Test Bank for LPN to RN Transitions, 5th Edition by Lora Claywell

TEST BANK

TEST BANK

UNIT ONE ESSENTIAL SKILLS TO BEGIN YOUR TRANSITION Chapter:1 Honoring Your Past, Planning Your Future Chapter:2 Assessing Yourself and Designing Success Chapter:3 Study Habits and Test-Taking Skills

UNIT TWO THE PROFESSION AND DISCIPLINE OF REGISTERED NURSING Chapter:4 Distinguishing the RN Role from the LPN/LVN Role Chapter:5 Using Nursing Theory to Guide Professional Practice Chapter:6 Providing Patient-Centered Care Through the Nursing Process Chapter:7 Critical and Diagnostic Thinking for Better Clinical Judgment

UNIT THREE THE RN AS PROVIDER OF CARE Chapter:8 Practicing Evidence-Based Decision Making Chapter:9 Communicating with Patients and Co-Workers Chapter:10 Teaching Patients and Their Families Chapter:11 The Nurses, Ideas, and Forces That Define the Profession Chapter:12 Upholding Legal and Ethical Principles Chapter:13 Care and Safety Standards, Competence, and Nurse Accountability

UNIT FOUR THE RN AS MANAGER OF CARE Chapter:14 Leading, Delegating, and Collaborating Chapter:15 Promoting Healthful Living in the Primary Care Setting Chapter:16 Managing Care in Secondary and Tertiary Health Care

UNIT FIVE PUTTING IT ALL TOGETHER Chapter:17 Reflecting on Your Transition Chapter:18. Prepare Now to Pass NCLEX-RN®

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Chapter 01: Honoring Your Past, Planning Your Future

MULTIPLE CHOICE 1. A nursing advisor is meeting with a student who is interested in earning her RN degree. She knows that licensed practical nurse/license vocational nurse (LPN/LVNs) who enter nursing school to become RNs come into the learning environment with prior knowledge and understanding. Which statement by the nursing advisor best describes her understanding of the effect experience may have on learning? a. “Experience may be a source of insight and motivation, or a barrier.” b. “Experience is usually a stumbling block for LPN/LVNs.” c. “Experience never makes learning more difficult.” d. “Once something is learned, it can never be truly modified.”

ANS: A Experience accentuates differences among learners and serves as a source of insight and motivation, but it can also be a barrier. Experience can serve as a foundation for defining the self.

DIF: Cognitive Level: Application OBJ: Identify how experiences influence learning in adults.

TOP: Adult Learning

2. There is a test on the cardiovascular system on Friday morning, and it is now Wednesday night. The student has already taken a vacation day from work Thursday night so that she can stay home and study. She is considering skipping her exercise class on Thursday morning to N go to the library to prepare for the test. Which response best identifies the student’s outcome priority? a. Exercise class b. Going to the library c. Avoiding work by taking a vacation d. Doing well on the test on Friday ANS: D The outcome priority is the essential issue or need to be addressed at any given time within a set of conditions or circumstances.

DIF: Cognitive Level: Application OBJ: Identify motivations and personal outcome priorities for returning to school. TOP: Motivation to Learn

3.

A nurse who has been an LPN/LVN for 10 years is meeting with an advisor to discuss the possibility of taking classes to become an RN. The advisor interprets which statement by the nurse as the driving force for returning to school? a. “I’ll need to schedule time to attend classes.” b. “I’ll have to budget for paying tuition.” c. “I’ll have to rearranging my schedule.” d. “There is a possibility of advancement into administration.”

ANS: D

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Driving forces are those that push toward making the change, as opposed to restraining forces, which are those that usually present a challenge that needs to be overcome for the change to take place or present a negative effect the change may initiate.

DIF: Cognitive Level: Application OBJ: Identify motivations and personal outcome priorities for returning to school. TOP: Motivations for Change

4.

An RN is caring for a diabetic patient. The patient appears interested in changing her lifestyle and has been asking questions about eating better. The nurse can interpret this behavior as which stage of Lewin’s Change Theory? a.

Moving b. Unfreezing c. Action d. Refreezing ANS: B The patient is in the first phase of Lewin’s Change Theory, known as unfreezing. This phase involves determining that a change needs to occur and deciding to take action. Moving is the second phase and involves actively planning changes and taking action on them. Refreezing is the last stage, and it occurs when the change has become a part of the person’s life.

DIF: Cognitive Level: Analysis OBJ: Understand Change Theory and how it applies to becoming an RN. TOP: Change Theory

5.

An LPN is talking with her clinical instructor about her decision to return to school to become an RN. The clinical instructor interprets the LPNs outcome priority based on which N statement? a. “My family wanted me to go back to school.” b. “I want to better my financial situation.” c. “I really enjoy school.” d. “I would like to advance to a teaching role someday.”

ANS: B The outcome priority is the essential need that must be addressed, determined by internal and external factors, such as needing to better a financial situation. The other statements indicate reasons for returning to school, but they are not essential needs or issues to be addressed.

DIF: Cognitive Level: Analysis TOP: Adult Learning

6.

OBJ: Identify how experiences influence learning in adults.

A nurse notices a posting for a management position for which she is qualified. If the nurse is in the moving phase of Lewin’s Change Theory, which statement reflects the action she is most likely to take? a. Does nothing to obtain the position b. Applies for the position c. Identifies that change is needed d. Settles into the routine of her job ANS: B Unfreezing begins when reasons for change are identified. The moving phase involves active planning and action.

Moving also means you are dealing with both positive and negative forces as they ebb and flow, and you are making modifications to your plan as needed. Refreezing occurs after the change has become routine.

DIF:

Cognitive Level: Application

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OBJ: Understand Change Theory and how it applies to becoming an RN. TOP: Change Theory

7.

An Orthopedic Nurse is contemplating changes in her professional life and identifying goals.

Which action should the nurse take if she is interested in pursuing a long-term goal? a. Studies for a telemetry exam scheduled for next week b. Enrolls in a Nurse Practitioner program c. Attends a seminar to become a charge nurse d. Continues to work on the orthopedic floor full-time ANS: B A short-term goal is one that can be attained in a period of 6 months or less. Short-term goals include becoming a charge nurse and passing the telemetry exam. A long-term goal is attained in greater than 6 months and includes studying to become a Nurse Practitioner. Continuing to work on the orthopedic floor does not represent either a shortterm or a long-term goal.

DIF: Cognitive Level: Application OBJ: Identify both short- and long-term personal and professional goals. TOP: Setting Goals

8.

The RN is talking with the unit manager about ways to improve patient care. The manager introduces the concept of a cohort. Which statement by the RN indicates that the teaching has N been effective? a. “A cohort is a web of connections”. b. “A cohort is a group of people who share common experiences with each other”. c. “A cohort is a group linked together for common purposes”. d. “A cohort consists of groups of individuals that make up a whole”.

ANS: B A cohort is a group of people who share common experiences with each other. A scheme is a web of connections, a team is a group linked together for common purposes, and a unit consists of groups or individuals that make up a whole.

DIF: Cognitive Level: Evaluation OBJ: Identify how experiences influence learning in adults.

9.

TOP: Adult Learning

The nurse educator is presenting a lecture to a group of new RNs. Which statement by one of the RNs indicates that teaching has been effective? a. “Experience is a stepping stone to new learning”. b. “Experience can be a barrier to new learning”. c. “Experience can be an avenue to new learning”. d. “Experience can be a detour to new learning”.

ANS: B Experience accentuates differences among learners, serves as a source of insight and motivation, can be a barrier to new learning, and serves as a foundation for defining the self.

DIF: Cognitive Level: Evaluation OBJ: Identify motivations and personal outcome priorities for returning to school. TOP: Adult Learning

10. The nurse educator is presenting a lecture on experience and learning to a group of RNs.

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Which statement by one of the RNs indicates that teaching has been effective? a. “Experiences always help educational endeavors”. b. “The process of unlearning is easier than the initial learning”. c. “Learning can often be more difficult if previous knowledge is contradicted”. d. “Experiences rarely serve the student in the learning process”.

ANS: C Experiences may either help or hinder both present and future educational endeavors (Knowles et al., 2015). Experience may serve as a chain to which new learning may be linked, making concepts understandable within your personal context. Conversely, some experiences make learning more difficult in that new information may contradict previously accepted information and make it necessary to unlearn it. The process of unlearning is more difficult than initial learning.

DIF: Cognitive Level: Evaluation OBJ: Delineate both positive and negative effect experiences.

TOP: Adult Learning

MULTIPLE RESPONSE 1. A student nurse and the staff RN are discussing recent changes on the nursing unit. Which of the following are examples of change processes? (N Select all that apply.) a. Coercive b. Collaborative c. Technocratic d. Planned e. Organized ANS: A, C, D Coercive is a type of change that is forced or pushed on another. A decision for change made by the most knowledgeable person is known as technocratic. Planned change involves careful thought and decision-making.

Collaborative and organized are not considered to be types of change.

DIF: Cognitive Level: Application OBJ: Understand Change Theory and how it applies to becoming an RN. TOP: Change Theory

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Chapter 02: Assessing Yourself and Designing Success

MULTIPLE CHOICE

1. After a particularly challenging examination, a student is overheard in the hallway exclaiming, “That instructor just grades too hard! She only gave me a B on the test!” This student is exhibiting traits of a(n) a. external locus of control. b. internal locus of control. c. perfectionist. d. realist.

ANS: A Persons with an external locus of control often do not take responsibility for what happens to them. Persons with an internal locus of control take responsibility for what happens to them. A perfectionist strives for perfection in all that he or she does, which is a self-defeating behavior. A realist accepts the world as it is and handles it accordingly.

DIF: Cognitive Level: Application OBJ: Interpret the role of locus of control on personal empowerment.

Locus of Control

TOP:

2. A student must come back to the learning laboratory to repeat the skills and check for insertion of a nasogastric tube. The instructor overhears the student saying, “I know I can do this, I know I can do this!” The instructor interprets this behavior as a. a self-defeating behavior. N b. positive self-talk. c. perfectionism. d. blaming.

ANS: B The student is expressing positive self-talk by telling herself, “I know I can do this.” Stating “I can’t do this” is an example of a self-defeating behavior. A student expecting to perform tasks perfectly is striving for perfectionism.

Blaming is not occurring here because the student is taking responsibility for his/her own actions.

DIF: Cognitive Level: Analysis OBJ: Explain the impact of positive self-talk. TOP: Self-Talk

3. A clinical instructor notices that one of her students worries a lot, expects negative outcomes for most situations, strives for perfection, and seems to look for the tiniest faults in her work. The clinical instructor interprets these behaviors as a. commitment to learning. b. assuming an external locus of control. c. self-directedness. d. self-defeating behaviors.

ANS: D The student may be committed to learning, but she is showing signs of self-defeating behaviors. Self-defeating behaviors include pessimism, nit-picking, worrying, perfectionism, and blaming. Assuming an external locus of

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control means believing that action or inaction lies outside of oneself. Assuming ownership of learning defines selfdirectedness.

DIF: Cognitive Level: Analysis Behaviors and Empowerment

OBJ: Describe self-defeating behaviors. TOP: Self-Defeating

4. A nursing professor is grading an assignment on self-defeating behavior. The professor can expect to find which statement written by the student who has a good understanding of perfectionism?

a. Perfection is impossible to attain, and therefore constantly falling short of perfection leads to negative feelings and beliefs about oneself.

b. Perfection is the ultimate goal, and it is not a self-defeating behavior to demand it of oneself. c. Perfectionism is the only means by which we can truly improve. d. Perfectionism is a character flaw and cannot be addressed.

ANS: A Perfection is impossible to obtain. Students who strive for perfection set themselves up for negative feelings and beliefs about themselves.

DIF: Cognitive Level: Analysis OBJ: Describe self-defeating behaviors. TOP: Self-Defeating Behaviors

5.

The nurse understands that there are four key habits for managing the work of success. Which action by the nurse demonstrates her understanding? a. Participating in a yoga classN b. Analyzing case studies on her day off c. Taking time at the beginning of the work shift to make a plan for her day d. Setting short- and long-term goals ANS: C The nurse understands that there are four key habits of success when she makes a plan for her day. Joining a yoga class, analyzing case studies, and setting short- and long-term goals are not defined as one of the four key habits.

DIF: Cognitive Level: Application OBJ: Explain four key work habits that contribute to success.

Managing the Work of Success

6.

TOP:

A student has a large reading assignment that must be completed in order to be prepared for the next class. Which action by the student would be ineffective in the planning process? a. Put off the assignment until later so more content is remembered. b. Examine your schedule to determine time frames for study sessions. c. Determine a study environment fitting your learning style. d. Divide the assignment into manageable chunks, and take notes as you read.

ANS: A The time to begin to plan how to accomplish an assignment is the moment one is made aware of the assignment.

DIF: Cognitive Level: Application OBJ: Explain four key work habits that contribute to success.

TOP: Managing the Work of Success

7.

The roommate of a nursing student buys tickets to the student’s favorite play. The student realizes that the play is the night before her final exam. When the student turns down the tickets, the roommate interprets the student’s dedication to school as a. dedication to the plan until other mounting responsibilities interfere. b. total dedication, even in the face of other attractive opportunities.

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c. total dedication until resolve begins to wane. d. discipline to change the plan as needed.

ANS: B Commitment requires discipline to maintain resolve even when other responsibilities or attractive opportunities begin to mount.

DIF: Cognitive Level: Analysis OBJ: Explain four key work habits that contribute to success.

Managing the Work of Success

8.

TOP:

A nursing student is learning about effective time management in her first semester of nursing school. Which action by the student indicates that she understands the first critical step? a. Setting goals based on the desired outcome b. Prioritizing goals in order of simple to complex c. Prioritizing tasks in chronological order d. Assessing the reality of the complete situation ANS: D N Assessing the complete situation is the first step in time management. One must be clear about the reality of the current set of tasks and schedule in order to begin to manage the time associated with the tasks.

DIF: Cognitive Level: Application OBJ: Explain four key work habits that contribute to success. the Work of Success

9.

TOP: Managing

Stress reduction while in nursing school is an important part of maintaining one’s health. Holistic cognitive theory for stress reduction has four steps. The student shows that he or she understands the first step to achieving awareness by doing which of the following? a. Becomes aware of the early physical signs of stress b. Concentrates on placing himself or herself as the center of everything c. Mentally filters perceptions d. Disqualifies the positive in the experience ANS: A The awareness step is a time of understanding how the student feels under stress, coming to know the symptoms, and taking steps to neutralize the symptoms.

DIF: Cognitive Level: Application OBJ: Identify steps that aid in stress reduction.

TOP: Stress Reduction 10. A student exclaims, “I have to make a 100% on this test because anything less is just like failing in my book. I either know it or I don’t and if I don’t know it now, I never will.” This student is obviously stressed, and the statements represent a. awareness reduction. b. cognitive distortions. c. positive coping mechanisms. d. acceptance of reality.

ANS: B Cognitive distortions are illogical, irrational thoughts; those in this question are “all-or-nothing thinking” and “emotional reasoning.”

DIF: Cognitive Level: Application OBJ: Identify steps that aid in stress reduction. TOP: Stress Reduction

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11. A lab instructor is observing placement of a Foley catheter by a senior nursing student. If the student is in the active experimentation phase of Kolb’s Theory of Experiential Learning, what action can the lab instructor expect from the student? a. The student will need to observe placement before proceeding. b. The student assists the instructor in placing the catheter. c. The student places the Foley catheter without assistance. d. The student verbalizes beginning to understand catheter placement.

ANS: C According to Kolb’s Theory of Experiential Learning, the student is in the active experimentation phase. When the student nurse places the Foley catheter, he or she is actively involved in the experience. Concrete experience occurs when the student is actively involved in a new experience. Reflective observation begins when the student observes the experience. N Abstract conceptualization occurs when the student begins to understand the process of placing the Foley catheter.

DIF: Cognitive Level: Analysis TOP: Learning Style

OBJ: Describe how learning style affects the learning process.

12. A lab instructor is preparing to teach a group of students. After reading questionnaires filled out by the students in her group, she notes that the students would best learn by reflective observation. What activity should the instructor plan so that the students have the best chance of success? a. Set up stations so that the students can try to “figure it out for themselves.” b. Allow the students to observe a presentation. c. Present the information in a lecture while students take notes. d. Present information and allow the students to be directly involved in a hands-on setting.

ANS: B Learning by observing is what Kolb terms reflective observation. Concrete experience involves hands-on learning. In active experimentation, students learn by trying to figure it out for themselves. Abstract conceptualization is the process of learning through data collection, such as lecture.

DIF: Cognitive Level: Application OBJ: Describe how learning style affects the learning process.

TOP: Learning Style

13. A nurse is trying to manage success in the workplace. Which action demonstrates that she understands key habits that must be developed and maintained? a. Carefully list and organize the day’s tasks. b. Complete a task over again because it wasn’t done perfectly the first time. c. Avoid difficult tasks because they won’t be done correctly. d. Blame others for lack of organization.

ANS: A Carefully listing and organizing the day’s tasks demonstrates that the nurse understands key habits needed for success, such as time management. Completing tasks over again, avoiding tasks, and blaming others are all selfdefeating behaviors that do not help manage success.

DIF: Cognitive Level: Application OBJ: Explain four key work habits that contribute to success.

TOP: Habits for Success

14. A nurse is listening to a lecture on self-awareness. Which statement by the nurse indicates that the teaching has been effective? a. “Self-confidence involves knowing oneself”. b. “Competence involves knowing oneself”.

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c. “Understanding involves knowing oneself”. d. “Self-awareness involves knowing oneself”.

ANS: D Self-awareness involves understanding and being conscious of oneself. This involves being aware of one’s strengths and weaknesses. Self-confidence, competence, and understanding do not encompass this.

N DIF: Cognitive Level: Evaluation OBJ: Identify personal gifts and barriers. TOP: Self-Awareness

15. The student is listening to a lecture on self-defeating behaviors. Which statement by the student indicates that teaching has been effective? a. “Nit-picking is viewing situations from a negative aspect.” b. “Pessimism is looking for all imperfections.” c. “Worrying is being concerned over issues that may or may not be in your control.” d. “Perfectionism is rejecting responsibility for actions or inactions.”

ANS: C Worrying means to be concerned over issues that may or may not be in your control. Pessimism occurs when situations are viewed from a negative aspect. Nit-picking means to look for all imperfections. Perfectionism means to continuously strive to be perfect or do things perfectly.

DIF: Cognitive Level: Evaluation OBJ: Describe self-defeating behaviors. TOP: Self-Defeating Behaviors MULTIPLE RESPONSE

1. Which actions or statements can the nurse take to eliminate self-defeating behaviors? (Select all that apply.) a. Say, “I know that I can do this.” b. Accept responsibility for his or her actions. c. Worry about things that are out of his or her control. d. Strive for perfection. e. Believe that his or her actions are out of his or her control.

ANS: A, B Stating “I know I can do this” and accepting responsibility for his or her actions are actions and statements that the nurse can take to eliminate self-defeating behaviors. Worrying, striving for perfection, and believing that his or her actions are out of his or her control are examples of self-defeating behaviors.

DIF: Cognitive Level: Application OBJ: Describe self-defeating behaviors. TOP: Self-Defeating Behaviors

2. A group of nursing students is discussing how their lives have changed since beginning nursing school. The student who understands the second step of holistic cognitive theory for stress reduction recognizes which comments as descriptive of automatic thoughts? (Select all that apply.) a. “My lab instructor doesn’t like me. I had to repeat my cardiac assessment when no one else did.” b. “After studying for hours, I finally remembered all the steps to insert a Foley catheter. I will use this method again.” c. “My child is having behavioral issues in preschool. I know it is because I am in school right now.”

N d. “Right after I turned in my test I knew there were at least two answers that I should have changed. I know I failed the test.” e. “Everything is falling apart in my life. I never should have come to school.”

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ANS: A, C, D, E Automatic thoughts are immediate; without reflection; usually negative, with words such as should and never; and irrational and not based in reality. The correct options reflect automatic thoughts because they include the words “should” and “never.” Studying for hours would not be considered an automatic thought.

DIF: Cognitive Level: Application OBJ: Identify steps that aid in stress reduction. TOP: Stress Reduction

3. A patient is learning to improve her personal empowerment skills after going through a tough divorce. Which actions can she take to accomplish this? (Select all that apply.) a. Practice positive self-talk.

Manage the work of success.

Develop an external locus of control.

Eliminate self-defeating behaviors.

Manage good health.

b. c. d. e.

ANS: A, B, D, E Practicing positive self-talk, managing the work of success, eliminating self-defeating behaviors, and managing good health are all ways that the patient can improve her personal empowerment skills. A person with an external locus of control believes that responsibility for actions lies outside of himself or herself.

DIF: Cognitive Level: Application Empowerment Skills

OBJ: Explain the impact of positive self-talk. TOP: Personal

4. A student is listening to a lecture on stress reduction and coping mechanisms. Which statement by the student indicates that the teaching has been effective? (Select all that apply.) a. “Relaxation is a positive coping mechanism.” b. “Catharsis is a form of stress reduction.” c. “Reframing would aide in stress reduction.” d. “Distraction is the most helpful form of stress reduction.” e. “Adrenaline rush prevents stress.”

ANS: A, B, D The relaxation and catharsis generated by laughter are positive coping mechanisms.

Distraction takes the student’s mind off the stress for a while so that she can be recharged and handle it positively at another time. Reframing means looking at the situation from a different perspective. An adrenaline rush is considered a time waster, not a stress reduction technique.

DIF: Cognitive Level: Evaluation TOP: Stress Reduction

OBJ: Identify steps that aid in stress reduction.

N

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Chapter 03: Study Habits and Test-Taking Skills

MULTIPLE CHOICE

1. A first semester student is struggling in class and did not do well on her last exam. She has determined the problem to be her lack of skill in note taking. What can the student do in order to take more effective notes during lecture? a. Focus on writing key words and phrases. b. Photocopy someone else’s notes. c. Write verbatim all that is said. d. Practice memorization in class instead of taking notes.

ANS: A The student should focus on writing key words and phrases in order to be more effective at note taking. Photocopying someone else’s notes, writing verbatim, and memorizing lecture will not help the student with effective note taking.

DIF: Cognitive Level: Application OBJ: Describe the components of effective listening. TOP: Note-Taking

2. A student nurse feels that his reading skills are not adequate. Which action would he take in order to have effective reading skills?

Focus on improving reading speed.

Read slowly and thoroughly.

Ask his friends and family read to him.

a. b. c. d.

Passively engage in reading.N

ANS: A Evidence relates reading speed to comprehension; the faster you read, the more you understand what you are reading.

DIF: Cognitive Level: Application OBJ: Describe how to improve reading skills. TOP: Effective Reading

3. A struggling student admits that she is reading the same paragraph over and over when she tries to read the text. The instructor recognizes this as inhibitory to her comprehension of the material. Which suggestion could the instructor make to the student to help correct the situation? a. “Just keep trying. Maybe you need to read it over a few times to get it.” b. “Maybe you are waiting too late at night to study. Try studying earlier in the day.” c. “Try putting your finger under the words one at a time.” d. “If the words are a stumbling block, study them alone first, and then as you read, you will be less likely to stumble over them and regress.”

ANS: D Regression, or rereading what was just read, may be caused by stumbling over unfamiliar terms that cause reading to slow and decrease.

DIF: Cognitive Level: Application OBJ: Describe how to improve reading skills.

TOP: Effective Reading 4. The student is listening to a lecture on the SQRRR method. Which statement indicates that teaching has been effective? a. “The appropriate way to use the method is to scan, skim, survey, read, recite, review”. b. “The appropriate way to use the method is to scan, skim, read, recite, review, reread”. c. “The appropriate way to use the method is to survey, question, read, recite, review”.

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d. “The appropriate way to use the method is to survey, question, read, review, reread”.

ANS: C SQRRR is a tried and true method: survey, question, read, recite, and review.

DIF: Cognitive Level: Evaluation OBJ: Prepare to study effectively using the SQRRR method.

5.

TOP: Improving Your Study Skills

A nursing student is preparing for her first day of lecture. She knows that in order to succeed, she should skip the first day of class and read the material at home. sit in the front of the room, away from distractions. take notes from the book during lecture time. sit in the back of the class, next to her best friend.

a. b. c. d.

ANS: B Students should sit in the front of the classroom for optimal learning, away from distractions.

N DIF: Cognitive Level: Application OBJ: Describe positive face-to-face and online class strategies.

TOP: General Face-to-Face Classroom Behaviors

6.

A patient comes to the emergency department with complaints of crushing chest pain that radiates down his left arm. While reviewing his health history with the RN, the patient states that he has been getting over a cold. He also has seasonal allergies and is allergic to peanuts. The nurse interprets the major detail for the patient’s ER visit as the patient a. has a peanut allergy. b. is experiencing crushing chest pain. c. is getting over a cold. d. has seasonal allergies.

ANS: B The major detail in this scenario is the patient’s crushing chest pain, which brought him into the ER. All other are minor details.

DIF: Cognitive Level: Analysis OBJ: Distinguish between major and minor details. TOP: Major/Minor Details

7.

The RN is performing an assessment on a patient being admitted for back pain. The nurse interprets which of the patient’s statements as a minor detail? a. The patient has not been able to void in 12 hours. b. The patient ate 90% of his meal. c. The patient reports being unable to walk. d. The patient was involved in a car accident 2 days ago.

ANS: B Minor details support the major details and peripherally support the main idea. In this scenario, the patient eating 90% of his meal is a minor detail. The other choices are major details.

DIF: Cognitive Level: Analysis Main Idea

8.

OBJ: Describe how to improve reading skills. TOP: Relating Details to a

A student has been out of school for a number of years. She is concerned that she may not be able to study effectively. What action can the student take that will increase her ability to focus on her studies? a. Study for 1 hour a night. b. Study in a loud coffee shop. c. Stay up all night before tests to make sure she is proficient.

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d. Study with the TV off.

ANS: D The student should learn ways to study effectively in order to succeed in school. Studying for only 1 hour per night, studying in a loud coffee shop, and staying up all night to study are not ways to study effectively.

DIF: Cognitive Level: Application OBJ: Prepare to study effectively using the SQRRR method.

TOP: More Study Strategies

A student is reviewing new material for an upcoming test. She has decided to highlight so that N she can come back later to easily review the material. How can she use highlighting to be successful? a. She should highlight the first time she reads the material. b. She should highlight no more than 20% of the material. c. She should use only one method of highlighting. d. She should highlight the entire chapter.

9.

ANS: B The student should read the material at least once before she begins highlighting. Highlighting during the first read through, using only one method of highlighting, and highlighting the entire chapter would not assist the student in being successful.

DIF: Cognitive Level: Application OBJ: Describe how to improve reading skills. TOP: Highlighting Appropriately

10. The student is listening to a lecture on better study habits. Which statement indicates that teaching has been effective?

“I should study for 3 to 4”.

“I should study for 2 to 3”.

“I should study for 4 to 5”.

“I should study for 5 to 6”.

a. b. c. d.

ANS: B For every hour of class the student should spend 2 to 3 hours studying in order to be successful.

DIF: Cognitive Level: Evaluation OBJ: Prepare to study effectively using the SQRRR method.

TOP: Improving Your Study Skills

11. The student is attending a lecture on improving test taking. Which statement indicates that the teaching has been effective?

“Multiple incorrect options on a test are stems”.

“Multiple incorrect options on a test are structured responses”.

“Multiple incorrect options on a test are distracters”.

“Multiple incorrect options on a test are negative indicators”.

a. b. c. d.

ANS: C Multiple incorrect options on a test are known as distracters.

DIF: Cognitive Level: Evaluation TOP: Test-Taking Skills

OBJ: Incorporate strategies to improve test taking.

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MULTIPLE RESPONSE 1. A nursing student knows that effective listening requires attention and preparation. What actions can she take to ensure that she is proficient? (Select all that apply.) a. Read over the assigned material before class begins. b. Read over the material as soon as class is over. c. No special attention or preparation is required. d. Read the material during class.N e. Study independently during discussion time.

ANS: A, B To listen effectively, prepare for what you will hear before class. In class maintain concentration and actively engage in the discussion, and then after class review notes and add clarifying comments.

DIF: Cognitive Level: Application OBJ: Describe the components of effective listening. TOP: Effective Listening

2. You are a first semester nursing student and have just received your first reading assignment for class tomorrow. You know that in order to succeed you will need to practice effective listening. Which actions would prepare you for class tomorrow? (Select all that apply.) a. Read over the assigned material tonight. b. Scan over the material before class, looking at the main points and subpoints. c. Read the text during class instead of listening to lecture. d. Review your notes immediately after class. e. Do not review anything before class.

ANS: A, B, D In order to be prepared for class you should: Read over assigned material the night before; scan over the material before class, looking at both main points and subpoints; and review notes immediately after class. Practicing effective listening includes giving the instructor your undivided attention. Often instructors emphasize points that they do not want students to miss. These points often end up on exams.

DIF: Cognitive Level: Application OBJ: Describe the components of effective listening. TOP: Effective Listening

3. A student is studying for an upcoming test. She has read the assigned text once and is now ready to highlight. Which actions by the student indicate that she understands how to highlight? (Select all that apply.)

Uses circles to highlight key words or phrases Draws an asterisk next to an important paragraph or sentence Underlines sentences of importance Draws squares around words for emphasis Marks a section with a star for future reference

a. b. c. d. e.

ANS: A, B, C, E Circles, asterisks, underlines, and stars are all acceptable ways of highlighting that would indicate differences in the material.

DIF: Cognitive Level: Application OBJ: Describe how to improve reading skills. TOP: Highlighting

4. A student has just listened to a lecture on better strategies for studying. Which of the student’s actions indicate understanding? (Select all that apply.) a. Wait until the evening to study.N b. Begin with the most difficult subjects. c. Create a conducive study environment. d. Record the lectures and listen to them in your car. e. Begin to study the day before an exam.

ANS: B, C, D

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Beginning study sessions with the most difficult subjects, creating a conducive study environment, and listening to lectures in your car are all ways to create better strategies for studying.

DIF: Cognitive Level: Application OBJ: Prepare to study effectively using the SQRRR method.

TOP: Improving Your Study Skills

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Test Bank - LPN to RN Transitions [5E, Claywell]

Chapter 04: Distinguishing the RN Role from the LPN/LVN Role

MULTIPLE CHOICE

1. A nurse manager is discussing the RN’s scope of practice with a new hire. Which statement, made by the new hire, is not true of the RN’s scope of practice?

“A nurse may be disciplined by the Board of Nursing for practicing beyond his or her scope of practice.”

“Scope of practice is legally defined by the American Nurses Association (ANA).”

“Scope of practice defines the responsibilities of nurses.”

“Scope of practice can be found in state nurse practice acts.”

a. b. c. d.

ANS: B The RN’s scope of practice is legally defined by state nurse practice acts, not the ANA. A nurse may be disciplined by the Board of Nursing. The scope of practice defines the responsibilities of nurses and can be found in state nurse practice acts.

DIF: Cognitive Level: Application OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN. TOP: Scope of Practice MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. The nursing student is reviewing the different organizations that provide services for nurses.

She interprets the American Nurses Credentialing Center as a. an association that provides accreditation for baccalaureate and higher degree nursing education programs.N b. the unifying body for the state boards of nursing. c. an association that offers certification in many nursing specialties. d. an organization that offers the national licensure examination.

ANS: C The American Nurses Credentialing Center offers certification in many nursing specialties.

The Commission on Collegiate Nursing Education provides nursing school accreditation. The National Council of State Boards of Nursing is the unifying body for the state boards of nursing. NCLEX is the national licensure examination implemented by the National Council of State Boards of Nursing.

DIF: Cognitive Level: Analysis OBJ: Recognize the differences in the educational preparation of the LPN/LVN and RN. TOP: Educational Preparation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. The student is studying the history of nursing education. She is able to identify which nursing degree program as the first one in the United States for RNs? a. Associate’s degree b. Bachelor’s degree c. Diploma degree d. Master’s degree ANS: C The first nursing degree program in the United States was the diploma, which began in 1872. The associate’s, bachelor’s, and master’s nursing programs came later.

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Test Bank - LPN to RN Transitions [5E, Claywell]

DIF: Cognitive Level: Synthesis OBJ: Recognize the differences in the educational preparation of the LPN/LVN and RN. TOP: Educational Preparation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. Which function falls within the LPN/LVN’s scope of practice? a. Formulating the plan of care b. Collecting data c. Selecting nursing diagnoses d. Setting goals, objectives, and outcomes ANS: B One of the many functions of the LPN/LVN is that of data collector. Formulating the plan of care; selecting nursing diagnoses; and setting goals, objectives, and outcomes are not in the scope of practice for the practical nurse and must be performed by an RN. DIF: Cognitive Level: Application OBJ: Compare and contrast the professional roles of the LPN/LVN and the RN. TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5.

