Test Bank For Contemporary Practical Vocational Nursing 9th Edition by Corinne Kurzen, Anna LaVon Ba

Test Bank For Contemporary Practical/Vocational Nursing 9th Edition by Corinne Kurzen, Anna LaVon Barrett Chapter 1-16

Chapter 1, Adjusting to Student Life 1. The nursing student has found the first 2 weeks of the nursing program fascinating but

overwhelming. This student is anxious and unable to sleep. What action should the nursing student take to address these feelings?

A. Utilize the counseling services available at the college.

B. Reduce the course load.

C. Eliminate the family activities and recreational activities.

D. Create a study group with some classmates and divide the course work.

ANS: A

Feedback: Counseling services to help students make adjustments and solve problems may be available to students. If so, they are often very helpful. This is preferable to reducing the courses the student is taking or eliminating family and recreational activities, which are beneficial in stress management. Study groups can be helpful, but they are not intended to divide course work.

PTS: 1 DIF: Moderate REF: p. 5, Personal Adjustments OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 1 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A nursing student will soon begin a new course with a new instructor. When encountering a

new instructor for the first time, the student should: A. compliment the instructor on his or her knowledge and skills.

B. try to get to know the instructor as much as possible.

C. remain silent until the instructor reveals his or her expectations.

D. ask as many questions as possible so that the instructor notices the student.

ANS: B

Feedback: Every instructor is different, and it is beneficial to get to know each instructor‘s style, personality, and expectations as much as possible. This does not involve offering personal compliments to the instructor or asking questions for the purpose of becoming known. At the same time, a student should not be completely silent at the start of a course.

PTS: 1 DIF: Moderate REF: p. 6, Program Structure OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 1 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A student has just begun a nursing program and is committed to success. When creating a

schedule for the school term, what should the student do?

A. Make sure that recreation is prioritized over school work.

B. Spread out school work evenly between all 7 days of the week.

C. Ensure a balance between school activities and personal life.

D. Put off family activities until the midterm break.

ANS: C

Feedback: A good schedule should be realistic and balanced. To get the most from the program and still have time for a personal life, the student should make a schedule that fits the time available, not how much time the student wishes was available. This does not mean that school work should suffer because of personal activities, however. It is often helpful to schedule days off rather than studying every day of the week.

PTS: 1 DIF: Easy REF: p. 7, Scheduling Your Time OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 4. When learning how to assess clients‘ health, a student has found that the most beneficial

learning technique was watching an online video in which an experienced nurse demonstrated how to conduct an assessment. Which is this student‘s most likely learning style?

A. Tactile B. Visual C. Auditory D. Kinesthetic ANS: B

Feedback: Visual learners learn best by watching things such as videos, movies, and demonstrations. Tactile and kinesthetic learners benefit from touch. Auditory learners prefer to hear information.

PTS: 1 DIF: Easy REF: p. 9, Applying Your Learning Style OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 1 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A nursing student is aware of the importance of critical thinking, especially in clinical

situations. When applying the principles of critical thinking to a situation, the student should begin by asking: A. ―What did I do the last time I encountered a similar situation?‖ B. ―Why do I need to act in this situation?‖ C. ―What are the consequences of making the wrong decision in this situation?‖ D. ―What are the facts that I know about this situation?‖ ANS: D

Feedback: A useful starting point for the critical thinking process is to determine the facts about the situation. This should come before a comparison with previous situations. It is likely not helpful to ask what could possibly go wrong.

PTS: 1 DIF: Difficult REF: p. 17, Developing Critical Thinking Skills OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The nursing student is working with a female client who had recent hip surgery. The client

was drowsy. The nursing student used critical thinking to determine the action needed to prevent the client from falling. The nursing student should:

A. walk the client to the bathroom using a walker.

B. transfer the client to a bedside commode.

C. provide a fracture bedpan.

D. use a gait belt and walk the client to the bathroom.

ANS: C

Feedback: The student‘s synthesis of the facts of a situation and the translation of these facts into action demonstrate effective critical thinking. The client has recently had hip surgery and is drowsy and will be unsteady on her feet, so trying to get her up by transfer to a bedside commode or using a walker or a gait belt will not provide the safest choices for helping the client to be toileted. The fracture bedpan is the safest choice to prevent a fall in the drowsy postoperative client recovering from recent hip surgery.

PTS: 1 DIF: Moderate REF: p. 19, Applying Critical Thinking Skills OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 1 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A nursing student has been informed that much of the content of the nursing program will be

presented in the form of lectures. This means that the student should: A. make sure to do the assigned readings prior to each class.

B. determine whether the lecture will be beneficial before deciding to attend.

C. record each lecture electronically so that it can be referred to later.

D. schedule a one-on-one discussion with the instructor after each class.

ANS: A

Feedback: It is important to prepare for lectures by completing reading assignments in advance. A student should attend every class. It is not normally necessary to record every lecture or to meet with the instructor after each class.

PTS: 1 DIF: Easy REF: p. 19, Lectures OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 8. The student has recently begun the nursing program and is committed to getting the highest

grades possible. One of the student‘s strategies for meeting this goal is learning how to take effective notes. What should the student do to make sure the notes are effective? Select all that apply.

A. Aim to write down everything that the instructors say in class.

B. Take special note of information that the instructors say is most important.

C. Read the notes as soon as possible after class.

D. Review the notes regularly.

E. Get notes from a classmate to compare with the student‘s notes.

ANS: B, C, D

Feedback: Strategies for taking effective notes include highlighting main points, reading notes after class, and reviewing them regularly. Unless the student has been absent, it is not normally necessary to obtain a classmate‘s notes. It is unrealistic and unnecessary to write down everything an instructor says.

PTS: 1 DIF: Difficult REF: p. 19, Taking Notes OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Selection 9. A nursing student who has recently begun a nursing program is discussing study habits with

his or her classmates. Which statement by the student‘s classmates suggests effective study habits?

A. ―I find it‘s best to study the easy subjects first and then the hard subjects.‖ B. ―In order to be efficient, I always try to do my studying as fast as I can.‖ C. ―I don‘t take a break until I‘ve finished everything that I have to study.‖ D. ―I try to schedule my studying ahead of time so that I get everything done.‖ ANS: D

Feedback: Creating a schedule for studying is conducive to effective time management and success. It is best to study hard subjects before easy subjects. Regular breaks are important, and effectiveness, not speed, is the goal of studying.

PTS: 1 DIF: Moderate REF: p. 22, Studying OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A nursing student has learned that the nursing program will require frequent, lengthy readings.

In response, the student has resolved to apply the SQ3R method. This means that the student will begin each reading session by: A. writing down questions about the subject matter of an assigned reading.

B. looking over the reading for main headings, figures, titles, and objectives.

C. slowly and conscientiously reading the material.

D. reading the material aloud.

ANS: B

Feedback: The SQ3R method begins by surveying the chapter or unit by reading the title, objectives, key words, chapter heads, introduction, italicized passages, graphs, illustrations, photos, and end-of-chapter questions before you begin normal reading. Writing down questions follows this, as does a more detailed reading. Reading aloud is useful to some students, but this is not normally the first step in the process.

PTS: 1 DIF: Difficult REF: p. 25, Reading Assignments OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 11. The client wants to know the latest research about diabetes to guide care. Which resource

would be best for the nurse to use to provide the requested information?

A. Textbook published this year B. Peer-reviewed evidence-based journal C. Brochure from an organization supplying diabetes supplies

D. http://www.pence.edu/diabetesresearch ANS: B

Feedback: Peer-reviewed (expert peers review manuscripts prior to publication for their appropriateness) and evidence-based journals contain the most recent research and applications based upon research. The textbook may have been published this year but will contain older information than the journal. The brochure will advertise supplies for purchase but will not offer information about the latest research. The example website may or may not be reliable and valid, and there is no guarantee that it is kept up-to-date with the latest research related to diabetes.

PTS: 1 DIF: Moderate REF: p. 27, Other Materials OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A nursing student has announced to a classmate, ―Textbooks are so twentieth century. I do all

my research on the Internet.‖ How should the classmate best respond to this statement?

A. ―In the long run, you‘ll save money by investing in a few well-recognized

textbooks.‖ B. ―I agree, but I find that the pictures, graphs, and figures in a textbook can be useful supplements.‖ C. ―If you do this, make sure that you personally know the person who produced the information.‖ D. ―Remember that anyone can post information online, so the information isn‘t guaranteed to be accurate.‖ ANS: D

Feedback: Anyone can put information on a website, so information may or may not be accurate. It is necessary to critically appraise online information, but this does not mean that the student must personally know the individual who posts the information. Textbooks should not be seen solely as a supplement or adjunct to online information.

PTS: 1 DIF: Moderate REF: p. 28, The Internet OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A nursing student is scheduled to take the first written exam in the nursing program and is

experiencing test anxiety. What strategy should the nursing student implement to maximize the chances of being successful in this exam?

A. Take the written exam as quickly as possible in order to avoid ―second guessing.‖ B. Focus on the most difficult questions before answering the easier questions.

C. Scan the entire exam to make some estimates about the time that each section will require.

D. Focus on guessing instinctively rather than focusing on the specifics of a question.

ANS: C

Feedback: When taking a written exam, the student should begin by scanning the exam. It is advisable to do easy questions first to build confidence. The student should not aim for speed when writing an exam, and guessing is only an option when the student is unsure of the correct answer.

PTS: 1 DIF: Moderate REF: p. 31, Strategies for Taking Tests OBJ: 8 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 1 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 14. The nursing student received several lectures on caring for a client requiring bed rest. The

nursing student practiced essential skills related to caring for a client on bed rest. The nursing student has the first clinical experience. Which example supports the primary purpose of clinical instruction?

A. The nursing instructor demonstrates how to log roll the client and allows the nursing students to practice this for the first time since the students never learned this skill before.

B. The nursing student found that he or she could not insert the urinary catheter as easily as he or she had practiced it in the laboratory, and the clinical instructor stated that the client may have an obstruction in the urethra making it difficult to insert the catheter as taught.

C. The nursing student wrote in his or her clinical journal that he or she used what he or she learned in class and in the lab while caring for the client he or she was assigned.

D. The nursing student wrote in his or her clinical journal that he or she found that the skills he or she learned in the lab were able to be used in the clinical area.

ANS: C

Feedback: Clinical instruction is arranged by the faculty to give the student practical experience in the care of people in various health care settings as demonstrated by the example of writing in the clinical journal about using class instruction in the lab. The primary purpose is not simply to supplement learning as seen in the example of the instructor demonstrating a log roll or study skills as noted in the example of writing one‘s findings in a clinical journal, and it is not intended to show a disconnect between theory and practice as noted by the example difficulty inserting a urinary catheter.

PTS: 1 DIF: Moderate REF: p. 33, Clinical Instruction OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 15. During his or her first clinical placement, a nursing student will soon begin providing basic

care in a long-term care facility. How should the student best prepare for this experience?

A. Ask the residents of the facility what care they would like to receive.

B. Teach the residents about the material that the student has learned.

C. Thoroughly research the health conditions of the residents in the facility.

D. Tell the residents that they will not receive the same quality of care as provided by the nurses at the facility.

ANS: C

Feedback: Before beginning to care for a client, the nursing student should review his or her textbooks and notes to be sure he or she correctly understands the client‘s condition, the treatment being given, and the procedures he or she will be performing. It is wrong to tell residents they will receive substandard care or to teach the nursing program material to the residents. Respecting the residents‘ wishes is important, but this does not normally involve asking residents about the specific care they would like to receive.

PTS: 1 DIF: Difficult REF: p. 33, Clinical Instruction OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A nursing student is a single mother with three small children. She works a part-time job. Her

boss had someone quit and is pressuring her to work an extra shift each week to help out for a short time until he can hire another worker. Her babysitter became ill and is hospitalized. She recognizes the importance of attending the first nursing class, but she is stressed because of the recent life events. What should the student do in this situation?

A. Utilize a prearranged emergency babysitter, talk to her boss about her need to attend the first scheduled class, and talk with her instructor about the situation after class.

B. Utilize the emergency babysitter, ask another student to tape record the class, and go to work.

C. Bring the children to class, talk to the faculty member during class about the need to work for the next several weeks instead of attending class, and ask the faculty member to provide a means to learn the content.

D. Leave a message on the faculty member‘s telephone, and e-mail the instructor about the situation, and ask her to send materials that the nursing student may need to catch up in the class.

ANS: A

Feedback: It is important to design a school-study-family-work-recreational schedule that plans ahead for situations that may occur. One such back-up plan as a parent is emergency babysitting, in case the primary babysitter becomes unavailable. Since she is stressed about her situation, the best thing to do is to attend the first class. It is important to establish what the faculty member expectations are for the course and what strategies are needed to be successful in the course. This requires an active interaction with the faculty member and students to ensure success. The situation at hand may be discussed further with the faculty member after the class at a convenient time for both the faculty and student to discuss available ways for her to be successful. The faculty member may refer the nursing student to counseling services, and the campus may have a means for babysitting children on campus.

The faculty member may not want her to leave a tape recorder to gain the lecture information.

By going to work and not attending the first class, the student misses out on valuable information she may gain on how to be successful in the course. Bringing the children to class may not be acceptable to the faculty member and the rest of the classmates. I also may disrupt the learning environment and expose the children to information inappropriate for their age and development. It is not the responsibility of the faculty member to provide the materials for the student to catch up in a class she misses. It is important as a nursing student to act professionally by showing up on time, being prepared, and taking personal responsibility for her actions. These qualities are necessary to care for clients and their families.

PTS: 1 DIF: Moderate REF: p. 5, Personal Adjustments OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 1 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nursing student discovered that his or her primary learning style is visual and his or her

secondary learning style is tactile/kinesthetic. The nursing student is learning about caring for a client who requires an enteral feeding tube. Which way to enhance his or her initial learning is best?

A. Make a pictorial guide based upon lecture notes of caring for a client receiving an enteral feeding via the enteral tube.

B. Watch a nurse insert an enteral feeding tube, and then try it on another client.

C. Watch a video on insertion of the enteral feeding tube, and then practice it using a practice client simulator mannequin.

D. Read an illustrated textbook on how to care for a client requiring an enteral feeding tube.

ANS: C

Feedback: The best approach for initial learning is to watch a video showing and describing the procedure and then practicing it on a client simulator mannequin because the approach provides the primary learning style through visual presentation, and the secondary learning style is reinforced by immediate hands on learning. Watching the nurse insert the feeding tube may be helpful, but the student should not try to perform the procedure immediately on a client before practicing the procedure on a client simulator mannequin. An illustrated textbook provides the primary visual learning style but does not offer the reinforced secondary learning style that hands on learning will offer.

PTS: 1 DIF: Easy REF: p. 9, Applying Your Learning Style OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The nursing student brought in a lunch tray for a client admitted for right knee surgery

scheduled tomorrow morning. The client has a long-term history of hypertension and diabetes.

The client‘s medical record contains a long list of allergies to medications, foods, and substances. The client stated, ―I can‘t eat this food because there is no sugar or salt packets or anything to make this food taste good on the tray, take it away!‖ Which action is best for the nursing student to provide?

A. Provide the client sugar substitute and herbal seasoning packets.

B. Remove the tray out of the room and document that the client refuses to eat lunch.

C. Ask the client what he or she does at home to sweeten or season his or her food.

D. Tell the clinical instructor that the client refuses to eat his or her lunch because he or she wants sugar and salt packets, and his or her diet prohibits this.

ANS: C

Feedback: Using critical thinking, the nursing student evaluates the situation at hand and needs to ask the client for more information on what the client does at home to sweeten or season his or her food. The nursing student considers the facts that the client has multiple allergies to foods and substances, so bringing in herbal seasoning packets or sugar substitutes may be counter-productive. The client has a history of diabetes and needs to eat consistent meals, so removing the tray and charting that the client refuses to eat does not address the client‘s physical needs or need for acceptable tasting food that he or she will want to eat.

Communicating the issue to the clinical instructor does not solve the issue that the client needs acceptable food.

PTS: 1 DIF: Difficult REF: p. 19, Applying Critical Thinking Skills OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 1 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The nursing student needs financial assistance to pursue his or her career. Which way to

explore resources is best?

A. Pay a small fee for each application that a financial adviser completes for federal and state grants and loans, and area scholarships.

B. Ask for guidance from a local librarian in searching for different ways to finance the nursing program.

C. Accept the loaning agency‘s offer for additional money above the cost of school expenses for a vacation during a school break.

D. Call area hospitals and nursing homes inquiring if there is financial aid offered at their institution.

ANS: B

Feedback: The best approach from the choices is to ask for guidance from a local librarian and perform an extensive search for all possible ways to finance the education, and then decide the best method that meets the student‘s individual short- and long-term needs. There should not be any fees for applying to federal or governmental agencies for financial assistance, so students should be wary of any advisor asking for such demands. The nursing student should only borrow what is needed for school expenses and not borrow additional funds because it will be harder to pay the loan back after graduation. The area hospitals may offer financial assistance but will require a contract after graduation that the nurse will work at the facility for a given period of time before the nurse may go elsewhere for employment. This option may not best serve the student‘s long-term needs, and if the student does not fulfill the obligations of the contract, the student may have to pay back the funds received to the institution.

PTS: 1 DIF: Easy REF: p. 6, Financing Your Education OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 1 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The nursing student has an excellent memory and never had to study while in high school but

wants to succeed in nursing school. She notes that she is most energetic in the mornings before noon and in the late afternoon before 6 pm. She finds her 2 pm anatomy and physiology to be her most difficult class and her 10 am skills lab, her easiest class. Which strategies are acceptable? Select all that apply.

A. Study the material covered in class right after class.

B. Study anatomy and physiology content last.

C. Practice nursing skills after class to reinforce the content.

D. Study in the late evening, right before bedtime.

E. Take a short rest period and stretch and take a walk after every 45 to 60 minutes of

study time.

F. Schedule time to attend the review for the instructor-led anatomy and physiology

review.

ANS: A, C, E, F

Feedback: Studying content covered in class right after class helps reinforce the content and provides time to look up anything that is not clear in the text book, or write down a question to ask the instructor. The hardest class should be studied first, and the easiest subjects afterward. Practicing skills does reinforce the learning. Studying in the late evening before bedtime is during an identified low-energy time and will not be as productive in retaining the content covered. Taking a short break and incorporating physical activity will improve the ability to concentrate and remember content being studied. Scheduling time to attend a review offered by the instructor for a subject found to be difficult is an excellent way to help master the content.

PTS: 1 DIF: Moderate REF: p. 22, Studying OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Selection

Chapter 2, The Student Nurse as a Person 1. A student nurse has recently completed the first clinical placement of his or her nursing

program and is excited at the interactions he or she has been able to have with clients. He or she has confided to a classmate, ―For the first time I feel like I‘m able to make a real difference in people‘s lives.‖ This nursing student is expressing which of Maslow‘s categories of human needs?

A. Physiologic needs B. Love and belonging C. Fulfillment D. Safety and security ANS: C

Feedback: This student nurse has expressed fulfillment in his or her new role, stating that he or she is able to have a deeply significant and transcendent effect on others from which he or she also derives benefit. This statement does not express physiologic needs or safety and security. The student implies that he or she also belongs in this setting, but the meaning of his or her interactions goes beyond simply being in an appropriate place.

PTS: 1 DIF: Moderate REF: p. 38, Human Needs OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Caring BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. The nursing student has found that the first few months of his or her nursing program was

rewarding but challenging, and he or she has noticed that he or she often runs out of energy by Thursday or Friday each week. What can the nursing student do to increase his or her amount of energy?

A. Reduce his or her level of physical activity to conserve energy.

B. Try to eat high-calorie foods and eat more frequently during the day.

C. Avoid eating breakfast so that he or she can eat more later in the day.

D. Build time into his or her schedule each day for some exercise.

ANS: D

Feedback: Despite the fact that physical activity requires effort, it ultimately results in increased energy levels. In most cases, it is incorrect and ineffective to limit exercise, to increase food intake, or skip breakfast.

PTS: 1 DIF: Moderate REF: p. 41, Rest and Exercise OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 2 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A student nurse had long been in the habit of wearing perfume but has stopped doing so since

he or she began his or her nursing program. The student most likely took this action because: A. clients may not share the student‘s preferences in his or her choice of perfume.

B. some individuals are allergic to scents and they can trigger an unpleasant or dangerous reaction.

C. different cultures have different ideas about the ideal smell of an individual.

D. uniformity is a professional goal, and each student nurse should dress similar and smell similar.

ANS: B

Feedback: Body fragrances, scented deodorants, and hair sprays may create discomfort in clients and can aggravate allergies. This constitutes a health risk that is more important than considerations related to cultural preferences, uniformity, or personal preferences.

PTS: 1 DIF: Easy REF: p. 43, Personal Hygiene OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 2 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A nursing student has woken up with a throbbing headache, slight chills, and several bouts of

sneezing, but he or she is scheduled to be at a long-term care facility this morning for a day of clinical experience. What should the student do? He or she should: A. call in sick to protect clients or classmates from becoming ill.

B. go to the facility, but wear a facemask when providing care for clients.

C. go to clinical as scheduled to demonstrate his or her eagerness to learn.

D. phone his or her clinical instructor and ask the instructor to decide whether he or she should come to clinical.

ANS: A

Feedback: It is the student‘s obligation to avoid contaminating the clinical environment when he or she has any illness that could harm or affect a client‘s health or well-being. It is not the responsibility of an instructor to make this decision on the student‘s behalf. Wearing a mask is neither realistic nor effective.

PTS: 1 DIF: Moderate REF: p. 45, Personal Illness OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 2 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A nursing student is feeling discouraged and embarrassed after receiving some pointed

criticism from his or her clinical instructor. How should the student best respond to this criticism?

A. Focus on his or her positive attributes that others have mentioned in the past.

B. Reflect on the criticism to see how he or she could be a more effective nurse.

C. Make an appointment with the instructor and explain how the feedback made his or her feel.

D. Send an e-mail to the instructor and explain the factors that contributed to his or her poor performance.

ANS: B

Feedback: Mentally healthy students have the ability to accept constructive criticism. Students who use correction and comment to improve themselves and their work do not personalize the criticism but recognize it as a part of the education they have paid for and expect. Ignoring or challenging criticism is not normally an effective practice.

PTS: 1 DIF: Difficult REF: p. 46, Your Emotional Health OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

6. The demands of the nursing program have prompted the nursing student to rearrange most of

his or her regular activities and obligations to ensure that he or she has sufficient time and energy to complete his or her school work. Which guideline should the student follow when organizing his or her schedule?

A. Explain to his or her friends and family that he or she will be generally unavailable until the end of the semester.

B. Ask an instructor in the nursing program to draft an ideal schedule for him.

C. Let himself or herself enjoy a recreational activity only if he or she is ahead on his or her school work.

D. Make sure that he or she allows some time for socializing and recreation.

ANS: D

Feedback: To achieve balance and mental health, it is important to schedule time for recreation and socializing. This should not only occur when a student is ahead of his or her task schedule. It is not the responsibility of an instructor to create a student‘s schedule.

PTS: 1 DIF: Easy REF: p. 46, Your Emotional Health OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A nursing student has been assigned to provide care for a client who is from a different culture

and who has recently been diagnosed with cancer. After talking with the client and her family, the student is surprised to learn that the client wants her eldest son to make most of the decisions around her care and treatment. How should the student best respond to this situation?

A. Teach the client that she has the authority to make her own decisions while she is in the hospital.

B. Speak to the son and encourage him to let his mother make decisions independently.

C. Document this fact and ensure that a social worker gets involved in the client‘s care.

D. Understand that the members of this culture may have dynamics that differ from his or her own culture.

ANS: D

Feedback: Providing culturally competent care involves recognizing and acknowledging the differences between cultures, including one‘s own. The student would be wrong to try to change the family‘s decision-making process. This situation does not necessarily warrant involvement by a social worker.

PTS: 1 DIF: Difficult REF: p. 48, Personal Values and Beliefs OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A nursing student‘s current clinical placement is in a large, inner-city hospital that serves

clients from a wide variety of cultures. How should the student approach the prospect of working closely with members of another culture?

A. Try to learn as much as he or she can know about other cultures.

B. Arrange to provide care for clients whose cultures are similar to hers.

C. Try to identify the cultures that have the healthiest approach to life.

D. Explain his or her culture to clients and their families whenever possible.

ANS: A

Feedback: Nurses should value other cultures and try to learn as much as possible about them.

It is wrong to try to avoid members of another culture or limit one‘s interactions to members of one‘s own culture. It is wrong to ―rank‖ cultures according to certain attributes. The nurse‘s role is not to explain or advocate for his or her culture.

PTS: 1 DIF: Moderate REF: p. 49, Prejudice OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 9. The stresses of providing care for people who are ill have created a need for a nursing student

to relax. Which technique should the student choose to manage stress?

A. Avoid talking about school or clinical when at home.

B. Take time to do physical activity of some kind each day.

C. Schedule enough time for watching television and having two or three alcoholic drinks each evening.

D. Try to socialize with nursing instructors outside of school and clinical.

ANS: B

Feedback: Exercise is a healthy and effective way of managing stress. Avoid talking about stressful experiences can make stress worse. Using alcohol is not a healthy way of managing stress. It is not considered appropriate to try to socialize with the instructors in your nursing program.

PTS: 1 DIF: Moderate REF: p. 51, Relaxation OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A nursing student‘s classmate watched the student who performs a head-to-toe assessment of

a client and is now pointing out some errors in the student‘s assessment technique. The student feels that the classmate has made some unfair judgments. How should the student respond?

A. Ask another classmate to come and listen to the conversation.

B. Listen carefully and then respond in a clear but respectful manner.

C. Have the clinical instructor mediate between the student and the classmate.

D. Begin explaining the assumptions and misperceptions that the classmate has made.

ANS: B

Feedback: It is important to listen respectfully and carefully to the opinions of others. It is wrong to interject with defenses and it is not normally necessary or appropriate to bring others into the conversation with the goal of being defended by them.

PTS: 1 DIF: Moderate REF: p. 53, Skills for Career Development OBJ: 6 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

11. The nursing student is finding the demands of the nursing program heavy and nearly

overwhelming at times. He or she is amazed that his or her classmate seems unbothered by the workload and stressors of the program. How should the nursing student best interpret his or her classmate‘s experience with the demands of the program?

A. The classmate‘s mental and physical limitations may be different from the nursing student‘s.

B. The classmate may not be acknowledging the seriousness of providing nursing care.

C. The classmate is likely better than the nursing student at disguising the stressors in his or her life.

D. The classmate may be in denial about his or her responsibilities.

ANS: A

Feedback: Everyone‘s physical and mental limits are different. It is important to acknowledge these differences and not to compare oneself with others. The classmate is not necessarily in denial, dishonest, or unaware of the realities of the nursing program and nursing care.

PTS: 1 DIF: Difficult REF: p. 49, Stress OBJ: 7 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Caring BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. After several weeks of providing care on a busy medical unit, a nursing student has seen

evidence that a systematic approach to problem-solving is the best approach to the many decisions that nurses must make. A useful approach to problem-solving is to begin by: A. eliciting input from as many other people as possible.

B. brainstorming potential responses to the problem to maximize options.

C. stating the problem in your own words to ensure that you understand it.

D. trying to implement the simplest solution to the problem before trying more difficult solutions.

ANS: C

Feedback: The first step in solving problems is to make sure to understand the problem by stating the problem in one‘s own words as accurately as possible. This should take place before seeking input from others or brainstorming different options. The simplest solution to a problem is not always the best solution. Options should not be chosen based solely on simplicity.

PTS: 1 DIF: Moderate REF: p. 52, Problem Solving OBJ: 8 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A practical nurse secured a position on a postsurgical unit shortly after graduating and has

been in the position for 3 years. What should the nurse do to make sure that his or her knowledge and skills do not become obsolete?

A. Ask for input from his or her coworkers.

B. Review his or her textbooks and handouts from nursing school.

C. Pursue continuing education opportunities.

D. Reflect conscientiously on the care that he or she provides each day.

ANS: C

Feedback: To make sure nursing skills and knowledge do not become obsolete, it is important to include continuing education as a part of career development and planning. Asking for input from others, reviewing course materials, and reflecting on care are all useful activities but none will prevent a nurse‘s skill set from becoming obsolete.

PTS: 1 DIF: Moderate REF: p. 54, Continuing Education OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 14. In preparation for the process of searching for a new job, a nurse has begun to update his or

her career portfolio. What materials should the nurse include in his or her career portfolio?

Select all that apply.

A. Commendations from his or her close friends and family members B. His or her résumé C. Evidence of continuing education activities D. Letters of reference from previous employers E. A list of his or her nursing-related activities ANS: B, C, D, E

Feedback: A career portfolio presents a nurse‘s skills and interests in a variety of different formats and domains. These include a résumé, evidence of continuing education, references, and lists of nursing activities. Commendations from family members and friends are not appropriate to include in a career portfolio.

PTS: 1 DIF: Moderate REF: p. 55, Portfolios OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Selection 15. In anticipation of graduation, a nursing student has created a career plan. Which goal is most

appropriate for a nurse‘s career plan?

A. ―In 2 years, I expect to have my certification in geriatric nursing.‖ B. ―I want to be the best nurse that I can possibly be.‖ C. ―Within 6 months, I expect to be competent in my new workplace.‖ D. ―I commit to providing evidence-based, culturally-sensitive care.‖ ANS: A

Feedback: Career goals should be measurable and attainable. Aiming to achieve a particular certification in a particular time frame meets both of these criteria. The other cited goals are likely attainable but none is measurable.

PTS: 1 DIF: Moderate REF: p. 55, Career Plans OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

16. The nursing student is juggling nursing school, work, and family-related obligations. He or

she reports frequent tension headaches and fatigue related to multiple bouts of insomnia, and decreased appetite. He or she stated he or she skips meals and does not exercise nor use relaxation techniques. The nursing student has avoided attending postclinical conferences stating that the instructor has a different view about his or her clinical performance than he or she holds. He or she puts off completing assignments. He or she assessed his or her stress index several times in the past weeks and noted no change in his or her symptoms or score.

Which action is the best next step for this nursing student?

A. Assess the stress index to determine if a stress-relieving intervention decreased the score.

B. Self-refer to the school counselor for help.

C. Discuss with his or her instructor ways to improve his or her clinical performance.

D. Stick to his or her schedule and complete assignments on time.

ANS: B

Feedback: The nursing student is experiencing a high level of stress, making his or her vulnerable to stress-related symptoms. The next best action is to seek professional counseling to make changes in his or her life to decrease the level of stress. The student has reported not exercising, resting, or using known relaxation techniques. The counselor could provide other stress-relieving interventions, examine his or her schedule, and help his or her to balance nursing school, work, and family. After using a stress-reduction intervention, he or she could measure his or her stress index and compare the score with previous scores. Although discussing with his or her instructor ways how to improve his or her clinical performance, sticking to his or her schedule, and completing assignments on time are needed, they are not the next action warranted in this situation because the student is under extreme stress.

PTS: 1 DIF: Moderate REF: p. 49, Stress OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 2 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nursing student smokes two packs of cigarettes per day. He or she recognizes that he or

she needs to set the example of promoting health and wellness to his or her clients. He or she also recognizes that there is health risks involved with smoking and that he or she must stop smoking. Using the problem solving process, which action is the best next step for this student?

A. Visit the American Lung Society and read the available information.

B. Set a realistic, measurable goal for stopping smoking.

C. Get advice from his or her physician to help stop smoking.

D. Choose the best method to stop smoking.

ANS: B

Feedback: Using the problem-solving process, the problem is defined in the scenario. The next step is to state a realistic objective or goal that is measurable. Next, the student should gather information about smoking, especially ways to stop smoking. The student should get advice, if needed. He or she may be able to find the information needed to make the decision as to what method to use to quit smoking. After gathering information about the problem, the student should choose the best solution, and in this case the best method to stop smoking.

PTS: 1 OBJ: 8

DIF: Moderate REF: p. 52, Problem Solving NAT: Client Needs: Health Promotion and Maintenance

TOP: Chapter 2 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The nursing student observes that his or her client has no relief from his or her pain after

receiving the intravenous pain medication administered by the staff Registered Nurse (RN).

The RN takes frequent breaks using the restroom and has constricted pupils. The nursing student noted that he or she saw an empty syringe in the staff restroom. Using the problem-solving process, the next best action to take is to: A. report the observations to his or her clinical instructor, and follow the chain of command to report the issue within the institution according to the institution‘s policy.

B. gather as many facts about the incident as possible: what additional symptoms of narcotic use does the RN exhibit, do other clients he or she is caring report they are in pain, and is there multiple occasions of wasting narcotics by the RN. C. examine alternative reasons for the findings, such as the RN is in bright light constricting his or her eyes, and the syringe used to administer the med to the client had ―Morphine‖ on the label and the one in the trash was a regular unmarked syringe.

D. evaluate the consequences of the action you have taken—clients safety is protected, and the affected chemically dependent nurse may receive the help he or she needs.

ANS: B

Feedback: Using the problem-solving process, the nursing student needs to gather additional information about the incident. Next, the student needs to examine alternative reasons for the findings. Next, the responsible action is to report the observations and follow the chain of command. The last measure listed to take is to evaluate the consequences of the action.

PTS: 1 DIF: Difficult REF: p. 52, Problem Solving OBJ: 8 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 2 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The nursing student entered in the vocational nursing program at a local community college.

He or she developed a career plan. Which goal is realistic to complete within 5 years of graduation from the nursing program? Within 5 years, I expect to: A. obtain my doctorate in nursing and become a hospital administrator.

B. obtain an associate degree in nursing, pass the NCLEX-RN, and work in a local long-term facility.

C. teach at this college in this program.

D. become a nurse practitioner and work at a health clinic.

ANS: B

Feedback: It takes approximately 8 years of education to obtain a doctorate in nursing. To become a hospital administrator would most likely require experience in lower levels of management, so this is not a realistic goal. An associate degree in nursing is a 2-year degree, so within 5 years, this is realistic. To teach in a vocational nursing program at a college, the student would need to obtain bachelors in nursing, and although it is possible to do so in 5 years, the goal did not state any educational preparation past the vocational program was sought, so this is not a realistic career goal. It would take 6 or more years to become a nurse practitioner since it requires a master‘s degree, so this is also not a realistic goal.

PTS: 1 DIF: Easy REF: p. 55, Career Plans OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 20. While in nursing school, the nursing student developed a portfolio. Which item should the

student place in second section of the portfolio?

A. April 12, 2016. ―How to Avoid Nursing Malpractice: Update on State Board of

Nursing Rules and Regulations.‖ (Sally Field, RN, JD). (3 Contact Hours).

Seminar provided latest changes in nursing law as it relates to LPN/LVN, and RN, and advanced practice nurses. The seminar also provided helpful insights on how to prevent a needless malpractice suit by following medication rights, properly identifying clients, and making sure to follow institution policy and procedures, and best practices related to electronic charting.

B. State LPN or LVN license.

C. Geriatric nursing organization involvement.

D. Immunization records.

ANS: A

Feedback: The portfolio consists of four sections and the first section should contain the resume, letters of reference, certifications, licenses, letters of commendation from nursing instructors and clients. The second section contains all continuing education activities by date.

The third section contains nursing service in the community and nursing organization membership and activities. The fourth section contains miscellaneous information relevant to the nursing career such as immunization records.

PTS: 1 DIF: Moderate REF: p. 55, Portfolios OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 3, Communication Skills 1. A nursing student identifies that he or she slurs words and talks softly at times. He or she has

been trying to improve his or her verbal communication skills both in classroom settings and with clients in his or her current clinical placement. Which approach is best?

A. Ask the class to tell his or her when he or she gets too soft or slurs his or her words.

B. Practice in front of a mirror.

C. Audio record while practicing talking and assess his or her speech.

D. Ask the client to repeat what he or she says to make sure he or she is communicating adequately.

ANS: C

Feedback: Audio recording while practicing speaking gives the nursing student the best approach to improve his or her verbal communication skills. He or she can continue this process until he or she is comfortable that his or her speech does not become too soft or that his or her words could be slurred. Practicing in front of a mirror will help with improving nonverbal communication. Asking the client places the responsibility of pointing out problems on another person, and these actions does not offer the nursing student the opportunity to self-improve his or her verbal communication. The client should not have to repeat everything the student says.

PTS: 1 DIF: Easy REF: p. 63, Vocal Communication OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 2. The nursing student was recently reprimanded by a nurse at the hospital. The student was

accused of not following through with the morning care of one of the nurse‘s clients. The student attributes this unpleasant interaction to the fact that he or she did not communicate clearly with the nurse. The nursing student has resolved to make constructive changes to his or her communication style. How should the student begin this process?

A. Identify and evaluate his or her existing communication style.

B. Make a resolution to be assertive and clear when communicating.

C. Aim to model the behavior of nurses who are good communicators.

D. Ask his or her nursing instructor to give his or her some advice around communication.

ANS: A

Feedback: The first step in making changes to communication skills is to assess the one‘s present communication style. This should precede taking actions such as becoming more assertive, modeling other people, or asking for specific communication advice.

PTS: 1 DIF: Moderate REF: p. 61, Communication Skills Assessment OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 3. During his or her most recent performance appraisal, a nurse was told by his or her supervisor

that he or she tends to adopt a passive–aggressive communication style when he or she is in highly stressful situations. Which behavior is typical of passive–aggressive communication?

A. The nurse tends to be passive with supervisors and managers but aggressive when

communicating with coworkers.

B. The nurse often makes sarcastic comments when he or she is under stress.

C. The nurse has an inconsistent communication style that changes when he or she

experiences job stress.

D. The nurse has a fear of conflict and tends to avoid direct confrontation whenever

possible.

ANS: B

Feedback: Passive-aggression is characterized by condescension and sarcasm. Avoidance of conflict is associated with passive communication. Passive–aggressive communication is not necessarily dependent on the authority level of the other party nor is it associated with inconsistency in communication style.

PTS: 1 DIF: Difficult REF: p. 61, Communication Skills Assessment OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A nursing student is providing a brief report to a colleague before going on lunch break.

According to Dr. Albert Mehrabian, which component of this communication is most significant in determining how well the necessary information is exchanged?

A. ―Mr. Smith, Bed 4 admitted with Clostridium difficile colitis is in contact precautions and is currently in bed eating lunch. He or she is stable, and he or she needs assist  1 to a bedside commode. He or she has had frequent bouts of diarrhea, and just started medications to combat this.‖ B. The nursing student used perfect grammar during the report.

C. The nursing student has a high-pitched sarcastic voice as he or she gives report.

D. Nursing student holds nose when describing diarrhea and gags.

ANS: D

Feedback: Dr. Albert Mehrabian estimates that 7% of communication is verbal, 38% is vocal, and 55% is nonverbal. Nonverbal communication includes expressions and body language, while verbal communication includes the words and grammar. The sound and tone of the student‘s voice is vocal communication.

PTS: 1 DIF: Moderate REF: p. 62, Components of Communication OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A nursing student has learned about the importance of nonverbal communication and has

witnessed several examples of this in the clinical setting. Which event most clearly demonstrates nonverbal communication?

A. A client is bent over in a chair, holding his or her side and grimacing.

B. A client rings his or her call light and asks for an antiemetic (antinausea medication).

C. A client falls while trying to transfer from his or her bed to a commode.

D. A client accuses the student of prioritizing other clients over his or her.

ANS: A

Feedback: Nonverbal communication includes body positioning, body language, and expressions. Spoken requests and accusations are verbal messages. A fall is an event that is not a form of communication.

