Test Bank for Conceptual Foundations 7th Edition by Friberg

TEST

BANK Chapter 01: A Brief History of the Professionalization of Nursing in the United States Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition

MULTIPLE CHOICE 1. Historically, women were considered the obvious choice for nursing sick patients, because: a. caring for others was an extension of their homemaker role. b. early nurses were nuns, so the public was used to women in nursing. c. men, who had education, were reluctant to try nursing. d. women were often at home anyway, so caregiving was easy.

ANS: A

Women’s domestic role (as homemakers and mothers) was naturally associated with the caregiving required in nursing. Although religious orders did play a role in health care, it was the domestic duties of women that set the stage for their involvement in nursing. Widespread education for men and women is a fairly new phenomenon and did not play a role in the early history of nursing. Women did not care for sick or injured strangers in their homes, so being at home was irrelevant.

2. Florence Nightingale’s views about trained nurses were most influenced by her: a. experiences in wartime. b. ideas about sanitation. c. relationships with physicians. d. view of education.

ANS: A

Nightingale’s experiences in wN arU tiR mS eI deNmGoTnB str.aC teO d Mt o her that trained nurses were valuable in decreasing morbidity and mortality among soldiers. Nightingale had revolutionary ideas about hospital sanitation, but these are not credited with her advocacy of using trained nurses. Early trained nurses were taught to follow the directions of the physician; collegial relationships were not a part of health care practice in Nightingale’s day. Nightingale’s views of education were influenced by her opinion on the value of trained nurses, not the other way around.

3. A nursing instructor explains to students that the major goal of the Society of Superintendents

of Training Schools for Nurses of the United States and Canada was to: a. improve working conditions for students. b. obtain legal recognition for the profession. c. raise and standardize the training of nurses. d. reverse discrimination in admissions policies.

ANS: C

The goals of the Society of Superintendents were “to promote fellowship of members, to establish and maintain a universal standard of training, and to further the best interests of the nursing profession.” Students were expected to work in apprenticeships during their education in the hospital-based programs in existence at the time. Obtaining legal recognition for nurses was the goal of the Nurses’ Associated Alumnae of the United States and Canada, later renamed the American Nurses Association. Discrimination in nursing existed well into the civil rights era and beyond, with men and women of color routinely being banned from

admission and employment.

4. Today’s nurse understands that legal recognition for nurses was imperative to: a. allow nurses to expand beyond the hospital setting. b. lobby for better wages and working conditions. c. protect the public from untrained nurses. d. provide hospitals with accreditation requirements.

ANS: C

The goal of the Nurses’ Associated Alumnae of the United States and Canada (renamed the American Nurses Association in 1912) was to protect the public from untrained nurses by securing legal recognition for trained nurses. Graduate nurses predominantly worked as private duty nurses up through the early 20th century. Wages remained low, and working conditions remained long and arduous in hospitals (and seasonal for private duty nurses) until hospitals began hiring more graduate nurses in the 1930s. Hospital accreditation is a recent phenomenon, unattached to legal recognition for nurses.

5. Which patient would most likely have been cared for in a hospital in the 19th to early 20th

century? a. Dying patient b. Contagious patient c. Homeless patient d. Woman in labor ANS: C

Hospitals were considered places for people who had no one else to care for them.

Most patients were cared for in their homes. A dying patient probably would have been cared for at home. A patient with a communicable illness would have probably been confined to his or her home. Women in labor typically had their children at home.

6. Lillian Wald’s contribution to nursing can best be described as the: a. creation of community health nursing. b. development of college-based nursing schools. c. establishment of the Navy Nurse Corps. d. foundation of maternal-child nursing.

ANS: A

Wald responded to the changing social conditions in the late 1800s by establishing the Henry Street Settlement and Henry Street Visiting Nurse Services in response to the horrendous health conditions she witnessed in New York City. Wald was not involved in establishing college-based nursing programs. Wald was not involved in establishing the Navy Nurse Corps. Wald was not involved in establishing maternal-child nursing as a specialty, although she did care for many new mothers and their infants as part of her community nursing role.

7. Which event eventually led to the creation of military nursing? a. American Civil War b. Spanish-American War c. World War I d. World War II ANS: B

During the Spanish-American War, trained nurses cared for soldiers suffering from yellow fever. This convinced the military and Congress of the need for qualified nurses and set the stage for the eventual creation of the Army Nurse Corps in 1901 and the Navy Nurse Corps in 1908. During the Civil War, both sides wanted women to care for injured and ill soldiers, but these women were mostly untrained volunteers from the middle and upper classes. World War I occurred after the creation of the Army Nurse Corps and the Navy Nurse Corps. World War II occurred after the creation of the Army Nurse Corps and the Navy Nurse Corps.

8. A faculty nurse explaining the stratification in nursing roles seen today tells students that the

most important event leading to this development was: a. desegregation in nursing. b. limited nursing opportunities. c. the Korean conflict. d. World War II. ANS: D

The United States’ involvement in World War II dramatically increased the demand for trained nurses. To help fill this need, the American Red Cross and the Office of Civilian Defense co-established a program to train nurse aides. The success of the program encouraged hospitals to use employees with various levels of skill. Desegregation in nursing did come about in the same era as stratification, but it was not instrumental in creating this differentiated practice. Nursing opportunities were increasing throughout the 20th century.

Role stratification was already entrenched by the Korean conflict.

9. Discrimination against African-American nurses began to wane during: a. Kennedy’s presidency. b. the civil rights era. c. the Vietnam War. d. World War II. ANS: D

World War II saw discrimination against African Americans begin to wane with the end of segregation in the military Nurse Corps. At the end of World War II, many state nurses associations ended their discrimination in membership as well; by 1952, all state nurses associations had eliminated such discriminatory policies. Kennedy’s presidency, although known for civil rights advancements, was not when discrimination began to end. The civil rights era occurred at approximately the same time as the Kennedy era. The Vietnam War occurred at the same time as Kennedy’s presidency and civil rights era.

10. Between the years 1950 and 1967, the number of nurses and assistive personnel rose

dramatically in part as a result of the influence of the: a. Children’s Bureau. b. Hill-Burton Act. c. Nurse Training Act. d. Social Security Act. ANS: C

The Nurse Training Act provided funding for nursing student education through scholarships, loans, recruitment, school construction and maintenance, and special educational projects.

Until its passage, federal funding for nursing education was modest at best. The Children’s Bureau was created in 1912 in response to concerns about women and children’s health. The Hill-Burton Act provided federal funds for hospital construction and health care centers. The Social Security Act of 1935 included financial aid for older adults and Title V health care benefits for children with disabilities.

11. Mildred Montag’s major contribution to nursing is considered to be: a. encouraging minority women and men to enter nursing. b. establishing associate degree nursing programs. c. fighting for improved wages and recognition for nurses. d. paving the way for the military to use trained nurses.

ANS: B

In response to the severe nursing shortage in the post–World War II years, Montag proposed a 2-year nursing associate degree that would prepare technical nurses in community colleges.

Montag was not known for encouraging minorities and men to enter nursing. Montag’s major accomplishment was not fighting for improved wages and recognition. Montag was not involved in the military’s use of trained nurses.

12. Which nursing organizations are responsible for providing continuing education, establishing

practice standards, and offering certification examinations for their members? a. Councils of nurse educators b. National specialty organizations c. State boards of nursing d. State nurses associations ANS: B

National specialty organizations, such as the American Association of Critical Care Nurses, arose in response to the developing nursing specialties; these organizations offer continuing education, practice standards, and certification exams for their members. Organizations that consist of nurse educators would be primarily concerned with nursing education. State boards of nursing are charged with the legal oversight of nursing in their respective states. State nurses associations are often lobbying and marketing organizations for nursing within a specific state and act as the state arms of the American Nurses Association.

13. What influence did Loretta Ford and Henry Silver have on the nursing profession? a. Advocated for laws allowing autonomous practice b. Created a major scholarship for nursing education c. Designed the first doctoral nursing program d. Opened the first nurse practitioner program ANS: D

Loretta Ford and Henry Silver opened the first nurse practitioner program (in pediatrics) at the University of Colorado in 1965. They did not advocate for laws allowing autonomous practice, create a major scholarship, or design the first nursing doctoral program.

14. What change is anticipated that will guide advanced practice nursing roles? a. Changes in federal funding for advanced education b. Declining demand for advanced practice roles

c. Requirement of a doctor of nursing practice d. Third-party payer restrictions on this type of practice ANS: C

If the American Association of Colleges of Nursing Board (AACN) leadership holds sway, the doctor of nursing practice (DNP) will be the requisite preparation for all advanced practice nursing roles, including the NP, CNS, certified nurse midwife, and certified registered nurse anesthetist (CRNA), in the near future. It is not anticipated that there will be changes in federal funding for advanced education, a declining demand for advanced practice roles, or third-party payer restrictions on this type of practice in such a way that will guide advanced practice nursing roles as the requirement of a DNP will.

MULTIPLE RESPONSE 1. Benefits of the apprenticeship model of nursing education included: (Select all that apply.) a. a well-trained graduate nursing hospital staff. b. opportunities for further education in nursing. c. providing a skilled but inexpensive workforce. d. providing working-class women employment. e. reforms in the care of sick and injured individuals.

ANS: C, D, E

Nursing students provided the staffing for hospitals in exchange for their education. Nursing gave working-class women employment alternatives to domestic or factory work. The use of skilled, trained nurses decreased morbidity and mortality, and this benefit was evident in both civilian and military health care. Graduate nurses were typically employed as private duty nurses and did not remain w o r kNi nUgRi S nI h oNsG piT taB ls. .F CuOrtMher education for graduate nurses was rare; a postdiploma program was opened in 1899, but the first undergraduate college nursing program was not opened until 1909.

2. When nursing registration laws were enacted, a “registered nurse” was defined as someone

who had: (Select all that apply.) a. attended an acceptable nursing program. b. fit the definition of a professional nurse. c. had not been convicted of any felonies. d. passed a board evaluation examination. e. studied under a standardized curriculum.

ANS: A, D

One of the two criteria for being a registered nurse was having attended an acceptable nursing program. The other criterion for being a registered nurse was having passed a board examination. A weakness of the early registration laws was a lack of definition of professional nursing practice. Background checks were not part of the early registry laws. Universal education standards were still lacking in 1903 when the first registry law was passed in North Carolina.

3. Nurses in private duty positions faced several hardships, including: (Select all that apply.) a. a shortage of nurses as schools limited enrollment. b. a surplus of nurses starting in the mid-1920s. c. employment that was sporadic and seasonal.

d. opportunities primarily working with poorer families. e. pay that continued to be lower than other jobs.

ANS: B, C, E

The increased enrollment in schools led to a surplus of graduate nurses. Because communicable illnesses were often seen in the cooler months, employment for private duty nurses was seasonal. According to the Geister report (1926), nurses made less money than scrubwomen and worked in mostly short-term private duty cases. Schools were pressured to increase enrollment as the hospital census began to rise for the first time. Only the middle to upper class could afford to hire private duty nurses.

4. Community health nursing has been vital in shaping America’s health system and nursing in

general by providing: (Select all that apply.) a. advocacy regarding matters of health and welfare. b. autonomous nursing practice in patients’ homes. c. means to check on patients’ compliance with treatment. d. novel activities in health promotion and disease prevention. e. treatment that didn’t rely on the patient’s ability to pay.

ANS: A, D

Community health nurses expanded nursing services to new areas, including school, industrial, tuberculosis, and infant welfare nursing. They combined their training and knowledge to educate the public and served as the backbone for the Maternal and Infant Act of 1921. Community health nurses combined their training and knowledge to bring education to the public to promote health and well-being. Private duty nurses had always been the mainstay of nursing work; these nurses worked semi-autonomously in patients’ homes. A system for determining compliance was not a part of the developing health care system in this country. The use of com m uni t yNhUeR alS thInNu G rsT inBg .inCc O reM as ed because of concern with the public’s health, not the patient’s ability to pay.

5. Social events surrounding the Great Depression that had a major impact on American’s

emerging health care system included: (Select all that apply.) a. Blue Cross was developed as a prepaid health insurance plan. b. large hospitals experienced increasing numbers of nonpaying patients. c. many hospitals found their nursing schools too expensive to operate. d. nurses were hired in hospitals in increasing numbers. e. religious orders began supplying trained nurses, cutting the cost of nursing.

ANS: A, B, C, D

The development of Blue Cross helped hospitals’ financial stability by providing patients who were able to pay for care. Large hospitals, particularly those in cities, experienced more patients who needed medical care but were unable to afford it because of the economic hardships of the Depression. A total of 570 training programs for nurses were closed because of prohibitive costs during the decade of the Depression. As hospital care became more sophisticated, more nurses were hired as staff. By 1941, more than 100,000 registered nurses were employed in hospitals. Religious orders did not provide trained nurses to hospitals to decrease the cost of the nursing staff.

6. The development of associate degree (AD) nursing programs has had which effect on nursing

today? (Select all that apply.) a. A wider student pool has been able to study nursing.

b. c. d. e.

AD programs have helped ease the nursing shortage.

Hospitals have been influenced to close their training programs.

Social status for graduates of nursing programs has improved.

The public has suffered some confusion about nursing education.

ANS: A, B, C, E

Nontraditional students, such as mothers and older students, have found it convenient to study nursing at community colleges. More nurses enter the profession via AD programs than through baccalaureate and diploma programs combined. As college education for nurses became more widespread and accepted, hospital directors became convinced to close their expensive programs, lessening the burden of hiring a professional nursing staff. The public and nursing suffer from confusion about the educational requirements for becoming a registered nurse. AD programs do not necessarily contribute to the improved social status of nurses.

7. Enrollment in college-based nursing programs was initially hindered by: (Select all that

apply.) a. a lack of qualified applicants. b. little social and financial support. c. poorly trained faculty members. d. restrictive admissions criteria.

ANS: A, B

Nursing education differed from medical education, which had seen a rise in stature as a result of social support and financial endowments. Aspiring nurses found the time and monetary commitment to be too great compared with diploma programs. Poorly trained faculty members were not a factor in limited enrollment into college programs. Restrictive admissions criteria were not a factor in limN iteUdReSnI roN llG mT enBt . inCtoOcMollege programs.

8. Men in nursing in the early to mid-20th-century faced which barriers to practice and

education? (Select all that apply.) a. Denial of professional status in the military b. Frequent use of trained nurses as orderlies c. Limited areas of health care in which to practice d. Physical inability to perform delicate tasks e. Societal bias that nursing was women’s work ANS: A, B, C, E

Men in nursing faced multiple barriers, including denial of professional status in the military, the frequent use of trained nurses as orderlies, limited employment opportunities (e.g., in psychiatric care), and a societal belief that nursing was strictly women’s work. Men are physically able to perform delicate tasks.

Chapter 02: Academic Progression Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. A faculty member explains to students that one concern of the American Nurses Association’s

1965 position statement designating the baccalaureate degree (BSN) as the educational entry point for nursing is that: a. diploma programs remain the most popular educational program for nurses. b. it is difficult to monitor other programs for congruency with BSN programs. c. multiple educational paths create confusion for the public and the profession. d. some states are creating different licensure exams for different pathways.

ANS: C

The existence of multiple entry paths for nursing education is confusing both to the public and to aspiring nursing students, who may have difficulty understanding and comprehending the differences and what they mean. Diploma programs have declined sharply in number, with only 47 programs remaining in the United States in 2013. The ANA does not monitor different programs to evaluate congruency with BSN programs. States are not creating different licensure examinations for graduates of different programs.

2. A hospital-based nursing administrator is responsible for the diploma nursing program

affiliated with that hospital. In deciding to keep the program open, the administrator develops changes that address a major historical concern with this type of program. In doing so, the administrator would most likely: a. arrange for faculty from theNlU ocRaS l cIoN llG egTeBto.tC eaOcM h science courses. b. limit the hours students are expected to work in the hospital. c. lower the tuition rate and apply for increased federal student grants. d. require nursing faculty to be doctorally prepared to remain on staff.

ANS: B

Diploma students were traditionally expected to staff the hospital with which their program was affiliated, often to the detriment of their educational experiences. This exploitation was described in several important studies of nursing education. Traditional diploma programs do not offer college credit, no matter who teaches the courses. Diploma programs were expensive to operate and expensive to students, and this had a part in their decreasing numbers. Federal funding (through a variety of means) is available for individual students, and although it is administered by institutions, it is not granted to the institution itself. Requiring doctorally prepared faculty would not address an historic concern with diploma education.

3. In analyzing trends within the profession that are correlated to the rise in baccalaureate

nursing (BSN) programs, the nurse historian would outline that: a. degree inflation is contributing to the demand for BSN programs. b. increased social status and pay correspond to education at the college level. c. men in nursing demand an increase in BSN programs compared with other programs. d. the rise in doctorally prepared nurses corresponds to an increase in BSN programs.

ANS: D

BSN programs were often hampered by the lack of faculty prepared to teach at the collegiate level, which led to a reluctance of colleges and universities to establish BSN programs.

Doctoral programs have been preparing nurse scholars and researchers, who have contributed to nursing’s scientific backbone. The rise in these programs can be seen as a parallel development with the rise in BSN programs. The proliferation of advanced degrees in nursing is not the result of degree inflation; rather, it is a response to the increased sophistication and complexity of the health care environment today. Although nurses today do enjoy better pay and improved social status than in the past, this trend is not strongly correlated to the rise in BSN programs. Men in nursing are not a driving force for the increase in BSN programs.

4. A member of a state board of nursing explains to senior nursing students that liberal arts,

communication, and health care policy are all appropriate subjects for study in a BSN program because: a. a broad range of knowledge is important to work with educated consumers. b. as nurses they will care for patients from increasingly diverse backgrounds. c. physicians rely on the nursing staff to educate their patients on such issues. d. they are prepared to assume entry-level leadership positions in various settings.

ANS: D

BSN-prepared nurses are able to function as generalists and as entry-level leaders in a multitude of settings, leading to the need for inclusion of topics other than nursing care in their education. Consumers are more educated today than before, but this is not germane to the inclusion of these topics in nursing education. Diversity is increasing, but this is not related to the need for education in liberal arts and health care policy. These topics are not taught so that nurses can teach their patients.

5. A nursing dean in a baccalaureN atU eR nuSrsIinNgG(T BB SN ogram wishes to create a program that .)CpOrM

meets the needs of multiple and diverse students, responds to current trends, and increases enrollment. What modification to the existing program would best meet this goal? a. Allow RNs to validate community health nursing through volunteer work. b. Bring faculty and classes to major hospitals employing non-BSN nurses. c. Create seamless entry points and tracts for RN and second-degree students. d. Find alternative times and days for classroom and clinical experiences.

ANS: C

A large group of diploma and associate degree (ADN) nurses could benefit from seamless entry points and BSN tracts designed especially for them. Another group of potential BSN-prepared nurses consists of individuals changing careers after completing degrees in other fields. Programs to address the needs of these students have proliferated. RN-BSN and accelerated nursing programs that are seamless and easy to navigate would go far in helping nursing meet the goal of the National Advisory Council for Nursing Education that at least two thirds of the nursing workforce hold a BSN or higher degree. Programs that offer specialized tracts for RNs and second-degree students would also help ease the nursing shortage because they are typically shorter in duration. Although the inclusion of community health nursing was an early differentiator between diploma and BSN programs, BSN programs have expanded well beyond this, and coursework for the BSN is more varied and complex than just simply adding a course in community health nursing. Bringing faculty and classes to major hospitals might make it more convenient for non-BSN nurses to complete their degrees, but the logistics would be difficult, and enrollment might be small. This also only capitalizes on the non-BSN nurse working in hospitals and does not address the needs of second-degree students or those employed in other settings. Alternative days and times for classroom and clinical experiences may help those who are juggling family or work commitments but would not address current trends in nursing or specifically meet the needs of students with diverse educational backgrounds.

6. An advanced-degree nurse working in a hospital is responsible for evaluating and

synthesizing new knowledge and applying it to the population with whom he or she works.

Other nurses recognize that this nurse probably has which degree? a. Doctor of nursing practice (DNP) b. Doctor of nursing science (DNSc) c. Doctor of philosophy (PhD) d. Nursing doctorate (ND) ANS: A

The clinical practice doctorate in nursing is the DNP. This degree would prepare the nurse to translate and apply knowledge to the clinical setting rather than be responsible for generating new knowledge. The DNSc (or DNS) degree is a research-focused degree culminating in preparing and defending the student’s dissertation. The PhD is another degree awarded to nurses completing a research-focused doctoral level program. The holder of this degree must also prepare and defend a dissertation based on original research. The ND degree, originally intended for research utilization, has lost favor, with only four schools granting it in 2004.

With the advent of the DNP program, ND programs made the transition to the DNP model.

7. To discriminate between the two major branches of doctoral education for nurses, the aspiring

student would classify the differences between them as primarily: a. cognate versus practice emphasis. b. knowledge formulation versus utilization. c. systems generation versus systems thinking. d. tool generation versus tool application.

ANS: B

The main difference between the two programs of study is that the research-focused programs (PhD and DNSc) produce scholars who are capable of generating new knowledge, but the practice-focused programs (DNP) produce highly specialized practitioners who use knowledge in the clinical setting. The DNSc program is gradually being phased out. Both types of doctoral programs have cognate core courses. The DNP programs do prepare their graduates in highly skilled systems thinking, but the research-focused programs do not restrict their emphasis to the creation of new systems. Tool generation may be part of a research study but is not necessarily a component.

8. A potential nursing student is worried about the cost of attending a baccalaureate degree

program. After examining the available options, the student would conclude that which of the following is probably the best route for an affordable education? a. Attending an in-state government-sponsored institution b. Investigating work-study options at all program types c. Obtaining scholarships to attend a private institution d. Working part time while attending nursing school ANS: A

State- and government-sponsored institutions are nearly always much less expensive than private education and give significant tuition discounts to in-state students.

Work-study plans are just one component of financial aid. Although obtaining work-study financing will help with the cost of the education, this alone may not offer significant reduction in actual costs, especially if the student attends a private school.

Scholarships for private institutions can significantly decrease the cost of attending, but students may not be eligible or may not be awarded scholarships because they are based on need or scholarship or a combination of both. Considering that private education is usually significantly more expensive thNaU n R puSbI liN c G edTuB ca.tiC onOaMt a government-sponsored college, this option is not the most affordable, but it should be investigated because the possibility does exist for this option to make education quite affordable.

Working part time will probably not gain the student enough income to make a significant difference in the cost of attending college.

9. A prospective nursing student is researching nursing schools. One of the schools is fully

accredited by the CCNE, has no history of adverse actions taken by its state board of nursing, and is staffed by faculty members who appear to be appropriately credentialed for their positions. What inference can the student make about this program? a. CCNE accreditation is the only option for nursing school accreditation. b. Faculty credentials have little bearing on the quality of nursing programs. c. The findings ensure that the program meets at least minimal requirements. d. This is a top-rated program whose graduates are ultimately successful.

ANS: C

Students are protected from marginal programs by both regional and specialty accreditation and by approval of the program by state legal regulatory bodies, specifically state boards of nursing. Accreditation by specialty bodies means that programs at least meet, and may exceed, minimum standards.

Faculty qualifications are a vital component when assessing program quality.

Both the Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) are approved by the Department of Education as official accreditations agencies.

The information described means that the school at least meets basic requirements; however, it does not help rank it. Perhaps a better measure of the rank of schools can be found in the percentage of first-time writers of the board examination who are successful over several years.

10. A nurse practicing in a specialty area wishes to be recognized for the specialized skill set and

knowledge obtained in order to be an effective member of the health care team serving that particular patient population. The nurse would best complete this goal by: a. completing a rigorous continuing education program. b. gaining admission to a graduate nursing degree program. c. obtaining a secondary license in that area of practice. d. passing the certification examination in that particular specialty.

ANS: D

Certification by specialty nursing organizations recognizes the knowledge and clinical practices associated with high-quality practice in a specialty area of nursing.

Continuing education is vital and is required to maintain nursing licensure, but it will not ensure public and professional recognition for proficiency in a specialty area.

Gaining admission to a graduate degree program is admirable, but it will not reward current knowledge and skill with recognition. A higher degree focuses on attainment of new knowledge.

There are no secondary licenses.

11. A panel of nursing deans and faculty has met to discuss increasing the number of

baccalaureate-prepared nurses in a mostly rural state. What collaborative project could the panel design that would be best for meeting this goal? a. A summer-intensive prograN mUw reNsG tuT deBn.tsClO ivM e and study at the university RhSeI during the summer b. A “weekend college” program offered every other weekend at the university for working RNs c. An on-campus accelerated-track BSN program designed for the student who has a degree in another area d. An online program with outlying clinical sites that are run jointly between the university and community colleges ANS: D

An online program would greatly enhance accessibility. More nurses are educated in associate degree programs from junior or community colleges than in either diploma or BSN programs.

The coursework would be directed and taught by faculty with appropriate credentials for teaching at the BSN level, and clinical experiences could be managed locally by community college faculty with supervision by the parent university faculty.

In a mostly rural state, creating a summer-intensive program where students would still have to live and study outside their hometowns does not increase accessibility.

The weekend college idea would still require students from the rural areas to travel perhaps long distances to attend school.

Programs designed to capture non-nursing majors who wish to enter nursing are growing in popularity, but this does not improve accessibility for the rural population.

12. An analysis of the three major types of basic nursing education would reveal to the student

that the biggest difference in programs is that:

a. ADN nurses lack the education in community health that other program graduates

have. b. BSN nurses are educated to work independently and enter leadership roles. c. collegiate experiences in BSN programs ensure that graduates have a well-rounded education. d. diploma graduates are trained to function under the supervision of a BSN nurse.

ANS: B

BSN programs include coursework in liberal arts, humanities, leadership, and management, enabling the BSN graduate to use sound critical thinking skills, to function independently as a generalist nurse, and to assume entry-level leadership roles.

Although ADN nurses do not usually have community health in their curricula, this is not the biggest difference among programs.

Associate degree programs are also offered in collegiate environments, including junior and community colleges and universities.

Diploma graduates were envisioned as complete bedside nurses. The ADN nurse is a technical nurse trained to function under direct BSN supervision.

13. A recent high school graduate wants to pursue registered nursing education in the local

community. What type of program would this student most likely investigate? a. Associate degree program b. Baccalaureate degree program c. Diploma program d. Licensed practical nurse program ANS: A

The associate degree program is often offered at local community colleges. Baccalaureate programs are usually found at lN arUgR erScI olN leGgT esBo. r C u nOi vMe rs i t i e s . The few remaining diploma programs are associated with hospitals. Because the nurse wants RN education, a licensed practical nurse program would not be considered.

14. A registered nurse is considering doctoral programs but is concerned with accessibility.

Which type of program is probably most accessible to this RN? a. Clinical nurse leader program b. Nursing doctorate (ND) program c. Practice-focused program d. Research-focused program ANS: C

The practice-focused doctoral programs are growing rapidly as APRN programs are converting to the DNP. The clinical nurse leader is a master’s level education. The ND programs are being phased out. The research-focused programs are less accessible than the practice-focused programs.

15. The student of nursing history learns what information about the advent of nursing education? a. Baccalaureate programs caught on quickly after being started. b. Collegiate forces advocated for early university education. c. Early programs were patterned after the Nightingale model. d. Physicians were against using any trained nurse in hospitals.

ANS: C

The earliest nursing education occurred in hospital-based programs patterned after the Nightingale model of collegiate nursing education. However, anticollegiate forces prevailed, and the diploma process became the standard for nursing education. Baccalaureate programs did not catch on well until after World War II. Physicians recognized the value of a trained nursing staff.

16. A university nursing dean is particularly interested in attracting more male students. What

action by the dean would most likely result in the best outcome for this goal? a. Create an accelerated baccalaureate degree program. b. Establish a “fast track” program for business leaders. c. Partner with the local community college on seamless entry. d. Recruit heavily among male-dominated occupations.

ANS: A

Accelerated BSN programs are an important point of entry for underrepresented groups in nursing, including men. Although it may be difficult to recruit men directly from high school, the accelerated program offers men an attractive way to change careers later in life. Business leaders may not be all male. A seamless transition from an associate degree to an RN-completion degree is an important step in increasing the number of BSN-prepared nurses but does not specifically target men. Recruiting men from traditional “male” occupations may or may not be successful.

MULTIPLE RESPONSE 1. In comparing and contrasting licensed practical nursing (LPN) programs with associate degree

(ADN) programs, the potential nursing student notices similarities between the two, including: (Select all that apply.) a. both programs prepare graduates to be supervised by BSN nurses. b. graduates of both programs are considered to be technical nurses. c. licensure exams for graduates of both programs are interchangeable. d. LPN and ADN programs offer similar college credit for coursework. e. the programs both take a similar length of time to complete.

ANS: A, B

Both the LPN and ADN programs envision nurses who will be supervised by higher prepared RNs. Both the LPN and ADN programs prepare nurses who are considered technical in nature. Whereas the LPN takes the NCLEX-PN examination, the ADN graduate takes the NCLEX-RN examination. LPN programs often do not carry college credit, which makes it difficult to matriculate into RN programs. LPN programs generally are 9 to 15 months long, whereas ADN programs are typically 2 years in duration.

2. In evaluating the success of a clinical nurse leader (CNL) program, a nursing dean would

determine that program goals had been met when graduates were able to successfully: (Select all that apply.) a. demonstrate leadership in hospital nursing departments. b. function effectively in an advanced specialty nursing role. c. oversee care coordination of a distinct group of patients. d. provide direct patient care in complex situations. e. supervise ancillary and adjunctive nursing staff members.

ANS: C, D

One of the two major roles of the CNL is to oversee the care coordination of a distinct group of patients. The other major role of the CNL is to provide direct patient care in complex situations. CNLs design and implement care and are accountable for care outcomes, but they do not necessarily serve in departmental leadership positions. CNLs are considered generalists, not specialists. The CNL role is not designed as a direct supervisory role, such as a charge nurse.

3. A high school guidance counselor is working with a student who wants to attend a

baccalaureate nursing school. The counselor explains that the main considerations when choosing a nursing program are: (Select all that apply.) a. accessibility. b. cost. c. location. d. program length. e. quality.

ANS: A, B, E

Accessibility is one of three major considerations when choosing a nursing program. Cost is one of the three major considerations when choosing a nursing program. Quality is one of the three major considerations when choosing a nursing program. Location may be important to students either wishing or not wishing to relocate, but it is not generally one of the major considerations in choosing a program. Nearly all baccalaureate programs are designed to be 4 years in length, assuming a full-time load.

4. A nurse is discussing certification with a co-worker and explains that goals of the certification

process include: (Select all t h a tNaUpRp lSy .I) NGTB.COM a. endorsing demonstrated knowledge. b. enhancing nurses’ professionalism. c. helping boost pay scales for nursing. d. providing for differentiated practice. e. serving as a quality control activity.

ANS: A, B, E

Certification is directed to endorsing demonstrated knowledge and skill associated with high-quality performance in a specialty area. Certification also enhances professionalism and allows the public and other professionals to recognize those with professional achievements.

Certification does serve as a quality control activity, because nurses who obtain certification must demonstrate superior knowledge and clinical behaviors. Certification does not include boosting pay scales as a goal, although in some institutions, certified nurses do receive a monetary benefit. Although many certification exams require a BSN, differentiating practice is not a goal of certification.

5. A nursing dean oversees a BSN program that is taught partially online. In evaluating program

effectiveness and sustainability, the dean should pay special attention to the: (Select all that apply.) a. effect of online learning on the process of professional socialization. b. comparison of online graduates’ NCLEX-RN pass rates with traditional BSN pass rates. c. consequences of distance education on availability of financial aid.

d. correlation of online learning strategies with students’ learning needs. e. impact of distance technology needs on donor willingness to contribute.

ANS: A, B, C, D

Professional socialization can be profoundly affected by distance technology and should be evaluated during reviews of program effectiveness. Socialization into the professional role is vital to maintain ethical and moral standards. A comparison of board pass rates will allow evaluation of the effectiveness of both program types. Students’ ability to obtain financial aid may be affected by distance education, particularly when looking for work-study positions, tutoring, and assistantships. Matching student learning needs with online teaching styles to create effective learning environments would be another area to evaluate. Donations, although important, would be a secondary consideration. Not all donors designate their contributions to specific needs.

6. A nursing dean wants to recruit students who more closely match demographic trends. In

planning activities with the marketing department, the dean should plan activities to attract: (Select all that apply.) a. students with disabilities. b. ethnic minorities. c. men. d. recent high school graduates. e. underemployed groups.

ANS: B, C

Ethnic and racial minorities make up only about 18% of nursing students in baccalaureate and graduate programs today. The trends reflect growing ethnic and racial diversity in the country.

Men account for only 10% of BSN students today despite making up approximately 50% of the population. Recent high schNoU olRgSraIdN uaGteTsBa. reCnOoM t included in demographic trends.

Underemployed groups rise and fall sporadically with economic changes and are not reflected in trends that nursing schools typically follow. Recruitment of disabled students is not a trend in nursing school admissions.

7. When analyzing the development of nursing education for a research paper, the nursing

student notes that certain factors have been important contributors to the current system of nursing education in this country, including: (Select all that apply.) a. changing demographics. b. cost of education. c. historical events. d. societal health care needs. e. women’s roles.

ANS: C, D

Historical events, particularly wars, were vital contributors to our current system of nursing education. Changes in the health care needs of society have helped spur the development of our current system of nursing education. Changing demographics were not responsible for the current system of nursing education. The cost of education was not germane to the rise of our current system of nursing education. Women’s roles were not important in the development of our current system of nursing education.

8. A potential nursing student is evaluating a local hospital-based diploma program. The student

favors this program because several relatives are alumni. In helping the student critically evaluate the strengths and weaknesses of this program, what information does the high school guidance counselor offer? (Select all that apply.) a. Courses typically do not carry any college credit for transfer. b. Diploma programs are not accredited by any national organization. c. Short program duration leads to career entry sooner than other programs. d. Students typically have strong clinical skills upon graduation. e. Tuition in these programs is often the least expensive.

ANS: A, D

Diploma programs usually graduate nurses with strong clinical skills, but courses usually do not carry any college credit. Diploma programs are accredited and graduates are eligible for the NCLEX-RN examination. These programs are typically 2 to 3 years long. Tuition in community colleges is usually the cheapest option.

Chapter 03: Beyond Professional Socialization Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. An experienced nurse has accepted a new role in administration. Supervisors can best support

this transition by assisting the nurse to: a. learn the unspoken rules of the new role. b. manage time and other people effectively. c. obtain education regarding the new job. d. redefine the nurse’s professional identity.

ANS: D

A nurse changing roles would be expected to experience resocialization, in which the nurse needs to redefine his or her professional identity to fit the new role. Administrative support in adapting to the new role via socialization is crucial to a successful transition. Learning the unspoken rules of the new role might be important depending on the organizational culture in which the nurse has taken an administrative role, but it would not be the best choice.

Managing time and other people effectively is not the best choice because there is no information here suggesting that part of the new role includes directly managing others.

Obtaining information about the new job would be important, but it would not be the best choice.

2. A nursing faculty member would judge that activities designed to foster socialization in

students have been successful when the students: a. are able to communicate i n Na U nR efS feIctNivGeTmBa. nnCeO rM wi th other health care providers. b. incorporate professional values, norms, and behaviors into their self-identities. c. learn the legal and ethical standards required to practice as a professional nurse. d. understand the complexities of their new, multifaceted role in health care today.

ANS: B

Students must incorporate the values, skills, behaviors, and norms appropriate to nursing into their self-identities in a process called socialization, which begins in nursing school and occurs again as nurses change roles or jobs. Professional and effective communication is a vital part of working in a multidisciplinary team, but it does not demonstrate socialization.

Understanding legal and ethical standards is important to today’s nurses, but this is not the best choice for two reasons: First, simply learning the standards is not enough; one must act on them. Second, this is not all that is involved in the socialization process. Being able to understand the complexities of the nursing role today is something that the student will not truly understand until immersed in the first job. This is not directly related to socialization into a profession such as nursing.

3. A nursing dean oversees an RN-BSN program and is evaluating whether or not program

objectives have been met. The success of this program can be demonstrated when: a. attitudes of the returning RN students are reinforced in their identities. b. graduates are proficient in new subjects learned during the program. c. RNs resocialize into the role of baccalaureate-prepared nurses. d. the nurses can articulate why having a BSN should be a requirement.

ANS: C

Socialization occurs at three important points in a nurse’s career: when a new graduate leaves the educational setting and begins work as a professional nurse; when an experienced nurse changes work settings; and when the nurse takes on new roles, such as returning to school.

The hope is that graduates will leave school with changes in behaviors and attitudes that reflect their new status as baccalaureate-prepared nurses. It would be important for graduates to have a strong understanding of the subjects they encounter when they are back in school, but this choice is too narrow to support meeting broad goals. Nurses articulating that the BSN should be required are too narrow in focus to demonstrate that the program’s goals have been met.

4. A nursing manager recognizes that a registered nurse has a strong sense of professional

identity when which behavior is seen? a. Joins professional organizations and attends their conferences. b. Participates in unit governance and on hospital-wide committees. c. Reappraises own professionalism as new technologies and roles evolve. d. Relies on historical meanings of professionalism to guide practice.

ANS: C

As new technologies and roles develop, nurses must continually reappraise their professional identities and ensure congruent socialization with emerging trends. History does give background and context for socialization but is not as important as adapting to the current state of affairs. Joining organizations, attending conferences, and being active on committees are all part of socialization and one’s professional identity, but the larger scope of this concept revolves around maintaining a sound professional identity in the face of ongoing changes.

5. A nursing faculty would determine that a student was developing a strong sense of

professional identity when the N stuUdReS ntItaNkG esTw Bh.icChOaMction? a. Writes a paper describing nursing as being available to help patients and physicians. b. Establishes a discussion group to debate interdisciplinary care activities. c. Starts a letter writing campaign to boycott products advertised by “sexy nurses.” d. Volunteers to serve the community at a free flu shot clinic for the uninsured.

ANS: C

Nurses who have a strong sense of professional identity work to change perceptions that nurses and non-nurses carry about the profession. Starting a letter writing boycott campaign to protest the use of a negative stereotype of nurses to sell a product is an excellent example of this in action. Although nurses do assist in many different ways, a nurse with a strong professional identity will advocate for a more equitable role for nurses in health care.

Establishing a discussion group does not reveal what the nursing student feels about interdisciplinary care and the role of nursing in these activities. Volunteering is a respected and desired activity, but it does not strongly suggest the student’s view of his or her professional identity.

6. A hospital director of nursing (DON) establishes a hospital-wide committee to process the

Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” and to create unit-based activities that support its recommendations. A unit manager asks about the importance of the endeavor. What response by the DON is best? a. If nursing doesn’t change with the times, the future of the discipline is threatened. b. Nursing has to remodel itself according to the mandates of the report.

c. Operationalizing the report allows nurses to drive health care reform. d. Patient safety will be adversely affected if nursing doesn’t transform itself.

ANS: C

The IOM has identified nurses as key leaders in driving the reform and work to be done to reshape health care delivery in the United States. It is important that all nurses become educated and knowledgeable about this report, understand its implications for the future of the discipline, identify ways that individual nurses can get involved in implementing the recommendations, and educate others on what needs to be done. The other options all have elements of truth to them, but the broad implication is that nursing must lead the reform of health care.

7. A nurse manager is evaluating staff members for the strength of their professional identity and

ability to contribute to the profession into the future. Which nurse best demonstrates these qualities? a. Consistently incorporates knowledge, judgment, and ethics into everyday situations. b. Provides information on the latest research findings related to patient populations. c. Serves as the research “champion” on the hospital unit–based council structure. d. Uses evidence-based practice consistently when working with patients.

ANS: A

A nurse who consistently incorporates knowledge, judgment, and ethics into everyday situations best demonstrates these qualities. Although providing information on the latest research findings, serving as the research “champion,” and using evidence-based practice consistently are important actions, they are not as strong as indicators of professional identity and the potential for future professional contributions as incorporating knowledge, judgment, and ethics into everyday s i t u a t iNo nUsR. SINGTB.COM MULTIPLE RESPONSE 1. Which of the following does the nursing student learn about professional socialization?

(Select all that apply.) a. Everyday experiences are vital for professional socialization. b. Interaction with peers can have a positive or negative effect. c. Knowledge, skills, and behaviors contribute to socialization. d. Norms and values are more important than skill to socialization. e. Socialization happens during a memorable event in time.

ANS: A, B, C

Professional socialization is a complex process that reflects four critical attributes: learning, interaction, development, and adaptation. Interaction with peers can have both negative and positive effects and contribute to either a positive or negative socialization process.

Socialization does not happen through one salient event but rather through continuous exposure.

2. The faculty member understands that nursing schools contribute strongly to the process of

socialization in which ways? (Select all that apply.) a. Assisting students to commit to nursing values b. Developing students’ understanding of ethics

c. Grading students on professional socialization d. Helping students develop professional identities e. Requiring participation in professional organizations ANS: A, B, C

Nursing education is strong in ways of teaching that effectively assist students to develop a deep sense of professional identity, commit to the values of the profession, and act with ethical comportment. Grading behavior is part of providing feedback to enable students to gain a professional identity but is not a specific strength of education. Requiring participation in professional organizations does not specifically encourage the development of professional identity.

3. A nurse is giving a report to the hospital nursing counsel on the Institute of Medicine’s report:

“The Future of Nursing: Leading Change, Advancing Health.” What broad goals does the nurse report on? (Select all that apply.) a. Credentialing will continue to be the best way to advance practice. b. Nurses should be allowed to practice to the extent of their capabilities. c. Nursing should be included as an equal partner in health care reform. d. The nursing workforce is encouraged to attain higher levels of education. e. Workforce data collection needs infrastructure to enable meaningful use.

ANS: B, C, D, E

The IOM’s report’s key messages and related recommendations affirm and encourage professional nurses to practice fully, achieve higher levels of education, become full partners in providing and reforming health care, and develop an infrastructure for workforce data collection. Credentialing is not one of the key recommendations.

4. An astute practitioner re cogni zN esUt R haSt I thN eG dyTnBa. mC icOpM rocess of nursing includes which

possibilities? (Select all that apply.) a. Engaged stakeholder: speaking up and establishing leadership within the system b. Expert learner: engaging in lifelong learning and synthesizing learning into practice c. Innovation catalyst: developing new technologies and conducting research d. Interprofessional collaborator: being an advocate to promote systems-level change e. Reflective practitioner: reflecting on whether or not new knowledge is relevant ANS: A, B, D

The engaged stakeholder will no longer remain silent and accept others’ expectations but will develop leadership skills to position them to serve as advocates and change agents. The expert learner engages in lifelong learning and takes the time to synthesize new learning into practice. The interprofessional collaborator is an advocate for patients, families, and communities and for systems-level change. The innovation catalyst rejects old ways of thinking and doing to see, do, and be in the profession of nursing. The reflective practitioner is able to think systematically about actions and responses in a manner that allows transformed perspective and reframing for determination of future actions and response.

Chapter 04: Professional Nursing Roles Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. A military recruiter would point out to a potential male RN recruit that: a. approximately one third of all the nurses in the armed forces are men. b. not all branches of the military allow men in nursing positions. c. opportunities for men in nursing are limited and highly competitive. d. the number of military male nurses is similar to civilian numbers.

ANS: A

A total of 35.5% of Army nurses, 30% of Air Force nurses, and 36% of Navy nurses are men.

All three branches allow men to serve as nurses. Opportunities for men in the military are not limited, as can be seen by the high percentage of men in nursing in the armed services.

Although close to one third of all military nurses are men, only 9.6% of nurses in the civilian workforce are men.

2. A nursing dean who wishes to determine whether students had developed a beginning sense of

nursing identity would appraise the students’: a. ability to articulate expected behaviors. b. commitment to remain in their chosen field. c. emotional connection to the profession. d. understanding of the history of nursing.

ANS: C

Identity refers to an orien tationNtoUwRaSrdIsNoG mTetBhi.nC gO asMsociated with a strong emotional attachment. Being a nurse is about executing a number of roles in service to health and health care that are intertwined with the identity, talents, and values of each individual. This identity provides substance and motivation for work, which leads to an emotional connection to the profession. The ability to articulate expected behaviors is not the definition of identity.

Commitment does not necessarily reflect identity. Understanding history does not lead to identity.