Which of the following is an example of professional advocacy in nursing?

Charting and writing up a medication error Writing up a nursing assistant for excessive absences

a. b. c. d.

Writing one’s senator concerning mandatory overtimeN Mentoring a new graduate RN who is new to the unit

ANS: C Writing one’s senator concerning mandatory overtime is professional advocacy. Charting and writing up a medication error, writing up a nursing assistant, and mentoring a new graduate are expectations of the RN. DIF: Cognitive Level: Application OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.

TOP: Role Elements MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6.

The RN is caring for the following patients. Which patient and task are most appropriate to assign to the LPN/LVN? a. A 34-year-old female patient who will need discharge teaching b. A 40-year-old postoperative male patient who needs a dressing change c. A 64-year-old female patient who needs a bed bath d. A 79-year-old patient whose plan of care needs to be updated ANS: B The LPN/LVN is skilled in dressing changes. The nursing assistant is skilled in giving a bed bath. Discharge teaching and updating the plan of care are tasks that must be performed by the RN. DIF: Cognitive Level: Application OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN. TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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7.

Test Bank - LPN to RN Transitions [5E, Claywell]

The charge nurse is creating assignments for the oncoming shift. She notices that today staffing consists of three RNs and one LPN. Which assignment would be most appropriate for the LPN? a. Acute MI: needs preparation for the catheter lab b. Flu-like symptoms: needs reassessment of vital signs every hour c. Possible stroke: needs anticoagulation therapy d. Dehydration: needs IVF boluses and IV antiemetic ANS: B The most appropriate assignment for the LPN would be the patient with flu-like symptoms. The LPN can perform basic assessment and data collection and can meet the basic needs of the patient. The RNs should be assigned the patients with acute MI, possible stroke, and dehydration, all of whom require critical thinking and a higher level of care.

DIF: Cognitive Level: Application OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN. TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

8.

The RN understands that the National League for Nursing (NLN) delineates three professional roles of the associate degree nurse when she lists all of the following except a. manager of care. b. team player. N c. provider of care. d. member of profession.

ANS: B The NLN delineates the following as professional roles of the associate degree nurse: manager of care, provider of care, and member of the profession. For all three of these roles, the nurse follows the nursing process. The NLN does not delineate being a team player as a professional role.

DIF: Cognitive Level: Application OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN. TOP: Registered Nursing MSC: NCLEX: Safe and Effective Care Environment: Management of Care

9.

An LPN/LVN in RN school is experiencing frustration because the expectations of her as a nurse at work are very different from her role as a student in nursing school, and fulfilling both is confusing at times. She has an appropriate understanding of her situation when she states that it is known as a. role conflict. b. dissociative behavior. c. coping mechanism. d. license confusion.

ANS: A Role conflict may occur when expectations or requirements of competing roles are incompatible.

DIF: Cognitive Level: Application OBJ: Discuss the concept of role transition from practical nurse to registered nurse.

TOP: Role Transition MSC: NCLEX: Psychosocial Integrity

10. A nurse manager is teaching a class about the different role elements of RNs. If she has an adequate understanding, she can state that a care provider is a. “a nurse who medically manages patients.” b. “an RN who carries out interventions that assist patients to meet positive outcomes.” c. “a nurse who seeks out new endeavors.”

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d. “a nurse who seeks out positive changes in the best interest of his or her patients.”

ANS: B Care provider is the role element of the RN when interventions are provided.

DIF: Cognitive Level: Application OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.

TOP: Role Transition MSC: NCLEX: Caring

11. A student is preparing for an exam on the different role elements of an RN. She is prepared for the exam when she can state that all of the following are elements of the RN role except a. collaborator. b. manager. c. counselor. d. therapist.

N ANS: D Although there are many therapists involved in the collaborative care of the patient, RNs are not therapists.

Collaborator, manager, and counselor are identified elements of the RN role.

DIF: Cognitive Level: Application OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.

TOP: Role Transition MSC: NCLEX: Caring

12. An RN has called the physician to explain that the patient is having second thoughts about a procedure and would like to learn more about the alternatives before proceeding. In this instance the RN is enacting the element of the RN role known as a. counselor. b. researcher. c. advocate. d. mentor.

ANS: C The registered nurse’s role as advocate requires the nurse to be a protector willing to shield the client and family from harm. In assuming this duty, the nurse chooses to provide complete, honest information to those in his or her care and to speak up against any harmful or unnecessary forces that could impede progress toward a healthy state. A client advocate agrees to “take the side” of the health care recipient and “stand up for” the patient’s rights to autonomy and self-determination.

DIF: Cognitive Level: Application OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.

TOP: Role Transition MSC: NCLEX: Safe and Effective Care Environment: Management of Care

13. An RN student is discussing formal role socialization with her nursing professor. The professor believes the RN student has a good understanding when she states that formal role socialization “can occur in any informal setting.” “occurs during patient teaching.” “does not occur in the classroom setting.” “only occurs spontaneously.”

a. b. c. d.

ANS: B Formal professional role socialization is planned rather than happening spontaneously or vicariously. It involves planned educational experiences, such as performing physical assessment, developing nursing diagnoses for a patient’s care plan, or doing patient teaching.

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Test Bank - LPN to RN Transitions [5E, Claywell]

DIF: Cognitive Level: Application OBJ: Describe the process of professional socialization from practical nurse to that of registered nurse. TOP: Role Transition MSC: NCLEX: Psychosocial Integrity

14. The student understands that the LPN/LVN role differs from the RN role in many areas. She shows understanding when she can state that the LPN/LVN and RN are similar in which area? a. Educational preparation b. Thinking skills c. Assessment skills N d. Basic psychomotor skills ANS: D LPN/LVNs and RNs have similar preparation in basic psychomotor skills such as wound care, urinary catheterization, patient hygiene, and so on. It is the critical thinking and assessment skills that go beyond the basic task that make a difference.

DIF: Cognitive Level: Application OBJ: Compare and contrast differences in role responsibilities of practical and registered nurses.

TOP: RN to LPN/LVN Role Comparison MSC: NCLEX: Nursing Process

15. A student in an LPN to RN transition program is at the clinical site, monitoring the vital signs of a patient receiving blood. At 15 minutes into the infusion, the patient begins to complain of itching and shortness of breath. It is evident that the student nurse is developing critical thinking skills when she does which of the following? a. Stops the infusion, calls for the patient’s nurse, and reports a possible reaction to the blood. b. Calls for the patient’s nurse and asks whether she can slow the infusion down. c. Continues with routine monitoring and reports the patient’s condition as unremarkable. d. Calls for the patient’s nurse and asks whether she can speed up the infusion to deliver the blood faster.

ANS: A The student nurse is developing critical thinking skills of an RN when she connects the idea that the shortness of breath and itching are linked to the infusion and quickly takes action to prevent further harm to the patient.

DIF: Cognitive Level: Application OBJ: Discuss the concept of role transition from practical nurse to registered nurse.

TOP: Role Transition MSC: NCLEX: Safe and Effective Care Environment: Management of Care

16. Which action defines the nurse as a care provider in an inpatient setting? a. Holding an information session on diabetes management and prevention b. Running a blood pressure screening in the lobby of the hospital c. Assisting new parents after the delivery of preterm twins d. Handing out pamphlets on how to lower cholesterol ANS: C The nurse who assists new parents after the delivery of preterm twins is an example of a care provider role within the inpatient setting. Outpatient care provider roles include promotion and restoration of health through the use of screenings and interventions.

DIF: Cognitive Level: Application OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.

TOP: Care Provider Role MSC: NCLEX: Safe and Effective Care Environment: Management of Care

17. The nurse would assume the care provider role of educator during which action?

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a. b. c. d.

Test Bank - LPN to RN Transitions [5E, Claywell]

Leading a hand washing initiative to reduce infection rates Answering a new mother’s questions about breastfeedingN Working with colleagues to transfer a patient into a rehab center Requesting more pain medications for a patient who is recovering from a total hip replacement

ANS: B The nurse assumes the care provider role of educator when she answers a new mother’s questions about breastfeeding. Leading a hand washing initiative refers to a change agent. Working with colleagues to transfer a patient refers to the collaborator role. The nurse functions as an advocate when he or she requests more medication for a patient recovering from surgery.

DIF: Cognitive Level: Application OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.

TOP: Role Elements MSC: NCLEX: Safe and Effective Care Environment: Management of Care

18. A nurse on a postsurgical unit is alarmed by the number of postoperative infections that have been reported for her unit over the last year. The nurse acquires data from other hospitals and begins observing the health care team to determine the hand washing rates. This nurse is functioning in which care provider role? a. Manager b. Change agent c. Researcher d. Counselor ANS: C The nurse who researches the infection rate and begins data gathering by observing is functioning in the researcher role. Managers oversee change, change agents initiate change, and counselors assist patients and families with psychosocial needs.

DIF: Cognitive Level: Application OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.

TOP: Role Elements MSC: NCLEX: Nursing Process

19. The RN utilizes problem-solving skills to do all of the following except a. establish mutual goals with the patient and family. b. formulate a care plan. c. assist patients to achieve expected outcomes in the plan of care. d. oversee implementation and evaluation of the plan.

ANS: C The LPN/LVN typically assists patients to achieve expected outcomes in the plan of care. The RN utilizes problemsolving skills to formulate a plan of care, establish mutual goals, and oversee the implementation and evaluation of the plan.

DIF: Cognitive Level: Application OBJ: Compare and contrast the scope of practice for the LPN/LVN and the RN. TOP: Care Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE N 1. The registered nurse takes on different care provider roles in the health care setting. Which roles could the nurse assume when caring for a patient who has just been diagnosed with cancer? (Select all that apply.) a. Counselor b. Educator

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c. Advocate d. Collaborator e. Medical power of attorney ANS: A, B, C, D The nurse functions in the care provider roles of counselor, educator, advocate, and collaborator when caring for this patient. The nurse would not take on the role of medical power of attorney for the patient.

DIF: Cognitive Level: Application OBJ: Describe various role elements that are inherent in the scope of registered nursing practice.

TOP: Role Elements MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Test Bank - LPN to RN Transitions [5E, Claywell]

Chapter 05: Using Nursing Theory to Guide Professional Practice

MULTIPLE CHOICE

1. Which of the following are the concepts common among most nursing philosophies, models, and theories? a. Person, nurse, health, and environment b. Person, physician, health, and environment c. Person, nurse, health, and culture d. Person, nurse, environment, and culture ANS: A Person, nurse, health, and environment are the four universal concepts central to nursing practice. The physician and culture are not considered to be among the four universal concepts. These themes are described, defined, ordered, and interrelated in distinctive, meaningful, and powerful ways as nursing theorists endeavor to continue the development of nursing’s unique body of knowledge.

DIF: Cognitive Level: Analysis OBJ: Apply the four universal concepts central to nursing practice.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. What skills would a nurse demonstrate if the nurse reached the “competent stage” of Patricia Benner’s theory of skill acquisition?

a. b. c. d.

Relies on more experienced nurses for guidanceN Can multitask, set goals, and think analytically Can see the whole picture and recognizes subtle changes in condition Recognizes patterns and responds automatically

ANS: B The competent nurse is able to multitask, set goals, and think analytically. The advanced beginner is the new graduate nurse with marginally acceptable performance who relies on other experienced nurses. The proficient nurse sees the whole and focuses on long-term goals, and the level of expert nurse is reached after considerable experience (recognizes patterns and has responses that are automatic and integrated).

DIF: Cognitive Level: Application OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. A group of nursing students was discussing the functions of nursing theories. Which statement below would give the impression a student requires more review of the material? a. “Nursing theories help guide professional practice by interpreting evidence.” b. “Nursing theories have little effect on decision-making in practice.” c. “Nursing theories are influenced by personal values and beliefs.” d. “Nursing theories influence professional behaviors.”

ANS: B

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The statements that nursing theories serve as guidelines for professional practice, nursing theories are influenced by values and beliefs, and nursing theories influence professional behaviors are true about nursing theories. The statement that nursing theories have little effect on decision-making is incorrect because nursing theories do have a significant effect on decision-making.

DIF: Cognitive Level: Application OBJ: Discuss the role of nursing theory to the practice of nursing.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. What criterion would the nurse use to support Hildegard Peplau’s Theory of Interpersonal Relations? a. The relationship between nurse and doctor b. The mutual caring relationship c. Meeting the needs of nurse and patient d. The relationship between nurse and patient ANS: D The nurse–patient relationship is the focus of Hildegard Peplau’s theory. The doctor–nurse relationship, the mutual caring relationship, and meeting the needs of the nurse and patient are not the focus of Hildegard Peplau’s theory.

DIF: Cognitive Level: Evaluation OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care N 5. The nurse providing teaching on a weight loss program to the obese patient is applying which nursing model developed by Nola Pender? a. Interpersonal relations b. Health promotion c. Conservation d. Adaptation ANS: B Pender’s Health Promotion Model emphasizes the importance of the patient to manage his or her own health actively and focuses on wellness. Interpersonal relations is the theory developed by Hildegard Peplau. The Conservation Model was developed by Myra Levine, and the Adaptation Model was developed by Sister Callista Roy. DIF: Cognitive Level: Application OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. What changes in nursing practice did Florence Nightingale make to improve the personal care of patients? a. Behaviors b. Environment c. Culture d. Communication ANS: B Florence Nightingale’s theory of nursing primarily focused on the environment. It described in detail the concepts of light, cleanliness, ventilation, warmth, diet, and noise. Behaviors, culture, and communication were not her primary focus.

DIF: Cognitive Level: Synthesis

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Test Bank - LPN to RN Transitions [5E, Claywell]

OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7. Betty Neuman’s Systems Model for nursing emphasizes the holistic aspects of nursing from a systems-based perspective. Which of the following is not an example of the clinical application of this theory? a. Caring for the patient at the primary, secondary, and tertiary levels of care b. Evaluating patient stability c. Focusing on the nurse–patient relationship d. Evaluating the effect of stressors on the patient ANS: C Focusing on the nurse–patient relationship is the focus of Hildegard Peplau’s Theory of Interpersonal Relations.

Caring for the patient at the primary, secondary, and tertiary levels of care; evaluating patient stability; and evaluating the effect of stressors on the patient are examples of the clinical application of Neuman’s theory. The Neuman’s Systems Model focuses on responses of patient systems to actual or potential stressors and uses primary, secondary, and tertiary nursing interventions for optimal wellness.

DIF: Cognitive Level: Application N OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

8.

Which statement by a nurse reflects an accurate understanding of systems theory?

a. “My patient has anemia reflected by low RBC, Hgb, and Hct values, so I have to monitor for fatigue, dyspnea, and tachycardia.” b. “It is my responsibility to provide my patients with basic human needs including food, water, and sleep.” c. “Would you like me to call the chaplain for you to discuss your feelings about your upcoming surgery?” d. “My patient’s daughter makes all decisions and living arrangements for my patient such as reserving a home health aide and Meals on Wheels during the week.”

ANS: A “A change in one part of the whole will have an effect on another” is an accurate understanding of systems theory.

“Humans have certain basic needs” explains Maslow’s Theory of the Hierarchy of Needs. “One must consider how humans cope or do not cope with stress” is an example of Betty Neuman’s Healthcare Systems Model. “Roles change over a lifetime” illustrates role theory.

DIF: Cognitive Level: Evaluation OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

9.

The nurse is listening to a lecture on nursing conceptual models. Which statement indicates that the teaching has been effective? a. “Nursing conceptual models provide a broad explanation of the world”. b. “Nursing conceptual models are composed of a defined and interrelated set of concepts”. c. “Nursing conceptual models are abstract concepts that propose outcomes”. d. “Nursing conceptual models are related constructs that broadly explain a phenomenon of interest”.

ANS: D “Nursing conceptual models are related constructs that broadly explain a phenomenon of interest” is true of nursing conceptual models. “Nursing conceptual models provide a broad explanation of the world” is true of nursing

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philosophies, and “Nursing conceptual models are composed of a defined and interrelated set of concepts” and “Nursing conceptual models are abstract concepts that propose outcomes” are true of nursing theories.

DIF: Cognitive Level: Evaluation OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

10. Which of the following is an example of the application of Levine’s Conservation Model to the clinical setting? a. Teaching the patient to self-administer insulin b. Encouraging the patient to ambulate c. Obtaining a wheelchair for the patientN d. Arranging for the patient’s family to visit ANS: C Obtaining a wheelchair for the patient is a correct example of the application of Levine’s Conservation Model.

Teaching the patient to self-administer insulin and encouraging the patient to ambulate will not facilitate rest, and arranging for the patient’s family to visit may or may not further stress the patient.

DIF: Cognitive Level: Application OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

11. Select the scientific theory used in several nursing theories to explain the following scenario: One nurse, whose adult son died in the ER 11 years ago, contends that she can never walk into a hospital again and quits her job. A second nurse, whose husband died in the hospital, continues to work her shifts responsibly and compassionately without incident. a. Role theory b. Adaptation theory c. Developmental theories d. Systems theory ANS: B Adaptation theory explains the ability of living things to adjust, or adapt, in response to continuous internal or external stimuli. This theory illustrates how humans cope or do not cope with physical, developmental, emotional, intellectual, social, and spiritual stressors. Role theory describes how roles of individuals in their family may change over a lifetime. Developmental theories explain the interdependence of the systems in the body helping to reveal the presence of health and illness. Systems theory describes the relationship of the environment, both internal and external, with the individual and how changing one part affects all other parts.

DIF: Cognitive Level: Synthesis OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. Identify the catalyst of Jean Watson’s Theory of Care. a. Personal values and beliefs b. Belief that nursing practice should be autonomous c. Changes in health care delivery and patient satisfaction survey responses d. Theories promoting the capacity of self-care ANS: A

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Jean Watson’s Theory of Care (1979) emerged from her own values and beliefs guided by her commitment to the caring-healing role or nursing and its mission to help sustain humanity and wholeness as the foundation of health and nursing’s purpose for existing. The belief that nursing practice should be autonomous, changes in health care delivery and patient satisfaction survey responses, and the three theories promoting the capacity of self-care have nothing in common with Jean Watson’s Theory of Care.

N DIF: Cognitive Level: Application OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. Which of the following is an example of the application of Madeleine Leininger’s Cultural Care Theory of Diversity and Universality? a. Preparing a patient for a medical procedure by using medical terminology b. Learning about diverse ethnic patient populations c. Planning nursing care in a standardized manner ensuring that everyone is treated the same way d. Asking a non-English-speaking patient to provide an English-speaking person to translate details of care ANS: B Demonstrating cultural competency includes learning about the cultural community as individuals, families, and communities and their expressive abilities of caring, values, beliefs, actions, and practices that are based on their cultural lifestyles. This will ensure that nurses deliver the appropriate level of care respectfully based on these aspects with a noted increase in nursing satisfaction performance, healing, and well-being. Speaking in medical jargon is discouraged and does not help to explain or alleviate anxiety. Planning individualized nursing care is the goal, rather than treating everyone in the same manner. Asking a non-English-speaking patient to provide a translator does not demonstrate respect for a diverse population.

DIF: Cognitive Level: Application OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. Which is an example of Dorothea Orem’s Theory of Self-Care Deficit? a. A nurse asks a patient how much she can do for herself following a stroke. b. A nurse performs total care on a stroke patient to conserve the patient’s energy. c. A nurse leaves a stroke patient to walk to the bathroom and shower by herself. d. A nurse enables a stroke patient to wash up in bed by providing bath wipes.

ANS: D Dorothea Orem’s Theory of Self-Care Deficit is explained in the fifth edition of her book, Nursing: Concepts of Practice. In this model of practice, the outcomes of all nursing actions should be to promote the capacity for self-care in all individuals; activities of self-care are defined as purposeful, ordered, and learned; and the degree to which a person is able to participate in this is called self-care agency.

N DIF: Cognitive Level: Application OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. The goal of Ida Jean Orlando’s theory of effective nursing practice is to a. focus on relationships among the environment, nurse, and patient. b. reduce the duration of hospital stays.

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c. meet the immediate needs of the patient and relieve distress or discomfort. d. integrate holism into nursing.

ANS: C Orlando believed that the goal of the nurse is to meet the immediate needs of the patient and relieve distress and discomfort. A major assumption by Orlando was that nursing practice should be autonomous. She believed that using the nursing process in the provision of nursing care provides an overall framework for nursing and is effective in achieving a good outcome. Florence Nightingale’s theory focused on three major relationships: environment to patient, nurse to environment, and nurse to patient. Virginia Henderson is well known for defining nursing. She was also credited with integrating the view of holism into nursing. She believed that humans have needs that are not only biological but also psychological. Reduction of hospital stays is not discussed.

DIF: Cognitive Level: Application OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. Which theory focuses on patterns, life processes, and wholeness and describes seeing the life process as a progression believing that health and the evolving pattern of consciousness are the same? a. Theory of Goal Attainment b. Theory of Health as Expanding Consciousness: Margaret Newman c. Theory of Interpersonal Relations d. Roy Adaptation Model ANS: B Margaret Newman’s Theory of Health as Expanding Consciousness focuses on patterns, life processes, and wholeness. She saw the life process as a progression toward higher levels of consciousness health and believed that health and the evolving pattern of consciousness are the same. Imogene King developed the Theory of Goal Attainment. Her theory is based on her belief that humans are composed of three interacting systems (personal, interpersonal, and social), and that they can lead to goal attainment, representing outcomes. Hildegard Peplau developed the Theory of Interpersonal Relations. This theory describes the connection of nurse, patient, health, and environment and should be viewed within the context of environment. Sister Callista Roy developed the Roy’s Adaptation Model. Roy believed that the goal of nursing is to promote adaptive responses through a six-step nursing process.

DIF: Cognitive Level: Application OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of CareN

17. What example illustrates the conclusion that can be drawn from deductive reasoning? a. All men are mortal and the Dalai Lama is a man; therefore, the Dalai Lama is mortal. b. The planet Earth orbits the Sun; therefore, all planets orbit the Sun. c. Five marbles taken from the bag are blue; therefore, all marbles from the bag are blue. d. The first five people you met at a work interview were nice; therefore, everyone at this office is nice.

ANS: A “All men are mortal and the Dalai Lama is a man; therefore, the Dalai Lama is mortal” is correct. Deductive reasoning goes from the general to the specific. Here the reasoning progresses such that you would use a true broad premise or principle to progress logically to a more detailed conclusion. The other answer choices are all examples of inductive reasoning. Reasoning proceeds from the specific to the general.

DIF: Cognitive Level: Analysis

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OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Reasoning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

18. What example illustrates the conclusion that can be drawn from inductive reasoning? a. Bachelors are unmarried men and Danny is unmarried; therefore, Danny is a bachelor. b. Every eagle seen this week has dark feathers; therefore, all eagles have dark feathers. c. Most Ford vehicles are reliable, so the Ford you just bought will be reliable, too. d. All dogs have fleas; therefore, my dog has fleas.

ANS: B “Every eagle seen this week has dark feathers; therefore, all eagles have dark feathers” is correct. Inductive reasoning proceeds from the specific to the general. That is, an observation is made, and patterns are recognized; this leads to a tentative hypothesis and then finally a general conclusion about a broad generalization. The other answer choices are all examples of deductive reasoning. Deductive reasoning goes from the general to the specific.

DIF: Cognitive Level: Analysis OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Reasoning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE

1. What parts make up and work together in Imogene King’s Theory of Goal Attainment?

(Select all that apply.)

Creating a method to evaluate outcomes Defining quality nursing care Setting goals Focusing on self-care N Maintaining a clean environment

a. b. c. d. e.

ANS: A, B, C Imogene King believed that humans are composed of three interacting and changing systems consisting of social, interpersonal, and personal systems. Creating a method to evaluate outcomes, defining quality nursing care, and setting goals are reflective of King’s theory that emphasizes goal setting and evaluating outcomes. Focusing on selfcare and maintaining a clean environment are not included in King’s theory.

DIF: Cognitive Level: Analysis OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. How would you justify that a nursing theory is, in fact, a middle-range nursing theory? (Select all that apply.) a. It is simple, clear, generalizable, and accessible. b. It focuses on answering specific nursing practice questions. c. It predicts the effects of one phenomenon on another. d. It explains relationships. e. It is built on several important adapted scientific theories.

ANS: B, C, D Middle-range nursing theories focus on answering specific nursing practice questions. They can describe phenomena, explain relationships, and predict the effects of one phenomenon on another. All theories should be clear, simple,

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generalizable, important, and accessible, not just middle-range nursing theories. Nursing theories, in general, are built on adapted scientific theories, not just middle-range nursing theories.

DIF: Cognitive Level: Evaluation OBJ: Compare and contrast the nursing philosophies, theories, models, and frameworks discussed in this chapter.

TOP: Middle-Range Nursing Theory MSC: NCLEX: Safe and Effective Care Environment: Management of Care

N

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Chapter 06: Providing Patient-Centered Care Through the Nursing Process

MULTIPLE CHOICE

1. Which statement by the nurse illustrates how a RN’s patient assessment differs from the LPNs patient assessment? a. “The RN gathers basic date for interpretation by the LPN.” b. “The RN function is to provide assistance with dressing and bathing.” c. “The RN assesses the patient as a whole and interprets the findings.” d. “The RN reports abnormal findings to the physician.”

ANS: C The RN role differs from the LPN role in that the RN: gathers comprehensive date regarding the patient has a whole and interprets this information, and makes a plan of care for the patient. The LPN gathers basic data about the patient for the RN to interpret. Both the RN and LPN can report abnormal findings to the physician.

DIF: Cognitive Level: Evaluation OBJ: Compare and contrast the responsibilities of the RN with the role of the LPN/LVN in assessment and developing the plan of care.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. The nurse is using Gordon’s 11 categories for data collection in performing a health assessment. Which of the following represents assessment of cognition? a. How educated is the patient?

b. How does the patient describe his or her health?N c. Is the patient well nourished? d. Has the patient had treatment for emotional problems?

ANS: A Asking the patient’s educational level is an assessment of cognition. How the patient describes his or her health is an assessment of health perception and health management. Asking whether the patient is well nourished will assess metabolic pattern, and asking the patient about treatment for emotional problems will assess the patient’s pattern of coping and stress tolerance.

DIF: Cognitive Level: Application OBJ: Discuss the five realms that may affect a patient’s health status that should be addressed in order to complete a thorough nursing assessment.

TOP: Nursing Process MSC: NCLEX: Psychosocial Integrity

3. The nurse is charting on the patient who is status post-surgery for an abdominal abscess and notes: “Pt’s temperature has not exceeded 37°C this shift.” This is an example of a(n) a. intervention.

b. outcome. c. plan. d. diagnosis or analysis.

ANS: B An outcome measures the effectiveness of the plan of care. An intervention, a plan, and a diagnosis or analysis are incorrect.

DIF: Cognitive Level: Analysis OBJ: Compare and contrast the steps of the nursing process.

NCLEX: Safe and Effective Care Environment: Management of Care

TOP: Nursing Process MSC:

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4. Which outcome statement is a properly written goal? a. “The patient will be free of pain.” b. “The patient will verbalize the importance of lifestyle changes.” c. “The patient will get up into the chair one time daily for 1 hour.” d. “The patient will demonstrate breathing techniques by the end of shift.”

ANS: C To be evaluated, an expected outcome must be specific and measurable, meaning that the outcomes can be consistently evaluated. “The patient will get up into the chair one time daily for 1 hour” is specific and measurable.

The other outcome statements are vague and open to interpretation. First, being free from pain may mean absolutely no pain or a tolerable level of pain. Second, identifying which lifestyle changes are important to teach the patient may differ from nurse to nurse. Finally, there may be several breathing techniques to teach the patient.

DIF: Cognitive Level: Evaluation OBJ: Compare and contrast the steps of the nursing process.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. The nurse is planning care for a patient with hypertension and obesity. Which of the following is a reasonable and measurable outcome for the nursing diagnosis of noncompliance with treatment regimen related to side effects of medications? N a. The patient will state two lifestyle modifications for weight management by (date certain). b. The patient will be compliant with the treatment regimen by (date certain). c. The patient will understand the disease process by (date certain). d. The patient’s blood pressure will never increase.

ANS: A The patient’s stating two lifestyle modifications for weight management is reasonable and measurable. The patient’s being compliant with the treatment regimen is vague. The patient’s understanding the disease process does not state how the effectiveness of teaching will be measured (e.g., by return demonstration or verbalization). The patient’s blood pressure not increasing is not reasonable.

DIF: OBJ:

Cognitive Level: Application Formulate and apply reasonable and measurable outcomes to patient care in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. A patient admitted with a diagnosis of Alzheimer’s disease is anxious and dehydrated, has reportedly not been eating, and has had a weight loss of 5 lb in 1 week. Which nursing diagnosis is a priority? a. Dehydration related to fluid loss b. Inadequate nutrition related to anorexia c. Excessive fluid related to reduced urine output d. Reduced skin integrity related to lower fluid intake ANS: A Replacing fluids is the priority. Anorexia is common in the elderly and can be related to many conditions, including dementia. Excessive fluid is not present. Reduced skin integrity is not the priority.

DIF: OBJ:

Cognitive Level: Analysis Formulate and apply reasonable and measurable outcomes to patient care in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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7. An RN team leader has one LPN and one medical assistant assigned to the unit. Which patient would be most appropriate to assign to the LPN?

a. Right lower lobectomy, 1 day postoperatively, whose temperature went from 37.1°C to 38.3°C during the last shift.

b. 72-year-old right hip replacement, 2 days postoperatively, complaining of leg and chest pain. c. 48-year-old female patient who had a laparoscopic appendectomy 8 hours ago: urine output 165 mL, Hgb 7 g/dL, and Hct 21%.

d. Post cerebral vascular accident 1 week ago who had a Dobhoff feeding tube inserted and is now on continuous feedings at 45 mL/hour.

ANS: D Licensed practical nurses can implement actions specific to the patient care needs. Monitoring the stroke patient and maintaining the continuous feeding is an appropriate delegation. LPNs can also collect data, perform basic teaching, record data as well as interventions, and report N to the RNs the progress the patient is making. The patient one-day post-op from the right lower lobectomy, the patient with the hip replacement, and the patient with the appendectomy are inappropriate to delegate to a LPN because each requires a focused assessment, advanced interventions, evaluation, and updating of the patients’ plans of care and outcome priorities.

DIF: Cognitive Level: Application OBJ: Explain the steps of the nursing process.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

8.

Which of these strategies should be a priority when the nurse is planning care for a patient with hypertension?

Obtain less expensive antihypertensive medications.

Assist with dietary changes as the first action.

Follow evidence-based guidelines for appropriate interventions.

Teach about the impact of exercise on hypertension.

a. b. c. d.

ANS: C Planning goals and desired outcomes occurs in the planning phase. The plan of care includes the process of identifying the interventions needed for the patient to regain a level of independence at or higher than the patient had before admission into the hospital.

DIF: OBJ:

Cognitive Level: Application Formulate and apply reasonable and measurable outcomes to patient care in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

9.

The nurse reviews assessment findings for assigned patients. Based on this information, which patient demands the nurse’s immediate attention? The patient with a. renal failure on dialysis whose WBC is 10,000 mm3 (normal). b. abdominal aneurysm whose blood pressure is 170/90. c. atrial fibrillation whose lab results show and INR of 2.5 (normal). d. endocarditis who has a loud heart murmur.

ANS: B Assessment contains both objective and subjective data. Among other things, the nurse interprets laboratory data to determine whom to see first. The hypertensive patient with an abdominal aneurysm presents the greatest emergency.

The patient on dialysis, the patient with A-Fib, and the patient with endocarditis all have normal lab values and clinical findings and present no urgent need for attention.

DIF: Cognitive Level: Application OBJ: Explain the steps of the nursing process.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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10. While the nurse is taking the health history, the patient states, “My father and grandfather both had heart attacks and were unable to be very active afterward.” How does the nurse interpret this? This statement is related to the functional health pattern of a. activity-exercise. b. cognitive-perceptual. c. health perception–health management. d. coping-stress tolerance.

N ANS: C The information in the patient’s statement relates to risk factors that may cause cardiovascular problems in the future.

Identification of risk factors falls into the health perception–health management pattern. This pattern describes a patient’s perceived pattern of health and how health is managed.

DIF: Cognitive Level: Analysis OBJ: Compare and contrast steps of the nursing process.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

11. Which of the following is an example of a measurable outcome for the patient who has undergone a surgical procedure with a pain rating of 7 on a scale of 0 to 10? a. The patient’s pain will be under control by Sunday. b. The patient will have no pain by the end of this shift. c. The patient’s pain will decrease by the end of shift on (date). d. The patient’s pain will decrease to 2 or lower by the end of shift on (date).

