with prescriptions and no health a. insurance to cover the cost Assessing the patient’s resources and determining their ability to b. pay for prescriptions c. Setting the patient up for Meals on Wheels d. Giving the patient information on free support groups Calling local churches to see what services they can offer the e. patient

ANS: B, C, D, E The nurse demonstrates financial responsibility to the patient by assessing the patient’s resources and determining the ability to pay for prescriptions, setting the patient up for Meals on Wheels, giving the patient information on free support groups, and calling local churches to see what services they can offer the patient.

PTS: 1 DIF: Cognitive Level: Application REF: p. 368 OBJ: Discuss strategies you will use to achieve fiscal responsibility in clinical practice.

TOP: Fiscal responsibility to the patient MSC: NCLEX®: Safe and effective care environment 3. Which action by the nurse shows fiscal responsibility to the employing organization? (Select all that apply.)

NURSINGTB.COM a.

Wash hands after each patient contact.

b.

Turn patients every 2 hours.

c.

Round on patients.

d.

Toilet patients frequently to prevent falls.

e.

Use resources of the institution wisely.

ANS: A, B, D, E The nurse can show fiscal responsibility to the employing organization by washing hands after each contact, turning patients every 2 hours to prevent bed sores, toileting patients frequently to prevent falls, and using resources of the institution wisely.

PTS: 1 DIF: Cognitive Level: Application REF: p. 370 OBJ: Discuss strategies you will use to achieve fiscal responsibility in clinical practice.

TOP:Fiscal responsibility to the employing organization MSC: NCLEX®: Safe and effective care environment 4. Which action by the nurse demonstrates fiscal responsibility to the employing organization? (Select all that apply.)

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

a.

Only bringing needed supplies into a patient’s room

b.

Accurately documenting the patient’s condition

c.

Minimally documenting in the patient’s chart

d.

Taking breaks as scheduled

e.

Remaining healthy and able to function on the job

ANS: A, B, D, E The nurse shows fiscal responsibility to the employing organization by only bringing needed supplies into the patient’s room, accurately documenting the patient’s condition, taking breaks as scheduled, and remaining healthy and able to function on the job.

PTS: 1 DIF: Cognitive Level: Application REF: p. 370 OBJ: Discuss strategies you will use to achieve fiscal responsibility to the employing organization.

TOP:Fiscal responsibility to the employing organization MSC: NCLEX®: Safe and effective care environment 5. Which action by the nurse shows fiscal responsibility to the payer of care? (Select all that apply.)

NURSINGTB.COM a. Understand Medicare and Medicaid insurance coverage. b. Efficiently and effectively use resources to provide patient care. c. Document minimally in the patient chart. d. Select interventions which are cost effective. e. Document the patient’s plan of care.

ANS: A, B, D, E To show fiscal responsibility to the payer of care, the nurse should understand Medicare and Medicaid insurance coverage, efficiently and effectively use resources to provide patient care, select interventions that are cost effective, and document the patient’s plan of care as well as condition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 372 OBJ: Discuss strategies you will use to achieve fiscal responsibility to the employing organization.

TOP:Fiscal responsibility to the payer of care MSC: NCLEX®: Safe and effective care environment 6. A new graduate is preparing for a job interview. Which questions would be appropriate to ask the manager in regards to health care economics? (Select all that apply.)

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

a.

How is the acuity of patients factored into staffing?

b.

What is the turnover rate on this unit?

c.

How long are the breaks for staff on this unit?

d.

What is the overtime rate on this unit?

e.

What are the budgeted hours per patient day on this unit?

ANS: A, B, D, E The new graduate should consider asking how the acuity of patients is factored into staffing, what the turnover rate is, what the overtime rate is, and what the budgeted hours per patient day are for the unit.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 367 OBJ: Discuss strategies you will use to achieve fiscal responsibility to the employing organization.

TOP: Fiscal responsibility to the employing organization MSC: NCLEX®: Not applicable

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Chapter 17: Political Action in Nursing MULTIPLE CHOICE 1. The state nurses association writes a new version of the Nurse Practice Act, secures a sponsor in the legislature, and lobbies legislators to adopt the bill. Which of the laws of power would the nurse label this situation? a. Power is invariably personal. b. Power invariably fills any vacuum. c. Power is exercised through and depends on institutions.

Power is best exercised via large financial donations to individual d. legislators.

ANS: C As an individual, one can easily feel powerless and unable to deal with the complex problems facing a hospital, community, or state. Through a nursing service organization, a state nurses association, or a similar organization, an individual can garner the resources needed to magnify their power (Law 4: Power Is Exercised Through and Depends on Institutions). Initiatives such as this start with one person creating a new approach to a problem. That person exercises power by providing the leadership or spark to create the strategy to carry out such an initiative, thus inspiring people to contribute to the effort (Law 2: Power Is Invariably Personal). When a problem or issue arises, the prevailing desire is for peace and order. People are willing to give power to NURSINGTB.COM someone interested in restoring order to situations of discomfort. Therefore, someone will eventually step forward to handle the dilemma (Law 1: Power Invariably Fills Any Vacuum). Power is best exercised via large financial donations to individual legislators is not one of the five Sanford’s laws of power.

PTS: 1 DIF: Cognitive Level: Application REF: p. 382 OBJ:Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicable 2. A nurse plans to lobby a state senator regarding a particular health care bill. Which action would be appropriate?

The nurse should be specific about what action the senator should a. take early in the contact or letter.

The nurse should tell the senator that if their advice is followed, the b. nurse will vote for the senator.

The nurse should use a form letter to express personal opinion and c. encourage as many as possible to mail in the form letter.

The nurse should avoid making contact by phone and only submit d. personal views in writing.

ANS: A

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The structure and content of a visit or a written contact are very similar. That is, know your issue, keep it short, identify the issue by its bill number and title, and communicate exactly what action you want the lawmaker to take. Using a form letter is not as powerful as one that is specifically written by the person to the senator. It is not appropriate to tell the senator your persuasion on voting for them based on whether they follow your advice on the health care bill. Lobbying is about giving opinions.

PTS: 1 DIF: Cognitive Level: Application REF: p. 387 OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Health care bills MSC: NCLEX®: Not applicable 3. The clinical nurse leader makes out the daily assignments. One staff nurse tells another, “Last week I was asked to change my days off so the clinical nurse leader could go to a play in another city. I told the clinical nurse leader I couldn’t do it. Ever since then, I’ve been given the most difficult patients on the unit for my assignment.” The staff nurse can label this type of power as: a.

Inherent

c.

Legitimate

b.

Referent

d.

Expert

ANS: C Legitimate power is the power or the influence that comes with role and position. In this situation, the clinical NURSINGTB.COM nurse leader has legitimate power and authority because of the position to make the patient assignments.

Referent power is power a person has because others closely identify with that person’s personal characteristics. Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Inherent power is not a specific type.

PTS: 1 DIF: Cognitive Level: Application REF: p. 382 OBJ:Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicable 4. The nurses at Community General Hospital are concerned about violence involving children in their community. They wish to propose to the city government that drug-free and weapons-free zones and corridors be instituted near each school. The nurses send liaisons to the city school board and the parent–teachers association to ask them to join the effort. What is the term for this type of strategy? a.

Forming a coalition

c.

Collective bargaining

b.

Displaying legitimate power

d.

Seeking compromise

ANS: A A coalition is formed when individuals or organizations that share a common interest in a single issue work together toward a goal. Legitimate power is the power or the influence that comes with role and position. In some states, nurses have made a choice to gain that voice and assume control of their practice by using a

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

traditional collective bargaining model, commonly known as a labor union. Other states have elected to control practice through interest-based bargaining (IBB) or a nontraditional approach to collective bargaining to accomplish having that voice and control over practice. Seeking compromise or bargaining is when both positions or sides make concessions.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 383 OBJ: List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system. TOP: Coalitions MSC: NCLEX®: Not applicable 5. Which strategy is least effective in formulating political action? a. Ability to communicate information in concise terms b. Living and practicing in several different states c. Determining who should be contacted and for what political action d. Having the ability to use different channels of information

ANS: B The least effective strategy in formulating a political action is living and practicing in several different states.

Communication, the ability to determine who should be contacted, and knowing how to use the different channels of information are all important in political action.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 384

OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Political action MSC: NCLEX®: Not applicable 6. A nurse has recently moved from one state to another and wishes to write lawmakers to urge them to vote against a change in the Nurse Practice Act that would replace individual licensure with institutional licensure.

What lawmakers should the nurse contact? a.

The city council members

b.

The county (parish) legislators

c.

The state legislators from the district

d.

The federal legislators from the district

ANS: C Each state’s Nurse Practice Act is regulated by state laws. It would be important for the politically active nurse to contact state lawmakers and advise them of the pending legislation and the ramifications that would occur if institutional licensure replaced individual licensure—for instance, lack of regulation of safe nursing practice.

The Nurse Practice Act is not regulated by city, county (parish), or federal legislative bodies.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 386 OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Political action MSC: NCLEX®: Not applicable 7. What is an example of the weakest source of power?

Several nursing students talk with a head nurse regarding a problem they are having on the unit. The head nurse then discusses a. this problem with the chief nursing officer.

The clinical nursing instructor sends a student to the skills lab for b. further practice.

A nurse shares knowledge regarding nursing in a confident manner c. and style.

The head nurse tells staff members that as soon as all the care plans d. are completed, they may have some additional compensation time.

ANS: C When a nurse shares knowledge regarding nursing and nursing care, this is an example of expert power, which is the weakest in the power structure. The strongest power source is reward power as noted by tell staff nurses that once they are finished with their care plans, they may have some additional compensation time. Legitimate NURSINGTB.COM power is demonstrated by the nursing instructor sending a student to the skills lab for further practice. When student nurses discuss with the head nurse issues they are having on the unit and the head nurse discusses this with the chief nursing officer, this is considered an example of referent power.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 387 OBJ:Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicable 8. Which statement by the nurse educator is accurate regarding politics? a. “Politics involves influencing the allocation of scarce resources.”

“Politics involves identifying those in a public office that can be b. influenced.”

“Politics involves attempting to get people in government positions c. to think the way you want them to.”

“Politics involves lobbying for state and federal legislation to d. improve the quality of nursing care.”

ANS: A

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Politics is the process of influencing the allocation (who will receive) of scarce resources (nursing care and health care). It is a vital tool that enables the nurse to be more effective in the involvement in the political process and gives an individual nurse a tool that augments his or her power—or clout—to improve the care provided to patients. Whether on the community, hospital, or nursing unit level, political skills and understanding how laws are enacted enable the nurse to identify needed resources, gain access to those resources, work with legislative bodies to lobby for changes in the health care system, and overcome obstacles, thus facilitating the movement of the patient to higher levels of health or function. Lobbying is a part of the political process but is not a definition of politics. It is important to know who is in public office so that contact can be made to inform them of your position on certain issues.

PTS: 1 DIF: Cognitive Level: Application REF: p. 382 OBJ: Define politics and political involvement. TOP: Politics—definition MSC: NCLEX®: Not applicable 9. Which statement by the nurse would best represent the purpose of a political action committee (PAC)?

A vehicle for nurses across the country to organize collectively to a. endorse and support candidates for national offices A group of individuals or organizations who share a common b. interest in a single issue An organizational structure established for the purpose of c. supporting and fostering changes in the health care system

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A group that identifies special needs and raises funds to influence d. politicians to vote in a manner that supports the special needs

ANS: A PACs are a method by which a special-interest group can collectively endorse and support a candidate without the donation of large sums of money. ANA-PACs, as well as state PACs, enable nurses to organize and support candidates that have the ability to influence legislation on health care issues. A PAC can be active in any area of interest, not just health care or other special need areas. It is not an organizational structure for making changes in the health care system.

PTS: 1 DIF: Cognitive Level: Application REF: p. 378 OBJ: Define politics and political involvement. TOP: PACs MSC: NCLEX®: Not applicable 10. One of the five laws of power is that “power fills a vacuum.” Which statement by the nurse best captures that type of power?

“An individual who provides leadership and power to create a strategy that will address a problem and get people to contribute to a. the effort”

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

“People who are willing to give power to someone in order to b. restore comfort or handle a dilemma” “An individual who takes action to speak and act on behalf of a c. group A state nursing association that acts on behalf of the nurses within d. the respective state”

ANS: B People are willing to give power to someone interested in restoring order to situations of discomfort.

Therefore, someone will eventually step forward to handle the dilemma (Law 1: Power Invariably Fills Any Vacuum). As an individual, one can easily feel powerless and unable to deal with the complex problems facing a hospital, community, or state. Through a nursing service organization, a state nurses association, or a similar organization, an individual can garner the resources needed to magnify their power (Law 4: Power Is Exercised Through and Depends on Institutions). A person exercises power by providing the leadership or spark to create the strategy to carry out such an initiative, thus inspiring people to contribute to the effort (Law 2: Power Is Invariably Personal). Actions taken speak to the other nurses for who nurses act and, most important, the patients for who nurses advocate. The individual in the power position is acting on behalf of the group (Law 5: Power Is Invariably Confronted With and Acts in the Presence of a Field of Responsibility).

PTS: 1 DIF: Cognitive Level: Application REF: p. 386 OBJ:Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicableNURSINGTB.COM 11. How would a nurse determine the political views regarding health care issues of individuals who are running for public office?

Call the state or national political action committee of the a. American Nurses Association.

Talk with the administration of the institution to determine who is b. supporting health care issues.

Call the party headquarters of the candidates and ask them to share c. the views of the candidate with you.

Call the Accreditation Commission for Education in Nursing d. (ACEN) and obtain the political action reports.

ANS: A A political action committee should have the information regarding the views of specific candidates. It is the purpose of the committee to determine and collectively endorse candidates that support nursing and health care issues. The Accreditation Commission for Education in Nursing (ACEN), formerly the NLNAC, does not participate in political action activities; however, the National League of Nursing (NLN) does. Calling party headquarters may not provide you with a comprehensive list of the views of a candidate’s views. Talking to administration will provide you with their personal thoughts as to who is supporting health care issues, which may be biased.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 381 OBJ: Describe the function of a political action committee. TOP: PACs MSC: NCLEX®: Not applicable 12. A nurse is educating a group of students about reward power. The nurse knows the teaching has been effective when one of the students says: a. “Reward power does not actually exist anymore.”

“Reward power may cause a person to behave in a manner that b. benefits someone else.” c. “Nurses are not susceptible to reward power.” d. “Reward power only benefits nurses.”

ANS: B Reward power occurs when a person behaves in a manner that benefits someone else upon receiving a reward.

Reward power does exist in today’s society, although it is more closely monitored than in the past.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 386 OBJ:Discuss different types of power and howNURSINGTB.COM each is obtained.

TOP: Reward power MSC: NCLEX®: Not applicable 13. What action should the student nurse taken to begin networking? a.

Begin networking shortly after starting a new job.

b. Avoid networking and establish a career based on reputation. c.

Begin networking upon graduation.

d. Begin the networking process when a new position is needed.

ANS: C The student nurse should begin the networking process upon graduation to assist with future educational and career undertakings.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 383-384 OBJ:Discuss different types of power and how each is obtained.

TOP: Networking among colleagues MSC: NCLEX®: Not applicable

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14. A group of nurses are concerned about access to health care in rural communities. Which action should they take to voice their concerns? a.

Complain to their coworkers.

b.

Form a coalition to be combat the issue.

c.

Independently discuss the issues with other staff.

d.

Attend monthly staff meetings.

ANS: B To be effective, the nurses should form a coalition to combat the issues associated with access to health care in rural communities. Complaining to coworkers and working independently would not be as effective as forming a coalition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 384 OBJ:Discuss different types of power and how each is obtained.

TOP: Building coalitions MSC: NCLEX®: Not applicable 15. A nurse is actively involved in the political arena and is educating a colleague about becoming involved in the election process. The nurse knows that their teaching has been effective when a colleague states: NURSINGTB.COM a. “Nurses are discouraged from becoming involved in politics.” b. “The election process has nothing to do with nursing.” c. “It is easy for a nurse to become involved in the election process.” d. “Political campaigns never need any help.”

ANS: C Political campaigns typically need help folding letters, stuffing envelopes, looking up addresses, and preparing bulk mailings. It would be easy for nurses to become involved once they find a candidate that they wish to support.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 385 OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Election process MSC: NCLEX®: Not applicable 16. How does the Political Action Committee support candidates? a.

“Buys” a candidate

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b.

Lobby’s elected officials

c.

Evaluates candidates on nursing and health concerns only

d.

Does not endorse candidates for public office

ANS: C The Political Action Committee supports candidates by endorsing them for public office, providing them with financial supported need to win elections, and evaluating candidates on nursing and health concerns only.

Political action committees do not “buy” candidates or lobby elected officials.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 386 OBJ:List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system.TOP:Election process MSC: NCLEX®: Not applicable 17. Which of the following statements by the nurse shows understanding of the competence framework?

“Competence development is the means by which the nurse gains a. knowledge, skills, and abilities.”

“Competence development is the means by which the nurse’s b. knowledge, skills, and abilities are tested.”

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“Competence development refers to health and conduct c. expectations of the nurse.”

“Competence development refers to the nurse’s ability to perform d. the functions of the nursing role.”

ANS: A Competence development is the means by which the nurse gains knowledge, skills, and abilities. Competence assessment is the means by which the nurse’s knowledge, skills, and abilities are tested. Competence conduct refers to the health and conduct expectations of the nurse, as well as the nurse’s ability to perform the functions of the nursing role.

PTS: 1 DIF: Cognitive Level: Application REF: p. 391 OBJ:Discuss selected issues affecting nursing: multistate licensure, nursing and collective bargaining, and equal pay for work of comparable value.

TOP: Controversial political issues affecting nursing MSC: NCLEX®: Not applicable 18. Which statement would be accurate of nurses who support collective bargaining? a. “Collective bargaining has set nursing back.” b. “In general, collective bargaining is ineffective.”

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“Collective bargaining forces positive change in the practice c. setting.”

“Collective bargaining forces negative change in the practice d. setting.”

ANS: C Collective bargaining is highly effective and forces positive change in the practice setting because individuals are forced to look at and address situations together. Collective bargaining has helped nursing move forward because of advancements made during negotiations.

PTS: 1 DIF: Cognitive Level: Application REF: p. 392 OBJ:Discuss selected issues affecting nursing: multistate licensure, nursing and collective bargaining, and equal pay for work of comparable value.

TOP: Nursing and Collective bargaining MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. What actions can nurses take that would demonstrate the skills necessary to move a vision? (Select all that apply.) a.

Elect decision makers.

b.

Refrain from political involvement.

c.

Testify before legislative committee hearings.

d.

Compromise.

e.

Become elected officials.

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ANS: A, C, D, E Leavitt and colleagues (2005) stated that the future of nursing health care depends on nurse’s skills in moving a vision. The skills involve electing decision makers, testifying before legislative committee hearings, compromising, and becoming elected officials. These actions will help nurses protect the future of nursing and health care.

PTS: 1 DIF: Cognitive Level: Application REF: p. 384 OBJ: Define politics and political involvement. TOP: Political action in nursing MSC: NCLEX®: Not applicable 2. What action makes up a nurse’s political savvy? (Select all that apply.) a.

Analyzing a situation

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b.

Participating in a constructive way

c.

Following directions

d.

Voicing an opinion

e.

Presenting a possible resolution

ANS: A, B, D, E The actions that make up a nurses political savvy include the ability to analyze a situation, participate in a constructive way, voice an opinion, and present a possible resolution. The ability to follow directions does not make up the nurse’s political savvy.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 380 OBJ: Define politics and political involvement. TOP: Politics MSC: NCLEX®: Not applicable 3. The nurse understands the importance of participation in politics when stating which of the following? (Select all that apply.) a. “It is important for nursing to be presented in a positive light.” b. “Nurses should fight for better health care for all patients.”

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“Nurses should only worry about what is occurring where they c. practice nursing.” d. “Nurses should lobby for the availability of health care.” e. “The public should see what nurses really do.”

ANS: A, B, D, E It is important that the nurse understand how important political participation is. The following statements indicate understanding: “It is important for nursing to be presented in a positive light,” “Nurses should fight for better health care for all patients,” “Nurses should lobby for the availability of health care,” and “The public should see what nurses really do.” The statement “Nurses should only worry about what is occurring where they practice nursing” does not indicate understanding of the importance of political participation.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 378 OBJ: Define politics and political involvement. TOP: Politics MSC: NCLEX®: Not applicable 4. The nurse has an adequate understanding of power when listing which of the following as laws of power? (Select all that apply.)

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a. Power invariably fills any vacuum. b. Power is invariably public. c. Power is based on a system of ideas and philosophy. d. Power is exercised through and depends on institutions.

Power is invariably confront with and acts in the presence of a field e. of responsibility.

ANS: A, C, D, E The laws of power are: Law #1: Power invariably fills any vacuum; Law #2: Power Is Invariably Personal; Law #3: Power Is Based On a System of Ideas and Philosophy; Law #4: Power Is Exercised Through and Depends on Institutions; and Law #5: Power Is Invariably Confronted with and Acts in the Presence of a Field of Responsibility.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 381-382 OBJ:Discuss different types of power and how each is obtained.

TOP: Laws of power MSC: NCLEX®: Not applicable 5. In what ways can the nurse lobby? (Select all that apply.)

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Upon meeting the candidate for the first time and assessing a. knowledge b. Meet face-to-face with the candidate to discuss the issues. c. The nurse cannot lobby a candidate. d. Write a letter to the candidate. e. Email the candidate.

ANS: A, B, D, E The nurse can lobby a candidate in different ways. Meeting a candidate allows the nurse to assess that person as a potential office holder. Nurses can also write letters or email a candidate to discuss issues.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 383-384 OBJ: List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system. TOP: Lobbying MSC: NCLEX®: Not applicable 6. A nurse is educating coworkers on power. The nurse knows the teaching has been effective when the coworkers state: The sources of power are (Select all that apply.) a.

reward

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b.

coercive

c.

punishment

d.

expert

e.

legitimate

f.

referent

ANS: B, D, E, F There are five types of power: reward, coercive, expert, legitimate, and referent. Punishment is not one of the five types of power.

PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 381-382 OBJ:Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicable 7. A nurse has just moved to a new state and wants to know the names of the state senator(s), state representative(s), federal senator(s), and federal representative(s). How can the nurse find this information? a.

Call the Democratic Party headquarters.

b.

Call the Republican Party headquarters.

c.

Call the public library.

d.

Call the local newspaper.

e.

Call Congress.

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ANS: A, B, C The best action would be for the nurse to call the county Democratic or Republican Party headquarters or the public library. Calling the newspaper or Congress would not help the nurse find the information needed.

PTS: 1 DIF: Cognitive Level: Application REF: p. 385 OBJ: List specific strategies needed to begin to affect the laws that govern the practice of nursing and the health care system. TOP: Contacting political officials MSC: NCLEX®: Not applicable MATCHING Identify the type of power base associated with each of the following. a. Joining a coalition to lobby for a national health insurance plan

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b. Organizing nurses to work for the opponent in the next election c. The dean of the school discussing the educational program d. Testifying before a committee on a bill A political action committee’s endorsement or financial e. contribution

1. Reward 2. Coercive (punishment) 3. Expert (informational) 4. Legitimate 5. Referent (mentor) 1.ANS:EPTS:1DIF:Cognitive Level: Application REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicable 2.ANS:BPTS:1DIF:Cognitive Level: Application NURSINGTB.COM REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicable 3.ANS:DPTS:1DIF:Cognitive Level: Application REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicable 4.ANS:CPTS:1DIF:Cognitive Level: Application REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicable 5.ANS:APTS:1DIF:Cognitive Level: Application REF: pp. 381-382 OBJ: Discuss different types of power and how each is obtained.

TOP: Power MSC: NCLEX®: Not applicable

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Chapter 18: Collective Bargaining MULTIPLE CHOICE 1. Which statement best describes when collective bargaining by nurses can occur? a. Only when the nurses in the group are members of a union b. Whenever nurses see a need to organize to take collective action Only when the state nurses association is willing to represent c. nurses at a specific agency Whenever the state nurses association agrees that both wages and d. working conditions are inappropriate

ANS: B Professional nurses organize themselves. This may occur because administrators and nursing supervisors fail to recognize and address nurses’ individual and collective needs. Collective bargaining can be addressed through a formal union representative or through interest-based bargaining (IBB). The state nurses association may or may not be involved with collective bargaining.

PTS: 1 DIF: Cognitive Level: Application REF: p. 406 OBJ: Identify the conditions that may cause nurses to seek collective bargaining representation.

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TOP: Collective bargaining MSC: NCLEX®: Not applicable 2. In which situation would the traditional type of collective bargaining (union) help nurses attain their goals?

Management has agreed to no nursing layoffs for one year after a. reorganization. b. Nursing has received a 4% salary increase this year and next year. c. Nurses have identified workplace safety issues and health hazards.

Management has arranged for nurse practitioners to have admitting d. privileges.

ANS: C A conflict regarding safety between administration and nursing is a situation that could benefit from a nurses’ union. Many nurses support collective bargaining in the workplace as a way to control their practice by redistributing power within the health care organization. Salary increases, no nursing layoffs, and nurse practitioners having admitting privileges typically do not represent conflict.