3. In describing what it means to be a nurse, a student tells friends and family that caring in

nursing: a. only includes using nonscientific methods when choosing appropriate interventions. b. is easy to teach by experienced mentors for whom it comes naturally. c. is overlooked when judging a student’s clinical performance. d. means much more than physically caring for someone’s needs.

ANS: D

Caring implies physical care, concern for the whole person, commitment to the common good, and outreach to vulnerable persons, according to the National League for Nursing.

Caring involves devotion to the nurse’s clients, as well as using science and expertise in the relationship. Caring is not easy to teach; it involves compassion and empathy and seeing appropriate emotions in the student in response to the patient’s pain and suffering. The ability to demonstrate caring is—and should be—evaluated in clinical evaluations.

4. A nursing supervisor thinks that a staff nurse serving on several multidisciplinary committees

is not demonstrating collaborative practice behaviors. What behavior by the staff nurse would best illustrate the supervisor’s opinion? The staff nurse: a. agrees with, but does not incorporate, other disciplines’ input. b. does not listen to viewpoints and opinions of other disciplines. c. feels nursing is the only viewpoint for analyzing patient issues. d. is territorial and unwilling to share the patients’ care plans.

ANS: A

The nurse who indicates agreement with others’ suggestions but then does not incorporate them is not being collaborative. True collaboration involves a mix of different viewpoints and opinions to understand and solve complex issues. Working together toward common purposes, improving health, respecting shared strengths, offering effective peer review, caring, and compassion are fundamental to the profession. The nurse who does not listen to viewpoints and opinions of other disciplines falls well short of collaboration; this nurse is not even cooperating with others. The nurse who thinks nursing is the only viewpoint for analyzing patient issues is most likely not even listening to the input of others and being uncooperative. The nurse who is territorial and unwilling to share the patients’ care plans not only is uncooperative and noncollaborative, but also seems to be hostile toward other disciplines.

5. A staff nurse has been appointed to a multidisciplinary patient care task force. The unit

manager notes that the meetings have been less productive since this nurse joined; furthermore, the staff nurse seems unhappy with this assignment. What action by the manager would most likely help this staff nurse become a productive member of the task force? a. Ask the nurse whether there are problems with the other members. b. Instruct the nurse to observN eU foRr S thI eN neGxT tB f e. wCmOeMetings. c. Remind the nurse to focus mainly on patient outcomes. d. Ask the nurse to explain his or her feelings about the assignment.

ANS: D

According to Gardner (2005), there are 10 specific lessons for collaborative relationships, including constructive conflict resolution skills. Because this nurse seems unhappy and the group has been less productive, the most likely issue is that the nurse has brought some conflict to the task force since joining. Therefore, it is important for the manager to explore the feelings this nurse has about the assignment. Because the task force was more productive before this nurse joined, it seems unlikely that there are problems among the members that were not noticed before. Observing for a few minutes will not change anything that would lead to the nurse being happier with the task force. Reminding the nurse to focus mainly on patient outcomes is patronizing and does nothing to help the actual problem.

6. The student nurse describes to friends the nursing role that involves a systematic method of

providing care and precise attention to details. This is the role of: a. direct caregiver. b. collaborator. c. manager. d. teacher.

ANS: C

The manager role involves not only managing others, but also managing a patient case load and marshalling resources for patient care. The role of manager requires a systematic way of providing care, a precise tending to details, and working from a comprehensive assessment and plan, as well as engaging colleagues in compassionate, collaborative, interdisciplinary practice. The direct caregiver role uses the nursing process: assessment, planning, intervention, and evaluation. The collaborator role involves working with others to achieve common goals. The teacher role involves reciprocal teaching and learning.

7. A nursing faculty member explains to students that the nursing role with a significant effect

on patients’ health and quality of life is the role of: a. caregiver. b. collaborator. c. educator. d. manager.

ANS: C

The educator role is an active part of nursing in every situation because it has a significant impact on each patient’s health and quality of life, whether the “patient” is an individual, a family, a group, or a community. At every level, the patient educator role exists within the scope of practice because it significantly affects health and quality of life. The direct caregiver role uses the nursing process to provide physical care to patients. The collaborator role involves working with others to achieve common goals. The manager role involves not only managing others, but also managing a patient case load and marshalling resources for patient care.

8. A unit manager is concerned about turnover on her unit, which employs many new graduate

nurses. There is already a formN alUaR ndSlIenNgGthTyBo. riC enOtaMtion program in place. Which additional resource should the nursing manager add to the orientation program to best address turnover? a. Have the new graduates spend more time in the skills practice lab. b. Include intensive mentoring as part of the orientation program. c. Invite new nurses to informal meals and breaks with management. d. Post personal biographies of new nurses so staff gets to know them.

ANS: B

The first 3 months of employment for graduate nurses has been found to be vital in their long-term success, and mentoring is vital to assist with role integration and resolution of conflicts between work realities and academic ideals. There is no evidence from the question that suggests new nurses are not proficient in their skills or that they leave their jobs because of lack of skills. Although inviting new nurses to informal meals and breaks with management is a nice touch, this will not necessarily assist new graduate nurses in staying in their new positions. Posting personal biographies is also a nice idea, but it would not make a significant difference for the new nurses.

9. A nurse is explaining to students that the role of researcher is the most fascinating one

because of its flexibility at all levels of practice. Which explanation by this nurse would best justify this opinion? a. Nurses can join research teams in institutions where they already work. b. Many areas of nursing practice need to be researched. c. This role can be a part of the nurse’s identity at all levels of practice. d. When a study is finished, research nurses can return to staff nursing.

ANS: C

Bedside nurses can assist in the research process by bringing curiosity and a dedication to lifelong learning and best practices to their jobs. Nurses with more advanced preparation can join or even lead research teams. The role is vital to underpin nursing practice. All nurses need a basic understanding and comfort with the research process in order to identify studies that might pertain to their patient populations or work settings. Nurses may have the opportunity to join research teams in their institutions and assist this process at some level, but this does not fully explain the stated opinion. Nursing is a wide-open field with many areas needing research, but this is too narrow a description to explain the nurse’s stated opinion.

Returning to staff nursing after a research study is finished does show flexibility but only for the nurses involved in a research project.

10. Which nursing role is most closely connected to social justice? a. Advocate b. Caregiver c. Manager d. Researcher ANS: A

Human rights, social justice, equality, and interest in promoting global health care reform are all tied to the advocate role. The direct caregiver would be more concerned with providing care for basic human needs and collaborative care of medical or surgical problems. The manager can be in charge of other health care personnel or in charge of a patient load, but the role involves securing needed resources for optimal care. The researcher uses curiosity to either participate in research or read and incorporate best practices in patient care.

11. A nursing manager would like N toUsR eeStI heNnGuTrsBes.oCnOtM hat unit increase their commitment to

patient advocacy. Which action by the manager would best meet this goal? a. Bring a political activist to the unit for motivational speeches. b. Lobby for patient and family rights bills to pass state legislation. c. Organize a political drive for state coverage of all standard vaccinations. d. Schedule a walkathon for donations to pay for medications.

ANS: C

Working toward universal state coverage for all vaccinations would be the best choice to meet the intent of advocacy, which is strongly tied to human rights, equality, and social justice.

This would provide a certain health service to all in the larger community (the state). A motivational speaker might certainly inspire some nurses, but this would not in itself do much to increase social justice and equality in health care. Patient and family rights bills would be important legislation to get passed, but this would only affect individuals classified as “patients” and their families, not everyone in the community. A walkathon to help patients pay for medications would be a great help to many people, but this falls far short of providing a universal health service to all in the community.

12. A practicing nurse often volunteers for overtime when the unit is short staffed but now has a

child who has a recurring illness and worries about the ability to continue this practice. The nursing manager could help this nurse by educating him or her about role: a. ambiguity. b. conflict. c. integration.

d. stress.

ANS: B

Role conflict occurs when a person feels unable to meet the obligations of two or more roles, which is certainly the case here. Role ambiguity occurs when the expectations of a role are not clearly defined. Role integration refers to an ability to move fluidly between roles. Role stress occurs when either a situation or the environment prevents a person from fulfilling the obligations of a role.

13. The emotional response to an occurrence of role stress is called role: a. ambiguity. b. conflict. c. overload. d. strain.

ANS: D

Role strain refers to the emotional reactions to a role stress event and occurs when role stress is not resolved. Role ambiguity occurs when the expectations of a role are not clearly defined.

Role conflict occurs when a person feels unable to meet the obligations of two or more roles.

Role overload is a situation when time or resources are inadequate to meet the obligations of a role.

14. A chief nursing officer in a hospital is explaining to unit managers that the federal Family

Medical Leave Act (FMLA) can help nursing by potentially: a. creating employee loyalty. b. eliminating sick leave. c. not penalizing illnesses. d. reducing turnover rates.

ANS: D

The FMLA could reduce turnover rates by reducing the role conflict a nurse (or any other employee) might feel when the interests of his or her profession or career compete against the interests of a sick family member who needs care. Because this is a federal law, it is doubtful that this act would have a significant impact on employee loyalty. The FMLA was designed to ensure that employees can take up to 12 weeks off and still be ensured of their jobs; it was not designed to reduce or eliminate sick leave. The FMLA was not written in response to the penalization of employee illnesses but rather to ensure that employees can stay with an ill family member to provide care and still return to their jobs later.

15. A nursing manager believes that the unit staff is suffering from role overload. Which action

by the manager would best address this immediate situation? a. Authorize more overtime and bonus pay. b. Negotiate for more unit-stock supplies. c. Request more positions for nurses’ aides. d. Volunteer to help with workplace redesign.

ANS: B

Negotiating for more unit-stock supplies is something the unit manager could do on his or her own; furthermore, it would be the most rapid solution and would save nurses time, thus directly addressing role overload. Paying more for overtime and for bonuses does nothing to alleviate the situation of role overload. It adds some reward, but the nurses are still trying to do too much in a certain time frame. Requesting to hire more nurses’ aides is feasible, but it is not the best option because of the time it would take to have additional positions approved, posted, and filled. Redesigning the workplace is also a feasible option, but again, because it would take too much time to complete, it is not the best answer.

16. A charge nurse has decided that a newly hired nurse suffers from role ambiguity. The best

action by the charge nurse would be to: a. assist the new nurse with delegating and prioritizing tasks. b. help the new nurse organize and manage time more effectively. c. remind the new nurse that personal calls are allowed on breaks. d. review and clarify the job description with the new nurse.

ANS: D

Role ambiguity occurs when the expectations of a role are not clear. Clarifying the job description could help. Assisting the new nurse with delegating and prioritizing tasks would help with role overload. Helping the new nurse organize and manage time more effectively would help with role overload. Reminding the new nurse that personal calls are allowed on breaks could help with role strain or role conflict.

17. A health care organization is investigating a new computerized documentation system. Which

question by nursing management would address a source of work-related distress in nurses related to documentation? a. “How can we ensure the nuN rsUesRgSeI tN adGeqTuBa. teCtrOaiMning or updates?” b. “How can we make these computerized units more portable?” c. “How much more accurate and complete will this charting be?” d. “How will this system save my nurses time when documenting?”

ANS: D

In a recent study, nurses reported feeling as though they spend too much time on documentation and not enough on direct patient care. This can contribute to role discrepancy.

Ensuring adequate training and updates would be more a concern of management than of individual nurses on the floor. Portability does not get at the source of distress related to documentation, which is the fact that nurses feel they spend too much time documenting, taking time away from patient care. Ensuring more accurate and complete charting would be a concern more likely to arise from the management group than from individual nurses.

18. A staff nurse works on an inpatient OB-GYN floor that has begun admitting patients for

elective abortions. The nurse is not comfortable with this change. When the nurse talks with the unit manager, the manager explains that the nurse may be experiencing role: a. ambiguity. b. incongruity. c. overload. d. strain.

ANS: B

Role incongruity occurs when occupational obligations conflict with personal or professional values. Role ambiguity occurs when the expectations of the job are unclear. Role overload occurs when there is too much to do in the time provided or when resources are inadequate for the job. Role strain is the emotional reaction to role stress events. This nurse could be experiencing role strain, but role incongruity is more specific to this context.

19. A nurse manager wants to plan an intervention for some nurses who seem to be experiencing

role incongruity. The manager could best assist these nurses by creating a forum for: a. role clarification. b. staff debriefing. c. values clarification. d. work redesign.

ANS: C

Values clarification would help nurses articulate and understand the distress they feel when job obligations conflict with personal or professional values. Discussing roles and clarifying job expectations would reduce role ambiguity. A staff debriefing would be useful to reduce role discrepancy. Work redesign could help alleviate role overload.

20. A mentor is explaining the causes of role stress to a newly hired nurse. What statement best

explains why this occurs? “Role stress often occurs: a. as nurses rotate shifts and work strict days and hours.” b. because of the multiple roles we have to assume.” c. from not being able to provide care as we see fit.” d. when there is too little time to get our work done.”

ANS: B

Assuming multiple roles can reN suUltRiS nI mN anGyTtB yp.eC sO o fMro l e stress and lead to role strain.

Rotating shifts and strict schedules can contribute to role stress, but this answer is too narrow to account for the majority of role stress. Not being able to provide care seen as needed can contribute to role stress, but this is too narrow to account for the majority of it. This would lead to role overload, a cause of role stress, but it is too narrow an option to account for the majority of role stress.

21. A new nursing manager has created a template for working with role-related problems. The

manager’s mentor does not feel this is an effective approach to solving these issues. Which statement by the mentor would best explain this position? a. “As a new manager, you should not be dealing with role stress by yourself.” b. “If you assume role problems will occur, you are inviting them to happen.” c. “Interventions need to be based on specific stresses, not a generic template.” d. “Role problems are usually due to a poor fit between employee and the job.”

ANS: C

Interventions for role problems need to be specific and individualized, based on the type of role strain that is actually occurring and on the precipitating factors. Each type of role disharmony has specific strategies to help manage it. A new manager might need assistance dealing with role problems, but this is not the best answer. This manager may have had previous managerial experience in another field or might be quite skilled in dealing with problems on the unit. Having a plan of action available for common problems is always a good idea. Role problems can be the result of a poor fit, but they can also be caused by things that can be addressed, such as uncertainty about expectations or spending too much time on tasks that can be delegated.

22. A student of nursing history understands Nightingale’s use of the term “art” when describing

nursing as having what context? a. Care activities that were driven by experience and intuition b. Little scientific knowledge on which to base most nursing actions c. Nursing roles that were fluid and defined by context and environment d. Patient preferences dictating nursing actions when providing care ANS: C

Nightingale viewed nursing as an art and, as such, the various roles in nursing as multilayered and fluid defined by the context and demands of the environment in which that nurse works.

Although care activities were often driven by experience (“tried and true”) and there was little scientific knowledge on which to base nursing actions, these are not the main reason for the use of the term “art.” Patient preference has just begun to be incorporated into evidence-based practice.

23. A nursing manager understands that nurses need to experience which of the following in order

to find happiness in their cho seNn Up R r oSfeIssNioGnT? B.COM a. Alignment of professional role and personal identity b. Clear separation of personal and professional roles c. Opportunities to change work situations based on personal need d. Respect from physicians and the broader environment where they work ANS: A

Nurses are defined by the roles they play and their personal identities, which provide the substance and motivation for their work. When this complex tangle of role and identity is bifurcated and nursing practice is industrialized, the meaning of being a nurse is diminished.

Critically, this professional alignment of role and identity leads to personal and professional happiness; hence, understanding the nature of role and identity and their interconnection is essential in evaluating the roles played by professional nurses. Separation of personal and professional roles is often necessary to some extent to find work-home balance. Opportunities that are flexible and respect from others are both components of professional satisfaction, but the broader context for this is alignment of personal identity and professional roles.

24. The nursing manager evaluates which nurse as the best representative of the phrase “high

tech, high touch”? a. Able to form close bonds with patients requiring highly technological nursing care. b. Combines clinical and people skills to provide holistic patient-centered care. c. Uses ethics to make decisions and to guide daily nursing practice. d. Willingly works with the most difficult or complex patients as a team member.

ANS: B

When one explores the meaning of the professional nursing role, most definitions lead to dyads that partner expressions of highly educated, highly skilled professionals with definitions of individuals who care for others with great empathy and compassion. Nurses combine scientific clinical reasoning with people skills. A frequent expression is that nursing is both high tech and high touch. Forming close bonds, using ethics consistently, and being willing to work in difficult situations are all components of this view of nursing, but these are not broad enough to offer a full picture.

25. The preceptor for a new nursing graduate determines that the nurse is most able to practice

with caring and compassion when demonstrating which behaviors? a. Describes methods used to decrease stress after working. b. Makes inappropriate jokes in the lounge to relieve stress. c. Routinely skips breaks to care for patients’ special needs. d. Understands that asking for a different assignment may be necessary.

ANS: A

Fostering caring through compassion begins with teaching self-assessment; self-care; and reflective practices of inquiry, self-evaluation, and stress management techniques. When the nurse cares for him- or herself adequately, he or she will have the personal resources to practice caregiving with empathy and compassion. Inappropriate jokes do not demonstrate adequate stress reduction methods. Skipping breaks does not allow the nurse to care for himor herself. Understanding that asking for a different assignment may be necessary is important, but this is not the best option.

26. An informal leader on the inpatient unit has just returned to work after giving birth and finds it

increasingly stressful to manage the roles of nurse, informal leader at work, and new parent at home. What suggestion by the N mU anRaS geIrNmGigThBt . heClpOtMhis nurse find more life balance? a. Limit work-related activities at home to when your baby is sleeping. b. Try some role segmentation techniques after you leave the hospital. c. Use role integration techniques to create a seamless blend between roles. d. You might consider working part time until your child is older.

ANS: B

Role segmentation avoids blending any aspect of the professional role with the personal role.

This is the most comprehensive suggestion the manager can give the nurse. Limiting work time at home to the baby’s sleeping time might lead to sleep deprivation for the nurse. Role integration would create more blending of roles. Working part time might or might not be an option, but this still does not help the nurse separate the roles.

27. A nurse is asking the manager for help with role segmentation strategies. What suggestion by

the manager would be best? a. Develop an “I’m at home now” routine such as changing clothes immediately. b. Distract yourself by exercising, reading a book, or doing some other activity. c. Limit yourself to checking work e-mails only once on each day off. d. Try to forget about work when you get home and in the house.

ANS: A

Role segmentation means possessing clear boundaries between roles. One method might be to develop a ritual that physically and emotionally signifies to the nurse that he or she is at home and off work, such as changing clothes immediately when home. Distraction might be helpful, but it is only useful when the stress of role integration is apparent. Limiting work-related activities to once on days off only ensures the nurse really never has a true day off. Trying to forget work is a vague suggestion that has no concrete information to help the nurse operationalize that idea.

28. A nurse on the oncology unit is distraught because a patient died alone while the nurse was

charting and believes that the demands of documentation are excessive and harm patient care.

What action by the unit manager would be most helpful? a. Ask the nurse about a job transfer. b. Encourage the nurse to delegate more. c. Hold a debriefing on the situation. d. Refer the nurse to Employee Assistance.

ANS: C

This nurse is suffering from role discrepancy in which his or her conception of a role is incompatible with the actual obligations of the role. A helpful strategy for this situation is a debriefing, which involves reviewing the events of a particular situation with a colleague or group of colleagues. This can allow for the articulation of the role expectations that came into conflict in a given situation. Often, role expectations are taken for granted, and simply verbalizing these thoughts allows the concerned nurse to move forward in understanding the source of his or her stress. Additionally, colleagues who are present during a debriefing session can validate the concerned nurse’s views and share similar experiences and expectations. Asking about a job transfer is not likely to be helpful because role discrepancy can occur in any setting. DelegN atU ioR nSmIaN yG orTm Ba.yCnOotMhave been needed in this situation, but the nurse cannot delegate charting. The nurse may need a referral to Employee Assistance but not as the first step.

MULTIPLE RESPONSE 1. The nurse studying the image of nursing in society would conclude that: (Select all that

apply.) a. gender roles still strongly drive nursing image and perception. b. portrayal in the popular media affects nursing’s image. c. racial and ethnic stereotypes drive viewpoints of caregiving. d. society’s view of nursing helps to create media images. e. the status of women strongly influences societal perceptions.

ANS: A, B, D, E

Men in nursing face stereotypes such as being “not a man” and “doing women’s work.”

Works that portray nurses as sex kittens or sadistic influence how the public views nursing.

Media portrayals are in turn influenced by popular belief. Society’s views of women have shifted as women have had more opportunities in politics and in the work world. This has impacted the view of nursing. Racial and ethnic stereotypes may have some impact on nursing’s image, but they do not have the impact that popular culture and gender stereotypes have.

2. A novice nurse trying actively to create a nursing identity and synthesize role into self-image

formulates a personal view of praxis that includes: (Select all that apply.) a. a broader understanding of nursing. b. both reflection and specific actions. c. caring for others as a central theme. d. nursing as both an art and a science. e. performing skills without supervision.

ANS: A, B, C, D

The union of role and identity opens up the possibility of a broader understanding of nursing.

Praxis is the integration of reflection and action. The core identity in nursing is caring for others. Nursing is both an art driven by personal values and individualized approaches to health care and a science that comprises the intersection of person and disease. Mastery of specific skills is too narrow in focus, although skills are important in the scientific aspect of nursing.

3. A chief nursing officer (CNO) wishes to ensure that the organization has a strong ethical

orientation. Which actions by the CNO would be priorities? (Select all that apply.) a. Create an ethics committee that can support organizational values. b. Establish a corps of in-house chaplains to respond to all emergencies. c. Model assertive communication when working with other disciplines. d. Offer frequent onsite education on organizational ethics and values. e. Publish procedures employees can use when they see ethical violations.

ANS: A, D, E

The ethics committee can create a supportive infrastructure and can also examine ethical issues, creating guidelines or processes. Educating employees on ethical issues, including how to recognize and work t h roug h Nt hUe R mSaIndN cGoTr rBel.atCi nOgMt hem to organizational values, would be a strong component of an ethical organizational culture. All employees need to understand their options when they witness a violation of organizational ethics. In-house chaplain support for emergencies is a valuable tool, but this would not necessarily help establish and maintain an ethical organizational culture. Using assertive communication is important when working with others and might demonstrate an organizational value of respect, but it would not in itself ensure a strong ethical organizational culture.

4. What terms and definitions about role stress does the nurse learn? (Select all that apply.) a. Role ambiguity: expectations of a role are not clearly defined b. Role conflict: personal values conflict with job requirements c. Role discrepancy: conflict between conception and expectation of a role d. Role extension: expansion of duties associated with a role e. Role overload: demands of the role are overwhelming and endless ANS: A, C, D

Role ambiguity occurs when the expectations of a role are not clearly defined. Role discrepancy is a situation where a person’s conception of a role does not match the reality of that role. Role extension occurs as the duties associated with a specific role expand. Role conflict is the state of stress that occurs when a person struggles to meet the demands of two roles. Role overload is a situation in which the time and resources allotted for a given role are insufficient to meet the role expectations.

Chapter 05: Theories and Frameworks for Professional Nursing Practice Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. A nursing student is explaining to his or her family that nursing differs from medicine

primarily in that nursing: a. does not consider the patient’s environment. b. is concerned with the wholeness of human beings. c. primarily involves following doctors’ orders. d. revolves completely around systems theory.

ANS: B

Whereas medicine focuses on the identification and treatment of disease, nursing focuses on the wholeness of human beings. All nursing theories conceptualize environment as a core concept, whether stated or implied. Although following physician-prescribed treatments is a component of nursing, nurses can also create their own care plans using both independent and dependent nursing activities. Systems theory is a part of many nursing theories but not all.

2. A nursing educator summarizes the role of nursing theory across the domains of nursing

practice, education, and research by pointing out that in all three areas, theory: a. assists nurses to view patients and information in a uniform way. b. is useful for prediction but not for driving nursing activities. c. rigidly structures data collection and protocol implementation. d. serves to organize information in a meaningful, useful manner.

ANS: D

Across all three domains of nursing (education, practice, and research), theory remains a tool that serves to make meaningful connections among various bits of information collected.

Theories and frameworks provide direction and guidance for structuring professional nursing practice, education, and research. This meaning then guides nursing action. Theory can guide data collection and implementation of nursing activities, but all situations need to be seen in their holistic and individualized entireties. Theory should drive nursing actions, just as nursing action should inform theory. Theories are not meant to be rigid and unyielding; in fact, theories help explain variations in patient situations, guide holistic nursing education, and can help formulate questions for research.

3. A word or phrase used to convey the main thoughts in ideas, observations, and experiences is

called a: a. concept. b. construct. c. proposition. d. theory.

ANS: A

According to Fawcett (2005), a concept is “a word or phrase that summarizes ideas, observations, and experiences” (p. 4). The concept is the basic building block of a theory. A construct is a working hypothesis or idea that is part of a bigger whole. A proposition is another name for theoretical statements. A theory is a statement or group of statements that describe, explain, or predict relationships among concepts.

4. A nurse works in the intensive care unit (ICU) and is looking for an explanation of how

patients and families experience weaning from ventilators. This nurse would find the most useful information by searching for an appropriate: a. corollary theory. b. grand theory or framework. c. midrange theory. d. practice-level theory.

ANS: D

A situation-specific or practice-level theory seeks to explain and predict relationships among the core concepts for a specific patient population or nursing practice. In this case, ICU nursing and ventilated patients present situations best addressed by situation-specific theory.

These are sometimes called practice-level theories. A grand theory or framework is an overarching theory that explains the goals, purpose, and broad nature of nursing. A midrange theory considers specific phenomena across nursing practice settings and nursing specialties.

“Corollary theory” is not a type of theory.

5. A nurse whose practice is most strongly guided by Nightingale’s theory would likely

incorporate which intervention into the patient’s plan of care? a. Allow the patient to have uninterrupted periods of rest. b. Assist the patient with activities of daily living (ADLs) and other self-care deficits. c. Encourage the patient to be as independent as possible. d. Use installation of faith and hope to encourage the patient.

ANS: A

For Nightingale, the goal of nursing was to manipulate the environment in order to promote NG OeMnts to be manipulated include fresh air, the reparative process. The keyNeU nvRiS roI nm enTtaBl . elC em pure water, warmth, cleanliness, an appropriate diet, and quiet. A good nurse never allowed the patient to be awakened from sleep. Helping with ADLs would be more appropriate for Orem’s self-care deficit theory. Encouraging independence would be appropriate for Virginia Henderson’s complementary supplemental model, in which the goal of nursing is to assist the patient to become as independent as possible. Installation of faith-hope is a carative factor found in Jean Watson’s theory of caring.

6. A nurse whose practice is guided by Peplau’s theory would judge that care objectives had

been met when the patient: a. assists in setting goals that they work together to meet. b. has mastered all tasks and knowledge needed for self-care. c. is able to adapt to limitations and alter ways of doing activities of daily living (ADLs). d. understands the effects of stress in exacerbating illness.

ANS: A

Peplau’s theory views nursing as an interactive process in which two or more individuals have common goals toward which they work. Mastering self-care tasks would be more demonstrative of Orem’s self-care deficit theory. The ability to find alternate ways of doing ADLs might be applicable for Roy’s adaptation model. Understanding that stress is related to illness is not specific to any theory.

7. A nurse explains to a patient’s family that the role of nursing is to help the patient with

self-care when the patient is unable to do so. The nurse is using the theory of: a. Dorothea Orem. b. Imogene King. c. Jean Watson. d. Virginia Henderson.

ANS: D

Orem’s theory states that the individual practices self-care, a set of learned behaviors, to sustain life, maintain or restore functioning, and bring about a condition of well-being. The nurse assists the client with self-care when he or she experiences a deficit in the ability to perform. Peplau’s theory revolves around interpersonal processes. Imogene King’s theory states that the goal of nursing is to aid the patient in returning to health, so he or she can resume previous roles. Jean Watson’s theory is concerned with caring and specific behaviors that exemplify caring.

8. A student studying nursing theory recognizes that unique concepts in Martha Rogers’ science

of unitary human beings include: a. carative factors. b. cognator subsystems. c. homeodynamics. d. open systems.

ANS: C

For Rogers, homeodynamics are principles speculating about the nature and direction of unitary human development. Carative factors are part of Jean Watson’s theory of caring. The cognator subsystem is a component of Roy’s adaptation model. Open systems are part of several nursing theories.

9. A nursing unit subscribes to Orem’s theory as an overarching conceptual framework for

nursing care. A nurse on that unit would most likely include which intervention in a patient’s plan of care? a. Address all questions and concerns to the eldest male relative present. b. Assist the patient to order nutritious, heart-healthy foods from the menu. c. Dress the patient’s lower body and then have the patient dress his or her own upper body. d. Help the family understand the patient’s lived experience of the illness.

ANS: C

In Orem’s self-care deficit theory, nurses assist patients with self-care activities while helping them move toward self-care agency, which is the ability to meet one’s own self-care needs.

Addressing questions and concerns to the eldest male relative present might be a topic addressed in Leininger’s cultural care theory. Nightingale was most concerned with manipulating certain environmental features, including nutritious food, to promote health via the restorative processes. For Rosemarie Parse, illness is a lived experience, and nursing action is directed toward mobilizing family interrelationships.

10. The nursing instructor summarizes Imogene King’s view of health as: a. a state of harmony with the environment. b. being able to function in social roles. c. stability within the human system.

d. the absence of illness or disability.

ANS: B

For King, health is the ability to function in social roles. Rogers’ science of unitary beings is concerned with harmonious interactions between humans and their environment. Stability within the human system is a concept in Betty Neuman’s systems model. None of the nursing theorists studied view health as the absence of illness or disability.

11. A nurse subscribing to Neuman’s system model would explain to a patient that illness is

caused by: a. disharmony between the patient and the patient’s environment. b. disorganization and dysfunction, leading to imbalances in the system. c. losing the ability to successfully negotiate differing social roles. d. structural disturbances that limit the patient’s self-care abilities.

ANS: A

In Neuman’s model, the patient is seen as an open system exchanging energy with the environment; disharmony between the two leads to illness. The idea of disorganization and dysfunction leading to imbalances in the system is a key concept of Johnson’s behavioral systems model. For King, health is the ability to function within social roles; conversely, illness is the lack of this ability. Structural disturbances interrupt a person’s ability for self-care agency, or the ability to perform self-care in Orem’s self-care deficit theory.

12. A nurse is working with a family from a different culture with which he or she is not familiar.

The family insists on continuing health practices that the nurse is trying to get them to abandon. This results in the nurse viewing the family as noncompliant, because they seem to understand the instructions. Which action by the nurse would be most helpful? a. Ask the family to describe N thU eR imSpIoN rtaGnTceBo.fCthOeM ir beliefs. b. Call an interpreter to make sure they really understand. c. Determine whether instructions are available in their language. d. Give the family both written and verbal instructions.

ANS: A

According to Leininger, if the nurse understands the cultural values and beliefs that underpin these behaviors, he or she might be able to engage in culture care preservation, which includes professional decisions and actions that help people retain their indigenous care values. Calling an interpreter would be important, especially if the patient’s family’s English proficiency is in question, but this would not be as effective as designing interventions and teaching around the family’s beliefs. Giving the family both written and verbal instructions is also a helpful intervention, especially if instructions are available in their native language, but this would not be as effective as designing interventions and teaching around the family’s beliefs. Giving both written and verbal directions is important when teaching, but it does not address cultural diversity.

13. The nurse using Watson’s theory to guide practice would put highest priority on: a. assisting patients to achieve the state of self-actualization. b. creating a caring relationship with the patient. c. helping the patient understands the role of stress on illness. d. negotiating health care in a culturally congruent manner.

ANS: B

Jean Watson’s theory of caring sees caring as a moral value instead of a task. The goal of nursing is to develop a caring relationship that the patient can use for growth, personal development, and healing. Self-actualization is part of Maslow’s hierarchy of needs. Several theorists look at the role of stress, especially as a disrupting influence on harmony or system balance. This would be most consistent with Leininger’s theory.

14. A nurse working in a rehabilitation unit wishes to use nursing theory to guide a personal

concept of practice but has become frustrated when the chosen theory does not seem to be helpful. The nurse consults an expert on theory. What statement by the theory expert would best help the nurse choose a theory from which to work? a. “Any theory should work fine for you as long as you understand the concepts.” b. “Choose a theory that has clear explanations of all four key concepts.” c. “Rehabilitation nursing is probably too broad to find an appropriate theory.” d. “Since you work in a specialized area, use a theory that is very specific.”

ANS: D

Types of patients, setting, and practice should influence the theory chosen to guide practice. A specific setting is best served by a theory with specificity in its components. A global theory would be better suited for research and knowledge generation. Not all theories fit all circumstances, and in fact, many of the theories in this chapter are too broad to be used in their entirety. It is valid to suggest a theory that has clear explanations of all four key concepts; however, it does not go far enough in giving the nurse direction in choosing a theory. Nursing theory can guide practice in any setting; the key is finding a theory that fits.

15. A nursing manager is explaining to the staff how nursing theory is related to all components

of nursing practice. What statement by the manager best outlines this concept? a. Conceptual frameworks areNtU heRbSaI siN cG buTilBd. inC gO blMocks of theory and practice. b. Education is the foundation for all nursing understanding, including theory. c. Nursing knowledge can only be derived from well-tested theoretical models. d. Theory informs practice, research, and education, which in turn inform theory.

ANS: D

According to Figure 5-1, theory, research, education, and knowledge exist in a circular relationship, with each component influencing and informing the others. Concepts are the basic building blocks of theory. Education exists in a relationship with theory, practice, research, and knowledge but is not at the core of this relationship. Nursing knowledge is also derived from practice and experience.

16. A nurse volunteers time in a homeless shelter and wants to set up a free vaccination clinic in

the shelter. Although the shelter’s managers think that vaccinations are a good idea, they are skeptical that clients will take the time to visit the nurse. What modification to the proposal would generate better success according to Maslow? a. Educate the shelter clients on the benefits of vaccines. b. Give vaccinations after meals in a corner of the cafeteria. c. Make vaccinations mandatory for staying at the shelter. d. Offer vaccinations as clients check in to spend the night.

ANS: B

According to Maslow’s hierarchy of needs, there are five broad layers of need, starting with basic human physiological needs such as food and water. According to this theory, these basic needs must be met first. After clients’ needs for food and water have been satisfied, they might be open to vaccinations. Education is always a good idea, but according to Maslow, basic human needs come first. Making vaccinations mandatory might drive some of the homeless clients away. Basic physiological needs should be met first; offering vaccinations before meeting the need for sleep and rest might not result in a high level of acceptance.

17. The nursing instructor explains that a theory, at its simplest, aims to do what? a. Describe, explain, or predict relationships among concepts. b. Explain nursing in the broadest terms possible. c. Generate knowledge to be tested in practice situations. d. Predict what people will do in certain situations.

ANS: A

Nursing theories aim to describe, explain, or predict relationships among the four main concepts of nursing: person, environment, health/illness, and nursing. They are not all broad theories; some are quite specific and limited to particular situations. Not all theories aim to generate knowledge. Theories cannot predict what all people will do in a certain situation.

18. A patient is angry and frustrated and is complaining bitterly to the nurse about these feelings.

The nurse sits quietly and listens attentively, nodding occasionally. What Watson caritas process is the nurse using? a. Creating a healing environment b. Developing helping, trusting, and caring relationships c. Practicing loving kindness d. Promoting and accepting po eI anNdGnT egBa. tivCeOfM eelings NsUitiRvS ANS: D

Promoting and accepting positive and negative feelings as you listen to another’s story is being demonstrated by this nurse. The other options are other caritas processes, but allowing the patient to reveal his or her narrative while not shutting down the negative feelings is the prime activity.

19. A nurse in the oncology clinic uses Aguilera’s theory of coping to work with patients. After

assessing the patient’s usual coping strategies and the patient’s perception of the event, what action should the nurse take next? a. Assess for available situational coping supports. b. Determine if there are concurrent developmental crises. c. Question the patient’s readiness to make needed changes. d. Work to reduce the perceived threat to the patient.

ANS: A

Aguilera identifies three balancing factors (the perception of the event, the availability of situational supports, and usual coping mechanisms) that prevent an adverse reaction to a stressful situation. The nurse should assess for all three. Developmental crises are more appropriate to theorists such as Erickson or Duvall. Change theory is the work of Lewin, among others. Perceived threat is part of Lazarus’s theory of coping.

20. Using Maslow’s hierarchy of needs, which patient should the nurse assess first? a. Complains of pain of 6 on a scale of 1 to 10

b. Crying after receiving a terminal diagnosis c. Disoriented and agitated d. Waiting for discharge teaching ANS: C

According to Maslow, basic needs such as food, water, shelter, and safety are the priority before other needs can be met. The nurse should see the disoriented agitated patient first, because this patient has immediate safety concerns. The patient in pain should be seen next because this is a physiological need. The patient crying and the patient waiting for discharge instructions certainly need the nurse’s attention, but safety comes first.

MULTIPLE RESPONSE 1. Theories attempt to explain the relationships among the central phenomena of nursing, which

include: (Select all that apply.) a. caring. b. environment. c. health/illness. d. nursing. e. person.

ANS: B, C, D, E

The phenomena addressed by nursing theories include person, environment, health/illness, and nursing. Caring, although vital to the art and science of nursing, is subsumed into “nursing” and is not, by itself, one of the four phenomena addressed in nursing theories.

2. The nursing student learning abNoU utRtS heIoN ryGuTnB de.rsCtaOnM ds that which terms are sometimes used

instead of “grand theory”? (Select all that apply.) a. Conceptual model b. Framework c. Interrelated model d. Paradigm e. System ANS: A, B

Grand theories are also known as conceptual models or frameworks. They are not known as interrelated models, paradigms, or systems.

3. The nurse using Nightingale’s theory to guide nursing practice will manipulate which features

in the environment to enhance patient healing? (Select all that apply.) a. Airflow b. Light c. Noise d. Roommates e. Temperature ANS: A, B, C, E

Nightingale believed that nurses should manipulate environmental conditions to enhance healing, including ventilation (airflow), light, noise, and temperature. The nurse may not have any control over roommates.

4. A nurse uses Roy’s model to guide nursing care. When using this model, what stimuli would

be important for the nurse to assess? (Select all that apply.) a. Adaptive stimuli: stimuli the patient knows is beneficial b. Contextual stimuli: all stimuli in the patient’s environment c. Focal stimuli: what is confronting the patient immediately? d. Residual stimuli: stimuli that is left over from prior experience e. Transient stimuli: stimuli that is not expected to have a permanent effect ANS: B, C, D

According to Roy, there are three types of stimuli: focal (what is confronting the patient in the immediate time), contextual (all other stimuli in the environment), and residual (beliefs, attitudes, or traits that have an indeterminate effect on the present situation). Adaptive and transient stimuli are not part of Roy’s theory.

5. A nurse manager is planning a major change on an inpatient unit. Using Lewin’s theory, what

areas does the manager assess? (Select all that apply.) a. Coping factors b. Driving forces c. Motivators d. Restraining forces e. States of change ANS: B, C, D, E

Lewin’s change theory examines driving and restraining forces, motivators, and states of change. Coping factors are not part of this theory.

6. A nurse works in an emergency department and frequently uses Lazarus’s theory of coping.

When a family is distraught byNaUfaRmSiI lyNmGeT mBb. erC ’sOaM pparent heart attack, what action by the nurse is best from this theory’s standpoint? (Select all that apply.) a. Assess the family for coping strategies used during previous crises. b. Begin assessing the family for discharge teaching and support needs. c. Help the family understand treatments available to manage the condition. d. Inform the family of the location of the cafeteria and waiting rooms. e. Provide the family with food and beverages as a universal sign of caring.

ANS: A, C

The nurse’s role when using this theory is to use nursing interventions designed to alter the perception of the threat level and promote and support the coping process. By teaching the family how the patient’s condition will be managed, the nurse is helping to reduce the perception of the threat. Assessing previous coping methods helps support the coping process.

The other actions are not related to this theory.

Chapter 06: Health Policy and Planning and the Nursing Practice Environment Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. The nurse studying the development of the American health care system understands that

before the 1990s, health care funding was primarily: a. driven by fee-for-service costs. b. from charitable organizations. c. paid for by entitlement programs. d. the responsibility of each state.

ANS: A

Before the involvement of the federal government in health care financing in the 1990s, physicians (and health care facilities) charged a fee for services, which was generally paid for either out of pocket by the individual or by private health insurance companies. There has always been some charitable health care, but this has not been the primary method of payment. Entitlement programs, such as Medicare, cover health care expenses for certain designated groups. States are involved in some health care financing but certainly not the majority of it.

2. A nurse studying the intersection of politics and health care describes the relationship best by

saying that: a. hiring lobbyists is the most effective way to communicate ideas. b. only national organizations really have a voice in health care. c. politics provides a means foNrUdR ifS feI rinNgGvToB ic. esCtO oM be heard. d. voting in elections is the primary way to influence policy.

ANS: C

Through the political process, individuals, groups, agencies, and government entities have a voice in developing our health care system via regulations, establishing outcomes, and developing policy. Lobbyists can be an effective tool, but they are expensive, and in the case of issues that are very popular with the general public, they may not be necessary at all.

Everyone has a voice in our national health care system. There are multiple avenues for influencing health care policy; voting is one but is not necessarily the primary method.

3. A politically savvy nurse is explaining to co-workers that a plank in a political party’s

platform refers to the: a. documents that will be voted on. b. financing arm of the convention. c. party’s stand on specific issues. d. supporters of various programs.

ANS: C

The party’s stands on specific issues are called planks, which come together to form a platform, which represents the consensus of party delegates on specific issues of importance to the party leaders. The party votes on issues during the political conventions, which then become the basis of arguments made during a political race. The financing means of the convention is not known as a plank. The supporters of various programs are not known as planks.

4. Today’s nurse understands that the mission of political action committees (PACs) has

changed over the years to become more: a. invested in social and corporate agendas. b. involved at the state rather than the national level. c. fiscally responsible to the general population. d. responsive to needs of underserved groups.

ANS: A

Originally intended to represent traditionally underrepresented groups, PACs now typically represent particular groups interested in specific issues. PACs are active at both the national and state levels. The lack of transparency in financial matters related to politics and to PACs has led to grass-roots advocacy regarding inappropriate financing. Being responsive to needs of underserved groups was the original mission of PACs, but this has evolved to include specific groups of people with specific interests.

5. A nurse wishing to give money to a national political party without designating it for a

specific purpose is donating what is called a. hard b. soft c. unencumbered d. unrestricted

money.

ANS: B

Soft money is money donated to a national political party without a designated purpose. Hard money is given to specific campaigns. The term unencumbered money was not discussed in the chapter. The term unrestricted money was not discussed in the chapter.

6. A nurse wishes to encourage people to vote and energize those who feel strongly about a

particular political issue. The nurse would best accomplish this by: a. donating money to a political action committee (PAC). b. joining the office staff of an involved lobbyist. c. serving on a national candidate’s platform staff. d. volunteering for a related 527 political group.

ANS: D

A 527 political group is usually involved in voter mobilization, issue advocacy, and other political activities that do not call for endorsing a particular candidate. PACs typically work to raise money, assist in campaigns, and lobby on behalf of special interest groups. Lobbyists work for special interest groups, often as part of a PAC. Serving on the platform staff or on a convention staff would not be involved with “get out the vote” campaigns.

7. An elected member of Congress wishes to arrange discussion of a new bill related to heart

disease during February, which has been declared National Heart Month. Which action by the legislator would most likely lead to this happening as desired? a. Arrange the dates for discussion with the party whip’s secretary. b. Hire a lobbyist to present the proposed bill and timeline for debate. c. Meet with the appropriate committee chairperson to make the request. d. Reserve rooms in chambers for public discussion and debate on the issue.

ANS: C

Committee chairpersons develop the calendar for discussion of issues; this would be the appropriate avenue for this idea. The party whip is the minority leader and does not set the agenda. A lobbyist might be very helpful in getting bills passed, but the lobbyist would most likely not have any influence on the timing of debate. Public discussion is not the same thing as legislative debate.

8. A bill has passed both Houses. Before it gets sent to the president, it must be: a. approved by appropriate party chairs. b. fully financed with appropriations. c. registered as a pending law to sign. d. resolved in conference committee.