ANS: D “The patient’s pain will decrease to 2 or lower by the end of shift on (date)” states what is to be measured, how much it will decrease, and by when. “The patient’s pain will be under control by Sunday,” “The patient will have no pain by the end of this shift,” and “The patient’s pain will decrease by the end of shift on (date)” do not include these elements.

DIF: Cognitive Level: Application OBJ: Formulate and apply reasonable and measurable outcomes to patient care in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

12. Which of the following would be a priority nursing diagnosis for a 73-year-old male patient with heart failure? a. Constipation related to immobility b. Risk for infection related to IV lines c. Activity intolerance related to an imbalance of oxygen and demand d. Self-care deficit ANS: C Remember your ABCs. The highest priority for this patient is to conserve energy.

Constipation related to immobility, risk for infection related to IV lines, and self-care deficit are not priorities.

DIF: Cognitive Level: Analysis OBJ: Formulate and prioritize nursing diagnoses in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

13. Which of the following would be an expected outcome for a patient who is 12 hours status post hip replacement? a. Increase mobility and decrease pain. b. Care for the catheter independently. c. Walk without assistance.

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d. Bathe daily in a tub.

N ANS: A A reasonable outcome is that the patient’s mobility will increase as pain decreases. “Care for the catheter independently” is incorrect because the patient would not be expected to have a catheter. “Walking without assistance” and “bathe daily in a tub” are not reasonable for the patient 12 hours status post hip replacement.

DIF: OBJ:

Cognitive Level: Analysis Formulate and apply reasonable and measurable outcomes to patient care in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

14. An RN is making assignments on a medical-surgical unit. Which patient could the RN assign to a float RN from the maternity unit?

A 68-year-old female patient with COPD and viral pneumonia A 60-year-old female patient with atrial fibrillation and a heart rate of 150 A 50–year-old male patient post open heart surgery whose blood pressure is 90/50 A 36-year-old male patient who is severely neutropenic awaiting chemotherapy

a. b. c. d.

ANS: A When prioritizing nursing care, the most critical problems receive the highest priority. In this scenario, the float nurse from another department serves as another health care team member unfamiliar with the medical-surgical patient population. The medical-surgical RN serves as an all-around organizer of care and interventions that other health care team members provide. The patient with COPD and viral pneumonia is the most stable of the group. The patient with A-Fib, the post open heart surgery patient with dangerously low blood pressure, and the neutropenic patient awaiting chemotherapy all require close attention and advanced interventions by the RN familiar with these types of patients.

DIF: Cognitive Level: Application OBJ: Compare and contrast the steps of the nursing process.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

15. A patient with pneumonia has been using the incentive spirometer four times daily while awake during his 3-day hospitalization. How would the nurse explore the effectiveness of this intervention?

The nurse would ask whether the patient was breathing better.

The nurse would add turn, cough, and deep breathing exercises.

The nurse would watch the patient use the incentive spirometer.

The nurse would auscultate the lungs for adventitious breath sounds.

a. b. c. d.

ANS: D The nurse would evaluate the effectiveness of the incentive spirometer treatment by listening for adventitious lung sounds. Asking whether the patient is breathing better; adding turn, cough, and deep breathing exercises; and watching the patient using the incentive spirometer do not examine the effectiveness of the plan of care.

DIF: Cognitive Level: Synthesis N OBJ: Compare and contrast the steps of the nursing process.

NCLEX: Safe and Effective Care Environment: Management of Care

TOP: Nursing Process MSC:

16. Which nursing diagnosis would be a priority for a patient in acute respiratory distress? a. Pain b. Reduced gas exchange c. Reduced stamina d. Need for health teaching

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ANS: B Remember your ABCs. Airway is always a priority. Pain, reduced stamina, and the need for health teaching are not priorities.

DIF: Cognitive Level: Analysis OBJ: Formulate and prioritize nursing diagnoses in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

17. Determine which example is true of measurability within the context of the nursing diagnosis. a. The patient will list signs of infection such as redness, pain, swelling, and warmth by the end of the shift. b. The patient will be pain-free and then walk to the bathroom. c. The patient reported abdominal pain for 2 days but denies nausea, vomiting, and diarrhea. d. The patient received Dilaudid 1 mg IV and 2 hours later received Lortab 500/5.

ANS: A Measurability provides the means to evaluate outcomes consistently. The outcome criterion of listing the specific signs of infection is consistently measurable by anyone choosing to attain that outcome criterion. Being pain-free and then walking to the bathroom is not measurable because one outcome criterion cannot depend on completion of another criterion. Each outcome criterion is considered an individual goal. The statements addressing abdominal pain and nausea, vomiting, diarrhea are collected data and taking account of the pain medications administered to the patient have nothing in common with measurability.

DIF: Cognitive Level: Evaluation OBJ: Apply the nursing process to the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

18. The nurse is admitting a 64-year-old Hispanic male patient to the rehabilitation facility following surgical intervention for a broken hip. The nurse should first assess which of the following?

Self-care ability Self-esteem Communication Pain

a. b. c. d.

ANS: D Pain is the first priority for the patient admitted for rehabilitation following surgical intervention. Self-care ability and self-esteem are not the first to be assessed. The ability to communicate pain can be facilitated using graphic representations if the patient does not speak N English.

DIF: Cognitive Level: Analysis OBJ: Formulate and prioritize nursing diagnoses in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

19. The nurse is attempting to take the history of a newly admitted 92-year-old patient but is unable to obtain the information because of the patient’s cognitive status. The nurse should a. refuse to complete the admission without more information. b. contact the family for information on the patient’s history. c. call the doctor in the emergency room for a history. d. ask another nurse to try to obtain the information from the patient.

ANS: B

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The nurse should contact the family to obtain the needed information. Refusing to complete the admission without more information is not professional. Calling the doctor in the emergency room for a history is not likely to be helpful, and asking another nurse to try to obtain the information from the patient is not likely to change the outcome because of the patient’s cognitive status.

DIF: Cognitive Level: Analysis OBJ: Apply the nursing process to the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. The nurse is planning care for an 82-year-old obese female patient with Alzheimer’s dementia. The patient wanders, is unsteady on her feet, and is visually impaired. What should the nurse give priority to when developing the plan of care? a. Laboratory results b. Skin condition c. Safety d. Nutrition ANS: C Safety is the first priority for this patient who is cognitively and visually impaired, wanders, and is unsteady.

Laboratory results should be monitored, but safety is the priority. Skin condition and nutrition are of concern but are not immediate priorities.

DIF: Cognitive Level: Analysis OBJ: Formulate and prioritize nursing diagnoses in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

21. The nurse is listening to a lecture on collaborative problems. Which statement indicates that teaching has been effective?

“Collaborative problems fall within the definition of nursing diagnoses”.

“Collaborative problems are managed using two physicians”.

“Collaborative problems require the nurse to monitor for changes in status”.

“Collaborative problems emphasize prevention, treatment, or health promotion”.

a. b. c. d.

ANS: C Collaborative problems require the nurse to monitor for changes in patient status and for the N onset of complications for specific situations. Collaborative problems do not fall within the definition of nursing diagnoses.

The statement that collaborative problems are managed using two physicians is not true, and the statement that collaborative problems emphasize prevention, treatment, or health promotion is true of the nursing diagnosis phase of the nursing process.

DIF: Cognitive Level: Evaluation OBJ: Explain collaborative problems with respect to formulating the nursing diagnosis in the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

22. Errors may occur with the use of data in formulating an appropriate nursing diagnosis. Based on what you know, which of the following represents the main source of errors in the nursing diagnosis process?

Making assumptions without supporting data Placing data in incorrect categories Not validating data with the patient Relying on team members for data

a. b. c. d.

ANS: A

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Every nursing diagnosis must be substantiated by identifying criteria, also known as defining characteristics. For a nursing diagnosis to be accepted, often numerous signs and symptoms together make up the actual diagnosis. These identifying criteria must be present in the patient to assign that diagnosis. Placing data in incorrect categories, not validating data with the patient, and relying on team members are not discussed.

DIF: Cognitive Level: Evaluation OBJ: Compare and contrast the steps of the nursing process.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

23. An example of an intervention independently initiated by the nurse is a. starting a teaching plan for the patient who will go home tomorrow. b. instituting diet restrictions with subsequent progression of diet as tolerated. c. sending an abnormal appearing urine sample to the lab for routine urinalysis. d. writing an order for aspirin for a headache.

ANS: A Starting a teaching plan is an independent nursing function. Accountability for both independent and interdependent functions remains a part of the role of the RN. Instituting diet restrictions, sending a sample for urinalysis, and writing an order are not functions of a nurse and require physician’s orders to carry out.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

24. A nursing intervention directs the patient to be turned every 2 hours to prevent skin breakdown from immobility.

Assessment findings on new reddened areas on the lateral N aspects of the right knee and ankle are obtained. What is the most appropriate way for these findings to be used when the care plan is evaluated? a. The information will be added to the relevant area of the electronic medical record. b. The nursing diagnosis will be changed from an actual problem to a potential problem. c. The new intervention of calling the physician will be added to the care plan. d. The intervention will change to have the patient turned every hour.

ANS: D Evaluation is the process of examining the effectiveness of the plan of care and adjusting it to ultimately meet the needs of the patient. Because redness is observed over bony prominences with turning the patient every 2 hours, the intervention must be adjusted, so the patient must be turned more frequently to prevent further skin breakdown.

Documenting of information in the electronic medical record does not address the immediate skin integrity problem.

Changing the actual problem to a potential problem is incorrect. Calling the physician is not an independent nursing intervention and does not address the issue of skin integrity.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. In the assessment phase of the nursing process, there are several ways to collect data. Which statements reflect the need for more training? (Select all that apply.) a. “The patient is talking in full sentences with visitors and appears to be breathing without distress.” b. “Bowel sounds are hypoactive in all four quadrants; no pain with palpation.” c. “Mrs. Collins, are you experiencing any pain right now?” d. “According to the chart, the patient slept well last night as a result of the pain medicine administered at 2100.”

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e. “The abdominal wound is slightly red at the approximated edges, no edema noted.”

ANS: C, D Methods of data collection include observation, physical assessment, and interviewing. Asking yes-no questions may limit the information received. Reading the chart for any previous notes is important to know for continuity of care, but it is not a method of data collection in the assessment phase of the nursing process. Noticing the patient speaking in full sentences tells the nurse the patient is in no distress. Auscultating and palpating the abdomen are part of the physical assessment done at the beginning of every shift and as needed. Noting wound healing including redness and edema is a direct observation.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to the practice setting.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

N

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Chapter 07: Critical and Diagnostic Thinking for Better Clinical Judgment

MULTIPLE CHOICE

1. The nurse is listening to a lecture on critical thinking. Which statement indicates that teaching has been effective? a. “Critical thinking involves making inferences, solving problems, arriving at decisions.” b. “Critical thinking involves persuading others, inducing debate, using intuition.” c. “Critical thinking involves making inferences, reducing fractions, making decisions.” d. “Critical thinking involves solving problems, elevating issues, reflecting actions.”

ANS: A Although critical thinking may play a part in many processes, the primary uses are to make inferences, solve problems, and arrive at decisions.

DIF: Cognitive Level: Evaluation TOP: Critical Thinking

OBJ: Define critical thinking.

MSC: NCLEX: Nursing Process

2. The nursing is listening to a lecture on reasoned thought. Which statement indicates that teaching has been effective? a. “Reasoned thought is reflection.” b. “Reasoned thought is emotion.” c. “Reasoned thought is parity.”

N

d. “Reasoned thought is contrast.”

ANS: B Reasoned thought is discriminating and prudent and does not allow emotion, feelings, or prejudices to skew decisions. Individuals who practice reasoned thought recognize when negative factors may be interfering with their ability to think clearly.

DIF: Cognitive Level: Evaluation OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning MSC: NCLEX: Nursing Process

3. Using clinical judgment, the nurse makes decisions on whether to proceed with or revise a course of action. When providing this education to a nursing student, which statement indicates that the teaching has been effective?

a. “The inquiry (investigational or exploratory) subprocess necessary for sound clinical judgment is reflective thinking.” b. “The inquiry (investigational or exploratory) subprocess necessary for sound clinical judgment is persuasive thinking.” c. “The inquiry (investigational or exploratory) subprocess necessary for sound clinical judgment is critical thinking.” d. “The inquiry (investigational or exploratory) subprocess necessary for sound clinical judgment is intuitive thinking.”

ANS: C Through clinical judgment, the nurse makes decisions on whether to proceed with or revise a course of action. The inquiry (investigational or exploratory) subprocess necessary for sound clinical judgment is critical thinking.

DIF:

Cognitive Level: Evaluation

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OBJ: Identify the types of reasoning based on critical thinking.

TOP: Reasoning: Clinical Judgment MSC: NCLEX: Nursing Process

4. The nurse is listening to a lecture on critical thought. Which statement indicates that the teaching has been effective? a. “Critical thought is a disciplined, rational, and self-directed activity that uses standards and criteria.” b. “Critical thought is an intuitive process that relies only on the nurse’s experience.” c. “Critical thought is a persuasive process leading to sound decisions.” d. “Critical thought is a reactive process after an intervention is completed.”

ANS: A Critical thought is a disciplined, rational, and self-directed activity that uses standards and criteria. Critical thought assists the nurse in making more effective clinical decisions. The nurse who engages in critical thought will meet more of the patient’s needs and effect positive patient outcomes.

DIF: Cognitive Level: Evaluation OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning: Critical Thought MSC: NCLEX: Nursing Process

5. A patient has a problem that prevents him from shaving himself, tying his shoes, or fixing his meals. He is not physically able to compensate for the problem, so he is in need of assistance. N Data support the nursing diagnosis “impaired physical mobility” by what mode of reasoning? a. Induction b. Deduction c. Reduction d. Reflection ANS: B Taking general assessment data, drawing conclusions, identifying problems or needs, and formulating a plan of care are components of a deductive reasoning process. The nursing process is an example of deductive reasoning because it involves taking data and deducing a plan of care.

DIF: Cognitive Level: Analysis TOP: Inductive and Deductive Reasoning

OBJ: Compare inductive and deductive reasoning.

MSC: NCLEX: Nursing Process

6. An RN has been working with a patient on the nursing unit for a 12-hour shift. The nurse recognizes that each time the patient is turned to the left, the blood pressure drops 15 mm Hg. The same RN has seen this phenomenon in several other patients and makes the connection that patients with right-sided heart failure (the medical diagnosis) will experience a blood pressure drop if they are turned to their left side. This type of reasoning is called a. inductive. b. deductive. c. reductive. d. reflective.

ANS: A The nurse uses inductive reasoning when a patient has symptoms or problems the nurse has seen before. From the assessment data gathered, the nurse makes inferences (conclusions or assumptions), asks further questions, and makes decisions. The nurse, using inductive reasoning, goes from specifics to generalities and infers the likely outcomes based on supporting data.

DIF: Cognitive Level: Analysis TOP: Inductive and Deductive Reasoning

OBJ: Compare inductive and deductive reasoning.

MSC: NCLEX: Nursing Process

7. Each element of the nursing process involves critical thinking. Which definition of assessment reflects critical thinking? a. Correctly and completely documenting the assessment data on a form

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b. A process of discovery and decision-making about the nature of the patient’s needs c. Using a systematic approach to ensure comprehensive collection of assessment data d. Selecting the most accurate NANDA-I nursing diagnosis for the patient ANS: B Assessment is a process of discovering and making decisions about the nature of the patient’s nursing problems or needs. It involves purposeful and systematic data gathering about the patient’s present illness or situation and past health history (subjective data), data gathering by physical examination (objective data), and review of functional health patterns for both subjective and objective data.

DIF: Cognitive Level: Analysis N OBJ: Explain the importance of critical thinking in nursing.

NCLEX: Nursing Process

TOP: Critical Thinking MSC:

8. A novice RN is caring for a patient who is saying that something is wrong. Vital signs are normal and there are no new specific findings. The novice RN calls another, more experienced RN who briefly talks with the patient, calls the health care provider, and initiates a transfer to the ICU. Which statement is most likely true of the more experienced RN? a. The experienced RN is an advanced beginner with better assessment skills than the novice nurse. b. The experienced RN is proficient in assessment and the use of hospital protocol. c. The experienced RN is an expert nurse with intuitive judgment that the experienced nurse cannot quite explain. d. The experienced RN is arrogant, foolish, and likely to get in trouble for her assertive behavior.

ANS: C The expert RN is able to connect the understanding of a situation with an appropriate action. The expert RN has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of alternative actions. The strength of inference by the expert RN is based on the extent of the RN’s knowledge and experience. The RN with limited experience and with developing knowledge may rely on the proven and look to others for validation of decisions. Practice at this stage demonstrates the highest level of critical thinking in that the expert RN knows holistically what to do without consciously thinking through the process of critical thinking.

DIF: Cognitive Level: Application OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning MSC: NCLEX: Nursing Process

9.

An RN has collected extensive data on a patient with attention deficit disorder. When weighing potential actions to help the patient and considering alternative solutions, which of the attributes of the critical thinker is the RN demonstrating? a. Creativity b. Rational thought c. Reflection d. Curiosity ANS: A Creativity is the ability to be innovative, resourceful, and inventive in finding solutions. Rational thought is fueled by knowledge gained through study and experience. Reflection allows the critical thinker to look back and review ideas, thoughts, and actions. Curiosity is the desire to understand what something is or how something works.

DIF: Cognitive Level: Application N TOP: Attributes of Critical Thinkers

OBJ: Identify attributes of critical thinkers.

MSC: NCLEX: Nursing Process

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10. A nurse manager is designing orientation processes for new graduate nurses by using the work of Hansten and Washburn as a model. All of the new graduates are instructed in the model during orientation. The manager knows that a graduate nurse needs more instruction if which comment is made during the evaluation interview? a. “I think I need more mentoring to continue to build my thinking skill.” b. “Improving my critical thinking will assist in decreasing the risk of sentinel events for my patients.” c. “Using my improving thinking skills will help improve patient care.” d. “If my thinking skills are what they should be, fewer errors will happen in patient care.”

ANS: A Hansten and Washburn (1999) indicated that the nurse must be able to think critically as a way to decrease errors and sentinel events and assist in cultivating an improved patient care system. Mentoring new employees is not discussed.

DIF: Cognitive Level: Evaluation OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning MSC: NCLEX: Nursing Process

11. The nurse has received a shift report. Which patient should the nurse assess first? a. The patient diagnosed with type 2 diabetes mellitus who is complaining of dizziness with a glucose level of 120. b. The patient diagnosed with sleep apnea who is complaining of a morning headache. c. The patient diagnosed with diverticulitis who has a hard, rigid, abdomen and a temperature of 101.3 F. d. The patient diagnosed with a stomach virus who vomited three times during the previous shift.

ANS: C Clinical judgment is perceptive understanding of a situation based on knowledge, empirical data (data that can be observed or experienced), theory, and scientific inquiry. Clinical judgment requires a series of decisions based on changing observations and collected data. A hard, rigid abdomen and elevated temperature are abnormal in any circumstance, and the nurse should assess this patient first. These are clinical manifestations of peritonitis, a potentially life-threatening condition. A glucose level of 120 is normal for a patient with type 2 diabetes. The patient complaining of a headache is the least urgent compared with the other patients. The patient who vomited three times is an urgent patient requiring monitoring of hydration, but less urgent than a patient with a potentially life-threatening condition.

DIF: Cognitive Level: Application OBJ: Explain the importance of critical thinking in nursing.

NCLEX: Nursing Process

TOP: Critical Thinking MSC:

12. The nurse has received a change-of-shift report about these four patients. Which one should the nurse plan to assess first? a. A 23-year-old patient with cystic fibrosis who has pulmonary function testing N scheduled in 30 minutes.

b. A 35-year-old patient who was admitted the previous day with bacterial pneumonia and has a temperature of 100.2 F.

c. A 46-year-old patient who is complaining of dyspnea after having a thoracentesis 1 hour previously. d. A 77-year-old patient with TB who has four antitubercular medications due in 15 minutes.

ANS: C Clinical judgment is perceptive understanding of a situation based on knowledge, empirical data (data that can be observed or experienced), theory, and scientific inquiry. Clinical judgment requires a series of decisions based on changing observations and collected data. Dyspnea after a thoracentesis may indicate pneumothorax or hemothorax and requires immediate evaluation by the nurse. The other patients should also be assessed as soon as possible, but there is no indication that they may need immediate action to prevent deterioration.

DIF:

Cognitive Level: Application

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OBJ: Explain the importance of critical thinking in nursing.

NCLEX: Nursing Process

TOP: Critical Thinking MSC:

13. As elements of reasoning and critical thought, why are implications or consequences of outcomes important to consider? a. They can help the nurse make confident clinical decisions. b. They help the nurse understand complex ideas and events. c. They help the nurse understand how the patient is responding to the demands of the treatment. d. They can be expected or unexpected and affect the completion of a nursing intervention.

ANS: D Implications or consequences are defined through outcomes. Implications or consequences can be expected or unexpected, but each must be considered. For example, an expected consequence of bathing is a clean patient with intact skin that can fight infection or breakdown. An unexpected consequence is fatigue, which can cause stress on the patient’s body and affect healing and recovery. Every action or nursing intervention has consequences, so the nurse must critically think about the intervention and the consequences of performing the intervention. Inferences help nurses make confident clinical decisions. Concepts can help the nurse understand complex ideas, events, actions and entities, thereby defining and shaping our thought processes. Gathering data helps the nurse understand how the patient is responding to the demands of the treatment.

DIF: Cognitive Level: Application OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning MSC: NCLEX: Nursing Process 14. Which patient would the nurse see first at the start of the shift? a. A patient admitted yesterday with osteomyelitis of the right arm with a T of 101.0 F. b. A patient with hepatic encephalopathy who is being rude to the nursing assistant. c. A patient with lupus who has been on long-term corticosteroids and whose blood N sugar is 180.

d. A patient with circumferential burns of the right leg who is complaining of numbness in the right foot.

ANS: D People who engage in critical thought can be said to practice cultivated thinking, which is organized, enlightened, and educated. By organizing the thought process, the individual is able to make sense of information. Circumferential burns to the extremities can cause circulatory compromise distal to the burn with subsequent neurologic impairment of the affected extremity. The patient with a T of 101.0 F, the patient being rude, and the patient with a blood sugar of 180 are not exhibiting emergency conditions needing immediate attention.

DIF: Cognitive Level: Application OBJ: Explain the importance of critical thinking in nursing.

NCLEX: Nursing Process

TOP: Critical Thinking MSC:

15. Which statement best assists the nurse in planning care for the patient who is not adhering to the treatment regimen? a. Patients’ health attitudes directly affect behavior and therefore influence adherence. b. Patients usually go to the hospital without preconceived ideas about what is wrong with them. c. Most patients adhere to the advice of health care providers even if they do not believe that the treatment will work. d. Noncompliance with prescribed treatment is irrational behavior.

ANS: A Understanding the patient’s health attitudes helps the nurse to understand the patient’s point of view about the treatment regimen. All thinking stems from a point of view. An enlightened thinker is able to interpret data and clarify meaning from several points of view, that is, to explain or illustrate how the data can be understood from

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multiple positions. The RN can recognize that a routine treatment may seem strange and frightening from the patient’s point of view. In gathering data to support this assumption, the nurse will ask questions to better understand how the patient is responding to the demands of the treatment. An unenlightened nurse may make erroneous assumptions that label the patient as problematic and noncompliant. All the other answer choices have nothing to do with understanding the patient’s point of view.

DIF: Cognitive Level: Application OBJ: Explain the importance of critical thinking in nursing.

NCLEX: Nursing Process

TOP: Critical Thinking MSC:

16. Select the hospital patient who has the best chance of avoiding a hospital-acquired infection. a. A 42-year-old patient who had abdominal surgery b. A 35-year-old patient with a closed leg fracture c. A 5-month-old non-breastfed infant d. A 75-year-old patient receiving chemotherapy ANS: B Clinical judgment is perceptive understanding of a situation based on knowledge, empirical data (data that can be observed or experienced), theory, and scientific inquiry. Clinical N judgment requires a series of decisions based on changing observations and collected data. The patient with the closed leg fracture is the patient with the best chance of avoiding a hospital-acquired infection. The patient with abdominal surgery is at risk for contracting a hospitalacquired infection because of healing surgical wounds. The non-breastfed infant and the patient receiving chemotherapy are patients with compromised immune systems that put them at risk for a hospital-acquired infection.

DIF: Cognitive Level: Application OBJ: Explain the importance of critical thinking in nursing.

NCLEX: Nursing Process

TOP: Critical Thinking MSC:

17. The nurse is caring for a 19-year-old trauma patient paralyzed from the neck down. He is alert and oriented, requires assistance with ADLs, and keeps his spirits up with frequent visitors. A priority for the nurse is a. rounding hourly to assess the patient’s support system and acceptance of his condition. b. feeding the patient to maintain his nutritional status. c. ensuring the patient has constant stimuli through his friends because teenagers are peer-focused. d. watching and preventing skin breakdown as a result of immobility.

ANS: D Clinical judgment is perceptive understanding of a situation based on knowledge, empirical data (data that can be observed or experienced), theory, and scientific inquiry. Clinical judgment requires a series of decisions based on changing observations and collected data.

Patient safety is a nurse’s priority. Watching and preventing skin breakdown are the priorities for an immobile patient. Hourly rounding, nutritional status, and ensuring that the patient is kept busy are important but of lower priority.

DIF: Cognitive Level: Application OBJ: Explain the importance of critical thinking in nursing.

NCLEX: Nursing Process

TOP: Critical Thinking MSC:

18. Which of the following is the best example of an open-ended question regarding a patient’s pain? a. “For how many weeks have you been having this pain?” b. “Does it feel like a burning pain?” c. “Where on your body does the pain begin and end?” d. “Can you describe your pain for me?”

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ANS: D Curiosity, an element of reasoning, stimulates the RN to apply all available facts, principles, and theories, as well as specific knowledge of the situation, to formulate the plan of care.

Open-ended questions such as “Can you describe your pain for me?” allow the patient to think and express thoughts freely without limitations. The other answer choices are limiting and draw specific responses.

DIF: Cognitive Level: Application OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning MSC: NCLEX: Nursing ProcessN MULTIPLE RESPONSE 1. The nurse who can think critically will make more effective clinical decisions, meet more of the patient’s needs, and affect positive patient outcomes. How this is accomplished? (Select all that apply.) a. Committing to test one’s own thought process for clarity, accuracy, and logic b. Accepting an individual’s responsibility to develop critical thinking skills c. Joining nursing organizations to keep current on nursing policies affecting patient care d. Constantly seeking out others for answers to difficult clinical questions and problems e. Requesting that health care organizations adopt and foster a culture of critical thinking f. Maintaining the required amount of continued education units for license renewal ANS: A, B, E Committing to test one’s own thought process for clarity, accuracy, and logic; accepting individual responsibility to develop critical thinking skills; and requesting that health care organizations adopt and foster a culture of critical thinking are all ways to foster critical thinking. Joining nursing organizations to keep current on nursing policies affecting patient care is not discussed. Constantly seeking out others for answers to difficult clinical questions and problems is incorrect because critical thinkers demonstrate specific attributes that support the process, including curiosity, diligence in the pursuit of evidence and information, rational thought, reflection, and creativity.

Maintaining the required amount of continued education units for license renewal is not discussed.

DIF: Cognitive Level: Analysis TOP: Attributes of Critical Thinkers

N

OBJ: Identify attributes of critical thinkers.

MSC: NCLEX: Nursing Process

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Chapter 08: Practicing Evidence-Based Decision Making

MULTIPLE CHOICE

1. The American Nurses Credentialing Center (ANCC) developed the Magnet Recognition Program for hospitals to address quality patient care. What is the significance of achieving magnet status?

Excellence in quality patient care and recruitment and retention of nurses Excellence in research, patient care, and retention of physicians Excellence in recruiting nurses, early discharge, and effective billing Excellence in recruitment and retention of ancillary caregivers

a. b. c. d.

ANS: A Magnet recognition is one of the many responses to the call for quality of care of the ANCC’s Magnet Recognition Program. The significance of achieving Magnet status indicates a hospital that succeeded in creating an atmosphere that nurtures evidence-based practice in nursing practice. The nurses are free to exercise professional autonomy. The particular hospital becomes known for its excellence in quality effective and efficient nursing care. Physician retention, early patient discharge, effective billing, and ancillary caregivers are not criteria for Magnet status.

DIF: Cognitive Level: Analysis TOP: Magnet Recognition Program

OBJ: Define evidence-based practice.

MSC: NCLEX: Safe and Effective Care Environment

2. The chief purpose of evidence-based practice is to a. offer a problem-solving approach to systematically research clinical evidence N directed toward a specific patient problem. b. prepare the nurse to conduct specific research in patient care practices. c. prepare the nurse for employment in an evidence-based research center. d. research clinical evidence that covers the entire aspect of a specific problem.

ANS: A Evidence-based practice (EBP) is the integration of the best available evidence, combined with clinical expertise, which enables health practitioners of all varieties to address health care questions with an evaluative and qualitative approach. EBP preparing the nurse to conduct specific research in patient care practices reflects too narrow a scope for research. EBP preparing the nurse for employment in an evidence-based research center has no basis for requiring evidence-based research. EBP to research clinical evidence that covers the entire aspect of a specific problem is incorrect.

DIF: Cognitive Level: Analysis OBJ: Define evidence-based practice.

TOP: Evidence-Based Practice MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which statement reflects an important principle to be applied by the nurse who is developing a relevant clinical question regarding a specific patient concern, using PICO? a. The type of question will determine which resources to access. b. A systematic approach determines which questions will be asked. c. The clinical question is formulated at the conclusion of the literature search. d. Background questions are identified at the conclusion of the literature search.

ANS: A The type of question helps determine the resources to access to answer the question.

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Developing the clinical question is the most important step in the evidence-based process. The RN must develop a clinical question that encompasses the key components to ensure that the question addresses an answerable concern that can be converted into relevant application. Use of the PICO format allows the nurse to develop the question utilizing all needed components. A systematic approach that determines which questions will be asked is incorrect.

All evidence-based research is a systematic approach. Formulation of the he clinical question at the conclusion of the literature search and identification of the background questions at the conclusion of the literature search are stated in the wrong order of the research process.

DIF: Cognitive Level: Evaluation OBJ: Develop a sound clinical question utilizing the PICO format. TOP: Developing a Clinical Question MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. The nurse is interested in whether antibiotic therapy or observation only is most effective in the treatment of sinusitis in young adults. Which of the following best describes the type of question being considered? a. Background questions b. Foreground questions c. General knowledge questions d. Both A and B. ANS: B Foreground questions have four key components: (1) patient- or problem-centered focus on N knowledge about managing patients with a disease, (2) intervention, (3) comparative intervention (an optional step, used only if relevant), and (4) clinical outcome. Ask for specific information about managing patients with a disease. Background questions seek general knowledge about a disease or disease process.

DIF: Cognitive Level: Analysis OBJ: Develop a sound clinical question utilizing the PICO format.

TOP: Clinical Questions in Evidence-Based Practice MSC: NCLEX: Safe and Effective Care Environment

5. Can you explain how the nurse’s use of PICO helps to formulate an effective clinical question? a. PICO organizes the elements that guide the clinical question. b. PICO formulates an answer to the clinical question. c. PICO explains the hierarchy of evidence. d. PICO identifies the strength of the evidence.

ANS: A Using the PICO approach allows for a systematic method of identifying important concepts when formulating the clinical question. Although every component of the PICO model may not be used in every case, PICO is an acronym used to describe a format of the four elements required to formulate a good clinical question (P, patient or problem; I, intervention; C, comparison; O, outcomes). PICO questions do not formulate answers, nor do PICO questions have anything to do with evidence.

DIF: Cognitive Level: Analysis OBJ: Develop a sound clinical question utilizing the PICO format.

TOP: PICO Format MSC: NCLEX: Safe and Effective Care Environment

6. The nurse questions whether treatment with antibiotic therapy is as effective as observation in a 3-year-old boy with otitis media. What combination of information supports the proper order of information needed to compose a PICO statement? a. Effective treatment for otitis media; antibiotic therapy; observation; 3-year-old with otitis media b. Three-year-old with otitis media; antibiotic therapy; observation; effective treatment for otitis media

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c. Antibiotic therapy; 3-year-old with otitis media; effective treatment for otitis media; observation d. Observation; 3-year-old with otitis media; effective treatment for otitis media; antibiotic therapy ANS: B PICO is an acronym used to describe a format of the four elements required to formulate a good clinical question (P, patient or problem; I, intervention; C, comparison intervention; O, outcomes). “Three-year-old with otitis media; antibiotic therapy; observation; effective treatment for otitis media” organizes the elements in the correct order.