PTS: 1 DIF: Cognitive Level: Application REF: p. 400 OBJ: Identify the conditions that may cause nurses to seek collective bargaining representation.

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TOP: Collective bargaining MSC: NCLEX®: Not applicable 3. Which provision—if labor management included it in a contract—would not be to nursing’s advantage? a.

A workforce retraining provision

b.

Seniority rights

c.

A grievance procedure

d.

Wage adjustments based on bed occupancy

ANS: D Unions may stimulate better hospital management by fostering formal, central, and consistent personnel policies with better lines of communication. Consistent personnel policies include a consistent wage base, regardless of bed occupancy. Workforce retraining, seniority rights, and a grievance procedure would be important provisions in a labor contract that would be advantageous to nursing.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 407 OBJ: Identify the conditions that may cause nurses to seek collective bargaining representation.

TOP: Contracts MSC: NCLEX®: Not applicable 4. What would the nurse identify as a primaryNURSINGTB.COM difference between traditional and nontraditional collective bargaining?

Traditional collective bargaining is not organized through the state a. nursing association.

Traditional collective bargaining units are organized and members b. belong to the National Nurses United.

Nontraditional collective bargaining units are not recognized by c. health care organizations as a collective bargaining agency.

Nontraditional collective bargaining has a long history and is based d. on the support of organizations throughout the country.

ANS: B The nontraditional collective bargaining activities in nursing are organized and supported by the Center for American Nurses, which is affiliated with the American Nurses Association. The traditional unit in the past was the United American Nurses (UAN). This union has joined other traditional bargaining units and has become the National Nurses United, which is a relatively new union (started in 2009).

PTS: 1 DIF: Cognitive Level: Application REF: p. 400 OBJ: Compare traditional and nontraditional collective bargaining models.

TOP: Traditional and nontraditional collective bargaining MSC: NCLEX®: Not applicable

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5. The nurse believes that an adequate understanding of arbitration through the traditional collective bargaining unit has been obtained. Which of the following statements supports this belief? a. “Arbitration is a management technique to discharge an employee.”

“Arbitration is useful to resolve conflicts having a basis in the b. labor-management” contract. c. “Arbitration is always used before the formal grievance process.” d. “Arbitration is a process used to establish nursing standards.”

ANS: B Arbitration has also been used to resolve issues involving the “integrity of the bargaining unit.” Arbitrators have been asked to decide whether nurses remain eligible for bargaining unit coverage when jobs are changed and new practice models are implemented. Mediation, arbitration, and fact finding have all been used to resolve conflicts in union contracts. Nurses usually fare well when contract enforcement issues are submitted to an arbitrator and facts, not power or public relations, determine the outcome. Arbitration is used after a formal grievance process has not reached a resolution to the issue. Arbitration does not establish nursing standards because that is the purpose of national organizations to write and develop nursing standards of practice.

PTS: 1 DIF: Cognitive Level: Application REF: p. 408 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Arbitration MSC: NCLEX®: Not applicable NURSINGTB.COM 6. A staff nurse is scheduled to work 3 to 11 pm in the cardiac step-down unit. The staff nurse realizes they are the only RN that will be on duty. The staff nurse calls the supervisor to say that help will be needed. The supervisor replies that there are no available nurses to assign to this unit. What should the nurse do? a. Leave and go home rather than assume this responsibility. b. Protect themself by filing a written objection to the assignment.

Call a temporary agency and arrange for coverage by a registered c. nurse. d. Call the state health department to investigate the staffing issue.

ANS: B Nurses who disagree with an assignment should submit their objection in writing when the assignment could violate the patient protection language of the state nurse practice act. An assignment-despite-objection report is submitted to the nursing administrator and the bargaining agent simultaneously, thus officially registering the complaint. This procedure is used both in the traditional and in the nontraditional collective bargaining units.

Professional responsibility would be staying with the assignment and not abandoning the work (i.e., patients).

The staff nurse does not have the authority or power to contact a temporary agency for obtaining staffing. The state department of health does not review or investigate staffing issues.

PTS: 1 DIF: Cognitive Level: Application REF: p. 401

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OBJ: Identify the conditions that may cause nurses to seek collective bargaining representation.

TOP:Patient care assignments MSC: NCLEX®: Safe and effective care environment—management of care 7. A nurse is preparing a presentation. How can the nurse explain one of the primary concerns of the proponents for a nontraditional collective bargaining unit versus the traditional, union-based nursing model?

“The traditional-based union model frequently puts nurses and a. employers in adversarial positions.”

“The union dictates to members what they can and cannot do b. within the health care institution.”

“The union-based model can initiate strikes that can be detrimental c. to the provision of health care in an institution.”

“The union-based model is too expensive and nurses are not fairly d. compensated by the organization.”

ANS: A The traditional-based union model is adversarial and frequently puts nursing and administration in antagonistic positions. Strikes are most often the last resort and are planned well in advance so that the institution can be prepared. Nontraditional process is referred to as interest-based bargaining (IBB) or shared governance. This is a nontraditional style of bargaining that attempts to problem solve differences between labor and management.

NURSINGTB.COM Although this style of bargaining and mediation will not always eliminate the need for the more traditional and adversarial collective bargaining, many believe this nonadversarial approach of negotiation may be closer to the basic fabric of the discipline of nursing and its ethical code. In both models, nurses pay dues.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 400 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Nontraditional versus traditional collective bargaining units MSC: NCLEX®: Not applicable 8. A nurse is giving a lecture on the primary problem that decreases the power of both types of collective bargaining models. The nurse knows that the teaching has been effective when a colleague states: “The small number of states that recognize either type of collective a. bargaining” “The political influences of the American Hospital Association on b. nursing organizations” “The adversarial goals of each of the respective organizations or c. models” d. “The lack of membership of the majority of practicing nurses”

ANS: D

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Lack of membership of the majority of practicing nurses decreases the power of both types of collective bargaining models. Most people join an organization in response to a particular need. Almost 80% of nurses do not belong to any professional nursing organization. The traditional union based model is more adversarial than the nontraditional model. The American Hospital Association’s political influence does not decrease or increase power in either model. The other options do not accurately show the primary problem that decreases the power of the collective bargaining models.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 409 OBJ: Compare traditional and nontraditional collective bargaining models.

TOP:Nontraditional versus traditional collective bargaining units MSC: NCLEX®: Not applicable 9. A nurse is educating coworkers on the establishment of collective bargaining. The nurse knows the teaching has been successful when a coworker states: a.

“Collective bargaining is still not recognized by hospitals.”

b.

“Nurse activists believed in a unified voice for nurses.”

c.

“Nurse activists wanted to option of working more hours.”

d.

“Collective bargaining is not effective.”

ANS: B

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Nurse activists created the United America Nurse because they believed in the creation of a powerful, national, independent, and unified voice for union nurses. Collective bargaining is recognized in hospitals in states where it is effective. The other statements are not accurate of collective bargaining.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 399 OBJ:Identify the milestones in the history of collective bargaining.

TOP: The evolution of collective bargaining in nursing MSC: NCLEX®: Not applicable 10. A charge nurse is providing education to coworkers on state nursing associations. The charge nurse judges that the teaching has been effective when a coworker states: a. “These professional associations address nursing practice.” b. “These professional associations do nothing to support nursing.” c. “These professional associations protect the rights of physicians.”

“These professional associations are managed by hospital d. administrators.”

ANS: A

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State nursing associations have represented nurses since 1946. They are multipurpose and are involved in many activities such as addressing nursing practice. These organizations do not protect the rights of physicians and are not managed by hospital administrators.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 400 OBJ: Compare traditional and nontraditional collective bargaining models.

TOP: Who represents nurses for collective bargaining? MSC: NCLEX®: Not applicable 11. A union nurse is educating a new nurse on common issues faced by nurses today. The union nurse knows that the teaching has been effective when the new nurse states: “There are no common issues; nurses faces different issues based a. on their job.”

“Today, there are no issues because of the advancement of b. technology.” c. “Hospitals are fully staffed at all times.” d. “Hospitals frequently mandated nurses due to staffing shortages.”

ANS: D Common issues today include staffing shortages that lead to mandating nurses to work overtime. Nursing shortages create issues that cannot be fixed byNURSINGTB.COM advances in technology and leave hospitals inadequately staffed.

Although each nurse faces different issues based on the job, collectively nurses experienced many of the same issues in their day-to-day nursing activities.

PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 401-403 OBJ: Identify conditions that may lead nurses to seek traditional or nontraditional collective bargaining. TOP: Common issues MSC: NCLEX®: Not applicable 12. Which statement by the nurse indicates understanding of collective bargaining in the workplace? a. “Collective bargaining is not useful in the workplace.” b. “Collective bargaining is used by nurses to control their practice.” c. “Collective bargaining is used by managers to control nurses.”

“Collective bargaining is always an adversarial process in the d. workplace.”

ANS: B Collective bargaining is used by nurses to control their practice by redistributing power within the health care organization. It is not used by managers to control nurses. It is used in the workplace. Traditional collective bargaining has been considered an adversarial process. Nontraditional collective bargaining or interest-based

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bargaining (IBB) attempts to problem-solve issues between staff and management in a shared governance approach.

PTS: 1 DIF: Cognitive Level: Application REF: p. 403 OBJ:Identify the positive and negative aspects of traditional and nontraditional collective bargaining.TOP:The debate over collective bargaining MSC: NCLEX®: Not applicable 13. A nurse is discussing personal seniority with the department manager. The nurse has an adequate understanding of seniority when stating which of the following?

“Seniority provides certain rights to those with the highest number a. of years of service” “Seniority provides the same amount of vacation time as new b. hires” c. “Seniority no longer provides protection in today’s economy” “Seniority means that those with the highest number of years of d. service can be forced to retire”

ANS: A NURSINGTB.COM Seniority provides specific rights, which are spelled out in the bargaining agreement, to those who have the highest number of years of service. These rights will differ with each organization.

PTS: 1 DIF: Cognitive Level: Application REF: p. 408 OBJ:Identify the positive and negative aspects of traditional and nontraditional collective bargaining.TOP:The debate over collective bargaining MSC: NCLEX®: Not applicable 14. A nurse is educating a new nurse on grievance mechanisms. The nurse judges that the teaching has been effective when the new nurse states: “Nurses should attend any meeting where they believe discipline a. may be given without representation” b. “The nurse must ask a supervisor to file a grievance” c. “As a new nurse, I cannot file a grievance” d. “Any nurse can file a grievance”

ANS: D Any nurse can file a grievance. The nurse does not have to ask permission from a supervisor. The nurse should be represented in any meeting where discipline may be given.

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PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 408 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Resolution of grievances MSC: NCLEX®: Not applicable 15. A nurse is educating a new nurse on grievances. The teaching has been effective when the new nurse states: a.

“I can file a grievance”

b.

“My employer cannot file a grievance”

c.

“The nursing union cannot file a grievance”

d.

“My coworkers cannot file a grievance”

ANS: A Any nurse, the employer, or the nursing union can file a grievance.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 408 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Resolution of grievances MSC: NCLEX®: Not applicable 16. A nurse is teaching nursing students aboutNURSINGTB.COM issues that keep nursing from becoming a profession of choice.

The nurse knows that the teaching has been effective when one of the nursing students states: a. “Nurses downplay their role in health care” b. “Nurse’s take credit for their role in health care” “Nurses are often seen on the news discussing their role in health c. care” d. “Nurses are willing to take to media”

ANS: A There are many factors that prevent nursing from becoming a profession of choice. These include nurses downplaying their role in health care, not taking credit for their role, and nurses not being seen in the media.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 415 OBJ:Discuss the impact of the silence of nurses in public communications and the perception of nurses by the public.TOP:Future trends MSC: NCLEX®: Not applicable 17. A nurse is striving to control personal nursing practice. Which action should the nurse avoid?

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a.

Recommend a new system for bedside report.

b.

Refrain from participating in peer review.

c.

Create a unit presentation on how to increase patient safety.

d.

Identify ways to reduce hazards.

ANS: B The nurse can control personal nursing practice by recommending a new system for bedside report, participating in peer review, creating a unit presentation on how to increase patient safety, and identifying ways to reduce hazards.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 411 OBJ:Identify barriers to control of professional practice.

TOP: How can nurses control their practice? MSC: NCLEX®: Not applicable 18. A nurse has an adequate understanding of traditional collective bargaining when making which of the following statements?

“The goal of traditional collective bargaining is to win something a. that is controlled by another.”

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“The goal of traditional collective bargaining is to win something b. that another person has worked for.”

“The goal of traditional collective bargaining is to give all power to c. the nurse.”

“The goal of traditional collective bargaining is to give all power to d. the organization.”

ANS: A The goal of traditional collective bargaining is to win something that is controlled by another. The other statements are not accurate.

PTS: 1 DIF: Cognitive Level: Application REF: p. 400 OBJ: Identify the positive and negative aspects of traditional and nontraditional collective bargaining. TOP: Traditional collective bargaining MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. A nurse manager is speaking to a group of nurses about how to choose their representative if they wish to participate in traditional or nontraditional collective bargaining. The nurse manager knows the teaching has been effective if the nurses select which of the following as ways to choose their representative? (Select all that apply.)

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a.

Service Employees International Union

b.

The National League for Nursing

c.

Their state nurses association

d.

The American Federation of Teachers

e.

National Nurses United (NNU)

f.

Center for American Nursing (CAN)

ANS: C, E, F The professional association has the means and responsibility to represent nurses. The national professional organization for nursing is the American Nurses Association (ANA) with its constituent units, the state and territorial nursing associations. Nurses can enjoy the benefit of representation by nurses either through a traditional organized union, such as the National Nurses United (NNU), or through nontraditional interestbased bargaining, such as the Center for American Nurses (CAN).

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 400 OBJ: Identify steps nurses would take to initiate collective bargaining representation.

TOP: Representation MSC: NCLEX®: Not applicable 2. Which action can the nurse take during a job interview to ensure job satisfaction in the future? (Select all NURSINGTB.COM that apply.) a.

Ask about benefits associated with the job.

b.

Assess the potential employer’s mission.

c.

Determine wages and pay increases.

d.

Ask questions to determine the culture of the organization.

e.

Question the hours that are required for a full-time status.

ANS: B, D In the job interview, it is important that the nurse focuses on questions that will help determine which job is right and will ensure job satisfaction in the future. The nurse should be prepared to assess the potential employer’s mission and culture in order to determine if the job will support the nurse’s professional practice and growth. Although information about compensation, benefits, and hours are needed, these are not best predictors of job satisfaction.

PTS: 1 DIF: Cognitive Level: Application REF: p. 411 OBJ:Identify the milestones in the history of collective bargaining.

TOP: Job satisfaction MSC: NCLEX®: Not applicable

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3. Which action by hospitals in the 1940s began the journey to collective bargaining for nurses? (Select all that apply.) a.

Allowed nurses to work 40-hour work weeks

b.

Compensated nurses for overtime

c.

Scheduled nurses to work 50- to 60-hour work weeks

d.

Subjected nurse to arbitrary schedules

e.

Did not offer sick or personal time

ANS: C, D, E During the 1940s, nurses working in hospitals were subjected to arbitrary schedules, did not have sick or personal time, and were scheduled to work 50- to 60-hour work weeks.

PTS: 1 DIF: Cognitive Level: Application REF: p. 399 OBJ:Identify the milestones in the history of collective bargaining.

TOP: The evolution of collective bargaining in nursing MSC: NCLEX®: Not applicable 4. The nurse manager has an adequate understanding of the common issues in nursing when stating which of the following? (Select all that apply.)

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a.

“There are no common issues in nursing.”

b.

“Mandated staffing is a common issue.”

c.

“Unsafe patient assignments are a common issue.”

d.

“Lack of overtime is a common issue.”

e.

“Negotiations are a common issue.”

ANS: B, C, E Mandated staffing, unsafe patient assignments, and negotiations are common issues faced by nurses today.

Lack of overtime is not considered to be a common issue in nursing.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 401-403 OBJ:Identify conditions that may lead nurses to seek traditional or nontraditional collective bargaining.TOP:Common issues MSC: NCLEX®: Safe and effective care environment 5. A nurse believes that an assignment is unfair and refuses to care for the assigned patients. What could be the outcome if the nurse abandoned the patient assignment? (Select all that apply.)

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a.

The nurse would be assigned to another group of patients.

b.

Untoward patient outcomes

c.

Other nurses would take on the nurse’s assignment.

d.

Disciplinary action by the Board of Nursing

e.

Disciplinary action by the nurse’s employer

ANS: B, D, E Abandoning a patient assignment risks untoward patient outcomes and can result in disciplinary action by the nurse’s employer and the Board of Nursing.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 402 OBJ:Identify conditions that may lead nurses to seek traditional or nontraditional collective bargaining.TOP:Common issues MSC: NCLEX®: Safe and effective care environment 6. A nurse believes that the patient assignment received is unsafe. Which action should be taken to correct this? (Select all that apply.) a. Leave the hospital.

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b. Submit a report about the assignment following protocol. c. Report the assignment to a supervisor immediately. d. Accept the assignment.

Accept the assignment and only perform the skills that the nurse is e. comfortable with.

ANS: B, C The nurse should immediately report the assignment to the nurse supervisor and submit a report about the assignment following protocol. The nurse should not leave the hospital or accept the assignment if they cannot provide competent care.

PTS: 1 DIF: Cognitive Level: Application REF: p. 402 OBJ:Identify conditions that may lead nurses to seek traditional or nontraditional collective bargaining.TOP:Common issues MSC: NCLEX®: Safe and effective care environment 7. What action can the registered nurse take to control personal practice? (Select all that apply.) a. Improve the professional practice of nurses and nursing assistants.

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b. Refrain from shared governance. c. Implement peer review. d. Identify and recommend elimination of hazards in the workplace.

Identify and recommend processes that work to ensure the safety of e. patients.

ANS: A, C, D, E To control personal practice, the registered nurse can improve the professional practice of nurses and nursing assistants, implement shared governance, implement peer review, identify and recommend elimination of hazards in the workplace, and identify and recommend processes that work to ensure the safety of patients.

PTS: 1 DIF: Cognitive Level: Application REF: p. 411 OBJ:Identify barriers to control of professional practice.

TOP:How can nurses control their practice?

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Chapter 19: Ethical Issues MULTIPLE CHOICE 1. A nurse is educating an adult patient on patient rights, according to the American Hospital Association. The teaching has been effective when the adult states that the patient’s rights include: a.

“choice of diet to be eaten during hospitalization.”

b.

“considerate and respectful care from all care providers.”

c.

“medical care regardless of ability to pay.”

d.

“information from nurses about diagnosis and prognosis.”

ANS: B When you are a patient in the hospital, you have the right to receive considerate and respectful care. The American Hospital Association published a Patient’s Bill of Rights, which is now revised and called The Patient Care Partnership. This document reflects acknowledgment of patients’ rights to participate in their health care and was developed as a response to consumer criticism of paternalistic provider care. The statements detail the patient’s rights with corresponding provider responsibilities. This document reflects the increasing emphasis on patient autonomy in health care and defines the limits of provider influence and control. It does not contain information on diets, nursing diagnosis, or the ability to pay for medical care.

PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 421-423

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OBJ: Discuss the moral implications of the ANA and ICN codes of ethics.

TOP:Patient rights MSC: NCLEX®: Safe and effective care environment—management of care 2. A nurse manager is teaching the purpose of the nurse’s Code of Ethics to a group of high school students.

Which statement by one of the students indicates that the teaching has been effective? The purpose of the nurse’s Code of Ethics is “to assist in clarifying the individual nurse’s personal values and a. goals.” b. “to differentiate between moral and immoral acts.” c. “to guide the behavior of the professional nurse.” d. “to identify acts that are legal for the nurse to perform.”

ANS: C The American Nurses Association (ANA) Code of Ethics (2001) is a statement to society that outlines the values, concerns, and goals of the profession. It should be compatible with the values and goals of each nurse.

It does not outline moral or immoral acts or make statements regarding legal aspects of nursing.

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PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 428 OBJ: Discuss the moral implications of the ANA and ICN codes of ethics.

TOP: Ethics MSC: NCLEX®: Not applicable 3. Which statement best describes the Code of Ethics of the American Nurses Association?

A moral statement of accountability for practicing nurses and for a. student nurses b. A legal document describing the responsibilities of the nurse A statement regarding nursing care that outlines principles for the c. hospital to use to evaluate quality of care A document that is used as a guide for the nurse to consider in the d. decision-making process in legal situations

ANS: B The Code of Ethics is a moral statement of accountability for practicing nurses and for student nurses. It is a statement to society that outlines the values, concerns, and goals of the profession, thereby addressing accountability. The code provides direction for ethical decisions and behavior by repeatedly emphasizing the obligations and responsibilities that the nurse–patient relationship entails. It lacks legal enforceability and is not a legal document like licensure laws NURSINGTB.COM

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 428 OBJ: Discuss the moral implications of the ANA and ICN codes of ethics.

TOP: Ethics MSC: NCLEX®: Not applicable 4. Which ethical principle is applied when the nurse acts to safeguard the patient and the public by reporting poor nursing practice? a.

Autonomy

c.

Justice

b.

Fidelity

d.

Veracity

ANS: D Veracity—the duty to tell the truth—is represented in this situation. Autonomy is the right of the patient to make an informed decision. Fidelity means to act in a way that is loyal, such as keeping information private and confidential. Justice requires the nurse to treat all patients fairly without regard to age, socioeconomic status, or other variables.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 423 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics

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MSC: NCLEX®: Safe and effective care environment—management of care 5. What ethical principle is implemented, or supported, when the nurse encourages a patient to be involved in planning and implementing self-care? a.

Autonomy

c.

Justice

b.

Fidelity

d.

Veracity

ANS: A A patient’s right to self-determination implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Fidelity involves keeping information confidential and maintaining privacy and trust. Veracity is the duty to tell the truth.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Safe and effective care environment—management of care 6. The ethical principle of autonomy is not applicable in which patient situation?

NURSINGTB.COM a.

The patient does not speak or understand the English language.

b. The patient is unaware of who or where he or she is. c.

The patient has been in a long-term care facility for 10 years.

d. The patient has values that conflict with the caregiver’s values.

ANS: B This principle assumes rational thinking on the part of the individual, and being unaware of who and where the patient is, is not indicative of the ethical principle of autonomy. Autonomy is a patient’s right to selfdetermination implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. In the other situations, the patient has rational thinking even though he or she may not understand or speak English because an interpreter could assist.

PTS: 1 DIF: Cognitive Level: Application REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Not applicable 7. A nurse is educating a nurse aide on patient confidentiality. The nurse believes the teaching to be effective when the nurse aide states that confidentiality will be maintained by a nurse who believes in and values the ethical principle of

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a.

veracity.

c.

justice.

b.

autonomy.

d.

fidelity.

ANS: D Fidelity involves keeping information confidential and maintaining privacy and trust. Veracity means to tell the truth. Autonomy involves the patient making an informed decision and implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 422 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Not applicable 8. A patient who has a terminal illness wants to be able to take a prescription medication to end life when suffering becomes unbearable. The patient asks the nurse for advice. Operating from a deontological point of reference, what action does the nurse take? a. Advises the patient about local providers willing to participate b. Assesses the patient for more information about the situation

NURSINGTB.COM c. Determines what kind of insurance the patient has before acting d. Tells the patient that they cannot participate in this action

ANS: D Deontology is rule-bound and inflexible, obtaining moral authority from absolutes revealed by God. To preserve the sanctity of life, the nurse cannot participate in this situation. Advising the patient of providers to see is working from a teleological viewpoint because the end (patient death) might be seen as outweighing the means (helping the patient find a provider to provide a lethal prescription of drugs). Assessing the situation to see how the patient is affected (versus how some other patient would be affected) is situational. Determining financial status is not related to a specific philosophical outlook but might violate the principle of justice.

PTS: 1 DIF: Cognitive Level: Application REF: p. 424 OBJ:Discuss the role of the nurse in ethical health care issues.

TOP:Communication and Documentation MSC: NCLEX®: Safe and effective care environment—management of care 9. The nurse is very busy caring for a large case load. An adult patient mentions that by having slow mobility, “people just do things for me rather than allowing me to do as much as possible on my own.” To solve the dilemma of needing to conserve time versus supporting the patient’s involvement in self- care, what principle may help the nurse?

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a.

Veracity

c.

Justice

b.

Fidelity

d.

Autonomy

ANS: D Autonomy implies the freedom to have choices and make decisions about one’s own care without interference.

Just because this patient is slow does not mean he or she cannot make choices and participate in self-care.

Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables.

This principle involves the allocation of scarce and expensive health care resources. Veracity is the duty to tell the truth. Fidelity involves keeping information confidential and maintaining privacy and trust.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Not applicable 10. What element in health care is most responsible for the ethical dilemma of whether health care is a privilege or a right? a.

Cost

c.

Consumerism

b.

Technology

d.

Worker shortage

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ANS: A

Variables of the justice principle involve the allocation of scarce or expensive health care resources. The following questions are a few examples illustrating this principle: What kind of access to health care should illegal immigrants receive—preventive care or only more costly emergency care? How should the health care of children be allocated? Should all children receive the same health care regardless of ability to pay?

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 442 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Not applicable 11. Advance directives such as the health care proxy and living will support what ethical principle? a.