PTS: 1 DIF: Easy REF: p. 63, Nonverbal Communication OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A nursing student e-mailed an instructor to ask a question about a client‘s diagnosis and ended

the e-mail by making a lighthearted comment about the client. The instructor, however, interpreted the comment as disrespectful. This was not the student‘s intention and did not reflect that student‘s actual view of the client. Why are misunderstandings and miscommunications more common when using electronic forms of communication?

A. It is not usually possible to provide adequate context and detail when communicating electronically.

B. Electronic communication is only effective between members of the same generation or age group.

C. Because electronic communication is a relatively recent development, most people have not had sufficient time to adapt to its appropriate use.

D. Electronic forms of communication usually lack the vocal and nonverbal clues that convey meaning.

ANS: D

Feedback: Be aware that electronic communications, except for video connections, generally lack the vocal and nonverbal clues that accompany face-to-face communication. It is important to carefully think through your electronic message to avoid misunderstandings and misinterpretations. Electronic communication does not necessarily preclude detail or intergenerational communication. Electronic communication is certainly newer than other forms, but this does not lead to miscommunications.

PTS: 1 DIF: Moderate REF: p. 65, Sending the Message OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 7. A nursing student has asked a classmate for pointers that might help the student to

communicate more effectively when working with clients. What advice should the classmate provide?

A. ―Try to memorize some statements and explanations that are relevant in several clinical situations.‖ B. ―Before you start speaking to someone, take a moment to get your thoughts clearly organized.‖ C. ―Whenever you‘re speaking to someone, provide as much detail as you possibly can.‖ D. ―Try to adopt the mindset that you are more knowledgeable than the person that you‘re talking to.‖ ANS: B

Feedback: To communicate effectively, it is important to organize one‘s thoughts before speaking. Memorized statements should be avoided. It is not helpful to think of others as being less informed or less knowledgeable. Greater detail does not always equate with more effective communication.

PTS: 1 DIF: Difficult REF: p. 65, Speaking OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 8. The nursing student developed a close therapeutic relationship with a resident in a long-term

care facility over the past several weeks. This morning, the resident has confided in the nursing student that he or she feels like ―a burden to everyone around me.‖ How should the nursing student best respond?

A. ―Not at all, sweetie. We all love and taking care of you here.‖ B. ―That‘s not the case, and every dark cloud has silver lining anyhow.‖ C. ―I‘m sorry you feel that way, but I can assure you that I don‘t see you as a burden.‖ D. ―Perhaps getting more active in your care and being more involved socially would make you feel more useful.‖ ANS: C

Feedback: Trite terms of reference (―sweetie‖) and platitudes (―every dark cloud‖) should always be avoided, as should simplistic solutions to problems that may be complex.

Reflecting the individual‘s statement in an empathic way is an appropriate response to the client‘s statement.

PTS: 1 DIF: Difficult REF: p. 65, Speaking OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A nurse has given a nursing student detailed instructions on how best to safely mobilize a

client. After listening carefully to the nurse‘s explanation, what should the student do next?

A. Briefly restate the instructions to confirm understanding.

B. Ask the nurse as many questions as possible about the instructions.

C. Leave and go and apply the instructions as quickly as possible.

D. Confirm with the instructor that the nurse‘s instructions are correct.

ANS: A

Feedback: The final step in good listening is for the student to restate what he or she thought he or she heard. This action verifies the instructions were understood properly. The student should do this before applying the instructions. Questions may be appropriate, but the goal is not to ask as many questions as possible. It may or may not be necessary to confirm the instructions with the nursing instructor.

PTS: 1 DIF: Moderate REF: p. 67, Listening OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

10. A nursing student has complimented an older adult female client on her elaborate diamond

ring. The client replies, ―That was a gift from my late husband. He was a wonderful man.‖ The client then pauses and the nursing student notices a tear in her eye. Which action best demonstrates empathy?

A. Tell the client, ―I‘ll give you some privacy‖ and quietly leave the room.

B. Ask the client, ―Are you feeling sad because your husband died recently?‖ C. Stay silent for a moment and allow the client to gather her thoughts.

D. Ask the client if she would like to have a visit from the chaplain or a counselor.

ANS: C

Feedback: Even though every situation is different, it is often appropriate to allow silence rather than interjecting with questions. It is likely not therapeutic to leave the room or to immediately suggest counseling or spiritual care. Asking the client about the timing of her husband‘s death is unlikely to communicate empathy.

PTS: 1 DIF: Difficult REF: p. 67, Listening OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A nursing student is conscientious in his or her efforts to cultivate empathy with clients.

Which characteristic is associated with empathy?

A. Maintaining emotional distance in order to conserve emotional energy B. Experiencing the same emotions that clients and clients experience C. Providing evidence-based solutions to the problems of others D. Teaching clients and clients how to effectively distract themselves from their issues and problems ANS: A

Feedback: To empathize is to be able to intellectually (not emotionally) identify with the feelings, thoughts, or attitudes of another person. The nursing student should understand and respect what a person is experiencing without experiencing it him- or herself. Being empathic helps the nurse conserve emotional energy so that the nurse can be of help to him- or herself and to his or her family and others who depend on him or her. Empathy is not simply problem solving or teaching distraction techniques.

PTS: 1 DIF: Moderate REF: p. 70, Communicating Empathy OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 12. An older adult client who is scheduled for a computed tomography (CT) scan of his or her

abdomen has admitted to the nursing student that he or she is deeply fearful of having this test because of his or her fear of pain. Which response demonstrates a communication block?

A. ―What part of having a CT scan makes you most fearful?‖ B. ―You‘ll find that there‘s actually no pain involved with this test.‖ C. ―There, there. You have nothing to be afraid of.‖ D. ―It can be frightening to undergo medical tests.‖ ANS: C

Feedback: Saying, ―There, there. You have nothing to be afraid of‖ downplays the client‘s concerns and has a condescending tone. Asking about the client‘s specific fears, empathizing, or providing relevant explanations are different approaches that can be conducive to therapeutic communication.

PTS: 1 DIF: Difficult REF: p. 71, Blocks to Effective Communication OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A client who is in the hospital recovery from injuries he or she experienced in a motorcycle

accident has expressed dismay to the student nurse about the costs of his or her treatment.

How should the nursing student best respond to the client‘s financial concerns?

A. ―Have you given some thought to the different financing options available to you?‖ B. ―Do you have any assets that you could perhaps sell to pay your medical bills?‖ C. ―I know how you feel. My tuition and books cost a fortune as well.‖ D. ―That must be stressful for you, especially while you‘re trying to focus on your health.‖ ANS: D

Feedback: Reflecting and acknowledging the client‘s emotions allows the student to express empathy while at the same time not offering advice, becoming too personal, or pretending to be in similar circumstances.

PTS: 1 DIF: Difficult REF: p. 71, Blocks to Effective Communication OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A student nurse is providing care for a woman who has a hearing impairment. Which

measures should the student take when communicating with this client? Select all that apply.

A. Speak as loudly as possible.

B. Ask the client if she understands after each sentence.

C. Face the client directly.

D. Eliminate as much background noise as possible.

E. Speak clearly and not too quickly.

ANS: C, D, E

Feedback: When communicating with hearing impaired individuals, it is important to face the person directly, to eliminate background noise, and to speak clearly and slowly. It is inappropriate to speak very loudly. It is unnecessary to check understanding after every sentence.

PTS: 1 DIF: Moderate REF: p. 75, Communicating With Hearing-Impaired People OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Selection

15. The nursing student is preparing to perform morning hygiene for a resident of a long-term

care facility who has significant vision impairment. Before beginning to wash the resident, the nursing student should: A. give the resident a chance to feel the cloths and towel that will be used.

B. explain who he or she is and what he or she is going to do.

C. clearly and loudly ask the resident if he or she would like a wash.

D. assess the resident‘s orientation and cognition.

ANS: B

Feedback: When working with a visually impaired person, it is important to explain any actions clearly and ensure the person knows one‘s identity and role. It is likely unnecessary to have the person feel about the towels and cloths. It is not necessary to perform cognitive assessments or to speak loudly.

PTS: 1 DIF: Moderate REF: p. 75, Communicating With Vision-Impaired People OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 16. The nursing student is caring for a client who left his or her eyeglasses at home. The client has

hearing impairment and identified that he or she benefits from reading lips. The nursing student should: A. stand in front of a sunny window within several feet to the client while talking with the client.

B. stand on the opposite side of the bed from the window several feet from the client while talking with the client.

C. sit at the end of the bed in a chair against the wall while talking with the client.

D. sit on the client‘s bed facing the client while talking.

ANS: B

Feedback: Standing in front of the sunny window would make it difficult for the client to read the nursing student‘s lips. Sitting at the end of the bed in a chair would be too far away for the client to read the student‘s lips. It is not recommended to sit on a client‘s bed and violates principles of personal space and infection control. By standing on the side of the bed so the sunlight illuminates the student‘s face helps the client to read the lips and makes this the best choice.

PTS: 1 DIF: Moderate REF: p. 75, Communicating With Hearing-Impaired People OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nursing student is caring for a client who had a brain attack (stroke) with right-sided

paralysis several weeks ago and has difficulties expressing his or her thoughts when he or she talks. The nursing student should: A. complete the client‘s sentence when he or she pauses.

B. anticipate what the client wants and ignore what he or she says.

C. allow time for the client to finish talking before trying to figure out what it is he or she is trying to express.

D. ask the client to write down what it is he or she wants.

ANS: C

Feedback: The client may be able to express him- or herself when given ample time. If the client becomes frustrated, the nurse may help by asking simple yes and no questions to discover what the client is trying to communicate. The client will become more frustrated if the student tries to complete his or her sentences, or ignores his or her attempt to communicate. Providing a means to write down the thoughts will not help after a stroke because the brain injury will also impair written communication. If the client is right-handed, the client will not be able to even try to write since his or her right side is paralyzed.

PTS: 1 DIF: Moderate REF: p. 76, Communicating With Speech-Impaired People OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The nursing student is caring for a client who fell and hit the back of his or her head on the

way to the bathroom. The client stated that he or she became dizzy. The client had just begun a new medication to control his or her high blood pressure. The student noted that the blood pressure was low after the incident. Which should the nursing student communicate to the physician?

A. ―You should not have prescribed that new blood pressure med because it caused the client to become dizzy and fall and hit his or her head.‖ B. ―The client fell today hitting his or her head and I think he or she needs a computerized axial tomography (CAT) scan because he or she says he or she is dizzy.‖ C. ―Hello, Dr. Smith this is Sue Ellen, a nursing student at Smith Memorial Hospital caring for Joan Johnson in 15 bed 2, and he or she received the new blood pressure med, atenolol 100 mg 1 hour ago and became dizzy on the way to the bathroom this afternoon and fell hitting his or her head. His or her blood pressure before the med was 180/90, and currently, it is 88/40 and his or her pulse is 40, and he or she has a small raised bump on the back of his or her head and the RN stated his or her assessment is within normal limits. The atenolol is currently ordered b.i.d., what recommendations would you like to make?‖ D. ―Hello Dr. Smith, your client in 15 bed 2 became dizzy on the way to the bathroom after receiving the new blood pressure you ordered and he or she fell hitting his or her head and has a bump on it. What change in his or her medication would you like to make?‖ ANS: C

Feedback: When communicating with the physician, it is best to remain objective and do not interject personal opinion. Since physicians may care for clients in a number of hospitals, it is best to identify who you are and what hospital or place you are calling from, and what client you are calling about, and provide as many details as possible about the situation, background, the assessment, and request for the physician to make recommendations for the client. The nursing student would not be able to take telephone orders but could communicate what is going on with the client and his or her nursing instructor or the staff nurse also listening into the telephone conversation could write the orders. The other answers are not thorough and do not provide enough information for the physician to make an accurate judgment.

PTS: 1 DIF: Moderate REF: p. 72, Communicating With Team Members: Physicians OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 19. To prevent blocking communication, the nursing student should ask his or her client question?

A. ―When did you start having the pain in your abdomen?‖ B. ―Tell me all about the pain you are experiencing?‖ C. ―Did you get the pain in your abdomen from binge-drinking?‖ D. ―Do you think your weight makes your pain worse?‖ ANS: B

Feedback: An open-ended question helps to prevent blocking communication with the client.

The other questions require a yes or no. In addition, using the term binge-drinking or noting the client‘s excess weight has a negative tone to them and may block communication more with the client.

PTS: 1 DIF: Easy REF: p. 71, Blocks to Effective Communication OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The nursing student is caring for a female client from China who can only speak Cantonese.

The best way to communication should be to use: A. simple words and loud speech and pantomime what it is that needs to be conveyed.

B. a written download from the Internet on simple phrases of Chinese.

C. a picture board containing pictures of common care needs.

D. a male hospital employee who speaks Cantonese to discuss sensitive female issues.

ANS: C

Feedback: When working with a non-English speaking client, it is necessary to use the same sex interpreter to prevent violating cultural or sexual boundaries with sensitive issues.

Pantomiming and pointing to objects and speaking in clear simple English may be helpful, but the client is non-English speaking and can hear, so it is not necessary to speak loudly. Just because the client is from China does not mean he or she can understand or speak Chinese because there are many different languages, and he or she specifically speaks Cantonese. The picture board offers a simple way to communicate with anyone who is non-English speaking.

PTS: 1 DIF: Moderate REF: p. 74, Communicating With Non-English Speaking People OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 4, Education for Nursing 1. A LPN at a local hospital presents to the hospital board of directors her reasons why a LPN

can also be considered a professional. The best supporting evidence is?

A. If the amount of independence and autonomy that a professional holds should be

the criteria to make a health care worker a professional, then only those who prescribe and are paid through direct reimbursement are professionals.

B. If education that caregivers have completed was the only criteria, then only a doctorate prepared nurse should be considered a professional.

C. The high standards and level of integrity, license, continuing education, and belonging to a professional organization supports that the LPN is also a professional nurse.

D. The addition of certification should make the LPN a professional nurse.

ANS: C

Feedback: In nursing contexts, the terms professional and nonprofessional refer only to a nurse‘s educational preparation. All nurses should approach their responsibilities with a professional attitude. Any nurse, regardless of educational preparation, should be serious about the occupation, have a high level of integrity, be trustworthy, and maintain high standards. The best argument to support that the LPN is a professional is C because there are high educational standards, a code of ethics, a professional organization, and a license board, and the presence of life-long education since there are continuing education requirements.

Certifications alone do not make a professional nurse since lay persons and unlicensed personnel can also receive certifications. Answer A supports that nurse practitioners are the only ones to be assigned professional nurse status and does not support the LPN‘ s case that a LPN should also be considered a professional. Answer B supports that only a terminal degree in the career path should be considered a professional and does not support the LPN‘s case.

PTS: 1 DIF: Moderate REF: p. 81, Defining Professional and Nonprofessional OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Remember NOT: Multiple Choice 2. The nursing student is observing the health care team care for clients on a medical–surgical

unit. Which action by health care team members is appropriate for the member‘s scope of practice?

A. The Registered Nurse (RN) delegates to the nursing assistant (NA) to perform bathing and toileting for a client.

B. The LP/VN developed and carried out a research study on the unit.

C. The NA provided an intramuscular injection on a client on the unit.

D. The RN with an Associate‘s Degree prescribed medications for a client being discharged.

ANS: A

Feedback: Scope of practice permits the RN to delegate to other members of the nursing team following the principles of delegation. The RN can only prescribe medications with an advanced practice degree and nurse practitioner license. The RN can develop and carry out a research study upon approval of the institutional review board. The NA is not a medication aide and cannot administer intramuscular injections.

PTS: 1 DIF: Moderate REF: p. 82, Scope of Practice OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 3. An LP/VN has recently graduated and secured a position on a subacute medical unit of a

hospital. A large component of the nurse‘s orientation on the unit has focused on the nurse‘s scope of practice. What factors contribute to the definition of a nurse‘s scope of practice?

Select all that apply.

A. The quality of the nurse‘s clinical placements while a student B. State laws such as nurse practice acts C. The regulations and policies of the hospital D. The nurse‘s learning style and preferences E. The professional standards of the profession ANS: B, C, E

Feedback: State laws, employer rules and regulations, and professional standards all contribute to defining the scope of practice of nurses. The characteristics of a particular nursing education program and the nurse‘s individual learning style do not normally contribute to the definition of a nurse‘s scope of practice.

PTS: 1 DIF: Difficult REF: p. 82, Scope of Practice OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Remember NOT: Multiple Selection 4. A prospective nursing student is researching the various practical/vocational nursing programs

that are available in his or her region and is finding that there are significant differences in curriculum, especially with regard to the relationship between classroom and clinical learning.

Which arrangement is most conducive to effective learning?

A. Classroom learning in the first third of the program, laboratory learning in the second third, and clinical learning in the final third of the program B. An emphasis on classroom and laboratory learning in the first half of the program followed by clinical learning in the second half C. A brief clinical placement at the beginning of the program followed by intensive classroom and laboratory learning with a longer, final clinical placement at the end of the program D. Integration of classroom, laboratory, and clinical learning throughout the entire program ANS: D

Feedback: It is no longer believed that classroom instruction, followed by clinical instruction is educationally sound. The trend today is to relate classroom theory, laboratory practice, and clinical experience by offering integrated sections over the length of the entire program.

PTS: 1 DIF: Moderate REF: p. 85, Curriculum and Objectives OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Teaching/Learning

BLM: Cognitive Level: Remember

NOT: Multiple Choice

5. A nursing student graduated as a practical nurse several weeks ago and is preparing to begin

his or her new job in a long-term care facility. Because she has successfully completed his or her nursing program, he or she should: A. have the knowledge and skills that help to meet clients‘ physical and psychosocial needs.

B. have the ability to lead an interdisciplinary team in organizing and carrying out client care.

C. conduct nursing research that adds to the body of knowledge in the nursing profession.

D. be able to enter a master‘s degree program if he or she wants to continue her nursing education.

ANS: A

Feedback: On successful completion of a practical/vocational nursing course, a graduate should have the knowledge and skills that help to meet clients‘ physical, emotional, social, and spiritual needs. An LP/VN cannot directly enter a master‘ degree program and is not expected to lead the care team or conduct research.

PTS: 1 DIF: Easy REF: p. 85, Curriculum and Objectives OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Remember NOT: Multiple Choice 6. A nursing student has been admitted to a diploma nursing program and will begin classes

shortly. Which characteristic is associated with a diploma nursing program?

A. Takes place exclusively in classroom and laboratory settings B. Is sponsored by a hospital C. Lasts between 12 and 15 months D. Will prepare the student to take the NCLEX-PN ANS: B

Feedback: Nursing education programs sponsored by hospitals are called diploma nursing programs. These programs vary in length from 2 to 3 years, and prepare the student to take the NCLEX-PN and be qualified as a registered nurse. There is often a heavy emphasis on clinical learning.

PTS: 1 DIF: Moderate REF: p. 86, Diploma Nursing Programs OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Remember NOT: Multiple Choice 7. A new nursing student in a practical nursing program wants to become a nursing assistant

(NA) so he or she can gain practice at the bedside and earn money to help pay for expenses.

The student should: A. shadow a NA for 75 hours and then take the state mandated test for certification as a NA. B. apply online to the state board of nursing to become a NA automatically since he

or she is enrolled in a practical nursing program.

C. follow state guidelines as to the amount of the practical nursing program that needs

to be completed in order to become a NA. D. seek employment and ask his or her employer to sign a form certifying him as a

NA. ANS: C

Feedback: OBRA regulations require that nurse aides should complete the training prior to employment. Nursing students often meet the requirements for working as an NA at a designated point of time by state regulations. Once the nursing student has met the state requirements in their training, a form is completed and faculty sign the form, and the nursing student provides this form to their employment agency which submits the form to the state as required. Shadowing an NA will not meet the requirements. Being enrolled into a nursing program does not meet the requirements because the student has to complete certain portion of training before becoming eligible to be an NA. PTS: 1 DIF: Moderate REF: p. 82, Certified Nurse Aide Programs OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 8. An eighth grade student is planning his or her career in nursing and has a goal of being a

registered nurse (RN) 4 years after graduation from High School. He or she is intrigued that his or her High School offers a practical nursing program at the vocational school because this program will allow his or her to become a nurse sooner, gains experience caring for clients, and earn money within a short period of time. Which is most important for his or her to consider when planning for his or her future?

A. Will he or she be able to participate in his or her High School‘s sports and other campus activities?

B. Will he or she receive the necessary college prerequisites while attending the nursing program offered at the vocational school?

C. Will he or she be the correct age to sit for the NCLEX-PN? D. Will he or she gain clinical experiences in both long-term care facilities and hospitals?

ANS: B

Feedback: The most important consideration of the ones listed is to make sure that necessary college prerequisites are offered so the student will be able to enter college upon graduation from High School/vocational school. The vocational school nursing program may have an articulation agreement with a college for a LPN to RN or LPN to BSN so the student may streamline his or her educational process and be able to begin caring for clients and make an income early on in his or her career. If the nursing program prepares High School students for sitting for the license examination, then he or she should have no problems with age. The student may gain experience in acute and long-term care facilities over his or her career as a nurse, so whether or not the program offers clinical experiences in both areas is not the most important consideration. Most vocational schools affiliated with a High School encourage students to be involved in extracurricular activities.

PTS: 1 OBJ: 6

DIF:

Moderate

REF: p. 85, Program Overview

NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A prospective nursing student is investigating several schools of nursing in the area. One

school‘s website notes that the school is accredited by the Accreditation Commission for Education in Nursing (ACEN). This accreditation specifies that: A. graduates of the school are entitled to give care in facilities that are funded by Medicare.

B. the school exceeds the minimum requirements of a nursing program.

C. the students of the school qualify for government student loan programs.

D. the program is overseen and planned by members of the state board of nursing.

ANS: B

Feedback: Accreditation is a voluntary process which usually indicates that a nursing program exceeds the minimum requirements that are necessary for approval. It does not mean that the state board of nursing is involved in the planning or operation of the program. Graduates of the school would indeed qualify for loans and be able to give care in Medicare-funded facilities, but these characteristics are not limited to accredited schools.

PTS: 1 DIF: Difficult REF: p. 88, Approval and Accreditation OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Remember NOT: Multiple Choice 10. A junior college has just received word that the practical nursing program at the college has

had its approval renewed. Which organization would grant approval of the nursing program?

A. Accreditation Commission for Education in Nursing (ACEN) B. The National Association for Practical Nurse Education and Service (NAPNES) C. National Association of Licensed Practical Nurses, Inc. (NALPN) D. The board of nursing in the state where the college is located ANS: D

Feedback: State boards of nursing grant program approval. The ACEN, NAPNES, and NALPN do not perform this regulatory role.

PTS: 1 DIF: Moderate REF: p. 88, Approval and Accreditation OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Remember NOT: Multiple Choice 11. A nursing student desires to begin promoting his or her profession while attending a practical

nursing program. Which considerations or opportunities are important when joining a student organization? Select all that apply.

A. Secure and read a copy of the organization‘s bylaws.

B. Gain a fuller understanding of nursing as a profession.

C. Develop the school‘s nursing curriculum.

D. Determine if paid positions exist in the student organization.

E. Exercise leadership skills by sitting on a committee.

F. Compete in health-related local, state, and national competitions.

ANS: A, B, E, F

Feedback: It is important to secure a copy of a student organization‘s bylaws to determine if the purpose and philosophy and goals of the organization and the way the organization conducts its business match the nursing student‘s needs. Belonging to a student organization helps to promote a fuller understanding of nursing as a profession, which is the main desire of the nursing student in the scenario. A student organization may provide a voice in the development of nursing curriculum, but does not provide the opportunity to solely develop the curriculum. The student organization offers opportunities for nursing students to volunteer, and may ask students to participate in fund raising activities or need members to pay fees for belonging, and do not offer paid positions to the students. Students gain leadership experience by working in committees that the organization provides. Student organizations may also provide competitions at the local, state, and national levels for health-related activities, which may be an important opportunity for a student planning to join an organization.

PTS: 1 DIF: Moderate REF: p. 90, Student Organizations OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Selection 12. The administration of a hospital has referred to The National Association for Practical Nurse

Education and Service (NAPNES) ―Standards of Practice and Educational Competencies of Graduates of Practical/Vocational Nursing Programs‖ when reorganizing the skills mix at the hospital. What information does this document provide?

A. The material that a nursing student must learn in an approved nursing program B. The working relationship between LP/VNs and registered nurses C. The competencies that can be expected of an LP/VN D. The workplace regulations around salary and hours of work ANS: C

Feedback: The NAPNES Standards outline the professional behaviors and competencies in communication, assessment, planning, caring interventions, and managing that are expected of graduates of LP/VN programs. Standards of practice do not specify the curriculum of nursing programs, though nursing programs should be based on the standards. Standards of practice do not define wages and working conditions.

PTS: 1 DIF: Difficult REF: p. 91, Standards for the Licensed Practical/Vocational Nurse OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Remember NOT: Multiple Choice 13. Having recently graduated from a practical nursing program and successfully passing the

NCLEX-PN, a new nurse has just received her license. A nursing license is: A. valid for as long as the nurse wishes to practice, provided it is not revoked.

B. transferable to another nurse if the recipient has taken the NCLEX-PN. C. a legal authorization for the nurse to practice authorized skills.

D. the personal property of the nurse who possesses it.

ANS: C

Feedback: A nursing license gives legal authorization to perform (permission to practice) the skills learned in the practical/vocational nursing program. It must be periodically renewed, and it is not transferable. It is granted by the state board of nursing and is not the personal property of the nurse who possesses it.

PTS: 1 DIF: Difficult REF: p. 95, Boards of Nursing OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Remember NOT: Multiple Choice 14. The Nurse Licensure Compact (NLC) allows for the recognition of a nurse‘s license in

another state. Opponents of the NLC most often raise which criticism?

A. Multistate licensure can make it more difficult to discover and enforce disciplinary actions against nurses.

B. The standards of nursing practice vary greatly between different states and territories.

C. Multistate licensure makes it more expensive for nurses to renew their licenses when they expire.

D. It is difficult for nurses to obtain liability insurance when they are involved in work that spans more than one state.

ANS: A

Feedback: Opponents of multistate licensing believe that it may be difficult to discover disciplinary sanctions on a licensee. Educational programs vary between states, but standards of practice are more homogeneous. Cost and insurance issues are not commonly raised as points of opposition to the NLC. PTS: 1 DIF: Moderate REF: p. 96, Nurse Licensure Compact OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Remember NOT: Multiple Choice 15. A nurse has admitted to having a serious chemical dependency after being caught taking

narcotics home from work. If this nurse‘s license is to be suspended or revoked, what process must take place?

A. An application must be made to the US Department of Health and Human Services by the employer.

B. A committee of the nurse‘s peers and coworkers must convene.

C. The nurse must be charged with an offence and found guilty in a court of law.

D. A hearing must be held at the state board of nursing.

ANS: D

Feedback: A state board of nursing holds the jurisdiction to apply disciplinary action to a nurse. The nurse‘s peers, the courts, and the DHHS are not directly involved in this process.

PTS: 1 DIF: Moderate REF: p. 97, Disciplinary Sanctions OBJ: 11 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

16. A new graduate from a practical nursing program successfully passes his or her NCLEX-PN

and begins working on a busy neurologic unit. He or she should be able to: A. perform a detailed neurologic assessment of a comatose client.

B. write a client teaching lesson plan on caring for a neurologic shunt.

C. monitor a client‘s cerebral perfusion pressure and intracranial pressure readings and determine actions to take based upon the findings.

D. provide up-to-date information about preventing falls in the older adult population at a community health and wellness expo.

ANS: D

Feedback: The new graduate from a practical nursing program will care for stable clients with appropriate supervision and perform entry-level tasks and administer medications according to their state licensure. A client in a coma or a client requiring neurologic monitoring of cerebral perfusion pressure and intracranial pressure is beyond the educational preparation of a practical nurse. The practical nurse is taught to assess a client‘s neurologic status but does not have the training to perform a detailed neurologic assessment. A practical nurse graduate may teach skills to a client, such as postural drainage. The registered nurse should write a detailed teaching plan and teach the client on how to care for a neurologic shunt.

PTS: 1 DIF: Moderate REF: p. 85, Curriculum and Objectives OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 17. The nursing student from a practical nursing program is caring for a group of stable clients on

a team with a registered nurse (RN), and a nursing assistant (NA). Which action is appropriate for the nursing student to take?

A. Assess the newly admitted client, documenting the findings, and identify the nursing diagnoses and write the nursing care plan, and enter it into the electronic chart.

B. Use electronic social media to discuss the famous celebrity he or she was assigned today and post a picture of the celebrity and him- or herself.

C. Supervise and evaluate the complete bed bath and complete bed change assigned to the NA for one of the student‘s clients.

D. Inform the client who requested a Kosher diet that he or she has to either eat the bacon or just eat the eggs because dietary is too slow to get his or her the foods he or she wants in time.

ANS: C

Feedback: The nursing student should supervise and evaluate tasks assigned to the NA to ensure that the client is properly cared. The nursing student may assess a client and contribute to the nursing care plan, but needs to collaborate with the RN during this process. It is a violation of a client‘s right to privacy for the nursing student to post anything about the clients on social media. The nursing student must respect a client‘s religious and cultural practices and both were violated in Answer D. PTS: 1 DIF: Moderate REF: p. 91, Standards for the Licensed Practical/Vocational Nurse and Appendix C OBJ: 9

NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A beginning licensed practical/vocational nurse is caring for clients on a medical–surgical

unit. For which procedure should the LP/VN ask for assistance from the registered nurse (RN)?

A. Administer sitz bath to a client after a hemorrhoidectomy.

B. Titration of intravenous cardiac medications to a client who became unstable.

C. Document care provided in the electronic medical record.

D. Care for a client in contact isolation using precautions.

ANS: B

Feedback: All of the procedures listed are within the LP/VN‘s job responsibilities except caring for an unstable client and providing titration of intravenous cardiac medications intravenously. The LP/VN needs assistance from the registered nurse for the procedures provided to a client that is unstable.

PTS: 1 DIF: Moderate REF: p. 92, Job Responsibilities of the Licensed Practical/Vocational Nurse OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 19. A licensed practical/vocational nurse is planning a trip for a client he or she is caring for

which will involve several months and three separate states in the United States of America.

Which is the priority consideration the nurse needs to consider when planning the trip?

A. Location of hospitals near each place the client will stay.

B. Location of pharmacies in the client‘s network.

C. Medical supplies and equipment packed for the duration of the trip.

D. Which states are compact states and which states are not, so the nurse may get licenses as necessary.

ANS: D

Feedback: Planning a trip for a client involving multiple states requires that the nurse determines which states are compact states in which he or she can easily obtain an endorsement for practicing nursing and which states will require a separate license in order for the nurse to care for the client in that particular state. It will take the most time to secure needed licenses, so this is the first consideration to act upon. This is because state boards of nursing require references and background checks for criminal activity, etc. Ordering necessary medical supplies and equipment is the second consideration because of the time involved to secure supplies for several months. The hospitals and location of pharmacies is possible through an Internet search and telephone calls.

PTS: 1 DIF: Moderate REF: p. 96, Nurse Licensure Compact OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

20. A licensed practical/vocational nurse voluntarily entered the Impaired Nurse Program. The

license is retained if he or she: A. promises to not use any prescribed pain medications after a recent surgery and

leave of absence from work.

B. pays a fine to the state board of nursing for using narcotics while at work.

C. completes all requirements of his or her rehab process meeting nursing board

expectations.

D. always has another nurse administer ordered narcotics to his or her clients.

ANS: C

Feedback: The nurse may be treated during a leave of absence with pain medications prescribed by a physician after surgery. The physician may choose nonnarcotic analgesics, or alternative methods to treat the pain the client experiences. There may be fines to pay, but this in itself does not guarantee retention of the license. Part of the rehab process may entail having another nurse administer narcotics to the nurse‘s clients, but this does not provide the necessary proof to the nursing board that the nurse is ready to retain the license. Completing all requirements of the rehab process and meeting the nursing board‘s expectations is what is necessary for the nurse to retain his or her license.

PTS: 1 DIF: Moderate REF: p. 97, Disciplinary Sanctions OBJ: 11 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Understand NOT: Multiple Choice

Chapter 5, The NCLEX-PN® 1. A nursing student is nearing graduation and is preparing to take the NCLEX-PN. In

preparation for the exam, the student has familiarized him- or herself with computer adaptive testing (CAT). Which statement about CAT is most accurate? CAT: A. allows an exam to be continually customized to a student‘s performance.

B. ensures that two students never answer the same question during an exam.

C. allows the student to view test results immediately after answering each question.

D. allows the student to give feedback to the test creators as the student takes the exam.

ANS: A

Feedback: During the NCLEX-PN, the computer will select questions for the student based on the performance on the previous question. In this way, the test is customized to each individual student in real time. This does not mean that every question is unique to one student, and it does not allow the student to view results as the student progresses through the exam. As well, the student is not able to give feedback while the exam is in progress.

PTS: 1 DIF: Moderate REF: p. 102, Computerized Adaptive Testing OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Remember NOT: Multiple Choice 2. A student is experiencing significant test anxiety while taking the NCLEX-PN and has

answered the three most recent questions incorrectly. The computerized adaptive testing (CAT) system will then: A. inform the student that he or she has failed the exam.

B. offer a hint to the student on the next question.

C. present a question that is more difficult than the previous question.

D. ask a question that is easier than the most recent question.

ANS: D

Feedback: The way the CAT exam works, the student is given the first question. If the student chooses the correct answer, the student will get a slightly more difficult question. If the student chooses an incorrect answer, the student will get a slightly less difficult question.

Hints are not given during the NCLEX-PN. Three consecutive incorrect answers do not necessarily result in failure.

PTS: 1 DIF: Difficult REF: p. 102, Computerized Adaptive Testing OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A recent graduate licensed practical/vocational nurse is helping nursing students to become

familiar with both the subject matter and the format of the NCLEX-PN exam. Which statement made by one of the nursing students requires further teaching about the NCLEX-PN exam?

A. ―The NCLEX-PN has a minimum of 85 questions and a maximum of 205 questions.‖

B. ―There is no back tracking, so each question presented must be answered in the

order it is presented, even if the candidate makes a best educated choice when presented a question the candidate does not know the answer for sure.‖ C. ―Five hours of time is allotted for the exam whether there are a minimum or maximum number of questions provided.‖ D. ―After 85 questions are presented, the computerized adaptive testing compares the performance of the candidate to passing standards, and if the candidate did not pass, this is the only reason why the computer will shut down.‖ ANS: D

Feedback: The NCLEX-PN has a minimum of 85 questions and a maximum of 205 questions.

There is no back-tracking, so the candidate must answer each question when presented it, and it is better to make the best educated guess at a question than to lose a possibility for credit.

There is up to 5 hours allotted for the test, but it is recommended that the candidate take 1–2 minutes per question. After 85 questions are presented, the computer does determine if the candidate passed and could shut down, or may determine that the candidate needs additional questions in order to determine competence, or the computer may determine after 85 questions that the candidate is not competent and shut down with the candidate failing the exam.

PTS: 1 DIF: Easy REF: p. 102, Computerized Adaptive Testing OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A student has bought a review guide for the NCLEX-PN and has begun studying the different

types of questions that are found in the exam. What question format should the student anticipate during the NCLEX-PN? A. Short essay questions B. Questions that require the student to record a spoken response C. Questions that ask the student to respond to a video clip D. Questions that ask the student to identify a specific spot on a diagram ANS: D

Feedback: There are several different question formats in the NCLEX-PN. These include questions that ask the student to identify a specific spot on a drawing or diagram. Essays, spoken responses, and video questions are not used in the NCLEX-PN. PTS: 1 DIF: Moderate REF: p. 102, Computerized Adaptive Testing OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 5. The nursing student wanting to contribute to his or her profession made a long-term goal to

write questions as part of the NCLEX-PN Item Development Panel. Which step is most important to achieve his or her goal?

A. Practice writing different types of NCLEX-PN questions while in nursing school.

B. Gain experience as a licensed practical or vocational nurse for 1 year.

C. Read multiple NCLEX-PN practice books in order to understand the various styles

of questions.

D. Visit the National Council of State Boards of Nursing (NCSBN) website and read

the most recent test blueprint for the NCLEX-PN. ANS: B

Feedback: The first step for the NCLEX-PN Item Development Panel is to pass the examination and become either a practical or vocational nurse, and gain at least 1 year of experience in nursing practice. The panel meets for 3 or 4 days and is taught about writing items or reviewing items. Reading practice books for the NCLEX-PN will help the nurse to get ready to write the exam, but the test blueprint may change by the time the nurse may be chosen to be on the development panel. Visiting the NCSBN to read the most recent blueprint will help the nurse to pass the exam, but the blueprint may change by the time the nurse may serve on the development panel. The nursing student needs to gain practice as a licensed nurse and have the training offered by NCSBN in order to best meet his or her goal of writing questions for the NCLEX-PN. PTS: 1 DIF: Moderate REF: p. 104, Development of the NCLEX-PN® OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A student has downloaded the NCLEX-PN Test Plan from the National Council of State

Boards of Nursing (NCSBN) website. The best way for the student to prepare for the NCLEX-PN is to: A. use the test plan to retain important information through repetition of the application of course content with clinical situations.

B. check off each test plan item mastered while in nursing school and study what is left before taking the exam.

C. use the test plan during a review course to ensure that the speaker covered all of its content.

D. use the test plan to practice questions from each category before taking for the examination.

ANS: A

Feedback: The best way to prepare for the NCLEX-PN is using the test plan throughout the nursing program with repetition of important information applied in clinical situations in discussions, case studies, lab simulations, or directly in the clinical setting with clients.

Repetition reinforces learning of what it is that the nurse will need to safely and effectively practice as a novice nurse. Checking off what has been learned does not provide necessary repetition. Waiting until a review course to ensure that the test plan content is covered will not provide the best method to prepare for the NCLEX-PN. Practicing questions from each of the categories contained within the test plan does not ensure adequate mastery of the content necessary for safe nursing practice.

PTS: 1 DIF: Moderate REF: p. 105, The NCLEX-PN® Test Plan OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

7. A group of nursing students have recently begun their nursing program and been introduced to

the NCLEX-PN. The students have decided to form a study group in preparation for the exam.

What strategy should the students use to most effectively prepare for the NCLEX-PN? A. Study throughout their nursing program.

B. Begin studying as soon as their final exam is completed.

C. Begin studying 10–14 days before the exam.

D. Study after they have completed the classroom component of their nursing program.

ANS: A

Feedback: The most effective studying strategy for a large exam such as the NCLEX-PN is to study frequently over a prolonged period of time, ideally at several points throughout the nursing program. Waiting until very late in the program, or until the program is complete, may not be conducive to success.

PTS: 1 DIF: Easy REF: p. 106, Reviewing for the NCLEX-PN® OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 8. From his or her educational experience prior to entering a nursing program, a nursing student

is aware that he or she suffers from text anxiety that is often intense. The student believes that he or she has been unsuccessful on some previous exams directly because of his or her test anxiety. What action should the student take to address this problem?

A. Take an NCLEX-PN review course.

B. Become a member of a study group with some classmates.

C. Ask his or her nursing instructors for remedial help.

D. Explore the possibility of professional counseling.

ANS: D

Feedback: A student who becomes overly anxious in testing situations might want to consider professional counseling. Many psychologists specialize in helping students overcome serious test anxiety. A review course or study group is unlikely to help and nursing instructors likely have neither the time nor the expertise to help this student overcome his or her problem.

PTS: 1 DIF: Moderate REF: p. 107, Test Anxiety OBJ: 6 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A nursing student‘s given name is Liu Li Mei but among her peers and classmates she has

always gone by the name Sarah. When applying to take the NCLEX-PN, what name should this student use?