“Effective treatment for otitis media; antibiotic therapy; observation; 3-year-old with otitis media,” “Antibiotic therapy; 3-year-old with otitis media; effective treatment for otitis media; observation,” and “Observation; 3-year-old with otitis media; effective treatment for otitis media; antibiotic therapy” have the elements in the incorrect order.

DIF: Cognitive Level: Synthesis N OBJ: Develop a sound clinical question utilizing the PICO format.

TOP: PICO Format MSC: NCLEX: Safe and Effective Care Environment

7. The nurse wants to know how similar the 7-minute screen (7MS) is to the Mini-Mental State Examination (MMSE) in accurately screening for dementia. Can you distinguish the correct clinical question category for this type of question? a. Prognosis b. Diagnostic c. Harm/etiology d. Prevention ANS: B Diagnostic questions emphasize how to select a diagnostic test or interpret the results of a particular test.

Harm/etiology questions focus on what the harmful effects of a particular treatment are or how harmful effects can be avoided. Prognosis questions focus on the disease process, screening, and risk reduction. Prevention questions are interested in how to modify patient’s risk factors to reduce the risk of disease.

DIF: Cognitive Level: Analysis OBJ: Develop a sound clinical question utilizing the PICO format.

TOP: Screening for Dementia MSC: NCLEX: Safe and Effective Care Environment 8. If you had access to the following databases for your research, which would you choose to review clinical trials on effective smoking cessation therapies? a. The Cochrane Library b. HealthStar c. Medline d. InfoPOEMS ANS: A The Cochrane Database of Systematic Reviews is one of the most popular databases in the Cochrane Library. It evaluates individual clinical trials and condenses systematic reviews from more than 100 medical journals. The database provides an efficient method of interpreting the results of many studies. HealthStar includes published literature from journals, book chapters, and government documents on clinical and nonclinical aspects of health care delivery. Medline is the largest biomedical research literature database (more than 10 million references) for general information. Medline compiles information from Index Medicus, Index to Dental Literature, and International Nursing Index. InfoPOEMs (Patient-Oriented Evidence that Matters) is a clinical awareness system that allows health care practitioners to access the most current, concrete medical information available.

DIF: Cognitive Level: Analysis OBJ: Identify high-quality electronic resources for locating evidence-based nursing practice.

TOP: Electronic Databases MSC: NCLEX: Safe and Effective Care Environment 9. The process of understanding and applying researched clinical evidence to nursing practice requires the nurse to become information literate. Which action by the nurse best describes the use of information literacy?

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a. Identifies a specific clinical problem, accesses appropriate resources, and assesses the relevancy of use of informatN ion for that particular patient’s problem b. Identifies a particular patient problem and immediately notifies the physician and family for treatment c. Identifies the lack of research skills and consults a librarian for a workshop on conducting research studies d. Identifies the lack of research skills and consults a scientific researcher to teach basic computer information ANS: A Information literacy is a fundamental skill that the nurse must develop. Information literacy is defined as the ability to recognize when information is needed and have the ability to locate, evaluate, and effectively use the information.

Identifying a particular patient problem and immediately notifying the physician and family for treatment address direct patient care rather than nursing research. Identifying the lack of research skills and consulting a librarian for a workshop on conducting research studies and identifying a lack of research skills and consulting a scientific researcher to teach basic computer information incorrectly focus on the lack of research skills.

DIF: Cognitive Level: Analysis TOP: Information Literacy

OBJ: Discuss the hierarchy (levels) of evidence.

MSC: NCLEX: Safe and Effective Care Environment

10. Assess the given levels of evidence and choose the one most important when evaluating the strength of a research study.

Level 3 evidence indicates that specific-quality criteria were met.

Level 1 evidence implies an association with specific criteria.

Level 1 evidence indicates that specific-quality criteria were met.

Level 2 evidence implies a reliable association with specific criteria.

a. b. c. d.

ANS: C Level 1 evidence represents the most valid reports addressing patient-oriented outcomes. A level 1 ranking also indicates that specific-quality criteria were met based on the study type. Level 3 evidence represents reports that are not based on scientific analysis of patient-oriented outcomes. Level 2 evidence implies an association with specific criteria rather than reliable evidence.

DIF: Cognitive Level: Evaluation TOP: Hierarchy of Evidence

OBJ: Discuss the hierarchy (levels) of evidence.

MSC: NCLEX: Safe and Effective Care Environment

11. What is the relationship between the design and layout when creating a critical appraisal tool? a. Design and layout differ but measure the same areas. b. Design and layout differ, and reliability measures differ. c. Design, layout, and reliability are similar but relevancy differs. d. Design, layout, and reliability differ but trustworthiness is the same.

ANS: A The nurse remembers the three basic questions that are universal for any type of research study. Critique appraisal tools differ slightly in design and layout, but each tool asks these same questions of the research study: (1) Is it worth looking at the results of this study, and can I trust the results (reliability)? (2) What are the results? (3) Are the results relevant for the patient? “Design and layout differ, and reliability measures differ” and “Design, layout, and reliability are similar but relevancy differs” are incorrect because each critical appraisal tool asks the same questions of the research study. “Design, layout, and reliability differ but trust N worthiness is the same” is incorrect because trustworthiness has nothing to do with appraising research studies.

DIF: Cognitive Level: Analysis TOP: Critical Appraisal Tool

OBJ: Discuss the hierarchy (levels) of evidence.

MSC: NCLEX: Safe and Effective Care Environment

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12. Several sections are included in a research article. For example, the methods section describes the research study and what assessment quality and criteria were used. What information does the abstract or introduction section include?

a. An evidence summary from the results of several other studies b. An outline of the number of studies retrieved and excluded and respective reasons for their inclusions or exclusions c. A discussion about whether the results are heterogeneous with possible reasons d. A clearly stated review question ANS: D The review question should be clearly stated in the title, the abstract, or final paragraph of the introduction. The summary section provides an evidence summary from the results of several studies. The results section outlines the number of studies retrieved, excluded, and why. The data/analysis section states whether the results are heterogeneous and discusses possible reasons.

DIF: Cognitive Level: Synthesis OBJ: Articulate the role of the RN in research and research utilization.

TOP: Critical Appraisal MSC: NCLEX: Safe and Effective Care Environment

13. A nurse manager attempts to explain why the greatest number of medication errors occurs during the evening shift.

The nurse manager chooses a quasi-experimental design to study this relationship. Why did the nurse manager choose this type of research design? a. It does not allow for complete control over the variance. b. It allows for randomization. c. It allows for control over the independent variable. d. It requires manipulation of the variable.

ANS: A In quasi-experimental designs, strict control is not possible. Allowing for randomization and for control over the independent variable and requiring the manipulation of the variable are true of experimental studies.

DIF: Cognitive Level: Evaluation OBJ: Articulate the role of the RN in research and research utilization.

TOP: Nursing Research MSC: NCLEX: Safe and Effective Care Environment: Management of Care

14. The nurse manager wants to determine the cause of an increase in medication errors over the past 6 months. This is an example of which type of research? a. Experimental b. Trial and error c. Quality assurance d. Scientific N ANS: C Quality assurance research uses data not only to determine whether procedures are being done per protocol, but also to determine whether patient outcomes are being met, and if charting is complete. Experimental research is a type of study design. Trial and error is not proper research methodology. Scientific research is what all evidence-based research demonstrates.

DIF: Cognitive Level: Application OBJ: Describe the research process.

TOP: Nursing Research MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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15. A nurse evaluates the results of two different studies examining the relationship between time of day and sundowning in the geriatric setting. After 1 month, the nurse realizes that there is a difference of 1 hour in the instruments used for measurement. What conclusion can be drawn about the type of threat this causes the study? a. Validity b. Reliability c. Causality d. Truthfulness ANS: B Reliability refers to measuring the instrument by asking how trustworthy it is at gathering the intended data. Validity measures the degree to which an instrument is measuring what it is supposed to measure. Causality and truthfulness are not criteria researchers use to determine whether research instruments give accurate results.

DIF: Cognitive Level: Analysis OBJ: Describe the research process.

TOP: Nursing Research MSC: NCLEX: Safe and Effective Care Environment: Management of Care

16. Which question should the nurse ask in order to judge the validity of a research study? a. What reliability information has been provided? b. Are the instrument measures applied consistently? c. Does the instrument measure what it is supposed to measure? d. How much random error exists?

ANS: C Validity measures the degree to which an instrument is measuring what it is supposed to measure. Reliability measures whether the device, technique, or instrument accurately collects the intended data. How consistently the measurements are applied and what amount of random error exists have nothing to do with testing validity.

DIF: Cognitive Level: Application OBJ: Describe the research process.

TOP: Nursing Research MSC: NCLEX: Safe and Effective Care Environment: Management of Care

17. Which step does a researcher first use when starting a new study? a. Data collection b. Refining an abstract idea c. Literature review d. Statistical analysis ANS: B N The first step in the nursing research process is refining an abstract idea by developing an answerable question that is focused on a specific patient-centered concern. Data collection, literature review, and statistical analysis occur later in the research process.

DIF: Cognitive Level: Application OBJ: Describe the research process.

TOP: Nursing Research MSC: NCLEX: Safe and Effective Care Environment: Management of Care

18. Which of the following is an example of direct research utilization? a. Advocating for a change in policy b. Basing practice on current research available c. Implementing new techniques for practice d. Critiquing a research study ANS: C

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Direct research utilization describes applying research findings directly to change practice. Advocating a change in policy based on research findings such as when working on a policy and procedure committee is persuasive research utilization. Basing practice on current research available and critiquing a research study are examples of indirect research utilization.

DIF: Cognitive Level: Application OBJ: Articulate the role of the RN in research and research utilization.

TOP: Nursing Research MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. Characteristics of a quantitative study include all of the following except: a. clarifies underlying assumptions. b. asks who, what, why, where, when, or how. c. describes the relationship between variables. d. is highly structured and controlled.

ANS: A A quantitative study asks the question who, what, why, where, when, or how and attempts to describe the relationship between one variable and another. A quantitative study plan is also highly structured and controlled. A qualitative study tries to clarify underlying assumptions that are vague or unclear by asking what the perceptions, beliefs, or tenets are within a particular setting.

DIF: Cognitive Level: Application OBJ: Describe the research process.

TOP: Nursing Research MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE

1. Which of the following are most responsible for the emerging use of evidence-based practice (EBP) in health care? (Select all that apply.) a. Accountability by consumers of governmental and health care agencies b. Introduction of national health care guidelines c. Shorter implementation time of new research d. Variability of care among health care practitioners and facilities e. Similarity with other science disciplines and their amounts of researchN f. Eligibility to receive government grants for research excellence ANS: A, D Economic factors, the variability of care, and the rising cost of health care have been the driving force in the call for EBP. Consumers and governmental agencies are insisting on transparency, accountability for effectiveness, and efficiency in health care. EBP began before the introduction of national health care guidelines. Shorter implementation time of new research is irrelevant in the use of EBP. Similarity with other sciences and their amounts of research and eligibility to receive government funding for research excellence are incorrect.

DIF: Cognitive Level: Analysis OBJ: Define evidence-based practice.

TOP: Accountability and Variability in Health Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. What characteristics support evidence-based practice (EBP)? (Select all that apply.) a. The nurse’s clinical experience is fundamental to the evidence-based practice process. b. Evidence-based practice provides a theoretical framework for accuracy and safety in patient care. c. Evidence-based practice involves the use of a holistic approach to patient care in health care.

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d. Evidence-based practice is designed to create a generic plan of patient care in clinical settings. e. Evidence-based practice allows the nurse autonomy in patient care because research proves success.

ANS: A, B, C EBP is problem-solving in its approach, which takes into account the clinical experience of the nurse. Clinical experience refers to the nurse’s ability to use clinical skills and past experience to identify the patient’s health state, diagnosis, and the risks and benefits of the prospective interventions. EBP combines researched evidence with knowledge and theory. The use of patient-centered researched evidence allows for accuracy and precision of diagnostic tests and prognosis markers, in addition to the effectiveness and safety of therapeutic treatment. EBP allows for patients’ values to be expressed and incorporated into treatment regimens. Patients bring their individual preferences, concerns, and expectations to the clinical setting. The statement that EBP is designed to create a generic plan of patient care in clinical settings is incorrect because a patient’s plan of care should always be individualized and never generic. EBP does not authorize autonomy for any nursing professional.

DIF: Cognitive Level: Analysis OBJ: Define evidence-based practice.

TOP: Evidence-Based Practice MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. Research studies must be scrutinized to be deemed credible and trustworthy. Choose all the strategies that may be used to critically appraise a research study. (Select all that apply.) a. Examine the validity of the research.

Look at the reference list of the study.

Look for criteria of inclusion.

Look for use of PICO format.

Examine the credentials of the authors.

b. c. d. e. f.

Look for a proper sample size.N

ANS: A, B, C Examining the validity of the research, looking at the reference list of the study, and looking for criteria on inclusion are all strategies that can be used to appraise research studies critically. PICO is an acronym used to describe one format that includes four elements needed to construct a good clinical question. Looking for the PICO format and looking for a proper sample size are not strategies for critically appraising research studies.

DIF: Cognitive Level: Analysis TOP: Hierarchy of Evidence

OBJ: Discuss the hierarchy (levels) of evidence.

MSC: NCLEX: Safe and Effective Care Environment

4. Which goals best justify the need for evidence-based practice (EBP) in nursing? (Select all that apply.) a. Redesign the health care system and recruit more nurses. b. Improve patient outcomes with evaluations that track outcomes. c. Introduce national health care guidelines and standards. d. Restructure health care delivery and improve quality of health care. e. Apply clinical experience to improve patient care.

ANS: B, D The initial intent of EBP was to improve patient outcomes by evaluating and tracking outcomes, including qualitative reports by patients, and to redesign health care delivery and improve the quality of health care. EBP has nothing to do with nurse recruitment or national health care guidelines and standards. Applying clinical experience to patient care is not a goal of EPB. Clinical expertise is a factor used in research.

DIF: Cognitive Level: Analysis TOP: Evidence-Based Practice

OBJ: Define evidence-based practice.

MSC: NCLEX: Safe and Effective Care Environment

5. What are the problems with variables? (Select all that apply.)

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a. b. c. d. e.

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Vary from subject to subject Determined through statistics Difficult to account for them Challenging to explain in relation to the study topic Testing whether a correlation exists between results

ANS: A, C, D A variable is a concept, idea, or attribute that is captured and defined within a research study. Variables vary from subject to subject, as with height and weight. Researchers attempt to control the variables, statistically account for them, or explain them in relation to what is being studied. Variables are not determined through statistics, nor do they test for correlations.

DIF: Cognitive Level: Analysis OBJ: Describe the research process.

TOP: Nursing Research MSC: NCLEX: Safe and Effective Care Environment: Management of Care

N

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Chapter 09: Communicating With Patients and Co-Workers

MULTIPLE CHOICE

1. The student nurse is listening to a lecture on therapeutic communication. Which statement indicates that teaching has been effective?

“The purpose of therapeutic communication is psychotherapy.”

“The purpose of therapeutic communication is social communication.”

“The purpose of therapeutic communication is to develop a trusting relationship.”

“The purpose of therapeutic communication is emotional commitment to another.”

a. b. c. d.

ANS: C The purpose of therapeutic communication is to establish a trusting relationship. The RN should try to understand with sensitivity. Therapeutic communication and the establishment of the therapeutic relationship require empathy, genuineness, positive regard, and self-awareness. Psychotherapy, social communication, and emotional commitment to another are not definitions of therapeutic communication.

DIF: Cognitive Level: Evaluation OBJ: State the purpose of the therapeutic relationship and apply therapeutic communication to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

2. The student nurse is listening to a lecture on communication. Which statement indicates that the teaching has been effective?

a. b. c. d.

“A communication blocker is silence.”N “A communication blocker is eye contact.”

“A communication blocker is advising.”

“A communication blocker is clarifying.”

ANS: C Communication blockers tend to stop conversation and build mistrust. Giving advice fosters dependency and conveys to the patient that the nurse knows best. Silence, eye contact, and clarifying are techniques that enhance (facilitate) communication.

DIF: Cognitive Level: Evaluation OBJ: Compare and contrast facilitators and blockers of communication.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

3. The nurse is caring for a patient 2 hours after a left above-the-knee amputation. The patient states, “My left leg is really hurting, and that medicine you gave me earlier didn’t help.” Which response is the most therapeutic, if made by the nurse? a. “That’s impossible!” b. “You’ll have to talk to your doctor.” c. “Keep your chin up.” d. “I will call your physician.”

ANS: D

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“I will call your physician” is validating the patient’s perception of pain. “That’s impossible!” minimizes the patient’s feelings. “You’ll have to talk to your doctor” may cause the patient to feel rejected by the nurse. Making a stereotypical comment such as “Keep your chin up” is never therapeutic.

DIF: Cognitive Level: Application OBJ: Demonstrate effective communication skills to resolve conflict in the health care setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

4. The RN is documenting the patient’s complaint of pain rated 6 on a scale of 0 to 10. Which chart entry would be the most appropriate, if made by the nurse? a. Pt. complaining of pain. MD notified. b. Pt complaining of pain rated at 6 on a scale of 0–10, states “My left leg is really hurting.” Pt. grimacing, voice elevated. MD notified. c. Pt. complaining of pain rated at 6 on a scale of 0–10. Appears to be in pain. MD notified. d. Pt. complaining of pain rated 6. Wants more pain medication; appears to be drug-seeking. MD notified.

ANS: B With “Pt complaining of pain rated at 6 on a scale of 0–10, states ‘My left leg is really hurting.’ Pt. grimacing, voice elevated. MD notified,” the entry contains the problem, the assessment, subjective comments, observations, and the plan. The entry “Pt. complaining of pain. MD notified,” does not define the patient’s pain. The entries “Pt. complaining of pain rated at 6 on a scale of 0–10. Appears to be in pain. MD notified” and “Pt. complaining of pain rated 6. Wants more pain medication; appears to be drug-seeking. MD notified” reflect opinions of the nurse.

N DIF: Cognitive Level: Application OBJ: Utilize SBAR to assertively communicate with co-workers within the health care team to minimize risks associated with handoffs. TOP: The RN as Communicator MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. The RN has assigned the nursing assistant (NA) a task. The NA becomes angry and begins yelling at the RN. What is the best approach for the RN to take?

Tell the NA that you will let her leave early if she will do this for you.

Ignore her and reassign the task.

Meet with the NA to explore his or her feelings and the reason for resistance.

Call the nursing supervisor and report the NA for insubordination.

a. b. c. d.

ANS: C Meeting with the NA to explore the reason for resisting the request is the best approach in order to address the underlying issue. Telling the NA that you will let her leave early if she will do this for you and ignoring her and reassigning the task are negative reinforcements and will likely perpetuate the behavior. Calling the nursing supervisor and reporting the NA for insubordination should occur if the RN has been unsuccessful in resolving the problem.

DIF: Cognitive Level: Application OBJ: Demonstrate effective communication skills to resolve conflict in the health care setting.

TOP: The RN as Communicator MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. The nurse is caring for a 64-year-old woman 4 hours after knee replacement. Although she rates her pain at 6 out of 10, she refuses pain medication and tells the nurse, “I can deal with it.” Which of the following is the nurse’s best response? a. “OK, that’s your decision.” b. “You’re just being stubborn.” c. “OK, I’ll come back later.” d. “What is your concern?”

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ANS: D Encouraging the patient to talk about her concerns is the most therapeutic response in order to determine the reason for the refusal of pain medication. The comments, “OK, that’s your decision” and “You’re just being stubborn” are judgments and not therapeutic statements. The comment “OK, I’ll come back later” is not an appropriate response in this case because nothing is done to relieve the patient’s pain.

DIF: Cognitive Level: Application OBJ: State the purpose of the therapeutic relationship and apply therapeutic communication to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

7. Which statement, if made by the nurse, is an example of a communication technique that can facilitate communication? a. “Yes, I agree with you.” b. “You need to talk to your doctor.” c. “I know just how you feel.” d. “What are you thinking about?”

N ANS: D Using open-ended questions such as “What are you thinking about?” are more likely to facilitate communication.

Making comments such as “Yes, I agree with you” and “You need to talk to your doctor” are not therapeutic communication techniques. Stating “I know just how you feel” is never therapeutic because no one can say how another person feels even if the nurse had a similar experience.

DIF: Cognitive Level: Application OBJ: State the purpose of the therapeutic relationship and apply therapeutic communication to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity 8. The nurse is working in the outpatient clinic when a patient who has been waiting to be seen for an hour yells, “What are you people doing? I’m sick and tired of waiting!” Which response is the most therapeutic, if made by the nurse? a. “The doctor can only do so much.” b. “Would you like a magazine?” c. “I can see that you are frustrated.” d. “You need to be quiet!”

ANS: C Acknowledging the patient’s frustration with “I can see that you are frustrated” indicates that the nurse is listening and that the message has been received. Stating “The doctor can only do so much” is defensive and minimizes the patient’s issue. Asking “Would you like a magazine?” is a change of subject that discounts the patient’s feelings and is likely to irritate the patient further. Stating “You need to be quiet!” shows a total disregard for the patient’s frustration.

DIF: Cognitive Level: Application OBJ: State the purpose of the therapeutic relationship and apply therapeutic communication to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

9.

The physician orders a dose of morphine that the nurse considers excessive. The nurse should a. administer the medication. b. ask another nurse to administer the medication. c. call the supervisor.

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d. contact the physician.

ANS: D The physician must be notified for clarification of the dose. If the nurse still considers the dose excessive, he or she may refuse to administer it. Administering the medication is not a safe option, nor is asking another nurse to administer it. If the issue cannot be resolved between the nurse and physician, the supervisor should be notified.

DIF: Cognitive Level: Application OBJ: Appreciate the value of collaborative communication in the health care environment.

TOP: The RN as Communicator MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection ControlN

10. The nurse is caring for a patient following painful radiation treatment for newly diagnosed cancer. Which question, if asked by the nurse in the orientation phase of the nurse–patient relationship, is most likely to elicit a meaningful response? a. “Don’t you love this weather?” b. “How have things been going for you?” c. “Tell me why you didn’t stop smoking.” d. “Are you having any pain?”

ANS: D Pain must first be addressed before the interview can proceed. “Don’t you love this weather?” is a general and nondescript comment. “How have things been going for you?” is best offered once pain has been assessed and treated. Exploration of needs, feelings, emotions, and concerns would be addressed in the working phase. “Tell me why you didn’t stop smoking” is likely to elicit a defensive response and will hinder therapeutic communication.

DIF: Cognitive Level: Application OBJ: Conduct a patient interview in the clinical setting utilizing effective communication skills and active listening.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

11. The RN is educating the new RN on the primary focus of care when developing a therapeutic relationship with the patient. Which statement by the new RN indicates that teaching has been effective? a. “Meeting the needs of the nurse is the primary focus.” b. “Medication administration is the primary focus.” c. “The patient’s needs and problems is the primary focus.” d. “Self-care potential is the primary focus.”

ANS: C The primary focus of care is on the patient’s needs and problems. The focus of the nurse–patient therapeutic relationship is never to meet the needs of the nurse. Medication administration and self-care potential can be addressed once needs and problems have been identified.

DIF: Cognitive Level: Evaluation OBJ: Conduct a patient interview in the clinical setting utilizing effective communication skills and active listening.

TOP: The RN as Communicator MSC: NCLEX: Safe and Effective Care Environment: Management of Care

12. A patient scheduled for surgery has a severe level of anxiety. Which action, if taken by the nurse, would be most appropriate at this time?

Providing teaching about the upcoming surgery and what to expect Telling the patient that there is nothing to worry about Calling the patient’s family and demanding that they help out Asking the patient about her concerns, feelings, and perceptions about the surgery

a. b. c. d.

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ANS: D The most appropriate action for the nurse to take at this time is to ask the patient about her concerns, feelings, and perceptions about the surgery. Providing teaching during periods of high anxiety is ineffective and does not address the patient’s anxiety. Telling the patient that there is nothing to worry about is giving false reassurance. Calling the patient’s family and N demanding that they help out is projecting the nurse’s frustration onto the family and avoiding responsibility.

DIF: Cognitive Level: Application OBJ: Conduct a patient interview in the clinical setting utilizing effective communication skills and active listening.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

13. The nurse is preparing to assess a newly admitted Chinese patient. Which of the following would be most appropriate to assess first? a. Pain b. Language barrier c. Family support d. Religious preference ANS: B The nurse must first assess the ability to communicate with the patient before pain, family support, or religious preference can be assessed.

DIF: Cognitive Level: Application OBJ: Respect the cultural diversity among individuals.

TOP: The RN as Communicator MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. The nurse and patient are discussing the patient’s perceptions and feelings related to the patient’s illness. The patient is emotional and tearful and expresses feelings of hopelessness. During which phase of the nurse–patient relationship does the nurse interpret this patient to be in? a. Pre-orientation b. Orientation c. Working d. Termination ANS: C Discussing perceptions and feelings typically occurs in the working phase, at which time intense emotions may arise.

Pre-orientation is not a phase of the nurse–patient relationship. The orientation phase includes introductions and goal setting. The termination phase is the completion of the nurse–patient relationship as a result of discharge, transfer, or the nurse’s time off.

DIF: Cognitive Level: Analysis OBJ: State the purpose of the therapeutic relationship and apply therapeutic communication to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

15. A nurse has a plan for teaching the patient about a newly diagnosed disease. On entering the room the nurse realizes that the patient is blind. What considerations for communication should the nurse be aware of?

Tone, pitch, inflection, and intensity affect how messages are communicated.

Messages are clearer when verbal communication and nonverbal cues are opposite.

Verbal communication must be understood within the context of a patient’s culture, gender, and age. N Facial expressions and eye contact are characteristics of verbal communication.

a. b. c. d.

ANS: A

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Communication is the interaction between two or more individuals in which an exchange of information occurs. How we communicate is as important as what we communicate. For instance, tone, pitch, inflection, and intensity of how we speak affect how messages are communicated. Tone, pitch, inflection, and intensity are examples of nonverbal communication and affect how messages are communicated. Messages are clearer when verbal communication and nonverbal cues are agreeable. Nonverbal communication must be understood within the context of a patient’s culture, gender, and age. Facial expressions, personal appearance, eye contact, eye cast, and physical characteristics are examples of nonverbal communication.

DIF: Cognitive Level: Application OBJ: Compare and contrast facilitators and blockers of communication.

TOP: The RN as Communicator MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

16. The nursing student addresses an 86-year-old patient by his first name at their initial meeting.

To the patient, this behavior a. is a sign of the nursing student’s empathy for the patient. b. could be interpreted as a lack of respect on the part of the student. c. clearly indicates that the student feels comfortable working with the patient. d. indicates that the student is establishing firm boundaries for the relationship.

ANS: B Addressing an older adult by his first name by the nursing student may be interpreted as a lack of respect. Regarding therapeutic communication, positive regard implies respect and a willingness to work with the patient and communicate (through your actions) that the patient is a person worthy of caring about. Empathy is the ability to perceive the patient’s needs, feelings, and situation accurately. Focus on the student nurse is incorrectly directed with the answer choices that discuss the student nurse’s feeling comfortable working with the patient and the student nurse’s establishing boundaries for the nurse–patient relationship.

DIF: Cognitive Level: Application TOP: The RN as Communicator

OBJ: Respect the cultural diversity among individuals.

MSC: NCLEX: Psychosocial Integrity

17. When considering the creation of an environment for emotional support in a therapeutic relationship, the primary focus of the nurse should be a. removing stressors that cause anxiety and fear. b. developing a trusting relationship. c. encouraging the patient to become independent. d. allowing the patient to be in control of medical decision-making.

ANS: B Establishing trust is a primary activity of the therapeutic relationship. The nurse must project warmth, acceptance, friendliness, openness, empathy, and respect in all interactions with the patient and family. Removing stressors, encouraging independence, and allowing the patient to be in control of medical decision-making are not therapeutic communication facilitators.

DIF: Cognitive Level: Application N TOP: The RN as Communicator

OBJ: Respect the cultural diversity among individuals.

MSC: NCLEX: Psychosocial Integrity

18. A patient has just been informed by the physician that he will not be discharged today. The nurse brings in the patient’s lunch tray and puts it on the overbed tray. The patient pushes it off onto the floor and shouts, “Get out of my room and leave me alone.” The nurse’s most therapeutic response would be a. “Is there something wrong with your lunch tray?” b. “You seem angry. Can you tell me about it?” c. “Why are you angry? You seemed so much happier earlier today.”

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d. “I’ll order you another lunch, and I’ll be back when you’re in a better mood.”

ANS: B “You seem angry. Can you tell me about it?” is the most therapeutic response. The nurse must project warmth, acceptance, friendliness, openness, empathy, and respect in all interactions with the patient and family. Additionally, empathy is the ability to perceive the patient’s needs, feelings, and situation accurately. Additionally, asking openended questions allows the patient to express thoughts and feelings freely with no response limitations. The other answer items are not examples of a therapeutic response to the angry patient.

DIF: Cognitive Level: Application OBJ: Apply therapeutic communication skills to the clinical setting.

TOP: The RN as Communicator MSC: NCLEX: Psychosocial Integrity

19. When preparing for patient teaching what should the nurse do first? a. Assess the learner’s needs. b. List key points to be presented. c. Collect the teaching materials. d. Think about how the skill can be done at home.

ANS: A The principles of teaching and learning should be applied to make an accurate assessment of learning needs and evaluate the effectiveness of the teaching provided. Listing key points, collecting teaching materials, and thinking about how a skill can be done at home are all considerations after learning needs are assessed.

DIF: Cognitive Level: Application OBJ: State the purpose of the therapeutic relationship and apply therapeutic communication to the clinical setting.

TOP: Health Literacy MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

20. Laura, a nurse manager, is meeting with the staff, which consists of nurses from the Veteran, Baby Boomer, Generation X, and Millennial generations. Which of the following is the best approach to encouraging collaboration and feedback from everyone? a. Ask for volunteers to form a committee to explore the issue. b. Form a committee made up of at least one representative from each generation. c. Form a committee primarily composed of experienced, older nurses. d. Meet with each nurse individually to solicit feedback.

ANS: B Forming a committee made up of representatives from each generation is more likely to result in more collaborative and meaningful discussions. Asking for volunteers to form a committee would likely result in one generation being primarily represented and does not encourage N collaboration among the generations. Forming a committee of experienced, older nurses, discriminates against other generations and experience. Meeting with each nurse does not encourage collaboration because it does not allow staff members to interact.

DIF: Cognitive Level: Analysis OBJ: Demonstrate effective communication skills to resolve conflict in the health care setting.

TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Before signing the verbal orders given earlier, the physician notifies the nurse of incorrectly wording the order. The physician requests the nurse to go back and insert the missing information. Which actions illustrate a lack of knowledge by the nurse? (Select all that apply.) a. Use a black pen and insert the missing information.

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b. Insist that the physician write a new order. c. Write an addendum clarifying the order. d. Toss the old order and write a new one.

ANS: A, B, D The nurse should not add information to an order once it has been signed. It is not necessary for the physician or nurse to write a new order, and this may alienate the physician. No order should ever be thrown away because it is a permanent part of the patient’s medical record. The nurse should write an addendum clarifying the original order.

DIF: Cognitive Level: Application OBJ: Utilize SBAR to assertively communicate with co-workers within the health care team to minimize risks associated with handoffs.

TOP: The RN as Communicator MSC: NCLEX: Safe and Effective Care Environment: Management of Care

N

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Chapter 10: Teaching Patients and Their Families

MULTIPLE CHOICE

1. Which fact would you select to describe the mandate by The Joint Commission regarding educating patients? The training and education must be specific to the assessed needs, interdisciplinary, and evaluated for effectiveness. specific to the assessed needs, cost-effective, and focused. based on the patient’s ability to learn, cost-effective, and timely. specific to assessed needs, timely, and delivered by only one person for continuity.

a. b. c. d.

ANS: A The Joint Commission standards state, “The patient receives education and training specific to the patient’s assessed needs, abilities, learning preferences, and readiness to learn as appropriate to the care and services provided by the hospital.” The Joint Commission requires patient education to be interdisciplinary, not delivered by only one person.

Furthermore, health care facilities must audit patient education to ensure consistency of teaching and that the health care team members are evaluating the effectiveness of the patient education they give. Cost-effectiveness and timeliness are not requirements of The Joint Commission.

DIF: Cognitive Level: Application TOP: Patient Education

OBJ: Understand the requirements for patient education.