Veracity

c.

Beneficence

b.

Advocacy

d.

Autonomy

ANS: D Autonomy implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. Veracity is the duty to tell the truth.

Beneficence is the duty to actively do good for patients. Speaking out on behalf of the patient is an essential part of the advocacy role of the nurse.

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PTS: 1 DIF: Cognitive Level: Analysis REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Safe and effective care environment—management of care 12. A nurse is educating themself on the ANA Code of Ethics. Which action by the nurse would be unethical, according to the ANA Code of Ethics? a. Joining unions or bargaining units b. Engaging in lobbying related to health care issues c. Reporting an incompetent or impaired colleague d. Refusing to care for a patient who is diagnosed as HIV positive

ANS: D ANA Code 1: The nurse provides services with respect for human dignity and the uniqueness of the patient unrestricted by considerations of social or economic status, personal attributes, or the nature of the health problem. Nurses have the right to engage in collective bargaining and lobbying for health care issues. Nurses have a legal responsibility based on the Nurse Practice Act in their states to report an incompetent of impaired colleague.

PTS: 1 DIF: Cognitive Level: Application REF: p. 428 NURSINGTB.COM OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Ethics MSC: NCLEX®: Safe and effective care environment—management of care 13. Which action by the nurse shows an understanding of the ethical principle of autonomy?

Allowing a patient the right to make decisions regarding his health a. care even if the nurse does not agree with his decisions. b. Making decisions for the patient regarding his care Disregarding the patient’s decisions because they are not “normal” c. according to society Consulting the attending physician to make decisions for the d. patient

ANS: A The nurse shows understanding of the ethical principle of autonomy by allowing patients the right to make their own health care decisions even if the nurse does not agree with their decisions. It is not up to the nurse or the attending physician to make health care decisions for patients.

PTS: 1 DIF: Cognitive Level: Application REF: p. 421

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

OBJ: Define terminology commonly used in discussions about ethical issues.

TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment 14. The nurse is educating a coworker on the ethical principle of beneficence. The nurse judges the teaching to be effective when her coworker states: “Beneficence involves allowing patient to make their own health a. care decisions.” b. “Beneficence is the duty to actively do good for patients.” c. “Beneficence is the duty to do no harm.” d. “Beneficence involves treating all patients equally.”

ANS: B Beneficence is the ethical principle of actively doing good for patients. Allowing patients to make their own health care decisions is autonomy. Doing no harm to the patient is nonmaleficence. Justice involves treating all patients equally.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 422 OBJ: Define terminology commonly used in discussions about ethical issues.

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TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment 15. What action can the nurse take to uphold the ethical principle of fidelity? a.

Report unscrupulous billing practices.

b.

Disclose the results of an HIV test to a patient’s family.

c.

Make health care decisions for a patient.

d.

Accept an assignment that is unsafe.

ANS: A The nurse can uphold the ethical principle of fidelity by reporting unscrupulous billing practices. Disclosing the results of an HIV test to a patient’s family would violate fidelity. Making health care decisions would violate autonomy. Accepting an assignment that is unsafe violates nonmaleficence.

PTS: 1 DIF: Cognitive Level: Application REF: p. 422 OBJ: Define terminology commonly used in discussions about ethical issues.

TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment

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16. A nurse is caring for a patient who has just been diagnosed with cancer. The patient’s family has requested that the patient not be told at this time because it would be devastating. The patient asks the nurse if the diagnosis is cancer. If the nurse were to uphold the ethical principle of veracity, what would the response be? a. “No, you do not have cancer.” b. “The physician is unsure of your diagnosis at this time.”

“Yes, that is the diagnosis. Let me call the doctor so that we can c. have a discussion.”

“Yes, but your family told me that I could not talk to you about the d. diagnosis.”

ANS: C If the nurse were to uphold the ethical principle of veracity, the nurse would inform the patient of the diagnosis and involve the physician in the discussion. The nurse should not lie to the patient or withhold information at the family’s request; the patient has a right to know information regarding his or her health care.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 423 OBJ: Define terminology commonly used in discussions about ethical issues.

TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment 17. A nurse is educating a group of nursing onNURSINGTB.COM the deontological model of ethical reasoning. The nurse determines that the teaching has been effective when a student states: a.

“All life is worthy of respect.”

b.

“Abortions are ethical.”

c.

“Euthanasia is acceptable in certain situations.”

d.

“Lying is acceptable if it benefits the patient.”

ANS: A The deontological model of ethical reasoning states that all life is worthy of respect. Abortions and euthanasia are never acceptable because they violate the duty to respect the sanctity of all life. Lying is never acceptable because it violates the duty to tell the truth.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 424 OBJ: Define terminology commonly used in discussions about ethical issues.

TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment 18. A nurse is educating nursing students on the teleological model of ethical reasoning. The nurse judges that the education has been effective when a student states:

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“Abortion is acceptable because it results in fewer unwanted a. babies.”

“Abortion is never acceptable because it violates the sanctity of b. life.”

“Euthanasia is never acceptable because it violates the sanctity of c. life.”

“The rights on individuals should not be sacrificed for the good of d. the majority.”

ANS: A The teleological model of ethical reasoning is interpreted as meaning “the end justifies the means.” The rights of some individuals may be sacrificed for the majority. Therefore, abortion may be acceptable because it results in fewer unwanted babies. Euthanasia may be acceptable because it results in decreased suffering.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 425 OBJ: Define terminology commonly used in discussions about ethical issues.

TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment 19. A nurse and a patient are discussing the patient’s wishes regarding resuscitation. The patient decides that resuscitated is not wanted under any circumstances. What action can the nurse take to identify the ethical issues of the situation?

NURSINGTB.COM a. Encourage the patient to discuss his wishes with his family. b. Encourage the patient to change his mind.

Coerce the patient into changing his mind by calling his physician c. to the bedside. d. Continue to treat the patient as a “full code.”

ANS: A When identifying the ethical issues of the situation, the nurse should encourage the patient to share his wishes with his family. It is not the position of the nurse to try to change the patient’s mind or force him to remain a “full code.” The nurse should respect the patient’s wishes and document them accordingly.

PTS: 1 DIF: Cognitive Level: Application REF: p. 424 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment 20. A patient with cancer has decided to end treatment and is discussing end-of-life care with family. The nurse notices that the attending physician has just ordered another dose of chemotherapy. What would be the best action for the nurse to take as an advocate for the patient?

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Send the order to pharmacy so that the chemotherapy can be a. prepared.

Call the attending physician and request a meeting so that there can b. be open communication between the physician, patient and family.

Tell the patient that because the chemotherapy has been ordered, it c. must be given.

Request a meeting with the attending physician, patient, and family so the attending physician can convince the patient to receive the d. chemotherapy.

ANS: B As an advocate for the patient, the nurse should advocate for the patient with the attending physician and family by facilitating communication. It would be best for all parties to be in a room together so that a discussion can take place. It would not be appropriate to send the order to pharmacy, try to convince the patient to receive chemotherapy, or to tell the patient that the drug must be given because it was already ordered.

PTS: 1 DIF: Cognitive Level: Application REF: p. 424 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Understanding ethics MSC: NCLEX®: Safe and effective care environment 21. A young woman has come to the hospital requesting medication to induce an abortion. The nurse assigned NURSINGTB.COM finds it too hard to provide care to this patient because it violates the nurse’s ethical principles. Which action would be the best for the nurse to take?

Continue to provide care for the patient but refuse to administer the a. medication. b. Administer the medication because the doctor ordered it. c. Find another nurse to provide care for the patient. d. Try to talk the patient out of taking the medication.

ANS: C To ensure care for the patient without violating the nurse’s ethical principles, the nurse should find another nurse to care for the patient. Because the patient has rights, it would be inappropriate to try to talk the patient out of receiving the medication or to deny the patient’s access to the medication.

PTS: 1 DIF: Cognitive Level: Application REF: p. 421 OBJ:Discuss the role of the nurse in ethical health care issues.

TOP:Controversial ethical issues affecting nursing MSC: NCLEX®: Safe and effective care environment

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22. A nurse is caring for a young patient recovering from a traumatic car accident. The patient has lost a lot of blood and is in need of a blood transfusion. The patient states< “I’m a Jehovah’s Witness,” and will not accept the blood. The nurse knows the patient will likely not survive if they do not receive the blood. What action should the nurse take? a.

Administer the blood anyway; the patient will die without it.

b.

Try to talk the family into signing the consent for the blood.

c.

Call the physician and report the patient’s decision.

d.

Stop all care for the patient to respect their wishes.

ANS: C The nurse should immediately call the physician to report the patient’s decision. The nurse should not administer the blood against the patient’s wishes or try to talk the family into signing the consent. The nurse should continue all care for the patient except administration of the blood.

PTS: 1 DIF: Cognitive Level: Application REF: p. 421 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Moral/ethical principles MSC: NCLEX®: Safe and effective care environment 23. The nurse has an adequate understanding of ethical issues regarding transplantation when stating which of NURSINGTB.COM the following? a. “There are few Americans on the transplantation list.” b. “Everyone on the transplantation list receives the organ they need.” c. “There is an overabundance of organ donors.”

“The majority of individuals on the transplantation list will die d. because of the shortage of organs.”

ANS: D There are almost 110,000 Americans on the transplantation list, and the majority of them will die without a transplant because of the shortage of available organs.

PTS: 1 DIF: Cognitive Level: Application REF: p. 438 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Moral/ethical principles MSC: NCLEX®: Safe and effective care environment 24. A nurse manager is educating a group of staff nurses about genetics and genomics. The nurse manager judges that the teaching has been effective when one of the staff nurses states:

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“Health outcomes and treatment of disease processes have not a. increased with the study of genetics and genomics.”

“Only researchers benefit from the study of genetics and b. genomics.” c. “This area of study has nothing to do with nurses.”

“Genetics and genomes have increased the ability of health care d. professionals to assist patients in improving health outcomes.”

ANS: D The study of genetics and genomes has increased the ability of health care professionals to assist patients in improving health outcomes. Nurses involved in this area of health care educate patients; provide support and treatments based in the most current research.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 440 OBJ:Recognize the role of genetics and genomics in nursing practice.

TOP: Moral/ethical principles MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE 1. A nurse is educating students on physician-assisted suicide (PAS). The nurse judges that the teaching has NURSINGTB.COM been effective when a student states: (Select all that apply.) a. “PAS does not violate any ethical principles.”

“PAS threatens to destroy the fundamental relationship between b. physician and patient.” c. “PAS does not involve nurses.”

“Quality of life advocates support PAS as an example of personal d. autonomy and control.”

“Nurses should be aware of the legal and ethical implications of e. administering legal dosages of medications.”

ANS: B, D, E The American Medical Association opposes physician-assisted suicide (PAS) because it violates the most basic ethical principle: First, do no harm. Physicians have traditionally cared for living patients, and PAS threatens to destroy this fundamental relationship. On the other hand, quality of life advocates support PAS as an example of personal autonomy and control. Nurses working with physicians involved in PAS should be aware of the legal and ethical implications of administering legal dosages of medications.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 436 OBJ: Discuss the role of the nurse in ethical health care issues. TOP: Moral/ethical principles

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MSC: NCLEX®: Safe and effective care environment

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Chapter 20: Legal Issues MULTIPLE CHOICE 1. A nurse is giving a presentation on malpractice. Which statement indicates the nurse understands malpractice?

“The elements of duty, breach of duty, and patient injury must be a. present for a malpractice claim.”

“Negligent nursing care and failure to follow standards must be b. present for a malpractice claim.”

“Failure to report, defamation, and discrimination must be present c. for a malpractice claim.”

“Error in judgment and invasion of privacy must be present for a d. malpractice claim.”

ANS: A There are three elements that must be present for a malpractice claim: (1) You must have a duty—there must be a professional nurse–patient relationship. (2) You must have breached a duty that was foreseeable—you must have fallen below the standard of care. (3) Your breach of duty caused patient injury or damages. The other options do not indicate the nurse’s understanding of malpractice.

PTS: 1 DIF: Cognitive Level: Application REF: p. 454 NURSINGTB.COM OBJ: Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim.

TOP: Malpractice MSC: NCLEX®: Not applicable 2. In transcribing orders for a patient, the nurse finds a new order for aspirin, 500 mg, QID. The patient has a long history of gastrointestinal bleeding. What is the best nursing action? a. Give the medication. b. Withhold the medication and chart why it was not given.

Call the physician and question the order in light of the patient’s c. history. d. Ask if the patient is allergic to aspirin.

ANS: C The nurse should call the physician and question the medication order for aspirin based on the patient’s history of gastrointestinal (GI) bleeding. Claims involving medication errors are augmented when the nurse fails to recognize side effects or contraindications or fails to know a patient’s allergies. The nurse would withhold the medication until the physician is notified and the order clarified. Giving the medication could cause the patient to start bleeding. Although asking for allergies is an important nursing action, the important aspect in this situation in the medical history of GI bleeding.

PTS: 1 DIF: Cognitive Level: Application REF: p. 456

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OBJ:Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim.TOP:Doctor’s orders MSC:NCLEX®: Physiological integrity—pharmacological therapies 3. The nurse enters a patient’s room to complete the discharge paperwork and finds the patient in tears. The patient reports that someone from the business office stated they could not leave the hospital until the bill was paid. What is the best nursing action? a. Comfort the patient and continue the preparations for discharge. b. Call the social worker for a financial evaluation. c. Call the family to arrange for the payment. d. Cancel the discharge plans and notify the physician of the situation.

ANS: A The best action is to comfort the patient and continue the discharge preparations. If the patient’s claim is accurate, this could be false imprisonment (wrongfully making someone believe that they cannot leave a place). The nurse’s best action is to comfort the patient and continue the discharge preparations. However, this should also be reported to the supervisor. Calling the social worker or the contacting the family is not appropriate.

PTS: 1 DIF: Cognitive Level: Application REF: p. 472

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OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:False imprisonment MSC: NCLEX®: Safe and effective care environment—management of care 4. What is a correct statement regarding a nurse who acts beyond the scope of practice? a. Demonstrates what a good nurse he or she can be Provides enriched services to patients who would not otherwise b. receive them May make other nurses angry because of the increased expectations c. created d. May be disciplined by the board of nursing

ANS: D States may regulate nursing practice by controlling the scope of practice and determining the specific activities for each level of nursing. In most states, the Nurse Practice Act provides definitions and scope of practice for each level of nursing practice. The power of the board to discipline can have an adverse effect on the nurse’s ability to practice. Practicing beyond the scope of practice does not demonstrate what a good nurse the person is and does not provide enriched services. Other nurses would not be angry at increased expectations but at the foolishness of the nurse practicing beyond the scope of practice.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 454 OBJ: Understand functions of a state board of nursing. TOP: Scope of practice MSC: NCLEX®: Safe and effective care environment—management of care 5. Which error in judgment would be the most serious for the nurse defendant in a legal case? a.

Discussing the case with the plaintiff

b.

Tampering with the chart

c.

Hiding information from the plaintiff’s attorney

d.

Being discourteous on the witness stand

ANS: B The patient’s chart is a legal document. Changing or tampering with the chart would be in violation of the standards of practice, and the Nurse Practice Act and would not be considered “what a reasonable nurse would do.” The nurse is expected to perform as a reasonable nurse would. If your actions are not those of a reasonable nurse and this causes someone to be injured, you can be sued. Being discourteous on the witness stand may not be professional. It is also not appropriate to discuss the case with the plaintiff or hide information; however, tampering with the chart is a more serious error in judgment.

PTS: 1 DIF: Cognitive Level: Application REF: p. 464 NURSINGTB.COM OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Legal risks MSC: NCLEX®: Safe and effective care environment—management of care 6. A graduate nurse is preparing to start a first nursing job. What action would be the best legal safeguard for the graduate nurse to take? a.

Competent practice

c.

A valid license

b.

A legal contract

d.

Following management policies

ANS: A The best legal safeguard is competent practice. Practicing within the parameters of the state’s Nurse Practice Act, performing care based on established policies and procedures, and performing as a reasonable nurse are the best ways for a nurse to safeguard against legal action. It is important to maintain a current license and follow management policies; however, the best safeguard is being competent. A legal contract is not necessary for all situations and is not necessarily the best legal safeguard.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 467-471 OBJ: Relate the Nurse Practice Act to the governance of your profession.

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TOP:Nursing practice MSC: NCLEX®: Safe and effective care environment—management of care 7. A nurse is providing care to a 6-year-old child with a broken arm. The nurse notices multiple bruises. The child says, “my father got mad because I was bad, and he hit and broke my arm so that I would remember to be good.” What is the best nursing action? a. Chart that the child is a victim of abuse. b. Do nothing because the nurse cannot prove the child was abused. c. Report the situation to the appropriate authorities. d. Ignore what the child said because little children often lie.

ANS: C States have many statutes that require health care providers to report certain incidences or occurrences. If the provider fails to report as required and a person is injured, there can be negligence per se. It important for nurses to be aware of the reporting statutes in the state in which they are practicing. In most states, it is the law to report evidence of child or adult abuse. It is not appropriate to chart a decision that the child is a victim of abuse but rather to accurately describe injuries and comments that are made. Nurses should listen to what the patient has to say—whether the patient is a child or adult.

PTS: 1 DIF: Cognitive Level: Application REF: p. 471

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OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Reportable cases MSC: NCLEX®: Safe and effective care environment—management of care 8. What would be the most effective way for a nurse to validate “informed consent?” a. Check the chart for a completed and signed consent form. b. Determine from the physician what was discussed with the patient. c. Ask the family whether the patient understands the procedure. d. Ask the patient what he or she understand regarding the procedure.

ANS: D Asking the patient (not the family unless the patient is a minor child) what he or she understands regarding the procedure is an effective way to validate informed consent. Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for the procedure to be done. The piece of paper is simply evidence that the informed consent process has been completed. Determining from the physician what was discussed does not guarantee that the patient understands what was explained.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 472

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OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Informed consent MSC: NCLEX®: Safe and effective care environment—management of care 9. What action might be taken on a nurse who commits an infraction of the Nurse Practice Act? a. The nurse is subject to discipline by a court of law. b. The nurse is subject to discipline by the state board of nursing.

The nurse is subject to discipline by the local chapter of the state c. nurses association.

The nurse is subject to discipline by the National League for d. Nursing.

ANS: B The Nurse Practice Act is regulated and enforced by the state board of nursing. State Nurse Practice Acts regulate nursing by controlling the scope of practice and determining the specific activities for each level of nursing. Some states control who may use the titles registered nurse (RN) and licensed practical nurse (LPN) or licensed vocational nurse (LVN). The Nurse Practice Act is regulated and enforced by the state board of nursing. The National League of Nursing is involved with nursing program accreditation. The local state nurses association does not provide discipline for infarctions to the Nurse Practice Act. Only if the infarction is of a criminal nature will the state board of nursing refer the case to the local court of law.

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PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 477 OBJ: Understand functions of a state board of nursing. TOP: Nurse Practice Act MSC: NCLEX®: Not applicable 10. The nurse understands “scope of nursing practice” when making which of the following statements?

“The scope of nursing practice includes acts that permit some a. overlap between nursing and medicine.”

“The scope of nursing practice includes activities that are legally b. permissible for a nurse to perform in a particular state.”

“The scope of nursing practice are the specific duties the nurse c. owes to a patient.”

“The scope of nursing practice involves hose activities for which a d. nurse can be held liable for malpractice.”

ANS: B Defining the scope of nursing practice is part of the responsibility of the state board of nursing. This involves determining the specific activities for each level of nursing and who can perform what functions. The duty that a nurse owes to a patient is part of the professional nurse–patient relationship. Any nursing activity that is outside the scope of nursing practice can be grounds for malpractice or negligence.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 450 OBJ: Relate the Nurse Practice Act to the governance of your profession.

TOP:Scope of practice MSC: NCLEX®: Safe and effective care environment—management of care 11. A student nurse is studying assault and battery. The student interprets assault and battery to include the nurse, without consent, touched the patient in an offensive, a. insulting, or injurious way. the nurse threatened to put the patient in restraints if they did not b. stay in bed. c. the nurse said the bill has to be paid before the patient can leave. d. the nurse failed to perform an act expected of a reasonable nurse.

ANS: A Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Permission to do this touching is usually implied when the patient seeks medical care. Using restraints or threatening to use them on competent patients to make them do what you want them to do against their wishes is an example of false imprisonment. Failure to perform an act expected of a reasonable, prudent NURSINGTB.COM nurse can constitute negligence.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Assault MSC: NCLEX®: Safe and effective care environment—management of care 12. A nurse understands informed consent when making which of the following statements? a. “Informed consent is a binding agreement.” b. “Informed consent involves filling out an incident report.”

“Informed consent occurs when the patient receives information c. about a procedure before giving consent.” d. “Informed consent is a name for a written legal policy.”

ANS: C Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for it to be done. Informed consent is not a binding agreement, an incident report, or a written legal policy.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Informed consent MSC: NCLEX®: Safe and effective care environment—management of care 13. Which definition, given by the nurse indicates understanding of malpractice? a. “Malpractice is a criminal act committed against society.”

“Malpractice means doing something a reasonable person or nurse b. would not do.” c. “Malpractice is an intentional professional act of negligence.”

“Malpractice is a professional act or failure to act that leads to d. injury of a patient.”

ANS: D Malpractice may be defined as doing something outside your scope of practice or something that is unsafe for the patient and could cause injury. A criminal act committed against society may be a felony or a misdemeanor. Negligence is the failure to act as an ordinary prudent person when such failure results in harm to another.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Application REF: p. 454

OBJ:Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim.TOP:Malpractice MSC: NCLEX®: Safe and effective care environment—management of care 14. A nurse tells a patient, “If you don’t stop getting out of that chair, I’m going to put some restraints on you.”

What may this nurse be accused of? a.

False imprisonment

c.

Invasion of privacy

b.

Defamation

d.

Malpractice

ANS: A Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Use of restraints may also be interpreted as false imprisonment. False imprisonment means making someone wrongfully believe that they cannot leave a place. It is often associated with assault and battery claims. Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Malpractice is the improper performance of professional duties, a failure to meet the standards of care that results in harm to another person. Defamation (libel and slander) refers to causing damage to someone else’s reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander. Invasion of privacy applies to several behaviors, such as

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photographing a procedure and showing it without the patient’s consent, going through a patient’s belongings without consent, or talking about a patient’s private life publicly.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Assault MSC: NCLEX®: Safe and effective care environment—management of care 15. During a malpractice suit, how can the standard of “what the wise and prudent nurse would do” best be established? a.

From the testimony of an expert nurse

b. By consulting with nursing faculty regarding standards of care c.

Conferring with a lawyer regarding malpractice parameters

d. By consulting the standards of The Joint Commissions

ANS: A The most common way to establish the duty owed by a nurse is by the testimony of a registered nurse— usually, but not always, with training and background similar to the nurse being sued. This expert witness will then testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. The NURSINGTB.COM Joint Commission standards may reflect on hospital policies and procedures, not the nurse’s practice. A lawyer provides legal advice but cannot attest to the standards of nursing practice that a nurse can. Faculty can be knowledgeable about standards of care, but the testimony of a nurse with similar training and background can determine what the wise and prudent nurse would have done.

PTS: 1 DIF: Cognitive Level: Application REF: p. 481 OBJ:Participate as a professional when dealing with nurses who are impaired or functioning dangerously in a work setting.TOP:Expert testimony MSC: NCLEX®: Not applicable 16. During a life-threatening emergency, a nurse hurriedly gives the patient a medication by IV push. There is extravasation of medication. Later, necrosis and tissue sloughing take place. The nurse’s behavior may be the basis for what action? a.

Felony charge

c.

Tort suit

b.

Misdemeanor charge

d.

Defamation suit

ANS: C Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Civil, as opposed to criminal, actions are also called torts. Remember that civil actions occur when a plaintiff files a lawsuit to receive compensation for damages he or she suffered as a result of a perceived

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wrong. Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Defamation (libel and slander) refers to causing damage to someone else’s reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 472 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:TortsMSC:NCLEX®: Not applicable 17. At the time of admission, a patient gave a history of allergy to penicillin that was duly noted in all critical areas of the patient’s record. While giving medications, a nurse accidentally administered penicillin to this patient. The patient had a severe reaction but recovered. What is the implication of the nurse’s action?

The nurse cannot be sued for malpractice because the patient did a. not directly the nurse of the allergy.

The nurse failed to act in a reasonable and prudent fashion and thus b. is liable for malpractice.

The nurse who gave the medication can bring a countersuit against c. the nurse who took the history.

There is no cause for concern because the action did not result in d. the patient’s death.

ANS: B NURSINGTB.COM

The nurse failed to act in a reasonable and prudent fashion and thus is liable for malpractice. The most common errors include failure to administer the right drug to the right patient, in the right amount, by the right route, at the right time, and with the right documentation. Claims involving medication errors are augmented when the nurse fails to record the medication administration properly, fails to recognize side effects or contraindications, or fails to know a patient’s allergies. There is no justification for the nurse to bring about a countersuit for the nurse who took the medication history because it was clearly noted in all critical areas of the chart.

PTS: 1 DIF: Cognitive Level: Application REF: p. 467 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Medication errors MSC:NCLEX®: Physiological integrity—pharmacological therapies 18. In a legal suit, what element is necessary to prove a tort has been committed? a.