A. Sarah Liu B. Sarah Liu Li Mei C. L. M. Liu D. Liu Li Mei ANS: D

Feedback: It is critical that you use the same form of your name on all applications and that this name matches the photo identification (driver‘s license or passport) you intend to use for admission to the test center.

PTS: 1 DIF: Moderate REF: p. 109, Application Procedures OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A nursing student has successfully completed a nursing program and has registered to take the

NCLEX-PN. What item should the student bring into the test room at the NCLEX-PN test center?

A. A nursing drug guide B. A calculator C. Photo identification D. A manual of laboratory values ANS: C

Feedback: Photo identification is required at a test center. Students are not allowed to bring calculators, books, or other items into the test center.

PTS: 1 DIF: Easy REF: p. 110, Test Center Regulations OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A new graduate nurse from a practical/vocational nurse program applied to a local hospital to

work. The nurse has to be licensed before beginning his or her orientation. He or she will take the NCLEX-PN and should expect: A. the computer to score the test and electronically transfer the information to the testing service which will provide the official exam results to his or her employer.

B. to see his or her name and license number posted on the board of nursing website within hours to days of passing the examination.

C. unofficial results of the exam after 24 hours by paying an additional fee to the state board of nursing.

D. to wait several months to get official results from the board of nursing to be sent to his or her home.

ANS: B

Feedback: The NCLEX-PN is computerized testing which scores the exam and sends the information directly to the testing service so it may be verified before being submitted electronically to the state board of nursing. The state board of nursing is the only agency which will then issue the license and many states will post the license within hours to days of the candidate successfully passing the examination. The state board of nursing sends by mail the official exam results directly to the candidate within 6 weeks from the time of the exam.

Unofficial results may be obtained within 48 hours after taking the exam by paying an additional fee to the testing service, Pearson via their website.

PTS: 1

DIF:

Moderate

REF: p. 110, Getting Your Results

OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Remember NOT: Multiple Choice 12. A nursing graduate is disappointed to learn that he or she was not successful on his or her first

taking of the NCLEX-PN. What is the first thing he or she should do to prepare for a retaking the exam?

A. Arrange for tutoring from a trusted nursing instructor.

B. Revisit the materials he or she earlier used to study for the exam.

C. Consult his or her Candidate Performance Review.

D. Ask the NCSBN to reevaluate his or her exam results.

ANS: C

Feedback: If a candidate does not pass the examination, the candidate will receive a Candidate Performance Report (CPR). This can be used to determine where the student needs to improve in preparation for a retaking the NCLEX-PN. This is more important than arranging for tutoring or beginning to study again. The NCSBN will not normally reevaluate the student‘s exam.

PTS: 1 DIF: Moderate REF: p. 111, Retaking the Examination OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A few weeks after learning that the first taking of the NCLEX-PN was unsuccessful, what

should the graduate do to prepare for retaking the NCLEX-PN? Select all that apply.

A. Arrange a clinical internship to gain more bedside experience.

B. Focus his or her studying on the areas that were most challenging on the first exam.

C. Take mock exams, focusing on the types of questions where he or she had difficulty.

D. Get help from a nursing instructor on interpreting his or her Candidate Performance Review.

E. Ask LP/VNs who have passed the NCLEX-PN about why they believe they were successful.

ANS: B, C, D

Feedback: There are several strategies that a graduate can use to prepare for retaking the NCLEX-PN. These include seeking help on interpreting the CPR, taking mock examinations, and focusing on identified areas of weakness. Gaining more bedside experience and asking nurses why they passed are not strategies that are likely to increase the student‘s chances of success.

PTS: 1 DIF: Difficult REF: p. 111, Retaking the Examination OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Selection

14. A fellow nursing student in a study group preparing for the NCLEX-PN is concerned about

the fairness of questions used in the test bank. Which instruction should the study partner provide? Test questions: A. are written by a panel of expert educators and reviewed by practicing licensed practical or vocational nurses and are reviewed by a sensitivity panel and statistical analysis before being placed in the test bank.

B. go through a strenuous process to ensure high quality, validity, and test reliability before trialing questions for noncredit, and if the questions statistically are sound, the questions are included in the test bank.

C. are written by licensed practical or vocational nurses who are trained to review and remove any stereotypical questions or wording that may be misconstrued by various groups before placing them in the test bank.

D. are written by both educators and licensed practicing nurses and are reviewed by the publisher for the computerized adaptive testing as to their reliability and validity before including them in the test bank.

ANS: B

Feedback: The National Council of State Boards of Nursing (NCSBN) is the organization that is responsible for the development of actual test questions and the procedures associated with taking the examination. The questions are written following NCSBN guidelines by licensed practical nurses or vocational nurses with at least one year of experience. The questions are reviewed by a panel and revised according to feedback. The questions are also reviewed by a NCLEX Sensitivity Panel that makes necessary adjustments to avoid misinterpretation among various ethnic, geographic locations, or gender groups. Test questions are trialed for noncredit, and statistical data are used to determine reliability and validity, and if the question is deemed a fair question, it is included in the test bank for credit.

PTS: 1 DIF: Moderate REF: p. 104, Development of the NCLEX-PN® OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Remember NOT: Multiple Choice 15. Several of a nursing student‘s classmates have enrolled in an NCLEX-PN review course that

will take place over the following weekend. The student is considering joining them, but is unsure whether the course is worthwhile, both in terms of time and money. Which characteristic of the course should prompt the student to avoid enrolling in the review course?

A. The course will be presented by DVD with an instructor accessible by e-mail.

B. The organizers of the course are practical nurses who work in acute care.

C. The course has testimonials from individuals who have previously taken it.

D. The course is structured around the Category of Client Needs.

ANS: A

Feedback: A course that offered by recordings, with no instructor present, is not likely to be a worthwhile exercise. Involvement by LP/VNs, testimonials by satisfied participants, and the integration of the Category of Client Needs are all potential merits of a review course.

PTS: 1 DIF: Moderate REF: p. 107, Review Courses OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning

BLM: Cognitive Level: Analyze

NOT: Multiple Choice

16. A new nursing student reported a high score on his or her test anxiety self-assessment. Which

intervention should the student follow to decrease the level of test-anxiety?

A. Review the exam with instructor after taking it for the rationale of missed questions.

B. Study what the majority of study partners believe will be on the test.

C. Develop and follow a daily study schedule to review content.

D. Take practice tests and study rationale of missed questions to prepare for exam.

ANS: C

Feedback: The intervention that will decrease test-anxiety is to develop and follow a daily study schedule to review the content. Reviewing the test for rationales of questions missed will not help the student to prepare for the exam itself or decrease test-anxiety. The nursing student needs to study the content that the faculty outlines in a study guide, or a test plan.

Taking practice tests can be helpful in timing and help to decrease test-anxiety, but studying practice test rationales will not cover all the content contained in the actual examination.

PTS: 1 DIF: Moderate REF: p. 107, Test Anxiety OBJ: 6 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 5 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A nursing student is preparing to take the NCLEX-PN and has a hectic schedule which

changes frequently. The student works with computers at the hospital. Which review material has the potential to be the most effective for the student?

A. The online review written by seasoned nursing educators using the most recent NCLEX-PN test plan offering self-paced study plans, access to live help 24 hours/day, computerized adaptive testing, full length study materials, and quizzes.

B. A local review provided over a week, which is highly recommended by the hospital that the student is employed offering a review book, computerized testing software, and a money back guarantee if the nurse fails the examination.

C. Free videos online reviewing content for the NCLEX-PN, which may be downloaded into an audio format that the student could listen to while exercising or driving, and a list of websites offering free practice questions and rationales.

D. A review book not cross-referenced to nursing texts from a reputable publisher written by seasoned nursing educators using the most recent NCLEX-PN test plan with a CD containing practice questions in the various question formats and rationales for all answers.

ANS: A

Feedback: The nursing student has a hectic schedule, is computer literate, and has access to the computer making the online review the best option since it is written by seasoned educators using the most current NCLEX-PN test plan and it offers a self-paced study, full length study materials, computerized adaptive testing and quizzes, and live help any time the student may need it. The local review requires the student being able to take off from work, which does not seem to be an option. The review book offered with the live review does not state if it is cross-referenced to nursing texts. There is no guarantee that every computer the student uses could support the software that comes with the review book. The free videos online for a NCLEX-PN review do not state what test plan was used, or what credentials the speakers have that lead the study. There is no supporting evidence that the free practice questions offered from the list of websites were written to the most recent test plan or by reputable writers. Also, there is no opportunity to ask questions during the review process when using the free videos and practice questions. The review book listed in D has one notable downfall, which is it does not offer cross-referencing to nursing texts, so if the student does not understand a particular topic, the student has no way of getting additional help.

PTS: 1 DIF: Moderate REF: p. 106, Reviewing for the NCLEX-PN® OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. A nursing student is preparing to take the NCLEX-PN and notes that he or she must bring

which items the day of the exam? Select all that apply.

A. ―Authorization to Test‖ card from the state board of nursing B. Official transcript from the nursing program you graduated C. Current driver‘s license with correct legal name and picture D. Social Security Card with full legal name E. A note from your physician explaining your learning disability and special accommodations needed during testing ANS: A, C

Feedback: The candidate for the NCLEX-PN needs to bring an official picture identification card containing legal name and picture. The Social Security card does not contain a picture id.

The official transcripts are not needed to write for the exam because the nursing program submitted verification of eligible candidates as part of the application process. The note from the physician regarding the learning disability asking for special testing accommodations needed to be provided during the application to test process. The ―Authorization to Test‖ card is needed, but the booklet included with the card is not.

PTS: 1 DIF: Moderate REF: p. 110, Test Center Regulations OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Selection 19. A nursing student with a documented learning disability requires special testing

accommodations: a quiet environment, computerized reading software to audibly read the test, and twice the amount of testing time. When applying to take the NCLEX-PN, the student should: A. call the list of available testing centers to determine if the facility is able to meet

the special testing needs.

B. complete the application and provide documented supporting evidence when

requesting accommodations for testing.

C. request special testing needs and provide the necessary accommodation software

and equipment during examination.

D. complete the application knowing the school of nursing will forward the

documentation regarding the special testing needs.

ANS: B

Feedback: The application process for the NCLEX-PN requires that the student submits documented evidence from medical professionals supporting the need for accommodations during testing, and the state board of nursing will determine granting the request. Asking the testing center if they can meet special accommodations or providing the necessary support to meet the accommodations skips the approval from the state board of nursing‘s application process. The school of nursing cannot forward the information for the application process because the medical information is private and protected by Federal law.

PTS: 1 DIF: Moderate REF: p. 109, Application Procedures OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A nursing student is planning to apply to take the NCLEX-PN. The student wants to study for

the test, and takes a family trip to Europe for 3 weeks. Choose the best actions the student should take?

A. Apply for the exam right after the trip is completed, and review ongoing during school and practice questions daily until taking the NCLEX-PN. B. Apply for the exam after graduation and once receiving e-mail authorization to test, make an appointment to take the exam after the trip and the review is completed.

C. Apply for the exam before graduation and study for the exam during the trip and take it upon return to the United States.

D. Apply for the exam within 45 days of calling to schedule taking the NCLEX-PN, which will give ample time to study and go on the trip.

ANS: A

Feedback: Once the candidate calls for the test through application, there is 30 days of time to take the test. Repeat applicants have a 45-day window to schedule the test. Trying to study during the trip may be disastrous and take away from the family trip. It is best to study for the NCLEX-PN ongoing throughout nursing school and to continue the review process by practicing questions daily until writing the exam. Daily practice continues the reinforcement of past learning through application of content to clinical situations presented through questions. Applying after the vacation also provides some time to perform a concentrated review, in addition to the ongoing review throughout school.

PTS: 1 DIF: Moderate REF: p. 109, Application Procedures OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 5 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 6, Nursing From Past to Present 1. A nursing student taught a group of High School students interested in nursing about the

various ancient civilizations‘ (3000 BCE–0) beliefs about what caused diseases. Which statement made by students about the Greece civilization reflects adequate understanding?

A. ―Most diseases are caused by making a god or gods angry.‖ B. ―Diseases are caused by imbalances in the humors of the body.‖ C. ―Diseases are caused by uncleanliness.‖ D. ―Many diseases are caused by invisible microorganisms.‖ ANS: B

Feedback: Hippocrates, the ancient Greece physician called ―The Father of Medicine‖ was incorrect in attributing illness to imbalances in bodily ―humors,‖ but the idea that it is not magic or wrongdoing that causes illness was a big step forward. He did not address the idea that diseases were caused by uncleanliness. The germ theory of disease did not come forward until many centuries later.

PTS: 1 DIF: Moderate REF: p. 117, Ancient Civilizations (3000 BCE–0) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 2. During the early Middle Ages, the theory and practice of health care and nursing continued to

change from earlier eras. Emphasis went from scientific principles for health care to providing personal care and comfort. Which circumstance caused the changes in the health care delivery system?

A. The lack of intellectual growth because of constant war left monks and nuns to care for the sick.

B. The Roman Empire fell to the barbarians who had a different approach of caring for the ill.

C. The Catholic Church had the greatest impact on society and became the authority for health care over other groups.

D. The last of the deaconesses‘ order died, so the nuns and monks provided the health care that the people needed.

ANS: A

Feedback: The deaconesses were daughters and widows of Roman officials, and their movement diminished when the Catholic Church took over health care during the early middle ages, called the Dark Ages. It was called the Dark Ages because intellectual growth ceased because of the war taking all of the people‘s energy and efforts leaving no time to learn or be creative. The Catholic monks and nuns went into their walled monasteries because war had broken out across the land. The nuns and monks took care of the ill and injured in the monasteries with the approach of personal care and comfort because they were not trained with scientific principles that the Greeks promoted with the Hippocrates movement. The Roman Empire did fall, but the barbarians offered no approach to caring for the sick or promoting health. The Catholic Church was not the authority on health care over other groups, but simply filled a void in a war laden land.

PTS: 1

DIF:

Moderate

REF: p. 119, The Early Middle Ages (476–1000)

OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 3. The concept of hospitals as specific places where the ill were treated has not always existed.

This concept first emerged in Europe during The Middle Ages with hospices. Which event helped bring about this change?

A. During the wars, the monasteries were destroyed, and it was more feasible to build multiple smaller hospices.

B. Hospices could provide a place where crusaders could hide and find rest and take their sick when the monasteries were full.

C. Crusaders discovered Persians and Arabs hospitals cared just for the sick and were staffed by religious and secular people.

D. During the Crusades there needed to be separate hospices where the sick could be taken because of the distance of travel to a monastery.

ANS: C

Feedback: The event that brought about the change was when the crusaders discovered Persians and Arabs cared just for the ill in their hospice, or hospital. Care was also provided in the monasteries, and hospices did not develop because the monasteries were destroyed.

Although the hospices offered additional locations to care for the sick and injured, and it offered places to make it quicker to receive help, these were not the events that brought about the change in the health care system during The Middle Ages.

PTS: 1 DIF: Difficult REF: p. 121, Hospices OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 4. By the end of the 1700s, industrialization changed social conditions creating a greatly

increased need for compassionate and effective health care. Which changes heralded the need for health care reform? Select all that apply.

A. Women were limited to working in domestic service.

B. People declared insane were placed in asylums.

C. Sanitary conditions were deplorable.

D. The poor were placed into warehouses for the needy.

E. Farmers markets sold fresh produce and vegetables, milk, and eggs.

ANS: A, B, C, D

Feedback: Social conditions deteriorated sharply by the end of the 1700s. Industrialization was replacing familiar agricultural society. Cities with large populations were breeding grounds for poverty, poor hygiene, and disease. Societies treated their members badly. The sick, insane, poor, and homeless were put into hospitals, jails, asylums, and poorhouses that were little more than warehouses for the needy. Living, health, and sanitary conditions were deplorable. The young women who arrived in the cities were particularly disadvantaged because there were few job opportunities. Men could find work in factories, but women were limited to domestic service.

PTS: 1

DIF:

Easy

REF: p. 122, The 18th, 19th and Early 20th Centuries (1700–1940) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Selection 5. A nursing student was talking to a group of High School students interested in nursing about

how Florence Nightingale from the 19th century was called the founder of modern nursing.

Which statement made by students about the way nursing was conceptualized and carried out

by Florence Nightingale needs further clarification?

A. ―Nursing was based upon trial and error, and what worked was written in Nightingale‘s book.”

B. ―Rounds were used to check on the clients to meet their needs for comfort and care.‖ C. ―Nursing should provide the optimal conditions to help nature to heal the client.‖ D. ―A nurse must wash his or her hands before caring for a client to prevent spreading sickness.‖ ANS: A

Feedback: Florence Nightingale used scientific principles of her day and founded the basic theory that nursing provides optimal conditions for the client: hygiene, sanitation, nutrition, and a proper clean environment and nature can heal the client. She promoted nurses bringing basins of clean water to the beds of clients and promoted hand washing to prevent nurses from carrying sickness from one client to another. She promoted cleansing wounds with soap and water and providing clean bandages. She kept statistical records comparing the mortality rates before and after applying her scientific principles, which constitutes research. She did not provide nursing care through trial and error. She promoted rounding to check on clients in order to provide comfort and care effectively to all of the clients in the hospital. At night, she carried a lamp while rounding and was called ―The lady with the lamp.‖ PTS: 1 DIF: Moderate REF: p. 124, Florence Nightingale OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The Crimean War of the mid-19th century was the venue for many of the sweeping changes to

nursing that were introduced by Florence Nightingale. Which statement best describes these changes?

A. Because of Nightingale‘s ideas, nursing became a profession that was appropriate for men as well as women.

B. Nightingale proposed the germ theory of disease and organized nursing care around the principles of this theory.

C. Nightingale helped schools of nursing transition from being based on superstition to being evidence based.

D. Under Nightingale‘s influence, nursing became respectable, organized, and effective.

ANS: D

Feedback: Florence Nightingale transformed nursing from a profession for disreputable poor women into a noble occupation. As well, her practices greatly improved mortality and morbidity rates. She did not propose that the profession was appropriate for men or introduce the germ theory of disease. Nursing schools as we know them were not in existence during most of this historical period.

PTS: 1 DIF: Difficult REF: p. 124, Florence Nightingale OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 7. The development of nursing in the United States has been closely associated with certain

watershed events in American history. What event created the greatest awareness of the need for skilled nurses?

A. The Declaration of Independence B. The Civil War C. The abolition of slavery D. The entry of the United States into World War II ANS: B

Feedback: The Civil War (1861–1865) dramatized the need for skilled nurses in the United States, and people realized that society was responsible for its own health.

PTS: 1 DIF: Moderate REF: p. 126, Nursing in the United States OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. Susie Walking Bear Yellowtail was an American nursing leader. To directly improve the

health care system for Native Americans, she took which action as a first step?

A. Assessed the reservation‘s over-all health, socioeconomic, and educational problems.

B. Collaborated for funding and supplies to modernize the health care delivery system.

C. Founded the Native American Association of Nursing to provide political voice.

D. Secured funding to help Native Americans to become professional nurses.

ANS: A

Feedback: Nursing process begins with assessment, so Susie Walking Bear Yellowtail traveled throughout the Montana reservation assessing the over-all health, socioeconomic, and educational problems of her people. After gathering the evidence, she formulated nursing diagnoses for the existing problems, and presented the evidence through collaboration with the reservation and Federal agencies to help solve the issues by gaining necessary funding and supplies to modernize the health care delivery system. She also worked to stop health care abuse, such as women being sterilized without proper informed consent. As part of securing supplies and funding, she founded the Native American Association of Nursing to provide political voice for her people and the nurses serving her people. She also worked to secure funding to help Native Americans to be able to become nurses.

PTS: 1 DIF: Moderate REF: p. 126, Emergence of American Nursing Leaders OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 9. Hildegard Peplau (1909–1999) was a pioneer in the development of the theory and practice of

mental health and psychiatric nursing. Which was Peplau‘s primary focus in nursing?

A. The nurse provides interventions as ordered by the physician.

B. The nurse provides whatever the client wants.

C. The development of the client–nurse relationship is the foundation of nursing practice.

D. The nurse provides the client with what the nurse believes the client needs.

ANS: C

Feedback: Hildegard Peplau‘s primary focus in mental health/psychiatric nursing, which can be used across multiple areas of nursing, is the development of the client–nurse relationship, which improves communication and develops a trusting working relationship, which is client-centered. The nurse does not provide whatever the client wants because the nurse needs to offer the best possible care to the informed client. Providing only what the physician orders acts upon the client without considering the client‘s needs. If the nurse provides only the care that he or she believes, the client needs may miss what it really is that the client must have.

PTS: 1 DIF: Moderate REF: p. 126, Emergence of American Nursing Leaders OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 10. During the years between 1948 and 1954, the number of schools dedicated to educating

practical nurses in the United States grew by more than 260 schools. This rapid growth was primarily a result of what phenomenon?

A. Developments in the scientific understanding of infectious diseases B. Pressure from physicians for more assistance in providing care C. Growth of hospitals as places to treat illness and give birth D. Shortages in the number of registered nurses in the United States ANS: D

Feedback: Probably as a result of World War II and the serious shortage of registered nurses, 260 schools of practical nursing were opened between 1948 and 1954. This exponential growth in the profession has not been attributed to increases in the use of hospitals, pressure from physicians, or scientific developments.

PTS: 1 DIF: Difficult REF: p. 126, Emergence of American Nursing Leaders OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 11. Prior to 1940, schools of nursing in the United States were loosely controlled and poorly

organized, with low educational standards. Which event ushered in a new era of organization and accountability in practical nursing education?

A. Legislation that put nursing schools under the control of state legislation B. Entry of registered nurses into faculty positions at practical nursing schools C. Political pressure from clients and families that were dissatisfied with their hospital

care D. Influence from European nurses during World War II who had higher educational

standards ANS: A

Feedback: There were few controls, little educational planning, and minimum supervision of practical nursing schools before 1940. Standards were nonexistent and the programs varied widely. It was only after state agencies that were subject to legislation took over that controls were established. This change in structure and practice was not a result of influence from RNs, disgruntled clients, or European nurses.

PTS: 1 DIF: Difficult REF: p. 133, Rise of National Organizations OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 12. There are currently two major organizations that represent the interests of practical and

vocational nurses, the National Association for Practical Nurse Education and Service (NAPNES) and the National Association of Licensed Practical Nurses, Inc. (NALPN).

Together, these nursing organizations perform which roles? Select all that apply.

A. Set standards of practice for practical and vocational nurses.

B. Promote the interests of practical and vocational nurses.

C. Inform the public about practical and vocational nursing.

D. Negotiate wages and working conditions for practical and vocational nurses.

E. Manage nurses‘ roles within the Medicare and Medicaid programs.

ANS: A, B, C

Feedback: NAPNES and NALPN set standards for practical/vocational nursing practice, generally promote and protect the interests of practical/vocational nurses, and educate, and inform the general public about practical/vocational nursing. These organizations do not directly negotiate with employers or contribute to the management of Medicare and Medicaid.

PTS: 1 DIF: Difficult REF: p. 133, Rise of National Organizations OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Selection 13. The nursing student is preparing for future career needs as a licensed practical/vocational

nurse with a focus in gerontology. The student researched a multiple professional organizations. Which information did the student discover about these organizations? Select all that apply.

A. NAPNE offers certifications in intravenous medications and gerontology nursing.

B. NALPN offers needed gerontology certification.

C. NAPNE includes continuing education as part of the membership fee.

D. Both NALPN and NAPNE offer continuing education.

E. NAPNE offers the ―Online Journal of Practical Nursing,‖ which will be helpful in

staying up-to-date with nursing.

F. NALPN offers the ―Online Journal of Practical Nursing,‖ which will be helpful in

staying up-to-date with nursing.

ANS: B, D, E

Feedback: Membership in NALPN will provide the opportunity to obtain certification in gerontology and take continuing education courses as part of the membership fee. NAPNE offers a low annual membership fee, but additionally charges for continuing education courses, and provides the journal online to help stay up-to-date with current practice, but does not offer certification. NALPN also has an honor society for student nurses.

PTS: 1 DIF: Moderate REF: p. 133, Rise of National Organizations OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Selection 14. Linda Richards is an American nursing leader who was a lifelong learner and also taught and

founded nursing schools. What was the most important contribution that Richards provided the profession of nursing?

A. Hundreds of nurses became a nurse because of her example.

B. Her system of client record keeping remains the basis for our health care system today.

C. She consulted at hospitals to improve their health care system.

D. She traveled across the United States and consulted to improve nursing schools.

ANS: B

Feedback: The most important contribution is the one that is most lasting and most encompassing, and Linda Richards developed a system of record keeping that is still used in health care systems today across the country. All of the other listed contributions are activities that all nurses should exhibit to help further the profession of nursing.

PTS: 1 DIF: Moderate REF: p. 126, Emergence of American Nursing Leaders OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 15. Today, most countries have their own Red Cross organization that also belongs to the

International Red Cross. What was the most important contribution of the Red Cross when it was founded by J. H. Dunant in the 19th century?

A. Established rules for the treatment of wounded people during wartime B. Publicized the important role of nurses in health care systems C. Sponsored the establishment of schools of practical nursing D. Created new standards for infection control and wound care ANS: A

Feedback: One of the early accomplishments of the Red Cross was to make rules for the treatment of the wounded and for the protection of medical personnel and hospitals. The Red Cross was not involved in advocating for nurses, establishing schools of nursing, or influencing standards of infection control.

PTS: 1 DIF: Moderate REF: p. 125, International Red Cross OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 16. Lillian Wald is an American nursing leader. What was the most important contribution that

Wald provided the profession of nursing?

A. She opened the Henry Street Settlement providing free care to the poor located in Lower East Side of New York City.

B. She was one of the advocates for nursing schools to follow standards during the educational process.

C. She founded Public nursing, which helped to improve access of health care to the underprivileged.

D. She was one of the advocates for minorities to be included in nursing programs for training to better represent the population.

ANS: C

Feedback: The most important contribution is the one that is most lasting and most encompassing and Lilian Wald founded Public nursing, which still exists today. Opening Henry Street Settlement served one portion of the population in the United States, but the foundations of Public nursing served all communities. All of the other listed contributions are activities that all nurses should exhibit to help further the profession of nursing.

PTS: 1 DIF: Moderate REF: p. 126, Emergence of American Nursing Leaders OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 17. During the Reformation (1500s–1600s) nursing changed drastically. Which key event brought

about this new era of nursing?

A. The Catholic Church no longer was the leader in health care and nursing care.

B. Protestantism changed societal view of women.

C. The Sisters of Charity were formed and provided health care.

D. Women cared for their children and the sick in their homes.

ANS: B

Feedback: The most important event during the Reformation period for changing nursing care was the rise of Protestantism, and society‘s change of the value placed on women. The Protestants taught that the woman was subservant to man and her place was at home having and raising children and caring for her family. The other events were all a result of the Protestantism changing society‘s view.

PTS: 1 DIF: Moderate REF: p. 122, The Reformation (1500s–1600s) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

18. A nursing student was teaching a group of High School students interested in nursing about

the history of licensed practical/vocational nurses. Which statement made by the High School students‘ needs further clarification?

A. ―At first the practical nurse/vocational school programs did not follow standards or regulations.‖ B. ―New York was the first state to pass mandatory licensing for the practical nurse/vocational nurse.‖ C. ―Nurse‘s duties in 1887 provided rules that the nurse was not to work more than 8 hours per day and no more than 5 days per week.‖ D. ―A nurse in 1887 caught smoking or drinking or getting his or her hair done in a beauty salon could be fired.‖ ANS: C

Feedback: The only statement needing clarified by the nursing student teaching the High School students about nursing refers to work hours for nurses in 1887. A nurse in 1887 worked long hours 6 days per week. The nurse would work from 7 am until 8 pm, except for going to a church service during the evening or one evening could be a date night. It is true that, at first, the practical nurse/vocational school programs did not follow standards or regulations; New York was the first state to pass mandatory licensing for the practical nurse/vocational nurse; and a nurse in 1887 caught smoking or drinking or getting his or her hair done in a beauty salon could be fired.

PTS: 1 DIF: Moderate REF: p. 129, The Development of Practical/Vocational Nursing OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 6 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 19. Isabel Hampton Robb is an American nursing leader dedicated to protecting clients and

advancing the profession of nursing. Robb‘s most important contribution was to advocate for: A. nurses‘ rights for 8 hour shifts and no more than 6 days per week.

B. nursing education standards and mandatory licensing.

C. nursing training taking at least 3 years to complete.

D. use of her nursing theory and textbook.

ANS: B

Feedback: Isabel Hampton Robb‘s most important way to improve both the profession of nursing and protect clients was to advocate for a set of standards to be adopted and followed by nursing programs and mandatory licensing for nurses to ensure competency of practicing nurses. All of the other choices are helpful to a lesser degree for furthering the profession and helping to protect clients. The other choices do not guarantee competent nurses at the bedside, if schools do not have to follow educational standards, or there are no means to test for minimal competency before placing a nurse at the bedside to practice, then the quality of the nurse at the bedside will be questionable. A shorter work week for nurses boosts morale, decreases nursing burnout, and helps protect clients from a potentially over-worked tired nurse making a mistake. A 3-year nursing program without testing for competence alone is not enough to provide a safe practitioner. Developing a nursing theory and writing a nursing textbook may promote the possibility for an improved nursing education, but there is no guarantee that the students will read and actually apply the content to practice.

PTS: 1 DIF: Moderate REF: p. 126, Emergence of American Nursing Leaders OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 20. Lavinia Dock and Mary Adelaide Nutting were both American nursing leaders instrumental in

improving the standards for nursing education. What was the most important contribution that the two provided the profession of nursing together?

A. Both were considered social activists and were instrumental in improving the standards of nursing education.

B. Both were considered to be two of the earliest nursing professors teaching at universities in the United States.

C. Helped to found the National League for Nursing (NLN) and the four volumes, History of Nursing.

D. Both were expert authors, and Mary Adelaide Nutting was the founder of the American Journal of Nursing in 1900.

ANS: C

Feedback: The most important contribution has the most impact that lasted the longest and that was Lavinia Dock and Mary Adelaide Nutting helped to improve standards in nursing education by helping to found the National League of Nursing and wrote the history of nursing. Answer D contributes the American Journal of Nursing only to Mary Adelaide Nutting and answer C contributes the two‘s finest writing and social activist strategy that improved the standards of nursing education, which was the founding of the NLN. Although they were two of the first nursing professors, this contribution is not the most important contribution to the profession of nursing.

PTS: 1 DIF: Moderate REF: p. 126, Emergence of American Nursing Leaders OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 6 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 7, The Health Care System 1. A client who has a history of multiple myeloma visits the nurse at his or her family

physician‘s office. The client has been treated for the past several years by an oncologist. He or she has found his or her experiences within the health care system to be emotionally challenging trying to understand the health maintenance organization (HMO), and why he or she received a letter from the HMO stating his or her oncologist is no longer in the network, and asked him or her to choose another oncologist, and what can he or she do to continue the oral chemotherapy that insurance stated is no longer formulary because the price would be unbearable. What best next action should the nurse take to help the client?

A. Instruct the client that the HMO contracts with physicians and services, and the client may need to contact his or her oncologist‘s office and find out what recommendations they may have for the situation and the need for the medication.

B. The nurse should ask the family physician if he or she can see the client or make an appointment for the client so he or she can get a referral to another oncologist.

C. Instruct the client to call the number on the back of his or her HMO membership card and ask the HMO how to file a formal complaint.

D. Call the pharmacist that provides the oral chemotherapy agent and ask if there is an equivalent agent that is formulary.

ANS: A

Feedback: The complexity of the American health care system is confusing for many consumers. The best first action the nurse should take to help the client is to instruct the client on how the HMO works and how to navigate it. Calling the oncologist‘s office is the first step in the process because the oncologist may be negotiating with the insurance company and may have already resolved or is close to resolving the issue, and the client may be able to continue with the oncologist. If the oncologist no longer aligns him- or herself with the HMO, he or she may be able to recommend an oncologist in the client‘s network. The oncologist may be out of network, and for an additional fee, the client may still be able to receive treatments. The issue of the medication also needs to be taken directly back to the prescriber who will provide the best option for the client. The oncologist may state the medication has a generic and it is formulary, or the drug is absolutely necessary, and he or she can write a letter to the HMO to help the client secure it. The oncologist may prescribe a formulary drug that is equal. The oncologist may help the client to apply for additional means to pay for the medication through the pharmaceutical company, for instance. Asking the family physician to make a referral to another oncologist will not provide the client an optimal opportunity for continuity of care, and the current oncologist needs to provide the referral, if needed to another oncologist since he or she knows the case. While the client may call the HMO to file a complaint, instructing the client to call the HMO is not the best action because a formal complaint process takes weeks to months and the client needs to continue care for the cancer.

Call even if the pharmacist recommends a new medication that is formulary, the nurse cannot prescribe it, and the current oncologist still may have reasons why the current medication the client is taking needs to be continued.

PTS: 1 DIF: Moderate REF: p. 136, The Health Care System OBJ: 1 | 8 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 7 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

2. Hospitals are categorized by a number of different criteria, including ownership, the care that

is provided, and the size of the hospital. Which type of hospital is funded by the federal government?

A. A county hospital B. A hospital affiliated with a university C. A Veterans Administration hospital D. A proprietary hospital ANS: C

Feedback: VA hospitals are federally owned and funded. County hospitals are locally owned, while most university hospitals are state owned. Proprietary hospitals are privately owned.

PTS: 1 DIF: Easy REF: p. 138, Types of Hospitals OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 3. A nursing student is caring for an older adult client admitted to the hospital for treatment for a

deep venous thrombus (DVT). The client and husband are both upset because they had to drive almost a hundred miles to get the treatment they believed they needed because the hospital emergency department near their home informed them that it was hospital policy to stop diagnostic testing after 5 pm, and since the client was stable, she could come back in the morning. The client‘s husband asked the nursing student to explain what agency or agencies he needed to contact to help prevent potential harm to others in the future? The nursing student should state: ―The first step you should take is to report the occurrence to: A. The Joint Commission because it is the agency that sets the standards and provides accreditation for the hospital.‖ B. your state board of health, which regulates and licenses the hospital and deals with any health facility–related violations.‖ C. your local ombudsman for seniors who will act as a client advocate for you and others.‖ D. the hospital administrator and discuss the situation and ask for a remedy that meets your satisfaction.‖ ANS: D

Feedback: The older adult client and her husband first need to contact the hospital administrator to discuss their concerns and ask for a remedy that meets their satisfaction. All of the other agencies listed require that the client and family discuss the situation first with the hospital administration, and if the situation is not resolved, then contacting the other listed agencies is acceptable. The next best contact would be the ombudsman for seniors because the agency acts as a client advocate and will guide them through the entire process and will do a lot of the work of contacting other agencies as necessary in order to find the best solution for the issue. An internet search should reveal toll free phone numbers available for the client‘s area ombudsman, state Board of Health, and The Joint Commission report line.

PTS: 1 DIF: Difficult REF: p. 142, Health Care Regulation, Approval, Accreditation, and Standards of Excellence OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation

BLM: Cognitive Level: Analyze

NOT: Multiple Choice

4. While approval of institutions that provide health care is mandatory, accreditation is usually

voluntary. What health care institution would require mandatory accreditation?

A. A hospital that receives funding from Medicare B. An assisted living facility that employs licensed vocational nurses C. A physician‘s office where controlled medications are prescribed D. A long-term care facility with more than 10 residents ANS: A

Feedback: Facilities that accept Medicare or Medicaid funds for their services must be accredited by an appropriate accrediting agency such as the JCAHO. PTS: 1 DIF: Moderate REF: p. 143, Approval and Accreditation of Hospitals OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. Continuous quality improvement (CQI) through quality assurance (QA) and quality

improvement (QI) programs are part of a continual evaluation process and are required by some accrediting agencies such as The Joint Commission. A nurse who provides care in a hospital setting can expect to contribute to the CQI process in what way?

A. Creating the strategy for evaluating the quality of care in the hospital B. Liaising and communicating between the hospital and The Joint Commission C. Participating actively in the surveys and evaluations that are used to determine quality of care D. Drafting the CQI report that will be submitted to the accrediting agency ANS: C

Feedback: Active participation in the data collection that constitutes a CQI initiative is an important contribution that can be made by the LP/VN. Normally, LP/VNs do not play a primary role in creating the overall strategy for the process, liaising with the accrediting agency, or creating the relevant reports.

PTS: 1 DIF: Difficult REF: p. 145, Quality Assurance, Peer Review, and Risk Management Programs OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The nursing student discussed the purpose and benefits of magnet accreditation during a

presentation to his or her peers. Which statement made by a peer needs further clarification?

A. ―Long-term care facilities may achieve magnet accreditation.‖ B. ―A magnet hospital attracts and retains the best talented nurses.‖ C. ―The magnet hospital provides quality client care through nursing excellence and using evidence-based practice.‖ D. ―The American Nurses Credentialing Center awards the hospital with the designation of magnet status.‖ ANS: A

Feedback: The nursing student needs to clarify that the magnet status is awarded to hospitals, and the pathway to excellence may be awarded to long-term care facilities that exceed the credentialing requirements.

PTS: 1 DIF: Moderate REF: p. 142, Health Care Regulation, Approval, Accreditation, and Standards of Excellence OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 7. The diagnosis-related groups (DRGs) method of payment was developed by the federal

government in the 1980s. The DRG payment system establishes: A. a minimum level of health care for every American who experiences illness or injury.

B. an obligation for citizens to participate in health promotion activities.

C. shared responsibility for health care between the individuals and the government.

D. fixed rates for health care treatments using rates that are based on client variables.

ANS: D

Feedback: The DRG system of payment takes age, complications, and multiple health problems into consideration and uses the principle of prospective payment to set rates for health care services in advance, rather than after the service has been delivered. The DRG system does not create an obligation for health promotion, a shared responsibility for health, or a national minimum level of care.

PTS: 1 DIF: Difficult REF: p. 149, Diagnosis-Related Groups OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. A rural community has experienced a significant outbreak of measles among children in the

area. Nurses in this community would primarily be in contact with what agency in the Department of Health and Human Services (DHHS)?

A. The Centers for Disease Control and Prevention (CDC) B. The Food and Drug Administration (FDA) C. The Health Resources and Services Administration (HRSA) D. National Institutes of Health (NIH) ANS: A

Feedback: The Centers for Disease Control and Prevention (CDC), headquartered in Atlanta, Georgia, is the agency to which communicable diseases are reported. This agency collects data and maintains statistics on diseases and their spread and supports research for controlling communicable diseases. The FDA, the HRSA, and the NIH do not share this mandate.

PTS: 1 DIF: Moderate REF: p. 151, U.S. Department of Health and Human Services OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

9. A nursing student volunteers at a homeless shelter that houses 25 adults. The shelter has a

computer connected to the internet. A 55-year-old client who dropped out of high school in the ninth grade asked the student what he or she could do to be able to access health care. The best response is: ―You can visit A. free clinics in the area let me give you a list of ones nearby the shelter.‖ B. the Health Insurance Market Place, I can help you apply online, if you like.‖ C. the Social Security office nearby, and you can apply for Medicare.‖ D. the local public board of health for free immunizations.‖ ANS: B

Feedback: The nursing student‘s best response is to help the client to visit the Health Insurance Market Place online and offer to help him or her complete the forms, if he or she needs help. The client is 55 years of age and may have problems reading the computer screen if he or she does not have reading glasses. The client may have difficulties reading and comprehending what he or she reads. The client may not be computer literate. Medicare is a hospital and health care insurance plan for persons 65 years of age and older, so the client does not qualify. Providing free clinics or emergency room services or the free immunizations fragments health care and does not provide essential health prevention and wellness the client needs.