ANS: D

After both Houses pass their version of a bill, a conference committee works on the bill to resolve any differences between the two versions that passed. After a bill passes in both Houses, it does not go to the party chairs. The party chairs run the political party; the committee chairs set the legislative agenda. Bills may be passed fully, partially, or not funded at all. Bills that have passed do not need to be registered anywhere as pending laws.

9. A nurse wants to see a bill passed that includes an increase in federal income taxes to fund it.

A friend should encourage the nurse to: a. call the appropriate committee members. b. provide information to the party secretary. c. send a petition to the nurse’s representative. d. write a letter to the nurse’s senator.

ANS: C

This answer is correct because N alU lR biS l l sItNhaGt TcaBl l.fCorOiMn cre as es in federal income tax must originate in the House of Representatives, and the nurse’s representative could direct the petition or the nurse to the appropriate chairperson. Committees can send forward ideas for bills, but only the House of Representatives can originate bills that call for increases in federal income tax. The party secretary would not be the appropriate place to send this request because bills that call for increases in federal income tax must originate in the House of Representatives. The Senate cannot originate bills that call for increases in federal income tax.

10. A nurse is worried about an upcoming judicial appointment. A co-worker explains that the

nurse can voice opinions about such matters best by: a. calling the majority party’s leadership. b. phoning the nurse’s House member. c. sending a petition to the president. d. writing to the senator from that state.

ANS: D

The Senate has the primary responsibility for such political appointments as judges, ambassadors, the surgeon general, cabinet members, and federal agency directors. The nurse should write (or call) the senators from his or her state. The majority party’s leadership would not necessarily be involved in a judicial appointment. The House of Representatives does not have primary responsibility for judicial appointments. The president nominates people for judicial appointments but does not get them appointed.

11. A nursing manager is concerned about staffing levels and their impact on patient safety. What

action by the nurse would have the best chance of influencing this issue? a. Call senators from the state, explaining the need for staffing laws. b. Donate money to the American Nurses Association for lobbying. c. Organize a petition drive calling for a city ordinance on staffing. d. Work with the state nurses association on related state legislation.

ANS: D

The nurse should work with the state nurses association in that state because state legislatures typically are the level of government to regulate nursing working environments, including staffing levels. Mandatory staffing issues are typically taken up at the state level. The American Nurses Association is a strong force to join, but staffing levels are typically mandated at the state level. A city ordinance would not be an effective way to ensure safe staffing levels.

12. Bills that include funding requests are known as _ a. authorization b. finalized c. funded d. supplemental

bills.

ANS: A

Bills that contain requests for funding are known as authorization bills. A finalized bill might be one that has passed both houses and has been resolved in conference committee, but the chapter does not discuss finalized bills. A program or mandate gets its funding via authorization bills. A supplemental bill might be used to provide funding for emergencies that were not anticipated and therefore not funded.

13. A congresswoman is explaining that she occasionally votes for bills that need, but do not

contain, provisions for funding because: a. appropriations bills are usually considered in specific years. b. once the bill has passed, it is often easier to find funding for it. c. she can support the cause without having to find money for it. d. there isn’t enough money left in the budget for some issues.

ANS: C

Congressional representatives often vote for bills that do not contain funding so they can be seen as supporting the cause without having to provide funding. Authorization bills for funding programs, if present, usually pass around the time the original bill passed, and the first authorization bill for a program is often named for the program it funds. Bills are not usually passed in the hope that funding can be found at a later date. It certainly may be true that there is not enough money left in the budget, but it is not the reason that this is done as a practice.

14. A voter is angry that his or her congressman voted for a bill that contained an amendment

unrelated to the bill without knowing about the amendment. The congressman explains that this occurs because: a. aides do not have time to fully read bills and inform congressional members. b. amendments sometimes are added at the last minute. c. representatives do not get copies of full bills before they vote on them. d. there simply is not enough time to understand each bill.

ANS: B

Amendments are sometimes added at the last minute in order to get a specific congressional member to vote for the bill. Other legislators may not be aware of the addition of such “pork barrel” legislation to the bill and may vote for (or against) the bill without knowing that they are voting on specific projects. Aides do read bills and give reports to their congressional members, but members should not rely totally on the aides to understand bills.

Representatives do get the bills before voting on them; however, to gain the vote of specific congressional members, “pork barrel” legislation (for special “pet” projects) is often added to the bill at the last moment (and some members may not be aware of this). Congressional members should take the time to fully understand the contents of each bill before voting.

15. A nurse does not understand why the U.S. Department of Health and Human Services

(USDHHS) cannot allocate more money for public health efforts. Another nurse explains that money for public health and other expenditures is limited because the majority of the USDHHS budget must fund: a. any program deemed in need of funding. b. initiatives according to Healthy People 2020. c. Medicare and other legislated programs. d. United Nations health and wellness plans.

ANS: C

About two thirds of the budget of the USDHHS goes to fund Medicare and other entitlement programs, leaving a minority of funds for other items. Only about one third of USDHHS’s budget is discretionary; the remainder goes to fund other legislated programs. Healthy People 2020 does focus on the health care priorities of the nation, but budgetary expenditures from USDHHS for these initiatives are limited because of fixed spending on entitlements. The USDHHS budget does not fundNU UnRiS teI dN NG atT ioBn. s pClO anMs. 16. A nurse understands that the first major government involvement in health care occurred with

passage of the a. Brady b. Hill-Burton c. Nurse Reinvestment d. Social Security

Act.

ANS: D

The Social Security Act of 1935 was the first incursion of the federal government in health care and provided grants to the states for specific health programs. The Brady Act (1993) concerned gun control and the prevention of handgun violence. The Hill-Burton Act (1946) concerned building hospitals and improving their physical capabilities. The Nurse Reinvestment Act (2008) is a training act funded as a discretionary health care expenditure.

17. A nurse is confused because a federal agency does not seem to be providing services

according to the law. Another nurse explains that this can happen because: a. agencies do not work under any specific federal laws. b. agency interpretation is needed to implement the law. c. not all government agencies fall under specific laws. d. there is considerable infighting among different agencies.

ANS: B

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Agencies are charged with implementation of law according to their interpretation of the intent of the law, and agencies can change their procedures without revising the original law.

Often, interpretation—and, hence, action—varies according to the personnel at the agency.

Agencies do work that falls under their jurisdiction according to law, whether that is at the state or federal level. All government agencies fall under the auspices of some law. Agencies have specific established functions and so would not be fighting among themselves over how each agency should do its job.

18. A nurse working for a governmental agency is charged with establishing evaluation plans for

the programs the agency oversees. To show the agency is meeting health-related objectives, the nurse would most likely compare the agency’s outcomes to: a. benchmarks for health care at the local level. b. budget guidelines imposed by Congress. c. goals established in Healthy People 2020. d. taxpayer satisfaction with health programs.

ANS: C

Healthy People 2020 is a blueprint to the nation’s health, and many funding decisions are based on attempting to meet targets set forth in this document. A federal agency would most likely look to national, not local, benchmarks when evaluating specific programs. Staying within budget guidelines is important, but this does not give information about how well an agency is meeting health-related objectives. Taxpayer satisfaction is certainly an important issue, but this would not allow evaluation on whether or not health-related goals have been met.

19. A nursing dean wishes to establish a center to study the feasibility of creating a curriculum

based on community-based nurNsiU ngR.STI oNacGqTuB ire.fCuO ndMing, the dean would most likely apply to the: a. National Institutes of Health. b. Pew Charitable Trusts. c. state board of nursing. d. Surgeon General’s office.

ANS: B

The Pew Charitable Trusts is a philanthropic foundation that supplies grants for health care demonstration projects, research studies, and training and education of health care professionals. The National Institutes of Health do provide funding for health-related projects, but most are research studies. The state board of nursing is involved in regulation of nursing practice, not funding studies. The Surgeon General’s office works to ensure health programs that affect the nation as a whole are effective.

20. An undergraduate nursing dean is expecting a site visit from the school’s accrediting agency.

To ensure that the school meets the agency’s objectives for accreditation, it would be most important that the dean would assess whether course work provided opportunities for students in: a. different types of health care organizations and levels of care. b. mastering basic science concepts as they apply to nursing care. c. providing charitable care through nurse-run clinics and offices. d. working with community-based clients and regional health needs.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

The two agencies that accredit schools of nursing (the National League for Nursing Accreditation Commission and the Commission on Collegiate Nursing Education) require undergraduate nursing programs to tailor their curricula to local and regional health care needs. Having the ability to work within several different types of agencies providing multiple levels of care is a good skill but is not one of the specific requirements of the two accreditation agencies. Students do need a mastery of basic science skills in order to advance to more sophisticated concepts, but this is not a specific requirement of the accreditation agencies. Nurse-run clinics are an increasingly used method of providing care and educating students, but they are not a specific requirement of accreditation agencies.

21. A nurse has been investigating how health care policy is made and believes that the system is

too complicated and difficult to navigate. Which statement best justifies this position? Health care policy is: a. created at many governmental levels and affected by multiple variables. b. enacted mostly by federal law, which requires compromise by both parties. c. funded by appropriations bills, making additional policies hard to enact. d. politicized with the current administration’s party views taking priority.

ANS: A

Health care policy can be developed by federal or state law; by federal, state, or local rules and regulations; or by think tanks and philanthropic organizations. Policy is affected by funding decisions, public opinion, the economy, demographics, technology, and many other factors. This creates a system that is very complex and difficult for the average person to navigate. Policy is not only enacted by federal law but can be enacted at the state level and created by agencies and organizations. Funding does occur through appropriations bills, but this is not the reason the system is complicated. This statement is true; however, this viewpoint is too narrow to explNaiUnRthSeIcN om ex.itC yOoM f the entire system.

GpTlB 22. A nurse is explaining to a co-worker that the Patient Self-Determination Act, the Ryan White

Act, and the McKinney Homelessness Act are all examples of: a. bills that were passed without matching appropriations bills. b. health care policies and regulations created in the 1990s. c. laws that were enacted after involvement of philanthropies. d. the only times nurses will ever make differences in legislation.

ANS: B

The 1990s were a very prolific time for health care laws and regulations. These bills were all passed during that decade. The McKinney bill was partially funded, the Ryan White Act was a funding bill, and the chapter does not describe funding for the Patient Self-Determination Act. Philanthropies may or may not have been instrumental in getting some of these bills passed; the chapter provides no information on this. Nurses can make a difference in any legislation that is proposed, debated, or passed.

23. A nurse is able to correlate Medicare regulations with which major trend in health care?

Medicare has influenced decisions regarding: a. creation of policies related to genetic privacy acts. b. inclusion of women and children in research studies. c. purchasing prescription drugs from foreign countries. d. reimbursement through capitated cost agreements.

Care provided under capitated costs are the major way in which health care is paid for by third parties and is a direct result of the diagnostic-related groups, which were the cost agreements negotiated under Medicare rules. Genetic privacy is an issue, resulting in the Genetic Information Nondiscrimination Act of 2008, but this is not a major trend influenced by Medicare. Inclusion of women and children into research studies has been a topic of national prominence lately, but it has not been influenced by Medicare regulations. Medicare regulations have not required prescriptions to be purchased in foreign countries.

24. A chief nursing officer (CNO) wishes to demonstrate to the community that the quality of

nursing in his or her particular hospital meets or exceeds professional standards. The best method for demonstrating this would be for the CNO to: a. advertise nurse-patient ratios. b. apply for magnet hospital status. c. hire advanced practice nurses. d. publish complication rates.

ANS: B

Applying for and receiving magnet hospital status from the American Nurses Association shows a facility meets or exceeds eight standards of care and can be used to publicize the quality of nursing services in that facility. Advertising nurse-patient ratios would give the public some information about nursing quality, but many individuals would not understand the implications of specific nurse-patient ratios. Hiring more advanced practice nurses would not specifically demonstrate that the hospital had met or exceeded professional standards.

Publishing complication rates for specific procedures or populations of patients would be valuable information to some consumers, but this often reflects medical care more than nursing care.

25. A nursing school dean is looking for external funding for an innovative program that recruits

underemployed sectors of the workforce into nursing. Which action by the dean would most likely result in gaining external funding for this new program? a. Apply for federal grants through the Department of Health and Human Services Bureau of Health Professions (DHHS BHP). b. Contact governmental agencies to gain scholarship money for specific students. c. Negotiate with a local hospital to sponsor, or fund, education for some students. d. Work with the Alumni Association to find corporate or individual sponsors.

ANS: A

The largest source of external funding for nursing education is through the DHHS BHP. This funding is generally for programs, not individual students. There are governmental agencies that provide some student scholarships; however, the question specifically asked about program funding. Hospitals do sometimes sponsor students who are already employees of theirs, but this question asked about program funding. Corporate or individual sponsors are important sources of funding for most institutions, but the largest source of external funding for nursing education is the federal government.

26. The nurse researcher explains to a co-worker that the priority in funding for research today is

research studies that examine: a. effectiveness of care as evidenced by specified outcomes. b. how standards improve the cost effectiveness of therapies. c. if local standards of care measure up to national standards.

d. ways to determine whether health disparities are being addressed.

ANS: A

Outcomes research is a priority in health care research today. Meeting outcomes demonstrates effective and accountable practice and, in fact, is a required element of research. Using standards of care may improve cost effectiveness of therapies, but determining this is not as important as determining whether care meets stated outcomes. Local standards of care should, for the most part, be reflective of national standards. Health disparities are important, especially as addressed in Healthy People 2010, but determining whether these had been addressed would be a form of outcomes research, which is too narrow in scope to be the correct answer.

MULTIPLE RESPONSE 1. An individual is an ardent supporter of a specific candidate in a federal election. This person

wants to contribute $2800 to the candidate’s campaign. How can the individual make this kind of contribution? The individual can give: (Select all that apply.) a. $2600 to the candidate and $200 to the national party. b. all of it to the candidate of choice without restriction. c. half to the candidate and the other half to the national party. d. the entire amount to the national party without restriction.

ANS: A, C, D

In 2013 and 2014, individuals were restricted to giving $2600 to an individual candidate and $32,400 to a national party, so this contribution would maximize the donation to the specific candidate and use the remainder toward a contribution to the national party. A person can give up to $2600 to an individual caN ndUiR daSteIaNnG dT upBt.oC$O 32M,400 to a national party, so splitting it in half would be possible. A person can make a donation of up to $32,400 to a national political party, so one option would be to give it all to the national party and assume that some of it is being used for the candidate the individual favors. This probably is not the best option, but it is a possible choice. Because the individual restriction on donations to specific candidates is $2600, the person cannot give all of it to the particular candidate favored.

2. A student nurse understands that state nurse practice acts delineate: (Select all that apply.) a. eligibility for licensure. b. national accreditation standards. c. required educational preparation. d. rules for members of compacts. e. scope of practice for nurses.

ANS: A, C, E

Eligibility for licensure is explained in the individual state nurse practice acts. The required educational preparation nurses must obtain is included in state nurse practice acts. The scope of practice for nurses is outlined within each state’s nurse practice act. Nursing students have to graduate from a program approved by the state board of nursing, but this program does not have to have national accreditation. State compacts allow nurses who have licenses in one member state to practice nursing in the other member states without having to get another license. Rules for these compacts are not included in the state nurse practice acts. These compacts were developed by the National Council of State Boards of Nursing.

3. A nurse is concerned about an upcoming debate on a proposed state health care policy change.

What actions can the nurse take in order to have his or her voice heard on this issue? (Select all that apply.) a. Contact legislators by phone to express opinions. b. Encourage nursing experts to testify at hearings. c. Gather information and speak at the hearings. d. Run for election to governmental office. e. Write letters to supportive state representatives.

ANS: A, B, C, E

Nurses have many avenues for becoming politically active and ensuring that their voices are heard. To influence the outcome of this proposed change, the nurse can contact legislators by phone, encourage experts to testify, speak at hearings, and write letters. Running for office will allow the nurse great political involvement but will not affect the outcome of a policy change soon to be debated.

Chapter 07: Economic Issues in Nursing and Health Care Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. While studying health care economics, the nursing professor explains to a class that the

economic principle of opportunity costs means that: a. economic decisions are based on the best opportunity that arises. b. free market failure occurs when efficient use of resources is lacking. c. satisfying one desire eliminates the possibility of satisfying another. d. we make our decisions based on opportunities to benefit others.

ANS: C

Because resources spent on one set of desires cannot be used to satisfy other desires, decisions are made based on the value of what was not chosen. This is the principle of opportunity costs; in other words, what has acting on this one opportunity cost you?

Although we do make many decisions based on the best choices or opportunities that arise for us, this is not a complete or accurate description of the concept.

A lack of efficient use of resources contributes to market failure, not opportunity costs.

Making decisions to benefit others is not as common as making decisions based on self-interest.

2. The nurse is explaining the American health care system to a patient from another country that

has government-sponsored health care. The nurse would explain that one driving force for private insurance has been: a. consumer-driven markets dN em anS diInN gG inTsuBr. anCcO e.M UR b. necessary rationing of scarce health care resources. c. the lack of government involvement in health care. d. uncertainty related to the need for medical care.

ANS: D

Most health care needs, other than those for preventive care, occur in an unpredictable manner and are costly enough that people cannot typically save or borrow enough money to pay for them. This led to the rise of private insurance. Private insurance was not created out of a demand from the consumer-driven marketplace. Rather, it was created from the uncertainty related to medical need. Private insurance and the lack of private insurance have contributed to what is essentially rationing of health care resources (not the other way around). People who are uninsured or underinsured often do not get the care they need. The federal government has been involved in health care at least since the 1960s.

3. A practicing nurse is interested in health care economics. To create an environment where

health care more closely resembles the consumer market, this nurse would place high priority on activities revolving around: a. educating patients and families. b. exploring the costs of treatment. c. understanding payment options. d. using less expensive supplies.

ANS: A

In the consumer market, consumers have knowledge that allows them to dictate conditions. In the health care market, “consumers” often have much less information on which to base decisions about what to “buy.” This violates a basic assumption of economics, so having more highly educated “consumers” would help to rebalance this situation. All nurses should have a basic understanding of the costs of health care, but this in itself does not address a difference in general economics and the economics of health care. Understanding payment options will not address a difference in general economics and the economics of health care. Using less expensive supplies may be a good idea if quality is not sacrificed, but this does nothing to address a difference in general economics and the economics of health care.

4. In trying to understand current problems in today’s health care environment, the nurse could

reframe the discussion as a problem created by: a. competing interests of market and governmental forces. b. tension between for-profit and not-for-profit institutions. c. too many different agencies providing the same services. d. unchecked rises in providers’ salaries and fees for service.

ANS: A

The U.S. health care system is a mix of market forces (based on equilibrium created through pricing mechanisms) and government entities (which should be based on egalitarian ideals).

This mix of systems is primarily responsible for inequities in the health care system today.

There are both for- and not-for-profit organizations operating in health care today.

Not-for-profit status is a tax designation; all entities must make enough profits to continue operating. Redundancy in health care does exist, but it is not one of the root causes of its problems. Unchecked rises in fees were part of the reason managed care came into being, but this is not broad enough to reframe an entire concept.

5. A nurse is explaining Medicaid and Medicare to a patient and describes the biggest difference

in the programs as being the: a. duration of benefits. b. health services provided. c. level of administration. d. waiting period for coverage.

ANS: C

Whereas Medicare is purely a federal administered program, Medicaid programs are administered by individual states. The duration of benefits is dependent on meeting the criteria for inclusion. Both programs cover specified health services, and both do determine coverage for health care services (set at the state level for Medicaid and the federal level for Medicare), but this is not the biggest difference in the two programs.

The waiting period for coverage is not a major differentiator between the two programs.

6. A nurse wishes to get a job in a large city with many hospitals from which to choose but is

dismayed to learn that the wages for nurses are nearly as low in the city as in the rural area where the nurse lives. The nurse concludes that: a. city hospitals have agreed on wage levels for nurses. b. demand for nurses in the city is similar to the rural area. c. state government has mandated wage scales for nurses. d. the cost of living in the city is similar to the rural area.

ANS: A

The situation of low wages and a nursing shortage is an economic contradiction. The model of monopsony describes a situation in which a market containing few hospitals will set a nurse’s wage according to the returns that the nurse brings to the organization; hence, in that organization, wages stay low despite a nursing shortage. In markets with more opportunities for nurses, wages are more competitive. In this situation, the nurse concludes that the city hospitals have created an artificial monopsony model by banding together to set wages for nurses contrary to market principles. The relative demand might be the same, but the sheer number of hospitals in a city compared with a rural area would mean that there were more organizations competing for nurses, leading to higher wages.

Although it is possible for a state government to mandate wage scales for nurses, it is not probable. Costs of living in the city and rural area might be comparable, but the larger number of hospitals in the city should equate to higher demand and therefore higher wages for nurses.

7. A state nurses association has convinced hospitals in that state to offer very attractive wage

and benefits packages to nurses. To determine whether this strategy is working to provide a long-term solution to the nursing shortage, the association would measure the: a. comparative RN vacancy rates before and after the change. b. hospitals’ use of agency personnel to fill nursing positions. c. number of students admitted to nursing schools in that state. d. percentage of nurses stating on a survey that they work second jobs.

ANS: C

Wage increases can improve the nursing shortage by both short- and long-term methods. In the short term, nurses reenter the job market, work more hours, or add part-time nursing jobs.

In the long term, the improved wages influence individuals in deciding to enter nursing school and join the profession. An improvement of vacancy rates would show that the increased wages and benefits have had a N shUoR rtS -teIrm ffB ec. tC onOtM he nursing shortage in that state. Hospitals NGeT often use agency personnel to cope with nursing shortages, but this is a short-term solution.

Working a second nursing job would help alleviate the nursing shortage, but this is considered a short-term mechanism.

8. A chief nursing officer (CNO) is concerned about the ongoing nursing shortage and wants to

implement strategies to keep it from getting worse. Which action by the CNO would best meet this goal? a. Create a career ladder for registered nurses. b. Institute an across-the-board wage hike. c. Offer tuition reimbursement at area colleges. d. Provide perks, such as unit holiday parties.

ANS: A

Organizational attributes, including workload, management style, and opportunity for promotion, all figure into nurses’ decisions to work. A career ladder provides a forum for promotion without competing for scarce management jobs. An across-the-board wage hike may attract and keep nurses, but research demonstrates that opportunities for promotion are more important for entering or remaining in the workforce, so this is not the best answer.

Tuition reimbursement, similar to many other perks, may affect some nurses’ work decisions; however, a specific perk may not be relevant to specific nurses’ decisions about working.

Holiday parties can contribute to a collegial environment, but research shows that other organizations characteristics are more important, including the availability of promotion.

9. A nurse midwife has moved into town and wishes to establish a practice. Economically

speaking, what could this nurse do that would best enhance her chances of establishing a successful practice? a. Become affiliated with the busiest maternity group. b. Find a sponsor who will provide low-interest loans. c. Investigate the costs associated with physician care. d. Locate offices near a hospital that has a lot of births.

ANS: C

Having costs that are lower than the competition will help bring in business according to the economic concept of substitutes. When two items or services are relatively equal in substance, an increase in the cost of one will drive up the demand for the other, which people will use as a substitute for the first item. By understanding the cost of physician care, this nurse can keep her prices low as the physicians raise theirs, leading patients to choose the midwife. Becoming affiliated with the busiest maternity group would not be the best choice; in a large group, the midwife might not have any control of overhead costs or decisions about how the practice is run or what to charge patients. Having low-interest loans will help the bottom line, but it would be more important to begin bringing in income. Locating offices near a hospital that has a lot of births may not be possible, and it may not lead to a successful business anyway.

10. An insurance company’s internal statistics show that the company is losing a great deal of

money processing small, frequent claims submitted by its customers. The company accountant suggests that the best way to decrease this loss is to: a. delay payment until the claims reach a set figure. b. educate customers on how much these claims cost. c. increase the deductible customers must satisfy. d. refuse to accept claims beloNwUaRcSeI rtaNinGT am Bo.uCntO. M ANS: C

Deductibles and co-payments are types of cost sharing used by most insurers. Deductibles are designed to persuade customers to make better decisions about care and to dissuade them from submitting small claims. Delaying payment until the claims reach a set figure might serve to annoy customers, who then might choose another insurer. This approach might also cost more because someone would have to track the claims. There probably is not an effective way to educate perhaps millions of customers enough to dissuade them from submitting claims for reimbursements or payments they are owed.

Refusing to accept claims below a certain amount would probably be an unpopular action, perhaps leading to customers switching insurance companies.

11. A health care practice has changed its mix of patients and now accepts fewer self-paying and

more insured patients. The office manager tells the staff to anticipate: a. caring for more-educated patients. b. offering expanded office hours and days. c. ordering more diagnostic tests. d. providing more preventive care.

ANS: C

When consumers carry health insurance, they become insulated from the cost of medical care, and the demand for health care services increases. Insured patients are not necessarily more-educated patients. Having more insured patients does not necessarily translate into the need for expanded hours and days of operation. Insured patients generally demand more health care services of all types, not just preventive care.

12. A nurse economist is explaining to a class that the health care market exists in a state of

“market failure” because: a. complex variables prevent a consensus on health care “production.” b. health care fails to meet the needs of its customers and consumers. c. more health care practices are failing economically in this market. d. practices suffer as their investments in the stock market fail to grow.

ANS: A

The economics of health care are unlike any other business sector. Demand for health care is not directly related to the quality and availability of services. Incomplete information by “consumers” and uncertainty related to the need for future health care result in a situation in which society cannot agree on an acceptable level of “output.” This is known as market failure. It can be argued that health care today is not meeting demands, but this is unrelated to the concept of market failure. It may be true that more health care practices are failing economically in this market, but it is not related to the concept of market failure. Investment in the stock market is not related to market failure.

13. The student nurse knows that employer-sponsored health insurance was: a. a new idea for health care financing invented after World War II. b. created by the federal government to stimulate the economy. c. never envisioned as being aNpUeR rmSaI neNnGt T paBrt.oCf O thMe health care arena. d. originally a way to increase revenue for doctors and hospitals.

ANS: D

During the Depression, doctors and hospitals saw their revenue decline because people were not able to pay for health care. The American Hospital Association created Blue Cross of California in 1939 with the intent of securing income. Employer-sponsored health insurance came into existence during the Great Depression. The federal government did not create employer-sponsored insurance plans. Employer-sponsored insurance was not created as a temporary solution.

14. At a rally for better health care coverage, a nurse hears someone say that

government-sponsored health programs are inherently unfair. What statement best justifies this position? a. Government-sponsored plans have no system of ensuring accountability. b. Taxes should not be used for anything other than running the government. c. The people who pay the most in taxes often get the fewest benefits. d. There are no tax deductions for the contributions made to the plans.

ANS: C

Whereas healthy, middle-income people often pay more in taxes than they receive in benefits, the less affluent usually pay less than the value of the health care services they receive.

Government activities have the ultimate accountability: the vote. Many people argue that taxes should not be used for anything other than running the government, but this does not get at the equity debate. In fact, if the government were not somehow involved in health care financing, there would be less equity because many individuals would have no way of paying for needed health care. Social security taxes are not deductible, but this affects everyone equally.

15. A nursing manager wants to be involved in activities that would systematically improve

quality care. The manager would best accomplish this by: a. ensuring that temporary agency nurses fill open positions. b. hiring only baccalaureate-prepared nurses on that unit. c. preparing cost estimates for a new telemetry system. d. teaching nurses on the unit to use positive conflict-resolution skills.

ANS: C

Nurse managers are involved in quality improvement activities in two ways: by creating a culture that is supportive of quality improvement and by making business cases for investments in technology and structural changes. By preparing a cost analysis for a new telemetry unit, this nurse manager is participating in systemic quality improvement.

Filling open positions is important to maintain quality in the hospital, but using temporary agency nurses is working from a crisis mode and not working toward long-term quality improvement. Policy groups do recommend a higher proportion of BSN-prepared nurses on staffs. However, this does not guarantee improved quality. Conflict-resolution skills are a great asset, but this does not address quality improvement.

16. A chief nursing officer (CNO) wants to respond to a threatened reduction in nursing positions

in a hospital where financial conditions are poor. Which action by the CNO would be best? a. Compare nurse-patient ratios nationwide, describing the impact of layoffs. b. Hire a lobbyist to put political pressure on the hospital’s administration. c. Prepare a cost-benefit analysis of the effect of nursing care in that hospital. d. Use a cost-minimization strategy to show how nursing costs can decrease.

ANS: C

A cost-benefit analysis is a powerful tool for justifying investments into nursing care.

A nationwide comparison of nurse-patient ratios might yield important information, but information that is national in scope is easily dismissed as “someone else’s problem” and might not convince administrators of the value of nursing care in this hospital. Hospital administrators are not elected to their positions, so political pressure probably would not garner the desired results. Cost-minimization strategies are rarely useful in health care settings because of the variability in interventions and outcomes.

17. A nurse performing a technology assessment understands that the results of the assessment

will be used to: a. compare different brands of equipment. b. determine whether up-to-date items are being used. c. distribute technology evenly across units. d. make decisions on resource allocation.

ANS: D

Technology assessments are used to look at safety, effectiveness, and costs associated with technology, with the final outcome being decisions on resource allocation. A technology assessment is not used to compare different brands of equipment. A technology assessment does not evaluate equipment for its currentness. The technology assessment findings would not be used to distribute technology evenly across units.

18. The nurse studying health care economics understands that a system that valued attaining

competitive advantage as its primary goal would be classified as operating in the model of -sum competition. a. negative b. normative c. positive d. zero ANS: D

Zero-sum competition is associated with profit maximization. In health care, this is done via limiting resources dedicated to patient care. Negative-sum competition is not an economic model. Normative-sum competition is not an economic model. Positive-sum competition creates value as its central goal.

19. A nurse economist is explaining the principle of stakeholder cooperation as part of

positive-sum competition to students. The student who understands this concept would paraphrase the concept as: a. encouraging stakeholders to cooperate to allow continuous change. b. giving stakeholders options in design and output of the system. c. many entities working together to satisfy each group’s needs. d. valuing each stakeholder’s N coUnR trS ibI utNioGnTtoBt.hC eO s yMs t em ’s creativity.

ANS: C

The principle of stakeholder cooperation says that over the long run, the interests of each group must be satisfied by the organization, and mutual support from all entities is needed for this to happen. Encouraging stakeholders to cooperate to allow continuous change corresponds to the principle of continuous creation. Giving stakeholders options in design and output of the system more closely relates to the principle of emergent competition. The principle of continuous creation states that entities cooperate with each other to create change and value.

20. A nurse realizes that nurse-run clinics demonstrate increasing economic value in nursing

because they: a. allow these nurses to set their own salaries. b. create value by filling unmet health needs. c. focus on nurses’ economic competitiveness. d. provide new job opportunities for nurses.

ANS: B

Based on the principles of stakeholder cooperation and emergent competition, nurse-run clinics are an example of increased economic value in nursing, because they fill an unmet need. Setting one’s own wage or salary is definitely a perk, but this does not provide evidence of economic value. Economic competitiveness implies winners and losers and does not show system-wide value. Nurse-run clinics are a source of new job opportunities for nursing, but this is not related to demonstrating economic value.

21. A student is discussing the impact of magnet hospitals as an example of positive-sum

competition. The student would best describe magnet hospitals’ contribution to this model as: a. a workplace culture encouraging collegiality balanced with autonomy for best care. b. having a positive-sum revenue stream using technologically advanced practice. c. providing a quantitative analysis of the value of nursing care to stakeholders. d. having the ability to compete within the health care marketplace in a positive manner.

ANS: A

Magnet hospitals are an example of positive-sum competition because their leadership philosophy stresses developing cultures and systems that promote clinical excellence through collegiality, autonomy, and excellent performance. A positive-sum revenue stream is not related to positive-sum competition. Analyses of the value of nursing care are not a component of positive-sum competition. Although it might be true that magnet hospitals contribute to the ability to compete within the health care marketplace in a positive manner, this is a very vague benefit and does not get to the heart of the characteristics making up an organization that values positive-sum competition.

22. An economist explains that consumerism is not a preferred mechanism for the health care

market because of the: a. ethical viewpoint that equal access to health care is a universal human right. b. inability of most people to save for or borrow enough money to pay for care. c. trend for prices of health care goods and services that continue to skyrocket. d. variability in people’s ability to articulate current and future health care needs.

ANS: D

The inability to predict future hNeU alR thScI arN eG neTeB ds., CthOe Mdifficulties undereducated people have in negotiating the complex health care system, and the information imbalance make it very difficult for people to articulate their needs, and consumerism is based on being able to demand when and how people want health care services delivered. People disagree as to whether or not health care is a universal human right, but consumerism says that people should dictate when and how they want health care services, not whether or not it is a right. It is true that people cannot generally save or borrow enough money to pay for expensive health care, but this is not related to consumerism because of the advent of insurance, which guarantees continuing payment for services. Prices and salaries and wages do continue to rise, but this does not explain why consumerism is not a good model for health care.

23. A patient who returns to the emergency department 2 days after being seen is feeling no

better. On assessing the patient, the nurse learns that the antibiotic prescription the patient left with has not been filled. Which question or statement by the nurse would elicit the most information about this situation? a. “I’d like to know why you haven’t gotten that filled.” b. “Is that medicine too expensive for you to get filled?” c. “Please tell me about the type of insurance you have.” d. “Why haven’t you gotten that prescription filled yet?”

ANS: C

In a recent survey sponsored by the Kaiser Family Foundation, 33% reported relying on home remedies and over-the-counter drugs rather than visiting a doctor, and 28% postponed necessary care. Seventeen percent reported experiencing serious financial problems because of family medical bills. Seven percent reported being unable to pay for basic necessities such as food, heat, or housing because of health care costs. Forty percent reported being “very worried” about having to pay more for their health care or health insurance. The nurse should assess insurance status using open-ended statements.

Although the nurse is interested in why the prescription has not been filled, the goal is not to sound accusing. “Is that medicine too expensive for you to get filled?” is a yes/no question that will elicit only a limited amount of information. “Why” questions frequently promote defensive responses and are not the best choice for asking about sensitive information.

24. A nurse is lobbying for a bill to allow more third-party reimbursement for expanded nursing

roles, such as those in retail clinics. To best make the argument for expanded reimbursement, the nurse should provide data on: a. how many other countries have similar reimbursement? b. marketing to increase expanded community nursing roles. c. quality, cost effectiveness, and need for these services. d. patient dissatisfaction with traditional medical practices.

ANS: C

Nurses need to demonstrate the quality, cost effectiveness, and need for services in justifying their current and future roles and benefits of third-party reimbursement for care. Global trends may be of interest, but this would not be the most important information to provide. A marketing plan would not help make the argument for expanding third-party reimbursement.

Patient dissatisfaction with traditional medical practices might be part of the data set, but focusing on this would not be tN heUbReS stImNeG thToB d. o fCdOe M m ons tratin g the need for third-party reimbursement.

25. The Director of Nursing (DON) at a large urban hospital is tasked with increasing the

hospital’s profits and improving quality. What action by the DON is best? a. Engage in monopsony with regional hospitals. b. Hire more nonprofessional ancillary staff. c. Implement policies to prevent hospital-acquired infections. d. Purchase capital budget items only when necessary.

ANS: C

The provisions of the Affordable Care Act encourage quality improvement through the development of reliable quality measurements and enforcing accountability. Specifically, the Act reduces payments to hospitals with 25th percentile or higher rate of hospital-acquired infections. To avoid losing that money and to show quality, the DON would implement policies that are designed to prevent hospital-acquired infections. Monopsony is the practice of hospitals setting nurses’ wages to maximize profits. This does not ensure quality. Hiring more nonprofessional staff may save money but does not improve quality. Purchasing capital budget items only when necessary may be a sound financial strategy but may have a deleterious effect on quality. The only option to both improve profit and quality is to prevent hospital-acquired infections.

MULTIPLE RESPONSE

1. The student studying health care economics knows that this includes: (Select all that apply.) a. capital inputs. b. diagnostic equipment. c. medical supplies. d. patients. e. personnel.

ANS: A, B, C, E

Capital inputs, including items such as hospitals, nursing homes, and medical equipment, are included in health care resources. Diagnostic equipment falls under capital inputs and, as such, is part of health care resources. Medical supplies, such as gloves, linens, and pharmaceuticals, are part of health care resources. Personnel are included as a category within the health care resources. Patients are not included in the list of items in the health care system as defined by economists.

2. A faculty member explains to a class of nursing students that Medicare: (Select all that apply.) a. covers children younger than 18 years of age. b. covers persons older than 65 years of age. c. helps pay for medications. d. includes some chronic disability. e. is a federal insurance program.

ANS: B, D, E

Medicare is for those older than 65 years of age. Medicare Part D does cover prescription drugs, but the supplement must be purchased; it is not automatically included in Medicare coverage. Other populations covered by Medicare include those with selected severe and chronic disabilities. Medicare is administered by the federal government. Medicare is for those older than 65 years of ageN. URSINGTB.COM 3. A nurse working in a retail clinic correctly describes the practice environment as: (Select all

that apply.) a. incorporating retail items. b. limited to wealthier patients. c. located in retail facilities. d. providing limited services. e. staffed by physicians.

ANS: C, D

Retail clinics got their name from the fact that they are located in retail outlets such as drug stores or grocery stores. Retail clinics provide limited acute and preventive services.

Retail clinics are so named because they are located in retail outlets, not because they sell items. Retail clinics are increasingly viewed as a safety net for patients underserved by traditional practices. Retail clinics are staffed by advanced practice nurses or physician assistants.

4. A nurse is evaluating an economic analysis paper. In critiquing the analysis, the nurse should

note whether it: (Select all that apply.) a. considers from whose viewpoint the analysis is being considered. b. demonstrates that the interventions discussed are clinically effective. c. determines whether the analysis was based on a clearly defined question. d. includes a description of the type of analysis performed.

e. evaluates interventions that can be performed in all practice settings.

ANS: A, B, C, D

Determining the viewpoint from which the analysis is written can give information as to possible biases. An analysis of interventions that are not all effective produces a skewed report. To be useful, there has to be a defined and clear clinical question that drove the analysis. To fully critique an analysis, the nurse needs to know the type of analysis performed as well as its appropriateness to this study. To be valid, the interventions have to be sensible and workable in the specific practice setting. Comparing interventions that don’t work across all practice settings would not give the person reading the report useful information about the quality of the report.

5. The student learning about the Affordable Care Act (ACA) understands the three entities that

were created to oversee and evaluate the quality of care and cost of the health care system.

Which entities are involved in this process? (Select all that apply.) a. Center for Medicare and Medicaid Innovation b. Centers for Medicare and Medicaid Services c. Children’s Health Insurance Program d. Patient-Centered Outcomes Research Institute e. The Independent Payment Advisory Board ANS: A, D, E

The ACA established three entities to oversee and evaluate the quality of care and cost of health care. They include the Center for Medicare and Medicaid Innovation, The Patient-Centered Outcomes Research Institute, and the Independent Payment Advisory Board.

The Centers for Medicare and Medicaid Services and the Children’s Health Insurance Program are not included in this list.

6. A student is explaining the Health Insurance Marketplace to a relative. What information does the student provide? (Select all that apply.) a. Available at both the state and federal levels. b. Publishes quality-related data for insurers. c. Provides information on types of insurance available. d. Shows consumers if they are eligible for subsidies. e. Penalties for the noninsured are set by the Centers for Medicare and Medicaid.

ANS: A, B, D

Health exchanges, or the Health Insurance Marketplace, is available at both the state and federal levels, provides consumers with information on insurance options, and allows consumers to determine if they are eligible for subsidies. It does not publish quality data.

Penalties for not being insured are set by the internal revenue service.

Chapter 08: Effective Communication Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. The student learning about therapeutic communication techniques knows that the most

important concept in the definition of communication is: a. exchanging. b. messages. c. receiver. d. sender.

ANS: A

The key word in the definition of communication is “exchanging,” which implies a giver and a receiver and an active process. Messages or signals are ways that information is shared. The receiver is the person who gets the message, but this linear process does not account for the dynamic nature of communication. The sender is the person giving the message, but this linear process does not account for the dynamic nature of communication.

2. Why are communication theories that consider only a linear relationship between the sender

and receiver of messages considered to be too simplistic? a. In relationships of unequal power, linear models do not work well. b. Linear pathways imply both sender and receiver actually participate. c. Linear models do not consider the dynamic interactions of multiple variables. d. There are often more than one sender and more than one receiver.

ANS: C

Communication is a complex process that incorporates multiple variables, including relationships, past experiences, and personalities. These linear models simplify a process that is very complex and makes static a process that is dynamic. Linear models show communication flowing from a sender to a receiver; whether or not both are active participants is not part of the criteria of linear models, although active participation would create better communication. There may be more than one sender and receiver in a communication exchange, but this would make the theory more, not less, complex.

3. A nurse explains to a preceptor student that values clarification helps with intrapersonal

communication because: a. communication is enhanced when it occurs between people with similar values. b. it allows the nurse to separate his or her values from those of the patient. c. it helps the nurse avoid saying things that might offend or anger others. d. understanding values will help prevent communication misunderstandings.

ANS: B

Engaging in values clarification allows the nurse to separate his or her values from those of the patient; this in turn allows the nurse to truly attend to what the patient is saying.

Communication may be more awkward when it is between people of vastly differing value systems, but this would make values clarification more useful and help ease communication tensions. The purpose of values clarification is not to help avoid making offensive statements.

Clarity of the message is what will help avoid misunderstandings.

4. A nurse usually avoids physical contact with patients, but when one is diagnosed with a

terminal disease, the nurse wishes to hug the patient. This contradiction initially confuses the nurse, but a co-worker helps the nurse differentiate the two behavioral responses based on: a. feelings of closeness to this patient. b. the context in which each occurred. c. therapeutic communication techniques. d. values that guided each situation.

ANS: B

Context is the biggest influence on the interpretation of communication, and it means more than the place and time in which communication occurred. The nuances and shared meanings that occur in each situation give rise to individually constructed meanings. In the setting of a new terminal diagnosis, the nurse was aware of contextually driven communication needs and responded by wanting to hug the patient. Nurses do become closer to some patients than to others, but this is a very narrow explanation. Touch is part of therapeutic communication, but this is too narrow an explanation. Values are part of all communication encounters, but this is too narrow to explain the appropriateness of the different responses.

5. A nurse works with victims of sexual abuse. In counseling these individuals, the nurse often

elicits information that surprises the client when it is revealed. The nurse describes this situation to a preceptor student as working in the part of the Johari window that is labeled the pane. a. blind b. hidden c. open d. unknown ANS: D

The unknown pane represents the unconscious element that is not known to either party. This information often is revealed during conversations. The blind pane is the pane of glass that reveals what a person knows about another but is unknown to the self. In the Johari window, the hidden pane is that which is known to the self but not to the other. The open pane is what is visible and known to both the self and to the other.

6. A new nurse is friendly and talkative and often tells her patients about her personal life as a

way to make friends with them. The manager is counseling her because of recent complaints from these patients that she is unprofessional. Which statement by the manager best summarizes the problem? a. “Be careful about sharing information; patients can use it against you.” b. “It is unprofessional to divulge any personal information to your patients.” c. “Personal disclosure can be helpful only if it is in the patient’s best interest.” d. “You are not here to make friends with patients; you are a professional nurse.”

ANS: C

Personal information can be shared with patients, but remember that the focus of all professional interactions is the patient; share only that which will be beneficial to the patient.

It might be unprofessional to divulge personal information with patients in some cases, but this is not the reason to be cautious about sharing personal information. Selective sharing of personal information can help the nurse and patient bond and might give patients information that helps them resolve an issue. Telling the nurse that he or she is not here to make friends is a very cold response and does not get to the heart of the problem.

7. A seasoned nurse and a student are completing an admission history with a patient. On

leaving the room and discussing their findings, the novice nurse is stunned that what the seasoned nurse learned about the patient seems so different from what he or she took from the interview. What explanation by the seasoned nurse best illustrates the dynamics of this interaction? a. Experience facilitates selective attention and helps create reality for seasoned nurses. b. Nurses working on one floor see similar patients and learn how to focus the questions. c. The novice nurse simply does not know the most important questions to ask patients. d. The novice nurse was focusing on asking all the questions on the admission database.