MSC: NCLEX: Integrated Processes: Teaching/Learning

2. A nurse discusses home arrangements and safety factors related to emptying and changing the patient’s new colostomy bag. The patient has strong concerns about visibility of any stored N colostomy supplies. Which teaching-learning principle does this example demonstrate? a. Using multiple teaching strategies to accommodate a variety of learning styles. b. Increased effectiveness of teaching by involving the patient in the setting of objectives. c. Paying attention to the timing during the hospitalization and planned discharge date when providing needed information. d. Developing a strong nurse–patient relationship from the beginning of the contract with the patient.

ANS: B An informed patient is better able to manage health care, is more compliant with the plan of care, and as a result, experiences more positive outcomes. Active learning facilitates the learning process. A patient who is educated regarding his or her condition and plan of care is less likely to refuse the plan of care in lieu of his or her own plan, less likely to complain more when the plan is revised, and less likely to demand explanation for each intervention.

The other answer choices are also teaching-learning principles, but they are not reflected in the scenario.

DIF: Cognitive Level: Evaluation TOP: Patient Teaching

OBJ: Understand the requirements for patient education.

MSC: NCLEX: Integrated Processes: Teaching/Learning

3. The nurse recognizes that new parents may be ready to learn about their newborn after the birth. What understanding leads the nurse to this conclusion?

The baby will not be discharged until the parents have the training.

The nurses on the mother–baby division do a better job of teaching baby care.

The parents now have the motivation to learn because the baby has been born.

The parents have no choice at this point.

a. b. c. d.

ANS: C

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The motivation to learn often results from a life-changing event, such as childbirth or illness. The RN who recognizes the significance of the event can seize the opportunity to explore the patient’s motivation to learn. The baby is not being discharged until the parents have training is untrue. That the nurses on the mother–baby division do a better job of teaching baby care is irrelevant. That the parents have no choice at this point is an opinion.

DIF: Cognitive Level: Analysis OBJ: Compare motivations, facilitators, and barriers to learning.

TOP: Patient Teaching MSC: NCLEX: Integrated Processes: Teaching/Learning

4. A patient has been newly diagnosed with type 2 diabetes. The teaching begins in the hospital with an interdisciplinary approach and continues with outpatient classes. However, the patient continues to state, “I know I do not need to spend my time doing all this because I will be fine once I get out from under all this stress.” The barrier to learning that the nurse recognizes and must deal with is the a. patient already knows all she needs to know, so more education is not necessary. b. patient doesn’t know what she doesn’t know, so the circle will continue. c. patient’s blood sugar is keeping her from thinking clearly, so it is too soon to try to teach her. d. patient is in denial and that will need to be dealt with before she will accept the diagnosis and thus the education related to it.

ANS: D N The patient is in denial of her new diagnosis. The RN must use rational thought and convey that logic in the presentation of the facts. The patient must decide that the change is necessary. The RN must understand the patient’s decision and show acceptance of it. The patient’s already knowing all she needs to know so more education is unnecessary is incorrect based on the patient’s statement. The patient’s not knowing what she does not know so the circle will continue is irrelevant. That the patient’s blood sugar is keeping her from thinking clearly is a presumption.

DIF: Cognitive Level: Analysis OBJ: Compare motivations, facilitators, and barriers to learning.

TOP: Patient Teaching MSC: NCLEX: Integrated Processes: Teaching/Learning 5. The nurse recognizes that, for learning to be effective, the patient must first have his or her basic and most immediate needs met. Which statement best indicates that the nurse clearly understands this principle? a. The nurse administers pain medication to the new diabetic patient before she starts her teaching just in case the patient is in pain. b. Thirty minutes before the planned teaching, the nurse assesses the patient for comfort and ensures that the patient has eaten and had the opportunity to complete his bath routine. c. The nurse decides that conversation works best during a meal, so she plans to teach while the patient eats. d. The nurse asks the patient’s spouse to leave before beginning the teaching.

ANS: B Assessing the patient for comfort 30 minutes before the planned teaching and ensuring that the patient has eaten and had the opportunity to complete his bath routine validates that learning is best facilitated if the learner has had immediate needs met. Administering pain medication to the newly diabetic patient before teaching is incorrect because the nurse should delay (if advisable) medication that may cause distracting side effects. Deciding to teach while the patient eats is incorrect because eating a meal provides an unnecessary distraction. Making the spouse leave may be counterintuitive to the patient’s learning because family may reinforce the patient’s education, advocate for the patient, and seek clarification of the information taught.

DIF: Cognitive Level: Analysis TOP: Patient Teaching

6.

OBJ: Identify factors conducive to learning.

MSC: NCLEX: Integrated Processes: Teaching/Learning

Adult patients are adult learners. Knowing this, the nurse understands the assumptions about adult learners that will help the nurse plan and provide the appropriate education. Which statement provides proof that more instruction about adult learners is needed?

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a. b. c. d.

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“Adults will learn as the need develops and the learning will fulfill that need.”

“Adults use their lives as the point of reference for all learning.”

“Adults are visual learners and learn best by taking notes.”

“Adults prefer to have a say in their learning.”

ANS: C Adults may represent different learning styles such as being a visual learner, auditory learner, or kinesthetic learner, so it is not a correct assumption that adults learn from taking notes. Adults will learn as the need arises and believe that the learning will fulfill the need. Adults use their lives as the point of reference for all learning and prefer to be self-directed in N learning or at the very least have a say in it.

DIF: Cognitive Level: Application TOP: Patient Teaching

7.

OBJ: Explain the unique qualities of adult learners.

MSC: NCLEX: Integrated Processes: Teaching/Learning

A 78-year-old patient has shortness of breath on very slight exertion. The physician has written an order for her to be taught about a 2-gram sodium diet. Based on these data, which factor would be likely to interfere with diet teaching? a. The patient’s age b. The patient’s shortness of breath c. The patient’s reluctance to change d. The chronic nature of the patient’s illness ANS: B It is important to assess the patient’s readiness to learn. In reality the patient experiences little benefit from patient teaching often because of the stress from the medical problem as well as the environment, and the addition of a learning experience would add to the stress. The patient may be motivated to learn but not yet ready to learn. In this scenario, the patient’s shortness of breath is the medical problem interfering with the patient’s readiness to learn. The patient’s age and the chronic nature of the patient’s illness have nothing to do with readiness to learn. The patient’s reluctance to learn is an opinion.

DIF: Cognitive Level: Application OBJ: Describe the impact of readiness on learning.

TOP: Patient Teaching MSC: NCLEX: Integrated Processes: Teaching/Learning 8. Assessment of patient learning is a required element of patient education. Shorter hospital stays make this step challenging, and we tend to evaluate learning immediately after teaching.

What conclusion can be drawn from this? a. It takes time to truly incorporate what is learned, so immediate evaluation is not as accurate. b. The nurse will not have time to evaluate immediately after teaching. c. The patient will be too tired to participate in the evaluation. d. That would be too much information at one time.

ANS: A For learning to have occurred, the patient must incorporate the learned behavior into his or her life. In reality, an assessment done a day or two later may be a better indicator of the retention and incorporation of new information or behavior changes. For this reason, the other answer items are incorrect.

DIF: Cognitive Level: Analysis TOP: Patient Teaching

9.

OBJ: Describe the impact of readiness on learning.

MSC: NCLEX: Integrated Processes: Teaching/Learning

A 63-year-old patient is uncertain whether she can self-inject her medication. Which would be most likely to be an effective strategy at this time? a. Start with the details about her condition, why she has it, and the importance of her medication. b. In the first session, teach the patient how and why to rotate her abdominal injection sites. c. Start with information about avoiding rubbing or putting pressure on the site after an injection.

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d. In the first session let the patient handle a syringe while the nurse prepares and N administers the next injection with another syringe.

ANS: D The nurse should consider the learning style of the individual patient. For example, some people learn best by practice or hands-on experience. The nurse should also have appropriate teaching aids. In the first session, giving the patient a syringe to handle while the nurse administers the next injection helps the patient’s readiness to learn.

Starting a new teaching session with details, teaching the patient how and why to rotate injection sites, and sharing information about care of the injection site after the medication administration may overwhelm the patient and create a barrier to learning.

DIF: Cognitive Level: Application TOP: Patient Teaching

OBJ: Understand the requirements for patient education.

MSC: NCLEX: Integrated Processes: Teaching/Learning

10. A home health nurse is teaching a patient about a new medication he will be starting in the morning. The patient lives with his son’s family, including two spirited children less than 6 years old. The patient replies, “I just can’t learn new information like I used to.” The nurse will plan to a. schedule the patient for daily visits for medication administration. b. provide privacy and minimize distractions and noise and try again. c. teach the patient’s family members to give the medications. d. tell the patient it is not safe to take the medication independently.

ANS: B The process of teaching new information requires the nurse to prepare the learning environment. Providing as much privacy as possible and minimizing distractions and noise can help ensure that the patient is comfortable discussing the treatment plan. Scheduling daily visits to administer medications defeats the purpose of teaching. Teaching the family to give the medication is unnecessary because the patient is able to care for himself. Telling the patient it is unsafe to take his medication is a false statement.

DIF: Cognitive Level: Application OBJ: Understand the requirements for patient education. TOP: Patient Teaching MSC: NCLEX: Integrated Processes: Teaching/Learning

11. Which item would most likely be a barrier to learning for a patient who must begin to care for a large open wound at home?

Curiosity about the new experience and equipment Tendency for uneasiness about making mistakes Ability to prioritize tasks Understanding that he can promote his own healing

a. b. c. d.

ANS: B Patients’ values influence the willingness to accept the need to change and therefore the need to learn. Patients are often uneasy if they do not believe they can understand and perform the task of taking care of a wound. Patients may not live in the best environment and may feel embarrassed about their particular situation. When teaching patients about the care they require, it helps to reduce barriers to learning by considering their home situation, living arrangements, and usual activities. Curiosity about new experiences and new equipment, the ability to prioritize tasks, and understanding that the patient can promote his own healing are not barriers to learning.

N DIF: Cognitive Level: Analysis OBJ: Understand the requirements for patient education.

TOP: Patient Education MSC: NCLEX: Integrated Processes: Teaching/Learning

12. The nurse has just taught an adult patient with a new diagnosis of diabetes mellitus how to check blood glucose. The nurse should document

a. “Demonstrated understanding of checking blood glucose.”

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b. that the patient demonstrated the procedure properly and the time it took to complete the educational session. c. the steps of the procedure the patient was taught. d. that the nurse taught the patient how to check blood glucose.

ANS: B When documenting, the nurse can record that the patient was able to answer questions and demonstrate procedures correctly at the time of observation. The nurse also must record how much time it took to complete the educational sessions. To state that the patient demonstrated understanding as a result of one observation would be incorrect because many factors are present at the time of the observation that may influence the patient’s ability to understand.

Documenting the steps of the procedure and noting that the nurse taught the procedure do nothing to communicate that learning took place.

DIF: Cognitive Level: Application OBJ: Understand the requirements for patient education.

TOP: Patient Education MSC: NCLEX: Integrated Processes: Teaching/Learning 13. Persons seeking health care have increased autonomy and insist on taking an active role in their medical treatment decisions. What aspect of a nurse’s role does this fact affect? a. Use of professional communication when doing patient teaching and admitting patients to the unit. b. Coordination of human and material resources that are directly used in the delivery of care at the bedside. c. Evaluation of performance and skills of nursing staff members involved in direct patient care. d. Patient collaboration with health care team members involved with the development of focused, quality care.

ANS: D More people are seeking information before seeing physicians and researching options that physicians suggest before accepting and implementing these suggestions. Extensive information is available about illnesses and treatments, and with the advent of the Internet, this information is even more readily available. Including the patient in developing a health-promotion plan of care provides the best opportunity for effective teaching and long-term learning.

DIF: Cognitive Level: Analysis TOP: Patient Education

OBJ: Understand the requirements for patient education.

MSC: NCLEX: Integrated Processes: Teaching/Learning

14. Which item would most likely be a barrier to learning for a patient who must begin to wear an insulin pump? a. Curiosity about new experiences and equipment. b. Tendency toward embarrassment about making mistakes and being seen with the pump.

N c. Ability to prioritize diabetes management. d. Understanding that the patient can promote his or her own well-being.

ANS: B Patients are often embarrassed if they do not believe they can understand and perform the tasks of living with diabetes. When teaching patients about their illness and care required, it helps to consider their home situation, living arrangements, and usual activities. Myths and misconceptions about health, illness, and health care are often perpetuated by the experiences of the individual.

DIF: Cognitive Level: Application OBJ: Understand the requirements for patient education. TOP: Patient Education MSC: NCLEX: Integrated Processes: Teaching/Learning

15. Which patient characteristic must a nurse consider when planning teaching? a. Literacy level b. Discharge instructions c. Good lighting d. Pain medication ANS: A

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The correct answer is their literacy level. In many cases, institutions provide written instructions to patients in the hope that they will use them as references. Studies have shown that a lower-than-expected level of literacy may exist in patient populations seeking health care with the United States, as reported in a study by Fisher (1999). The implication for nursing of this and other studies is that the RN should recognize that patients may not have the comprehension of material needed to manage their own care. Discharge instructions, good lighting, and pain medications are not characteristics.

DIF: Cognitive Level: Application TOP: Patient Education

OBJ: Understand the requirements for patient education.

MSC: NCLEX: Integrated Processes: Teaching/Learning

16. The nurse is assessing a patient who needs teaching about how to care for her wound at home. The nurse knows to be sensitive about asking questions that cause embarrassment. Which question is stated in the best manner?

“Would you like for me to write down how to change this dressing or is it better for you to see a demonstration?”

“What is the highest grade you completed when you were in school?”

“Do you read and write?”

“I am going to give you a handout on how to perform your dressing change. Now don’t worry if you do not read, I’ll read it to you.”

a. b. c. d.

ANS: A “Would you like me to write down how to change this dressing or is it better for you to see a demonstration?” is correct. In many cases, institutions provide written instructions to patients in the hope that they will use them as references. Studies have shown that a lower-than-expected level of literacy may exist in patient populations seeking health care in the United States, as reported in a study by Fisher (1999). The implication for nursing of this N and other studies is that the RN should recognize that patients may not have the comprehension of material needed to manage their own care. All the other answer choices are insensitive and condescending.

DIF: Cognitive Level: Application TOP: Patient Education

OBJ: Understand the requirements for patient education.

MSC: NCLEX: Integrated Processes: Teaching/Learning

17. An 85-year-old patient with chronic health problems is being considered for placement in a long-term care facility after discharge from the hospital. What purpose does the cost-effective nursing strategy of patient teaching help to achieve? a. Providing reasonable expectations from health care b. Giving the patient a sense of control over illness c. Preventing complications of chronic illness d. Increasing patient satisfaction with care ANS: C As of late, the Centers for Medicare and Medicaid Services (CMS) has stated that reimbursement to hospitals will be limited for patients readmitted for the same conditions within a certain time period after admissions. Education is a critical part of transitional care, and nurses are key to providing adequate patient and family or caregiver education.

DIF: Cognitive Level: Application OBJ: Understand the requirements for patient education.

TOP: Patient Education MSC: NCLEX: Integrated Processes: Teaching/Learning 18. An 18-year-old patient is scheduled for heart surgery tomorrow. To assess this patient’s level of knowledge, the nurse would say a. “Tell me the name of the surgery you are going to have.” b. “Do you understand what the doctor is going to do to you?” c. “Would you be willing to take a test for me?” d. “Tell me what you know about what is going to happen tomorrow.”

ANS: D

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“Tell me what you know about what is going to happen tomorrow” is correct. Some patients are experts in regard to their ailment. To avoid or correct errors, determine the accuracy of information the patient provides about the condition. Not only are many reliable resources of medical information available but many unreliable, untested sources are as well. All other answer options are closed-ended questions and call for limited responses.

DIF: Cognitive Level: Application TOP: Patient Education

OBJ: Understand the requirements for patient education.

MSC: NCLEX: Integrated Processes: Teaching/Learning

19. Which example demonstrates the principle that all adults learn best from and in relation to their experiences? a. Teaching the attitude of personal responsibility for health care b. Showing a patient newly diagnosed with diabetes the similarities between an insulin syringe and a 3-cc syringe c. Refraining from teaching two skills at one time d. Showing the patient how the current hand washing procedure he is now learning is like the hand washing he has always done ANS: D Showing the patient how the current hand washing procedure he is now learning is like the N hand washing he has always done is correct. Adults need new information to be related to something they already know. This creates a link so that the information can be readily recalled. For example, compliance with fluid restriction may be easier if you, as a nurse, create an analogy to a familiar frame of reference. Teaching personal responsibility has nothing to do with teaching principles. Showing the patient the difference between syringes may be of no significance if the patient has no information about syringes. Teaching one topic at a time facilitates learning but has no relation to learning best from experience.

DIF: Cognitive Level: Application TOP: Patient Education

OBJ: Understand the requirements for patient education.

MSC: NCLEX: Integrated Processes: Teaching/Learning

MULTIPLE RESPONSE 1. The nurse recognizes that, to be an effective teacher, communication must be clear. In an educational session for a patient newly diagnosed with congestive heart failure, which statements by the nurse would demonstrate barriers to teaching? (Select all that apply.) a. “Furosemide will increase urination, so you take it every morning.” b. “To help reduce the risk of pulmonary edema, your sodium intake must be monitored.” c. “Just remember, no sodium!” d. “Pulmonary edema can form if you have too much sodium.” e. “You will need to make sure you eat less salt to help prevent fluid from collecting in your lungs.”

ANS: B, C, D “To help reduce the risk of pulmonary edema, your sodium intake must be monitored” and “Pulmonary edema can form if you have too much sodium” use medical jargon and little explanation. “Just remember, no sodium!” is a directive. Clear, precise communication skills are fundamental to teaching. The nurse must adjust his or her explanations such that patient education is delivered clearly, accurately, and in understandable terms. Examples of this include explaining the indication and administration of medication and the reason for diet changes.

DIF: Cognitive Level: Application TOP: Patient Teaching

OBJ: Describe characteristics of a successful teacher.

MSC: NCLEX: Integrated Processes: Teaching/Learning

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N

Chapter 11: The Nurses, Ideas, and Forces That Define the Profession

MULTIPLE CHOICE

1. It has been said that Florence Nightingale revolutionized nursing. Which example supports this statement? a. She encouraged men to become nurses. b. She encouraged nurses to serve physicians in order to learn from them. c. She instituted changes that affected patient survival rates. d. She organized nursing in America.

ANS: C When she learned of the lack of medical and nursing care for British troops during the Crimean War (1853–1856), Nightingale organized a group of 38 nurses to travel to the Crimea in southern Russia.

Despite societal opposition, she and her team reached the Crimean battlefields in 1854. They found overcrowding in the hospitals, no medical supplies, and limited space for the sick and injured. Using her own funds, Nightingale obtained supplies, cleaned up the unsanitary conditions, and established laundries to wash linens. At the end of 6 months, Nightingale and her nurses had decreased the death rate from 42% to 2%.

DIF: Cognitive Level: Application Nursing

OBJ: Discuss historical contributions to modern nursing. TOP: History of

2. A student is studying the history of nursing. Which statement made by the student would be correct if she had an adequate understanding of America’s first trained nurse? a. “America’s first trained nurse reduced student nurses’ working hours.”N b. “As America’s first trained nurse, Isabel Hampton Robb promoted licensure exams.” c. “America’s first trained nurse worked to create associate degree programs.” d. “America’s first trained nurse was Linda Richards.”

ANS: D Linda Richards is known as America’s first trained nurse. Isabel Hampton Robb reduced student nurse working hours and promoted licensure exams. Mildred Montag worked to create associate degree programs as a shorter route into nursing.

DIF: Cognitive Level: Application Nursing

OBJ: Discuss historical contributions to modern nursing. TOP: History of

3. Which is the dominant focus of patient care in the current health care environment? a. To increase cost to increase profit b. To contain rising costs c. To ignore rising costs d. To manage care according to cost ANS: B The dominant focus of patient care in the current health care environment is to contain rising costs. Hospitals, faced with financial difficulties, are merging into large health care systems. Managed care, an insurance-based approach to reducing costs, has invaded patient care in every setting. Nurses are challenged to deliver quality nursing care in an environment that limits consumers’ options.

DIF: Cognitive Level: Evaluation

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OBJ: Describe the impact of managed care and merging health care services on the nursing profession.

Nursing in the Current Health Care Environment

TOP:

4. What is the function of Continuous Quality Improvement? a. To improve staff compliance with training b. To assist staff in building on nursing skills c. To assess patient care, from admission to discharge d. To improve collaboration of staff ANS: C Continuous Quality Improvement involves assessing patient care, beginning with point-of- entry into the health system through discharge or transitional care.

DIF: Cognitive Level: Analysis OBJ: Discuss the role of nursing in quality improvement of patient care. TOP: Quality Improvement in Nursing

5.

Florence Nightingale contributed to nursing in many different ways. The student nurse has an understanding of the history of nursing when she does which of the following? a. Educates another student about the efforts of Florence Nightingale to promote research.

N b. States that Nightingale is responsible for minor contributions to the early education of nurses. c. Believes that Nightingale was not involved in the theory of nursing. d. States that Nightingale did not assist in the development of the nursing process.

ANS: A The student shows an understanding of the history of nursing when he or she educates another student on the research efforts of Nightingale. Nightingale is responsible for major contributions to education of nurses, began the development of the nursing process, and served a large role in the development of nursing theory.

DIF: Cognitive Level: Application Nursing

6.

OBJ: Discuss historical contributions to modern nursing. TOP: History of

A student understands the contributions of Clara Barton when she states, “Clara Barton is known as the Lady with the Lamp.” fought for women’s rights.” is known as the Angel of the Battlefield.” was America’s first trained nurse.”

a. b. c. d.

ANS: C Clara Barton is known as the Angel of the Battlefield; Lavinia Dock fought for women’s rights; Florence Nightingale is known as the Lady with the Lamp; and Linda Richards was America’s first trained nurse.

DIF: Cognitive Level: Application OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing

7.

Which action by the nurse shows the use of the nursing process? a. The nurse works with the health care team to set outcomes and plan interventions for the patient. b. The same nurse admits the patient and then discharges him the next day. c. The nurse works with the patient to set outcomes and plan interventions. d. The nurse sends the provider in for an immediate assessment of the patient.

ANS: C

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In the nursing process, nurses work with patients to set expected outcomes and plan interventions to meet these outcomes.

DIF: Cognitive Level: Application and Disease Prevention

8.

OBJ: Understand concept of the nursing process. TOP: Health Maintenance

What is the major social factor that has developed the role of nursing to what it is today?

Society’s attitude toward the role of women Society’s lack of qualified health providers Society’s lack of resources to pay for health care Society’s lack of education about health care

a. b. c. d.

ANS: A Society’s attitude toward the role of women is a major social factor that has developed the role of nursing.

N DIF: Cognitive Level: Application OBJ: Discuss historical contributions to modern nursing. TOP: History of Nursing

9.

The nurse is listening to a lecture on Florence Nightingale. Which statement indicates that the teaching has been effective? a. “Nursing is defined as doing as much as possible for each patient.” b. “Nursing involves helping the patient restore health and prevent disease or injury.” c. “Nursing is management of the patient and control of the environment.” d. “Nursing is focused solely on care of the sick patient.”

ANS: B Florence Nightingale defines nursing as “care which puts a person in the best possible condition for nature to restore or preserve health, and to prevent or to cure disease of injury”.

DIF: Cognitive Level: Evaluation Nursing

OBJ: Discuss historical contributions to modern nursing. TOP: History of

10. The nurse is listening to a lecture on Mildred Montag. Which statement indicates that teaching has been effective? a. “Montag fought for women’s rights.” b. “Montag promoted the associates degree as a way to enter the field of nursing.” c. “Montag was America’s first trained nurse.” d. “Montag care for tenement families by establishing a visiting nurse service.”

ANS: B Mildred Montag promoted associate degrees as a way for nurses to enter the field of nursing in a shorter time period.

Lavinia Dock fought for women’s rights and the right to vote. Linda Richards, America’s first trained nurse, improved nursing education. Lillian Wald cared for tenement families by establishing a visiting nurse service.

DIF: Cognitive Level: Evaluation TOP: History of Nursing

OBJ: Discuss historical contributions to modern nursing.

MULTIPLE RESPONSE

1. Based on what you know, what events would you select to show the contributions that Isabel Hampton Robb made to nursing? (Select all that apply.) a. Established a visiting nurse service

b. Reduced student working hours c. Wrote a book on the history of nursing

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d. Promoted licensure exams e. Fought for women’s rights and the right to vote ANS: B, D Isabel Hampton Robb reduced student working hours and promoted licensure exams. Mary Adelaide Nutting wrote a book on the history of nursing; Lillian Wald established a visiting nurse service; and Lavinia Dock fought for women’s rights and the right to vote.

DIF: Cognitive Level: Evaluation Nursing

OBJ: Discuss historical contributions to modern nursing. TOP: History of N

2. The “graying of America” is estimated to include 65 million older Americans by 2030. What current evidence supports the need for increased nursing knowledge of geriatrics and home health care? (Select all that apply.) a. The elderly utilize more health care dollars per person than younger members of society. b. The elderly rely minimally on Social Security. c. The elderly have chronic illnesses. d. The elderly typically have fewer years of schooling. e. Some elderly are widowed and need assistance with care.

ANS: A, C, D, E The elderly currently utilize more health care dollars per person than the younger members of society. They typically rely heavily on Social Security, have chronic illnesses, have fewer years of schooling, and are widowed.

DIF: Cognitive Level: Analysis TOP: Aging Population

OBJ: Understand factors influencing practice.

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Chapter 12: Upholding Legal and Ethical Principles

MULTIPLE CHOICE

1. The nurse who fails to remove a patient from an unsafe situation has violated which bioethical principle? a. Justice b. Fidelity c. Veracity d. Beneficence ANS: D The nurse who fails to remove a patient from an unsafe situation violates the bioethical principle of beneficence, which means to prevent harm, or promote good. Justice refers to fairness, and fidelity is the principle of faithfulness.

Veracity refers to truth-telling.

DIF: Cognitive Level: Application OBJ: Apply the seven universal biomedical ethical principles discussed in this chapter to the clinical setting.

TOP: Nursing Ethics MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. The nurse who respects the patient’s right to refuse treatment is following which bioethical principle? a. Justice b. Beneficence c. Autonomy N d. Fidelity ANS: C Autonomy refers to the patient’s right to refuse treatment and to make one’s own decisions regarding health care. Justice, beneficence, and fidelity refer to fairness, doing no harm, and truth-telling.

DIF: Cognitive Level: Application OBJ: Apply the seven universal biomedical ethical principles discussed in this chapter to the clinical setting.

TOP: Nursing Ethics MSC: NCLEX: Psychosocial Integrity

3. The student understands the bioethical decision-making theory of utilitarianism when she makes which statement? a. “Utilitarianism is concerned only with duty.” b. “Utilitarianism is also called Kantian ethics.” c. “Utilitarianism judges actions based on possible consequences.” d. “Utilitarianism judges actions based on intent.”

ANS: C Utilitarianism uses potential consequences to judge whether actions produce the greatest good. Kantian ethics judge actions based on intent and possible consequences. Deontology is a duty-oriented theory.

DIF: Cognitive Level: Application OBJ: Apply an ethical framework or model for ethical decision-making.

TOP: Nursing Ethics MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. Which statement made by the nursing student indicates an accurate understanding of culturally competent care?

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a. b. c. d.

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“It means having knowledge of the health-related beliefs and practices of all cultures.”

“It is the ability to care only for individuals from one’s own culture.”

“It means working within the cultural context of individuals, families, and communities.”

“It means avoiding discussing the patient’s practices or beliefs because they may not agree with your own.”

ANS: C Working within the cultural context of individuals, families, and communities is the definition of culturally competent nursing care. Knowing the health-related beliefs and practices of all cultures is unrealistic. The ability to care only for those from one’s own culture or avoiding discussing the patient’s beliefs is not within the definition of culturally competent care.

DIF: Cognitive Level: Application TOP: Nursing Ethics

5.

OBJ: Explain the role of culture in biomedical ethics.

MSC: NCLEX: Psychosocial Integrity

The student understands the American Nurses Association (ANA) Code of Ethics for Nurses when she identifies which statement as incorrect? The Code of Ethics for Nurses a. provides a framework for ethical decision-making. b. is non-negotiable.

N c. is applicable to most practice settings. d. helps with professional self-regulation.

ANS: C The ANA Code of Ethics is applicable to all practice settings. The Code also provides a framework for ethical decision-making, is non-negotiable, and helps with professional self-regulation.

DIF: Cognitive Level: Application OBJ: Explain the role of the Code of Ethics for Nurses to the practice of nursing.

TOP: Nursing Ethics MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6.

Which statement is correct about the bioethical decision-making theory of deontology? a. It is concerned only with consequences. b. It judges actions based on motive or intent. c. It emphasizes treating others as a means to an end. d. It cannot be applied to research.

ANS: B Deontology judges actions based on motive or intent and is especially applicable to the field of research. Deontology is not solely concerned with consequences and does not emphasize treating others as a means to an end.

DIF: Cognitive Level: Application OBJ: Apply an ethical framework or model for ethical decision-making.

TOP: Nursing Ethics MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7.

The RN student has been studying ethics in health care. Based on what she has learned, how would she explain the bioethical principle of autonomy? a. It states that the physician knows what is best for the patient. b. It does not apply to informed consent. c. It refers to patient self-determination. d. It states that every patient has a right to health care.

ANS: C

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Self-determination, or the right to make one’s own health care decisions, and informed consent are grounded in the principle of autonomy. The belief that a physician knows what is best for the patient is known as paternalism, and the belief that every patient has a right to health care, as well as informed consent, is the principle of justice.

DIF: Cognitive Level: Evaluation OBJ: Define the seven universal biomedical ethical principles discussed in this chapter.

TOP: Nursing Ethics MSC: NCLEX: Safe and Effective Care Environment: Management of Care

8.

The nursing student is listening to a lecture on ethics. Which statement indicates that teaching has been effective?

“Ethics is a branch of sociology.”

“Ethics is a branch of law.”

a. b. c. d.

“Ethics is a branch of philosophy.”N “Ethics is a branch of medicine.”

ANS: C Ethics is a branch of philosophy. Nursing, law, and medicine each have a Code of Ethics based on general ethical principles.

DIF: Cognitive Level: Evaluation OBJ: Define the term “ethics.”

TOP: Nursing Ethics MSC: NCLEX: Safe and Effective Care Environment: Management of Care

9.

For the RN to practice ethical decision-making, it is most important for him or her to base decision-making on whether an action is right or wrong. base decision-making on possible consequences. accurately assess a situation. seek the assistance of an ethics committee.

a. b. c. d.

ANS: C As with all nursing functions, the first step is assessment. Basing a decision on whether an action is right or wrong is an ethical decision-making framework based on deontology. Basing a decision on the possible consequences reflects the theory of utilitarianism. Seeking the assistance of an ethics committee would occur after assessment if the ethical dilemma cannot be resolved among the patient, family, and caregivers.

DIF: Cognitive Level: Application OBJ: Discuss the eight-step ethical decision-making process discussed in this chapter as it applies to the clinical setting. TOP: Nursing Ethics MSC: NCLEX: Safe and Effective Care Environment: Management of Care

10. The RN understands administrative law when she says, “Administrative law governs a. federal treaties.” b. the operations of government.” c. the conduct of judges.” d. the United States Supreme Court.”

ANS: B Administrative law controls the operations of government, such as the National Labor Relations Board.

Administrative law does not govern federal treaties, the conduct of judges, or the United States Supreme Court.

DIF: Cognitive Level: Application OBJ: State the three most common sources of law.

TOP: Law MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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11. The nurse working in family practice is assessing an elderly female patient and notices bruises on the patient’s arm and back. Which action is the most appropriate for the nurse to take? a. Ignore the bruises because her daughter tells you that her mother is clumsy. b. Do nothing because you cannot prove anything. c. Report the suspected abuse to the appropriate authorities. d. Confront and accuse the daughter of elder abuse.

ANS: C Nurses are mandatory reporters, and suspected abuse or neglect cannot be ignored. Suspicion of abuse or neglect is sufficient to report suspected abuse to authorities. It is not your burden N to prove.

DIF: Cognitive Level: Application OBJ: Apply mandatory reporting requirements to the clinical setting.

TOP: Law MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

12. The nurse threatens to place a verbally abusive patient in restraints. The patient could press charges against the nurse for which of the following? a. Battery b. Assault c. Malpractice d. Negligence ANS: B Assault is the threat to do harm. Battery is the actual touching of another. Malpractice and negligence are the basis for civil lawsuits.

DIF: Cognitive Level: Application OBJ: Compare and contrast negligence and intentional torts.

TOP: Law MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

13. Steps the RN can take to reduce the risk of malpractice include all of the following except a. administer drugs carefully.

b. document accurately. c. do not delegate any tasks. d. think before you speak.