PTS: 1 DIF: Moderate REF: p. 148, Government Insurance OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A licensed practical nurse provides care on a postsurgical unit of a large, urban hospital. The

nurse is aware that nursing documentation about clients is used in the administration of the prospective payment system (PPS) that applies to many clients‘ care. How would the principles of the PPS relate to client care?

A. PPS is used to determine clients‘ health care costs before they receive care.

B. PPS is used to calculate the amount of care that a client may receive before having to pay privately.

C. PPS is used to accurately and efficiently determine a client‘s medical diagnosis and care plan.

D. PPS is used to communicate between care providers and relevant government departments.

ANS: A

Feedback: PPS was developed by the federal government in an attempt to control health care costs associated with the Medicare program. The principle of prospective payment is to set rates for health care services in advance, rather than after the service has been delivered. It does not directly determine how much a client will have to pay out-of-pocket, and it is not used to obtain a medical diagnosis. PPS is not a communication tool.

PTS: 1 DIF: Moderate REF: p. 149, Diagnosis-Related Groups OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

11. A nursing student is caring for a hospitalized client, who stated he or she cannot afford health

care coverage. He or she heard the Affordable Care Act (ACA) makes it too complicated to get coverage, and it takes too long to complete the online application. He or she also heard that the plans only paid a fraction of the costs, and he or she would not be able to continue with his or her doctor. How should the student respond?

A. ―I understand your concern because the health care plans are expensive and have high deductibles. In addition, they are limited in the amount of coverage the plan will provide, and often times, the plan does not have your doctor or pharmacy included.‖ B. ―I can give you the website for the Health Insurance Market Place. There is a question and answer area and live chat that you can connect with a spokesperson that can answer your questions.‖ C. ―Have you actually tried to use the Health Insurance Market Place, or are you just going by what others have told you?‖ D. ―The Health Insurance Market Place offers coverage based upon income, and at times, it can be free or a minimal amount. I can contact our Certified Case Manager to help you get the coverage you need, and help you possibly find coverage that also includes your doctor.‖ ANS: D

Feedback: The ACA goal is to provide affordable health insurance access to all Americans.

The plan is based upon income, so persons at poverty may receive free or extremely low rates for coverage. There are numerous plans to help best serve the needs of the individual, and health insurance companies sell plans on the Health Insurance Market Place, so often times a plan or plans may have the physician and services the client wants to continue. It is best for the nursing student to use the Certified Case Manager who can help the client navigate the website and other resources to get the coverage of the client needs. The nursing student should not state a personal opinion, which is incorrect and misleading and does not help the client to gain access to health care insurance. Providing the website for the Health Insurance Market Place does not dispel misconceptions that the client has heard and sends the client to a website that he or she already feels confused by. Asking the client if he or she has tried the website is judgmental and should never be stated to a client because it would impede communication.

PTS: 1 DIF: Moderate REF: p. 154, Issues and Concerns OBJ: 6 | 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 12. The managers of a small long-term care facility have proposed that medication be

administered by unlicensed assistive personnel, rather than by licensed practical/vocational nurses or registered nurses. How should the nurses at the facility best respond to this proposal?

A. Ensure that the unlicensed care providers receive adequate training.

B. Elicit input from the residents themselves and their family members.

C. Oppose the delegation of nursing duties to nonnursing personnel.

D. Advocate for a pay increase for the unlicensed care personnel in light of their increased responsibilities.

ANS: C

Feedback: It is important for practicing nurses to vigorously oppose the delivery of nursing care by nonnursing personnel. It is insufficient to provide training to the unlicensed care personnel; medications should be administered by educated nurses.

PTS: 1 DIF: Difficult REF: p. 154, Health Care Providers OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A 72-year-old woman with multiple chronic health conditions has been informed that she will

need to have hip replacement surgery. The woman is having difficulty navigating the complexity of the health care system but wishes to maximize her health outcomes. Who would be most helpful in assisting the woman?

A. A coordinated care manager B. A nurse practitioner C. A client advocate D. A family physician ANS: A

Feedback: To address the complexity of the health care system, a case or coordinated care manager can help clients and their families meet their health needs by explaining options and services, identifying medical and financial resources, and identifying providers and facilities.

The case manager works to coordinate care that utilizes the best options for the individual client. This role is not normally performed by a nurse practitioner, a physician, or a client advocate.

PTS: 1 DIF: Moderate REF: p. 154, Health Care System OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A licensed practical nurse is aware that the costs associated with health care have been rising

steadily and are predicted to continue to rise for the foreseeable future. Which reason for these rising costs is most significant?

A. HIV-positive population is growing and living longer, and the lifelong treatments are extremely costly, and with the Affordable Care Act, no one can be denied affordable health insurance because of preexisting diseases.

B. The large baby boomer population is graying, and aging brings an increase in chronic diseases, which increase health costs, and Medicare funds are depleting and may not be able to handle the growing older population.

C. There are more people receiving organ transplants, and the drugs to prevent rejection are increasing the health care costs.

D. The increase in number of malpractice lawsuits and the increase in settlement costs make the costs for health care continue to rise.

ANS: B

Feedback: All of the choices are reasons why it is difficult to control or reduce spending. One of the most significant is the increased number of elderly people in America. By 2030, it is predicted that the population aged 65 years or older will double, and it is feared that the Medicare fund will not be able to handle this increase in the population. Medicare is the largest health insurance provider, and the most dollars are spent in this insurance plan.

PTS: 1 DIF: Moderate REF: p. 157, Health Care Financing OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 15. There was an increase incidence of client falls on the unit where the licensed

practical/vocational nurse serves on the continuous quality improvement (CQI) committee.

Several of the incident reports noted that clients fell during the change of shift and other reports noted multiple causes. The unit practiced reporting to the oncoming nurses at the nursing station. Which activity should the CQI committee perform next?

A. Search for the best evidence-based fall prevention protocol that meets the unit‘s needs and will help to decrease the incidence of falls in the future.

B. Continue to track the number of falls and review the incident reports to determine actions to take in the future.

C. Place signs by the room of a client that is at risk for falls to help all health care personnel to provide added observation when rounding.

D. Change the policy for change of shift reporting to be carried out at the client‘s bedside to help decrease the number of falls.

ANS: A

Feedback: The next step the CQI committee needs to take is to search for the best evidence-based fall prevention protocol that meets the unit‘s needs in helping to decrease the incidence of falls. Not only are the falls a result of no one rounding during change of shift report, but there are other reasons for the falls. If the committee simply tracks the number of falls and reviews the incidence reports, then the committee is ignoring the problem and not addressing it, which goes against the principles of CQI. Placing a sign by the door of clients at risk for falls may help increase rounding but does not address end of shift coverage when all nursing staff is at the nursing station giving and receiving report. Simply changing the policy for change of shift reporting to be at the bedside addresses decreasing some of the falls, but it does not address all of the reasons for the increased incidence of falls.

PTS: 1 DIF: Moderate REF: p. 145, Quality Assurance, Peer Review, and Risk Management Programs OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 7 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 16. The quality assurance (QA) committee determines the standards of care for the hospital. An

opening exists on the committee. Which applicant should be accepted based upon the principles of quality assurance?

A. A new graduate registered nurse from a Bachelor‘s in Science of Nursing (BSN) program has just completed orientation and an internship for 3 months and is working in the emergency unit caring for clients across the life span.

B. A licensed practical/vocational nurse with gerontology certification is newly hired

to the hospital with 6 years of experience working in a nursing home and is currently enrolled into a BSN program.

C. A registered nurse (RN) with an Associate‘s Degree in Nursing, certified in critical care with 3 years‘ experience in critical care nursing and 4 years‘ experience in medical–surgical nursing, is currently enrolled in a RN to Master‘s Science of Nursing (MSN) program.

D. A registered nurse with an advanced degree and certification in medical–surgical nursing has 5 years of experience floating to multiple medical–surgical nursing units and 2 years of experience working in a maternity unit, recently passed the Health Care Quality Management certification.

ANS: D

Feedback: The quality assurance committee establishes standards of care based upon best evidence, recommendations from accreditation and regulatory agencies, and expert advice arising from educational preparation, and experiences in nursing and working with the hospital system being served. The standards of care set the minimum expectation for practice.

When provided a group of applicants, the most qualified nurse will be chosen. The new graduate registered nurse (RN) has limited experience in nursing and working in the hospital, so the committee would not choose this candidate as their first choice. The licensed practical/vocational nurse offers experience, commitment to lifelong learning, and certification in gerontology but does not have any experience working at the hospital. The last two RNs have 7 years of experience working at the hospital and offer two areas of nursing and certification. The last candidate offers the most because of already completing an advanced degree, providing two certifications, with the one in Health Care Quality Management, which prepares the nurse to have a working knowledge to decrease medical errors, decrease client days, improve the quality of client care, and improve client safety, all aspects of QA programs.

PTS: 1 DIF: Moderate REF: p. 145, Quality Assurance, Peer Review, and Risk Management Programs OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A client plans to go on a church missionary trip to Ethiopia. The client asks the licensed

practical/vocational nurse, ―Where should I look for information that instructs me about what I need to do medically to be prepared for such a trip?‖ Which is the nurse‘s best response?

A. ―The Food and Drug Administration (FDA) provides the latest information about various immunizations dosages, side effects, and safety information.‖ B. ―The Centers for Disease Control and Prevention (CDC) provides up-to-date immunization requirements for travel to various countries outside of the United States.‖ C. ―The Health Resources and Services Administration (HRSA) provide what immunizations and resources are available to underserved areas.‖ D. ―The National Institutes of Health (NIH) offers the up-to-date information about various contagious diseases and prevention measures.‖ ANS: B

Feedback: The person planning a trip outside of the United States to a third world country needs specific up-to-date information on immunizations needed when traveling to the specific country outside of the United States. This information is found at the CDC website. The CDC also provides travel advisories about food and water safety, etc. The FDA may have latest information on the vaccines and the dosages, but it does not offer the schedule recommended for specific countries. HRSA provides services and supplies mostly to underserved areas inside of the United States and does not provided information as to what the traveler needs before going to the foreign country. NIH may provide information about various infectious diseases and how to prevent their spread but does not offer the up-to-date immunization schedule needed for persons planning foreign travel.

PTS: 1 DIF: Moderate REF: p. 151, U.S. Department of Health and Human Services NAT: Client Needs: Health Promotion and Maintenance KEY: Integrated Process: Communication and Documentation NOT: Multiple Choice

OBJ: 7 TOP: Chapter 7 BLM: Cognitive Level: Apply

18. A licensed practical/vocational nurse is preparing for an annual employee evaluation. Which

example supports the hospital‘s pay for performance initiatives?

A. The nurse makes a thorough assessment of the client‘s wounds before gathering supplies, and the nurse makes sure that all supplies are properly charged to the client‘s account.

B. The nurse participates in his or her care team consisting of the registered nurse and nursing assistant and completes the care maps for his or her clients following hospital standards of care.

C. The nurse asked the client if he or she smokes and the client sated that he or she smoked two packs per day for 30 years but has decided to quit so the nurse charted the client is a nonsmoker.

D. The nurse provided care he or she was taught in nursing school 2 years ago, which does not always go along with the critical pathway.

ANS: B

Feedback: Pay for performance involves reimbursement by Medicare and insurance for health care provided. A flat rate is provided for various diagnostic-related procedures and services, and if the health care facility can deliver the care for less than the provided fee, then the facility gains additional profit. The nurse during the performance review provides an example of being fiscally responsible for the pay for performance reimbursement by following the facility‘s standards of care, and completing critical pathways and care maps to help manage client‘s care by providing quality, cost-effective evidence-based care that a critical pathway or care map outlines. Involving the entire team in the process is wise to ensure that the best care is provided and duplicate services that can be costly are not provided. Making a thorough assessment of the client‘s wounds before gathering supplies and makings sure that all supplies are properly charged to the client‘s account is conservation of materials and making sure that the client is properly billed, but it does not guarantee the best care was provided. Charting a former smoker as a nonsmoker does not follow standards set by accreditation and regulatory bodies, such as The Joint Commission, so the nurse is expected to chart for each client upon admission if he/she smokes, and if a smoker plans to quit, and if the client received educational materials about smoking cessation. In this case, the nurse did not accurately chart, which goes against the expectations for a nurse. The nurse needs to follow the hospital‘s policies, procedures, and standards of care, which should be current and evidence based. The nurse needs to recognize that information learned in nursing school may become outdated, so it is important to stay up-to-date with practice.

PTS: 1 DIF: Difficult REF: p. 149, Controlling Health Care Costs OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 7 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 8, The Health Care Team 1. The nursing student prepares for team work by completing the self-assessment ―Are you ready

to be a team member?‖ The student scored zero on the areas of finding it difficult to ask others for help, and the student wants to work alone. Which action should the student take next?

A. Delegate unwanted tasks to the nursing assistant on the team, so there is more time to teach the client about health prevention and promotion activities.

B. Observe grand rounds and how the health care teams from various disciplines works together to better understand team work.

C. Plan before the next clinical areas that teams approach would benefit the client instead of trying to do the care alone, and ask the team members to help.

D. Ask the health care team to ask for help, so the student can get involved in team work and learn how to go about working in a group.

ANS: C

Feedback: The health care team consists of members from different professions and different educational backgrounds and skill sets that complement each other and together can provide the most efficient highest quality of care. The purpose of team work is not to delegate unwanted tasks to nursing assistants. The nursing student identified having problems with asking others for help and wants to work alone, so observing how a team works together does not help the student take the needed step of asking the team for help. Asking the team to assign tasks for the student to complete does not provide the practice the student needs in asking team members to help. By planning ahead for the next clinical experience areas that the client may benefit from a team approach and asking team members for help provides the needed practice to help the student become a solid team member.

PTS: 1 DIF: Moderate REF: p. 161, Personal Qualities of Health Care Workers OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 2. Licensed practical/vocational nurses, as well as the other members of the health care team,

require a specific set of skills and personal characteristics. Which personal characteristic is essential to be a competent and effective provider of health care?

A. Willingness to tell clients and clients what is best for them B. Ability to emotionally disengage in order to remain objective C. Willingness to inflict pain on others D. Ability to keep their personal problems private and to themselves ANS: D

Feedback: People who provide health care services must have the ability to keep their personal problems and concerns to themselves. This is not, however, the same as emotional disengagement. Health care does not normally involve telling people ―what is best for them.‖ The provision of health care often involves discomfort or pain on the part of the client or the client, but this is not an essential characteristic of all health care providers.

PTS: 1 OBJ: 1 TOP: Chapter 8

DIF: Moderate REF: p. 161, Personal Qualities of Health Care Workers NAT: Client Needs: Psychosocial Integrity KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

NOT: Multiple Choice 3. A licensed practical/vocational nurse was working on a busy medical–surgical nursing unit

and saw a charge nurse violate principles of sterile technique. The licensed practical/vocational nurse approached the charge nurse privately about the matter, and the charge nurse stated that he or she was in charge, and he or she would perform the procedure the way he or she wanted. What action should the licensed practical/vocational nurse take?

A. Do nothing because the charge nurse is his or her supervisor, and if he or she says anything he or she may be assigned a heavy client load.

B. Follow the chain of command in the organization, and contact the next person over the charge nurse about the matter.

C. Tell the registered nurse (RN) on his or her team and get help on what to do in this situation because he or she can trust the RN. D. Tell the physician caring for the client, so he or she can do something about the situation before his or her client ends up with a hospital-acquired infection.

ANS: B

Feedback: An organizational chart is a graphical portrayal of individuals‘ areas of responsibility and the relationships of accountability that exist between the individuals. It is best to always follow the chain of command in situations warranting action required by the administration of the institution. The licensed practical/vocational nurse appropriately began by having a crucial conversation with the charge nurse about the situation witnessed. Since the charge nurse was not going to take ownership for the care he or she delivered, the licensed practical/vocational nurse should go to the person in charge over that individual to discuss what was witnessed and what the charge nurse had stated. Doing nothing potentiates harm for clients and creates a bullying situation at work. Telling the RN or the physician avoids taking personal action as a client advocate to remedy the situation, which is potentially harmful to the client.

PTS: 1 DIF: Moderate REF: p. 162, Health Care Networks and Systems OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A nurse is acting in a case manager role. In this role, the nurse is participating in the care of a

client who has been diagnosed with colorectal cancer and who will receive chemotherapy before having surgery. What aspect of this client‘s care will most likely be performed by this nurse?

A. Organizing the client‘s care to minimize cost and maximize benefit.

B. Ensuring that the client‘s psychosocial and spiritual needs are met during this difficult time.

C. Performing dressing (bandage) changes after the client has surgery.

D. Teaching other nurses how to safely handle and administer chemotherapy drugs.

ANS: A

Feedback: The case manager‘s job is to monitor a client‘s health care in an effort to provide safe and effective care and at the same time contain costs. Dressing changes, nurse education, and spiritual care are not normally performed by case managers.

PTS: 1

DIF:

Difficult

REF: p. 166, Members of the Health Care Team

OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A nurse practitioner (NP) is a registered nurse who has advanced education in a specialty.

Which aspect of nursing care is exclusive to the NP role?

A. Ordering medications and diagnostic tests B. Meeting the psychosocial needs of clients and families in crisis C. Initiating and maintaining intravenous (IV) access D. Performing care of surgical incisions and traumatic wounds ANS: A

Feedback: In all 50 states, NPs are permitted to write prescriptions for certain medications and diagnostic tests. All nurses may meet the psychosocial needs of clients and families, and nurses with appropriate education may manage IV access and perform wound care.

PTS: 1 DIF: Moderate REF: p. 166, Members of the Health Care Team OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 6. A 76-year-old client is being treated in hospital for pneumonia and his or her discharge

planning is in progress. The client had been living with his or her son and daughter-in-law, but they have expressed to the care team that this will no longer be the case. The client, however, is unable to live independently due to a number of chronic health problems. What member of the care team would be most able to assist the client with organizing his or her living situation?

A. Social worker B. Psychologist C. Registered nurse (RN) D. Physical therapist (PT) ANS: A

Feedback: A social worker helps clients and their families adjust to personal problems. A psychologist specializes in diagnosis, treatment, and counseling of clients with mental, emotional, or emotionally caused physical problems. RNs do not normally organize living arrangements, and PTs specialize in physical functioning.

PTS: 1 DIF: Moderate REF: p. 166, Members of the Health Care Team OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 8 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 7. Since being admitted to the hospital with a stroke, a client has received direct and indirect care

from dozens of members of the health care team. What member of the team completed the most postsecondary education?

A. Laboratory technologist B. Dietitian C. Electrocardiograph technician D. Pathologist

ANS: D

Feedback: A pathologist is a licensed physician who specializes in the nature and causes of disease. Consequently, he or she has completed 4 years of college, 4 years of medical school, and a medical residency lasting 3–6 years. Dietetics is a 4-year university degree, and laboratory technologists and electrocardiograph technicians complete shorter courses of education.

PTS: 1 DIF: Moderate REF: p. 166, Members of the Health Care Team OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. A highly experienced licensed practical nurse (LPN) has provided care on an acute medical

unit for several years. A registered nurse (RN) who is new on the unit has asked the LPN to flush a client‘s central venous catheter (CVC), a task that is outside of the LPN‘s scope of practice but one that he or she has often witnessed and feels confident in doing safely. How should the LPN respond to the RN‘s request?

A. Flush the CVC after ensuring the RN is aware of the LPN‘s qualifications and job title.

B. Inform the RN that he or she cannot flush the CVC because it is outside of his or her scope of practice.

C. Flush the CVC this time, but inform the RN that he or she cannot do so under normal circumstances.

D. Ask the RN to observe his or her technique while he or she flushes the CVC. ANS: B

Feedback: Someone with the required skill to do a procedure does not automatically have the right to do it. Because you are personally and legally responsible for what you do at all time, for your own protection and the protection of your client and employer, never perform nursing acts beyond your approved competencies.

PTS: 1 DIF: Difficult REF: p. 168, The Nursing Team OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A licensed practical nurse has recently begun working in a new setting and has been informed

by the unit manager that he or she will be responsible for admitting a client who will soon be arriving on the unit. The nurse is unsure of the specific admission process that is used on the unit and was not responsible for admissions in his or her previous nursing role. How should the nurse respond to the manager‘s directive?

A. Perform the admission to the best of his or her ability since it is within his or her scope of practice.

B. Inform the client that he or she is doing an admission for the first time before performing the task.

C. Delegate the task to an unlicensed care provider who has more experience on the unit.

D. Ask the manager for further teaching and training about the admission process on

the unit.

ANS: D

Feedback: Education should not be confused with competence. A job title or assignment to perform a specific task does not necessarily qualify that person to do it, and it is appropriate to ask for more teaching before performing an unfamiliar task. It would be inappropriate to proceed without further teaching. This task may not be delegated to unlicensed care personnel.

PTS: 1 DIF: Difficult REF: p. 168, The Nursing Team OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 10. Numerous job opportunities exist for licensed practical/vocational nurses (LP/VNs) who have

skills and interests outside of providing direct client care. Which nursing role is most likely to be open to an experienced LP/VN? A. Clinical nurse specialist (CNS) B. Nurse manager C. Team leader D. Nurse practitioner (NP) ANS: C

Feedback: NP‘s, CNS‘s, and nurse managers are normally registered nurses. However, experienced LP/VNs frequently work as team leaders in long-term care facilities.

PTS: 1 DIF: Moderate REF: p. 169, Team Leaders OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A licensed practical nurse (LPN) has recently graduated from nursing school, passed the

NCLEX-PN, and secured employment at a long-term care facility. At the facility, the nurse will be providing care along with several unlicensed assistive personnel (UAPs). Which task may be delegated to UAP by the LPN? A. Any task that a nursing assistant is able to perform B. Any tasks requiring minimal amount of training C. Only tasks that do not involve direct client care D. Only tasks that the UAP is capable to safely perform ANS: D

Feedback: Unlicensed assistive personnel (UAP) are those who are taught to perform specific tasks associated with client care and who work under the supervision of a nurse. They do not have the same level of training that the nursing assistant has, and they did not pass a state test, so they cannot perform all of the tasks that the nursing assistant can. Because of the minimal amount of training for client-related tasks, the nurse must make sure the UAP is capable of performing the task safely before delegating it.

PTS: 1 DIF: Moderate REF: p. 171, Unlicensed Assistive Personnel OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care

TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A licensed practical/vocational nurse is caring for a client with end-stage lung cancer. The

client is tired of receiving palliative care (providing comfort by relieving symptoms, but no hope for cure or to prolong life) along with chemotherapy and radiation treatments. The client states a desire to die peacefully in his or her home with his or her family. The client‘s multidisciplinary team consists of the licensed practical/vocational nurse, a registered nurse clinical specialist in oncology, and a pulmonologist, an oncologist, a respiratory care practitioner, a psychologist, and a social worker. To best care for the client, the licensed practical/vocational nurse should call: A. for a team meeting to discuss the client‘s request and to best determine what team members and resources are needed to meet the client‘s request.

B. the psychologist to discuss that the client is exhibiting symptoms of depression, and ask for recommendations.

C. hospice so their multidisciplinary team may meet the client‘s requests with a hospice nurse, hospice physician, social worker, and clergy.

D. the oncologist to discuss the client‘s request and ask for a ―do not resuscitate‖ status and discharge the client to his or her home.

ANS: A

Feedback: Multidisciplinary teams are made up of health care workers with different areas of expertise all working together to benefit the client. In this case, the client no longer wants palliative chemotherapy and radiation measures but wants to die peaceably at home with his or her family, so with this change in care needs, a multidisciplinary team meeting is appropriate, so the team may work together to provide the best comfort for the client in his or her home. The client exhibits no signs or symptoms of depression, so calling the psychologist is inappropriate. Calling the oncologist for discharge orders and ―do not resuscitate‖ order leaves out the input from the other team members. The oncologist would most likely call the team meeting. The nurse should not supersede the existing team to call another multidisciplinary team to take over the client‘s care.

PTS: 1 DIF: Moderate REF: p. 172, Patient-Centered Team-Based Care OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A licensed vocational nurse (LVN) provides care on an inpatient hospital unit that has a

census of 27 beds. The LVN works together with a registered nurse and a nurse‘s aide to provide care for nine of the clients on the unit, and two similar groups of care providers are responsible for the remaining 18 clients on the unit. What model of nursing care is utilized on this unit?

A. Team nursing B. Primary nursing C. Total client care D. Case method ANS: A

Feedback: In team nursing, the large client unit is divided into smaller units with team members working together. Each member performs the duties for which they are best prepared. In primary nursing, a professional nurse has total responsibility for a particular client or group of clients, 24 hours a day, 7 days a week. In total client care, one RN or LP/VN is assigned to provide all of the care a client needs. In the case method, the nurse is responsible for the entire care of one or more clients for one shift in a 24-hour period.

PTS: 1 DIF: Difficult REF: p. 174, Team Nursing OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. The care of the many residents of a large, long-term care facility is organized according to the

functional nursing model. The use of this nursing delivery model has what consequence for residents?

A. Each resident is able to develop a close relationship with one particular care provider.

B. Residents can be confident that every care provider is being held accountable by his or her peers.

C. Residents experience efficient, but fragmented, care because of the large number of people who care for them.

D. Residents must choose what activities they require assistance with on a daily basis.

ANS: C

Feedback: Functional nursing is sometimes efficient, but it is a fragmented approach to client care. Clients often have a difficult time establishing a relationship with the nursing staff because so many members of the staff provide for their care. Clients are not obliged to identify their needs daily, and accountability may or may not exist.

PTS: 1 DIF: Difficult REF: p. 173, Functional Nursing OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. Hospital administration is considering a fundamental reorganization of the way that nursing

care is provided in the medical–surgical units. The administration would like to provide more people to care for the clients‘ every need. To do this, the administration plans to decrease registered nurses (RN) and replace them with more unlicensed assistive personnel (UAP) and fewer licensed practical nurses (LPN). Which of the following is the most important consideration to base a decision regarding reorganization for nursing care delivery?

A. Cost analysis supports the change providing more profit for the hospital, a decrease in costs to clients and insurers, and a potential for increased market because of an increase in client satisfaction.

B. Previous research studies support that a decrease in licensed professional nurses at the bedside increase rates of mortality, increase hospital-acquired infections and complications, and increase the rate of medication and procedural errors.

C. A consumer poll of clients and families support providing more persons at the bedside to care for them when they are hospitalized; clients and families expressed that they would feel safer when more people cared for their every need.

D. A risk-to-benefit analysis supports a trial of the reorganization based upon the gain

of profits versus the potential loss in any potential for lawsuits or mishaps of not identifying an unstable client in time and transferring the client to a critical care unit.

ANS: B

Feedback: The most important consideration should be client safety, which research suggests that a decrease in licensed professional nurses at the bedside result in an unsafe client environment. UAPs receive minimal training and need close supervision by licensed nurses.

Costs analysis examines profits, and human lives should always be placed above money. A consumer poll may have asked biased questions that did not explain the motives for the consumer research, and the desires of consumers should not outweigh a potential for unsafe practice. The risk benefit analysis examines financial losses and profit benefits. In its consideration of causes for potential losses were safety-related issues, which should be a red flag for the stakeholders considering adopting such a nursing delivery system.

PTS: 1 DIF: Moderate REF: p. 174, The Changing Roles of Nurses in Health Care OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A new graduate licensed practical/vocational nurse has recently begun working in a new

nursing home and has been informed by the manager that he or she will be responsible to care for clients requiring mechanical ventilation. The nurse has never cared for a client requiring mechanical ventilation, but did learn how to suction a trachea, and read about caring for a client requiring mechanical ventilation. What should the nurse do in this situation?

A. Care for the clients because it is an expectation of his or her job, and he or she has a license allowing him or her to care for the clients.

B. Watch other nurses caring for clients requiring mechanical ventilation to get an idea of how to care for the clients before caring for his or her clients.

C. Ask the respiratory therapist to show his or her how the mechanical ventilator works before caring for the clients assigned, and enroll into classes to learn about caring for clients requiring mechanical ventilation.

D. Ask the manager for further teaching and training about caring for clients requiring mechanical ventilation and admit that he or she has never cared for a client needing such care.

ANS: D

Feedback: The nurse should always place the safety of his or her clients as a first priority. She needs to communicate to the nurse manager that he or she has not cared for clients requiring mechanical ventilation. The manager can help him or her get the training he or she needs to gain competence before caring for the clients requiring mechanical ventilation. A license and education do not equate to competency, and there is not a single nurse that knows all and can do all. Trying to care for clients requiring mechanical ventilation while trying to learn how to do so is not safe practice.

PTS: 1 DIF: Moderate REF: p. 168, The Nursing Team OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process)

BLM: Cognitive Level: Apply

NOT: Multiple Choice

17. A licensed practical/vocational nurse has a cochlear implant and was instructed to not go

inside or around magnetic resonance imaging (MRI). While working for an agency at a local hospital, the nurse was assigned a client on a telemetry monitor who developed neurologic symptoms and needed an MRI. The telemetry unit required the nurse to stay with the client during diagnostic testing to monitor the electrocardiogram and provide emergency interventions, if needed. The best action the nurse should take is to: A. inform the charge nurse that he or she has a cochlear implant, and ask if there is someone that can stay with the client during the MRI. B. ask the MRI technician to turn off the magnetic field, so he or she can accompany the client into the MRI, and where he or she can stay while the client is being tested.

C. ask an unlicensed care provider to accompany the client to the MRI since he or she has a cochlear implant and cannot be around the MRI. D. ask the client‘s family to accompany the client into the MRI while he or she stays in the waiting room, so the nurse can accompany the client to the MRI. ANS: A

Feedback: The best action for the nurse to take considering the fact that he or she has a cochlear implant and cannot go inside or near the MRI is to inform the charge nurse. The charge nurse will find the best individual to accompany the client throughout the MRI. The instructions before taking a client inside of an MRI is to remove all metal objects and the oxygen tank since the magnetic will attract the objects, so it is not the best action, and asking the technician the question only delays the charge nurse to find a licensed individual to accompany the client. It is inappropriate to ask an unlicensed individual or the family to stay with the client because they are not trained on emergency procedures, if such a need should arise.

PTS: 1 DIF: Moderate REF: p. 168, The Nursing Team OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A licensed practical/vocational nurse who is in his or her second year of an Associate Degree

in Nursing on a path to become a registered nurse has recently begun working in an oncology unit and has been assigned by the RN on his or her team to access the client‘s port-a-cath and administer intravenous chemotherapy. The RN had attended the same nursing school to become an RN and knew that the licensed practical/vocational nurse was taught how to access a port-a-cath and had learned about chemotherapy. How should the nurse respond to the RN‘s directive?

A. Perform the assigned task and administer the medication to the best of his or her ability since it is within his or her recent training.

B. Perform the assigned task and administer the medication with the RN present and have the RN chart the task.

C. Inform the RN that he or she is only going to perform the task and administer the medication because the RN delegated it.

D. Inform the RN that although he or she has the training, the task is not covered by his or her current license.

ANS: D

Feedback: The RN delegated an inappropriate task for the licensed practical/vocational nurse (LPN/LVN) since the task is not covered by the LPN/LVN license. It is the responsibility of both the person delegating the task and the person receiving the delegation to determine if the task is appropriate or not and to communicate with each other if there is a discrepancy. While attending the registered nurse program, the LPN/LVN may not perform the duties of the licensed RN. It is not appropriate for the LPN/LVN to perform the task and administer the medication in the presence of the RN and have the RN chart it, such an action jeopardizes both licensed individuals. Most of all, such actions would risk the safety of the client.

PTS: 1 DIF: Moderate REF: p. 168, The Nursing Team OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A new graduate licensed practical/vocational nurse is working in a rehabilitation center and is

caring for an older adult client who is recovering from a stroke. The health care team consists of the licensed practical/vocational nurse, a clinical nurse specialist in geriatrics, a social worker, a physical therapist, occupational therapist, a speech pathologist, a psychologist, and a rehabilitation physician. The nurse notes that the client stated he or she feels a little blue and wanted the drapes pulled and to be left alone. The client refuses to participate in rehab activities today. The client‘s family shared that they are worried about the costs of the rehab because the Medicare limit has been met. Which action is best?

A. Contact the rehab physician about the recent changes and receive orders to help the client with his or her problems.

B. Discuss all of the findings during the daily rounds with the entire team for a multidisciplinary approach.

C. Discuss the financial concerns that the family has with the social worker, so the client and family can focus on rehab.

D. Discuss the findings with the clinical nurse specialist and the psychologist because the client is exhibiting signs of depression, and intervention is needed right away.

ANS: B

Feedback: The main purpose of a multidisciplinary health care team is to provide the client with the best possible care using a team approach, so daily rounds are a means to discuss assessment findings and explore the best interventions to provide. The team meeting is the most efficient way to tackle any problems. The client is exhibiting symptoms of depression, which is common after a stroke, or a chronic illness, but there is no immediate threat of suicide present, so contacting the psychologist and clinical nurse specialist for immediate measures is not necessary.

PTS: 1 DIF: Difficult REF: p. 160, The Health Care Team OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

20. A licensed practical nurse (LPN) has recently begun working in a nursing home that uses the

functional nursing model. The nurse recognizes that each part of the nursing team has a specific function or task to complete. The LPN was assigned to change all of the dressings on the wing. While caring for a client requiring a large wet-to-dry dressing change to debride the infected wound, the LPN noted that the client was screaming in pain when he or she removed the old dressing, and the wound looked worse than it did the other day. Which actions should the LPN provide next?

A. Complete the dressing, chart the findings, and go on to change the next client‘s dressing.

B. Provide the pain medication and then change the dressing, and chart the findings.

C. Ask the medication nurse to provide pain medication before completing the dressing.

D. Report the findings to the physician and change the dressing and document.

ANS: C

Feedback: Functional nursing needs the team members to communicate with each other, in order to provide the best possible quality of care for the client. Since the client is exhibiting pain, the LPN functioning as the wound dressing nurse needs to ask the medication nurse to medicate the client before continuing with the dressing. Usually the medication nurse is the only one that has access to medications. Any combination of actions—completing the dressing, charting the findings, reporting the findings to the physician, and going on to the next client—that ignores the client‘s pain should not be the next actions. These actions also may further fragment the care being delivered.

PTS: 1 DIF: Moderate REF: p. 172, Nursing Care Delivery Models OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 9, Theory, Culture, and Diversity in Nursing Care 1. The licensed practical/vocational nurse is caring for a client from China who is admitted to the

hospital with a respiratory infection. The client told the nurse about wanting to follow principles of Yin and Yang to help in the healing process. The nurse recognizes that there are cultural differences and should: A. accept the client‘s deep-rooted values and beliefs, and ask the client if there is a specific treatment or healer he or she would like to use.

B. inform the client that the nurse must provide only what the physician prescribes.

C. accept that the client is different, but ask the client to try American treatment ways.

D. provide treatments from the client‘s culture as long as they do not interfere with the one‘s ordered by the physician.

ANS: A

Feedback: Cultural practices stem from values and beliefs. The nurse should accept the client‘s cultural beliefs and practices and ask what specific treatments or if the client has a healer he or she would want to help to provide the Yin and Yang. The nurse does not respect the client‘s culture by informing the client about having to receive only what the physician orders. If the nurse states acceptance of the client‘s differences but asks the client to try American treatments, this provides the message that the other culture is not as good as the American culture. The nurse should inform the physician about the client‘s request, so the physician may talk with the client and provide treatments that do not interfere with cultural-based remedies.

PTS: 1 DIF: Moderate REF: p. 187, Cultural Characteristics OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 2. The licensed practical/vocational nurse is caring for a client. The client asks the nurse if the

window in the room is facing east. The client wants to clear furniture from the room and place a mat in front of an eastern window. The client also noted the desire to avoid eating pork. The nurse wants to provide adequate ethnic care. What should the nurse tell the client?

A. The client can place the mat against the wall since it faces east and that the dietician will be notified that the client does not want any pork.

B. The furnishings have to stay, but the client can place the mat on the bed facing the east, and the dietician will talk with the client.

C. The nurse will secure a room with an eastern window and create the environment needed to respect the client‘s religious, cultural beliefs, and diet needs.

D. The client is too ill to get out of bed on one‘s own, so the client can pray toward the East once better, and the dietary team will stop any pork from being served.

ANS: C

Feedback: Ethnic identity is largely a consequence of race, religion, language, and nationality.

The nurse should respect requests that the client makes based upon the ethnic background. In this case, the nurse should secure a room with an eastern window, create an environment to provide privacy for prayer times, and the nurse should notify the dietary team that the client requests no pork. Choices A and B do not follow the specific instructions the client has made in order to meet ethnic needs. Answer D is incorrect because the nurse could help the client achieve a prayer stance or a modified one upon the client‘s instructions.

PTS: 1 DIF: Moderate REF: p. 191, Ethnic Characteristics OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 3. To accept and respect differences in others, one must first: A. identify those differences.

B. know people with many differences.

C. study differences among people.

D. understand oneself.

ANS: D

Feedback: Research verifies that understanding oneself is the first step in being able to understand others. Identifying differences does not result in respecting differences, and knowing people with differences does not result in respecting them. Studying differences does not necessarily lead to accepting differences.

PTS: 1 DIF: Moderate REF: p. 188, Assess Yourself: How do you Relate to Various Groups of People in the Society?

OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A cultural assessment should be done: A. on every client to whom the nurse is assigned.

B. before developing a nursing care plan.

C. when the client‘s beliefs may impact care.

D. when the client is from another country.

ANS: C

Feedback: Nurses must find ways to elicit the client‘s participation in his or her care. It is impractical to assess every client‘s culture, and a client might be from another country but not from another culture.

PTS: 1 DIF: Moderate REF: p. 198, Cultural Assessment OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 5. The nurse finds that a client does not speak the dominant language. The client is quietly

crying in bed. What should the nurse do first?

A. Find an interpreter.

B. Notify the supervisor.

C. Gently touch the client‘s shoulder.

D. Ask the client why he or she is crying.

ANS: C

Feedback: Because much of human communication is nonverbal, the nurse can provide reassurance and comfort without speaking. A smile and a gentle touch will go a long way toward comforting those who do not understand the same spoken language. An interpreter may not be necessary, and the nurse should not walk away. Asking a question in a language a client does not understand would only be more upsetting.

PTS: 1 DIF: Moderate REF: p. 191, Language OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The nurse goes to the client‘s room to give morning care. The client is reading a Bible. What

should the nurse do?

A. Ask the client what religion he or she practices.

B. Ask the client if the nurse should come back in 15 minutes.

C. Tell the client that morning care will only take a few minutes and then the client can return to reading.

D. Leave the toilet articles on the table for the client to use later.

ANS: B

Feedback: Asking about the client‘s religious practices is not relevant. Asking if the client wants the nurse to come back in 15 minutes indicates acceptance of a client‘s religious practice. Pushing through to complete the required care is incorrect and indicates a lack of respect for the client‘s religious practice. Leaving the toilet articles on the table for the client to use later would probably be disruptive to the client‘s reading.

PTS: 1 DIF: Moderate REF: p. 193, Religion OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 7. The licensed practical/vocational nurse is caring for a client. The client is in a large private

room and requests that the family and church community join the client providing prayer, food, and fellowship. The nurse wants to provide adequate transcultural care. What should the nurse do?