ANS: A

Experience teaches the nurse how to selectively pick out the most important messages, and habituation helps block out irrelevant messages. People are able to make sense of the messages they receive, in part, because of their past experience such that present reality is tied to these past experiences. The novice nurse has not yet been able to develop the skills of selective attention and habituation in a health care setting and has little experience to shape his or her understandings. With a specific population, the nurse might be able to focus questions in this manner, but working on one floor consistently does not adequately explain the interaction. The novice nurse may not yet be able to differentiate between important and not-so-important questions, but this explanation is too narrow to fully describe the interaction.

Novices do focus on procedures and steps to complete, but this explanation is too narrow to fully explain the interaction.

8. An experienced nurse is telling a recent graduate nurse that engaging in active listening with

patients can be very tiring because: a. developing the skills needed for active listening takes time and effort. b. it is difficult to stay quiet and let the patients do all the talking. c. it requires actively examining the content of what the patient says. d. more time is required to engage in active listening with patients.

ANS: C

Active listening is an active, not a passive, process and involves working to understand the words and the meanings behind what the patient is saying. It does take some effort to develop this skill, but this is not the best explanation of the issue. It is difficult for some people to use silence in conversation, but this is not the reason active listening can be tiring. It is debatable whether more time is required to engage in active listening with patients.

9. A nurse wishes to have the patient reflect on what the patient has just said. To allow this to

happen, the nurse should: a. ask the patient to reflect on what was just said. b. clarify the meaning of the words with the patient. c. repeat what was said and ask what was meant. d. stay silent until the patient begins to talk again.

ANS: D

Silence is an important therapeutic communication technique because it allows time for both the patient and the nurse to reflect on what has been said. This might work with some patients who understand what is being asked of them, but it is not the best answer. Making sure the nurse understands exactly what the patient means is important, but it will not encourage the patient to reflect. Repeating what was said and asking what was meant will not aid the patient in reflection.

10. A nurse talking with a patient about a new diagnosis of advanced cancer wishes to encourage

the patient to continue speaking without asking direct questions. The patient has not decided whether to have treatment or go on hospice. Which statement by the nurse would best accomplish this goal? a. “My brother had the same thing, and he did well with treatment.” b. “So you are not sure if you want to try the treatment or not.” c. “Tell me more about what you are thinking about your options.” d. “Uh huh, I see you are having a conflict about having treatment.”

ANS: B

In restatement, the nurse repeats what the patient just said, either verbatim or paraphrased.

The goal is to let the patient know the nurse is listening and to encourage elaboration. Telling the patient about a family member’s experience with cancer is an example of inappropriate self-disclosure and might make the patient feel as if his or her own feelings were not as important. Asking the patient to further explain what has just been said is an example of clarification, which helps ensure the message received is the one that was sent. Although useful, this is not the best choice in this situation. “Uh huh, I see you are having a conflict about having treatment” sounds patronizing and would most likely make the patient feel as if he or she is not really being listened to because the nurse is deciding what the patient meant.

11. A patient has just made some statements that seem vague and ambiguous to the nurse. The

best statement by the nurse after the patient finishes speaking would be, a. “Are you afraid these tests will bring results that will upset you?” b. “I’d like to understand more about what happened earlier today.” c. “Why do you think this happened to you today instead of earlier?” d. “You said earlier that you were upset by the physician on rounds.”

ANS: B

Saying “I’d like to understand more . . .” shows clarification, a technique used when a patient makes vague statements or after the patient finishes a train of thought. Asking whether the patient is afraid to get test results would be an example of reflection, a technique used when a patient does not state his or her underlying feelings. This would not be the best choice in this particular situation. This “why” question is probing and might well put the patient on the defensive, especially if the patient does not understand the feelings behind what is being said.

“You said earlier that you were upset by the physician on rounds” is an example of restatement.

12. A nurse is discussing an emotional topic with a patient and wants the patient to continue

talking but would also like to convey encouragement. Which action by the nurse would best accomplish this? a. Lean back and keep eye contact. b. Nod his or her head and say, “Uh huh.” c. Repeat what the patient just said.

d. Say, “I’d like to hear more, please.”

ANS: B

Nodding the head, making brief positive vocalizations such as “uh huh,” or giving short leads such as “go on” are called minimal cues and leads. This and the use of touch show the patient that the nurse is listening and encourage the patient to keep talking. Maintaining eye contact is a good idea, but leaning back in the chair will convey distance. Repeating what the patient just said would not encourage continued talking; rather, it would be seen as a break in the train of thought. Saying, “I’d like to hear more, please” would take longer than necessary and might break the patient’s train of thought and end the conversation prematurely.

13. A nurse serves as a preceptor to a new graduate who is taking an admission database from a

new patient. Afterward, the preceptor critiques the new graduate’s use of “why” questions, stating, a. “Avoid using ‘why’ questions because they make people defensive.” b. “Good job. Your ‘why’ questions were focused and right to the point.” c. “Nice work. Your ‘why’ questions were clear and very understandable.” d. “Try using other kinds of questions because ‘why’ questions get monotonous.”

ANS: A

“Why” questions are not useful because they ask people to explain things. The person might not understand the rationale behind this and may become defensive. The questions might have been focused, but “why” questions are not considered a good communication technique. The questions may have been clear and understandable, but “why” questions are not considered a good technique; they can put people on the defensive. “Try using other kinds of questions because they get monotonous” would not be a relevant critique of “why” questions.

GTerBge.nCc yOdMe p a rt m ent about injuries the nurse thinks 14. A nurse is interviewing a wo maNnUiR n St hIe Nem might have been caused by domestic violence. The woman seems hesitant to discuss her injuries. Which action by the nurse would most likely result in improved communication? a. Ask the woman why she does not want to discuss the injuries. b. Close the door and assure the woman of confidentiality. c. Maintain eye contact while jotting down only brief notes. d. Sit close, lean in to the woman, and use touch liberally.

ANS: B

Being in a busy location may make the woman fear being overheard, and assurances of confidentiality will encourage her to talk about this sensitive subject. “Why” questions tend to place people on the defensive and are seen as a barrier to effective communication.

Maintaining eye contact, if culturally appropriate, is a good idea, but is probably not enough to get this woman to elaborate on her injuries. Writing only brief notes is not a good idea for complete documentation. Sitting close may violate this patient’s personal space. Although leaning in conveys interest, touch should be used judiciously.

15. A new graduate nurse is concerned about the ability to communicate effectively with patients

and families. An experienced nurse explains to the new nurse that a good rule of thumb is for the new nurse to: a. avoid using silence until comfortable with patients. b. find and use metaphors that are easily understood. c. mirror patients in actions and depth of conversation. d. use personal stories to encourage bonding with patients.

ANS: C

Mirroring the patient allows the patient to direct the interaction. Follow the patient’s leads.

Nurses are often uncomfortable with silence, but it is an important therapeutic communication technique and should be used. Practice will make the nurse more comfortable with it.

Metaphors can be useful devices but are also often overdone. Personal stories can be a valuable means of opening up conversations, but the nurse must not overuse them and should not share information that has not been resolved.

16. The nurse knows that reframing is a useful technique when the patient: a. cannot articulate fears embedded in the conversation. b. is confused and unable to articulate his or her concerns. c. pauses the conversation, letting the nurse summarize. d. uses absolutely concrete verbiage such as “never.”

ANS: D

When patients use such black-and-white words as “always” or “never,” reframing helps them put things into perspective. When a patient cannot articulate fears, reflection is an appropriate technique. When a patient is confused and unable to articulate concerns, clarification may be useful, with the nurse validating what the patient is trying to say. When a patient pauses the conversation, summarization is beneficial to provide a short synopsis of the conversation so that both parties can review it.

17. A faculty member explains to the class that during the working phase of a therapeutic

relationship, the nurse: a. follows the patient’s lead on what topics need exploration. b. needs to establish trust through honesty and commitment. c. reflects on the professional NroUleRaSnI d NitG sT reB sp.oC nsOibMilities. d. reviews the patient’s status, setting goals for the interaction.

ANS: A

During the working phase, as the interaction becomes more focused and intense for both the patient and nurse, the nurse needs to mirror the patient closely and to pursue the topics the patient deems important and that the patient seems ready to work on. Establishing trust is part of the orientation phase. Reflecting on the professional role is part of the orientation phase.

Reviewing the patient’s status is part of the orientation phase.

18. A nurse and client have been working together for many months, and all goals for their

relationship have been met. The nurse notes that the client has cancelled two appointments in a row. In assessing this situation, which statement by the nurse would gather the most important information? a. “I see you keep cancelling appointments. Is this time inconvenient?” b. “I’d like to know what you think will happen when you stop seeing me.” c. “Why do you feel uncomfortable talking to me after all this time?” d. “Would you please explain to me why you keep cancelling appointments?”

ANS: B

The termination phase of a working relationship might cause stress, and clients might exhibit behaviors such as anger or even cancelling appointments. The nurse’s role is to help the client understand the meaning behind these actions. Asking about one rather superficial issue (appointment times) does not show the client that the nurse is really interested in the client. By guessing at the reason for the client’s action (assuming the appointment times are inconvenient), the nurse is limiting the chance for a meaningful interaction. “Why” questions are generally not a good idea; they tend to put people on the defensive. Asking for an explanation for cancelled appointments sounds patronizing and authoritarian.

19. A manager is concerned about the level of gossip and “grapevine” communication on the unit.

A management consultant explains to the manager that the “grapevine” often occurs when: a. little communication comes from management. b. management is not trusted to divulge information. c. regular communication is too slow or irregular. d. workers feel uncertain or worried about changes.

ANS: D

Grapevines provide a valued source of information when employees feel threatened, insecure, or are facing organizational changes. Lack of communication is not one of the core reasons grapevines come into being. Distrust of management is not one of the core reasons grapevines exist. Slow or irregular communication is not one of the causative factors for the “grapevine.”

20. A nursing manager is frustrated by a committee that consistently fails to meet goals and

generally demonstrates a lack of progress or results. The manager can conclude that: a. established policies and procedures might be inhibiting productivity. b. self-serving behaviors outweigh the task behaviors in the group. c. the committee’s goals are vN agUuReSanIdNtG heTcBo. mCmOitM tee lacks direction. d. the leadership within the group is not skilled at group management.

ANS: B

Groups encounter task behaviors, maintenance behaviors, and self-serving behaviors.

Whereas the task behaviors push the group toward goal attainment, self-serving behaviors inhibit group work. The manager can conclude that the members in this group exhibit more self-serving behaviors. It is possible that established policies and procedures might be inhibiting productivity, but this is too narrow an answer to explain the situation without further information. Vague goals and lack of direction may be a factor, but without further exploration, this is not the best choice. The leadership within the group may not be skilled at group management, but this conclusion needs further exploration.

21. A nurse manager is briefed by hospital administration about a new nursing expectation. The

manager educates the nursing staff on the unit about the new policies. The student studying communication understands this as what type of communication? a. Downward b. Horizontal c. Intraprofessional d. Vertical ANS: A

Downward communication occurs from those in higher level positions to those in lower level positions, often in the form of commands. Horizontal communication often occurs among peers in working groups. Intraprofessional communication would occur between members of different professions. Vertical communication can be part of both formal and informal processes.

22. The director of nursing (DON) of a hospital is concerned about communication problems

among different professionals that seem to lead to patient care problems. What action by the DON would be most appropriate? a. Call a meeting of the managers from all the professional areas. b. Develop a task force to encourage better communication. c. Host informal sessions where professionals can clarify their roles. d. Institute formal communication channels between groups.

ANS: C

Lack of interprofessional understanding is cited as a significant impediment to communication. The DON can best approach this by hosting sessions in which different professional clarify their roles within the health care system. Calling a meeting of managers may or may not produce beneficial results. “Developing better communication” is vague.

Formal communication channels are not likely to reduce the lack of intraprofessional understanding.

MULTIPLE RESPONSE 1. The nursing student correctly tells a friend that communication occurs in several interrelated

spheres, including the: (Select all that apply.) a. hierarchical. b. interpersonal. c. intrapersonal. d. organizational. e. small group.

ANS: B, C, D, E

The second level of communication is known as the interpersonal level. Communication starts in the intrapersonal sphere. Organizational communication occurs within and between organizations. Small group communication occurs in both formal and informal groups.

Communication does not include a hierarchical level.

2. A new nurse wishes to show concern and caring by using touch and seeks advice on the most

appropriate ways of doing so. An experienced nurse explains that: (Select all that apply.) a. because of negative experiences, some patients do not want to be touched. b. nurses should be cautious about touching a patient of the opposite sex. c. patients’ culture can strongly influence a nurse’s ability to use touch. d. the nurse should assess whether touch is acceptable to patients or not. e. touch can be used in the absence of any other communication technique.

ANS: A, C, D

Nurses should assess whether any past experiences make a patient uncomfortable with touch.

Cultural differences may mandate whether touch is acceptable or not. The nurse should always assess whether touch would be welcomed by the patient. The gender of the nurse or patient is not generally an issue with using therapeutic touch. The use of touch is part of a repertoire of therapeutic communication techniques and should be used sometimes; in other situations, other techniques should be used.

3. The nursing student knows that examples of important nonverbal communication include:

(Select all that apply.) a. eye contact. b. facial expressions. c. hand and arm gestures. d. touch. e. use of personal space.

ANS: A, B, C, E

Eye contact is one form of nonverbal communication. Facial expressions are considered a form of nonverbal communication. Gestures are a type of nonverbal communication. The use of personal space is also a type of nonverbal communication. Touch is a therapeutic communication technique of its own and is not considered a nonverbal communication.

4. The student studying group processes learns about the four phases of groups, which include:

(Select all that apply.) a. forming. b. norming. c. organizing. d. storming. e. working.

ANS: A, B, D

The phases in the group process include forming, storming, norming, performing, and adjourning. Organizing and working are not phases in the group process.

Chapter 09: Think Like a Nurse: Essential Thinking Skills for Professional Nurses Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. A faculty member explains to a class of nursing students that the primary goal of critical

thinking in clinical practice is to: a. compete with other health professionals. b. create diverse theories of nursing practice. c. determine an effective course of action. d. judge the relative value of chosen actions.

ANS: C

Critical thinking in nursing is used to make sound clinical judgments and, after considering all plausible alternatives, to determine course of action most likely to be effective. Critical thinking aids the patient, whether that patient (client) is a person, a family, or a group. It is used to meet the patient’s needs, not to compete with other health care professionals. Critical thinking may be used when theorists examine the components of a theory in progress, but this is not the primary goal. Judging the value of actions, or evaluation, is part of the critical thinking process, but this is not the goal.

2. The nursing student knows that critical thinking is: a. an innate trait, not a learned skill. b. applicable only to nursing care. c. generalizable across professions. d. only needed for certain posN itiUoR n sS. ANS: C

The goals of critical thinking are unique to nursing, but the process can be applied to many disciplines and professions. Critical thinking is a skill requiring certain knowledge and practice. Although some people may be naturally better at it than others, all nurses can and should learn to use critical thinking in practice. The goals of critical thinking are unique to nursing, but the process can be applied to many disciplines and professions. All nurses need to use critical thinking skills in every position.

3. A nurse studying critical thinking theories can generalize the process as: a. a reflective process of gathering and evaluating data to choose a course of action. b. one conceptual mechanism for critiquing ideas and establishing goal-oriented care. c. researching best-practice literature to create care pathways for certain populations. d. using the nursing process to design individualized and specific nursing care plans.

ANS: A

Looking across theories and definitions of critical thinking, they all have in common the ability to reflect on data and choose actions. Reflection also considers evaluating the result of the actions to determine whether they were effective. Although critiquing ideas and establishing goal-oriented care could be considered as part of a generalized statement of critical thinking, this is not broad enough without the reflection and evaluation. Critical thinking would most likely be used to create care paths derived from best-care literature, but this is not a generalized statement covering all definitions and theories of critical thinking.

Critical thinking is used when engaging in the nursing process, but this is too narrow in focus to capture the essence of critical thinking definitions and theories. Critical thinking is not synonymous with the nursing process.

4. A student nurse asks how the nursing process is different from critical thinking. The best reply

by the faculty member is that the nursing process is: a. a tool for applying critical thinking to patient care. b. merely the way nurses articulate patient care needs. c. the only way to use critical thinking for best outcomes. d. the same thing as critical thinking divided into steps.

ANS: A

The nursing process is the tool nurses use to operationalize their critical thinking judgments about patient care. Saying that the nursing process is merely the way nurses articulate patient care needs does not differentiate between the two concepts, nor does it show any relationship between them. Critical thinking can be used in many different ways, including systematically and without the use of the nursing process. Nursing process and critical thinking, although related, are not synonymous.

5. When the nurse is assessing a pNaU tieRnS t,IthNeGbT esBt . acCtiO onMby the nurse is to: a. focus on assessment data collected with the five senses. b. not rely on information from friends, who may be wrong. c. use both primary and secondary sources of information. d. use secondary sources to determine assessment priorities.

ANS: C

To collect a complete database, the nurse needs to use both primary and secondary sources of information. Physical assessment data are collected through the nurse’s five senses, but limiting data to this severely restricts the database. Significant others, including friends and family, are important secondary sources of information about the patient. Neither primary nor secondary sources of data should be considered solely to guide further assessments. They are both valuable sources of complete information about the patient.

6. A new graduate nurse is working with an experienced nurse to chart assessment findings. The

experienced nurse warns that charting assessment data can be difficult. The best explanation for this statement is that assessment data: a. can sometimes be charted in a biased manner. b. change as the patient’s condition changes. c. are usually difficult to obtain from the patient. d. can be time consuming and tedious to chart.

ANS: A

It is important that the nurse records only what is assessed without adding judgments or interpretations to the record. Data do indeed change (and need to be charted) as the patient’s condition changes, but this would not be the best answer to this question. Assessment data may at times be difficult to obtain, but that would not occur often enough to warrant a warning about the difficulty in charting it. Also, obtaining data is a clearly different activity than charting it. Charting can be time consuming and tedious, but this is not the most complete answer to this question.

7. A patient has been admitted for a complex operation that will require complicated home care,

including dressing changes. The primary nurse should begin the process of teaching and discharge planning: a. after the operation and the patient is awake. b. upon admission along with the initial assessment. c. the day before the patient is to be discharged. d. when narcotics are no longer needed routinely.

ANS: B

Initial discharge planning begins upon admission. The assessment phase is a time to establish the nurse-client and nurse-family relationships and begin the discharge planning process.

After the operation has been completed is too late to begin the discharge planning process.

The day before discharge is too late for the nurse to gather all pertinent information and begin teaching and coordinating resources. After a complicated operation, the patient may well be discharged on narcotic analgesics. Waiting for the patient to not need them anymore might mean the patient gets discharged without teaching being done.

8. When applying the nursing process to patients, the nurse knows that the goal of data analysis

is:

a. b. c. d.

to decide when new assessments should occur. to ensure that enough data have been collected. the creation of appropriate nursing diagnoses. to discovery disparities in the collected data.

ANS: C

Data analysis is used to formulate sound nursing diagnoses. Assessment should be an ongoing process. Ensuring adequate data collection is a good practice, but that is not the goal of analysis. Analyzing data can reveal discrepancies in the data set, but that is not the goal of analysis.

9. A nurse has designed an individualized nursing care plan for a patient, but the patient is not

meeting the goals. Further assessment reveals that the patient is not following through on many items. Which action by the nurse would be best for determining the cause of the problem? a. Assess whether the actions were too hard for the patient. b. Determine whether the patient agrees with the care plan. c. Question the patient’s reasons for not following through. d. Reevaluate data to ensure the diagnoses are sound.

ANS: B

Having patient or family input to the care plan is vital in order to gain support for the plan of action. The actions may have been too difficult for the patient, but this is a very narrow item to focus on. The nurse might want to find out the rationale for the patient not following through, but instead of directly questioning the patient, which can sound accusatory, it would be best to offer some possible motives. Reevaluation should be an ongoing process, but the more likely cause of the patient’s failure to follow through is that the patient did not participate in making the plan of care.

10. A preceptor nurse is critiquing the student nurse’s outcome statements on a patient’s care

plan. The preceptor tells the student the most well-written outcome statement is “The patient will: a. ambulate 50 feet with walker by Tuesday.” b. dress self with correct assistive devices.” c. eat majority of meals by 3:00 PM.” d. give self-insulin injections as instructed.”

ANS: A

To ambulate 50 feet with a walker by Tuesday is a patient-centered, specific, realistic, and measurable goal, and it includes a time frame. It is the most well-written goal statement listed.

“Dress self with correct assistive devices” is not specific (what assistive devices? dress what part of self?). Also, it does not have a time frame. “Majority of meals” is not measurable (what portion 75% or 90%?). “Give self-insulin injections as instructed” does not indicate a time frame.

11. A patient has not met goals on the care plan. The nurse assesses that the patient is in full

agreement with the plan and has the motivation to carry it out. The diagnoses are supported by data, and the outcome st atemenNtsUaRreSw IeNllGwTrBitt.enC. OTMhe nurse concludes that: a. delegated activities were not done correctly. b. the interventions did not help meet the goal. c. the patient is incapable of meeting the goal. d. there was not enough time for goals to be met.

ANS: B

Each outcome toward attaining a goal should have accompanying interventions that are based on scientific rationale and that are aimed at helping the patient meet the goal. If appropriate outcomes are not met, then the nurse must look to the interventions to ascertain whether they were appropriate to meet the outcome(s) and the overall goal. It is certainly possible that delegated activities were not done or were done incorrectly, but this probably would not apply to every activity on the care plan directed toward meeting a certain goal. Accurate assessment and input from the patient should have prevented the nurse from establishing outcomes the patient could not meet. Good care planning takes into account the patient’s unique personal attributes and the characteristics of the health alteration to formulate outcomes with a reasonable time frame. Inadequate time would not be the most likely cause of the failure.

12. A recent graduate nurse charts the following entry: “1200: Ambulated patient 25 feet with

walker.” The preceptor nurse critiques the entry. Which statement by the preceptor nurse is most accurate? “This charting: a. has missing data you must incorporate.” b. is accurate and timely—very well done.” c. needs to say whether the patient did well or not.”

d. should include the patient’s response.”

ANS: D

The chart entry needs to include the specific response of the patient to the intervention.

Something is missing, but this option is vague and not the best choice. The chart entry is not accurate. The charting does need to show how the patient responded, but nurses should avoid subjective words such as “well,” “fair,” or “poorly,” so this answer is not the best choice.

13. The student nurse learning to write nursing care plans learns that evaluation: a. happens at the end of an episode of care. b. is valuable when the patient has met goals. c. occurs at each step of the nursing process. d. should occur every few days on a schedule.

ANS: C

Evaluation should occur at each step of the nursing process to ensure that appropriate actions were taken. It may be done to judge whether assessment data were accurate or whether planned interventions were effective. An evaluation should occur at the end of an episode of care, but this is not the only time it should occur; thus, this is not the best answer. Evaluation after the patient has met goals does not really help the nursing process for that patient.

Evaluation should occur more frequently than every few days; it should also occur on a less rigid schedule.

14. The nursing student understands that being willing to listen and examine all ideas, even if they

cause a negative reaction when considering them, describes the critical thinking characteristic is known as intellectual: a. autonomy. b. courage. c. humility. d. integrity.

ANS: B

Intellectual courage is a willingness to listen and examine all ideas, including those that trigger a negative response. Intellectual autonomy means having rational control of one’s beliefs, values, and inferences. Intellectual humility is an awareness of the limits of one’s knowledge and sensitivity to the possibility of self-deception. Intellectual integrity is the application of rigorous and consistent standards of evidence and the admission of errors when they occur.

15. A new nurse is always asking questions, even when there does not seem to be a problem,

much to the annoyance of some of the new nurse’s co-workers. The nurse manager’s best response to this situation is to: a. explain to co-workers this is a characteristic of critical thinking. b. suggest the nurse work more closely with a preceptor. c. talk with the nurse and suggest asking fewer questions. d. tell the staff that all new nurses go through this phase.

ANS: A

Inquisitiveness is a characteristic of critical thinking and reflects a desire to learn even when the knowledge may not appear readily useful. The manager should promote this. Suggesting the nurse work more closely with a preceptor implies that the manager thinks that the nurse needs to learn more and increase confidence. In reality, this nurse is demonstrating a characteristic of critical thinking. Suggesting that the nurse ask fewer questions would hamper the development of the nurse as a critical thinker. All new nurses do go through a phase of asking more questions at one time, but dismissing the nurse’s behavior with this explanation is simplistic and will discourage critical thinking.

16. A unit has a continuous problem with a certain complication in a specific patient population.

One nurse has read extensively about this issue and thinks the problem lies mainly in the unit’s failure to follow one or two particular best practices because they use a standardized order set preferred by their physician group. Using the disposition of critical thinking known as analyticity, the best action for this nurse to take is to: a. get support from other staff nurses and collectively stop implementing specific orders. b. go directly to the physician group’s weekly meeting, asking them to change the orders. c. show evidence to unit management and ask for help in speaking with the physicians. d. take the issue to the hospital’s policy and procedures committee, asking for a review.

ANS: C

When using the characteristic of analyticity, the nurse uses reasoning and evidence to solve problems but also is able to anticipate difficulties. In this case, getting the manager “on board” is a great first step. By an t i c i p aNt i nUgRpSoIs sNi bGl eTrBes.i sCt aOnM c e from the physicians, the nurse gets assistance in the best way to approach them so that his or her message is most likely to be heard. To collectively stop implementing specific orders would tend to alienate the physicians and is not a good example of professional communication or collaboration. Going directly to the physician group’s meeting and asking them to change the orders might work, but more likely, it would have the effect of alienating the physicians. If that occurred, the end result would not be beneficial to patients. A policy and procedures committee is a valuable resource in hospitals (and in other settings as well), but going directly to them without speaking to the physicians first might well antagonize them.

17. A nurse is thought of as being difficult to work with because of the attitude that his answers

are always correct (even in differing situations) and that no other options can work. The nurse manager should counsel this nurse on developing the critical thinking disposition of: a. maturity. b. open-mindedness. c. self-confidence. d. systematicity.

ANS: A

Maturity means judicious decision making in light of understanding that some situations will have several different options and that judgments need to be made in light of professional standards and individual contexts. This nurse does not display this disposition.

Open-mindedness is the disposition that allows people to realize their opinions may be biased and to be tolerant of divergent views. Self-confidence is trust in one’s own reasoning and decision-making processes and the ability to take a leadership stand in resolving problems.

Systematicity is an orderly approach toward inquiry.

18. A nurse has committed a serious medication error. The manager is a firm believer in

developing critical thinking skills. From this standpoint, what action by the manager would best nurture this ability in the nurse who made the error? a. Have the nurse present an in-service related to the cause of the error. b. Instruct the nurse to write a paper on how to avoid this type of error. c. Let the nurse work with more experienced nurses when giving medications. d. Send the nurse to refresher courses on medication administration.

ANS: A

Nurturing critical thinking skills is done in part by turning errors into learning opportunities. If the nurse presents an in-service on the cause and prevention of the type of error committed, not only will the nurse learn something, but also many others nurses on the unit will learn from it to. This is the best example of developing critical thinking skills. This option would allow the nurse to learn from the mistake, which is a method of developing critical thinking skills, but the paper would benefit only the nurse, so this option is not the best choice. Letting the nurse work with more experienced nurses might be a good option in a very limited setting, for example, if the nurse is relatively new and the manager discovers a deficiency in the nurse’s orientation or training on giving medications in that system. Otherwise, this option would not really be beneficial.NS eUnRd S i nIg Nt hGe Tn B u r.s eCtOo Mr e f r e s h e r courses might be a solution, but it is directed at the nurse’s learning, not critical thinking. The nurse might feel resentful at having to attend such classes, but even if they were helpful, only this one nurse is learning.

Going to generic classes also does not address the specific reason this error occurred and thus might be irrelevant. Critical thinking and learning can be enhanced by a presentation to the staff on the causes of the error.

19. Some nursing students are complaining about having to write “so many journals.” Which

statement by the nursing instructor provides the best explanation for this? “Journaling: a. allows reflection, an important critical thinking skill.” b. gives you time to review what happened in your clinical.” c. is a way to organize your thoughts about your experiences.” d. teaches open-mindedness, a critical thinking disposition.”

ANS: A

Critical thinking requires reflection on what occurred, how data were processed, and how decisions were made. Journaling is one method of developing critical thinking skills.

Journaling does give nurses time to review what happened in their clinical, but this statement does not go far enough in explaining the importance of the journal-writing process. Journaling may be a way to organize thoughts about one’s experiences, but this statement is too narrow an explanation and does not account for the critical aspect of reflection. Open-mindedness is a critical thinking disposition that allows one to be tolerant of divergent views. Journaling can assist with developing this disposition but only if what is written reflects that specific topic.

20. A student is confused about the need to answer questions in a clinical journal about what

happened during the day that could have been handled differently and what the possible outcomes might have been. The nursing instructor explains that this kind of questioning: a. allows students to contemplate theoretical possibilities in clinical. b. focuses on the need for interdisciplinary collaboration and the skills required for this. c. helps cement in students’ minds that the actions they took were best. d. provides a chance to understand assumptions that guided their actions.

ANS: D

To use critical thinking skills effectively, one must dig deeper than the surface attributes of a given situation and examine the assumptions held that led to certain actions. In patient care settings, these assumptions may be right or they may be erroneous, and actions taken as a result will have corresponding results. A discussion of possible actions in clinical could include a review of the theories behind possible actions, but it does not necessarily include this aspect. If the student writes specifically about a clinical situation that includes interdisciplinary collaboration, then this statement could be correct, but not all journal entries will include this activity. If students had several options and the chosen course of action was a good one, journaling about the experience could “cement” the action in the students’ minds as appropriate, which would be good if they realized that all actions need to be context driven, and what worked in this situation might not be beneficial in another setting. Regardless, this is not the best choice.

21. An experienced nurse explains to a nursing student that validating, organizing, and

categorizing data are critical thinking processes most correlated with the nursing process step of: a. analysis. b. assessment. c. implementation. d. planning.

ANS: B

These are critical thinking skills used during the assessment step of the nursing process.

Critical thinking skills related to analysis include making inferences, stating the problem, and suspending judgment, among others. The implementation step of the nursing process includes such skills as applying knowledge and testing hypotheses. The planning step of the nursing process includes generalizing, transferring knowledge from one situation to another, and developing evaluative criteria, among others.

MULTIPLE RESPONSE 1. A nurse assessing a patient knows that secondary sources of information include: (Select all

that apply.) a. data from other professionals. b. information from the patient. c. physical assessment findings. d. significant others and friends. e. written records about the patient.

ANS: A, D, E

Secondary sources include written records, other health care providers, and significant others.

Information from the patient would be a primary source of data. Physical assessment findings would be a primary source of data.

2. A nurse wishes to obtain data about a new patient’s self-esteem. To gain the clearest picture,

the nurse uses the assessment technique of: (Select all that apply.) a. asking about the patient’s perception of self-esteem. b. completing an entire head-to-toe assessment first. c. conducting a structured interview with direct questions. d. interviewing the patient in an unstructured format. e. observing for relevant verbal and nonverbal clues.

ANS: D, E

An unstructured interview format allows the nurse to establish rapport and get insight into the patient’s perspective. Combined with observation, this would yield the best information.

Observation often results in gathering a depth of data that is difficult to gain by other methods.

Combined with an unstructured interview to gain the patient’s trust, this technique would be very valuable. A head-to-toe assessment would not yield information about self-esteem. A structured interview is often used to gather specific information, but because this nurse has not yet had time to develop rapport, focusing questions on a sensitive issue such as self-esteem would probably not elicit accurate information. Also, structured interviews are most often used in emergency situations, and this does not qualify as an emergency.

3. The faculty member teaches nursing students that a nursing diagnosis: (Select all that apply.) a. can be treated with nurse-prescribed activities. b. describes human responses to health events. c. leads to actions that are desN igUnR edStI oN cuGrT e. d. reflects actual or potential health problems. e. revolves around pathophysiological problems.

ANS: A, B, D

The diagnosis paves the way for selecting an outcome and interventions. The interventions are independent nursing actions, or nurse-prescribed actions. A nursing diagnosis describes the human response to an illness or life event. Diagnoses can be either actual or “risk for,” which reflect potential health problems. A medical diagnosis leads to actions that are designed to cure. A diagnosis that has a pathophysiological base is a medical diagnosis, focused on a specific illness.

4. A practicing nurse uses the Universal Intellectual Standards when providing care. Which

standards do these include? (Select all that apply.) a. Accuracy b. Clarity c. Confidence d. Humility e. Precision ANS: A, B, C

The Universal Intellectual Standards include accuracy, clarity, precision, relevance, depth, breadth, logic, and fairness. Confidence and humility are not included.

5. A nurse readily admits errors when they occur and is aware of the limits of his knowledge in

practice. The nurse’s manager would evaluate that this nurse demonstrates which traits of mind of a critical thinker? (Select all that apply.) a. Confidence in reason b. Fair-mindedness c. Intellectual courage d. Intellectual humility e. Intellectual integrity ANS: D, E

Intellectual humility is the awareness of the limits of one’s knowledge and sensitivity to the possibility of self-deception. Intellectual integrity is the application of rigorous and consistent standards of evidence and the admission of errors when they occur. Confidence in reason is the confidence in one’s ability to think fairly. Fair-mindedness is a consciousness of the need to treat all viewpoints alike, without reference to one’s own feelings or vested interests.

Intellectual courage is a willingness to listen and examine all ideas, including those that trigger a negative reaction.

Chapter 10: Teaching and Learning in the 21st Century Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. A nurse educator recognizes that presenting course content in a logical progression from

simple concepts to more complex ones is a characteristic of a. behaviorist b. change c. cognitive d. humanistic

theories.

ANS: A

Behaviorist theories emphasize learning concepts from simple to complex with minimal learner participation in the learning activity. Change theories posit that learning occurs in ways that are congruent with an individual’s value systems. Cognitive theories state that learners link new knowledge to meaningful knowledge they already possess. Humanistic theories allow learners to set their own goals.

2. A diabetic nurse educator teaches according to the principles of the cone of experience theory.

Which activity planned by this nurse would best demonstrate the concepts in the theory when teaching a patient with diabetes to self-administer insulin injections? a. Demonstrate and then allow plenty of practice and return demonstrations. b. Find out the client’s motivating factors and design rewards that fit these motivators. c. Identify the learning styles N ofUiR ndSivIiN duGaT l cBli.enCtO sM a n d tailor teaching to his or her style. d. Use teaching styles that stimulate all five senses, limiting environmental distractions.

ANS: A

Edgar Dale’s cone of experience theory says that skills are best learned with an initial demonstration followed by lots of practice time and the opportunity for repeat demonstrations.

Finding out the client’s motivating factors and designing rewards that fit these motivators would reflect concepts of change theory. Identify the learning styles of individual clients and tailoring teaching to his or her style would reflect concepts found in cognitive theories. Using teaching styles that stimulate all five senses and limiting environmental distractions would reflect the concepts in cognitive theory.

3. A nursing dean is telling an applicant for a nursing faculty position that the school uses

“learning-centered education” in which students are responsible for active learning and faculty members serve as guides. The potential faculty member labels the style of teaching at this college as based on theories. a. behaviorist b. change c. cognitive d. humanistic ANS: C

Cognitive theories detail active engagement in learning while designing activities that link new knowledge to old. A learning-centered environment would fit this description.

Behaviorist theory includes presenting material from simple to complex with minimal learner engagement. This would be best observed in lectures. Change theories are most often used in patient teaching and include assessing readiness to learn and recognizing that changes must be congruent with the patient’s values. Humanistic theory would encourage students to set their own goals for the learning experience.

4. A faculty member is preparing a class that covers very sophisticated and difficult material.

This faculty member uses the cognitive learning theories predominantly. To use cognitive theory to teach this material, the faculty member would most likely: a. assess students’ knowledge first because they may need to “unlearn” other material. b. assign a case study that requires group collaboration and problem solving. c. prepare a detailed lecture complete with informative slides and handouts. d. require students to read heavily on their own and give minimal information.

ANS: B

Active learning, including having to actively seek information and collaborating with others, is consistent with cognitive learning theories. Having students “unlearn” old knowledge would be consistent with behaviorist theories. Detailed lectures and handouts are most consistently aligned with behaviorist theory. Having students do heavy reading on their own might be part of a cognitive theory–based class, but there is not enough detail about the learning process to make this answer correct.

5. A nurse working with professionals in continuing education understands that the learning

theory that probably will be moNsU t uRsS efI ulNiG nT thB is.joCbOiM s a a. behaviorist b. change c. cognitive d. humanistic

theory.

ANS: D

Humanistic theories are usually most useful for adult learning because the learners tend to be self-motivated, self-directed, and self-evaluated. This nurse will be working with self-motivated adult learners, so behaviorist theory is not a good match. This nurse will be working with self-motivated adult learners, so change theory is not a good match. This nurse will be working with self-motivated adult learners, so cognitive theory is not the best match.

6. A clinical faculty member stresses “see one–do one–teach one” as a teaching methodology.

When asked about this technique, the instructor explains that: a. doing all three things covers several learning styles. b. it gives the students a feeling of mastery of the topic. c. people retain a high percentage of what they teach. d. teaching others helps develop leadership in students.

ANS: C

According to Dale (1969), people will retain about 95% of what they teach. Multiple learning styles do come into play with this methodology, but this is not the best answer. Giving students a “feeling” of mastery is not the focus of teaching; the goal is actual mastery of the subject. Promoting leadership is a good goal, but it is not the reason for this educational technique.

7. According to the cone theory of learning, the least effective method for learning is: a. discussing. b. listening. c. reading. d. writing.

ANS: C

People retain only 10% of what they read, according to this theory. People retain 70% of what they discuss, according to this theory. People retain 20% of what they hear, according to this theory. People retain 60% of what they write, according to this theory.

8. A nursing school wants to invest in expensive simulation equipment. The college president

resists, asking why so much money is needed for a computerized simulation mannequin and programs instead of just having students practice in the skills lab. The best response the nursing dean can offer to justify this expense is: a. “A day doing simulations can substitute for clinical when census is low.” b. “Actively engaging in scenarios will improve students’ ability to learn.” c. “Routinely practicing skills in the lab is helpful but boring to students.” d. “Because other colleges use simulations, we need them to stay competitive.”

ANS: B

Actively engaging in learning aNcU tivRitSieIsNthGroTuBg. h Cs i O mMu l a t i o n s , role-play, or other experiential learning is a more effective way to learn content that requires motor skills. Some courses that typically have an unpredictable patient census (e.g., Obstetrics) often substitute simulations for clinical days, but it is not the best answer because it does not address learning specifically.

Practicing in a traditional skills lab may be boring, but this is not the best reason. Staying competitive with other schools may be important, but this is not the best answer.

9. A nurse has planned a detailed and individualized teaching plan for a patient who had a

double mastectomy. While working with her, the nurse notes that the patient seems distracted and unable to remember what was just taught; also, her skill at changing her dressings is poor.

The nurse is frustrated and consults a colleague, who explains that the most likely reason for this behavior is: a. denial of the need to learn self-care. b. inadequate pain relief or treatment. c. lack of emotional readiness to learn. d. not enough time to perform the skills.

ANS: C

This patient has had emotional upheaval related to a diagnosis of cancer and the loss of both breasts. The most likely cause of her seeming inability to learn is lack of emotional readiness.

The patient may certainly be in denial. This is a very narrow interpretation of lack of emotional readiness, the correct answer. There may be other factors that contribute to lack of emotional readiness besides denial. Pain should be assessed and treated, but this is not the most likely cause. The nurse may be pushing the patient through the skills set too quickly, and this should be assessed, but it is not the most likely reason for the difficulty learning.

10. A nurse has spent time teaching a patient and has provided several pamphlets along with

written discharge orders in anticipation of discharge from the hospital in the morning. The patient appears bored and says, “I can’t find my glasses.” The best action by the nurse is to: a. ask the patient why he or she is bored. b. come back later when the patient is ready. c. inquire gently about reading ability. d. stop teaching and find the patient’s glasses.

ANS: C

A likely explanation for the patient’s behavior is illiteracy. The nurse should gently ask the patient about his or her reading level. A statement such as “Many people find this information difficult to read and understand” can open the door to a discussion about reading ability. As an alternative, the nurse can simply read the information out loud to the patient. Assuming the patient is actually bored might well cause defensiveness. In addition, “why” questions also often put patients on the defensive. If the patient is truly not ready to listen, coming back later might be an option after assessing that this is the case. However, this is not the best answer in this case because it does not address the reason for the lack of readiness. Finding the patient’s glasses is not the best answer; the patient may continue looking bored and find other ways to stall the learning session.

11. A patient needs to make several challenging life changes to cope with a serious chronic

illness. Instead of teaching the patient, the nurse spends time visiting with the patient and inquiring about family life, work, and hobbies. When a new nurse asks the reason for “wasting so much time” with the patient, the first nurse explains, a. “All patients like to feel important and that you are interested in them.” b. “I like to establish rapport first before just jumping in and teaching.” c. “Knowing more about the patient informs me about possible motivators.” d. “When patients view you as friendly, they are more likely to respond.”

ANS: C

Motivation can be a very powerful tool to encourage a patient to make desired behavior changes. For instance, if a patient with a serious chronic illness wants to participate in activities with his or her children, this could serve as a motivation to stay well and out of the hospital, which uses time, money, and other resources that could be instead applied toward the desired activity. The motivation for learning can be powerful and should be harnessed to enhance learning. It may be true that patients like nurses to be interested in them, but this is not related to an educational purpose. Establishing rapport is very important in all nurse-patient relationships, but this is not the best answer for this question. Although it is true that being friendly is more likely to cause patients to respond, this is not the best answer to this question.

12. A patient has been attending an outpatient diabetes education group. On assessing the patient

after several sessions, the nurse determines that the patient’s knowledge is far below what the diabetic educator expects. The patient states, “I can’t stand that group! All that talk mixes me up.” The nurse concludes the most likely reason for this response is that the patient: a. is not an auditory learner and is frustrated. b. should give the group experience more time. c. really does not like the people in the group. d. would respond better to personal discussion.

ANS: A

There are three predominant learning styles: visual, auditory, and tactile/kinesthetic. If discussion is frustrating and confusing, the patient is probably not an auditory learner, and teaching techniques need to be adjusted. The patient has already been to several sessions and remains unhappy with the experience, so giving the group experience more time is not a good choice. Whether or not the patient likes the other people in the group is not highly relevant. It would be more reasonable to assess the patient’s learning style. If the patient is not an auditory learner, even one-on-one discussions will not be the best learning experience. It would be better to reason that the learning style is the issue and conduct further assessments.

13. A nurse is directing a patient to information on the Internet and recommends the site Health

on the Net (HON). The nurse explains that this site: a. evaluates the reliability of Internet health information. b. presents a variety of health care topics written for lay people. c. is a telehealth site with online health care consultations. d. uses a program to determine the reading level of text.

ANS: A

HON is the gold standard site for investigating the reliability of health information found on the Internet. HON does not contain health information of its own but rather evaluates other websites for reliability. HON is not a telehealth site where people can obtain health care consultations. There are computer programs and websites that can determine the reading level of various materials, but HON is not one of them.

14. A nursing faculty member wants to use Internet-based synchronous learning to make up a

class that was missed because of school closure. The instructor would plan to create a(n): a. electronic drop box. b. e-mail discussion. c. slide presentation. d. web conference.

ANS: D

A web conference would be considered a synchronous activity because all participants could log on to and participate in the activity at the same time. An electronic drop box is merely an Internet site where materials (e.g., a Word document) can be deposited. This would be an asynchronous learning activity. E-mail discussion does not occur synchronously, so this would be an asynchronous learning activity. A slide presentation can be uploaded to a specified website, and students can view it at their leisure, which would be an asynchronous activity.

15. The technology-savvy nurse often refers patients to interactive online learning resources for

health care information. What issue does this nurse need to consider as a priority when using this method of instruction? a. Divide between people with technology and those without it. b. Learning style most receptive to using Internet resources. c. Relative lack of information on specific disease topics. d. The types of devices on which patients access these sites.

ANS: A

According to a recent survey, 85% of Americans use the Internet. For whatever reason, 15% do not. The nurse must be cognizant of the divide between these two groups because not everyone even has ready access to the Internet. If patients need to go to a public library or some other public space to access information, this decreases the likelihood of their actually doing so. The other options are items to assess, but they are not nearly as important as ensuring the patients have the ability and resources to use the Internet.