Intent

c.

Injury

b.

Assault

d.

Malpractice

ANS: C

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There are four elements that need to be present in a malpractice case, one of which is patient injury. The patient will have to prove that the specific nursing action caused injury or harm. The nurse, as a defendant, does not have a “burden of proof.”

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 472 OBJ: Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim.

TOP: Malpractice, tort MSC: NCLEX®: Not applicable 19. What action must occur to prove a breach of duty? a.

Liability testimony of physician

b.

Testimony from state board of nurses

c.

Expert testimony

d.

Testimony of coworkers

ANS: C The duty of a nurse is to act as a reasonable nurse would under the same or similar circumstances. An expert witness may testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. Testimony from a physician, the state board of nursing, or coworkers does not establish a breach of duty.

The state board of nursing provides the statues and laws that govern nursing practice.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 455

OBJ: Be able to identify the elements of nursing malpractice and how they are proven in a malpractice claim.

TOP: Breach of duty MSC: NCLEX®: Not applicable 20. What is a significant action a nurse can take to prevent being named in malpractice suits? a.

Refuse to care for suit-prone patients.

b.

Carry professional liability insurance.

c.

Maintain updated professional knowledge and skills.

d.

Check with a nursing supervisor before undertaking care.

ANS: C When you become a registered nurse, you will have a license to practice nursing. This license sets certain standards, which you must follow as a nurse in the state. Should you not live up to these standards, your state can take away your ability to practice as a nurse. The best way to maintain those standards to practice professionally is to stay updated on skills and knowledge. Refusing to care for patients does not prevent you from being named in other malpractice suits. Carrying professional liability insurance does not prevent a malpractice suit but may provide assistance and monies in paying out claims. Although it is important to check with a supervisor about questions concerning nursing care, it may not prevent you from being named if you perform a procedure or intervention incorrectly.

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PTS: 1 DIF: Cognitive Level: Application REF: pp. 466-471 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Malpractice MSC: NCLEX®: Safe and effective care environment—management of care 21. A nurse places a heating pad on the lower leg of a patient with peripheral vascular disease. When the heating pad is removed, it is apparent that the patient has sustained partial-thickness burns to the area covered by the pad, and the nurse is sued for malpractice. Which statement is true? a. All elements are present to find the nurse liable for damages.

Proximate cause cannot be established, so the nurse will not be b. found liable.

The standard of care in such a situation cannot be established, so c. the nurse will not be found liable. d. No duty to the patient exists, so the nurse will not be held liable.

ANS: A The nurse had a duty, that duty was breached, the injury was foreseeable, and the patient suffered harm (partial-thickness burn). All four elements for a malpractice suit are present. The other options do not show that all elements are present and are therefore incorrect.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 470 OBJ: Incorporate an understanding of legal risks into your nursing practice and how to minimize risks. TOP: Malpractice MSC: NCLEX®: Not applicable 22. A nurse has relocated to another state and wants to find a full-time nursing job. What action should be taken first in order to provide care as a nurse? a. Begin applying for jobs at the local hospital.

Contact the board of nursing in the nurse’s new state to obtain b. licensure to practice.

Begin practicing immediately, as the nurse is still licensed in the c. formerly lived in state.

Begin practice on a part-time basis so that a new license is not d. needed.

ANS: B The nurse should contact the board of nursing in the state the nurse just moved to in order to determine what needs to be done to obtain licensure to practice in that state. The nurse should not begin practicing without an updated license even on a part-time basis. Each state may require a new license, and the nurse will not be covered by a license issued in another state unless the state is part of the nurse licensure compact. Either way, the nurse will need to contact the board of nursing first.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 451 OBJ: Describe your responsibilities for obtaining and maintaining your license.

TOP:Legal control over nursing practice MSC: NCLEX®: Safe and effective care environment 23. The nurse has an adequate understanding of nurse practice acts when stating which of the following? a. “Nurse practice acts do not help guide nurses.”

“Nurse practice acts describe how to prepare for the NCLEX b. exam.”

“Nurse practice acts describe how and when to renew a nursing c. license.” d. “Nurse practice acts provide a list of job openings.”

ANS: C Nurse practice acts are great resources that provide information to nurses, including how and when to renew a nursing license. The nurse practice acts do not describe how to prepare for the NCLEX exam or provide a list of job openings.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 451

OBJ: Relate the Nurse Practice Act to the governance of your profession.

TOP:Legal control over nursing practice MSC: NCLEX®: Safe and effective care environment 24. A nurse wants to avoid malpractice claims. What action can be taken to greatly reduce the risk of a lawsuit? a.

Reduce work status to part time.

b.

Implement fall precautions on an older adult patient.

c.

Leave clutter on the floor in patient rooms.

d.

Leave the patient’s bed in the highest position.

ANS: B To protect themself from a malpractice claim, the nurse can implement fall precautions on an older adult patient. These include supervising the patient when getting out of bed, keeping the floor clear, and placing the bed in the lowest position. Reducing work status to part time would not guarantee that the nurse wouldn’t be named in a lawsuit.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 454 OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Preventing malpractice claims MSC: NCLEX®: Safe and effective care environment 25. A nurse has just administered a medication when suddenly realizing that more medication was given than was ordered. Which action should the nurse take? a. Call the patient’s physician and report the error.

Say nothing about the medication error and continue to monitor the b. patient.

Document the dose that was supposed to be given in the medical c. record.

Document the amount given in the medical record but keep the d. error quiet.

ANS: A The nurse should call the physician and report the error after assessing the patient’s condition. The nurse should never falsify a document in the medical record or keep the error to themself.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Application REF: p. 467

OBJ:Incorporate an understanding of legal risks into your nursing practice and how to minimize risks.TOP:Preventing malpractice claims MSC: NCLEX®: Safe and effective care environment 26. Which of the following would be considered a criminal action? a. A nurse who steals narcotics from the hospital b. A nurse who gets into a verbal disagreement with a visitor A nurse who restrains a patient who is considered a threat to c. himself A nurse who refuses to allow a visitor onto the unit who appears d. intoxicated

ANS: A An example of a criminal action is the nurse who steals narcotics from the hospital. Verbal disagreements, restraining a patient who has the potential to harm themselves, and refusing visitors who appear intoxicated are not examples of a criminal action.

PTS: 1 DIF: Cognitive Level: Application REF: p. 477

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OBJ:Discuss various sources and types of law.

TOP:Court actions based on legal principles MSC: NCLEX®: Safe and effective care environment 27. Which of the following can result in a civil action against the nurse? a. Failure to monitor Enforcing strict compliance with contact precautions against the b. family’s wishes Refusing to discuss the patient’s medical history with the family c. per patient request Assisting the physician in a bedside procedure after obtaining d. informed consent

ANS: A Failure to monitor can result in a civil action against the nurse. Enforcing strict compliance with contact precautions against the family’s wishes, refusing to discuss the patient’s medical history with family per the patient’s request, and assisting the physician in a bedside procedure after obtaining informed consent are not examples that could lead to civil action.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Application REF: p. 450

OBJ:Discuss various sources and types of law.

TOP:Court actions based on legal principles MSC: NCLEX®: Safe and effective care environment 28. Which of the following statements by the nurse indicates understanding of legal actions? a.

“A misdemeanor is a less serious crime resulting in a fine.”

b.

“A felony is a less serious crime that can result in a fine.”

c.

“Civil actions are serious and often result in prison time.”

d.

“The defendant is the victim.”

ANS: A A misdemeanor is a less serious crime resulting in a fine. A felony is a serious crime that often results in prison time. In court cases, the victim is the plaintiff.

PTS: 1 DIF: Cognitive Level: Application REF: p. 450 OBJ:Discuss various sources and types of law.

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TOP:Court actions based on legal principles MSC: NCLEX®: Safe and effective care environment 29. Which statement by the nurse indicates understanding of the nurse practice act? a. “The nurse practice act defends any action the nurse may take.”

“The nurse practice act defines the scope of practice for each level b. of licensure.”

“The nurse practice act details pay raises for each year of service to c. an organization.”

“The nurse practice act has language that grants nurses vacation d. time.”

ANS: B The nurse practice act defines the scope of practice for each level of licensure. It is a type of state statutory law and can be obtained from the state board of nursing or online. It does not defend any action the nurse may take, detail pay raises, or discuss vacation time.

PTS: 1 DIF: Cognitive Level: Application REF: p. 450 OBJ: Relate the Nurse Practice Act to the governance of your profession.

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TOP:Legal control over nursing practice MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE 1. Which actions take place in organizations to monitor quality improvement? (Select all that apply.) a.

Evaluation of what nurses are doing for patients

b.

Development of policies and procedures

c.

Employee evaluations

d.

Intermittent monitoring

e.

Continuing education

ANS: A, B, C, E There are many actions that take place in organizations to monitor quality improvement. These include evaluation of what nurses are doing for patients, development of policies and procedures, employee evaluations, ongoing monitoring, and continuing education.

PTS: 1 DIF: Cognitive Level: Application REF: p. 453

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OBJ: Take an active role in improving the quality of health care as required by legal standards.

TOP:Risk management and quality improvement MSC: NCLEX®: Safe and effective care environment 2. A nurse is completing an incident report. The nurse demonstrates an adequate understanding of the report when refraining from putting which of the following on the form (Select all that apply.) a.

Conclusions about the incident

b.

The name of the patient

c.

Blame of others

d.

Judgment

e.

The nurse’s opinion about what happened

ANS: A, C, D, E The nurse should avoid putting conclusions, blame, judgment, and opinions on the incident report. The nurse should only relay facts. It would be appropriate for the nurse to list the patient’s name.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Application REF: p. 479

OBJ: Take an active role in improving the quality of health care as required by legal standards.

TOP:Risk management and quality improvement MSC: NCLEX®: Safe and effective care environment 3. The nurse has an adequate understanding of risk management when stating which of the following? (Select all that apply.) a. “Risk management becomes involved when incidents occur.”

“Risk management becomes involved when untoward events b. occur.” c. “Risk management becomes involved to discipline the nurse.” d. “Risk managers gather evidence surrounding the event.” e. “Risk managers will interview those involved in an event.”

ANS: A, B, D, E

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Risk management becomes involved when incidents and untoward events occur. Risk managers gather evidence surrounding the event and interview those involved. Risk management does not become involved to discipline the nurse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 479 OBJ: Take an active role in improving the quality of health care as required by legal standards.

TOP:Risk management and quality improvement MSC: NCLEX®: Safe and effective care environment

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Chapter 21: Cultural and Spiritual Awareness MULTIPLE CHOICE 1. What action by the nurse would indicate cultural competence? a.

Displays no favoritism

b.

Tries to treat all patients the same

c.

Prioritizes care based on cultural needs

d.

Wants to learn more about other ethnic groups

ANS: D One model of cultural competence has five aspects. They include cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural knowledge is seeking and obtaining information regarding different cultural and ethnic groups. The other options are applicable to quality nursing care.

PTS: 1 DIF: Cognitive Level: Application REF: p. 489 OBJ:Define cultural competence.TOP:Cultural competence MSC: NCLEX®: Psychosocial integrity NURSINGTB.COM

2. What is an example of a system barrier to cultural competence? a. No kosher diet options on menu b. No sinks in every patient room c. No privacy curtains in exam rooms A strict and enforced policy against more than one visitor in the d. ICU

ANS: D System barriers are due to the agency’s structure and policies that do not support cultural diversity. A strict and enforced ICU visitor policy, for example, will impact those cultures with a strong emphasis on the extended family. Provider barriers are those such as a nurse may have, including lack of information about a culture.

Including kosher diet options on the menu and making changes to room environments (including privacy curtains and sinks in every room) are provider barriers that can be addressed.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 491 OBJ:List practice issues related to cultural competence.

TOP:System barriers to cultural competence

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MSC: NCLEX®: Psychosocial integrity 3. Which of the following actions cause health care disparities? a. Refusal of treatment

c. Trust in the health care system

Provider–patient b. relationships

Provider bias and d. discrimination

ANS: A Disparities in health care can include both provider and patient variables. Patient variables are mistrust of the health care system and refusal of treatment.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 491 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting.

TOP: Health care disparities MSC: NCLEX®: Psychosocial integrity 4. Which of the following actions would have little to no impact in helping resolve health care disparities? a.

Research on life stressors

b.

Access to basic health care

c.

Increasing diversity of health care workers

d.

Health promotion and wellness programs

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ANS: A Some solutions to help resolve health care disparities include the following: increasing the diversity of health care providers; ensuring that all people have access to affordable, basic health care; promoting wellness and a healthy lifestyle; strengthening provider–patient relationships; increasing cultural competency of health care providers; and conducting research to determine why certain diseases affect minorities so greatly and to discover effective intervention strategies. Research on life stressors does not have an impact on resolving health care disparities.

PTS: 1 DIF: Cognitive Level: Application REF: p. 491 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting.

TOP: Resolving health care disparities MSC: NCLEX®: Psychosocial integrity 5. Based on assessment data, the nursing diagnosis for a patient is spiritual distress related to loneliness or social alienation. What would be included in spiritual nursing interventions?

Participate in active a. listening.

Assist with activities of daily c. living.

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Identify level of b. functioning.

Evaluate ability to understand d. events.

ANS: A Active listening is an example of a spiritual nursing intervention. Other interventions include the following: prayer, presence, scripture reading, peaceful environment, meditation, music, pastoral care, inspiring hope, validation of the patient’s thoughts and feelings, values’ clarification, sensitive responses to patient beliefs, and developing a trusting relationship. Identifying level of functioning and ADLs address basic human needs.

Evaluating the ability to understand events is addressing cognitive function.

PTS: 1 DIF: Cognitive Level: Application REF: p. 493 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting.

TOP: Spiritual nursing interventions MSC: NCLEX®: Psychosocial integrity 6. By asking, “How has being sick affected your spiritual practices?” the nurse is trying to determine the need in what spiritual dimension? a.

Sources of hope and strength

b.

Spirit-enhancing practices or rituals

c.

Involvement in spiritual community

d.

Experience of God or transcendence

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ANS: B According to Taylor in Spiritual Care: Nursing Theory, Research, and Practice (2002), asking the following assessment question helps determine the patient’s spirit-enhancing practices or rituals: “How has being sick affected your spiritual practices?” As a testing strategy, note that the answer has the spiritual practices and so does the question. Other questions would assess sources of hope and strength, involvement in the spiritual community, and their experience of God or transcendence.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 494 OBJ:Assess spiritual needs of patients in the health care setting.

TOP: Spiritual dimension MSC: NCLEX®: Psychosocial integrity 7. Using a spiritual assessment tool helps the nurse gain more understanding of the patient. What would be the best question to assess a patient’s inner strengths? a.

What gives your life meaning?

b.

Are you motivated to get well?

c.

What do you do to show love for yourself?

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d.

What brings you joy and peace in your life?

ANS: D Asking what brings joy and peace to a person’s life is an example of a reflective question to help increase the awareness of the inner strengths of a patient’s spiritual process. Such a question assesses a person’s ability to manifest joy. Asking about what gives meaning could address family and career and not necessarily a patient’s inner strength. Asking about motivation and what a person does to show love for themself does not encourage reflection on inner strengths but asks a question that could be briefly answered.

PTS: 1 DIF: Cognitive Level: Application REF: p. 494 OBJ:Assess spiritual needs of patients in the health care setting.

TOP: Spiritual assessment MSC: NCLEX®: Psychosocial integrity 8. Determine which of the following situations would be a provider barrier to the nurse developing cultural competence? a. A nurse who is unaware of personal biases to other ethnic groups b. No family rooms to accommodate a critically ill patient’s family c. A nurse who seeks encounters with individuals from other cultures A health care provider who incorporates alternative therapies in NURSINGTB.COM d. health care

ANS: A A nurse who is unaware of personal biases to other ethnic groups represents a provider barrier. “No family rooms” is an example of a system barrier. Nurses who seek encounters with individuals from other cultures and incorporate alternative therapies into health care have a developed sense of cultural competence.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 490 OBJ: List practice issues related to cultural competence. TOP: Culture MSC: NCLEX®: Psychosocial integrity 9. A manager is educating a group of nurses on the importance of cultural competence. The manager knows that the teaching has been effective when one of the nurse’s states: a. “Cultural competence does not impact patient care.” b. “Cultural competence is not important in health care.”

“Lack of cultural competence leads to suboptimal patient c. outcomes.”

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“Lack of cultural competence does not cause active harm to the d. patient.”

ANS: C Lack of cultural competence is extremely important in health care because it directly impacts patient care.

Lack of cultural competence leads to suboptimal care and can cause active harm to the patient.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 489 OBJ: Define cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity 10. A nurse has an adequate understanding of the barriers to cultural competence when making which of the following statements?

“Barriers to cultural competence no longer exist in today’s a. society.” b. “The barriers to cultural competence cannot be broken down.”

“Provider barriers include having knowledge about a custom’s c. culture regarding health care.”

“Systems barriers exist when an agency’s structure and policies are NURSINGTB.COM d. not designed to support cultural diversity.”

ANS: D Barriers to cultural competence exist in today’s society and can be broken down with the help of health care providers. Provider barriers include having a lack of knowledge about a custom’s culture regarding health care.

Systems barriers exist when an agency’s structure and policies are not designed to support cultural diversity.

PTS: 1 DIF: Cognitive Level: Application REF: p. 490 OBJ: Define cultural competence. TOP: Barriers to cultural competence MSC: NCLEX®: Psychosocial integrity 11. A nurse is attending a lecture on health disparities. The education has been effective when the nurse states: “Inequalities in income and education are the root of many health a. disparities.”

“Today, there are no longer inequalities preventing access to health b. care.”

“Low education and low income levels are related to lower rates of c. health disparities.”

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“Higher income is associated with more health disparities then d. lower income.”

ANS: A Inequalities in income and education are the root of many health disparities. Individuals with low education and low income levels often have higher rates of health disparities, and higher income is associated with less health disparities.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 491 OBJ: List practice issues related to cultural competence. TOP: Health disparities MSC: NCLEX®: Psychosocial integrity 12. A nurse is working in a disaster area as a volunteer with the local ambulance agency. The nurse is providing care to a Spanish-speaking patient. What actions can be taken to properly care for this patient? a.

Use gestures to emphasize what he is saying.

b.

Obtain an interpreter.

c.

Provide wound care instructions written in English.

d.

Treat the patient without speaking to her.

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ANS: B The Office of Minority Health and Disaster Preparedness launched an initiative in 2009 to help first responders better manage disaster and crises in diverse populations. The nurse can use this initiative by obtaining an interpreter and providing wound care instructions written in English. The nurse should not rely on gestures to get his point across or treat the patient without speaking to her.

PTS: 1 DIF: Cognitive Level: Application REF: p. 491 OBJ:List practice issues related to cultural competence.

TOP:Office of minority health and disaster preparedness MSC: NCLEX®: Psychosocial integrity 13. A nurse is caring for a patient experiencing spiritual distress. What nursing intervention would be appropriate for this patient? a. Asking the patient to reserve prayer for the hospital chaplain Placing the patient by the nurses’ station because it is busy and will b. keep the patient entertained c. Developing a trusting relationship with the patient

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d. Allowing the patient’s roommate to have visitors late into the night

ANS: C It is important that the nurse develop a trusting relationship with the patient, as well as being supportive of the patient’s needs. The nurse should allow the patient a quiet environment that allows time for prayer and meditation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 493 OBJ: Identify challenges in defining spirituality. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity 14. A nurse is caring for a diabetic patient who frequently uses alternative medicine to manager ailments. The feels nauseous and requests ginger tea. What should the nurse be aware of before giving the patient ginger tea? a.

Nothing; natural remedies do not cause unwanted side effects.

b. Ginger can cause blood glucose levels to decrease. c.

Ginger causes blood glucose levels to rise.

d. Ginger can cause a diabetic patient to become more nauseous.

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ANS: B

Nurses should be aware of natural remedies and their interactions because more patients turn to these remedies as opposed to medication for management of ailments. In this scenario, the nurse should be aware of the fact that ginger can cause blood glucose levels to decrease, possibly causing harm to the diabetic patient.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 496 OBJ: Identify challenges in defining spirituality. TOP: Cultural/spiritual assessment MSC: NCLEX®: Psychosocial integrity 15. A nurse manager is looking for ways to improve the cultural competency of unit staff. Which action would help the manager accomplish this? a.

Propose voluntary cultural competence training.

b.

Hire bicultural clinical and administrative staff.

c.

Hire staff from the same ethnic background.

d.

Avoid issues pertaining to cultural competence.

ANS: B

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The nurse manager can improve the staff’s cultural competence by hiring bicultural clinical and administrative staff to improve education, care delivery, and outcomes. The nurse manager should also propose mandatory cultural competence training and hire staff from different ethnic backgrounds.

PTS: 1 DIF: Cognitive Level: Application REF: p. 490 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting.

TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity 16. A nurse is educating a patient’s family on holistic nursing. The nurse judges the teaching as effective when the family states all of the following except: a. “Holistic nursing is an attitude.” b. “Holistic nursing is a way of being.” c. “Holistic nursing focuses on healing the person as a whole.” d. “Holistic nursing focuses on healing the system causing ailment.”

ANS: D Holistic nursing is an attitude, a way of being and is focused on healing the person as a whole. It is not focused on the system causing the ailment.

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PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 496

OBJ:Assess spiritual needs of patients in the health care setting.

TOP: Holistic nursing MSC: NCLEX®: Psychosocial integrity 17. A nurse is gathering data on a patient of a different culture. Which action can the nurse take to enhance communication while gathering cultural data?

Ignore the patient’s culture and focus on the reason for hospital a. admission.

Use hand gestures to get points across to a patient with poor b. English. c. Use close-ended questions to gather information. d. Determine the patient’s level of fluency in English.

ANS: D The nurse should determine the patient’s level of fluency in English to enhance communication. The nurse should not avoid the patient’s culture during the assessment. Hand gestures should not be used because they could be offensive to the patient. The nurse should use open-ended questions or questions phrased in different ways as a method to gather data.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 491 OBJ: List practice issues related to cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity 18. The nurse understands that the following organization believes that cultural competence in nursing is necessary? a.

Nurse Practice Acts of state boards of nursing

b.

Code of Ethics of the American Nurses Association

c.

Accreditation standards of the National League of Nursing

d.

Accreditation standards of The Joint Commission (TJC)

ANS: B The American Nurses Association indicates in its Code of Ethics the necessity of the nurse to be sensitive to individual needs. State boards of nursing are involved in the regulation and licensure of nursing practices. The National League of Nursing is involved with accreditation of nursing programs. TJC is involved with hospital accreditation.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 490 NURSINGTB.COM

OBJ:List practice issues related to cultural competence.

TOP: Necessity of cultural competence MSC: NCLEX®: Psychosocial integrity 19. In what culture is it very important for females to be evaluated by female health care providers? a.

Asian

c.

Hispanic

b.

Muslim

d.

Native American

ANS: B Muslims have a respect for modesty and avoid nakedness. Having a same-gender health care provider will help meet their spiritual needs. Native American, Asian, and Hispanic culture individuals do not have specific issues related to nakedness and modesty.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 495 OBJ:Assess spiritual needs of patients in the health care setting.

TOP:Cultural and spiritual beliefs affecting nursing MSC: NCLEX®: Psychosocial integrity

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20. The nurse knows that in this culture the older adult is respected and makes the decisions. a.

Asian

c.

Native American

b.

Hindu

d.

African American

ANS: A In the Asian ethnic group, older family members are honored and respected, and their authority is unquestioned. The oldest man is the decision maker and spokesman. Native Americans have strong tries to family and tribe. African Americans and Hindus do not have any specific practices related to the importance of older family members.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 495 OBJ:Assess spiritual needs of patients in the health care setting.

TOP:Cultural and spiritual beliefs affecting nursing MSC: NCLEX®: Psychosocial integrity MULTIPLE RESPONSE 1. The nurse is creating a plan of care for a patient. Which would be important for to consider before implementing the plan? (Select all that apply.)NURSINGTB.COM a.

The patient’s lifestyle

b.

The patient’s insurance coverage

c.

The patient’s value system

d.

The patient’s religious beliefs

e.

The patient’s ability to pay for services

ANS: A, C, D When creating a plan of care for the patient, the nurse should consider the patient’s lifestyle, value system, and religious beliefs.

PTS: 1 DIF: Cognitive Level: Application REF: p. 494 OBJ: Define cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity 2. A nurse manager is educating unit staff on cultural competence. The manager knows that the teaching has been effective when one of the staff members states that cultural competence is (Select all that apply.)

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a.

“not important in health care.”

b.

“accepting and respecting cultural differences.”

c.

“demonstrating knowledge of the patient’s culture.”

d.

“demonstrating an understanding of the patient’s culture.”

e.

“adapting care to be congruent with the patient’s culture.”

ANS: B, C, D, E Purnell and Paulanka (2009) define cultural competence as accepting and respecting cultural differences, demonstrating knowledge of the patient’s culture, demonstrating an understanding of the patient’s culture, and adapting care to be congruent with the patient’s culture.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 490 OBJ: Define cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity 3. Which action by the nurse shows cultural competence of Native American culture? (Select all that apply.) a.

Refuse to allow rituals to be practiced at the bedside.

b.

