Test Bank Nursing Todays World 10th Edition, Ellis
Chapter 1: Exploring the Growth of Nursing as a Profession
1. Which of the following statements most accurately describes the practice of medicine in Greece from 800 BC to 300 BC?
A) Greek culture stressed natural causes for disease, a patient-centered approach, and the necessity of accurate observations and record keeping.
B) Greek culture borrowed medical practices from the countries it conquered, and physicians were often slaves.
C) Major and minor surgery, children’s diseases, and diseases of the nervous and urinary systems were described in Greek culture.
D) Medicine men (known first as shamans and later as priests) were responsible for curing ills of body and mind.
2. Florence Nightingale fostered the development of nursing as a profession. What was the basis of her nursing theory?
A) The nurse’s role is to assist individuals (sick or well) to carry out those activities that they would perform unaided if they had the necessary strength, will, or knowledge.
B) The goal of nursing is to put the patient in the best condition for nature to act upon him, primarily by altering the environment.
C) The focus of nursing is the spiritual subjective aspects of both the nurse and the patient and the “caring moment” relating to the time when the nurse and the patient first come together.
D) The focus of nursing is the care of human beings who are viewed as open systems in constant interaction with their environments.
3. Which one of the following statements accurately describes an element of the process of providing a definition of nursing?
A) Researchers can pinpoint the period in history when nursing first evolved.
B) Nurses agree on a single definition of nursing, partly because of the history of nursing.
C) There is an obvious distinction between nursing and medicine.
D) Nursing theorists developed definitions of nursing consistent with their conceptual frameworks.
4. A nurse wishes to document nursing actions using a standardized language. Which of the following systems might the nurse use?
A) NANDA International (NANDA-I)
B) Nursing Outcomes Classification (NOC)
C) Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS)
D) Nursing Interventions Classification (NIC)
5. An RN who practices in a community clinic recognizes the need for a standardized classification and documentation system. Which of the following systems of nursing care classification and documentation would best fit the RN’s needs?
A) NANDA International (NANDA-I)
B) Nursing Outcomes Classification (NOC)
C) The Omaha System
D) Patient Care Data Set (PCDS)
6. The number and size of nursing schools in the United States grew significantly in the years of the early 20th century. Which of the following characteristics was emphasized in these schools?
A) A thorough knowledge of anatomy, physiology, and epidemiology
B) Critical thinking, assertiveness, and autonomy
C) An understanding of the relationship among mind, body, and spirit
D) Religious devotion and subservience to authority
7. Florence Nightingale is acknowledged as one of the individuals who contributed most significantly to the development of nursing as a profession. What other phenomenon contributed most to this development?
A) Labor-saving technology that freed many women from working in the home
B) The social recognition of the importance of public funding for the treatment of disease
C) Increased understanding of the pathophysiology of illness and the importance of infection control
D) The high mortality rates that existed during times of war
8. Nurses have historically had difficulty identifying a single, comprehensive definition of nursing. What factor most accounts for this difficulty in agreeing on a definition for nursing?
A) It can be challenging to reconcile the theoretical and practical aspects of nursing.
B) Nursing exists in the psychomotor (hands-on) domain rather than in the cognitive domain.
C) Compared with medicine, nursing has a relatively short history.
D) Nurses have traditionally been reluctant to acknowledge the outcomes of their practice.
9. One of the challenges that nurses have faced in the past, and which continues to the present, is the need to distinguish the practice of nursing from that of medicine. Which of the following statements best conveys a defining characteristic of nursing?
A) Education within a formal, credential-granting setting
B) An emphasis on objective, rather than subjective, health assessment
C) A holistic perspective on the health of individuals
D) A recognition that health is not always attainable for all individuals
10. Society has sometimes questioned whether nursing can be considered to be a true profession and whether nurses can be considered to be professionals. What characteristic of nursing is among the characteristics that social scientists use to define a profession?
A) The median annual nursing wage is greater than $45,000.
B) Nurses use the scientific method to enhance their body of knowledge.
C) Nurses can be held legally accountable for their actions.
D) Nursing has a demonstrated commitment to the well-being of the public.
Chapter 2: Educational Preparation for Nursing
1. Manuel has a baccalaureate degree in biology and wishes to make a career change to eventually become an advanced practice RN. Which of the following courses of study would be the most time-efficient choice to meet his educational goals?
A) Master’s degree in nursing
B) Baccalaureate degree in nursing
C) Doctoral degree in nursing
D) Associate degree in nursing
2. Which nursing report recommended that nursing education move away from the system of apprenticeship that predominated at the time and move toward a planned program of education similar to that offered by other professions?
A) The Surgeon General’s Consultant Group Report on Nursing
B) The Brown Report
C) The American Nurses Association Position Paper
D) The Pew Health Profession Commission Study
3. Which of the following accurately states a major position of the ANA Position Paper on Educational Preparation?
A) The education of those who are licensed to practice nursing should take place in hospitals.