16. A nurse is teaching a patient who is a recent immigrant from an Asian culture. The patient

listens politely to discharge instructions and agrees to follow them. Two days later, the patient is readmitted, and the nurse is surprised to find none of the discharge instructions have been followed. The nurse would most likely conclude the patient: a. did not have the resources to adhere to the directions. b. is noncompliant or he or she would have asked questions. c. lacked enough knowledge to follow through the instructions. d. was too embarrassed to indicate a lack of understanding.

ANS: D

Although individuals within cultures vary widely and nothing should be assumed, people from traditional Asian cultures placeNaUhRigShIvN alG ueToBn.“CsaOvM ing face” and not being embarrassed.

With this patient’s cultural background, the nurse should assess for this possibility. Before doing so, the nurse should probably consult with someone more familiar with the patient’s culture. The nurse should also consider using printed material in the patient’s native language.

The patient’s resources should certainly be assessed, but given the patient’s cultural background, this would not be the most likely cause. Assuming that the patient is noncompliant is a very judgmental view and leaves no room for any explanation other than the patient choosing to not follow through. Insufficient knowledge may have been the cause, despite the teaching. However, given the patient’s cultural background, this is not the most likely cause.

17. A nursing professor has three students from Africa in class. None of them is doing well, but

they rebuff invitations to come to the professor’s office with questions about the material.

What action by the nursing professor would best address this problem? a. Find a mentor from their own culture who can help them be successful. b. Meet with them in a neutral spot and have discussion questions for them. c. Reassure them that the professor is available during office hours for questions. d. Send them to the academic skills specialist in the college for more help.

ANS: B

Although individuals within cultures vary widely and nothing should be assumed, people from traditional African cultures respect authority and may be hesitant to ask questions for fear that it will appear they are challenging the instructor. Meeting the students in a neutral place (not the professor’s office) lessens the power hierarchy. By having discussion questions ready for them, the instructor eliminates this burden from the students. It may be possible to find a mentor from the students’ own culture, but it also may be quite difficult to find someone who is both successful and willing to work with these students. It would also require a great deal of time; thus, it is not the best answer. It is important to let students know when you are available, but this alone will not do much to encourage the students to seek help. Some students may need more intensive help from an academic skills specialist, but simply sending these students to someone else does little to address the possible cultural issues behind the problem.

18. A student nurse is teaching a patient from an unfamiliar culture about diabetic self-care. The

patient is willing and able to take blood glucose readings and give insulin injections but will not use the sliding scale insulin protocol the physician has ordered. Which action by the student would be most beneficial? a. Ask why the patient is unwilling to follow the scale. b. Assess the patient’s health-related value system. c. Call the physician and ask for a simplified regimen. d. Have someone else try to teach the sliding scale.

ANS: B

Because the patient is from an unfamiliar culture, it is possible that health-related values are interfering with the patient’s adaptation of the desired behaviors. In a culture that is fatalistic, the patient may believe he or she does not have the same choices the nurse might have and so cannot make the kind of self-deNteUrm inI atN ioGnTdB ec.isCioOnM s required to use a sliding scale for insulin RS injections. Assessing the patient’s health-related beliefs can shed light on this situation.

Asking “why” questions often puts people on the defensive and may not elicit helpful information. A simplified regimen, in itself, is not what is important. The physician may need to abandon the idea of a sliding scale for this patient, but changes should not be made to the regimen without first gaining more information and assessing how culture is influencing the patient’s actions. Without understanding the patient’s cultural influences, simply having someone else try the teaching will probably not be helpful.

19. A mentor is working with a new faculty member to design learning activities and explains that

using Bloom’s taxonomy is helpful to: a. describe changes in the learner’s biases and values. b. distinguish cognitive levels based on complexity. c. level text material based on year in nursing school. d. organize assessment data into the nursing process.

ANS: B

Cognitive objectives involve the mastery of material along a continuum of complexity.

Bloom’s taxonomy describes this continuum. Describing changes in the learner’s biases and values describes affective objectives. Bloom’s taxonomy is not used to level material across a curriculum. Bloom’s taxonomy is not used to organize data into the nursing process.

20. A faculty mentor is explaining to a new faculty member how to assess affective objectives.

The mentor states that the individual needing to make a health-related behavior change first needs to accomplish: a. accepting. b. receiving. c. responding. d. valuing.

ANS: B

Receiving indicates that the message has been heard and is thus the first-level objective.

Accepting is not one of the affective objectives. Responding occurs after receiving. Valuing occurs after responding.

21. A nurse who runs a pulmonary rehabilitation program wants to incorporate an educational

component designed to facilitate patients’ ownership of their own health. To accomplish this goal, the nurse would most likely create sessions based on: a. individual counseling. b. group discussions. c. lectures. d. role-playing.

ANS: B

Group sessions in which individuals all have a common concern—in this case, pulmonary disease—offer the participants a chance to share information and opinions and provide the best opportunity for people to take responsibility for learning about their health needs.

Counseling and education are not synonymous. Counseling would not necessarily accomplish the goal of teaching material and having patients take responsibility of their health. Lectures NaUteRriSalInNeG are a good format when basic m edTs B to.bCeOpM resented first. This is not the best answer in this situation. Role-playing helps people understand the feelings and reactions to situations.

Because the participants all have the experience in common, this strategy would not best meet the goal.

22. A student is meeting with a faculty member for a midterm clinical evaluation. The faculty

member explains that this type of evaluation is: a. finalized. b. formative. c. professional. d. summative.

ANS: B

This type of evaluation is called formative and occurs while the learning activity is still taking place. Finalized is not one of the three major types of evaluations. Professional is not one of the three major types of evaluations. A summative evaluation occurs after the learning activity has occurred.

23. A faculty member who has substantially changed the way he conducts classes and presents

content now wishes to evaluate the effectiveness of the new strategies. To best meet this goal, the faculty member should plan to: a. ask the students which method of instruction they liked best. b. compare final examination grades for this class and previous classes. c. give pop quizzes periodically throughout the course of the class.

d. have an experienced faculty member conduct a peer evaluation.

ANS: B

Performing a summative evaluation at the end of the semester would allow the faculty member to determine which instructional method might be best. Comparing final examination results would provide this information, although the instructor needs to consider other influencing factors as well. If the faculty member were assessing student satisfaction, this would be a valid answer; however, the faculty member wants to assess learning effectiveness.

Pop quizzes would be a type of formative evaluation, allowing for shifts in teaching style so that students could better meet objectives. A peer evaluation can provide important feedback, but this will not provide definitive information on which teaching method worked best.

24. A faculty member is experienced and has taught the same material successfully for several

semesters. This year’s class is having more difficulty than usual. The faculty member would most likely conclude that: a. admissions standards may have been relaxed recently. b. students are less prepared for college than in the past. c. texts should be updated to reflect enhanced technology. d. unknown barriers exist that are hindering the learning.

ANS: D

Because the teacher is experienced and has been successful in the past, he or she should assess the students for unknown barriers such as stress, lack of time, lack of support, or other personal characteristics of the learners. Even if it were true that admission standards had been relaxed, this would only explain one type of barrier to learning. Before assuming this, further assessment would need to be made. It is possible that current students are less prepared for college than past students, but this is too narrow to be the correct answer. Students who are younger and more capable withNtU ecRhS noIloNgGyTmBa. yCpO reM fer “texts” that are web based or web enhanced, but this in itself would not prevent students from learning.

MULTIPLE RESPONSE 1. A patient has been readmitted to the hospital, and the admitting nurse discovers that the

patient did not follow through with previous discharge instructions. The nurse also discovers that the patient understood the directions and had all the necessary supplies. The nurse would gain the most valuable information by asking the patient about: (Select all that apply.) a. how important the patient thought the self-care was. b. whether the patient felt capable of actually performing self-care. c. whether the patient realizes the consequences of noncompliance. d. whom the patient can call when he or she has questions about care. e. why the patient was unwilling to perform self-care measures.

ANS: A, B

To attain behavior changes, the person being taught must value the information and the behavior change. The person must feel confident in his or her ability to perform the self-care measures; if the person does not believe that he or she has the ability to do the activity, the person may not even attempt it. Using such threatening language as “the consequences of noncompliance” probably would make the patient feel defensive. Although this needs to be assessed (in a more gentle fashion), it is not the priority and can be addressed later. It is important to know what resources, including other people, the patient has available, but this is not likely the most important area to assess. Assuming the patient is unwilling is judgmental; in fact, the patient may have been very willing but felt unable to perform the activity. Other stresses may have interfered as well.

2. A nurse is assessing a patient before developing a teaching plan. What questions or statements

will best obtain data on this patient related to health literacy? (Select all that apply.) a. Have you missed appointments because you misunderstood the instructions? b. How well are you able to read? c. How would you look for information on your diagnosis? d. Tell me how you compare two similar products? e. What would make you go to the emergency department?

ANS: A, C, D, E

Health literacy is not just the ability to read; it also includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor’s directions and consent forms, and the ability to negotiate complex health care systems. Asking questions related to missing appointments, looking for information, comparing products, and making decisions would yield good information on the state of this patient’s health literacy. Reading level is important but is not the best indicator.

3. A nurse has finished teaching a patient about self-management of a new disease just

diagnosed. What statements by the patient indicate to the nurse that the patient’s health literacy may be a barrier to learning? (Select all that apply.) a. “Can you write down the instructions step by step?” b. “I can’t read this brochure you gave me yesterday.” c. “I got admitted because I didn’t know which doctor to call.” d. “These instructions mix me up and frustrate me.” e. “This new medication is too expensive for me to take.”

ANS: A, C, D

Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor’s directions and consent forms, and the ability to negotiate complex health care systems. Needing instructions written down step by step, not knowing what health care provider to call, and getting mixed up and frustrated over instructions demonstrate this patient’s lack of the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Not being able to read well and not being able to afford medications are certainly barriers to explore, but they are not related to health literacy.

4. A patient states that she uses the Internet to look up everything related to her medical

condition and treatment and so does not need the teaching prepared by the nurse. What aspects of health literacy are especially important for the nurse to assess in this patient?

(Select all that apply.)

a. b. c. d. e.

Ability to condense a huge amount of information Ability to determine what information is reliable Motivation of the patient to do her own research Reason the patient prefers learning on the Internet Trust in the nurse to provide accurate information

ANS: A, B

Health literacy includes the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions. If the patient can condense the enormous amount of information on the Internet and determine what is reliable, she has a reasonable degree of health literacy. Motivation, the rationale for the patient’s preference, and trust are not related to health literacy, although they might be important pieces of information to obtain.

Chapter 11: Legal Aspects of Nursing Practice Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. A practicing nurse knows that laws passed by legislatures are known as a. common b. private c. public d. statutory

law.

ANS: D

Statutory law is created through the enactment of laws by a legislative body. Common law is established by previous court decisions. Private law is concerned with relationships between individuals and includes tort law and contract law. Public law defines relationships between individuals and the government. This includes constitutional, administrative, and criminal law.

2. A nurse lawyer explains to attendees at a legal conference that when judges decide cases that

involve disputes between people in part based on laws determined in previous court cases, this creates or expands the area of law known as law. a. common b. contract c. private d. tort ANS: A

Common law helps maintain order in a society and assists in settling disputes. Common law is applied through the use of previous court cases and expands each time a judge makes a ruling.

Contract law is a type of private law. Private law regulates relationships between individuals.

Tort law is a specific type of private law.

3. A nurse knows that patient rights would be protected by a. administrative b. constitutional c. contract d. tort

law.

ANS: B

Constitutional law would affect nursing because it contains patients’ and nurses’ rights and responsibilities. Administrative law would affect nursing because it involves the licensing and regulation of nursing practice. Contract law is a type of private law and determines employer-employee relationships. Tort law is a type of private law that is concerned with remedies for wrongs suffered because of the actions of one person on another person.

4. A nurse is surprised to find that states have police power or, laws controlling licensure, over

nursing. A colleague explains this means: a. all nursing actions are under scrutiny by the states. b. nurses do not have any rights unless given by the state. c. state police are in charge of nursing investigations.

d. states can use their power to protect their citizens.

ANS: D

Based on the U.S. Constitution, states have “police power” that they use to protect their citizens’ health, safety, and welfare. The state board of nursing can scrutinize nursing actions, but the statement that “all nursing actions are under scrutiny” implies somehow that the state is monitoring every action. In reality, the states and regulatory agencies become involved only in specified situations. Nurses, like all other individuals, have rights guaranteed them by both state and federal constitutions and various laws that have been enacted. The state police are not in charge of investigations of nursing practice.

5. A nurse wants to change a law that regulates nursing practice. Before proposing this change,

the priority action by the nurse should be to: a. check for national standards regarding the practice under question. b. determine whether other professional groups would help implement it. c. find a state senator who will sponsor and support the proposed bill. d. hire a lobbyist to represent the nurse’s opinion in the legislature.

ANS: A

National standards and guidelines developed by professional organizations are very useful references for nurses proposing legal changes. This is the priority action. Determining whether other groups would help implement it is not the priority action. First, the nurse should research national standards regarding the practice. Having a sponsor is a great tool, but this is premature. The nurse should first ascertain if there are any relevant national standards. A lobbyist would help the nurse’s cause, but this is premature, because the bill has not yet been proposed. The nurse should first research national standards.

6. A nurse is considering becominNgUaR n SadIvNanGcTedB. prC acOtiMce nurse (APRN). After studying practice

requirements, the nurse concludes that for the RN and the APRN, licensure: a. differs because the APRN license is granted state by state. b. does not exist for advanced practice nurses. c. is exactly the same for both types of nurses. d. varies depending on the region of practice.

ANS: C

There is no additional licensure for APRNs. An APRN must have an RN license and a certification to practice as an APRN in the state(s) he or she practices in. APRNs need to obtain certification, not a license, in each state of practice. Becoming an RN requires a license; an APRN is a certification. Licensure exists for the RN; APRNs have certification.

7. A nurse is interested in taking a second job in an adjoining state but does not want to take

another licensure examination. A helpful co-worker correctly states, a. “Check to see if that state is in our Compact.” b. “See if that state will just give you a license.” c. “There’s no way around it; you have to take it.” d. “You won’t have to take another test.”

ANS: A

Many states have enacted the Nurse Multi-State Licensure compact. Nurses in “Compact” states can practice in any state within the compact with a valid license from one of the states.

The state will not just issue a nursing license to someone who asks. If the states both belong to the Nurse Multi-State Licensure compact, having a license in one state allows practice in any of the other Compact states without taking another exam. This might be true but not unless the adjoining state belongs to the Compact. The nurse must check to find out.

8. A nurse who practices in two different Compact states describes one consideration to this

system to a colleague, stating, a. “I have to know the nursing laws of both states.” b. “It’s hard to remember which license to carry.” c. “Taking two licensure exams was pretty tough.” d. “Telehealth nursing isn’t allowed in Compact states.”

ANS: A

The nurse working in more than one Compact state is subject to the laws of each state in which he or she is practicing and so must know the laws of each. One does not need to carry a nursing license to work. The purpose of the Compact is to allow nurses who are licensed in one of the states to practice in each of the others within the Compact without taking another licensure exam. The ability to do telehealth nursing is one reason Compact agreements are so beneficial. The nurse working in this field may have patients in several states.

9. A lay health care advocate claims that nursing practice exists in a situation of inherent conflict

of interest and that there needs to be legally mandated changes to some practices. Which statement by the advocate would best support this claim? “Nurses: a. are always looking for ways to increase their scope of practice without need.” b. control access, standards, aN ndUdRisScI ipN liG neT, B w. hiC chOM gives them too much power.” c. create their own standards for entry into the profession without any oversight.” d. should practice under the auspices of physicians but fight to be independent.”

ANS: B

This is the basis of a conflict-of-interest fear. Nurses themselves control access to the profession, design their own standards of professional behavior, and discipline those whose actions fall outside the realm of acceptable practice. To allay that fear, nurses need to be vocal advocates for their patients and demonstrate the ability to perform these three functions with integrity. Nurses have been expanding their scope of practice through specialties (e.g., wound care nursing) and advanced practice roles. However, when this has been done, nurses have been able to show a clear need for these services. Nurses do create their own standards but do so in organizations or as individuals that use best practice guidelines and conduct research to show patient benefit. The public does have a voice, and in essence, oversight, because they can be involved in politics (voting) and give commentary to nursing organizations and boards of nursing. Nursing does have dependent (physician-directed) activities along with independent activities, but as a profession, nursing should have autonomous control over its practice.

10. A nurse has delegated some tasks to the unlicensed nursing assistant. At the end of the shift,

the nurse discovers that most of the tasks have not been done. Which action by the nurse would be best? a. Devise a plan ensuring delegated tasks are completed and evaluated. b. Remind the assistant that he or she carries the responsibility for these tasks.

c. Report the situation to the manager and request an assignment change. d. Stop delegating and perform all the nursing actions him- or herself.

ANS: A

When delegating a task, the nurse must ensure that the task is completed and provide feedback, or an evaluation, afterward. This nurse should plan some way to remember to check that delegated tasks have been completed and evaluated, because the nurse remains ultimately responsible for the task. The nurse (not the assistant) retains the legal responsibility for the tasks that are delegated. Perhaps the nurse should report the situation to the manager, but doing so and requesting an assignment change do not provide the nurse an opportunity to use delegation appropriately. Most nurses are very busy and need to delegate. This also does not get to the core of the question, which is that nurses retain responsibility for delegated tasks.

11. A nurse is having a hearing before the state board of nursing for a possible misconduct

occurrence. The nurse is worried about possible sanctions, which can include: a. being fined or sentenced to prison. b. having to compensate the patient. c. mandatory community service hours. d. suspension of the nursing license.

ANS: D

A board action is taken only against the nurse’s license and can include suspension or revocation.

12. A nurse has received a charging document. The nurse manager advises the nurse that this

document means: a. a lawsuit charging nursing malpractice has been filed, and the nurse is being sued. b. someone filed a motion wi tN h Ut hRe Ss tIatNe Gb T oaBrd. rCeO quMes t i ng a license revocation hearing. c. the board of nursing has cause to believe the nurse violated the state practice law. d. the nurse has been charged with a civil or criminal offense and must appear in court.

ANS: C

A charging document is sent to a nurse when the state board of nursing has due cause to believe that the nurse has violated the state’s nurse practice act. A charging document does not indicate that a malpractice suit has been filed. A charging document does not specifically indicate that the nurse is to have a hearing for possible license revocation, although license revocation is a possible sanction for violations of the state nurse practice act. A charging document does not indicate that the nurse has been charged with a civil or criminal offense.

13. A nurse is reading the state board of nursing’s quarterly report and notes that several nurses

have been disciplined for drug addiction or dependence. The nurse concludes that: a. addiction is not covered under the Americans with Disabilities Act (ADA). b. nurses are succumbing to drug addiction with increasing frequency. c. these nurses have not been compliant with their drug rehabilitation. d. the state board is increasing typical sanctions for drug dependency.

ANS: C

Nurses who are in treatment for a protected disability such as drug addiction do not have a public record connected with that disability, so if these nurses have had disciplinary action taken that is reported in a public format, the nurse can conclude that they are not in compliance. Drug addiction is covered under the ADA. The number of nurses with drug addiction problems is not related directly to licensure actions. The state board increasing typical sanctions for drug dependency would not be related to reporting licensure actions.

14. A nursing faculty member has signed a 2-year contract. This faculty member knows this type

of contract is known as: a. enforceable. b. express. c. implied. d. promissory.

ANS: B

A contract with terms spelled out in writing is known as an express contract. An enforceable contract simply means that a contract meets all criteria to be valid. The contract the faculty member signed was most likely an enforceable one, but this answer is not specific enough. An implied contract in one based solely on the conduct of the parties. “Promissory” in the context of contracts refers to an agreement that creates a legal relationship and is not a specific type of contract.

15. A nurse has been fired for refusing to work the designated number of weekend and holiday

shifts each quarter. The nurse protests to the human resources department, saying that unit managers modified this requirement because this nurse has the most seniority on the floor and that therefore, they cannot fire him or her for this. Which statement by the human resources officer best explains the situatioNnU?RSINGTB.COM a. “A court of law will uphold your written contract, not verbal promises.” b. “It doesn’t matter how long you have worked here; the rules apply equally.” c. “Unit management does not have the authority to allow these alterations.” d. “You should not have been fired; I would suggest getting a lawyer.”

ANS: A

The parole evidence rule provides that if oral agreements are made in addition to written agreements, the court will not allow these to take precedence over the written agreement.

Nurses should never rely on verbal agreements; they should get all employment contracts or changes to contracts in writing. This may be a true statement at that facility, but this answer is not specific enough to explain the rationale. Unit management may or may not have authority to make modifications to work agreements, but this answer is not specific enough to explain the situation. Suggesting that the nurse get a lawyer does not provide any type of explanation of the situation.

16. A nurse works in a unionized hospital but has not joined the union. This nurse feels deserving

of a raise for several exceptional acts during the past year. What action by the nurse would be best in this situation? a. Ask the unit management for a raise, because the nurse is not a union member. b. Consult with the union to determine whether individualized raises are possible. c. Join the union before approaching management with a request for a raise. d. Request a meeting with union and floor management to discuss the raise.

ANS: B

The union agreements cover a certain classification of employees included in the agreement and include wages, hours, and working conditions. If the nurse is not classified as exempt from the agreement, the nurse should check to see whether there are any “merit” raises available under the union contract. The nurse must bargain with the union because she or he cannot bargain individually with the employer. The union agreements cover a certain classification of employees, whether or not they are individual members of the union. A union covers a certain classification of employees even if they are not members. This might be a good second step but only after the nurse determines whether merit raises are possible under the union contract.

17. A nurse administered the wrong dose of insulin to an assigned patient after bypassing the

facility policy to have insulin doses double checked. The patient’s blood glucose level remained within normal limits afterward, and the physician was notified per protocol. The patient and family were extremely upset and demanded to be moved to another floor. Later, the patient filed a malpractice suit against the hospital. The nurse lawyer reviewing the case would conclude that: a. malpractice occurred because the patient had emotional distress. b. malpractice occurred because the nurse didn’t follow the policy. c. no malpractice occurred because most nurses don’t verify insulin. d. no malpractice occurred because there were no actual damages.

ANS: D

The four elements of malpractice are duty, breach of duty, causation, and damages. Because this patient did not have damages, as evidenced by normal blood glucose levels afterward, a case of malpractice would likely not prevail. The four elements of malpractice are duty, breach of duty, causation, and damages. Emotional distress might be a type of nonpecuniary damage, but the patient would N haUvR eS toIpN roGvT eB th. e CnuOrM se caused it. However, because there were no physical damages, it would be difficult to win a case based solely on emotional distress.

The four elements of malpractice are duty, breach of duty, causation, and damages. The nurse clearly breached the duty by not following policy to double-check insulin. However, the patient did not suffer any damages, so a malpractice claim would likely not prevail. The four elements of malpractice are duty, breach of duty, causation, and damages. Even if it is common practice to sidestep policy, the nurse still has the duty to follow it. However, the patient had no damages, so a case of malpractice would likely not prevail.

18. A nurse is testifying as a witness in a court case. The attorney has asked a series of questions

that the nurse is having trouble understanding. The best action by the nurse is to: a. ask that the questions be reworded for comprehension. b. be cautious and not answer questions about medical care. c. request a break to get something to eat or drink. d. try his or her best to answer all of the questions honestly.

ANS: A

If a question is difficult to understand, the nurse should ask that it be reworded. Then he or she should restate it to make sure it is understood. Nurses should not answer questions related to medical care; however, this option does not answer the question. If the nurse is fatigued, taking a short break can be helpful, and the nurse should request it; however, this option did not answer the question. Although it is always good to answer questions honestly, this option does not answer the question.

19. A nurse is performing a procedure on a patient, and the patient suddenly says, “I don’t want

you to do that anymore.” The best action by the nurse is to: a. discuss the patient’s wishes. b. finish the procedure quickly. c. stop the procedure immediately. d. tell the patient that the procedure is almost done.

ANS: C

The nurse should stop the procedure immediately to avoid committing battery. The nurse should discuss the patient’s wishes but only after the procedure has been stopped. Finishing the procedure despite the patient’s wishes that the nurse stop could be considered battery.

Telling the patient the procedure is almost done and continuing would probably constitute battery.

20. A patient is constantly disrupting therapeutic medical devices, such as intravenous lines and

catheters. The staff wants to restrain the patient. Before doing this, the best action by the nursing staff would be to: a. be sure security is available to apply restraints. b. get orders from the physician for a sedative. c. move the patient away from other patients. d. try other methods to keep the patient safe.

ANS: D

Before applying restraints, try less intrusive methods to keep the patient safe, such as calming music, a sitter, or covering medical devices so that the patient cannot see them. This will help avoid a lawsuit based on false imprisonment. Nurses can apply restraints; security would only be needed in cases in which the patient was a danger to the nursing staff. Sedatives are considered chemical restraints;NthUeRsS t aIffNs G hoTuB ld.fC irsOt Mtry less intrusive methods to keep the patient safe. Moving the patient away from other patients would not be beneficial unless the staff thought that being near others made the patient more agitated.

21. A patient walked into an emergency department (ED) and then collapsed before checking in.

The priority action by the nurse is to: a. check the patient’s wallet for identification. b. get consent when the patient wakes up. c. check to see whether the patient has any family nearby. d. treat the patient first because consent is implied.

ANS: D

Walking into an ED implies consent to treatment; since the patient walked in and then collapsed, it is safe to treat the patient under implied consent, which looks to the patient’s action for consent. The priority is caring for the patient. As this is being done, someone else can check the patient’s wallet for identification and contact information, but the priority is the patient. If the patient wakes up, or “comes to,” then the nurse should obtain consent.

However, in this situation, patient care comes first, and the nurse should care for the patient immediately. While the patient is being cared for, someone else can look for family or friends nearby, but the priority is caring for the patient.

22. A patient is having an operation in the morning. During the nurse’s shift, the patient asks

several questions that lead the nurse to determine that the patient does not understand the procedure. The best action by the nurse is to:

a. b. c. d.

call the surgeon to come back and explain the procedure. pass this information on to the day shift in shift report. reassure the patient that he or she understood the operation correctly earlier. try to explain the operation so that the patient understands.

ANS: A

Informed consent is a priority in health care. If the patient does not understand the operation, the surgeon needs to return and explain it again. The legal mandate for informed consent in the United States is unambiguous and overwhelming. Passing the information on is a good idea, but this does not show the nurse meeting the obligation of ensuring informed consent for procedures. Telling the patient that he or she understood the procedure earlier is patronizing and does not address the patient’s concerns. The person performing the procedure (the surgeon, not the nurse) is responsible for explaining it.

23. A physician asks a nurse to witness a consent form the patient has already signed, even though

the nurse did not see the patient sign the form. The best action by the nurse is to: a. ask the patient if the signature on the form is his or hers. b. refuse because the nurse did not witness the signing. c. tell the physician the consent cannot be witnessed now. d. write “consent procedure witnessed” on the consent.

ANS: A

The nurse is witnessing that the signature on the consent form is the patient’s. The nurse can show the document to the patient, verify that the signature is authentic, and then sign as a witness to the signature. The nurse does not have to witness the provider obtaining the signature for informed consent. The consent can be witnessed retroactively because the nurse is only verifying that the signature is the patient’s. This phrase could be included if the nurse had actually witnessed the physNicUiaRnS(I orNoGthTeB r. prC ovOidMer) providing the information needed for consent and the patient signing the form. However, in this case, the nurse did not actually witness those actions.

24. Several nurses are discussing a patient and family in the cafeteria. The best response by one of

the nurses to this discussion is: a. “Let’s discuss this once we get back to the nurses’ station.” b. “Shh! The patient’s family might be in the cafeteria now.” c. “This is confidential information and shouldn’t be discussed.” d. “We should really keep our voices down, so others can’t hear us.”

ANS: C

This is the correct response because it is not likely that all the parties to this conversation are involved in direct care of the patient and need to know what is being shared. Even if all parties were involved in direct care of the patient, the cafeteria is not a private area and should never be used as a place to discuss patients or their care. The nurses’ station is not a private area, and conversations there are easily overheard. Confidential information should not be shared there even if the employees in the conversation all need to know the information. The patient’s family might or might not be in the cafeteria, but even if they are not there, the nurses should not be discussing patients with people who do not need to know the information. The nurses should not be discussing patients in a public area at all, and they should not be sharing information with any other people who do not have a need to know in order to care for the patient.

25. A nurse is explaining to some co-workers that the basic premise behind the confidentiality

section of the Health Insurance Portability and Accountability Act (HIPAA) is that: a. health information belongs to the patient. b. it is unethical to disclose health records. c. minor transgressions are not the real issue. d. only electronic patient records are protected.

ANS: A

Although the patient’s record itself belongs to the health care provider who created it, the information that the record contains belongs to the patient. It is unethical to disclose someone’s health records in violation of HIPAA, but this is not the best answer because it is more specific to state that the information belongs to the patient. Any transgression can potentially result in fines or prison sentences. There are specific sections of HIPAA that deal with electronic record security, but all patient records are protected as confidential information.

MULTIPLE RESPONSE 1. A faculty member explains to students that laws regulating state nursing licensure incorporate

which actions? (Select all that apply.) a. Disciplining licensees b. Entry into the profession c. Establishing curricula d. Handling nurse imposters e. Safeguarding nurses’ rights ANS: A, B, D

Disciplining nurses who fail to meet minimum standards is done through state licensure statutes. Entry into the profession is regulated through state licensure statutes. Responding to “nurse imposters” does fall under state licensure statutes. Establishing curricula for nursing schools does not fall under state licensure statutes. Safeguarding nurses’ rights does not fall under state licensure statutes.

2. A faculty member is explaining to the senior nursing class that to become licensed, applicants

must: (Select all that apply.) a. demonstrate good moral character. b. graduate from an approved program. c. maintain a certain grade point average. d. pass the standard licensure examination.

ANS: A, B, D

A requirement for entry to practice is having a good moral character. A requirement for entry to practice is graduation from an approved nursing program. A requirement for entry to practice is passing the standardized licensure examination. The applicant need not have a specified grade point average.

3. A staff development nurse is orienting several new employees to the facility. The nurse

explains that any good compliance program: (Select all that apply.) a. functions to identify and correct potential concerns. b. ensures a confidential way for staff to report violations.

c. promotes conformity to the facility’s legal requirements. d. protects staff from retaliation for good-faith reports. e. works to ensure that union negotiations become public knowledge.

ANS: A, B, C, D

Compliance programs promote conformity to legal requirements, identify potential concerns and correct them before they can cause problems, and prevent recurrence of any known problems. A compliance program should ensure that employees are able to make confidential reports of possible violations. Compliance programs promote conformity to legal requirements, identify potential concerns and correct them before they can cause problems, and prevent recurrence of any known problems. People who make good-faith reports should be protected from retaliation. Compliance programs do not work to ensure that union negotiations are made public.

Chapter 12: Ethical Dimensions of Nursing and Health Care Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. The practicing nurse best understands the concept of ethics to mean: a. doing what is right in a situation. b. always doing what patients want. c. being of good moral character. d. following strict guidelines for action.

ANS: A

The nurse who practices ethically can analyze ethical conflicts in light of situational variables to determine what is right and wrong and then doing what is right. Patients do have the right to make their own decisions, even when they could cause harm, but being ethical does not mean a blanket approval for the patient to do what he or she wants in every situation. The patient may not understand the facts of a situation, may be impaired by drugs or alcohol, or may have cognitive disabilities that preclude full understanding. Being of good moral character certainly does play into ethical practice, but ethical practice goes well beyond just a characteristic and requires action. No strict guidelines exist for ethical behavior, but standards can be used to guide ethical decision making and action. No one set of guidelines will apply to every situation.

2. A nurse subscribes to the philosophy of deontology. This means the nurse makes decisions

based on: a. cultural competence. b. equal access. c. greatest good. d. perceived duty.

ANS: D

Deontology means acting according to a perceived duty. Deontology does not denote cultural competence. Deontology does not denote equal access. Deontology does not denote working for the greatest good.

3. A nurse has volunteered to practice in a disaster area in a developing country where supplies

are extremely scarce. Despite bringing large amounts of supplies to the area, the volunteer group members find they are still very limited. The volunteer group decides to focus on providing care according to the ethical concept of utilitarianism. Which action by the group would best fit under this philosophy? a. Choosing to treat children and pregnant women as priorities b. Converting vehicles into ambulances for transport to hospitals c. Establishing a mobile ventilator unit for critically ill patients d. Providing clean water, food, shelter, and basic health care ANS: D

Utilitarianism focuses on doing the greatest good for the largest number of people.

Presumably, the majority of people need fresh water; good food; shelter from the elements; and basic health care such as wound suturing, immunizations, and antibiotics. Choosing to treat children and pregnant women as priorities would be acting according to a perceived duty (assuming these patients are perceived as more “important” somehow), so this would be more in line with deontology. Converting vehicles into ambulances for transport to hospitals would not help the largest number of people, most of whom do not require hospitalization.

Establishing a mobile ventilator unit for critically ill patients would only help a small number of people.

4. A faculty member explains that professional ethics: a. guide behavior based on group consensus. b. is completely an individual nurse’s concern. c. is optional in groups considered professions. d. should not consider the goals of the profession.

ANS: A

Members of a profession come to group consensus on what they consider ethical actions; then each individual nurse is responsible for making sure his or her practice incorporates these “good” actions as conceptualized by the group. Professional ethics, although acted on by individual nurses, reflect the professional group’s consensus of what is ethical. One requirement for an occupation to be considered a profession is the existence of a professional code of conduct that guides the members of that group. The goals of a profession do partially determine what is considered ethical or nonethical action.

5. A nursing student is skeptical about the concept of professional ethics even being possible,

much less a requirement for proNfU esRsiS onIaNl G prT acBti.ceC. OWMhich statement by this student best justifies this belief? a. “A group cannot determine what is right in each specific situation.” b. “Each nurse should be smart enough to determine solutions to issues.” c. “Ethics are too personal to be dictated by a professional organization.” d. “There are too many gray areas for any code of ethics to be universally right.”

ANS: D

“There are too many gray areas for any code of ethics to be universally right” is an understandable statement. Situational variables are innumerable and unique, and they complicate every situation. There are usually no strict right or wrong answers. A professional code of ethics does not seek to determine correct solutions to every situation but rather attempts to define the ethics that should guide decision making. The use of ethics is not related to intelligence but rather gives nurses a framework in which to analysis situations. A requirement of a profession is a code of ethics to guide behavior. The goal is not to dictate to nurses what to do in every situation but to provide guidance for decision making an action in difficult situations.

6. The nurse knows that the American Nurses Association (ANA) adopted its first code of ethics

in: a. b. c. d.

1893.

1896.

1950.

1969.

ANS: C

The ANA accepted the code of ethics in 1950. The code of ethics was not established in 1893, 1896, or 1969.

7. A nurse studying the history of nursing ethics over the years would conclude that: a. articles show the topics of concern have stayed fairly similar. b. ethics has been slow in responding to independent practice. c. nurses’ behavior in caring for sick patients is the main subject. d. the subject has evolved to more abstract situational ethics.

ANS: D

Over the years, ethical concerns have grown more complex and increasingly abstract. Topics of concern have changed over the years and no longer focus on law and conduct. Ethics has evolved to keep pace with increasing independence in nursing practice. Nurses’ behavior in caring for sick patients was an early focus of nursing ethics.

8. A nurse is complaining about the pharmacy being too slow in delivering medications. The

nurse describes an example in which a patient could have been harmed from the delay and is angry because the nurse knows it is critical that certain medications be given on time. This nurse is most likely experiencing: a. caregiver fatigue. b. job burnout. c. moral distress. d. personal fatigue.

ANS: C

Moral distress occurs when a person feels uneasy about a situation in which he or she knows the right course of action but isNuU naRbSleItN o Gp eTr B f o.r mC Oi t .MT h i s nurse is suffering from moral distress. Caregiver fatigue occurs when the burden of giving care is too great for an individual. It is often used to describe a situation involving a lay person giving care to a significant other. Although this might be the case, it is not the most likely answer. Job burnout occurs when the demands of the job are too great and often leads to nurses leaving the profession or to change jobs. This could be a component of the problem, but it is not the best answer because it is too narrow in focus. Personal fatigue is certainly a barrier to providing excellent patient care, but it does not appear to be involved in this situation.

9. A nurse who was previously known to be a role model has become distant and cool toward

patients. The manager suspects the nurse is experiencing moral distress. Which action by the nurse’s manager would be best in this situation? a. Ask the nurse about perceived barriers to caregiving. b. Remind the nurse that patient relations are important. c. Ask whether the nurse needs to take a vacation or time off. d. Tell the nurse that others have noticed a behavior change.

ANS: A

Moral distress is caused when a person knows the right thing to do but is unable to do it. The manager should ask the nurse about any barriers encountered that have prevented effective caregiving. Patient relations are important but not as important as a nurse who is engaged and meeting the individualized needs of the patients. Telling the nurse anything, rather that inquiring about the difficulty, does not allow for exploration of the problem. The nurse may indeed be fatigued and in need of time off, but this option is so narrow that it does not allow exploring the real problem. Telling the nurse that others have noticed a behavior change should certainly be part of a discussion with the nurse, but this should be used as a lead-in to finding out the nature of the problem. This option does not go far enough.

10. The nurse explains to a co-worker that in order to practice in an ethical manner, the first thing

the nurse must do is to: a. clarify one’s own values to be sure they can be helpful in ethical dilemmas. b. find an employer with organizational goals consistent with ethical practice. c. follow an established set of rules when confronted with an ethical dilemma. d. understand nursing’s role in meeting the professional goals of nursing.

ANS: D

The first step to being able to practice in an ethical manner is to understand the goals of nursing as a profession and the responsibility each nurse has in helping the profession meet its goals. A solid understanding of one’s own values is extremely important when working with ethical dilemmas, but this is not the first step in being able to practice in an ethical manner.

Health care organizations and patient care often have competing goals, because all organizations have to consider financial matters that are different from patient care issues.

Although some employers may be known for unethical patient care practices, the chances of finding an organization with goals completely consistent with ethical nursing practice are slim. When working with ethicN alUdR ilS em , tB he.rC eO arM e no rules—only guidelines—because Im NaGsT when working with people, there are innumerable variations in background and response.

Nurses need ethical guidelines and processes to help them in their practices.

11. A nurse explains to a student that the object of beneficence is to: a. consider all the ways patients benefit from action. b. do the best thing in every patient care scenario. c. provide “good” according to the patient’s wishes. d. use one’s own judgment to make patient care decisions.

ANS: C

The object of beneficence is to provide good to the patient, but the meaning of “good” must be clarified within each patient’s wishes and desires. There is no practical way to consider every single way a patient can benefit from an action, particularly when you realize that every patient is a unique individual and will have potential benefits that are unique to him or her.

Doing good for patients is the basis of the principle, but merely doing the best thing does not specify using the patient’s preferences and values in each setting. It would also be impossible to accomplish this in every single situation. Making care decisions without considering the patient’s wishes is not practicing ethically, although there are times when professional judgment may be a priority.

12. A nurse admits a patient with end-stage cancer who is very obviously in pain yet refuses pain

medication because of the desire to remain aware of family members who are present. The best example of the nurse acting under the ethical principle of beneficence is to:

a. b. c. d.

assess the patient and pain thoroughly and discuss the patient’s wishes. call the doctor and get orders for around-the-clock pain medication anyway. tell the patient and family that the patient has the right to refuse treatment. try convincing the patient that the family does not want her to be in pain.

ANS: A

The heart of ethical nursing practice is a therapeutic nurse-patient relationship in which the nurse’s actions are influenced by each patient’s unique situation. To follow the principle of beneficence, the nurse needs to promote good understanding of the patient’s wishes. After obtaining this information, the nurse can move on to a plan to manage the patient’s pain that is acceptable to the patient (possibly nonpharmacological therapies). But without having this information first, the nurse cannot treat the patient’s pain in a beneficent manner. One option might be to call the doctor and get pain medication ordered so it will be available should the patient change her mind. But first, the nurse needs to understand the patient’s wishes and desires in order to assist the physician in ordering the most appropriate medication. It is not beneficent to merely get pain medication ordered anyway. The patient does have the right to refuse any treatment (if the patient is able to make reasoned judgments), but this corresponds to the principle of autonomy. Trying to convince the patient to act in accordance with the wishes of others is not promoting beneficence.

13. A nurse speaking in the legislature in favor of providing universal health care would best

support this cause by calling on the ethical principle of: a. autonomy. b. beneficence. c. justice. d. veracity.

ANS: C

The principle of justice relates to fairness and how health care resources should be distributed.

The argument may well be made that justice requires equal access to health care for all.

Autonomy is the principle that relates to self-determination. Beneficence means doing good, which may be applicable to such discussions but is not the strongest principle to use for this argument. Veracity is telling the truth and keeping promises, which would not be the most applicable concept in this situation.

14. A nurse feels strongly that nursing practice should be based on justice. The action by the nurse

that best demonstrates this principle is to: a. allow patients to make their own decisions regarding nursing care. b. make sure all patients get their meals ordered at the same time. c. spend the same amount of time with each patient during the shift. d. use a consistent approach in deciding which patients to see first.

ANS: D

When a nurse cares for multiple patients, their needs often conflict. The nurse practicing within the principle of justice has a clear plan for deciding how to allocate her or his time as a resource, seeing to it that those with the most pressing needs are seen first and that other patients’ needs are cared for as well during the shift. Doing so according to a consistent standard helps ensure that personal biases do not influence this decision. Allowing patients to make their own decisions regarding nursing care would relate more to autonomy, which is the right to self-determination and to make choices regarding health care. On the surface, making sure all patients get their meals ordered at the same time sounds fair and just, but it does not take into account individual patient needs.

Spending the same amount of time with each patient does not allow for individual patient needs.

15. A nurse is assessing factors that may influence a patient’s decision-making ability. Which

assessment by the nurse would provide the most useful information? a. Financial ability to pay for care b. How long the patient has to decide? c. The patient’s current pain level d. What information is available?

ANS: C

Constraints to autonomy include patient variables that affect the person’s capacity to make choices. Factors such as pain, cognitive ability, and fatigue can all influence this. Financial ability to pay for health care does not have an effect on autonomy. How long the patient has to decide should not affect the patient’s ability to make decisions. The patient may or may not have enough information to make an informed decision, but this does not affect the personal abilities to choose.

16. A nursing instructor tells the class the most important ethical principle involved in informed

consent is: a. autonomy. b. beneficence. c. confidentiality. d. veracity.

ANS: A

Autonomy is the ability to make one’s own decisions. Informed consent is based on this self-determination. Beneficence is doing good for patients; although this is important in all health care interactions, it is not the most important principle in informed decision making.

Confidentiality is a vital component of ethical practice, but it does not create the foundation for informed consent. Veracity, or telling the truth and keeping promises, is not the most important principle for informed consent.

17. A patient with a head injury is confused and combative and wants to leave the hospital,

repeatedly getting out of bed. The nurses obtain an order for soft wrist restraints and a vest restraint. This action best demonstrates: a. beneficence. b. justice. c. nonmaleficence. d. paternalism.

ANS: D

This patient is confused and combative after sustaining a head injury. It is reasonable to think the patient does not understand the implications of his or her actions and thus is incapable of making informed decisions. Thus, the nurse needs to use professional judgment and provide care that meets the patient’s needs. Overriding a patient’s choice for his or her good is called paternalism and can be justified in specific situations. Beneficence is doing good, but it must take into consideration the patient’s needs and wishes in order to provide good. However, this patient is confused and combative and unable to articulate wishes in a way that the nurse can use them when providing good. This is not the best answer to this question because it does not take into account the patient’s diminished cognitive abilities. Justice means using health care resources equally and is not applicable to this situation. Nonmaleficence means doing no harm, which is not the best answer in this case.

18. A patient is in pain and requests pain medication. The nurse sees that it is too early to

administer the medication. Practicing under the principle of veracity, the nurse should: a. bring the medication a little bit early to give the patient pain relief. b. call the physician and request an extra dose of the pain medication. c. sit with the patient and offer nonpharmacological pain interventions. d. tell the patient when to expect the medication and bring it on time.