ANS: C To reduce the risk of malpractice the nurse should administer drugs carefully, document accurately, and think before speaking. Avoiding the delegation of tasks is not realistic.

DIF: Cognitive Level: Application OBJ: Apply the legal principles of safe practice to the clinical setting.

TOP: Law MSC: NCLEX: Safe and Effective Care Environment: Management of Care

14. A nurse educator is preparing a presentation on professional negligence. The nurse determines that all of the following actions would be considered professional negligence except a. administering the wrong medication.

b. failure to obtain informed consent. c. taking a picture of a patient without his or her consent. d. refusing to permit the patient to walk without assistance.

ANS: D Refusing to permit the patient to walk without assistance is an appropriate nursing intervention. Administering the wrong medication is an act of commission; failure to obtain informed consent is negligence. Taking a picture of a patient without his or her consent is considered invasion of privacy.

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DIF: Cognitive Level: Application OBJ: Compare and contrast negligence and intentional torts.

TOP: Law MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection ControlN

15. A nurse manager is preparing a presentation on negligence to present at the next staff meeting. She would not consider which as a form of negligence? a. Malfeasance

b. Nonmalfeasance c. Misfeasance d. Nonfeasance ANS: B Nonmalfeasance is the bioethical principle of doing no harm and would not be considered a form of negligence.

Malfeasance, misfeasance, and nonfeasance are all forms of negligence.

DIF: Cognitive Level: Application OBJ: Compare and contrast negligence and intentional torts.

TOP: Law MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

16. An RN administers an ordered dose of medication over the patient’s refusal. On review, the manager interprets this action to be a. assault.

b. battery. c. negligence. d. malpractice.

ANS: B Battery is the actual touching of another, including administering a medication over the patient’s refusal. Assault is the threat to do so. Negligence is the failure to act as an ordinary and reasonably prudent person would act in the same or similar circumstances. Malpractice is a specialized kind of negligence and is defined as the violation of a professional duty.

DIF: Cognitive Level: Analysis OBJ: Compare and contrast negligence and intentional torts.

TOP: Law MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

17. The nurse accidentally administers the wrong dose of a medication. Her first action would be to a. notify the physician. b. fill out an incident report. c. assess the patient. d. tell her supervisor.

ANS: C Assessing the patient is the highest priority. The physician must be notified after the patient is assessed. Filling out an incident report and telling the supervisor are not priorities.

DIF: Cognitive Level: Application OBJ: Apply the legal principles of safe practice to the clinical setting.

TOP: Law MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

18. The RN is listening to a lecture on malpractice. Which statement indicates that the teaching has been effective? a. “The elements that must be present to prove malpractice are: duty, breach of duty, N actual injury and insurance.”

b. “The elements that must be present to prove malpractice are: duty, breach of duty, actual injury and battery.” c. “The elements that must be present to prove malpractice are: duty, breach of duty, actual injury and intent.”

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d. “The elements that must be present to prove malpractice are: duty, breach of duty, actual injury and causation.”

ANS: D The fourth element that must be present for a person to recover damages as the result of alleged malpractice is causation; in other words, the injury was foreseeable and the conduct was the cause of the injury. Battery is an intentional tort for which an action can be brought. Intent or insurance does not need to be present for a personal to recover damages as the result of alleged malpractice.

DIF: Cognitive Level: Evaluation OBJ: State the four elements that must be present for a person to recover damages.

TOP: Law MSC: NCLEX: Safe and Effective Care Environment: Management of Care

19. A nurse is working the night shift on a respiratory floor. She is walking toward a patient’s room when she sees a nursing assistant performing patient care with the curtain and door open. The nurse knows that the nursing assistant is violating which legal principle? a. Right to privacy b. False imprisonment c. Failure to rescue d. Informed consent ANS: A The nursing assistant is violating the patient’s right to privacy by keeping the curtain and door open. The legal principles of false imprisonment, failure to rescue, and informed consent are not occurring in this situation.

DIF: Cognitive Level: Application OBJ: Identify the three major types of law and explain how they apply to nursing.

TOP: Legal Principles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

20. A nurse is working with a patient who is well known to the public. Shortly before lunch, a news reporter walks into the nursing unit and begins questioning the nurse. The nurse knows that if she gives out patient information without the patient’s consent, she would be failing to comply with which law? a. Informed consent b. Health Insurance Portability and Accountability Act (HIPAA) of 1996 c. Hospital policy d. Common law ANS: B The nurse would be violating HIPAA of 1996. This law was enacted to protect the privacy of patients, including medical records and personal health information.

DIF: Cognitive Level: Application N OBJ: Identify the three major types of law and explain how they apply to nursing.

TOP: Patient’s Rights MSC: NCLEX: Safe and Effective Care Environment: Management of Care

21. The nurse manager shows an understanding of preventable medical errors when she makes which statement? a. “There are only a few deaths related to medical errors per year.” b. “Medical errors are made only by nurses who are not focused.” c. “About 20,000 patients die each year from preventable medical errors in the United States.” d. “Each year between 44,000 and 98,000 patients die from preventable medical errors.”

ANS: D

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The Institute of Medicine estimates that each year in the United States, between 44,000 and 98,000 patients die from preventable medical errors.

DIF: Cognitive Level: Application OBJ: Define professional negligence and malpractice.

TOP: Negligence and Malpractice MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 22. The nurse on a busy surgical floor is preparing her patient for surgery. The patient refuses to sign the surgical consent form because he has not spoken to the surgeon regarding the procedure. When the nurse speaks to the surgeon on the phone, he tells her that he is too busy to come to the floor. If the nurse were to insist that the patient sign the consent anyway, she would be violating which of the patient’s rights? a. Right to refuse treatment b. Confidentiality c. Right to informed consent d. Right to privacy ANS: C In order for the consent to be valid, the patient must fully know what he is consenting to. He has the right to know the potential risks, benefits, and any other treatments that may be available.

DIF: Cognitive Level: Application OBJ: Identify the three major types of law and explain how they apply to nursing.

TOP: Legal Principles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

23. A nurse is working in the surgical recovery unit and is caring for a patient who is still under anesthesia. She notes that the patient’s oxygen level is 82% on room air. What would the nurse be guilty of if she were to withhold oxygen from this patient? a. Commission of an act b. Nothing, because the patient will naturally recover from the anesthesia c. Professional negligence d. Assault and battery N ANS: C The nurse would be guilty of professional negligence through the omission of an act, giving oxygen, to a patient who was in need.

DIF: Cognitive Level: Application OBJ: Define professional negligence and malpractice.

TOP: Negligence and Malpractice MSC: NCLEX: Safe and Effective Care Environment: Management of Care

24. The nurse has an adequate understanding of a tort when she makes which statement? a. “A tort is a legal wrong committed against another person or their property.” b. “A tort refers to the nurse’s duty to practice within the boundaries of the nurse’s role.” c. “A tort is a principle concerned with being fair or just.” d. “A tort refers to truth telling and not intentionally misleading patients.”

ANS: A A tort is a legal wrong that is committed against either a person or the person’s property. Fidelity is a term that defines the nurse’s duty to practice within the boundaries of the nurse’s role, as determined by state rules and regulations. Justice is a principle concerned with being fair or just. Veracity refers to truth-telling and not intentionally misleading patients.

DIF: Cognitive Level: Application TOP: Negligence and Malpractice

OBJ: Define professional negligence and malpractice.

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MSC: NCLEX: Safe and Effective Care Environment: Management of Care

25. A nurse is caring for an elderly patient with terminal cancer. The patient has just told his family that he wants to end treatment and be kept comfortable for the remainder of his life. His family is very upset and does not agree with his decision. Both the patient and his family have confided their wishes to the nurse privately, and the family has asked the nurse to intervene. How would you classify the ethical dilemma that the nurse is experiencing? a. Right to life b. Informed consent c. Right to die d. Medical futility ANS: C The ethical dilemma that the nurse is experiencing is right to die. Although the patient’s family may be upset with his decision, it is ultimately the patient’s right to choose when to end treatment for his terminal cancer.

DIF: Cognitive Level: Analysis OBJ: Value the need for registered nurses to demonstrate the ethical duties owed to self and others.

TOP: Ethics Committees MSC: NCLEX: Safe and Effective Care Environment: Management of Care

26. A nurse is working the night shift in the ICU. She notices cardiac alarms sounding for one of the patients, and on arriving to the patient’s room, finds him in full cardiac arrest. It is later determined that the patient’s assigned nurse was at the front desk sleeping. The nurse realizes the important of reporting this issue but does not want to face backlash from her co-worker. Which describes what the nurse is experiencing? a. Decision-making N b. Ethical dilemma c. Preconceived beliefs d. Discrimination ANS: B This nurse is experiencing an ethical dilemma. She understands the importance of reporting her co-worker’s lack of patient supervision but is concerned with the backlash that she may experience from her co-worker.

DIF: Cognitive Level: Application OBJ: Identify an ethical dilemma in the clinical setting and outline a framework for ethical decision-making.

TOP: Ethical Dilemmas MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE

1. A new nurse has just been hired to work at a local hospital. Which actions by the nurse show her understanding of the Patient’s Bill of Rights? (Select all that apply.) a. Allowing the patient access to health records Responding to patient care requests in a timely manner Explaining to another nurse the patient’s right to refuse treatment Maintaining the patient’s confidentiality Ensuring that the patient is informed about his or her medical condition ANS: A, C, D, E The Patient’s Bill of Rights states that patients have the right to access to their health records, the right to refuse treatment, the right to confidentiality, and the right to be informed about their medical conditions, among others. The right to timely care is not listed in the Patient’s Bill of Rights.

b. c. d. e.

DIF: OBJ:

Cognitive Level: Application Identify the three major types of law and explain how they apply to nursing.

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TOP: Patient’s Rights MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. Which statements by the nursing student describe how ethics help nurses solve dilemmas in health care? (Select all that apply.) a. “Ethics requires us to analyze our actions or potential actions critically.” b. “Ethics assists us in determining the right course of action to take.” c. “Ethics allows nurses to let others more qualified make decisions for us.” d. “Ethics allows nurses to take a break from the situation by waiting for the ethics committee.” e. “Ethics causes problems in health care rather than helps.”

ANS: A, B Ethics assists nurses in solving dilemmas by requiring them to analyze their actions or potential actions critically and by assisting in determining the right course of action to take.

DIF: Cognitive Level: Application OBJ: Value the need for registered nurses to demonstrate the ethical duties owed to self and others.

TOP: Nursing Ethics MSC: NCLEX: Safe and Effective Care Environment: Management of CareN

3. The RN understands the importance of providing culturally competent nursing care when she does which of the following? (Select all that apply.) a. Uses flexibility to accommodate the patient Becomes knowledgeable about other cultures Lets go of negative attitudes about other cultures Believes that her culture is superior Avoids patients of different cultures

b. c. d. e.

ANS: A, B, C In order to provide culturally competent nursing care, the nurse must be able to integrate skills, knowledge, and attitudes into care. The nurse must be able to work within the cultural context of the patient, family, or community.

Using flexibility in the patient’s care to accommodate needs, becoming knowledgeable about other cultures, and letting go of negative attitudes are all ways that the nurse can provide culturally competent care.

DIF: Cognitive Level: Application OBJ: Recognize your personal attitudes about working with patients from different ethnic and cultural backgrounds.

TOP: Ethics and Culture MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Chapter 13: Care and Safety Standards, Competence, and Nurse Accountability

MULTIPLE CHOICE

1. A new graduate has been working as an RN for 6 months and is no longer working with a preceptor. However, she still frequently checks with an experienced nurse to validate that she is following the rules and the policies she is still learning. The new graduate in this scenario exhibits the actions of what theoretical level of skill? a. Expert b. Competent c. Proficient d. Novice ANS: D In general, a novice is rule driven, is a concrete thinker, and believes and trusts whomever has authority or whatever direction is perceived to have come from someone in authority. Benner (1984) suggests that with experience and practice, nurses advance through the different levels of nursing knowledge—novice, competent, proficient, and expert.

DIF: Cognitive Level: Analysis OBJ: Compare the theoretical classifications of nursing skill.

TOP: Classification of Nursing Skill MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. An RN has been working on a cardiac unit for 1 year and has settled comfortably into an efficient, safe, and organized routine for each shift. However, whenever an urgent issue arises, N the nurse feels uncomfortable. It is most likely that this nurse is functioning at which skill level? a. Novice b. Proficient c. Competent d. Expert ANS: C A competent nurse has some experience and has developed safe organizational skills to get through the day’s tasks efficiently. Flexibility within the nursing role is difficult to manage at this point, and when deviations from the schedule occur, the nurse generally has a feeling of unease.

DIF: Cognitive Level: Analysis OBJ: Compare the theoretical classifications of nursing skill.

TOP: Classification of Nursing Skill MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. Which action would indicate that the RN is practicing at the proficient level? a. Asks another nurse to be present while a Foley catheter is inserted b. Becomes frazzled when two patients are unexpectedly admitted at the same time c. Thinks critically about situations and is able to anticipate patient needs d. Assumes the role of charge nurse while managing a tough patient assignment ANS: C A proficient nurse is experienced and has a beginning ability to recognize patterns and think critically. This allows her to think critically about situations and anticipate the needs of her patients. Novice nurses may ask the help of

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other more experienced nurses. Competent nurses have developed skills and are routine driven, often struggling with flexibility. Expert nurses are skilled critical thinkers and they handle challenges with ease.

DIF: Cognitive Level: Application OBJ: Compare the theoretical classifications of nursing skill.

TOP: Classification of Nursing Skill MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. An RN has been practicing for 12 years in pediatrics. Peers often seek out this nurse to help them with complex problems. This experienced nurse is assigned the patients with the highest acuity, and the nurse accepts these assignments with confidence. This nurse is likely practicing at which skill level? a. Novice b. Competent c. Proficient d. Expert ANS: D An expert nurse has had a great deal of experience and is flexible and adaptable, responding to change with ease.

According to Benner (1984), the expert nurse is a skilled critical thinker who has gained experience and skills through practice.

DIF: Cognitive Level: Analysis OBJ: Compare the theoretical classifications of nursing skill. N TOP: Classification of Nursing Skill MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. The nurse is working on a busy cardiac floor. While preparing medications, the nurse is interrupted by a co-worker, who has a question about another patient. After administering the medication, the nurse realizes that she gave the medication to the wrong patient. Which action by the nurse would indicate accountability? a. Shifting blame to the co-worker who interrupted her b. Attempting to hide the medication error to avoid getting into trouble c. Accepting partial responsibility for her own actions d. Taking responsibility for her own actions and interventions by immediately assessing the patient and reporting the error to a physician ANS: D Accountability is being answerable for the actions or interventions one performs as a nurse. Immediately assessing the patient and reporting the error to a physician demonstrate accountability. Shifting blame, attempting to hide the error, and accepting only partial blame do not.

DIF: Cognitive Level: Application OBJ: Describe accountability as it applies to nursing practice.

TOP: Accountability MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. An RN realizes that she inadvertently gave a patient who was NPO for surgery his otherwise normally scheduled PO medications. Which action would she take if she were exhibiting professional accountability? a. Report the error to the charge nurse and follow up with the patient’s surgeon. b. Report the incident to the charge nurse and blame the co-worker who interrupted her medication pass. c. Keep the incident to herself so that the patient’s surgery will not be canceled. d. Report the incident the next day that she works.

ANS: A Accountability is being answerable for the actions or interventions one performs as a nurse. Accountability also means taking responsibility for one’s other actions and growth. Although individuals are ultimately accountable to

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themselves, the RN is particularly accountable to the patient, society, and the profession. The RN should report the incident immediately to the charge nurse and surgeon, in the best interest of the patient.

DIF: Cognitive Level: Application OBJ: Describe how using the chain of command to resolve issues supports accountability.

TOP: Accountability MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7. While passing noon meds, an RN notes that one of her patients did not receive his 0600 dose of antibiotic during the prior shift. She calls the prior nurse to try to determine whether the medication was given, then fills out an occurrence or care aberrance report, and follows through as institutional policy indicates. What is the best explanation for why the RN who found the error took action? a. Because the prior nurse needed to know she made an error

b. Because she is accountable for not contributing to the error by ignoring itN c. To keep the patient from suing the hospital d. To keep herself out of trouble ANS: B The RN must act judiciously and prudently in the delivery of care. By not going to the supervisor when a mistake is made and failing to demonstrate accountability for contributing to the mistake, the RN risks not only harm to the patient but also potential legal and ethical consequences.

DIF: Cognitive Level: Analysis OBJ: Identify the RN’s role in managing care aberrances.

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

TOP: Managing Care Aberrances

8. In a situation involving a medication error, the hospital policy is to use root-cause analysis to evaluate the situation fully. In the root-cause analysis process, which action would take place? a. A committee is formed to determine the risk of litigation. b. A committee is formed to determine the punishment for those involved. c. A committee is formed that can reconstruct the events leading to the error. d. A committee is formed that can correct the error and avoid damages.

ANS: C In a root-cause analysis, a committee is formed, which in this case would include a facilitator (usually the risk manager or performance improvement director), the nurse or nurses involved, a pharmacist, the physician, and the team leader or supervisor. The purpose of the committee is to reconstruct the events leading up to the error. By looking at the process, the committee may discover that the physician’s order was unclear, that two drugs with similar names were placed next to each other in the medication-dispensing unit, or that the unit of measure for the drug was unclear.

DIF: Cognitive Level: Application OBJ: Identify the RN’s role in managing care aberrances. TOP: Managing Care Aberrances: Root-Cause Analysis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. There are a number of characteristics that will help a novice nurse find success in a mentoring relationship. Which action represents one of these positive characteristics? a. The novice nurse asks clear, thoughtful questions and seeks clarifications. b. The novice nurse is patient and waits for the mentor to approach with learning opportunities. c. The novice nurse is directive rather than open to dialogue. d. The novice nurse stays busy, and the mentor seeks the opportunities.

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ANS: A The novice nurse makes his or her learning needs known, is prepared to take on new learning experiences, and is thoughtful about the learning that is taking place. The novice nurse is confident enough to ask questions, seek clarification, and seek constructive input. The novice nurse understands the experience needed to gain expertise and will open a dialogue with the mentor. The novice nurse is clear, precise, and thoughtful in the questions asked and in the dialogue that follows. The novice nurse is hungry for learning experiences, demonstrates this N through a sound plan, and is focused on the matters at hand.

DIF: Cognitive Level: Analysis OBJ: Compare the theoretical classifications of nursing skill.

NCLEX: Safe and Effective Care Environment: Management of Care

TOP: Mentoring Relationship MSC:

10. An operating room nurse has returned from a conference on the impact of never events. Recognition of which of the following would lead her to believe that a never event could occur?

The patient is losing an anticipated amount of blood during surgery.

Toward the end of a surgical procedure, the sponge count does not match up with the beginning count.

The procedure is taking longer than planned.

The surgeon was late to the procedure.

a. b. c. d.

ANS: B Never events are preventable events that can cause illness, injury, or even death of a patient. Noticing a difference in the beginning and end sponge counts indicates that a never event could occur. Losing an anticipated amount of blood or a lengthy procedure does not necessarily indicate the possibility of a never event. Timeliness of the surgeon is not a factor.

DIF: Cognitive Level: Application OBJ: Identify the benchmarks for judging nursing care.

TOP: Never Events MSC: NCLEX: Safe and Effective Care Environment: Management of Care

11. A nurse has just received training on the Quality and Safety Education for Nurses (QSEN) Project. What should the nurse do to show that she understands the importance of the project? a. After assessing the patient, determine a list of priorities for care and begin implementing them. b. Collaborate with medical personnel involved in the patient’s care to develop a treatment plan for the patient. c. Develop a treatment plan with the patient and medical personnel that best fits the patient’s needs and lifestyle. d. Develop a treatment plan based on what the patient’s wife says he needs.

ANS: C Patient-centered care is one of the six primary competencies in the QSEN Project.

Patient-centered care includes involvement of the patient as well as medical personnel. Treatment plans should be tailored to fit the patient’s needs and lifestyle. This sets the patient up for success.

DIF: Cognitive Level: Application OBJ: Identify the benchmarks for judging nursing care.

TOP: QSEN Project MSC: NCLEX: Safe and Effective Care Environment: Management of Care

12. A nurse has just realized that her license is due to expire in 5 months. The nurse knows that she is responsible for maintenance of her license in order to continue practicing as a nurse.

What would be the best action for her to take? a. Put off obtaining the continuing education credits until 1 month before the expiration date.

b. Immediately begin working on obtaining the continuing education credits.N c. Email the nursing board to inquire about why she was not notified earlier. d. Forgo obtaining the continuing education credits and hope that she does is not audited.

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ANS: B Personal responsibility indicates that the nurse is responsible for her own actions and for maintenance of her nursing license. The nurse should be aware of the expiration date and should plan to obtain continuing education credits accordingly.

DIF: Cognitive Level: Application OBJ: Describe accountability as it applies to nursing practice.

TOP: Personal Accountability MSC: NCLEX: Safe and Effective Care Environment: Management of Care

13. On administering a medication, the RN realizes that she gave the incorrect amount. After assessing the patient, which action would not be appropriate for the nurse to take? a. Report the incident to the patient’s physician. b. Immediately report the incident to her manager. c. Keep the incident to herself and continue to monitor the patient. d. Continue to reassess the patient.

ANS: C The RN has a duty to act judiciously and prudently in the delivery of care to the patient. Failure to report a medication error could cause harm or even death. Along with risk of harm to the patient, the RN also risks legal and ethical consequences. Keeping a medication error to herself would be inappropriate, even if the nurse continued to assess the patient.

DIF: Cognitive Level: Application OBJ: Describe accountability as it applies to nursing practice.

NCLEX: Safe and Effective Care Environment: Management of Care

TOP: Managing Care Aberrances MSC:

14. A nurse manager is reviewing an incident report submitted by the previous day’s charge nurse. The incident report indicates that the wrong IV antibiotic was given to a patient. What is the best way for the nurse manager to address this incident with the nurse involved so that it may be prevented in the future? a. Provide education to the nurse on how to assess the five rights before medication administration. b. Punish the nurse for the error by sending her home for the day. c. Allow the nurse one error, and educate her if the same mistake happens again. d. Ask the charge nurse to educate the nurse because she caught the error.

ANS: A The nurse manager has the responsibility to meet with the nurse involved in the error and create a plan to help ensure that the error does not happen again. This can be done by setting up a time in which to educate the RN about the five rights of medication administration. The nurse should not ignore the error, ask someone else to handle it, or use the incident report in a punitive way.

DIF:

Cognitive Level: Application

OBJ: Identify the RN’s role in managing care aberrances.N TOP: Incident Reports MSC: NCLEX: Safe and Effective Care Environment: Management of Care

15. The medical team determines that a patient needs to be transferred to another facility to continue receiving the most appropriate and beneficial care. The transfer process has been slow and difficult, and the nurse is struggling to care for the transferring patient along with her other assigned patients. What is the best action the nurse can take to improve her situation? a. Continue to do the best that she can do for all of her patients. b. Inform the medical team that the transfer will have to wait for the next shift. c. Involve management so that the nurse can focus on patient care. d. Ask her co-workers to manage her patient assignment.

ANS: C

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The best action the nurse can take is to involve management so that she can focus on patient care. Continuing to struggle takes away from the care she is able to provide and could be detrimental to her patients. Halting the transfer could possibly be detrimental to the patient in need of the medical transfer. Asking her co-workers to absorb her assignment could reduce the quality of care that they are able to provide as well.

DIF: Cognitive Level: Application OBJ: Identify the RN’s role in managing care aberrances. TOP: Involving Management in Decision-Making MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A patient on a medical-surgical floor is unhappy with the care he is receiving from his physician and wants to speak to someone about it. Which action should the nurse take? a. Contact the director of medical-surgical nursing. b. Leave an urgent message for the patient’s physician. c. Notify the nurse’s immediate supervisor. d. Ask another nurse on the floor to talk with the patient.

ANS: C The nurse should consult the first person in the chain of command, her immediate supervisor. If the immediate supervisor is unable to assist, the next person in line should be consulted, and so on.

DIF: Cognitive Level: Application OBJ: Describe how using the chain of command to resolve issues supports accountability.

TOP: Chain of Command MSC: NCLEX: Safe and Effective Care Environment: Management of Care

17. A nurse manager wants to assess quality of care over the last 6 months for her unit. How could the nurse manager best accomplish this?

Interview each nurse about the patients on the unit for the last 6 months.

Review the results of patient satisfaction surveys.

Obtain charts from medical records for all of the patients.

Ask the nurses to perform discharge phone calls on previous patients.

a. b. c. d.

ANS: B The nurse manager could best accomplish her goal by reviewing the result of patient satisfaction scores. It is not realistic for her to interview each nurse, obtain the charts for every patient over the course of 6 months, or ask the nurses to perform discharge phone calls on N previous patients.

DIF: Cognitive Level: Application OBJ: Describe how using the chain of command to resolve issues supports accountability.

TOP: Quality of Care Measurement MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Chapter 14: Leading, Delegating, and Collaborating

MULTIPLE CHOICE

1. Which of these tasks is appropriate for the RN to delegate to a licensed practical nurse/license vocational nurse (LPN/LVN)?

Documenting patient teaching about a routine surgical procedure Teaching a patient how to self-administer insulin Administering an oral medication to a patient Completing the initial assessment and plan of care

a. b. c. d.

ANS: C The education and scope of practice of the LPN/LVN include administration of oral medication. Patient teaching and the initial assessment and development of the plan of care are nursing actions that require RN-level education and scope of practice.

DIF: Cognitive Level: Application OBJ: Compare leadership styles.

TOP: Leadership Styles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. All of these nursing actions are included in the plan of care for a patient who is malnourished.

Which action is appropriate for the RN to delegate to a nursing assistant? a. Assist the patient in choosing high-nutrition items from the menu. b. Monitor the patient for skin breakdown over the bony prominences. c. Assess the patient’s strength while ambulating the patient in the room.

d. Offer the patient the ordered nutritional supplement between meals. N ANS: D Feeding the patient and assisting with oral intake are included in nursing assistant education and scope of practice.

Assessing the patient’s strength and assisting the patient in choosing high-nutrition foods require LPN/LVN- or RNlevel education and scope of practice.

DIF: Cognitive Level: Application OBJ: Compare leadership styles.

TOP: Leadership Styles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. A nurse manager must confront an employee about excessive absenteeism. During the confrontation with this employee, which introductory statement is most appropriate?

“Is there something occurring in your life that is interfering with your attendance at work?”

“What is your understanding of our absenteeism policy and being placed on probation?”

“You are always calling in sick and leaving the staff in a real mess.”

“Let’s pull the policy manual out and read the absenteeism policy together.”

a. b. c. d.

ANS: A Similar to a focused patient assessment when a complaint pain is given, a manager must also assess and gather more information about an employee’s excessive absenteeism. With this in mind, the statement asking about the employee’s life occurrences interfering with work is an appropriate way to start this conversation. Asking the employee about the absenteeism policy and offering to read the policy together give no opportunity to engage in a healthy discussion.

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Attacking the employee by saying “You are always calling in sick and leaving the staff in a real mess” is not a respectful and professional way to begin this conversation.

DIF: Cognitive Level: Application OBJ: Compare leadership styles.

TOP: Leadership Styles MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse is assigned to care for a patient who has been admitted with an opiate overdose and tells the nursing supervisor, “This is a waste of my time. The patient will be back on the needle right after being discharged.” The most appropriate response by the nursing supervisor is a. “Your lack of professionalism will make it difficult for you to provide adequate care.” b. “You know we are obligated to provide appropriate care no matter how we feel.” c. “It is important to recognize these feelings and then figure out how to deal with them.” d. “Since you feel so strongly, perhaps you should be assigned to care for a different patient.”

ANS: C To provide nonjudgmental care for substance-abusing patients, the nurse must examine his or her own values and feelings. This statement validates the nurse’s feelings but recognizes the need to care for the patient in a nonjudgmental way. The response about the lack of N professionalism is critical of the nurse and is unlikely to lead to a change in the nurse’s attitude. The response about the obligation to care for this patient is accurate but does not encourage the nurse to examine his or her own values. The response about feeling strongly about the patient would solve the immediate problem but would not encourage self-examination.

DIF: Cognitive Level: Application OBJ: Describe the leadership role in nursing.

TOP: Leadership and Collaboration in Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A charge nurse and staff nurse are in disagreement over the team assignment for the shift that is about to begin. What is the charge nurse’s best first step to resolving the conflict collaboratively? a. Determine the shared goal. b. Open a respectful dialogue to bring forth each point of view. c. Design a plan to meet the shared goal. d. Determine the roles of those involved in the plan.

ANS: B The steps to collaborative conflict resolution are as follows: (1) open a dialogue that brings forth and is respectful of each individual’s point of view; (2) determine a group or shared goal; (3) identify the expertise and contribution of each individual as the group agrees on the shared goal; (4) review the goal and move to accept or reject it honestly (acceptance requires the consensus of the group); (5) design a plan to meet the new goal by using the expertise of the group to design interventions to meet the goal; (6) determine the roles of the members in carrying out the interventions; a role must be within the capacity of the member and mutually accepted as fairly defined; and (7) set an evaluation point, and include all individuals in the evaluation process, maintaining respect for everyone’s input or contribution and focusing on interventions and actions rather than personalities, feelings, or prejudices.

DIF: Cognitive Level: Application OBJ: Analyze strategies for conflict management.

TOP: Conflict Management MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6.

Nurse A is in conflict with Nurse B regarding holiday scheduling. Because Nurse A really wants to avoid being in this conflict, and because Nurse A just wants to fill the holiday schedule, Nurse A agrees to give up one favored holiday. This is an example of which type of conflict resolution? a. Competition resolution b. Win-win resolution

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c. Sacrifice resolution d. Active resolution ANS: C In sacrifice resolution, one person may strongly want to avoid or end the conflict and will therefore accommodate the other by essentially sacrificing his or her position, thus allowing the other to have his or her way. Competition resolution describes one or both parties working N competitively to get their way; ultimately, one wins and the other loses. Win-win resolution is illustrated when both parties come together and decide on mutual goals, design interventions, and work together to evaluate outcomes.

DIF: Cognitive Level: Application OBJ: Analyze strategies for conflict management.

TOP: Conflict Management MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7.

Holiday scheduling is always a sensitive issue on the nursing unit, and the manager is trying something different this year. The manager says that whoever works the most extra shifts when asked to do so will get first pick for the holiday schedule. Which type of conflict resolution does this represent? a. Competition resolution b. Win-win resolution c. Sacrifice resolution d. Active resolution ANS: A Competition resolution is when one or both of the parties work competitively, instead of cooperatively, toward resolution; one party wins and one party loses. Win-win resolution is illustrated when both parties come together and decide on mutual goals, design interventions, and work together to evaluate outcomes. Sacrifice resolution is when both parties give up their positions so no one gets exactly what they want or when one party wants to end the conflict and gives up his or her position for the other party. Active resolution was not discussed.

DIF: Cognitive Level: Application OBJ: Analyze strategies for conflict management.

TOP: Conflict Management MSC: NCLEX: Safe and Effective Care Environment: Management of Care

8.

Which of these nursing interventions for the patient who has had right-sided breast-conservation surgery and axillary lymph node dissection is appropriate to assign to an LPN/LVN? a. Teaching the patient how to avoid injury to the right arm b. Administering an analgesic 30 minutes before the scheduled arm exercises c. Assessing the patient’s range of motion for the right arm d. Evaluating the patient’s understanding of discharge instructions about drain care ANS: B LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics.

Assessment, teaching, and evaluation of a patient’s understanding of instructions are more complex tasks that are more appropriate to RN-level education and scope of practice.

DIF: Cognitive Level: Application OBJ: Collaborate as a part of the health care team.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of CareN

9.

The nurse is a very busy charge nurse with responsibilities for a unit with 24 acute care patients. An experienced nursing assistant is assigned to the unit. The nursing assistant notes that the IV pump is beeping because the tubing appears kinked. The assistant unkinks the tubing, and this resets the pump. The assistant reports the action to the nurse. It is most important that the nurse

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a. thank the nursing assistant for taking the initiative to correct the problem and to “keep up the good work.”

b. provide the assistant with additional instructions on safety in IV management. c. warn the other staff to watch out for the nursing assistant because she works beyond her scope. d. explain that help is appreciated; however, legally the nursing assistant cannot perform the action.

ANS: D IV management is not a part of a nursing assistant’s education or scope of practice.

Explaining that the assistant’s help was appreciated but further explaining that the actions cannot legally be performed is the appropriate response. Commending the assistant for taking the initiative does not reestablish the proper boundaries for the nursing assistant. Warning the other staff about the nursing assistant can be considered gossip and unprofessional.