NURSINGTB.COM Allow the family to bring in a medicine man for healing.

c.

Allow the family and patient time for prayer.

d.

Provide space for rituals.

e.

Work hard to gain trust.

ANS: B, C, D, E The nurse can show culturally competent care of an American Indian patient by allowing the family to bring in a medicine man, allowing time for prayer, providing space for rituals, and working hard to gain trust.

PTS: 1 DIF: Cognitive Level: Application REF: p. 495 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting.

TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity 4. Which statement by the nurse shows understanding of the Vietnamese culture? (Select all that apply.) a. “Vietnamese are slow to trust authority figures.” b. “Vietnamese have a very patriarchal society.”

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“Vietnamese will try home remedies before seeking Western c. medicine.”

“Vietnamese are often compliant with Western treatment one d. sought.” e. “Vietnamese are generally noncompliant with health care.”

ANS: A, B, C, D The nurse shows understanding of Vietnamese culture by stating that the Vietnamese are slow to trust authority figures, a very patriarchal society, will try home remedies before seeking Western medicine, and are often compliant with Western treatment once sought.

PTS: 1 DIF: Cognitive Level: Application REF: p. 495 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting.

TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity 5. A nurse is educating a student nurse on African American culture. The nurse judges the teaching to be effective when the student nurse states that African Americans (Select all that apply.) a. “have extended family that has a great influence on the patient.” b. “honor and respect older family members.”

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c. “have the oldest woman as the decision maker.” d. “do not disagree with health care recommendations.” e. “don’t always follow up with health care recommendations.”

ANS: A, B, D, E The teaching has been effective when the student nurse states that African Americans have extended family that has a great influence on the patient, older family members are honored and respected, do not disagree with health care recommendations, and don’t always follow up with health care recommendations. The oldest man is the decision maker.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 494 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting.

TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity 6. The nurse has an adequate understanding of Japanese culture when stating which of the following? (Select all that apply.)

“The Japanese believe that contact with blood, skin diseases, and a. corpses causes illness.”

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b. “The Japanese believe in healers and herbalists.” c. “The Japanese have high regard for physicians.” d. “The Japanese tend to not question the care of the physician.” e. “The Japanese verbally express pain.”

ANS: A, B, C, D The nurse has an adequate understanding of Japanese culture when stating that the Japanese believe that contact with blood, skin diseases, and corpses causes illness; have high regard for physicians; and often do not question their care. The Japanese do not express pain, believing that it is a virtue to bear pain.

PTS: 1 DIF: Cognitive Level: Application REF: p. 494 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting.

TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

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Chapter 22: Quality Patient Care MULTIPLE CHOICE 1. The primary role of The Joint Commission (TJC) is a. granting magnet status to excellent hospitals. b. lobbying Congress on behalf of Medicare/Medicaid patients. c. ensuring medical facilities meet patient safety guidelines. d. inspecting hospitals for compliance of infection control standards.

ANS: C The Joint Commission (TJC) is the primary accrediting body for health care institutions. Its standards directly address patient safety issues. Magnet status is approved by the American Nurses Association. TJC does not lobby Medicare/Medicaid issues. The CDC is the agency that maintains standards regarding infection control for hospital compliance.

PTS: 1 DIF: Cognitive Level: Application REF: p. 508 OBJ:Identify the role of regulatory standards and agencies.

TOP:Role of The Joint Commission

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MSC: NCLEX®: Safe and effective care environment—management of care 2. The Joint Commission publishes a Sentinel Event Alert every month. Which of the following is the best example of a sentinel event? a. Tylenol #3 is given to a patient when plain Tylenol was ordered.

Code pink is called after a newborn is discovered missing from the b. nursery.

After receiving the correct medication, the patient complains of c. itching all over, and a rash is noted on the patient’s trunk.

During a blood transfusion, the patient’s temperature increases to d. 100.4° F, and the patient complains of generalized pruritus.

ANS: B A sentinel event is an unexpected occurrence involving death or loss of limb or function. Examples of sentinel events include serious medication errors, significant drug reactions, surgery performed on the wrong body site, blood transfusion reactions, and infant abductions.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 511 OBJ:Describe the history and evolution of quality in health care.

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TOP:Sentinel events MSC: NCLEX®: Safe and effective care environment—management of care 3. A nurse is reviewing the technique used to identify the factors involved in an error. Which statement indicates the nurse has an adequate understanding? a. “The rapid cycle test is a technique that is widely used.”

“A root cause analysis is a process designed to investigate and b. categorize the root cause of the event.”

“A failure mode and effects analysis is a procedure to investigate c. the cause of the error.”

“Define, measure, analyze, improve, control prevents events from d. occurring.”

ANS: B When an error is analyzed, the primary causes need to be determined so that a workable and effective solution can be developed. A root cause analysis is such a process designed to investigate and categorize the root cause of the event. The Six Sigma DMAIC process (define, measure, analyze, improve, control) is used primarily for improving existing processes that do not meet institutional goals or national norms. Rapid cycle tests are components of continuous quality improvement. A failure mode and effects analysis (FMEA) is a procedure in product development and operations management for analysis of potential failure modes within a system for classification by the severity and likelihood ofNURSINGTB.COM the failures.

PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ:Identify tools and processes for continuous quality improvement.

TOP:Causation of errors MSC: NCLEX®: Safe and effective care environment—management of care 4. A nurse is discussing the Pareto principle (80/20 rule), which leads to the idea of total quality management.

Which statement indicates an adequate understanding of this principle? a.

Peter Pareto

c.

Phillip Crosby

b.

Joseph Juran

d.

Edward Deming

ANS: B Joseph Juran is one of the forefathers of quality initiatives. He stressed the meaning of the Pareto principle and how it applies to improving quality in all organizations.

PTS: 1 DIF: Cognitive Level: Application REF: p. 506 OBJ:Describe the history and evolution of quality in health care.

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TOP:History of quality care MSC: NCLEX®: Safe and effective care environment—management of care 5. The nurse manager is educating a new hire on The Joint Commission (TJC). The manager tells the new hire that TJC mandates the use of continuous quality improvement and measurement of specific quality outcomes for patients with certain diagnoses. The teaching has been effective when the new hire states: “These mandates include patients admitted with Acute MI and a. COPD.” “Outcomes measures are mandated for patients with a diagnosis of b. congestive heart failure and brain attack.”

“Acute renal failure and deep vein thrombosis have mandated c. outcomes by The Joint Commission.”

“Outcome measures are mandated for patients admitted with d. community-acquired pneumonia and congestive heart failure.”

ANS: D TJC mandates outcome measures for patients admitted with a diagnosis of acute MI, congestive heart failure, community-acquired pneumonia, surgical infection prophylaxis, pregnancy-related conditions, and deep vein thrombosis. Keep in mind that each item in the option must be correct for the option to be correct, which is the reason acute MI and COPD as well as congestive heart failure and brain attack are incorrect.

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PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 517 OBJ:Discuss the use of key indicators to measure performance.

TOP:Specific quality outcome measurements MSC: NCLEX®: Safe and effective care environment—management of care 6. A nurse manager is providing education to a new nurse on barriers to the implementation of quality improvement processes. The manager judges the teaching to be effective when the new nurse states: a. “Expense is a primary barrier.” b. “Resistance to change is a primary barrier.” c. “One of the primary barriers is complacency with the status quo.” d. “Not identifying the correct problem is a primary barrier.”

ANS: A A primary barrier to implementing effective quality improvement (QI) programs is the cost. The cost of providing health care has greatly increased over the past few decades. However, through quality improvement measures, overall health care costs can be reduced. Other barriers (but not the primary one) to QI are nurses’ loyalty to old practices and failure to recognize that changes are needed. Hospital administrators often oppose

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change of any kind because they may value traditional practices, have an authoritative management style, or may not value innovators. Nurses are often unaware or unwilling to change their practice from the way they have always done things—complacency with the status quo. Many practicing nurses remain resistant to change because it seems threatening and because it requires effort, retraining, and restructuring of habits, but cost still remains the primary barrier to implementing QI. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 514 OBJ:Describe your role in quality and performance improvement.

TOP:Barriers to quality improvement MSC: NCLEX®: Safe and effective care environment—management of care 7. The nurse manager has an adequate understanding of the continuous quality improvement process of Six Sigma when doing which of the following? a. “Uses Six Sigma to identify errors” b. “Uses Six Sigma to increase profits” “Uses Six Sigma to keep standard policies and procedures c. consistent” d. “Uses Six Sigma to improve patient-provider communication”

ANS: B

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The primary goal of Six Sigma is to increase profits and reduce problems by improving standard operating procedures, reducing errors (not just identifying them), and decreasing misuse of the system. Six Sigma methodology is based on strategies that focus on CQI and reducing variation in practice through the application of DMAIc. In other words, once a protocol is found to be effective, everyone is trained to do it the same way. The Six Sigma DMAIC process (define, measure, analyze, improve, control) is used primarily for improving existing processes that do not meet institutional goals or national norms. Although patient–provider communication is important, it is not the primary goal of Six Sigma.

PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ:Identify tools and processes for continuous quality improvement.

TOP:Continuous quality improvement goals MSC: NCLEX®: Safe and effective care environment—management of care 8. A nurse is a team member assisting with the define-measure-analyze-improve-control (DMAIC) process.

Which action would the nurse take during the define phase? a.

Identify the stakeholders.

b.

Agree on the key performance indicators.

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c.

Identify gaps between performance and goals.

d.

Identify those responsible for data collection.

ANS: A In the define phase, a charter is developed; goals, team leaders, membership, and team roles and responsibilities are identified; and the stakeholders affected by the process are identified. In the measurement phase, everyone within the team needs to agree on what is to be measured, which are called key performance indicators (time, costs, distance, numbers of incidents, or items). The analyze phase is usually a short phase, but it can be longer depending on the issue because analysis of baseline data is collected. It is important to be objective in identifying where the real problems exist during this phase. The improve phase is a good place to determine whether measures reflect the true problems. The problem statement and goal statement may need to be revised based on the findings. The data collected may have shown that no real problem exists or that the problem involves other issues. During the control phase, controls are established to keep things going in the right direction. Controlling and sustaining the improvement is not easy and requires the development, documentation, and implementation of an ongoing monitoring plan.

PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ: Incorporate successful process improvement strategies including DMAIC. TOP: Define phase of the define-measure-analyze-improve-control (DMAIC) process MSC: NCLEX®: Safe and effective care environment—management of care NURSINGTB.COM

9. A nurse is interested in becoming credentialed as a Certified Professional in Health Care Quality. Which action would the nurse take to achieve this? a.

Take an exam.

b.

Complete a 6-week internship.

c.

Have at least a bachelor’s degree.

d.

Have at least 1 year of experience in quality management.

ANS: A Although there is no longer a minimum education requirement, those who test should have worked in quality management for a minimum of 2 years. Approximately 75% of those who apply to test actually achieve certification.

PTS: 1 DIF: Cognitive Level: Application REF: p. 527 OBJ:Consider the value and requirements of quality credentialing.

TOP:Credentialing for a CPHQ MSC: NCLEX®: Safe and effective care environment—management of care

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10. The continuous quality improvement (CQI) committee has performed a retrospective chart audit to investigate whether outcomes recorded in each nursing care plan are patient centered and written in behavioral terms. The expected standard is 98% compliance. The sample size was 200. Results showed that 180 charts met the standard. What assessment can be made? a. The standard was met. No action plan is necessary.

The standard was not met, but no action plan is necessary because b. the rate of compliance was close to the standard. c. The standard was not met. An action plan should be developed. d. The standard was not met. An immediate re-audit is necessary.

ANS: C A threshold, or cutoff point, is determined for each indicator. This example represents a 90% compliance rate (180 divided by 200 = 0.9 or 90%), but the threshold or expected standard was set at 98%. Therefore, the standard was not met, and an action plan needs to be developed.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 508 OBJ: Discuss the impact that health care provider credentialing and quality improvement activities have on nursing practice. TOP: Continuous quality improvement (CQI) MSC: NCLEX®: Safe and effective care environment—management of care NURSINGTB.COM

11. The nurse manager has an adequate understanding of root cause analysis when stating which of the following? a. “Root cause analysis determines who to place the blame on.”

“Root cause analysis can identify some factors leading up to an b. error.” c. “Root cause analysis is rarely conducted effectively.”

“Root cause analysis investigates the root causes of events that d. occur.”

ANS: D The nurse manager has an adequate understanding of root cause analysis when they state it involves investigation of the root causes of events that occur. Root cause analysis does not determine who to blame, identifies all factors leading up to an error, and is conducted effectively by trained professionals.

PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ:Define quality standards in health care management.

TOP: Standards of quality health care management MSC: NCLEX®: Not applicable

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12. A nurse is educating students on the history of quality improvement. The teaching has been effective when one of the students states that the historically, quality improvement focused on a. “controlling process by inspection so that errors were prevented.” b. “quality improvement did not begin until recently.” c. “proactive approaches to lessen errors.” d. “error prevention strategies.”

ANS: A Teaching is effective when the student states that historically, quality improvement focused on controlling process by inspection so that errors were prevented. Later, the emphasis changed from inspection to proactive approaches to error prevention.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 510 OBJ:Describe the history and evolution of quality in health care.

TOP: History and evolution of quality in health care MSC: NCLEX®: Not applicable 13. A nurse is explaining to another nurse about the contributions of Edward Deming. The nurse judges that the explanation is effective when the nurse states: NURSINGTB.COM a. “Quality is the responsibility of everyone within an organization.” b. “Quality is the responsibility of the quality control inspector.” c. “Quality is the responsibility of the CEO of the organization.” d. “Quality is the responsibility of the manager of the organization.”

ANS: A Edward Deming embraced the philosophy that quality is the responsibility of everyone within an organization.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 518 OBJ:Describe the history and evolution of quality in health care.

TOP: History and evolution of quality in health care MSC: NCLEX®: Not applicable 14. Which action takes place during the design phase of the DMAIC process? a.

A charter is developed.

b.

Key performance indicators are agreed upon.

c.

Analyze baseline data.

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d.

Determine whether measures reflect the true problems.

ANS: A During the design phase of the DMAIC process, a charter is developed. Key performance indicators are agreed upon during the measure phase, baseline data are analyzed during the analyze phase, and it is determined whether measures reflect the true problems during the improve phase.

PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ: Incorporate successful process improvement strategies. TOP: DMAIC MSC: NCLEX®: Not applicable 15. Which of the following statements by the nurse indicates an understanding of Quality and Safety for Nurses (QSEN)? a. “QSEN helps prepare future nurses for improving patient safety.”

“QSEN helps prepare future nurses for working mandatory b. overtime.” c. “QSEN helps train nurses in the clinical setting.”

“QSEN provides nurses with strategies for passing the NCLEX d. exam.”

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ANS: A Quality and Safety for Nurses (QSEN) was developed to help prepare future nurses who will be needed in their health care environment to improve patient safety. QSEN does not prepare nurses to work mandatory overtime, train them in the clinical setting, or provide them with strategies to pass the NCLEX exam.

PTS: 1 DIF: Cognitive Level: Application REF: p. 515 OBJ: Incorporate successful process improvement strategies. TOP: QSEN MSC: NCLEX®: Not applicable 16. The nurse manager has an adequate understanding of Six Stigma when making which of the following statements?

“The primary goal of Six Stigma is to increase profits and reduce a. problems.”

“The primary goal of Six Stigma is to attract physicians to an b. organization.”

“The primary goal of Six Stigma is advertisement of the c. organization.”

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“The primary goal of Six Stigma is to attract nursing to an d. organization.”

ANS: A The primary goal of Six Stigma is to increase profits and reduce problems. The primary goal is not to attract physicians or nurses to an organization or advertise.

PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ:Identify tools and processes for continuous quality improvement.

TOP: Tools and processes for continuous quality improvement MSC: NCLEX®: Not applicable 17. A nurse manager is brainstorming quality improvement methods. Which action would help implement these methods on the assigned unit? a.

Continue without change.

b. Resist change from upper management. c.

Empower employees to carry out needed strategies for change.

d. Agree to change what is directly beneficial.

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ANS: C

To implement and benefit from quality improvement methods, the nurse should encourage employees to carry out needed strategies for change. Continuing without change, resisting change, or only agreeing to change that is only directly beneficial would not be helpful.

PTS: 1 DIF: Cognitive Level: Application REF: p. 516 OBJ:Identify tools and processes for continuous quality improvement.

TOP: Monitoring quality of care MSC: NCLEX®: Not applicable 18. The nurse understands that the following statement is true about patient classification systems? a. “The systems measure all the needs of patients.” b. “The systems provide an absolute formula for unit staffing.”

“The systems should not be used to make patient care assignments c. because acuity systems are more accurate.”

“The systems provide historical data of the usage of nursing time, d. which is helpful when developing the department budget.”

ANS: D

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A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. It is helpful for developing a department budget. It is not a formula for unit staffing and does not measure all the needs of the patients.

PTS: 1 DIF: Cognitive Level: Application REF: p. 508 OBJ:Describe strategies to coordinate care and reduce costs.

TOP: Coordination of care and cost control MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. If the nurse had an adequate understanding of continuous quality improvement, which of the following statements would the nurse? (Select all that apply.)

“The accountability for quality is vested in quality circles that a. function along service lines to improve patient care.”

“After quality standards are achieved, the nurse strives to maintain b. that standard of care.”

“Quality standards must incorporate the expectations of patients c. and their families.”

“Systems within the hospital must be reviewed to determine how d. care can be enhanced.”

NURSINGTB.COM “Reducing costs to provide for substantial pay increases for nursing e. staff is an example of continuous quality improvement.”

f.

“Computerized electronic documentation systems that provide continuous assessment of patient charges are an example of continuous quality improvement.”

ANS: A, B, D Quality improvement (QI) refers to the process or activities that are used to measure, monitor, evaluate, and control services so that nurses can provide some measure of confidence to health care consumers. It includes reports that must be generated to track progress. This approach emphasizes continually looking for opportunities to improve. QI looks not only at what the nurse does in the pursuit of quality but also at how the systems of the units in the hospital can be improved to provide better care at lower cost. Reducing costs by providing for pay increases for nursing staff and computerized documentation systems are not examples of QI. Although quality improvement affects patients, their expectations and their family members’ expectations are not necessarily incorporated into quality circles and the work that they do. Nurses must monitor quality care compliance; otherwise, people tend to go back to their old ways of doing things. The QI department is typically the department that receives data, analyzes trends, and recommends actions to facilitate improvement in the organization. However, there should also be a continuous quality improvement (CQI) council as a primary decision-making nursing team, as well as quality circles (QCs) that function along service lines, collaborating to improve care for a group of patient types.

PTS: 1 DIF: Cognitive Level: Application REF: p. 511 OBJ: Describe factors that influence staffing and scheduling in nursing care delivery.

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TOP:Quality patient care—continuous quality improvement MSC: NCLEX®: Safe and effective care environment—management of care 2. Which of the following are considered core measures and monitored by The Joint Commission? (Select all that apply.) a.

Code arrests infection rates

b.

Advance directives

c.

Medication error rates

d.

Nurse staffing and vacation patterns

e.

Restraint use

f.

Numbers of hospital admissions

ANS: A, B, C, E The Joint Commission mandates that organizations continuously track certain core measures in order to monitor quality care. Some of these include advance directives, autopsy rates, leaving against medical advice (AMA) and elopement rates, blood product use rates, blood transfusion reaction rates, code blue rates, conscious sedation complication rates, fall rates, medication error rates, mortality rates, pain management effectiveness, restraint use, perinatal care, rates of deep vein thrombosis, and surgical-site infection rates.

Nurse staffing and vacation patterns and tracking hospital admissions are not core measures.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Analysis REF: p. 507 OBJ: Describe factors that influence staffing and scheduling in nursing care delivery.

TOP:Quality patient care—continuous quality improvement MSC: NCLEX®: Safe and effective care environment—management of care 3. A nurse manager is educating a group of nurses on common medication errors. The manager judges the teaching to be effective when one of the nurses states that common medication errors include (Select all that apply.) a.

good communication

b.

look-alike packaging

c.

wrong-dose errors

d.

inadequate monitoring

e.

rule violations

ANS: B, C, D, E

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The teaching has been effective when the nurse states that common medication errors include look-alike packaging, wrong-dose errors, inadequate monitoring, and rule violations. Common medication errors also include poor communication.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 513 OBJ:Define quality standards in health care management.

TOP: Standards of quality health care management MSC: NCLEX®: Not applicable 4. A nurse is listening to a pharmacist lecture about factors that contribute to medication errors. The teaching has been effective when the nurse states: (Select all that apply.) a.

“Problems within the system contribute to medication errors.”

b. “Human factors contribute to medication errors.” c.

“Work-design problems contribute to medication errors.”

d. “Environmental factors contribute to medication errors.” e.

“The nurse alone contributes to medication errors.”

ANS: A, B, C, D The teaching has been effective when the nurse states that contributions to medication errors include problems within the system, human factors, work-designNURSINGTB.COM problems, and environmental factors.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 514 OBJ:Define quality standards in health care management.

TOP: Standards of quality health care management MSC: NCLEX®: Not applicable 5. A nurse is preparing a presentation on core measures. Which medical diagnosis should the nurse plan on presenting during the lecture? (Select all that apply.) a.

Myocardial infarction

b.

Congestive heart failure

c.

Diabetes

d.

Pregnancy-related conditions

e.

Deep vein thrombosis

ANS: A, B, D, E Core measures include those for patients admitted with myocardial infarction, congestive heart failure, pregnancy-related conditions, and deep vein thrombosis. Diabetes does not fall under these core measures.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 513 OBJ:Define and discuss core measures.TOP:Core measures MSC: NCLEX®: Not applicable 6. A nurse manager is educating unit staff about HCAHPS. The manager judges the teaching to be effective when a staff nurse states that the HCAHPS survey contains rating about (Select all that apply.) a.

communication.

b.

pain management.

c.

responsiveness.

d.

cost of hospital stay.

e.

discharge information.

ANS: A, B, C, E Teaching has been effective when the nurse states that HCAHPS survey contains rating about communication, pain management, responsiveness, and discharge information. HCAHPS does not include the cost of the hospital stay.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 507

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OBJ:Discuss the use of key indicators to measure performance.

TOP: HCAHPS MSC: NCLEX®: Not applicable 7. A nurse has an adequate understanding of barriers to quality improvement when stating which of the following? (Select all that apply.) a.

“Cost is a barrier in quality improvement.”

b.

“There are no barriers to quality improvement.”

c.

“Nurses’ loyalty to old practices is a barrier.”

d.

“Failure to recognize that change is needed is a barrier.”

e.

“Being unwilling to change is a barrier.”

ANS: A, C, D, E There are several barriers to quality improvement. These barriers include cost, loyalty to old practices, failure to recognize that change is needed, and being unwilling to change.

PTS: 1 DIF: Cognitive Level: Application REF: p. 514 OBJ:Describe your role in quality and performance improvement.

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TOP: Quality improvement MSC: NCLEX®: Not applicable 8. Which action by a group of nurses involves brainstorming? (Select all that apply.) a.

List one solution to the problem.

b.

Identify stakeholders.

c.

Think about solutions to the problem.

d.

Write the problem statement.

e.

Write a goal statement.

ANS: B, C, D, E To brainstorm, the nurses should think about solutions to the problem, identify stakeholders, list solutions to the problem, and write the problem statement as well as the goal statement.

PTS: 1 DIF: Cognitive Level: Application REF: p. 519 OBJ: Incorporate successful process improvement strategies. TOP: Brainstorming MSC: NCLEX®: Not applicable 9. Which action would be occurring if a group of nurses were in the analyze phase of the DMAIC NURSINGTB.COM process? (Select all that apply.) a.

Identify gaps between current performance and the goal.

b.

Identify possible sources of variation.

c.

Determine the goal.

d.

Write the problem statement.

e.

Determine where to begin making a change.

ANS: A, B, E If the nurses were in the analyze phase of the DMAIC process, they would identify gaps between current performance and the goal, identify possible sources of variation, and determine where to begin making a change. Determining the goal and writing the problem statement occur in the define phase.

PTS: 1 DIF: Cognitive Level: Application REF: p. 519 OBJ: Incorporate successful process improvement strategies. TOP: DMAIC process MSC: NCLEX®: Not applicable 10. Which statement by the nurse indicates understanding of the control phase of the DMAIC process? (Select all that apply.)

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“In the control phase, only the leader should be informed of a. changes.”

“Only those directly affected by the new process should be b. educated.”

“In the control phase, steps in the new process should be c. standardized.” d. “Changes should be monitored to ensure compliance.” e. “Standard operating procedures should be written.”

ANS: C, D, E In the control phase of the DMAIC process, everyone should be kept informed of changes, standard operating procedures should be written, everyone should be educated about the new process, the steps in the new process should be standardized, and changes should be monitored to ensure compliance PTS: 1 DIF: Cognitive Level: Application REF: p. 519 OBJ: Incorporate successful process improvement strategies. TOP: DMAIC process MSC: NCLEX®: Not applicable

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Chapter 23: Nursing Informatics MULTIPLE CHOICE 1. Which statement by the nurse indicates an understanding of the definition of nursing informatics?

“Nursing informatics is a specialty area of hospital nursing in a. which management of patient care is done via computers.”