A. Incorporate all aspects of the person‘s culture in planning and providing care.

B. Remove any foods or remedies that may conflict with current prescribed treatments.

C. Avoid anything that conflicts with the nurse‘s values, beliefs, or customs.

D. Help the client understand the importance of following all of the health care provider‘s orders.

ANS: A

Feedback: The phrase transcultural nursing is used to describe nursing care that incorporates all aspects of a client‘s culture in planning and providing care. The nurse should not avoid anything that conflicts with his/her beliefs, values, or customs because the emphasis is on client-centered care. The primary goal of transcultural nursing is not compliance with treatment.

PTS: 1 OBJ: 3

DIF: Moderate REF: p. 185, Transcultural Nursing NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 8. How can the nurse best demonstrate respect for a client‘s ethnic practices?

A. Asking the client to describe his or her ethnic practices B. Arranging the environment to accommodate his or her ethnic practices C. Completing an ethnic assessment D. Introducing the client to another client who has a similar ethnic background ANS: B

Feedback: Respect is demonstrated by providing an environment in which practices are accommodated and supported. Assessment, introductions to other clients, and asking the client to describe practices do not necessarily demonstrate respect.

PTS: 1 DIF: Moderate REF: p. 191, Ethnic Characteristics OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 9. An unmarried pregnant adolescent asks the nurse for advice on what she should do about the

pregnancy. How should the nurse respond?

A. Suggest abortion or adoption.

B. Ask the client what the family wants her to do about the pregnancy.

C. Ask the client what she wants to do about the pregnancy.

D. Ask the client if she would like to talk to a counselor.

ANS: D

Feedback: The nurse should recognize that he or she does not have the specialized training of a counselor. A counselor has specialized training to help clients examine all options.

PTS: 1 DIF: Moderate REF: p. 201, The Patient Who Is a Single Parent OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 10. Immediately after the death of a client, family members should be: A. escorted to a private area.

B. allowed to spend time with the deceased.

C. asked what they want to do.

D. consoled by the hospital chaplain.

ANS: C

Feedback: Escorting family members to a private area, allowing family to spend time with the deceased, and consoling by the chaplain are all possibilities, but asking the family what they want to do is the best answer. Asking people what they want shows consideration of their needs and respect for individual responses to death.

PTS: 1 DIF: Moderate REF: p. 198, Views on Death and Mourning OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice

11. A licensed practical nurse performs many tasks and functions in the course of his or her job.

Which aspects of nursing reflects Dorothy Orem theory of nursing? Select all that apply.

A. The nurse identifies a client‘s stressors and provides interventions to decrease or eliminate the stress level.

B. The nurse provides total care for the client who is comatose since the client cannot meet all of his or her needs.

C. The nurse provides care to compensate for the client‘s limitations—the client can bathe everything except his or her back and legs, so the nurse bathes those parts.

D. The nurse teaches the client with diabetes how to monitor his or her blood sugars, and use a sliding scale to adjust the amount of insulin and self-administer the insulin.

E. The nurse provides a diet for the client with diabetes who is struggling with monitoring blood sugar levels.

ANS: B, C, D

Feedback: Orem theory says that the nurse helps clients meet self-care deficits. Providing total care for the client who is comatose demonstrates wholly compensatory care. Helping the client bathe by assisting with body parts the client cannot perform oneself demonstrates compensatory care. Teaching a client to monitor blood sugar levels demonstrates supportive–educative care. Identifying stressors and providing interventions to decrease or eliminate them as well as providing a diet for the client perform the actions for a client that can perform some actions oneself.

PTS: 1 DIF: Moderate REF: p. 182, Orem OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Selection 12. A nursing student has been learning how to apply the nursing process in clinical situations.

This morning, the student has just completed a head-to-toe assessment of a client who has a complex medical history. What is the next step in the student‘s application of the nursing process?

A. Perform another assessment to identify changes from the previous assessment.

B. Teach the client how he or she can best maintain health.

C. Perform interventions that best meet the client‘s needs.

D. Identify nursing diagnoses that apply to the client.

ANS: D

Feedback: The formulation of nursing diagnoses follows assessment in the nursing process.

The student would not repeat an assessment, or perform interventions, or education before formulating nursing diagnoses.

PTS: 1 DIF: Moderate REF: p. 183, Nursing Process OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

13. A licensed practical/vocational nurse is caring for a mother and newborn boy at a hospital.

The mother and father stated they will not name the child until the boy is 8 days old. The couple wants their rabbi to perform the circumcision. The hospital‘s policy demands that the birth certificate is filed with the state birth registry. What action should the nurse take?

A. Respect the rights of the parents and inform the couple that they can complete a supplemental name report after the couple has met with the rabbi and decided upon a name, and send it to the state birth registry.

B. Ask the couple to provide a name for the baby before they leave the hospital so that the birth certificate may be registered.

C. Ask the couple to talk with their rabbi and find out what the name will be, so the birth certificate may be filed with the state birth registry.

D. Respect the rights of the couple and give them all of the paperwork to file on their own whenever they have chosen a name.

ANS: A

Feedback: It is important to respect the cultural and religious rights of your clients and their family. The nurse should register the live birth with the state according to hospital policy, but the couple may file a supplemental name report, which they may send directly to the state birth registry to update the birth certificate. The state registry will have vital information of the date, time of the live birth, gender of the infant, race, birth weight and height, names of parents and their addresses, etc. Asking the couple to provide a name for the baby before they leave the hospital and asking the couple to talk with their rabbi and find out what the name will be do not respect the couple‘s religious beliefs as to the process that the infant son receives his name. Giving the couple paperwork to file on their own whenever they have chosen a name is against hospital and state birth registry policy.

PTS: 1 DIF: Moderate REF: p. 193, Religion OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 14. The licensed practical/vocational nurse is caring for a client at the end stages of terminal

cancer. Which is the best way to involve the family with the client‘s care?

A. Encourage the family to take time away from the dying loved one to make funeral arrangements.

B. Encourage the family to leave the loved one to call any relatives or friends to visit.

C. Involve the family in providing comfort measures for the loved one.

D. Provide information about the dying process, so the family may read it and ask any questions they may have.

ANS: C

Feedback: The best way to involve the family of a dying client is to involve them with providing comfort measures. This will help the family to feel like they helped their loved one achieve a peaceful death. It provides an active role for the family to show their respect for the individual. The funeral arrangements can wait because it is more important for the family to visit their loved one while the client is still alive. The family does not have to leave the bedside to make phone calls for any relatives or friends that have not been notified; they may use a cell phone or the phone in the room. Providing information about the dying process and then offering to answer any questions that the family have does not actively get the family involved with care for the dying client.

PTS: 1 DIF: Easy REF: p. 205, The Patient Who Is Dying OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A middle-aged man has just died in a motorcycle accident and his wife has been informed by

the care team. According to Dr. Elizabeth Kübler-Ross, what is the first stage of grief that the client‘s wife will likely experience?

A. Depression B. Acceptance C. Denial D. Rage ANS: C

Feedback: Kübler-Ross‘ stages of grief are denial, anger, bargaining, depression, and acceptance.

PTS: 1 DIF: Moderate REF: p. 205, The Patient Who Is Dying OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 9 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 16. During a clinical rotation, the nursing student was caring for a client from China. The client

was 1-day postoperative after abdominal surgery. The client silently grimaced while moving but smiled and was ready to complete anything the student asked. What should the nurse do next?

A. Ask the client if he or she is experiencing pain and complete a pain assessment.

B. Find out when the client last received pain medication.

C. Continue with daily activities because the client‘s culture refuses pain medications.

D. Provide alternative means of pain relief, which are acceptable to the client‘s culture.

ANS: A

Feedback: People from various cultures express pain differently. The client is showing nonverbal signs of pain: grimacing with movement. The nurse should assess if the client is experiencing pain and complete the pain assessment. Assessment is always the first step in the nursing process. The nurse after completing the assessment should check the medical record to determine the last time the client received pain medication, or if he or she refused it.

Answers C and D are incorrect because the nurse is assuming that the client will act according to stereotypes the nurse may have learned about the client‘s culture—that the client is stoic and will refuse pain medications but may accept alternative means for pain relief, such as acupuncture. Often times, the nurse never communicated to the client that the physician had ordered pain medication, and it is best to take it on a schedule right after surgery so that the medication will maintain a steady state and will be effective.

PTS: 1 DIF: Moderate REF: p. 197, Views on Pain OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

17. The licensed practical/vocational nurse is caring for a group of clients. The nurse applies

multiple nursing theories when delivering nursing care to a group of clients seen in the clinic.

Which is an example of applying Betty Neuman‘s health systems model?

A. The nurse cleanses a client‘s wound with soap and water and provides a clean dressing so nature can heal the wound.

B. The nurse demonstrates how to perform self-care and evaluates client‘s ability to self-administer a medication.

C. The nurse provides hepatitis B immune globulin (HBIG) to a client exposed to hepatitis B within 24 hours to prevent the client from acquiring the infection.

D. The nurse assists a client to transfer from his or her wheelchair to the exam table and back.

ANS: C

Feedback: The nurse using Betty Neuman‘s model identifies stressors in the client‘s environment and provides interventions to reduce or eliminate them. The example of providing HBIG to prevent the client from acquiring hepatitis B is such an example. Cleaning the wound and providing a clean dressing is an example of applying Florence Nightingale‘s theory. Demonstrating how to perform self-care and evaluating the client‘s ability to self-administer medication is an example of the nurse using Orem‘s self-care model of nursing. Assisting a client to transfer from the wheelchair is an example of applying Virginia Henderson‘s model of nursing of assisting the client to reach the potential of doing as much as possible independently.

PTS: 1 DIF: Moderate REF: p. 182, Neuman OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. A nursing student is caring for a client admitted with pneumonia. The client believes that

when the person is sick, the family cares for their every need. The client also believes that once the person feels better, then the person will push the family away and begin caring for self. When the student is planning the care, which intervention is appropriate?

A. Provide all basic care needs until the client is ready to perform tasks.

B. Involve the family with basic care needs of client.

C. Instruct the client on the importance to participate actively with basic care.

D. Instruct the family on how to administer the medications.

ANS: B

Feedback: With transcultural nursing, it is important to respect the culture of the client and provide client-centered interventions. The appropriate intervention is to involve the family with the basic care needs of the client. Once the client feels better, the client will push away the family‘s help and take on a more active role. Answer A is inappropriate because the nurse is providing all the basic care needs and leaving the family out, which goes against the client‘s cultural care needs. Answer C goes against the client‘s cultural needs by insisting that the client take an active role in care while the client perceives self as sick and unable. Answer D is inappropriate because the nurse needs to administer medications and observe for any side effects and provide appropriate interventions accordingly. Providing medications is not part of basic care.

PTS: 1

DIF:

Moderate

REF: p. 183, Nursing Process

OBJ: 3 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A licensed practical/vocational nurse is caring for a client who has cervical cancer and needs a

hysterectomy to improve her chance to survive the cancer. The client does not speak the dominant language, but the adult child is in the room does. The nurse needs to obtain an informed consent for surgery. What should the nurse do?

A. Acquire a same sex interpreter who is not a family member to discuss the surgery and obtain the informed consent.

B. Use the adult child as an interpreter to discuss the surgery and obtain the informed consent.

C. Wait until the spouse who also speaks the dominant language arrives to discuss the surgery and obtain the informed consent for surgery.

D. Have an opposite sex nurse who speaks the client‘s language discuss the surgery and obtain the informed consent.

ANS: A

Feedback: The nurse applying principles of transcultural nursing must respect the client‘s culture by providing a same sex interpreter who is unrelated to the client because the client may not feel comfortable discussing matters that can result in sterility with her family and especially the opposite sex. Based upon these principles, the other three choices are inappropriate to use and could result in the client not accepting the surgery that could save her life.

PTS: 1 DIF: Moderate REF: p. 191, Language OBJ: 3 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The licensed practical/vocational nurse is caring for a client who is of the Mormon faith. The

unlicensed assistive personnel (UAP) is providing delegated interventions. The nurse should intervene if the UAP: A. makes the client‘s bed while the nurse is walking in the hall.

B. knocks on the client‘s door before bringing the lunch tray.

C. enters the client‘s room to take vital signs when the two elders from the church are visiting.

D. reports to the nurse the finger stick blood sugar results.

ANS: C

Feedback: The nurse should intervene when seeing the UAP enters the client‘s room to take vital signs when the two elders are from the church because the client needs privacy during these visits. The nurse needs to privately talk to the NA and emphasize that the NA knock on a client‘s door and gain permission before entering, so that if the client is having a visit from her church, or wants privacy that the client‘s rights are not violated. The other listed interventions are acceptable actions for the NA to perform.

PTS: 1 DIF: Moderate REF: p. 196, Other Religions OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 9 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process)

BLM: Cognitive Level: Apply

NOT: Multiple Choice

Chapter 10, Ethical Issues in Health Care 1. The nursing student observed behaviors during clinical rotation. Which behavior reflects the

ethical behavior described by National Federation of Licensed Practical Nurses (NFLPN) and National Association for Practical Nurse Education and Service (NAPNES)?

A. A nursing assistant (NA) wears gloves while cleansing the client‘s perineum, then goes into the hall and after looking both ways picks up additional linens off the cart using gloved hands.

B. A licensed practical/vocational nurse administered the wrong dosage of a medication and assesses the client for harm, reports and records the incident, and reviews proper drug administration.

C. A registered nurse (RN) behind a pulled curtain is performing a sterile procedure but drops a sterile item on the floor, picks it up and uses it during the procedure.

D. An unlicensed assistive personnel (UAP) enters into a client in airborne isolation without the proper protective attire, and then the UAP looks both ways in the hall and enters another client‘s room without first washing the hands.

ANS: B

Feedback: Ethics is the study of what is right and wrong related to human conduct. The licensed practical/vocational nurse demonstrates ethical behavior by showing accountability and taking personal responsibility to do no harm when taking care of the client. The NA chooses to do what is wrong by violating principles of aseptic technique by not first washing hands and by picking off linens off the cart with contaminated gloved hands. The RN violates sterile technique and places the client at risk for an infection. The UAP violates principles of tiered isolation precautions by not wearing proper protective attire and places other clients and self at risk for acquiring the infection.

PTS: 1 DIF: Moderate REF: p. 213, Ethics and Appendix B and Section A of Appendix C OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 2. The licensed practical/vocational nurse is caring for a client who recently became blind from

retinitis pigmentosa (RP), a rare disease. A retina implant is available, which early clinical trials support its safety and ability to return eyesight to once blind individuals, but the Food and Drug Administration (FDA) will not approve its use for all clients, and the physician who invented the implant cannot find financial support to complete all of the expensive clinical trials to gain full FDA approval. The FDA is also reluctant to grant a hardship case, so clients may have the implant. The nurse recognizes this as what type of ethical dilemma and which approach should he or she take?

A. This is a society ethical dilemma, and there are others who need the retina implant on a waiting list across the United States, so the nurse should go to congressional leaders to propose a bill to permit streamlining for hardship cases through the FDA for clients with RP to receive the implant and support for hospitals to allow surgeons to perform the operation.

B. This is an individual ethical dilemma, and the nurse needs to represent just this individual because it will take too long to fight for others in similar circumstances.

The nurse needs to help the client to file a form for a hardship case with the FDA

for the retina implant.

C. This is a situational ethical dilemma, and the nurse needs to weigh treatment

options or training to function being blind for the client and the pros and cons of all situations.

D. This is strictly a legal issue, so the nurse would serve the client best by helping her to secure an attorney that will work pro bono.

ANS: A

Feedback: Determining what is right and what is wrong depends on the individual, the society, and the situation. In this case, it is a society ethical dilemma since it involves numerous Americans across the United States, and the FDA is reluctant to grant any hardship cases, so the client may receive the retina implant, then the nurse using political voice may contact congressional leaders to try to obtain a bill to streamline hardship cases through the FDA, so the woman may receive the implant.

PTS: 1 DIF: Moderate REF: p. 213, Ethics OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 3. How should the licensed practical/vocational nurse (LP/VN) use the NALPN Code of Ethics

to guide nursing practice?

A. Maintain a current license to practice nursing as an LP/VN in every state the nurse cares for clients.

B. Follow the nurse practice acts for every state that the LP/VN provides nursing care to clients.

C. Commit to follow moral obligations of the practice of nursing.

D. Commit to follow standards of practice to protect the safety of clients.

ANS: C

Feedback: The National Association for Licensed Practical Nurses (NALPN) and the National Association for Practical Nurse Education and Service (NAPNES) have each developed a code of ethics for practical/vocational nurses. A code of ethics is a list of rules of good conduct for members of a particular group, and the nurse applies the code of ethics by being committed to follow moral obligations of the practice of nursing. Laws and ethics are different concepts. The nurse practice act and licensure deal with legal concepts. Standards of practice are minimal care guidelines to protect the safety of clients. The ethical principles or moral obligations that guide nursing practice include the conduct of the nurse and the nurse with other health care team members, clients and families, and with society.

PTS: 1 DIF: Moderate REF: p. 214, Nursing and Ethics OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 4. What three guidelines should the nurse follow when deciding on a course of action related to

an ethical dilemma?

A. Discuss the issue with an expert, read research on the subject, and investigate current public laws.

B. Collect the facts, ask yourself what would happen if everyone behaved in this way,

and discuss concerns with an authority.

C. Present the issue to the ethics committee, ask others what they would want in this

situation, and list possible courses of action.

D. Make a list of possible solutions, test the solutions, and revise the decision based

on results.

ANS: B

Feedback: Your first guideline in thinking about a specific ethical dilemma is to collect the facts. The second guideline is to ask yourself what would happen if everyone acted or behaved in the manner in question. If your ethical dilemma is not resolved, a third guideline may provide further direction. In this step, you discuss your concerns with an authority.

PTS: 1 DIF: Difficult REF: p. 216, Ethical Dilemmas OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A licensed practical/vocational nurse was caring for a pregnant client who underwent genetic

testing and was positive for being a carrier of Huntington disease (HD). She has a 50% chance of delivering an infant who will have HD. Symptoms of HD usually don‘t develop until the person is 35 years or older. The woman wanted help reaching a decision. Her religious beliefs forbid abortion. She also knew that her child could suffer a debilitating neurologic disease and die from it. Which demonstrates the nurse‘s use of the first step in the ethical decision-making process?

A. Is it right to end an unborn life because of 50% chance to develop a debilitating disease and die early in life? Is it wrong to end an unborn life because of the risk for HD when the person will have up to 35 years or more of quality life before developing symptoms of HD? Is it wrong to end the unborn life because 50% will not have HD? B. Action A: End the pregnancy. Advantages: Help prevent potential suffering.

Disadvantage: Not allow the person to enjoy several decades of life, or abort an unaffected fetus. Action B: Don‘t end the pregnancy. Advantage: Provide life to unaffected fetus, or up to several decades of life for the affected fetus and potential for a cure to stop the disease.

C. Religious beliefs: sanctity of life; no abortion; Personal values—follow teachings of the church and provide the best quality of life for an individual; Personal moral principles—it is not right to take a life of an unborn child; Laws—not illegal for abortion; Society‘s beliefs—both right to life and right to choose.

D. The situation is genetic testing is not 100% accurate and provided that the mother is positive as a carrier, but the father is not a carrier and does not have HD. The mother has firm beliefs in not aborting the fetus, but also wants what is best for her unborn child‘s future. The mother could receive additional fetus testing to determine if the fetus actually has HD or not to help her make the decision, if she wants.

ANS: C

Feedback: The first step of the ethical decision-making process is understanding the components involved to make the decision, which is included in answer C. Answer A is the description of the dilemma, the third step. Answer B is possible courses of action, the fifth step. Answer D is the description of the situation, the second step.

PTS: 1 DIF: Moderate REF: p. 224, Human Genome Project | p. 219, Box 10-2 OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A licensed practical/vocational nurse has been employed in a hospital short procedure unit for

3 years. The hospital was recently sold, and the new owners have hired a doctor who will be performing outpatient elective abortions. The nurse‘s religious convictions forbid the nurse to be involved in any way in elective abortion procedures. What should the nurse do?

A. Submit a resignation and look for another job.

B. Ask the new owners to cancel plans to offer elective abortions.

C. Conduct information picket lines outside the hospital.

D. Ask for a mediator to intervene in the situation.

ANS: A

Feedback: If your religious convictions forbid the nurse from being involved in any way with abortions, the nurse should look for another job. It is highly unlikely that the new owners will change their philosophy to accommodate your personal beliefs. Picketing is inappropriate, and a mediator is not necessary.

PTS: 1 DIF: Moderate REF: p. 221, Ethical Issues in Nursing OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 7. Which example describes an ethical dilemma for a nurse?

A. Reporting a nurse who you observed putting a medication from a client‘s med

drawer in her pocket B. Reporting a nurse who drank too much alcohol at a retirement party C. Reporting a nurse who casually mentioned in the break room that she forgot to

renew her nursing license D. Reporting a parent who, as a discipline measure, struck her child in a mall ANS: A

Feedback: The dilemma is not knowing what the nurse intends to do with the medication.

Inappropriate behavior at a social function is not a dilemma since the nurse was not on duty.

There is a legal obligation to report the unlicensed nurse. A licensed nurse has a legal obligation to report child abuse regardless of where it occurs.

PTS: 1 DIF: Difficult REF: p. 221, Ethical Issues in Nursing OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

8. The licensed practical/vocational nurse was caring for a client in a nursing home who has

end-stage cancer and recently had a debilitating stroke (brain attack). On several occasions, nurses reported that the client stated he wished he was dead. One night, the client arrested.

The client was a full code. When the licensed practical/vocational nurse found him, she called a code blue. The staff took their time to respond and even longer to call ―911.‖ Which exemplifies the third step in the process of ethical decision-making for this situation?

A. A client is at the end of his life and has verbalized that he wished he was dead.

B. Is a slow code acceptable when the client stated that he wished he was dead, or should he have made the choice known and secured an order for ―do not resuscitate‖ and since he did not, the nurses are bound to resuscitate quickly?

C. Facts: the client has end-stage cancer and a debilitating stroke decreasing quality of life. Hearsay: several occasions the client has stated that he wished he was dead.

Rumors: the man deserves to join his wife in heaven; he has no family left.

Emotional components: the nurses feel they would want to not be resuscitated if they were in the client‘s shoes.

D. Action A: Slow code and call ―911‖ late into the code—client dies; nurses feel guilty because of legal/ethical obligations. Action B: Perform the code quickly and client may live—no change in quality of life; may have ability to secure a ―do not resuscitate‖ order in future. Action C: Perform the code quickly and client may die—client ends poor quality of life.

ANS: B

Feedback: Asking if a slow code is acceptable in this instance exemplifies the third step of the ethical decision-making process. With this process, the first step is to describe the situation, the second step is to describe the dilemma (Answer A), the fourth step is to sort the information (Answer C), the fifth step is to identify (Answer D), and the sixth step is to make a decision. A code blue is not the time to make a decision about an ethical dilemma, so nurses must advocate for clients with their end-of-life decisions and secure the decisions before a code blue happens.

PTS: 1 DIF: Moderate REF: p. 216, Ethical Dilemmas | p. 220, Box 10-3 OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 9. The licensed practical/vocational nurse‘s neighbor and friend stops the nurse as he is walking

in to his house after work. She says she heard that another neighbor across the street was in the hospital where the nurse works with a heart attack and is not doing very well. She asks the nurse if that is true. The nurse knows that the neighbor across the street is in cardiac care and has a poor prognosis. Which is the best response to the friend‘s question?

A. ―I heard he was in the hospital. I‘ll check this out tomorrow.‖ B. ―I don‘t know if he is in the hospital or not. I‘ve just been so busy.‖ C. ―We‘re all good friends and good neighbors and I know he wouldn‘t mind me telling you about his condition.‖ D. ―I‘m sorry but I can‘t share confidential client information.‖ ANS: D

Feedback: The nurse should be honest in providing an answer to the neighbor‘s question. The nurse is prevented by HIPPA laws from disclosing any information to anyone, even when the discussion is between friends. A correct and honest answer includes explaining how laws prevent disclosing information.

PTS: 1 DIF: Difficult REF: p. 216, Ethical Dilemmas, Box 10-1 OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 10. The licensed practical/vocational nurse was working on a neurologic unit. A client with

Parkinson disease (PD) was informed of a new treatment, which required autologous stem cell therapy to increase the levels of dopamine-producing cells to lessen the symptoms of PD. The client and family asked the nurse if this presents an ethical dilemma because they don‘t want to use human fetal stem cells. How should the nurse respond?

A. ―The important thing to consider is participating in this treatment will improve your symptoms.‖ B. ―The term ‗autologous‘ means from the same individual, so the procedure involves using the client‘s stem cells and not cells from a human fetus.‖ C. ―The ethical dilemma you are referring to is whether it is right or wrong to allow science to manipulate genetic tissue in order to improve a person‘s life?‖ D. ―Usually fetal tissue arises from umbilical cord blood, so no unborn babies were destroyed in the process of obtaining stem cells.‖ ANS: B

Feedback: Autologous means that the tissue is taken from and transplanted into the same individual, so it is best that the nurse clarifies the misconception that the tissue will arise from a human fetus with the client and family. Answer A suggests that the client is correct, and there is an ethical dilemma, and it is better to weigh benefits versus risks for the treatment.

Answer C is incorrect because the nurse is trying to determine if the client has another ethical dilemma and ignores the client‘s main concern about using fetal tissue. Answer D is incorrect because it does not go along with the type of tissue being used for the treatment the client was offered.

PTS: 1 DIF: Difficult REF: p. 227, Stem Cell Research OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A nursing student has been learning from his or her clinical and classroom instructors about

the importance of maintaining high ethical standards. Which is the best way to study ethics and learn the importance of ethical behavior before practicing as a licensed nurse?

A. Participating in clinical-based ethical dilemma scenarios or case studies and applying principles of ethics and ethical reasoning B. Visiting a hospital ethics committee and talking to the members about various types of ethical dilemmas they have experienced C. Reading a textbook on ethics in nursing and visiting websites about ethics and professional organizations‘ statements about ethics D. Asking practicing nurses about how they handle ethical dilemmas in the past and

what types of situations they have experienced ANS: A

Feedback: The most effective way to prepare for nursing practice is to apply ethical principles the student has learned to clinical-based ethical dilemmas. The student has a controlled environment to explore different types of clinical situations that the nurse may face once licensed. Through practice, the nurse masters the process to use with new ethical dilemmas that arise. Visiting a hospital ethics committee, reading a textbook, exploring websites about ethics, or interviewing practicing nurses as to how they handled various ethical dilemmas in the past all offer information, which is valuable in the learning process but not as valuable as actually applying what the nurse has read or learned in controlled clinical-based ethical dilemma scenarios or case studies.

PTS: 1 DIF: Moderate REF: p. 214, Nursing and Ethics OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 12. In the management of a difficult situation, two licensed practical nurses have referred to the

code of ethics provided by the National Association for Licensed Practical Nurses (NALPN).

What is the purpose of a code of ethics?

A. To protect nurses from legal problems B. To guide the choices of nursing interventions C. To establish chains of command in hospital settings D. To specify ideal behaviors that nurses should aspire to ANS: D

Feedback: Although laws establish the minimum behaviors of a group, codes of ethics attempt to describe the ideals of that group. They do not exist solely to prevent legal problems, and they do not specify particular interventions. Codes of ethics do not address chains of command.

PTS: 1 DIF: Moderate REF: p. 214, Nursing and Ethics OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 13. During his or her last shift, a nurse realized that he or she made a medication error by

administering a medication to the wrong client. Which of the nurse‘s subsequent actions best demonstrates accountability?

A. Administering the correct medication to the correct client during his o her next shift B. Assessing the client vigilantly after discovering the drug error C. Writing up an incident report and taking action to review correct medication administration D. Reviewing his or her notes on adverse reactions to medications and explaining these to a colleague ANS: C

Feedback: Being held accountable means to accept the consequences of the action and taking action to address these consequences. Performing better in the future does not necessarily indicate accountability. Careful assessment and reviewing notes are important in this situation, but these also do not necessarily indicate accountability.

PTS: 1 DIF: Moderate REF: p. 215, Personal Accountability OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 14. The care team on an acute care unit is facing an ethical dilemma around a client whose family

members do not want the client to learn the results of the latest diagnostic test. What is the first step that the care team should take when addressing this ethical dilemma?

A. Implement the simplest solution and then evaluate the results.

B. Defer the decision to a religious leader from the client‘s culture.

C. Gather all the known facts surrounding the ethical dilemma.

D. Choose the plan of action that has had the most favorable results in the past.

ANS: C

Feedback: Your first guideline in thinking about a specific ethical dilemma is to collect the facts. This should precede any decision, including the decision to defer to another individual.

PTS: 1 DIF: Difficult REF: p. 216, Ethical Dilemmas OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 15. The care providers on an obstetrical unit have been confronted with difficult ethical decisions

around the care of a 16-year-old girl who does not want her parents to know about her pregnancy. Which question could care providers ask themselves when attempting to create an ethical plan of action?

A. ―What would happen if everyone did what we plan to do?‖ B. ―What is in the best interests of this girl‘s parents?‖ C. ―How can we be sure that this plan will work?‖ D. ―What would happen if we took no action?‖ ANS: A

Feedback: When facing difficult ethical situations, the second guideline is to ask yourself what would happen if everyone acted or behaved in the manner in question. Your answer to this question may make the right course of action clear to you. The other given questions may be relevant to a situation, but they are not as applicable to a variety of ethical dilemmas.

PTS: 1 DIF: Moderate REF: p. 216, Ethical Dilemmas OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

16. The licensed practical/vocational nurse administered the premixed intravenous antibiotic on

the wrong client because he or she failed to check the client‘s identification band. The client that he or she administered the antibiotic was allergic to the medication, had a ―do not resuscitate‖ code status, and was diagnosed with end-stage acquired immune deficiency syndrome (AIDS). Which action by the nurse is best?

A. Call pharmacy for another premixed antibiotic and administer the correct medication to the right client after checking the client identification band.

B. Call the physician immediately explaining what happened and together explain treatment options to the client, then chart the incident report.

C. Administer epinephrine per standing orders to prevent anaphylaxis and don‘t chart the medication given to the wrong client.

D. Complete an incident report and call pharmacy for another premixed bag and administer it to the correct client following proper drug administration guidelines.

ANS: B

Feedback: The nurse acting in an ethical manner shows accountability for his or her actions and also takes actions to protect his or her client‘s rights, do no harm, and provide safe care.

The nurse should call the physician immediately explaining what happened and together, even if the physician is on a speaker phone, the client needs to know what happened, the consequences of the incident, and treatment choices the client has, so the client may make an informed decision. If the client decides, the client may want the epinephrine and continue as a ―do not resuscitate‖ after the treatment is provided. The client may choose to not accept the treatment and die from the allergic reaction to the wrong medication that the nurse administered. The nurse needs to act ethically and not ignore what happened and continues caring for the other client. Administering a resuscitation medication to a client who chose a ―do not resuscitate‖ code status is an unethical action, and not charting the medication administered to the wrong client is both ethically and legally wrong. The most important action is to care for the client that received the incorrect medication.

PTS: 1 DIF: Moderate REF: p. 215, Personal Accountability OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nursing student was so excited about her first day of clinical on the maternity unit at the

hospital and wanted to tell her friends on social media about her experience, so she posted information about her client. She posted the following: ―Today I cared for one of my neighbors who had a baby girl, so adorable, weighing 6 pounds 5 ounces and mom has a huge episiotomy-ouch!‖ One of the other nursing students saw the post and informed the instructor.

The student quickly removed the post and blocked everyone from seeing the site. The nursing instructor confronted the student about the event. Which statement demonstrates personal accountability?

A. ―I can show you what I posted, and I meant nothing by it and when the other student told me that I should not post anything about clients because people reading the site may figure out who the person is, I quickly removed the post and shut the social site down; I will never post or talk about anything at clinical again.‖ B. ―I don‘t agree that there is anything wrong with posting items when there is no name mentioned or the name of the hospital, and our school has clinical at several area hospitals, and my neighborhood has at least 4 mothers who delivered that day,

but since the other student made a big deal out of it, I removed it and shut down the social site; do you want to see the post?‖ C. ―I never posted anything about my clinical because I know there is a rule against such action, and I don‘t even have a social media site; I don‘t know what you heard, but I believe someone is jealous and trying to frame me because I am a great nursing student and love my clients and what I do.‖ D. ―I am so sorry, and I did not know it was wrong to post anything, but the other student showed me the policy our school has on social media, and I quickly removed the post and shut down the social site, but I believe it is wrong for the other student to go to you instead of just me because I handled the situation, so she needs to learn about accountability.‖ ANS: A

Feedback: The nursing student demonstrates personal accountability by acting as soon as she found out she had made a mistake; she shut down the site and removed the post, and she admitted what she did to her clinical instructor and stated she had learned from the incident and will safeguard client information in the future. The student should not argue that she did not do anything wrong and does not want to take personal accountability for her actions, which is unethical behavior. The nursing student should not lie or cover her tracks to try to prevent suffering possible consequences for her actions, and this is also unethical. The student should not try to project the blame unto the student who confronted her about the post, which is also unethical behavior.

PTS: 1 DIF: Moderate REF: p. 215, Personal Accountability OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The licensed practical/vocational nurse is caring for a client frequently admitted for constant

stabbing pain in her lower back, rated 8 out of 10 on a pain scale. Diagnostic testing reveals no treatable back issues. The physician prescribes a placebo (a substance that has no therapeutic effect to comfort the client). The physician wants the nurse to administer normal saline in a syringe that will look like the narcotic because he or she does not believe the client‘s pain is real. The nurse believes this is an ethical dilemma because is it right or wrong to administer a placebo and lie to the client that it is the narcotic the client requested for her pain. The nurse believes that pain is what the client says it is. Which is the best action for the nurse to take?

A. Administer the placebo, but don‘t say what it is, and if the client remains in pain within 15 minutes, then administer the narcotic analgesic as ordered and report the findings to the physician.

B. Ignore the physician‘s order and continue to administer the narcotic analgesic as ordered previously.

C. Inform the physician that he or she has an issue with administering the placebo because he or she feels it is unethical, and ask if it would be best served to refer the client to a chronic pain management clinic.

D. Inform the nursing supervisor of the physician‘s unethical behavior, and ask what to do in the situation.

ANS: C

Feedback: When presented with an ethical dilemma, there is no right or wrong way to approach the matter, and since the nurse is uncomfortable about administering the placebo and lying to his or her client, he or she should inform the physician and ask the physician about referring the client to a chronic pain management clinic. Just because the client‘s diagnostic tests reveal no treatable cause for her back pain does not mean that her back pain is not real.

Since she is frequently visiting the hospital for pain management solidifies that the pain management is ineffective, and she needs expert help that the pain clinic may offer to provide the client with the fullest potential for a pain-free or manageable level of pain. Administering the placebo goes against the nurse‘s belief that an ethical dilemma exists and that he or she feels it is wrong to lie to a client and withhold treatment because he or she believes pain is what the client says it is. Ignoring the order is an incorrect action to take because the newest order supersedes the previous order for narcotic administration. Informing the nursing supervisor that the physician is acting unethically is also incorrect because the nurse recognizes the situation as an ethical dilemma. The nursing supervisor should advise the nurse to call the physician back and discuss the issue and ask about a referral to a chronic pain management clinic.

PTS: 1 DIF: Difficult REF: p. 215, Personal Accountability | p. 216, Ethical Dilemmas OBJ: 6 | 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The licensed practical/vocational nurse is caring for a client at a clinic who reports his or her

concern that three of his or her brothers died from a brain aneurysm. His or her physician has ordered a computerized tomography (CT) scan, but his or her insurance will not authorize this test to determine if he or she has an aneurysm because he or she does not have any headaches.

The client believes this is an ethical dilemma because if he or she lies, he or she gets the treatment paid and possibly waste insurance money to find out it was not necessary. He or she could go along with the insurance‘s rules and wait until he or she has a headache with the risk of dying from an aneurysm. Which should the nurse suggest to the client?

A. ―Discuss the situation with your physician and have him write an appeal to the insurance underwriters stating the reasons why you should have the procedure and e-mail the form to them to expedite the process.‖ B. ―You should take the situation to the hospital board of ethics and let them make a decision, and if they believe it is wrong for insurance to withhold treatment, they will permit you to receive the treatment.‖ C. ―You should just lie and say you are experiencing the worst headache in the world, and insurance will cover the CT scan, and you will find out if you have an aneurysm or not, and if you have one, the physician can repair it.‖ D. ―If you are not experiencing a headache, then you don‘t have an aneurysm, and the insurance company knows this based upon statistics, and they would never try to harm an individual and refuse treatment to save costs.‖ ANS: A

Feedback: The client is facing an ethical dilemma he or she identified; having to lie to get diagnostic testing that may not be needed or waiting until he or she has a headache and risking his or her life if the aneurysm ruptures. The nurse should have the client discuss the situation with his or her physician, so an appeal may be made because the client has not had any headaches, and the insurance company needs to be made aware of the high probability that the client may have an aneurysm, so he or she may receive the diagnostic test before having a headache. The client does not need to take the matter to the hospital board of ethics because they have no authority to make insurance pay, and the hospital will administer the test without insurance paying for it, if the client wants. The nurse should not tell the client to go against his or her moral convictions and lie. The client would not have brought up his or her ethical dilemma if he or she believed it to be alright to lie and get the procedure. The nurse gives false assurance by stating that statistics is what drives insurance underwriters‘ decisions, so the client not having a headache equals no aneurysm.

PTS: 1 DIF: Moderate REF: p. 221, Ethical Issues in Nursing OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The licensed practical/vocational nurse is working with a team of nurses from the hospital to

secure funding for free mammograms for the homeless population. The licensed practical/vocational nurse posed this potential ethical issue: What happens if a homeless woman has a positive mammogram, but travels from center to center and is hard to find, or has no insurance or way to pay for follow-up, or treatments for breast cancer? Is it appropriate to diagnose but not communicate the results, or not be able to treat a life-threatening disease?

Which of the following is the best action for the team to take next?

A. Apply for an additional grant to provide funds for the support team needed to help women with a positive mammogram.

B. Provide the mobile free mammograms in the homeless area.

C. Create an ethical plan of action and a detailed follow-up plan to communicate the results to women who travel from center to center.

D. Determine a support system to counsel, secure affordable care act insurance, and gain access to treatment.

ANS: C

Feedback: Whenever nurses are planning community services, they must first consider the ethical issues and develop a plan of action to address the concerns. The team also needs to develop a plan to communicate the results to a population that travels from center to center.

The second step is to determine a support system to counsel, secure affordable care act insurance, and gain access to treatment because the resources must be available and applicable for the population being served before another grant may be secured to hire the support team and have the equipment they will need. The third step is to apply for an additional grant to provide funds for the support team needed to help women with a positive mammogram. The last step is to provide the mobile free mammograms in the homeless area.

PTS: 1 DIF: Moderate REF: p. 221, Ethical Issues in Nursing OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 11, Legally Responsible Nursing Practice 1. A licensed practical/vocational nurse caring for clients should be aware of the different types

of laws that influence public life. Which situations exemplify public law (statutory law)?

Select all that apply.

A. The nurse provides an absentee voter‘s ballot for a presidential election for a client aged 18 as requested following the U.S. Constitutional 26th Amendment.

B. The nurse signed a legal contract to work at a hospital according to contract law.

C. The nurse follows the strict rules and regulations set forth by the nurse‘s state nurse practice act.

D. The nurse failed to pay his or her rent on time and was evicted by the court from his or her apartment.

E. The nurse follows Occupational Safety and Health Administration (OSHA) guidelines by not caring for clients requiring chemotherapy administration while pregnant.

