Test Bank for Success in Practical-Vocational Nursing 10Ed.by Janyce Carroll & Lisa Collier

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TEST BANK

2022

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COMPLETE Elaborated Test Bank for Success in Practical/ Vocational Nursing 10Ed. Janyce L. Carroll Lisa Collier 2022

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Success in Practical/Vocational Nursing 10Ed.by Janyce L. Carroll, Lisa Collier ISBN-10 0323810179 ISBN-13 978-0323810173 Test bank for Success in Practical/Vocational Nursing 10Ed.by Janyce L. Carroll, Lisa Collier

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TABLE OF CONTENTS 1. Personal Resources 2. Academic Resources 3. Community Resources 4. How Practical/Vocational Nursing Evolved: 1836 to Present 5. Critical Thinking: A Lifelong Journey 6. Ethics Applied to Nursing: Personal vs. Professional Ethics 7. Nursing and the Law: What Are The Rules?

8. Straightforward Communication: Instructors, Patients, Family and the Interdisciplinary Team 9. Assertiveness: Your Responsibility 10. Cultural Uniqueness, Sensitivity, and Competence 11. Spiritual Needs, Spiritual Caring, and Religious Differences 12. Nursing Process: Your Role 13. Nursing Theory, Research, and Evidence-Based Practice 14. The Health Care Team: Where the LPN/LVN Fits In 15. Health Care Settings: Continuum of Care 16. Health Care System: Financing, Issues, and Trends 17. Collaboration: Leading and Managing 18. Work Force Trends: How to Find a First Job you Will Love 19. Licensure and Regulation: Know Your State Practice Act

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Chapter 01: Personal Resources of an Adult Learner Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. Which individual in a practical/vocational nursing class would be identified as a traditional adult learner? a. One who has been out of school for many years b. One who has children and grandchildren c. One who knows the routine of education d. One who is in his or her early 20s ANS: D

Traditional adult learners are individuals who come to the educational program directly from high school or another program of study. They are usually in their late teens or early 20s. The learner who has been out of school for many years and the learner who has children and grandchildren would be identified as a returning adult learner. The learner who knows the routine of education does not provide sufficient information for classification.

DIF: Cognitive Level: Application TOP: Adult Learner MSC: NCLEX: N/A

REF: p. 3 OBJ: 1 KEY: Nursing Process Step: N/A

2. A student enrolled in an LPN/LVN program states, “I’m fresh out of high school and living alone for the first time in my life. I’m learning how to take care of myself as well as learning to care for my patients.” This statement identifies the student as a. a traditional adult learner. b. a returning adult learner. c. someone in need of counseling. d. someone who is not accustomed to formal education.

ANS: A

Traditional adult learners are individuals who are in their late teens or early 20s who have come to the practical/vocational program directly from high school or another program of study. A returning adult learner is someone who has been out of school for several years. A person in needed of counseling is commonly a student who has been evaluated by the instructor as having areas that need improvement. This student is a traditional adult learner, and traditional adult learners are accustomed to formal education.

DIF: Cognitive Level: Analysis TOP: Adult Learner MSC: NCLEX: N/A

REF: p. 3 OBJ: 1 KEY: Nursing Process Step: N/A

3. A nursing student states, “I have taken advantage of informal learning experiences.”

Another student asks, “Could you give me an example?” The best example of an informal learning experience is a. caring for a disabled family member. b. taking a continuing education course. c. enrolling in an academic program. d. attending credit classes at the mall.

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ANS: A

Informal learning experiences are those that take place outside a formal educational setting. A person who cares for a disabled family member would gain knowledge and skill in providing personal care. An education course, academic program, and credited classes all take place in a formal educational setting.

DIF: Cognitive Level: Comprehension TOP: Informal educational experience MSC: NCLEX: N/A

REF: p. 3 OBJ: 2 KEY: Nursing Process Step: N/A

4. What strategy can be used by a nursing student to effectively combat a fear of failure? a. Picture in your mind the rewards of succeeding b. Positive self-talk c. Create a mental script of positive thoughts d. All of the above ANS: D

Picturing the rewards of succeeding, positive self-talk, and a mental script of positive thoughts all contribute a positive mental attitude and are all ways to combat the fear of failure.

DIF: Cognitive Level: Comprehension REF: p. 4 TOP: Promoting success in the program of study MSC: NCLEX: N/A

OBJ: 2 KEY: Nursing Process Step: N/A

5. An example of a self-talk “script” that promotes success in a practical/vocational nursing program is a. “I get sick from smelling bad odors.” b. “What if I’m ‘all thumbs’ in practice lab?” c. “I don’t think the instructor likes me.” d. “I work well with my hands.”

ANS: D

The statement “I work well with my hands” is a positive thought. It focuses on a strength and promotes the expectation that the individual will succeed. All other options are examples of negative thinking that create expectations for problems and failure.

DIF: Cognitive Level: Analysis TOP: Hidden dangers MSC: NCLEX: N/A

REF: p. 3 OBJ: 2 KEY: Nursing Process Step: N/A

6. Select the factor common to ALL types of adult learners that predisposes them to success in a nursing program. a. They have few responsibilities at home. b. They have the motivation to succeed. c. They automatically qualify for financial aid. d. They have few daily distractions.

ANS: B

The only statement applicable to all types of adult learners is that the majority is motivated to succeed. The other factors may be applicable to one or two classifications of learners but not to all three.

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DIF: Cognitive Level: Comprehension TOP: Factors predisposing to success MSC: NCLEX: N/A

REF: p. 4 OBJ: 2 KEY: Nursing Process Step: N/A

7. When a class of nursing students discusses their concerns about their program, the concern shared by most learners is generally the fear of a. succeeding. b. economic problems. c. failure. d. ridicule.

ANS: C

Some degree of fear of failure is nearly universal and often relates to earlier failures or setbacks the learner has experienced in other educational settings. Few individuals are afraid of succeeding. Uncertainty about economic issues is common among students but is not as universal as fear of failure. Fear of ridicule is rarely a concern; if present, it is usually superseded by fear of failure.

DIF: Cognitive Level: Analysis TOP: Hidden dangers MSC: NCLEX: N/A

REF: p. 4 OBJ: 2 KEY: Nursing Process Step: N/A

8. The First Amendment of the U.S. Constitution guarantees students the right to a. graduate from a program. b. fail an academic program. c. express oneself in class. d. have unlimited absences.

ANS: C

The First Amendment provides for freedom of expression as long as what is expressed does not disrupt class or infringe on the rights of peers. The remaining options are topics that are not addressed by this amendment.

DIF: Cognitive Level: Knowledge TOP: Learner rights MSC: NCLEX: N/A

REF: p. 6 OBJ: 6 KEY: Nursing Process Step: N/A

9. Which amendment to the U.S. Constitution protects the learner from being asked to leave an educational program without due process? a. Eleventh b. Twelfth c. Thirteenth d. Fourteenth ANS: D

The Fourteenth Amendment guarantees due process. The learner has the right to defend himor herself if charged with a violation of policy or rules. The Eleventh, Twelfth, and Thirteenth amendments do not address due process.

DIF: Cognitive Level: Knowledge TOP: Learner rights

REF: p. 6 OBJ: 6 KEY: Nursing Process Step: N/A

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MSC: NCLEX: N/A

10. When a nursing student expresses concern about being dismissed unfairly from the program, the most effective peer response would be a. “Better get over being so negative.” b. “You have rights under the Fourteenth Amendment.” c. “Watch what you say in class to reduce this possibility.” d. “Instructors really do have control over what happens.”

ANS: B

The Fourteenth Amendment guarantees due process to the student. The learner has the right to defend him- or herself if charged with a violation of program policy or rules. The other statements are not the most effective responses to give a student concerned with being unfairly dismissed.

DIF: Cognitive Level: Application TOP: Learner rights MSC: NCLEX: N/A

REF: p. 6 OBJ: 6 KEY: Nursing Process Step: N/A

11. A nursing student monopolizes class discussions. Which statement about the situation is most accurate? a. The student is violating the rights of others to participate in class. b. The student is demonstrating interdependency with the instructor. c. The student is demonstrating passive learning strategies. d. The student is at risk for being immediately terminated.

ANS: A

The First Amendment provides the right to freedom of speech as long as what is said does not disrupt the class or infringe on the rights of other students. In this case, the student who monopolizes discussion is violating the right of free expression by others in the class.

Interdependency involves a student who is actively involved in his or her own learning and who has a collaborative relationship with the instructor. A passive learner is someone who is not actively involved in his or her own learning. The Fourteenth Amendment assures the student due process, meaning that first the student must be charged with a violation and presented with evidence of misconduct. The student will be entitled to state his or her case.

DIF: Cognitive Level: Analysis TOP: Learner rights MSC: NCLEX: N/A

REF: p. 6 OBJ: 6 KEY: Nursing Process Step: N/A

12. Which remark by a student in a nursing program verbalizes a strategy that promotes success in the program? a. “I set goals and work to achieve them.” b. “I avoid interacting with instructors.” c. “I spend 2 to 3 hours daily surfing the net.” d. “I limit my partying to 3 to 4 nights a week.”

ANS: A

Setting goals and working to implement them is a strategy associated with active, self-directed learning and will promote success. The other responses refer to behaviors that are not conducive to success, such as avoiding the facilitators of your learning (instructors) and demonstrating poor time management skills.

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DIF: Cognitive Level: Analysis TOP: Active learning MSC: NCLEX: N/A

REF: p. 8 OBJ: 5 KEY: Nursing Process Step: N/A

13. Which statement is true regarding the teaching/learning process in practical/vocational nursing? a. If the student fails, the instructor is ultimately at fault. b. By asking questions, the student interferes with the instructor’s work. c. The student has little responsibility when it comes to evaluation. d. The student is responsible for preparing for theory classes and clinical experience.

ANS: D

Advance preparation provides a basis for continued learning in the classroom. It provides the learner the opportunity to ask relevant questions about theory. Preparation prior to clinical experience safeguards patients’ safety. If students fail, it is their own fault; students have responsibility for their own learning. A key responsibility of learners is to receive and participate in evaluation; it plays an important role in their education and throughout their career. Instructors are responsible for creating an environment in which learning can take place, and a critical part of this is being available to assist with questions and problems that students cannot solve.

DIF: Cognitive Level: Analysis TOP: Learner responsibilities MSC: NCLEX: N/A

REF: p. 11 OBJ: 5 KEY: Nursing Process Step: N/A

14. A student who wishes to use research findings regarding the best way for students to learn will a. stay up late each night and study. b. actively participate in the learning process. c. sit passively during each lecture session. d. cram before each examination.

ANS: B

Studies have shown that people learn best when they are actively involved in their own learning and have an interdependent relationship with the instructor. The remaining options are counterproductive behaviors.

DIF: Cognitive Level: Application TOP: Learner responsibilities MSC: NCLEX: N/A

REF: p. 7 OBJ: 5 KEY: Nursing Process Step: N/A

15. When explaining the responsibility of the learner to a group of nursing students, a mentor should emphasize that the learner’s first priority is to a. absorb the knowledge taught by the instructor. b. be self-directed and active in the process of learning. c. study only what the instructor emphasizes in class. d. focus on learning 65% of the information that is taught.

ANS: B

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Studies have shown that people learn best when they are actively involved in their own learning and have an interdependent relationship with the instructor. Absorbing the knowledge taught by the instructor describes passive learning. Studying only what the instructor emphasizes in class and focusing on learning 65% of the information that is taught are approaches that severely limit learning; students must be self-directed and curious in their learning.

DIF: Cognitive Level: Application TOP: Active learning MSC: NCLEX: N/A

REF: p. 7 OBJ: 5 KEY: Nursing Process Step: N/A

16. Which statement best describes an active learning situation? a. The learner practices bed-making. b. The learner watches a peer make a bed. c. The learner watches the instructor make a bed. d. The learner pays attention during lecture.

ANS: A

Active learning requires the learner to gain knowledge and skill by his or her own efforts. A learner who participates takes an active role. The other options all describe passive learning situations.

DIF: Cognitive Level: Analysis TOP: Active learning MSC: NCLEX: N/A

REF: p. 8 OBJ: 5 KEY: Nursing Process Step: N/A

17. What understanding about the goal of evaluation would be most helpful to a student in a nursing program? a. Evaluation lowers learner self-esteem. b. Evaluation ridicules student performance. c. Evaluation identifies behaviors that stand in the way of meeting goals. d. Evaluation informs the learner of things that annoy the instructor.

ANS: C

Progression toward goal attainment is identified by evaluation. During the process, behaviors that stand in the way of goal attainment are identified, along with strengths of performance.

Evaluations should not lower self-esteem, ridicule the student, or point out behaviors the instructor finds annoying as these will not help the student attain his or her goal.

DIF: Cognitive Level: Analysis TOP: Role of evaluation MSC: NCLEX: N/A

REF: p. 8 OBJ: 7 KEY: Nursing Process Step: N/A

18. Which learner is fulfilling an important student responsibility when receiving examination results? a. The student who looks at the test grade and hands the test and answer sheet back b. The student who argues each wrong answer with the instructor c. The student who tries to understand mistakes made on the test d. The student who appears interested in the test results ANS: C

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Tests should be considered learning experiences. Learners should look at tests with the goal of understanding why incorrect answers are wrong, as well as the rationale for correct answers.

Looking at the test grade and handing the test and answer sheet back are not optimal learning behaviors. Arguing each wrong answer with the instructor does not promote the openness required for optimal learning. Appearing interested in the test results does not promote learning.

DIF: Cognitive Level: Analysis TOP: Tests as a learning opportunity MSC: NCLEX: N/A

REF: p. 8 | p. 9 OBJ: 5 KEY: Nursing Process Step: N/A

19. To explain clinical evaluation to a new student, what information would best describe where responsibility for the process of clinical evaluation lies? a. The instructor evaluates the student’s performance in the clinical area. b. Peers evaluate change in clinical skills in each other in the clinical area. c. The student continuously monitors his or her performance of selected clinical skills. d. Clinical evaluation is a shared responsibility between instructor and student.

ANS: D

The instructor is responsible for evaluating student performance, and the learner is responsible for becoming aware of clinical behaviors and modifying the behaviors that hinder goal attainment. The other options do not address responsibility; they are ways an instructor or student can identify strong behaviors and behaviors that need improvement.

DIF: Cognitive Level: Analysis TOP: Clinical evaluation MSC: NCLEX: N/A

REF: p. 9 OBJ: 7 KEY: Nursing Process Step: N/A

20. Learner A is concerned about the clinical evaluation component of the nursing program. A peer could help alleviate anxiety by explaining that the purpose of clinical evaluation is to a. assist the learner to identify strengths and areas needing improvement. b. provide constructive criticism related to poor performance behaviors. c. keep unsuitable persons from achieving licensure. d. help learners develop the ability to listen to negative comments about performance.

ANS: A

Identifying positive behaviors allows them to be reinforced, and identifying areas needing improvement fosters modification of the negative behaviors. Providing constructive criticism related to poor performance behaviors refers to only half of the purpose. Keeping unsuitable persons from achieving licensure is not the purpose, because early identification and change in negative behaviors foster ultimate success in the program. Helping learners develop the ability to listen to negative comments about performance is not a purpose of the clinical performance evaluation.

DIF: Cognitive Level: Application TOP: Clinical evaluation MSC: NCLEX: N/A

REF: p. 9 OBJ: 7 KEY: Nursing Process Step: N/A

21. Which statement by a nursing student is an example of self-evaluation? a. “The other student forgot to use a bath blanket.”

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b. “I contaminated my glove on the edge of the bed.” c. “The staff nurse was abrupt with the resident.” d. “It was nice to be complimented by my instructor.”

ANS: B

Awareness of one’s actions is a component of self-evaluation. Noticing a breach of sterile technique during performance of a clinical skill is an excellent example of self-evaluation.

“The other student forgot to use a bath blanket” describes evaluation of one student by another. “The staff nurse was abrupt with the resident” describes evaluation of a staff nurse by another person. “It was nice to be complimented by my instructor” is a reflection of feelings associated with being complimented, not self-evaluation.

DIF: Cognitive Level: Analysis TOP: Self-evaluation MSC: NCLEX: N/A

REF: p. 9 | p. 10 OBJ: 7 KEY: Nursing Process Step: N/A

22. Which student expectation of an instructor is reasonable? a. The instructor will help resolve the student’s personal problems. b. The instructor will motivate the student to improve grades. c. The instructor will seek out students to review examinations. d. The instructor will provide academic counseling.

ANS: D

Providing academic counseling or making referrals for academic counseling is a responsibility of faculty members. The other options are not reasonable expectations. Only the individual with the problem can resolve it, albeit with assistance from another. Motivation is an internal factor for the student. It is the learner’s responsibility to seek out the instructor for examination review.

DIF: Cognitive Level: Analysis TOP: Faculty responsibility to students MSC: NCLEX: N/A

REF: p. 10 OBJ: 7 KEY: Nursing Process Step: N/A

23. The practical/vocational nursing student asks an instructor, “How perfect do I have to be to pass my clinical evaluation? Are any mistakes allowed?” The best response by the instructor is, “The expected standard of performance in clinical lab is to provide patient care a. at the level of an LPN/LVN.” b. with a minimum of two errors.” c. at the same level as your classmates.” d. with manual dexterity and confidence.”

ANS: A

Students are required to provide care at the same level of safe practice as the LPN/LVN. A lesser standard is not acceptable. This makes the importance of skill practice in the school’s practice laboratory understandable. Errors may affect patient safety. Provision of patient care at the same level as classmates is true only if the level of classmates is consistent with LPN/LVN safe practice. Provision of patient care with manual dexterity and confidence does not provide for safe practice.

DIF: Cognitive Level: Application REF: p. 11 TOP: Standard for level of practice by students MSC: NCLEX: N/A

OBJ: 7 KEY: Nursing Process Step: N/A

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24. A nursing student tells a peer, “I’m having trouble understanding the rationale for not restraining confused patients.” The best advice for the peer to offer would be a. “Ask the smartest student in the class.” b. “Ask a patient for his or her view about it.” c. “Ask the instructor to explain it again.” d. “Do an Internet search.”

ANS: C

This response reflects the student’s responsibility for seeking faculty help when having difficulty in class or clinicals. Asking the smartest student in class might not be helpful if this student is also having difficulty understanding the content. Asking the patient for his or her view would not provide balanced information. An Internet search might not yield relevant information.

DIF: Cognitive Level: Application REF: p. 7 | p. 11 TOP: Student responsibility for seeking help MSC: NCLEX: N/A

OBJ: 7 KEY: Nursing Process Step: N/A

25. A nursing student tells a peer, “My instructor is on my case all the time. I’m picked on more than any other student in the group. The more I’m criticized, the more nervous I get. I don’t think I can do anything right. What do you think I should do?” The best advice for the peer to give would be a. “Just keep trying. Things are bound to get better.” b. “Make an appointment to talk about this with the instructor.” c. “Go see the program director and explain that you’re being harassed.” d. “Ask another instructor for help with your skills so you’ll be better prepared.”

ANS: B

This option suggests following the recognized channel of communication by seeking out the individual with whom the perceived problem lies—the instructor. “Just keep trying. Things are bound to get better” is encouraging but will not help resolve the student’s concerns.” “Go see the program director and explain that you’re being harassed” and “Ask another instructor for help with your skills so you’ll be better prepared” do not follow the recognized channel of communication.

DIF: Cognitive Level: Application REF: p. 7 | p. 11 TOP: Addressing problems by going to the source MSC: NCLEX: N/A

OBJ: 7 KEY: Nursing Process Step: N/A

MULTIPLE RESPONSE

1. A student in the nursing program has made various statements relating to his life situation. Which statements indicate the potential for success? (Select all that apply.) a. “I have to hold a full-time job while enrolled in the nursing program.” b. “I’m an excellent manager of my time.” c. “My spouse is away so much that I don’t have enough help with the children.” d. “I’m really looking forward to working as a nurse. It has been my goal for years.”

ANS: B, D

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Time management skills and enthusiasm for the profession are both indicators for success in the nursing program. Having a full-time job and a demanding spouse can be deterrents to the successful completion of a nursing program.

DIF: Cognitive Level: Analysis REF: p. 4 TOP: Factors influencing potential for success/failure MSC: NCLEX: N/A

OBJ: 4 KEY: Nursing Process Step: N/A

2. In response to a learner’s questions, which of the following options should be used to describe desirable outcomes of clinical performance evaluations? (Select all that apply.) a. Discover positive actions of students. b. Make students aware of ineffective clinical behaviors. c. Role-model how to conduct evaluations of others when in the LPN/LVN expanded role. d. Give the student an opportunity to tell the instructor how the instructor’s attitude discourages learning.

ANS: A, B, C

Discovering positive actions of students indicates that it is important to identify positive actions and reinforce them via clinical performance. Making students aware of ineffective clinical behaviors indicates that ineffective clinical behaviors stand in the way of attaining the goal of providing safe, effective patient care. If this goal is not met, the long-term goal of program completion is jeopardized. Role-modeling how to conduct evaluations of others indicates that role-modeling is a desired outcome of clinical performance evaluations.

Providing students the opportunity to tell the instructor how the instructor’s attitude discourages learning is not a desired outcome of clinical performance evaluation.

DIF: Cognitive Level: Analysis TOP: Clinical performance evaluation MSC: NCLEX: N/A

REF: pp. 8-10 OBJ: 7 KEY: Nursing Process Step: N/A

3. With regard to the teaching-learning process, what can the nursing student identify as the instructor’s responsibility to the student? (Select all that apply.) a. Solve each of the student’s learning problems. b. Create an environment in which learning can occur. c. Make learning simple and free from psychological pain. d. Eliminate difficult concepts from lectures and laboratories. e. Assist students to answer questions not independently resolved.

ANS: B, E

Faculty are responsible for providing a curriculum, planning for its implementation, and creating a safe learning environment. Part of creating an optimal learning environment includes having approachable faculty who are available to help students who encounter questions or problems the student cannot independently resolve using available resources.

Solving each of the student’s learning problems is unrealistic and would rob the student of active participation. Making learning simple and free from psychological pain is not realistic.

Learning is rooted in the learner. The instructor cannot guarantee student response.

Eliminating difficult concepts from lectures and laboratories is not realistic. Many important nursing concepts are complex and may seem difficult. They cannot be eliminated from a curriculum if the learner’s education is to meet standards.

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DIF: Cognitive Level: Analysis TOP: Faculty responsibility to students MSC: NCLEX: N/A

REF: p. 7 OBJ: 6 KEY: Nursing Process Step: N/A

4. A nursing student remarks that she would like to make better use of time during the school day. Which behaviors can be identified as ones that would contribute to this goal? (Select all that apply.) a. Smoking during the time between classes b. Practicing skills in the learning resource center during free time c. Eating a candy bar for energy during the afternoon break d. Using break time to review for the next class e. Discussing class topics with a peer ANS: B, D, E

Each of these behaviors focuses on something related to the program of study and thus is a constructive use of learner time. Smoking reduces the flow of oxygen to the brain. Eating a candy bar results in rebound hypoglycemia. Both smoking and eating a candy bar reduce the efficiency of learning and thus are poor uses of time.

DIF: Cognitive Level: Analysis TOP: Making the most of one’s time MSC: NCLEX: N/A

REF: pp. 29-31 OBJ: 4 KEY: Nursing Process Step: N/A

COMPLETION

1. The generation influenced by events such as the Vietnam War, the space race, and the civil rights movement is called the .

ANS:

baby boomers Depending on their birth year, baby boomers may have been shaped by the Watergate scandal, the Vietnam War, the space race, the civil rights movement, women’s liberation, and the assassinations of John and Robert Kennedy and Martin Luther King, Jr. DIF: Cognitive Level: Knowledge OBJ: 3 TOP: Evaluation MSC: NCLEX: N/A

REF: p. 2; Box 1-2 KEY: Nursing Process Step: N/A

2. A nursing student caring for a patient recognizes that he has contaminated his sterile glove during a dressing change requiring surgical asepsis, so he puts on a new sterile glove. The student’s action demonstrates that he has learned .

ANS:

self-evaluation Learners must work at developing the skill of viewing themselves and their actions objectively.

DIF: Cognitive Level: Application TOP: Self-evaluation

REF: p. 9 OBJ: 7 KEY: Nursing Process Step: N/A

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MSC: NCLEX: N/A

Chapter 02: Academic Resources (Study Skills and Test Strategies) Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. A nursing student was ill when the class toured the learning resource center (LRC).

What independent action should the student take? a. Perceive it as a missed opportunity. b. Ask the librarian if a self-guided online tour is available. c. Ask to see another student’s notes about the tour. d. Report his or her unawareness to the instructor of LRC features.

ANS: B

It is important that the student learn about features and services of the LRC. Asking the librarian for a self-guided online tour is a self-directed approach to gaining the needed information. If this is not available, it is likely that the librarian will offer an alternative.

Perceiving being ill as a missed opportunity is unacceptable, as the student needs the information. Asking to see another’s notes would be inadequate to understand the physical layout. Reporting unawareness of the LRC features to the instructor attempts to make the missed tour the instructor’s problem rather than the student’s.

DIF: Cognitive Level: Application REF: p. 31 | p. 32 TOP: LRC KEY: Nursing Process Step: N/A

OBJ: 3 MSC: NCLEX: N/A

2. A nursing student tells another student, “The instructor assigned both a textbook chapter and a journal article! It should be one or the other, not both!” The reply that shows the best understanding of the assignment is a. “The journal article may give us updated information on one aspect of the assignment.” b. “Sometimes textbooks have incorrect information, so it provides checks and balances.” c. “Reading articles allows us to make sure the instructors provide current information in lecture.” d. “Copyright laws prevent the instructor from lecturing directly from that source, so we have to read.”

ANS: A

Periodical articles give up-to-date information to supplement textbook readings. The statements that “textbooks have incorrect information” and/or “reading articles allows instructors to provide information in lectures” do not provide the best understanding.

Copyright laws do not prevent instructors from using material in lectures.

DIF: Cognitive Level: Comprehension TOP: Periodical articles MSC: NCLEX: N/A

REF: p. 33 OBJ: 4 KEY: Nursing Process Step: N/A

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3. A nursing student states, “When we have lecture-discussion sessions, I never know what’s expected of me.” The best reply by a peer would be a. “I think it’s our responsibility as students to avoid actively disagreeing with the instructor or other students.” b. “I think it’s our responsibility as students to make a list of questions about material we don’t understand.” c. “I think it’s our responsibility as students to listen until we’re called upon to answer questions.” d. “I think it’s our responsibility as students to use review books to check the depth of the material we’re learning.”

ANS: B

Making a list of questions about material that is not understood is an action that shows active student participation. Lecture-discussion sessions expect students to be self-directed in learning. Avoiding actively disagreeing with the instructor or other students and listening until called upon to answer questions are more passive than active behaviors. Using review books to check the depth of the material is beyond the scope of what’s expected from a student and would not be productive.

DIF: Cognitive Level: Application REF: p. 34 | p. 35; Box 2-9 OBJ: 1 TOP: Lecture-discussion sessions KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

4. A nursing student asks a peer, “Why do we need a course outline when we have a course syllabus?” The response that best explains the importance of course outlines is a. “They replace the teacher.” b. “They substitute for the textbook.” c. “They eliminate the need for class attendance.” d. “They indicate the level of understanding needed to pass the course.”

ANS: D

The course outline contains details, such as class objectives, whereas the syllabus provides only an overview. The other options are false statements.

DIF: Cognitive Level: Analysis TOP: Course outlines MSC: NCLEX: N/A

REF: p. 36 OBJ: 6 KEY: Nursing Process Step: N/A

5. A nursing student has a course syllabus and a course outline. When anticipating what topics to study for an examination, it is best to refer to the a. course objectives. b. unit objectives. c. bibliography. d. course policies.

ANS: B

The unit objectives provide details regarding what information the instructor expects the student to know. Examination questions are often framed from these detailed unit objectives.

The course objectives state the overall outcomes of the course and are not particularly useful as study aids. The bibliography simply lists the resources used by the instructor in course preparation. Course policies do not delineate topics for study.

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DIF: Cognitive Level: Application TOP: Unit objectives MSC: NCLEX: N/A

REF: p. 36 OBJ: 6 KEY: Nursing Process Step: N/A

6. When a nursing student goes to the nursing skills lab, the best utilization of that resource would be as a place to a. read the textbook. b. discuss personal problems with another student. c. practice a difficult dressing change procedure. d. take a coffee break.

ANS: C

The nursing skills lab supports learning/practicing the psychomotor skills of nursing, such as dressing changes. It would be difficult to practice these skills in other, nonclinical settings.

The remaining options can be completed in other settings that do not require the special equipment found in the nursing skills lab.

DIF: Cognitive Level: Analysis TOP: Nursing skills lab MSC: NCLEX: N/A

REF: p. 37 OBJ: 7 KEY: Nursing Process Step: N/A

7. A nursing student is experiencing difficulty performing calculations involving fractions and decimals. The most helpful resource would be the a. library. b. Internet. c. nursing skills lab. d. study skills lab.

ANS: D

The study skills lab has remedial materials, such as books that teach basic math concepts, and faculty who are prepared to provide guidance for learning such material. The library might have books at the appropriate level but would not provide individualized teaching. The Internet would be more likely to provide information about books available as resources rather than the actual remediation needed. The nursing skills lab is more oriented toward teaching the psychomotor skills of nursing, such as bed-making, asepsis, and other procedures.

DIF: Cognitive Level: Analysis TOP: Study skills lab MSC: NCLEX: N/A

REF: p. 37 OBJ: 7 KEY: Nursing Process Step: N/A

8. A nursing student who wishes to check out a book listed in the course outline informs the librarian that the book is unavailable at the reserve desk. The librarian advises the student to look in the a. stacks. b. CD-ROM. c. vertical files. d. periodical section.

ANS: A

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The stacks are where the majority of materials that can be checked out are located. It is necessary to know the call number found in the online catalog or card catalog to find the book. CD-ROMs, a source of textbook-like information, are rarely available for checkout.

Vertical files hold pamphlets. The periodical section contains journals and magazines.

DIF: Cognitive Level: Application REF: p. 33 TOP: Stacks KEY: Nursing Process Step: N/A

OBJ: 3 MSC: NCLEX: N/A

9. A nursing student has an assignment that requires looking up an article about nursing care following knee replacement surgery. The nursing student has only the title and the knowledge that the article was published within the past year. Which resource would be most helpful in completing the assignment? a. Education Index b. Materia Medicus c. Reader’s Guide to Periodical Literature d. Cumulative Index to Nursing and Allied Health Literature ANS: D

The Cumulative Index to Nursing and Allied Health Literature (CINAHL) is a periodical index containing current listings for nursing and allied health fields. It is produced in five bimonthly issues each year. The issues are later bound by year. The index in Education Index would not present technical data on nursing topics. Materia Medicus is more pertinent to medicine. Reader’s Guide to Periodical Literature focuses on articles from nontechnical magazines and would not contain references to nursing journal articles.

DIF: Cognitive Level: Analysis TOP: CINAHL as a resource MSC: NCLEX: N/A

REF: p. 33 | p. 34 OBJ: 3 KEY: Nursing Process Step: N/A

10. A nursing student tells a peer, “There’s so much to remember that I’m afraid I’ll never pass the skill evaluation for changing a sterile dressing.” A helpful response by the peer would be based on the understanding that for most nursing students, psychomotor/clinical skills can best be learned by a. performing them. b. reading about them. c. watching a peer practice them. d. watching a filmstrip about them.

ANS: A

Psychomotor skills must be practiced if proficiency is to be gained. The remaining options may be helpful as first steps in developing the physical skill, but the learner must eventually practice performing the skill.

DIF: Cognitive Level: Comprehension REF: p. 37 TOP: Learning psychomotor skills associated with nursing MSC: NCLEX: N/A

OBJ: 7 KEY: Nursing Process Step: N/A

11. Which statement is true about the usefulness of audiovisual materials and computerassisted instruction in a nursing course? a. They can be omitted because they add little to student learning. b. It is unnecessary to take notes on their content.

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c. They provide multisensory channels for learning content. d. Their content cannot be used by instructors for examination questions.

ANS: C

These learning modalities stimulate both visual and auditory centers, making them useful for learners with a variety of learning style preferences. The modalities in the other options can be assigned to meet class and unit objectives and thus are considered integral parts of the curriculum. Therefore, learners can be tested on the content they provide.

DIF: Cognitive Level: Knowledge TOP: AV and CAI advantage MSC: NCLEX: N/A

REF: p. 37 | p. 38 OBJ: 7 KEY: Nursing Process Step: N/A

12. A nursing student could best explain an Internet search engine to a peer by saying it is most like a. a book or periodical index. b. a clinical contact with a patient. c. a videotape. d. the vertical file.

ANS: A

Search engines periodically scan the Internet and index it. Search engines help find specific information, much as a book or periodical index can direct one’s search. None of the other options provides an adequate comparison.

DIF: Cognitive Level: Analysis TOP: Function of search engines MSC: NCLEX: N/A

REF: p. 38 OBJ: 7 KEY: Nursing Process Step: N/A

13. When a nursing student needs a journal article from a periodical that is not available in the holdings of the learning resource center, the student should a. try to find a substitute article. b. request an interlibrary loan. c. go to the stacks and look again. d. check the vertical file.

ANS: B

If the learning resource center (LRC) does not subscribe to a particular journal, a student may obtain a copy of the article by requesting that the LRC obtain a copy of the article from a cooperating library that subscribes to the journal. A substitute article would not provide identical information. The remaining options would not be productive.

DIF: Cognitive Level: Application TOP: Interlibrary loan MSC: NCLEX: N/A

REF: p. 33 OBJ: 3 | 4 KEY: Nursing Process Step: N/A

14. A nursing student states, “My grades aren’t what I’d like. I don’t know whether to use a study group or ask for tutoring.” Which statement is true for both study groups and tutoring? a. Leaders/tutors derive more benefit than other participants. b. They are most helpful to students with learning disabilities. c. They provide low benefits when compared with the amount of time spent. d. Active participation by the student is critical to success in raising grades.

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ANS: D

Study groups and tutoring are most helpful to students when active listening is involved.

Leaders/tutors deriving more benefit than other participants may or may not be a true statement. The remaining options are not supported by research data.

DIF: Cognitive Level: Analysis TOP: Active listening MSC: NCLEX: N/A

REF: p. 36 | p. 37 OBJ: 7 KEY: Nursing Process Step: N/A

15. An LPN/LVN has enrolled in a program with minimal pediatric clinical experience. The student will not have an opportunity to administer medications to pediatric patients. To seek out a learning opportunity that would closely resemble judgments made during clinical experience, the student should arrange to a. perform a 2-hour observation of a pediatric nurse assigned to administer medications. b. complete a computer simulation, “Morning Medications with the Pediatric Medication Nurse.” c. shadow a venipuncturist making rounds on the pediatric unit. d. attend an in-service program on the topic of avoiding pediatric medication administration errors.

ANS: B

A computer simulation would require the student to actively use the nursing process to gather data, set priorities, plan, determine the best ways to implement, and evaluate care outcomes in carefully chosen representative clinical situations. Students are often more passive during observational experiences than while working through a computer simulation. Shadowing a venipuncturist, too, is a more passive situation for the learner and is limited to only one aspect of medication administration. Error avoidance is only one aspect of medication administration.

DIF: Cognitive Level: Application TOP: Computer simulations MSC: NCLEX: N/A

REF: p. 37 OBJ: 7 KEY: Nursing Process Step: N/A

16. A nursing student who is receiving poor grades states, “I am experiencing difficulty due to lack of time to devote to school.” The additional factor that should be explored is lack of a. aptitude. b. interest. c. motivation. d. study skills.

ANS: D

Lack of understanding of how to study and how to use available time to study is generally a greater problem than actual lack of time. The other options are less relevant as causes of failure to learn and retain material.

DIF: Cognitive Level: Application TOP: Lack of study skills MSC: NCLEX: N/A

REF: p. 23 OBJ: 1 KEY: Nursing Process Step: N/A

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17. A nursing student is studying for an examination and becomes distracted by things needing to be done. The best intervention would be to a. make a list of things that need to be done and return to studying. b. turn on the radio in an attempt to “drown out” the distraction. c. stop studying until there are fewer distractions with which to contend. d. do what has to be done immediately and then return to studying.

ANS: A

Concentration can be disrupted by internal distractions. In this case, taking a short break and making a list of the things to do so they are not forgotten could be enough to allow the student to concentrate. Turning on the radio to “drown out” distraction would not be helpful. Stopping studying is not appropriate because there may never be fewer distractions. Doing what has to be done immediately and then returning to studying could take too much time away from studying.

DIF: Cognitive Level: Analysis TOP: Concentration/Distractions MSC: NCLEX: N/A

REF: p. 24 OBJ: 1 KEY: Nursing Process Step: N/A

18. Which student would be classified as a passive listener? a. Student A, who completes a grocery list during class b. Student B, who asks questions about class content c. Student C, who puts key concepts into words during note taking d. Student D, who contributes to classroom discussion of the topic ANS: A

Student A demonstrates no personal involvement in the class and thus is considered a passive participant. The students described in all of the other options demonstrate personal involvement and are considered active listeners and participants.

DIF: Cognitive Level: Analysis TOP: Active vs. passive listening MSC: NCLEX: N/A

REF: p. 24 OBJ: 1 KEY: Nursing Process Step: N/A

19. Which technique is most helpful to a student who wishes to better organize the material presented during a lecture? a. Note making b. Shorthand c. Tape recording d. Passive listening ANS: A

Note making and condensing material require active listening and promote organization of key ideas and concepts. Using shorthand requires transcription and does not necessarily result in organized notes. Tape recording simply gives a replay of the lecture; it does not organize the information. Passive listening does not contribute to organization.

DIF: Cognitive Level: Comprehension REF: p. 25 TOP: Note making KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

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20. A nursing student complains about difficulty remembering information read in the text. To resolve this problem effectively, the student should address the fact that the most common reason students cannot remember information is a. information overload. b. lack of understanding of the material. c. new knowledge interferes with recall of old knowledge. d. old knowledge interferes with recall of new material.

ANS: B

Reading with comprehension is required if one is to retain the information. Information overload is a fallacy. New and old knowledge interfering with recall is not the most common reason for not remembering.

DIF: Cognitive Level: Application REF: p. 26 OBJ: 1 TOP: Relationship of reading comprehension and remembering KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

21. The rationale for use of short, frequent study periods that focus on understanding the material is a. to memorize facts. b. to lay down a neural trace. c. to prevent old knowledge from interfering with recall of new knowledge. d. to motivate learning by developing a positive attitude toward the subject matter.

ANS: B

A neural trace is required to move information from temporary to permanent memory. Striving for understanding gives the 4 to 5 seconds necessary for the formation of the neural trace. The other options do not provide a valid rationale.

DIF: Cognitive Level: Comprehension REF: p. 27 | p. 28 TOP: Permanent memory requires formation of a neural trace MSC: NCLEX: N/A

OBJ: 1 KEY: Nursing Process Step: N/A

22. A struggling nursing student studies several hours daily while children watch television nearby. It is likely that this student needs to a. schedule another hour of nightly study. b. correct eyestrain by having his or her eyes tested. c. study where there are fewer external distractions. d. listen actively in class to reduce study hours.

ANS: C

When a student’s study habits are not working, a change is necessary. It is likely that the student is distracted by the television and the children and is unable to fully concentrate. The quality of study may be more problematic than the quantity. The scenario does not suggest eyestrain. Active listening is important but may not be sufficient to reduce study hours.

DIF: Cognitive Level: Application REF: p. 23 | p. 24 TOP: Distractions KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

23. At what level of information processing must LPN/LVNs function in order to pass the NCLEX-PN examination and meet employer expectations? a. Knowing and being able to repeat facts

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b. Understanding the meaning of material and being able to apply it in new situations c. Grasping information and being able to analyze advanced concepts d. Questioning the validity of all information and being able to synthesize material ANS: B

The level of information processing necessary for licensure and meeting employer expectations is best described as understanding the meaning of material, storing it in longterm memory, and being able to apply it clinically. Knowing and being able to repeat facts is insufficient. Grasping information, being able to analyze advanced concepts, questioning the validity of all information, and being able to synthesize material are beyond realistic expectations for practical/vocational nursing.

DIF: Cognitive Level: Knowledge REF: p. 28 TOP: LPN/LVN level of understanding theory MSC: NCLEX: N/A

OBJ: 1 | 2 KEY: Nursing Process Step: N/A

24. A nursing student has difficulty concentrating while studying and is easily distracted by external activity. Daydreaming is triggered by relaxation and music. The best physical environment for studying would be sitting a. on a bed with the feet up and the back against a pillow. b. in a reclining chair facing a television with the volume turned on low. c. at the kitchen table during meal preparation or “clean-up” time. d. at a desk in a quiet room.

ANS: D

The scenario describes a student who is negatively affected by environmental distractions.

Sitting at a desk in a quiet room is the best environment for one who is easily distracted by environmental events, because it limits environmental stimuli. Sitting on a bed with the feet up and the back against a pillow would promote relaxation (sleep) and daydreaming. Sitting in a reclining chair with the television on or at the kitchen table during meal preparation or clean-up places the student in the midst of considerable environmental stimulation.

DIF: Cognitive Level: Analysis TOP: External distractions MSC: NCLEX: N/A

REF: p. 23 | p. 24 OBJ: 1 KEY: Nursing Process Step: N/A

25. A struggling nursing student reports studying best in an environment with some background sound. The student should first consider a. studying with a peer group. b. re-evaluating the study environment. c. hiring a tutor. d. cramming for examinations.

ANS: B

When a learning style preference is not producing results, one should consider change.

Thinking that one can study in the presence of noise and other distractions is a common fallacy. The student should try studying in a quiet place. Joining a study group should not be the first consideration. Tutoring may not be necessary; it should not be the first consideration.

Cramming is never advocated as a helpful method for improving grades.

DIF: Cognitive Level: Analysis TOP: Study environment

REF: p. 23 | p. 24 OBJ: 1 KEY: Nursing Process Step: N/A

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MSC: NCLEX: N/A

26. A nursing student researched a topic for a class presentation online and explored several sites, using up most of the evening’s study time. The next time there is an Internet assignment, a helpful strategy would be to a. set a kitchen timer for 30 minutes. b. do the assignment only after doing all other study tasks. c. “forget” to do the assignment. d. ask a friend to do the assignment.

ANS: A

Creating a situation in which the student is reminded of elapsed time should limit the time spent on the Internet yet permit the student to complete the assignment independently.

DIF: Cognitive Level: Application TOP: External distractions MSC: NCLEX: N/A

REF: p. 24 OBJ: 1 KEY: Nursing Process Step: N/A

27. A nursing student states, “I have trouble writing what the instructor says in class.” The most helpful hint to give the student would be a. “Try to write the lecturer’s statements word for word.” b. “Write the main ideas in condensed form.” c. “Take notes in shorthand and transcribe them.” d. “Underline in the textbook what the lecturer is saying.”

ANS: B

This technique is called note making. It is the most effective of the options listed relating to notes.

DIF: Cognitive Level: Analysis REF: p. 25 TOP: Note making KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

28. A nursing student asks, “Are there any techniques to help me better understand difficult nursing concepts?” The best reply would be a. “Memorize as much as you possibly can.” b. “Begin by learning the definition of all terms.” c. “Repeat key ideas in your own terms.” d. “Cram for examinations.”

ANS: C

Repeating key ideas in one’s own words fosters understanding. Understanding is required for laying down neural traces and long-term memory storage. Memorizing is only marginally effective. Learning the definition of all terms may be an excessively large order. Cramming is never advisable.

DIF: Cognitive Level: Analysis TOP: Understanding key concepts MSC: NCLEX: N/A

REF: p. 25 OBJ: 1 KEY: Nursing Process Step: N/A

29. In what significant way does the NCLEX-PN examination differ from a paper and pencil multiple choice examination given during the program of study? a. The NCLEX-PN questions are more difficult.

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b. The test taker cannot guess when taking the NCLEX-PN exam. c. The questions on the NCLEX-PN must be answered in sequence. d. Only program tests contain alternate format items, such as short answer questions.

ANS: C

The NCLEX-PN computer programming does not permit skipping a question and returning to it.

DIF: Cognitive Level: Analysis REF: p. 29 | p. 30 TOP: NCLEX-PN KEY: Nursing Process Step: N/A

OBJ: 2 MSC: NCLEX: N/A

30. A nursing student is asked to identify distractions that limit the ability to concentrate.

An example of an internal distraction is a. mental fatigue. b. background noise. c. the physical environment. d. other nursing students.

ANS: A

External distractions are those that come from outside oneself, whereas internal distractions are those that come from inside oneself. Mental fatigue is an example of an internal distraction. All the other options are examples of external distractions.

DIF: Cognitive Level: Comprehension REF: p. 24 TOP: Distractions KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

31. A nursing student is asked to identify distractions that limit the ability to concentrate.

An example of an external distraction is a. anxiety. b. daydreaming. c. mental fatigue. d. background noise.

ANS: D

External distractions are those that come from outside oneself, whereas internal distractions are those that come from inside oneself. Background noise is an example of an external distraction. All the other options are examples of internal distractions.

DIF: Cognitive Level: Comprehension REF: p. 23 | p. 24 TOP: Distractions KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

MULTIPLE RESPONSE

1. Which nursing students are using the learning resource center appropriately? (Select all that apply.) a. Student A checks out a text for home use. b. Student B obtains an article on interlibrary loans. c. Student C makes a copy of a reference article. d. Student D finds it a quiet place to study. e. Student E seeks to purchase a book. f. Student F obtains a back issue of a nursing journal.