“Nursing informatics is the specialty practice of nursing integrating b. nursing science with computer science and information science.”

“Nursing informatics includes the input and retrieval of a patient’s c. complete medical history via electronic data.”

“Nursing informatics is an area of computer system design and analysis to provide and retrieve patient health data during the d. period of hospitalization.”

ANS: B The ANA has defined informatics as “a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice.”

PTS: 1 DIF: Cognitive Level: Application REF: p. 553 NURSINGTB.COM

OBJ:Define nursing informatics.TOP:Informatics MSC: NCLEX®: Safe and effective care environment—management of care 2. What are examples of regulatory agencies that will affect health care policy with regard to informatics? a.

Health Insurance Portability and Accountability Act (HIPAA)

b. American Nursing Credentialing Center (ANCC) c.

American Nurses Association (ANA)

d. Medicare/Medicaid authorization

ANS: A The Joint Commission (TJC) and the Health Insurance Portability and Accountability Act (HIPAA) are two regulatory and governmental agencies instituting health care policy. The American Nurses Association (ANA) is the professional nursing organization. Medicare and Medicaid are governmental organizations that provide services. They do not regulate health care policy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 535-537 OBJ:Describe regulatory issues that affect the profession of nursing.

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TOP:Regulatory agencies MSC: NCLEX®: Safe and effective care environment—management of care 3. What is the importance of using classification systems for nursing nomenclature to describe nursing practice?

To provide a system to develop and use a patient care management a. system To allow nursing administration to project, define, and implement b. nursing care policies and guidelines To assist the quality control team to survey and gather data that c. will reflect the acuity classification of patients To facilitate collection of consistent data that can be accurately d. manipulated in an electronic medical record

ANS: D Nursing nomenclatures offer a recognized systematic classification and consistent method of describing nursing practice. Without a common language, data cannot be aggregated into a useful language. If the unique nomenclature of accepted classification systems is used consistently, gathered data elements can be captured, stored, and manipulated accurately in the electronic medical record. Acuity systems allow nursing administration to address ways to deal with issues such as shift-to-shift changes in patient care needs, admission–discharge–transfer volumes, and factors such as ancillary support and technology and equipment NURSINGTB.COM considerations to support CQI measures. Nursing classification systems do not assist in the use of a patient care management system or the writing of policies and guidelines.

PTS: 1 DIF: Cognitive Level: Application REF: p. 538 OBJ:Discuss the necessity of using recognized taxonomies and nursing nomenclature in nursing documentation.TOP:Nomenclature and classification MSC: NCLEX®: Safe and effective care environment—management of care 4. Which statement by the nurse indicates understanding of general systems theory in regards to nursing informatics?

“General systems theory organizes interdependent parts that, when working together, can produce a product that none used alone could a. produce.”

“General systems theory provides theory support for a system that maintains confidentiality when handling patient data and b. information.”

“General systems theory incorporates external databases from state agencies to allow for performance comparison within a specific c. institution.”

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“General systems theory is a nursing theory regarding the use of nurse informatics to integrate the systems within health care for d. support of nursing education and practice.”

ANS: A Nursing informatics uses a theoretical foundation. This theory organizes interdependent parts that, when working together, can produce a product that none of the interdependent parts used alone could produce.

Nursing informatics uses this theoretical foundation for analysis and design, implementation and support, and testing and evaluation of automated systems. It is used as a basis for decision making, education curriculum needs, and foundation for system and project management. HIPAA defines standards that were developed to ensure that health care organizations collect the right data in a common format so that the data can be shared, as well as protect the privacy and security of patient data.

Systems theory consists of six elements: (1) Interdependent parts—elements of the system that interact for processing (2) Input—any outside element or factor that is brought into the system (3) Process—the activity within the system (4) Output—any product that is produced from the processing activity (5) Control—rules or procedures within the system

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(6) Feedback—reusing output from the system as input back into the system for validation or correction There is no mention of external databases in these six elements.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 539 OBJ: Discuss the history of nursing informatics. TOP: Nursing informatics MSC: NCLEX®: Safe and effective care environment—management of care 5. Which of the following statements indicates the nurses understanding of the difference between the electronic health record (EHR) and electronic medical record (EMR) is: “EHR provides nursing with a standardized nomenclature of a. taxonomy to record nursing care.”

“EMR is the inclusion of only data collected by the patient b. (personal health record (PHR).” c. “EHR is a longitudinal record of the patient’s health information.”

“EMR allows nurses to document nursing care in a system that is d. intuitive to their level of computer literacy.”

ANS: C

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EHR is the longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EHR automates and streamlines the clinician’s work flow. The EHR has the ability to generate a complete record of a clinical patient encounter—as well as supporting other care-related activities directly or indirectly via interface—including evidence-based decision support, quality management, and outcomes reporting. The EMR is composed of data from multiple software applications used by a facility such as a hospital or provider officer to order, document, and store patient information just as a paper medical record did in the past. The ability of the computer systems to combine data from various EMRs to form a more holistic view of a patient is one of the major benefits of electronic documentation. The inclusion of data collected by the patient into the EHR is called the personal health record (PHR).

PTS: 1 DIF: Cognitive Level: Application REF: p. 541 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices.

TOP: Informatics MSC: NCLEX®: Safe and effective care environment—management of care 6. The nurse manager is teaching a new nurse about computer monitoring on a telemetry unit. The nurse manager judges the teaching to be effective when the new nurse states: “Computer monitoring provides continuous streaming of data that a. allows nurses to respond to patient changes quickly.”

“Computer monitoring provides for continuous around-the-clock b. direct observation of patients.”

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c. “Computer monitoring improves documentation of patient care.”

“Computer monitoring reduces the need for additional nurses to d. provide patient care.”

ANS: A The continuous flow of data from a computer allows nurses to respond to patient changes very quickly. Timely nursing responses and actions are crucial in leading to positive outcomes when caring for critically ill patients.

Computer monitoring is not a substitute for patient observation. The number of nurses required to care for patients is not reduced because of computer monitoring, nor does it improve documentation, but rather provides a means to document data.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 548 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices.

TOP: Informatics MSC: NCLEX®: Safe and effective care environment—management of care 7. A nurse is educating students on how to evaluate a website. The nurse judges the teaching to be effective when the students can state: “Internet information must go through careful screening before it a. can be posted.”

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“Credibility, accuracy, and reasonableness of the information b. should be considered.”

“It is important to have the hospital librarian verify the authenticity c. of the website.”

“Most Internet information can be downloaded or beamed to a d. smartphone or handheld device (personal digital assistant [PDA]).”

ANS: B The credibility of the information that you obtain from Internet searches should be challenged. It is important to be skeptical because not all information that is posted on a website is accurate. Information should be evaluated and reevaluated on a regular basis. It is important to remember that Internet information is dynamic and fluid in nature compared with printed information. Although librarians can assist with the verification of the authenticity of the website, nurses need to understand how to evaluate information from various Internet sources. It is true that most information can be downloaded to a smartphone or handheld device; however, the question is asking about evaluating a website.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 550 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices.

TOP: Informatics MSC: NCLEX®: Safe and effective care environment—management of care 8. The nurse is educating a nursing student on the difference between the informatics nurse and the informatics NURSINGTB.COM nurse specialist. The teaching has been effective when the nursing student states: a. “The informatics nurse has a graduate degree.”

“The informatics nurse specialist has experience in informatics but b. no advanced degree.” c. “The informatics nurse supports consumers.” d. “The informatics nurse specialist has an advanced degree.”

ANS: D The informatics nurse has experience in nursing informatics but does not have a degree in the specialty. The informatics nurse specialist does have an advanced degree. Both the informatics nurse and the informatics nurse specialist support consumers and nurses.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 555 OBJ:Define nursing informatics.TOP:Nursing informatics MSC: NCLEX®: Not applicable 9. A nursing student is interested in the field of nursing informatics. What should the student do to prepare for a career in this specialty as a nurse leader?

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a.

Obtain a baccalaureate degree in nursing,

b.

Complete 5 years on a medical-surgical unit,

c.

Obtain critical care experience,

d.

Obtain a graduate degree,

ANS: D Informatics nurses who want to hold a leadership role in nursing informatics will need graduate-level preparation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ:Define nursing informatics.TOP:Nursing informatics MSC: NCLEX®: Not applicable 10. The nurse has an adequate understanding of the informatics nurse (IN) and informatics nurse specialist (INS) when making which of the following statements?

“The IN/INS does not require any computer or network knowledge a. on entry into the profession.” b. “The IN/INS does not interact directly with clinical staff.”

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“”The IN/INS does not need prior knowledge of software or c. hardware implementation.”

“The IN/INS should be prepared to help with system d. implementation.”

ANS: D The IN/INS should be prepared to help with system implementation, have computer and network knowledge on entry into the profession, and interact directly with staff.

PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ:Define nursing informatics.TOP:Nursing informatics MSC: NCLEX®: Not applicable 11. A nurse is self-educating on the role of the informatics nurse/informatics nurse specialist. The nurse has an adequate understanding when listing which as a primary success indicator?

“Making sure that information technology did no harm to the a. patient.” b. “There were no primary success indicators listed for the IN/INS.”

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“There are not enough data on primary success indicators for the c. IN/INS role.”

“Primary success indicators include excellence in bedside patient d. care.”

ANS: A A primary success indicator for the IN/INS role is making sure that information technology did no harm to the patient. Excellence in bedside patient care is not listed as a primary success indicator for the IN/INS role.

PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ:Define nursing informatics.TOP:Nursing informatics MSC: NCLEX®: Not applicable 12. Which statement by the nurse is true regarding the focus of nursing informatics? The focus of nursing informatics a. “is to improve patient care with health care technology.” b. “is to improve patient care by increasing health care expertise.” c. “is to improve patient care by improving nursing performance.” “is to improve patient care by allowing the patientNURSINGTB.COM access to d. medical records.”

ANS: A The focus on nursing informatics is to improve patient care with health care technology that encourages clinicians to make more accurate and timely decisions. The focus is not on increasing health care expertise, improving nursing performance or access to medical records.

PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ:Define nursing informatics.TOP:Nursing informatics MSC: NCLEX®: Not applicable 13. Which statement by the nurse indicates understanding of the General Systems Theory?

“It is a 5-step process of an individual’s decision to adopt an a. innovation.” b. “It is known as a change theory.”

“It includes knowledge, persuasion, decision, implementation, and c. confirmation.”

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“It organizes interdependent parts working together to produce a d. product that none used alone could produce.”

ANS: D The nurse understands the General Systems Theory when he or she states that it organizes interdependent parts working together to produce a product that none used alone could produce. Rogers’ Diffusion of Innovation Theory is a 5-step process of an individual’s decision to adopt an innovation. It includes the steps of knowledge, persuasion, decision, implementation, and confirmation. Kurt Lewin’s theory is known as the Change Theory.

PTS: 1 DIF: Cognitive Level: Application REF: p. 539 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices.

TOP: Models and theories MSC: NCLEX®: Not applicable 14. How can the nurse expect to be impacted by nursing informatics?

The nurse would not be directly impacted unless he or she worked a. in nursing informatics. b. Nurses at the bedside are minimally impacted.

Nurses are impacted by the use of barcode medication c. administration.

NURSINGTB.COM d. Nurse managers are the only hospital staff who are impacted.

ANS: C Everyone in the health care system is impacted by nursing informatics in one way or another. Nurses are directly impacted by the use of barcode medication administration.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 553 OBJ: Describe what a nurse specializing in nursing informatics might do.

TOP: Nursing informatics and you MSC: NCLEX®: Not applicable 15. Which action can the nurse take to evaluate an internet resource? a. Assume that the resource is credible if it is on an internet page. b. Determine if the resource provides evidence for claims made. c. Assess the popularity of the resource.

Determine the date the resource was published; older material is d. more reliable.

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ANS: B To evaluate an internet resource, the nurse should use the CARS checklist developed by Harris (2007). The nurse should assess credibility, accuracy, reasonableness, and support. The nurse assesses support by determining if the source provides evidence for claims made. The nurse should not assume that the resource is credible because it is on the internet, assess popularity, or rely on information that is old or outdated.

PTS: 1 DIF: Cognitive Level: Application REF: p. 550 OBJ: Review the steps in evaluating the validity of a website. TOP: Evaluating internet resources MSC: NCLEX®: Not applicable 16. The nurse understands the benefits of Computerized Provider Order Entry (CPOE) when stating: a. “CPOE does not change the process of patient care.” b. “CPOE averts problems with hand-written orders.” c. “CPOE benefits only the nurses in the health care system.” d. “CPOE benefits only the pharmacists in the health care system.”

ANS: B Computerized Provider Order Entry benefits everyone in the health care system and greatly changes the NURSINGTB.COM process of patient care, as well as averts problems with handwritten orders.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 554 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices.

TOP: Clinical information systems MSC: NCLEX®: Not applicable MULTIPLE RESPONSE 1. A nurse is preparing to graduate with a degree in nursing informatics. The nurse is explaining career options to friends. The nurse understands the options when stating: (Select all that apply.) a. “I can work alongside engineers as they create new products.”

“I can work for a consulting firm and specialize in workflow b. improvement.” c. “I cannot work for third-party payers.” d. “I do not have the option of working for the government.” e. “I am excited to work for an educational institution.”

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ANS: A, B, E The nurse graduating with a degree in nursing informatics has a variety of opportunities. These include working alongside engineers and for consulting firms, third-party payers, the government, and educational institutions.

PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ:Define nursing informatics.TOP:Nursing informatics MSC: NCLEX®: Not applicable 2. How does the IN/INS use HIPPA regulations and TJC requirements in daily practice? (Select all that apply.) a.

Investigation of violations

b.

Writing of policies

c.

Involvement in the discipline process

d.

Writing of procedures

e.

Managing the nursing unit

ANS: A, B, D NURSINGTB.COM The IN/INS’s use of HIPPA regulations and TJC regulations includes writing of policies and procedures and investigation of violations. It does not involvement in the discipline process or managing the nursing unit.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 534-535 OBJ:Discuss laws and regulations impacting nursing informatics.

TOP: Professional practice, trends and issues MSC: NCLEX®: Not applicable 3. The nurse has adequate understanding of HIPAA when stating that the major impact from this privacy regulation is in (Select all that apply.) a.

“health information privacy law.”

b.

“bedside nursing care.”

c.

“nursing report communication.”

d.

“data security standards.”

e.

“electronic transaction standards.”

ANS: A, D, E

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The nurse has an adequate understanding of HIPAA when stating that the major impact from this privacy regulation is in health informatics privacy law, data security standards, and electronic transaction standards.

Bedside nursing care and nursing report, communication is not included as an area of major impact.

PTS: 1 DIF: Cognitive Level: Application REF: p. 535 OBJ:Discuss laws and regulations impacting nursing informatics.

TOP: Professional practice, trends and issues MSC: NCLEX®: Not applicable 4. A nurse manager is educating a group of staff nurse on violation of HIPPA standards. The manager judges the teaching to be effective when one of the staff nurses states: (Select all that apply.)

“Violations of HIPPA standards no longer occur because the a. consequences are so severe.”

“Violations of HIPPA standards can result in termination of b. employment.” c. “Violations of HIPPA standards can result in an indictment.”

“Violations of HIPPA standards are waived if it is your first d. offense.” e. “Violations of HIPPA standards can result in prison time.”

ANS: C, E

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The teaching has been effective when one of the staff nurses states that violation of HIPPA standards can result in termination of employment, indictment, or prison time. Violations still occur, even in the face of consequences, and are not waived for first offenses.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 535 OBJ:Discuss laws and regulations impacting nursing informatics.

TOP: HIPPA MSC: NCLEX®: Not applicable 5. Which action by the nurse incorporates standard practice for protecting patient privacy on mobile devices? (Select all that apply.) a. Keep careful physical control of the device at all times. b. Avoid use of mobile devices. c. Use a password and a time-out to authenticate the re-activation. d. Enable encryption. e. Keep security software up to date.

ANS: A, C, D, E

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The nurse can incorporate standard practice by doing the following: keeping careful physical control of the device at all times, using a password and a time-out to authenticate the reactivation, enabling encryption, and keeping security software up to date. Avoiding use of mobile devices may not be realistic in the health care setting.

PTS: 1 DIF: Cognitive Level: Application REF: p. 537 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices.

TOP: Use of mobile devices MSC: NCLEX®: Not applicable 6. A nurse manager is lecturing staff nurses on the barriers to the full integration health information technology. The nurse manager judges the teaching to be effective when a staff nurse states: (Select all that apply.) a.

“Barriers include lack of standardization across care areas.”

b.

“A barrier to the full integration is funding.”

c.

“Currently there are no barriers.”

d.

“A current barrier is privacy laws.”

e.

“Barriers to full integration are not likely to be overcome.”

ANS: A, B, D NURSINGTB.COM

The teaching has been effective when a staff nurse states that barriers include a lack of standardization across care areas, funding, and privacy laws.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 545 OBJ: Review the steps in evaluating the validity of a website. TOP: What is meaningful use?

MSC: NCLEX®: Not applicable

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Chapter 24: Using Evidence- Based Practice and Nursing Research MULTIPLE CHOICE 1. A nurse educator is teaching a nurse about research utilization. Which statement by the nurse indicates understanding?

“Research utilization is the collection of data to answer a specific a. question.” b. “Research utilization is the analysis of the practice context.”

“Research utilization is the process of integrating the findings of c. completed studies into practice.”

“Research utilization involves application of the findings of one d. research study.”

ANS: C Research utilization is the process of systematically integrating the findings of completed nursing research studies into clinical nursing practice. The important aspect is using already existing research data and findings to modify nursing practice.

PTS: 1 DIF: Cognitive Level: Application REF: p. 560 NURSINGTB.COM OBJ: Discuss the difference between conducting research and research utilization.

TOP:Using nursing research in practice MSC: NCLEX®: Safe and effective care environment—management of care 2. The nurse understands the process of research utilization when the nurse does not complete which of the following steps? a. Assessing patient care

c. Implementing a plan of care

Planning for the patient’s b. needs

Guessing the extent of care d. needed

ANS: D The steps included in using nursing research in practice are preutilization, assessing, planning, implementing, and evaluation. The nurse does not guess during the research utilization process.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 560-564 OBJ:Identify the steps in the process of research.

TOP:Using nursing research in practice

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MSC: NCLEX®: Safe and effective care environment—management of care 3. What does research utilization on an inpatient unit require? a. A nursing theoretical framework should be followed. b. Orem’s theory of self-care requisites should be followed. c. Only the nurses should participate in the implementation.

The implementation should be consistent with the nursing d. framework in the practice context.

ANS: D Implementation of a new approach should follow a specific plan. It is also important that evaluation data be collected at the same time as the implementation to clearly determine the effect of the new approach. A major component of the research utilization process is reviewing completed nursing research studies that have been published in the literature. In contrast, conducting new research involves the collection of new data to answer a specific clinical practice question. Nursing research utilization is a step-by-step process incorporating critical thinking and decision-making to ensure that a change in practice has a sound basis in nursing science. Using a nursing theoretical framework, such as Orem’s, may assist in guiding nursing care delivery PTS: 1 DIF: Cognitive Level: Application REF: pp. 540-541 OBJ:Identify the steps in the process of research.

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TOP:Using nursing research in practice MSC: NCLEX®: Safe and effective care environment—management of care 4. Which statement by the nursing professor shows understanding of the major function of the National Institute of Nursing Research?

“Serves as a major source of federal grants to fund nursing a. research” b. “Provides direction to nurses interested in research utilization” c. “Collects data about the major nursing schools in the country” d. “Provides money to fund the education of nurses”

ANS: A Federal grants fund nursing research and also support education in research methods, research career development, and excellence in nursing science.

PTS: 1 DIF: Cognitive Level: Application REF: p. 565 OBJ: Describe the function of the National Institute of Nursing Research.

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TOP: Using nursing research in practice MSC: NCLEX®: Not applicable 5. What is the correct sequence of activities in the research utilization process?

Identification of practice problem, evaluation of related published a. research, planning, implementation, evaluation Planning, implementation, evaluation, review of published b. research, application to practice problem Evaluation of published research, decision to identify practice c. problem, planning, implementation, evaluation Determining question to be answered, determining data-gathering d. methods, data evaluation, plan for utilization, evaluation

ANS: A The proper sequence in the research utilization process must begin with the identification of a practice problem (preutilization), which in turn sets the stage for the step-by-step approach incorporating critical thinking and decision making, including evaluation of published research (assessing), planning, implementing, and evaluating.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 571 OBJ:Identify the steps in the process of research.

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TOP: Using nursing research in practice MSC: NCLEX®: Not applicable 6. Which statement would indicate a unit nursing staff is entering the preutilization step of research utilization?

“We’ve found two studies that have explored methods for reducing a. violent behavior on psych units.”

“We need a new approach to containing violence on the psych b. unit.” c. “This is the plan for implementing the new antiviolence strategies.” d. “This is a summary of the evaluation data we collected.”

ANS: B The first step in using research in nursing practice is the recognition that some aspect of nursing practice could be done in a more efficient, a more beneficial, or simply a different way, so wanting a new approach to containing violence on a psych unit would be an example. Identifying studies about methods for reducing violent behavior would be step 2—assessing. Planning to implement new antiviolence strategies would be step 3 of the process. A summary of evaluation data would be included in the final step (step 5) of the process.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 560-564 OBJ:Identify the characteristics of your practice context.

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TOP:Using nursing research in practice MSC: NCLEX®: Safe and effective care environment—management of care 7. Which statement by the nurse shows understanding of what would not be a barrier to research utilization?

“Too few studies reported in the literature relating to the identified a. problem” “Obtaining consensus to implement a new approach to resolve the b. care problem” “Staff suggesting there is too little time to learn a new approach to c. the care problem” d. “Staff asking, ‘Why fix it if it isn’t broken?’”

ANS: B Consensus building constitutes a second phase of step 1 that is used to identify the specific practice to be changed. In this phase, the incorporation of the principles of change theory will increase the possibility of success. A change will be more acceptable if those affected are included in the decisions related to the change.

Clear communication and teamwork are essential elements of this process. Group consensus is crucial for the successful application of research findings. Barriers include those who are resistant to the change, budgetary and personnel constraints, too few research studies related to the practice problem, the lack of replication of the findings, and the time lag from the completion of a research project until the project report is published may make the research findings obsolete.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Application REF: p. 560 OBJ: Discuss the difference between conducting research and research utilization.

TOP: Using nursing research in practice MSC: NCLEX®: Not applicable 8. A student asks the nurse manager, “When I was reading an article about research utilization, I ran across the phrase ‘practice context.’ What does that mean?” What is the best response?

“It is made up of the factors and systems that contribute to delivery a. of nursing care in a particular setting.”

“It refers to the specific group of patients who are to receive care in b. a particular setting.”

“It describes the type of health care delivery system that is c. currently in place in a particular setting.”

“It refers to the policies, procedures, and staffing patterns of a d. nursing unit.”

ANS: A Practice context determines to what degree you can use the findings from nursing research. It is a blending of all those factors and systems that contribute to the delivery of nursing care. This blend includes the health,

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social, and cultural characteristics of the patient population served; the type of practice setting; the economic resources of the setting; the type of health care delivery system; the existing policies and procedures; the staffing pattern; and the administrative structure. Each factor or system can be either enabling or inhibiting, but it is the practice context as a whole that is evaluated to determine the applicability of nursing research findings.

The other options are components or part of the practice text. The answer includes all of the factors, not just the specific ones listed in the distracters.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 568 OBJ:Identify the characteristics of your practice context.

TOP: Using nursing research in practice MSC: NCLEX®: Not applicable 9. A nursing professor has just joined the National Institute of Nursing Research (NINR). Which activities should the professor anticipate being a part of? a. Providing financial support for any worthy nursing research study Channeling federal money into nursing research related to the b. national nursing research agenda Publishing information detailing successful research utilization c. projects d. Arranging traineeships in development of research proposals

ANS: B

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One function of the NINR is to establish the National Nursing Research Agenda, which is composed of priority topics for nursing research. These topics may be related to a national health need, or they may be in an area that requires research for the development of nursing science. The NINR is a major source of federal funding for nursing research. The NINR also supports education in research methods, research career development, and excellence in nursing science. It does not arrange nursing research traineeships or publish information on the success of research utilization projects.

PTS: 1 DIF: Cognitive Level: Application REF: p. 567 OBJ: Describe the function of the National Institute of Nursing Research.

TOP: Using nursing research in practice MSC: NCLEX®: Not applicable 10. How does evidence-based practice (EBP) differ from research utilization?

EBP has similar steps to the nursing process, which differ from a. research utilization.

EBP is a systematic method of applying research findings to nursing practice that incorporates many additional sources of data b. that may contribute to improved nursing care.

Research utilization is a component of nursing practice that involves the collection of data to answer a specific research c. question and EBP uses the data to make protocols.

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EBP uses a nursing theoretical framework for implementation of practice guidelines, which is essential for the continued d. development of nursing theories

ANS: B Evidence-based practice is similar to research utilization in that it is a systematic method of applying research findings to nursing practice that incorporates many additional sources of data (not just nursing and nursing theory) that may contribute to improved nursing care. A brief definition of evidence-based practice that is generally accepted is the integration of the best research evidence with clinical expertise and patient values.