ANS: A, C, E

Feedback: Laws that come from the government (federal, state, and local) are termed public (statutory) laws and include constitutional law, administrative law, and criminal law. This includes providing an absentee ballot, following the rules and regulations of the nurse practice act, and following OSHA guidelines. Contracts and civil or common laws are part of private law. Private law is between persons or parties and does not involve the larger public. This includes signing a contract to work and being evicted from one‘s apartment.

PTS: 1 DIF: Moderate REF: p. 233, Sources of Laws | p. 234, Box 11-1 OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Selection 2. A nursing student provided a presentation to his or her class about nursing legal issues and

aspects about sources of law. At the end of the session, the student asked classmates to share what they learned. Which classmate‘s statement should be clarified by the student providing the presentation?

A. ―Private laws define rights, duties, and other legal relationships between citizens.‖ B. ―Private law includes contract laws, but torts are considered to be criminal law, which is public law.‖ C. ―Offenses against the welfare or safety of the public are criminal matters that exist in public law.‖ D. ―The Good Samaritan Statute can vary from state to state, and it is void if the person accepts payment for services rendered.‖ ANS: B

Feedback: The presenter should clarify that private law includes contract laws and torts. Torts are considered to be private law because the victim of the tort may sue the person, group, or organization who intentionally did the tort against the person or group or organization in civil court, which is private law. The purpose of lawsuit is for the victim to receive monetary award for the damages suffered. The tort may be prosecuted by criminal law as well.

PTS: 1

DIF:

Moderate

REF: p. 233, Sources of Laws

OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A licensed practical/vocational nurse is caring for a client in a semiprivate room and overhears

an unlicensed assistive personnel (UAP) arguing with the other client. ―You are going to walk in the hall like I said, or I will hit you.‖ The nurse peeks around the curtain, and the UAP smacked the client across his face, which is now bleeding. The nurse needs to include which information in the incident report and in the report to adult protective services? Select all that apply.

A. Statement made by the perpetrator (the one who performed the tort).

B. Complete description of injury victim received.

C. Incident is considered to be strict liability.

D. Intentional tort was committed by the perpetrator.

E. Client experienced false imprisonment.

ANS: A, B, C, D

Feedback: The nurse needs to include statements made by the perpetrator verbatim. A complete description of the injury and use of injury maps and with permission, the agency may include photos as forensic evidence for the physical abuse/battery that occurred. There is strict liability, injury to the victim present, and since the UAP intentionally assaulted (verbally abused) and battered (physically abused) the victim, this constitutes an intentional tort. There is no evidence of false imprisonment, restricting the client against his or her will physically or verbally.

PTS: 1 DIF: Moderate REF: p. 239, Torts OBJ: 7 | 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Selection 4. A nursing student is caring for an older client with dementia (decline in mental function)

enters the room and tried to help the client out of bed to his or her chair. He or she quickly refused to allow the student to touch him or her. Which is the best action for the student should take first?

A. Inform the nursing instructor that the client is refusing to get out of bed to the chair, and ask for help.

B. Discuss with the physician the attempts to provide care and the behaviors the client is exhibiting.

C. Discuss the matter with the licensed practical/vocational nurse assigned to his or her care if this is a change in his or her behavior.

D. Leave and care for another client and come back and ask the client for permission to move him or her from chair to bed.

ANS: D

Feedback: The best next action for the student to take is to leave and care for another client and then return and introduce self and purpose and ask for permission before proceeding to touch and care for the client. Clients with dementia have problems with short-term memory, so the nursing student may gain a new chance to gain the client‘s trust and be able to properly care for the client. Informing the nursing instructor will most likely result in having the student try leaving and caring for another client, then return. The student needs to find out from the client‘s licensed practical/vocational nurse if the behavior is a change and try other attempts to try to provide care before discussing the matter with the physician. Although the student should discuss the matter with the licensed practical/vocational nurse assigned to the client‘s care, this step would be done after leaving and caring for another client.

PTS: 1 DIF: Moderate REF: p. 241, Assault and Battery OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A group of students have been examining the functions of the state board of nursing and the

state nurse practice act. Which best describes a nursing practice act?

A. The law that defines the practice of nursing in a state B. Rules and regulations for nursing education in a state C. A document that describes the process of a hearing for nurses D. A document that describes the process of delegation ANS: A

Feedback: The best description of the nurse practice act is the law that defines the practice of nursing in a state. The other answers are merely a component of the encompassing law.

PTS: 1 DIF: Easy REF: p. 235, Regulation of Nursing Practice OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A nursing student is learning about nursing standards of care. Which standard should the

nurse consider when providing care for clients?

A. Always follow standards of care taught in school to provide responsible client care.

B. Always follow government published standards of care to practice safely.

C. Always follow the institution‘s standards of care to help decrease risk for a malpractice lawsuit.

D. Always admit what parts of a standard of care were omitted and why in charting to provide accountability.

ANS: C

Feedback: Failure to provide the standard of care expected of a nurse in the same or similar circumstance can result in a malpractice suit or disciplinary action. The nurse should follow the institution‘s current standards of care over ones taught in nursing school or ones published by the government because they may conflict with the institution‘s philosophy and mission or become outdated. The nurse should not omit parts of a standard of care because the action could result in harm to the client.

PTS: 1 DIF: Moderate REF: p. 236, Standards of Care OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 7. The client is scheduled to have a colonoscopy tomorrow, during which a camera is inserted

into the rectum to visualize the lower bowel. The nurse asks the client if he has any questions and he says, ―No, the doctor explained the procedure and I signed the consent form. It sounds easy enough—all I have to do is stand in front of a machine for 1 minute and I‘m all done.‖ Which is the appropriate response?

A. ―You‘ve confused the colonoscopy with something else.‖ B. ―You should likely not have signed that consent form.‖ C. ―I doubt if this is how your doctor explained the procedure.‖ D. ―This doesn‘t sound like the procedure for a colonoscopy. Let me ask the team leader to discuss this procedure with you.‖ ANS: D

Feedback: The client‘s consent is based on erroneous information and is thus invalid. The team leader would know if the client is scheduled for tests in addition to the colonoscopy and he could also go over the consent form again. The nurse should not belittle the client by noting the client is confused or by stating doubt as to the client‘s interpretation of the procedure. The nurse also should not scold the client by telling him or her that the client should not have signed the form.

PTS: 1 DIF: Difficult REF: p. 240, Violating Informed Consent OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A nurse has completed morning care and assessments and will now document the findings.

When documenting care on a client‘s chart, the nurse should: A. include personal opinions and feelings that are related to care.

B. use only officially approved abbreviations.

C. completely erase or delete all errors.

D. write a detailed explanation of all reasons for a medical error.

ANS: B

Feedback: Using incorrect abbreviations is the source of many medical and nursing errors.

Personal opinions and feelings should not appear in the legal record. Charted entries are never erased or deleted, and details of a medical error are entered on an incident report, not the client‘s chart.

PTS: 1 DIF: Easy REF: p. 244, Documentation OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 9. How can a nurse best avoid a malpractice claim?

A. By maintaining high personal standards

B. By establishing a good rapport with his or her clients C. By having all nursing actions witnessed D. By carefully documenting all nursing actions ANS: A

Feedback: The nurse with high personal standards will be cognizant of actions and activities that might harm a client. Careful documentation does not eliminate injury, and strong rapport does not negate the risk of malpractice. It is unrealistic to have every nursing action witnessed.

PTS: 1 DIF: Difficult REF: p. 242, Malpractice Claims OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 10. While caring for the client, the nurse hears a coworker telling a client to ―get out of bed

immediately and get dressed or there will be no breakfast today.‖ This statement is an example of: A. libel.

B. abuse.

C. slander.

D. battery.

ANS: B

Feedback: This is an example of verbal and emotional abuse. The definition of battery is to touch someone without permission. Slander and libel involve derogatory remarks.

PTS: 1 DIF: Moderate REF: p. 247, Criminal Law and Nursing OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 11. In which situation would a state‘s Good Samaritan laws be a relevant consideration?

A. A nurse performs a nursing intervention that is beyond his or her scope of practice

and the client experiences an injury.

B. A person offers a drug to a friend and the friend suffers an adverse drug reaction.

C. A nurse assesses a client and fails to correctly document the assessment findings.

D. A person unsuccessfully performs cardiopulmonary resuscitation on a stranger in a

mall.

ANS: D

Feedback: Good Samaritan laws protect people from prosecution who voluntarily go to the aid of others in an emergency. If the person providing emergency care does not act recklessly or does not intend to harm the victim, the Good Samaritan is almost always exempt from any legal action. Good Samaritan laws do not protect nursing acting in the course of their jobs.

PTS: 1 DIF: Moderate REF: p. 233, Good Samaritan Statutes OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process)

BLM: Cognitive Level: Analyze

NOT: Multiple Choice

12. A nurse recently committed a drug error in which a client received 10 times the ordered dose

of an opioid analgesic. How might the concept of respondeat superior affect the consequences of this event?

A. The nurse‘s employer may share some of the liability for this error.

B. There is partial obligation on the part of the client to refuse unreasonable interventions.

C. The nurse‘s peers have a responsibility to oversee his or her practice.

D. There is no legal liability unless the client suffers injury as a result of the nurse‘s actions.

ANS: A

Feedback: A legal term, respondeat superior, is used to describe the legal responsibility of an employer for acts of an employee. In other words, both the nurse who injures a client and the nurse‘s employer can be held liable for the nurse‘s acts. This legal concept does not place responsibility on the nurse‘s peers or the client. The presence or absence of injury is not directly relevant.

PTS: 1 DIF: Difficult REF: p. 236, Legal Relationships Between the Employer and the Employee OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 13. The managers of a long-term care facility have accused a licensed practical nurse of breach of

contract. To strengthen their case, what must the managers of the facility demonstrate?

A. The nurse does not meet the requirements for licensure that are defined in the state‘s nurse practice act.

B. They took action to correct the nurse‘s behavior.

C. They suffered a financial loss as a result of the nurse‘s actions.

D. Clients or residents experienced a loss of health as a result of the nurse‘s negligence.

ANS: C

Feedback: Breach of contract is the term used to describe failure of one party to fulfill any or all parts of a contractual obligation. Breach-of-contract suits against nurses are most often suits in which damages are claimed. Damages are awarded to the plaintiff (complaining person) if it can be shown that he or she has suffered a financial loss. Breach of contract is not dependent on injury, corrective actions, or licensure status.

PTS: 1 DIF: Difficult REF: p. 238, Contracts OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A recent nursing graduate has questioned the need to carry malpractice insurance, telling a

colleague, ―I don‘t actually need to pay for personal insurance because my hospital has its own malpractice insurance.‖ How should the nurse‘s colleague respond?

A. ―That‘s true, but you should make sure you know how much coverage the hospital

carries.‖ B. ―You could be sued personally, and the hospital‘s insurance might not cover all

your liability.‖ C. ―Your personal insurance would replace the insurance that the hospital carries.‖ D. ―That‘s not true because the hospital‘s insurance only covers criminal cases.‖ ANS: B

Feedback: There are several reasons why nurses should carry their own liability insurance policy; if you and your employer are co-defendants and found liable and the cost of the settlement exceeds your employer‘s policy limits, you may be required to pay the excess out of your own pocket. A hospital‘s insurance is not limited to criminal matters, and personal insurance does not substitute for a hospital‘s insurance.

PTS: 1 DIF: Moderate REF: p. 246, Malpractice Insurance OBJ: 11 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 15. Which situation is most likely to be considered a crime?

A. A nurse physically restrains a client, resulting in injury.

B. A nurse inadvertently gives the wrong medication to the wrong client.

C. A nurse makes an error due to extreme fatigue.

D. A nurse refuses to delegate tasks to unlicensed assistive personnel.

ANS: A

Feedback: Inappropriate restraint that results in injury may be considered a crime. Inadvertent errors and unwillingness to delegate are unlikely to result in criminal prosecution.

PTS: 1 DIF: Moderate REF: p. 247, Criminal Law and Nursing OBJ: 12 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Create NOT: Multiple Choice 16. A licensed practical/vocational nurse cared for a client who was bedridden at his or her home.

The nurse did not regularly turn the client or provide care after the client was incontinent of urine and stool. The client developed a stage 3 pressure ulcer on his or her buttocks. He or she became very ill and had to be admitted to the hospital with sepsis (the infected pressure ulcer infection spread throughout the bloodstream). The client died. Which best describes what occurred?

A. The nurse cared for the client in the particular situation the same way a prudent nurse would have.

B. The nurse committed gross negligence as a result of not providing care a prudent nurse would have provided in the same situation.

C. The nurse committed negligence because of not providing the care a prudent nurse would have provided in the same situation.

D. The nurse intentionally physically abused the client resulting in death, which constitutes murder.

ANS: B

Feedback: The nurse did not act in a way that a prudent nurse (a nurse with the same level of education and experience in the same situation) would have acted because nursing students are taught from the beginning of the schooling to turn a client who cannot at least every 2 hours and to check a client with every turn for incontinence and cleanse and dry the skin. The definition of gross negligence is met by the nurse not providing adequate care resulting in significant harm to the client, and in this case, death from sepsis resulting from the pressure ulcer that arises from not relieving pressure to dependent areas of the body lying in one position for too long of a time. The nurse shows no intent to physically abuse or murder the client.

PTS: 1 DIF: Moderate REF: p. 242, Negligence OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A licensed practical/vocational nurse was presenting a seminar on ways to prevent malpractice

claims to a group of new hires. The nurse asked the new hires to identify the one thing that they had learned and planned on using in practice. Which statement requires further clarification by the nurse leading the seminar?

A. ―I need to make a true self-assessment of areas I am competent in nursing and provide care based upon my strengths.‖ B. ―I should refuse an assignment I do not feel I am adequately trained or prepared to handle.‖ C. ―I should document what is supposed to be done according to the institutional standards of care to prevent malpractice suits.‖ D. ―I need to keep up-to-date on any institutional changes in policies and procedures.‖ ANS: C

Feedback: The nurse needs to clarify that the nurse should document the care provided and that care should be carried out following the institution‘s standards of care. The statement made by the new hire suggests that the new hire will document what is supposed to be done but provide care that may not meet the standards of care. The other three statements made by new hires reflect activities to help prevent a malpractice claim.

PTS: 1 DIF: Moderate REF: p. 242, Malpractice Claims | p. 243, Box 11-3 OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A licensed practical/vocational nurse works at a local hospital, which provides malpractice

coverage for their nurses. The nurse volunteered at a girls‘ camp for a week. The nurse provided the wrong nursing advice, and a child suffered complications from an injury as a result of the nurse‘s actions leading to a malpractice lawsuit. Which statement best describes malpractice insurance coverage in this incident?

A. The nurse does not need a separate policy for malpractice insurance because the hospital carries the policy covering the nurse on and off duty as long as she is employed at the hospital.

B. The nurse does not have a separate policy for malpractice and will be liable for any damages because the hospital policy only covers the hospital and the nurse

working at the hospital.

C. The nurse‘s home owner‘s insurance will cover him or her under personal liability,

so he or she does not need a separate policy for malpractice since she was providing the nursing care as a volunteer.

D. The camp‘s liability insurance should cover the expenses for the nurse‘s malpractice claim since the nurse does not have a personal policy for malpractice insurance.

ANS: B

Feedback: The hospital malpractice insurance is purchased to protect the hospital, and the nurses employed to cover malpractice claims while the nurse is working at the institution. The hospital malpractice insurance does not cover volunteer activities. Home owner‘s insurance covers personal liability for nonmedical situations that may arise at the home, such as not clearing a sidewalk of ice and someone falls suffering an injury and sues the homeowner. The camp may carry liability insurance to cover an accidental injury that may occur at the camp, for instance. The camp‘s liability insurance does not cover the nurse who provides ill advice resulting in an injury. Since the nurse failed to carry a separate policy for malpractice, the nurse is totally liable for his or her actions.

PTS: 1 DIF: Moderate REF: p. 246, Malpractice Insurance OBJ: 11 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The charge nurse assigns a client requiring peritoneal dialysis (PD) to a new graduate licensed

practical/vocational nurse. The new nurse informed the charge nurse that he or she was not comfortable with providing PD. The charge nurse stated that he or she would show him or her how to perform the PD, and then he or she could perform the task since he or she delegated the task. The nurse wants to avoid respondeat superior. Which action should the nurse do?

A. Inform the charge nurse that he or she must abide by the state nurse practice act, which states he or she must first take classes on peritoneal dialysis, so he or she must decline.

B. Perform the PD after the nurse teaches him o her how to perform the procedure to keep from getting in trouble for not obeying his o her superior.

C. Provide the PD as the nurse delegates because the charge nurse becomes fully responsible for any task that is delegated.

D. Perform the PD with charge nurse present, so the charge nurse charts and takes full responsibility for the care delivered.

ANS: A

Feedback: Answer A. The new graduate nurse must practice under his or her state nursing practice act, and if that act states that he or she must complete classes and formal training before providing PD, then he or she must decline to prevent respondeat superior, which happens when a nurse acts under the order of a superior resulting in harm to a client, then both the nurse following the order, and the one in charge giving the order are responsible.

Performing the PD after the charge nurse in-services the nurse at the bedside is against the law, the particular state nurse practice act. The charge nurse delegating a task must ensure that the task is appropriate and that the one he or she is delegating the task to is fully capable to perform the task competently. The one who receives a delegation request must refuse to perform a task that he or she is not fully prepared and competent to perform. In this instance, both parties would be responsible since the delegation is inappropriate. Performing the PD in the presence of the charge nurse and the charge nurse charting the care is also illegal and unethical.

PTS: 1 DIF: Moderate REF: p. 236, Legal Relationships Between the Employer and the Employee OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A nursing student documents the following entries after providing care for the client. Which

entry should the student revise?

A. Midline abdominal incision, approximately 3 inches in length is open to air with staples well approximated, and no redness, edema, or drainage present.

B. Client smells like rotten eggs, is visibility filthy, and is uncooperative with staff trying to bathe him or her, and stated he or she wants to be left alone, appears depressed.

C. Report of stabbing pain in lower back radiating down right leg, rated 5 out of 10 on pain scale, requests pain medication.

D. Lungs are clear to auscultation anteriorly and posteriorly with easy, even, nonlabored respirations; no report of pain, discomfort, or shortness of breath.

ANS: B

Feedback: When charting nursing care, the nurse should record concise, accurate findings, and avoid personal opinion. The nurse should not chart personal opinion about the odor and appearance of the client nor that the client is uncooperative and appears depressed. A better way to chart the information would be refuses staff to bathe him or her and stated he or she wants to be left alone. When charting about the client, it is implied it is about the client, so the word ―client‖ may be omitted.

PTS: 1 DIF: Moderate REF: p. 244, Documentation OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 11 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 12, Leadership and Followership Skills 1. The licensed practical/vocational nurse is assigned to work on the unit safety committee lead

by an authoritarian leader. Which behavior should the nurse expect from the leader?

A. Provide no direction for the team, and assume the team knows what to do.

B. Consult and collaborate with the team members.

C. Make the decisions, which will affect the whole team.

D. Motivate members through effective team building increasing productivity.

ANS: C

Feedback: The authoritarian leader dictates what will be done, when it will be done by, and how it will be done. The leader will check on the team members often and will make decisions affecting the whole team without their input. The leader is a laissez-faire or passive leader who assumes the team knows what to do and will get the job done and offers no direction for the team. The leader is a democratic leader encouraging the team to participate, consult, and collaborate producing better decisions. The leader is a transformational leader who motivates the whole team to work together through effective communication, which leads to team building and increases productivity.

PTS: 1 DIF: Moderate REF: p. 254, Leadership Styles OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A democratic leader would most likely make which statement to a staff member?

A. ―Thank you for your idea. I‘ll present your suggestion at our meeting on Tuesday.‖ B. ―Your suggestion is good but it is too costly.‖ C. ―Why don‘t you hold that thought until our next meeting.‖ D. ―I don‘t think your suggestion has much merit.‖ ANS: A

Feedback: The democratic leader encourages participation in decision-making, a quality that is evident in presenting a staff member‘s idea in another context. The other statements do not demonstrate a clear appreciation for the staff member‘s contribution.

PTS: 1 DIF: Difficult REF: p. 254, Democratic Leader OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 3. Good followership is characterized most clearly by which action?

A. Not questioning the decisions of the leader B. Completing his or her assignment on time C. Participating in planning and making decisions D. Having a positive attitude ANS: C

Feedback: A good follower contributes to planning and making decisions. It is sometimes appropriate to question decisions. Reliability and a good attitude are useful attributes, but they are not necessarily associated with followership.

PTS: 1 DIF: Moderate REF: p. 263, Followership Qualities OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A licensed practical/vocational nurse (LP/VN) is working on a team with a registered nurse

(RN) and a nursing assistant (NA) on a long-term unit. The RN wanted the LP/VN to work the Thanksgiving holiday. The LP/VN has a large family and needs this holiday off. The RN was upset that the LP/VN would not work the holiday and would not talk to the LP/VN. The LP/VN recognizes that the conflict makes it difficult to work together on a team and could jeopardize care provided to clients. Which demonstrates the first step in resolving this conflict?

A. The LP/VN could suggest the RN could ask other RNs and other LP/VNs on their unit or a similar unit if someone could work the requested shift, and the RN will work another holiday, and list the holidays the RN is willing to trade.

B. An RN on another unit offers to work the Thanksgiving holiday, trading for New Years. Another RN on their unit offers to work the Thanksgiving holiday, trading for Labor Day. The RN trades with the RN on their unit because it helps maintain continuity of care with the clients.

C. The LP/VN not able to reach a resolution to the conflict seeks help from the nurse manager.

D. Two nurses working together on the same team have a conflict over needing Thanksgiving holiday off resulting in a breakdown in communication and ability to provide safe care for the clients.

ANS: D

Feedback: Before identifying options (Answer A), choosing options (Answer B), or eliciting input (Answer C), it is important to clearly define the problem or issue at hand (Answer D).

PTS: 1 DIF: Moderate REF: p. 262, Handling Conflict OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 5. The nursing student is learning about becoming a leader and recognizing types of behavior

that hinder effective leadership. Which behavior should the nurse recognize to make needed changes?

A. While working with a nursing assistant to pull a client up in bed, the student states, ―You don‘t know what you are doing, you are incompetent.‖ B. The student assesses the client and reported abnormal lung sounds to the physician, and the client was treated for pneumonia.

C. The student states to another student, ―I do not want to hear gossip about our instructor.‖ D. The student states to another student in the clinical, ―I know you can do the nasogastric intubation because I saw you perform in the most compassionate

excellent way in lab.‖ ANS: A

Feedback: In order to be an effective leader, the nurse needs to self-assess and regulate behaviors that are passive or aggressive and remain assertive. Answer A, the student is displaying aggression toward the nursing assistant stating the nursing assistant is incompetent.

The nursing student should have talked with the nursing assistant privately away from the client and stated, ―I am concerned that you are not comfortable with moving a client up in bed; may I help you learn a more effective way?‖ Using ―I‖ statements helps the behavior to be assertive, instead of aggressive. Answer B, the student exhibits a behavior of leaders, which is to provide excellent nursing care. Answer C, the student is being assertive and providing an honest request, which is focused on protecting the nursing team. Answer D, the student is assertive and motivating a team member to help the member reach their fullest potential as a nurse.

PTS: 1 DIF: Moderate REF: p. 253, Leader and Leadership Defined | p. 257, Types of Behavior OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 6. As the team leader of a unit in a long-term care facility, the nurse decided to make changes in

how residents are assigned to staff. Which method is best for informing staff of these changes?

A. Tell staff that changes are being made and the date when the changes will become effective.

B. Schedule a staff meeting to explain the changes and why these changes are being made.

C. Make the changes gradually over a long period of time.

D. Ask your supervisor to explain the changes to the staff.

ANS: B

Feedback: Scheduling a staff meeting to explain the changes and why these changes are being made gives the staff a chance to ask questions about the change and reasons for it. Phasing-in often creates more chaos and uncertainty than just making the change. Blunt announcements of a change can be perceived as dictatorial. It is inappropriate to delegate this task to a superior.

PTS: 1 DIF: Moderate REF: p. 254, Democratic Leader OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 7. One of the best ways a licensed practical/vocational nurse (LP/VN) can prepare for a

leadership position is to: A. maintain a strong work attendance record.

B. work with culturally diverse staff and clients.

C. establish strong therapeutic relationships with clients.

D. complete education programs and attending workshops on leadership.

ANS: D

Feedback: Completing online continuing education programs and attending workshops and seminars can also provide opportunities to learn and practice new leadership skills. A good attendance record is essential but does not help a person prepare to be a leader. Similarly, experience with persons of different cultures and strong relationships with clients are positive but do not necessarily contribute to leadership skills.

PTS: 1 DIF: Moderate REF: p. 264, Developing Leadership Skills OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A licensed practical/vocational nurse is a client care manager in an assisted living facility and

just heard a weather alert on a resident‘s television. The prediction is that a tornado will pass through the area very soon. Which is the best course of action?

A. Let each staff member decide what is best for their assigned residents.

B. Assemble your staff to outline a plan of action for the residents.

C. Tell your staff members that you are instituting the Tornado Emergency Protocol.

D. Inform your local ambulance service of the potential need for hospital transport.

ANS: C

Feedback: Democratic and permissive leadership is not appropriate in this emergency situation. All staff members should carry out their duties as described in the Protocol. Local ambulance services are well aware of their role in a disaster.

PTS: 1 DIF: Moderate REF: p. 262, Handling Change OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 9. The licensed practical/vocational nurse is the team leader in a long-term care facility. A topic

for discussion at a recent staff meeting was the effect that a scheduled 1 week absence of one of the staff members will have on the staff and how that absence might be managed. One of the staff members thinks a person should be hired to cover the temporary absence. The other six staff members each want to take on an extra resident for that week. They feel that bringing in someone new would not be best for the residents. Which statement might be made by a person who is considered a good follower?

A. ―I think the decision is wrong and I really want everyone to reconsider.‖ B. ―I don‘t care. I‘ll go along with whatever everyone else wants to do.‖ C. ―This is your decision—not mine. I will not accept being assigned an additional resident.‖ D. ―I certainly don‘t agree with the decision but I will do my best to carry it out.‖ ANS: D

Feedback: The person may not agree with the decision, but a good follower is willing to support an unpopular group decision. Attempting to persuade others to reconsider is an example of assertive behavior. Going along with the group is an example of passive behavior.

Not accepting the group‘s decision is an example of aggressive behavior.

PTS: 1 DIF: Moderate REF: p. 262, Handling Change OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A new graduate licensed practical/vocational nurse wants to become a nursing team leader on

the geriatric unit. First the nurse performs a self-assessment of leadership and discovers he or she has a high desire and perception of abilities to become a leader. Which is the best next action for the nurse to help achieve his or her goal?

A. Apply for a team leader position, which has become available on the unit he or she currently practices as a nurse.

B. Visit the National Association for Licensed Practical Nurses (NALPN) website to determine requirements of leadership.

C. Enroll into a program to become certified in nursing leadership.

D. Achieve certification in geriatrics supporting expertise.

ANS: B

Feedback: The new graduate‘s best next action to achieve the goal of becoming a team leader is to visit the NALPN website and find out the specific requirements needed for leadership.

The nurse will find out that clinical expertise is a goal and can work toward certification in geriatrics. The nurse can also find out from the NALPN website about education for becoming an effective leader, which will be a later action to take to prepare for the position of team leader. The next best action is definitely not to apply for the team leader position because the new graduate nurse must first gain experience and expertise and educational preparation to be ready for such a challenge.

PTS: 1 DIF: Moderate REF: p. 252, Introduction | p. 255, Asses Yourself: Leadership Self-Assessment Activity OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A licensed practical/vocational nurse (LP/VN) is working with a nursing assistant (NA) on a

team on a geriatric unit. The LP/VN delegated the morning care for four clients to the NA. The NA did not perform all of the tasks delegated by the LP/VN. Which of the following should be the best course of action for the LP/VN as a leader?

A. Reevaluate the tasks assigned to determine if the assignment was reasonable.

B. Assign the tasks not completed to another NA. C. Complete the tasks not completed by the NA. D. Report the NA to the team leader because the NA should have completed the tasks.

ANS: A

Feedback: A leader is a person who, through leadership skills, is able to get others to follow his or her plan to achieve specific goals. The best course of action for the LP/VN is to reevaluate the tasks delegated to the NA to determine if the assignment was too heavy, or beyond the estimated capabilities of the NA, or if there were unforeseen circumstances that made it impossible for the NA to complete the tasks on time. The reevaluation process will open the channels of communication and help build team work. The LP/VN should not assign incomplete tasks to another NA because, if the assignment was reasonable and the NA was not working to his/her full potential, then providing more tasks to another NA who does work to their full potential will lead to burnout and resentment for that NA. The LP/VN should not complete the incomplete task because, if the LP/VN takes on additional tasks, this may jeopardize ability to provide safe and effective care for the clients. The LP/VN should not report the NA because it jeopardizes effective lines of communication and team work in the future, if there was a reasonable explanation why the NA was not able to perform the tasks.

PTS: 1 DIF: Moderate REF: p. 253, Leader and Leadership Defined OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 12. The nurses on geriatric hospital unit are frustrated with their current manager who seems to

want to ―be all things to all people‖ and resists taking ownership for conditions on the unit. As well, staff members claim that the manager is more interested in being their friend than their leader. This manager is demonstrating which leadership style?

A. Permissive leadership B. Autocratic leadership C. Democratic leadership D. Authoritarian leadership ANS: A

Feedback: The permissive or laissez-faire leader provides little or no direction or control for the team. This type of leader assumes that the staff is self-directed and will do what needs to be done correctly and efficiently without supervision or direction. The permissive leader often has a personal need to be liked by everyone and, for this reason, avoids blame for team actions by giving responsibility to individual team members. Autocratic, or authoritarian, leaders are dictatorial, and democratic leadership respects others‘ input but is still willing to own outcomes.

PTS: 1 DIF: Moderate REF: p. 254, Permissive Leader OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 13. The nurse leader of a large long-term care facility is aware that different leadership styles are

appropriate in different situations. Which situation should warrant the application of authoritarian leadership principles?

A. The existing process of making nursing assignments needs to be reexamined.

B. It has just come to the attention of staff that a resident is missing.

C. The nurse manager has been informed that there will be a budget reduction for the next year.

D. There have been communication problems between nurses and unlicensed assistive

personnel in recent weeks.

ANS: B

Feedback: Emergency situations often justify the use of authoritarian leadership in order to create a prompt, united response. Budget challenges, work assignment issues, and communication issues are not emergencies that would justify authoritarian principles.

PTS: 1 DIF: Difficult REF: p. 256, Situational Leader OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A nurse is frustrated with a coworker who has habitually failed to take his or her breaks on

time. As a result, the nurse‘s own breaks are often delayed or cut short. Which statement is most appropriately assertive?

A. ―It‘s selfish to make me pay the price for your poor time management.‖ B. ―Have you given some thought to ways that you could reorganize the way you take your breaks?‖ C. ―I would appreciate it if you made sure you took your breaks on time so that I can do the same.‖ D. ―I‘m afraid I‘m going to have to report this to our manager because it‘s inconsiderate.‖ ANS: C

Feedback: Assertive statements are clear, direct, and often contain an ―I‖ subject. Accusing the coworker of being selfish or inconsiderate is unlikely to be effective or constructive. An indirect question is not a demonstration of assertiveness.

PTS: 1 DIF: Difficult REF: p. 257, Assertive Behavior OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A licensed vocational nurse has a reputation for providing excellent nursing care but being

passive in his or her interactions. What behavior is most clearly associated with being passive?

A. Frequently criticizing managers and supervisors B. Seeking approval for every decision that he or she makes C. Being unclear about his or her true character and identity D. Failing to clearly express what he or she really wants or feels ANS: D

Feedback: Passive people rarely express their true thoughts and feelings about a situation.

Open criticism is not associated with passivity. Seeking approval and having an unclear identity may be associated with passive behavior, but this is not always the case.

PTS: 1 DIF: Moderate REF: p. 257, Passive Behavior OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice

16. A licensed practical/vocational nurse (LP/VN) is frustrated that the physician rounding with

resident physicians makes distasteful comments in front of the clients. The LP/VN should provide which statement to be assertive with the physician?

A. When the physician is rounding in a client‘s room, ―You have no right to talk to a client that way.‖ B. Right after the physician makes a distasteful comment, ―You will pay for that comment because I will be the witness for the client when she sues you.‖ C. ―Doctor, I would like to talk with you about a situation in the private conference room, as soon as possible.‖ And then discuss the matter with the physician in the conference room.

D. Under her breathe in the back of the room of a client, ―Please stop saying those things, doctor.‖ And hope he or she hears and will stop.

ANS: C

Feedback: The LP/VN should provide the assertion without involving the residents or the client by stating that there is a situation to discuss privately as soon as possible. Assertive statements have ―I‖ involved and ask that the nurse‘s rights are valued but not at the expense of others rights. Once alone with the physician in the conference room, the nurse should follow-up with another assertive statement, such as, ―Doctor, I am frustrated that you have made distasteful comments in front of the client and in front of your residents, such as, ―This is the fat lady who ate her way into a gallbladder attack.‖ I would appreciate it if you would stop making distasteful comments in the future.‖ Telling the physician ―You have no right to talk to a client that way‖ or ―You will pay for that comment because I will be the witness for the client when she sues you‖ is aggressive and pushy or hostile in tone. The nurse trying to avoid the conflict by hoping the physician may hear the message and change is passive tone.

PTS: 1 DIF: Moderate REF: p. 257, Assertive Behavior OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A licensed practical/vocational nurse (LP/VN) is frustrated with a physician who consistently

yells at him or her while the nurse is in the client‘s room to drop everything and gather supplies, so he or she can perform a sterile procedure. Which is the best possible next action for the nurse to take to handle this conflict?

A. Yell back at the physician that he or she is busy and for the physician to get the supplies on his or her own.

B. Calmly in front of the physician ask the unlicensed assistive personnel (UAP) to get the items the physician wants.

C. Assertively confront the physician in private regarding his or her behavior and seek a resolution to the matter.

D. Report the physician‘s inconsiderate actions to the nurse manager and ask him or her to deal with the issue.

ANS: C

Feedback: The nurse wanting to resolve the conflict should meet privately with the physician and calmly and assertively confront the physician with his or her behaviors and seek a resolution to the situation. When a nurse is confronted with an angry aggressive individual using a calm voice in an assertive manner will help diffuse the other person‘s anger. The client should not have to witness two health care professionals aggressively yelling at each other. Avoiding the conflict of open aggression to the nurse in front of a client is a passive action from a busy LP/VN delegating the gathering of supplies to the UAP. The nurse manager did not witness the event, has no vested interest in the conflict, and may not resolve the issue, so both the nurse and physician should work out their issues professionally.

PTS: 1 DIF: Moderate REF: p. 262, Handling Conflict OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 12 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 18. An experienced licensed practical/vocational nurse (LP/VN) is sitting at the nurse‘s station

charting. A newly hired LP/VN also sits down at the station to chart. A physician approaches the new nurse stating, ―You are the stupidest nurse I have ever seen; I can‘t believe they gave you a license.‖ The new hire begins to cry and the physician continues to yell about various issues. The new hire runs to the bathroom. The best next action the experienced LP/VN should provide is to: A. not interfere because the conflict does not involve him or her, and the nurse that has the conflict should resolve it.

B. ask the physician to meet privately and discuss the behaviors seen and ask that the conflict be handled professionally.

C. report the situation to the nurse manager, and file an incident report, and go see if the nurse is alright.

D. agree with the physician that they are not hiring competent nurses, and ask what he or she needs to help resolve the issues.

ANS: B

Feedback: The LP/VN as a team member should help the new nurse by assertively and privately talking to the physician about the behaviors seen and that the conflict between the physician and the nurse needs to be handled in an assertive, professional manner. Although the conflict is between the new nurse and the physician, the new nurse is exhibiting passive behaviors avoiding the conflict by running to the bathroom. Since the conflict occurred in the presence of the more experienced nurse, it also involves his or her need to support his or her team member. Reporting the situation, writing an incident report, and checking on the new nurse do not solve the conflict. Agreeing with the physician and asking him or her what he or she needs does not solve the conflict and may make it worse. The action does not support the team member either.

PTS: 1 DIF: Difficult REF: p. 262, Handling Conflict OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 12 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

19. Nursing students take turns being the team leader for the group of clients, their assigned

students, and team members. The team leader evaluates the followership qualities of the team members during the past clinical experience. Which followership behavior exhibited by the four team members should the team leader discuss with the individual team member to improve teamwork?

A. Asks for help to reposition an immobile client who slid down in bed in order to maintain proper body mechanics, prevent any back injuries, and to provide safe and efficient care for the client.

B. Asks the team leader for clarification on his or her assignment, and after receiving the clarification carries out the assignment, charting it according to the institution‘s policy and procedure.

C. Attempts to place a nasogastric (NG) tube while the client is lying flat, and after the team leader discussed the best way to insert the NG tube. Then, the student inserted an NG into another client while the client was lying flat in bed.

D. Offers suggestions to the team leader making the team member assignments to provide the same clients the nursing students had during their last clinical in order to better provide continuity of care.

ANS: C

Feedback: The team leader needs to discuss with the student who has problems with constructive criticism the value of following the advice to improve the quality of care delivered to clients. Team members should ask for help when moving or repositioning clients.

A team member should ask for clarification from the team leader in order to provide safe efficient care for clients. A team member with appropriate followership skills provides suggestions to improve the effectiveness of the health care team members.

PTS: 1 DIF: Moderate REF: p. 263, Followership Qualities OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A nursing team leader is making an assignment for a new graduate licensed

practical/vocational nurse (LP/VN) who just completed general orientation for the nursing facility. The nurse reports that he or she is nervous and afraid to care for a full assignment of clients. Each nurse on the geriatric unit usually cares for a total of six clients. There are two triads of one NA shared by two LP/VNs for the 24-bed unit, and there is one registered nurse (RN) acting as team leader. Which leadership quality of the team leader will be most helpful for the new nurse‘s first day on the geriatric unit?

A. Is skilled at problem solving when urgent or emergent situations with clients arise on the unit.

B. Acts as a mentor and assigns the new nurse three clients and takes the other three clients.

C. Is clinically proficient and is an excellent resource for the nurses working on the geriatric unit.

D. Uses humor appropriately to lighten up the work day for the staff and to help clients have some fun.

ANS: B

Feedback: The most helpful quality of the leader to help the new nurse who is unsure of himor herself and afraid to care for a full assignment is to be a positive role model or mentor. By assigning fewer clients, the nurse may adjust to the unit environment and working with the team. Each of the other listed qualities by itself would not provide the most help to meet the needs of the new nurse.

PTS: 1 DIF: Moderate REF: p. 260, Box 12-1 OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 12 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 13, Management Skills 1. The licensed practical/vocational nurse (LP/VN) is working on a medical–surgical unit in a

hospital and needed dressing change supplies for his or her client. The supply bins are empty.

The nurse needs to contact the management who order the supplies. Who should the nurse contact about the needed supplies so a rush delivery may occur, or the management contact may obtain supplies from another unit?

A. Nursing supervisor B. Hospital administrator C. Director of nursing D. Charge nurse ANS: D

Feedback: The charge nurse is a first-level manager who is directly responsible for client care, ordering supplies and equipment for the unit. If the charge nurse is not available, the nurse should contact the next person in the chain of command, the nurse manager. Supervisors, administrators, and directors of nursing are higher level managers, and the nurse should not contact them to order unit supplies or equipment.

PTS: 1 DIF: Easy REF: p. 275, Levels of Management OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A new graduate licensed practical/vocational nurse (LP/VN) begins working in the geriatric

resident unit. Which is the first step toward the LP/VN‘s goal to becoming a first-level manager?