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g. Student G goes there to instant message.

ANS: A, B, C, D, F

The activities practiced by students A, B, C, D, and F describe appropriate uses of the learning resource center (LRC). LRCs are not for purchasing books. Bookstores sell books.

Getting and sending instant messages does not describe a program-related task.

DIF: Cognitive Level: Application TOP: Learning resource centers MSC: NCLEX: N/A

REF: pp. 32-34 OBJ: 3 KEY: Nursing Process Step: N/A

2. A student nurse is utilizing the technique of cooperative learning. Cooperative learning includes which of the following? (Select all that apply.) a. Working in small groups b. Active involvement in learning c. Development of critical thinking skills d. Assistance in learning the course content e. Discouragement of the development of teamwork f. An emphasis on individual accountability for learning ANS: A, B, C, D, F

Cooperative learning is a technique that emphasizes individual accountability for learning a specific academic task while working in small groups. Cooperative learning encourages active involvement in learning, the development of critical thinking skills, and the development of positive relationships with peers. It also helps with learning the course content.

DIF: Cognitive Level: Comprehension TOP: Cooperative learning MSC: NCLEX: N/A

REF: p. 35 OBJ: 1 KEY: Nursing Process Step: N/A

3. Which behaviors indicate that a nursing student is taking responsibility for learning during a lecture-discussion or a cooperative learning session? (Select all that apply.) a. Advance preparation b. Discussion participation c. Listening closely d. Heated argument ANS: A, B, C

Learning via these modalities is facilitated when the learner is actively involved. Involvement is demonstrated by behaviors such as advance preparation, classroom participation, and active listening. Heated arguments have no place in any learning setting, although respectful opinion-stating is permitted.

DIF: Cognitive Level: Evaluation REF: p. 34 | p. 35 OBJ: 1 TOP: Behaviors associated with taking responsibility for own learning KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

4. A nursing student uses the Internet to learn about the use of antidepressant medications.

Select the domain names that would suggest that information on the site is credible. (Select all that apply.) a. .com b. .gov

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c. .edu d. .net ANS: B, C

Sites ending with .gov are U.S. federal government sites. Examples are sites sponsored by the Center for Communicable Diseases, National Institutes for Health, and Department of Defense. Government sites are carefully monitored for accuracy. A .edu site is sponsored by an educational facility, such as a university. These sites are usually credible. A .com site may promote a product. For example, a drug company might promote information about one of its drugs. A domain name that ends in .net refers to infrastructure machines and organizations.

For example, a provider of Internet service might be called Constellation.net.

DIF: Cognitive Level: Analysis REF: p. 38 | p. 39; Box 2-12 OBJ: 7 TOP: Internet domain names KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

5. A nursing student tells a peer, “After working nights, I have a problem staying focused during the afternoon lectures. My mind wanders, and all of a sudden I realize that I’m lost.”

What helpful hints should the peer offer? (Select all that apply.) a. If possible, sleep before coming to class. b. Complete readings after attending lecture. c. Write down key concepts and examples. d. Ask questions during and after class. e. Try to write everything the lecturer says.

ANS: A, C, D

Being rested can improve concentration. Completing readings before the lecture increases comprehension of the lecture material. Note making is more effective than note taking.

Active involvement improves concentration.

DIF: Cognitive Level: Analysis REF: p. 25; Box 2-3 OBJ: 1 TOP: Active listening KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

6. A nursing student asks for suggestions for successful test preparation. Select the items that give the best advice. (Select all that apply.) a. “Go to a movie or watch television the night before the test.” b. “Reread pertinent chapters in the textbook.” c. “Plan to study from 8 PM until 2 AM the night before the test.” d. “Focus on note summaries, margin writings, and underlined text.” e. “Clarify the examination format with the instructor.”

ANS: D, E

Reviewing material identified as important is vital to success on the examination. Knowing the format for questions helps students focus on the types of answers they will need to formulate.

Going to a movie or watching television the night before the test may interfere with memory during the examination. Rereading pertinent chapters in the textbook is counterproductive, because key concepts have been identified in notes, margin notes, and underlined sections.

Cramming is a poor strategy, whereas getting a good night’s sleep is helpful.

DIF: Cognitive Level: Analysis

REF: p. 28

OBJ: 2

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TOP: Preparation for the test MSC: NCLEX: N/A

KEY: Nursing Process Step: N/A

7. A nursing student has difficulty taking multiple choice tests. The test is graded according to the number of right answers. Select the strategies most likely to be helpful when taking this type of test. (Select all that apply.) a. Leave easy questions until last. b. Answer all questions. Guess if necessary. c. Leave answers unchanged after recording them. d. Save time; stop reading options when the answer is found. e. Read options and eliminate all wrong options. f. Eliminate options unrelated to the subject matter.

ANS: B, E, F

With the type of scoring described, guessing is not penalized. Reading all options and eliminating obviously wrong distracters and those unrelated to the subject matter facilitate answering the question. Easy questions should be answered first. Answers may be changed if the learner is sure the revised answer is correct. All options should be read. First choice may seem correct, but sometimes a better option could be given later in the question.

DIF: Cognitive Level: Analysis REF: p. 30; Box 2-5 OBJ: 2 TOP: Multiple choice examinations KEY: Nursing Process Step: N/A MSC: NCLEX: N/A COMPLETION

1. The area in which library materials are checked out and returned is the .

ANS:

circulation desk The circulation desk is the area in which library materials are checked out and returned.

DIF: Cognitive Level: Knowledge TOP: Circulation desk MSC: NCLEX: N/A

REF: p. 32 OBJ: 3 KEY: Nursing Process Step: N/A

2. A technique that emphasizes individual accountability for learning a specific academic task while working in small groups is known as .

ANS:

cooperative learning Cooperative learning is a technique that emphasizes individual accountability for learning a specific academic task while working in small groups.

DIF: Cognitive Level: Knowledge TOP: Cooperative learning MSC: NCLEX: N/A

REF: p. 35 OBJ: 1 KEY: Nursing Process Step: N/A

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3. A nursing student spends lecture time doodling and staring out the window while thinking about what to cook for dinner. This student can best be described as a/an listener.

ANS:

passive The passive listener receives sounds with little recognition or personal involvement. This listener may be doodling, staring out the window, or even staring at the instructor but thinking about having to change the oil in the car or deciding what to cook for dinner.

DIF: Cognitive Level: Comprehension REF: p. 24 TOP: Listening KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

4. A nursing student listens with full attention during lectures, is open-minded and curious, and asks questions about the content. This student can best be described as a/an listener.

ANS:

active The active listener is always thinking, not just hearing the words. Active listeners listen with full attention, are open-minded and curious, and are always asking themselves questions about the content.

DIF: Cognitive Level: Comprehension REF: p. 24 | p. 25 TOP: Listening KEY: Nursing Process Step: N/A

OBJ: 1

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Chapter 03: Community Resources Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. A nursing student states that recent unsatisfactory academic performance is due to inadequate nutrition. What step in Maslow’s Human Needs Theory needs to be met? a. Safety b. Love and belonging c. Esteem d. Physiological ANS: D

The five steps of Maslow’s Human Needs Theory are physiological needs, safety, love/belonging, esteem, and self-actualization. The first step, basic physiological needs, includes food and is necessary for human survival. Once the basic needs are met the focus can move to the next step.

DIF: Cognitive Level: Comprehension REF: p. 43 OBJ: 2 TOP: Maslow’s Human Needs Theory KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

2. The Director of a Practical/Vocational Nursing program is reviewing surveys and determines that graduates rate confidence levels high. What step in Maslow’s Human Needs Theory does this reflect? a. Safety b. Love and belonging c. Esteem d. Physiological ANS: C

The five steps of Maslow’s Human Needs Theory are physiological needs, safety, love/belonging, esteem, and self-actualization. Success in a practical/vocational nursing program is based on feelings respect and self-confidence. These attributes are part of the fourth step, esteem.

DIF: Cognitive Level: Comprehension REF: p. 43 OBJ: 2 TOP: Maslow’s Human Needs Theory KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

3. What community resource is available to assist people with disabilities to achieve employment and independence? a. Workforce Investment Act b. Adult Basic Education (ABE) c. Office of Vocational Rehabilitation (OVR) d. Salvation Army ANS: C

Downloaded by Sturdy Drone (sturdydrone2707@gmail.com)

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The Office of Vocational Rehabilitation (OVR) is available to assist people with disabilities to achieve employment and independence. The Workforce Investment Act provides funding and training grants. An Adult Basic Education (ABE) program assists with basic math, reading, or literacy skills. The Salvation Army is a faith-related mission that provides services such as short-term housing.

DIF: Cognitive Level: Knowledge TOP: Community Resources MSC: NCLEX: N/A

REF: p. 46 OBJ: 1 KEY: Nursing Process Step: N/A

4. A nursing student moved from Florida to Pennsylvania and began school immediately. Where should the student go first to become familiar with county services? a. YMCA b. Career Link c. Referral Agencies d. Welfare office ANS: C

Information and referral agencies can serve as the first stop for those unfamiliar with services in their county. The YMCA is an organization that provides short-term housing.

Career Link is an employment center. The welfare office provides financial assistance for things such as food, child care, unemployment, and housing.

DIF: Cognitive Level: Comprehension TOP: Community Resources MSC: NCLEX: N/A

REF: p. 44 OBJ: 1 KEY: Nursing Process Step: N/A

5. When participating in an advisory session a student states that she cannot afford health insurance for her family. What resource is the best to recommend? a. Welfare office b. Affordable Care Act Health Insurance Exchange c. Habitat for Humanity d. Workforce Investment Act ANS: B

Health insurance is available through specific states’ Affordable Care Act Health Insurance Exchange, and specific state-related children’s insurance programs. The welfare office provides financial assistance for things such as food, child care, unemployment, and housing.

Habitat for Humanity is a housing organization that builds affordable housing for people in need. The Workforce Investment Act provides funding and training grants.

DIF: Cognitive Level: Comprehension TOP: Community Resources MSC: NCLEX: N/A

REF: p. 45 OBJ: 1 KEY: Nursing Process Step: N/A

6. What is the best social media site to use when seeking professional employment? a. Facebook b. AllNurses.com c. Twitter d. LinkedIn ANS: D

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LinkedIn is the biggest professional site, and interactions are more formal. It is a site for posting resumes, education, work history, accomplishments, and professional memberships.

AllNurses.com is a social media community that provides an opportunity for nursing students to connect with other students and nurses. Facebook and Twitter are social networking sites commonly used for communicating with family and friends, to communicate and collaborate with nursing organizations and keep up-to-date with colleagues.

DIF: Cognitive Level: Knowledge TOP: Social Media MSC: NCLEX: N/A

REF: p. 46 | p. 47 OBJ: 3 KEY: Nursing Process Step: N/A

7. Nursing students are assigned to write a paper about professional use of social networking.

Which professional organization has compiled a resource guide that nursing students can use to learn? a. American Nurses Association (ANA) b. National Council of State Board of Nurses (NCSBN) c. National Association for Practical Nurse Education and Service, Inc. (NAPNES) d. National Federation Licensed Practical Nurses Association (NFLPN) ANS: A

The American Nurses Association (ANA) has compiled a resource guide that nursing students can use to learn about professional use of social networking. The National Council of State Board of Nurses (NCSBN) is a not-for-profit organization through which boards of nursing act and counsel together on matters of common interest and concern affecting public health, safety and welfare, including nursing licensure examinations. The National Association for Practical Nurse Education and Service, Inc. (NAPNES) and the National Federation of Licensed Practical Nurses Association (NFLPN) are practical/vocational nursing membership organizations in the United States that are dedicated to promoting competence and advancing the profession of LPNs/LVNs. DIF: Cognitive Level: Knowledge TOP: Social Networking MSC: NCLEX: N/A

REF: p. 46 | p. 47 OBJ: 3 KEY: Nursing Process Step: N/A

COMPLETION

1.

is food program that will deliver meals to the doors of Senior Citizens and disabled individuals.

ANS:

Meals on Wheels Seniors and disabled individuals can have special programs that deliver meals to their doors such as Meals on Wheels.

DIF: Cognitive Level: Knowledge TOP: Community Resources MSC: NCLEX: N/A

REF: p. 45 OBJ: 4 KEY: Nursing Process Step: N/A

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2. The 2011 National Council of State Board Examiners (NCSBN) white paper “A Nurse’s Guide to the Use of Social Media” addresses violation of patient confidentiality/privacy by posting patient information on sites.

ANS:

nurses; social networking The 2011 National Council of State Board Examiners (NCSBN) white paper “A Nurse’s Guide to the Use of Social Media” states that 46 Boards of Nursing (BON) were surveyed by the National Council, and 33 boards reported receiving complaints about nurses who violated patient confidentiality/privacy by posting patient information on social networking sites.

DIF: Cognitive Level: Knowledge TOP: Social Networking MSC: NCLEX: N/A

REF: p. 47 OBJ: 3 KEY: Nursing Process Step: N/A

OTHER

1. Place the five steps of Maslow’s Human Needs Theory in the correct order: a. Self-actualization b. Safety c. Physiologic needs d. Esteem e. Love/belonging ANS:

C, B, E, D, A The five steps of Maslow’s Human Needs Theory in order are physiological needs, safety, love/belonging, esteem, and self-actualization.

DIF: Cognitive Level: Analysis TOP: Maslow’s Human Needs Theory MSC: NCLEX: N/A

REF: p. 43 OBJ: 2 KEY: Nursing Process Step: N/A

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Chapter 04: How Practical/Vocational Nursing Evolved: 1836 to the Present Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. The “first real school of nursing” was located in a. Israel. b. Greece. c. Italy. d. Germany.

ANS: D

The first real school of nursing was founded by the Lutheran Order of Deaconesses under the supervision of a German pastor, Theodor Fleidner, in Kaiserswerth, Germany. The other options are incorrect.

DIF: Cognitive Level: Knowledge REF: p. 50 TOP: History KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

2. The best reason for studying nursing history is a. to prepare for the NCLEX-PN examination. b. to make nurses more professional. c. to help nurses adapt to change. d. to learn from nursing’s past mistakes.

ANS: C

Knowledge of the changes that have occurred in nursing prepares one to better understand and adapt to continuing changes. The other options have lesser degrees of validity.

DIF: Cognitive Level: Analysis TOP: Change in nursing MSC: NCLEX: N/A

REF: p. 50 OBJ: N/A KEY: Nursing Process Step: N/A

3. When was the first U.S. school of practical nursing founded? a. 1830 b. 1853 c. 1892 d. 1902 ANS: C

The first class for formal training of practical nurses was offered in 1892 at the YWCA in Brooklyn, NY. DIF: Cognitive Level: Knowledge TOP: History—first PN school MSC: NCLEX: N/A

REF: p. 50 OBJ: 1 KEY: Nursing Process Step: N/A

4. In what year was practical nurse licensure used for the first time? a. 1903 b. 1914 c. 1938

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d. 1941 ANS: B

Mississippi law provided for practical nurse licensure in 1914.

DIF: Cognitive Level: Knowledge TOP: Practical nurse licensure MSC: NCLEX: N/A

REF: p. 57 OBJ: 4 KEY: Nursing Process Step: N/A

5. The emergence of modern nursing is usually attributed to the influence of a. Florence Nightingale. b. Clara Barton. c. Lillian Wald. d. Sairy Gamp.

ANS: A

Miss Nightingale’s insistence that nurses be women of good character helped nursing emerge from its “Dark Ages” and elevated it to a respectable vocation. In addition, she established a school for nurse training and wrote several books on nursing. Although Barton and Wald are positive examples in nursing history, neither influenced nursing to the extent that Nightingale did. Sairy Gamp is a negative character associated with nursing history.

DIF: Cognitive Level: Comprehension TOP: Florence Nightingale MSC: NCLEX: N/A

REF: pp. 52-55 OBJ: 2 KEY: Nursing Process Step: N/A

6. The first formal training for practical nurses focused on a. care for victims of war injuries. b. home care for children and people with chronic illness. c. training visiting nurses and public health nurses. d. creating nursing instructors for nursing programs.

ANS: B

The school at the Brooklyn YWCA placed the focus of training for practical nurses on home health care for patients with chronic illness, the aged, and children. The first program, created in 1892, was not affected by war. When visiting nurses and public health nurses went into the community, they were armed with their basic education, as described. Any trained nurse could teach in a practical nurse program at this point in time.

DIF: Cognitive Level: Knowledge REF: p. 57 | p. 58 TOP: History KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

7. The event that had the greatest influence on the role of practical nurses in modern hospital nursing was a. the Crusades. b. the Industrial Revolution. c. the U.S. Civil War. d. World War II. ANS: D

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World War II and the shortage of nurses it created greatly expanded the practice sites available to practical nurses. In the face of the nursing shortage, hospitals gradually increased the responsibilities designated for the practical nurse. The other options had a lesser impact on modern hospital nursing.

DIF: Cognitive Level: Analysis TOP: PN role change MSC: NCLEX: N/A

REF: p. 58 | p. 59 OBJ: 3 | 6 KEY: Nursing Process Step: N/A

8. When in history was it first recommended that tasks of the RN and LPN be differentiated and that practical nurses should function under the supervision of registered nurses? a. 1750-1760 b. 1826-1850 c. 1949-1950 d. 1965-1980 ANS: C

In 1949, the Joint Committee on Practical Nurses and Auxiliary Workers in Nursing Services recommended the title licensed practical nurse to differentiate between the tasks of PNs and LPNs; the joint committee also recommended that LPNs work under the supervision of RNs. DIF: Cognitive Level: Comprehension TOP: LPN task differentiation MSC: NCLEX: N/A

REF: p. 59 OBJ: 4 KEY: Nursing Process Step: N/A

9. The role of self-defined practical nurses throughout history has been to a. care for the ill, injured, and dying and birthing mothers. b. compete with physicians and surgeons. c. perform complex nursing skills independently. d. make contact with the gods on behalf of the ill person.

ANS: A

History has seen people called attendants, midwives, and self-proclaimed nurses who had special skills in helping those who were ill. These self-proclaimed nurses were the original home health nurses and visiting nurses, who cared for patients who were ill, injured, or dying and mothers who were giving birth. The other options were never considered roles of the practical nurse.

DIF: Cognitive Level: Comprehension TOP: Role of self-proclaimed nurses MSC: NCLEX: N/A

REF: p. 56 OBJ: 4 KEY: Nursing Process Step: N/A

10. The event that had the most profound influence in changing practical/vocational nursing was a. the depression of the 1930s, when nurses worked for room and board in lieu of salary. b. the World War II movement of practical/vocational nurses into hospital positions. c. the American Medical Association (AMA) proposal to develop registered care technicians as new health care workers. d. the first computer-adaptive test for practical/vocational nursing graduates.

ANS: B

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The nursing shortage following World War II was responsible for hospitals hiring practical/vocational nurses and for the gradual expansion of the role of the practical/vocational nurse. None of the other options offered had the same degree of influence as World War II and the subsequent nursing shortage.

DIF: Cognitive evel: Analysis REF: p. 58 | p. 59 TOP: History KEY: Nursing Process Step: N/A

OBJ: 6 MSC: NCLEX: N/A

11. When permitted by the state Nurse Practice Act, under what conditions can the LPN/LVN perform complex nursing skills not taught in the basic educational program? a. When ordered to do so by the attending physician b. When the task is delegated to a competent LPN/LVN by a supervising RN c. When the LPN/LVN has graduated from a nursing program accredited by the National League for Nursing d. When the state of practice has declared a severe nursing shortage ANS: B

Delegation, if allowed by the Nurse Practice Act of the state, can take place if the RN teaches the skill, observes a return demonstration, documents the teaching/learning process in the LPN/LVN’s file, and provides ongoing direct supervision. LPN/LVNs are under the direct supervision of professional nurses. Accreditation of the school does not confer the right to accept delegation. Nursing shortages cannot dictate the acceptability of delegation.

DIF: Cognitive Level: Comprehension REF: p. 50 | p. 64 TOP: Delegation KEY: Nursing Process Step: N/A

OBJ: 3 MSC: NCLEX: N/A

12. A major reason for LPN/LVN graduates to join nursing organizations is that membership a. keeps one updated on issues that affect practical nursing. b. enhances one’s standing among registered nurses. c. provides an opportunity to draft legislation for health care workers. d. encourages practical nurses to expand their social horizons.

ANS: A

Membership in a nursing organization provides access to information relevant to the standing, as well as the practice, of nursing. Proposed changes in the Nurse Practice Act can be disseminated and the organization can use its collective power to support or call for defeat of such measures. The greater the membership in an organization, the greater the political power the group has. The other options are not considered major reasons for belonging to a nursing organization.

DIF: Cognitive Level: Analysis TOP: Political action MSC: NCLEX: N/A

REF: p. 63 OBJ: N/A KEY: Nursing Process Step: N/A

13. Which statement best explains the “entry into practice” controversy? a. Nursing shortages would be relieved if all nurses entered into practice as LPN/LVNs. b. The return to self-proclaimed nurses would save scarce health care dollars. c. “Entry into practice” refers to discerning the educational level most appropriate for entry into the practice of nursing: ADN, BSN, MSN. d. After graduation, all professional and vocational nurses should enter practice by

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serving a 1-year internship in a hospital setting.

ANS: C

“Entry into practice,” originally advanced by the ANA, refers to the movement to establish two levels of nursing. More recently it has become a question of determining the most appropriate entry into practice for professional nurses: the ADN, BSN, or master’s level of preparation. The other options are not related to entry into practice.

DIF: Cognitive Level: Comprehension TOP: Entry into practice MSC: NCLEX: N/A

REF: p. 62 OBJ: 5 KEY: Nursing Process Step: N/A

14. Which was the first state to pass a law licensing practical nurses? a. Alabama b. California c. New York d. Mississippi ANS: D

Mississippi was the first state to pass a law licensing practical nurses.

DIF: Cognitive Level: Knowledge TOP: Nursing history MSC: NCLEX: N/A

REF: p. 57 OBJ: 4 KEY: Nursing Process Step: N/A

15. The first chapter of the American Red Cross was established by a. Clara Barton. b. Sairy Gamp. c. Dorothea Lynde Dix. d. Florence Nightingale.

ANS: A

Clara Barton established the first chapter of the American Red Cross. Sairy Gamp was a fictional character in Charles Dickens’ novel Martin Chuzzlewit. Dorothea Lynde Dix was appointed superintendent of nurses and organized a corps of female nurses during the Civil War. Florence Nightingale nursed wounded soldiers during the Crimean War. DIF: Cognitive Level: Knowledge TOP: Nursing history MSC: NCLEX: N/A

REF: p. 56 OBJ: 1 KEY: Nursing Process Step: N/A

MULTIPLE RESPONSE

1. Which of the following are major concerns associated with the present nursing shortage? (Select all that apply.) a. Patient safety b. High patient acuity c. High nurse-to-patient ratios d. High stress among nurses e. High recruitment incentives ANS: A, B, C, D

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Patient safety is a concern, because errors are more common when nurse-to-patient ratios are high. Patients in hospitals now are sicker than they were previously. High patient acuity requires increasingly skilled nurses, and the high-acuity patient requires more nursing time; neither may be available during a nursing shortage. Errors increase when one nurse has a patient load that is so large that care is rushed. Nurses leave the workforce as a result of high stress; this worsens the shortage. High recruitment incentives are not considered major concerns associated with the shortage of nurses.

DIF: Cognitive Level: Analysis TOP: Present nursing shortage MSC: NCLEX: N/A

REF: p. 63 OBJ: 5 KEY: Nursing Process Step: N/A

2. Practical nurses are referred to as those who, from the beginning of time, chose (or were appointed) to care for individuals who were ill, injured, dying, or having babies. Names used to designate this person have included which of the following? (Select all that apply.) a. Midwife b. Attendant c. Trained nurse d. Practical nurse e. Self-proclaimed nurse f. Babysitter ANS: A, B, C, D, E

Practical nurses have had a varied and colorful evolution. Practical nurses are referred to in a broad sense as those who, from the beginning of time, chose (or were appointed) to care for individuals who were ill, injured, dying, or having babies. Names used to designate this person have included midwife, attendant, trained nurse, practical nurse, and self-proclaimed nurse.

DIF: Cognitive Level: Comprehension TOP: Nursing history MSC: NCLEX: N/A

REF: p. 56 OBJ: N/A KEY: Nursing Process Step: N/A

3. Which individuals made significant contributions to nursing? (Select all that apply.) a. Lillian Wald b. Linda Richards c. Sairy Gamp d. Betsy Prig e. Mary Mahoney ANS: A, B, E

Wald organized the first visiting nurse service for the poor. Linda Richards was America’s first professionally trained nurse; she organized other training schools. Mary Mahoney was the first African-American graduate nurse. Gamp and Prigg were Dickens characters who portrayed nurses as scoundrels and women of ill repute.

DIF: Cognitive Level: Comprehension REF: p. 64 TOP: History KEY: Nursing Process Step: N/A COMPLETION

OBJ: N/A MSC: NCLEX: N/A

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1. After licensing, the LPN/LVN is permitted to perform complex nursing skills as delegated by

the registered nurse (RN) and allowed by the

.

ANS:

Nurse Practice Act After licensing, the LPN/LVN is permitted to perform complex nursing skills as delegated by the registered nurse (RN) and allowed by the Nurse Practice Act. DIF: Cognitive Level: Knowledge TOP: Modern practical nurses MSC: NCLEX: N/A

REF: p. 50 OBJ: N/A KEY: Nursing Process Step: N/A

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Chapter 05: Critical Thinking: A Lifelong Journey Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. A first-postoperative-day patient received pain medication 6 hours ago. He states he is not experiencing pain but refuses to deep breathe and ambulate as ordered. The nursing student caring for him consults her instructor, asking whether it might be advisable to administer pain medication. The student is using a. the right brain hemisphere. b. the intrapersonal learning style. c. linguistic memory. d. critical thinking.

ANS: D

The student has questioned the reason for the patient’s refusal to deep breathe and ambulate and has suggested that a possible cause may be the presence of discomfort that could be relieved by medication. This qualifies as critical thinking. The action described is not a good example of right brain hemisphere use or use of the intrapersonal learning style, and it is not related to linguistics.

DIF: Cognitive Level: Application

REF: p. 67 | p. 68

OBJ: 2 | 3

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TOP: Critical thinking MSC: NCLEX: Physiological Integrity

KEY: Nursing Process Step: Planning

2. The nursing student tells a peer, “Once I begin studying, I don’t dare take a break. If I stop for even 5 minutes, I know I’ll never go back to studying.” The peer identifies this statement as a. negative thinking. b. random thinking. c. ruminative thinking. d. all-or-nothing thinking.

ANS: D

All-or-nothing thinking is characterized by making up one’s mind and not considering any additional facts. The thinking is black and white, without grays. Negative thinking occurs when the mind is stuck on negative thoughts and cannot move to other thinking. Random thinking is characterized by intermittent thoughts without purpose or goal. Ruminative thinking occurs when the individual focuses on a situation or scene and repeatedly replays it in the mind.

DIF: Cognitive Level: Application TOP: Critical thinking MSC: NCLEX: N/A

REF: p. 66 OBJ: 1 KEY: Nursing Process Step: N/A

3. A patient tells the nursing student, “I keep thinking of the mistake I made that led to the accident. I can’t get it out of my mind. Now my son has a broken leg.” The nursing student correctly identifies this as a. random thinking. b. habitual thinking. c. ruminative thinking. d. directed thinking.

ANS: C

Ruminative thinking replays the same situation repeatedly without reaching an outcome.

Random thinking involves many thoughts or scenes running aimlessly through the mind.

Habitual thinking involves routines performed as if on automatic pilot. Directed thinking is purposeful and outcome oriented.

DIF: Cognitive Level: Analysis REF: p. 66 TOP: Critical thinking KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Safe, Effective Care Environment

OBJ: 1

4. Which question should be asked by a nursing student who is developing a plan to increase his critical thinking ability so as to achieve higher grades? a. “Do I comprehend information from textbooks and classes?” b. “I wonder how to improve my overall efficiency.” c. “I’ll have to learn from my mistakes.” d. “Someone needs to check my conclusions.”

ANS: A

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This question deals with an important aspect of using critical thinking in nursing. One must comprehend the information and then be able to recall and apply it. “I wonder how to improve my overall efficiency” is a diffuse question and does not lend itself to planning without first being narrowed and better focused. The other two options are not questions.

DIF: Cognitive Level: Comprehension TOP: Critical thinking MSC: NCLEX: N/A

REF: p. 68 OBJ: 7 KEY: Nursing Process Step: N/A

5. The student reads a definition of a nursing term and is asked to state whether the sentence is true or false. The cognitive level of this exercise is a. knowledge. b. comprehension. c. application. d. analysis.

ANS: A

Knowledge refers to the ability to recall and repeat memorized information. The other options are higher cognitive levels—comprehension: the ability to basically understand information, recall it, and identify examples; application: the ability to use learned material in new situations; analysis: to break down complex information into its basic parts and relate those parts to the whole picture.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

6. When an instructor asks a nursing student to answer a question in her or his own words and give an example, the cognitive level used is a. knowledge. b. comprehension. c. application. d. analysis.

ANS: B

Comprehension refers to the ability to understand information, recall it, and identify examples.

Knowledge is the ability to recall and repeat memorized information. Application refers to being able to use learned information in new situations. Analysis refers to being able to break down complex information into its basic parts and relate the parts to the whole.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

7. The nursing student has learned the principles of determining and recording intake and output. When the student cares for a patient who has had a liquid breakfast and has voided twice and vomited once, the student documents intake and output in the patient’s chart using the cognitive level known as a. knowledge. b. comprehension. c. application.

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d. analysis.

ANS: C

Knowledge refers to recalling memorized information. Comprehension refers to repeating information in one’s own words or identifying an example. Analysis refers to breaking down complex information and relating the parts to the whole picture. Application calls for being able to use learned material in new situations. Because the student documents the intake and output, he is using information learned.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: Physiological Integrity

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: Implementation

8. During morning report, the nursing student receives a description of the assigned patient’s current problems. When the student determines the priority nursing intervention, she is processing information at the cognitive level known as a. knowledge. b. comprehension. c. application. d. analysis.

ANS: D

Analysis is used when the individual organizes and prioritizes. This scenario suggests a higher level of functioning than cited in the other options.

DIF: Cognitive Level: Application REF: p. 70 OBJ: 4 TOP: Cognitive levels KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

9. Which factor that influences critical thinking provides the best rationale for using a team meeting to plan care for a patient? a. Collaboration b. Moral development c. Self-confidence d. Maturity ANS: A

Collaborative effort promotes critical thinking skills; thus, care planning by a knowledgeable group is likely to result in creative solutions to problems. The other options do not provide a rationale for using team planning sessions.

DIF: Cognitive Level: Analysis REF: p. 67 | p. 70 OBJ: 7 TOP: Critical thinking KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

10. Which remark by a nurse demonstrates the use of critical thinking? a. “I just let my thoughts flow.” b. “My mind is made up. Why listen further?” c. “I play and replay a situation, like using instant replay.” d. “I think about what other information I need before proceeding.”

ANS: D

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Critical thinking requires the individual to have access to all necessary information. This is accomplished by collecting and verifying data in an organized way, arranging data in an organized way, looking for gaps in information, and then proceeding with data analysis.

DIF: Cognitive Level: Application REF: pp. 68-70 TOP: Critical thinking KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 2 MSC: NCLEX: N/A

11. A nurse is caring for a postpartum patient. The nurse assesses the patient’s fundus, notes that it is deviated to the side, and instructs the patient to void. The nurse understands that this intervention should allow the fundus to effectively contract. The nurse’s thinking is purposeful and outcome oriented. This is an example of a. directed thinking. b. habitual thinking. c. nonfocused thinking. d. ruminative thinking.

ANS: A

Directed thinking is purposeful and outcome oriented. Habitual thinking involves any routine that is important but does not require one to think hard about how to do it. Nonfocused thinking occurs when the brain is engaged out of habit without much conscious thought.

Ruminative thinking occurs when the same situation or scene is replayed in the mind over and over, without reaching an outcome.

DIF: Cognitive Level: Application TOP: Critical thinking MSC: NCLEX: N/A

REF: p. 66 OBJ: 1 KEY: Nursing Process Step: N/A

12. A nurse is performing routine vital signs on patients. The nurse has obtained vital signs many times before and is able to do so without much conscious thought. This is an example of a. directed thinking. b. negative thinking. c. ruminative thinking. d. nonfocused thinking.

ANS: D

Directed thinking is purposeful and outcome oriented. Negative thinking occurs when the mind is stuck on negative thoughts and blocks worthwhile thinking. Ruminative thinking occurs when the same situation or scene is replayed in the mind over and over, without reaching an outcome. Nonfocused thinking occurs when the brain is engaged out of habit, without much conscious thought.

DIF: Cognitive Level: Application TOP: Critical thinking MSC: NCLEX: N/A

REF: p. 66 OBJ: 1 KEY: Nursing Process Step: N/A

13. A nursing instructor encourages student nurses to use critical thinking in the clinical setting.

The instructor understands that critical thinking a. uses both logic and intuition. b. is driven by the nurse’s needs. c. entails nonpurposeful thinking.

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d. is based on nonscientific methods.

ANS: A

Critical thinking entails purposeful, informed, outcome-focused thinking that uses both logic and intuition; is driven by the patient’s, family’s, and community’s needs; and is based on the principles of the nursing process and scientific methods.

DIF: Cognitive Level: Application TOP: Critical thinking MSC: NCLEX: N/A

REF: p. 66 OBJ: 3 KEY: Nursing Process Step: N/A

14. A nursing student demonstrates the ability to break down complex information into its basic parts and relate those parts to the whole picture. This is an example of what cognitive level? a. Analysis b. Knowledge c. Application d. Comprehension ANS: A

Analysis means being able to break down complex information into its basic parts and relate those parts to the whole picture. Knowledge refers to the ability to recall and repeat information one has memorized. Application means being able to use learned material in new situations. Comprehension refers to the ability to very basically understand information, recall it, and identify examples of that information.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

15. A student nurse recalls that sleeping medications are administered at 2100. When the student is questioned about why sleeping medications are given at this time, the student states, “I memorized that sleeping pills are given at 2100. I have no idea why.” The student is using what cognitive level? a. Analysis b. Knowledge c. Application d. Comprehension ANS: B

Analysis means to be able to break down complex information into its basic parts and relate those parts to the whole picture. Knowledge refers to the ability to recall and repeat information one has memorized. Application means being able to use learned material in new situations. Comprehension refers to the ability to very basically understand information, recall it, and identify examples of that information.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

16. A student nurse recently learned about Maslow’s Hierarchy of Needs during a lecture. During the clinical rotation, the student is able to prioritize patient care based on Maslow’s Hierarchy of Needs. The student is using what cognitive level?

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a. b. c. d.

Analysis Knowledge Application Comprehension

ANS: C

Analysis means to be able to break down complex information into its basic parts and relate those parts to the whole picture. Knowledge refers to the ability to recall and repeat information one has memorized. Application means being able to use learned material in new situations. Comprehension refers to the ability to very basically understand information, recall it, and identify examples of that information.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

17. A nurse is caring for a postpartum patient who is hemorrhaging. The nurse considers several possibilities for postpartum hemorrhaging, including retained placental fragments, a full bladder, and uterine atony. The nurse is using what cognitive level? a. Analysis b. Knowledge c. Application d. Comprehension ANS: A

Knowledge refers to the ability to recall and repeat information one has memorized.

Comprehension refers to the ability to very basically understand information, recall it, and identify examples of that information. Application means being able to use learned material in new situations. Analysis means to be able to break down complex information into its basic parts and relate those parts to the whole picture.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

18. A nursing student demonstrates the ability to recall and repeat memorized information but does not understand the information. This is an example of what cognitive level? a. Analysis b. Knowledge c. Application d. Comprehension ANS: B

Knowledge refers to the ability to recall and repeat information one has memorized.

Comprehension refers to the ability to very basically understand information, recall it, and identify examples of that information. Application means being able to use learned material in new situations. Analysis means to be able to break down complex information into its basic parts and relate those parts to the whole picture.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

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19. A nursing student demonstrates the ability to basically understand information, recall it, and identify examples of that information. This is an example of what cognitive level? a. Analysis b. Knowledge c. Application d. Comprehension ANS: D

Knowledge refers to the ability to recall and repeat information one has memorized.

Comprehension refers to the ability to very basically understand information, recall it, and identify examples of that information. Application means being able to use learned material in new situations. Analysis means to be able to break down complex information into its basic parts and relate those parts to the whole picture.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

20. A nursing student demonstrates the ability to use learned material in new situations. This is an example of what cognitive level? a. Analysis b. Knowledge c. Application d. Comprehension ANS: C

Analysis means to be able to break down complex information into its basic parts and relate those parts to the whole picture. Knowledge refers to the ability to recall and repeat information one has memorized. Application means being able to use learned material in new situations. Comprehension refers to the ability to very basically understand information, recall it, and identify examples of that information.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

21. Clinical judgments about patients that result from critical thinking have what as their basis? a. Evidence b. Assumptions c. Ethical principles d. Personal preference of the nurse ANS: A

Judgments should be made on the basis of facts or evidence, rather than assumptions or the nurse’s preference. Ethical principles influence decisions, with the nurse choosing to do the right thing for the patient.

DIF: Cognitive Level: Comprehension REF: p. 67 | p. 68 OBJ: 2 TOP: Critical thinking KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

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MULTIPLE RESPONSE

1. To describe critical thinking in nursing to a peer, which characteristics would the nurse mention? (Select all that apply.) a. Random use b. Patient focused c. Uses logic and intuition d. Bases judgments on assumptions e. Does not require ongoing evaluation ANS: B, C

Critical thinking in nursing attempts to find a solution for a patient problem or need. It is purposeful and uses both logic and intuition. Critical thinking is purposeful rather than random. Judgments are based on evidence rather than assumptions. Critical thinking is constantly re-evaluating and self-correcting.

DIF: Cognitive Level: Application REF: p. 66 | pp. 68-70 OBJ: 2 | 3 TOP: Critical thinking KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

2. During a performance evaluation, the evaluator describes several behaviors of the nurse.

Select the observations that indicate the nurse uses critical thinking. (Select all that apply.) a. “I have noted that you base care on patient needs.” b. “Your caregiving is guided by identified outcomes.” c. “You use professional standards as guidelines.” d. “You tailor interventions to the circumstances.”

ANS: A, B, C, D

Each behavior is consistent with the advanced way of thinking known as critical thinking and with use of clinical judgment.

DIF: Cognitive Level: Analysis REF: p. 66 OBJ: 2 | 3 TOP: Critical thinking KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

3. An instructor tells a nursing student, “I have noticed that you sometimes engage in nonfocused thinking.” Which behaviors are consistent with the instructor’s observation? (Select all that apply.) a. The student consistently looks for solutions to problems. b. The student makes up his mind quickly and ignores additional facts. c. The student focuses on the negative aspects of nearly every situation. d. The student looks for creative ways to improve situations.

ANS: B, C

The student who makes up his mind quickly and ignores additional facts is an example of allor-none thinking, a type of nonfocused thinking. The student who focuses on the negative aspects of nearly every situation is an example of negative thinking, another type of nonfocused thinking. The remaining options are goal oriented and purposeful; therefore, they are not examples of nonfocused thinking.

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DIF: Cognitive Level: Analysis REF: p. 66 OBJ: 1 TOP: Critical thinking KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

4. To think critically, it is necessary to do which of the following? (Select all that apply.) a. Access information b. Comprehend information c. Recall the comprehended information when needed d. Store comprehended information in short-term memory only e. Know what to do when information is not in long-term memory ANS: A, B, C, E

To think critically, it is necessary to access information, comprehend information, store comprehended information in long-term memory, recall the comprehended information when needed, and know what to do when information is not in long-term memory.

DIF: Cognitive Level: Comprehension TOP: Critical thinking MSC: NCLEX: N/A

REF: p. 68 OBJ: 2 | 3 KEY: Nursing Process Step: N/A

5. A nursing student determines that she needs to increase her reading effectiveness. Identify two effective strategies for accomplishing this goal that can be implemented immediately. a. Read one word at a time. b. Move her lips while reading. c. Read recreational literature more slowly than technical material. d. Underline unfamiliar words.

ANS: B, D

Moving the lips while reading increases understanding for readers who are auditory learners.

Underlining unfamiliar words signals the need to determine the definition of the word and thus enhance one’s medical vocabulary.

DIF: Cognitive Level: Comprehension TOP: Reading effectively MSC: NCLEX: N/A

REF: p. 68 OBJ: 6 KEY: Nursing Process Step: N/A

6. Characteristics and attitudes of critical thinkers include which of the following? (Select all that apply.) a. Self-confident b. Honest and upright c. Logical and intuitive d. Sensitive to diversity e. Analytical and insightful f. Closed- and unfair-minded ANS: A, B, C, D, E

Characteristics and attitudes of critical thinkers include self-confidence, inquisitiveness, honesty and uprightness, alertness to context, openness and fair-mindedness, analytical and insightful thinking, logical and intuitive perception, reflection and self-correction, and sensitivity to diversity.

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DIF: Cognitive Level: Comprehension TOP: Critical thinking MSC: NCLEX: N/A

REF: pp. 68-70 OBJ: 2 | 3 KEY: Nursing Process Step: N/A

7. Which of the following are the cognitive levels used in the NCLEX-PN examination?

(Select all that apply.) a. Analysis b. Intuition c. Application d. Knowledge e. Correlation f. Comprehension ANS: A, C, D, F

The NCLEX-PN examination includes items that require various levels of thinking to answer a test item. These various levels are called cognitive levels. The cognitive levels used on the NCLEX-PN examination are knowledge, comprehension, application, and analysis.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

COMPLETION

1. The NCLEX-PN examination includes items that require various levels of thinking to answer a test item. These various levels are called .

ANS:

cognitive levels The NCLEX-PN examination includes items that require various levels of thinking to answer a test item. These various levels are called cognitive levels. The cognitive levels used on the NCLEX-PN examination are knowledge, comprehension, application, and analysis.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 | p. 71 OBJ: 4 KEY: Nursing Process Step: N/A

2. The cognitive levels used on the NCLEX-PN examination are knowledge, comprehension, application, and .

ANS:

analysis The NCLEX-PN includes items that require various levels of thinking to answer a test item.

These various levels are called cognitive levels. The cognitive levels used on the NCLEX-PN examination are knowledge, comprehension, application, and analysis.

DIF: Cognitive Level: Application TOP: Cognitive levels MSC: NCLEX: N/A

REF: p. 70 OBJ: 4 KEY: Nursing Process Step: N/A

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Chapter 06: Ethics Applied to Nursing: Personal Versus Professional Ethics Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. The nurse states, “I like being part of the health care team caring for the traditional two-parent family during the postpartum period as they bond with their newborn.” This statement reveals the nurse’s a. values. b. duty. c. fidelity. d. ethics.

ANS: A

Values involve the worth assigned to an idea or action. In this statement the nurse reveals that she values the traditional two-parent family. The statement does not clearly address any of the other options. Duty refers to the nurse’s responsibility to provide care in an acceptable way.

Fidelity challenges the nurse to be faithful to the charge of acting in the patient’s best interest when the capacity to make free choice is no longer available to the patient. Ethics is a system of standards or moral principles that direct actions as being right or wrong.

DIF: Cognitive Level: Application REF: p. 74 TOP: Values KEY: Nursing Process Step: N/A

OBJ: 2 MSC: NCLEX: N/A

2. A student nurse asks, “What’s the difference between laws and ethics?” Which response best explains the difference between nursing laws and ethics? a. “Ethics refer to expected behavior of nurses, but laws require mandatory observance by nurses.” b. “Nursing ethics are formalized by statutes, whereas laws are permissive codes.” c. “Ethics are derived from laws, whereas laws are enacted by nonnurse legislators.” d. “Ethics are specific to individual agencies, but laws are state specific.”

ANS: A

Ethics refers to behaviors nurses “ought” to observe. Laws refer to statutes that must be observed.

DIF: Cognitive Level: Application TOP: Ethical vs. legal aspects of practice MSC: NCLEX: N/A

REF: pp. 77-79

OBJ: 11 KEY: Nursing Process Step: N/A

3. The nurse providing care for patients or residents must act on the knowledge that a basic right of a patient or a resident is to receive a. considerate and respectful care from all care providers. b. information about the diagnosis and prognosis from the practical nurse. c. the medical care of their choice, regardless of their ability to pay. d. any food requested and in as large a quantity as desired.

ANS: A

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The individual rights of patients are an important ethical theme in health care. It is imperative that nurses separate personal ethics from nursing ethics and provide appropriate care to patients regardless of whether the nurse likes or dislikes the patient and regardless of the nurse’s values relating to the patient’s lifestyle, ethnicity, or other factors. Receiving information about the diagnosis and prognosis is not considered a right that is met by the LPN/LVN. The remaining options are not rights.

DIF: Cognitive Level: Knowledge REF: pp. 79-82 OBJ: 3 TOP: Individual rights KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

4. A major change in medical ethics that affected nursing occurred when the Western secular belief system shifted emphasis from duties to a. individual autonomy and rights. b. satisfying Medicare regulations. c. the cost-effectiveness of care. d. nonmaleficence.