ANS: D

Keeping one’s word by returning when the patient expects upholds the principle of veracity, which involves telling the truth and not deceiving others. Giving the pain medication a little early would not be upholding the principle of veracity, which involves telling the truth and not deceiving others. Calling the physician and requesting an extra dose of the pain medication might be a good intervention, but this is not related to veracity, which involves telling the truth and not deceiving others. Nonpharmacological interventions might help reduce the patient’s pain, but this is not reN laU teR dS toIvNeG raT ciB ty. ,C wO hiM ch involves telling the truth and not deceiving others.

19. A nurse is in a difficult patient care situation and thinks that there is an ethical dilemma. The

first action this nurse should take is to: a. decide what predominant values are operating in the situation. b. determine who is involved and uncover their individual goals. c. identify courses of action and possible consequences of actions. d. identify the actions that are justifiable.

ANS: D

The first step in ethical decision making is to determine what actions are justifiable in the situation. Deciding what predominant values are operating in the situation is an important step in ethical decision making, but identification of justifiable actions is the first step.

Determining who is involved and uncovering their individual goals is an important step in ethical decision making, but identification of justifiable actions is the first step. Identifying courses of action and possible consequences of actions is an important step in ethical decision making, but identification of justifiable actions is the first step.

20. The nursing faculty member correctly classifies the American Nurses Association (ANA)

Code of Ethics as a tool for: a. articulating actions that incorporate professional values. b. describing ethics associated with membership in the ANA. c. listing and explaining ethical principles used in nursing.

d. solving ethical dilemmas encountered in daily practice.

ANS: A

The ANA Code of Ethics articulates actions that exemplify the ethics of professional nursing.

Although the code is not a list of behaviors, some activities are specified, and others can be inferred. The ethics described in the ANA Code pertain to the profession of nursing, not just to members of the ANA. The code does not contain a list and explanation of ethical principles. The code is not a tool for problem solving.

MULTIPLE RESPONSE 1. What areas does the nurse explore with the patient when using patient-level ethics? (Select all

that apply.) a. External factors b. Medical indications c. Previous health history d. Patient preferences e. Quality of life ANS: A, B, D, E

In patient-level ethics, the nurse can use the four topics approach in which separating the relevant facts of the case into four categories (external factors, medical indications, patient preferences, and quality of life) the nurse will be able to identify key issues that require further investigation or that will play a role in the ethical analysis of the case. Previous health history is not included but could influence preferences.

Chapter 13: Information Management Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. A new nurse is confused by the terminology used by the electronic health record (EHR).

When the nurse complains to the precepting nurse, the best explanation by the preceptor is that this occurs because: a. many systems interact with each other and need a standardized language. b. nursing is not the only discipline to use the EHR, so wording reflects this. c. terminology used by the EHR is driven by financial reimbursement needs. d. the system was designed by people in computer and information sciences.

ANS: A

The EHR uses different interconnecting modules, so it is imperative that terminology used in each is standardized. This allows for seamless patient care delivery. It is true that nursing is not the only discipline to use the EHR, but it is not the disciplines themselves that use different vocabularies; it is the system each discipline uses that creates the need for a standardized vocabulary. Needs of the financial departments are considered when developing EHRs, but this is not the only consideration. The information technology side of EHR development allows for standardization of terminology among disciplines. This is not the most inclusive answer.

2. A hospital is planning to convert to an electronic health record (EHR) system. Which action

by administration would best address both legal and ethical issues related to EHRs? a. Create consent forms that aN ckUnR ow leN dgGeTthBe.uC seOoMf EHRs. SI b. Develop policies and procedures related to patient privacy. c. Hold public meetings to describe use of the EHR system. d. Train the nursing staff on proper use of the EHR system.

ANS: B

Privacy is paramount to using an EHR. Federal privacy laws established under the Health Insurance Portability and Accountability Act (HIPAA) require the development of privacy rules for technologies that use electronic data exchange. Merely acknowledging the use of the EHR system would not really address legal and ethical concerns. Public meetings might create goodwill but would not really address legal and ethical concerns with the use of electronic records. Training those who use the EHR is an important component of its proper use, but this does not go far enough in addressing ethical and legal issues.

3. The nurse is framing a research question. What does the “T” stand for in the PICOT format? a. Transition b. Time frame c. Type of problem d. Technology ANS: B

The “T” in the PICOT format stands for “time frame.” The nurse would include this information in the question framing, when it is important to know how long an intervention will take.

4. A student is researching a topic for a class paper. The student would find the most information

by: a. looking for related research instruments. b. querying a database such as the Cumulative Index to Nursing and Allied Health

Record (CINAHL). c. reading textbook and journal indexes. d. searching the newspaper’s online index.

ANS: B

Electronic databases such as CINAHL will provide the student access to a comprehensive set of journals going back for many years. In these databases, the student can query key words and phrases to find information on the topic quickly. Although it might be important to find research articles related to the topic (depending on what the topic is), research instruments themselves will not provide a lot of information. Indexes are a good way to find out about the topics in a book or journal, but this is a time-consuming process and limited to information only in that specific book or journal. The newspaper might have information important to the student’s paper, but the information will be limited to this one source.

5. A student explains to a classmate using an electronic database that the scope note describes: a. best searching strategies for this topic. b. how far back in time the topic is covered. c. the breadth of scope of the topic searched. d. the definition of the term being searched.

ANS: D

The scope note contains a definition of the term being searched. The scope note does not describe the best searching strategies for a topic. The scope note does not describe how far NhGeTscBo.pC back in time citations for this toNpUicRgSoI .T eO noMte does not describe the breadth of the scope of the topic being searched.

6. A patient has researched a medical condition on the Internet. The nurse’s best response to the

patient’s questions and concerns is: a. “Have you verified this information with your doctor?” b. “Quality health information is not available on the web.” c. “What websites did you visit to get this information?” d. “You can’t really trust what you find on the Internet.”

ANS: C

This question can lead the nurse into a discussion of what websites have quality information and how the lay person can evaluate the site as a source of information. This is the best option, because it opens the door to the nurse teaching the patient how to be a good consumer of health care information. Instead of helping the patient navigate the web, this option seems paternalistic, leaving the patient to be totally dependent on the expertise of the physician.

Although it is a problem that a good deal of health information on the web is confusing, out of date, or even incorrect, nurses should not try to discourage patients from using the Internet but rather help them become better at finding more reliable sites. Many websites offer quality health information, but lay people need to be able to differentiate between the good ones and the poor ones. The Internet does have sites that provide misleading, out-of-date, or even false information. However, many good sites are also available.

7. A student is confused about standardized language in nursing and asks the faculty to explain

its value. What response by the faculty is best? a. Allows easier database searching especially for novice researchers. b. Combines several similar terms for the same item under one heading. c. Eventually will lead to third-party reimbursement for nursing care. d. Makes the value of nursing care explicit and comparable in electronic systems.

ANS: D

Today, there are many groups working to standardize nursing terminologies to make the value of nursing care explicit and comparable in electronic systems. Standardized terminology may make searching easier, combine similar terms, and may eventually lead to third-party reimbursement, but this is not the main value of standardized terminology.

8. A first-year nursing student needs to write a paper on urinary tract infections (UTIs) in

nursing home residents. What search strategy does the faculty recommend to the student? a. Have the medical librarian search for you. b. Look the topic up in your textbook. c. Start your search with Google or Bing. d. Use CINAHL to search for your topic.

ANS: D

Information-literate professionals will know (or learn) how to use databases to search topics.

CINAHL is a database that provides the most comprehensive coverage of nursing literature.

The student will be able to combine terms to search for UTIs in nursing home residents. Using the librarian as a resource to assist is a good idea, but if the librarian does the search, the student will not learn this vital skill. The student should not start with lay sites such as Google. The textbook will have some information on UTIs and may include a section that includes nursing home resi den tNs ,UbRu tSfIo rNcGo T mBpr.ehCeOn M s i v e data, the student will need to do a database search.

9. A nurse has written a PICO question as follows: Are there specific urinary catheter care

practices that decrease infection in the intensive care population? What element of the question is missing? a. Comparison b. Intervention c. Outcome d. Population ANS: A

The elements of a PICO question include population (intensive care patients), intervention (urinary catheter care practices), comparison (missing), and outcome (decrease infection).

10. The student is researching a clinical problem using the Cochrane database and only finds

random-controlled studies. When asked why this is so, what answer by the faculty is best? a. “Cochrane uses other types of studies, too.” b. “Random controlled studies are the gold standard.” c. “Their interests are only in research studies.” d. “They are paid only to use those kinds of studies.”

ANS: B

The Cochrane database only uses random-controlled studies because this type of research study is considered to have the most rigorous format. The other options do not take this into account and are considered to not be as accurate.

MULTIPLE RESPONSE 1. A student studying informatics in nursing understands which of the following terms? (Select

all that apply.) a. An information-literate person can find, retrieve, analyze, and use information. b. Health informatics is the study of systems and information technology. c. Information literacy incorporates informatics and information management processes. d. Information management consists of collecting, processing, and communicating data. e. The focus of health information is on the management of the systems used.

ANS: A, B, C, D

A person who is information-literate can find, retrieve, analyze, and use health information.

Health informatics is the study of systems and information technology, but its focus is on information management, not computer systems. Information literacy incorporates both informatics and information management, consisting of collective, processing, and communicating data.

2. A nurse manager is assessing the unit staff on their degree of information literacy. What

actions by staff members best indicate good information literacy skills? (Select all that apply.) a. Able to conduct relevant computer searches for information. b. Evaluate sources of informaNt U i oR nS asItN o GthTeiBr . vaCliOdM i ty and reliability. c. Notice that a particular problem exists and recognize the need for information. d. Search common lay Internet sites for health care–related information. e. Use information to inform best practices and improve patient care.

ANS: A, B, C, E

Different organizations have criteria for an information-literate health care provider, which include being able to conduct a search effectively, being able to evaluate the source of information, recognizing that a question exists and recognizing the depth of information needed, and using information to inform best practices, which ultimately improves patient care. Searching common lay-level websites (e.g., Google) does not qualify a person as information literate.

3. The student is investigating the use of a citation management program. What advantages do

these programs offer? (Select all that apply.) a. Automatic formatting of citations b. Creation of a personal database c. Editing papers written by the student d. Sharing citations with others e. Storing and organizing citations ANS: A, B, D, E

Citation management programs have the advantage of automatic formatting of citations in papers, the ability to create a personal database, the ability to share citations with others, and the functions of storing and organizing citations. They do not edit papers.

4. A nursing manager wants the unit’s staff to consistently use evidence-based practices (EBP).

What rationale does the manager give for desiring this practice? (Select all that apply.) a. Better patient outcomes b. Decreased health care costs c. Enhanced work satisfaction d. Improved quality of care e. Increased intraprofessional communication ANS: A, B, C, D

EBP offers advantages for nursing, including better patient outcomes, decreased health care costs, enhanced work satisfaction, and improved quality of care. It does not improve intraprofessional communication.

5. A nursing manager wants the unit staff to use evidence-based practice (EBP). To decrease

barriers to using EBP, what actions by the manager are best? (Select all that apply.) a. Build time for EBP activities into workloads. b. Create policies mandating the use of EBP. c. Develop a relationship with a medical librarian. d. Engage administration with the EBP process. e. Provide access to health care databases.

ANS: A, C, D, E

Common barriers to using EBP include lack of time, lack of resources, and lack of institutional support. The manaN geUrRcS anIaNdG drTesBs.thCeO seMby adding time into workloads for EBP activities, developing a relationship with a medical librarian who can help the staff, engaging administration in the process, and allowing nurses to access health care databases at work.

Mandating the use of EBP will not decrease these barriers.

6. The student nurse is learning to write PICOT questions. What elements does the student

include? (Select all that apply.) a. C: Cost b. I: Intervention c. O: Outcome d. P: Place e. T: Time element ANS: B, C, E

PICOT stands for population, intervention, comparison, outcome, and time.

Chapter 14: Diversity in Health and Illness Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. A nurse is frustrated because a patient does not make any needed health changes despite

ongoing and comprehensive education on the health-related topic. The best action by the nurse would be to: a. ask the patient if he or she really wants to make changes. b. assess for barriers to implementing the knowledge. c. continue trying to education the patient on the topic. d. find out whether the patient learns in a different way.

ANS: B

If the patient has the knowledge needed to make changes but does not, something is inhibiting the patient’s ability or willingness to make the change. The nurse would be wise to assess for things that are keeping the patient from changing. Asking the patient whether he or she really wants to make changes will most likely sound challenging to the patient and might result in the patient’s being defensive. More education is not the key unless the patient does not have enough information. Patients do learn in different ways, and tailoring the education to the patient’s strengths is a good idea, but in this case, the nurse needs to determine whether something is keeping the patient from making the needed changes.

2. Much of what we believe, think, and act is attributed to: a. diversity. b. holism. c. culture. d. faith.

ANS: C

Culture can be defined in multiple ways. In general, most definitions encompass socially inherited and shared beliefs, practices, habits, customs, language, and rituals. It shapes how people view their world and how they function within that world. It can transcend generations.

The one unifying theme in defining culture is that it is learned. Much of what we believe, think, and act is attributable to culture. Hence one’s culture can profoundly determine what is perceived as health versus illness.

3. The nursing faculty member explains that paternalism refers to: a. the physician must understand new ethical and professional standards. b. the patient is responsible for obtaining health care knowledge. c. the government imposed strict regulations on patient consent. d. the belief that physicians know more about the patient’s needs than the patient

does.

ANS: D

Paternalism refers to the presumption that health care providers know more about the patient’s health needs than the patient does.

4. The nurse educator is presenting a lecture on diversity. How should diversity be explained? a. Faith differences

b. Differences in nationality c. Differences in social class d. Ethnic differences ANS: D

While there are many different definitions for diversity, many people define it as racial or ethnic differences.

5. The nursing professor understands that percentage of students from minority backgrounds in

entry-level baccalaureate programs is: a. 31.0. b. 30.1. c. 26.5. d. 34.9.

ANS: B

The percentage of students from minority background in entry-level baccalaureate programs is 30.1%, for master’s programs 31.9%, and doctoral programs 29.7%.

6. A nurse assessing the needs of a patient. Which question demonstrates sensitivity to the

client’s culture? a. “Are you able to meet your needs when you are sick?” b. “Are there any special foods that you like?” c. “How much stress do you have in your life right now?” d. “When did the symptoms first become bothersome?”

ANS: B

Cultural sensitivity can improvN eU paRtiS enItN ’sGoT utB co.m CeOs,Mand overall satisfaction for care received.

The nurse should inquire about any specific foods that the client enjoys, or typically incorporates during times of illness.

7. Which action displays cultural knowledge? a. Examining biases b. Interviewing the patient c. Creating a careplan for the patient d. Educating oneself on different cultures ANS: D

The process of cultural awareness occurs when the nurse is able to examine his or her own values, biases, and stereotypes. It also requires the nurse to examine the potential cultural biases (racism) that may exist within the health care setting. The process of cultural knowledge occurs when nurses educate themselves about the worldviews of other cultures and ethnic groups. This cultural knowledge may include learning how disease processes and management may vary depending on the cultural group. Cultural skill occurs when the nurse can conduct a relevant cultural assessment. Hence, it is achieved when cultural data are used to develop and implement a culturally relevant treatment plan. Cultural encounters encourage the nurse to engage directly with patients from different ethnic and cultural backgrounds to modify existing beliefs about a cultural group and prevent potential stereotyping. Finally, cultural desire addresses the motivation of the health care provider to acquire new knowledge about different cultures.

8. Which action by the nurse demonstrates cultural awareness? a. Stating Maslow’s level of self-actualization b. Becoming educated about a new culture c. Examines own biases and stereotypes d. Understanding the importance of health in their lives ANS: C

The process of cultural awareness occurs when the nurse is able to examine his or her own values, biases, and stereotypes. It also requires the nurse to examine the potential cultural biases (racism) that may exist within the health care setting. The process of cultural knowledge occurs when nurses educate themselves about the worldviews of other cultures and ethnic groups. This cultural knowledge may include learning how disease processes and management may vary depending on the cultural group. Cultural skill occurs when the nurse can conduct a relevant cultural assessment. Hence, it is achieved when cultural data are used to develop and implement a culturally relevant treatment plan. Cultural encounters encourage the nurse to engage directly with patients from different ethnic and cultural backgrounds to modify existing beliefs about a cultural group and prevent potential stereotyping. Finally, cultural desire addresses the motivation of the health care provider to acquire new knowledge about different.

9. A nurse explains to a nursing student that an advantage of a broad view of health is: a. family, friends, culture, and environment are all resources the patient can use. b. it leaves room for alternative, holistic views about health and health care practices. c. patients are free to define health and illness according to their own philosophies. d. the health care team will not inadvertently overlook important issues for the

patient.

ANS: A

In a broad view of health, the nurse recognizes the impact of family, friends, culture, and environment on the patient, who exists within a relationship with each of these components.

Thus, each part of the patient’s life can be harnessed as a supportive resource for the patient.

Alternative practices are not specifically addressed in a broader view of health and illness.

Furthermore, holistic does not mean “alternative,” although many people have this impression. The broader view of health considers that mind, body, and spirit are all interrelated and that the patient’s family, friends, culture, and environment have effects on the patient that cannot be ignored; it is not related to patients’ definitions of health and illness.

The broader view of health is not necessarily a way to avoid overlooking issues of importance to patients.

10. The nurse explains to a student that health promotion means: a. encouraging people to avoid unhealthy habits. b. maintaining a preventive health schedule. c. preventing major diseases and injuries. d. protecting health and improving wellness.

ANS: D

Protecting health and taking people beyond their current level of wellness are the goals of health promotion. Encouraging patients to avoid unhealthy habits is part of health promotion, but this is too narrow in focus to be the best answer. Maintaining a preventive health schedule, such as routine checkups, is part of health promotion, but this is too narrow in focus to be the best answer. Preventing disease is disease prevention, which is part of the clinical model of health.

11. A nurse is counseling a patient on disease prevention for a condition seen often in the

patient’s family history. Which instruction would the nurse be most likely to include in the patient’s teaching? a. “Fresh fruits and vegetables have healthy nutrients.” b. “Sleep deprivation has some very harmful effects.” c. “Stress can be reduced through many different methods.” d. “You should limit red meat to three servings a week.”

ANS: D

Disease prevention is often aimed at preventing specific diseases and often addresses the problem by having people restrict or avoid certain items. This statement gives specific advice the patient can follow. The statement about fresh produce is too vague and does not give specific advice the patient can follow. The statement about sleep deprivation is too vague and does not give specific advice the patient can follow. The statement about stress is too vague and does not give specific advice the patient can follow.

12. A nurse has worked to teach patients disease prevention strategies and is frustrated by the low

level of compliance. This nurse would most likely conclude that: a. it is hard to convince people that they can attain higher wellness levels. b. most people have very l o w Nl eUv R el S sI ofNmGoTtiB va.tiCoO nM to make changes. c. patients do not like being told that good health requires deprivation. d. the information being given is too difficult for patients to follow.

ANS: C

Disease prevention aims to prevent specific diseases by avoiding, limiting, or restricting certain behaviors. This negative focus may discourage people and make them feel deprived.

Considering higher levels of wellness would be health promotion, not disease prevention.

People are often motivated to make changes but lack information and concrete plans to do so.

Certainly, the nurse would not want to assume a negative view of patients as being generally unmotivated. The nurse should assess whether or not the information is too difficult for patients, but for the majority of patients, this will not be the case.

13. A nurse is beginning discharge teaching when the patient states, “I just don’t know if I can

follow this diet at home. What difference will it make?” In further refining the discharge teaching plan, the nurse should: a. ask the patient to help set nutritional goals. b. give the patient clear written directions. c. provide the patient with a list of websites. d. tell the patient when to return to the clinic.

ANS: B

A person with an external locus of control, such as this patient, needs clear directions and firm support to make healthy changes. Clear written instructions would be very helpful. With a patient who has an internal locus of control, it is a good strategy to ask the patient to help set his or her own nutritional goals. However, this patient has an external locus of control and would not believe that he or she has this control. A patient with an external locus of control may not see value in searching websites and likely would not do it. Although telling the patient when to return to the clinic is very clear, it does nothing to assist the patient in making healthy changes to dietary behaviors.

14. Which construct of the Campinha-Bacote Model of Competence is based solely on the nurses

intrinsic need to acquire new knowledge? a. Cultural knowledge b. Cultural skill c. Cultural awareness d. Cultural desire ANS: D

The process of cultural awareness occurs when the nurse is able to examine his or her own values, biases, and stereotypes. It also requires the nurse to examine the potential cultural biases (racism) that may exist within the health care setting. The process of cultural knowledge occurs when nurses educate themselves about the worldviews of other cultures and ethnic groups. This cultural knowledge may include learning how disease processes and management may vary depending on the cultural group. Cultural skill occurs when the nurse can conduct a relevant cultural assessment. Hence, it is achieved when cultural data are used to develop and implement a culturally relevant treatment plan. Cultural encounters encourage the nurse to engage directly with patients from different ethnic and cultural backgrounds to modify existing beliefs about aNcU ulR tuSraIl N grGoT upBa.nC d OpM revent potential stereotyping. Finally, cultural desire addresses the motivation of the health care provider to acquire new knowledge about different. Cultural desire occurs when the nurse has an intrinsic need to acquire new cultural knowledge.

15. A nurse who is teaching a patient assesses the patient’s goals in life. The nurse then explains

to a student nurse that this practice is important because: a. goals can be motivators for making health changes. b. it helps the nurse become familiar with the patient. c. social interactions relax the patient and increase trust. d. this shows whether the person has self-agency or not.

ANS: A

The nurse can use the patient’s goals as motivating factors. Without good health, the patient probably won’t be able to meet most goals. Although teaching a patient how to assess his or her life goals does assist the nurse in getting to know the patient as a unique individual, it is what the nurse does with this knowledge (motivate the patient) that is important. This answer is too narrow in focus to be the best choice. Increasing trust will help the nurse convince the patient that health-related changes are needed, but this answer is too narrow in focus to be the best answer. Goals are not related to self-agency.

16. Which is a more viable mechanism than race for examining similarities and differences? a. Religion b. Ethnicity

c. Cultural d. Social status ANS: B

Ethnicity is a more viable mechanism than race for examining similarities and differences. In the United States, race is still influential in every day social experiences, and is still a major issues that nurses must confront to effectively manage diversity.

17. A nurse wishes to encourage a patient to begin an exercise program. Which action should the

nurse take in order to increase the likelihood of long-term compliance? a. Create a list of possible long-term health benefits. b. Gain insight into the patient’s culture. c. Encourage the patient to invest in expensive and durable fitness equipment. d. Create a exercise routine for the patient to try.

ANS: B

In order to encourage the client to engage in an exercise program with long-term compliance, the nurse should first gain insight into the patient’s culture. Knowledge of immediate benefits is often more motivating than focusing on something that may or may not occur in the future.

Expensive equipment is not necessary to maintain good health. The costs may be prohibitive for some people, discouraging their participation. Creating an exercise program for the patient will not work, unless it is tailored to the patient’s needs and interests.

18. Which statement is true of overall trends regarding racial and ethnic minorities? a. Life expectancy has decreased slightly. b. Infant mortality has remained the same. c. They are more likely to receive medical procedures. d. They experience a lower quNaU litR ySoI f hNeG alT thBs. erCvO icM es.

ANS: D

Overall, racial and ethnic minorities have seen an increase in life expectancy and reduced infant mortality. They are less likely to receive medical procedures and experience a lower quality of health services.

19. A nurse is helping an obese patient alter dietary habits, but the patient does not seem to follow

through with agreed-upon recommendations. Which action by the nurse would be most beneficial? a. Ask the patient about foods that have special meanings. b. Describe the health risks of not staying on the regimen. c. Encourage the patient to keep a food log during the day. d. Review dietary teaching to see what is not understood.

ANS: A

Dietary habits are particularly difficult to change because food is often imbued with social and cultural meaning. Furthermore, if the patient is the person doing the cooking for the family, the dietary choices affect all members, who may also not like the prescribed regimen. The nurse could assess the meaning that food has for this patient and make alterations in the recommendations so that special foods can be enjoyed in their traditional manner on limited occasions. People respond much more favorably to messages about the benefits that accrue from making changes; they do not respond as well to threats of vague future repercussions.

Keeping a food log does help patients lose weight, but finding out whether certain foods have special meanings would be more helpful than just having the patient keep a journal of what foods were eaten. The patient may have some misunderstandings in regard to the dietary teaching, but the nurse should assess for these, not assume they exist.

20. When working with patients on changing health-related behaviors, the nurse understands that

the first priority is to: a. assess the patient’s knowledge about the behavior. b. determine how motivated the patient is to change. c. establish a collaborative relationship with the patient. d. plan interventions and set goals for behavior change.

ANS: C

Establishing a collaborative relationship with the patient is the priority when working with patients to make health-related behavior changes, because many people have had negative experiences with health care providers in the past and hold unfavorable views of them.

Assessing prior knowledge is important but is not the priority. Determining motivation, including what factors can serve as motivators, would be important, but this is not the priority.

Planning goals and interventions would come after establishing a collaborative relationship and assessing the patient’s knoN wU leR dgSeI . NGTB.COM 21. Before providing written information or behavioral contracts to a patient, a nurse should

ascertain that the patient: a. can read and understand. b. has resources for change. c. is ready to make changes. d. wants to make changes.

ANS: A

High numbers of Americans are functionally illiterate, or read at the third or fourth grade level, so the nurse must assess that the patient can read and understand written information before giving the patient printed materials or contracts. It is important to assess a patient’s access to resources for change, but this does not specifically relate to written material. It is important to assess whether a patient is ready to make changes, but this does not specifically relate to written material. It is important to assess whether a patient wants to make changes, but this does not specifically relate to written material.

22. A grant-awarding organization is reviewing a nurse-led program promoting weight loss and

healthy eating habits in a minority population. The program has a high success rate. The organization’s members might conclude that: a. members of the cultural group have specific health needs the program helps meet. b. nurse-run programs have better outcomes than those led by other providers. c. the nurse sought assistance from cultural leaders to develop the program.

d. this cultural group is well assimilated and uses Western medical practices.

ANS: C

Culture plays a huge role in people’s understandings and beliefs about health and wellness.

Before designing programs offered to minority populations, the nurse would be wise to consult with community leaders to ensure that interventions are culturally appropriate. This measure is associated with a high success rate in such programs.

It may be true that members of the cultural group have specific health needs that the program helps meet, but this cannot be assumed from the high success rate. The success rate of one program alone cannot determine whether nurse-run programs have better outcomes than those led by other providers. The success of the program cannot prove that this cultural group is well assimilated or that it uses Western medical practices.

23. Which groups has the highest burden of human immunodeficiency virus? a. Asian Americans b. Hispanics Latinos c. African Americans d. Pacific Islanders ANS: C

According to research, African Americans have the highest burden of human immunodeficiency virus, at all stages of infection. This rate is 20 times that of white women, and nearly five times that of Latinos.

Chapter 15: Health and Health Promotion Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. A nurse is frustrated because a patient does not make any needed health changes despite

ongoing and comprehensive education on the health-related topic. The best action by the nurse would be to: a. ask the patient if he or she really wants to make changes. b. assess for barriers to implementing the knowledge. c. continue trying to education the patient on the topic. d. find out whether the patient learns in a different way.

ANS: B

If the patient has the knowledge needed to make changes but does not, something is inhibiting the patient’s ability or willingness to make the change. The nurse would be wise to assess for things that are keeping the patient from changing. Asking the patient whether he or she really wants to make changes will most likely sound challenging to the patient and might result in the patient’s being defensive. More education is not the key unless the patient does not have enough information. Patients do learn in different ways, and tailoring the education to the patient’s strengths is a good idea, but in this case, the nurse needs to determine whether something is keeping the patient from making the needed changes.

2. The word holism was first used in print by: a. Dorothea Orem. b. Halbert Dunn. c. Jan Smuts. d. Martha Rogers.

ANS: C

Jan Smuts wrote about holism in a 1926 book, describing holism as a dynamic striving toward integration. Dorothea Orem, a nursing theorist, developed a nursing theory around patients’ self-care agency. Halbert Dunn coined the phrase “high level wellness.” Martha Rogers developed a nursing theory of people as unitary human beings who are more than the sum of their parts.

3. The nursing faculty member explains that dissatisfaction with the power imbalance in health

care in part led to: a. new ethical and professional standards. b. requirements for patient education. c. strict regulations on patient consent. d. the consumer wellness movement.

ANS: D

The consumer wellness movement was a direct result of dissatisfaction with paternalistic health care and occurred at a time when consumers of health care were becoming better educated. New ethical and professional standards did not emerge from dissatisfaction with power imbalances in health care. Requirements for patient education did not change as a result of dissatisfaction with power imbalances in health care. New regulations on patient consent did not emerge from dissatisfaction with power imbalances in health care.

4. The nursing policy analyst explains to a class of nursing students that the consumer wellness

movement helped create: a. a surge in wellness and fitness centers across the nation. b. market-based competition for customer services. c. new types of health care insurance. d. self-care focus in health policies and public health initiatives.

ANS: D

As a result of the influence of the consumer wellness movement, federal policies and initiatives began incorporating self-care education for the general public. A surge in wellness and fitness centers was not the direct result of the consumer wellness movement, although in recent years, fitness center membership has grown, especially among affluent individuals.

Market-based competition for health care services was not the direct result of the consumer wellness movement. New categories of insurance were not the direct result of the consumer wellness movement.

5. The idea that health is the absence of disease is a predominant feature of the

model of health. a. adaptive b. clinical c. eudaemonistic d. role performance ANS: B

The clinical model of health considers the absence of disease to be the defining characteristic of health. The adaptive model of health emphasizes continual adaptation and readjustment to demands. The eudaemonistic mNoU deRlSoI f hNeG alT thBf. ocCuO seMs on the complete development of human potential. The role performance model of health considers illness to exist when one cannot perform one’s roles.

6. A nurse assessing a patient with the role performance model of health in mind would add

which question to the nursing assessment as a priority? a. “Are you able to meet your needs when you are sick?” b. “How has this illness affected your daily activities?” c. “How much stress do you have in your life right now?” d. “When did the symptoms first become bothersome?”

ANS: B

Daily activities reflect roles, and the role performance model of health looks at disease as interfering with the ability to fulfill one’s social roles. The adaptive model of health addresses whether or not patients are able to meet their own needs. The adaptive model of health addresses the amount of stress patients have in their lives. The clinical model of health considers the absence of disease (and absence of symptoms) to be the defining characteristic of health.

7. A nurse assessing a patient with the adaptive model of health in mind would most likely ask

which question as part of an admission database? a. “Does this illness cause problems in your relationships?” b. “How have these symptoms interfered with your daily life?” c. “What impact has this illness had on your usual lifestyle?”

d. “What type of support systems do you have to help you?”

ANS: D

This question would fit with the adaptive model of health, which considers that humans need to adapt constantly to the stresses and demands of their ever-changing lives. The role performance model of health addresses how illness affects a patient’s relationships. The role performance model of health addresses how illness affects a patient’s daily life. The role performance model of health addresses how illness affects a patient’s usual lifestyle.

8. The nurse who is interested in the eudaemonistic model of health would likely assess patients

regarding their position related to: a. a broad range of feelings about health. b. ease of making health care changes. c. Maslow’s level of self-actualization. d. the importance of health in their lives.

ANS: C

The eudaemonistic model of health emphasizes human growth and depicts health as total development of the human, which is analogous to Maslow’s stage of self-actualization. The eudaemonistic model would not specifically focus on a broad range of feelings about health.

The ease of making health care changes is not related directly to models of health. The nurse using the eudaemonistic model of health would not specifically be interested in the importance of health in people’s lives.

9. A nurse explains to a nursing student that an advantage of a broad view of health is: a. family, friends, culture, and environment are all resources the patient can use. b. it leaves room for alternative, holistic views about health and health care practices. c. patients are free to define hN eaUltR hS anIdNiG llnTeB ss.aCccOoMrding to their own philosophies. d. the health care team will not inadvertently overlook important issues for the

patient.

ANS: A

In a broad view of health, the nurse recognizes the impact of family, friends, culture, and environment on the patient, who exists within a relationship with each of these components.

Thus, each part of the patient’s life can be harnessed as a supportive resource for the patient.

Alternative practices are not specifically addressed in a broader view of health and illness.

Furthermore, holistic does not mean “alternative,” although many people have this impression. The broader view of health considers that mind, body, and spirit are all interrelated and that the patient’s family, friends, culture, and environment have effects on the patient that cannot be ignored; it is not related to patients’ definitions of health and illness.

The broader view of health is not necessarily a way to avoid overlooking issues of importance to patients.

10. The nurse explains to a student that health promotion means: a. encouraging people to avoid unhealthy habits. b. maintaining a preventive health schedule. c. preventing major diseases and injuries. d. protecting health and improving wellness.

ANS: D

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Protecting health and taking people beyond their current level of wellness are the goals of health promotion. Encouraging patients to avoid unhealthy habits is part of health promotion, but this is too narrow in focus to be the best answer. Maintaining a preventive health schedule, such as routine checkups, is part of health promotion, but this is too narrow in focus to be the best answer. Preventing disease is disease prevention, which is part of the clinical model of health.

11. A nurse is counseling a patient on disease prevention for a condition seen often in the

patient’s family history. Which instruction would the nurse be most likely to include in the patient’s teaching? a. “Fresh fruits and vegetables have healthy nutrients.” b. “Sleep deprivation has some very harmful effects.” c. “Stress can be reduced through many different methods.” d. “You should limit red meat to three servings a week.”

ANS: D

Disease prevention is often aimed at preventing specific diseases and often addresses the problem by having people restrict or avoid certain items. This statement gives specific advice the patient can follow. The statement about fresh produce is too vague and does not give specific advice the patient can follow. The statement about sleep deprivation is too vague and does not give specific advice the patient can follow. The statement about stress is too vague and does not give specific advice the patient can follow.

12. A nurse has worked to teach patients disease prevention strategies and is frustrated by the low

level of compliance. This nurse would most likely conclude that: a. it is hard to convince people that they can attain higher wellness levels. b. most people have very l o w Nl eUv R el S sI ofNmGoTtiB va.tiCoO nM to make changes. c. patients do not like being told that good health requires deprivation. d. the information being given is too difficult for patients to follow.

ANS: C

Disease prevention aims to prevent specific diseases by avoiding, limiting, or restricting certain behaviors. This negative focus may discourage people and make them feel deprived.

Considering higher levels of wellness would be health promotion, not disease prevention.

People are often motivated to make changes but lack information and concrete plans to do so.

Certainly, the nurse would not want to assume a negative view of patients as being generally unmotivated. The nurse should assess whether or not the information is too difficult for patients, but for the majority of patients, this will not be the case.

13. A nurse is beginning discharge teaching when the patient states, “I just don’t know if I can

follow this diet at home. What difference will it make?” In further refining the discharge teaching plan, the nurse should: a. ask the patient to help set nutritional goals. b. give the patient clear written directions. c. provide the patient with a list of websites. d. tell the patient when to return to the clinic.

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A person with an external locus of control, such as this patient, needs clear directions and firm support to make healthy changes. Clear written instructions would be very helpful. With a patient who has an internal locus of control, it is a good strategy to ask the patient to help set his or her own nutritional goals. However, this patient has an external locus of control and would not believe that he or she has this control. A patient with an external locus of control may not see value in searching websites and likely would not do it. Although telling the patient when to return to the clinic is very clear, it does nothing to assist the patient in making healthy changes to dietary behaviors.

14. A faculty member explains to a student that when a person has self-care agency, the person: a. believes in personal control of his or her life and its consequences. b. controls his or her own health care practices instead of relying on others for this. c. has an innate sense of direction and sets goals for the future. d. thinks he or she is able to accomplish things and is willing to try them.

ANS: D

A person with self-care agency believes that he or she is capable of completing a behavior and therefore is more prone to attempt it. A person has an internal locus of control when he or she is able to believe in personal control of his or her life and its consequences. A person’s ability to control health care practices, rather than relying on a health care professional or other people, is not directly related to self-care agency. A person who has a sense of direction and sets goals for the future has a sense of purpose.

15. A nurse who is teaching a patient assesses the patient’s goals in life. The nurse then explains

to a student nurse that this practice is important because: a. goals can be motivators for making health changes. b. it helps the nurse become faNm liaSrIwNitG hT thBe.pC atO ieM nt.

UiR c. social interactions relax the patient and increase trust. d. this shows whether the person has self-agency or not.

ANS: A

The nurse can use the patient’s goals as motivating factors. Without good health, the patient probably won’t be able to meet most goals. Although teaching a patient how to assess his or her life goals does assist the nurse in getting to know the patient as a unique individual, it is what the nurse does with this knowledge (motivate the patient) that is important. This answer is too narrow in focus to be the best choice. Increasing trust will help the nurse convince the patient that health-related changes are needed, but this answer is too narrow in focus to be the best answer. Goals are not related to self-agency.

16. A nurse assesses a patient for frequently occurring barriers to implementing behavior changes

according to the health belief model. Which question by the nurse will yield the most useful information? a. “Do you think you know enough to change your diet?” b. “How much time do you have each week to exercise?” c. “What other information can I give you about this topic?” d. “Why haven’t you started these healthy behaviors yet?”

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In using the health belief model, the nurse assesses for perceived barriers to action. Lack of time might well be a barrier for this patient. The question “Do you think you know enough to change your diet?” is concerned with lack of knowledge, which is not one of the most frequent barriers to behavior change. Lack of knowledge is not one of the most frequently occurring barriers to behavioral change. “Why” questions are probing and tend to make patients defensive. Furthermore, the patient may not be able to answer this question because he or she may not be aware of the reasons behind the behavior.

17. A nurse wishes to encourage a patient to begin an exercise program. Drawing on past

research, to increase the likelihood of long-term compliance, the nurse suggests that the patient: a. create a list of possible long-term health benefits. b. exercise in the home or around the neighborhood. c. invest in expensive and durable fitness equipment. d. join an exercise class at the local fitness center.

ANS: B

Research has shown that exercise regimens that are home-based result in better compliance than do regimens that rely on participating in a group activity in a local fitness center.

Knowledge of immediate benefits is often more motivating than focusing on something that may or may not occur in the future. Expensive equipment is not necessary to maintain good health. The costs may be prohibitive for some people, discouraging their participation. Group participation has not been shown to create more compliance than home-based exercise regimens.

18. A nurse is working with a patient on an exercise regimen. Which outcome, as written by the

nurse, is most likely to en cou raNgeU cRoSmIpNl i aGnTceB w . iCt hOaMne wl y established exercise regimen? The patient will: a. increase exercise by 10% a week for 10 weeks. b. participate in an exercise class three times weekly. c. swim for 30 minutes a day five times a week. d. walk for 10 minutes a day three times a week.

ANS: D

Setting a goal that the patient will walk for 10 minutes a day three times a week is realistic and achievable even for a patient who has been completely sedentary. Good outcomes for health behavior change are realistic and measurable. It would be difficult for most people to determine what constitutes a 10% increase in their exercise each week. People are more likely to remain compliant with a home-based exercise regimen than one that relies on group participation at a fitness center. Setting an outcome that the patient will swim for 30 minutes a day, five times a week is not realistic for the beginning phase of an exercise regimen.

19. A nurse is helping an obese patient alter dietary habits, but the patient does not seem to follow

through with agreed-upon recommendations. Which action by the nurse would be most beneficial? a. Ask the patient about foods that have special meanings. b. Describe the health risks of not staying on the regimen. c. Encourage the patient to keep a food log during the day. d. Review dietary teaching to see what is not understood.

ANS: A

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Dietary habits are particularly difficult to change because food is often imbued with social and cultural meaning. Furthermore, if the patient is the person doing the cooking for the family, the dietary choices affect all members, who may also not like the prescribed regimen. The nurse could assess the meaning that food has for this patient and make alterations in the recommendations so that special foods can be enjoyed in their traditional manner on limited occasions. People respond much more favorably to messages about the benefits that accrue from making changes; they do not respond as well to threats of vague future repercussions.

Keeping a food log does help patients lose weight, but finding out whether certain foods have special meanings would be more helpful than just having the patient keep a journal of what foods were eaten. The patient may have some misunderstandings in regard to the dietary teaching, but the nurse should assess for these, not assume they exist.

20. A nurse tailors smoking cessation and smoking prevention activities toward teenagers because

the nurse knows: a. adolescents can become “captive audiences” in school programs. b. smoking as a teenager is a strong predictor of smoking as an adult. c. teenagers are more amenable to messages about good health habits. d. the health risks associated with smoking are worse for adolescents.

ANS: B

Smoking in adolescence is a very powerful predictor of smoking as an adult. School assemblies do create captive audiences, but they may not all be listening. Teenagers are not necessarily more amenable to health-related messages; they may in fact be less willing to listen because of their sense of invincibility. Health risks from smoking accumulate over time, so they are much worse the longer one smokes.

21. When working with patients onNcUhR anSgI inNgGhT eaBlt. h-Cr eOl aMt e d behaviors, the nurse understands that

the first priority is to: a. assess the patient’s knowledge about the behavior. b. determine how motivated the patient is to change. c. establish a collaborative relationship with the patient. d. plan interventions and set goals for behavior change.

ANS: C

Establishing a collaborative relationship with the patient is the priority when working with patients to make health-related behavior changes, because many people have had negative experiences with health care providers in the past and hold unfavorable views of them.

Assessing prior knowledge is important but is not the priority. Determining motivation, including what factors can serve as motivators, would be important, but this is not the priority.

Planning goals and interventions would come after establishing a collaborative relationship and assessing the patient’s knowledge.

22. Before providing written information or behavioral contracts to a patient, a nurse should

ascertain that the patient: a. can read and understand. b. has resources for change. c. is ready to make changes. d. wants to make changes.

ANS: A

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High numbers of Americans are functionally illiterate, or read at the third or fourth grade level, so the nurse must assess that the patient can read and understand written information before giving the patient printed materials or contracts. It is important to assess a patient’s access to resources for change, but this does not specifically relate to written material. It is important to assess whether a patient is ready to make changes, but this does not specifically relate to written material. It is important to assess whether a patient wants to make changes, but this does not specifically relate to written material.

23. A grant-awarding organization is reviewing a nurse-led program promoting weight loss and

healthy eating habits in a minority population. The program has a high success rate. The organization’s members might conclude that: a. members of the cultural group have specific health needs the program helps meet. b. nurse-run programs have better outcomes than those led by other providers. c. the nurse sought assistance from cultural leaders to develop the program. d. this cultural group is well assimilated and uses Western medical practices.

ANS: C

Culture plays a huge role in people’s understandings and beliefs about health and wellness.

Before designing programs offered to minority populations, the nurse would be wise to consult with community leaders to ensure that interventions are culturally appropriate. This measure is associated with a high success rate in such programs. It may be true that members of the cultural group have specific health needs that the program helps meet, but this cannot be assumed from the high success rate. The success rate of one program alone cannot determine whether nurse-run programs have better outcomes than those led by other providers. The success of the program cannot prove that this cultural group is well assimilated or that it uses Western medical practices.

24. A patient who smokes has decided to cut down on the number of cigarettes smoked each day

and not to go outside with other smokers during work breaks. The nurse can conclude, according to Prochaska’s transtheoretical model of change, that this patient is in the stage of: a. action. b. maintenance. c. precontemplation. d. preparation.

ANS: A

In the action stage, a person adopts goals for behavior change, attempts to enact the behavior change, and works to modify the environment to support the change. The maintenance stage consists of working to prevent reverting to the old behaviors. In the precontemplation stage, individuals do not see their behavior as a problem and have no intentions of changing their behavior. In the preparation stage, individuals make a decision to change behaviors in the next month and may take some very small steps to begin the process.

25. A nurse is explaining a behavioral contract with the patient. Which statement by the nurse is

most accurate? “A behavioral contract: a. lets me decide what rewards I will give you when you meet certain objectives.” b. does not have a specific time frame and continues until I terminate it.” c. eliminates the need to keep records of the behavior we are working on.” d. is planned and evaluated by both of us and concerns a specific goal.”

ANS: D

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Both the patient and nurse are involved in planning and evaluating the contract and selecting the goals. There are both intrinsic and extrinsic rewards in a good contract, and both the patient and nurse agree upon them. The nurse and patient mutually decide on the time frame of a contract. Good data collection and recording are part of a behavioral contract and can include things such as a food log.