A. Practice leadership and management skills while caring for clients.

B. Complete the geriatric specialty certification.

C. Ask a charge nurse to mentor him or her as he or she performs charge nurse duties.

D. Work with the charge nurse and help make the team assignments for the unit.

ANS: A

Feedback: The first step the new nurse should take is to practice leadership and management skills while providing excellent care for the clients. During this process, the new nurse should learn about the various nursing needs of the population and study about how to best provide nursing care for the clients. Completing the geriatric specialty is an excellent way to support expertise and competency with caring for the geriatric population, but the nurse needs to work a minimum of 6 months in the nursing home before applying to sit for the exam. Working with the charge nurse and helping to make the team assignments or asking for a charge nurse to mentor is later steps in the process of reaching the goal to become a first-level manager.

PTS: 1 DIF: Easy REF: p. 275, Managing Patient Care OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

3. A nurse manager works on a busy rehabilitation unit. The nurse notes that the work schedule

is due tomorrow, and there are three pages of time requested off for vacations, scheduling needs for education, and personal days he or she must consider. He or she also has to order the supplies and equipment before leaving work today. The facility nursing educator asked the nurse manager to check if all of the staff completed the required safety education; the staff was instructed to drop off the completion form in his or her door slot. The priority responsibility of the nurse manager should be to: A. direct client care on a day-to-day basis.

B. order supplies and equipment.

C. be sure staff have completed required safety education.

D. develop work schedules for the staff for the subsequent 6 weeks.

ANS: A

Feedback: Directing client care on a day-to-day basis is the priority despite the deadlines to complete the tasks required by the manager‘s job. The next priority should be to order the supplies and equipment. The nurse manager should be able to quickly check if the staff has completed the required safety education. The nurse manager can complete the work schedule as the last priority since it is due tomorrow.

PTS: 1 DIF: Moderate REF: p. 275, Managing Patient Care OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 4. One of the best ways to prepare for a first-level management position is to: A. earn a college degree in management.

B. attend seminars in management.

C. earn certification in a clinical specialty.

D. develop excellent clinical skills through job experience.

ANS: D

Feedback: Excellent clinical skills through job experience helps a manager understand the work from a worker‘s perspective. A college degree in management would exceed the requirement of a first-level management position. Attending seminars is good but not as good as clinical experience. The certification may or may not be in the specialty area in which the manager will work.

PTS: 1 DIF: Moderate REF: p. 275, Levels of Management OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 5. Which licensed practical/vocational nurses (LP/VN) should be most qualified to be promoted

to the position of manager of a long-term client care unit? The nurse who: A. has passed the NALPN IV Therapy National Certification Assessment.

B. has 4 years clinical experience in gerontology.

C. has earned the respect of his or her coworkers.

D. completed a 3-day seminar in managing a client care unit.

ANS: B

Feedback: Clinical experience provides the foundation for making client care decisions.

Respect is important but doesn‘t assure experience, knowledge, or skills. Completing a 3-day seminar is good, but clinical experience may be missing. Experience with IV therapy does not prepare a nurse for a management position.

PTS: 1 DIF: Difficult REF: p. 269, Education OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The main task of the nurse manager is to make client assignments. Which information about

each staff member must the nurse manager prioritize in order to make appropriate assignments?

A. Continuing education record B. Year of graduation from nursing school C. Job description D. Absenteeism and tardiness record ANS: C

Feedback: Individuals‘ job descriptions form the basis of a safe and efficient client assignment. These are more important than continuing education. Attendance records and high school education are not relevant.

PTS: 1 DIF: Moderate REF: p. 278, Implementing Assignments OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 7. One of a manager‘s daily management tasks is to: A. evaluate the quality of client care.

B. write formal evaluations.

C. develop policies and procedures.

D. accept verbal orders.

ANS: A

Feedback: A manager must constantly evaluate the quality of client care. Formal evaluations generally occur annually, and developing policies and procedures is not a daily management task. These are usually developed by a committee. Verbal orders should be an infrequent occurrence.

PTS: 1 DIF: Moderate REF: p. 278, Evaluating Performance OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

8. The licensed practical/vocational nurse (LP/VN) delegates the insertion of urinary straight

catheterization to a nursing assistant (NA) without first assessing the client‘s situation and failed to read the client‘s history of previous urinary strictures (a narrowing of the urethra).

The NA had never performed the task before on a client but had practiced on a lab mannequin.

The LP/VN did not provide any directions or when to ask the nurse for help. The NA performed the task forcing the urinary catheter and traumatized the client‘s urethra resulting in bleeding. The LP/VN promptly cared for the client after the complication occurred. Which of the five delegation rights did the LP/VN fail to consider resulting in an improper assignment?

Select all that apply.

A. Right task B. Right circumstances C. Right person D. Right direction/communication E. Right supervision/evaluation ANS: A, B, C, D

Feedback: The National Council State boards of Nursing/American Nurses Association (NCSBN/ANA) document, https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf, lists the right task, circumstances, person, direction/communication, and supervision/evaluation as the five rights of delegation. The LP/VN did not delegate the right task and should have caught this by reading the client‘s history and performing an assessment of the client. The LP/VN should have stopped the delegation at the first step of the process. The right circumstances did not exist because the client has a history of urinary strictures and may need a special catheter, or if any resistance is noted while attempting the catheterization, the procedure should be stopped and the ordering physician notified. The right person was not considered properly because the client needed someone with experience and the LP/VN delegated the task to an NA that had not performed the procedure on a client and only had practiced it in the lab on a mannequin.

The nurse should always provide directions for a delegation and at what point the NA should ask for help. The LP/VN did supervise and evaluate the situation, but by missing the other stopping points, the consequences of the delegation was unfavorable for the client.

PTS: 1 DIF: Difficult REF: p. 276, Planning and Delegating Patient Care OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Selection 9. One of the nurse manager‘s staff members is always complaining about his or her assignment.

The manager should: A. use nonverbal behaviors to modify his or her behavior.

B. use assertive communication skills to confront the issue.

C. let him or her make out his or her own assignments.

D. ask your supervisor to talk to him or her about his or her attitude.

ANS: B

Feedback: Nonverbal behavior could be misinterpreted, and it also does not clearly identify your expectations. Using ―I‖ and describing how you expect him or her to behave lets him or her know what is expected. It would be unfair to allow one employee to create his or her own assignments and a manager is expected to try to resolve issues.

PTS: 1 DIF: Moderate REF: p. 276, Planning and Delegating Patient Care OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 10. The nurse manager verbally and in writing requested that the maintenance department repair a

broken electrical receptacle three times in the last 2 weeks. It has not been repaired, and there has been no explanation from the maintenance manager and he or she does not return calls.

This receptacle was frequently used and not being able to use it causes extra work for the staff. The nurse manager‘s best course of action at this point should be to: A. schedule an appointment with the maintenance director to discuss the situation.

B. submit another request and explain how important it is to have this repair completed.

C. report the maintenance department‘s unresponsiveness to your nursing supervisor.

D. tell the staff that you are working on getting the receptacle repaired as soon as possible.

ANS: C

Feedback: The maintenance department had sufficient time to make the repair. It is obvious that some ―higher power‖ has to intervene. No response to a request such as this in 2 weeks is not acceptable, and the previous three requests were not acknowledged.

PTS: 1 DIF: Difficult REF: p. 280, Maintaining a Safe Environment OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A nurse manager is responsible for creating the daily assignment sheet on a busy inpatient

unit. What question should the manager ask him- or herself in order to create a safe and efficient work assignment for caregivers?

A. ―What is each team member‘s educational level and qualifications?‖ B. ―What type of leadership style do I need to apply in this situation?‖ C. ―How will this decision affect the budget of the unit?‖ D. ―How many admissions and discharges do I anticipate today?‖ ANS: A

Feedback: The first step in directing client care is to assess staff capabilities. To do this, you will need to know the functions all team members are legally permitted to perform, their educational preparation, how long they have been working in their positions, and what technical and interpersonal skills they have. This consideration is more important than leadership style or budget considerations. Admissions and discharges are important, but staff capabilities are the priority when planning safe care.

PTS: 1 DIF: Moderate REF: p. 275, Assessing Staff Capabilities OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

12. A nurse manager is aware of the importance of safety on the unit and takes measures to

protect and promote the safety of clients, families, and employees alike. In order to meet this goal, the manager should: A. aim to provide a private room for as many clients as possible.

B. keep medication cart locked when they are not in use.

C. allow clients to participate in the planning of their care.

D. ensure that each caregiver has an assigned ―buddy.‖ ANS: B

Feedback: Securing medications is an integral component of safety. Providing private rooms and encouraging client participation in care do not enhance safety. It is unnecessary and unrealistic to create a ―buddy‖ system for staff.

PTS: 1 DIF: Moderate REF: p. 280, Maintaining a Safe Environment OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A long-term care facility has recently admitted several new residents, and the increased

workload means that nurses must delegate more tasks to unlicensed assistive personnel. When doing so, what should the nurses and their manager prioritize?

A. Resident preferences B. Cost constraints C. Time efficiency D. Resident safety ANS: D

Feedback: Safety is the ultimate priority in the planning and execution of delegation. This consideration supersedes resident preferences, cost factors, and time efficiency.

PTS: 1 DIF: Easy REF: p. 276, Planning and Delegating Patient Care OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A nurse manager is responsible for directing the client care on a subacute geriatric medicine

unit at the local hospital. What is the final step that the manager should take in the process of directing client care?

A. Gather input from clients and their families.

B. Determine each staff members‘ qualifications and job description.

C. Evaluate the performance of nursing staff.

D. Organize the delegation process.

ANS: C

Feedback: Similar to the nursing process, the process of care management ends with evaluation. Staff qualifications form the basis of the management process and delegation precedes evaluation.

PTS: 1 OBJ: 3

DIF:

Difficult

REF: p. 278, Evaluating Performance

NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 15. The licensed practical/vocational nurse (LP/VN) is caring for a client who is frequently

admitted to the hospital with chronic renal failure. In the past, the client wanted the family and neighbors to visit freely and welcomed the nursing staff to share information about the client‘s health. The LP/VN is approached by the client‘s neighbor in the lobby of the hospital asking, ―Could you tell me where Mary Smith is and what is going on with her?‖ Which is the best response to make to the client‘s neighbor?

A. ―Let me check to see what room your neighbor is in, and her visitor status.‖ B. ―Oh, sure I am caring for her, she is in room 1203.‖ C. ―You will need to check with Mary‘s family; she is not on my unit.‖ D. ―She is in room 1203, and she is having problems with her dialysis access.‖ ANS: A

Feedback: Privacy rules are the primary focus of the Health Insurance Portability and Accountability Act (HIPPAA), and just because the client in past admissions wanted her neighbors and family to know where she was in the hospital and update them on the information does not mean that she wants her private information handled the same way this admission. Every admission the client has to sign paperwork regarding HIPPAA. The nurse‘s best response includes checking the neighbor‘s visitor status. It is risky for the nurse to provide the room number because, if the client changed how she wanted to deal with private information and did not want visitors or certain visitors or information provided, then the nurse violated her rights. The nurse should not lie; this is unethical.

PTS: 1 DIF: Moderate REF: p. 281, Managing Communication OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A licensed practical/vocational nurse (LP/VN) enters a client‘s room finding the bed in high

position, both top side rails down (which violate facility policy) and the call light within reach. There is a puddle of spilt bath water on the floor by the bed. The nurse recognizes that the unlicensed assistive personnel (UAP) stepped out of the room during the bath to gather some linen she forgot. Which actions is the priority?

A. Return the bed to low position and place top side rails up.

B. Wipe up the spilled water.

C. Discuss the situation with the UAP. D. Write an incident report.

ANS: A

Feedback: The nurse‘s top priority is to provide a safe environment for the client first by working from client to surrounding environment. Step 1: Return the bed to low position and place top side rails up. Step 2: Wipe up the spilled water. Step 3: Discuss the situation with the UAP. (Rationale: The UAP stepped out and will return, so the nurse needs to privately discuss the situation with the UAP and reach an acceptable resolution to provide safe care for the client). Step 4: Write an incident report. (Rationale: Charting occurs after care is provided, and part of creating and maintaining the safe environment is step 3 input to include in the incident report).

PTS: 1 DIF: Moderate REF: p. 280, Maintaining a Safe Environment OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 13 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A licensed practical/vocational nurse (LP/VN) is caring for a resident who has orders

providing supervised smoking of cigarettes in the smoking area. The LP/VN rounds and smells smoke. He or she enters the client‘s room and finds the resident sitting up in bed and smoking while on a nasal cannula at 2 L/minute of oxygen. He or she has caught the top blanket of two blankets on fire (a small area of the blanket, 3 inches  2 inches). Which priority action should the nurse provide?

A. Throw the full water pitcher onto the fire.

B. Turn off the oxygen concentrator; grab the cigarette and put it in the sink next to the bed with running water.

C. Remove the blanket and place into sink with running water.

D. Call for help and assess and treat client.

ANS: B

Feedback: The first best action in the scenario is to turn off the oxygen concentrator because oxygen potentiates the flames and get rid of the source of flame, the cigarette. The next action is to dump the full water pitcher onto the fire. If the nurse tried to remove the blanket while it is on fire, the nurse risks injuring self. The nurse can remove the top blanket and other blankets and client gown, etc., and place the blanket that was on fire in the sink with running water to ensure it stays out. The nurse can call for help, assess, and treat the client using first aid per institution policy and procedure.

PTS: 1 DIF: Moderate REF: p. 280, Maintaining a Safe Environment OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 13 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A licensed practical/vocational nurse (LP/VN) is caring for clients on a rehabilitation unit.

The nursing supervisor announced that a tornado has been spotted nearby and is headed toward the nursing facility, and the clients need to be placed into safety immediately. The staff are instructed that since they are on the first floor of a four story building to place anyone able to walk into the bathrooms, which are on the inside of the building without windows. If anyone has to stay in the room, place them as close to the center of the building as possible and cover them with pillows and blankets and pull the wood blinds and curtains. Which actions should the LP/VN provide to achieve protecting his or her clients in the timeliest fashion? Select all that apply.

A. Ask nursing assistant (NA) to pull blinds and curtains in rooms of clients who cannot be moved, rooms 4 and 6; place pillows over client‘s body with face free, and cover with three blankets from head to toe; move bed as close to door as possible with ventilator staying plugged into the essential ―red‖ socket.

B. Ask unlicensed assistive personnel (UAP) to pull blinds and curtains in rooms of clients who cannot be moved, rooms 4 and 6; place pillows over client‘s body with face free, and cover with three blankets from head to toe; move bed as close to hall door as possible with ventilator staying plugged into the essential ―red‖ socket.

C. Ask NA to transfer clients in rooms 5A and 5B to their wheelchairs and take them

to the hall bathroom.

D. Ask UAP to transfer client in room 5A and 5B to their wheelchairs and take them

to the hall bathroom.

E. The LP/VN quickly tells clients in rooms 1, 2, and 3 to go to the hall bathroom and

stay there because a tornado has been sited.

F. The LP/VN quickly checks that all clients have been evacuated or are made as safe as possible and that the NA and UAP and the LP/VN enter the hall bathroom.

ANS: B, C, E, F

Feedback: The LP/VN should delegate tasks according to the qualifications of the staff, so the NA has the most training and experience with transferring a client to a wheel chair and transporting clients. The UAP has the least training and experience, and the nurse needs to provide specific instructions and may use this staff member to help with basic duties. The LP/VN should quickly round starting with the ambulatory clients and direct them to the safe place, and then make sure all delegated tasks have been performed properly, and all clients are safe, and make sure the staff is safe.

PTS: 1 DIF: Moderate REF: p. 280, Maintaining a Safe Environment OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Selection 19. A nursing student is newly assigned to care for a client transferred from the intensive care unit

from another hospital who needs pain medication. The student noticed that the client‘s identification wrist band is not present, and there is a client identification band taped to the client‘s foot of his bed, which looks different from other bands the nursing student has seen in the hospital. Which action should the nurse take next?

A. Ask the client to state his first and last name and date of birth, and if it matches the computerized chart, skip scanning the band and go ahead and administer the medication.

B. Ask the client to state his first and last name and date of birth and compare the information with the wrist band taped to the bed, and if it matches, administer the medication.

C. Ask the client‘s primary care nurse to properly identify the client and place a client identification wrist band on the client before administering medication.

D. Ask the client if he is John Jones and born November 15, 1970, and if affirmed, place the wrist band at the end of the bed on the client‘s wrist and repair it with tape, and administer the med.

ANS: C

Feedback: The nursing student should make the primary care nurse aware that the client‘s wrist identification band is not present, so the client needs to be properly identified and a new band placed. The student may state that there is a client identification band taped to the end of the bed, which does not look like the hospital‘s band. The nursing student should not assume that the band taped at the end of the bed is correct because the client was transferred from another hospital and the band may be from that hospital. The student should not bypass safety features of the medication administration system by identifying the client without using the proper hospital-approved identification band. The nursing student should not read the information of name and birthdate to a client and ask to affirm it because if the client was confused or did not hear the student correctly, the client may state ―yes‖ and the nurse could make a medication error by administering the med to the wrong client.

PTS: 1 DIF: Moderate REF: p. 280, Maintaining a Safe Environment OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 13 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The licensed practical/vocational nurse (LP/VN) is caring for a group of clients and delegates

tasks to the nursing assistant (NA). Which action by the NA requires the LP/VN to intervene immediately?

A. Gather extra linens and stores them in the client‘s room.

B. Prepare a client for an enema without first properly identifying the client.

C. Take 15 extra minutes on her lunch making the other NAs breaks late.

D. Fail to clock out and is walking out the door to go home.

ANS: B

Feedback: The LP/VN needs to intervene immediately when the NA is preparing the wrong client for the enema. The other actions necessitate action but not immediate action because it does not directly affect the client. The LP/VN needs to discuss with the NA that storing additional linens in a client‘s room decreases supplies available that may be needed for other clients, and once the supplies are in the client‘s room, they cannot be used for the care of another client. Taking extra time on a lunch break is not being a good follower, so team work principles need to be reinforced. There are alternative ways to deal with a failure to clock out in the system, so this is not a priority situation to be addressed.

PTS: 1 DIF: Moderate REF: p. 276, Planning and Delegating Patient Care OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 13 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 14, Beginning Your Nursing Career 1. A nursing student from a licensed practical/vocational nursing (LP/VN) program is trying to

find suitable LP/VN positions to apply. Which is the first step the student should take to find a nursing position?

A. Search the Internet by inserting ―LPN or LVN jobs‖ into a search engine.

B. Determine what area of nursing the student is most interested.

C. Network with nursing students, practicing nurses the student worked with in the clinical areas, and the student‘s preceptor during a role transition experience.

D. Visit area health care facilities‘ websites for job postings and apply online.

ANS: B

Feedback: The first step the nursing student wanting to find a position as a LPN or LVN is to determine the area of nursing the student is most interested. Once the student identifies the area of nursing, the student may network with other students and nurses the student has worked with during clinical and use the network to keep the student up-to-date on any openings in a potential area the student is interested. Job listings on the Internet will give the student access to information about local, national, and international jobs. Area websites for health care facilities are only helpful if the student plans to start the career locally.

PTS: 1 DIF: Moderate REF: p. 298, Finding a Position OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 2. Near the end of an interview with the director of an assisted living facility, the nurse asks for a

job description for the position. The director said that since it is a small facility, they do not feel they need written job descriptions. Which response would be most appropriate?

A. ―I prefer an informal work environment and from what you‘ve told me, this would be perfect for me.‖ B. ―I really would like to work here but I would need to read a written job description before I would consider a position.‖ C. ―Thank you for your time but I would not take a job that doesn‘t have a written description of the job.‖ D. ―My teachers told me not to take a job that doesn‘t have a written job description.‖ ANS: B

Feedback: No matter how informal, a job description outlines what an employer expects.

Without this, the employer can arbitrarily make all sorts of job requirements. A written job description is necessary and serves as a sort of contract describing what you will do in return for a salary. Outright refusal is rather negative and closes the door on this employer even if they do eventually write a job description. Deferring to a teacher‘s instructions does not demonstrate autonomy or independent thinking.

PTS: 1 DIF: Moderate REF: p. 302, The Interview OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

3. Shortly after graduation, the licensed practical/vocational nurse was hired as a staff nurse in a

highly respected rehabilitation facility. Since the nurse started this job, he or she has been assigned four clients, just like every other staff member, every day. He or she is not getting his or her assignments finished on time, and the nurse feels disorganized, and sometimes wants to quit before making a big mistake. What should the nurse do?

A. Ask for a transfer before getting compassion fatigue or burnout.

B. Discuss feelings with a good friend.

C. Give him- or herself more time; things will get better with experience.

D. Explain his or her concerns to the nurse manager on the unit.

ANS: D

Feedback: The manager who has probably had this same conversation with other new employees could make suggestions that would help the new nurse adjust to his or her new role. The manager might also adjust his or her assignment to match his or her beginning skills.

If the nurse leaves prematurely, he or she will probably end up in the same situation on a new unit. Discussing feelings will not help because the nurse needs help with the work.

PTS: 1 DIF: Moderate REF: p. 296, Transitional Challenges OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A licensed practical/vocational nurse (LP/VN) wants to secure a position at a well-known

health care institution as a team leader and wants to impress the employer, so that his or her letter of application will be chosen over numerous other applicants wanting the position in the geriatric specialty unit. Which of the following should the LP/VN include in the letter of application to best persuade the potential employer?

A. Briefly identify the qualifications in the letter and how the candidate will best serve the position: ―I am applying for the team leader position on the geriatric specialty unit. I have 10 years of experience in geriatric nursing with certification in geriatrics maintained for more than 8 years. I have served as a team leader for past 5 years, and look forward to providing excellent service as a team leader in the geriatric specialty unit at Hospital Excellence.‖ B. Briefly identify experience in all areas of nursing in the letter: ―I am applying for the team leader position on the geriatric specialty unit with 5 years of experience in pediatrics; 3 years in obstetrics, and 10 years of experience in geriatrics with current certification in geriatrics, and currently serve as a team leader on the geriatric rehab unit.‖ C. Include a detailed explanation of the qualifications and how the LP/VN will serve the institution as the best possible candidate, and include leadership and management strengths.

D. Explain the involvement in professional organizations and how the nurse best serves the needs of geriatric nurses and the clients through exercising political voice.

ANS: A

Feedback: The nurse should include in the application letter, which is no longer than one page, the desired position being applied for and the specific qualifications the nurse offers to meet the expectations for that career. The nurse should include all areas of previous experience as a nurse and involvement with professional organizations in the resume and not include these items in the application letter. The goal of the application letter is to spark the interest of the employer, and if this occurs, the resume will be read. The nurse should not share a detailed explanation of the qualifications the nurse offers to serve as the best possible candidate because if the letter is more than one page in length, the employer will move on in the stack of applicants.

PTS: 1 DIF: Moderate REF: p. 300, The Letter of Application OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 5. Access to health care in the United States is a national concern. The licensed

practical/vocational nurse can most directly influence legislation by: A. reading about legislation related to various issues.

B. explaining your views to your coworkers.

C. joining a national organization.

D. getting elected to a public office.

ANS: D

Feedback: Election would allow a person to write as well as influence legislation. The other cited activities facilitate involvement in public life and the political process but do not allow a person to direct legislation.

PTS: 1 DIF: Moderate REF: p. 313, Political Process OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A licensed practical/vocational nurse plans on being active in nursing. Which activity best

serves this goal?

A. Practice safe and effective nursing practice to help make a crucial difference one client‘s life at a time.

B. Continue a lifelong pursuit to keep up-to-date in nursing and use the best evidence to guide practice at the bedside.

C. Maintain a sharp sense of cultural, ethical, and legal reasoning when caring for clients and their families.

D. Join a professional organization and initiate activities that advance the profession of nursing.

ANS: D

Feedback: The best way for the nurse to serve the goal of being active in nursing is to join a professional organization and initiate activities that will advance the profession of nursing.

The nurse is active as a nurse when practicing safe and effective nursing practice and caring for clients. The nurse is active as a nurse by keeping up-to-date in practice, which provides safe and efficient practice care for clients. The nurse is active as a nurse caring for clients by maintaining a sharp sense of cultural, ethical, and legal reasoning. The nurse working with a professional organization initiates activities (lobbying; continuing education) that advance the profession.

PTS: 1 DIF: Moderate REF: p. 312, Nursing Organizations OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 7. Several of the nurse‘s coworkers constantly report about everything, and they try to get the

nurse to join them. The nurse has always been a happy and positive person and wants to enjoy his or her time at work, especially since this is his or her first job. What should be an appropriate first step in the situation?

A. Let the coworker know that he or she will work with them but that he or she doesn‘t wish to join them in complaining.

B. Ask for a transfer to another unit within the facility where the staff is more positive.

C. Discuss his or her concerns with his or her nurse manager or the unit supervisor.

D. Contact a nursing organization with his or her concerns.

ANS: A

Feedback: Assertive behavior that clearly lets the coworkers know that the nurse will not now or ever be joining their group but the nurse will certainly be able to work with them. This is the nurse‘s first job and leaving it would have a negative impact on the nurse and nurse‘s resume. Being assertive should precede the involvement of a manager. A nursing organization would be unlikely to help.

PTS: 1 DIF: Moderate REF: p. 308, On the Job OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A nursing student in a licensed practical/vocational nursing program has written his or her

first resume. The student recognizes that it would be logical to update the resume and portfolio: A. once every 6 months.

B. once a year.

C. when there is new information to add.

D. when the nurse needs it to apply for a job.

ANS: C

Feedback: If new information is not added at the time it occurs, it may be forgotten and then never appear on the résumé. The nurse should not wait for a new job opportunity before updating.

PTS: 1 DIF: Difficult REF: p. 300, The Résumé OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 9. When the licensed practical/vocational nurse (LP/VN) was hired, the nurse was told that the

nurse would not have to work more than 1 weekend a month. In the lasts 4 months, the nurse has been assigned to work 3 weekends each month and nurse‘s complaints have been ignored.

Which procedure should the nurse use to address this situation?

A. Grievance procedure B. Collective bargaining procedure C. Disciplinary procedure D. Arbitration procedure ANS: A

Feedback: Grievance procedures describe the problem resolution process for the employee with an employer. Collective bargaining is used to represent the rights of the employees as a whole within the union, and in this situation, only one employee is having the work-related dispute. The means to communicate an issue to the union is to file a grievance with the employer, and the union can help, if the nurse calls the union representative for assistance.

The disciplinary procedure is between an employer and the employee and is not the case with the situation because the nurse worked all required shifts, but the employer asked for more shifts than originally agreed upon. Arbitration is used to settle a grievance, if the employer and employee cannot resolve the conflict on their own, so it is too early to bring in arbitration.

PTS: 1 DIF: Difficult REF: p. 316, Grievances OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 10. One of the most effective ways to maintain clinical competence is to: A. seek frequent feedback from instructors who taught in your nursing program.

B. keep a journal of client encounters and interesting cases.

C. consistently read work-related articles published in reputable journals.

D. enroll in college courses that focus on communication.

ANS: C

Feedback: Print and electronic journals provide a wealth of easily accessible information that helps maintain clinical competence. A college course would be expensive and not the most effective way to maintain clinical competence. It is unrealistic to expect feedback from previous instructors. Journaling does not necessarily foster competence.

PTS: 1 DIF: Easy REF: p. 311, Your Career OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

11. A licensed practical/vocational nurse (LP/VN) is caring for a client as a private duty nurse in

the client‘s home. The client needs to be hospitalized. The private duty nurse should best serve the client in this situation by: A. accompanying the client to the hospital and staying with the client acting as the client‘s advocate and abiding by the hospital guidelines.

B. going to the client‘s home and setting up anticipated equipment and supplies may need once the client is discharged from the hospital.

C. caring for the client in the hospital taking on all duties as the primary care nurse and charting in the electronic medical record.

D. giving report to the nurse caring for the client now in the hospital, and then the private duty nurse is not needed until the client is discharged.

ANS: A

Feedback: The private duty nurse provides comprehensive care to one client in an arrangement where the nurse works directly for the client in the client‘s home, or wherever the client may require care. The nurse best serves the private duty client by accompanying the client to the hospital and staying with the client, providing care according to the guidelines of the hospital, and acting as the client‘s advocate as care is provided by the hospital. The private duty nurse should not leave the client to set up equipment and supplies.

PTS: 1 DIF: Moderate REF: p. 293, Private Duty Nursing OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 12. After distributing a number of résumés and application letters over the past several weeks, a

nurse has been contacted by two prospective employers, each of whom is offering an identical wage structure. Which factor should the nurse prioritize when choosing between the two positions?

A. The size of each work setting B. The fringe benefits that is associated with each position C. The presence or absence of friends who work at each site D. The date on which each job would begin ANS: B

Feedback: Benefits are an important consideration that should have a significant impact on the nurse‘s choice of workplace. Benefits are likely a more important consideration than friends, the start date, or the size of each facility.

PTS: 1 DIF: Moderate REF: p. 307, Benefits OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 13. After the introduction of sweeping changes in the workplace, a nurse is in the process of

writing a resignation letter because he or she opposes these changes. The nurse‘s resignation letter should include: A. the nurse‘s future career plans.

B. feedback about the decision-making abilities of leaders and managers.

C. reasons why the changes should not have been introduced.

D. the date that the resignation will take effect.

ANS: D

Feedback: A resignation letter should clearly state the date that the resignation will take effect.

Opinions should be withheld, and it is unnecessary to state your future plans.

PTS: 1 DIF: Easy REF: p. 309, Resignation OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 14. After a long and often difficult process of organization, the nurses at a chain of long-term care

homes have joined a union. Which aspect of nursing practice will the union be most directly involved with?

A. Establishing standards of nursing practice B. Relationships between individual nurses C. Organizing the accreditation process D. The issue of mandatory overtime ANS: D

Feedback: Unions are most often involved in issues related to work hours, conditions, and wages. They do not establish standards of practice or become involved in the accreditation process. It is rare that unions become involved in relationships between individual nurses.

PTS: 1 DIF: Moderate REF: p. 315, Collective Bargaining OBJ: 11 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A hospital nurse has become aware that certain nurses have been offered overtime more often

than other, less senior nurses and has brought this matter to the attention of the manager. The manager, however, has downplayed the nurse‘s concerns and the practice continues. What action should the nurse take?

A. Confront the nurses who are benefiting from the practice.

B. Inform the state board of nursing.

C. Follow the hospital‘s grievance procedure.

D. Ask a physician to intervene.

ANS: C

Feedback: Disputes about working conditions and practices can often be resolved through the institution‘s grievance procedure. Confronting the nurses may not be beneficial, and it would be inappropriate and ineffective to involve the state board of nursing or physicians.

PTS: 1 DIF: Difficult REF: p. 316, Grievances OBJ: 11 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

16. A newly graduated licensed practical/vocational nurse plans to interview for several potential

career opportunities. The nurse is apprehensive about working on a busy medical–surgical unit. The nurse wants to use the interview process to decide which employer will fit the nurse‘s needs. Which question is most important to ask during the interview process?

A. ―How many clients are assigned to each nurse, and what additional expectations do you have for a staff nurse position?‖ B. ―How do you determine the acuity level of the clients and staffing ratios, and how do you provide breaks for the nurses?‖ C. ―May I see a job description for the position, and what type of orientation and mentoring process do you provide?‖ D. ―What style of nursing care delivery model does your unit use, and what team members are used to provide nursing care?‖ ANS: C

Feedback: The nurse is apprehensive about working on a busy medical–surgical nursing unit as a new graduate nurse, and the best question when comparing job offers is ―May I see a job description for the position, and what type of orientation and mentoring process do you provide?‖ This answer address that the job description‘s expectations for the nursing position, and asking about the orientation and mentoring process will help the nurse to judge if the unit is the right fit or not. When comparing the available places for employment, the nurse needs to request to see expectations in writing in the job description, and assignments for the staff nurse may be different than the assignment for a new nurse in orientation. Asking ―How do you determine the acuity level of the clients and staffing ratios, and how do you provide breaks for the nurses?‖ or ―What style of nursing care delivery model does your unit use, and what team members are used to provide nursing care?‖ do not address orientation or mentoring to help the new nurse to acclimate to the unit and caring for the particular client population.

PTS: 1 DIF: Moderate REF: p. 295, Employer Expectations OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A new graduate nurse applies for a physician‘s office licensed practical/vocational nurse

position. The nurse has no training in bookkeeping, clerical duties, or phlebotomy. During the interview which is the most important question for the nurse to ask?

A. ―What is the scheduling process, and what breaks are provided?‖ B. ―What specific duties does this position require of the nurse to perform?‖ C. ―Do you provide additional training for any skills I may not possess?‖ D. ―Who is the supervisor I will report to and take orders from while working here?‖ ANS: B

Feedback: The nurse‘s most important question to ask is what specific duties will the position require the nurse to perform because an office nurse may provide nursing care to clients and other staff handle the other tasks of an office, or the nurse may have a wide gamete of tasks to perform, including desk reception, scheduling appointments, obtaining labs and specimens, helping the physician, or collecting payments for the visit.

PTS: 1 OBJ: 1

DIF:

Difficult

REF: p. 293, Office Nursing

NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A graduate nurse wants to make the transition from being a student to employee a smooth one

on a busy geriatric rehabilitation unit. The nurse should take which action to be more successful? Select all that apply.

A. Ask other nurses to perform some of the duties initially to lighten the workload, and gradually take on more of the assignment if there is time.

B. Find out before beginning the job the client population‘s most frequent medical diagnoses and study the nursing care needed.

C. Ask an experienced nurse on the unit for suggestions on how to best organize care for your assignment.

D. Clock out at the end of the shift on time and continue to work to catch up with tasks not completed.

E. If you are presented with a medical diagnosis that is unfamiliar, look it up to learn how to care for the client and ask for help as needed.

ANS: B, C, E

Feedback: The new graduate should ask for help with tasks if the nurse is behind schedule, but should not assign tasks and then take them back, if there is time. Before beginning a new job, assessing the client population‘s medical diagnoses and looking up nursing care and studying it is an excellent way to be prepared for the challenges of taking a full assignment. Asking an experienced nurse working on the unit for suggestions on how to best organize care for your assignment is an excellent learning opportunity. The nurse may have created a report sheet to make organization of the assignments on the unit easier and may share this with the new nurse. The new nurse should not have to clock out to finish up work not completed after the shift. The nurse should be paid for working the additional time to complete the tasks. Nursing care is a round-the-clock process; the nurse should be able to report to the next shift what needs to be done for the client. The nurse should only finish up tasks that the nurse began that have to be completed. Even the most experienced nurses will be presented with medical diagnoses they are unfamiliar with and need to look up information about what nursing care to provide. So the new grad should look it up quickly on the unit and ask for help as needed. The nurse could read more about the new medical diagnosis and about the nursing care needed at home to reinforce the professional growth process.

PTS: 1 DIF: Moderate REF: p. 296, Transitional Challenges OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Selection 19. A licensed practical/vocational nurse (LP/VN) is concerned that the clients he or she cares for

in the geriatric clinic report that recent changes in legislation has brought about changes in prescription coverage and now the clients are unable to afford the medications they need. The LP/VN may exercise political voice best by writing: A. the state representative for the state senate about the issue.

B. the local newspaper to make people aware of the changes in Medicare.

C. his or her U.S. Senator about the issue, and suggestions as to what needs to be done.

D. the U.S. Senator from another state who presented the bill about the issue.

ANS: C

Feedback: The best way the nurse may use political voice in this instance to help the clients is to write his or her United States Senator about the issue. Nurses are able to give valuable information to the congressional leaders to help them make necessary changes, which in turn will help their older adult constituents. The U.S. Senator from another state does not have to answer his or her letter, and most likely will not do anything about the issue since the nurse is not one of his or her constituents. Writing the local newspaper to publish information about the changes in Medicare may or may not occur, and without urging the citizens and taking action him- or herself to write the appropriate U.S. Senator, the nurse will not accomplish the needed political voice. Medicare funding is Federal, so writing the state representative for the state senate will not help the nurse to exercise his or her political voice.

PTS: 1 DIF: Moderate REF: p. 313, Political Process OBJ: 10 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The nursing student is planning for a career as a licensed practical/vocational nurse (LP/VN)

in another state and begins to prepare his or her resume. The nursing student should consider which of the following when writing the resume? Select all that apply.

A. Ask permission from clinical nursing instructors, faculty, and nurse manager of the unit where the nurse worked as a nursing assistant to be used as references.

B. List volunteer nursing activities completed while in nursing school.

C. List honors related to nursing scholarship and service.

D. Names of institutions where the student had nursing school clinical experiences.

E. Membership to a collegiate honor society unrelated to nursing.

F. Short-term and long-term goals related to nursing in the particular area of nursing the student plans to apply for positions.

ANS: A, B, C, F

Feedback: The nursing student preparing to take a position in another state should contact the potential references related to nursing for permission to use them as a reference and ask for their contact information, address, e-mail, and telephone number. The nurse should list volunteer activities completed while in school related to nursing, honors related to nursing scholarship and service, and short-term and long-term goals related to nursing in the particular area of nursing that the nurse plans to apply. The nurse does not need to include collegiate honors unrelated to nursing or the names of the institutions where the student had nursing clinical while in school. The resume needs to be clear, concise, and provide a quick summary of previous education and career experience.

PTS: 1 DIF: Moderate REF: p. 22, The Résumé OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Selection

Chapter 15, Challenges in the Workplace 1. A nurse feels threatened by his or her manager who recently cornered him or her in an empty

room and angrily berated him or her for his or her slow pace of nursing care. What action should the nurse take first in response to this abusive behavior?

A. Enlist the help of some trusted colleagues and meet with the manager as a group.

B. Contact the state board of nursing and ask for advice and assistance.

C. Draft a written complaint for submission to his or her manager‘s supervisor.

D. Confront the manager during a private meeting.

ANS: C

Feedback: Workers who want to report abusive behavior should first provide written complaints to their human resources managers or others who are in a position to stop the abuse. If the situation does not improve, the U.S. Equal Employment Opportunity Commission may be able to help. The state board of nursing is not likely to be of assistance and a private meeting or confrontation may not be effective.

PTS: 1 DIF: Moderate REF: p. 321, Hostile Work Environment OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 2. The licensed practical/vocational nurse (LP/VN) is working at a geriatric physician‘s office.

The LP/VN has heard numerous reports from older adult clients that the physician has sent bills to their insurance for times they were not at the office for a visit. The LP/VN saw the computer spreadsheet submitting bills to Medicare for services that were not provided because during the same times, the physician was seeing other clients in the office. The nurse wants to act according to the federal whistleblower law. The nurse‘s best next action is to: A. gather sufficient documentation copies, which the nurse retained to support allegations before reporting the information to a federal agency.

B. discuss the numerous reports about billing (have names and information on paper) and the information found in the spreadsheet (printed out) with the employer.

C. seek legal advice from an attorney regarding the state and federal whistleblower laws and steps to take to protect him- or herself from any harm.

D. report the Medicare fraud via the Medicare Fraud Hotline and provide all necessary information.

ANS: B

Feedback: To protect those who report unethical or illegal practices, the federal government and at least 31 states have passed ―whistleblower‖ legislation that protects nurses and others from retaliation by employers. The nurse‘s best next action is to discuss the numerous reports from the clients and what was found in the spreadsheet with the employer. After this step, if the issue is not resolved, then ethically and legally the nurse needs to act under the whistleblower law guidelines and in this case federal guidelines since it is potentially Medicare fraud. The nurse next steps include taking the copies of the evidence that the nurse secured in case the employer should try to delete the computer files to make it more difficult for the nurse to report. The nurse should consult with an attorney for legal advice before blowing the whistle, in case of employer retaliation, such as a sudden firing occurs. The nurse then reports the potential fraud via the Medicare Fraud Hotline, and the federal investigators will check out the legitimacy of the claims, and work to rectify the situation.