ANS: A

Freedom of choice (autonomy) and the ability to assert one’s individual rights have become the major operative beliefs of the Western secular belief system affecting medical ethics today. These beliefs, in turn, affect the way nurses interact with patients. Satisfying Medicare regulations and the cost-effectiveness of care are not aspects of the Western secular belief system. The remaining option is an ethical principle that has always been important in medical ethics.

DIF: Cognitive Level: Comprehension REF: p. 77 TOP: Impact of Western secular belief system MSC: NCLEX: N/A

OBJ: 3 KEY: Nursing Process Step: N/A

5. The patient asks the nurse, “I overheard the instructor talking to a student about accountability. What does the word ‘accountability’ really mean?” The best response by the nurse would be a. “It is a transfer of responsibility for wrong actions.” b. “It is shared responsibility with the physician for wrongdoing.” c. “It is taking personal responsibility for one’s nursing actions.” d. “It is giving up responsibility when the situation dictates.”

ANS: C

Accountability means that one is personally answerable for specific actions. The other options do not accurately explain accountability.

DIF: Cognitive Level: Application TOP: Accountability MSC: NCLEX: Psychosocial Integrity

REF: p. 77 | p. 78 OBJ: 5 KEY: Nursing Process Step: Implementation

6. When a student nurse prepares diligently for a clinical assignment, the ethical principle being observed is a. autonomy. b. justice. c. nonmaleficence.

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d. fear of punishment.

ANS: C

Being prepared to provide skillful nursing care, anticipating problems that may occur, and thinking through alternative solutions qualifies as observing the principle of doing no harm.

Autonomy and justice are not principles that apply. Fear of punishment is not an ethical principle.

DIF: Cognitive Level: Comprehension REF: p. 78 | p. 83 OBJ: 7 TOP: Nonmaleficence KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

7. Encouraging a patient to be involved in planning and carrying out his or her own care is a nursing action that supports the ethical principle of a. confidentiality. b. privacy. c. autonomy. d. justice.

ANS: C

Autonomy means being free to choose. Possible patient choices include identifying goals and care measures compatible with one’s culture, religion, and personal values. Confidentiality means avoiding sharing patient information with anyone not directly involved in care without the patient’s permission. Privacy is the patient’s right to choose care based on personal beliefs, feelings, or attitudes. Justice means the nurse must deliver fair and equal treatment to all patients, recognizing and avoiding personal bias.

DIF: Cognitive Level: Application REF: p. 78 | p. 83 OBJ: 8 TOP: Autonomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

8. Leaving an unconscious patient exposed during a treatment or procedure is a violation of the ethical principle of a. fidelity. b. autonomy. c. justice. d. nonmaleficence.

ANS: B

Autonomy includes the patient’s right to privacy. It is assumed that an autonomous patient would reject unnecessary exposure of the body. Fidelity challenges the nurse to be faithful to the charge of acting in the patient’s best interest when the capacity to make free choice is no longer available to the patient. Justice means the nurse must deliver fair and equal treatment to all patients, recognizing and avoiding personal bias. Nonmaleficence is the ethical principle of “first do no harm.”

DIF: Cognitive Level: Comprehension REF: p. 80 TOP: Autonomy KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

OBJ: 8

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9. When a treatment team decides to go to court to obtain permission to provide chemotherapy for a child whose parents refuse to give consent for the treatment based on religious grounds, the ethical principles that are in conflict are a. fidelity and justice. b. beneficence and autonomy. c. justice and beneficence. d. autonomy and fidelity.

ANS: B

The parents’ autonomy to make decisions for their child is in conflict with the beneficence (doing good) of the health care team. The other principles are not relevant to the scenario.

DIF: Cognitive Level: Application REF: p. 79 | p. 80 TOP: Role of religion in ethical decisions MSC: NCLEX: N/A

OBJ: 8 KEY: Nursing Process Step: N/A

10. A way of practicing fidelity to a patient would be to a. discuss the patient with friends at a social gathering. b. document the patient’s expression of feelings and wishes. c. categorize the patient as a “down-and-out alcoholic.” d. develop the care plan without patient input.

ANS: B

The nurse who documents the patient’s expression of feelings or wishes without subjective interpretation is demonstrating fidelity (being true) to the patient. The other options demonstrate lack of fidelity.

DIF: Cognitive Level: Application REF: p. 80 | p. 81 OBJ: 9 TOP: Fidelity KEY: Nursing Pr cess Step: Implementat on MSC: NCLEX: Safe, Effective Care Environment

11. To provide justice to patients on the unit, the nurse must a. treat all patients with the same diagnosis utilizing the same plan of care. b. treat all patients with equal dignity and respect. c. base care on the patient’s culture, religion, and social status. d. determine who is most deserving of extra care.

ANS: B

Being fair does not mean giving every patient the same thing. It means treating them the same; that is, with dignity and respect. Basing care on a patient’s culture, religion, and social status and determining who is most deserving of extra care would result in care that is provided based on subjective criteria.

DIF: Cognitive Level: Application REF: p. 81 OBJ: 10 TOP: Justice KEY: Nursing Pr cess Step: Impleme tation MSC: NCLEX: Safe, Effective Care Environment

12. The patient asks the nurse what he should do about continuing cancer treatment. The nurse responds, “You should stop before you get so weak you can’t enjoy a few good weeks with your family.” This is an example of a. fidelity. b. beneficence.

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c. nonmaleficence. d. beneficent paternalism.

ANS: D

This response assumes the nurse knows what is right for the patient and robs the patient of decision making. It discounts the patient’s knowledge of self. The scenario does not describe the other ethical principles listed as options.

DIF: Cognitive Level: Application TOP: Beneficent paternalism MSC: NCLEX: Psychosocial Integrity

REF: p. 82 OBJ: 7 KEY: Nursing Process Step: N/A

13. What ethical principle underlies the statement in the National Federation of Licensed Practical Nurses (NFLPN) Code for Licensed Practical/Vocational Nurses, “The practical nurse provides health care to all patients regardless of race, creed, cultural background, disease, or lifestyle”? a. Autonomy b. Confidentiality c. Beneficence d. Justice ANS: D

Justice means treating all patients fairly according to their needs; that is, with dignity and respect. The other principles listed in the options do not fit the scenario. Autonomy is having control over personal decisions. Confidentiality means avoiding sharing patient information with anyone not directly involved in care without the patient’s permission. Beneficence means to “do good” with your nursing actions.

DIF: Cognitive Level: Comprehension REF: p. 75 TOP: Justice KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

OBJ: 10

14. A nurse injects himself or herself with a narcotic prescribed for a patient. This is an example of a. unethical and illegal behavior. b. ethical and legal behavior. c. unethical but legal behavior. d. ethical but illegal behavior.

ANS: A

It is unethical because the nurse has the ethical obligation to place the patient’s needs above his or her own. It is illegal to use a narcotic prescribed for another person.

DIF: Cognitive Level: Application TOP: Ethical vs. legal MSC: NCLEX: N/A

REF: pp. 75-79 OBJ: 2 | 3 | 11 KEY: Nursing Process Step: N/A

15. A student nurse is assigned to care for a patient with complex nursing care needs. The student was busy and did not prepare in advance for the assignment. In preconference, the student is unable to describe the care to be given and admits not knowing how to execute one of the treatments. The instructor would be ethically justified in a. telling the student to be very careful during caregiving.

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b. sending the student home and turning the patient’s care over to staff. c. suspending the student. d. dismissing the student from the program.

ANS: B

Nonmaleficence is the operative ethical principle. The student is ethically obligated to provide safe care to assigned patients. The instructor is also obligated to do no harm. Sending the student home and turning the patient’s care over to staff is a safe alternative to allowing the student to care for the patient. Suspending or dismissing the student from the program does not permit the student to have due process.

DIF: Cognitive Level: Analysis REF: pp. 75-79 OBJ: 6 TOP: Nonmaleficence KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

16. Which situation can be identified as abandonment of patients by the nurse? a. Calling in sick b. Floating to a unit after a 2-day orientation to the unit c. Starting to care for patients on wing A and being reassigned to wing B d. Going off duty without giving report rather than care for patients on an unfamiliar unit ANS: D

The nurse cannot leave a unit unless able to turn the care of patients over to a qualified nurse.

DIF: Cognitive Level: Analysis REF: p. 79 OBJ: 6 TOP: Abandonment KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment MULTIPLE RESPONSE

1. The nurse is asked to explain the meaning of ethics to a patient. The nurse should correctly state, “Ethics is a system of standards that refer to ideas and actions in terms of being (Select all that apply.): a. right and wrong.” b. moral and immoral.” c. legal and illegal.” d. good and bad.” e. ought and ought not.” f. like and dislike.” g. rights and duties.”

ANS: A, B, D, E, G

Ethics is concerned with all of the options except “legal and illegal” and “like and dislike.”

Ethics and legalities are not the entirely the same, although some ethical principles may be enacted into law. “Like and dislike” refer to values.

DIF: Cognitive Level: Application REF: p. 74 OBJ: 2 TOP: Ethics KEY: Nursing Process Step: Impleme tation MSC: NCLEX: Psychosocial Integrity

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2. The introduction of the nursing process and critical thinking into nursing practice has resulted in increased ethical and legal responsibilities for nurses in the areas of (Select all that apply.): a. peer reporting. b. accountability. c. personal ethics. d. patient advocacy. e. cost containment.

ANS: A, B, D

Peer monitoring and reporting are essential to patient safety and professional integrity.

Accountability means being held accountable for all nursing actions performed. Because the scope of practice has expanded, nursing accountability is greater. Patient advocacy requires the nurse to provide more information to patients. Personal ethics and cost containment are not included as areas of increased ethical and legal responsibility.

DIF: Cognitive Level: Comprehension REF: p. 77 OBJ: 3 | 4 TOP: Ethical responsibilities of nurses KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

3. What actions should be taken by the nurse to increase the possibility of doing no harm while caring for a patient? (Select all that apply.) a. Never participate in any action that will deliberately harm the patient. b. Question how to do the least amount of harm when doing something that is expected to result in good. c. Make sure the patient has agreed to the procedure verbally or in writing. d. Perform new procedures without seeking supervision. e. Become aware of side effects of commonly administered medications.

ANS: A, B, C, E

Each of these measures, except option D, would increase the potential for nonmaleficence in practice. Performing new procedures without seeking supervision has an increased potential for doing harm.

DIF: Cognitive Level: Comprehension REF: p. 78 | p. 79 OBJ: 6 TOP: Nonmaleficence KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

4. Which nursing actions are examples of use of the ethical principle of beneficence? (Select all that apply.) a. The LPN/LVN tells a patient to ask for a second doctor’s opinion. b. The LPN/LVN provides emotional support when the patient cries. c. The LPN/LVN places the bed in a low position before leaving the room. d. The LPN/LVN places medication the patient brought from home at the nurses’ station. e. The LPN/LVN provides report for the staff of the oncoming shift.

ANS: B, C, D

Beneficence means to do good. It also involves preventing harm, removing harm, and putting the patient’s interests first.

DIF: Cognitive Level: Application REF: p. 79 | p. 80 OBJ: 7 TOP: Beneficence KEY: Nursing Process Step: Implementation

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MSC: NCLEX: Safe, Effective Care Environment

5. Which statements would the nurse evaluate as suggesting that the patient’s decision has not been autonomous? (Select all that apply.) a. “I wish I knew for sure that I had all the facts about the treatment.” b. “I thought through all the alternatives.” c. “My son told me emphatically what he thought would be best for the family.” d. “I am going to refuse to take the treatment because it will prolong life.”

ANS: A, C

Autonomy means being free to choose. The statement, “I wish I knew for sure that I had all the facts about the treatment,” suggests that the patient may not have had all the relevant facts.

The statement, “My son told me emphatically what he thought would be best for the family,” suggests undue influence from the family. Thinking through all the facts is part of autonomous decision making, as is acting on one’s personal decision.

DIF: Cognitive Level: Analysis REF: p. 80 OBJ: 8 TOP: Autonomy KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Psychosocial Integrity COMPLETION 1. A system of standards or moral principles that direct actions as being right or wrong is called

.

ANS:

ethics Ethics is a system of standards or moral principles that direct actions as being right or wrong.

Ethics is concerned with the meaning of words such as right, wrong, good, bad, ought, and duty.

DIF: Cognitive Level: Knowledge REF: p. 74 TOP: Ethics KEY: Nursing Process Step: N/A

OBJ: 2 MSC: NCLEX: N/

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Chapter 07: Nursing and the Law: What Are the Rules?

Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. To function within the scope of the law, the nurse must know that the legal duties and functions of the nurse in a given state are determined by the a. U.S. Constitution. b. Bill of Rights. c. bylaws of the professional organization. d. Nurse Practice Act of the state.

ANS: D The Nurse Practice Act of each state determines the scope of practice of RNs and LPN/LVNsin that state. The U.S. Constitution and the Bill of Rights are incorrect answers, because matters dealing with the health and welfare of its citizens are states’ rights. Professional organizations may issue position papers, but these do not have the force of law.

DIF: Cognitive Level: Knowledge REF: p. 86 | p. 87 OBJ: 1 TOP: Nurse Practice Act KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

2. An example of a criminal action committed by a nurse is a. restraining a patient without a physician’s order. b. releasing information without the patient’s consent. c. discontinuing a ventilator without a physician’s order. d. making a medication error.

ANS: C

Commission of a felony, such as murder, is clearly a criminal act. The other options represent examples of torts, or matters of civil concern.

DIF: Cognitive Level: Application REF: p. 91 OBJ: 9 TOP: Criminal action: felony KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

3. A new LPN/LVN passes the NCLEX-PN examination and obtains licensure in state X. The LPN/LVN wishes to work in a state other than state X but is unsure of how to proceed.

Which statement provides sound advice in this situation? a. The effect of current national licensure allows a nurse licensed in one state to work in any other state for a maximum of 2 years without applying for endorsement. b. The nurse can work legally in any state that borders state X without applying for endorsement. c. The nurse should contact the state board of nursing of the state in which she wishes to work to determine whether they have multistate licensure with state X. d. The nurse should apply to take the NCLEX-PN examination in the state in which she wishes to work.

ANS: C

The state board of nursing of the state in which the LPN/LVN wishes to work can provide the essential information. Eighteen states have mutual recognition compacts, and Minnesota has a border recognition agreement. National licensure does not exist. A nurse working legally in any state that borders state X without applying for endorsement describes a border recognition agreement, such as the one in existence in Minnesota. It is unnecessary for a nurse to apply to take the NCLEX-PN examination; nurses can obtain endorsement without retaking the NCLEX-PN examination.

DIF: Cognitive Level: Comprehension TOP: Working in other states

REF: p. 89 OBJ: 2 | 3 KEY: Nursing Process Step: N/A

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MSC: NCLEX: N/A

4. A resident asks an LPN/LVN, “What is meant by the practical/vocational nurse’s standard of care in a long-term care agency?” The LPN/LVN should respond, “The practical/vocational nurse who provides care for residents in a long-term care agency must implement care that is consistent with a. shortcuts acceptable to the agency that allow nurses to assume larger and more complex patient assignments.” b. care that an ordinary, prudent LPN/LVN with the same education and experience would perform in similar circumstances.” c. the minimum competency necessary to function as a health care giver in the state in which the nurse resides.” d. customs of the agency in which the nurse is employed.”

ANS: B

This is the standard used by the courts, and it is the same regardless of the type of agency in which the nurse is employed. The other options do not define the nurse’s standard of care.

DIF: Cognitive Level: Application REF: p. 90 OBJ: 7 TOP: Standard of care KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

5. Civil law is concerned with a. acts that threaten society. b. decision making based on the nursing process. c. intentional and unintentional torts. d. guilt associated with criminal behavior.

ANS: C

Torts are civil wrongs and may be intentional (intended to cause harm) or unintentional (did not mean to do harm to the patient). Acts that threaten society are considered criminal acts.

Civil law is not directly concerned with the nursing process. Civil law is concerned with liability rather than guilt.

DIF: Cognitive Level: Knowledge REF: p. 91 TOP: Civil law KEY: Nursing Process Step: N/A

OBJ: 9 MSC: NCLEX: N/A

6. A nurse is found liable for battery. What does this mean? a. The nurse threatened the patient, causing fear of bodily harm. b. The nurse, without consent, touched the patient in a way that caused harm. c. The nurse detained the patient against his will. d. The nurse incorrectly performed a procedure that is within her scope of practice.

ANS: B

Battery is touch that causes actual physical harm to someone. Threatening a patient, causing fear of bodily harm, is assault. Detaining a patient against his will is false imprisonment.

Incorrectly performing a procedure that is within the nurse’s scope of practice is malpractice.

DIF: Cognitive Level: Knowledge REF: p. 91 | p. 92 TOP: Battery KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9

7. A nurse who angrily tells a patient, “If you don’t go to sleep, I’m going to give you an injection,” can be accused of

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a. b. c. d.

defamation. breach of confidentiality. assault. respondeat superior.

ANS: C

The nurse has threatened the patient. Assault is an unjustified attempt or threat to touch someone. Defamation means damaging someone’s reputation. Breach of confidentiality refers to revealing personal data to individuals not entitled to know without the patient’s permission.

Respondeat superior is a legal term meaning “let the master respond.”

DIF: Cognitive Level: Application REF: p. 91 | p. 92 TOP: Assault KEY: Nursing Pr cess Step: N/A MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9

8. Patient A, who has Alzheimer’s disease, wanders and is often noisy and intrusive. The patient has a prn order for haloperidol (Haldol) IM for assaultive behavior. At report, the LPN/LVN charge nurse explains that staffing is poor and she is unable to provide the supervision the patient needs. She directs the medication nurse to administer the patient’s prn haloperidol q4h during the shift. This action constitutes a. negligence. b. libel. c. assault. d. false imprisonment.

ANS: D

This is false imprisonment, an intentional tort. Chemical restraint is a means of detaining a person against his or her will. Negligence is an unintentional tort. Libel is a type of defamation. Assault refers to threatening behavior.

DIF: Cognitive Level: Application REF: p. 92 OBJ: 9 TOP: False imprisonment KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

9. The student nurse caring for a patient with a large decubitus ulcer photographs the ulcer without obtaining permission from the patient. The patient developed the ulcer while being cared for at home by her physician husband. The student plans to give the patient’s history and use the photograph in a paper she is writing. The instructor explains to the student that this action is unacceptable and could result in a court action for a. battery. b. malpractice. c. negligence. d. libel.

ANS: D

An intentional tort, libel is defined as defamation through written communication or pictures.

Giving the history and showing the photograph could damage the reputation of the physician husband. Battery refers to doing bodily harm to the patient. Malpractice and negligence are unintentional torts.

DIF: Cognitive Level: Application REF: p. 92 TOP: Libel KEY: Nursing Process Step: N/A

OBJ: 9

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MSC: NCLEX: Safe, Effective Care Environment

10. Legally, student practical/vocational nurses are held to the level of performance a. described in the job description for nursing assistants. b. described in the outline/syllabus of the course in which the student is enrolled. c. of the LPN/LVN. d. of the LPN/LVN instructor.

ANS: C

The standard of practice for the SP/VN is that of the LPN/LVN. Beginning practitioners are not held to a lesser standard. SP/VNs are not held to the same level of performance as nursing assistants. Holding the student practical/vocational nurse to the level of performance described in the outline/syllabus of the course in which the student is enrolled may not correspond to the Nurse Practice Act (although it should!). The instructor would be held to the standard for RNs. DIF: Cognitive Level: Knowledge REF: p. 93 OBJ: 1 | 7 TOP: Standard for performance KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

11. Which of the following is an example of breach of duty? a. The LPN/LVN walks off the unit during the shift. b. The LPN/LVN resigns from the position. c. The LPN/LVN delegates duties to unlicensed assistive personnel. d. The LPN/LVN does not perform duties according to the standard of care.

ANS: D

Breach of duty means the nurse did not adhere to the nursing standard of care. Walking off the unit during the shift refers to abandonment. Resigning from the position is a right of the nurse.

Delegating duties according to the standard of care is not a breach of duty if it is permitted by the state Nurse Practice Act and is correctly performed.

DIF: Cognitive Level: Application REF: p. 94 OBJ: 11 TOP: Breach of duty KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

12. When documenting patient behavior, the LPN/LVN should a. record subjective interpretations of patient behavior. b. avoid mentioning communicating with supervisors to report changes in condition. c. record all interventions performed and patient instruction given. d. Use white-out to erase errors in documentation.

ANS: C

The nurse should record all interventions and instructions given to the patient. Legally, if it is not documented, it cannot be proved that the care was given. Documentation should be objective. All patient-related communication with supervisors or physicians should be documented. Flow sheets must be marked appropriately.

DIF: Cognitive Level: Comprehension REF: p. 90 | p. 95 OBJ: 13 TOP: Documentation KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

13. How should an LPN/LVN explain the term accountability to a student nurse?

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a. b. c. d.

“Accountability is the transfer of responsibility for wrong actions.”

“Accountability is shared responsibility with the physician for wrongdoing.”

“Accountability is assuming personal responsibility for one’s nursing actions.”

“Accountability is giving up responsibility when the situation dictates.”

ANS: C

Accountability means that one is answerable for one’s actions. The other options do not correctly reflect the meaning of accountability.

DIF: Cognitive Level: Application REF: p. 96 OBJ: 13 TOP: Accountability KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

14. The instructor tells an SP/VN, “You have functioned at a substandard level of clinical performance recently. Now you have a chance to redeem yourself. I’m assigning you to a complex nursing situation. I expect you to function without asking for assistance.” What is the most accurate assessment of the instructor’s action? a. The action will enable the instructor to determine whether the student should pass or fail the course. b. The instructor is accountable for making an unsafe patient care assignment. c. It is an acceptable teaching practice to challenge students to higher levels of performance. d. The instructor should be investigated for fraud by the state board of nursing.

ANS: B

Assigning an SP/VN to a complex nursing situation shows poor judgment. A complex nursing situation involves a patient whose clinical condition is unpredictable. Nursing care expectations are beyond what the LPN/LVN has learned during the educational program. An instructor is expected to make patient assignments based on student knowledge and ability to give safe nursing care and is expected to provide necessary supervision.

DIF: Cognitive Level: Analysis REF: p. 90 | p. 96 OBJ: 13 TOP: Instructor liability KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

15. The instructor tells a student nurse, “You have functioned at a substandard level of clinical performance recently. Now you have a chance to redeem yourself. I’m assigning you to a complex nursing situation. I expect you to function without asking for assistance.” The most appropriate response from the student nurse would be a. “I’ll try my best, but I will need someone on staff to answer my questions.” b. “Is this your way of asking for my resignation from the program?” c. “I cannot accept the assignment. Complex nursing situations are beyond my abilities.” d. “You’d better remember that if anything goes wrong, the hospital will hold you responsible.”

ANS: C

The student nurse is obligated to refuse an assignment that is clearly beyond the scope of his or her abilities rather than jeopardize patient safety. Placing a student in a complex nursing situation without access to supervision is totally inappropriate.

DIF: Cognitive Level: Application

REF: p. 90 | p. 96

OBJ: 13

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TOP: Student liability/functioning beyond scope of practice and experience KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

16. A patient tells the LPN/LVN, “I want you to bring my medical record so I can read it. I know HIPAA gives me the right to see it.” The LPN/LVN should a. bring the record from the nurses’ station to the patient within the hour. b. explain that the request will be made to the RN, who will follow agency policy. c. try to talk the patient out of seeing the record by offering to answer questions. d. tell the patient to make the request in writing to the physician.

ANS: B

The patient’s request must be honored, but agency protocol must be followed in doing so.

Usually a physician or RN reviews the record with the patient to translate medical terminology and answer questions. Student nurses and LPN/LVNs do not provide the patient with the record.

DIF: Cognitive Level: Application REF: p. 98 | p. 99 OBJ: 16 TOP: Implementing HIPAA provisions KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

17. With regard to HIPAA implementation, the LPN/LVN who is newly employed at a health care agency should a. realize that enough was learned about the provisions of the act in school to function effectively at work. b. be aware that each agency may interpret HIPAA provisions somewhat differently. c. operate on the assumption that all agency privacy practices are similar. d. depend on the HIPAA website to provide all necessary job-related information.

ANS: B

Because each agency may interpret HIPAA provisions somewhat differently, it is important for the nurse to become familiar with the facility’s notice of privacy practices and function within its parameters. The remaining options are inadequate because they do not address facility specifics.

DIF: Cognitive Level: Application REF: p. 98 | p. 99 OBJ: 16 TOP: HIPAA implementation KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

18. The patient tells the nurse, “I want to make sure that my daughter can make health care decisions for me in the event I’m unable to make decisions for myself. What do I need to do?” The nurse should advise the patient that he or she needs to execute a(n) a. living will. b. civil action. c. informed consent. d. durable medical power of attorney.

ANS: D

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A durable medical power of attorney names a health care proxy, an individual whom the patient wishes to make health care decisions for him or her when the patient is not able to make decisions. A living will sets forth the care the patient is willing and unwilling to receive but does not name a health care proxy. The remaining options (civil action, which protects individual rights and results in payment of money to the injured person, and informed consent, which is obtained by the physician for invasive procedures after the physician has provided with the facts about effects, side effects, alternative treatments, prognosis, etc.) have no relevance to the scenario.

DIF: Cognitive Level: Application REF: p. 101 | p. 102 OBJ: 18 TOP: Advance directives KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

19. The term used to describe a competent patient’s agreement to have a surgical procedure after the physician explains the procedure, the desired outcome, possible complications, and possible alternative treatment is a. statute. b. competency. c. informed consent. d. standard of care.

ANS: C

Informed consent requires that the individual receive all relevant information and be able to make a decision based on consideration of the information. Statute is a synonym for law.

Competency refers to having the mental capacity to be able to make informed decisions.

Standard of care refers to that which a prudent nurse would do in a given situation.

DIF: Cognitive Level: Knowledge REF: p. 100 | p. 101 OBJ: 17 TOP: Informed consent KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

20. The nurse discusses the patient’s condition on the phone with the patient’s brother. On learning this, the patient is upset, saying he has not spoken with his brother for years and does not want his brother to know anything about his condition. The nurse has a. slandered the patient. b. committed a felony. c. breached confidentiality. d. assaulted the patient.

ANS: C

Confidentiality and privacy are the issues. HIPAA provides for only limited disclosure of patient health care information. Patient consent is required to disclose. Disclosure of information is not necessarily slander unless the nurse speaks of the patient in a derogatory way. A felony is a major crime. Assault involves threatening the patient.

DIF: Cognitive Level: Application REF: p. 97 OBJ: 16 TOP: Privacy KEY: Nursing Pr cess Step: Impleme tation MSC: NCLEX: Safe, Effective Care Environment

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21. What is the nurse’s responsibility regarding an improper medical order that, if carried out, may harm a patient? a. The nurse must carry out the orders as written without questioning. b. The nurse must go directly to the physician and, if necessary, refuse to carry out the order. c. The nurse must go directly to the patient and ask the patient to make a decision about the order. d. The nurse should carry out the order and then immediately resign so as not to be held responsible.

ANS: B

The nurse should deal directly with the physician who wrote the order. If this is unsuccessful, the nurse should use the nursing chain of command. Carrying out the orders as written without questioning is unsafe and may cause harm to the patient. Going directly to the patient and asking the individual to make a decision about the order is unrealistic and inappropriate.

Carrying out the order and then immediately resigning so as not to be held responsible is unsafe.

DIF: Cognitive Level: Comprehension REF: p. 95 | p. 96 OBJ: 21 TOP: Questionable order KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

22. A risk management strategy a nurse can use to prevent being named in malpractice lawsuits is a. carrying malpractice insurance. b. requesting supervision for all care. c. not signing her or his name to patient medical records. d. maintaining good relationships with patients and families.

ANS: D

One of the best defenses for prevention of legal liability is developing rapport with patients. A patient who was treated with respect and consideration is less likely to sue. Carrying liability insurance does not prevent lawsuits. Requesting supervision for all care is an impractical action. Not signing a name to patient’s medical records is an impossibility.

DIF: Cognitive Level: Knowledge REF: p. 95 | p. 96 OBJ: 21 TOP: Risk management KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

23. A nursing student is assigned to care for a patient who requires several technical procedures.

The student was busy and did not prepare in advance for the assignment. In preconference, the student is unable to describe the care to be given. The instructor would be justified in a. telling the student to be very careful during caregiving. b. sending the student off duty and turning the patient’s care over to staff. c. suspending the student. d. dismissing the student from the program.

ANS: B

The instructor is ultimately responsible for ensuring that the patient receives safe, effective care at the hands of the student. If the instructor has doubts created by the student’s lack of preparation, the student should not be allowed to continue with the assignment.

DIF: Cognitive Level: Analysis

REF: p. 96

OBJ: 13

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TOP: Instructor liability KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

24. Which statement is true regarding durable medical power of attorney and living wills? a. They set standards for care of terminally ill patients by nurses. b. They allow patients a voice about medical interventions after they are incapable of acting. c. They prevent occurrences of intentional torts. d. They complicate ethical decision making for nurses.

ANS: B

Durable medical power of attorney and living wills are advance directives. Advance directives allow the individual to appoint a health care proxy and to make the individual’s wishes about health care known. Advance directives do not set standards. Advance directives do not prevent intentional torts. Advance directives usually simplify ethical decision making for nurses.

DIF: Cognitive Level: Comprehension REF: p. 101 | p. 102 OBJ: 18 TOP: Advance directives KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

25. An example of statutory law is a. informed consent. b. the Nurse Practice Act. c. a patient’s right to refuse treatment. d. a hospital’s written policies and procedures.

ANS: B

The Nurse Practice Act, which governs the practice of nursing, is an example of statutory law. Informed consent and a patient’s right to refuse treatment are examples of common law.

Statutory law is developed by the legislative branch of the state and the U.S. Congress of the federal government. Written policies and procedures are created by the agency for which a nurse works.

DIF: Cognitive Level: Comprehension REF: p. 91 TOP: Law KEY: Nursing Process Step: N/A

OBJ: 8 MSC: NCLEX: N/A

26. An example of battery is a. a patient who refuses to be suctioned and is suctioned anyway after refusal. b. a patient who uses the call light and yells out repeatedly is threatened with bodily harm. c. a patient who threatens to leave the hospital against medical advice is told she will be restrained. d. a patient who refuses to take his medications is threatened with being forcibly given the medications.

ANS: A

Battery means to cause physical harm to someone. When a patient refuses a treatment or medication, forcing the patient to take medication could result in an assault and battery charge. Assault is an unjustified attempt or threat to touch someone.

DIF: Cognitive Level: Analysis REF: p. 92 TOP: Battery KEY: Nursing Process Step: N/A

OBJ: 9

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27. A nurse damages a physician’s reputation through false written communication without the physician’s permission. This is an example of a. libel. b. assault. c. battery. d. slander.

ANS: A

Libel is defamation through written communication or pictures. Assault is an unjustified attempt or threat to touch someone. Battery means to cause physical harm to someone. When a patient refuses a treatment or medication, forcing the patient to take medication could result in an assault and battery charge. Slander is defamation by verbalizing untrue or private information (gossip) to a third party.

DIF: Cognitive Level: Analysis REF: p. 92 TOP: Libel KEY: Nursing Process Step: N/A

OBJ: 9 MSC: NCLEX: N/A

28. A nurse damages a patient’s reputation by verbalizing private information about the patient to a third party. This is an example of a. libel. b. assault. c. battery. d. slander.

ANS: D

Slander is defamation by verbalizing untrue or private information (gossip) to a third party.

Libel is defamation through written communication or pictures. Assault is an unjustified attempt or threat to touch someone. Battery means to cause physical harm to someone. When a patient refuses a treatment or medication, forcing the patient to take medication could result in an assault and battery charge.

DIF: Cognitive Level: Analysis REF: p. 92 TOP: Libel KEY: Nursing Process Step: N/A

OBJ: 9 MSC: NCLEX: N/A

29. Which of the following is true regarding informed consent? a. Informed consent must be obtained for surgical procedures only. b. Parents can give informed consent for the treatment of their children. c. Informed consent means the patient is informed in medical language. d. A patient is informed that he or she has the right to revoke consent at any time.

ANS: D

Informed consent must be obtained for invasive procedures ordered for therapeutic or diagnostic purposes. Parents cannot give informed consent for the treatment of their children, but they can authorize their treatment up to a certain age (authorized consent). Informed consent means that the patient is informed in nonmedical language. The patient is told in nonmedical language that he or she has the right to revoke written permission at any time.

DIF: Cognitive Level: Analysis REF: p. 100 | p. 101 OBJ: 17 TOP: Informed consent KEY: Nursing Process Step: Implementation

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MULTIPLE RESPONSE

1. Which statements are accurate with regard to a living will? (Select all that apply.) a. An attorney is required to draft a living will. b. Living wills are recognized as legal documents in Canada. c. A living will does not let the person select someone to make decisions for them. d. Living wills are recognized as legal documents in 47 states in the United States, the District of Columbia, and Guam. e. The living will is filled out by the individual and witnessed by a person who will benefit by the death of that individual. f. A living will is a legal document that describes the kind of medical or lifesustaining treatments the person would want if seriously or terminally ill.

ANS: C, D, F

An attorney is not required to draft a living will. Living wills are not recognized as legal documents in Canada. A living will does not let the person select someone to make decisions for them. Living wills are recognized as legal documents in 47 states in the United States, the District of Columbia, and Guam. The living will is filled out by the individual and witnessed by a person who will not benefit by the death of that individual. A living will is a legal document that describes the kinds of medical treatments or life-sustaining treatments the person would want if seriously or terminally ill.

DIF: Cognitive Level: Comprehension OBJ: 18 TOP: Living will MSC: NCLEX: N/A

REF: p. 101 | p. 102 KEY: Nursing Process Step: N/A

2. Individual A has worked as an LPN/LVN for a year. The agency where she works discovers that the registration document she presented at the time she was hired was altered to remove the name of the rightful registrant and show her name instead. What are the possible outcomes of this situation? (Select all that apply.) a. The state board of nursing, when notified, will charge the nurse with fraud and deceit. b. The agency will terminate the employment of the individual. c. The agency will notify all patients for whom the individual cared to determine injury. d. The individual will be arrested for misrepresentation. e. The individual’s license to practice will be revoked.

ANS: A, B

Obtaining the registration of license document and changing the name on the document so that one may represent herself as a nurse when she is not is fraudulent behavior. The agency will terminate the individual’s employment, because she cannot continue to work as an LPN/LVN. The agency would not notify all patients for whom the individual cared to determine injury. Arrest would occur only if criminal charges are filed. The individual does not hold licensure, so revocation cannot occur.

DIF: Cognitive Level: Application REF: p. 88 | p. 89 OBJ: 2 TOP: Professional discipline: fraud KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

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3. In the following list, identify the instances of possible malpractice. (Select all that apply.) a. The nurse accidentally administers an excessively large dose of a prescribed medication, and the patient becomes comatose. b. The nurse runs a red light en route to work and causes an auto accident in which three people are seriously injured and one dies. c. The nurse notes the patient’s poor capillary return distal to a cast, becomes busy and does not report it, and the patient later loses limb function. d. The nurse discusses a patient’s condition in a disparaging way in a hospital elevator and is overheard by the patient’s husband.

ANS: A, C

Medication errors and failure to communicate important information, resulting in harm to the patient, are common sources of malpractice. Running a red light en route to work and causing an auto accident in which three people are seriously injured and one dies would be considered negligence, because the nurse is not engaged in the practice of the profession while driving to work. Discussing a patient’s condition in a disparaging way in a hospital elevator and being overheard by the patient’s husband would be considered slander.

DIF: Cognitive Level: Application REF: p. 93 TOP: Malpractice KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9

4. Nurse A is assigned to care for a patient with diabetes who is being regulated on new types of insulin. The patient performs most of her own care and rarely uses the call bell to summon the nurse. The nurse knows this and leaves the patient unobserved most of the shift. Just before change of shift report, the aide reports that she cannot rouse the patient. The patient has entered a vegetative state as the result of brain damage related to severe hypoglycemia.

Which, if any, of the four elements needed to prove malpractice are present? (Select all that apply.) a. Duty b. Breach of duty c. Damages d. Proximate cause e. No elements are present ANS: A, B, C, D

The assignment for the nurse to care for the patient constitutes duty. Breach of duty is seen when the nurse fails to observe the patient as a prudent nurse would do. The vegetative state is the injury caused by the nurse’s failure to act according to the standard of care. Proximate cause can be shown based on the nurse’s failure to periodically observe the patient. It can be argued that early intervention to reverse the hypoglycemia would have prevented injury to the patient.

DIF: Cognitive Level: Analysis REF: p. 94 OBJ: 9 TOP: Elements of malpractice KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment COMPLETION

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1. A legal document that describes the kinds of medical or life-sustaining treatments the person

would want if seriously or terminally ill is known as a

.

ANS:

living will The living will is a legal document that describes the kinds of medical or life-sustaining treatments the person would want if seriously or terminally ill.

DIF: Cognitive Level: Comprehension REF: p. 101 TOP: Living will KEY: Nursing Process Step: N/A

OBJ: 18 MSC: NCLEX: N/A

Chapter 08: Effective Communication: Health Care Team, Patients, Faculty, and Peers Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. A trusting relationship with a patient can be fostered by a. introducing oneself and stating one’s role. b. identifying the patient by room number. c. seeing the patient every 5 to 7 minutes. d. making up answers when one does not know the answer.

ANS: A

Trust begins by gaining the patient’s confidence through introducing oneself and stating one’s role. Identifying the patient by room number depersonalizes the patient. Seeing the patient every 5 to 7 minutes would be excessive in most situations. Making up answers when one does not know the answer is dishonest.

DIF: Cognitive Level: Application OBJ: 2 TOP: Trust MSC: NCLEX: Psychosocial Integrity

REF: p. 114 | p. 115 KEY: Nursing Process Step: Implementation

2. A patient is crying. The nurse can correctly conclude from this type of nonverbal communication that a. the patient is sad. b. the tears reflect happiness. c. the patient is in pain. d. the situation needs clarification.

ANS: D

The reason for the patient’s crying cannot be determined on the basis of the data supplied. The patient could be sad, happy, or in pain. The situation needs clarification.

DIF: Cognitive Level: Analysis REF: p. 109 | p. 110 OBJ: 7 TOP: Communication KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Psychosocial Integrity

3. The nurse who demonstrates empathy a. feels sorry for the patient’s situation.

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b. understands the patient’s thoughts but is unaware of his or her feelings and emotions. c. understands and appreciates the patient’s feelings while remaining objective. d. attempts to remove physical and emotional pain and fix all of the patient’s problems.

ANS: C

Empathy is the ability to understand and appreciate what someone else is feeling without actually experiencing the emotion itself. This permits the nurse to remain objective. Feeling sorry for the patient’s situation suggests sympathy rather than empathy. Understanding the patient’s thoughts but being unaware of his or her feelings and emotions speaks of a nurse who lacks awareness of others’ emotions. Attempts to remove physical and emotional pain and fix all of the patient’s problems suggests overinvolvement.

DIF: Cognitive Level: Application REF: p. 115 OBJ: 2 TOP: Empathy KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

4. The nurse demonstrates commitment to the patient by a. delivering nursing care skillfully. b. using humor to poke fun at the patient. c. giving advice to solve the patient’s problems. d. talking about what the nurse plans to do after work.

ANS: A

Commitment involves performing at an optimal level to meet the patient’s needs. Delivering nursing care skillfully is the only appropriate behavior listed.

DIF: Cognitive Level: Application TOP: Commitment MSC: NCLEX: Psychosocial Integrity

REF: p. 115 OBJ: 2 KEY: Nursing Process Step: Implementation

5. To communicate interest and caring to a patient of the majority culture, the nurse should a. call the patient on days off. b. keep conversation on a social level. c. direct the patient to make a list of all problems. d. make eye contact and encourage the patient to communicate.

ANS: D

Making eye contact is a means of conveying interest to patients of the majority culture.

Encouraging and supporting communication is also a means of conveying interest. Calling the patient on days off is unnecessary. Keeping conversation on a social level is not therapeutic.

Directing the patient to make a list of all problems might not be necessary or appropriate.

DIF: Cognitive Level: Application REF: p. 111 TOP: Communicating interest and caring KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

OBJ: 2 | 7

6. A patient states, “I’m really turned off when the doctor hurries out of here.” The nurse responds, “You’re feeling upset with your doctor because he doesn’t spend enough time with you.” This interaction demonstrates

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a. summarizing. b. validating. c. clarifying. d. reflecting.

ANS: D

Reflecting involves putting into words the information received from the patient at an effective communication level. Summarizing means briefly stating the main data you have gathered. Validating provides the patient with an opportunity to correct information.

Clarifying is asking a closed-ended question in response to a patient’s statement to be sure you understand. The example given does not relate to definitions of the other communication strategies.

DIF: Cognitive Level: Comprehension REF: p. 111 OBJ: 1 TOP: Reflecting KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

7. The patient states, “My pain is awful!” The response that illustrates the use of focusing is a. “On a scale of 1 to 10, tell me the number that represents your level of pain.” b. “I am not sure I understand what you’re telling me.” c. “You seem to be in considerable pain.” d. “Can you handle the pain you’re having?”

ANS: A

Focusing, or asking focused questions, prompts the patient to provide more definitive information. Asking a patient to rate his or her pain on a scale of 1 to 10 exemplifies this definition.

DIF: Cognitive Level: Application REF: p. 111 TOP: Focused questions KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Physiological Integrity

OBJ: 1

8. A patient states, “This is my fourth miscarriage.” A response by the nurse that demonstrates active listening would be a. “Having another miscarriage must be hard to accept.” b. “This is nature’s way. You can be glad it happened.” c. “How lucky to have lost the baby so early in your pregnancy.” d. “I’ve had two miscarriages, so I know how you must feel.”

ANS: A

Reflection is a strategy that is useful in active listening. The statement, “Having another miscarriage must be hard to accept” is an example of reflection, or putting into words the affective communication received from the patient. The statements, “This is nature’s way.

You can be glad it happened” and “How lucky to have lost the baby so early in your pregnancy” are insensitive and do not suggest active listening. The statement, “I’ve had two miscarriages, so I know how you must feel” is nurse centered, and therefore not an example of active listening.

DIF: Cognitive Level: Application TOP: Active listening MSC: NCLEX: Psychosocial Integrity

REF: p. 111 OBJ: 1 KEY: Nursing Process Step: Implementation

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9. The patient asks, “What is an IVAC thermometer?” The nurse replies, “It is a heat-sensitive probe inserted into the sublingual area or rectal orifice. Heat transmission proceeds via an electrical system to a control center that interprets the temperature and displays it.” This reply can be analyzed as a. one-way communication. b. active listening. c. unnecessary use of jargon. d. displaying sensitivity.

ANS: C

This explanation is unnecessarily scientific and uses nursing jargon when a simple answer would suffice. The communication described is two-way. Active listening involves responding therapeutically rather than in a confusing manner. The nurse’s response displays insensitivity.

DIF: Cognitive Level: Analysis REF: p. 109 | p. 115 OBJ: 6 TOP: Communication block: use of jargon KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

10. A patient states, “I don’t seem to be getting my strength back.” The nurse replies, “Don’t worry. You are coming along just fine.” This response is an example of a. probing. b. false reassurance. c. disagreeing. d. active listening.

ANS: B

False reassurance involves telling the patient that there is nothing to worry about when that may or may not be true. Probing means pushing for more information. Disagreeing conveys disapproval of the patient’s verbalization. Active listening is a therapeutic strategy.

DIF: Cognitive Level: Application REF: p. 112 | p. 119 OBJ: 6 TOP: Communication block KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

11. The nurse enters a patient’s room and asks, “How are things today?” The nurse has used a. an open-ended question. b. a focused question. c. probing. d. paraphrasing.

ANS: A

An open-ended question permits the patient to answer in whatever way is most meaningful. It is sometimes called a broad opening. The remaining options are incorrect, because focused questions permit only specific and narrow answers; probing suggests that the nurse is probing or digging for information; and paraphrasing allows the nurse to say in his or her own words the message conveyed by the patient.

DIF: Cognitive Level: Application REF: p. 111 TOP: Therapeutic communication: open-ended question

OBJ: 3

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KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

12. Characteristics of one-way communication include all of the following except a. it is sender controlled. b. receiver feedback is not expected. c. it always has negative value. d. it is useful to give commands.

ANS: C

Always having negative value is not a characteristic of one-way communication, because oneway communication may have either positive or negative value. The remaining options are characteristics of one-way communication.

DIF: Cognitive Level: Analysis TOP: One-way communication MSC: NCLEX: N/A

REF: p. 108 OBJ: 3 KEY: Nursing Process Step: N/A

13. Two-way communication differs from one-way communication because with one-way communication a. the impact is positive. b. the receiver contributes as much as the sender. c. no feedback is expected. d. body language does not affect the receiver.

ANS: C

It is true that in one-way communication, the sender does not expect the receiver to provide feedback. The impact of one-way communication is not always positive. The receiver of oneway communication does not contribute to the interaction. Body language may affect the receiver.

DIF: Cognitive Level: Analysis REF: p. 108 TOP: Comparison of one-way vs. two-way communication MSC: NCLEX: N/A

OBJ: 3 KEY: Nursing Process Step: N/A

14. A patient asks a practical/vocational nursing student the following questions. To which option should the nurse respond, “I don’t know the answer to your question, but I’ll find someone who will discuss it with you”? a. “What do you mean when you say ‘vital signs’?” b. “May I get out of bed?” c. “How do I call a nurse when I need one?” d. “How much longer do I have to live?”