EBP implies internal decision making on the nurse’s part. The steps in applying evidence-based practice include defining the problem; identifying, reviewing, and evaluating the data applicable to the problem; designing a practice change based on the data; implementing the change in nursing practice; and evaluating the implementation. All three processes—research utilization, nursing research, and the nursing process—have the same five major steps. However, the specific tasks for each process are different. The collection of data to answer a research question is the research process, not research utilization.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 571 OBJ: Discuss the difference between conducting research and research utilization.

TOP:Using nursing research in practice MSC: NCLEX®: Safe and effective care environment—management of care NURSINGTB.COM 11. Which of the following nursing activities are necessary to provide evidence-based nursing care?

Maintaining self-directed practice and using the Internet to locate a. relevant research articles Having an advanced degree (CNS or FNP) and providing clinical b. supervision for peers Attending continuing education programs and working toward a c. graduate degree in nursing Systematically integrating nursing research findings and applying d. relevant evidence to practice

ANS: D Providing evidence-based practice involves searching the research literature, critically synthesizing research findings, and applying relevant evidence to practice. The other activities are myths about what makes effective practitioners.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 569 OBJ: Discuss the difference between conducting research and research utilization.

TOP:Using nursing research in practice

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MSC: NCLEX®: Safe and effective care environment—management of care 12. The nurse manager has an adequate understanding of research utilization when stating which of the following?

“In the process of research utilization, the emphasis is on finding a. new data.”

“A major component of the process is reviewing current nursing b. practices.” c. “The process involves transferring research findings into practice.” d. “The process is solely based on critical thinking.”

ANS: C Research utilization involves transferring research findings into practice. Emphasis is based on using existing data. A major component is reviewing completed nursing research studies and is based on critical thinking and decision making.

PTS: 1 DIF: Cognitive Level: Application REF: p. 569 OBJ:Identify the steps in the process of research utilization.

TOP:What is nursing research utilization?

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MSC: NCLEX®: Safe and effective care environment 13. Which action can the nurse expect in the preutilization step in nursing research utilization?

Recognition that some aspect of nursing care could be done in a a. different way Recognizing that nurses need shortcuts in order to manage their b. workload c. Critical evaluation of published research d. Using electronic databases to search current literature

ANS: A The action that the nurse can expect in the preutilization step is the recognition that some aspect of nursing care could be done in a different way. This step is not meant to create shortcuts for nurses to manage their workload. Critical evaluation of published research and using electronic databases to search current literature occurs in the second step, assessing.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 560 OBJ:Identify the steps in the process of research utilization.

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TOP:What is nursing research utilization?

MSC: NCLEX®: Safe and effective care environment 14. A nursing instructor is educating a group of student on research utilization. The teaching has been effective when a student states: “Research utilization is using the results of a single study in a. nursing practice.”

“Research utilization is the collection of data to answer a research b. question.” c. “Research utilization is a review of nursing practice.”

“Research utilization is the process of transferring research d. findings into clinical practice.”

ANS: D Research utilization is the process of transferring research findings into clinical practice. It is not using results of a single study in nursing practice, the collection of data to answer a research question, or a review of nursing practice.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 560 NURSINGTB.COM OBJ:Identify the steps in the process of research utilization.

TOP:What is nursing research utilization?

MSC: NCLEX®: Safe and effective care environment 15. How can nurses being to define their practice context?

Identify characteristics that are specific to the group of people who a. will receive nursing care. b. Specify all types of settings that nursing occurs in.

Determine all characteristics of the setting that contribute to c. nursing care. d. Determine all characteristics of the setting that inhibit nursing care.

ANS: A To define their practice context, nurses should do the following: identify characteristics that are specific to the group of people who will receive nursing care, specify the type of practice setting that the care will occur in, and determine characteristics of the setting that contribute to or inhibit nursing care.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 567

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OBJ:Identify the characteristics of your practice context.

TOP: Defining your practice context MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE 1. A nurse is educating a coworker on the similarities between conducting research and research utilization.

The nurse judges the teaching to be effective when the coworker states: (Select all that apply.) a. “Both are a step-by-step process.” b. “Both involve critical thinking.” c. “Decision making must occur in both processes.” d. “Knowledge generation is essential in both processes.” e. “Collecting new data occurs in both.” f.

“Reviewing published research studies is part of both processes.”

ANS: A, B, C Using nursing research in practice is a step-by-step process incorporating critical thinking and decision making to ensure that a change in practice has a sound basis in nursing science. Collecting new data is primarily done in conducting research, and research findings can generate new knowledge. Reviewing published research studies is a component of research utilization. NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 560 OBJ: Discuss the difference between conducting research and research utilization.

TOP:Using nursing research in practice MSC: NCLEX®: Safe and effective care environment—management of care 2. A nursing professor is educating students on barriers to incorporating nursing research into practice. The nurse professor judges the teaching to effective when a student states: (Select all that apply.) a. “Because of advances in research, there are no barriers.”

“A barrier is time lag from completion of research until the project b. report is published.” c. “Resistance of individuals involved can cause a barrier.” d. “Budget constraints are a barrier.” e. “Personnel constraints are rarely a barrier.”

ANS: B, C, D

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The teaching has been effective when the student lists the following as a barrier to incorporating nursing research into practice: Time lag from completion of research until the project report is published, resistance of individuals, and budget and personnel constraints.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 564 OBJ:Identify the characteristics of your practice context.

TOP: Defining your practice context MSC: NCLEX®: Safe and effective care environment 3. The nurse has an adequate understanding of evidence-based practice when the nurse states which of the following? (Select all that apply.) a. “Evidence-based practice is similar to research utilization.”

“Evidence-based practice is becoming important in all areas of b. health care.”

“Evidence-based practice incorporates many additional sources of c. data that may contribute to improved nursing care.”

“Evidence-based practice is not accepted as best research d. evidence.” e. “Evidence-based practice is not used in nursing care.”

ANS: A, B, C

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Evidence-based practice is similar to research utilization, is becoming important in all areas of health care, and incorporates many additional sources of data that may contribute to improved nursing care. It is also accepted as best research evidence and used directly in nursing care.

PTS: 1 DIF: Cognitive Level: Application REF: p. 569 OBJ: Describe ways in which nursing research can be used to guide your nursing practice.

TOP: Defining your practice context MSC: NCLEX®: Safe and effective care environment 4. Which steps can the nurse take to apply evidence-based research into nursing practice? (Select all that apply.) a. Identify, review, and evaluate the data applicable to the problem. b. Define the problem. c. Design a practice change based on the data. d. Implement the change in nursing practice. e. Continue to work around the problem.

ANS: A, B, C, D

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The nurse should begin by defining the problem. Next, the nurse should identify, review, and evaluate the data applicable to the problem. The next steps are to design a practice changed based on the data and implement the change in nursing practice. The nurse should not continue to work around the problem.

PTS: 1 DIF: Cognitive Level: Application REF: p. 570 OBJ: Describe ways in which nursing research can be used to guide your nursing practice.

TOP: Defining your practice context MSC: NCLEX®: Safe and effective care environment 5. The nurse understands the function of The National Institute of Nursing Research (NINR) when stating: (Select all that apply.)

“The NINR is a major source of federal funding for nursing a. research.” b. “The NINR supports education in research methods.” c. “The NINR funds local hospitals.” d. “The NINR supports education in research career development.” e. “The NINR establishes National Nursing Research Agenda.”

ANS: A, B, D, E NURSINGTB.COM The NINR has several functions, including acting as a major source of federal funding for nursing research, supporting education in research methods and research career development, and establishing the National Nursing Research Agenda. Funding local hospitals is not a function of the NINR.

PTS: 1 DIF: Cognitive Level: Application REF: p. 571 OBJ: Describe the function of the National Institute of Nursing Research.

TOP:The National Institute of Nursing Research MSC: NCLEX®: Safe and effective care environment 6. The nurse understands the role of the National Institute of Nursing Research (NINR) in the American Recovery and Reinvestment Act of 2009 when stating: (Select all that apply.) a. “The NINR was not involved in the recovery act.”

“The act was created to assist with the economic recovery of the b. country.”

“The act includes measures to modernize our national c. infrastructure, including health care.” d. “The act was created to take control away from Americans.”

“The act was created to modernize our national infrastructure e. excluding health care.”

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ANS: PTS: 1 DIF: Cognitive Level: Application REF: p. 571 OBJ: Describe the function of the National Institute of Nursing Research.

TOP:The National Institute of Nursing Research MSC: NCLEX®: Safe and effective care environment 7. A staff nurse recognizes the need for a change in practice regarding hand hygiene. How can the nurse implement a change in practice? (Select all that apply.) a.

Ignore the problem until management enforces a change.

b.

Ask if the manager can hold a staff in-service.

c.

Implement the change on the unit.

d.

Monitor the change.

e.

Evaluate the effectiveness of the change.

ANS: B, C, D, E The fourth step of applying evidence-based practice is to implement the change in nursing practice. The nurse can accomplish this by asking if the manager can hold a staff in-service, implementing the change on the unit, monitoring the change, and evaluating the effectiveness of the change.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 570 OBJ:Identify the characteristics of your practice context.

TOP: Defining your practice context MSC: NCLEX®: Safe and effective care environment

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Chapter 25: Workplace Issues MULTIPLE CHOICE 1. Ergonomic hazards are a major safety risk for nurses, causing serious musculoskeletal injuries. To reduce the risk, nurses should a. use assistive devices.

c. never lift or move patients.

b. take up weight lifting.

d. stretch out after pulling or reaching.

ANS: A The current recommendations by the American Nurses Association (ANA) include the use of assistive patienthandling devices for lifting, transferring, and turning patients. According to the ANA, there is no safe way to manually lift or turn a physically dependent person (i.e., proper lifting techniques or good body mechanics) without risking back and shoulder injuries. Becoming stronger by lifting weights would not reduce the risk of injury. It is not rational to think that patients would never need lifting or moving, which is why having assistive patient-handling devices is so important for risk reduction in nurse injuries.

PTS: 1 DIF: Cognitive Level: Application REF: p. 575 OBJ: Understand ergonomics and ways to safeguard your musculoskeletal system.

TOP:Ergonomic hazards

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MSC: NCLEX®: Safe and effective care environment—safety and infection control 2. After completing a crisis intervention course, the nurse recognizes the signs of escalating violence as:\ a.

pacing and cursing.

b.

repeatedly pushing the call bell.

c.

crying and complaining of no pain relief.

d.

staring out the window and not responding to questions.

ANS: A Signs of escalating violence include pacing, using foul language, cursing, raising of fists, and threats. The other options are typical behaviors that are noted in the hospital setting that do not reflect a situation where the person is escalating out of control.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 579 OBJ: Understand the risk for violence at work and how to reduce your risk.

TOP:Workplace violence

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MSC: NCLEX®: Safe and effective care environment—safety and infection control 3. Which statement by the nurse indicates an adequate understanding of violence in the health care setting? a.

“Violence is a new problem.”

b.

“Violence can occur anytime and anywhere.”

c.

“Violence is a problem in the acute care setting.”

d.

“Violence occurs mostly in mental health settings.”

ANS: B Workplace violence is a growing risk and the second leading cause of occupational death in the United States.

The nature of health care workers’ jobs puts them at risk for workplace violence, which can result in injury or death. Health care workers are at risk for harm from coworkers, patients, families, and visitors in any health care setting at anytime.

PTS: 1 DIF: Cognitive Level: Application REF: p. 579 OBJ: Understand the risk for violence at work and how to reduce your risk.

TOP:Violence in the health care setting MSC: NCLEX®: Safe and effective care environment—safety and infection control NURSINGTB.COM 4. The Occupational Safety and Health Administration (OSHA) provides guidelines to protect health care workers from needlesticks. Which action by the nurse manager shows the use of the guidelines in practice? a.

Purchasing safety devices

b.

Providing a safe working environment

c.

Working with the local health department

d.

Establishing guidelines for safe nursing practice

ANS: A OSHA has established guidelines that employers must follow to protect their workers. The Needlestick Safety and Prevention Act became law in November 2000, requiring the use of safer devices to protect workers from sharps injuries. Advocating for workplace safety, the ANA was very instrumental in having this piece of federal legislation passed. This act amends the Blood-Borne Pathogen Standard (administered by OSHA) to require the use of safer devices to protect from sharps injuries. It also requires that employers solicit the input of nonmanagerial employees who are responsible for direct patient care regarding the identification, evaluation, and selection of effective engineering and work-practice controls. Providing a safe working environment is a good option, but it does not specifically address the safety devices required for prevention of needlestick injuries. OSHA does not provide for safe nursing practice guidelines.

PTS: 1 DIF: Cognitive Level: Application REF: p. 584

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OBJ: Discuss the importance of personal protective devices and how to use them.

TOP:OSHA worker protection guidelines MSC: NCLEX®: Safe and effective care environment—safety and infection control 5. Which statement by the nurse manager indicates understanding of Magnet status?

“Hospitals are granted Magnet status by the National League of a. Nursing.” b. “The American Nurses Association grants Magnet status.”

“Hospitals are granted Magnet status by the American Nurses c. Credentialing Center.”

“The National Council of State Boards of Nursing grants Magnet d. status.”

ANS: C The American Nurses Credentialing Center is responsible for judging whether hospitals achieve Magnet status, which is an American Nurses Association subsidiary. The National League of Nursing accredits nursing programs. The National Council State Boards of Nursing is the national regulatory body for nursing practice and nurse licensure.

NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Application REF: p. 585

OBJ:Assess trends in the job market.TOP:Best places to work MSC: NCLEX®: Safe and effective care environment—management of care 6. The staff nurse, in the tenth hour of a 12-hour shift, is told by the house supervisor that the nurse replacement will be 2 hours late and the staff nurse must work these extra 2 hours. The nurse is unable to stay over. What is the best action for the nurse to talk? a. Talk to the person over the house supervisor. b. Refuse and go home on time because from being too tired to work. c. Fix some strong coffee and call home to explain the situation.

Ask if the supervisor could work a double because the supervisor d. needs the money.

ANS: A When nurses are concerned that their patients require more care than they can provide, they must report this. If the nurse does not get adequate direction or an answer from the immediate supervisor, then the nurse should follow the chain of command and report it to the person above the supervisor. It would not be advisable or prudent to go home and abandon the patient assignment without adequate staffing or to work a double shift

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when the nurse has admitted being too tired. Loading up on caffeine may give the nurse immediate energy, but the fatigue may impair judgment and reasoning in patient care.

PTS: 1 DIF: Cognitive Level: Application REF: p. 588 OBJ:Determine your risk for encountering a workplace issue that can affect your health or wellbeing.TOP:Mandatory overtime MSC: NCLEX®: Safe and effective care environment—management of care 7. A nurse manager is educating a coworker on agencies that oversee environmental hazards at ambulatory care centers. The nurse manager judges the teaching to be effective when the coworker states: “National Council of State Boards of Nursing has a role in a. overseeing any environmental hazard.”

“American Nurses Credentialing Center oversees all environmental b. hazards in the United States.”

“Ambulatory Care Nursing Administration and Practice oversees c. only local environmental hazards.” “ The Occupational Safety and Health Administration oversees all d. environmental hazards at ambulatory care centers.”

ANS: D NURSINGTB.COM

The purpose of the Occupational Safety and Health Administration (OSHA) and the state health department is to establish safety and health standards in the work environment. OSHA requires employers to provide a safe work environment for employees. The other options refer to agencies that regulate professional nursing practice (NCSBN) and provide credentialing (ANCC). Ambulatory Care Nursing Administration and Practice is not a recognized agency. There is the American Academy of Ambulatory Care Nursing (AAACN), which is the association of professional nurses and associates who identify ambulatory care practice as essential to the continuum of high quality, cost-effective health care.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 584 OBJ:Identify useful Internet sites to keep up-to-date with potential workplace issues (e.g., OSHA, CDC, ANA).TOP:Environmental hazards MSC: NCLEX®: Safe and effective care environment—management of care 8. How does the federal government affect environmental safety in the hospital setting? a. Requires employers to provide a safe working environment Identifies those nurses who are not implementing standard b. precautions c. Works with the state boards of nursing in disciplining nurses d. Requires employers to establish guidelines for safe nursing practice

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ANS: A The purpose of the Occupational Safety and Health Administration (OSHA), a federal agency, is to establish safety and health standards in the work environment. OSHA requires employers to provide a safe work environment for employees. OSHA is part of the United States Department of Labor. OSHA does not work on discipline issues because that is the function of the state board of nursing. Guidelines for safe nursing practice are provided by accepted nursing standards. The CQI group at the hospital would identify issues or violations of not implementing standard precautions.

PTS: 1 DIF: Cognitive Level: Application REF: p. 584 OBJ: Identify potential threats to your health. TOP: Environmental safety MSC: NCLEX®: Health promotion and maintenance—prevention and early detection of disease 9. A nurse professor is educating nursing students on The American Nurses Association’s recommendation to use assistive devices for safe patient handling. The nurse professor judges the teaching to be effective when one of the students state: “Research indicated that patients were being injured by falls during a. transfers.”

“Research indicated that back injuries in staff nurses were b. occurring even with good body mechanics.”

“Research showed an increased number of lawsuits resulted from c. patient falls.”

NURSINGTB.COM “Research uncovered reports from state boards of nursing showed d. increased back injuries.”

ANS: B In many situations, proper body mechanics are not adequate to protect the nurse. The nurse cannot adjust body mechanics in a way that fully protects the back. Teaching nurses to use proper body mechanics to lift and turn patients has not resulted in fewer injuries. The current recommendations by the ANA include the use of assistive patient-handling devices for lifting, transferring, and turning patients. The state board of nursing would not necessarily be the agency tracking data regarding back injuries. This would more than likely be the local or state hospital association tracking this data. Even if there are increased lawsuits related to back injuries, there are also a great number of injuries that do not end up in litigation, so the data would be inaccurate to make the assumption.

PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 576-577 OBJ:Determine your risk for encountering a workplace issue that can affect your health or wellbeing.TOP:Ergonomic hazards MSC: NCLEX®: Health promotion and maintenance 10. The Needlestick Safety and Prevention Act of 2000 was implemented to prevent health care workers from experiencing needlestick injuries. Which of the following is required to be documented regarding a needlestick injury?

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a. Notify the patient’s physician. b. Advise the hospital risk management department.

Document the department or work area in which the exposure c. occurred.

Send the injured staff person to the emergency room for d. documentation of the incident.

ANS: C The Needlestick Safety and Prevention Act requires documentation of the department and work area in which the needlestick injury occurred. It also requires employers to maintain a sharps injury log to document the type and brand of device involved and an explanation of how the incident occurred. The information is to be recorded and maintained in a way that protects the confidentiality of injured employees. The test question is asking for “required documentation,” so notifying the doctor is not appropriate. More than likely, the person would be sent to the occupational safety department for follow-up and documentation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 584 OBJ: Determine your risk for encountering a workplace issue that can affect your health or well-being. TOP: Workplace safety MSC: NCLEX®: Not applicable 11. A nurse feels bullied at work. Which of the following actions should the nurse take first? a.

Ignore the bullying.

b.

Report the bullying.

c.

Take action against the bully themself.

d.

Take time off from work.

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ANS: B The nurse should first report the bullying to get the behavior to stop. The next step would be to take time off of work recover from the incident. The nurse should never ignore the bullying or take action against the other person by themself.

PTS: 1 DIF: Cognitive Level: Synthesis REF: pp. 580-583 OBJ:Understand workplace bullying and harassment.

TOP:Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment 12. A nurse has been floated to another department, and things are not going well. What should the nurse do? a.

Leave the unit.

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b.

Refuse to provide care to the patients.

c.

Tell the immediate supervisor.

d.

Keep any problems to themselves.

ANS: C The nurse should tell the immediate supervisor if things are not going well on the new unit to ensure safe patient care. The nurse should not leave unit, refuse to provide patient care, or keep problems to themself.

PTS: 1 DIF: Cognitive Level: Application REF: p. 589 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment 13. A nurse is passing medications when interrupted by a colleague. Upon resuming work, the nurse realizes a medication was given to the wrong patient. What should the first action be? a. Document the medication error according to hospital policy. b. Keep the medication error to themself. c. Tell her immediate supervisor or charge nurse.

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Keep the medication error to themself, but assess the patient every d. hour.

ANS: C The nurse should tell the immediate supervisor or charge nurse. Documentation of the error is important and should occur after the supervisor is contacted and the patient is cared for. The nurse should never keep the medication error to themself.

PTS: 1 DIF: Cognitive Level: Application REF: p. 591 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment 14. A nurse is working on a unit with short staffing. The nurse has voiced concerns to the charge nurse, who appears to brush them off. Which action would be the most appropriate for the nurse to take? a.

Document the concerns.

b.

Raise a voice to get the point across.

c.

Talk about the charge nurse to coworkers.

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d.

Keep the issues to themself.

ANS: A The most appropriate action for the nurse to take would be to document the concerns. Raising a voice, talking about the charge nurse to coworkers, or keeping the issue to themself will not help resolve the short staffing.

PTS: 1 DIF: Cognitive Level: Application REF: p. 584 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment 15. A nurse believes to be bullied at work. Which of the following actions by the perpetrator lead them to believe this? a.

Offering to help with their assignment

b.

Asking them to switch a shift

c.

Asking them to cover for a break

d.

Being given the “silent treatment”

ANS: D

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Being given the “silent treatment” is a sign of bullying. Offering to help with an assignment and asking to switch a shift or cover a break are not considered signs of bullying.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 580 OBJ:Understand workplace bullying and harassment.

TOP:Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE 1. A nurse manager is educating a new nurse on how to prevent back injuries in the workplace. The teaching has been effective when the new nurse states: (Select all that apply.) a.

“Back injuries can be caused by lifting.”

b. “Back injuries can be caused by transferring.” c.

“Back injuries are not common in the workplace.”

d. “Back injuries can occur when reaching for something.”

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e.

“Back injuries only occur when performing work incorrectly.”

ANS: A, B, D The teaching has been effective when the new nurse states that back injuries can be caused by lifting, transferring, or reaching. Back injuries are very common in the workplace and can occur when work is performed both correctly and incorrectly.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 576 OBJ:Determine your risk for encountering a workplace issue that can affect your health or wellbeing.TOP:Ergonomic hazards for health care workers MSC: NCLEX®: Safe and effective care environment 2. What can be suggested to a nurse wanting to protect back health while caring for patients? (Select all that apply.) a.

Use proper body mechanics.

b.

Use assistive patient-handling devices.

c.

Use ergonomic equipment.

d.

Only care for patients that can move independently.

e.

Be aware of potential risk.

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ANS: A, B, C, E The nurse should use proper body mechanics, assistive patient-handling devices, and ergonomic equipment and be aware of potential risk. Only caring for patients that can move independently is not realistic.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 576 OBJ: Understand ergonomics and ways to safeguard your musculoskeletal system.

TOP:Ergonomic hazards for health care workers MSC: NCLEX®: Safe and effective care environment 3. A nurse manager is evaluating her computer chair. What should the nurse manager look for to make sure the chair is a good ergonomic design? (Select all that apply.) a.

Appropriate padding

b.

Arm rests that are locked into place

c.

Strong lumbar support

d.

Easily adjustable

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e.

Wheels that allow easy movement

ANS: A, C, D, E The nurse should look for appropriate padding, arm rests that can be removed, strong lumbar support, ease of making adjustments, and wheels that allow easy movement.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 578 OBJ: Understand ergonomics and ways to safeguard your musculoskeletal system.

TOP:Ergonomic hazards for health care workers MSC: NCLEX®: Safe and effective care environment 4. What action can the nurse take to reduce the risk of repetitive motion disorders? (Select all that apply.) a. Avoid frequent position changes. b. Frequently alternate between standing and sitting. c. Have a good understanding of ergonomic principles.

Engage in routine stretching of shoulders, neck, arms, hands, and d. fingers.

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e. Attend training on how to reduce injury.

ANS: B, C, D, E The nurse can frequently alternate between standing and sitting; have a good understanding of ergonomic principles; engage in routine stretching of shoulders, neck, arms, hands, and fingers; and attend training on how to reduce injury.

PTS: 1 DIF: Cognitive Level: Application REF: p. 579 OBJ: Understand ergonomics and ways to safeguard your musculoskeletal system.

TOP:Ergonomic hazards for health care workers MSC: NCLEX®: Safe and effective care environment 5. A nurse manager is educating a group of new nurses on workplace violence. The nurse judges the teaching to be effective when one of the nurses states: (Select all that apply) a. “Workplace violence is uncommon in today’s society.” b. “Workplace violence does not include threats of assault.” c. “Workplace violence includes physical assaults.”

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d. “Workplace violence includes unwanted sexual advances.” e. “At least 80% of nurses have experienced workplace violence.”

ANS: C, D, E The teaching has been effective when the nurse states the following: workplace violence includes physical assaults and unwanted sexual advances, and at least 80% of nurses have experienced workplace violence.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 579 OBJ: Understand the risk for violence at work and how to reduce your risk.

TOP:Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment 6. A new nurse is preparing to start a new job. What actions should the nurse take to be prepared in case workplace violence occurs? (Select all that apply.)