DIF: Cognitive Level: Application OBJ: Describe the role of advocate.

TOP: Advocacy MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A newly admitted patient has several orders the physician has written. As manager of care, a graduate RN knows that three of the following tasks can be routinely delegated to a nursing assistant, but one of them must be reserved for the RN to complete. Which task must the RN complete? a. Reminding to use the incentive spirometer b. Irrigating of a urinary catheter c. Conducting fingerstick glucose tests d. Collecting data for intake and output ANS: B Irrigating a urinary catheter is a nursing skill and cannot be delegated to unlicensed personnel. Reinforcement of health teaching done by the RN, conducting fingerstick glucose tests, and collecting data for intake and output are all included in the nursing assistant’s education and scope of practice.

DIF: Cognitive Level: Application OBJ: Delegate according to professional principles.

TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

11. The best way for a nurse to determine that a newly hired certified nursing assistant (CNA) is competent to transfer a patient safely from the bed to the commode would be to a. look in the CNA’s personnel file to determine previous experience. b. observe the CNA perform the procedure the first time and discuss the outcome. c. have the CNA explain the procedure before doing it. d. establish that the CNA is comfortable performing the transfer.

ANS: B N Directly observing the CNA perform the task first and discussing the outcome comprise the best answer. The nurse can ensure that the patient and the CNA are safe during execution of the transfer. Looking in personnel files for previous experience is an inappropriate action. Asking the CNA to explain the procedure does not equate to performing the action correctly and safely. Establishing a comfort level of the procedure does not equate to mastery of the skill.

DIF: Cognitive Level: Application OBJ: Define leadership.

TOP: Leadership MSC: NCLEX: Safe and Effective Care Environment: Management of Care

12. Which statement by the RN best represents the “right communication” when delegating a task to an unlicensed individual?

a. “Feed the patient and watch for cheeking and choking.”

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b. “I want you to help the patient to eat his lunch. You should elevate the head and feed him slowly enough so he does not choke.”

c. “Feed the patient his pureed diet at lunchtime. Elevate the head of the bed to 90 degrees and make certain he swallows each bite.”

d. “Assist the patient with lunch, and make sure he sits up and doesn’t store food in his cheek in between bites.”

ANS: C “Feed the patient his pureed diet at lunchtime. Elevate the head of the bed to 90 degrees and make certain he swallows each bite” is stated in the most specific manner. The other statements are open for interpretation. The statement discussing “cheeking and choking” is vague and does not have any instruction on what diet to expect, the position of the patient, or what “cheeking or choking” means. The statement starting with “I want you to help the patient to eat his lunch” is also vague because it has no instruction on diet type, the level of elevation of the head of the bed, or how slowly to feed the patient. (The patient may store food in his mouth without swallowing and without choking.) The statement beginning with “Assist the patient with lunch” gives no instruction on diet type or the proper elevation the patient should sit up.

DIF: Cognitive Level: Application OBJ: Compare leadership styles.

TOP: Leadership Styles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

13. In a patient care conference one of the nurses makes a controversial statement about the patient’s behavior. The other health care providers raise their eyebrows, and silence follows the original comment. A democratic leader would a. agree with the comment about the patient, and direct the group to the next topic on the agenda. b. ignore the statement about the patient’s behavior and the nurse’s judgmental attitude. c. gather input from the group about the patient’s behavior, and elicit suggestions about how to best work with the patient. d. respond to the nurse that the comment is judgmental and inappropriate, and ask the nurse to stay after the meeting.

N ANS: C Gathering input from the group on how to best work with the patient exemplifies the democratic leader. This type of leader bases decisions on mutual agreement within the group. Agreeing with the comment and moving on to the next topic and chastising the nurse in front of the group demonstrate lack of leadership.

DIF: Cognitive Level: Application OBJ: Describe the accountability embedded in leadership. TOP: Accountability in Leadership MSC: NCLEX: Safe and Effective Care Environment: Management of Care

14. A family member of an elderly Hispanic patient admitted to the hospital tells the nurse that the patient has traditional beliefs about health and illness. Being a patient advocate, the best action by the nurse is to avoid asking any questions unless the patient initiates conversation. obtain further information about the patient’s cultural beliefs from the family member. ask the patient whether it is important that cultural healers are contacted. explain the usual hospital routines for meal times, care, and family visits.

a. b. c. d.

ANS: C Because the patient has traditional health care beliefs, it is appropriate for the nurse to ask whether the patient would like a visit by a cultural healer. There is no cultural reason for the nurse to avoid asking the patient questions, and questions may be necessary to obtain important health information. The patient, rather than the family member, should be consulted about personal cultural beliefs. The hospital routines should be adapted to the patient’s preferences, rather than expecting the patient to adapt to the hospital schedule.

DIF:

Cognitive Level: Application

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OBJ: Describe the accountability embedded in leadership.

TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

15. While talking with the nursing supervisor, a graduate RN expresses frustration that a Mexican American client always has several family members at the bedside. The most appropriate action by the nursing supervisor to help the graduate RN become a patient advocate is to a. ask about the graduate RN’s personal beliefs about family support during hospitalization. b. remind the graduate RN that this cultural practice is important to the family and the patient. c. suggest that the graduate RN ask family members to leave the room during patient care. d. have the graduate RN explain to the family that too many visitors will tire the patient.

ANS: A The first step in providing culturally competent care is to understand one’s own beliefs and values related to health and health care. Asking the nurse about personal beliefs will help to achieve this step. Reminding the graduate nurse that this cultural practice is important to the N family and patient will not decrease the graduate nurse’s frustration. The remaining responses are not culturally appropriate, nor do they advocate for the patient.

DIF: Cognitive Level: Application OBJ: Analyze strategies for conflict management.

TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

16. Which patient described below most needs an advocate? a. A 68-year-old female patient who tells you that she always relies on her husband to decide what is best. b. An 80-year-old patient who states, “Why do people talk over my head as if I was a child?” c. A 4-year-old patient whose mother visits each evening but goes home to care for her other two children each night. d. A 36-year-old patient who states, “I really wish this surgery wasn’t necessary. I want to look at my other choices, again.”

ANS: B The 80-year-old patient needs an advocate to assist her in engaging in conversation that takes place in her presence about her care. The 68-year-old patient has her husband to help make decisions for her. The 4-year-old patient has an attentive parent who splits her time and attention between her hospitalized child and the rest of her family. The 36year-old patient is engaged and involved in his or her personal health care decisions.

DIF: Cognitive Level: Application OBJ: Compare leadership styles.

TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

17. Which question or statement by the nurse is most helpful in ensuring that a nursing assistant new to the unit understands what is expected of the assistant? a. “Are you ready to begin work now?”

b. “Now, repeat for me what I have just asked you to do.” c. “Do you know what I expect from you?” d. “Let me know if you need any help.”

ANS: B Asking the assistant to repeat the instructions just given helps to assure the nurse that the assistant knows what is expected. Asking whether the assistant is ready to begin work, whether the assistant knows what is expected of the assistant, or whether the assistant needs any help does not ensure that the assistant understands what is expected.

DIF:

Cognitive Level: Application

OBJ: Compare leadership styles.

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TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

18. The RN is planning care for the day. Which would be the most appropriate task to assign to the nursing assistant? a. Collecting a 24-hour urine specimen b. Feeding the patient who has difficulty swallowing c. Changing the dressing on an abdominal wound d. Monitoring a tube feeding N ANS: A The nursing assistant is qualified to collect a 24-hour urine specimen. An LPN/LVN can change the dressing on an abdominal wound. Feeding the patient with dysphagia and monitoring a tube feeding calls for the specialized knowledge of the RN. DIF: Cognitive Level: Application OBJ: Delegate according to professional principles.

TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

19. Which statement best reflects that the nurse manager has taken the first action in the decision-making process? a. “We could hire four additional nursing assistants.” b. “We need to decrease patient falls.” c. “Patient falls have decreased by 20%.” d. “Here is the revised staffing schedule.”

ANS: B Stating that patient falls need to be decreased is setting a desired goal or outcome and is the first step in the decisionmaking process. “We could hire four additional nursing assistants” offers an option, the second step in the process.

“Patient falls have decreased by 20%” indicates that evaluation has occurred, which is the last step of the decisionmaking process.

“Here is the revised staffing schedule” indicates that an option has been implemented.

DIF: Cognitive Level: Application OBJ: Collaborate as a part of the health care team.

TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

20. Which patient should be assigned to an experienced LPN/LVN? a. One day post-op coronary artery bypass graft (CABG) who is on telemetry with T 37.1 C, BP 95/50, P 92, R 18 b. Two day post-op appendectomy with T 36.8 C, BP 118/78, P 78, R 18 c. Snake bite 2 days prior with hematuria, melena, and blood seepage at the IV site with stable vital signs d. One day post cerebral vascular accident (CVA) on a heparin drip experiencing increasing hemiplegia, with stable vital signs ANS: B The best patient to assign to the LPN/LVN is the 2-day postoperative appendectomy patient because there is nothing that requires immediate advanced interventions. The patient on telemetry who had a CABG is still critical and requires close monitoring for sudden changes in condition and anticipated advanced nursing interventions. The patient with a snake bite is experiencing active complications of that snake bite and may require advanced interventions. The patient with a CVA is currently experiencing effects of the stroke despite the heparin drip and requires advanced interventions.

DIF:

Cognitive Level: Application

OBJ: Collaborate as a part of the health care team.

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TOP: Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE N 1. According to the American Nurses Association (ANA), which elements of nursing cannot be delegated? (Select all that apply.) a. Initial and subsequent nursing assessments requiring professional judgment b. The determination of nursing diagnoses, goals, plans of care, and progress c. Interventions that require the application of professional knowledge and skills d. Interventions that require additional knowledge and skills e. Routine daily care elements including recording vital signs ANS: A, B, C Initial and subsequent nursing assessments requiring professional judgment; the determination of nursing diagnoses, goals, plans of care, and progress; and interventions that require the application of professional knowledge and skills are the three elements of nursing that cannot be delegated. LPN/LVNs and nursing assistants can perform additional skills for which they have been trained, following the appropriate evaluation. The RN may delegate components of care like activities of daily living and vital signs but does not delegate the nursing process itself.

DIF: Cognitive Level: Application OBJ: Delegate according to professional principles.

TOP: Professional Roles MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Chapter 15: Promoting Healthful Living in the Primary Care Setting

MULTIPLE CHOICE

1. A patient admitted with chest pain who is a one pack-a-day smoker tells the nurse, “I am just not ready to quit smoking yet.” The most appropriate response by the nurse is a. “This would be a really good time to quit.”

b. “Are you familiar with the nicotine patch?” c. “Your smoking is the cause of your chest pain.” d. “What do you think keeps you from quitting?”

ANS: D Pender and Pender discuss the relationship of situational influences with regard to health promotion. The nurse’s role is to assist the patient in identifying motivators to quitting. In addition, the nurse may also ask the patient about roadblocks to quitting. The responses about this being a good time to quit and naming smoking as the cause of the chest pain express judgmental feelings by the nurse and are not likely to motivate the patient. Suggesting the use of medication would be appropriate for the patient only if the patient expressed a desire to quit smoking.

DIF: Cognitive Level: Application TOP: Health Promotion

OBJ: Analyze the RN’s role in health promotion.

MSC: NCLEX: Health Promotion and Maintenance

2. A nurse is caring for a non–English-speaking Asian patient whose cultural practices are not familiar to the nurse. The nurse is curious about practices regarding communication and eye N contact. The nurse should a. tell the patient that it is cultural practice in the United States to maintain good eye contact when communicating with someone. b. observe the behaviors and interactions between the patient and other members of the culture. c. avoid all eye contact unless the patient establishes eye contact. d. use eye contact and communication techniques that are most comfortable for the nurse.

ANS: B Telling the patient what US practices are will not be helpful in assessing the patient’s cultural values regarding eye contact. Avoiding eye contact may not be appropriate for interactions with some patients. The nurse should attempt to adapt communication to the patient’s communication style.

DIF: Cognitive Level: Application OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

3. After the nurse implements diet instruction with a patient with heart disease, the patient can explain the information but fails to make the recommended dietary changes. The nurse’s evaluation is that learning did not occur because the patient’s behavior did not change. the nursing responsibility for helping the patient make dietary changes has been fulfilled. choosing not to follow the diet is the behavior that resulted from the learning. the teaching methods were ineffective in helping the patient learn the dietary information.

a. b. c. d.

ANS: C Orem assumes that the responsibility of primary health promotion lies with the individual. Although the patient’s behavior has not changed, the patient’s ability to explain the information indicates that learning has occurred and the patient is choosing at this time to continue with the previous diet. The patient may be contemplating or preparing to

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transition his behavior. The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.

DIF: Cognitive Level: Application OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

4. A patient is admitted to the hospital with a new diagnosis of diabetes mellitus type 1 and is scheduled for discharge on the second day after admission. In view of the patient’s 2-day inpatient stay, the nurse should set realistic goals by planning to a. teach the patient how to monitor glucose and self-administer insulin. b. include detailed information about diet and medication use in patient teaching. c. use every interaction to teach the patient about the details of glucose control. d. focus on teaching the family instead of the patient about diabetic management.

ANS: A When time is limited, the nurse should set realistic goals with the patient that will meet immediate needs. The patient and family will need further teaching about the role of diet, exercise, medications, and so forth, in controlling glucose, but these topics can be addressed through planning for appropriate referrals.N DIF: Cognitive Level: Application OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

5. A nurse recognizes that a homeless patient must walk great distances to obtain food. What kind of need does this patient demonstrate? a. Health-deviation need

b. Developmental need c. Universal need d. Health continuum need ANS: C A universal need is an essential requirement for everyone: food, shelter, air, water, and other basic needs. A developmental need, such as trust, love, and belonging, changes as a person moves through each life-cycle period. A health-deviation need is based on an individual’s genetic or constitutional deviations from normal. A health continuum need is not a true term.

DIF: Cognitive Level: Application OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

6. A patient has had no visitors for the 2 weeks he has been on your unit. The patient seems dejected and insists on having his few belongings in sight at all times. The nurse realizes that he may be experiencing what kind of need? a. Health-deviation need b. Developmental need c. Universal need d. Health continuum need ANS: B Orem considers self-care as meeting one’s own basic needs, including the self-care requisites of universal, developmental, and health-deviation needs. A developmental need, such as trust, love, and belonging, changes as a person moves through each life-cycle period. A health-deviation need is based on an individual’s genetic or constitutional deviations from normal. A universal need is an essential requirement for everyone: food, shelter, air, water, and other basic needs. A health continuum need is not a true term.

DIF: Cognitive Level: Analysis OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

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7. The priority health promotion nursing diagnoses for an overweight, but not yet obese, patient who is learning about weight reduction may include a. the potential for obesity.

b. the potential for impaired mobility. c. alteration in nutrition. d. health-seeking behaviors or knowledge deficit.

ANS: D The priority of care for health promotion is to help a patient regain control over his or her health. The priority nursing diagnoses include health-seeking behaviors or knowledge deficit. The potential for obesity, the potential for impaired mobility, and alteration in nutrition do not address the health promotion intervention of teaching.

N DIF: Cognitive Level: Analysis OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

8. Negative dietary influences on the health of Asian immigrants to the United States are most likely considered to be which type of environmental factor affecting health promotion? a. Spiritual b. Cultural c. Developmental d. Economic ANS: B Cultural influences on health are most obviously observed in the form of dietary habits. For example, as a whole, Americans consume a higher degree of fat and empty calories in their diets than other cultures. The result is that a large percentage of the American population will develop negative health consequences, such as peripheral vascular disease, coronary artery disease, hypertension, obesity, and diabetes. Dietary habits have nothing to do with spiritual, developmental, and economic components of the environmental influences on health promotion.

DIF: Cognitive Level: Analysis OBJ: Explain environmental influences on health promotion.

TOP: Environmental Influences on Health MSC: NCLEX: Health Promotion and Maintenance 9. A nurse is developing a health promotion care plan for an otherwise healthy man who is married with four children and has a career as a public school teacher. Which of the following environmental factors could have a major effect on the patient’s health promotion activities? a. Developmental b. Spiritual c. None of the above d. Both A and B ANS: A Developmental factors describe positive or negative influences on health-seeking behaviors or compliance with a health promotion plan of care. Health promotion may be on the man’s mind, but he may be caught up in self-imposed time constraints providing for his family and planning for retirement that may make it difficult to maintain a healthy lifestyle. The man may not perceive the task of self-health promotion as a priority. The spiritual environment includes a person’s perception of help from a higher power and is not relevant in this scenario.

DIF: Cognitive Level: Analysis OBJ: Explain environmental influences on health promotion.

TOP: Environmental Influences on Health MSC: NCLEX: Health Promotion and Maintenance

10. While obtaining a health history of a patient who has a large infected wound on the foot, the nurse learns that the patient has taken goldenseal to boost immune function rather than taking antibiotics for the infection. Which action by the nurse is initially most appropriate? a. Instruct the patient about the reasons for antibiotic use with infection.

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b. Ask the patient, “How do you feel about using both antibiotics and natural remedies?” c. Tell the patient that the doctor is likely to prescribe antibiotics.N d. Tell the patient that studies of goldenseal show that it is not effective in treating infection.

ANS: B Further assessment of the patient’s feelings about using Western and natural therapies is needed before further action should be taken. The patient may need instruction about antibiotics if further assessment indicates that the patient is receptive to antibiotic use. It is inappropriate for the nurse to tell the patient what another health care provider will do, and it is disrespectful to the patient’s values system. Studies of goldenseal are unclear about benefit as an immune stimulant.

DIF: Cognitive Level: Application TOP: Health-Illness Continuum

OBJ: Define health-illness continuum.

MSC: NCLEX: Health Promotion and Maintenance

11. Several family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?

Take the family members to the patient’s room.

Discuss ICU visitation policies and encourage family visits.

With the patient’s approval, describe the patient’s injuries and the care that is being provided.

Invite the family to participate in a multidisciplinary care conference.

ANS: C Lack of information is a major source of anxiety for family members and should be addressed first. Family members should be prepared for the patient’s appearance and the ICU environment before visiting the patient for the first time.

ICU visiting should be individualized to each patient and family, rather than being dictated by rigid visitation policies. Inviting the family to participate in a multidisciplinary conference is appropriate but should not be the initial action by the nurse.

a. b. c. d.

DIF: Cognitive Level: Application OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

12. A homeless patient with severe anorexia, fatigue, jaundice, and hepatomegaly is diagnosed with viral hepatitis and has just been admitted to the hospital. In planning care of the patient, the nurse assigns the highest priority to the patient outcome of a. establishing a stable home environment. b. maintaining adequate nutrition. c. increasing activity level. d. identifying the source of exposure to hepatitis.

ANS: B The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the patient and identifying the source of the infection would be appropriate activities, but they do not have as high a priority as adequate nutrition. Although the patient’s activity level will be gradually increased, rest is indicated during the acute phase of hepatitis.

DIF: Cognitive Level: Application OBJ: Explain environmental influences on health promotion. N TOP: Environmental Influences on Health MSC: NCLEX: Health Promotion and Maintenance

13. When developing strategies to decrease health care disparities, the nurse working in a hospital located in a neighborhood with many Vietnamese individuals will include a. educating the staff about Vietnamese health beliefs. b. improving public transportation. c. obtaining low-cost medications.

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d. updating equipment and supplies for the clinic.

ANS: A Health care disparities result from stereotyping, biases, and prejudices of health care providers. The nurse can decrease these disparities through staff education. The other strategies also may be addressed by the nurse but will not impact health disparities.

DIF: Cognitive Level: Application OBJ: Explain environmental influences on health promotion.

TOP: Environmental Influences on Health MSC: NCLEX: Health Promotion and Maintenance

14. Which family would the nurse consider healthy? a. A family in which the parents do not allow their 10-year-old child to make basic decisions. b. A family that encourages independence while supporting each other. c. A family that does not require a specific curfew for their 16-year-old son. d. A family that does not allow their 15-year-old child to be an individual.

ANS: B Inductive reasoning explains how a family that encourages independence while supporting each other and is considered to have healthy family functioning. In terms of health promotion, the nurse’s role is working with people with generally good health but who are experiencing life or development changes. Health promotion efforts by nurses are educational efforts to help the individual remain an independent self-care agent.

DIF: Cognitive Level: Application OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

15. A home health nurse is going to visit a new patient for admission to the nurse’s care. At the first meeting the nurse is able to meet the entire family. The nurse recognizes some unhealthy characteristics. Which statement made by the patient would lead the nurse to this conclusion? a. “We all have specific chores that we are responsible for on a daily basis.” b. “We allow our 14-year-old to make all of her own decisions.” c. “We like to go camping together as a family in the summertime.” d. “Our children are actively involved in school-sponsored sports.”

ANS: B Allowing a 14-year-old child to make her own decisions led to the nurse’s conclusion that unhealthy characteristics existed within this family. The nurse should engage in health protective behaviors as well as health promotion behaviors. Health protective behaviors take a person away from a dangerous situation or from a dangerous habit.

Health promotion behaviors move an individual to a higher level of health, greater vigor, or energy to do more N than he or she is currently capable of doing. All the other statements imply a strong and healthy family unit.

DIF: Cognitive Level: Application OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

16. A patient has chosen to see a Family Nurse Practitioner (FNP) to assist with health promoting activities. Which of the following services provided by the FNP is the best example of a health promotion activity? a. Teaching about a low-fat diet for a patient with a blood pressure of 136/82 b. Prescribing a cholesterol-lowering medication c. Scheduling a cardiac stress test d. Prescribing an anticoagulant for a patient with atrial fibrillation ANS: A

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A nurse practitioner is more likely to treat the patient from a holistic perspective and provide teaching to prevent illness or promote wellness. Although health promotion is a portion of the nurse’s role, many other organizations and individuals provide primary health care. The FNP is a primary health care provider. Patients seek out FNPs and trust that their counsel will help keep them well. Writing prescriptions and scheduling stress tests are functions of an FNP and are also good health promoting activities but are not the best in terms of motivating lifestyle changes.

DIF: Cognitive Level: Application OBJ: Analyze the RN’s role in health promotion.

TOP: Primary Health Care Systems MSC: NCLEX: Health Promotion and Maintenance

17. A program designed to increase exercise, reduce fat in a diet, and teach low-fat cooking methods to improve the health of a large population could be best described as a. supportive care. b. rehabilitation. c. diagnosis and treatment. d. health promotion and health protective.

ANS: D Exercise and a low-fat diet promote health and prevent illness. The nurse should engage in health protective behaviors as well as health promotion behaviors. Health protective behaviors take a person away from a dangerous situation or from a dangerous habit. Health promotion behaviors move an individual to a higher level of health, greater vigor, or energy to do more than he or she is currently capable of doing.

DIF: Cognitive Level: Application OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

18. Healthy People 2020 is a a. new global action plan to prevent and treat disease. b. prevention agenda for the nation. c. national effort to improve lives of US citizens. d. set of national health mandates.

ANS: C Healthy People 2020 is an example of a national effort to improve the lives and health of all N Americans. For 30 years, the government has encouraged informed decisions about healthful living through collaboration across all communities of interest. Topical objectives can be found at www.healthypeople.gov. It is expected that through the help of governmental partners and their resources, states, cities, communities, and individual people will be able to achieve the objectives in each of the topic categories by 2020. The other answer choices are incorrect.

DIF: Cognitive Level: Application OBJ: Describe the theoretical basis of self-care.

TOP: Self-Care MSC: NCLEX: Health Promotion and Maintenance

19. To help prevent drug–drug interactions in an older adult patient taking many medications, the most appropriate instruction by the nurse is

a. “Do not take any over-the-counter (OTC) drugs with your prescription drugs.” b. “Bring a list or all of your medications, supplements, and herbs that you use to every health care appointment and/or the hospital.” c. “Be sure to have all your prescriptions filled at the same pharmacy.” d. “Use a medication reminder system so that you won’t forget to take your medications as scheduled.”

ANS: B The information about drug use and possible interactions is obtained when the patient brings all prescribed medications, OTC medications, and supplements to every health care appointment. The patient should discuss the use of any OTC medications with the health care provider and obtain all prescribed medications from the same pharmacy, but these interventions alone will not prevent drug–drug interactions among prescribed drugs, OTC drugs, and any

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herbal supplements. Use of a medication reminder system will help the patient take medications as scheduled but will not prevent drug–drug interactions.

DIF: Cognitive Level: Application TOP: RN’s Role in Health Promotion

OBJ: Analyze the RN’s role in health promotion.

MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE 1. Before discharging a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae, the nurse teaches her about management of the condition. Which replies by the patient demonstrate proper understanding of how to manage her condition? (Select all that apply.) a. “I should try and stay active all the day to keep my joints from becoming stiff.” b. “I can use a cane if I find it helpful in relieving the pressure on my back and hips.” c. “A warm shower in the morning will help relieve the stiffness I have when I get up.” d. “I should take no more than 1 gram of acetaminophen four times a day to control the pain.” e. “Exercising daily on a stationary recumbent bicycle will lessen joint stress.”

ANS: B, C, D Protection and avoidance of joint stressors are recommended for patients with OA, so this N patient should use a cane to ambulate more comfortably, take warm showers to lessen joint stiffness, and should use nonsteroidal antiinflammatory medication as directed. Staying active all day or exercising daily will likely exacerbate joint swelling and pain.

DIF: Cognitive Level: Application OBJ: Explain environmental influences on health promotion.

TOP: Environmental Influences on Health MSC: NCLEX: Health Promotion and Maintenance

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Chapter 16: Managing Care in Secondary and Tertiary Health Care

MULTIPLE CHOICE 1. The nurse is listening to a lecture on the Orem’s theory. Which statement indicates that teaching has been effective? a. “Patients enter the acute health care setting when they are experiencing a dependent-care agency.” b. “Patients enter the acute health care setting when they are experiencing a community-care agency.” c. “Patients enter the acute health care setting when they are experiencing a dependent-care deficit.” d. “Patients enter the acute health care setting when they are experiencing a community-care deficit.”

ANS: C At various times in life, a person will have a health care demand, either a self-care or dependent-care demand that exceeds his or her self-care agency. When this happens, the person is said to have a self-care or dependent-care deficit. When this deficit is such that the person needs the specialized training of health care professionals, the person enters the health care setting and engages in a collaborative relationship with the RN and other health care team members. All other answer options are incorrect.

DIF: Cognitive Level: Evaluation OBJ: Discuss the theoretical framework for managing in secondary care. N TOP: Managing Secondary Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. The nurse is listening to a lecture on the acute care environment and the role of the RN. Which statement indicates that the teaching has been effective? a. “The RN ensures more independence in self-care ability.” b. “The RN avoids discussing wait times as the patient progresses through the illness state.” c. “The RN changes the medical plan of care according to the RN’s assessments.” d. ”The RN delegates the majority of decisions to the medical assistants.”

ANS: A Acute health care requirements vary with the progress of the disease either toward a cure or through complications that can occur. The RN uses information from many different sources to identify potential and actual problems with the patient’s progress. The overall focus is to prevent complications while promoting a higher level of health.

Changing the medical plan of care is not the role of a nurse. The nurse would not delegate decision making to the medical assistant staff.

DIF: Cognitive Level: Evaluation OBJ: Identify outcome priorities for secondary care.

TOP: Managing Secondary Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse writes the diagnosis of “potential for infection” for a postoperative patient. The charge nurse makes certain not to place a patient with a diagnosed infection in the same room with the fresh postoperative patient. The nurse does this to manage which of the following? a. The potential for noise in the room b. The potential for patient complaints related to odors c. The physical environment of the secondary health setting d. The social environment within the secondary health setting ANS: C Much within the environment of the acute care setting has the potential to extend the patient’s length of stay by introducing unexpected complications. Moving the patient through the acute care setting effectively and safely requires the RN to pay attention as the patient responds to the environment, as well as to anticipate the potential

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effects of the environment, including staffing issues. A common nursing diagnosis is “potential for infection,” and nosocomial, or hospital-acquired, infection is just one of the problems that competent nursing management can prevent. The charge nurse can manage this environmental concern by basing bed assignments on the diagnoses of the patients and then subsequently basing caregiver assignment on qualifications. The potential for noise, the potential for complaints, and the social environment have nothing to do with infections or the potential for infections.

DIF: Cognitive Level: Analysis OBJ: Analyze factors influencing patient outcomes.

TOP: Managing Secondary Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. After being diagnosed with cancer, the patient appears angry. At this point it would be appropriate for the nurse to assess for which kind of distress? a. Environmental

b. Developmental c. Physical d. Spiritual

N

ANS: D Patients facing stressful health care-related events may also experience spiritual distress. Illness states can place a patient in a position that forces consideration of the fragile nature of life. Resulting from a potential life-or-death experience or a life-changing event, spiritual distress may take on many manifestations. Much as in the grief process, the patient may display anger, blame, bargaining, or denial or may overtly cling to a spiritual guide. RNs assess for spiritual distress and implement interventions that will help the patient cope, such as facilitating the patient’s spiritual connection either through a referral or just by respecting personal wishes. Environmental, developmental, and physical distresses are not typically related to chronic or terminal disease situations.

DIF: Cognitive Level: Analysis OBJ: Analyze factors influencing patient outcomes.

TOP: Managing Secondary Care: Spirituality MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. Some cultures see personal touching as an insult unless you are intimately related. In the acute care setting, the need for touching to administer care may produce what within the patient? a. Cultural strain b. Impaired functioning c. Cultural insult d. Increased self-care deficit ANS: A Cultural strain may be manifested in the patient’s responses to the surroundings or to the plan of care. One culturederived concept is personal space, the distance surrounding a person considered to be part of his or her identity.

Personal space is generally thought to be between 1 and 3 feet around a person, depending on cultural upbringing and personal interpretation. A breach of that space by objects or another person may cause discomfort and stress.

Impaired functioning, cultural insult, and increased self-care deficit are not discussed in relation to cultural needs and influences.

DIF: Cognitive Level: Analysis OBJ: Analyze factors influencing patient outcomes.

TOP: Managing Secondary Care: Culture MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. By allowing the ICU patient’s family to visit as often as the patient’s condition will allow, the nurse is considering which type of need within the patient and his family? a. Trust

b. Social support c. Environmental d. Dependence

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ANS: B The acute care facility is a stressor to both patient and family. It can isolate the patient from the social support systems that he or she has in place. The needs of the family may not appear to be a priority for the nurse in planning the patient’s care, but they must be considered for the patient to receive ample social support. The rest of the family is facing some of the same stresses as the hospitalized family member. Trust, environmental, and dependence needs are N not related to social needs and influences.

DIF: Cognitive Level: Analysis OBJ: Analyze factors influencing patient outcomes.

TOP: Managing Secondary Care: Social MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7. The nurse is listening to a lecture on discharge planning. Which statement indicates that the teaching has been effective? a. “Discharge planning involves assessing the patient’s plan of care to determine whether the outcome criteria are met.” b. “Discharge planning involves evaluation of whether the patient and family can continue with the necessary interventions or whether they need assistance.” c. “Discharge planning involves obtaining specific orders from the physician to begin the process of discharge planning.” d. “Discharge planning involves assessing the level of the patient’s understanding with regard to his or her illness state and treatment regimen.”

ANS: C Discharge planning requires assessing the patient’s plan of care to determine whether the outcome criteria are met. If a need exists for continuation of the plan of care, then the RN must evaluate whether the patient and family can continue with the necessary interventions or whether they need assistance. If the patient and the family are able to continue the plan of care, discharge teaching with regard to the continued care is needed. Discharge teaching will require the RN to assess the level of the patient’s understanding with regard to his or her illness state and treatment regimen. There is no need to obtain an order to begin this process.

DIF: Cognitive Level: Evaluation OBJ: Identify outcome priorities for secondary care.

TOP: Discharge Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

8. The nurse is listening to a lecture on the health maintenance focus for the patient in tertiary care. Which statement indicates that the teaching has been effective? a. “The focus in tertiary care is to regain or attain as much independence as possible.” b. “The focus in tertiary care is to extend the time in tertiary care as long as possible.” c. “The focus in tertiary care is to ensure total independence with self-care.” d. “The focus in tertiary care is to avoid acquired infections while in the tertiary facility.”

ANS: A The health maintenance focus of tertiary health care is to ensure that the patient regains or attains as much independence as possible. Time in tertiary care is only as long as necessary. The purposes of tertiary care are to provide health restoration and maintenance and to continue with health promotion. It is recognized that patients will require some level of dependent care. Avoiding infections in tertiary care facilities is not discussed.

DIF: Cognitive Level: Evaluation N OBJ: Define the purposes of tertiary care.

TOP: Tertiary Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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9. A stroke patient has been discharged from the hospital and requires care at home. Family support includes the patient’s husband and one adult child who lives 90 minutes away with her family, who helps as often as possible.