ANS: D

Questions about prognosis and impending death are the responsibility of the physician or, in some cases, the advanced practice nurse. The LPN/LVN should know in advance what can be discussed with the patient and be prepared to refer the person to a more knowledgeable practitioner. The other options are examples in which the LPN/LVN is capable of giving answers.

DIF: Cognitive Level: Analysis TOP: Therapeutic communication

REF: p. 110 OBJ: 2 KEY: Nursing Process Step: Implementation

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MSC: NCLEX: Psychosocial Integrity

15. A patient who has had knee surgery tells the nursing student that he is “doing fine” and “doesn’t need anything.” The student observes that he winces when moving in bed and that he has a worried frown. The student asks him to rate his pain on a numerical scale and then encourages him to take his prn analgesic. Which is true of this interaction? a. The nursing student recognized that the patient’s verbal and nonverbal messages were incongruent. b. The nursing student understood that verbal messages outrank nonverbal messages in importance. c. The nursing student realized that affective communication is of lesser importance. d. The nursing student used one-way communication effectively.

ANS: A

This is an example of incongruence between verbal and nonverbal communication, requiring further investigation. Verbal messages do not outrank nonverbal messages in importance, and affective communication is not of lesser importance. Two-way communication is being used in the scenario, not one-way communication.

DIF: Cognitive Level: Analysis REF: p. 110 TOP: Incongruent verbal and nonverbal communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

OBJ: 7

16. Which option provides information that allows an individual to identify the patient’s affective state? a. Mr. B states that he is in considerable pain, about 8 on a scale of 1 to 10.

He characterizes the pain as stabbing. b. Mrs. T’s facial expression looks sad. Tears well up in her eyes, and the corners of her mouth droop. c. Miss L lies still with her eyes shut, her arms held rigidly at her side, and her fists clenched. d. Mr. A listens carefully to the directions for blood glucose monitoring and then asks several relevant questions.

ANS: B

Affective communication is assessed by observing mood and emotions. Option B provides information on the patient’s affective state. The patient verbalizing that he is in pain and describing it is an example of verbal behaviors. Body language, such as lying still with the eyes closed, the arms held rigidly at the side of the body, and the fists clenched, better describes nonverbal communication than affective state. A patient listening to directions and then asking relevant questions describes verbal communication.

DIF: Cognitive Level: Application REF: p. 109 | p. 110 OBJ: 7 TOP: Affective communication KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: N/A

17. Which statement is true regarding open-ended, closed-ended, and focused questions? a. Open-ended questions always achieve their purpose. b. Closed-ended and focused questions are used to get specific information. c. Closed-ended questions are used primarily with children and older adults.

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d. Focused questions are more useful when communicating with men.

ANS: B

Closed-ended and focused questions require the patient to give an answer that is narrower in scope than the answers possible for open-ended questions. Open-ended questions do not necessarily always achieve their purpose. Closed-ended questions may be useful with persons of any age. Focused questions are equally useful for men and women.

DIF: Cognitive Level: Comprehension REF: p. 111 TOP: Types of questions KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

18. On which statement about life span communication differences can the nurse rely when implementing patient care? a. Children from birth to age 2 are most soothed by a high-pitched tone of voice. b. Preschool children tend to respond well to a reasoning approach. c. It is important to try to communicate with teens using their slang. d. Older adults hear lower frequency sounds more easily than high-pitched sounds.

ANS: D

Older adults lose the ability to hear high-frequency sounds but are often able to hear lower frequency sounds. Using a low voice register will be more helpful than pitching the voice in the higher registers. Children from birth to age 2 are soothed by low-pitched voices. Preschool children have immature reasoning skills. Use of slang with teenagers is ill-advised, because meanings change with great speed.

DIF: Cognitive Level: Analysis TOP: Life-span communication MSC: NCLEX: Psychosocial Integrity

REF: p. 118 OBJ: 10 | 11 KEY: Nursing Process Step: Implementation

19. A patient tells the nurse, “I don’t know what to expect in the hospital. Everybody speaks medical-talk. Nobody tells me if I’m getting better or worse. Doctors march in and poke and prod me without asking my permission. And another thing, I can’t stay here forever; I have to look after my elderly mother.” From these data the nurse can correctly determine that the patient is a. experiencing a difficult transition to the patient role. b. unnecessarily sensitive to loss of independence. c. excessively fearful of unknown aspects of hospitalization. d. suffering from sensory overload.

ANS: A

The patient is voicing concerns typical of someone experiencing negative aspects of role transition. Nothing is familiar, the patient feels left out, lacks privacy, and has a major personal concern regarding her mother. The patient’s reactions would be considered normal.

The patient is not demonstrating excessive fear. The patient’s complaints are not consistent with sensory overload.

DIF: Cognitive Level: Analysis REF: p. 113 | p. 114 OBJ: 10 TOP: Role transition to patient KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Psychosocial Integrity

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20. A patient states, “My chest incision hurts. I can’t walk because of the pain.” The nurse responds, “You’ve been unable to walk because of incisional pain.” The nurse’s response is an example of which active listening behavior? a. Restating b. Reflection c. Clarification d. Paraphrasing ANS: A

Restating refers to repeating in a slightly different way what the patient has said. Reflection is putting into words information received from the patient at an effective communication level.

Clarification is asking a closed-ended question in response to a patient’s statement to be sure it’s understood. Paraphrasing refers to expressing in one’s own words what one thinks the patient means.

DIF: Cognitive Level: Analysis TOP: Active listening behaviors MSC: NCLEX: N/A

REF: p. 110 OBJ: 1 | 2 KEY: Nursing Process Step: N/A

MULTIPLE RESPONSE

1. The practical/vocational nursing student is assigned the task of helping a new mother and father learn to bathe their newborn. The instructor asks the student how the session went, and the student replies, “The mother seemed to understand everything. She smiled and nodded at everything I told her. The father watched and didn’t ask any questions.” The instructor comments, “Without validation, you can’t be sure.” Which statements contributed to the instructor’s knowledge on which to base the comment to the student? (Select all that apply.) a. Women nod to show that they are listening. b. Men ask fewer questions than women. c. Women smile to establish rapport. d. Nonverbal communication is a good indicator of understanding.

ANS: A, B, C

The facts that women nod to show they are listening, men ask fewer questions than women, and women smile to establish rapport serve as a basis for the instructor mentioning the need for validation of patient understanding. None of these actions proves that the new parents understood what the nursing student was teaching. Nonverbal communication is not a good indicator of understanding and may belie what is actually occurring.

DIF: Cognitive Level: Analysis REF: p. 112 | p. 113 OBJ: 8 TOP: Male/female differences KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

2. Types of communication include which of the following? (Select all that apply.) a. Verbal communication b. Affective communication c. Nonverbal communication d. Symptomatic communication ANS: A, B, C

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The three types of communication are verbal communication (spoken or written word), nonverbal communication (body language), and affective communication (feeling, tone).

Symptomatic communication does not exist.

DIF: Cognitive Level: Knowledge TOP: Types of communication MSC: NCLEX: N/A

REF: p. 109 OBJ: 1 | 2 KEY: Nursing Process Step: N/A

COMPLETION 1. A patient states, “I don’t want to die from cancer.” The nurse responds, “I heard you say you

don’t want to die from cancer.” The nurse’s response is an example of which is an active listening behavior.

,

ANS:

summarizing Summarizing means briefly stating the main data gathered. For example: Nurse: “This is what I heard you say. Is that correct?”

DIF: Cognitive Level: Analysis TOP: Active listening behaviors MSC: NCLEX: N/A

REF: p. 111 OBJ: 1 | 2 KEY: Nursing Process Step: N/A

Chapter 09: Assertiveness: Your Responsibility Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. The instructor tells a nursing student to hurry with the assignment in order to help a classmate who is behind with work. The student has promised a patient she’d return in 15 minutes to polish the patient’s nails. Which response would be considered assertive? a. “Why me? I’m still busy with my own patients. Ask one of the others who are standing around at the nurses’ station.” b. “I suppose I can, if you insist.” c. “I’ve promised one of my patients that I’ll come back to polish her nails. I’d like to be able to keep that promise. Can you possibly ask someone else?” d. “I’ll be glad to help.” Then go and apologize to the patient, saying the instructor won’t let you polish her nails.

ANS: C

Telling the instructor of the promise and asking him or her to find someone else is an honest, positive response that protects one’s own rights but does not infringe on the rights of others.

Asking “Why me?” and stating, “I’m still busy with my own patients. Ask one of the others who are standing around at the nurses’ station” is aggressive. The statement “I suppose I can, if you insist” is passive. Stating “I’ll be glad to help” and then apologizing to the patient saying the instructor won’t let you polish her nails is dishonest.

DIF: Cognitive Level: Application

REF: pp. 123-125

OBJ: 2

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TOP: Assertive behavior MSC: NCLEX: N/A

KEY: Nursing Process Step: Implementation

2. A nursing student’s mother states, “I need you to watch your younger siblings while I play bingo.” The nursing student had planned to prepare for a unit examination. An assertive approach would be to say a. “What you’re asking isn’t fair. I have an examination to study for. You never win at bingo anyway.” b. “OK. If your bingo means more to you than my passing a big exam, I’ll watch the kids.” c. “I’ll make a deal with you. I’ll watch the kids if you’ll cook my favorite meal tomorrow night.” d. “I’m sorry, but I won’t be able to babysit. I have an examination tomorrow. I need the time tonight to study.”

ANS: D

Telling the mother, “I’m sorry, but I won’t be able to babysit. I have an examination tomorrow. I need the time tonight to study” is honest and protects the nursing student’s rights.

Stating “What you’re asking isn’t fair. I have an examination to study for. You never win at bingo anyway” is aggressive. The statement “OK. If your bingo means more to you than my passing a big exam, I’ll watch the kids” is passive aggressive. “I’ll make a deal with you. I’ll watch the kids if you’ll cook my favorite meal tomorrow night” is manipulative.

DIF: Cognitive Level: Application TOP: Assertiveness MSC: NCLEX: N/A

REF: pp. 123-125 OBJ: 2 KEY: Nursing Process Step: N/A

3. A staff nurse enters the room in which you’re giving care to a patient in traction. She calls you aside and states, “I’ve watched you all morning. You don’t seem to know how to do anything right. Look at you now! You’re bathing the patient and it’s almost time for lunch.”

An assertive approach would be to say a. “You’re right. I am still bathing the patient. She was in pain earlier. I waited until her narcotic made her more comfortable.” b. “I’m sorry you think I give poor care. I’m still pretty new, and I’m trying hard to learn.” c. “I’ve watched you, too. You’ve criticized every student. Is this some game you play?” d. “I hope you won’t report this to my instructor.”

ANS: A

Saying “You’re right. I am still bathing the patient. She was in pain earlier. I waited until her narcotic made her more comfortable” assertively tells the staff nurse that the student has used critical thinking in arriving at a course of action. The statement “I’m sorry you think I give poor care. I’m still pretty new, and I’m trying hard to learn” is passive. Stating “I’ve watched you, too. You’ve criticized every student. Is this some game you play?” is aggressive. Stating “I hope you won’t report this to my instructor” is passive.

DIF: Cognitive Level: Application TOP: Assertive behavior MSC: NCLEX: N/A

REF: pp. 123-125 OBJ: 2 KEY: Nursing Process Step: N/A

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4. The student nurse has a goal to become a more assertive person. To achieve this, the student nurse must be willing to a. keep a daily journal. b. be disliked by others. c. put down other people. d. take a positive stand.

ANS: D

Assertiveness is characterized by taking a positive stand in a persistent way. Keeping a daily journal is not a requirement of assertiveness. Assertiveness should not result in incurring the dislike of others. Putting down others is aggressive, not assertive.

DIF: Cognitive Level: Comprehension TOP: Assertive behavior MSC: NCLEX: N/A

REF: p. 123 OBJ: 4 KEY: Nursing Process Step: N/A

5. A newly graduated LPN/LVN who is orienting to the unit tells a peer, “You should have seen that new associate degree RN trying to take care of three patients! She was so disorganized that it made me glad I’m an LPN/LVN.” The LPN/LVN is demonstrating a. manipulation. b. assertiveness. c. projection. d. passiveness.

ANS: C

Projection is a coping mechanism that allows the individual to unconsciously attribute his or her own weaknesses to others. Manipulation is an indirect way of dealing with issues that may be positive or negative. Assertiveness is another name for “honesty”; that is, it is a way to live the truth from your innermost being and to express this truth in thought, word, and deed.

Passiveness (or being nonassertive) is a fear-based, emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the health care team.

DIF: Cognitive Level: Application TOP: Using coping mechanisms MSC: NCLEX: N/A

REF: p. 125 OBJ: 2 KEY: Nursing Process Step: N/A

6. When a nurse tells a peer, “You have to watch out for the charge nurse. Sometimes she’s OK, but sometimes she’s just plain unreasonable. The best thing to do is to tell her off the first time she gets on your back about something. Keep me posted and I’ll try to help you.” An assertive reply would be a. “Thanks for the warning. I’ll be careful.” b. “You take care of yourself, and I’ll watch out for myself.” c. “I think it would be best for me to work on my relationship independently.” d. “It seems to me that you’re playing a manipulative game and giving out poor advice.”

ANS: C

This response deals directly with the nurse who is labeling the charge nurse and attempting to divide and conquer. It makes it clear that the nurse is capable of making assessments and planning actions.

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DIF: Cognitive Level: Application REF: p. 129 | p. 130 OBJ: 2 TOP: Assertive behavior KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

7. Which statement shows a personal commitment to work on the goal of devoting more time to coursework for the LPN/LVN program? a. “My friends have to stop asking me to do time-consuming favors for them.” b. “My family needs to take on more responsibility for household tasks so I have more time to study.” c. “The charge nurse should stop asking me to work overtime and instead ask other CNAs.” d. “I will say ‘no’ when people ask me to do things that take time away from my studies.”

ANS: D

This “I” statement shows that the individual can assume responsibility for implementing a goal. The other options are all statements indicating what others should do.

DIF: Cognitive Level: Analysis TOP: Assertive behavior MSC: NCLEX: N/A

REF: p. 124 OBJ: 2 KEY: Nursing Process Step: N/A

8. Which nonverbal behavior is most congruent with a nurse’s assertive verbal statement? a. Firm voice, erect posture, direct eye contact b. Soft voice, shoulders relaxed, eyes down c. Loud voice, back stiff, eyes glaring d. Smile while speaking, touch person’s arm, eyes lowered ANS: A

Use of a firm voice with erect posture and direct eye contact describes nonverbal behavior that is congruent with assertive verbalization. Using a soft voice with shoulders relaxed and eyes down is passive submissive. Smiling while speaking and touching the person’s arm with lowered eyes is passive submissive. Use of a loud voice, back stiff, and eyes glaring is consistent with aggressive behavior.

DIF: Cognitive Level: Comprehension TOP: Nonverbal assertive behavior MSC: NCLEX: N/A

REF: p. 129 OBJ: 2 KEY: Nursing Process Step: N/A

9. Which behavior should be considered an early sign that a coworker may have the potential for violence? a. Verbalization of a wish to harm someone b. A suicidal threat c. Destruction of agency property d. Lack of cooperation with supervisors ANS: D

Lack of cooperation is an early covert sign of the potential for violent acting out. The other behaviors are seen later.

DIF: Cognitive Level: Comprehension

REF: p. 132

OBJ: 10

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TOP: Workplace violence KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Safe, Effective Care Environment

10. A student nurse is assigned to care for a patient who is known to be angry. During the caregiving process, the patient hits the student nurse. The action the student nurse should initially take is a. indicate that he does not like being hit and continue to provide care to the patient. b. leave the patient in a safe situation and immediately report the event to the instructor. c. immediately leave the room and call the patient’s physician for an order to medicate the patient. d. go to the telephone and call the local police to report the incident.

ANS: B

Leaving the patient in a safe situation and immediately reporting the event to the instructor should be the initial action of the student nurse, who needs both the support and guidance of the instructor. Indicating that he does not like being hit and continuing to provide care is dangerous. Immediately leaving the room and calling the physician for a medication order is inappropriate. Calling the local police to report the incident would not be the initial action.

DIF: Cognitive Level: Analysis REF: p. 131 | p. 132 OBJ: 10 TOP: Workplace violence KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

11. The intervention that is most effective at reducing patient violence against nurses is a. teaching nurses to communicate respect for patients and confidence in themselves. b. requiring nurses to work in groups rather than alone. c. having security personnel stationed on all units. d. assigning only male nurses to care for psychiatric or chemical dependency patients.

ANS: A

Violence prevention includes both respect for patients and self-confidence in nurses. Nurses who are passive and tentative are more likely to be victims of violence. Patients who feel they are not respected are more likely to use violence as a way of getting their needs met.

Requiring nurses to work in groups rather than alone would not be possible. Having security personnel stationed on all units would not entirely eliminate violence; many patients would not be aware of the presence of security officers on the unit, whereas others impaired by medication or illness would not factor in the presence of security personnel. Assigning only male nurses to care for psychiatric or chemically dependent patients is neither practical nor desirable.

DIF: Cognitive Level: Analysis REF: p. 132 TOP: Assault KEY: Nursing Process Step: N/A

OBJ: 11 MSC: NCLEX: N/A

12. When a nurse is the target for unwanted behavior that she perceives as sexually harassing, she should first a. resign from the job. b. assertively tell the person that the behavior is unwanted. c. report the behavior to the nursing supervisor.

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d. report the behavior to the union representative.

ANS: B

The initial action should be to tell the individual that the behavior is unwanted and offensive.

Use assertive verbal and nonverbal communication. Resigning from the job should be unnecessary. Reporting the behavior to the nursing supervisor and/or union representative should not be the first action but might be necessary if assertive communication does not stop the behavior.

DIF: Cognitive Level: Analysis TOP: Sexual harassment MSC: NCLEX: N/A

REF: p. 133 OBJ: 8 KEY: Nursing Process Step: N/A

13. A nurse demonstrates assertive behavior by doing which of the following? a. Limiting contact with a patient who is dying, because it causes the nurse to feel depressed b. Routinely telling patients who have questions about their medications to ask the physician c. When asked about something unfamiliar, admitting to not knowing but agreeing to find out d. Telling another nurse how ridiculous a doctor is for ordering hourly vital sign assessments ANS: C

Assertiveness is a current name for honesty; it is a way to live the truth from one’s innermost being and to express this truth in thought, word, and deed. Admitting to not knowing and agreeing to find out the answer is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally. The remaining options are all examples of nonassertive behavior.

DIF: Cognitive Level: Analysis REF: p. 124 OBJ: 2 TOP: Assertive behavior KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

14. A nurse demonstrates assertive behavior by doing which of the following? a. Assuming a patient would like to skip the bath when the patient’s spouse comes to visit b. Being unable to continue suctioning a patient because she is concerned the patient will not like her for doing it c. Experiencing a feeling of devastation when the patient questions her ability to insert an intravenous catheter d. Requesting to speak with the physician privately when she feels that the physician has ordered an inappropriate treatment ANS: D

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being and to express this truth in thought, word, and deed. Requesting to speak with the physician privately is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally.

The remaining options are all examples of nonassertive behavior.

DIF: Cognitive Level: Analysis TOP: Assertive behavior MSC: NCLEX: N/A

REF: p. 124 OBJ: 2 KEY: Nursing Process Step: Implementation

15. A nurse demonstrates assertive behavior by doing which of the following? a. When a patient asks the nurse to stop and feed the patient’s cats on the way home, the nurse frowns but agrees to do so. b. The nurse feels the team leader’s assignment is unfair, so the nurse drops hints to coworkers about feelings of unfairness. c. When the patient asks about the nurse’s personal life, the nurse answers the questions out of fear of not being liked for not answering. d. When working with a patient who is critical of the nurse, the nurse sits down with the patient and listens attentively to the patient’s concerns.

ANS: D

Assertiveness is a current name for honesty; it is a way to live the truth from one’s innermost being and to express this truth in thought, word, and deed. Sitting with the patient and listening attentively is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally.

The remaining options are all examples of nonassertive behavior.

DIF: Cognitive Level: Analysis TOP: Assertive behavior MSC: NCLEX: N/A

REF: p. 124 OBJ: 2 KEY: Nursing Process Step: Implementation

16. A nurse demonstrates assertive behavior by doing which of the following? a. When making an error, the nurse over explains and over apologizes and is unaware of the right to make a mistake. b. When asked by the charge nurse to accept an admission, the busy nurse hesitantly responds by saying, “Well, I guess I could.” c. When the nurse is very busy and needs help with an assignment, the nurse says nothing and refrains from expressing the need for help. d. A patient complains of pain when ambulating and asks not to walk. The nurse respects the patient’s feelings and medicates the patient as ordered for pain while supporting the need to carry out the physician’s order ANS: D

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being and to express this truth in thought, word, and deed. Respecting the patient’s feelings but supporting the need to carry out the physician’s order is an example of assertive behavior.

Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team.

Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed on, deliberately or accidentally. The remaining options are all examples of nonassertive behavior.

DIF: Cognitive Level: Analysis TOP: Assertive behavior MSC: NCLEX: N/A

REF: p. 124 OBJ: 2 KEY: Nursing Process Step: Implementation

17. A nurse demonstrates assertive behavior by doing which of the following? a. When the physician yells at the nurse in front of the patient, the nurse is angry but refrains from speaking about it. b. The nurse plans on seeking new employment out of fear of approaching the supervisor to tell his or her side of what happened. c. When working with a patient who has had the call light on repeatedly, the nurse tells the patient, “Do not put your call light on again.” d. When unexpected visitors arrive to visit the patient during breakfast, the nurse asks whether the patient would prefer to eat now or visit.

ANS: D

Assertiveness is a current name for honesty; it is a way to live the truth from one’s innermost being and to express this truth in thought, word, and deed. Giving the patient the choice between breakfast and visitors is an example of assertive behavior. Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team. Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally. The nurse refraining from talking about being angry after a physician yells and the nurse planning on seeking new employment out of fear are examples of nonassertive behavior. Telling the patient not to put the call light on again is an example of aggressive behavior in which the rights of others are violated.

DIF: Cognitive Level: Analysis TOP: Assertive behavior MSC: NCLEX: N/A

REF: p. 124 OBJ: 2 KEY: Nursing Process Step: Implementation

18. A nurse demonstrates nonassertive behavior by doing which of the following? a. When a patient asks about the nurse’s personal life, the nurse responds to the patient’s questions out of fear of not being liked by the patient. b. When a patient asks about the nurse’s personal life, the nurse says that the information is personal and chooses not to discuss it. c. When a nurse feels the team leader has been unfair, the nurse approaches the team leader and asks to speak privately at a time that is convenient for the person. d. When pressured by staff members to help with their assignments, the nurse, who is too busy to help, refuses without feeling guilty but leaves the door open to help at a

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future date.

ANS: A

Nonassertive (passive), fear-based behavior is an emotionally dishonest, self-defeating type of behavior. Nonassertive nurses attempt to look the other way, avoid conflict, and take what seems to be the easiest way out; they are never full participants on the nursing team.

Nonassertive individuals do not express feelings, needs, and ideas when their rights are infringed upon, deliberately or accidentally. Responding to the patient’s questions out of fear of not being liked is an example of nonassertive behavior. Assertiveness is a current name for honesty; it is a way to live the truth from one’s innermost being and to express this truth in thought, word, and deed. The remaining options are examples of assertive behavior.

DIF: Cognitive Level: Analysis TOP: Assertive behavior MSC: NCLEX: N/A

REF: p. 124 OBJ: 2 KEY: Nursing Process Step: Implementation

MULTIPLE RESPONSE

1. What are the expected outcomes of using assertive communication in the nursing workplace? (Select all that apply.) a. It enmeshes the person and the issue. b. It promotes positive relationships. c. It is clear and unequivocal. d. It respects the rights of oneself and others. e. It is focused on the personal needs of the nurse. f. It guarantees the user will get his or her way.

ANS: B, C, D

These statements about assertive communication outcomes are correct. Assertive communication in the nursing workplace does not enmesh the person and the issue; assertiveness separates the person and the issue. Assertive communication allows the nurse to focus on the patient’s needs rather than being inner focused. Assertive communication does not guarantee that the user will get his or her own way; instead, it guarantees that the user will feel in control of emotions and responses.

DIF: Cognitive Level: Analysis REF: p. 123 | p. 124 OBJ: 1 TOP: Assertiveness KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

2. Which statements about manipulation would be useful to the nurse who interacts with both patients and peers? (Select all that apply.) a. Manipulation usually disregards the feelings and needs of others. b. Manipulation exploits the weaknesses of others. c. A divide-and-conquer strategy is often used by those who manipulate. d. Firm limit setting rarely protects against manipulation. e. Manipulation often results in individuals being treated as objects. f. Manipulation should be permitted if it is consistent with the nurse’s needs.

ANS: A, B, C, E

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Manipulation usually disregards the feelings and needs of others; manipulation exploits the weaknesses of others; a divide-and-conquer strategy is often used by those who manipulate; and manipulation often results in individuals being treated as objects—these are all true statements that would help the nurse put manipulative behavior into perspective. The statement indicating that firm limit setting rarely protects against manipulation is incorrect.

Firm limit setting is one of the better strategies for handling manipulative behavior.

Permitting manipulation if it is consistent with the nurse’s needs is not an appropriate basis for interactions with either patients or peers.

DIF: Cognitive Level: Analysis REF: p. 129 | p. 130 OBJ: 5 TOP: Manipulation KEY: Nursing Process Step: Implementation MSC: NCLEX: Comprehension

3. Which of the following measures are most helpful to the nurse who makes a personal commitment to practice violence prevention in the workplace? (Select all that apply.) a. Get to know coworkers and look out for them. b. Treat patients and coworkers with courtesy and respect. c. Become familiar with policies relating to violence and harassment. d. Assume individuals will not act on threats they make. e. Interject opinions while attempting to clarify issues. f. Set clear, firm limits on unacceptable behavior.

ANS: A, B, C, F

Each of the correct answers is an example of general safeguards. All threats should be taken seriously and reported to management. Clarification requires questioning, listening to information given, and repeating what the individual said she or he thinks or feels. It is not a time to argue one’s own point of view.

DIF: Cognitive Level: Analysis REF: p. 132 OBJ: 11 TOP: Workplace violence KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

4. A nurse is appointed to a workplace committee to plan changes in the emergency department.

The committee’s task is to make recommendations that will provide an environment that deters violence. Which recommendations are consistent with this goal? (Select all that apply.) a. Install bullet-resistant glass in the nurses’ station. b. Install security alarm devices in examining rooms. c. Institute a limited toleration of violence policy. d. Develop a minimum safe staffing policy. e. Change security officers’ uniforms to shirt, tie, blazer, slacks.

ANS: A, B, D, E

Development of a minimum safe staffing policy and installation of bullet-resistant glass and security alarm devices are part of the OSHA National Guidelines for Deterring Violence.

Surveys indicate that officers better convey authority when they wear a customer-friendly uniform of jacket and tie. OSHA recommends a no toleration of violence policy.

DIF: Cognitive Level: Analysis REF: p. 131 OBJ: 11 TOP: Workplace violence KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

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5. A nurse experiences potential danger from a patient who is highly suspicious and fears being harmed. Which behaviors by the nurse will help alleviate the threat of violence?

(Select all that apply.) a. Stand in the doorway of the room. b. Maintain an open position with the hands in view. c. Occasionally touch the patient gently on the forearm. d. Turn away from the patient to demonstrate lack of fear. e. Speak in a quiet, controlled voice.

ANS: B, E

Maintaining an open position with the hands in view suggests that the patient can trust the nurse not to have a weapon in his or her pocket. Speaking in a quiet, controlled voice is important, because it reduces the patient’s anxiety. Never block the doorway. The patient may cause harm when attempting to flee. Maintain a distance of 5 feet from the patient, and never attempt to touch the patient without his or her permission. Never turn away from a potentially violent patient. Maintain observation at all times.

DIF: Cognitive Level: Analysis REF: p. 131 OBJ: 11 TOP: Violence KEY: Nursing rocess Step: Implementation MSC: NCLEX: Safe, Effective Care Environment COMPLETION 1. A male nurse has been assigned to mentor a newly hired female nurse. Several times during

the day, the new nurse perceives her mentor as touching her inappropriately. In the afternoon the mentor tells the new nurse, “I think we should meet after work for a drink. I could give you the lowdown on other staff, and we could get our relationship off to a good start. With my help, you’ll be able to get raises and promotions regularly.” The new nurse thinks, “I don’t want this man’s help.” The new nurse can correctly determine that these behaviors suggest .

ANS:

sexual harassment Sexual harassment is about abuse of power. In this situation, the mentor has used unwanted touch and suggested that having a relationship with him would be a condition of advancement.

DIF: Cognitive Level: Application TOP: Sexual harassment MSC: NCLEX: N/A

REF: p. 133 OBJ: 8 KEY: Nursing Process Step: N/A

Chapter 10: Cultural Uniqueness, Sensitivity, and Competence Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. The nurse who states, “I believe in the uniqueness and value of human beings” is basing care on the philosophy of a. cultural competence. b. individual worth.

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c. assimilation. d. cultural diversity.

ANS: B

Belief in the uniqueness and value of each human being, regardless of differences that may be observed or perceived in that individual, is called the philosophy of individual worth. The other options do not identify this belief. Cultural competence is the continuous attempt of LPNs/LVNs to gain the knowledge and skills that will allow them to effectively provide care for patients of different cultures. Assimilation is the process of a group giving up parts of their own culture and adopting parts of the culture of the dominant group. Cultural diversity refers to the many differences in the elements of culture in groups of people in American and Canadian society.

DIF: Cognitive Level: Comprehension TOP: Philosophy of individual worth MSC: NCLEX: Psychosocial Integrity

REF: p. 143 OBJ: 5 KEY: Nursing Process Step: Implementation

2. A behavior to avoid when interacting with a person of a different culture is a. diversity. b. assimilation. c. stereotyping. d. behavior based on nonjudgmental attitudes.

ANS: C

Stereotyping, which is making inaccurate generalizations about all members of a specific group without exception, is to be avoided. Stereotypes ignore individual differences. Diversity refers to the many differences in the elements of culture in groups of people in American and Canadian society. Assimilation is the process of a group giving up parts of their own culture and adopting parts of the culture of the dominant group. A nonjudgmental attitude involves being open-minded and taking difference at face value, accepting people as they are, and giving high-quality care.

DIF: Cognitive Level: Analysis REF: p. 148 OBJ: 1 TOP: Stereotypes KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

3. A new mother on the OB unit refuses to allow her newborn to wear disposable diapers. She insists on applying cloth diapers without safety pins, because this is how her culture applies diapers. During break, the nurse discusses the patient’s strange diapering technique compared with the excellent American method of diapering. Besides violating confidentiality, the nurse is displaying a. ethnocentrism. b. stereotyping. c. unusual behavior during break. d. lack of adherence to hospital policy on diapering.

ANS: A

Ethnocentrism is the belief that one’s way of doing things is better than the ways of people of different cultures. Stereotyping is making false assumptions about others based on inaccurate generalizations. Discussing the patient’s diapering technique during break is unethical. It is unlikely that there is a policy on diapering.

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DIF: Cognitive Level: Application REF: p. 137 OBJ: 1 TOP: Ethnocentrism KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

4. Which statement about culture will help the nurse implement culturally competent care? a. Each culture measures other cultures using its own ways as the norm. b. Culture is primarily based on genetic inheritance. c. Stereotypes about cultures can be accepted as true. d. Cultural diversity is based entirely on race.

ANS: A

The worth of everything, within or outside the group, depends on whether it fits the world view of the cultural group. The other options are untrue statements. Culture is the total of all the ideas, beliefs, values, attitudes, communication, customs, traditions, and objects a group of people possess. A stereotype is an assumption used to describe all members of a specific group without exception. It is an expectation that all individuals in a group will act exactly the same in a situation just because they are members of that group. Cultural diversity refers to the many differences in the elements of culture in groups of people in American and Canadian society.

DIF: Cognitive Level: Analysis REF: p. 137 OBJ: 7 TOP: Culture KEY: Nursing rocess Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

5. Patient A has terminal cancer, and Patient B has a bladder infection. They are sharing a hospital room. Neither patient is a member of the majority culture of the area. Patient A is quiet and rarely acknowledges pain. Patient B cries and moans loudly much of the day.

What understanding will help the nurse provide culturally sensitive care for both patients? a. The better educated the person, the less likely the person is to openly express pain. b. A mentally unstable person is more likely to be noisy about pain sensations. c. People respond to the sensation of pain in culturally determined ways. d. People who distrust health care workers tend to be silent about their pain.

ANS: C

One’s culture influences both the definition of pain and provides guidelines for approved ways of expressing response to the sensation of pain. The other options are not true statements.

DIF: Cognitive Level: Analysis REF: p. 145 OBJ: 6 | 7 TOP: Pain expression KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

6. Mrs. Lee tells the nurse who asks why she ate so little of the food on her tray that her condition requires “hot” foods, so she ate only the “hot” foods on the tray. The nurse notices that several items the patient left on the tray were served hot, and several of the foods the patient ate were served cold. The nurse should a. tell the dietary department to make sure Mrs. Lee’s foods are hot when served. b. check Mrs. Lee’s menu choices and change choices from cold entrees to hot entrees. c. tell Mrs. Lee that no hospital food service serves entrees as hot as she may fix at home.

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d. ask Mrs. Lee to make a list of foods she believes would help her condition.

ANS: D

For this patient, “hot” and “cold” do not refer to the temperature at which food is served but rather to culturally determined properties of the food. Asking for a list of foods Mrs. Lee believes would help her condition is the most helpful action for the nurse to take. The other options do not demonstrate understanding the culturally diverse meanings of “hot” and “cold.”

DIF: Cognitive Level: Application REF: p. 146 | p. 152 | p. 153 OBJ: 6 | 7 TOP: Health practices KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

7. A Native American patient keeps a small bunch of feathers on the over-the-bed table. They are in the way whenever the nurse serves a tray or sets up equipment for a treatment. A culturally competent action would be to a. throw them away while the patient is sleeping. b. move them to a place where they won’t be in the way. c. leave them where the patient wishes to place them. d. ask why there are a bunch of feathers in a hospital room.

ANS: C

Individuals of some cultures believe that amulets and charms are helpful in preventing or curing illness. It is likely that the small bunch of feathers serves this purpose. Leaving them where placed is the culturally sensitive thing to do. The nurse might also respectfully ask about the feathers to gather data about the patient’s health beliefs and practices. The other options are not culturally competent behaviors.

DIF: Cognitive Level: Application TOP: Culturally competent care MSC: NCLEX: Psychosocial Integrity

REF: p. 153 OBJ: 6 | 7 KEY: Nursing Process Step: Implementation

8. A student nurse asks, “Does ethnocentrism have any negative consequences?” The most accurate reply is based on the understanding that a. discrimination is the basis for ethnocentrism and prejudice. b. ethnocentrism may give rise to prejudice, which may result in discrimination. c. prejudice has no relationship to ethnocentrism and discrimination. d. ethnocentrism has only positive consequences associated with ethnic pride.

ANS: B

When ethnocentrism, the belief that one’s culture is superior to other cultures, leads to intolerance of another culture, prejudice results. Discrimination results when rights and privileges are withheld from the other culture. The other options do not accurately explain the relationship.

DIF: Cognitive Level: Comprehension TOP: Ethnocentrism MSC: NCLEX: N/A

REF: p. 137 OBJ: 1 KEY: Nursing Process Step: Implementation

9. During a discussion on cultural diversity, a nurse asks for an example of an ethnic group.

The most accurate response would be a. Caucasians.

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b. Spanish-speaking. c. Irish-Americans. d. homosexuals.

ANS: C

Ethnic groups are composed of people who are members of the same race, religion, or nation and speak the same language. Irish-Americans are an example of an ethnic group. Caucasian is a racial grouping. Spanish-speaking refers only to shared language, but the individuals might be from Mexico, Spain, or the West Indies, each of which is ethnically different.

Homosexuals do not comprise an ethnic group.

DIF: Cognitive Level: Comprehension REF: p. 143 TOP: Ethnicity KEY: Nursing Process Step: N/A

OBJ: 1 | 7 MSC: NCLEX: N/A

10. Which statement by a nurse is an example of nonjudgmental thinking? a. “Hispanic-American patients live at the poverty level and don’t have a chance.” b. “Asian-American patients are unreadable. Nurses don’t know what they’re feeling.” c. “Native-American patients could benefit from a lesson in assimilation.” d. “Cultural diversity accounts for some African Americans thinking illness is caused by a curse.”

ANS: D

The correct statement makes no value judgments regarding whether this is good or bad. The other options make judgments.

DIF: Cognitive Level: Application TOP: Nonjudgmental thinking MSC: NCLEX: N/A

REF: p. 143 OBJ: 1 | 5 | 7 KEY: Nursing Process Step: N/A

11. Which statement regarding cultural diversity can be used as a basis for caregiving? a. Silence should always be interpreted as an indication of the patient’s dissatisfaction with care. b. Rules regarding the appropriate amount of eye contact vary among cultures. c. Personal space requirements are similar for all cultures. d. The germ theory of illness is universally accepted.

ANS: B

The amount of eye contact that is desirable varies among cultures. The nurse should be aware of cultural norms for eye contact for culturally diverse groups. The other options are not true statements.

DIF: Cognitive Level: Analysis REF: p. 151 OBJ: 7 TOP: Eye contact KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

12. Which statement by a nurse demonstrates cultural competence? a. “Without knowledge of cultural diversity, misunderstandings arise between patient and nurse.” b. “Nurses who assume care for persons of different cultures need to assume those beliefs as their own in order to give good care.” c. “Women of most cultures have adopted assertive communication.”

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d. “Traditional healing practices should not be combined with Western medicine to treat a patient.”

ANS: A

Failure to develop cultural sensitivity to patients of diverse cultural backgrounds may create misunderstandings between nurse and patient. Data may be misinterpreted. Implementation of plans and patient compliance with plans may be sabotaged if the nurse does not understand the culture of the patient. The statement, “Nurses who assume care for persons of different cultures need to assume those beliefs as their own in order to give good care” is unnecessary and impractical. It is not true that women of most cultures have adopted assertive communication. Traditional healing practices and Western medicine may be used in combination with good results.

DIF: Cognitive Level: Application TOP: Cultural competence MSC: NCLEX: Psychosocial Integrity

REF: p. 143 OBJ: 1 | 7 KEY: Nursing Process Step: Implementation

13. How would a culturally competent care plan differ from a standard care plan? a. It would contain adaptations that recognize the patient’s cultural preferences. b. It would follow the legal mandates for providing care regardless of culture. c. It would provide information about nonjudgmental behaviors to use. d. It would focus on the nurse’s values, assumptions, and health beliefs.

ANS: A

Culturally competent care involves continuous attempts by staff to use knowledge and skills to effectively provide care for patients of different cultures. Adapting standard care to meet the specific cultural preferences of the patient is part of a culturally competent care plan. The other options would not be contained in a culturally competent plan of care.

DIF: Cognitive Level: Analysis REF: p. 152 | p. 153 OBJ: 1 | 7 TOP: Culturally competent care plan KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

14. Which of the following is an example of the process of socialization? a. The student nurse assesses the needs of a patient who is a member of another culture. b. The student nurse learns how to think and act like a nurse. c. The student nurse uses cultural bias when evaluating the beliefs of a diverse culture. d. The student nurse demonstrates ethnocentrism related to health-illness beliefs.

ANS: B

Socialization is the process by which a person of one culture learns how to function within another culture. The other options are not examples of the socialization process but rather are merely statements that incorporate terms relating to culture.

DIF: Cognitive Level: Application TOP: Socialization MSC: NCLEX: N/A

REF: p. 137 OBJ: 6 KEY: Nursing Process Step: N/A

15. Which statement by a health care worker can the nurse identify as a stereotype?

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a. b. c. d.

“People over 65 are poor drivers.”

“Assimilation requires adopting part of the dominant culture.”

“All individuals have common basic daily needs.”

“Most people perceive themselves as members of the middle class.”

ANS: A

A stereotype is a false assumption about all members of a specific group. Saying people over 65 are poor drivers is an inaccurate generalization about a specific group of people. The other options do not fit the definition of a stereotype.

DIF: Cognitive Level: Application REF: p. 137 TOP: Stereotyping KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

16. A patient tells the nurse that she is accustomed to adhering to a strict schedule for meals and sleep. The nurse reports that the patient a. follows clock time. b. lives on linear time. c. is obsessive-compulsive. d. will complain if medications and treatments are not performed on time.

ANS: A

People who follow clock time eat, sleep, work, and engage in recreational activities at definite times each day. People who live on linear time eat when they are hungry and sleep when tired, without regard to the clock. The assessment that the patient is obsessive-compulsive cannot be made with the provided information. The report that the patient will complain if medications and treatments are not performed on time cannot be concluded from the information provided.

DIF: Cognitive Level: Application REF: p. 144 TOP: Concept of time KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Psychosocial Integrity

OBJ: 3

17. When collecting data, which question provides the best understanding of the patient’s culturally determined food patterns and assists with developing a culturally competent care plan? a. “What effect will hospitalization have on your family?” b. “What religious practices are important in your life?” c. “Do you use food to maintain health or treat illness?” d. “Describe the role of children in your family.”

ANS: C

Although each of the questions is appropriate to ask in order to increase understanding of cultural diversity, only one relates to food patterns.

DIF: Cognitive Level: Application REF: p. 151 TOP: Culturally competent care KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Psychosocial Integrity

OBJ: 1 | 7

18. Data collection suggests that a patient’s health beliefs are personalistic. Which statement by the patient would the nurse determine as consistent with personalistic health beliefs? a. “Please call my physician for me so I can discuss my symptoms.”

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b. “I would like to wear the amulet that’s in my bedside stand.” c. “X-rays will find the cause of my back pain.” d. “I hope the doctor will recommend surgery.”

ANS: B

Personalistic health beliefs suggest that illness is caused by magical powers and is cured by rituals. Wearing amulets offers protection from illness and may sometimes be considered curative. The other statements are consistent with beliefs in biomedicine.

DIF: Cognitive Level: Analysis REF: p. 148 TOP: Personalistic health belief system KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Psychosocial Integrity

OBJ: 7

19. Recently a community has experienced an influx of individuals from Afghanistan. What action should the nurse suggest to modify the agency environment to better accommodate these culturally diverse patients? a. Provide handouts and patient teaching materials in appropriate languages. b. Hold meetings in the community to explain the Afghan culture. c. Provide reference guides about Far Eastern cultures to all nursing staff. d. Use the cookbook method of learning to accommodate this immigrant group.

ANS: A

Providing information in the language of the culturally diverse group indicates that the agency is interested in serving individuals in the group. Ensuring understanding may also foster compliance by the individual. The other options would not help to accommodate the individuals from this group.

DIF: Cognitive Level: Application TOP: Cultural competence MSC: NCLEX: Psychosocial Integrity

REF: pp. 150-152 OBJ: 7 KEY: Nursing Process Step: Implementation

20. The nurse sets a goal to avoid stereotyping culturally diverse patients. Which of the following measures will help the nurse attain this goal? a. Automatically apply all information known about a culture to patients of that cultural group. b. Assume that all individuals from Southeast Asia practice Buddhism. c. Refer to textbook information about cultural groups to predict individual behavior. d. Gather information about how the patient believes illness can best be treated.

ANS: D

The treatments generally used by a patient will correspond to beliefs about illness causation and may reveal the expectation to combine Eastern and Western treatments. Automatically applying all information known about a culture to patients of that group, assuming that all individuals from Southeast Asia practice Buddhism, and referring to textbook information to predict individual behavior do not take into account the individual differences of patients from the same cultural groups.

DIF: Cognitive Level: Comprehension REF: p. 152 OBJ: 7 TOP: Stereotyping KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

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21. A nursing instructor is working with a Native-American student nurse. When the student is late for the first clinical day, the instructor states, “I’m not surprised she’s late; NativeAmerican students are always late.” The instructor’s statement is an example of a. prejudice. b. stereotyping. c. ethnocentrism. d. discrimination.

ANS: B

Stereotyping is an assumption used to describe all members of a specific group without exception. It is an expectation that all individuals in a group will act exactly the same in a situation just because they are members of that group. Stereotyping ignores the individual differences that occur within every cultural group.

DIF: Cognitive Level: Comprehension REF: p. 137 TOP: Stereotypes KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

22. A patient who uses the biomedical health belief system would be most likely to respond to interventions by a a. diviner. b. c. shaman. herbalist. d. physician.

ANS: D

A physician cures disease based on the biomedical health belief system. The other options refer to persons who cure disease based on the personalistic health belief system.

DIF: Cognitive Level: Comprehension TOP: Health belief systems MSC: NCLEX: N/A

REF: p. 148 OBJ: 7 KEY: Nursing Process Step: N/A

MULTIPLE RESPONSE

1. Which statements about emotions and their expression can provide a basis for providing care to culturally diverse patients? (Select all that apply.) a. In some cultural groups, people do not display emotions openly in public. b. Emotions are universal, but cues to those emotions vary. c. Culture provides guidelines for approved ways of responding to pain. d. Silence has various culturally determined meanings.