PTS: 1 DIF: Moderate REF: p. 321, Whistleblowing OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 15 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 3. Bullying is described as aggressive behavior that is intended to gain power over or hurt

another person. Which situation in health care settings would be considered bullying?

A. A unit manager‘s performance appraisal of a nurse is highly critical of the nurse‘s practice.

B. A nurse repeatedly tells the same story about a coworker‘s embarrassing workplace situation.

C. A nurse receives a client assignment that is more difficult than that of his or her colleagues.

D. A nurse refuses to take his or her breaks in the unit break room because he or she does not wish to socialize.

ANS: B

Feedback: Gossiping and telling stories that are humiliating to the subject can be a form of bullying. A negative performance appraisal may be justified, and an unequal client assignment can be the result of numerous factors other than bullying. A nurse who refuses to socialize is not necessarily engaging in aggressive behavior.

PTS: 1 DIF: Difficult REF: p. 322, Bullying OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A nurse has recently accepted a position in a care setting that has nurses and other care

providers from a number of different cultural backgrounds. Which statement about diversity in the workplace is most accurate?

A. Cultural diversity makes effective communication impossible in a busy care setting.

B. Health care providers from different countries typically have lower standards of practice.

C. Cultural diversity in the workplace is associated with increased conflict.

D. Workers from diverse backgrounds bring different perspectives to the workplace.

ANS: D

Feedback: Coworkers from diverse cultural backgrounds add their different perspectives to the work environment. However, this does not necessarily preclude communication or result in conflict and lower standards of practice.

PTS: 1 DIF: Difficult REF: p. 323, Diversity OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 15 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A female licensed practical/vocational nurse (LP/VN) applied for a team leader position at a

public health care facility and was not hired by the male nursing manager. The nurse felt it was gender discrimination based upon the fact that she had 4 more years than the male applicant who got the position, and she had certification in geriatrics and was 1 year from completing a Bachelor‘s of Science of Nursing (BSN), and the male applicant had no plans on furthering his education or obtaining certification. Which action should the female LP/VN take next?

A. Search the public records of posted nurse‘s salaries at the institution to determine if there is a discrepancy in wages for each of the pay grades and same positions based upon gender.

B. Discuss the situation with the human resources department, and try to find a favorable resolution.

C. Read fact sheets provided by the Equal Employment Opportunity Commission (EEOC).

D. File discrimination charges against the institution via the EEOC. ANS: B

Feedback: While practices are slowly changing, men get promotions more quickly than women; men continue to make more money than women; and men get more job training than women. The nurse should first discuss the matter with the human resources department to try to find a resolution for the situation. If the nurse is not satisfied with the results, then the nurse may search the public records since it is a public institute to determine if there are apparent differences found in the institution or if she has an isolated case. The next step is to read the fact sheets provided by the EEOC and then pursue talking with an agent at EEOC about the situation, so appropriate reports of discrimination may be filed and the agency will investigate the situation and report back to the nurse.

PTS: 1 DIF: Moderate REF: p. 324, Gender OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A nurse is caring for a client who made a sexually suggestive comment earlier in the shift and

the client has now made another lewd remark to the nurse. Which action should the nurse take first?

A. Go home for the day and ask for a new client assignment tomorrow.

B. Draft a report to be submitted to the state board of nursing.

C. Withhold care from the client.

D. Assertively state that such comments are not acceptable.

ANS: D

Feedback: The preferred first response to sexual comments from a client is to inform the client that such comments will not be tolerated. It would be unacceptable to withhold care from the client, though a change in client assignment is likely necessary. A written report would not be the first point of action.

PTS: 1 DIF: Moderate REF: p. 325, Sexual Harassment OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A nursing student has had a clinical placement in a busy emergency department and has found

the experience exhausting and stressful. In contrast, many of the nurses in the department find the fast pace exhilarating and stimulating. What factor accounts for these very different experiences of job stress?

A. Individuals who do not perceive stress are considered to be in denial.

B. Job stress is highly subjective and depends on individual and situational factors.

C. A lack of stress in a potentially stressful situation indicates a lack of understanding and caring.

D. Some people experience stress often, while other personalities are immune to all forms of stress.

ANS: B

Feedback: Research indicates that how you perceive a situation or what you think about a situation is the key to how you will respond to it. Two people in an identical situation could have very different feelings about it. One person may see the situation as very stressful and experience the effects of job stress. Another person in the same situation may see the situation as a challenge that he or she can overcome. Lack of stress does not necessarily indicate denial or lack of understanding. No one is wholly immune to all forms of stress.

PTS: 1 DIF: Difficult REF: p. 326, Job Stress OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. A nurse has a busy home life and a full-time work schedule and has just been asked to work

an overtime night shift. The nurse should recognize that: A. fatigue and lack of sleep can cause errors in care.

B. increased hours of work lead to increased competence and confidence.

C. rejecting an overtime shift places an unfair burden on coworkers.

D. work responsibilities should take precedence over personal responsibilities.

ANS: A

Feedback: Mental and physical fatigue put nurses at risk for personal injury and clients at risk for errors in care. It is true that experience leads to confidence, but maximizing hours of work does not necessarily lead to better care. Work responsibilities do not always supersede personal responsibilities. A nurse should not feel obliged to accept all overtime.

PTS: 1 DIF: Moderate REF: p. 328, Work Fatigue OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

9. Nursing is among the occupations that have the highest risks of work-related injuries. In order

to reduce these risks, a nurse should take extra precautions when: A. providing morning hygiene.

B. lifting or mobilizing a client.

C. performing client assessments.

D. approaching unfamiliar clients.

ANS: B

Feedback: Research has shown that 52% of nurses report of chronic back pain and 38% say they had to take a leave of absence from work because of back pain. Because musculoskeletal injuries are so prevalent in the nursing population and because lifting a client can cause serious injuries to the nurse and the client, it is vitally important to take precautions when lifting, transferring, and mobilizing clients. These actions pose a greater threat than providing hygiene to clients, assessing clients, or approaching unfamiliar clients.

PTS: 1 DIF: Easy REF: p. 332, Health Risks OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A nurse is aware of the reality of terrorist threats in the United States and recognizes that

terrorist events create a sudden demand on health care services. What action should the nurse prioritize in order to prepare for such an event?

A. Participate in emergency preparedness activities B. Become certified in high-acuity nursing C. Become politically active in the fight against terrorism D. Teach clients and families about the reality of terrorism ANS: A

Feedback: It is important for all nurses to participate in emergency preparedness training programs offered by employers and community groups. This action is of greater benefit than achieving certification, being politically active or, teaching clients and families.

PTS: 1 DIF: Moderate REF: p. 334, Terrorism OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A nurse has joined a committee that will oversee all of the disaster preparedness activities in a

chain of long-term care facilities. Which principle should underlie the committee‘s activities?

A. Disasters most often occur in the Midwest and on the Gulf coast.

B. Disasters are much more common in urban settings than in rural areas.

C. Disasters can happen at any time and in any place.

D. Disasters can be predicted by conscientious and well-organized efforts.

ANS: C

Feedback: Disasters are unpredictable and can happen anywhere and at any time. This principle should underlie emergency preparedness and disaster preparedness efforts.

PTS: 1 DIF: Easy REF: p. 336, Emergency Preparedness OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A nurse is unsure whether a cleaning agent that is in use at the hospital is toxic. What

information source should the nurse prioritize when making this judgment?

A. Advice from the charge nurse or unit manager B. An online search about the cleaning agent C. Information from the individual who is using the cleaner D. The Safety Data Sheets (SDS) about the cleaner ANS: D

Feedback: The U.S. Department of Labor‘s division of Occupational Safety & Health Administration (OSHA) requires that all employers make Safety Data Sheets (SDS) available to all employees. (SDS were formerly called Material Safety Data Sheets [MSDS] until June 1, 2015, when the name was officially changed). Among the information you can learn from an SDS is what first aid measures are appropriate for that toxic substance, what to do in the event of an accidental release, what measures to take to protect yourself when handling this substance, and how to dispose of the substance. This information is more detailed and reliable than individuals‘ opinions or online information, which could be inaccurate.

PTS: 1 DIF: Moderate REF: p. 337, Toxic Substances OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 13. An organization called Practice Green Health has been created to educate health care

professionals about pollution prevention opportunities. How can a nurse best help this organization meet its goals?

A. By reusing items such as gloves as often as possible B. By recycling as much nonhazardous waste as possible C. By sterilizing syringes rather than disposing of them D. By opposing the use of radioactive materials in hospitals ANS: B

Feedback: Many hospitals and other health care facilities are working to recycle as much nonhazardous waste as possible. As a worker in the health care industry, the nurse has a responsibility to comply with employer‘s procedures for recycling and reducing waste.

However, it would be unsafe to reuse syringes or gloves. Radioactive materials are necessary in many aspects of health care. Such materials should be handled and disposed of appropriately.

PTS: 1 DIF: Moderate REF: p. 338, Pollution OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

14. As part of an emergency preparedness program, a nurse learned about the threat of

bioterrorism and the appropriate responses to this threat. A mock scenario is presented to the nursing staff. The emergency room is swarmed by people who were previously healthy with a high fever, flu-like symptoms, productive cough, shortness of breath, and anterior chest pain.

Which measure should the nurses provide until the cause for the client‘s symptoms is determined?

A. Wear a mask and gloves.

B. Don a gown and gloves.

C. Wash the hands.

D. Use all available precautions.

ANS: D

Feedback: The OSHA defines bioterrorism as ―the intentional use of microorganisms to bring about ill effects or death to humans, livestock, or crops.‖ Until the potential microorganism causing the illness has been identified, it is best for the nurse to use all available precautions while caring for the client. In this case, the client has a productive cough, so meticulous hand washing, mask, goggles, gown, and gloves are warranted. The nurse should use standard precautions with all clients in general.

PTS: 1 DIF: Easy REF: p. 334, Bioterrorism OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 15. Nurses have been providing care for a palliative client and his family for several weeks, and

one of the nurses is beginning to experience the signs and symptoms of compassion fatigue (CF). Which statements made by the nurse in the past week reflects that the nurse is experiencing CF? A. ―I am so tired of taking care of the client; he just needs to go ahead and die.‖ B. ―I care so much for the client that I feel emotionally, physically, and spiritually spent.‖ C. ―I look forward to helping the client and can‘t wait to be at work.‖ D. ―I feel spiritually fulfilled caring for a dying client.‖ ANS: B

Feedback: CF is a state of physical, emotional, and spiritual exhaustion that is a result of caring too much for an individual client. By stating ―I am so tired of taking care of the client; he just needs to go ahead and die,‖ the nurse is displaying apathy toward the client. By stating ―I look forward to helping the client and can‘t wait to be at work,‖ the nurse expresses energy and optimism and shows no signs of CF. By stating ―I feel spiritually fulfilled caring for a dying client,‖ the nurse has a feeling of purpose for providing the care, so this is not a sign of CF. PTS: 1 DIF: Moderate REF: p. 330, Compassion Fatigue OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 15 KEY: Integrated Process: Caring BLM: Cognitive Level: Analyze NOT: Multiple Choice

16. An experienced nurse on a busy telemetry step-down unit walked into the nurse‘s station to

find that several of the nurses were criticizing a newly hired licensed practical/vocational nurse (LP/VN) from the orthopedics unit stating that she did not know anything about cardiac emergency drugs because she is stupid and they planned on making her miserable so she would leave. Which is the best statement for the experienced nurse to help decrease or stop the bullying?

A. ―You were once inexperienced and I helped you and did not make fun of you, so stop it.‖ B. ―I am not going to tolerate the bullying, and I found that she doesn‘t bully us when we don‘t know how to set up traction for a trauma client, so she has strengths that can help us, and we should help her.‖ C. ―She has not gone through cardiac telemetry training, or Advanced Cardiac Life Support (ACLS) training, so of course she doesn‘t know the emergency drugs yet.‖ D. ―I don‘t want to hear any gossip about anyone; if you can‘t say something nice about someone, then don‘t say anything at all.‖ ANS: B

Feedback: The best response is for the experienced nurse to name the behavior specifically, bullying, and make a firm statement that it will not be tolerated. The experienced nurse also should point out that the nurse has strengths coming from another unit, orthopedics, which she is willing to share and she does not bully the staff of the telemetry unit when they don‘t know how to set up traction. The other responses do not directly call the action going on bullying, so the statements will not be as effective. The experienced nurse should not call it a lesser issue, ―making fun of someone,‖ when there is nothing fun about the behaviors of the nurses plotting to destroy the nurse‘s career on the unit. Pointing out that the nurse does not have adequate training is positive, but by not calling the behavior bulling, the nurses may continue to bully. The nurse should not call the behavior gossip or use a cliché to try to stop the nurses; this will not affect the nurses as well as calling it what it is, bullying PTS: 1 DIF: Difficult REF: p. 322, Bullying OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 15 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The licensed practical/vocational nurse (LP/VN) is caring for another nurse‘s clients while he

is on break. One of the client rooms has a radioactive material sign on the door and precautions listed for brachytherapy (radioactive seeds placed in the client‘s prostate). The nurse should intervene when who attempts to enter the client‘s room?

A. The nursing assistant (NA) who is pregnant is taking an adult incontinence brief and supplies to perform perineal care.

B. The male unlicensed assistive personnel (UAP) is bringing the client‘s lunch.

C. The client‘s wife, age 62, and son, age 40, want to visit.

D. The housekeeper is preparing to clean the client‘s room using standard precautions.

ANS: A

Feedback: The nurse needs to intervene with the pregnant NA who is planning to perform perineal care because the potential risk of exposing the unborn fetus to radiation. Precautions are posted on the door, including pregnant women remain 3 feet away and children cannot sit on lap for more than 5 minutes per day.

PTS: 1 DIF: Moderate REF: p. 338, Radiation OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A licensed practical/vocational nurse is working in a busy medical–surgical unit and wants to

prevent nursing burnout. Which steps should the nurse take? Select all that apply.

A. Use a close friend who listens, so the nurse may vent during times of high stress.

B. Work longer hours, so all tasks may be accomplished.

C. Discuss work-related issues with other nurses and administration to problem-solve to make the work environment better.

D. Take breaks, use relaxation techniques during the break to help relieve stress.

E. Apply for other positions in other institutions.

ANS: A, C, D

Feedback: Nursing burnout may occur on busy high acuity units, which become understaffed, or when nurses are not appreciated for their experience by resident physicians or others who may ignore what they have to say. Often times, the nurse who is a perfectionist wants everything done just right for all of the clients, and often feels to be perceived as being ―weak‖ if he/she asks for help from others. Nurses need to approach the nursing care as a team and support each other. The team needs to always look for the signs of burnout and always be willing to help each other. It is best for a nurse to have a close friend who listens, so the nurse may vent about the stress and work situation but not identify any of the clients. Working longer will add to the burnout. Involving the team to identify the problems of the work environment and eliciting help from administration to provide solutions is the best way to decrease the hectic work environment that increases the stress and burnout. Taking a break when stress builds and use relaxation techniques is helpful to re-energize. Jumping from one unit with problems to another is not helpful because all units experience problems from time to time.

PTS: 1 DIF: Moderate REF: p. 329, Burnout OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 15 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Selection 19. A licensed practical/vocational nurse (LP/VN) is caring for an older adult client on the

geriatric psychiatric unit. The nurse is in a hurry and enters the client‘s room to provide the morning care, change his dressing, and get him dressed and walk him in the hall with assistance of one. The nurse has cared for him for days, and the client always spoke in a soft voice and was pleasant, but today, the client started yelling and swinging at the nurse. Which is the best first action for the nurse to provide?

A. Place a physical restraint and obtain an order from the physician.

B. Get back from the client‘s swinging distance and speak calmly.

C. Talk loudly because the client has problems hearing.

D. Administer the as-needed sedation.

ANS: B

Feedback: The nurse should get out of swinging distance and speak in calm, reassuring voice and slow down actions toward the client because the client perceives the sudden hurried actions of the nurse as a threat and is acting out to protect himself. Using medication restraint is unnecessary as the best first action because behavior management should be tried before medications. Physical restraint at this point of time would increase the client‘s agitation and anger. Speaking loudly would also increase the client‘s behaviors, and there is no evidence that the client has difficulty hearing since he spoke in a soft voice in the past.

PTS: 1 DIF: Moderate REF: p. 331, Violence OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The licensed practical/vocational nurse (LP/VN) is working on a medical–surgical unit in a

hospital and recently had an in-service on emerging contagious diseases. Which of the following actions should the nurse take to best safe guard the clients he or she cares for, and the staff he works with on this unit? When any client is admitted to the unit, the nurse should: A. assess the client for signs and symptoms of an infectious disease.

B. ask the client if he or she has traveled outside of the country in the past 2 months, or if someone close to the client has, if so what country and when.

C. visit the Centers of Disease Control National Center for Emerging and Zoonotic Infections Diseases website.

D. provide all possible precautions to prevent the potential spread of infectious disease.

ANS: B

Feedback: Along with proper hand washing, using alcohol-based hand sanitizer, and using standard precautions, the nurse‘s best safe guard for helping to prevent the spread of emerging contagious diseases is to ask the client if he/she or someone they are close to has recently traveled outside of the country in the past couple of months, and if so, what country and when.

Assessing the client for signs and symptoms of an infectious disease should not be performed because the client may have been exposed to the illness and may not immediately show signs and symptoms but be contagious and spread the illness. Visiting the CDC website may not provide the most up to date information, thus the information would not be identified in time to warn the staff of an emerging illness. The nurse‘s hospital may be the first hospital to experience an emerging contagious disease. It is costly and isolating all clients is impractical and decreases the ability for the nurse–client relationship to adequately occur with if all of the possible personal protective equipment is used.

PTS: 1 DIF: Moderate REF: p. 334, Contagious Diseases OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 15 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 16, Current Issues and Future Concerns 1. A licensed practical/vocational nurse (LP/VN) provides an in-service for all of the health care

staff on Green health care. At the end of the session, the nurse asked the health care workers to provide ways they planned on helping keep Green health care. Which statement should the LP/VN further clarify to improve the worker‘s application of Green health?

A. ―I will only take in the linens I need to care for my client into my client‘s room.‖ B. ―I will place confidential client report papers into the paper shredder for recycling.‖ C. ―I will dispose of used batteries from the telemetry monitors into the trash can.‖ D. ―I will volunteer to serve on a committee that searches for reusable medical supplies.‖ ANS: C

Feedback: Green health care has goals to use reusable supplies over disposable ones, conserve supplies by not wastefully taking more supplies than needed into a client‘s room, and dispose of potential toxic substances properly to prevent polluting the environment. The nurse should further clarify the regarding disposal of used batteries. The used batteries need to go into a special container, not into the waste can, because the toxic substances in the battery will pollute the ground and water supply.

PTS: 1 DIF: Easy REF: p. 343, Green Health Care OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 2. One of the best ways to avoid getting an injury at work is to: A. read the policy and procedure manual.

B. comply with safe lifting and handling procedures.

C. wear gloves at all times.

D. always ask a coworker assist you with tasks.

ANS: B

Feedback: Reading something does not mean the knowledge will be put into practice; following procedures is the best way to avoid an occupational injury. Gloves and assistance are not necessary for every task.

PTS: 1 DIF: Moderate REF: p. 349, Occupational Risks OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 16 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A licensed practical/vocational nurse (LP/VN) suffered a back injury and is working while

taking prescription narcotic analgesics. A coworker noticed that the impaired nurse is risking clients‘ care because of altered judgment and has a crucial conversation with the nurse. The nurse chooses to enter a voluntary recovery program with the state board of nursing. Which statement made by the nurse seeking recovery needs further clarification by the coworker helping the nurse to enroll into the program?

A. ―I will sign an agreement with the board of nursing to voluntarily be monitored for

using any narcotics the next 3 years.‖ B. ―I will enter a drug treatment program approved by the state board of nursing and

complete it and the rehab portion of the treatment.‖ C. ―I will not work in the hospital until I meet the requirements of the state board of

nursing for treatment and rehab.‖ D. ―I will lose my license and I will need to go through nursing school again after

completing the program.‖ ANS: D

Feedback: All of the boards of nursing disciplinary treatment programs offer rehabilitation and the nurse signs an agreement to voluntarily accept the help and to abide by the requirements set forth by the state board of nursing. If the nurse successfully completes a treatment program, there is no loss of license, so the coworker needs to clarify the statement the nurse made regarding the loss of licensure. Most programs initially prohibit working for a period of time, and if the nurse complies with the treatment program, in most states, there is no record. The coworker in this scenario best serves the safety of the clients by removing the nurse from caring for the clients while impaired.

PTS: 1 DIF: Moderate REF: p. 349, Chemically Impaired Nurses OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 4. The newly graduated licensed practical/vocational nurse searched the state board of nursing

website finding that there is a requirement for continuing education, which must be met before renewing the license. How should the nurse store and document the required proof of continuing education?

A. List the continuing education activities on the resume and keep it up-to-date.

B. Provide the list of continuing education activities required by the nurse manager.

C. Keep certificates of proof of attendance and the amount of contact hours and the information related to the state board of nursing approval.

D. Keep all of the printed learning materials, including learning objectives from all continuing education activities as proof of attendance.

ANS: C

Feedback: In case of a state board of nursing audit to determine if the nurse has completed the required continuing education, the nurse should maintain copies of all of the actual certificates of proof of attending or completing the activity. The nurse‘s name should be included on the certificate and the date of the educational activity and the official state board of nursing approval number and learning objectives are included on the certificate. The other items are all important to maintain in order to keep the resume up-to-date, meet requirements of the job, and recognize if the continuing education requirements have been met or not. The handouts or materials from an educational offering offer no proof to the state board of nursing that the continuing education was completed or credit was awarded.

PTS: 1 DIF: Moderate REF: p. 350, Maintaining Competence OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

5. The licensed practical/vocational nurse (LP/VN) maintains competency through informal and

formal education. The nurse checked the state board of nursing requirements and noted that he or she needed 24 continuing education or contact hours, and the license is renewed every 2 years. Which educational activity will count toward the state board of nursing requirements?

A. A mandatory 1-hour videoconference at work on workplace violence.

B. An 8-hour workshop on using nursing research to care for clients.

C. A 10-hour seminar awarding state board approved contact hours.

D. Reading the most current nursing textbook and write notes to improve care.

ANS: C

Feedback: All of the activities may help the nurse stay up-to-date with practice, but the state board of nursing requires formal approved contact hours or what is defined as acceptable, such as a nursing college course may be awarded contact hours. The only activity that is approved by the state board of nursing is the 10-hour seminar.

PTS: 1 DIF: Moderate REF: p. 350, Maintaining Competence OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 6. Which is an example of workplace discrimination?

A. A male nurse is assigned to assist female nurses with transferring clients.

B. A pregnant nurse is assigned to administer medications.

C. A nurse aide is assigned to take blood pressures.

D. A registered nurse is assigned to complete admission assessments.

ANS: A

Feedback: Always requiring a male nurse to assist in lifting clients is saying that men are for physical work, and this is discrimination. Pregnancy usually has nothing to do with administering medications. Nurse‘s aides may assist with blood pressures. Admission is a part of the job of the registered nurse.

PTS: 1 DIF: Easy REF: p. 356, Discrimination OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 7. The licensed practical/vocational nurse (LP/VN) is informed at a staff meeting that the

hospital plans on cross training the LP/VNs to draw the blood specimens and perform the electrocardiograms (ECGs). The state nurse practice act permits the additional tasks through cross training. Which question is the most important question the LP/VN should ask at this meeting?

A. What is happening to the phlebotomists and ECG technician‘s positions, will they still be around?

B. What training will be provided to ensure that the nurses performing the skills are competent and have the necessary knowledge to practice safely?

C. Will the LP/VNs receive additional pay compensation for the additional skills we provide for the hospital?

D. What happens if I cannot learn the skills or perform them proficiently, is there

another unit I can work and not perform the skills?

ANS: B

Feedback: The most important question to ask is the one questioning if training will be provided. Training needs to include the performance of the skill, psychomotor training, and the knowledge necessary to make competent decisions. The safety of the clients should be the top concern of the nurse in this situation.

PTS: 1 DIF: Moderate REF: p. 357, Delegation and Cross-Training OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 16 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 8. The nursing administrator wants all the licensed practical/vocational nurses (LP/VNs)

employed in the facility to be cross-trained to do chest percussion therapy. This task is covered by the state‘s nursing board practice act. Before cross-training occurs, which is the most important aspect that the employer should consider?

A. Does the benefits of cross-training the LP/VN to perform the task outweigh the potential risks to the client?

B. Will the LP/VNs be able to perform all of the other duties sufficiently?

C. Will client satisfaction initially go down until the nurses are comfortable with performing the procedure?

D. Will the LP/VN job satisfaction decrease initially until the nurses are comfortable with the task?

ANS: A

Feedback: The most important aspect for the employer to consider before beginning cross-training is to analyze all the potential benefits and risks, and if any of the risks could adversely affect clients, then the idea should be abandoned. Client safety is the number one priority over satisfaction. Clients are placed in more importance over employee satisfaction or perceived ability to perform all tasks sufficiently.

PTS: 1 DIF: Moderate REF: p. 357, Delegation and Cross-Training OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A licensed practical/vocational nurse (LP/VN) acts as a client advocate by discussing end of

life issues with the client who has a terminal illness and does not have any advanced directives. The client asks the nurse what is an advanced directive and how can I get one? The best response for the nurse is, ―an advanced directive A. describes what you want done if you stop breathing and your heart stops, and I can have the client representative visit you and help you make one.‖ B. is a statement of whom you trust and want to manage your care in the event that you are unable to do so, and I can have the client care representative visit and help you make one.‖ C. describes your preferences for care should you become incapacitated, and I can have the client care representative visit you and help you make one.‖

D. is a statement of what organs or tissues you want to be donated in the event that

you die, and I can have the client care representative visit and help you make one.‖ ANS: C

Feedback: All 50 states have laws that allow people to write an advanced directive or a living will that specifies their health care preferences if they are incapacitated. The best description of advanced directives, a larger encompassing term for many different types of directives is answer C. Answer A is describing a ―do not resuscitate,‖ which the client and physician would discuss and the physician would order. Answer B is describing a durable power of attorney for health care. Answer D is describing organ and tissue donation. The American Hospital Association provides a pamphlet, http://www.aha.org/content/13/putitinwriting.pdf which can be given to clients about advanced directives, and it is links for free downloadable forms that hospitals use to help clients wanting to make advanced directives.

PTS: 1 DIF: Moderate REF: p. 362, End-of-Life Issues OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A nursing student learned about reasons for health care reform. Which is a main reason why

health care is a top concern of Americans?

A. Geographic concentration of physicians.

B. Decreases in the number of acute care hospitals.

C. The shortage of licensed nurses.

D. Increasing cost of health insurance.

ANS: D

Feedback: All premiums for all types of plans are steadily increasing while at the same time, employer contributions are steadily decreasing. The importance of this phenomenon in the lives of Americans supersedes the nursing shortage, decreases in hospital beds, and the distribution of physicians.

PTS: 1 DIF: Moderate REF: p. 364, Health Care Reform OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A nurse who floats between several different hospital units has been asked to work in a shift

on the palliative care unit. What subject for continuing education should benefit this nurse during future shifts on this unit?

A. Assessment and management of pain B. Interdisciplinary communication C. Mobilization and musculoskeletal function D. Respiratory assessment and management ANS: A

Feedback: Palliative clients are receiving care at the end of life, a time when pain is a frequent and severe problem. This subject would be of greater benefit than topics related to mobilization, respiratory health, or communication.

PTS: 1 DIF: Moderate REF: p. 362, End-of-Life Issues OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 12. The Patient Protection and Affordable Care Act was signed into law on March 23, 2010. How

can a nurse best contribute to a meaningful discussion about this piece of legislation with coworkers, friends, and family?

A. Become informed about the provisions and implications of the law B. Refer people to the Department of Health and Human Services website C. Collect stories about Americans who have been unable to afford necessary health care D. Distribute copies of the legislation to individuals who are interested ANS: A

Feedback: Being informed is a vital prerequisite to a meaningful and thoughtful discussion of the Affordable Care Act. This is more beneficial than referring people to a website, sharing cautionary tales, or encouraging people to read the legislation itself.

PTS: 1 DIF: Difficult REF: p. 364, Health Care Reform OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A newly graduated licensed practical/vocational nurse (LP/VN) learned about causes for the

current nursing shortage. How can the nurse best reduce his or her chances of leaving the profession?

A. Work at the institution that offers the highest wages and the best benefits.

B. Interview with institutions that offer tuition pay back.

C. Try another position at another institution at the first sign of job dissatisfaction.

D. Recognize and act upon early signs of burnout and compassion fatigue.

ANS: D

Feedback: Causes for nurses leaving the profession include job dissatisfaction, nurse burnout, and compassion fatigue. The nurse‘s best way to help decrease leaving the profession is by recognizing and acting upon the early signs of burnout and compassion fatigue. Other interventions the nurse could do to help decrease exiting nursing is to communicate with staff and management to decrease bullying and be active to improve the work conditions on the particular unit the nurse works. Working at the institution that offers the highest wages and the best benefits does not guarantee happiness because other work conditions may be unbearable, such as staffing, job expectations, lack of mentoring and support, etc.

Interviewing with institutions that offer tuition pay back may help lessen the financial burden, but the nurse may not be happy at the institution if other work-related issues are unbearable.

Trying another position at another institution at the first sign of job dissatisfaction is not always the best solution because learning to work through conflicts and reach a resolution is a lifelong skill nurses that stick with the profession have used.

PTS: 1 OBJ: 7

DIF:

Moderate

REF: p. 358, Nurse Shortage

NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 14. Nurses maintain their competence through a variety of formal and informal methods. What

activity could contribute to competence in a formal way?

A. Taking a college course about family dynamics B. Learning new procedures from other skilled nurses C. Listening to physicians discuss a client‘s treatment options D. Reading a client‘s chart in detail to understand context ANS: A

Feedback: Informal education may include reading journals, attending staff development programs offered by your employer, learning new procedures or techniques from those skilled in their performance, reading client health records, listening to physicians as they discuss treatment options, and learning to use new and different equipment. College courses are formal educational offerings.

PTS: 1 DIF: Moderate REF: p. 350, Maintaining Competence OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. Two nurses are discussing the introduction of mandatory continuing education requirements

in their state. Which argument in favor of this change is most accurate?

A. Nurses forget most of what they learned in nursing school within 18 months of

graduating.

B. Continuing education requirements allow state boards of nursing to track nurses

more closely.

C. In the absence of mandatory continuing education, no nurse would build on his or her knowledge.

D. Ensuring that nurses keep their knowledge current promotes client safety.

ANS: D

Feedback: Advocates of mandatory continuing education point out that such requirements promote currency of knowledge which has the potential to improve client outcomes and protect client safety. Nurses have not been shown to forget their learning quickly. All nurses have a responsibility to keep their knowledge current and the majority of nurses act on this responsibility. Education requirements do not exist to track nurses more closely.

PTS: 1 DIF: Difficult REF: p. 351, Continuing Education for License Renewal OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze NOT: Multiple Choice 16. The licensed practical/vocational nurse (LP/VN) is concerned about the recent changes at the

hospital where he or she works. The hospital in an attempt to cut costs increased staffing ratios. This has led to increased stress and a feeling that clients are not being properly cared for. In addition, nurse burn out, nursing turnover, and mistakes have all increased. Which action should the nurse take next?

A. Gather information from staff nurses regarding the staffing issue, level of stress,

rate of burnout, and client safety issues and contact the administration of the hospital presenting the case for better staffing ratios.

B. Visit the American Nurses Association to learn more about what changes are being made in different states to provide safe nurse to client ratios and to gather best evidence to support change.

C. Write the state legislators about producing a bill to create safe staffing ratios presenting a case for the needed change based upon increased staffing leads to nurse burnout, increased nurse turnover, and increase in errors leading to a decrease in client safety.

D. Contact the professional organization the nurse belongs to about the situation and ask for their help.

ANS: B

Feedback: The first step in the process is to learn more about staffing ratios via the American Nurses Association website. There the nurse will find research articles to support adopting safe staffing ratios in order to decrease errors with client care, decrease nurse burnout, and increase retention of nurses. After this first step, the nurse may gather information from staff nurses regarding the issues related to the change in staffing and take the concerns and the research findings to administration to present the case. Next the nurse could contact the professional organization and state legislators to exercise political voice.

PTS: 1 DIF: Moderate REF: p. 358, Safe Staffing OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 16 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A nursing student is caring for a client who states that she plans on taking Black Cohosh for

her menopausal symptoms and Gingko to help improve her memory and concentration. She has enrolled into Tai Chi to help improve balance, and reduce stress. Which statement is the most important point for the nurse to cover during a teaching session with the client?

A. ―Herbals may interfere with other medications you take, react with a medical condition you have or interfere with surgery, so always tell your physician what you are taking.‖ B. ―The herbal treatments are considered supplements by the Federal Drug Administration and are perfectly safe as long as you follow the directions on the bottle.‖ C. ―There is a website I may show you that has up-to-date information about herbals.‖ D. ―When you purchase an herbal, you may want to shop around because there may be sales, so you may buy one bottle and get one free.‖ ANS: A

Feedback: All points mentioned may be made when teaching, but the most important aspect to cover is that the herbals may interfere with other medications the client takes, such as gingko and aspirin or warfarin leading to an increased bleeding risk. Herbals may interfere with surgery because some herbals increase the risk for bleeding, such as gingko. Some herbals may only be used short term as noted on the bottle, or the herbal will interfere with the condition it is treating and make it worse.

PTS: 1

DIF:

Moderate

REF: p. 359, Complementary and Alternative Therapies

OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 16 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The licensed practical/vocational nurse (LP/VN) wants to settle a conflict in the workplace

regarding holiday schedules. Those with years of experience want to work only minor holidays leaving newer nurses to work major holidays. Others want to rotate holidays so all nurses can have minor and major holidays off, and different holidays off each year. Which action should the nurse take to best resolve the conflict?

A. Discuss the situation with the nurse manager and ask him what to do to help resolve the issue.

B. Discuss the issue with each nurse separately to determine their stance and try to persuade each team member to take the nurse‘s side.

C. Suggest coworkers meet to brainstorm solutions and discuss the pros and cons of the plans, and then vote by secret ballot to determine what the majority want.

D. Distribute secret ballots with the two ways to schedule holidays and have each team member vote, and then announce the winner.

ANS: C

Feedback: The workplace conflict is among the staff, so the nurse may best serve the team and helps resolve the conflict by asking the coworkers to meet to brainstorm solutions to the issue, and then discuss pros and cons of each idea and allow the majority vote to choose the method of holiday scheduling to be used. Discussing the situation with the nurse manager would be the best means to resolve a conflict that just the nurse has but will not help when the conflict is with all of the nurses. Discussing the issue with each nurse separately will outrage coworkers who want their opinion to be valued. It is too early in the conflict to distribute secret ballots because the nurses need to explore solutions before voting on a solution.

PTS: 1 DIF: Moderate REF: p. 366, Workplace Conflicts OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The hospital purchased a new electronic health record (EHR) system. The licensed

practical/vocational nurse (LP/VN) should immediately report which items discovered while using the EHR to administration?

A. The system is not user friendly and adds more time to the work load when compared to the previous paper chart, so it takes away time that nurses could be caring for clients.

B. A client went to surgery, so a medication was held and the EHR did not retain the med on the list, and treated a held med as a deleted med removing it from the system entirely.

C. The cart that the computer is mounted has to be plugged in from time to time and the nurse has to bend over to do so because the receptacles are low.

D. The keyboard needs some type of protective cover so the area can be easily disinfected from time to time since nurses are going from client room to another one.

ANS: B

Feedback: The issue of the EHR deleting a medication is a dangerous situation because, if the nurse did not catch the glitch, the client would not have had the medication he or she needed after surgery. The issue of the system taking up added work time may be because the system is new and the nurses need to get acclimated to using it. Needing to plug in the cart is an annoyance that can be addressed later on by adding plugs higher on the wall where the nurses may best utilize them. The issue of the system needing a cover is a potential issue for spreading germs and can be addressed by investigating a cover that will work so the nurse may disinfect the keyboard in between use easier. Before using the covers, a quick solution is a disinfectant wipe on the keyboard. Thus, this issue is not as pressing as clients not receiving needed medications.

PTS: 1 DIF: Difficult REF: p. 352, Electronic Health Records OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The new licensed practical/vocational nurse (LP/VN) is not only excited about the new career

but also wants to incorporate a simple rule of taking time for personal well-being. Which is the best approach to take?

A. Take time each day for exercise, a proper diet, and stress relieving techniques.

B. Go to the spa once a month and get a relaxing deep massage.

C. Take a relaxing vacation on a beach or in the mountains to relax and enjoy nature.

D. Take a day off once a week and do something special just for you.

ANS: A

Feedback: Nurses spend so much energy and time caring for their clients and others in volunteer activities, they end up emotionally, physically, and spiritually spent. They end up burned out and may quit nursing. To best prevent this from happening the new nurse must budget time each day to exercise, use stress relieving techniques, and eat a proper diet. Stress relieving techniques may be used at work during a break, such as Tai Chi or Yoga, or meditation, or whatever it is that helps take you away from nursing for 15 minutes to reduce stress. Taking a special day once a week, or a spa break once a month, or a relaxing vacation are great, but stress builds every day and the nurse needs to relieve it through the same advice we tell our clients, eat a proper diet, exercise, and use stress reduction techniques.

PTS: 1 DIF: Moderate REF: p. 45, Personal Well-Being OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice 21. The administrator plans to adopt electronic health records (EHR) in the nursing home. The

licensed vocational/practical nurse serving on a committee to choose one of three EHR systems should consider which system based upon the information listed?

System A: Requires the purchase of the most current computers, and scanner printer Affordable Care Act (ACA) compliant in exchanging client information/billing Noncompliant with some of the area hospitals current EHR systems Requires individual traceable log-in Requires extensive training for users Quick search for research activities

System B: Uses current computers, scanner printer Requires a special screen preventing nonusers to view information on screen Requires individual traceable log-in Minimal training required and provided by EHR provider ACA compliant in exchanging client information/billing/quick research Communicates with all area hospital networks System C: Uses new computers, scanner printer, and monitor display with privacy ACA compliant in exchanging client information/billing Extensive training required/customers rate system performance 2/5 scale over-all Communicates with all area hospital networks Individual nontraceable log-in Limited search ability for research activities A. System A. B. System B. C. System C. D. Any of the systems is acceptable based upon the evidence.

ANS: B

Feedback: System B offers the best options when compared to the other two options. System B offers necessities for the EHR: client confidentiality/privacy, ACA compliant, and communicates with other health care facilities, and has the ability for quick research within the system for quality assurance/continuous quality improvement and research needs. System A is not an appropriate choice because it will not communicate with some of the area hospitals, and this goes against the principle of ACA that facilities may communicate with one another. System C is not an appropriate choice because it has a nontraceable log-in so health care workers could access and perform activities leaving client‘s privacy vulnerable.

PTS: 1 DIF: Moderate REF: p. 352, Electronic Health Records OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16 KEY: Integrated Process: Clinical Problem-solving Process (Nursing Process) BLM: Cognitive Level: Analyze NOT: Multiple Choice