26. A patient needs to lose weight. The nurse has assessed the patient to be in the contemplation

stage of Prochaska’s transtheoretical model of change. Which intervention by the nurse would be most appropriate? a. Give the patient a referral to a dietician for teaching. b. Help the patient devise a log to record all food eaten. c. Provide information on the benefits of losing weight. d. Teach the patient small, simple steps for weight loss.

ANS: C

At this stage, the patient realizes that weight is a problem and is thinking about changing some associated behaviors. However, the patient is not yet ready to change. Providing information could encourage the patient to move on to the next stage in the model. The patient is not yet ready to take action in this stage, so giving a referral would probably not be beneficial because the patient most likely would not go. The patient is not yet ready to take action at this point and would probably not be willing to maintain a food log. The patient is not yet ready to take action in this stage, so instructions on specific behavior changes would not be helpful.

27. A patient needs to make a health-related behavior change, and the nurse using the health

beliefs model is working with the perceived severity factor. Which action by the nurse is most appropriate? a. Assist the patient to identifyN U thRe S beInN efGitT sB as. soCcO iaM ted with the wanted change. b. Help the patient determine the barriers that prevent changing this behavior. c. Illustrate some of the consequences of not changing the selected behavior. d. Inform the patient about the morbidity associated with current behavior.

ANS: C

Illustrating some of the consequences of not changing the selected behavior relates to perceived severity. Assisting the patient to identify the benefits associated with the wanted change relates to perceived benefits. Helping the patient determines the barriers that prevent changing health-related behavior relates to perceived barriers. Informing the patient about the morbidity associated with current behavior relates to susceptibility.

MULTIPLE RESPONSE 1. A nurse using the health promotion model assesses for the best predictors of behaviors that

promote health, including: (Select all that apply.) a. perceived barriers. b. perceived benefits. c. perceived wellness. d. prior behavior. e. self-efficacy.

ANS: A, D, E

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According to the health promotion model, the best predictors of engaging in health-promoting behaviors are perceived self-efficacy, perceived barriers, and prior behavior. Perceived benefits and perceived wellness are not predictors of health-promoting behavior according to this model.

2. A nurse is planning a community health assessment event using a tool called a health risk

appraisal (HRA). For best results, which other activities should the nurse plan to include in this event? (Select all that apply.) a. Gym memberships b. Laboratory testing c. Physical measurements d. Support group interaction e. Tailored education ANS: B, C, D

Laboratory testing is an important adjunct to the use of HRAs in health assessment events.

Objective data lend support to findings from the tool. Physical measurements are an important part of screening events using HRAs. Blood pressure, height and weight, and body mass index are all physical measurements that can lend support to findings from the HRA. Education tailored to the risks that are uncovered with the HRA, laboratory testing, and physical measurements allows the practitioner to design wellness interventions for each participant.

Exercise compliance is better with home-based programs than with other types of routines.

Gym memberships are not typically part of an HRA event. Support group interaction is typically not associated with HRAs. 3. The faculty member explains to students that the Healthy People documents: (Select all that

apply.) a. focus on health disparities among Americans. b. guide the planning of public health programs. c. have specific, measurable health-related objectives. d. rate hospitals and physicians based on patient satisfaction. e. routinely assess peoples’ willingness to make healthy changes.

ANS: A, B, C

The Healthy People documents highlight the disparities in health care among Americans. The written goals of Healthy People initiatives help guide planning for public health programs.

Written objectives exist for both health promotion and disease prevention that are clear and measurable. Healthy People documents do not rate physicians and hospitals based on patient satisfaction. Healthy People documents do not assess willingness to engage in health-related changes.

4. A nurse planning events related to Healthy People 2020 goals would include activities related

to: (Select all that apply.) a. creating screening programs for childhood obesity. b. developing health literacy programs for adults. c. implementing classes on cultural competence for nurses. d. planning smoking prevention classes for middle school children. e. teaching healthy nutrition and eating to children.

ANS: A, B, D, E

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Healthy People 2020 documents are the nation’s roadmap to better health. Some of the goals in this document are decreasing childhood obesity and tobacco use and improving the number of adults who say their providers explain things in a way they can understand. Improving cultural competence is not one of its goals.

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Chapter 16: Genetics and Genomics in Professional Nursing Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. The nurse studying genomics explains to another nurse that the era between the 1950s and

1980s was notable for: a. creation of medications tailored to genetics. b. developing tests for some genetic conditions. c. passage of a genetic nondiscrimination act. d. the complete mapping of the human genome.

ANS: B

Genetic testing for specific conditions such as Down syndrome was developed because of research findings from the period between the 1950s and 1980s. Newborn screening for some genetic conditions was developed during that time frame as well. The creation of medications tailored to a specific patient’s genomic profile is a very recent development. The Genetic Information Nondiscrimination Act (GINA) was passed in 2008.The human genome was completely mapped and sequenced in 2003.

2. A young adult patient whose family history contains many first- and second-degree relatives

who have had colon cancer wants to know if yearly colonoscopies would be a good idea. The best response by the nurse would be to encourage the patient to: a. ask the physician about the colonoscopies. b. not worry because risks are low at his or her age. c. search for a company to proNvU idReSscIrN eeGnT inB g..COM d. talk to the doctor about genetic screening.

ANS: D

The patient and physician can go over the patient’s history, family history, and benefits and drawbacks to screening. This also keeps the health care provider in the communication loop with the patient and the results. The patient could ask the physician about doing yearly colonoscopies, but this invasive procedure carries risks. The best answer would be to inquire about genetic screening. Although colon cancer does occur more often in older patients, this patient’s family history puts him or her in a high-risk group and that needs to be addressed.

Some companies do provide private genetic screening, but this approach can lead to misunderstanding and confusion. It would be better for the patient to have genetic screening guided by the health care professionals who know the patient.

3. The nurse knows that the science of all the genes in the human genome, along with their

interactions with each other, the environment, and other influences, is known as the study of: a. genes. b. genetics. c. genomics. d. inheritance.

ANS: C

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Genomics is the study of all a person’s genes in interaction with each other, the environment, and many other factors. A gene is a functional unit of heredity passed from parent to offspring. Genetics is a term that refers to the study of genes and their role in inheritance.

Inheritance is the way genes and traits are passed from parents to children.

4. A nurse is seeing a patient for a wellness checkup and collects data on the patient’s family

history of medical problems. The nurse would evaluate that goals for related teaching have been met when the patient states, a. “Exercise is important for me because I lead such a sedentary lifestyle already.” b. “I have a family history of heart disease, so I must make heart-healthy choices.” c. “I know now that my mother’s breast cancer does not really impact me.” d. “The chances of developing a disease are not greater if a relative has had it.”

ANS: B

Teaching goals have been met when the patient states an understanding that having relatives with heart disease increases his or her own risk of developing heart disease and so should take precautions to avoid it. Exercise is important for everyone, especially those who are sedentary, but this is not related to the information found in the family history. Having relatives with specific diseases, particularly if they are first-degree relatives, greatly increases one’s chance of developing the diseases.

5. A patient comes to the clinic and is worried about developing a neurological condition seen in

the patient’s mother and aunt. The best action by the nurse is to: a. conduct a thorough neurological examination on the patient. b. develop a multigenerational family health history (pedigree). c. have the patient voice these concerns to the physician. d. refer the patient to a geneticNcUoR unSsI elN orGiT mBm.eC diO atM ely.

ANS: B

The nurse should work with the patient to develop a multigenerational family health history, known as a family pedigree, so that the patient can present this information to the physician and have a better understanding of how this neurological disorder has impacted the patient’s family. Because the patient is not complaining of any neurological symptoms, conducting a thorough neurological examination would not be the best action by the nurse. Although the patient should voice his or her concerns to the physician, the nurse needs to be more proactive and intervene with the patient independently. This patient may or may not need referral to a genetic counselor; more information is needed before making that decision.

6. A couple wanting to start a family is concerned about possible ethnically related genetic

disorders. The nurse would advise this couple to undergo: a. carrier testing. b. diagnostic testing. c. genetic counseling. d. genetic variability testing.

ANS: A

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Carrier testing is done to determine whether individuals carry the genes for particular diseases. These genes can be passed to one’s offspring, leading to clinical disorders. Couples from specific racial and ethnic groups are often advised to have carrier testing before conceiving. Diagnostic testing identifies a specific gene that may be causing a health condition now or could cause one in the future. Genetic counseling may be needed pending the results of the carrier testing. Genetic variability is not one of the main types of genetic testing offered.

7. A genetics nurse is working with a couple undergoing genetic counseling. The nurse would

evaluate that goals for counseling have been met when the couple: a. decides not to have children because of the chance of genetic illness. b. is able to consider consequences of testing without cultural influences. c. makes informed decisions regarding testing and subsequent actions. d. understands a particular genetic illness and how it can be transmitted.

ANS: C

The couple who is able to make informed decisions regarding testing and subsequent activities has benefitted greatly from genetic counseling. The couple may decide not to have children, but a specific decision one way or the other does not show that goals for the genetic counseling have been met. The goal is not to convince the couple not to have children but rather to help the couple make an informed decision. Genetic counseling is done considering the ethical, social, and medical consequences of decisions. Making decisions in a cultural vacuum might well cause this couple more stress and anxiety. The couple demonstrating an understanding of a particular genetic illness does not necessarily mean that the goals of counseling have been met. This is a narrow bit of information.

8. A genetics nurse explains to a pNaU tiR enSt I thN atGpThB ar. mC acOoM genetics is the study of: a. how individuals respond uniquely to medications. b. the effects of drug therapy on developing fetuses. c. the way drugs interact with reproductive ability. d. using genetic material to create new pharmaceuticals.

ANS: A

Pharmacogenetics is the field of research that looks at the variability in individuals’ responses to medications, including medication transport and metabolism. Pharmacogenetics is not the study of how drugs affect developing fetuses. Pharmacogenetics is not the study of how medications interact with reproduction. Pharmacogenetics is not the field of developing new medications from genetic material.

9. A patient wants to enroll in a research study that involves genetic testing but is worried that if

the insurance carrier gets the results, coverage could be denied if the results showed a high risk for developing an expensive health problem. The nurse should explain that: a. insurers cannot use research participants’ genetic information against them. b. research companies would not sell or otherwise share their participants’ results. c. this is a valid concern and has been the topic of several recent costly lawsuits. d. there is legislation pending on this topic, but no law currently addresses this.

ANS: A

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Under the Genetic Information Nondiscrimination Act (GINA), insurers and employers are prohibited from using research participants’ genetic information against them. Although everyone hopes that research companies would not sell or otherwise share their participants’ results, there are enough concerns about the sharing of genetic information that President George W. Bush signed into law GINA in 2008. Part of GINA addresses the use of research participants’ genetic information. It is true that the patient’s concern is valid, but it has been addressed by the creation of GINA, which will hopefully forestall any need for litigation.

Currently, GINA is the law that covers genetic nondiscrimination by insurers and employers.

10. A patient wants to know where to find a certified genetic counselor. The best response by the

nurse would be to refer the patient to: a. a private direct-to-consumer testing company. b. the Internet to conduct a web-based search. c. the National Society of Genetic Counselors. d. the primary care physician for a formal referral.

ANS: C

The National Society of Genetic Counselors’ web page has a link for individuals to use to find genetic counseling services. One concern with the rise of direct-to-consumer genetics testing is that no genetic counseling is available with the test results. This would not be a good place to refer the patient. For most people, Internet searching is time consuming, overwhelming, and difficult. The patient may find genetic counselors but would have no way to judge their qualifications. The primary care physician may be able to provide a referral to the patient, but many primary care providers are not knowledgeable about these services and are not well versed in this field at all.

11. A patient wishes to construct aNfaUmRilSyImNeG diTcaBl.hiCstOoM ry but does not know how to begin. The

best response by the nurse would be to: a. have the patient use the U.S. Surgeon General’s Family History Tool. b. interview the patient and try to construct as good a history as possible. c. refer the patient to a qualified genetics and genomics counselor for help. d. send the patient home with a list of questions to ask his or her relatives.

ANS: A

The U.S. Surgeon General’s Family History Initiative website has a Family History Tool that individuals can use to create a detailed family history. Because many nurses lack knowledge in the area of genetics and genomics, having the nurse interview the patient and construct the history would not be the best answer. The nurse may not have the knowledge to ask the most appropriate questions. The patient may or may not need the services of a qualified counselor; at this point, the patient just wants to construct a family history. Because many nurses lack knowledge in the area of genetics and genomics, having the nurse develop a list of questions to ask the patient’s relatives would not be the best answer. The nurse may not have the knowledge to guide the patient’s questions.

MULTIPLE RESPONSE 1. A nurse is explaining to a student that the benefits of genomic health care include: (Select all

that apply.) a. health care tailored to each person’s unique needs. b. insurance discounts for those with few genetic risks.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG c. mandated coverage for any genetic screening done. d. treatments that are maximally effective for patients. e. understanding how disease affected past generations.

ANS: A, D

Genomics can guide health care providers to using treatments that are tailored to each patient’s genomic information, increasing the chances of successful treatment. By using a patient’s genomic profile, health care providers can choose treatments with the best chance of success for each patient. Health care insurers are not permitted to adjust premiums based on genetic information. Health care insurers are not required to provide payment for genetic testing. The patient may have a better understanding of how disease has affected his or her family, but this is not a specific benefit of genomic health care.

2. A patient wants to know if he or she should order some genetic testing from a private firm that

has been advertising heavily in the area. The nurse explains that some drawbacks to using a private firm for direct-to-consumer (DTC) genetic testing are: (Select all that apply.) a. a physician might not accept the findings of the tests. b. private firms charge far more for testing than hospitals. c. providers may not have the knowledge to interpret results. d. the consumer might misunderstand the information. e. the consumer might order unnecessary genetic tests.

ANS: C, D, E

Consumers, or patients, may bring DTC genetic test results to their health care providers, but these providers might not be knowledgeable enough to interpret the results for them.

Consumers probably do not have enough knowledge about genetic testing to accurately interpret the results of DTC genetic testing, which can cause confusion and fear. Without professional assessment and guNidUaR ncSeI , cNoG nsTuB m. erCs O mMay be swayed into ordering inappropriate genetic testing. It is possible that a physician might not accept the findings of the tests, but this is not one of the recognized concerns regarding DTC testing. It is possible that private firms may be more expensive, but this is not one of the recognized concerns regarding DTC testing.

3. The nursing instructor explains the Essentials of Genetic and Genomic Nursing:

Competencies, Curricula Guidelines, and Outcome Indicators. What information does the faculty member include? (Select all that apply.) a. Fifty nursing organizations laid the foundation for the first edition published in 2005. b. Creates nursing responsibilities outside the traditional scope of practice boundaries. c. Outlines the minimum genetics and genomics competencies needed by all registered nurses. d. Provides funding information for nurses interested in genetic and genomic research activities. e. Requires advanced practice nurses in all fields to have a set of minimum competencies.

ANS: A, C

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

The foundations for the Essentials were created by the combined work of 50 nursing organizations, and the first edition was published in 2005.The Essentials sets forth the minimum genetics and genomics competencies needed by all registered nurses, regardless of educational background or practice specialty. The responsibilities set forth in this document are consistent with the traditional scope of practice. The Essentials does not provide funding information. The Essentials requires all levels of nurses to have the same set of minimum competencies.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Chapter 17: Global Rural Nursing Practice Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. The nursing instructor explains that defining “rural” is often difficult because: a. agencies use multiple different definitions. b. everyone’s ideas of “rural” are different. c. there has been no need to define this population. d. there is no interest in defining this population.

ANS: A

Many governmental agencies use different definitions of “rural.” In this country, there are more than 15 “official” definitions of rural. Although people may have different ideas of what the word “rural” means, this is not the reason defining it is difficult. There is a need and an interest in defining the rural population.

2. A community nurse working in a rural area is planning programming to meet community

needs. Which program option should the nurse develop? a. Adolescents who need after-school activities b. Free or reduced cost immunizations for children c. Mother–parent classes for expectant families d. Older residents who have chronic illnesses ANS: D

Rural areas tend to have high numbers of the very old and very young, and often the older IhNiG population has chronic illnesseN sU wR ithSw chTtB o. coCnO teMnd. A program for this demographic would be very beneficial. Rural areas tend to have large populations of older adults and the very young, not adolescents. Rural areas tend to have large populations of older adults and the very young, not necessarily children of all ages. Rural families are often slightly larger than city families, but the very old and very young are the largest segments of their populations.

3. A nurse works in a rural community. Concerning the minority population in rural regions, the

best action by the nurse is to: a. determine which American Indian tribes are most populous in this area. b. invest in a telephone translation service for different languages. c. learn Spanish and aspects of Hispanic cultural beliefs and practices pertinent to health care. d. investigate specific health care concerns of African Americans in the Midwest.

ANS: C

Rural areas have increasing minority populations, especially Hispanics. From 2000 to 2010, more than half of all rural population growth was in Hispanic populations, followed by African-American populations increasing by 2.9%, and the Native American population by 7.5%. The nurse would do the most good by learning some Spanish and some Hispanic cultural beliefs and practices that are important when delivering health care. Although all of these options are good actions to take, rural communities are the sites of the most rapidly growing Hispanic populations, and the best action by the nurse would be to learn some Spanish and Hispanic cultural beliefs and practices that are relevant to health care.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG 4. The nurse knows that the Rural Healthy People (RHP) 2020 project identified the top priority

health care need as: a. access to quality health care. b. emergency department care. c. more inpatient hospital beds. d. the need for female doctors.

ANS: A

RHP 2020 identified access to quality health care as the overwhelming priority health care need in rural areas. Emergency department care is a needed health care service in rural areas but was not identified as the top priority need. More inpatient beds are indeed needed in some rural areas, but this was not identified as the top priority in the RHP 2020 document. Female doctors are needed in higher numbers in rural areas, but this was not the identified top priority need according to the RHP 2020 report.

5. A rural nurse is planning a community health event and explains to the sponsors that the focus

needs to be the most common health problems faced in the area, which include: a. diabetes and premature birth. b. heart failure and stroke. c. lung disease and stroke. d. liver disease and cancer.

ANS: B

Rates for chronic medical conditions such as hypertension, vascular disease (including stroke), diabetes, and some cancers are higher in many rural regions compared with urban areas. The nurse needs to focus efforts on combating these diseases. Diabetes is a common health problem in rural areas, but with a majority older population, obstetrical problems are OM not as pressing. Stroke is a p r e sNs iUn R gS heIaN lthGpTrB ob.leCm in rural areas, but lung disease is not one of the highest ranking problems. Some cancers are seen at a high rate in rural areas, but liver disease is not a common problem.

6. A nurse who is conducting research on treatment outcomes with patients diagnosed with

depression sees a trend toward improved quality of life and satisfaction. Understanding rural health care conditions and needs, this nurse might conclude: a. fewer people are diagnosed with depression and medications are better. b. more psychiatrists and psychologists are coming to the area to treat patients. c. primary care providers are receiving education on mental health issues. d. transportation to larger communities has been arranged with grant funds.

ANS: C

Mental health providers are absent in 40% of rural communities, leaving a large share of mental health treatment to primary care physicians and other providers. Although medications may be improving, no data are available to suggest fewer people are being diagnosed with depression. Mental health providers are not coming to rural areas in higher numbers and are actually absent from about 40% of rural locations. Transportation is a problem for many rural residents.

7. The nurse studying rural health trends knows that which of the following is true regarding

motor vehicle crashes (MVCs) in rural communities? a. A large number of deaths from MVCs occur in rural areas. b. Rural children have a much lower death rate from MVCs.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG c. Speeds are lower in rural locations, so death rates are also lower. d. Rural roads are much less traveled, so they tend to be safer.

ANS: A

Trauma-related death and injury rates are higher in rural areas than in metropolitan areas, and more than half of the MVC-related deaths occur in rural residents. Rural children have higher rates of death from all kinds of trauma. A disproportionate number of deaths from MVCs occur in rural areas. Rural roads may be less traveled, but they are not necessarily safer, considering that a disproportionate number of fatalities in this country occur in rural areas.

8. A nurse working in a rural hospital explains to a friend in another location that one aspect of

rural nursing that differs markedly from urban practice is that the rural nurse: a. has to use critical thinking on a daily basis in order to practice. b. may know some of his or her patients personally, leading to stress. c. might have to handle situations on her or his own until help arrives. d. will see a variety of patients with a variety of medical problems.

ANS: C

In rural facilities, there may be no medical staff available during off times, and the nurse may be one of a very few number of employees present when a medical emergency strikes. The nurse must be able to intervene appropriately and manage the situation alone until other help arrives. This is markedly different than in metropolitan hospitals with onsite medical staff and larger nursing staffs. All nurses should use critical thinking skills on a daily basis. The rural nurse is probably more prone to knowing the patients personally, but this can happen anywhere. Although the rural nurse probably does see a great variety of patients, this can also be true of nurses working in general medical or surgical units or in tertiary care centers that have an influx of unusual referral cases.

9. A nurse from an urban area has moved into a rural location and is now working at the small

local hospital. The nurse is concerned about doing many tasks that at the former place of employment were done by ancillary personnel or by physicians. The nurse’s mentor explains that the best way to determine whether the nurse is still practicing appropriately would be to: a. ask the manager for further advice. b. check the state nurse practice act. c. consult other nurses at that facility. d. search professional nursing websites.

ANS: B

A nurse should always refer to the state nurse practice act for legalities regarding scope of practice within specific states. This nurse should be directed to this document. The manager may not be a good source of information on this legal issue, especially if the manager is used to practicing in this fashion. Other nurses working at the same facility may not be good sources of information about this legal topic. Professional organizational websites would not have information regarding scope of practice in a specific state, unless of course the website searched was the state board of nursing website for that particular state.

10. A nurse has designed a hospital-based wellness program in a rural community that has been

very successful with consistently high rates of attendance. An accrediting agency would most likely conclude that the: a. nurse is skilled at designing and implementing programs. b. nurse used community leaders to design the program.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG c. program meets an unusual need in the rural area. d. residents of the community realize they have this need.

ANS: B

Community members are more likely to participate in programs they have helped develop. In fact, providing services without community input may not be beneficial at all. The high attendance and success rates of this program point to the nurse involving members of the community in designing it. The nurse may well be skilled in these activities, but this is not the best answer; community buy-in and help from community leaders are vital when planning rural programs. The program might be meeting a unique need, but this is not the best answer; community buy-in and help from community leaders are vital when planning rural programs.

The residents of the area might be aware of this need, but this is not the best answer; community buy-in and help from community leaders are vital when planning rural programs.

11. A rural nurse is explaining to a friend who works in an urban area that the most important

ethical issue for rural patients is probably: a. beneficence. b. confidentiality. c. justice. d. veracity.

ANS: B

Confidentiality is vital in all areas, but in rural areas, this poses some special problems. First, patients and health care providers may know each other well and have many friends and acquaintances in common, and patients need to feel secure in their ability to trust the nurse with sensitive information. Second, in rural areas, people are often recognized by their cars, so parking outside the clinic on sexually transmitted infection testing day or in front of a mental B. health clinic might make the paNtiU enRt S feIeN l sGtiT gm atiCzO edM. The rural nurse needs to make accommodations for these considerations. Beneficence, or doing good, is an important ethical standard, but it is probably not the most important one for rural residents. Justice is an important ethical standard but probably not the most important one for rural residents.

Veracity, or telling the truth, is an important ethical standard but probably not the most important one for rural residents.

12. A nurse plans to work in a rural hospital and commute from her suburban home. What

response by the nursing manager is best? a. “Are you sure that long commute won’t be too much for you?” b. “Living that far away won’t work with being on call on your days off.” c. “That arrangement will give you the best of both worlds.” d. “You should seriously consider moving into this community.”

ANS: D

Nurses need to be seen as part of the community in order to be accepted and trusted. The manager should suggest the nurse move into the community. The commute time is not the issue; building the community’s trust is. The nurse may or may not be on call, but that is not the issue; the issue is gaining the community’s trust. Although having the “best of both worlds” may be good for the nurse, it will not generate the community’s trust.

MULTIPLE RESPONSE

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG 1. The nurse employed in a rural area works to enhance the social determinants of health, which

include: (Select all that apply.) a. access to health care. b. economic factors. c. employment. d. physical environment. e. rural culture.

ANS: A, B, D, E

Seven social determinants of health care are important in rural communities; these are access to health care, economic factors, the physical environment, rural culture, education, personal characteristics, and social support.

2. The nurse working in a rural community understands that the 8 Millennium Development

Goals (MDGs) include: (Select all that apply.) a. achieve universal primary education. b. create employment opportunities. c. improve maternal health. d. promote gender equality and empower women. e. reduce child mortality.

ANS: A, C, D, E

The 8 Millennium Development Goals are eradicate extreme poverty and hunger; achieve universal primary education; promote gender equality and empower women; reduce child mortality; improve maternal health; combat HIV/AIDS, malaria, and other diseases; ensure environmental sustainability; and global partnership for development. Creating employment opportunities is not a specific goal.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Chapter 18: Violence Against Women: An Epidemic and a Health Issue Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. The nurse can expect to find that what percentage of women encountered during practice will

be victims of violence? a. 10% b. 25% c. 35% d. 40% ANS: C

Violence against women is a global epidemic affecting 35% of women worldwide.

2. A nurse is talking to a friend who thinks the importance of intimate partner violence (IPV) is

overrated because only a small percentage of the population is affected. The best response by the nurse is, a. “Although few in number, victims take enormous time and resources.” b. “It is a legal requirement that all nurses screen all women for abuse.” c. “About 25% to 33% of women are affected by IPV, and they often experience poor health outcomes.” d. “This still is a significant number when considering the population.”

ANS: C

About 25% to 33% of women in the United States will experience IPV in their lifetimes, and being a survivor of IPV is oftenNaUsR soSciIatNeG dT wB ith.C poOoM r physical and mental health outcomes.

Victims should not be blamed for using resources. Working with victims of IPV to create a plan of care that responds to their needs is no more time consuming than working with other types of patients. It is not a legal requirement to screen all women for IPV, but consensus practice guidelines are available that provide recommendations for when screening should occur. There are a significant number of people affected by IPV, but this response is not specific enough.

3. A married woman being seen in the clinic has symptoms of a sexually transmitted infection

(STI). The best action by the nurse is to: a. ask the woman whether she feels safe to leave the clinic now. b. find out whether the woman is cheating on her husband. c. gently suggest that she ask her husband whether he is cheating. d. teach how STIs are transmitted and can be prevented.

ANS: A

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Higher rates of STIs are seen in women who are victims of intimate partner violence. The nurse should suspect the woman is in a violent relationship, and because patient safety comes first, the nurse should assess whether the patient feels safe to go home. Asking whether the patient is “cheating” is judgmental and inappropriate. It also implies that the woman is to blame for her medical problem. Suggesting that the patient’s husband is “cheating” is judgmental and does not consider the safety of the patient. The other thing to consider is that some STIs can be asymptomatic in women for long periods of time. Placing blame on either partner is counterproductive and misses the opportunity to assess for violence. Women in violent relationships have higher rates of STIs. Education on how STIs are transmitted and can be prevented is important for any patient who has a suspected STI, but this does not consider the patient’s safety, so it is not the best answer.

4. A nursing student asks the clinic nurse why it is important to find out whether a woman in a

violent relationship feels safe leaving the clinic. The best response by the nurse would be to tell the student that: a. femicide is a major cause of death, especially in African-American women. b. if the woman is not safe, the nurse can have the police escort her. c. the law requires asking about patient safety in this situation. d. women who are not safe need to be given referral information.

ANS: A

Femicide, the murder of a woman, is the seventh leading cause of premature death in women overall, and it is the most serious consequence of intimate partner violence. The student (and nursing staff) need to ensure the woman feels safe going home. Offering to have police escort the woman home does not explain where the police would escort the woman to, nor does it consider that police may not be available at the time. The law does not require asking specifically whether a woman iN sU saRfeStI oNleGavTeBa.m ical facility, but there are consensus CeOdM guidelines on appropriate questioning. Women who are not safe do need referral information, but this answer is too narrow in scope to be the best answer.

5. A new nurse working in an obstetrics (OB) practice questions the rationale for screening all

OB patients for intimate partner violence (IPV). The best answer by the nurse’s mentor is, a. “Battering slows down during pregnancy, so it’s an ideal time to intervene.” b. “It should just be a routine part of every nurse’s practice to screen for IPV.” c. “Most women seek health care when pregnant, so we can make a big difference.” d. “Pregnant women tend to be more emotional and more willing to confide in us.”

ANS: C

Most women do seek health care during their pregnancy, so OB nurses see a high number of women. This makes OB visits an ideal time to screen for IPV. Battering does not slow down during pregnancy. IPV rates are similar to the rates in the rest of the population, but being pregnant does increase a woman’s risk for femicide. Although it should be a routine part of every nurse’s practice to screen for IPV, this is not the best answer to explain why the OB staff specifically should screen for IPV. It is not true that pregnant women tend to be more emotional and more willing to confide in nurses.

6. A nurse wants to begin screening all women encountered during clinic visits for intimate

partner violence (IPV) but is uncomfortable and worried about making the women uncomfortable, too. The nurse manager should teach this nurse to say, a. “All women should be able to tell someone if they are in an abusive relationship.”

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG b. “I ask all my female patients if they are getting hurt or are afraid of their partners.” c. “I need to ask you some questions about domestic abuse if that is OK with you.” d. “This clinic has a policy of assessing women for being in abusive relationships.”

ANS: B

The statement “I ask all my female patients if they are getting hurt or are afraid of their partners” is the best option because it shows empathy and interest and does not make it seem that this particular woman has some sign that has caused the nurse to ask about IPV. This open and nonjudgmental statement can lead to disclosure by the woman. The statement “All women should be able to tell someone if they are in an abusive relationship” can put a lot of pressure on the woman to fit in with “all women.” Plus, it does not show any empathy or interest on the part of the nurse. Also, the word “abusive” may sound judgmental, and the woman may not identify her relationship with that term. The statement “I need to ask you some questions about domestic abuse if that is OK with you” sounds as though it is a task the nurse must accomplish and gives the woman the opportunity to decline assessment. Also, the phrase “domestic abuse” is not accurate and may be misconstrued as only meaning violence that happens inside the home or by a person living in the home with the woman. IPV can occur anywhere. The statement “This clinic has a policy of assessing women for being in abusive relationships” does not show any interest or empathy by the nurse. The word “abusive” may sound judgmental, and the woman may not identify her relationship with that term.

7. A nurse is working with a woman who is experiencing intimate partner violence (IPV). The

woman states, “At least my children aren’t getting hurt.” The best response by the nurse is, a. “Children who witness violence have many indirect injuries.” b. “It’s just a matter of time before one of them really does get hurt.” c. “Many children get hurt whNeU nR thS eyItNryGtToBin.teCrvOeMne in the situation.” d. “Yes, you are right. You are lucky they haven’t been hurt.”

ANS: A

Children who witness IPV have indirect injuries such as poor health, behavior problems, school problems, and social problems. IPV is associated with increased numbers of child abuse, but predicting that one of the patient’s children will get hurt is extremely insensitive and not helpful. Some children do get hurt intervening in a situation of IPV, but this statement is inaccurate, because it implies large numbers of them are injured. Agreeing with the patient that she is “lucky” does nothing to help. The nurse needs to educate the patient on the harmful effects of IPV on her children.

8. A nurse in the emergency department (ED) wants to screen a patient for intimate partner

violence (IPV), but the woman’s partner will not leave her side. Which intervention by the nurse would be best? a. Ask the patient the questions with the partner present, because he will not leave. b. Bluntly tell the partner he has to leave, so the nurse can assess the patient. c. Have security escort the partner to the ED waiting room. d. Tell the patient she will help her collect a urine specimen in the restroom.

ANS: D

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Telling the patient that she will help her collect a urine sample in the restroom is the best response because it will likely get the woman away from the partner for a short time, during which the nurse can assess for IPV and help the woman make a plan for her safety. In extreme cases, with the woman and partner now separated, the partner can be escorted out and the woman assisted to leave safely. Privacy is of the utmost importance when asking about IPV, and the nurse should ensure the patient’s privacy during this time. A nurse should never assess a woman for IPV with the partner present. Bluntly telling the partner he must leave will likely result in anger and resistance on the part of the partner, and the woman may side with the partner and insist he be allowed to remain if she is fearful of the consequences of having him leave. Having security escort the partner to the ED waiting room would be very confrontational, and the patient may become fearful and side with the partner to avoid future violence.

9. A nurse manager in the emergency department (ED) wants to ensure that the staff conducts

thorough and consistent screens for intimate partner violence (IPV) on every woman but is concerned about privacy. The best intervention by the manager would be to formulate a policy that: a. all female patients must be assessed by the nurse before having others present. b. creates a “survey” with a check-off box indicating the patient needs help with IPV. c. each patient, male or female, is given a short questionnaire to complete on IPV. d. allows only the patient into the ED until the nurse has done a complete assessment.

ANS: D

A policy of admitting only the patient into the ED until the nurse is able to complete a physical assessment and screen for IPV would be most likely to be beneficial and not arouse the suspicion of the batterer. Privacy is of the utmost importance during this time. A policy that pertained only to women wNoU ulRdSliI keNlG yT mBa k.eCaObMa t t e r e r suspicious, and he and the patient might resist its implementation. Unless the survey was completed in privacy, the woman would not feel safe answering it honestly. Assessing both male and female patients is a good idea because anyone can be the victim of IPV, but filling out a questionnaire in the presence of the batterer would not be safe.

10. A patient presents to the clinic with a sore throat and sinus pain, but the nurse notices several

bruises of different ages, including some on her face. When asked, the patient states she fell down the stairs last week. Which action by the nurse is best? a. Ask the patient outright whether she is being abused by someone. b. Call local law enforcement to come and take a crime report. c. Document the injuries but do not question the patient about it. d. Explain that these injuries do not seem consistent with a fall.

ANS: D

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Gently confronting the patient with the fact that the injuries are not consistent with the explanation lets the patient know you suspect another cause of the injury and gives her time to tell the story. Many times the patient will confide in the nurse at this point but not always.

Asking the patient bluntly may result in the patient denying that she is being injured. Also, the patient may not self-identify with the word “abused.” Nurses should know the law in the states where they practice; this action may be required in some locations. However, unless required, the nurse should not take this action; to call law enforcement without the patient’s consent and without the patient admitting to being injured may cause the patient to lose trust in the nurse. Documenting the injuries is very important, but the nurse should follow up with further questions about the injuries, especially if they appear suspicious.

11. A nurse is evaluating the plan of care for a woman who has experienced intimate partner

violence (IPV). The nurse would evaluate that goals had been met when the woman: a. articulates her choices. b. leaves the abuser safely. c. phones the abuse hotline. d. presses criminal charges.

ANS: A

Women should always feel that they have choices. Often women think their only choice is to stay or leave, when in reality there are several options. Leaving the abuser may sound like the best choice to the nurse, but for the woman, it may not be feasible at the time. Plus, this would not necessarily indicate that goals had been met. Likewise, the woman staying with the abuser does not necessarily mean that goals were not met. It is good for the woman to have resources, such as hotline numbers, at her fingertips, but she may not be ready to make a call to a hotline yet. For many women, pressing charges is a scary prospect, although women should know that contacting the police and filingNcU haRrS geIs N arGeToB pt. ioC nO s. M 12. A nurse has assessed that a woman is a victim of intimate partner violence (IPV). The woman

feels safe to go home from the clinic. The priority action by the nurse would be to: a. give the woman resources she can keep with her at all times. b. help the woman create a safety plan for her and her children. c. let the woman make phone calls from the clinic telephones. d. tell the woman that the nurse is available to help her if needed.

ANS: B

Having a sound safety plan for both herself and her children would be the priority for this woman. Giving the woman resources and information is very important, but it is not as comprehensive as helping her create a safety plan for herself and her children. Allowing the woman to make phone calls from the clinic phones (which cannot be monitored or traced by the abuser) is a valuable service to offer, but it is not as comprehensive as helping her create a safety plan for both herself and her children. Letting the woman know that you are available to help her will be important both now and in the future, but it is not the best answer because it is not as comprehensive or safety oriented as helping her create a safety plan.

13. A nurse working in a community clinic usually is consistent about screening women for

intimate partner violence (IPV). However, the nursing manager found two charts during an audit in which the nurse did not do the screening. When asked, the nurse stated that the two women were lesbians, so she did not need to screen them. What response by the manager is best?

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG a. b. c. d.

“Lesbians who are in intimate relationships are considered intimate partners.”

“There is a specific screening tool just for lesbians and homosexuals.”

“You have to screen all women for IPV regardless of their sexual preference.”

“You’re right; lesbians have a far lower rate of IPV than heterosexuals do.”

ANS: A

Intimate partners are described as “current and former husbands and wives, same-sex partners, boyfriends, and girlfriends,” so the nurse should screen these patients too. There is no specific screening tool for same-sex partners. The policy may be to screen all patients, but this statement does not give the nurse-specific information about this situation. Lesbians have a somewhat lower rate of IPV than heterosexual couples do.

14. A nurse has assessed an Asian woman for intimate partner violence (IPV) using the Abuse

Assessment Screen (AAS). The woman has screened negative. What can the nurse conclude from this screening result? a. The tool may not be reliable for this patient. b. The woman is not a victim of IPV. c. The woman is not at risk for future IPV. d. The woman may be being deceitful.

ANS: A

The AAS has been validated in several clinical settings and has been found to be valid and reliable for whites, Hispanics, and African Americans. The validity of the tool for Asian women is not yet known. The woman may not be a victim of IPV, but the nurse cannot conclude that without question as the tool has not been researched enough on Asian women to determine its validity and reliability. The AAS does not screen for possible future IPV. The nurse should never conclude that a woman is being deceitful when being screened for IPV. Some women may not answer N allUqRuS esItiN onGsTtrBu. thC fuOllM y because of fears for their safety, but labeling a woman “deceitful” is judgmental and shows a lack of understanding of IPV. MULTIPLE RESPONSE 1. A woman has screened positive for intimate partner violence (IPV). The nurse should also

assess for: (Select all that apply.) a. depression and anxiety. b. mania and binge behavior. c. persistent sleep disturbances. d. posttraumatic stress disorder (PTSD). e. psychosis and schizophrenia.

ANS: A, C, D

Victims of IPV often have depression or anxiety. They have been found to be more than three times as likely to be depressed and more than twice as likely to be anxious. Sleep disturbances, including difficulty in falling asleep, have been reported with increased frequency by women who are victims of IPV. PTSD is associated with IPV. Mania and binge behavior do not seem to be connected with IPV. Psychosis and schizophrenia do not seem to be seen with increased frequency in women who are victims of IPV.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG 2. A nurse working in the emergency department explains to a student nurse that the sexual

assault nurse examiner (SANE) works with victims of intimate partner violence (IPV) to provide: (Select all that apply.) a. ongoing counseling. b. evidence collection. c. health examinations. d. psychological counseling. e. treatment if needed.

ANS: B, C, E

SANEs are specially trained forensic nurses who provide evidence collection to victims of sexual violence and IPV. SANEs are specially trained forensic nurses who provide health evaluations to victims of sexual violence and IPV. SANEs do not provide psychological counseling. SANEs are specially trained forensic nurses who provide necessary treatment to victims of sexual violence and IPV. 3. The nurse working with female patients assesses each for exposure to the many forms of

violence against women, which include: (Select all that apply.) a. femicide. b. fraud. c. isolation. d. name calling. e. sexual coercion.

ANS: A, C, D, E

There are many forms of violence against women, including acts of sexual violence (rape, sexual assault, trafficking, genital mutilation) and sexual coercion, physical violence (hitting, slapping, kicking, punching), pN syUcR hoSloIgNicGaT l vBi o.leCnOceM (b el i t t l i ng, name calling, isolation), economic violence, and femicide (the killing of a woman). Fraud is not considered to be a form of violence against women.

4. The nurse taking a continuing education course in intimate partner violence (IPV) learns what

information about the roots of this violence? (Select all that apply.) a. Female subservience b. Male dominance c. Money imbalances d. Societal gender attitudes e. Unequal social power balance ANS: B, D, E

IPV has roots in many societal values, such as male dominance, social gender attitudes, and unequal social power imbalances. Female subservience is not a root cause of IPV. Although in some cases money imbalance may contribute to unequal social power, it is not a specific cause, because violence occurs in all types of households.

5. What information about intimate partner violence (IPV) should the nurse understand? (Select

all that apply.) a. A large number of women are sexually assaulted by their partners. b. Annually, up to 12% of women are assaulted by their partners. c. Coercive, controlling behavior is often seen in lesbian relationships. d. Male homosexuals have the same rates of IPV as do heterosexuals.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG e. Most IPV is done by men against women, but men can be victims, too.

ANS: B, D, E

About 12% of women will be assaulted by their partners annually, according to Tjaden and Thoennes (2000). The prevalence of IPV in male homosexual partners is roughly the same as in heterosexual partners. Most IPV is male against female, but men can be victims, too. More than 7% of women have been sexually assaulted in their lifetimes. Lesbian relationships have a slightly lower rate of IPV than heterosexual relationships.

6. The nurse using standardized assessment tools to screen for intimate partner violence (IPV)

knows what facts about the tools? (Select all that apply.) a. The Abuse Assessment Screen (AAS) has a body drawing to mark injuries. b. The Abuse Assessment Screen (AAS) includes a question about pregnancy. c. The Woman’s Experience with Battering (WEB) scale has been updated to include strangulation. d. The Woman’s Experience with Battering (WEB) scale looks for coercive behaviors. e. The Woman’s Experience with Battering (WEB) scale screens for psychological abuse.

ANS: A, B, D, E

The AAS has a body drawing on which the nurse can mark injuries and includes a question about abuse during pregnancy, which can be omitted if the patient is not pregnant. The WEB scale includes questioning about coercive behaviors and psychological abuse. The AAS was recently updated to include strangulation behaviors.

7. The nurse assessing women for their risks of becoming victims of intimate partner violence

(IPV) knows that which fact orsNiU ncRreSaIseNtG hiTs B ri . skC? O(SMelect all that apply.) a. Exposure to abuse as a child b. Harmful use of alcohol c. Lower educational levels d. Single-parent family e. Witnessing IPV between parents ANS: A, C, E

Factors that increase a woman’s risk of becoming a victim of IPV include exposure to abuse as a child, lower educational levels, and witnessing IPV between parents. Alcohol abuse is associated with a risk of becoming a perpetrator of abuse. Single-parent families do not have an increased risk of becoming victims of IPV.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Chapter 19: Telehealth Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. The nurse understands that the phrase “the use of medical information exchanged from one

site to another via electronic communications to improve a patient’s clinical health status” refers to what aspect of health care? a. Computerized charting systems b. Electronic medical records c. Telehealth d. Telemedicine ANS: D

The American Telemedicine Association defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” Computerized charting systems are usually referred to by name. Electronic medical records are not synonymous with telemedicine. Telehealth usually has a broader definition.

2. The nursing faculty explains to a class of nursing students that one difference between

telemedicine and telehealth is that: a. electronic medical records are required by law. b. medical ethics are more ingrained in telemedicine. c. telehealth is used by many health care specialties. d. telemedicine is not coveredNbUyRhS eaIltN hG inTsuBr. anCcO e.M ANS: C

Telehealth is a broader term and is often used by health care professionals other than physicians. Electronic records are not a distinguishing feature between telemedicine and telehealth. Medical ethics is not a distinguishing feature between telemedicine and telehealth.

Health insurance coverage is not a distinguishing feature between telemedicine and telehealth.

3. A new nurse is being oriented to the intensive care unit and is startled when, during

intradisciplinary patient rounds, a person “joins” the conversation on a computer screen in the patient’s room. How does the nurse’s mentor best explain the benefits of this procedure? a. “It’s another set of eyes and ears for good patient care.” b. “The remote person can help assess, treat, or educate patients.” c. “This ensures we are compliant with all our policies.” d. “We are short physicians here, so this fills the gaps.”

ANS: B

Health care providers attending live videoconferencing can help assess, treat, manage, and educate and counsel patients from a distance. Although the videoconferencing does provide another set of eyes and ears, this is not the best explanation of the use of telehealth. The main focus of telehealth is not to ensure adherence to policies. Telehealth can be used where there is a provider shortage, but this is not the main purpose or best explanation.