ANS: A, B, C, D

Each of the statements is correct and should be considered when planning care for patients of the majority culture and for culturally diverse patients.

DIF: Cognitive Level: Analysis TOP: Cultural competence MSC: NCLEX: Psychosocial Integrity

REF: p. 145 OBJ: 7 KEY: Nursing Process Step: Implementation

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2. Mrs. X is a patient from South Korea. She has never experienced Western medical care. She is hospitalized with hepatitis C. Which measures will lead to successful negotiation of a treatment plan with this culturally diverse patient? (Select all that apply.) a. Encourage the patient to explain her views about the cause of illness. b. Explain the biomedical point of view of the health problem. c. Support beliefs and practices the patient sees as helpful and that do no harm. d. Realize that it is impossible to prevent a patient’s use of harmful health practices.

ANS: A, B, C

Encouraging the patient to explain her views about the cause of illness is necessary to understand her health beliefs. Explaining the biomedical point of view of the health problem allows the patient to compare her belief system with the biomedical explanation and to find common ground. It also helps the patient understand the rationale for treatment. This is part of the process of negotiating treatment plans with the patient. Many alternative healing practices are known to be beneficial (acupuncture), and others may do no harm if used (diet based on hot and cold principles). The nurse is participating in preserving helpful beliefs and practices. The nurse can participate in repatterning by counseling against harmful practices and supporting alternatives offered in the care plan.

DIF: Cognitive Level: Application REF: p. 152 | p. 153 OBJ: 7 TOP: Negotiating treatment plans KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity COMPLETION 1. The process of giving up parts of one’s own culture and adopting parts of the culture of the

dominant group is called

.

ANS:

assimilation The process of giving up parts of one’s own culture and adopting parts of the culture of the dominant group is called assimilation.

DIF: Cognitive Level: Knowledge REF: p. 138 TOP: Assimilation KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

Chapter 11: Spiritual Needs, Spiritual Caring, and Religious Differences Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. A nurse is preparing a presentation about spirituality and religion. To adequately prepare for peer questions, the nurse should know that the three major religious groups in the United States are the a. Lutherans, Catholics, and Presbyterians. b. Baptists, Assembly of God, and Lutherans. c. Roman Catholics, Protestants, and Jews. d. Protestants, Unitarians, and Catholics.

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ANS: C

Roman Catholics number more than 67 million members, all Protestant denominations combined have 66 million members, and Jews are estimated at 5.6 million members. The other options do not reflect current data.

DIF: Cognitive Level: Knowledge TOP: Religions in the United States MSC: NCLEX: N/A

REF: p. 166 OBJ: 3 KEY: Nursing Process Step: N/A

2. Select the patient who would benefit least from the nurse reading from the New Testament. a. Mrs. A of the Assembly of God b. Mr. B, who is Roman Catholic c. Miss C, who is a Jehovah’s Witness d. Mr. D, who is an Orthodox Jew ANS: D

Mr. D, an Orthodox Jew, does not believe in Jesus as the Messiah. New Testament readings are Christianity based. The other options identify patients who are Christians.

DIF: Cognitive Level: Comprehension TOP: Christian sects MSC: NCLEX: Psychosocial Integrity

REF: p. 161 OBJ: 7 KEY: Nursing Process Step: Implementation

3. To provide effective spiritual care for a Muslim patient, the nurse recognizes that those who believe in Islam refer to God as a. Brahma. b. Moroni. c. Redeemer. d. Allah.

ANS: D

Muslims believe in one god, Allah. Brahma is the Hindu creator god. Moroni is the angel sent to reveal the Book of Mormon (Church of Jesus Christ of Latter Day Saints). Redeemer is a term used by Christians to refer to Jesus.

DIF: Cognitive Level: Comprehension REF: p. 165 OBJ: 7 TOP: Islam KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

4. The nurse working in the neonatal intensive care unit would implement baptism for a baby not expected to live if the infant’s religion is listed as a. Assembly of God. b. Roman Catholic. c. Mormon. d. Baptist.

ANS: B

Roman Catholic infants who are critically ill may be baptized by a nurse without a witness.

Baptism is considered necessary for salvation and cleansing of all sin. The other Christian denominations do not practice infant baptism.

DIF: Cognitive Level: Application

REF: p. 162

OBJ: 8

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TOP: Baptism KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

5. The nurse is caring for an Orthodox Jewish patient who is close to death. An important intervention would be to find out whether the patient a. wishes to have the Sacrament of the Sick. b. has been baptized. c. wishes to have his Koran nearby. d. can be touched by the nurse after death.

ANS: D

Some Jews may not want the nurse to touch the body of a deceased Jew. The nurse should respect this consideration. The other options refer to preferences of other religions.

DIF: Cognitive Level: Application REF: p. 161 TOP: Care of the dying patient KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Psychosocial Integrity

OBJ: 8

6. The Jewish patient tells the nurse that he does not observe the Sabbath on Sundays.

What other time interval would the nurse need to provide for patient Sabbath observances? a. Monday noon to Tuesday noon b. Friday sundown to after sunset Saturday c. Thursday midnight to Friday midnight d. Alternate Saturdays ANS: B

Jews celebrate the Sabbath from sunset Friday to sunset Saturday. The other options are not times religious groups celebrate the Sabbath.

DIF: Cognitive Level: Application TOP: Religious practices MSC: NCLEX: Psychosocial Integrity

REF: p. 161 OBJ: 8 KEY: Nursing Process Step: Implementation

7. The nurse who is preparing a Muslim female for a physical examination is told by the patient, “I cannot undress completely.” The nurse will appropriately choose interventions based on the knowledge that Muslim women a. observe standards of modesty requiring coverage from head to ankle. b. speak openly to women but are silent in the presence of men. c. wear writings from the Koran on the neck, arm, or waist. d. are given alcoholic beverages with each meal.

ANS: A

Modesty standards in Islam may require the women to have her body covered from head to ankle. If this is the case, the nurse should arrange for the individual to be draped and able to expose one body part at a time for examination.

DIF: Cognitive Level: Application TOP: Modesty standards MSC: NCLEX: Psychosocial Integrity

REF: p. 166 OBJ: 8 KEY: Nursing Process Step: Implementation

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8. A patient who is a member of the Church of Latter Day Saints (Mormon) must increase fluid intake. Which beverages should the nurse offer? a. Wine or beer b. Fruit juice, milk, or water c. Coffee, tea, or iced tea d. Unfermented or fermented apple juice ANS: B

Patients who are Mormon do not drink alcoholic beverages and usually avoid beverages that contain caffeine, making fruit juice, milk, or water the only correct answers.

DIF: Cognitive Level: Application TOP: Dietary restrictions MSC: NCLEX: Psychosocial Integrity

REF: p. 167 OBJ: 7 | 8 KEY: Nursing Process Step: Implementation

9. A patient has a small piece of paper on which unfamiliar symbols are written hanging on a black string around the neck. To prepare the patient for the operating room (OR) the nurse should a. allow the patient to wear the item, but make note of it for the OR staff to see and reposition if needed. b. insist that the patient take off the item and leave it in the bedside stand. c. remove the item and tie it to the foot of the patient’s bed. d. place the item in a plastic bag and lock it in the narcotics cabinet.

ANS: A

Muslim patients often wear writings from the scriptures tied to their bodies. They should be allowed to remain on the patient. Making a note of the location of the writing is appropriate, so the OR staff can reposition it, if necessary, for the surgical procedure. The remaining options are incorrect, because the patient should be allowed to wear the writing.

DIF: Cognitive Level: Application TOP: Religious practices MSC: NCLEX: Psychosocial Integrity

REF: p. 166 OBJ: 7 | 8 KEY: Nursing Process Step: Implementation

10. A patient who is terminally ill describes himself as “agnostic.” The nurse caring for this person can correctly assume that the patient a. does not possess spirituality. b. will not experience spiritual distress. c. will practice the rituals of a particular denomination. d. will benefit from general spiritual care interventions.

ANS: D

Spiritual assessment and interventions are appropriate for agnostic patients, because all people have spirituality, even if they do not profess religious beliefs. Agnostic patients possess spirituality. Agnostics may experience spiritual distress. Agnostics do not practice the rituals of any religion.

DIF: Cognitive Level: Analysis REF: p. 159 OBJ: 6 TOP: Agnosticism KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

11. For which patient should the nurse be most alert for emerging spiritual needs?

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a. b. c. d.

Miss A, who has been given the diagnosis of gallbladder disease Mrs. B, who has been told she has metastatic cancer Mr. C, who has varicose veins Mr. D, who has herpes zoster

ANS: B

Patients who have been given bad news are at high risk for experiencing spiritual distress. Of the options provided, only metastatic cancer is considered an incurable disease.

DIF: Cognitive Level: Application TOP: Emerging spiritual needs MSC: NCLEX: Psychosocial Integrity

REF: p. 156 OBJ: 4 KEY: Nursing Process Step: Implementation

12. A Hindu patient is admitted after a severe head injury and is near death. The organ procurement person tells the nurse, “I don’t know much about the Hindu religion, and I have to talk to the family about organ donation. Can you give me any hints?” The best response for the nurse would be a. “Organ donation is prohibited by the religion.” b. “The family is very concerned about where the patient’s soul will go after death.” c. “The religion permits organ donation, but you would have to ask the family their feelings about it.” d. “It’s hard to know what people who believe cows are sacred will think about organ donation.”

ANS: C

Although the religion permits organ donation, individuals or families may have differing viewpoints. Organ donation is not prohibited by religion, and the family would not be very concerned about where the patient’s soul will go after death. The statement that “it’s hard to know what people who believe cows are sacred will think about organ donation” is not culturally sensitive.

DIF: Cognitive Level: Application TOP: Organ donation MSC: NCLEX: Psychosocial Integrity

REF: p. 166 OBJ: 8 KEY: Nursing Process Step: Implementation

13. A patient who practices Buddhism tells the nurse, “My pain is the result of things I have done in the past.” The nurse, who wishes to be supportive, should respond a. “Are you saying you have been a bad person?” b. “This understanding helps give meaning to your pain.” c. “Perhaps you could ask God to help you bear the pain.” d. “Pain can be an enlightening experience.”

ANS: B

Buddhists believe pain and suffering are due to actions in this or a past life. The correct option accepts the patient’s belief. The statement, “Are you saying you have been a bad person?” is probing. Encouraging a patient who practices Buddhism to ask God to help him or her bear the pain is inappropriate, because Buddhists do not believe in God. Enlightenment has a specific meaning to Buddhists; it refers to finding the truth of existence and should not be used as a general term.

DIF: Cognitive Level: Application TOP: Buddhist philosophy

REF: p. 168 OBJ: 7 | 8 KEY: Nursing Process Step: Implementation

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14. A patient tells the nurse, “I know my minister will visit me when he checks at the admissions desk and learns I’m a patient.” The most facilitative response the nurse can make would be a. “I’m sure you can count on seeing your pastor within a day or two.” b. “Because of a federal law, the hospital cannot make your name available to clergy.” c. “Clergy rarely make calls to this hospital, so your pastor may not know you’re here.” d. “I can arrange for a phone so that you may call your minister and ask him to visit.”

ANS: D

The correct option provides an acceptable way of notifying the minister of the patient’s desire for a visit without violating HIPAA privacy standards. Telling the patient that he can count on seeing his pastor within a day or two is false reassurance. It is true that due to federal law, the hospital cannot make the patient’s name available to clergy, but that statement does nothing to help the patient make contact with the minister. Telling the patient that clergy rarely make calls to the hospital offers an explanation that is probably untrue.

DIF: Cognitive Level: Application REF: p. 158 OBJ: 7 | 8 TOP: Privacy KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

15. When a patient is asked about religious preference, she states, “I am agnostic.” The nurse’s best interpretation of this is a. the patient does not believe in God. b. the patient believes in God and supernatural powers. c. the patient does not believe that the supernatural exists. d. the patient believes that the existence of God can be neither proved nor disproved.

ANS: D

Agnostics hold the belief that the existence of God can be neither proved nor disproved.

Atheists do not believe that the supernatural exists, so they do not believe in God. DIF: Cognitive Level: Comprehension REF: p. 159 TOP: Religion KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

OBJ: 6

16. A nurse is caring for an Orthodox Jewish patient who has terminal cancer. The nurse demonstrates cultural sensitivity toward the patient by stating: a. “Would you like me to assist you in praying to Jesus?” b. “I’m sure you will go to heaven. You’re a good person.” c. “Would you like me to ask your rabbi to come to visit you?” d. “Would you like me to bring you a copy of the New Testament?”

ANS: C

Orthodox Jews follow the traditional faith and strictly adhere to rituals. Jews believe in God but do not have a belief in Christ. A nurse should avoid making references to heaven or Jesus.

Jewish clergy are called rabbis. The holy books of the Jews are the Torah and the Talmud.

DIF: Cognitive Level: Analysis REF: p. 161 OBJ: 8 TOP: Religion KEY: Nursing Process Step: Implementation

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17. A nurse is caring for a Sunni Muslim patient. The nurse demonstrates cultural sensitivity by a. allowing the patient to pray three times daily. b. placing the patient’s dinner tray on top of the Koran. c. offering the patient food and fluids during Ramadan. d. positioning the patient’s bed in a southeast direction from the United States.

ANS: D

Muslims are called to prayer five times a day. If a Muslim brings the Koran, the holy book of Islam, to the health care facility, the nurse should not touch it or place anything on top of it.

During Ramadan, the ninth month of the Islamic calendar, adult Muslims abstain from dawn to sunset from food, drink, and sexual activity. If a patient requests to face Mecca, the holy city of Islam, a bed or chair may be positioned in a southeast direction from the United States.

DIF: Cognitive Level: Analysis REF: p. 166 OBJ: 8 TOP: Religion KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

18. A nurse is caring for a Sunni Muslim patient. The nurse demonstrates cultural sensitivity by understanding that the patient would likely pray to a. Allah. b. Islam. c. Buddha. d. Jesus Christ.

ANS: A

Muslims believe in one God, Allah. The word Islam implies peace. In the sixth century AD, the prophet Muhammad founded Islam in Arabia. Followers of Islam are called Muslims.

Siddhartha Gautama (Buddha) founded Buddhism in the sixth century BC in India.

Christianity is based on a belief in Jesus Christ as the Son of God. DIF: Cognitive Level: Comprehension OBJ: 7 TOP: Religion MSC: NCLEX: Psychosocial Integrity

REF: p. 165 | p. 166 KEY: Nursing Process Step: Assessment

19. In what religion do adults abstain from food, drink, and sexual activity from dawn to sunset during the ninth month of their religious calendar? a. Buddhism b. Jehovah’s witness c. Mormon d. Islam ANS: D

During Ramadan, the ninth month of the Islamic calendar, adult Muslims abstain from food, drink, and sexual activity from dawn to sunset.

DIF: Cognitive Level: Comprehension REF: p. 165 TOP: Religion KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

OBJ: 7

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20. The LPN/LVN is preparing to educate a healthy patient regarding methods of birth control. The patient’s history indicates she is a member of the Mormon church. The LPN/LVN is aware that education of this patient should include information related to a. oral contraceptives. b. natural family planning. c. barrier methods. d. spermicides.

ANS: B

Mormon beliefs and practices allow natural methods of birth control. Artificial means may be used when the physical or emotional health of the woman is in question. Because the patient is healthy, educational information should relate to natural family planning methods.

DIF: Cognitive Level: Analysis TOP: Beliefs and practices MSC: NCLEX: Psychosocial Integrity

REF: p. 167 OBJ: 6 KEY: Nursing Process Step: Implementation

21. A nurse is caring for a patient who follows teachings from a holy book called the Koran.

The nurse understands that this patient practices what religion? a. Hindu b. Islam c. Quaker d. Buddhism ANS: B

Muslims, who practice Islam, believe in one God, Allah. Salvation depends on one’s commitment to Allah and his teachings in the Koran. This holy book contains the words of Allah as he spoke to Muhammad.

DIF: Cognitive Level: Comprehension REF: p. 165 TOP: Religion KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

OBJ: 7

22. When Martin Luther separated from the Catholic Church because of scandals in the church, which religion was formed? a. Mormonism b. Lutheranism c. Scientology d. Jehovah’s Witness ANS: B

When Martin Luther separated from the Catholic Church because of scandals in the church, this started the Reformation and the beginning of Lutheranism.

DIF: Cognitive Level: Comprehension REF: p. 165 TOP: Religion KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

OBJ: 7

23. A religion that began in Scotland and evolved from John Calvin in the sixteenth century is known as a. Presbyterianism. b. Episcopalian.

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c. Seventh-Day Adventist. d. United Church of Christ.

ANS: A

The Presbyterian religion began in Scotland and evolved from John Calvin in the sixteenth century.

DIF: Cognitive Level: Comprehension REF: p. 163 TOP: Religion KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

OBJ: 7

24. A religion in which members believe they receive Divine Truth from “inner” light supplied by the Holy Spirit is a. Quaker. b. Episcopalian. c. Seventh-Day Adventist. d. United Church of Christ.

ANS: A

Quakers believe they receive Divine Truth from “inner” light supplied by the Holy Spirit.

DIF: Cognitive Level: Comprehension REF: p. 163 TOP: Religion KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

OBJ: 7

25. A religion in which members observe the Sabbath from sunset on Friday to sunset on Saturday is a. Mormonism. b. Catholicism. c. Islam. d. Seventh-Day Adventist.

ANS: D

Seventh-Day Adventists observe the Sabbath from sunset on Friday to sunset on Saturday.

They do not pursue their jobs or worldly pleasures at this time.

DIF: Cognitive Level: Comprehension REF: p. 164 TOP: Religion KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

OBJ: 7

26. A religion that was formed in 1957 by merger of Congregational and Evangelical and Reformed Churches is a. Mormonism. b. Presbyterianism. c. Seventh-Day Adventist. d. United Church of Christ.

ANS: D

United Church of Christ was formed in 1957 by merger of Congregational and Evangelical and Reformed Churches.

DIF: Cognitive Level: Comprehension REF: p. 164 TOP: Religion KEY: Nursing Process Step: N/A

OBJ: 7

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MSC: NCLEX: Psychosocial Integrity

27. A nurse is caring for a patient who refuses to consume meat on Ash Wednesday and all Fridays during Lent. The nurse understands that this patient is of what religion? a. Islam b. Mormonism c. Catholicism d. Presbyterianism ANS: C

Roman Catholics 14 years of age and older are to abstain from meat on Ash Wednesday and all Fridays during Lent. Catholics ages 14 to 59 are to fast (eat one full meal and two lighter meals) on Ash Wednesday and Good Friday. Fasting and abstaining are excused during hospitalization.

DIF: Cognitive Level: Comprehension REF: p. 162 TOP: Religion KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

OBJ: 7

28. A religion that was founded in the nineteenth century by Mary Baker Eddy is a. Mormonism. b. Christian Scientist. c. Jehovah’s Witness. d. Seventh-Day Adventist.

ANS: B

Christian Scientist (Church of Christ, Scientist) was founded in the nineteenth century by Mary Baker Eddy, who wrote Science and Health with Key to the Scriptures.

DIF: Cognitive Level: Comprehension REF: p. 167 TOP: Religion KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

OBJ: 7

29. A patient following a kosher diet consumes a breakfast of toast, eggs, and turkey bacon.

The LPN/LVN is aware that 6 hours must pass before the patient is offered a. water. b. juice. c. milk. d. coffee.

ANS: C

With a kosher diet, meat may be consumed a few minutes after drinking milk, but 6 hours must pass after eating meat before drinking milk.

DIF: Cognitive Level: Application TOP: Beliefs and practices MSC: NCLEX: Psychosocial Integrity

REF: p. 161 OBJ: 7 | 8 KEY: Nursing Process Step: Implementation

30. A religion that was founded by Joseph Smith in the nineteenth century is a. Mormonism. b. Catholicism. c. Lutheranism.

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d. Mennonite.

ANS: A

In the nineteenth century, Joseph Smith founded the Mormon Church.

DIF: Cognitive Level: Comprehension REF: p. 167 TOP: Religion KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

OBJ: 7

31. A religion that was founded by Siddhartha Gautama in the sixth century BC in India is a. Buddhism. b. Hinduism. c. Mormonism. d. Catholicism.

ANS: A

Siddhartha Gautama (Buddha) founded Buddhism in the sixth century BC in India.

DIF: Cognitive Level: Comprehension OBJ: 7 TOP: Religion MSC: NCLEX: Psychosocial Integrity

REF: p. 168 | p. 170 KEY: Nursing Process Step: N/A

MULTIPLE RESPONSE

1. To implement effective patient care, which patients would the nurse identify as non-Christian?

(Select all that apply.) a. Mr. A, who is Jewish b. Miss B, who is Presbyterian c. Mrs. C, who is Roman Catholic d. Mr. D, who is Eastern Orthodox e. Miss E, who is Seventh-Day Adventist f. Mr. F, who is Buddhist ANS: A, F

Jewish patients believe in God but not Christ. Buddhist patients follow the teaching of Siddhartha Gautama rather than the teachings of Jesus. The remaining options are Christian religious groups.

DIF: Cognitive Level: Application TOP: Religions in the United States MSC: NCLEX: Psychosocial Integrity

REF: p. 167 OBJ: 7 KEY: Nursing Process Step: Implementation

2. The LPN/LVN is providing care to a patient of the Roman Catholic (Western) faith. Necessary knowledge regarding beliefs, practices and nursing interventions for care of this patient would include which of the following? (Select all that apply.) a. Medicine cannot be taken before communion. b. The nurse may baptize a stillborn infant without a witness. c. Cremation is prohibited. d. Organ donation is allowed. e. Water may be taken before communion.

ANS: B, D, E

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People of the Roman Catholic faith may take medicine and water before communion. If the patient is a gravely ill infant, a stillbirth, or a fetus, the nurse may baptize without a witness.

Cremation and organ donation are allowed.

DIF: Cognitive Level: Comprehension REF: p. 162 OBJ: 8 TOP: Beliefs, practices, and nursing interventions KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity COMPLETION

1. A patient whose religion is listed as Seventh-Day Adventist is admitted to the unit just before lunch. The patient is being examined, and the nurse does not want to interrupt to ask about lunch preferences. A good choice would be to order a meal.

ANS:

vegetarian Many Seventh-Day Adventists are vegetarians. When dietary preferences are unknown, this choice would be safe.

DIF: Cognitive Level: Application TOP: Dietary preferences MSC: NCLEX: Psychosocial Integrity

REF: p. 164 OBJ: 8 KEY: Nursing Process Step: Implementation

2. A nurse is caring for a patient who practices Mormonism. The nurse should expect the patient to study religion from the Holy Bible and the .

ANS:

Book of Mormon Members of the Mormon faith read from the Book of Mormon, which contains accounts of ancient peoples in America. This book is considered complementary scripture to the Bible.

DIF: Cognitive Level: Comprehension REF: p. 167 TOP: Religion KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

OBJ: 7 | 8

Chapter 12: The Nursing Process: Your Role Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. A student nurse asks, “If RNs use a five-step nursing process and LPN/LVNs use a four-step process, what phase is missing?” The best response would be, “The phase of the nursing process that is the sole responsibility of the registered nurse is a. assessment. b. nursing diagnosis. c. planning. d. implementation. e. evaluation.

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ANS: B

The LPN/LVN participates in all phases of the nursing process with the exception of establishing a nursing diagnosis.

DIF: Cognitive Level: Application REF: p. 174 TOP: Nursing diagnosis: the responsibility of the RN KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Safe, Effective Care Environment

OBJ: 3

2. The student nurse asks, “How does knowing the nursing diagnosis assist the LPN/LVN?” The best response is based on understanding that a. a nursing diagnosis identifies the patient’s problems. b. it permits the practical nurse to go beyond the scope of practice. c. this step makes the practical nurse equal to the medical doctor. d. knowledge of the nursing diagnosis ensures a cure for the patient.

ANS: A

The LPN/LVN uses the nursing diagnosis to identify a patient’s problems. The other statements are false.

DIF: Cognitive Level: Application REF: p. 174 OBJ: 3 | 5 TOP: Nursing diagnosis KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Safe, Effective Care Environment

3. Which of the following is the primary reason that LPN/LVNs are taught to use the nursing process? a. To diagnose disease b. To provide reimbursement c. To resolve patient problems d. To communicate with health team members ANS: C

The nursing process provides a structure for nurses to identify and respond to patient needs within the scope of nursing. Diagnosing disease is the domain of the physician.

Reimbursement is not the primary purpose of the nursing process. Communication facilitation is not the primary purpose of the nursing process.

DIF: Cognitive Level: Analysis REF: p. 174 OBJ: 5 TOP: Purpose of nursing process KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

4. During the assessment phase of the nursing process, the LPN/LVN is expected to a. establish goals and outcome criteria. b. collect data about the patient. c. determine whether established goals have been met. d. plan interventions to implement for the patient.

ANS: B

Data are collected as part of the assessment phase. This is the only option that relates to assessment.

DIF: Cognitive Level: Comprehension

REF: p. 175

OBJ: 3

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TOP: Assessment and data collection KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment

5. The nursing care plan requires the nurse to ambulate the patient twice daily. The phase of the nursing process in which the nurse is participating is a. assessment. b. planning. c. implementation. d. evaluation.

ANS: C

Carrying out the care plan is termed implementation. Assessment involves data collection.

Planning involves creation of the nursing care plan. Evaluation involves determining goal attainment.

DIF: Cognitive Level: Application TOP: Implementation MSC: NCLEX: Physiological Integrity

REF: p. 175 OBJ: 3 KEY: Nursing Process Step: Implementation

6. An LPN/LVN demonstrates to a new mother how to safely bathe her infant. This is an example of the phase of the nursing process called a. assessment. b. nursing diagnosis. c. planning. d. implementation.

ANS: D

Initiating teaching that is within the role of the LPN/LVN and supporting teaching by the RN are examples of implementation.

DIF: Cognitive Level: Application REF: p. 182 TOP: Teaching as part of the implementation phase KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

OBJ: 3

7. When the LPN/LVN participates in the evaluation phase of the nursing process, she or he compares the patient’s responses with the a. nursing orders. b. outcome criteria. c. nursing diagnosis. d. data collection.

ANS: B

The process of determining outcome attainment involves comparing actual patient outcomes with desired patient outcomes. The nursing orders are orders for treatments and medication written by a medical doctor or other health care provider with prescriptive authority. A nursing diagnosis is provided by the RN and is defined by the International Journal of Nursing Terminologies and Classifications as a clinical judgment about individual, family, or community responses to actual or potential health problems/life

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processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable. The data collection is a systematic gathering and review of information about the patient, which is communicated to appropriate members of the health team.

DIF: Cognitive Level: Comprehension REF: p. 175 TOP: Evaluation KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment

OBJ: 3

8. Which of the following are considered subjective data? a. The patient tells the nurse that he has a headache. b. The nursing assistant tells the nurse that the patient vomited. c. The patient’s mother tells the nurse that the patient needs a ride to the clinic for follow-up. d. The physician tells the nurse that the patient needs a chest x-ray.

ANS: A

Subjective data are based on the patient’s report or opinion. This option is the only example of patient report.

DIF: Cognitive Level: Analysis REF: p. 176 TOP: Data collection KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

9. “I feel like I can’t catch my breath” is an example of a. effective data. b. objective data. c. subjective data. d. evaluative data.

ANS: C

Subjective data are based on the patient’s report or opinion. Objective data are data the nurse can verify. Effective data and evaluative data are not used as data classifications.

DIF: Cognitive Level: Application REF: p. 176 TOP: Subjective data KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Physiological Integrity

OBJ: 3

10. A blood pressure of 110/70 at 8 PM is most accurately described as an example of a. planning data. b. subjective data. c. objective data. d. reassessment data.

ANS: C

Objective data are sometimes called signs. Objective data can be verified. Subjective data are based on the patient’s report. Planning data and reassessment data are not used as data classifications.

DIF: Cognitive Level: Application TOP: Objective data

REF: p. 176

OBJ: 3

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KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Physiological Integrity

11. When a nurse uses Maslow’s Hierarchy of Needs to prioritize patient problems, which problem would be considered the highest priority? a. The patient is unsteady and may become injured. b. The patient is experiencing marital difficulties. c. The patient has deficient knowledge about the condition. d. The patient is acutely short of breath.

ANS: D

The priority problem is one that is potentially life-threatening: shortness of breath.

Physiologic or survival needs take priority over higher level needs. The problems mentioned in the other options do not threaten survival.

DIF: Cognitive Level: Application TOP: Priority setting MSC: NCLEX: Physiological Integrity

REF: p. 178 OBJ: 2 KEY: Nursing Process Step: Planning

12. Which of the following statements regarding short-term goals is accurate? a. Short-term goals are broad rather than specific. b. Short-term goals can be accomplished within days or hours. c. Short-term goals must be accomplished while the patient is hospitalized. d. Short-term goals are less realistic than long-term goals.

ANS: B

Short-term goals can usually be accomplished within hours or days, whereas long-term goals may take weeks.

DIF: Cognitive Level: Comprehension REF: p. 180 TOP: Goals KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

OBJ: 3

13. The patient’s problem has been identified as insufficient intake of oral fluids. The best outcome statement is a. the patient will ingest 1500 mL of oral fluids during each 24-hour period. b. the patient will request fluids when thirsty. c. the nurse will encourage fluid intake by the patient. d. the nurse will provide the patient with 100 mL of fluid hourly.

ANS: A

An outcome may be attained by stating the problem in positive terms. It is always a statement of what the patient will do. Stating that the patient will request fluids when thirsty may not result in the desired intake. The remaining options are nurse centered.

DIF: Cognitive Level: Application REF: p. 180 TOP: Outcomes KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

OBJ: 3

14. A student nurse asks, “What’s the primary purpose of the evaluation phase of the nursing process?” The best response is a. to establish a time frame for completion of goals.

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b. to determine whether the nurse completed all nursing interventions. c. to determine which nurses are eligible for raises or promotion. d. to compare actual patient outcomes with desired outcomes.

ANS: D

Data collection, with comparison of actual and desired patient outcomes, is the focus of the evaluation phase of the nursing process. The response “to establish a time frame for completion of goals” is initially part of the planning phase. Time frames for goal attainment may be revised during the evaluation phase, but this is not the primary purpose of evaluation.

In the remaining options, evaluation is patient centered.

DIF: Cognitive Level: Application REF: p. 183 TOP: Evaluation KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment

OBJ: 3

15. How does the LPN/LVN use nursing diagnosis in patient care? a. To set patient-centered goals b. To convert nursing diagnoses to patient problems c. To implement independent nursing interventions d. To justify participation in data collection ANS: B

The LPN/LVN uses the nursing diagnosis as the reference point for identifying patient problems that require intervention. The nursing diagnosis is not required by the LPN/LVN to set goals and outcomes, implement nursing interventions, or participate in data collection.

DIF: Cognitive Level: Comprehension REF: p. 176 OBJ: 4 TOP: Nursing diagnosis KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Safe, Effective Care Environment

16. The phases of the nursing process in which the LPN/LVN participates with the greatest degree of independence are a. goal setting and evaluation. b. planning and implementation. c. data collection and implementation. d. evaluation and data collection.

ANS: C

The LPN/LVN curriculum trains graduates to collect data and implement a variety of nursing interventions, making a high degree of independence possible in these areas. Goal setting, evaluation, and planning all require a greater degree of interdependence with the RN. DIF: Cognitive Level: Analysis REF: p. 175 TOP: LPN/LVN relative independence/interdependence MSC: NCLEX: Safe, Effective Care Environment

OBJ: 3 KEY: Nursing Process Step: N/A

17. The RN head nurse is having a busy day. When the LPN/LVN reports data she has collected, the RN states, “Incorporate that into the nursing care plan and write down the intervention you’d use. I’ll cosign the entry.” The LPN/LVN should a. do as requested. b. ask the advice of the shift supervisor later in the shift. c. tell the RN that this action is not within the LPN/LVN scope of practice.

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d. write a letter to the state board of nursing to report the RN’s unprofessional conduct.

ANS: C

The RN is responsible for determining the nursing care plan. The LPN/LVN collects data that the RN may use to modify the plan, but the LPN/LVN may not independently modify the plan. If the LPN/LVN functions outside the identified scope of practice, he or she would be breaking the law. The remaining options do not directly address the problem at the time it occurs.

DIF: Cognitive Level: Application REF: p. 181 OBJ: 2 | 3 TOP: Scope of practice KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

18. The LPN/LVN learns at report that a patient’s priority problems are pain and inability to ambulate associated with arthritis. During the patient’s bath, he becomes short of breath.

The LPN/LVN should implement interventions based on a. the priorities given at the report. b. the patient’s identified strengths. c. the patient’s changing status. d. information obtained from the Nursing Outcomes Classification (NOC) project.

ANS: C

Status changes are a priority. Priorities may change rapidly, depending on the patient’s condition. This change challenges survival and assumes priority over the other identified problems.

DIF: Cognitive Level: Application REF: p. 178 TOP: Priorities KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

OBJ: 3

19. Identify the outcome that would be appropriate to include in the nursing care plan of a patient who has undergone total knee replacement. a. The patient will be stronger by (date). b. The patient will transfer from the bed to a chair with the assistance of a walker and one staff member by the third postoperative day. c. The nurse will help the patient ambulate the length of the hall twice daily. d. The nurse will evaluate the patient’s strength based on his ability to ambulate in the hall on the first postoperative day.

ANS: B

“The patient will transfer from the bed to a chair with the assistance of a walker and one staff member by the third postoperative day” contains the elements necessary for a well-written outcome. It is patient centered, realistic, measurable, and time referenced. “The patient will be stronger by (date)” is not measurable. The remaining options are nurse centered.

DIF: Cognitive Level: Analysis REF: p. 180 TOP: Outcomes KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

OBJ: 3

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20. A nurse expresses difficulty deciding which nursing interventions to suggest for a patient with arthritic pain during an upcoming patient-centered conference. A peer suggests referring to the Nursing Interventions Classification (NIC) taxonomy. This would provide the nurse with information on a. how to provide basic care to patients. b. identification of nursing measures to help patients progress toward goals. c. a language for measuring patients’ response to nursing interventions. d. how to translate nursing diagnoses into nursing problems.

ANS: B

NIC standardizes, defines, and assists nurses in choosing the appropriate nursing interventions. It includes physical and psychosocial interventions, health promotion, illness treatment, and independent and collaborative interventions. NIC is not a basic text. NIC does not provide a measurement language. NIC does not give information about translating nursing diagnoses into nursing problems.

DIF: Cognitive Level: Comprehension REF: p. 184 OBJ: 6 TOP: Nursing Interventions Classification KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

21. The patient’s nursing diagnosis is pain associated with walking related to knee injury.

The LPN/LVN should accurately identify the patient problem as a. arthritis. b. unwillingness to exercise. c. need for knee brace. d. knee pain.

ANS: D

Knee pain is the best translation given for the nursing diagnosis. Arthritis is a medical diagnosis. Unwillingness to exercise assumes information not given in the scenario. Need for a knee brace prescribes a treatment.

DIF: Cognitive Level: Application REF: p. 178 OBJ: 3 TOP: Translating nursing diagnosis to patient problem KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

22. A beginning nurse asks an experienced nurse, “When should I focus on data collection?” Which statement provides the best description for when a nurse should collect patient- centered data? a. After report when coming on duty b. Within 1 hour of reporting off duty c. While assisting a patient with hygiene d. During each patient contact ANS: D

Data are collected whenever the nurse and patient interact. The other options limit data collection.

DIF: Cognitive Level: Application REF: p. 176 TOP: Data collection KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Safe, Effective Care Environment

OBJ: 3

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23. The nursing process consists of collecting data (assessment), nursing diagnosis, planning, implementation, and evaluating nursing care. Which step of the nursing process is the sole responsibility of the registered nurse? a. Planning b. Assessment c. Implementation d. Nursing diagnosis ANS: D

The nursing process consists of collecting data (assessment), nursing diagnosis (which is the RN’s responsibility), planning, implementation, and evaluating nursing care. Nursing diagnosis is within the RN’s legal role, but LPN/LVNs have an important role in assisting the RN in the other steps of the nursing process.

DIF: Cognitive Level: Comprehension REF: p. 175 OBJ: 4 TOP: Nursing process KEY: Nursing Process Step: Assessment | Nursing Process Step: Diagnosis| Nursing Process Step: Planning| Nursing Process Step: Implementation| Nursing Process Step: Evaluation MSC: NCLEX: N/A

24. A nurse is gathering and reviewing information about a patient. The nurse is participating in which step of the nursing process? a. Planning b. Evaluation c. Data collection d. Implementation ANS: C

The nursing process consists of collecting data (assessment), nursing diagnosis (which is the RN’s responsibility), planning, implementation, and evaluating nursing care. Data collection is a systematic gathering and review of information about the patient, which is communicated to appropriate members of the health team.

DIF: Cognitive Level: Comprehension REF: p. 175 TOP: Nursing process KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

25. An LPN/LVN is assisting the RN in the development of goals and interventions for a patient’s plan of care. The LPN/LVN is participating in which step of the nursing process? a. Planning b. Evaluation c. Data collection d. Implementation ANS: A

The nursing process consists of collecting data (assessment), nursing diagnosis (which is the RN’s responsibility), planning, implementation, and evaluating nursing care. Planning involves assisting the RN in the development of nursing diagnosis, goals, and interventions for a patient’s plan of care and maintaining patient safety.

DIF: Cognitive Level: Comprehension

REF: p. 175

OBJ: 3

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TOP: Nursing process MSC: NCLEX: N/A

KEY: Nursing Process Step: Planning

26. A nurse is comparing a patient’s outcomes of nursing care to the expected outcomes. The nurse then communicates these findings to members of the health care team. The nurse is participating in which step of the nursing process? a. Planning b. Evaluation c. Data collection d. Implementation ANS: B

The nursing process consists of collecting data (assessment), nursing diagnosis (which is the RN’s responsibility), planning, implementation, and evaluating nursing care. Evaluation compares the actual outcomes of nursing care to the expected outcomes, which are then communicated to members of the health care team.

DIF: Cognitive Level: Comprehension TOP: Nursing process MSC: NCLEX: N/A

REF: p. 175 OBJ: 3 KEY: Nursing Process Step: Evaluation

27. A nurse reviews a patient’s care plan and finds a goal for the patient to ambulate at least three times a day. The nurse assists the patient to accomplish this goal. The nurse is participating in which step of the nursing process? a. Planning b. Evaluation c. Data collection d. Implementation ANS: D

The nursing process consists of collecting data (assessment), nursing diagnosis (which is the RN’s responsibility), planning, implementation, and evaluating nursing care. Implementation is the provision of required nursing care to accomplish established patient goals.

DIF: Cognitive Level: Comprehension TOP: Nursing process MSC: NCLEX: N/A

REF: p. 175 OBJ: 3 KEY: Nursing Process Step: Implementation

28. A nurse is gathering data about a patient. The nurse determines that which of the following is subjective data? a. The patient complains of excruciating, crushing chest pain. b. The patient is short of breath and coughs up green sputum. c. The patient has gained 1 lb within the past 24 hours. d. The patient is experiencing sinus tachycardia and peripheral edema.

ANS: A

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information helps support or cast doubt on subjective information. The patient complaining of chest pain is the only option that is subjective. The remaining options are all examples of objective data.

DIF: Cognitive Level: Analysis REF: p. 176 TOP: Subjective data KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

29. A nurse is gathering data about a patient. The nurse determines that which of the following is subjective data? a. The patient complains of feeling anxious about her upcoming surgery. b. The patient is short of breath and has an oxygen saturation level of 86%. c. The patient has a heart rate of 85 beats per minute and has a sinus rhythm. d. The patient has consumed 60% of breakfast, 45% of lunch, and 50% of dinner.

ANS: A

Subjective information is based on the patient’s opinion. Some refer to subjective information as symptoms. This usually includes feelings of physical discomfort, anxiety, and mental stress that are more difficult to measure. The nurse cannot experience subjective symptoms.

Objective information includes data that the nurse can verify; these are also known as signs. A physical assessment provides objective data. The terms check, observe, monitor, weigh, measure, and smell are cues that this may be objective data collection. Obtaining initial data, such as vital signs, height, and weight, is often assigned to the LPN/LVN. Objective information helps support or cast doubt on subjective information. The patient’s complaint of anxiety is the only option that is subjective. The remaining are all examples of objective data.

DIF: Cognitive Level: Analysis REF: p. 176 TOP: Subjective data KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

30. A nurse is gathering data about a patient. The nurse determines that which of the following is objective data? a. The patient complains of phantom pain after receiving a left below-theknee amputation. b. The patient complains of crushing chest pain and states, “I feel like there is an elephant sitting on my chest.” c. The patient complains of feeling anxious about being hospitalized and states, “I feel like I’m going to die.” d. The patient has a heart rate of 99 beats per minute, respirations of 20 per minute, and a temperature of 99.2° F. ANS: D

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information helps support or cast doubt on subjective information. Option D, which contains the patient’s heart rate, respirations, and temperature, is the only option that has objective data.

The remaining are all examples of subjective data.

DIF: Cognitive Level: Analysis REF: p. 176 TOP: Objective data KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

MULTIPLE RESPONSE

1. The LPN/LVN should be alert to possible barriers to data collection, such as which of the following? (Select all that apply.) a. Inadequate assessment skills b. Presence of distractions c. Respectful distancing d. Insufficient time e. Inability to speak the language f. Patient labeling ANS: A, B, D, E, F

Each of the options except respectful distancing may create a barrier to data collection.

Respectful distancing suggests calling the patient by title and surname and avoiding overly familiar approaches.

DIF: Cognitive Level: Analysis REF: p. 178 TOP: Barriers to data collection KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Safe, Effective Care Environment

OBJ: 3

2. Which strategies would facilitate patient data collection? (Select all that apply.) a. Ensure that the patient knows who you are and what you are going to do. b. Address the patient with familiarity, using terms of endearment. c. Repeat questions the patient has previously answered. d. Clarify what you do not understand with the patient. e. Judge the patient’s behaviors and attitudes.

ANS: A, D

Use of good communication strategies facilitates data collection. Orienting the patient to your role and the purpose of the interaction and clarifying what is not understood facilitates data collection. Addressing the patient with familiarity, using terms of endearment, is disrespectful and creates a barrier to communication. Repeating questions the patient has previously answered suggests to the patient that no one listens to what has already been revealed. Judging the patient’s behaviors and attitudes results in labeling of patients and making judgmental statements to the patient.

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DIF: Cognitive Level: Analysis REF: p. 178 TOP: Data collection KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Psychosocial Integrity

OBJ: 3

3. Which of the following are reasons the nursing process and critical thinking are included in the LPN/LVN curriculum? (Select all that apply.) a. Both are needed to identify patient problems, issues, and risks. b. They foster making evidence-based judgments. c. Clearer communication between RN and LPN can take place. d. Job stress and burnout are diminished. e. Patient safety is adversely affected.

ANS: A, B, C

The nursing process provides a reasoning model for use in planning and implementing care.

This model requires the use of critical thinking skills. Diminishing job stress and burnout and adverse effects on patients’ safety are not reasons the nursing process and critical thinking are included in the LPN/LVN curriculum. Job stress and burnout have not been directly associated with use of the nursing process or critical thinking. The aim of both the nursing process and critical thinking is to promote patient safety.

DIF: Cognitive Level: Analysis REF: p. 174 OBJ: 5 TOP: Inclusion of nursing process and critical thinking in LPN/LVN curriculum KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

4. Which statements accurately describe the role of the LPN/LVN in relation to use of the nursing process? (Select all that apply.) a. LPN/LVNs have an interdependent relationship with other health team members. b. LPN/LVNs act in a more dependent role when participating in the planning and evaluation phases. c. LPN/LVNs act more independently when participating in data collection and implementation phases than in any other phases of the nursing process. d. LPN/LVNs are able to use the NANDA list to make nursing diagnoses. e. LPN/LVN basic education enables them to perform patient interviews and assessment of body systems.

ANS: A, B, C

LPN/LVNs implement orders for treatments and medication written by physicians, dentists, nurse practitioners, physician assistants, and other qualified health team members. The LPN/LVN contributes by collecting and sharing data that are used by the RN to plan and evaluate care. The LPN/LVN is skillful in data collection and providing planned nursing interventions. Nursing diagnosis is the domain of the RN. LPN/LVN basic education does not teach interview skills and physical assessment of body systems.

DIF: Cognitive Level: Analysis REF: p. 175 OBJ: 2 TOP: Role in the nursing process KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

5. Which of the following are examples of subjective data? (Select all that apply.) a. A patient has an offensive body odor.

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b. c. d. e. f.

A patient complains of feeling stressed.

A patient complains of feeling anxious.

A patient complains of substernal chest pain.

A patient falls when ambulating to the bathroom.

A patient states, “I feel a sense of impending doom.”

ANS: B, C, D, F

Subjective information is based on the patient’s opinion. Some refer to subjective information as symptoms. This usually includes feelings of physical discomfort, anxiety, and mental stress that are more difficult to measure. The nurse cannot experience subjective symptoms.

Objective information includes data that the nurse can verify; these are also known as signs.

A physical assessment provides objective data. The terms check, observe, monitor, weigh, measure, and smell are cues that this may be objective data collection. Obtaining initial data, such as vital signs, height, and weight, is often assigned to the LPN/LVN. Objective information helps support or cast doubt on subjective information. The patients’ statement and complaints are the only options that are subjective. The remaining options are examples of objective data.