Take a crisis intervention course to understand signs of escalating a. violence. b. Become familiar with the organization’s policy regarding violence. c. Be prepared to handle any violent situation alone.NURSINGTB.COM d. Be aware of procedures that can be used to defuse situations. e. Appear intimidating so that the violent person will back down.

ANS: A, B, D The nurse should take a crisis intervention course to understand signs of escalating violence, become familiar with the organization’s policy regarding violence, and be aware of procedures that can be used to defuse situations. The nurse should never handle any violent situation alone or try intimidation to make a violent person back down because this could backfire.

PTS: 1 DIF: Cognitive Level: Application REF: p. 579 OBJ: Understand the risk for violence at work and how to reduce your risk.

TOP:Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment 7. The new nurse has an adequate understanding of bullying when stating which of the following? (Select all that apply.) a.

“The purpose of bullying is to control the target.”

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b.

“Bullying can verbal, behavioral, or sabotage.”

c.

“Bullying usually occurs as a single event.”

d.

“Bullying is initiated by the perpetrator.”

e.

“The victim usually deserves the bullying.”

ANS: A, B, D The new nurse has an adequate understanding when stating that the purpose of bullying is to control the target.

It can be verbal, behavioral, or sabotage. Bullying is not a single event; rather, it occurs over time. It is initiated by the perpetrator and is not something that the victim deserves to have happen.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 580-583 OBJ: Understand the risk for violence at work and how to reduce your risk.

TOP:Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment 8. A nurse manager is educating new hires on the different perpetrators of bullying. The teaching has been effective when the new hires state: (Select all that apply.) a.

“A perpetrator can be a manager.”

b.

“A perpetrator can be coworker.”

c.

“A perpetrator is always the same licensure as the victim.”

d.

“A perpetrator is never someone in management.”

e.

“Perpetrators are sometimes supervisors.”

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ANS: A, B, E The teaching has been effective when the new hires state that perpetrators can be managers, coworkers, or supervisors. A perpetrator may or may not have the same licensure as the victim, and sometimes the perpetrator can be in management.

PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 580-583 OBJ:Understand workplace bullying and harassment.

TOP:Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment 9. A nurse manager is brainstorming creative solutions to mandatory overtime. Which of the following actions would help prevent the occurrence of mandatory overtime? (Select all that apply.)

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a. Create an on-call system with one or two extra nurses on per shift.

Create an incentives system for part-time nurses to pick up extra b. shifts. c. Ask the nurses to take on extra patients during the short shifts. d. Reward nurses who put forth an extra effort for the organization. e. Create shifts for high-volume times.

ANS: A, B, D, E The nurse manager can create an on-call system, an incentive system, and shifts for high-volume times and can reward nurses who put forth an extra effort for the organization. Asking the nurses to take on extra patients may prevent mandatory overtime but can place the nurses and patients in an unsafe situation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 588 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment 10. A manager told a nurse to float to another unit. The nurse is nervous about floating. Which of the following actions would be the best to take? (Select all that apply.)

NURSINGTB.COM a.

Remain calm.

b.

Refuse to float.

c.

Focus on the patients.

d.

Ask for a quick tour of the unit.

e.

Inquire about the units standards of care.

ANS: A, C, D, E The nurse should remain calm, focus on the patients, ask for a quick tour of the unit, and inquire about the units standards of care. The nurse should not refuse to float because this may place patients in an unsafe situation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 589 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment

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Chapter 26: Emergency Preparedness Chapter 26: Emergency Preparedness MULTIPLE CHOICE 1. In understanding terrorist threats as they relate to public health and medical preparedness, the nurse understands the current acronym that categorizes the scope of threats is a. BOMB. c. CBRNE. b.THREAT.d.ESAR-VHP. ANS: C CBRNE is the current acronym used to classify the scope of terrorist threats. The acronym stands for Chemical, Biological, Radiological, Nuclear, and Explosive threats. The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) is a federal program to establish and implement guidelines and standards for the registration, credentialing, and deployment of medical professionals in the event of a large-scale national emergency. BOMB and THREAT are not public health acronyms.

PTS: 1 DIF: Cognitive Level: Application REF: p. 597 NURSINGTB.COM

OBJ: Identify various public health threats the medical community is susceptible to.

TOP:Terrorism threats MSC: NCLEX®: Safe and effective care environment—safety and infection control 2. A nurse manager is educating a group of nurses on biological agents that do not have a chemoprophylaxis therapy and only allows for the nurse to provide supportive care. The manager judges the teaching to be effective when the nurses can state: a. “Anthrax is one of these biological agents.” b.“The plague is one of these biological agents.” c. “Smallpox is one of these biological agents.” d.“Botulism is one of these biological agents.”

ANS: D Botulism is the only CDC Level A biological agent that has no known therapy or treatment.

Because of the toxin that is released from the bacterium, there is methodology known to minimize or reduce the activation and metabolism of the toxin that causes flaccid paralysis within the patient. Standard isolation precautions are used for anthrax. Plague can be treated with

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antibiotics and droplet isolation precautions. For smallpox, droplet precautions are recommended, especially if pocks develop outside the buccal cavity.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 597 OBJ:Discuss the variety of diseases that are likely to be involved in a bioterrorism attack and what to look for.TOP:Biological agents MSC: NCLEX®: Safe and effective care environment—safety and infection control 3. A nursing professor is educating students on nerve agents. The nursing professor judges teaching to be effective when one of students states: a. “Sarin gas is a chemical agent that is classified as a nerve agent.” b.“Mustard gas is a chemical agent that is classified as a nerve agent.” c. “Ricin is a chemical agent that is classified as a nerve agent.” d.“Chlorine gas is a chemical agent that is classified as a nerve agent.”

ANS: A Sarin gas is an organophosphate ester classified under nerve agents. The nerve agents inhibit the uptake of acetylcholine. Mustard gas is classified as a vesicating (skin) agent. Ricin is a biological agent. Chlorine gas is classified as a choking agent.

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PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 597 OBJ:Discuss the variety of diseases that are likely to be involved in a bioterrorism attack and what to look for.TOP:Chemical agents MSC: NCLEX®: Safe and effective care environment—safety and infection control 4. The nurse has an adequate understanding of phosgene gas when stating which of the following? a. “Phosgene gas smells like bleach.” b.“Phosgene gas smells like fresh cut grass.” c. “Phosgene gas smells like almonds.” d.“Phosgene gas smells like rotting fruit.”

ANS: B The residue from the choking agent known as phosgene gas on the clothes or skin of an affected patient has the distinct odor of freshly cut grass. Chlorine gas has been described as smelling like bleach. Cyanide gas has been described as smelling like almonds. VX gas has been described as smelling like Vicks VapoRub or rotting fruit.

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PTS: 1 DIF: Cognitive Level: Application REF: p. 599 OBJ:Discuss the variety of diseases that are likely to be involved in a bioterrorism attack and what to look for.TOP:Chemical agents MSC: NCLEX®: Safe and effective care environment—safety and infection control 5. A public health nurse is giving a presentation on the recovery stage of a disaster to a group of nursing managers. The teaching has been effective when one of the nurse managers states: a. “The recovery stage deals with operations that occur after the disaster.” b.“The recovery stage deals with operations during a disaster.” c. “The recovery stage deals with operations before a disaster.” d.“The recovery stage involves the process of dealing with disasters.”

ANS: A The recovery mode of a disaster deals with operations that occur after the disaster. During the recovery stage, the nurse may be confronted with unexpected or sudden loss of key personnel, patients, and the management of mental health issues related to the disaster. The preparedness mode of a disaster deals with operations done before a disaster. The response mode of a disaster deals with operations during a disaster.

PTS: 1 DIF: Cognitive Level: EvaluationNURSINGTB.COM REF: p. 604 OBJ: Discuss what constitutes an all-hazards plan. TOP: Disasters MSC: NCLEX®: Safe and effective care environment—safety and infection control 6. Which of the following represents a Level II disaster? a. A building collapse that fills the local emergency room with patients. b.A freeway accident that involves multiple vehicles. c. Flooding of a three-state area affecting food and water resources. d.Earthquake that destroys homes and transportation facilities.

ANS: A Level II disasters require the community health nurse to respond in a greater capacity using larger casualty practices in coordination with regional response agencies (such as state health and emergency management agencies). Level I disasters are small-scale, local disasters that do not require an outside agency response. Level III disasters consume local, state, and federal resources to the fullest extent and will require an extended response time by the community health nurse that can extend into weeks or months.

PTS: 1 DIF: Cognitive Level: Application REF: p. 604

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OBJ: Discuss what constitutes an all-hazards plan. TOP: Disasters MSC: NCLEX®: Safe and effective care environment—safety and infection control 7. A nurse is one of the first responders on the scene of a disaster. What is initial priority? a. Triage the patients. b.Delegate care to additional personnel as they arrive. c. Task assignment. d.Prioritize care.

ANS: A Triage can be used by lightly trained emergency department (ED) personnel and is not to supersede or instruct medical techniques. A common triage system is known as START (Simple Triage and Rapid Treatment). Triage is used during natural disasters and mass casualty events.

Delegation, assigning tasks, and prioritizing care are daily functions done by the nurse manager.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 606 OBJ: Discuss what constitutes an all-hazards plan. TOP: Triage MSC: NCLEX®: Safe and effective care environment—safety and infection control NURSINGTB.COM

8. A patient is tagged as “Minor” during a mass casualty event. An example of a “Minor” triage is a patient with a. a strained right shoulder. c. an obstructed airway. b.a large laceration to the right leg.d.who is unconscious.

ANS: A Under the START triage system, those tagged “Minor” are injured persons who can be assisted after those who are tagged as “Immediate” and “Delayed” have been medically tended to.

Persons tagged as “Minor” will not need medical care for at least several hours and can usually walk with assistance (usually consisting of bandages and acute first aid). A patient with a large laceration to the right leg would be classified under Delayed triage. Patients with obstructed airway or who are unconscious would be classified under Immediate triage.

PTS: 1 DIF: Cognitive Level: Application REF: p. 607 OBJ: Discuss what constitutes an all-hazards plan. TOP: Triage MSC: NCLEX®: Safe and effective care environment—safety and infection control

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9. Second- or third-degree burns that cover more than 50% of the body would be classified under what stage of triage? a. Expectantc. Minor b.Delayed d.Immediate ANS: D Patients classified as “Immediate” require advanced medical care within 1 hour of trauma, such as a patient who has burns. Expectant patients are those who are deceased or beyond the scope of medical care and services. Delayed patients are those who can be assisted after Immediatetagged patients are cared for first. Minor-tagged patients are those who can be cared for last; these persons can usually wait several hours before medical care and can walk with little to no assistance with minor bandages and first aid.

PTS: 1 DIF: Cognitive Level: Application REF: p. 607 OBJ: Discuss what constitutes an all-hazards plan. TOP: Triage MSC: NCLEX®: Safe and effective care environment—safety and infection control 10. A nurse manager is educating a new hire on which form of standardized structure is implemented in the hospital during an emergency response. The teaching has been effective NURSINGTB.COM when the new hire states: a. “Emergency System for the Advance Registration of Volunteer Health Professionals (ESARVHP) is implemented to coordinate and standardize command and operations.” b.“START system of triage is implemented to coordinate and standardize command and operations.” c. “Hospital Incident Command System (HICS) is implemented to coordinate and standardize command and operations.” d.“Initiation of the Medical Reserve Corps (MRC) is implemented to coordinate and standardize command and operations.”

ANS: C The Hospital Incident Command System (HICS) is a standardized command structure that allows for coordination and collaboration across jurisdictions and professions within a hospital facility during an emergency response. ESAR-VHP is a registry of health professionals that can be accessed and executed to recruit medical and clinical professionals (e.g., retired, nonlicensed) during an emergency response. START is a form of triage care used during a mass casualty event. MRC is a registry of medical reserve corps persons who can be recruited for overall assistance with a health or hospital facility during an emergency response.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 608

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OBJ: Identify regulatory initiatives undertaken to prevent future emergencies.

TOP:Emergency response MSC: NCLEX®: Safe and effective care environment—safety and infection control 11. Which federal program provides a “push-pack” that, when requested, can be transported within 12 hours to an affected community and consists of medical assets such as medications, medical equipment and supplies, and personal protective equipment? a. Strategic National Stockpile (SNS) b.CHEMPACK federal program designed to supplement the medical response. c. Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) d.National Incident Management System (NIMS) ANS: A This federally funded program under the auspices of the Centers for Disease Control and Prevention can aid any stricken community within the United States or its territories within 12 hours by delivering critical medical assets to assist the emergency medical and public health response. The SNS is primarily stored for biological acts of terrorism or large-scale natural disasters. CHEMPACK is a similar program but is specifically targeted for chemical agents or chemical exposures on a large scale. ESAR-VHP is a registry of health professionals that can be accessed and executed to recruit medicalNURSINGTB.COM and clinical professionals (e.g., retired, nonlicensed) during an emergency response. The National Incident Management System (NIMS) provides a consistent nationwide template to establish federal, state, tribal, and local governments and private sector and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism.

PTS: 1 DIF: Cognitive Level: Application REF: p. 609 OBJ: Identify regulatory initiatives undertaken to prevent future emergencies.

TOP:Emergency response MSC: NCLEX®: Safe and effective care environment—safety and infection control 12. Which unit’s responsibilities include triage of victims at a disaster site, medical care at the site, and staging locations outside the disaster site for transportation of patients to alternative health care facilities? a. Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) b.Medical Reserve Corps (MRC) c. Disaster Medical Assistance Teams (DMAT) d.NIMS National Incident Management System (NIMS)

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ANS: C DMAT units are composed of teams of various clinical health specialties that include, but may not be limited to, communications, logistics, maintenance, and security. These teams are locally based but can be deployed federally on request. ESAR-VHP is a registry of health professionals that can be accessed and executed to recruit medical and clinical professionals (e.g., retired, nonlicensed) during an emergency response. START is a form of triage care used during a mass casualty event. MRC is a registry of medical reserve corps persons who can be recruited for overall assistance with a health or hospital facility during an emergency response. NIMS is the national framework developed by the Department of Homeland Security and FEMA to standardize emergency response from a local through federal level.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 611 OBJ: Identify regulatory initiatives undertaken to prevent future emergencies.

TOP:Emergency response MSC: NCLEX®: Safe and effective care environment—safety and infection control 13. The charge nurse is educating a nurse on the process of surveillance for the outbreak of disease in the hospital setting. The charge nurse judges the education to be effective when the nurse states: NURSINGTB.COM

a. “Surveillance is primarily the responsibility of the safety officer.” b.“Surveillance is primarily the responsibility of the risk manager.” c. “Safety is primarily the responsibility of the infection control nurse.” d.“Safety is primarily the responsibility of the hospital surveillance officer.”

ANS: C In the hospital, the infection control nurse is responsible for both passive and active hospital surveillance monitoring.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 603 OBJ: Identify various public health threats the medical community is susceptible to.

TOP:Disease surveillance MSC: NCLEX®: Safe and effective care environment—safety and infection control 14. An infection control nurse is educating a nurse about potential bioterrorism agents. The nurse knows the teaching has been effective when the nurse states: a. “Smallpox has three routes of exposure to humans.”

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b.“Anthrax has three routes of exposure to humans.” c. “Botulism is caused by a bacterium found only in animals.” d.“Tularemia is transmitted via ingestion of toxin-contaminated food.”

ANS: B Infection with Bacillus anthracis, the cause of anthrax, can occur via three routes of exposure: cutaneous, gastrointestinal, and inhalation. Botulism can be transmitted via ingestion of toxincontaminated food. The toxin can be aerosolized and inhaled (artificial). Tularemia is not known to be spread from person to person and is caused by the bacterium Francisella tularensis, which is found in animals (especially rodents, rabbits, and hares).

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 597 OBJ:Discuss the variety of diseases that are likely to be involved in a bioterrorism attack and what to look for.TOP:Transmission of biological agents MSC: NCLEX®: Safe and effective care environment—safety and infection control 15. An emergency department nurse should suspect a possible bioterrorist agent if, during the Fourth of July weekend, the nurse notices which of the following? a. Three patients arrive complaining of abrupt onset of severe myalgia, fever, sore throat, and NURSINGTB.COM headache. b.Four patients, all from the same family picnic, arrive complaining of abdominal pain and nausea, vomiting, and diarrhea. c. Two patients arrive from the local lake complaining of tiredness, weakness, dizziness, muscle cramps, and headache. d.Two patients arrive from a local concert with superficial burns on the faces, necks, arms, and legs and complaining of pain in these areas. They are tachycardic and appear dehydrated.

ANS: A Symptoms of influenza in July are not a normal occurrence and should be investigated further.

Bioterrorist agents are usually not endemic to an area (patients coming from the same location [e.g., local lake or local concert]). Having GI symptoms after a picnic more than likely is a foodborne pathogen.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 597 OBJ:Discuss the variety of diseases that are likely to be involved in a bioterrorism attack and what to look for.TOP:Epidemiological principles MSC: NCLEX®: Safe and effective care environment—safety and infection control

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

16. A nurse is caring for a group of sick patients. Which patient would the nurse be less likely to use isolation precautions with? a. Tuberculosis (TB)c. Botulism b.Plague d.Smallpox ANS: C Botulism is transmitted by ingestion of toxin-contaminated food. It can be aerosolized and inhaled. The patient needs supportive care only; no isolation precautions are necessary.

Tuberculosis (TB), smallpox, and plague require droplet precautions.

PTS: 1 DIF: Cognitive Level: Application REF: p. 597 OBJ:Discuss the variety of diseases that are likely to be involved in a bioterrorism attack and what to look for.TOP:Precautions with biological agents MSC: NCLEX®: Safe and effective care environment—safety and infection control 17. The nurse has been studying endemic diseases and understands that they can occur in clusters of people from the same geographically distinct area. Which statement by the nurse indicates the understanding of the biological agents that can be disseminated by airborne release?

NURSINGTB.COM a. “Anthrax and plague can be disseminated 50% of the time.” b.“Botulism and anthrax can be disseminated.” c. “Plague and smallpox are airborne illnesses that can be disseminated.” d.“Botulism and smallpox can be disseminated 100% of the time.”

ANS: B Both anthrax and botulism can be aerosolized and inhaled and disseminated by airborne release.

Plague and smallpox are spread person to person.

PTS: 1 DIF: Cognitive Level: Application REF: p. 597 OBJ:Discuss the variety of diseases that are likely to be involved in a bioterrorism attack and what to look for.TOP:Transmission of biological agents MSC: NCLEX®: Safe and effective care environment—safety and infection control 18. Which statement by the nurse indicates the most important goal in the management of a disaster such as one caused by a category 5 hurricane? a. “Rescue the victims.” b.“Plan to prevent such disasters.” c. “Give immediate first aid and medical care to the victims.”

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

d.“Evacuate the injured to medical facilities.”

ANS: B Although all of the options are important, the most important aspect of any disaster management is to have a plan of prevention in place. Disaster prevention can eliminate or reduce tremendous pain, suffering, and loss of life that could occur if, for example, people were not evacuated from a coastal area before a hurricane. Having a plan in place sets the procedures for rescuing victims, evacuating facilities, and administering first aid and medical care. The National Incident Management System (NIMS) provides a consistent nationwide template to establish federal, state, tribal, and local governments and private sector and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism. NIMS benefits include a unified approach to incident management; standard command and management structures; and emphasis on preparedness, mutual aid, and resource management.

PTS: 1 DIF: Cognitive Level: Application REF: p. 597 OBJ:Discuss what constitutes an all-hazards plan.

TOP:National disaster preparedness MSC: NCLEX®: Safe and effective careNURSINGTB.COM environment—management of care 19. The nurse has an adequate understanding of smallpox when the nurse states which of the following? a. “Smallpox does not exist because of vaccines.” b.“Smallpox can easily be spread from person to person.” c. “Smallpox must be ingested for a person to become sick.” d.“Smallpox is resistant to vaccines.”

ANS: B The nurse has an adequate understanding when the nurse states that smallpox an easily be spread from person to person. Smallpox does still exist, does not need to be ingested for a person to become sick, and is not resistant to vaccines.

PTS: 1 DIF: Cognitive Level: Application REF: p. 614 OBJ: Identify various public health threats the medical community is susceptible to.

TOP: Clinical preparedness MSC: NCLEX®: Safe and effective care environment

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

20. After the September 11, 2001, attack on the United States, President George W. Bush created what agency in response to the terrorist attacks? a. The Incident Command System (ICS) b.The Office of Emergency Response (OER) c. The Federal Emergency Management Agency (FEMA) d.The Department of Homeland Security (DHS) ANS: D President George W. Bush created the Department of Homeland Security (DHS) in 2001. FEMA was created in 1979 to coordinate federal disaster assistance. The ICS was adopted by FEMA to coordinate responses to a disaster. The OER was an office existing before 2001 that was moved to the DHS. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 597 OBJ: Identify regulatory initiatives undertaken to prevent future emergencies.

TOP:National disaster preparedness MSC: NCLEX®: Safe and effective care environment—management of care MULTIPLE RESPONSE

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1. The nurse interprets which of the following to be a Level III disaster? (Select all that apply.) a. Car accident b.Train derailment c. Hurricane d.Tsunami e. House fire f. Tornado ANS: C, D Hurricanes and tsunamis are large-scale disasters that consume local, state, and federal resources to the fullest extent and will require an extended response time by the community health nurse that can extend into weeks or months. Car accidents and house fires are Level I disasters, which are small-scale, local disasters that do not require an outside agency response. Train derailments and tornadoes are Level II disasters, which require the nurse to respond in a greater capacity using larger casualty practices in coordination with regional response agencies (e.g., state health and emergency management agencies).

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 604

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

OBJ: Discuss what constitutes an all-hazards plan. TOP: Disasters MSC: NCLEX®: Safe and effective care environment—safety and infection control 2. A nurse manager is educating a staff nurse on the four top agents for potential bioterrorism.

The nurse manager judges that the teaching has been effective when the staff nurse states that the top agents include (Select all that apply.) a. smallpox. b.anthrax. c. flu virus. d.botulism. e. plague.

ANS: A, B, D, E The teaching is effective when the staff nurse identifies the following as the top four agents for potential bioterrorism: Smallpox, anthrax, botulism, and the plague. The flu virus is not considered one of the four agents.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 597 OBJ: Discuss the variety of diseases/agents that are likely to be involved in a biological, chemical, or radiological terrorism attackNURSINGTB.COM in addition to the clinical and community health consequences of each.

TOP: Clinical preparedness MSC: NCLEX®: Safe and effective care environment 3. A patient has been exposed to chlorine gas. What symptoms can the nurse expect the patient to have? (Select all that apply.) a. Nose and throat irritation b.Eye redness c. Ear pain d.Cough e. Suffocation ANS: A, B, D, E The nurse should expect the patient to have the following symptoms: nose and throat irritation, eye redness, cough, and suffocation. Ear pain is not a symptom of exposure to chlorine gas.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 599

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

OBJ: Discuss the variety of diseases/agents that are likely to be involved in a biological, chemical, or radiological terrorism attack in addition to the clinical and community health consequences of each.

TOP: Clinical preparedness MSC: NCLEX®: Safe and effective care environment 4. A nurse is caring for patients after a major disaster has occurred. What is the best action in caring for these patients? (Select all that apply.) a. Avoid discussing the disaster that has occurred. b.Encourage patients to talk about their experience. c. Empathize with patients and their emotions and experiences. d.Ask patients not to discuss the disaster until they are under the care of a psychologist. e. Reinforce their emotions and reactions as normal.

ANS: B, C, E The nurse should encourage patients to talk about their experience, empathize with patients about their emotions and experiences, and reinforce their emotions and reactions as normal.

PTS: 1 DIF: Cognitive Level: Application REF: p. 611 OBJ: Identify approaches to enhance personal and family preparedness for emergencies.

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TOP:Community health nurse issues and public health MSC: NCLEX®: Safe and effective care environment 5. A public health nurse is discussing disaster planning with family. What suggestions can be made to help them be prepared? (Select all that apply.) a. Discuss probable disasters in the area. b.Create a family disaster preparedness kit. c. Establish family emergency communication. d.Only prepare if there is a guarantee of a disaster in the area. e. Create an evacuation plan.

ANS: A, B, C, E The nurse can suggest that the family discuss probable disasters in the area, create a family disaster preparedness kit, establish family emergency communication, and create an evacuation plan. The family should not wait until there is a guarantee of disaster because the goal is to be prepared in advance.

PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 613

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NURSING TODAY TRANSITION AND TRENDS 9TH EDITION ZERWEKH TEST BANK

OBJ: Identify approaches to enhance personal and family preparedness for emergencies.

TOP:Community health nurse issues and public health MSC: NCLEX®: Safe and effective care environment 6. A nurse is receiving education on disaster levels. The teaching has been sufficient when the nurse states that a Level III disaster includes (Select all that apply.) a. earthquakes. b.house fires. c. tsunamis. d.train derailment. e. hurricanes.

ANS: A, C, E The teaching has been effective when the nurse identifies Level III disasters as earthquakes, tsunamis, and hurricanes. House fires are considered Level I disasters, and train derailments are considered Level II disasters.

PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 604 NURSINGTB.COM OBJ: Identify various public health threats the medical community is susceptible to.

TOP: Clinical preparedness MSC: NCLEX®: Safe and effective care environment

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