The husband has had to miss work often and has stopped playing golf weekly to care for his wife. What tertiary care service may be a benefit not only to the family members but to also the patient? a. Home health care b. Respite care c. Hospice care d. Extended care ANS: B Long-term care of a patient can take a toll on family members. Respite care describes services provided by trained individuals for the care of people with special needs and can be given within the home or through adult day care centers. It is intended to offer the patient’s family members time off from their dependent-care duties. Home health care services provide assistance for short periods of time after discharge home with a variety of services including physical therapy, respiratory therapy, or occupational therapy. The need for care is generally assessed with an intake interview by an RN case manager. The level of care and treatment are then determined accordingly. Hospice care helps patients and family cope with the end-of-life experience. Patients are referred to hospice when a patient has approximately 6 months or less to live.

DIF: Cognitive Level: Application OBJ: Define the purposes of tertiary care.

TOP: Tertiary Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A patient has endured 3 years of treatment for colon cancer but recently learned that the cancer has spread to her liver and bone. The patient and her family have learned she may have less than 6 months to live and there is nothing medically to consider. What tertiary service can the RN suggest to the patient and family? a. Hospice care b. Wound care c. Home health care d. Ostomy care ANS: A Hospice care helps patients and family cope with the end-of-life experience. Patients are referred to hospice when a patient has approximately 6 months or less to live. The RN assesses the continued needs of the patient and works with the physician to provide comfort N measures for the patient. The goal of hospice care is the patient’s peaceful and dignified death. Wound care and ostomy care are not discussed. Home health care services provide assistance for short periods of time after discharge home with a variety of services including physical therapy, respiratory therapy, or occupational therapy. The need for care is generally assessed with an intake interview by an RN case manager. The level of care and treatment are then determined accordingly.

DIF: Cognitive Level: Application OBJ: Define the purposes of tertiary care.

TOP: Tertiary Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A patient has been discharged home after being hospitalized for a fractured foot following a motor vehicle accident.

The doctor has ordered physical therapy for the patient to help gain strength and flexibility after the cast can be removed. This patient will likely receive a referral for what tertiary service? a. Respite care b. Home health care c. Wound care d. Rehabilitation care ANS: B Home health care services provide assistance for short periods of time after discharge home with a variety of services including physical therapy, respiratory therapy, or occupational therapy. The need for care is generally assessed with an intake interview by an RN case manager. The level of care and treatment are then determined accordingly. Respite care describes services provided by trained individuals for the care of people with special needs and can be given

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within the home or through adult day care centers. It is intended to offer the patient’s family members time off from their dependent-care duties. Wound care and rehabilitation care are not discussed.

DIF: Cognitive Level: Application OBJ: Define the purposes of tertiary care.

TOP: Tertiary Care MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. Which of the following is an example of a responsible resource manager in an acute care facility? a. Listens to staff input about implementing a new procedure b. Consumes foods and drinks kept on the unit for patients c. Considers the unit’s patient census when determining staffing d. Uses supplies that are not accounted for ANS: C Nurses are responsible for recognizing that limited funds are available to provide acute health care. Within limits set by administration, staffing mixes, and restrictions on equipment and supplies, the RN must provide the patient with consistently safe and effective care, including managing resources. Listening to staff input is an example of a democratic style of leadership, not a way to manage resources. Staff consumption of patients’ nutrition items and failure to bill for supplies used for patient care are examples of poor resource management.

N DIF: Cognitive Level: Application OBJ: Identify outcome priorities for secondary care.

TOP: Managing Secondary Care: Clinical Pathways MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. Spiritual assessment is not usually a part of a formal assessment tool, with the exception of asking about religious practices that may be important to continue in the hospital. Which question addresses religious practices? a. “Would you like a chaplain to come pray with you?” b. “Do you turn to spiritual guidance as a source of strength in illness?” c. “What helps you most when you feel afraid?” d. “What is most frightening about your situation?”

ANS: A Asking about a chaplain is assessing whether the patient requires a spiritual guide by his or her side. Religious beliefs may affect the patient’s willingness to participate in the medical plan of care. The plan of care must be respectful of the patient’s beliefs while still providing the optimal environment for recovery. Asking about spiritual guidance as a source of strength, what helps most when afraid, and what is most frightening are not specific to religious beliefs.

DIF: Cognitive Level: Application OBJ: Analyze factors influencing patient outcomes.

TOP: Managing Secondary Care: Spirituality MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. In what way(s) do clinical pathways help nurses to manage patient care? (Select all that apply.) a. Evaluate long-term care facilities. b. Enable consistently safe care. c. Manage the resources of the health care facility. d. Define standard assessment data and frequency for data collection. e. Review patient charts for quality improvement opportunities.

ANS: B, C, D A clinical pathway is a standardized care map that defines nursing care, outcome criteria, and evaluation time frames for specific disorders. Clinical pathways are designed to manage the resources of the health care agency, as well as

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enable consistent, safe care for patients. A clinical pathway defines the standard assessment data and frequency of the collection of the data needed for a specific illness or surgical procedure. The responsibility of the RN is to evaluate the effectiveness of the plan of care and the patient’s progress toward discharge. Evaluation of long-term care facilities and reviewing of patient charts for quality improvement are not discussed.

DIF: Cognitive Level: Analysis OBJ: Identify outcome priorities for secondary care.

TOP: Managing Secondary Care: Clinical Pathways MSC: NCLEX: Safe and Effective Care Environment: Management of Care

N

Chapter 17: Reflecting on Your Transition

MULTIPLE CHOICE 1. A toddler is brought to the well-child community clinic by her grandmother. The health history reveals recurrent nausea, vomiting, and diarrhea. Her physical exam reveals a negligible gain in height and weight, lethargy, and a delay in achieving milestones. As a result of the child’s delays, multiple disciplines would likely be involved in caring for the child. Which of the following represents the most effective role the nurse would play in caring for the child? a. Coordinator b. Teacher c. Counselor d. Advocate ANS: A One of nursing’s major contributions to the health care team is the role of the coordinator. Care can easily become fragmented when patients are seen by numerous specialists, each interested in a different aspect of the patient. A major risk of this situation is that the orders of different specialists may conflict with one another and be counterproductive. Therefore, it is important for the nurse to make rounds with other health care professionals and to read the results of the various consultations. The nurse can help interpret the specialists’ findings for the patient and family, prepare the family to participate in the patient’s plan of care, and serve as a liaison among the members of the health care team. Nurses also play the roles of teacher, counselor, and advocate, but this patient requires coordination of care.N DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

2. A 43-year-old patient is scheduled for a laparoscopic cholecystectomy. A nurse has a plan to teach the preoperative patient how to splint his abdomen with a pillow and cough and deep breathe, so the patient can avoid fluid accumulation in the lungs postoperatively. When the nurse enters the room, it becomes evident that the patient is blind. What critical thinking skill would you recommend a scenario like this requires? a. Intellectual curiosity b. Flexibility c. Reflection d. Open-mindedness

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ANS: B Flexibility is the critical thinking skill that the nurse needs to teach the necessary information to the blind patient. In developing critical thinking, a graduate RN is encouraged to seek out situations that require thinking outside of the box to enhance and broaden the graduate RN’s nursing knowledge and experience. Intellectual curiosity, reflection, and open-mindedness are also skills of critical thinking but are not applicable to this scenario.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. It is 0800 and the nurse just received report. Which patient situation demands the nurse’s immediate attention? The patient a. with a blood glucose of 200.

b. who needs a 0800 vancomycin level drawn. c. receiving a blood transfusion who reports slight itching and chills. d. with a serum potassium level of 4.3 mEq/dL who is receiving digoxin.

ANS: C Slight itching and chills during a blood transfusion may indicate an allergic reaction and require immediate attention.

A blood glucose of 200 and the need for a vancomycin level will eventually need attention. A potassium level of 4.3 mEq/dL is within normal range.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. A patient who had recent abdominal surgery is becoming increasingly agitated and confused. He has pulled out his IV and his nasogastric tube. His skin is pale and clammy, heart rate 120 bpm, BP 130/60. The physician has been called. What nursing action is most important at this time? a. Gather needed supplies and assign the aide to remain with the patient. b. Stay with the patient and have another nurse obtain needed supplies. c. Administer pain medication and then recheck vital signs.N d. Assign the aide to retake vital signs every 15 minutes.

ANS: B Staying with the patient while another nurse obtains needed supplies is the best action because the patient’s condition is deteriorating. Asking the aide to stay with the patient and assigning the aide to take vital signs every 15 minutes are inappropriate delegations. Administering pain medication is an incorrect action because the patient is not complaining of pain.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. Which patient is at greatest risk for injury and requires the nurse’s immediate attention? The patient who had a(n) a. paracentesis 20 minutes ago and is sitting in bed with the arms resting on the overbed tray. b. surgical repair of an incarcerated hernia yesterday and now has slight bruising at the incision site. c. echocardiogram that showed an ejection fraction of 40% and has a resting heart rate of 110 occasional PVCs. d. needle liver biopsy 1 hour ago and is now thrashing about in bed and complaining of severe abdominal pain.

ANS: D

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The only scenario that illustrates a major risk for injury is the patient who had a needle liver biopsy 1 hour ago and is now complaining of severe abdominal pain. The patient may be bleeding internally, requiring immediate attention.

The other scenarios illustrate normal expectations.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. What could a nurse say who believed that a nursing student has a duty to understand pertinent clinical information to make sound clinical judgments?

“Sometimes work does get in the way of studying.”

“Nursing school is difficult, and striving for average is understandable.”

“You should be honest when critically reflecting on your strengths and weaknesses.”

“Experience after nursing school will provide real nursing knowledge.”

a. b. c. d.

ANS: C Being honest with yourself when reflecting on strengths and weaknesses is paramount in developing a plan that focuses on your problem areas. A problem can be resolved only after you know the reasons behind it. Your strengths will also help in becoming the best nurse you can be. Allowing your studies to be put aside, striving for average, and believing that real nursing knowledge comes only from experience after nursing school will defeat the goal of becoming the best you can be.

DIF: Cognitive Level: Synthesis N OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. As a graduate nurse, which statement strongly suggests future success in the current nursing practice environment? a. “I am really good at performing nursing skills.” b. “I always get my work done on time.” c. “When possible I attend all staff meetings.” d. “I am actively involved in decision-making on the unit.”

ANS: D To be a part of the profession of nursing, you must set goals that advance your professional development, building up your knowledge, skill, and critical thinking abilities. Becoming a professional means establishing yourself as capable, competent, and safe. It also means that you act to advance the practice of nursing through your actions and your skills. Being professional is more than just being licensed as an RN. Being good at performing nursing skills, promptly completing work, and attending staff meetings are expectations of a proficient nurse.

DIF: Cognitive Level: Synthesis OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. Which of the following is an example of an anxiety-causing situation below that is potentially caused by a role transition from licensed practical nurse/license vocational nurse (LPN/LVN) to RN? a. A shift assignment of four patients b. Managing care based on your knowledge and skills c. Changing work shifts from days to nights d. Delegating tasks to LPNs/LVNs and medical assistants

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ANS: B Change can provoke anxiety, especially at the initiation of a whole new direction in life. Within your nursing program, you have been guided and had a safety net. Now you are going to be making decisions on your own, with patients and a team depending on you. You will be required to manage care based on the soundness of your knowledge and skills. This alone could be a source of anxiety and could give you pause.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

9. The patient reports intense pain and rates it 10/10. He is talking and laughing on the telephone but interrupts his conversion to request pain medication. The nurse would make a decision about the administration of medication based on which indicator of pain? a. The patient’s body language and emotional state b. The patient’s level of activity and interaction with others c. The patient’s subjective statements about the pain

d. The nurse’s objective data regarding the physical characteristics of the painN ANS: C The choice of the patient’s subjective statements about the pain is correct. With pain, regardless of how the patient behaves, the patient’s comments and rating of his pain assist the nurse in making the decision to administer pain medication. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patient’s medical and nursing problems.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. The nurse asks a hospitalized patient to sign the operative consent. The patient tells the nurse, “I do not really understand what is involved in the surgery.” The nurse should a. postpone the consent form signing and notify the operating room that the anesthesiologist needs to discuss the surgery with the patient. b. explain what the planned surgical procedure entails before having the patient the sign the consent form. c. have the patient sign the form and ask the health care provider to visit the patient before surgery to explain the procedure further. d. delay the patient’s signature on the consent form and notify the surgeon that the informed consent process is not complete.

ANS: D The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate with the surgeon directly about the consent form. It is not within the nurse’s legal scope of practice to explain the surgical procedure.

Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role.

These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patient’s medical and nursing problems.

DIF: OBJ:

Cognitive Level: Application Apply the nursing process to transitioning from LPN/LVN to RN.

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Test Bank - LPN to RN Transitions [5E, Claywell]

MSC: NCLEX: Safe and Effective Care

11. If a patient refuses a medication or is undergoing a diagnostic test that results in a missed dose of medication, the nurse will document the omission on the medication administration record and a. discontinue the physician’s order. b. document why the dose was not given. c. write an incident report. d. double the dose at the next scheduled administration time.

N ANS: B Document what was done. Do not document before performing an intervention. The nurse is not authorized to discontinue any physician’s order or to double the dose of medication unless directed by the physician. Missing a medication dose does not warrant an incident report. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patient’s medical and nursing problems.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A patient weighed 200 lb 6 months ago. He now weighs 160 lb. He has not been trying to lose weight. Based on the defining characteristics of nutrition, less than body requirements, the nurse’s best response would be a. “You need to modify your diet so you don’t lose more weight.” b. “That is a significant weight loss. How would you account for it?” c. “Congratulations. That is a major achievement.” d. “How tall are you? I am wondering if that is a good weight for your height.”

ANS: B Acknowledging the weight loss and asking how the patient could account for it are respectful and allow the patient to express himself freely without judgment. The other responses are insensitive and/or limiting in patient responses. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patient’s medical and nursing problems.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. The nurse enters the room of a sleeping patient to administer the 0200 dose of antibiotic that has been ordered every 6 hours. Which action would most effectively maintain a therapeutic blood level of this medication? a. Administer the medication whenever the client awakens. b. Omit this dose and chart the reason for doing so. c. Awaken the patient and administer the medication. d. Let the patient sleep and double the next dose.

ANS: C

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Giving the ordered medication on time will maintain the patient’s therapeutic blood level. Administering the medication or omitting the medication will interfere with this. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to N design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patient’s medical and nursing problems.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. The nurse is to take a meal tray to a patient the nurse knows nothing about. Before leaving the tray with the patient, which is the most critical safety factor the nurse should determine? a. The room is neat and orderly without offending odors. b. The tray has condiments placed within easy reach. c. The patient is seated securely and in a comfortable position. d. The patient’s ability to swallow is intact.

ANS: D The primary goal for any nurse is delivery of safe patient care. Confirming the patient’s ability to swallow is critical before leaving a meal tray in reach. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patient’s medical and nursing problems.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

15. A nurse notices that the respiratory therapist assigned to his unit frequently forgets to raise the bed rails after completing treatments. The nurse’s best action is to a. ask other nurses whether they have noticed the same problem.

b. discuss the problem with the therapist. c. report the problem to the nurse in charge. d. report the problem to the director of respiratory therapy.

ANS: B Discussing a problem directly with the person involved is a respectful and professional action. Specifically, handling this problem directly and promptly ensures patient safety. Asking others whether they have noticed the same problem does nothing to ensure patient safety. Reporting the problem to the charge nurse or the respiratory therapy director may be necessary if a direct conversation with the respiratory therapist proves futile.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

16. A nurse is assigned to care for an elderly, confused patient. The patient’s son is sitting at the bedside and is watching a loud television program. The nurse needs to complete the respiratory and cardiac assessment and vital signs. What would be the best approach to this N situation? a. Do not say anything. Just do the best you can with the TV on loud.

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Test Bank - LPN to RN Transitions [5E, Claywell]

b. Say: “That TV is too loud for me to do my work. You have to shut it off.” c. Say: “I’ll come back after you’ve finished watching this TV show. Can you use the call bell to let me know when it’s over?”

d. Say: “I need a quiet environment while I listen to your mother’s chest. I will need to turn the TV down until I’m finished.”

ANS: D The primary goal for any nurse is delivery of safe patient care. The assessment is the nurse’s baseline determination of that patient’s condition and the basis for that shift’s plan of care. Working with the family and patient by explaining what the nurse needs can establish a trusting and cooperative rapport. Doing nothing accomplishes nothing. Directing the son to turn off the TV is not a professional response. The nurse manages the care of the patient.

Giving the son authority over the nurse’s duty to care for the patient is inappropriate.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A graduate RN on the telemetry unit is on the way to the nurse’s station to chart and suddenly hears from a patient’s room, “Help! Nurse!” This is not the nurse’s assigned patient. Others also hear this cry for help and quickly run in with the crash cart while the graduate RN looks on. In planning care for this patient, the beginning RN must realize the importance of identifying and (Select all that apply) a. arranging experiences. b. correcting weaknesses. c. investigating insights. d. leveraging strengths. e. applying poise. f. accepting doubts.

ANS: B, D In planning care, pointing out and leveraging strengths is as important as identifying and correcting weaknesses.

Capitalize on your strengths in your plan of action as tools to be built on. Your strengths will also assist you in your quest to become the best you can be. As a graduate from a mobility program, not needing to concentrate on practicing basic psychomotor skills, you will be more open to the evolving changes in the conditions that define the needs of your patient. Thus your unique set of strengths has enhanced a critical component of your ability to provide safe, effective care. Identifying and arranging experiences, identifying and investigating insights, identifying and applying poise, and identifying and accepting doubts were not discussed.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care N 2. Which comments by the graduate RN are examples of interventions that will lead to a successful transition into professional nursing? (Select all that apply.) a. “May I care for patients with COPD? I feel I need more experience with that pulmonary condition.” b. “How should I prioritize my five patients in order of importance?” c. “Thanks for your insights about knowing when to appropriately call the physician.” d. “Now that my new role is as an RN, I would like to be treated as any new graduate RN although I’ve worked here as a LVN for 3 years.” e. “I’m so nervous every day I come to work, hoping nothing happens to my patients.”

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Test Bank - LPN to RN Transitions [5E, Claywell]

ANS: A, C, D Certain common interventions can be helpful in your role transition. Because learning is better when it has direct application or when it will be used soon after it has taken place, one intervention is to request assignment that complements your area of need. You will learn more about complications of hypertension, for example, if you take a patient with hypertension than if you just read about them. Another way to enhance your knowledge base is to ask your mentor or preceptor questions that help you understand how he or she arrived at a conclusion of decision. It will be important to communicate with your nurse manager or director when your role changes from that of LPN/LVN to RN. Asking assistance in prioritizing the nurse’s patient assignments is a rudimentary exercise at this point in role transition. Feeling a little nervous at work may give a graduate RN the alertness to anticipate changes in condition, but too much nervousness may be debilitating, giving the impression of a lack of confidence.

DIF: Cognitive Level: Application OBJ: Apply the nursing process to transitioning from LPN/LVN to RN. TOP: Transition and the Nursing Process MSC: NCLEX: Safe and Effective Care Environment: Management of Care

N

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Test Bank - LPN to RN Transitions [5E, Claywell]

Chapter 18: Prepare Now to Pass NCLEX-RN®

MULTIPLE CHOICE

1. A nursing student is giving a presentation on the different organizations that support nurses. She has an adequate understanding of the American Nurses Association when she states, “The American Nurses Association a. sets the guidelines for entrance into nursing programs.” b. represents and advocates for nurses.” c. evaluates and updates licensure exams.” d. determines who is eligible to take the NCLEX exam.”

ANS: B The American Nurses Association represents and advocates for nurses. The National Council of State Boards of Nursing evaluates and updates licensure exams to ensure that all nurses who enter into practice meet the minimum requirement for knowledge and skills. Individual schools of nursing set the guidelines for entrance into nursing programs.

DIF: Cognitive Level: Application NCLEX-RN® Exam

OBJ: Discuss the development of the NCLEX-RN®. TOP: Evolution of the

2. A graduate nurse is submitting documentation so that she may take the NCLEX-RN within a few months. Which action shows an understanding of the content of the most updated test plan?

a. Spending additional study time reviewing health promotion and maintenance b. Taking a cardiology course before the examN c. Reviewing notes from previous nursing classes d. Setting aside time to study pathophysiology of the brain ANS: A The graduate nurse should be aware that the most updated NCLEX-RN test plan will cover health promotion and maintenance, among other areas.

DIF: Cognitive Level: Application Plan

OBJ: Discuss the development of the NCLEX-RN®. TOP: NCLEX-RN® Test

3. A faculty member is discussing question types found on NCLEX. The faculty member knows that students need more teaching about question types if they select which question type? a. Fill-in-the-blank b. Multiple choice c. Essay d. Completing calculations ANS: C Candidates will be asked to answer types of questions such as fill-in-the-blank, multiple choice, and drug calculations. Candidates will not be asked to write answers in essay format.

DIF: Cognitive Level: Application OBJ: Discuss the development of the NCLEX-RN®.

TOP: NCLEX-RN®–Style Test Items 4. A student is a month into her LPN-RN program. She realizes that proper studying is key to success and passing the NCLEX-RN exam. What would be the most appropriate action for the student to take when it comes to studying?

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a. b. c. d.

Test Bank - LPN to RN Transitions [5E, Claywell]

She should begin studying at the beginning of her program.

She should wait until she learns more about becoming an RN. She should begin studying after graduation so that she retains information better.

She does not have to study for the exam at all; she will learn everything in class.

ANS: A The student should begin studying for the NCLEX-RN at the beginning of her program in order to be the most prepared to take the exam on graduation. She should not wait until the end of her program to begin studying or assume that she will retain all information from class alone to pass the exam successfully.

DIF: Cognitive Level: Application Strategies for Testing Success

5.

OBJ: Prepare for the NCLEX-RN. TOP: Evidence-Based

Every 3 years the NCSBN conducts practice analysis to determine the expectations for entry level nurses who are newly licensed. The nurse manager understands and can state that nursing care activities are analyzed in relation to all of the following except a. frequency of performance. b. time commitment. c. impact on maintaining client safety. d. client care setting where the activities are performed.

ANS: B Frequency of performance, impact on maintaining client safety, and client care setting where the activities are performed are analyzed by the NCSBN. The time commitment of nursing N care is not one of the activities that are analyzed by the NCSBN. DIF: Cognitive Level: Application Testing

6.

OBJ: Discuss the development of the NCLEX-RN®. TOP: Computer Adaptive

A student is studying the KATTS Framework in class. She has offered to tutor a friend who is struggling to grasp the concept of the framework. She knows that her teaching has been effective when her friend states that the KATTS Framework consists of all of the following, except a. knowledge base. b. anxiety control. c. time management skills. d. test-taking skills.

ANS: C The KATTS Framework focuses on knowledge base, anxiety control, and test-taking skills for success.

DIF: Cognitive Level: Application OBJ: Apply evidence-based strategies to achieve NCLEX-RN success. TOP: KATTS Framework

7.

When taking an exam the student remains positive, steady, and able to handle tensions that build. The course instructor interprets the student’s behavior as a. confidence. b. control. c. common sense. d. content.

ANS: B

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Test Bank - LPN to RN Transitions [5E, Claywell]

Remaining positive and steady and handling tensions demonstrates control. Confidence relates to the student’s ability to believe in himself or herself. Common sense refers to listening to intuition. The content component refers to knowing the specific content that is being studied.

DIF: OBJ: Cs

8.

Cognitive Level: Analysis Apply evidence-based strategies to achieve NCLEX-RN success. TOP: The Five

Before beginning the exam, a student stops and reflects on the Five C’s: content, confidence, control, common sense, and comparison. Which statement made by the student indicates her understanding of confidence? a. “I know I can do this.” b. “I just need to remember what I studied.” c. “I just need to narrow down the right answer.” d. “What do I think is the right answer?” e. “Relax, stay calm and focused.”

ANS: A When the student stops before beginning an exam and thinks, “I know I can do this,” confidence is being demonstrated. The content component refers to knowing the specific content that is being studied. Comparison refers to narrowing down to the right answer. Common sense refers to listening to intuition. Remaining positive and steady and handling N tensions demonstrates control.

DIF: OBJ: Cs

9.

Cognitive Level: Application Apply evidence-based strategies to achieve NCLEX-RN success. TOP: The Five

It is helpful to understand the difference between school exams and the NCLEX-RN in order to ensure that you are prepared to succeed. The student demonstrates adequate understanding of the NCLEX-RN when she makes which statement? a. “The exam content will test only recall and recognition of knowledge.” b. “The exam will test my critical and higher thinking skills.” c. “The exam will test my understanding of basic nursing concepts.” d. “The exam will test my knowledge of how to care for patients in the hospital setting.”

ANS: B The NCLEX-RN specifically tests critical and higher thinking skills, in order to ensure that candidates meet the minimum criteria needed to practice safely.

DIF: Cognitive Level: Application OBJ: Apply evidence-based strategies to achieve NCLEX-RN success.

TOP: Evidence-Based Strategies for Testing Success 10. Students are applying the KATTS Framework in order to be successful in their nursing program. The instructor knows they are following the framework properly when they report which of the following? a. They are studying 1 hour for every 2 to 3 hours of question drill time. b. They are studying for 2 hours for every 2 to 3 hours of question drill time. c. They are studying in group for 3 hours total. d. They are engaged in question drill time for 2 to 3 hours per study session.

ANS: A Students should spend 1 hour on focus content review for every 2 to 3 hours of question drill time.

DIF:

Cognitive Level: Application

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Test Bank - LPN to RN Transitions [5E, Claywell]

OBJ: Apply evidence-based strategies to achieve NCLEX-RN success. TOP: KATTS Framework

11. The student is attending an information session on the NCLEX RN. Which statement indicates that teaching has been effective?

“If I am prompted to answer 265, I have failed the test.”

“The number of questions does not indicate whether or not I have passed the test.”

“The more questions I answer, the more likely I am to pass the test.”

“If I answer only 75 questions, I have passed the test.”

a. b. c. d.

ANS: B Students may either pass or fail the NCLEX-RN after completing 75 or up to 265 questions.

DIF: Cognitive Level: Evaluation TestingN

OBJ: Discuss the development of the NCLEX-RN®. TOP: Computer Adaptive

12. The student is attending a NCLEX RN workshop. Which statement indicates that the teaching has been effective? a. “Computer Adaptive Technology (CAT) testing is reliable and valid.” b. “CAT testing is difficult and tricky.” c. “CAT testing is inconclusive and time-consuming.” d. “CAT testing is easy and efficient.”

ANS: A Rigorous and ongoing testing continues to conclude that Computer Adaptive Testing is both reliable and valid. The NCSBN ensures this by continually evaluating tests and making changes as needed.

DIF: Cognitive Level: Evaluation Testing

OBJ: Discuss the development of the NCLEX-RN®. TOP: Computer Adaptive

13. The student is listening to a lecture on passing the NCLEX RN exam. Which statement indicates that the teaching has been effective? a. “The student should have good study habits.” b. “The student should have a positive attitude.” c. “The student should have a good support system.” d. “The student should have adequate sleep.”

ANS: B Having a positive attitude and believing in oneself are critical for students preparing for the NCLEX-RN exam.

DIF: Cognitive Level: Evaluation OBJ: Apply evidence-based strategies to achieve NCLEX-RN success. TOP: KATTS Framework

14. A student is designing a study plan to prepare for NCLEX. The student analyzes testing processes and determines which goal is the best preparation process?

Review the medical surgical book 15 minutes each day for each disease process in the book.

Answer 2500 to 3000 NCLEX-type questions before taking boards.

Make flash cards to study lab values.

Outline chapters for exams with a score of less than 80%.

a. b. c. d.

ANS: B

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Test Bank - LPN to RN Transitions [5E, Claywell]

Students should complete upward of 2500 NCLEX-RN-style questions to prepare adequately for the exam. Although reviewing the medical surgical book, making flash cards, and outlining chapters for exams with a score of less than 80% are also helpful, completing NCLEX-type questions is the best preparation process.

DIF: Cognitive Level: Application OBJ: Apply evidence-based strategies to achieve NCLEX-RN success.

TOP: Evidence-Based Strategies for Testing Success

15. Studies have found that students tend to answer questions at a slower pace as they proceed through exams. With this in mind, students should be aware of during school exams as practice for the NCLEX-RN. N a. what their classmates are doing b. the amount of time they are spending on each question c. the wording of each question d. which questions they answer first ANS: B Students should be aware of time as they take exams in school so that they can practice pacing themselves before taking the NCLEX-RN. DIF: Cognitive Level: Application OBJ: Apply evidence-based strategies to achieve NCLEX-RN success.

TOP: Evidence-Based Strategies for Testing Success MULTIPLE RESPONSE

1. The use of CAT has drastically changed the process of licensure testing. The graduate nurse understands this process when she makes which statements? (Select all that apply.) a. “The implementation of CAT allows me to choose what study material to use when testing.” b. “CAT allows me to choose a testing center that is close to my home.” c. “CAT gives me the flexibility to select a testing time and date that fits into my work schedule.” d. “CAT implementation allows me to schedule multiple testing dates, in case I cannot make one.” e. “CAT ensures easier questions than the older written tests.”

ANS: B, C With the implementation of CAT, students are able to make testing plans that accommodate their lifestyles. These choices include choosing a date/time to test, as well as a center that is most convenient for them. Students are not allowed to bring study material to use on the test or schedule multiple testing dates. CAT implementation does not ensure easier questions.

DIF: Cognitive Level: Application Technology

OBJ: Understand the evolution of the NCLEX-RN®. TOP: Computer Adaptive

2. A student is preparing to begin her final semester of nursing school. She is aware that academic and nonacademic factors can affect her ability to pass the NCLEX-RN. Which statements indicate an understanding of the nonacademic factors? (Select all that apply.) a. “My self-esteem can impact my performance on the exam.” b. “Having test anxiety can prevent me from testing well.” c. “My ability to focus on studying can lead to a pass or fail.” d. “Role strain is a factor in testing success.” e. “Being good at testing would certainly help me pass.”

ANS: A, B, D

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Test Bank - LPN to RN Transitions [5E, Claywell]

Self-esteem, test anxiety, and role strain are all nonacademic factors that can lead to the student’s ability to pass NCLEX-RN exam.

DIF: Cognitive Level: Application OBJ: Apply evidence-based strategies to achieve NCLEX-RN success.

TOP: KATTS Framework N

3. Students in a nursing class have just finished an exam on the KATTS Framework. The students should know that they can do which of the following, in order to strengthen the knowledge component of the KATTS Framework?

(Select all that apply.) a. Complete NCLEX-RN pretests. b. Review past NCLEX-RN test plans. c. Create a study plan, and then identify knowledge deficits. d. Reread textbooks from nursing courses. e. Focus studying on strong areas of knowledge.

ANS: A, B, C Completing NCLEX-RN pretests is a way for students to strengthen the knowledge component of the KATTS Framework. Students should review updated NCLEX-RN test plans and assess knowledge deficits before creating a study plan.

DIF: Cognitive Level: Application OBJ: Apply evidence-based strategies to achieve NCLEX-RN success. TOP: KATTS Framework

4. A group of nursing students is planning to utilize the KATTS Framework for their group study this week. In order to complete a drill set effectively, they should do which of the following? (Select all that apply.)

Complete a minimum of 50 questions within 1 hour, and work up to 100 questions in 2 hours.

Create a study plan for gaps in knowledge.

Understand the rationale for the both the correct and incorrect answers.

Analyze the results of the drill set, and look for gaps in knowledge.

Complete a minimum of 100 questions in 1 hour, and work up to 200 questions in 2 hours.

a. b. c. d. e.

ANS: A, B, C, D The steps for completing a drill set include completing a minimum of 50 questions in 1 hour and working up to 100 questions in 2 hours, analyzing the results of the drill set and looking for gaps in knowledge, understanding the rationale for the correct and incorrect answers, and creating a study plan for gaps in knowledge.

DIF: Cognitive Level: Application OBJ: Apply evidence-based strategies to achieve NCLEX-RN success. TOP: KATTS Framework

5. A graduate nurse is preparing to take the NCLEX-RN exam. She knows that which self-care activities that will help her pass the exam? (Select all that apply.) a. Getting adequate sleep at night

b. Eating a balanced diet c. Studying all night before the exam d. Consuming energy drinks to stay awake and focused ANS: A, B The graduate nurse should focus on self-care activities that will help her reach her goal of passing the NCLEX-RN exam. These include getting adequate sleep at night and eating a balanced diet. Staying up studying the night before the exam would be counterproductive, and consuming energy drinks is not a healthy self-care activity.N DIF: Cognitive Level: Application OBJ: Apply evidence-based strategies to achieve NCLEX-RN success.

TOP: KATTS Framework