DIF: Cognitive Level: Analysis REF: p. 176 TOP: Subjective data KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

6. Which of the following are examples of objective data? (Select all that apply.) a. A patient has an offensive body odor. b. A patient complains of feeling stressed. c. A patient complains of feeling anxious. d. A patient complains of substernal chest pain. e. A patient falls when ambulating to the bathroom. f. A patient states, “I feel a sense of impending doom.”

ANS: A, E

Subjective information is based on the patient’s opinion. Some refer to subjective information as symptoms. This usually includes feelings of physical discomfort, anxiety, and mental stress that are more difficult to measure. The nurse cannot experience subjective symptoms.

Objective information includes data that the nurse can verify; these are also known as signs. A physical assessment provides objective data. The terms check, observe, monitor, weigh, measure, and smell are cues that this may be objective data collection. Obtaining initial data, such as vital signs, height, and weight, is often assigned to the LPN/LVN. Objective information helps support or cast doubt on subjective information. Body odor and a patient falling are examples of objective data. The remaining options are examples of subjective data.

DIF: Cognitive Level: Analysis REF: p. 176 TOP: Objective data KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

COMPLETION

1. A patient states, “I’m feeling left-sided chest pain that radiates to my left arm.” This is an example of data.

ANS:

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subjective Subjective information is based on the patient’s opinion. Some refer to subjective information as symptoms. This usually includes feelings of physical discomfort, anxiety, and mental stress that are more difficult to measure. The nurse cannot experience subjective symptoms.

Objective information includes data that the nurse can verify; these are also known as signs. A physical assessment provides objective data. The terms check, observe, monitor, weigh, measure, and smell are cues that this may be objective data collection. Obtaining initial data, such as vital signs, height, and weight, is often assigned to the LPN/LVN. Objective information helps support or cast doubt on subjective information.

DIF: Cognitive Level: Analysis REF: p. 176 TOP: Subjective data KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

2. A nurse notes that a patient is experiencing increased peripheral edema and has urinated 20 cc of urine in the past hour. This is an example of data.

ANS:

objective Subjective information is based on the patient’s opinion. Some refer to subjective information as symptoms. This usually includes feelings of physical discomfort, anxiety, and mental stress that are more difficult to measure. The nurse cannot experience subjective symptoms.

Objective information includes data that the nurse can verify; these are also known as signs. A physical assessment provides objective data. The terms check, observe, monitor, weigh, measure, and smell are cues that this may be objective data collection. Obtaining initial data, such as vital signs, height, and weight, is often assigned to the LPN/LVN. Objective information helps support or cast doubt on subjective information.

DIF: Cognitive Level: Analysis REF: p. 176 TOP: Objective data KEY: Nursing Process Step: Assessment (Data Collection)

OBJ: 3 MSC: NCLEX: N/A

Chapter 13: Nursing Theory, Research, and Evidence-Based Practice Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. The three concepts considered important to nursing are person, health, and a. socialization. b. procedure. c. environment. d. theory.

ANS: C

The three concepts important to nursing are person (recipient of care), health (the goal of nursing), and environment (the setting where nursing care takes place). The remaining options are not considered concepts important to nursing.

DIF: Cognitive Level: Knowledge

REF: p. 187

OBJ: 1

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TOP: Rationale for nursing theories MSC: NCLEX: N/A

KEY: Nursing Process Step: N/A

2. The LPN/LVN is caring for a postoperative appendectomy patient. When assessing the patient for pain, the nurse documents that the patient reports pain rating an “8” on a scale of 0 to 10. According to Sister Callista Roy’s adaptation model, a patient experiencing pain would be an example of a. focal stimuli. b. contextual stimuli. c. residual stimuli. d. physiological stimuli.

ANS: A

Sister Roy’s adaptation model identifies the types of stimuli as focal, contextual, and residual. Physiological stimuli are not a type included in Sister Roy’s theory. Focal stimuli refer to something direct, such as a patient experiencing pain. Contextual stimuli refer to other factors that affect the focal stimuli, such as being examined in the area of pain.

Residual stimuli refer to both internal and external factors that may not always be evident.

DIF: Cognitive Level: Application TOP: Nursing theories MSC: NCLEX: N/A

REF: p. 190 OBJ: 2 KEY: Nursing Process Step: N/A

3. The nursing instructor provides positive feedback to the student LPN/LVN after observing the student administer an intramuscular injection to a patient. According to Maslow’s human needs theory, the instructor is helping to meet the student’s a. physiological needs. b. safety needs. c. love and belonging needs. d. esteem needs.

ANS: D

According to Maslow’s human needs theory, esteem needs include respect and recognition.

The instructor is assisting the student to earn a positive sense of self. Physiological needs include oxygen, food, water, elimination, safety, sleep, activity, mental stimulation, and sexual procreation. Safety needs include security, freedom from harm, and protection. Love and belonging needs are defined as love, affection, and companionship.

DIF: Cognitive Level: Application TOP: Nursing theories MSC: NCLEX: N/A

REF: p. 188 OBJ: 2 KEY: Nursing Process Step: N/A

4. Quantitative research studies are considered a. subjective studies. b. grounded theory studies. c. objective studies. d. phenomenological studies.

ANS: C

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Quantitative research studies are objective studies. Qualitative research studies are subjective studies. Phenomenology is a type of qualitative study used to study lived experiences.

Grounded theory studies describe a process that people use to deal with problem areas of their lives and are considered qualitative research.

DIF: Cognitive Level: Comprehension TOP: Nursing research MSC: NCLEX: N/A

REF: p. 191 OBJ: 4 KEY: Nursing Process Step: N/A

5. The level of nurse qualified to design and implement research studies and publish findings is a nurse with a a. research doctorate. b. practice doctorate. c. master’s degree. d. baccalaureate degree.

ANS: A

Nurses with a research doctorate design and implement research studies and publish findings.

Nurses with a practice doctorate review present research and formulate evidence-based protocols. Nurses at the master’s level formulate research questions and evaluate the effect of evidence-based solutions on nursing problems. Nurses with a baccalaureate degree identify questions that need to be studied, critique published research, and use evidence as solutions to nursing problems.

DIF: Cognitive Level: Knowledge TOP: Nursing research MSC: NCLEX: N/A

REF: p. 192 OBJ: 4 KEY: Nursing Process Step: N/A

6. The nursing theory that is most likely to be implemented by the nurse as a basis for developing a therapeutic relationship with the adult or child psychiatric patients is a. Maslow’s human needs theory. b. Jean Watson’s theory of human care. c. Orem’s self-care deficit theory. d. Peplau’s interpersonal relations theory.

ANS: D

Nurses who work with adult or child psychiatric patients are more likely to use Peplau’s interpersonal relations theory as a basis for developing a therapeutic relationship with the patient. The relationship that is developed has four overlapping phases—orientation, identification, exploitation, and resolution—and is the major part of the treatment. During the therapeutic relationship, the nurse fulfills the roles of resource person, teacher, leader, surrogate, and counselor. Maslow’s human needs theory is portrayed as a pyramid and has five steps, with the most basic needs existing at the bottom of the pyramid. The five steps include physiological needs, safety, love/belonging, esteem, and self-actualization. Jean Watson’s theory of human care health is defined as harmony between the body, mind, and spirit. It also involves self-perception and how the self is experienced. Illness is a lack of harmony within the self and the soul. The nursing role is a caring process to help the patient regain harmony and health. Orem’s self-care deficit theory is a general theory that consists of three subtheories—self-care, self-care deficit, and nursing system—and is concerned with growth and development needs, as well as physiologic and psychosocial needs.

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DIF: Cognitive Level: Application TOP: Nursing theories MSC: NCLEX: N/A

REF: p. 189 OBJ: 2 KEY: Nursing Process Step: N/A

7. A guest speaker is addressing a group of practical nursing students. The speaker informs the students that she is actively pursuing a doctoral degree in research and is in the process of collecting and measuring numerical data using statistics to describe variables of this study.

The nursing students are aware that this type of study is most likely a a. quantitative research study. b. subjective research study. c. qualitative research study. d. grounded theory research study.

ANS: A

A quantitative research study is an objective study in which a variable is the event the researcher is trying to measure. Numerical data is collected and measured using statistics to describe variables, examine relationships among variables, or determine cause and effect interactions between variables. Qualitative research studies are subjective and provide a narrative description of the “lived experience” of individuals. Grounded theory research studies are a type of qualitative research study that describe a process that people use to deal with problem areas of their lives.

DIF: Cognitive Level: Analysis TOP: Nursing research MSC: NCLEX: N/A

REF: p. 191 OBJ: 4 KEY: Nursing Process Step: N/A

8. The National League of Nursing (NLN) expects the practical/vocational nurse’s main role in evidence-based practice to be a. To challenge the status quo b. To identify questions that need to be studied c. To formulate evidence-based protocols d. To question the basis for nursing actions ANS: D

Practical/vocational nurses question the basis for nursing actions by considering research, evidence, tradition, and patient preference. Associate degree/diploma nurses challenge the status quo. Nurses with a baccalaureate degree identify questions that need to be studied.

Nurses with a practice doctorate formulate evidence-based protocols.

DIF: Cognitive Level: Comprehension TOP: Evidence-based practice MSC: NCLEX: N/A

REF: p. 193 OBJ: 9 KEY: Nursing Process Step: N/A

9. A newly admitted patient reports to the practical nurse that she is “hungry.” The nurse confirms that the patient is on a regular diet and promptly retrieves a meal and provides it to the patient. According to Maslow’s needs theory, the nurse is meeting the patient’s a. physiological needs. b. safety needs. c. self-actualization need. d. love and belonging needs.

ANS: A

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Physiological needs include oxygen, food, water, elimination, safety, sleep, activity, mental stimulation, and sexual procreation. Safety needs include security, freedom from harm, and protection. Self-actualization is the highest level of needs. This involves maximum realization and fulfillment of the individual’s potential. Love and belonging needs include love, affection, and companionship.

DIF: Cognitive Level: Application TOP: Nursing theories MSC: NCLEX: N/A

REF: p. 188 OBJ: 2 KEY: Nursing Process Step: N/A

10. The health belief theory was developed by a. Leininger. b. Watson. c. Rosenstock. d. Orem.

ANS: C

Irwin Rosenstock developed the health belief theory, which tries to explain the reasons a person will or will not take action to prevent or detect illness. Leininger developed the culture care theory. Watson developed the theory of human care. Orem’s theory is the self-care deficit theory.

DIF: Cognitive Level: Knowledge REF: p. 189 | p. 190 OBJ: 2 TOP: Nursing theories KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

11. According to the culture care theory, the two kinds of care in every culture are a. practical and generic. b. generic and professional. c. professional and nonprofessional. d. practical and professional.

ANS: B

According to the culture care theory, the two kinds of care in every culture are generic and professional care. Generic care refers to home remedies used in care, and professional care is provided by people who are specifically trained to provide care. The other options do not correctly reflect the two kinds of care addressed in the culture care theory.

DIF: Cognitive Level: Comprehension TOP: Nursing theories MSC: NCLEX: N/A

REF: p. 189 OBJ: 2 KEY: Nursing Process Step: N/A

MULTIPLE RESPONSE

1. According to Watson’s theory of human care, health is harmony of what factors? (Select all that apply.) a. People b. Body c. Environment d. Spirit e. Mind

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ANS: B, D, E

According to Watson’s theory of human care, health is harmony of the body, mind, and spirit.

It also involves self-perception and how the self is experienced. People and the environment are not specific components of this theory.

DIF: Cognitive Level: Comprehension TOP: Nursing theories MSC: NCLEX: N/A

REF: p. 190 OBJ: 2 KEY: Nursing Process Step: N/A

2. Which of the following are the elements of evidence-based practice? (Select all that apply.) a. Patient preferences b. Basic needs c. Best research evidence d. Nurse’s clinical expertise e. Hypothesis ANS: A, C, D

The elements of evidence-based practice essentially form a triangle. They are best research evidence, the nurse’s clinical expertise, and patient preferences.

DIF: Cognitive Level: Knowledge TOP: Evidence-based practice MSC: NCLEX: N/A

REF: p. 192 OBJ: 6 KEY: Nursing Process Step: N/A

3. According to the adaptation model, interdependence is related to which of the following? (Select all that apply.) a. Role in society b. Spiritual aspects c. Love d. Respect e. Values ANS: C, D, E

According to the adaptation model, interdependence is related to love, respect, and values and can include the patient’s support system. Self-concepts are related to psychological and spiritual aspects of the patient. Role functions as the patient’s role in society.

DIF: Cognitive Level: Knowledge TOP: Nursing theories MSC: NCLEX: N/A

REF: p. 190 OBJ: 2 KEY: Nursing Process Step: N/A

4. In regard to research and evidence-based practice, the National League of Nursing (NLN) expects nurses at the master’s level to do which of the following? (Select all that apply.) a. Design research studies b. Publish research findings c. Formulate research questions d. Evaluate the effect of evidence-based solutions on nursing problems e. Implement research studies ANS: C, D

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The National League of Nursing (NLN) expects nurses at the master’s level to formulate research questions and evaluate the effect of evidence-based solutions on nursing problems.

Nurses with a research doctorate design and implement research studies and publish findings.

DIF: Cognitive Level: Comprehension TOP: Evidence-based practice MSC: NCLEX: N/A

REF: p. 192 OBJ: 5 KEY: Nursing Process Step: N/A

5. Which of the following are the three subtheories of Dorothea Orem’s self-care deficit theory? (Select all that apply.) a. Self-care b. Self-care deficit c. Self-actualization d. Nursing system e. Cultural care ANS: A, B, D

Dorthea Orem’s self-care deficit theory is a general theory with three subtheories: selfcare, self-care deficit, and nursing system. Self-actualization is a component of Maslow’s needs theory. Cultural care is a component of Leininger’s culture care theory.

DIF: Cognitive Level: Comprehension TOP: Nursing theories MSC: NCLEX: N/A

REF: p. 189 OBJ: 2 KEY: Nursing Process Step: N/A

6. Research studies in nursing are important because they generate knowledge for which of the following? (Select all that apply.) a. Clinical practice b. Surgical procedures c. Nursing education d. Delivery of nursing e. Prescribing medications ANS: A, C, D

Research studies in nursing are important because they generate knowledge for clinical practice, nursing education, and delivery of nursing services. The other options are not areas applicable to nursing research.

DIF: Cognitive Level: Comprehension TOP: Nursing research MSC: NCLEX: N/A

REF: p. 191 OBJ: 3 KEY: Nursing Process Step: N/A

COMPLETION

1.

was the first to emphasize the environment as influencing the course of illness and is often spoken of as the first nursing theorist.

ANS:

Florence Nightingale

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Florence Nightingale was the first to emphasize environment: ventilation, warmth, noise, light, and cleanliness. Nightingale is often spoken of as the first nursing theorist. Nightingale felt strongly that environmental issues influenced the course of illness.

DIF: Cognitive Level: Knowledge TOP: Nursing theorists MSC: NCLEX: N/A

REF: p. 187 OBJ: 2 KEY: Nursing Process Step: N/A

2. An independent, not-for-profit organization established in 1993 with the purpose of preparing and promoting the accessibility of a collection of evidence-based health care interventions obtained by systematic reviews of research is known as the ANS:

Cochrane Collaboration In 1993, the Cochrane Collaboration, an independent, not-for-profit organization, was established to prepare and promote the accessibility of Cochrane Reviews, a collection of evidence-based health care interventions obtained by systematic reviews of research.

DIF: Cognitive Level: Knowledge TOP: Evidence-based practice MSC: NCLEX: N/A

3. In 2010, the graduates at all levels.

REF: p. 191 OBJ: 5 KEY: Nursing Process Step: N/A

established competencies for nursing

ANS:

National League for Nursing (NLN) National League for Nursing In 2010, the National League for Nursing (NLN) established competencies of nursing graduates at all levels.

DIF: Cognitive Level: Knowledge TOP: Nursing Organizations MSC: NCLEX: N/A

REF: p. 192 OBJ: 8 KEY: Nursing Process Step: N/A

Chapter 14: The Interdisciplinary Health Care Team: The Role of the Practical/Vocational Nurse Knecht: Success in Practical/Vocational Nursing, 8th Edition MULTIPLE CHOICE

1. Which groups are members of a nursing team? a. RNs, LPN/LVNs, nursing assistants b. Radiologists, dietitians, respiratory therapists c. Occupational therapists, physical therapists, pharmacists d. Physicians, pharmacists, dietitians, physical therapists ANS: A

.

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RNs, LPN/LVNs, and nursing assistants are members of the nursing team who have been cross-trained to perform selected nursing tasks. The groups listed in the other options are not considered part of the nursing team.

DIF: Cognitive Level: Comprehension TOP: Nursing team MSC: NCLEX: N/A

REF: p. 200 OBJ: 3 KEY: Nursing Process Step: N/A

2. How should the nurse accurately describe a nurse practitioner to a student nurse? a. “The nurse practitioner is a student nurse who is near graduation from a basic program.” b. “The nurse practitioner is a registered nurse with a master’s degree in nursing and specialty certification.” c. “The nurse practitioner is a registered nurse with doctoral preparation in research methodology.” d. “The nurse practitioner is a nurse who practices exclusively in a university medical center.”

ANS: B

The nurse practitioner has a minimum of a master’s degree in nursing and certification in an area of specialization, such as primary care, geriatrics, pediatrics, and so on. The other options do not accurately describe the nurse practitioner’s education or role.

DIF: Cognitive Level: Application TOP: Nurse practitioner MSC: NCLEX: N/A

REF: p. 196 OBJ: 3 KEY: Nursing Process Step: N/A

3. Which statement best describes the relationship between the student nurse assigned to a hospital unit for clinical experience and the unit staff? a. The student is under direct supervision of the nurse manager of the unit at all times. b. Students are on the clinical unit to give service to the hospital as they care for patients. c. The student applies classroom learning under the supervision of faculty members during clinical training. d. Practical nursing students form a nursing team of their own and are not a part of the larger unit team.

ANS: C

Student nurses are not counted as clinical staff when receiving clinical experience on a unit.

They are supervised by instructors, and their objective is to apply classroom theory in selected clinical situations. It is not an expectation that a student be under direct supervision of the nurse manager. Students are not unit employees. It is not a usual practice for practical nursing students to form a nursing team of their own and not be a part of the larger unit team on the clinical unit.

DIF: Cognitive Level: Analysis OBJ: 3 TOP: Student role MSC: NCLEX: N/A

REF: p. 204 | p. 205 KEY: Nursing Process Step: N/A

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4. Select the method of delivering nursing care that facilitates continuity of care, individualizes care, and fosters 24-hour accountability for patient care. a. Case nursing b. Team nursing c. Functional nursing d. Primary care nursing ANS: D

This care delivery method uses RNs only. Each primary nurse cares for six patients from admission to discharge, developing the nursing diagnoses and plans of care and assuming ultimate responsibility for 24-hour care, although associate nurses may actually provide care when the primary nurse is not on duty.

DIF: Cognitive Level: Analysis REF: p. 206 | p. 207 OBJ: 5 TOP: Primary nursing KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

5. The member of the health care team responsible for assisting patients to arrange for community agencies to provide services after discharge is the a. nurse. b. physician. c. physical therapist. d. social worker.

ANS: D

The social worker explores needs identified by discharge plans and works with community agencies to meet these patient needs.

DIF: Cognitive Level: Comprehension REF: p. 198 OBJ: 2 TOP: Social work KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity |NCLEX: Physiological Integrity

6. The member of the health care team responsible for performing treatments to assist the patient to breathe more efficiently and effectively is the a. occupational therapist. b. physical therapist. c. respiratory therapist. d. psychotherapist.

ANS: C

Respiratory therapists are responsible for evaluating patient respiratory status and suggesting treatment to prevent or treat respiratory problems. The health care team members mentioned in the other options do not focus on patient breathing.

DIF: Cognitive Level: Comprehension TOP: Health care team MSC: NCLEX: Physiological Integrity

REF: p. 197 OBJ: 2 KEY: Nursing Process Step: N/A

7. Which member of the health care team is responsible for initially teaching a patient about medication side effects? a. Registered nurse b. LPN/LVN

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c. Occupational therapist d. Patient care technician ANS: A

The RN initiates all health teaching. This would include education about medication effects and side effects. The LPN/LVN is able to initiate health teaching only for basic health habits, such as cleanliness. Occupational therapists and patient care technicians are not qualified to undertake medication teaching.

DIF: Cognitive Level: Comprehension TOP: Patient teaching MSC: NCLEX: Physiological Integrity

REF: p. 201 OBJ: 3 KEY: Nursing Process Step: Implementation

8. The goal of the health care team is best described as a. restoring optimal physical, emotional, and spiritual health to patients. b. preventing communicable diseases. c. selecting health care professionals who serve people with health care needs. d. attaining personal satisfaction of the need to help others.

ANS: A

Restoring optimal physical, emotional, and spiritual health to patients is a frequently used statement that describes the goal of health care. Prevention of communicable diseases is a narrow statement and does not best describe the goal of the health care team. The remaining options are not goals of the health care team.

DIF: Cognitive Level: Knowledge TOP: Goal of health care team MSC: NCLEX: N/A

REF: p. 199 OBJ: 1 KEY: Nursing Process Step: N/A

9. The most important reason for a student nurse to prepare adequately before providing patient care is a. to be able to give the same safe care as a nurse. b. to avoid arousing the anger of the instructor. c. to maintain self-esteem by performing well. d. to make a favorable impression on unit staff.

ANS: A

Student nurses are legally and ethically responsible for giving the same safe nursing care that nurses provide. Avoidance of arousing the anger of the instructor is not a valid reason. The remaining options are not the most important reasons.

DIF: Cognitive Level: Analysis REF: p. 205 OBJ: 3 TOP: Student nurses KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

10. The aspect of functioning that distinguishes RNs from LPN/LVNs is that only RNs a. plan and organize daily care for groups of patients. b. implement measures ordered to prevent complications. c. provide health information to patients and families. d. initiate independent nursing actions based on nursing diagnoses.

ANS: D

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LPN/LVNs function interdependently rather than independently. The LPN/LVN functions under the supervision of the RN. The LPN/LVN is able to perform the remaining options.

DIF: Cognitive Level: Knowledge TOP: LPN/LVN role vs. RN role MSC: NCLEX: N/A

REF: p. 201 OBJ: 3 KEY: Nursing Process Step: N/A

11. A student nurse asks, “What determines the LPN/LVN’s role and responsibilities in the practice setting?” The best answer is a. “The job analysis performed by the National Council of State Boards of Nursing.” b. “The Nurse Practice Act of the state in which the LPN/LVN is employed.” c. “The skill mix of the agency unit to which the nurse is assigned.” d. “The degree of centralization of the unit on which the LPN/LVN works.”

ANS: B

The LPN/LVN’s role is determined by the Nurse Practice Act of the state in which the nurse is working. The Nurse Practice Act differs from state to state but generally allows LPN/LVNs to provide care in basic and complex patient situations under the general supervision of an RN, physician, podiatrist, or dentist. The other options are not determinants of scope of practice.

DIF: Cognitive Level: Application REF: p. 201 OBJ: 3 TOP: Scope of practice KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

12. A nurse describes the method of care delivery on a unit as “using nursing staff in varying ratios to meet patient needs and coordinating care using care pathways.” This best describes a. nursing case management. b. primary nursing. c. team nursing. d. the skill mix method.

ANS: A

Nursing case management care delivery uses critical paths to coordinate cost-effective care provided by nursing team members from a variety of educational backgrounds. The description of the care delivery method does not match any of the other care delivery methods mentioned in the options.

DIF: Cognitive Level: Comprehension REF: p. 207 OBJ: 5 TOP: Nursing case management KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

13. An LPN/LVN offers input to the RN about the effectiveness of the patient’s care plan. By doing this, the LPN/LVN is functioning in an a. entrepreneurial role. b. expanded role. c. interdependent role. d. independent role.

ANS: C

Interdependence calls for the LPN/LVN to provide input and feedback to the RN planning and evaluating care for a specific patient.

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DIF: Cognitive Level: Application TOP: Interdependent role of LPN/LVN MSC: NCLEX: N/A

REF: p. 201 OBJ: 3 KEY: Nursing Process Step: N/A

14. The case method of care delivery is used on the surgical unit. The LPN/LVN asks what this means regarding work assignments. The best answer would be: a. “You will be assigned to provide care for two or three relatively stable patients with predictable care outcomes.” b. “You will be assigned to perform specific nursing tasks for a number of patients, such as taking vital signs, doing simple dressings, and so on.” c. “You will be assigned to provide daily total care for several patients from admission to discharge.” d. “You will receive cross-training to be assigned as unit secretary, venipuncturist, or to nursing duties.”

ANS: A

Case method calls for a nurse to provide complete care to several patients. Stable patients are generally assigned to LPN/LVNs. Performance of specific nursing tasks for a number of patients, such as taking vital signs, doing simple dressings, and so on, describes the team method of care delivery. Provision of daily total care for several patients from admission to discharge describes primary care nursing that uses only RN staff. Cross-training to be assigned as unit secretary, venipuncturist, or to nursing duties describes patient-focused nursing.

DIF: Cognitive Level: Application REF: p. 206 TOP: Case method of nursing care delivery MSC: NCLEX: N/A

OBJ: 6 KEY: Nursing Process Step: N/A

15. Which care delivery method has the greatest potential for fragmenting patient care? a. Primary nursing b. Case method c. Functional method d. Patient-focused care ANS: C

The functional method of care delivery assigns various nursing team members to provide specific aspects of care to the patient. The RN might give medications and provide health teaching, the unlicensed assistive personnel (UAP) might provide hygiene, the LPN/LVN might take vital signs and change a dressing, lab personnel might draw blood specimens, and so on. Primary nursing provides the least fragmentation. With the case method, one nurse is responsible for most of the patient care. Patient-focused care attempts to limit fragmentation by using cross-trained personnel.

DIF: Cognitive Level: Evaluation TOP: Care delivery methods MSC: NCLEX: N/A

REF: p. 206 OBJ: 5 KEY: Nursing Process Step: N/A

16. The LPN/LVN describes herself as “working in an expanded role in a long-term care facility.” What is the most correct interpretation of this statement? a. The LPN/LVN is able to administer oral medications. b. The LPN/LVN is a first-line manager responsible to the RN.

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c. The LPN/LVN formulates nursing diagnoses and care plans. d. The LPN/LVN interprets and implements research findings.

ANS: B

The expanded role of the LPN/LVN in long-term care occurs in the role of manager of care.

The LPN/LVN may be a first-line manager, supervising care given by LPN/LVNs and unlicensed assistive personnel while being directly responsible to the RN nurse manager. Oral medication administration is part of the traditional role. Formulation of nursing diagnoses and care plans and interpreting and implementing research findings are outside the LPN/LVN role.

The LPN/LVN assists in implementing research findings.

DIF: Cognitive Level: Analysis TOP: LPN/LVN expanded role MSC: NCLEX: N/A

REF: p. 204 OBJ: 3 KEY: Nursing Process Step: N/A

17. The role of the LPN/LVN can best be described as which of the following? a. Initiates all health teaching b. Works in an independent role c. Initiates all phases of the nursing process d. Assists with all phases of the nursing process ANS: D

Initiating health teaching, working in an independent role, and initiating all phases of the nursing process are roles of the RN. An RN initiates all health teaching; an LPN/LVN initiates health teaching for basic health habits and reinforces the health teaching of the RN in other areas. An RN works in an independent role; an LPN/LVN identifies possible new nursing problems and reports them to the RN. An RN initiates all phases of the nursing process and formulates nursing diagnoses; an LPN/LVN assists with all phases of the nursing process and works with established nursing diagnoses.

DIF: Cognitive Level: Comprehension TOP: Role of the LPN/LVNKEY: MSC: NCLEX: N/A

REF: p. 203 OBJ: 3 Nursing Process tep: N/A

MULTIPLE RESPONSE

1. Select the person or persons who may be included on the physical therapy team. (Select all that apply.) a. RN b. LPN/LVN c. Physical therapists d. Physical therapy assistants ANS: C, D

Strictly speaking, the physical therapy team includes only those individuals who have education in physical therapy. Nurses may assist the patient to perform exercises to provide continuity of care when members of the physical therapy team are not present.

DIF: Cognitive Level: Comprehension TOP: Health care team MSC: NCLEX: Physiological Integrity

REF: p. 198 OBJ: 3 KEY: Nursing Process Step: N/A

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2. Nursing management and executive roles include which of the following? (Select all that apply.) a. Supervisor b. Nurse manager c. Director d. Chief nursing officer e. Charge nurse ANS: A, B, C, D

The four levels of nursing management include supervisor, nurse manager, director, and chief nursing officer (CNO). Charge nurse is not considered a level of nursing management.

DIF: Cognitive Level: Comprehension TOP: Health care team MSC: NCLEX: Physiological Integrity

REF: p. 203 OBJ: 3 KEY: Nursing Process Step: N/A

COMPLETION 1. The role of the LPN/LVN in the health care team is best described as

.

ANS:

interdependent The LPN/LVN functions interdependently by providing care according to the established plan, collecting data, and offering input to the RN about the effectiveness of care and suggestions for care improvement.

DIF: Cognitive Level: Knowledge TOP: LPN/LVN role KEY: MSC: NCLEX: N/A

REF: p. 201 OBJ: 3 Nursing Process Step: N/A

Chapter 15: Health Care Settings: Continuum of Care Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. An example of a public sector health care agency supported primarily by U.S. taxpayer dollars is the a. U.S. Public Health Service. b. Kaiser Permanente hospitals. c. American Cancer Society. d. World Health Organization.

ANS: A

The U.S. Public Health Service (USPHS) is an official health care agency under the umbrella of the Department of Health and Human Services, supported by tax money and accountable to the government. Kaiser Permanente is a private health care agency. The American Cancer Society is an example of a voluntary agency. The World Health Organization is an international health organization funded through fees paid by member nations of the UN.

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DIF: Cognitive Level: Knowledge TOP: Public Health Care Agency MSC: NCLEX: N/A

REF: p. 212 OBJ: 1 KEY: Nursing Process Step: N/A

2. A nurse is asked, “What does it mean if a health care agency is described as ‘proprietary’?”

The nurse should respond: a. “It operates by government mandate.” b. “It is funded by local tax money and government subsidies.” c. “It operates for profit.” d. “It uses a large number of volunteers.”

ANS: C

Proprietary agencies operate for profit. The remaining options describe other categories of health care agencies.

DIF: Cognitive Level: Application TOP: Health care agency types MSC: NCLEX: N/A

REF: p. 214 OBJ: 8 KEY: Nursing Process Step: N/A

3. An example of a voluntary health agency that is focused on research and education of the public is a. the Alcohol, Drug Abuse, and Mental Health Administration. b. the Visiting Nurse Association. c. St. Jude’s Children’s Hospital. d. the American Heart Association.

ANS: D

The American Heart Association is a voluntary health agency, supported by voluntary donations, that focuses on research and education on heart disease and stroke. The Alcohol, Drug Abuse, and Mental Health Administration is an official agency. The Visiting Nurse Association is a public voluntary agency that provides home care to persons with acute and chronic diseases. St. Jude’s Children’s Hospital is a nonprofit hospital.

DIF: Cognitive Level: Comprehension TOP: Voluntary Health Agency MSC: NCLEX: N/A

REF: p. 213 OBJ: 2 KEY: Nursing Process Step: N/A

4. Knowing that Alcoholics Anonymous is a nonprofit group that receives no taxpayer money and is aimed at meeting the needs of a selected population segment would help the nurse to classify it as a a. public agency. b. private agency. c. voluntary agency. d. proprietary agency.

ANS: C

Alcoholics Anonymous (AA) is a voluntary agency. Voluntary agencies are nonprofit and often provide services complementary to official health agencies. AA meets the needs of a selected population segment and complements the official agency, Alcohol, Drug Abuse, and Mental Health Administration.

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DIF: Cognitive Level: Comprehension REF: p. 212 | p. 213 OBJ: 2 TOP: Voluntary agencies KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

5. A nurse working in the emergency department who must obtain data to identify the patient’s primary care provider should ask the patient about a. hospital stays. b. low-cost health care providers. c. receiving specialized care aimed at restoring the function of a body part. d. the referring physician, nurse practitioner, or ambulatory care setting.

ANS: D

Primary care is the term used to describe the point at which an individual enters the health care system. This is often the referring party or agency.

DIF: Cognitive Level: Application REF: p. 213 OBJ: 9 TOP: Primary care KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Safe, Effective Care Environment

6. A patient tells the nurse, “I was treated for an asthma attack at a freestanding ambulatory services center.” The nurse correctly identifies the treatment as taking place at a(n) a. urgent care center. b. domiciliary residence. c. intermediate care facility. d. fitness club.

ANS: A

An urgent care center provides services for walk-in patients who do not have an appointment and who usually have no family physician and do not wish to go to the more expensive emergency room. The other facilities listed would not have been able to provide care to this patient.

DIF: Cognitive Level: Application REF: p. 215 TOP: Ambulatory care facilities/urgent care centers KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Physiological Integrity

OBJ: 12

7. An older adult patient is to be discharged from the acute care hospital with left-sided weakness, difficulty swallowing, and inability to independently perform ADLs, therefore requiring daily physical therapy. The patient has no family and lives in a high-rise apartment building. Referral to which level of long-term care would the nurse likely recommend at the care planning conference? a. Sheltered housing b. Skilled nursing facility c. Assisted living facility d. Domiciliary care ANS: B

The patient requires the ongoing assistance of trained medical professionals, including nurses, doctors, and physical therapists. A skilled nursing facility should be recommended.

DIF: Cognitive Level: Analysis

REF: p. 217 | p. 218

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OBJ: 14 TOP: Skilled nursing KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

8. A patient who has had a cerebrovascular accident needs nursing care, physical therapy, and speech therapy. The patient’s spouse would like to provide care at home but needs assistance.

During the planning conference, the nurse should suggest that the agency that could best meet the patient’s needs is a. a home health agency. b. the American Red Cross. c. the American Heart Association. d. a local wellness center.

ANS: A

Home health agencies provide home health services supervised by a licensed health professional in the patient’s home.

DIF: Cognitive Level: Analysis TOP: Home health agency MSC: NCLEX: Physiological Integrity

REF: p. 215 OBJ: N/A KEY: Nursing Process Step: Planning

9. After several weeks of outpatient care, a patient with a badly burned hand has been referred for rehabilitation. The patient asks the nurse what the purpose of rehabilitation is.

The best answer would be a. “It will help you get back the function of your hand and will prevent further disability.” b. “It’s a way of keeping you under direct supervision while healing continues.” c. “You’ll need to learn new ways of eating and dressing using your good hand.” d. “In your case, I don’t know what the purpose is. Why not ask your doctor?”

ANS: A

Rehabilitation services are used after patients have stabilized following an illness or injury.

The focus of rehabilitation is the return of function and prevention of further disability.

DIF: Cognitive Level: Application TOP: Rehabilitation MSC: NCLEX: Physiological Integrity

REF: p. 218 OBJ: N/A KEY: Nursing Process Step: Implementation

10. Which individual is best served by receiving care at an adult day care center? a. Mr. A, who needs a nebulizer treatment to control an acute asthma attack b. Mr. B, who has been referred for carpal tunnel surgery c. Mr. C, a new diabetic who needs teaching d. Mr. D, who has first-stage Alzheimer’s disease and a working wife ANS: D

Adult day care centers provide services for individuals who need supervision because of physical or safety needs but are not candidates for nursing home placement. The center would provide supervision during the day, and the patient’s wife would assist at other times. The patient who needs a nebulizer treatment to control an acute asthma attack would go to an urgent care center. The person who has been referred for carpal tunnel surgery would go to an ambulatory surgical center. The patient who is a new diabetic and needs teaching could be referred to a community health nursing service or an outpatient clinic.

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DIF: Cognitive Level: Application TOP: Adult day care MSC: NCLEX: Physiological Integrity

REF: p. 216 OBJ: N/A KEY: Nursing Process Step: N/A

11. At a patient care planning conference, the nurse hears the remark, “We need to report this event to our official public health agency.” The nurse interprets this as meaning the speaker will contact the a. American Cancer Society. b. Visiting Nurse Association. c. National Easter Seal Society. d. local health department.

ANS: D

Local health departments are examples of official public health agencies.

DIF: Cognitive Level: Comprehension TOP: Official public health agencies MSC: NCLEX: N/A

REF: p. 211 OBJ: 4 KEY: Nursing Process Step: N/A

12. The U.S. Public Health Service (USPHS) is funded by a. tax money. b. lottery money. c. voluntary contributions. d. estates and endowments.

ANS: A

The USPHS is an official health care agency funded by tax dollars.

DIF: Cognitive Level: Knowledge TOP: Funding of official agencies MSC: NCLEX: N/A

REF: p. 212 OBJ: 1 KEY: Nursing Process Step: N/A

13. Accountability of private health care agencies is assumed by the a. taxpayer. b. government. c. owners of the agency. d. board of directors of the agency.

ANS: C

Proprietary agencies are accountable to the owners of the agency.

DIF: Cognitive Level: Knowledge REF: p. 212 | p. 213 OBJ: 1 TOP: Accountability—private health care agencies KEY: Nursing Process Step: N/A MSC: NCLEX: N/A MULTIPLE RESPONSE

1. Which of the following are types of health care agencies in which the LPN/LVN would most likely find work? (Select all that apply.) a. Board and care home b. Emergency unit facility c. Skilled nursing facility

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d. Adult day care center e. Hospice ANS: C, E

Board and care home residences offer housing and custodial care and usually do not employ licensed staff. Intermediate care facilities provide health-related care to persons who do not require acute or skilled nursing services but who need facility placement. Care is usually provided by CNAs. Skilled nursing facilities rely heavily on LPN/LVNs. Adult day care centers are more likely to hire CNAs and personal care assistants who are supervised by RNs. Hospices often employ LPN/LVNs. DIF: Cognitive Level: Comprehension TOP: Employment opportunities MSC: NCLEX: N/A

REF: p. 219 OBJ: N/A KEY: Nursing Process Step: N/A

2. A nurse is asked about public health care agencies. Which of the following would help the nurse frame a comprehensive response? (Select all that apply.) a. Public health agencies are entirely supported by fees for services. b. There are two types of public health agencies: official and voluntary. c. Public health agencies seek to make a profit for the owners. d. Public health agencies focus on curing illness and disease. e. Public health agencies emphasize disease prevention, wellness promotion, research, and education.

ANS: B, E

There are two types of public health care agencies: official, which are tax supported, and voluntary, which are supported primarily by voluntary contributions. Official agencies tend to focus on disease prevention and wellness promotion, whereas the focus of voluntary agencies is usually research and education.

DIF: Cognitive Level: Comprehension REF: p. 211 TOP: Public vs. private health care agencies MSC: NCLEX: N/A

OBJ: 1 KEY: Nursing Process Step: N/A

3. Which agencies are considered part of the U.S. Public Health Service? (Select all that apply.) a. National Institutes of Health b. Food and Drug Administration c. Department of Veterans Affairs d. Centers for Disease Control and Prevention e. American Cancer Society f. Alcohol, Drug Abuse, and Mental Health Administration ANS: A, B, D, F

These agencies are part of the USPHS, a division of the Department of Health and Human Services. The American Cancer Society is a voluntary agency. The Department of Veterans Affairs is an official agency, but it is not under the USPHS. DIF: Cognitive Level: Knowledge REF: p. 212 TOP: USPHS KEY: Nursing Process Step: N/A

OBJ: 6 MSC: NCLEX: N/A

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4. A resident who is terminally ill and his family are considering hospice. They ask the nurse for information about hospice. Which of the following would be information the nurse could correctly relay? (Select all that apply.) a. Maintaining comfort as death approaches is the hospice philosophy. b. Hospice care may be provided at home or in a freestanding agency. c. Family members are encouraged to care for the individual. d. Hospice can be tailored to meet the individual’s and the family’s needs. e. The cost of hospice is more than the cost of hospital care. f. Respite care is available when the individual is cared for at home.

ANS: A, B, C, D, F

Relaying that the cost of hospice is more than the cost of hospital care is inappropriate for the nurse to convey to the family. Usually the nurse does not know comparative costs.

DIF: Cognitive Level: Analysis REF: p. 219 OBJ: N/A TOP: Hospice KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A COMPLETION

1.

are for-profit hospitals operated for the financial benefit of the owner of the hospital.

ANS:

Proprietary hospitals Proprietary hospitals are for-profit hospitals operated for the financial benefit of the owner of the hospital. The owner may be an individual, a partnership, or a corporation.

DIF: Cognitive Level: Knowledge TOP: Types of health care agencies MSC: NCLEX: N/A

REF: p. 214 OBJ: 8 KEY: Nursing Process Step: N/A

2. The health care agency that provides information and support for breast-feeding mothers and breast milk for infants because of health reasons is the .

ANS:

La Leche League The La Leche League provides information and support for breast-feeding mothers, as well as breast milk for infants because of health reasons.

DIF: Cognitive Level: Knowledge TOP: Public health care agencies MSC: NCLEX: N/A

REF: p. 213 OBJ: 4 KEY: Nursing Process Step: N/A

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Chapter 16: The Health Care System: Financing, Issues, and Trends Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. When the nurse is asked by a patient, “Why is it necessary to have deductibles and copayments when I already have health insurance?” The best response would be: a. “They are a way to improve the margin of profit in the fee-for-service method of paying for health care.” b. “They prevent health care agencies from having huge deficits associated with uncompensated care.” c. “They were developed to save health care dollars at the time Medicare introduced DRGs.” d. “They are part of the incremental changes designed to provide more universal care.”

ANS: A

Deductibles and copayments require the patient to pay an increased share of the cost of treatment, thus improving the profit margin for the insurer. They benefit the insurer more than the agency. Deductibles and copayments were not developed to save health care dollars at the time Medicare introduced DRGs. Deductibles and copayments are not part of the incremental changes designed to provide more universal care.

DIF: Cognitive Level: Application REF: p. 223 OBJ: 2 TOP: Deductibles and copayments KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

2. A patient tells the nurse, “I didn’t sign up for health care insurance at my job because I’m young and healthy and can use the money in other ways.” The response that best explains the advantage of health insurance would be a. “With insurance a fiscal middleman pays your health care bills.” b. “With insurance your individual contributions go directly to paying your personal expenses.” c. “With insurance you can borrow money for unexpected health care expenses at a very low interest rate.” d. “With insurance you are spreading the risk in case you have a serious health event, such as cancer or major trauma.”

ANS: D

Health insurance, like any insurance, spreads risk. The risk that is spread in health insurance is that the young and the healthy generally subsidize (support financially) the sick and older persons in the health insurance group. Individual contributions are pooled for the protection of individuals from financial disaster due to health care bills. A fiscal middleman does pay health care bills, but this does not address the best explanation of the advantage of health insurance.

The remaining options are not factual statements.

DIF: Cognitive Level: Analysis REF: p. 223 OBJ: 2 TOP: Advantage of health insurance KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

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3. A patient asks the nurse, “What do health maintenance organizations (HMOs) do to reduce health care costs?” The response giving the best example of an HMO cost-containment method would be: a. “HMOs pool individual contributions for use in catastrophic illness.” b. “HMOs provide supplemental coverage for items not covered by Medicare.” c. “HMOs use a retrospective payment system.” d. “HMOs provide services aimed at keeping members healthy.”

ANS: D

HMOs attempt to reduce costs by providing services aimed at keeping members healthy, such as smoking cessation classes and weight loss programs. The other options are not factual statements.

DIF: Cognitive Level: Analysis REF: p. 224 OBJ: 3 TOP: HMOs KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

4. Which of the following constitutes a problem that affects data collected by the nurse interviewing a chronically ill older adult patient? Many older adults who are covered only by Medicare Parts A and B find it difficult to pay the cost of a. hospital care for an acute short-term illness. b. prescription drugs while living at home. c. post-hospitalization rehabilitation services in a skilled nursing facility. d. doctor’s office visits, Pap smears, and mammography.

ANS: B

Data collection should include medications prescribed for the patient and whether the patient is medication compliant. Often patients are without medication when funds are limited. The other costs mentioned in the remaining options are covered by Medicare Parts A and B. DIF: Cognitive Level: Application REF: p. 225 TOP: Medicare coverage KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Health Promotion and Maintenance

OBJ: 3

5. When involved with discharge planning for a patient recovering from a mild cerebrovascular accident, the nurse should understand that Medicare provides a. longer stays for Medicare patients in acute inpatient settings. b. increased use of extended care units for rehabilitation needs. c. inappropriate early discharge of large numbers of patients. d. universal coverage for U.S. citizens and permanent residents.

ANS: B

Medicare provides for 20 days’ post-hospitalization care in a skilled nursing facility for rehabilitation services. Medicare patients in acute inpatient settings do not have longer stays.

Medicare does not provide universal coverage for U.S. citizens and permanent residents.

Inappropriate early discharge of large numbers of patients is not an advantage to a patient.

DIF: Cognitive Level: Application REF: p. 225 OBJ: 3 | 4 TOP: Medicare benefits KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment

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6. Diagnosis-related groups (DRGs) and prospective payment systems are most clearly the reason for a. Medicare and Medicaid. b. critical pathways and managed care. c. group health insurance and centralization. d. a shortage of nurses and unlicensed assistive personnel.