4. A nurse works in a very remote area and is interested in discovering how telehealth services

might improve local health care. What action by the nurse is best?

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG a. b. c. d.

Conduct a survey of residents on the potential use of telehealth.

Interview providers where telehealth is already in use.

Perform a literature search on the topic of telehealth.

Visit the website of the closest telehealth resource center (TRC).

ANS: D

TRCs exist to improve the understanding of telehealth and how it can be used to improve access to and quality of care in rural and other medically underserved areas and to help develop telehealth programs that match the needs of a practice or community. Accessing the TRC’s website for information would be the most beneficial action by the nurse. A survey of local residents might provide useful data but would not be the best method of obtaining information about how telehealth could improve care. Interviewing providers who already use telehealth would give the nurse some valuable information but would not be the best method of obtaining information about how telehealth could improve care. Performing a literature search would give the nurse current published information on telehealth but would not be the best method of obtaining information about how telehealth could improve care.

5. A director of nursing (DON) of a small, remote hospital wants to use telehealth technology,

because the facility just updated all of its computers. What action by the DON is best? a. Assess the capability of the hospital’s LAN (local area network). b. Check on the facility’s WAN (wide area network) access. c. Determine if nurses are interested in telehealth capability. d. Write network protocols for telehealth activity.

ANS: B

WAN encompasses a larger geographic area and includes leased telecommunication lines.

WAN access would need to be assessed to determine the capability of reaching out to remote IpNuGteTr B CoOrM sites. LAN encompasses a smaN lleUrRcoSm ne.tw k and may only include the hospital itself.

The facility would need WAN access. Determining nursing interest would give some good information about what is needed to facilitate this change, but it is not the most important action for the DON to take. The DON would not write network protocols; the technology department would.

6. The nurse who works in telehealth best evaluates that overarching goals for the program have

been met with which information? a. Decreased mortality rate b. Fewer exacerbations of chronic illness c. Improved health status and quality of life d. Lowered costs for provision of health care ANS: C

All options show good outcomes from the use of telehealth. However, the broadest measure is improved health status and quality of life. Decreased mortality rate, in itself, is too narrow a measurement to evaluate broad goals. Fewer exacerbations of chronic illness is, in itself, too narrow a measurement to evaluate broad goals. Lowered costs for the provision of health care is, in itself, too narrow a measurement to evaluate broad goals.

7. A school nurse is advocating for the use of telehealth in the school-based health clinic. What

information does the nurse provide to support her request? a. “It can help me teach kids with diabetes how to do insulin self-injection.” b. “Because I can only be at one school at a time, this will provide extra coverage.”

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG c. “Telehealth can provide teaching prohibited by school policy.” d. “We can reduce absences and hospital admissions.”

ANS: D

A recent study showed the use of telehealth reduced missed days of school and hospital admissions for kids who have asthma. This can be extrapolated to include children with other chronic diseases as well. Telehealth can be used to improve self-efficacy in those with chronic illness, but this is not the most important reason for the nurse to provide. Telehealth can improve health services delivered to schools in the absence of a provider, but this is not the most important reason the nurse should provide. Telehealth is not a way to provide teaching prohibited by school policy.

8. An experienced intensive care unit (ICU) nurse is resisting the implementation of telehealth in

the ICU because “we each only have one or two patients and are always available.” What action by the manager is best? a. Explain how telehealth can reduce specific adverse events in ICU patients. b. Provide education on the advantages of telehealth in the ICU. c. Remind the staff that telehealth is part of their health care environment. d. Visit with the nurse and ask why the nurse is so against telehealth.

ANS: A

The manager should explain specific details of how telehealth can improve outcomes for ICU patients. For example, the use of electronic intensive care units (e-ICUs) helps to prevent untoward outcomes, such as reintubation or unplanned extubation, and improves patient outcomes by recognizing changes in patient trends. These events are significant for this nurse’s patient population. Providing education is a good intervention, but this option is too vague to be the best choice for the manager. The manager should discuss specific events NeUmRinSdIinNgGthTeBs.taCffOoMf policies and procedures is always an related to the ICU population. R appropriate action, but without the nurse’s “buy-in” of the process, this information alone will not encourage the nurse to support the system. Asking “why” question is a nontherapeutic communication technique that often puts people on the defensive.

9. A nurse working in a rural area is convinced of the benefits of using telehealth to improve

patient outcomes. What action by the nurse would be best to ensure the availability of telehealth services to all those who need them? a. Advocate for federal legislation requiring third-party reimbursement for services. b. Become certified in telehealth nursing by the telehealth resource center (TRC). c. Provide education for small, rural facilities and their staffs on telehealth practice. d. Work to ensure telehealth centers have specific policies on confidentiality.

ANS: A

Third-party reimbursement for telehealth services is a challenge to the field. The nurse can best promote access to telehealth by working to pass bills requiring third-party reimbursement for these services. There is no certification in telehealth nursing offered by the TRC. Providing education is important, but ensuring third-party reimbursement would have more impact. Policies on confidentiality are vital, but working to ensure third-party reimbursement would have more impact.

10. A rural hospital administrator is resistant to creating a telehealth system because of its impact

on finances. What response by the director of nursing, who thinks a system should be started as soon as possible, would be best?

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG a. b. c. d.

Inform the administrator of research findings related to telehealth.

Lobby federal lawmakers to require third-party funding for telehealth costs.

Work with the administrator to find ways to make up the revenue shortfall.

Write grants for funding to offset the costs of starting a telehealth system.

ANS: C

One of telehealth’s successes is reducing admissions in patients who have chronic illnesses.

This could make a huge impact on a hospital’s finances, especially in a rural area populated by a large number of older adults with chronic illnesses. The DON could collaborate with the administrator to create billable services to help make up for this shortfall. Informing the administrator of research findings will not change the financial impact of a telehealth service.

Lobbying for third-party reimbursement is an excellent choice but would take too long to be the best action. Writing grants would also be an excellent choice, but the grant process is arduous and takes too long to be the best option, plus it will not address the real concern of loss of income.

MULTIPLE RESPONSE 1. The nursing instructor explains different modes of telehealth technology to nursing students,

including: (Select all that apply.) a. computer transmission. b. interactive live videoconferencing. c. store-and-forward images. d. voice-only via telephone. e. voice-over images.

ANS: A, B, C, D

The four modes of telehealth technology include computer transmission, interactive live videoconferencing, store-and-forward images, and voice-only telephone conversations.

Voice-over images is not a telehealth technology.

2. An emergency department manager in a rural hospital wants to investigate “telestroke”

processes. Which actions by the nurse manager would best facilitate this process? (Select all that apply.) a. Collaborate with pharmacy on supplies of appropriate drugs. b. Discuss store-and-forward capabilities with radiology. c. Install special telephone lines for live consultations. d. Investigate the possibility of acquiring robotic technology. e. Request funding for interactive live videoconferencing.

ANS: B, E

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Telestroke programs improve outcomes for patients with ischemic stroke. Upon arrival to the emergency department with symptoms of a potential ischemic stroke, the stroke specialist can examine a patient, obtain medical history, and review computed tomography studies remotely.

Patients can receive tissue plasminogen activator before transfer to a tertiary medical center, if warranted. The manager needs to determine how well images are forwarded and their clarity upon receipt and obtain funding for interactive live videoconferencing, so the stroke specialist can “examine” the patient remotely. Collaborating with pharmacy on the amount of drugs needed on hand would be done after the telestroke program was implemented. This action is not part of getting the telehealth process started, although once approved, it would be important to ensure adequate supplies were on hand. Special telephones are not needed.

Robotic technology is not needed.

3. The rural nurse advocating for more telehealth services in the local area would provide what

information to support this cause? (Select all that apply.) a. Access to health care would be improved. b. Care by medical specialists would be enhanced. c. Chronic conditions could be monitored to decrease exacerbations. d. Computer charting systems would be more “user friendly.” e. Patient satisfaction with care would be improved. f. Transportation barriers would be mostly eliminated.

ANS: A, B, C, E, F

Advantages to telehealth systems as reported in the research include improved access to health care overall, improved access to medical specialists, chronic conditions can be monitored to reduce exacerbations, improved patient satisfaction, and elimination of transportation barriers.

More “user-friendly” charting systems are not an advantage of telehealth systems.

4. A rural hospital’s director of nursing (DON) is establishing a telehealth system. What actions

by the DON are important policy measures? (Select all that apply.) a. Creating work agreements that consider licensure issues b. Educating staff on telehealth practice and procedures c. Ensuring confidentiality in telehealth records and encounters d. Reducing patient perception of “distance” in interactions e. Writing policies that include ethics applied to telehealth ANS: A, C, E

Policy matters important in telehealth include licensing issues (if the remote providers reside or work in a different state), confidentiality, and ethical policy creation. Education is important but is not a policy issue. Reducing the perception of patients that there is an emotional distance between them and the provider is important but is not a policy issue.

5. A rural hospital has a new nurse manager who has never worked with telehealth before. In

evaluating the program, what indicators would best demonstrate a successful program? (Select all that apply.) a. Fewer hospital admissions for chronic conditions b. Patient report of satisfaction with the process c. Police report fewer encounters with mentally ill patients in crisis d. Remote providers report satisfaction with technical quality e. Third-party reimbursement for 90% of billed charges ANS: A, B, D

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

A successful telehealth program will result in improved patient satisfaction, fewer admissions for chronic conditions, and satisfaction with the technology as reported by remote providers.

Police reporting that they encounter fewer mentally ill patients in crisis may or may not be related to having access to mental health providers remotely. That is one possibility for fewer crisis situations. Third-party reimbursement would be ideal but is not yet the reality.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Chapter 20: Patient Safety Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. In the 2000 Institute of Medicine’s milestone report To Err Is Human: Building a Safer

Health System, how many patients were estimated to die each year as a result of errors occurring in a hospital setting? a. 25,000 b. 35,000 c. 50,000 d. 98,000 ANS: D

A total of 98,000 people were estimated to have died each year from errors during hospital care. The report estimated that more than 25,000 people, as many as 98,000, die each year from errors occurring during hospital care. The report estimated that more than 35,000 people, as many as 98,000, die each year from errors occurring during hospital care. The report estimated that more than 50,000 people, as many as 98,000, die each year from errors occurring during hospital care.

2. A nurse asks the manager why the nursing staff seems to have the bulk of the responsibility

for preventing errors in patient care. The manager explains that the primary reason nurses are best situated to recognize and prevent errors is because they: a. are leaders on the health care team. b. have refined communicatioN n UskRilSlsI. c. interact with patients so frequently. d. provide the majority of risky care.

ANS: C

Nurses interact with patients on a frequent basis and so are positioned to prevent medical errors as much as 90% of the time. Nurses should play a leadership role in all patient care situations, but this is not the best answer for this question because in many work environments, nurses still take a subservient role. Nurses are taught communication skills in nursing school, but nurses and other health care providers are taught to communicate in very different ways. Nurses do provide some care that is considered risky, such as medication administration, but physicians often provide the riskiest care, such as operations and invasive procedures.

3. The nurse executive explains to a group of newly hired nurses that the major responsibility for

preventing errors in patient care lies with the: a. individual because of legal obligations for safety. b. individual, because that is who makes the error. c. system, because it is responsible for employee acts. d. system, because process designs can lead to errors.

ANS: D

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Process design and implementation most often lead to the commission of errors. The nurse is a key member of the team to identify poor processes and to work on improvement of processes. Professional staff does have a legal responsibility for safe care, but hospital systems are more often the root cause of errors. Individuals do make each error, but often the error is the result of many problems within the system and processes of the health care facility. The system is responsible for many of its employees’ actions but not for all.

4. A nursing executive wishes to implement a new policy based on initial National Patient Safety

Goals 2002 to eliminate wrong patient, wrong site, and wrong procedure. Which action by the executive would best meet one of the goals? a. Collaborate with the laboratory for timely reporting of laboratory values. b. Formulate a time-out policy. c. Mandate that all fall-prone patients be clearly identified. d. Reevaluate workflow design and patient-staffing ratios.

ANS: B

One of the initial National Patient Safety Goals 2002 was to eliminate wrong patient, wrong site, and wrong procedure surgeries, so establishing a policy that requires a time-out to verify patient, site, and procedure before starting an operation would help meet this goal. Timely reporting of lab values would not be closely related to any of the initial National Patient Safety Goals 2002. Reducing falls is a laudable goal, but identifying high-risk patients was not one of the initial National Patient Safety Goals 2002. Workflow design and patient-staffing ratios may be related to patient errors, but these measures would not closely align with any of the original National Patient Safety Goals 2002.

5. A nurse manager in a hospital receives Joint Commission sentinel event alerts. When one is

received that concerns a procesN s Ut hRa tSoIc N c uGr sTiBn .t hCe OmMa n a g e r ’ s facility, the best action by this manager is to: a. consult with other managers to see whether this has been a problem. b. create a file and add related information as it becomes available. c. initiate a new policy to address the shortcomings of the process. d. investigate how this process has been affecting patient safety.

ANS: D

The best answer would be for the nurse manager to begin a thorough investigation of how this process works in the specific facility and how it affects patient safety. Although consulting with other managers would be part of the best response, this is not the most complete answer.

Whereas maintaining a file of information is a passive activity, responding to patient safety requires an active approach. Initiating a policy may be needed, but first the manager needs to investigate how the process at this specific facility affects patient safety.

6. The nurse knows that the purpose of the Department of Health and Human Services (DHHS)

is to: a. prioritize patient safety regulations. b. promote use of research in practice. c. protect the health of all Americans. d. provide guidance on hospital policy.

ANS: C

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Protecting the health of all Americans and providing services for people who cannot provide for themselves is the overarching goal of the DHHS. Prioritizing safety regulations is not the main purpose of the DHHS. Promoting research in practice is not the main purpose of the DHHS. Providing guidance on hospital policies is not the main goal of the DHHS. 7. A nursing manager wants to investigate the best practice research on a specific patient safety

issue. The best action by the nursing manager would be to: a. consult with other facilities to see what their related practices are. b. convene a work group to develop related policies and procedures. c. read recent issues of a nursing management journal for research. d. research the literature, paying special attention to synthesis work.

ANS: D

The manager should research the relevant literature, using such resources as the Agency for Healthcare Research and Quality (AHRQ). One of the goals of AHRQ is to promote research in everyday practice, and as part of that goal, this agency provides syntheses of current research. Other facilities may not be using best practice. It is premature to convene work groups before collecting data. This might be part of an action plan once the research has been done. Journals of nursing management do carry some research articles and best practice articles but would not be the best location for this information.

8. The nurse knows that the primary purpose of the Patient Safety and Quality Improvement Act

of 2005 was to: a. create a government agency that tracks all patient safety problems. b. encourage sharing of information to promote a culture of safety. c. mandate patient safety programs and prescribe penalties for errors. d. require hospitals create quaN liU tyRim SpIrNovGeTmBen.tCinOitMiatives for safety.

ANS: B

The primary purpose of this act was to encourage health care institutions to share information related to safety issues in a safe environment. This allows for trends to be identified that can be mitigated through safety programs and process improvement, thus creating a culture of safety. The primary purpose of this act was not to create a new government agency to track safety problems. The primary purpose of this act was to create a safe environment in which information can be shared to help create a culture of safety, not to penalize those who commit errors. The Patient Safety and Quality Improvement act of 2005 does not require quality improvement initiatives.

9. A nursing manager is concerned about professional sanctions that might result if several

near-miss episodes are reported to a Patient Safety Organization (PSO) under the Agency of Healthcare Research and Quality (AHRQ). The chief nurse executive explains to the manager that under the Patient Safety and Quality Improvement Act of 2005, a. certain critical errors or near misses can be penalized under law. b. PSOs only provide safety initiative information data to the AHRQ. c. state legislatures are able to sanction facilities under the 2005 Act. d. this information is confidential and protected from legal action.

ANS: D

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

PSOs maintain strict confidentiality, and their work products are protected against legal action. This helps encourage reporting and a culture of safety. Saying that certain critical errors or near misses can be penalized under law does not address the manager’s concern.

Information about errors and near-miss episodes is handled through PSOs. Saying that state legislatures are able to sanction facilities under the 2005 Act does not address the manager’s concern.

10. The nurse defends DHHS reporting of successful medical error reduction initiatives to

Congress by summarizing that: a. Congress has oversight when safety is poor. b. congressional members oversee state reporting. c. laws are created to meet patient safety needs. d. increasing patient safety is national priority.

ANS: D

The Patient Safety and Quality Improvement Act of 2005 was passed by Congress to address critical national patient safety issues and foster a culture of safety nationwide. Congress does not begin the oversight process when safety records are poor. Congressional representatives do not oversee individual state reporting. Laws have been created to address patient safety issues, but this is not the main reason why patient safety data are eventually reported to Congress.

11. A hospital has significantly reduced the number of errors and near-miss episodes it has in the

past 2 years. An accreditation body visitor might conclude that error and near-miss reductions are most directly related to: a. remediation of individual employees who make errors. b. policies and procedures t h aN t hUaR veSbIeNenGT crB ea.teCdOtoMavoid problems. c. facility strategies to detect and address any potential problems. d. staff education in facility patient safety processes.

ANS: C

Facilities that operate under a culture of safety encourage all employees to be vigilant in observing for conditions and processes that could potentially lead to errors and near misses.

Individuals who make errors may indeed be given additional education or training, but this is not the best answer because most errors come from system problems. Facilities should have policies and procedures to help lessen the number of errors or near misses, but without vigilance in finding sources of potential problems, the policies created may not be maximally beneficial. Educating the staff does not go far enough in preventing errors. The facility needs to make a concerted effort to detect and address potential system problems, as system problems are the most common cause of errors.

12. A nursing manager explains to the executive committee that reducing errors requires: a. disciplining staff members who continue to make errors. b. focusing on systems problems and not blaming individuals. c. having an anonymous error reporting procedure for staff. d. holding individuals responsible for the errors they commit.

ANS: B

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

A “just culture” encourages open and honest reporting when errors or near misses occur. The analysis that follows reporting should focus on system flaws and not individual fault. Having a culture in which individuals are blamed and shamed for their errors reduces the probability of error reporting. If this occurs, no meaningful action can be taken to reduce the likelihood of errors. A safe mechanism for reporting errors should be available, but if all reporting were anonymous, it would be difficult to track and trend data. Individuals and organizations should be held accountable for errors if indicated, but most errors are the result of system flaws.

13. The nursing manager understands that the phrase “active failure” in regard to patient safety

means a(n): a. system process is actively injuring patients and needs modification. b. workplace practice is actively contributing to poor patient outcomes. c. error has actively caused a patient to have a negative consequence. d. unsafe act was committed by someone in direct contact with patients.

ANS: D

An active failure is an unsafe act committed by a person in direct contact with the patient.

This is directly opposite a latent failure, which is caused by a systems problem. An active failure is caused by a person in direct contact with the patient, not by a systems process. An active failure is caused by a person in direct contact with the patient, not by a workplace practice per se. An active failure is an unsafe act committed by a person in direct contact with the patient.

14. A manager is concerned with the number of medication errors occurring on their unit. The

manager determines that these errors represent latent errors when an investigation reveals that: a. many nurses are not using two different forms of patient identification. b. nurses do not take the timeN toUhRaS veIhNigGhT-rBis.k CmOe M dication s double checked. c. the medication bar codes are often unreadable by the computer scanner. d. to save time, nurses gather all their patients’ medications at one time.

ANS: C

Using bar codes that are unreadable to the computer scanner is a system problem, otherwise known as a latent failure. Failure to use two different forms of patient identification is an error committed by individuals who have direct patient contact. This is known as an active failure.

Nurses failing to double-check high-risk medications is an error committed by individuals who have direct patient contact. This is known as an active failure. Nurses gathering all of their patients’ medications at one time is an error committed by individuals who have direct patient contact. This is known as an active failure.

15. An accreditation body visitor is touring a facility that has been designated as a high reliability

organization (HRO). The visitor could reasonably conclude that this facility’s nursing staff: a. is highly reliable in preventing errors. b. has a reliable patient safety record and is a model for hospitals. c. is constantly alert for systems processes that could lead to errors. d. reliably reports all patient care errors to the appropriate body.

ANS: C

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

An HRO has employees who are constantly alert for things that could go wrong and ways to recognize and recover from mistakes if they are made. An HRO is not defined by whether or not it employs nursing staff that is highly reliable in preventing errors. An HRO is not defined by whether or not it has a reliable patient safety record or is a model for hospitals. An HRO is not defined by whether or not it reliably reports all patient care errors to the appropriate body.

16. A nurse is working with a patient who seems changed from earlier in the shift. The nurse

cannot pinpoint exactly what has changed but is concerned that the patient is getting worse.

The best action by the nurse would be to: a. call the physician and voice concerns about the patient’s status. b. consult with the charge nurse and ask for his or her opinion. c. continue monitoring the patient, looking for distinct changes. d. document the findings and reassess the patient in an hour.

ANS: A

Nurses should listen to their inner voices and confidently voice concerns, in this case by calling the physician about the patient’s status. Consulting with someone who has more expertise is always a good idea, but the best option is for the nurse to voice concerns to the physician. Waiting for distinct changes to occur before reporting the patient’s status may lead to a poor outcome. Many times the patient deteriorates significantly before showing distinct symptoms. Nurses often report that “something was not right” with a patient who later worsens. Documentation is important, but if the nurse feels, the patient is getting worse, waiting an hour to reassess would not be in the interest of patient safety.

17. A nursing manager explains to a group of newly hired graduate nurses that maintaining

situational awareness means: a. being aware of possible proNbU leR mS sI enNcG ouTnBte.reCdOinMpatient situations. b. remaining aware of patient status and how it can change quickly. c. the ability to recover quickly from mistakes once they do occur. d. understanding how everyone’s role is related to patient outcomes.

ANS: D

The nurse must understand everyone’s role in the complex health care situation and how each role contributes to patient outcomes. This also includes understanding how problems can occur related to everyone else’s roles. Being aware of possible problems encountered in patient situations is an important concept for patient safety, but this is not the meaning of situational awareness. Remaining aware of patient status and how it can change quickly is an important concept for patient safety, but this is not considered situational awareness. The ability to recover quickly from mistakes when they occur is the concept known as “resiliency.”

18. A manager is counseling a nurse who has violated safety protocols several times. The most

appropriate action by the manager is to: a. allow the nurse to continue working only under direct supervision. b. have the nurse prepare an educational in-service on safety protocols. c. maintain a confidential file on the nurse’s actions and outcomes. d. report the behavior to the state board of nursing for discipline.

ANS: D

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Protection for nurses who commit errors or are involved in near-miss episodes is an important part of a just culture. However, according to the Institute of Medicine, protection from disciplinary action from the facility and from regulatory agencies should not be granted in three specific situations: criminal misconduct, active malfeasance, or when reporting an incident has been delayed unnecessarily. This nurse would likely be seen as committing active malfeasance (actively or purposely violates safety protocols) and should be reported to the state board of nursing for discipline. A nurse who has violated safety protocols on several occasions would most likely be seen as committing active malfeasance by continuing to violate the protocols. The nurse’s behavior should be reported to the state board of nursing for discipline. Having the nurse prepare an educational in-service on safety protocols might have been an option for the first offense, but continuing to violate safety protocols warrants a much more serious response. The nurse’s behavior should be reported to the state board of nursing for discipline. Confidentiality when making mistakes is an important part of a just culture, in which reporting errors and near misses is institutionalized. However, in the case of repeatedly violating safety protocols, this nurse cannot expect to have the incidents remain confidential.

The nurse’s behavior should be reported to the state board of nursing for discipline.

19. The nursing executive attempting to incorporate the American Association of Critical-Care

Nurses’ (AACN’s) Healthy Work Environment Standards would formulate which policy? The manager would create a policy to: a. encourage all nurses to return to school to complete degrees. b. limit environmental hazards currently present in the facility. c. provide discounts to a local fitness center for all employees. d. use a standard “handoff” report format at change of shift.

ANS: D

The AACN standards contain sN ixUaRreSaI s,NinGcT luB di.nC g Os kMi l l e d communication. Using a standardized handoff tool would improve nurses’ communication skills. Although important, encouraging all nurses to return to school to complete degrees is not related to the AACN standards. Although important, limiting environmental hazards currently present in the facility is not related to the AACN standards. Providing discounts to a local fitness center for all employees would be a nice benefit but is not related to the AACN standards.

20. A chief nursing officer (CNO) has been hired to develop a healthy work environment and

culture of safety in a hospital with a long record of safety problems and poor patient outcomes. The best initial action by the CNO would be to: a. create a policy where any nurse can stop procedures for a safety check. b. design team-building events and basic communications in-services. c. have all nurses in the facility reapply and interview for their jobs. d. inform nurses that it is their job to report potential safety problems.

ANS: B

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

This culture or environment would be considered immature, so the CNO needs to start with basic building blocks of a safe environment, including teamwork and skilled communication.

Eventually, the CNO would want to implement policies similar to “Stop the Line,” whereby all nurses have the authority to speak up and intervene before problems arise. However, in a facility where even basic safety is an issue (an immature environment), training needs to occur on more basic ideas of safety, such as skilled communication and teamwork. A culture of safety includes focusing on system problems leading to safety issues, not on individual nurses.

Having all nurses reapply for their jobs indicates that because of past problems, only the “best” nurses (or nurses with better safety records) will be retained. It would be better to start fresh by implementing the “just culture” philosophy and move forward without penalizing the staff for past problems. Informing nurses that it is their job to report potential safety problems would be part of any drive to improve patient safety and outcomes, but this alone will not empower the staff to report problems, especially proactively.

21. A nursing manager for a cardiac unit wishes to improve collaborative teamwork to improve

patient care outcomes. Which action by the manager would best accomplish this goal? a. Create permanent nurse-aide work groups. b. Formulate nurse-cardiologist work teams. c. Implement daily multidisciplinary rounds. d. Require face-to-face reports between nurses.

ANS: C

Implementing daily multidisciplinary rounds would best accomplish the goal because all members of the team would hear about each other’s contributions and how each member views the patient situation. Each member of the team would feel like an important member.

When collaboration occurs, patient safety improves. Creating permanent nurse-aide work groups would help with teamwN orUkRanSdIcNoG llaTbB or.aC tioOnMbut only between nurses and nurses’ aides, so this answer is too narrow in focus. Formulating nurse-cardiologist work teams would help with teamwork and collaboration, but because it only includes two members of the multidisciplinary team, the answer is too narrow in focus. Requiring face-to-face reports between nurses would help with teamwork and collaboration but only involves the professional nursing staff, so this answer is too narrow in focus.

22. A nurse applying for a job in a hospital notes that administration promotes accurate and timely

reporting of errors and near misses. The facility has a multidisciplinary team to analyze this information as it becomes available and design solutions to identified problems. This nurse could infer that: a. nurses in this facility have a high degree of ownership in patient safety. b. nursing staff has been penalized in the past for reporting safety protocol violations. c. the hospital has had some significant issues with patient safety in the past. d. this facility’s culture would be considered “immature” related to safety.

ANS: A

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

To maintain a strong culture of safety, nurses need to have ownership and a sense of personal responsibility in promoting a work environment that prioritizes patient safety. In a culture where proactive reporting of safety problems and timely reporting of errors is the norm, nurses need to feel safe from disciplinary action when they make such reports. It may or may not be true that the hospital has had some significant issues with patient safety in the past; one cannot tell from the information given. An immature safety culture should focus on teamwork and communication skills; this environment is more mature, with a focus on more advanced safety concepts.

23. A chief nursing officer (CNO) wishes to integrate the Team Strategies and Tools to Enhance

Performance and Patient Safety (TeamSTEPPS) model of teamwork training into the hospital where the CNO works. The first action by the CNO should be to: a. design training for onsite trainers. b. determine readiness for such training. c. investigate specific training models. d. pick high-risk areas to start training.

ANS: B

The first phase of teamwork training should be to conduct a preassessment to determine the facility’s readiness to change. Using the TeamSTEPPS program, this occurs in phase 1.

Designing training for selected onsite trainers would be part of phase 2, in which members are trained. Because the CNO has already decided on a specific model to use, this means that investigating specific training models has already been done. After the CNO determines readiness, phase 2 consists of a “train the trainer” approach, which is then implemented in identified high-risk areas first. This is part of phase 3.

24. A chief nursing officer (CNO) N h aUsRim em te. dC aO mModel for teamwork training in the facility.

SpIlN GeTnB

The model seems to be working in some areas but not in others. The best action by the CNO would be to: a. assess for formal and informal leaders who oppose the plan. b. inform the staff that teamwork improves safety and is expected. c. provide more education and training on benefits of the model. d. rotate staff between areas with different levels of acceptance.

ANS: A

The most important element of a teamwork training program is the support of both formal and informal leaders. The CNO should assess for any change agents within the facility who do not support the program and whose attitudes might be sabotaging the program. Informing the staff that teamwork improves safety and is expected would be part of the educational process. This information, provided in isolation, might make the staff resentful that this is being forced upon them. More education and training might be needed, but the CNO first needs to find out whether there are leaders who are not supportive of the plan. Rotating staff members to different areas would create confusion and possibly decrease patient safety because nurses could be forced to work in areas in which they had no expertise.

25. The practicing nurse knows the following factor contributes to more patient injuries and death

than the other factors. a. Communication failures b. High-technology equipment c. Medication administration

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG d. Performing high-risk tasks ANS: A

Communication failures are the leading cause of preventable patient injuries and death, according to The Joint Commission. High-technology equipment is not the leading cause of preventable patient injuries and death, according to The Joint Commission. Medication administration is not the leading cause of preventable patient injuries and death, according to The Joint Commission. Performing high-risks tasks is not the leading cause of preventable patient injuries and death, according to The Joint Commission.

26. A newly hired graduate nurse is asking the preceptor why the facility uses a standardized

template for change-of-shift reports. The preceptor explains that this template is used to: a. decrease communication failures at a risky time. b. decrease reports containing frivolous information. c. ensure all nurses get the same patient information. d. make it easier for nurses to remember what to say.

ANS: A

Communication failures are the leading cause of patient injury and death, and change-of-shift or handoff reports are a time when communication failures often occur. Eliminating frivolous information from shift reports would certainly be beneficial, because nurses are more likely to listen to reports that are to the point, but this is not the main reason for standardizing shift report. Using a standardized handoff report does ensure that nurses all get the same information about their patients, but this is secondary to minimizing the chance of a communication failure during a high-risk time. A minor benefit of using a standardized reporting format is that it makes it easier for nurses to remember what to say, but this is secondary to minimizing the chance of a communication failure during a high-risk time.

27. A nurse is explaining to a student that SBAR is a type of: a. format for conducting a debriefing. b. process for multidisciplinary meetings. c. standardized patient chart template. d. structured communication strategy.

ANS: D

SBAR is a structured communication strategy and stands for situation, background, assessment, and recommendation. SBAR is not a format for conducting debriefings. SBAR is not a process used in multidisciplinary meetings. SBAR is not a template for standardized patient charting.

MULTIPLE RESPONSE 1. The nurse explains that benefits of the Patient Safety and Quality Improvement Act of 2005

include: (Select all that apply.) a. being able to learn from the mistakes of others. b. finding trends amenable to quality improvement. c. financial rewards to facilities that reduce errors. d. having data that can be aggregated into trends. e. tax breaks if facilities show quality improvement.

ANS: A, B, D

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

One of the benefits that this act provides is being able to learn from others’ mistakes through sharing of information. With information available, trends can be identified that can be resolved through program or process improvement activities. Having a large pool of data means that trends can be identified. This act does not provide financial rewards to facilities.

The act does not provide for tax breaks.

2. The nurse working in health care today understands the ways in which the Patient Affordable

Care Act (ACA) will affect patient safety. Which are the ways this is true? (Select all that apply.) a. Create incentives for hospitals to participate in patient safety organizations (PSOs). b. Exempt hospitals from participating in the Patient Safety and Quality Improvement Act. c. Mandate that hospitals begin reporting safety events to patient safety organizations (PSOs). d. Permit hospitals to discipline employees for safety failures and near misses. e. Require hospitals establish a patient safety evaluation system.

ANS: A, C, E

Provisions of the ACA related to patient safety include creating incentives for hospitals to participate in PSOs, mandating reporting of safety events to PSOs, and requiring hospitals to establish patient safety evaluation systems. Exemption from patient Safety and Quality Improvement Act is not a feature of the ACA. Permitting disciplinary measures for errors and near misses is not a feature of the ACA.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Chapter 21: Palliative Care: Compassionate Care Across Settings of Care Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. What is the purpose of palliative care? a. To determine treatment for disease b. To provide relief of suffering c. To learn to live with a chronic disease d. To take the place of hospice care ANS: B

Palliative care is a team approach to prevent and relieve suffering. This approach encompasses the entire care team, and assist in guiding care for individuals in advanced stages of illnesses.

Palliative care does not determine treatment for diseases, teach how to live with chronic illnesses or take the place of hospice care.

2. How many people are estimated to need palliative care at the end of life, worldwide? a. 20 million b. 6 million c. 12 million d. 2 million ANS: A

The World Health Organization estimates that 20 million people worldwide need palliative care each year at the end of life. 69% of these individuals are over 60 years of age.

3. Which action describes the illness-related concerns domain of palliative care? a. Psychological symptom management b. Supporting self-care c. Maintaining social support d. Providing care for the caregivers ANS: A

In the first domain within the model of palliative care, illness-related concerns, the focus is on physical, cognitive, and psychological symptom management. The second domain, dignity-conserving repertoire, incorporates interventions focusing on supporting self-care, building capacity for psychological and spiritual well-being. The third domain, social dignity inventory, focuses on maintaining social support, caring for the caregivers, and planning for the bereavement period.

4. Which action by the nurse would not be helpful for the family of a patient receiving palliative

care? a. Facilitating spiritual guidance b. Providing emotional support to the extended family c. Delegating tasks to a different nurse on the unit d. Managing pain ANS: C

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Delegating tasks to another nurse would not be helpful for the family of a patient receiving palliative. The nurse should remain focused on building and maintain rapport with the patient and family. Facilitating spiritual guidance, providing emotional support, and managing pain are all appropriate interventions by the nurse.

5. The nurse is discussing palliative care with a patient and family. Which does is not a benefit

of palliative care? a. Bedside services of a community-based physician b. Symptom management c. Caregiver support d. Availability across all settings of care ANS: A

There are many benefits of palliative care including symptoms management, caregiver support, availability across all settings of care, among others. Palliative care exists to provide services because bedside services of a community-based physician are limited or nonexistent.

6. The nurse is educating family on what physician symptoms to expect in the dying patient who

is newly admitted to palliative care. Which would the nurse include? a. Increased level of consciousness b. Dyspnea c. Hypothermia d. Increased energy ANS: B

The most common physical symptoms include dyspnea, pain, respiratory secretions, death rattle, and confusion.

7. Which is not an outcome of palliative care interventions? a. Increased length of stay in hospice b. Improved quality of life c. Decreased caregiver role strain d. Increased patient-physician communication ANS: A

Studies show that early palliative care interventions do not increase hospice length of stay, but increases life for patients who utilize palliative care. Also shown are improvements in quality of life, decrease caregiver role strain, and increase patient-physician interaction.

8. Which is not true regarding hospice and end-of-life needs? a. Hospice is located in hospital settings. b. The plan of care often changes. c. Symptoms are dynamic. d. Families are involved in care.

ANS: A

Hospice care is provided across a wide variety of settings, with 59% being provided at the patient’s home. The plan of care often changes, symptoms are dynamic, and families are involved in the care of their loved one.

9. Which does the nurse recognize as a barrier to palliative care?

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG a. b. c. d.

Lack of diversity of patients Educated personnel Social support based on patient need On-time referrals

ANS: A

Barriers to palliative care include lack of diversity in patients enrolling in palliative care.

Uneducated personnel, limited or lack of social support, and late referrals.

10. What does the nurse identify as a disadvantage to a late referral to palliative care? a. Insurance will not pay for services. b. The patient doesn’t fully benefit from care. c. The family doesn’t have time to accept diagnosis. d. The nursing staff doesn’t have time to arrange a visit.

ANS: B

Late referrals cause up to 30% of patients dying within 7 days of admission into palliative care. This does not allow for the patient and family to fully benefit from care or obtain needed skills to help care for their loved one.

11. Which is not a factor related to late referrals? a. Lack of insurance b. Fear c. Mistrust in the medical system d. Availability of a hospice provider ANS: A

Three categories have been i d e Nn tUi f Ri e Sd I foNr G laT teBr. efC erOraMls: patient/family related, health system related, and health care provider related.

12. Which does the nurse recognize as not being one of the five factors associated with increased

likelihood of death at home? a. High intensity of home care services b. Lack of extended family c. Social services support d. Additional in-home care ANS: B

Factors that increase the likelihood of death at home include: direct care in the home, high frequency of home care visits, living with relatives, extended family, friends, and support for the family.

13. The nurse educator is presenting a lecture on palliative care. Which statement is inaccurate? a. “The palliative care staff are the unit of care.” b. “Palliative is integrated throughout the course of disease.” c. “Palliative care is available across all settings.” d. “Family members receive education and hands-on caregiving instruction.”

ANS: A

Palliative care utilizes the patient and family as the unit of care. Palliative care is integrated throughout the course of the disease, is available across all settings, and family members receive education and hands-on caregiving instruction.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

14. Which is true regarding the Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ)

community? a. LGBTQ elders are confident with health and social services. b. LGBTQ elders have always been welcomed by palliative care. c. Gender identification needs have historically been met by the palliative care community. d. Nonheteronormative ideas have not always been embraced.

ANS: D

Nonheteronormative ideas have not always been embraced. This has led the LGBTQ elders to feel less than confident with health and social services.

MULTIPLE RESPONSE 1. Which was the primary patient population served by hospice providers during the early

movement? (Select all that apply.) a. White females b. Black males c. Hispanic females d. Asian males ANS: A, B

During the early days of the hospice movement, the primary patient population was white females with cancer.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG

Chapter 22: The Wisdom of Self-Care: Well-Being and Resilience in Nursing Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition MULTIPLE CHOICE 1. Which does the nurse identify as not being one of the four additional predictors of resilience? a. Ability to internalize stress b. Ability to find humor c. Capacity to find insight d. Ability to find meaning in spirituality ANS: A

A study by McCann et al. (2013) identified four predictors of resilience among health care professionals. These include the ability to laugh and find humor, the capacity for self-reflection and insight, the ability to finding meaning in their beliefs, spirituality, and finally, the willingness to embrace a professional identity.

2. Which action by the nurse shows resilience? a. Calling in after a rough shift b. Internalizing stress c. Going out for drinks with co-workers d. Utilizing humor as a stress reliever ANS: D

Resiliency among health care workers involves the use of positive behaviors, thoughts and actions to deal with stress events. Utilizing humor as a stress reliever is an example of resiliency.

3. Which factor is considered central to resiliency? a. Keeping a short-term perspective b. A pessimistic outlook c. Visualizing the wishes of others d. Maintaining good relationships ANS: D

Factors considered central to resiliency include maintaining good relationships, accepting circumstances that cannot be changed, keeping a long-term perspective, sustaining a hopeful outlook, and visualizing one’s goals.

4. Which does the nurse identify as a potential cause of burnout? a. Incentive pay b. High staff turnover c. Frequent pot lucks d. Visibility of the management team ANS: B

The potential for burnout exists due to high role expectations and difficult work conditions.

High turnover rate is stressful and taxing on health care workers.

5. Which is not one of the three C’s of the Stress-Hardy Personality?

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG a. b. c. d.

Commitment Challenge Creation Control

ANS: C

The three C’s of the Stress-Hardy Personality are: Commitment, Control, and Challenge.

6. Which does the nurse identify as not accurate regarding hardiness factors? a. Helps reduce burnout. b. Improves career satisfaction. c. Is a strong predictor of burnout. d. Affects men more than women.

ANS: D

Hardiness does not affect men more than women. Hardiness helps reduce burnout, improves career satisfaction, and is a strong predictor of burnout.

7. Which is true of the nurse with an internal locus of control? a. Do not believe they have influence. b. Believe they can control external events. c. Experience burnout less. d. Have a sense of empowerment.

ANS: D

Nurses with an internal locus of control have a sense of empowerment, believe they have influence, and understand that they cannot control all external events.

8. Which is true of the nurse with an external locus of control? a. Have a sense of control. b. Believe they can control outside events. c. Experience burnout less. d. Believe they have little or no control over their lives.

ANS: D

Nurses with an external locus of control believe they have little or no control over their lives, due to outside circumstances.

9. Which activity would be ineffective for the nurse educator to suggest as a method for stress

reduction during the work day? a. Working lunches b. Yoga c. Massage d. Meditation ANS: A

Working lunches would not give staff the needed time away from responsibilities during the work day. Appropriate and helpful methods including yoga, massage, and meditation.

10. Which is a benefit to stress management programs? a. Ability to take on an increase workload b. Ability to work longer hours

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG c. View unexpected events as stressors d. More control over one’s life ANS: D

Benefits to a stress management program include more control over one’s life and reduction in stress.

11. The nurse is teaching a group of co-workers about the benefits of meditation. Which statement

indicates an understanding of the presented information? a. “Meditation is only effective after 30 minutes of practice.” b. “Meditation takes only 5 minutes to be effective.” c. “Muscle tension is eased after 20 minutes of meditation.” d. “Benefits of meditation can be seen immediately after beginning practice.”

ANS: C

Research shows that meditation is effective after 20 minutes of practice. Benefits include ease of muscle tension, reduced blood pressure, slowed respiratory rate, and production of a relaxed, alert state.

12. Which conditions should the nurse expect to due triggering of “fight or flight” hormones? a. Hypotension b. Lethargy c. Headaches d. Seizures ANS: C

Fight or flight hormones trigger conditions such as headaches, insomnia, and hypertension.

Heart disease, stroke, and cancN erUcR anSaIlsNoGoT ccBu. r.

13. The nurse is creating a presentation on the purpose of journaling. What should the nurse

include as the purpose behind journaling? a. Helps induce a state of calmness. b. Is a form of meditation. c. Helps make important decisions. d. Gain insight into personal issues.

ANS: D

Journaling involves daily writing and analyzing of patterns. This helps with identifying patterns gaining insight into personal issues, relationships, special interests, and health.

14. Which is true regarding expressive writing? a. Write for 5 minutes everyday. b. Write when having episodes of anger or sadness. c. Used to treat mental illness. d. Disregard grammar and spelling errors while writing.

ANS: D

Expressive writing is a technique used to treat individuals after a traumatic experience. The individual writes for 15 to 20 minutes over the course of 3 to 4 consecutive days, disregarding grammar or spelling errors.

TEST BANK FOR CONCEPTUAL FOUNDATIONS 7TH EDITION BY FRIBERG 15. The nurse is suffering from stress and fatigue. Which action should the nurse take to help

reduce these symptoms? a. Take a leave of absence from work. b. Begin an exercise program. c. Sleep more on off days. d. Pick up extra shifts to increase endurance.

ANS: B

The nurse is likely experiencing burnout and should take these symptoms seriously.

Beginning an exercise program can help the nurse reduce overall stress.

16. Which does the nurse recognize as not being part of all-or-nothing thinking? a. I sometimes procrastinate. b. I always fail. c. I never get it right. d. I’m not good at anything.

ANS: A

Cognitive distortion, such as all-or-nothing thinking, includes phrases such as, “I always fail,” “I never get it right,” and “I’m not good at anything.”

17. Which thinking habit would not be helpful for someone who is trying to avoid all-or-nothing

thoughts? a. Consider what-ifs. b. Be aware of self-talk. c. Avoid thinking traps. d. Stay calm and focused.

ANS: A

Prevention of all-or-nothing thinking includes the following: avoid thinking about what-ifs, be aware of self-talk, avoid thinking traps, stay calm and focused, among others.

18. The nurse is working with veterans who suffer from PTSD. Which action by the nurse can

help relieve the symptoms among this group of individuals? a. Set strict visitor hours. b. Incorporate mandatory meditation. c. Request antidepressants. d. Promote regular use of a therapy dog.

ANS: D

Research shows that interaction with a therapy dog significantly reduces stress, and promotes the release of feel good hormones such as oxytocin, serotonin, and prolactin.