ANS: B

Both DRGs and prospective payment systems have resulted in cost-containment efforts by health care agencies. Managed care and critical pathways are responses to the need to contain costs. DRGs originated with Medicare. Group health insurance existed prior to DRGs and prospective payment systems. The reason for personnel shortages in health care is not as simplistic as a shortage of nurses and unlicensed assistive personnel.

DIF: Cognitive Level: Analysis REF: p. 225 | p. 226 OBJ: 3 TOP: Changes associated with DRGs and prospective payment KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

7. A patient tells the nurse, “I received a questionnaire that said my answers would be used for purposes of continuous quality improvement. I wonder if it’s worth my time to fill it out?” The response that best explains continuous quality improvement is: a. “Continuous quality improvement activities are used to restructure hospital departments and personnel assignments to ensure cost savings.” b. “Continuous quality improvement activities are used to provide an opportunity for staff members to participate in self-governance.” c. “Continuous quality improvement activities are used to obtain appropriate reimbursement for care given to ambulatory and inpatients.” d. “Continuous quality improvement activities are used to monitor and improve processes involved in providing safe, effective care for patients.”

ANS: D

Continuous quality improvement (CQI) activities provide information critical to total quality management. Feedback from patients is one data collection method for CQI. The other options do not describe CQI activities.

DIF: Cognitive Level: Application REF: p. 227 OBJ: 6 TOP: CQI KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

8. A 70-year-old patient tells the nurse, “I can’t go to the hospital for treatment because I have no hospital insurance. My Social Security and my pension pay my living expenses, but I don’t have any savings.” The nurse’s response should be focused on a. providing information about Medicare. b. explaining the provisions of Medicaid. c. exploring the patient’s ability to purchase group health insurance. d. investigating which hospitals provide free care for indigent patients.

ANS: A

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It is important to provide information that older adults, regardless of income, can receive federal payment for hospital and physician services through Medicare. There is not a clear need to provide information about Medicaid. It’s too late to secure group health insurance for this identified health care need. In addition, health insurance companies often refuse payment for treatment of preexisting conditions. Exploring the patient’s ability to purchase group health insurance should not be the initial focus.

DIF: Cognitive Level: Application REF: p. 226 OBJ: 3 | 4 TOP: Medicare benefits KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

9. A mother and her three children often seek medical services at the emergency room. The nurse realizes that they have no insurance and are unable to pay for services. The action the nurse should take that would provide the greatest assistance to the family would be to a. advise them to use urgent care centers where fees are lower. b. leave the newspaper classified ads in a visible place. c. advise the mother to seek work at the hospital personnel office. d. contact a social worker to discuss Medicaid with the mother.

ANS: D

The social worker would be able to help the family explore whether they might qualify for Medicaid or the Children’s Health Insurance Program. Advising the family to use urgent care centers might be considered a form of refusal of services. Leaving the newspaper classified ads in a visible place and advising the mother to seek work at the hospital personnel office assume that the uninsured mother is not working, when in fact she may have a job that does not provide the benefit of health care.

DIF: Cognitive Level: Analysis REF: p. 226 OBJ: 3 | 4 TOP: Medicaid KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

10. Which program offers an incentive to hospitals to discharge patients as quickly as possible? a. Retrospective payment system b. Prospective payment system c. Seamless system d. Private insurance plans in effect for under 1 year ANS: B

The prospective payment system tells the hospital what it will pay for specific health care in advance. This fixed payment does not change regardless of the number of days the patient is hospitalized. Thus, early discharge can result in a profit for the hospital, creating an incentive.

DIF: Cognitive Level: Comprehension REF: p. 225 | p. 226 OBJ: 3 TOP: Prospective payment system KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

11. A trend in health care that may negatively affect the number of practical nurses hired by an agency is a. the aging of the U.S. population. b. the increased use of unlicensed assistive personnel. c. decentralization of health care agencies.

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d. the emphasis on critical thinking and problem solving.

ANS: B

The trend toward using the least expensive personnel to perform nursing care negatively affects the number of licensed nurses employed by an agency. The aging of the population does not negatively affect the hiring of LPN/LVNs. Decentralization of health care agencies is more likely to affect middle managers. Critical thinking and problem-solving abilities make LPN/LVNs more attractive as employees.

DIF: Cognitive Level: Comprehension REF: p. 230 TOP: Trends KEY: Nursing Process Step: N/A

OBJ: 5 MSC: NCLEX: N/A

12. Which of the following is a quality improvement activity in which the LPN/LVN engages routinely? a. Collecting data for care plan development b. Identifying nursing diagnoses c. Initiating patient teaching about medications d. Evaluating patient goal attainment ANS: A

The creation of care plans is a major way to improve the quality of patient care. The LPN/LVN assists the RN in the formulation of nursing care plans by contributing relevant data. The LPN/LVN is not responsible for identifying nursing diagnoses, initiating patient teaching about medications, and evaluating goal attainment. These activities are reserved for RNs. DIF: Cognitive Level: Analysis REF: p. 227 OBJ: 6 TOP: CQI KEY: Nursing Process Step: Assessment (Data Collection) MSC: NCLEX: Safe, Effective Care Environment

13. Which LPN/LVN will be most successful in dealing with change? a. Nurse S, who always assumes that the worst will happen in any situation b. Nurse T, who agrees with whatever the administration proposes c. Nurse U, who sees change as an opportunity to improve conditions d. Nurse V, who predicts that the change will probably not work ANS: C

The nurse who sees change as an opportunity to be part of the solution to a problem is a navigator, one who feels confident and in control. The navigator fares well in change. The nurse who always assumes that the worst will happen in any situation is a victim who feels helpless during change. Victims do not fare well during times of change. The nurse who sees change as an opportunity to improve are survivors, individuals who go along with change but predict that it will be unsuccessful.

DIF: Cognitive Level: Analysis REF: p. 230 TOP: Change KEY: Nursing Process Step: N/A

OBJ: 6 MSC: NCLEX: N/A

14. The skill that will be most helpful to an LPN/LVN in navigating health care system changes successfully is a. the ability to work efficiently for long hours. b. problem-solving and critical thinking abilities. c. identifying the need for comprehensive system change.

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d. becoming knowledgeable about CQI processes.

ANS: B

Critical thinking and problem solving are important not only in patient care but also in nonclinical situations in the health care agency. The ability to work efficiently for long hours will not promote success during change. Identifying the need for comprehensive system change and becoming knowledgeable about CQI processes will be helpful but would not be assessed as most helpful.

DIF: Cognitive Level: Analysis REF: p. 230 TOP: Change KEY: Nursing Process Step: N/A

OBJ: 6 MSC: NCLEX: N/A

15. A set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of services is known as a. inflation. b. capitation. c. fee-for-service. d. gross domestic product.

ANS: B

Capitation is an alternative to the traditional fee-for-service method of payment. Capitation involves a set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of services. Inflation is a general rise in prices, usually persisting over several years. Fee-for-service is the traditional method of paying health care bills in which physicians are paid a fee by the patient for each service they provide. Gross domestic product is the combination of all goods and services produced in a nation’s economy.

DIF: Cognitive Level: Comprehension REF: p. 223 TOP: Capitation KEY: Nursing Process Step: N/A

OBJ: 2 MSC: NCLEX: N/A

16. A method of financing health care costs in which physicians are paid a fee by the patient for each service they provide is known as a. inflation. b. capitation. c. fee-for-service. d. gross domestic product.

ANS: C

Fee-for-service is the traditional method of paying health care bills in which physicians are paid a fee by the patient for each service they provide. Inflation is a general rise in prices, usually persisting over several years. Capitation is an alternative to the traditional fee-forservice method of payment. Capitation involves a set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of services.

Gross domestic product is the combination of all goods and services produced in a nation’s economy.

DIF: Cognitive Level: Comprehension TOP: Fee-for-service MSC: NCLEX: N/A

REF: p. 223 OBJ: 2 | 3 KEY: Nursing Process Step: N/A

17. The monthly fee a person must pay for health care insurance coverage is known as the

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a. b. c. d.

premium. deductible. copayment. coinsurance.

ANS: A

The premium is the monthly fee a person must pay for health care insurance coverage. The deductible is the yearly amount an insured person must spend out-of-pocket for health care services before a health insurance policy will begin to pay its share. The copayment is the amount an insured person must pay at the time of an office visit, when picking up a prescription, or before a hospital service. Coinsurance is the percentage of the total bill paid by the insured person after a deductible has been met. The remainder is paid by the insurance company.

DIF: Cognitive Level: Comprehension TOP: Basic health insurance terms MSC: NCLEX: N/A

REF: p. 223 OBJ: 2 | 3 KEY: Nursing Process Step: N/A

18. The yearly amount an insured person must spend out-of-pocket for health care services before a health insurance policy will begin to pay its share is known as the a. premium. b. deductible. c. copayment. d. coinsurance.

ANS: B

The deductible is the yearly amount an insured person must spend out-of-pocket for health care services before a health insurance policy will begin to pay its share. The premium is the monthly fee a person must pay for health care insurance coverage. The copayment is the amount an insured person must pay at the time of an office visit, when picking up a prescription, or before a hospital service. Coinsurance is the percentage of the total bill paid by the insured person after a deductible has been met. The remainder is paid by the insurance company.

DIF: Cognitive Level: Comprehension TOP: Basic health insurance terms MSC: NCLEX: N/A

REF: p. 223 OBJ: 2 | 3 KEY: Nursing Process Step: N/A

MULTIPLE RESPONSE

1. A student nurse asked to identify the types of services currently provided in the U.S. health care delivery system should mention which of the following? (Select all that apply.) a. Restructuring b. Health promotion c. Diagnosis and treatment d. Illness prevention e. Seamless systems f. Alliances and networks ANS: B, C, D

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Of the options listed, those considered to be health care services are health promotion, diagnosis and treatment, and illness prevention. The other options are terms used in this chapter.

DIF: Cognitive Level: Knowledge TOP: Health care services MSC: NCLEX: N/A

REF: p. 223 OBJ: 5 KEY: Nursing Process Step: N/A

2. Which of the following phrases could be used by a nurse to characterize the present health care delivery system in the United States? (Select all that apply.) a. Responds to illness b. Is oriented to promote wellness c. Provides for universal access d. Depends on national health insurance e. Is fragmented and confusing f. Is unsafe ANS: A, E, F

The U.S. health care system responds to illness rather than health promotion. Universal access is not available. National health insurance is not available. The system is fragmented, with a variety of payment options and multiple sources of funding and only a few seamless systems in place. The U.S. health care system has been described as a poorly designed, fragmented, and disjointed maze of services that lacks preventive care, wastes resources, and is low quality, unsafe, and confusing.

DIF: Cognitive Level: Comprehension REF: p. 222 TOP: U.S. health care system characteristics MSC: NCLEX: N/A

OBJ: 5 KEY: Nursing Process Step: N/A

3. Which of the following are problems associated with the present health care delivery system that could be identified by a nursing student who is writing an essay? (Select all that apply.) a. High cost b. Insufficient number of doctors c. Widespread shortage of RNs d. Continuous quality improvement ANS: A, C

The cost of U.S. health care is higher than in any other developed country—16% of our gross national product—and there is an identified widespread shortage of professional nurses in both acute and long-term care agencies. There is no identified national shortage of physicians.

Continuous quality improvement is not considered a problem but rather a means for identifying health care problems.

DIF: Cognitive Level: Comprehension REF: p. 222 TOP: Problems in the health care delivery system MSC: NCLEX: N/A

OBJ: 5 KEY: Nursing Process Step: N/A

4. The LPN/LVN charge nurse has been designated to participate in the orientation of a new LPN/LVN by explaining cost-containment measures. Measures the charge nurse should mention include which of the following? (Select all that apply.) a. Charge patients for all supplies used in their care.

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b. c. d. e. f.

Document patient care according to the policy for reimbursement.

Use time management principles to work efficiently.

Use supplies carefully to avoid waste.

Implement measures to prevent complications.

Advise insured patients to select higher tiers whenever possible.

ANS: A, B, C, D, E

The correct options result in cost containment. Advising insured patients to select higher tiers whenever possible would not conserve health care dollars, because higher tier care and medications are more costly than those offered in lower tiers.

DIF: Cognitive Level: Application TOP: Cost containment MSC: NCLEX: N/A

REF: p. 229 OBJ: 5 | 6 KEY: Nursing Process Step: Implementation

COMPLETION

1. Once a deductible has been met, the percentage of the total bill paid by the insured person is known as the .

ANS:

coinsurance Coinsurance is the percentage of the total bill paid by the insured person after a deductible has been met. The remainder is paid by the insurance company.

DIF: Cognitive Level: Comprehension TOP: Basic health insurance terms MSC: NCLEX: N/A

REF: p. 223 OBJ: 2 | 3 KEY: Nursing Process Step: N/A

2. The amount an insured person must pay at the time of an office visit, when picking up a prescription, or before a hospital service is known as the .

ANS:

copayment The copayment is the amount an insured person must pay at the time of an office visit, when picking up a prescription, or before a hospital service. The premium is the monthly fee a person must pay for health care insurance coverage.

DIF: Cognitive Level: Comprehension TOP: Basic health insurance terms MSC: NCLEX: N/A

REF: p. 223 OBJ: 2 | 3 KEY: Nursing Process Step: N/A

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Chapter 17: Collaboration: Leading and Managing Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

a. b. c. d.

1. To discover the expanded role of the practical nurse, the LPN/LVN should investigate the state’s Nurse Practice Act. job descriptions for the practical nurse in local health care agencies. information gained from practical nurses working in various clinical settings. the opinions of physicians who service area nursing homes and extended care facilities.

ANS: A

The Nurse Practice Act of the state determines the parameters of LPN/LVN practice. The other options may be less detailed than the Nurse Practice Act, so they are not the best resources.

DIF: Cognitive Level: Comprehension REF: p. 235 OBJ: 2 TOP: LPN/LVN expanded role KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

2. The LPN/LVN day shift charge nurse in a nursing home usually reports to the a. owner of the nursing home. b. administrator of the nursing home. c. RN manager of the unit. d. board of directors of the nursing home.

ANS: C

Most organizational charts call for the LPN/LVN charge nurse to report to the RN manager of the unit. The other options are not logical.

DIF: Cognitive Level: Comprehension TOP: Organizational charts MSC: NCLEX: N/A

REF: p. 234 OBJ: 1 | 2 KEY: Nursing Process Step: N/A

3. The LPN/LVN nursing home charge nurse usually tells nursing assistants what to do and offers little opportunity for input or suggestions for how to improve care. This leadership style is called a. autocratic. b. democratic. c. situational. d. laissez-faire.

ANS: A

The charge nurse is task oriented and seeks no input from staff. This is consistent with autocratic leadership. The other options are not possibilities based on the description given in the scenario.

DIF: Cognitive Level: Application TOP: Autocratic leadership style MSC: NCLEX: N/A

REF: p. 237 OBJ: 4 KEY: Nursing Process Step: N/A

4. The LPN/LVN nursing home charge nurse encourages nursing assistants to make suggestions regarding improvement of nursing care and shows concern for the staff. This leadership style is called a. laissez-faire.

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b. democratic. c. autocratic. d. situational.

ANS: B

Democratic leadership style is demonstrated when the nurse is concerned about the work to be done and is also concerned about the team performing the work. The team is encouraged to participate in decision making about resident care. The other options are not possibilities based on the scenario description.

DIF: Cognitive Level: Application TOP: Democratic leadership style MSC: NCLEX: N/A

REF: p. 237 OBJ: 4 KEY: Nursing Process Step: N/A

5. A nursing assistant states, “I have never learned how to transfer a resident with end-stage Parkinson’s disease from the bed to the chair.” The nursing assistant refuses to transfer the resident at this time. Select the appropriate approach for the LPN/LVN charge nurse to take. a. Reprimand the nursing assistant for not performing the job. b. Encourage the nursing assistant to carry through with the transfer. c. Arrange to teach the nursing assistant how to transfer the resident. d. Mention that nursing assistants can be charged with insubordination if they do not perform their jobs.

ANS: C

The nursing assistant should not perform tasks for which he or she has not been trained.

The nurse should arrange to teach the nursing assistant so that he or she can safely perform the duty. Reprimanding the nursing assistant for not performing the job is unnecessary.

Encouraging the nursing assistant to carry through with the transfer is unwise and unsafe.

Mentioning that nursing assistants can be charged with insubordination if they do not perform their jobs is threatening.

DIF: Cognitive Level: Application REF: p. 240 OBJ: 7 TOP: Problem-solving KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

6. A nursing assistant (NA) did an exceptionally good job by encouraging a resident to leave his room and go to an activity. Select the response by the LPN/LVN charge nurse that would best encourage the employee to continue this effort. a. Write a note for the NA’s file explaining that she did not leave the resident in his room. b. Tell the NA she is a great nursing assistant and that the charge nurse wished all assistants were like her. c. Report the NA’s good efforts to the nursing home’s administrator and board of directors. d. Tell the NA that the charge nurse knows how hard she worked to get the resident out of his room and how pleased the nurse is that the NA is concerned with the resident’s need for socialization.

ANS: D

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Providing positive reinforcement for the specific behaviors used makes it more likely that the NA will use these strategies in the future. The LPN/LVN’s communication is straightforward and assertive. Writing a note for the NA’s file explaining that she did not leave the resident in his room would not be effective as a motivator. Telling the NA she is a great nursing assistant and the charge nurse wished all assistants were like her is not specific enough. Reporting the NA’s good efforts to the nursing home administrator and board of directors is not necessary at this point.

DIF: Cognitive Level: Application REF: p. 240 OBJ: 7 TOP: Communication KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

7. LPN/LVNs functioning in an expanded role are most often employed in a. critical care units. b. pediatric clinics. c. home health care. d. long-term care.

ANS: D

Long-term care lends itself to the use of LPN/LVNs functioning in the expanded role. The other practice environments involve patients who are less stable and therefore require greater direct supervision by the RN. DIF: Cognitive Level: Comprehension REF: p. 235 OBJ: 1 | 2 TOP: Expanded role of the LPN/LVN KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

8. Which understanding about leadership would help the LPN/LVN become a more skillful leader? a. Leaders in nursing are appointed by management to accomplish organizational goals. b. Leaders rarely take risks and virtually never make mistakes. c. Leaders have little confidence in themselves until they develop a power base. d. Leaders see change as challenging and providing opportunities for improving quality of care.

ANS: D

The only accurate statement is that leaders see change as challenging and providing opportunities for improving quality of care.

DIF: Cognitive Level: Comprehension REF: p. 236 TOP: Leadership KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

9. Which quality is rarely found in democratic leaders? a. Assertiveness b. Arrogance c. Desire for new learning d. Effective communication ANS: B

OBJ: 3 | 6

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Arrogance is an undesirable quality. The other options are desirable qualities consistent with the democratic leadership style.

DIF: Cognitive Level: Comprehension TOP: Democratic leadership MSC: NCLEX: N/A

REF: p. 237 OBJ: 4 KEY: Nursing Process Step: N/A

10. For an LPN/LVN to motivate staff members to meet the goals of the organization, it is helpful if the nurse a. practices intimidation. b. understands work motivators. c. offers laissez-faire leadership. d. emphasizes policies rather than people.

ANS: B

By understanding what motivates an employee, the nurse is better able to select appropriate motivational strategies. Intimidation is not an effective motivator. Laissez-faire leadership does not focus on motivating staff. People-oriented leaders are better at motivating workers.

DIF: Cognitive Level: Comprehension TOP: Work motivators MSC: NCLEX: N/A

REF: p. 239 OBJ: 7 | 9 KEY: Nursing Process Step: N/A

11. The LPN/LVN charge nurse asks the nurse manager, “How can I motivate the nursing assistants on my shift?” The best answer would be: a. “Motivation is an inner force. You can’t motivate someone else, but understanding the things that are important to workers can be helpful.” b. “Encouragement is the only way. If you praise and encourage the workers, you will have them eating out of your hand and doing their best.” c. “Money is the only thing that motivates workers. Since you can’t set a higher salary, you can’t change their motivation.” d. “Communicate! Communicate! Communicate! Be clear and specific. Spell things out. Give the impression that you know what you’re talking about at all times.”

ANS: A

The idea that motivation is an inner force most accurately explains motivation.

Encouragement and money are motivators but do not provide accurate information.

Referencing communication does not provide information on motivation.

DIF: Cognitive Level: Application REF: p. 239 TOP: Motivation KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Work Environment

OBJ: 7 | 9

12. What LPN/LVN charge nurse behavior will best accomplish the goal of promoting team building? a. Using “I” statements exclusively when talking about the unit’s mission and goals b. Never using rewards to change nursing assistant behaviors because this strategy is manipulative c. Assuming each nursing assistant is fully informed about the unit’s mission and goals d. Encouraging politeness, cooperation, respect, and trust

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ANS: D

The charge nurse is a role model for the attitude and behavior expected of nursing assistants. Team building requires an environment in which employees feel valued.

Politeness, cooperation, respect, and trust provide the foundation on which further team building proceeds.

DIF: Cognitive Level: Application REF: p. 239 OBJ: 7 | 9 TOP: Team building KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Work Environment

13. The LPN/LVN spends time exploring the agency mission statement with the nursing assistants who work that shift. They create a list of ways they can contribute to achieving the agency goals. This process is called a. stress management. b. problem solving. c. team building. d. conflict resolution.

ANS: C

Team building is a process by which employees become committed to management goals. The scenario does not describe any of the other options.

DIF: Cognitive Level: Application REF: p. 242 | p. 243 OBJ: 7 | 9 TOP: Team building KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

14. The LPN/LVN notices that the nursing assistants are taking longer breaks than agency policy permits and wishes to change this behavior as quickly as possible. The LPN/LVN’s initial actions should be to a. verbally confront the employees with their behavior. b. write reprimands to be placed in each employee’s file. c. ask for in-service classes on time management. d. determine the reason staff members are taking longer breaks.

ANS: D

Before attempting to solve any problem, the LPN/LVN must clearly identify the real problem.

In this case, longer breaks may be the staff’s reaction to a more fundamental workplace problem. Verbal confrontation should not be the initial action. Written reprimands should not be the initial action. In-service classes on time management would be an inappropriate initial action.

DIF: Cognitive Level: Analysis REF: p. 241 | p. 242 OBJ: 7 | 9 TOP: Problem-solving KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

15. The LPN/LVN reads this statement, “Stress is the body’s reaction to the mind’s analysis of a situation.” The LPN/LVN concludes that the critical factor to teach nursing assistants to help them control their stress levels is to a. manage how they think about a situation. b. consider the stressful situation as subjectively as possible. c. focus on developing good clinical skills.

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d. apply time management principles.

ANS: A

According to Ellis, managing one’s thinking by replacing irrational thinking with rational thinking reduces stress. The key is to think objectively. Focusing on developing good clinical skills and applying time management principles are not relevant to the scenario.

DIF: Cognitive Level: Analysis REF: p. 243 OBJ: 10 TOP: Stress management KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

16. Which behavior should the LPN/LVN charge nurse identify as dysfunctional behavior that violates OBRA regulations by threatening resident quality of life, health, or safety? a. The nursing assistant praises a resident who is having poststroke speech therapy for attempts to communicate verbally. b. The nursing assistant asks to talk to the LPN/LVN charge nurse about changes the nursing assistant would like to make in a resident’s plan of care. c. The nursing assistant uses a sharp tone of voice and body posture, suggesting impatience when feeding a resident. d. The nursing assistant offers to help coworkers after finishing his resident care assignment.

ANS: C

This behavior negatively affects the quality of life and safety of a resident. The other options do not negatively affect the resident’s quality of life.

DIF: Cognitive Level: Application REF: p. 245 OBJ: 9 TOP: OBRA regulations KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

17. The action the LPN/LVN charge nurse takes independently that would most likely require conflict resolution at the unit level is a. organizing shift activities before morning report. b. making sure the necessary equipment and supplies are available. c. eliminating morning breaks and adding 10 minutes to the lunch hour. d. creating a calm, supportive environment.

ANS: C

Unilaterally changing working conditions will create stress and conflict and require conflict resolution. The other options are desirable actions.

DIF: Cognitive Level: Application REF: p. 247 OBJ: 9 TOP: Conflict resolution KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

18. Which of the following is an example of objective, rational thinking rather than subjective, irrational thinking about nursing assistants whom the LPN/LVN charge nurse supervises? a. “I want nursing assistants to be on time for report.” b. “Neat appearance means good clinical skills.” c. “Nursing assistants who are late intend to take advantage of coworkers.” d. “Beware of nursing assistants who smile a lot. They’re manipulative.”

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This is an objective, rational thought that reflects a reasonable expectation for nursing assistants. The other options exemplify subjective, irrational thinking.

DIF: Cognitive Level: Application REF: p. 243 | p. 244 OBJ: 9 TOP: Irrational thinking KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

19. How can the LPN/LVN charge nurse meet needs for affiliation among staff on their shift? a. Reorient all staff to policies and shift routine. b. Encourage attendance at continuing education seminars. c. Arrange a social gathering for the staff on the shift. d. Offer training in violence prevention.

ANS: C

Affiliation needs are met by providing for good interpersonal relationships among staff.

Planning a social gathering is a way of meeting affiliation needs. Reorienting all staff to policies and shift routine is probably unnecessary and would not address affiliation needs.

Encouraging attendance at continuing education seminars addresses level 4 needs for recognition, growth, and responsibility. Offering training in violence prevention addresses level 2 safety needs.

DIF: Cognitive Level: Application REF: p. 240 TOP: Understanding motivation and human needs MSC: NCLEX: Safe, Effective Care Environment

OBJ: 10 KEY: Nursing Process Step: N/A

20. The LPN/LVN charge nurse notices that a nursing assistant has not weighed her assigned residents. The best statement by the nurse is: a. “You didn’t weigh your assigned residents this morning. Let’s get with the program.” b. “I need to have you weigh your assigned residents and report to me by 10 AM.” c. “Would you mind explaining why you didn’t weigh your residents today?” d. “You’ve been goofing off lately. Not weighing your assigned residents is a good example of this.”

ANS: B

This is straightforward and assertive and resolves a clinical problem. The other options fail to provide a solution to the clinical problem created by the nursing assistant’s failure to obtain the weights.

DIF: Cognitive Level: Knowledge REF: p. 241 TOP: Core knowledge and skills needed for leadership MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9 | 10 KEY: Nursing Process Step: N/A

21. In which situation would the LPN/LVN charge nurse be in violation of OBRA provisions? a. Letting the unit secretary, who has completed 30 hours of instruction in a CNA program, bathe and ambulate a resident b. Allowing a son to feed his father, who is a resident on the unit c. Scheduling a nursing assistant to attend a 2-hour in-service training session d. Notifying the RN supervisor that a nursing assistant needs additional training in administration of tap water enemas

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OBRA regulations call for all nursing assistants to be certified. Permitting an uncertified employee to perform the duties of a CNA violates OBRA regulations. Allowing a son to feed his father is permissible. Scheduling a nursing assistant to attend a 2-hour in-service training session and notifying the RN supervisor that a nursing assistant needs additional training are appropriate.

DIF: Cognitive Level: Analysis REF: p. 245 OBJ: 9 TOP: OBRA regulations KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

22. A new LPN/LVN asks the LPN/LVN charge nurse what continuous quality improvement (CQI) is all about. The charge nurse should explain that the focus of CQI in a health care agency is a. saving time. b. better patient care outcomes. c. making money for the health care agency. d. reducing stress for employees.

ANS: B

The focus of CQI is quality of care, as indicated by patient outcomes. CQI does not focus on saving time, agency profit, or stress reduction.

DIF: Cognitive Level: Application REF: p. 246 OBJ: 9 TOP: Continuous Quality Improvement KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

23. When conducting an employee performance evaluation conference, the LPN/LVN charge nurse should understand that a. giving measurable feedback such as “You’re doing fine” promotes personal growth. b. positive feedback should be given at the beginning of the interview to set the tone. c. the employee should develop a plan for improvement without input from the charge nurse. d. the employee should be encouraged to identify strengths and ask questions for clarification.

ANS: D

Evaluation should be a joint interactive process rather than a one-way communication.

Dialogue can clarify and enhance the process. Evaluation should focus on identification of strengths as well as behaviors to be modified. The statement “You’re doing fine” does not exemplify measurable feedback. The tone should be nonthreatening and objective but does not require the evaluation to begin with positive feedback. An employee may develop his or her own plan, but the individual needs to include problem areas identified by the charge nurse as well as the employee’s own goals.

DIF: Cognitive Level: Application REF: p. 249 OBJ: 9 | 10 TOP: Performance evaluation KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

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24. The long-term care agency has recently announced that it will soon lay off six LPN/LVNs and hire eight nursing assistants. Today, the RN charge nurse presents the LPN/LVN charge nurse with a certificate recognizing her ability to manage effectively despite short staffing.

The LPN/LVN responds somewhat politely but seems more angry than pleased. In terms of the Howlett hierarchy of needs, which of the following is the best explanation for the employee’s reaction? a. The LPN/LVN is probably responding to the poor working conditions. b. When job security is threatened, recognition needs assume lesser importance. c. Achievement and advancement needs are more fundamental than recognition needs. d. The adequacy of benefits is more basic to job satisfaction than affiliation needs.

ANS: B

Job security is a level 2 need, whereas recognition is a level 4 need. The level 2 need is threatened; therefore, the level 4 need seems less important. Data are not present to support that the LPN/LVN is responding to poor working conditions. The remaining options are either not accurate or not relevant to the scenario.

DIF: Cognitive Level: Analysis TOP: Howlett hierarchy MSC: NCLEX: N/A

REF: p. 248 OBJ: 10 KEY: Nursing Process Step: N/A

25. A people-oriented leadership style that focuses on people’s feelings but ignores the task at hand and allows people to act without any direction is the a. autocratic style. b. situational style. c. democratic style. d. laissez-faire style.

ANS: D

A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on people’s feelings but ignores the task at hand. It allows employees to act without any direction.

DIF: Cognitive Level: Knowledge TOP: Leadership styles MSC: NCLEX: N/A

REF: p. 237 OBJ: 4 KEY: Nursing Process Step: N/A

26. A leadership style that focuses on both the task and the employee is the a. autocratic style. b. situational style. c. democratic style. d. laissez-faire style.

ANS: C

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Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. A purely people-oriented style (laissez-faire) focuses on people’s feelings but ignores the task at hand. It allows employees to act without any direction.

DIF: Cognitive Level: Knowledge TOP: Leadership styles MSC: NCLEX: N/A

REF: p. 237 OBJ: 4 KEY: Nursing Process Step: N/A

27. During an emergency, the charge nurse tells the LPN/LVN, “I need you to place the patient on a non-rebreather mask now.” The charge nurse has little regard for the LPN/LVN’s input at this time. The charge nurse is displaying what leadership style? a. Autocratic b. c.

Situational Democratic d.

Laissez-faire ANS: A

A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on people’s feelings but ignores the task at hand. It allows employees to act without any direction.

DIF: Cognitive Level: Comprehension TOP: Leadership styles MSC: NCLEX: N/A

REF: p. 237 OBJ: 4 KEY: Nursing Process Step: N/A

28. The most fundamental requirement for assuming the practice role of LPN/LVN charge nurse is a. licensure in the state of practice. b. experience with resident assignment. c. the ability to coordinate patient care services. d. a knowledge of the principles of delegation.

ANS: A

The LPN/LVN practice role requires that the individual be licensed as an LPN/LVN in the state in which he or she is practicing. The other qualifications are important but are not the most basic.

DIF: Cognitive Level: Knowledge REF: p. 235 OBJ: 1 | 2 TOP: LPN/LVN charge nurse KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

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29. The 3 to 11 shift LPN/LVN charge nurse on a 20-bed nursing home unit is asked by the only other staff member on duty, a nursing assistant, “Will it be all right if I go home tonight while you are giving report to the night shift? My husband needs the car so he can go to work.” The best response by the charge nurse is: a. “It’s all right tonight, but don’t make a habit of it.” b. “Sure, our residents will be sound asleep by 11 PM.” c. “Have you lost your mind? What would happen if the owner dropped in for a surprise visit?” d. “That won’t be possible. You must be here to answer lights while I give report to the night staff.”

ANS: D

The LPN/LVN is not responsible for the problems the nursing assistant (NA) has at home and must uphold institutional policies. This response sets limits and explains the reason the NA is needed on the unit. Responding not to make a habit of it and stating that it is permissible because the residents will be sound asleep by 11 PM create an unsafe environment for residents. The remaining option does not explain the major reason the NA is needed on the unit.

DIF: Cognitive Level: Application REF: p. 244 OBJ: 1 TOP: Institutional policies KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

30. Which information can be omitted when the LPN/LVN charge nurse gives the change-ofshift report? a. Routine care for each resident b. New problems for any resident c. Prn medication administered d. New medical orders ANS: A

Routine care should not be included in the change-of-shift report. It is recorded on the resident’s Kardex and care plan and documented in the medical record and flow sheets.

The change-of-shift report should focus on new information about residents.

DIF: Cognitive Level: Knowledge REF: p. 255 OBJ: 9 TOP: Change-of-shift report KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

31. The LPN/LVN charge nurse at the long-term care facility has assigned a newly licensed LPN/LVN to care for a resident needing a colostomy irrigation. The new LPN/LVN voices concern, because he has never performed a colostomy irrigation. What would be the best course of action for the LPN/LVN charge nurse? a. State, “A colostomy irrigation is just like giving an enema. You’ll be fine.” b. Tell the new LPN/LVN, “I’ll do the irrigation while you care for your other assigned residents.” c. Delegate the procedure to a willing nursing assistant. d. Arrange to supervise the new LPN/LVN as he performs the irrigation.

ANS: D

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This action provides the supervision the new employee needs, and the new LPN/LVN probably will be capable of performing the task independently in the future. Stating, “A colostomy irrigation is just like giving an enema. You’ll be fine” does not recognize the need for supervision. Telling the new employee that the charge nurse will do the irrigation while the LPN/LVN cares for other assigned residents increases the workload of the charge nurse with no change in the employee’s capabilities. Delegating the procedure to a willing nursing assistant would be inappropriate. The delegate should be competent, and the delegation should be acceptable according to state and agency policy.

DIF: Cognitive Level: Application REF: p. 267 OBJ: 9 TOP: Assignment/delegation KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

32. The priority step the LPN/LVN charge nurse should take before delegating one of the charges to another LPN/LVN on staff is to a. determine whether the other LPN/LVN is competent to perform the task to be delegated. b. check the Nurse Practice Act of the state to learn whether an LPN/LVN charge nurse is allowed to delegate duties. c. delegate both the task and the responsibility that goes with the task. d. determine the directions that will be provided to the person to whom the task is delegated.

ANS: B

Charge nurse duties are part of an expanded LPN/LVN role. The charge nurse can delegate duties that are part of the ordinary role of the LPN/LVN to another LPN/LVN but may not be able to delegate duties that are part of the expanded role unless specifically permitted to do so by the Nurse Practice Act of the state. Determining whether the other LPN/LVN is competent to perform the task to be delegated is relevant but not the priority step to take. Delegating both the task and the responsibility that goes with the task is not the priority step to take.

Determining the directions that will be provided to the person to whom the task is delegated is relevant but not the priority step to take.

DIF: Cognitive Level: Analysis REF: p. 234 TOP: Delegation KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9

33. When the Nurse Practice Act of the state permits delegation as part of the LPN/LVN charge nurse duties, which task could be delegated to experienced, unlicensed assistive personnel who have been trained to perform the task? a. Calling the physician when a resident’s condition deteriorates b. Providing a performance evaluation for another nursing assistant c. Taking the vital signs of a resident whose condition is not critical d. Handling a grievance brought by a nursing assistant ANS: C

This duty is one that can be safely and appropriately delegated. The other options are duties that are reserved for charge nurses or higher level management. Duties that may be delegated to nursing assistants usually involve identified resident goals rather than goals relating to personnel management.

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DIF: Cognitive Level: Analysis REF: p. 259 OBJ: 1 | 9 TOP: Delegation vs. assignment KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

34. Assuming all the following are staff members on the unit, to whom should the LPN/LVN charge nurse assign a newly admitted 65-year-old resident with left hemiplegia and a large sacral decubitus requiring a sterile dressing change? a. LPN/LVN orientee with 1 week of experience b. LPN/LVN with 2 years of experience c. Nursing assistant with 3 years of experience d. Nursing assistant who is a nursing student at a local college ANS: B

The resident will require data collection by an experienced person to assist the RN with care planning. The assigned care giver will need to be able to implement relatively complex care, including use of surgical aseptic technique and nursing judgment. The care required might be more than the orientee can provide. A nursing assistant should not be assigned to care for a new resident requiring careful data collection and use of nursing judgment.

DIF: Cognitive Level: Analysis REF: p. 259 TOP: Assignment KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9

35. The new nursing assistant arrived 1 hour late for duty on the second day of employment, giving the excuse of car trouble. The LPN/LVN charge nurse should a. note the incident of tardiness in the charge nurse’s personal file. b. send a letter of reprimand to the nursing assistant. c. give an oral reprimand to the nursing assistant. d. arrange to terminate the nursing assistant before a pattern develops.

ANS: A

Documenting the incident in the charge nurse’s personal file will allow the charge nurse to later determine whether a pattern develops. If no pattern develops, no harm has been done to the employee’s work record. A first instance of tardiness does not require reprimand or termination but rather an explanation that the expectation for all employees is to be at work on time.

DIF: Cognitive Level: Analysis REF: p. 257 TOP: When nursing assistants bring problems from home KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9

36. The LPN/LVN charge nurse notices that a new nursing assistant has offensive body odor.

The LPN/LVN charge nurse should a. report this finding to the RN supervisor. b. send the person to the locker room to shower and put on clean clothes. c. terminate the nursing assistant. d. meet with the person to inform her of the problem and reinforce agency expectations.

ANS: D

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This action encourages the nursing assistant to take personal responsibility for her hygiene and appearance. The other actions do not permit the nursing assistant the opportunity to take personal responsibility.

DIF: Cognitive Level: Analysis REF: p. 257 TOP: Encouraging personal responsibility in nursing assistants KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9

37. A resident has not voided in 6 hours. Which instruction to a nursing assistant would likely ensure getting the information needed by the LPN/LVN charge nurse? a. “Watch the resident’s output closely today.” b. “I need to know if the resident is voiding sufficiently.” c. “The resident should void at least twice during the shift in quantities of 200 mL or more.” d. “Report to me immediately if the resident voids between now and 10 AM, and tell me the amount he voids. If he has not voided by 10 AM, please report this to me.”

ANS: D

This is an example of specific, complete communication. It should be followed by giving the nursing assistant an opportunity to repeat what is expected. The other instructions are vague and could leave the nursing assistant wondering what to do.

DIF: Cognitive Level: Application REF: p. 267 OBJ: 9 TOP: Right direction/communication KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

38. The LPN/LVN charge nurse has assigned tasks to the nursing assistant staff and the LPN/LVN orienting to the unit. On which statement about responsibility for outcomes should the LPN/LVN charge nurse base her or his actions? a. The LPN/LVN charge nurse has no further responsibility, because the staff members have accepted the assignments and are responsible for completing all tasks. b. The LPN/LVN charge nurse is responsible for checking the outcomes of care of the LPN/LVN orientee only because he is not an official member of the staff. c. The LPN/LVN charge nurse is responsible for checking the outcomes of care of the nursing assistants only, because the nursing assistants are unlicensed, whereas the LPN/LVN orientee is a licensed employee. d. The LPN/LVN charge nurse is legally responsible for checking the outcomes of all assignments made.

ANS: D

The LPN/LVN charge nurse is responsible for ensuring that all assigned tasks and delegated duties have been performed and for noting the outcomes.

DIF: Cognitive Level: Application REF: p. 244 TOP: Evaluation KEY: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9

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39. The plan of care for a resident in the rehabilitation unit requires the resident to receive teaching about how to monitor blood glucose as part of discharge teaching. The RN is working with a resident whose condition is deteriorating. The LPN/LVN charge nurse has performed blood glucose monitoring many times but is new and has not received facility certification. The nursing assistant assigned to the patient is a diabetic and monitors blood glucose several times a day. Who should perform the teaching? a. RN b. LPN/LVN charge nurse c. Nursing assistant d. Physician ANS: A

The RN is required to initiate teaching. The LPN/LVN can follow up, review, and reinforce.

DIF: Cognitive Level: Application REF: p. 259 OBJ: 3 TOP: Scope of practice KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

40. When a resident’s family complains that their mother is receiving inferior care in the extended care facility, which action should the LPN/LVN charge nurse initially take? a. Gently explain that Continuous Quality Improvement (CQI) would not permit giving inferior care. b. Mention that the staff is overworked and would be glad for the family’s assistance. c. Ask the family to be specific and give examples of “inferior care” the mother has received. d. Tell the family that their reaction is based on guilt because of their need to place their mother in an extended care facility.

ANS: C

Data collection is necessary to clarify the problem needing to be resolved. The other options display various levels of defensiveness.

DIF: Cognitive Level: Analysis REF: p. 257 | p. 258 OBJ: 9 TOP: Dealing with demanding/complaining families KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

41. To which goal should the LPN/LVN give priority? a. Resident X, who has been experiencing a medication reaction, will have no rash and uncompromised respirations. b. Resident Y, who is obese and has had a recent knee replacement, will ambulate using a walker with the assistance of a staff member. c. Resident Z will receive blood glucose monitoring and insulin as ordered. d. All residents will be weighed before breakfast.

ANS: A

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The goal for the resident who has been experiencing a medication reaction that states he will have no rash and uncompromised respirations reflects a level 1 priority, a life-threatening situation. The goal for an obese resident who has had a recent knee replacement that states she will ambulate using a walker with the assistance of a staff member is level 2, essential to safety. The remaining options are level 3 priorities, essential to the medical/nursing plan of care.

DIF: Cognitive Level: Analysis REF: p. 263 TOP: Priorities KEY: Nursing rocess Step: Planning MSC: NCLEX: Safe, Effective Care Environment

OBJ: 9

42. An LPN/LVN is working in a health care facility that allows delegation of nursing duties to nursing assistants by the LPN/LVN. Which of the following duties could be delegated to the nursing assistant? a. Weighing a patient b. Initial patient education c. Assessing a patient’s pain d. Changing a sterile dressing ANS: A

Weighing a patient is within a nursing assistant’s scope of practice. The remaining options are not within a nursing assistant’s scope of practice. Examples of duties not to delegate to a nursing assistant include sterile technique procedures, crisis situations, initial patient education, and interpretation of data.

DIF: Cognitive Level: Analysis REF: p. 261 OBJ: 9 TOP: Delegation KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Scope of Practice MULTIPLE RESPONSE

1. Which principles of delegation should the LPN/LVN charge nurse follow when delegating a duty to a nursing assistant? (Select all that apply.) a. Choose a nursing assistant who is competent to perform the delegated duty. b. Determine the nursing assistant’s willingness to accept the delegated duty. c. Transfer responsibility for the duty to the nursing assistant accepting the delegation. d. Permit the nursing assistant to perform the duty without guidance or monitoring. e. Plan to delegate duties the LPN/LVN charge nurse enjoys least.

ANS: A, B

Choosing a nursing assistant who is competent to perform the delegated duty fulfills the Right Person criteria. Delegation is complete only when the nursing assistant accepts the delegated duty. Responsibility for a delegated duty cannot be transferred. The LPN/LVN charge nurse is responsible for supervision and evaluation. Delegated duties should not necessarily be those that the nurse does not enjoy.

DIF: Cognitive Level: Comprehension REF: p. 261 OBJ: 9 TOP: Delegation KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment

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2. Examples of tasks the LPN/LVN charge nurse of the extended care unit might assign to a nursing assistant (NA) include which of the following? (Select all that apply.) a. Bathing a resident who is in stable condition b. Administering a nasogastric tube feeding c. Assisting a resident with Parkinson disease to ambulate d. Transferring a resident from bed to chair with the assistance of another NA ANS: A, C, D

These tasks have predictable outcomes. Additionally, the NA has been taught to safely perform these tasks. Administering a nasogastric tube feeding is an invasive procedure, beyond the scope of the NA because it requires nursing judgment.

DIF: Cognitive Level: Comprehension REF: p. 264 | p. 265 OBJ: 9 TOP: Right task KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment COMPLETION

1. A purely task-centered leadership style that thrives on power and involves telling someone what to do, with little regard for the employee as a person, is the style.

ANS:

autocratic A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer.

DIF: Cognitive Level: Knowledge TOP: Leadership styles MSC: NCLEX: N/A

REF: p. 237 OBJ: 4 KEY: Nursing Process Step: N/A

2. During a staff meeting, the charge nurse encourages feedback from staff nurses about improving patient safety. The charge nurse is displaying the leadership style.

ANS:

democratic A purely task-centered leadership style (autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve patient care or reach the goals of the employer. Situational leadership involves varying leadership style to meet the demands of the situation in the work environment. Focusing on both the task and the employee is characteristic of the democratic style of leadership. A purely people-oriented style (laissez-faire) focuses on people’s feelings but ignores the task at hand. It allows employees to act without any direction.

DIF: Cognitive Level: Knowledge TOP: Leadership styles MSC: NCLEX: N/A

REF: p. 237 OBJ: 4 KEY: Nursing Process Step: N/A

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Chapter 18: Work Force Trends: How to Find a First Job You Will Love Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. What advantage does a nurse have in locating a job he or she likes? a. Nursing school encourages one to decide on a career area prior to graduation and allows for extra experiences. b. Clinical assignments include practical nursing experience in a variety of clinical settings. c. For nursing students in a community college or vocational/technical setting, the school guarantees a job on graduation. d. Because of the rapid turnover of nurses in health care facilities, locating a choice job is easy.

ANS: B

Having experience in a variety of clinical settings makes it easier to determine which types of units one would find to be a good match for skills and personality traits. Nursing school does not encourage one to decide on a career area prior to graduation, nor does it allow for extra experiences. Community colleges and vocational/technical settings do not guarantee a job upon graduation. It is not necessarily true that because of rapid turnover of nurses in health care facilities, locating a choice of job is easy. There may be no openings on units the nurse would prefer.

DIF: Cognitive Level: Comprehension REF: p. 275 | p. 276 OBJ: 4 TOP: Job selection KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

2. Which of the following individuals is most likely to provide the most authoritative, positive reference for a student nurse who is beginning to search for postgraduation employment? a. Instructor A, who has provided positive feedback during clinical labs b. Program director B, who is familiar with the student nurse’s academic record c. Nurse C, who is the student nurse’s acquaintance at the health club d. Student nurse D, who is a peer enrolled in the same nursing program ANS: A

This individual would know both the academic record and clinical performance strengths of the student nurse. Because the instructor has given positive feedback, this person should be able to provide a positive reference. The program director may not have first-hand knowledge of clinical performance and might be less able to emphasize clinical performance strengths.

The nurse who is the student nurse’s acquaintance at the health club would be unable to provide first-hand information about academic and clinical performance. A fellow student cannot provide a reference that would have the same weight as an instructor or a nurse with whom the student has worked in a health care agency.

DIF: Cognitive Level: Analysis REF: p. 283 TOP: References KEY: Nursing Process Step: N/A

OBJ: 3 | 9 MSC: NCLEX: N/A

3. Which would be most valuable to include on a list of references? a. People who have worked in the agency to which one is applying

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b. Personal friends who can be trusted to provide a positive reference c. Influential people in the community d. Health care workers who have supervised one’s work and are willing to provide a reference ANS: D

Individuals who can comment authoritatively and positively on work skills are more valuable as references than individuals who are employed at the agency to which one is applying but who have no frame of reference for commenting on one’s work skills or those who know one socially or are influential in the community.

DIF: Cognitive Level: Analysis REF: p. 283 TOP: References KEY: Nursing Process Step: N/A

OBJ: 3 | 9 MSC: NCLEX: N/A

4. What is the first step that should be taken by a student nurse who wants to use a particular instructor’s name as a reference? a. Look in the catalog to make sure the name is spelled correctly. b. Pass the course taught by the instructor, which permits listing the name. c. Ask the instructor whether her or his name may be used as a positive reference. d. Check with recent graduates to see which instructor writes the best letters of reference.

ANS: C

The student should make sure the individual is willing to be a reference and, moreover, is willing to write a positive letter. Looking in the catalog to make sure the name is spelled correctly is relevant but not the first step. Passing a course does not confer the right to use the instructor as a reference. Checking with recent graduates to see which instructor writes the best letters of reference is not an appropriate action.

DIF: Cognitive Level: Analysis REF: p. 283 TOP: References KEY: Nursing Process Step: N/A

OBJ: 3 | 9 MSC: NCLEX: N/A

5. A student nurse is interested in working shortly after graduation. What action would have the greatest potential for achieving the goal of securing employment? a. Limit job applications to positions listed in the Help Wanted section of the newspaper. b. Obtain lists of job offerings posted in health care agencies. c. Research agencies of interest and write brief letters expressing an interest in employment. d. Depend on the school of nursing and school placement service to find employment.

ANS: C

Researching agencies of interest and writing brief letters expressing an interest in employment follows through on a broad strategy for obtaining employment. Limiting job applications to positions listed in the Help Wanted section of the newspaper makes use of only limited resources. Obtaining lists of job offerings posted in health care agencies suggests obtaining lists but does not suggest taking further action. Depending on the school of nursing and school placement service to find employment is both passive and unrealistic.

DIF: Cognitive Level: Analysis REF: p. 287 TOP: How to search for employment openings MSC: NCLEX: N/A

OBJ: 4 KEY: Nursing Process Step: N/A

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6. What action should the nurse take if the employer begins to ask interview questions about work experience on the phone when the nurse calls to set up an interview? a. Answer all questions asked by the employer pleasantly, accurately, and completely. b. Express willingness to discuss qualifications in detail during a scheduled interview. c. Mention being in a hurry now but give permission to receive a call back in an hour. d. Report the phone call to the civil liberties commission.

ANS: B

Deflecting employer questions until the actual interview is a good strategy. It prevents the employer from making a snap decision about the individual without seeing the applicant and exploring his or her qualifications in greater detail. Answering all questions asked by the employers pleasantly, accurately, and completely allows the employer to substitute a phone call for a personal interview. Mentioning that you are in a hurry now but giving permission to receive a call back in an hour would be perceived as impolite. Reporting the phone call to the civil liberties commission is unnecessary and inappropriate.

DIF: Cognitive Level: Analysis TOP: Scheduling an interview MSC: NCLEX: N/A

REF: p. 289 OBJ: 6 | 8 KEY: Nursing Process Step: N/A

7. Which statement indicates that a nurse is knowledgeable about good résumé preparation? a. “My résumé is comprised of nearly three and a half pages.” b. “It was difficult to write a good objective statement, but I finally managed.” c. “I used a bulleted style to call attention to my list of job skills.” d. “To make sure my résumé catches the eye, I used bright pink paper.”

ANS: C

Using bullets to draw the eye to job skills and make them easily readable helps the person reading the résumé match skills to the requirements of the job. Ideally a résumé should be one page. Use of objective statements is outdated. Paper color should be conservative.

DIF: Cognitive Level: Analysis REF: p. 289 TOP: Résumés KEY: Nursing Process Step: N/A

OBJ: 9 MSC: NCLEX: N/A

8. Assuming all are true, which information about a new graduate should be included in a résumé to highlight abilities that would be valuable to an employer? a. Prefers annual salary of $50,000 to $52,000 b. President of sky diving club c. Fluent in American sign language d. Plans to move to a nearby state after 1 year ANS: C

The ability to communicate with hearing-impaired patients who use sign language would be an asset. It is better not to include salary expectations. Leisure time activities are not relevant.

A résumé indicating plans to move to a nearby state after 1 year may prejudice the employer against hiring because it costs money to orient new employees.

DIF: Cognitive Level: Analysis REF: p. 289 TOP: Résumés KEY: Nursing Process Step: N/A

OBJ: 9 MSC: NCLEX: N/A

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9. The nurse asks for advice about sending a cover letter and résumé electronically to a local health care agency. The best advice would be: a. “Send the cover letter with the résumé as an attachment.” b. “Paste the résumé to the end of the cover letter.” c. “It is inappropriate to use electronic transmission in this instance.” d. “Phone first to find out whether the person hiring is computer literate.”

ANS: B

This method will ensure that the person receiving the cover letter has ready access to the résumé. Not all systems can open attachments. It is not inappropriate to use electronic transmission in this instance. Many employers prefer e-inquiries. It is not necessary to phone first to find out whether the person hiring is computer literate.

DIF: Cognitive Level: Analysis REF: p. 291 TOP: Résumés KEY: Nursing Process Step: N/A

OBJ: 9 MSC: NCLEX: N/A

10. When an SP/VN or LPN/LVN is seeking a new position, which pre-interview preparatory action would most likely contribute to a successful interview? a. Practice responding to sample interview questions. b. Focus on spontaneity as the key to answering questions. c. Choose casual clothing, because it denotes self-esteem. d. Remind oneself to address the interviewer by her or his first name.

ANS: A

Practice ensures that the interviewee has thought through what responses would be best and will be able to respond in an articulate, sincere fashion. Spontaneity does not always work well; it may not provide appropriate information. Conservative business attire is best. Use the individual’s surname unless invited to do otherwise.

DIF: Cognitive Level: Comprehension REF: p. 286 TOP: Interview KEY: Nursing Process Step: N/A

OBJ: 6 | 7 MSC: NCLEX: N/A

11. During an employment interview, the interviewee is asked, “What do you believe are your greatest weaknesses?” The best reply would be: a. “I’m not aware of any weaknesses.” b. “My instructors told me I was disorganized.” c. “My biggest problem is lack of clinical experience.” d. “I work hard to do my job and meet expectations for my work.”

ANS: D

It is preferable not to respond directly to a question requiring negatives for an answer. It is better to refocus the question so that one may sincerely say positive things about oneself without sounding boastful. It is probably not true that an interviewee would be unaware of any weaknesses. A prospective employer wants to hire people who are organized. Replying that the biggest problem is the lack of clinical experience has the wrong focus. Having clinical experience in a nursing program is a positive.

DIF: Cognitive Level: Analysis REF: p. 295 TOP: Interview KEY: Nursing Process Step: N/A

OBJ: 6 | 7 MSC: NCLEX: N/A

12. Dressing for success at an interview means an applicant should a. select clothing that could be worn at a cocktail party and a formal hair style.

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b. wear well-fitting, businesslike clothes and a neat hairstyle. c. wear only new, very conservative dark clothing and have a new haircut and/or style. d. wear an outfit that reflects one’s “off-duty” personality or hobbies and a casual hairstyle.

ANS: B

Conservative, business-appropriate clothing should be the first choice. Clothing should fit well so that it is comfortable to wear. Wearing conservative, tailored clothing will help the employer see an interviewee as one who will dress appropriately at work. One should try not to wear an outfit for the first time at the interview; having worn it before will give confidence that it fits well. The employer is interested in what appearance one will present at work and would not be able to extrapolate that from the applicant wearing an outfit that reflects “offduty” personality or hobbies and a casual hairstyle.

DIF: Cognitive Level: Comprehension REF: p. 298 TOP: Interview KEY: Nursing Process Step: N/A

OBJ: 6 | 7 MSC: NCLEX: N/A

13. As the interview at the long-term care facility is coming to a close, the interviewer asks the applicant, “What questions may I answer for you?” Which question would be most likely to create a favorable impression? a. “After completing the orientation, when will the first pay raise be given?” b. “Will it be possible to tour a unit such as the one to which I would be assigned?” c. “What will happen if I can’t meet the outcomes for the competency-based orientation?” d. “Do you have tuition reimbursement for courses toward my next degree?”

ANS: B

This request shows genuine interest in the facility. Asking when the first pay raise will be given indicates you are most interested in salary. Asking what will happen if orientation outcomes cannot be met creates a negative impression. Asking if tuition reimbursement is provided is not as negative as asking when the first pay raise will be given but should be deferred to a later time.

DIF: Cognitive Level: Analysis REF: p. 294 TOP: Interview KEY: Nursing Process Step: N/A

OBJ: 6 | 7 MSC: NCLEX: N/A

14. An LPN/LVN applicant wishes to use knowledge of interpersonal styles to his benefit during a job interview. He assesses the interviewer to be a “results-focused” person. Which behavior should he adopt? a. Answer the interviewer’s questions in detail. b. Try to interject information about himself as a person (e.g., his hobbies). c. Look for ways to interject humor into the interview. d. Keep answers to the point and relatively brief.

ANS: D

The LPN/LVN will supply answers without belaboring the point. Moving things along appeals to results-oriented people. Answering the interviewer’s questions in detail and trying to interject personal information are not the best ideas. Results-oriented people like shorter, wellorganized answers that do not deviate from the topic. Results-oriented people may have a sense of humor, but it’s better not to risk being seen as not serious.

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DIF: Cognitive Level: Application REF: p. 283 TOP: Interview KEY: Nursing Process Step: N/A

OBJ: 6 MSC: NCLEX: N/A

15. Which statement is true with regard to making a follow-up call after submitting a résumé and cover letter for a position? a. Do not call; the employer will call the applicant if interested. b. Call on the date and at the time mentioned in the cover letter. c. Call on a Monday before 8 AM if possible. d. Call on a Friday between 2 PM and 4 PM if possible.

ANS: B

This action shows dependability. Employers expect applicants to follow up if they are truly interested in the position. Monday mornings are poor times to call. People are trying to get organized for the week to follow. Calling on Friday is also a poor time to call. People are finishing last-minute details before leaving for the weekend.

DIF: Cognitive Level: Comprehension REF: p. 300 TOP: Follow-up KEY: Nursing Process Step: N/A

OBJ: 12 MSC: NCLEX: N/A

16. The LPN/LVN interviewee determines from personal appearance that the interviewer is from a different cultural background. What action should the interviewee take to minimize the impact of cultural difference during the interview? a. Answer questions in a straightforward manner. b. Use the same gestures the interviewer uses. c. Avert the eyes when responding to questions. d. Be prepared to tolerate decreased personal space.

ANS: A

Even if the interviewer is of a different cultural background, he or she may be fully comfortable interviewing applicants of another culture. One should be more interested in communicating interest in the job and qualifications than in mimicking the interviewer. The interviewer should be given the opportunity to establish norms concerning how to communicate. One cannot anticipate using any of these options, initially.

DIF: Cognitive Level: Analysis REF: p. 294 TOP: Interview KEY: Nursing Process Step: N/A

OBJ: 10 MSC: NCLEX: N/A

17. Which is a basic rule when writing a letter of resignation? a. Avoid venting negative feelings. b. Honesty is the best policy; say how it is. c. List suggestions for agency improvement. d. Prior notice is highly overrated; just don’t show up any more.

ANS: A

Never mention negative feelings about the agency or its personnel in a letter of resignation. A positive work reference may be needed at a later time. Reread the previous two sentences. It is not a wise idea to list suggestions for agency improvement. This suggests negative feelings about the agency. Proper notice is an important courtesy. Abrupt departure may mean the individual is not eligible to be rehired at a future time.

DIF: Cognitive Level: Knowledge

REF: p. 301 | p. 302

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OBJ: 14 TOP: Resignation MSC: NCLEX: N/A

KEY: Nursing Process Step: N/A

18. Which area of health care delivery services is the largest employer of LPN/LVNs? a. Long-term care facilities b. Hospitals c. Home health d. Military services ANS: A

Long-term care facility employment is expected to grow faster than other area of employment in response to the needs of the growing number of older adults and disabled people and the use of nursing homes for recuperation after hospitalization.

DIF: Cognitive Level: Knowledge REF: p. 277 TOP: Job outlook KEY: Nursing Process Step: N/A

OBJ: 2 MSC: NCLEX: N/A

19. The quality that is the greatest asset for the LPN/LVN working in home health care is a. flexibility. b. judgmental attitude. c. sympathetic approach. d. preference for working alone.

ANS: A

Flexibility is necessary because the LPN/LVN often has to improvise while still practicing sound nursing principles. A nonjudgmental attitude is desirable. Empathy, rather than sympathy, is needed. The home health LPN/LVN works with a health care team and the family.

DIF: Cognitive Level: Analysis TOP: Nursing characteristics MSC: NCLEX: N/A

REF: p. 278 OBJ: 2 KEY: Nursing Process Step: N/A

20. Desirable qualities and skills for the LPN/LVN working in mental health nursing include a. a judgmental attitude and sympathetic approach. b. preference for working alone and sticking to a routine. c. empathy, good communication, and the ability to work on a team. d. inflexibility, the ability to jump to conclusions, and sensitivity to change.

ANS: C

These qualities are desirable for working in the mental health setting; empathy and good communication contribute to development of a therapeutic relationship. The ability to work on a team is essential, because this is the structure adopted by mental health agencies.

Nonjudgmental attitudes and empathy are necessary. Mental health nursing requires working with other team members and flexibility. Flexibility, critical thinking, and good mental health are required.

DIF: Cognitive Level: Comprehension TOP: Mental health nursing MSC: NCLEX: N/A

REF: p. 279 OBJ: 2 KEY: Nursing Process Step: N/A

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21. During an employment interview, the interviewee asks what additional educational experiences the LPN/LVN can count on receiving when employed at the facility. Which continuing education opportunity is the interviewer most likely to say the agency offers? a. Annual off-site paid workshops b. Orientation and in-service classes c. Paid courses at a local 2-year college d. Correspondence courses funded by NAPNES ANS: B

These educational experiences are considered standard benefits at most agencies. The other options are benefits that may or may not be available at a given agency.

DIF: Cognitive Level: Application TOP: Continuing education MSC: NCLEX: N/A

REF: p. 281 OBJ: 16 KEY: Nursing Process Step: N/A

22. The LPN/LVN tells a mentor, “I want to join the nursing organization that gives me the greatest voice in making policy for LPN/LVN nursing.” The mentor can correctly suggest that the LPN/LVN will wish to join the a. National League for Nursing (NLN). b. National Association for Practical Nurse Education and Services (NAPNES). c. National Federation of Practical Nurses (NFPN). d. American Nurses Association (ANA).

ANS: C

The NFPN speaks on behalf of LPN/LVNs. It is governed entirely by LPN/LVNs and is the policy-making body and voice of LPN/LVNs. The NLN provides services for LPN/LVN schools of nursing, and NAPNES provides services for individual LPN/LVNs; however, these are not considered policy-making bodies for LPN/LVNs. The ANA is concerned with professional nursing.

DIF: Cognitive Level: Application REF: p. 304 | p. 305 OBJ: 15 TOP: Nursing organizations KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

23. The American Nurses Association (ANA) a. represents only registered nurses. b. represents only licensed practical nurses. c. represents both registered nurses and licensed practical nurses. d. has attempted to expand licensed practical nurses’ scope of practice.

ANS: A

The ANA represents only registered nurses. State affiliates of the ANA are altering bylaws to allow LPN/LVNs to join the association at the state level and pay dues but not to have a voice or vote in the organization. The ANA does not represent licensed practical/vocational nurses and has attempted to limit their scope of practice. In 1965 the ANA set a policy to eliminate LPN/LVNs and attempted to do so again in the 1980s.

DIF: Cognitive Level: Comprehension TOP: American Nurses Association MSC: NCLEX: N/A

REF: p. 303 OBJ: 15 KEY: Nursing Process Step: N/A

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24. The National League for Nursing (NLN) membership a. is open only to registered nurses. b. is open only to licensed practical nurses. c. is open only to advanced practice nurses. d. is open to anyone interested in nursing issues.

ANS: D

The NLN membership is open to all levels of nurses and anyone interested in nursing. issues.

DIF: Cognitive Level: Comprehension TOP: American Nurses Association MSC: NCLEX: N/A

REF: p. 303 OBJ: 15 KEY: Nursing Process Step: N/A

25. The first college in the United States to have a distance-learning nursing program (online) is: a. University of Phoenix. b. Minneapolis Community Technical College. c. Excelsior College. d. Lackawanna College.

ANS: C

Excelsior College (previously known as Regents College, in Albany, NY) is the first college in the United States to have a distance-learning (online) nursing program. Minneapolis Community and Technical College has one of the oldest nursing programs in the country, but it was not the first distance-learning college. The University of Phoenix offers distance learning but was not the first. Lackawanna College does not offer a distance-learning nursing program at this time.

DIF: Cognitive Level: Knowledge TOP: Educational mobility MSC: NCLEX: N/A

REF: p. 306 OBJ: 16 KEY: Nursing Process Step: N/A

MULTIPLE RESPONSE

1. Which questions should the nurse identify as illegal for the interviewer to ask and therefore the nurse need not feel obligated to answer directly? (Select all that apply.) a. “Have you been hospitalized within the past year?” b. “What are two important things about yourself that you would like me to know?” c. “Do you have a criminal record?” d. “What would you say is your greatest weakness in the clinical area?”

ANS: A, C

These questions have been determined to be illegal for the interviewer to ask. They do not relate to the interviewee’s ability to meet the criteria set forth in the job description. The remaining options may be somewhat difficult to answer but are not illegal.

DIF: Cognitive Level: Knowledge TOP: Interview questions MSC: NCLEX: N/A

REF: pp. 295-297 OBJ: 6 | 7 KEY: Nursing Process Step: N/A

2. Identify information that should be included in a résumé. (Select all that apply.) a. State of health

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b. c. d. e. f. g.

Salary requirements Education Marital status Work experience Licenses/professional memberships Military experience

ANS: C, E, F, G

This information will help the employer match the applicant’s qualifications and the job requirements. The other options supply nonessential information.

DIF: Cognitive Level: Knowledge OBJ: 9 TOP: Résumés MSC: NCLEX: N/A

REF: p. 289 | p. 290 KEY: Nursing Process Step: N/A

3. Which phrases would be helpful to remember when filling out a job application? (Select all that apply.) a. Never provide information regarding having held three or more jobs in the past year. b. Explain employment gaps by responses such as laid off, job hunting, family responsibilities. c. Answer questions about wage requirements by inflating current salary by 20%. d. Respond to questions about age, religion, number of children, even though it is not required by law. e. Do not leave questions unanswered or blank spaces on the application.

ANS: B, E

Employers look for unexplained gaps in employment, so providing information regarding why gaps exist will prevent discarding of the application. Many employers will not interview applicants unless all questions on the application have been answered. Writing in “Will explain” is preferable to leaving a blank. Never falsify an application. Be honest with the number of jobs held in the past year and give reasons for leaving. It is unwise to answer questions about wage requirements by inflating current salary by 20%. Place wage requirements at a realistic level for the job or write “Open.” It is not necessary to respond to questions about age, religion, number of children. One does not have to answer illegal questions.

DIF: Cognitive Level: Analysis REF: p. 293 TOP: Applications KEY: Nursing Process Step: N/A

OBJ: 11 MSC: NCLEX: N/A

4. What advice should an LPN/LVN use to adequately follow up an employment interview? (Select all that apply.) a. Write a letter to the editor of the local newspaper praising the facility. b. Offer a written critique of the interview sent to the interviewer. c. Call the interviewer to inquire how the process is proceeding. d. Write a thank you letter for granting the interview.

ANS: C, D

It is appropriate for the interviewee to write a thank you letter following the interview and to call to inquire whether he or she has been hired. The remaining options are inappropriate to the situation.

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DIF: Cognitive Level: Application OBJ: 12 TOP: Follow-up MSC: NCLEX: N/A

REF: p. 300 | p. 301 KEY: Nursing Process Step: N/A

5. Helpful qualities for home health nurses include which of the following? (Select all that apply.) a. Flexibility b. Judgmental attitude c. Self-confidence d. Ability to deal with emergencies e. Communication skills ANS: A, C, D, E

These are all helpful qualities for home health nurses. A nonjudgmental attitude is a must for the home health nurse, because he or she works in the patient’s home. If the nurse is comfortable with his or her own values, different values should not be personally threatening.

DIF: Cognitive Level: Comprehension REF: p. 278 TOP: Work areas KEY: Nursing Process Step: N/A

OBJ: 2 MSC: NCLEX: N/A

6. Which of the following trends should guide the LPN/LVN in planning for employment over the next 5 years? (Select all that apply.) a. Little change in numbers needed or in potential work sites is projected. b. The number of LPN/LVN positions available in hospitals will nearly double. c. Employment opportunities for LPN/LVNs will increase in long-term care settings due to the care needs of older adults. d. More LPN/LVNs will be needed to work in community-based settings. e. LPN/LVNs will provide care for larger numbers of terminally ill and acutely ill patients.

ANS: C, D, E

Nursing home employment of LPN/LVNs is expected to grow in response to the long-term care needs of the growing number of older adults and disabled individuals. The trend to move health care from inpatient to outpatient suggests that more LPN/LVNs will work in community-based agencies. The RN shortage, if unabated, will likely see more LPN/LVNs caring for acutely ill patients, and the LPN/LVN skill set is well matched with the care needs of many terminally ill patients in hospice care. Numbers are expected to increase about as fast as the average for all occupations, whereas work sites are likely to become increasingly diverse. The number of LPN/LVN positions available in hospitals are expected to nearly double according to employment projections.

DIF: Cognitive Level: Comprehension REF: p. 276 TOP: Work sites KEY: Nursing Process Step: N/A

OBJ: 1 MSC: NCLEX: N/A

7. In which of the following areas may LPN/LVNs obtain certification? (Select all that apply.) a. Managed care b.

Pharmacology c.

Long-term care d. Mental health care e. IV therapy

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f. Wound care g. Neonatal care ANS: A, B, C, E, F

Mental health nursing and neonatal nursing are certifications available at this time only to RNs. DIF: Cognitive Level: Knowledge REF: p. 277 TOP: Certification KEY: Nursing Process Step: N/A

OBJ: 2 MSC: NCLEX: N/A

8. Which services does membership in the National Federation of Practical Nurses (NFPN) provide? (Select all that apply.) a. Subscription to the American Journal of Nursing b. Insurance discounts c. Continuing education articles for CEUs d. Certification programs in IV therapy and gerontology e. Current standards of practice ANS: B, C, D, E

All options but subscription to the American Journal of Nursing are services provided by NFPN. Membership includes a subscription to the Practical Nursing Journal rather than the American Journal of Nursing.

DIF: Cognitive Level: Knowledge TOP: Professional nursing organizations MSC: NCLEX: N/A

REF: p. 304 OBJ: 15 KEY: Nursing Process Step: N/A

9. Nurse T has decided to seek certification in an area that will enhance employability in a nursing home. Which certifications would be of greatest value to the LPN/LVN working in a nursing home? (Select all that apply.) a. IV therapy b. Wound care c. Long-term care d. Managed care e. Pharmacology f. Gerontology ANS: B, C, E, F

The majority of nursing home residents are older adults and receive long-term care. Most receive medications. Those who develop pressure sores require wound care. IV therapy is used less in nursing homes than in hospital settings. Managed care is used less in nursing homes than in hospital and community health settings.

DIF: Cognitive Level: Analysis REF: p. 277 TOP: Certification KEY: Nursing Process Step: N/A

OBJ: 3 MSC: NCLEX: N/A

10. Select the various continuing education opportunities that are usually available to an LPN/LVN who accepts employment at a long-term care facility in a metropolitan area having a collegiate nursing program. (Select all that apply.) a. A competency-based orientation b. In-service programs c. Workshops

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d. CEUs through nursing publications e. Certifications through nursing organizations ANS: A, B, C, D, E

All of these forms of continuing education would be available in such a setting.

DIF: Cognitive Level: Comprehension TOP: Continuing education MSC: NCLEX: N/A

REF: p. 305 OBJ: 3 | 16 KEY: Nursing Process Step: N/A

COMPLETION 1. The area of nursing in which churches employ their own nurse to take care of basic health

needs of the congregation is called

nursing.

ANS:

parish Parish nurses are employed by the church to keep their groups happy and healthy by treating the whole person—body, mind, and spirit.

DIF: Cognitive Level: Knowledge REF: p. 281 TOP: Work areas KEY: Nursing Process Step: N/A

OBJ: 2 MSC: NCLEX: N/A

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Chapter 19: Licensure and Regulation: Becoming Licensed and Understanding Your State Nurse Practice Act Knecht: Success in Practical/Vocational Nursing MULTIPLE CHOICE

1. Preparation for the NCLEX-PN examination should include a. cramming difficult concepts the night before the examination. b. rereading each textbook used in the program of study. c. going to a party the evening before the test. d. reviewing content summaries and focusing on identified areas of weakness.

ANS: D

Identifying areas of weakness and undertaking a systematic study program is a good strategy for preparing for the NCLEX-PN examination. Cramming is rarely effective. Rereading all texts is time-consuming and lacks focus. Relaxing is a good idea, but partying may lead to fatigue and lack of clarity in thinking the next day.

DIF: Cognitive Level: Comprehension REF: p. 315 TOP: NCLEX-PN examination preparation MSC: NCLEX: N/A

OBJ: 4 KEY: Nursing Process Step: N/A

2. LPN/LVN licensure by endorsement in the United States and its territories is possible because a. English is the spoken language of each locale. b. the NCLEX-PN examination is used by the board of nursing of each locale. c. computer-adaptive testing maximizes testing efficiency. d. the NCLEX-PN examination test plan reflects current practice.

ANS: B

When the same examination is used, the boards of nursing can be assured that those who pass have the knowledge to practice practical/vocational nursing at a minimally safe and effective level.

DIF: Cognitive Level: Comprehension TOP: Endorsement MSC: NCLEX: N/A

REF: p. 314 OBJ: 8 KEY: Nursing Process Step: N/A

3. What advice should the testing candidate consider the best method for preparing to take the NCLEX-PN examination? a. “Participate in an all-night cram session the night before the test.” b. “Rely on your intuition to answer questions when you do not know the answer.” c. “Study throughout the year and review systematically before the exam.” d. “Quiz previous graduates about test content and study what they mention.”

ANS: C

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Studying for each nursing examination and passing it provide a firm foundation for the NCLEX-PN examination. Systematic review over a number of weeks prior to the NCLEXPN examination will refresh one’s knowledge. Cramming is usually counterproductive because it results in fatigue and lowers the ability to think clearly during the examination.

Better advice is to rule out wrong answers and consider clues and key words found in the stem of the question. With CAT, the topics covered in the questions answered by one person may be quite different from those selected for another person.

DIF: Cognitive Level: Analysis REF: p. 315 TOP: NCLEX-PN examination preparation MSC: NCLEX: N/A

OBJ: 4 KEY: Nursing Process Step: N/A

4. The practical/vocational nursing student tells a colleague, “I know I’m going to fail the NCLEX-PN examination. I’ve heard that a huge amount of the examination is psychology related, and I hated psychology!” The reply that shows the best understanding of the NCLEXPN examination is a. “You’d better retake the psychology course.” b. “There are equal numbers of questions related to each aspect of patient needs.” c. “Psychosocial integrity is the basis for 8% to 14% of the questions.” d. “I’ve heard there’s more emphasis on care planning than anything else.”

ANS: C

Psychosocial integrity is the basis for 8% to 14% of the questions of the NCLEX-PN examination test plan. The other options do not show understanding of the current test plan.

DIF: Cognitive Level: Application TOP: Framework of test plan MSC: NCLEX: N/A

REF: p. 312 OBJ: 3 | 4 KEY: Nursing Process Step: N/A

5. The SP/VN reviewing for the NCLEX-PN examination should study based on an understanding that the category of patient need that is most heavily tested is a. the clinical problem-solving process. b. safe, effective care environment. c. health promotion and maintenance. d. physiologic integrity.

ANS: D

The physiological integrity category of patient needs includes basic care and comfort, pharmacological therapies, reduction of risk potential, and physiological adaptation. It comprises 35% to 59% of the questions. Questions from the other three categories make up the remainder of the test. The clinical problem-solving process is not a category of patient needs.

DIF: Cognitive Level: Application TOP: Test plan: Category of patient need MSC: NCLEX: N/A

REF: p. 312

OBJ: 3 | 4 KEY: Nursing Process Step: N/A

6. One practical/vocational nursing student tells another student, “I’m computer phobic! I never understand what keys I’m supposed to use to get the thing to work.” The reply that shows the best understanding about NCLEX-PN examination testing is: a. “No problem! The question comes up on the screen, and you speak the letter of the

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correct answer aloud to the voice-activated computer.” b. “You answer practice questions before the examination begins to get you used to using the computer.” c. “You’ll be able to ask the test proctor for help if you get mixed up.” d. “If you can’t get the hang of the computer, they’ll let you use paper and pencil.”

ANS: B

Answering the practice questions provides orientation to the tester. Voice-activated computers are not used. Asking the test proctor for help if you get mixed up and using paper and pencil are not permitted.

DIF: Cognitive Level: Application TOP: Orientation to use of the computer MSC: NCLEX: N/A

REF: p. 315 OBJ: 3 KEY: Nursing Process Step: N/A

7. When an SP/VN asks for advice about how to “reduce anxiety before the NCLEX-PN examination,” the LPN/LVN should respond, “An effective strategy for reducing test anxiety prior to the NCLEX-PN examination is to a. maintain a confident, positive attitude about your abilities and the outcome.” b. drink 3 ounces of an alcoholic beverage 30 minutes before the test.” c. prepare yourself for the worst by picturing yourself having to reapply.” d. use scrap paper to keep track of the number of questions you think you answered correctly and incorrectly.”

ANS: A

Positive thinking reduces anxiety. Testing with mild anxiety is more productive than testing with moderate to high anxiety. Drinking alcohol will interfere with critical thinking.

Preparing yourself for the worst by picturing yourself having to reply is negative thinking and raises anxiety. Using scrap paper to keep track of the number of questions you think you answered correctly and incorrectly takes the focus away from thinking critically about the questions and wastes time that could better be used to consider question options.

DIF: Cognitive Level: Application TOP: Anxiety reduction MSC: NCLEX: N/A

REF: p. 315 OBJ: 4 KEY: Nursing Process Step: N/A

8. The LPN/LVN tells a peer, “I want to be endorsed in state X. What step do you think I should take first?” The best response would be: a. “Ask our state board to send you a copy of your NCLEX-PN examination score.” b. “Photocopy your license and current registration.” c. “Write to the board of nursing in state X and ask for instructions.” d. “Request our state board to inactivate your license.”

ANS: C

Endorsement to practice in another state begins by contacting the state board of nursing in that state and asking for instructions about how to proceed. The board will send an application, instructions, fee schedules, and other materials. Asking the state board to send a copy of you NCLEX-PN examination score and photocopying your license and current registration are neither necessary nor priorities. Requesting the state board to inactivate your license is premature. Current licensure and registration are necessary to continue to work in your state while awaiting endorsement for state X.

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DIF: Cognitive Level: Application TOP: Endorsement MSC: NCLEX: N/A

REF: p. 314 OBJ: 8 KEY: Nursing Process Step: N/A

9. Which statement pertains to a temporary work permit? a. It is issued automatically upon completion of the LPN/LVN program. b. It permits one to work as an LPN/LVN. c. It is required to take the NCLEX-PN examination. d. It is revoked once the NCLEX-PN examination result is reported. e. It allows one to assume LPN/LVN charge nurse duties.

ANS: D

One must apply for the permit on program completion if wishing to work. One works as a GP/VN, not as a fully licensed LPN/LVN. The temporary work permit and the application to take the examination are not dependent on one another. The temporary permit is revoked once the NCLEX-PN examination is reported. If the examination is passed, the individual works as a fully licensed LPN/LVN. If the examination is failed, the individual must surrender the permit and work as a nursing assistant.

DIF: Cognitive Level: Comprehension TOP: Temporary permit MSC: NCLEX: N/A

REF: p. 310 OBJ: 9 KEY: Nursing Process Step: N/A

10. The fundamental difference between holding licensure as an LPN/LVN and having a temporary permit is that a temporary permit a. is surrendered after 2 years; a license is never surrendered. b. requires close RN supervision; a license gives permission to practice without RN supervision. c. certifies minimal competency in LPN/LVN skills; a license guarantees safe practice. d. provides permission to work as a GP/VN; a license certifies minimal competence in LPN/LVN skills.

ANS: D

A temporary permit allows a graduate practical or vocational nurse to work until the results of the NCLEX-PN examination are in. The temporary permit is automatically revoked once these results are available. Passing the NCLEX-PN examination allows employment as a fully licensed practical or vocational nurse (LPN or LVN). If the examination is failed, the temporary permit is surrendered.

DIF: Cognitive Level: Analysis TOP: Temporary permit MSC: NCLEX: N/A

REF: p. 310 OBJ: 9 KEY: Nursing Process Step: N/A

11. The requirement for taking the NCLEX-PN examination that is universal to every U.S. state and territory is a. the ability to pay fees using a major credit card. b. holding a valid temporary work permit. c. a conviction-free legal record. d. completion of a PN/VN program.

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ANS: D

One cannot apply to any state board of nursing and receive permission to take the NCLEX-PN until program completion has been certified by the school of nursing. Taking the NCLEX-PN examination is not contingent on any of the other options.

DIF: Cognitive Level: Analysis REF: p. 313 TOP: Requirements to take NCLEX-PN examination MSC: NCLEX: N/A

OBJ: 7 KEY: Nursing Process Step: N/A

12. Prior to taking the NCLEX-PN examination, candidates sign a confidentiality clause.

A candidate would be in violation of “terms of confidentiality” when doing which of the following? a. The candidate asks the examination proctor a question. b. The candidate informs others that she has taken the exam. c. The candidate discusses the examination with his instructor. d. The candidate refrains from discussing the examination with others.

ANS: C

Candidates sign an NCLEX-PN examination confidentiality clause prior to testing. Dr. Tom O’Neill, associate director, NCLEX-PN examination, states that, “technically if students were to discuss the examination with an instructor, they would be in violation of the ‘terms of confidentiality’ they must agree to before they take the exam. These terms include not disclosing the content of the examination items before, during, or after the examination.

Legal action could be taken against candidates that break the NCLEX-PN confidentiality clause, including criminal prosecution and civil litigation as well as other administrative disciplinary action.”

DIF: Cognitive Level: Analysis REF: p. 314 TOP: NCLEX-PN examination confidentiality clause MSC: NCLEX: N/A

OBJ: 5 KEY: Nursing Process Step: N/A

13. Endorsement for an LPN/LVN taking the NCLEX-PN examination means that a. the LPN/LVN will never risk losing his or her license. b. the LPN/LVN may apply for licensure in a different state or territory without retesting. c. the LPN/LVN is entitled only to practice in the state in which he or she took the NCLEX-PN examination. d. the LPN/LVN must retake the NCLEX-PN examination if wishing to practice nursing in another state or territory.

ANS: B

The NCLEX-PN examination is given in the United States, American Samoa, the District of Columbia, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands. This makes it possible to provide licensure by endorsement from one board of nursing to another.

Endorsement means that an LPN/LVN may apply for licensure in a different state or territory without retesting. Taking the same examination in the United States and its territories facilitates endorsement from one nursing board to another.

DIF: Cognitive Level: Analysis TOP: Endorsement MSC: NCLEX: N/A

REF: p. 314 OBJ: 8 KEY: Nursing Process Step: N/A

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14. The content of the NCLEX-PN examination is divided into four Patient Needs categories.

The Safe, Effective Care Environment category includes a. the aging process. b. abuse and neglect. c. advance directives. d. medication administration.

ANS: C

Advance directives are included in the Patient Needs category Safe, Effective Care Environment. The aging process is included in the Patient Needs category Health Promotion and Maintenance. Abuse and neglect are included in the Patient Needs category Psychosocial Integrity. Medication administration is included in the Patient Needs category Physiological Integrity.

DIF: Cognitive Level: Analysis TOP: Patient Needs categories MSC: NCLEX: N/A

REF: p. 312 OBJ: 3 KEY: Nursing Process Step: N/A

15. The content of the NCLEX-PN examination is divided into four Patient Needs categories.

The Health Promotion and Maintenance category includes a. ethical practice. b. family planning. c. crisis intervention. d. basic pathophysiology.

ANS: B

Family planning is included in the Patient Needs category Health Promotion and Maintenance. Ethical practice is included in the Patient Needs category Safe, Effective Care Environment. Crisis intervention is included in the Patient Needs category Psychosocial Integrity. Basic pathophysiology is included in the Patient Needs category Physiological Integrity.

DIF: Cognitive Level: Analysis TOP: Patient Needs categories MSC: NCLEX: N/A

REF: p. 312 OBJ: 3 KEY: Nursing Process Step: N/A

16. The content of the NCLEX-PN examination is divided into four Patient Needs categories.

The Psychosocial Integrity category includes a. surgical asepsis. b. human sexuality. c. therapeutic communication. d. nutrition and oral hydration.

ANS: C

Therapeutic communication is included in the Patient Needs category Psychosocial Integrity.

Surgical asepsis is included in the Patient Needs category Safe, Effective Care Environment.

Human sexuality is included in the Patient Needs category Health Promotion and Maintenance. Nutrition and oral hydration are included in the Patient Needs category Physiological Integrity.

DIF: Cognitive Level: Analysis

REF: p. 312

OBJ: 3

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TOP: Patient Needs categories MSC: NCLEX: N/A

KEY: Nursing Process Step: N/A

17. The content of the NCLEX-PN examination is divided into four Patient Needs categories.

The Physiological Integrity category includes a. newborn care. b. stress management. c. medical emergencies. d. accident/error prevention.

ANS: C

Medical emergencies are included in the Patient Needs category Physiological Integrity.

Newborn care is included in the Patient Needs category Health Promotion and Maintenance.

Stress management is included in the Patient Needs category Psychosocial Integrity.

Accident/error prevention is included in the Patient Needs category Safe, Effective Care Environment.

DIF: Cognitive Level: Analysis TOP: Patient Needs categories MSC: NCLEX: N/A

REF: p. 312 OBJ: 3 KEY: Nursing Process Step: N/A

MULTIPLE RESPONSE

1. Which phrases describe the format of the NCLEX-PN examination? (Select all that apply.) a. Uses multiple choice questions exclusively b. Includes questions of varying levels of difficulty c. May have fill-in-the-blank questions d. Uses charts, tables, and graphics as parts of questions e. Requires tester to select a single best answer for every question f. Tests the cognitive levels of knowledge, comprehension, application, and analysis g. Integrates three of the four steps of the nursing process used by LPN/LVNs ANS: B, C, D, F

The NCLEX PN examination includes questions of varying levels of difficulty; it may have fill-in-the-blank questions, charts, tables, and graphics; and it tests the cognitive levels of knowledge, comprehension, application, and analysis. Using multiple choice questions exclusively is incorrect because alternate types of questions are used in the examination.

Requiring the tester to select a single best answer for each question is inaccurate because multiple answers may be correct for some questions. Integrating three of the four steps of the nursing process used by LPN/LVNs is incorrect because all four steps of the LPN/LVN nursing process are integrated into the examination.

DIF: Cognitive Level: Comprehension TOP: Examination format MSC: NCLEX: N/A

REF: p. 311 OBJ: 3 KEY: Nursing Process Step: N/A

2. Which phrases accurately describe computerized adaptive testing (CAT) as used in the NCLEX-PN examination? (Select all that apply.) a. Selects questions of varying difficulty, depending on previous responses b. Provides an individualized examination for each tester c. Requires the tester to answer a minimum of 85 questions

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d. Selects an equal number of questions from the four categories of patient need e. Ends testing when 50% of the questions have been answered correctly ANS: A, B, C

CAT varies the question difficulty based on previous responses, provides an individualized exam, and requires the tester to answer a minimum of 85 questions. Patient needs are not tested equally. The test plan calls for physiological integrity to be weighted more heavily than the other categories. Testing ends when a minimum of 85 questions have been answered and when 50% of the more difficult questions have been answered correctly.

DIF: Cognitive Level: Comprehension TOP: Computerized adaptive testing MSC: NCLEX: N/A

REF: p. 311 OBJ: 3 KEY: Nursing Process Step: N/A

3. Which statements provide accurate information about determination of pass/fail by NCLEX- PN computerized adaptive testing? (Select all that apply.) a. Only questions testing the application or analysis level of cognition are scored. b. Each question that appears on the screen must be answered; none can be skipped. c. Of the more difficult questions asked, 50% must be answered correctly to pass. d. One’s score must be at least 75% of the 205 total questions asked.

ANS: B, C

Each question that appears on the screen must be answered in order for the examination to continue. The basis for this is that question selection is based on the correctness of the answer given for the previous question. The computer determines that the candidate has passed when he or she has completed at least 85 questions and it can be determined that the person has correctly answered 50% of the questions with a high index of difficulty. All questions are scored. Not all testers answer the maximum number of questions (205). Seventy-five percent is not used to determine passing.

DIF: Cognitive Level: Comprehension REF: p. 311 TOP: CAT KEY: Nursing Process Step: N/A

OBJ: 3 MSC: NCLEX: N/A

4. Which phrases identify differences between taking the NCLEX-PN examination and a “regular” test in a nursing program? (Select all that apply.) a. One can skip questions and return to them in a program exam. b. One will be penalized for guessing on the NCLEX-PN examination. c. There are a variety of question formats on the NCLEX-PN examination. d. One should stop reading possible answers on the NCLEX-PN examination as soon as selecting the correct answer. e. The NCLEX-PN examination is individualized; program examinations are identical for all testers.

ANS: A, E

Most program examinations allow the tester to skip a question and return to it at a later time.

The NCLEX-PN examination, as a computerized adaptive examination, individualizes testing, whereas program examinations are identical for all students taking a specific test. There is no penalty for guessing on the NCLEX-PN. Alternate formats can be used in program examinations and the NCLEX-PN examination. One should read all possible answers for both program examinations and the NCLEX examination. Early selection may lead to missing an answer that is better.

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DIF: Cognitive Level: Analysis REF: p. 311 OBJ: 3 TOP: NCLEX-PN examination vs. program examination formats KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

5. Which of the following are needed by the candidate to arrange for and take the NCLEXPN examination? (Select all that apply.) a. An authorization-to-test letter b. An appointment at a testing center c. A picture identification and one other acceptable form of identification d. A copy of one’s fingerprint card ANS: A, B, C

The authorization-to-test letter comes from the state board of nursing. An appointment for testing at the testing center is necessary. Walk-in testing is not available. Appropriate identification is necessary to satisfy security requirements. Fingerprinting is done at the time of testing.

DIF: Cognitive Level: Comprehension REF: p. 313 TOP: Overview of the application process MSC: NCLEX: N/A

OBJ: 2 KEY: Nursing Process Step: N/A

COMPLETION 1. The NCLEX-PN examination measures the

competencies needed to practice

practical/vocational nursing.

ANS:

minimum The NCLEX-PN examination measures the minimum competencies required to safely and effectively practice as a newly licensed practical/vocational nurse.

DIF: Cognitive Level: Knowledge TOP: NCLEX-PN examination MSC: NCLEX: N/A

REF: p. 311 OBJ: 1 KEY: Nursing Process Step: N/A