B) Minimum preparation for beginning professional nursing practice at the present time should be an associate degree in nursing.
C) Minimum preparation for beginning technical nursing practice at the present time should be a baccalaureate degree in nursing.
D) Education for assistants in health service occupations should be short, intensive preservice programs in vocational educational institutions.
4. Sister Calista Roy identified an adaptation model that characterizes the individual as being in constant interaction with a changing environment, therefore requiring adaptation. Which of the following identifies an adaptive mode listed in her theory?
A) Role function
D) Genetic makeup
5. Mr. Van is a 79-year-old widower who is being transferred to a long-term facility following hip replacement surgery. The nurse in charge of his care hopes to provide holistic nursing care for him based on his response to the interaction between his internal and external environment. This approach represents the model of care proposed by which of the following theorists?
A) Dorothy Johnson
B) Madeleine Leininger
C) Dorothea Orem
D) Myra Levine
6. A college sophomore has become disillusioned with her current field of studies and has begun exploring careers in nursing. To her surprise, she is unable to identify any hospital-based programs of study in her home state. Which of the following factors have contributed to the demise of hospital-based diploma programs? (Select all that apply.)
A) Increased patient acuity in hospitals
B) Increased popularity of college- and university-based nursing programs
C) The growth of managed care and its influence on hospital management
D) Increased costs to hospitals for maintaining nursing programs
E) The emergence of the baccalaureate degree as the entry to technical nursing practice
7. Kirsten is a 22-year-old woman who has just been granted admission to an associate degree program at a local college. During her course of study, Kirsten should expect to complete
A) the National Council Licensure Examination (NCLEX®).
B) a preceptorship under the direction of a licensed practical (vocational) nurse.
C) a major, original research project immediately prior to graduation.
D) numerous nonnursing courses in a variety of disciplines.
8. Ben is a 30-year-old man who has applied for an accelerated baccalaureate program at a university because the 15-month program of study will allow him to accommodate his family and financial responsibilities. In order to be granted admission, what will Ben most likely require?
A) A varied work history that demonstrates initiative and responsibility
B) A baccalaureate degree in another field
C) A mentor or sponsor within the nursing field
D) Volunteer experience in a health-related setting
9. Julia has just graduated with her Bachelor of Science in Nursing degree from her state university and has begun seeking employment. However, she is anxious about her level of clinical competence due to the fact that she completed far fewer clinical hours than many practicing nurses. Which of the following has the potential to ease Julia’s transition to practice?
A) Completing a residency or internship at the hospital where she will be employed
B) Auditing courses in a nonnursing, health-related discipline
C) Working for several months as a nursing assistant in order to gain confidence
D) Taking online courses in advanced nursing practice
10. According to the ANA Position Paper on Educational Preparation, which of the following four individuals is adequately prepared to provide care?
A) A nursing assistant who has just completed an on-the-job training program in a local hospital
B) A nurse who graduated from a hospital-based diploma program
C) A nurse in a high-acuity setting who possesses an associate degree in nursing (ADN) degree
D) A nursing assistant who graduated from the training program at a community college
Chapter 3: Credentials for Healthcare Providers
1. What is the major advantage of “sunset laws”?
A) Nurses can modify their standards of practice on a daily basis.
B) They guarantee that the legislature will review and evaluate agencies and programs.
C) The legislature can close facilities that do not meet governmental requirements.
D) Facilities must renew their accreditation in a specified amount of time.
2. A nurse who is licensed to practice in Pennsylvania decides to seek a nursing position in Florida. This nurse would obtain this license by which of the following methods?
A) Licensure by endorsement
B) Licensure by examination
C) Licensure by renewal
D) Reciprocal licensure
3. A nursing board asks the court to stop a nurse from practicing until it investigates allegations that the nurse was providing care while under the influence of alcohol. What is the name of the process that allows this action?
C) Injunctive relief
D) Court investigation
4. Which of the following is a recommendation of the Institute of Medicine report Health Profession Education: A Bridge to Quality (2003)?
A) Developing separate core competencies to regulate each health profession
B) Revising the processes of accreditation bodies to require outcomes related to core competencies
C) Allowing each profession to educate, practice, and dialogue within its own boundaries
D) Changing healthcare workforce regulations based on what is termed a “safe” focus
5. A nurse administers insulin to a diabetic patient via an insulin pump. Based on the NCLEX®examination, this action would fall under which of the categories of client needs?
A) Safe effective care environment
B) Health promotion and maintenance
C) Psychosocial integrity
D) Physiological integrity
6. A nurse who has provided care in acute settings for several years has begun the process of gaining additional credentials. Which of the following statements best describes credentials?
A) Credentials indicate that an individual has demonstrated a continuing commitment to competence.
B) Credentials recognize an individual’s professional superiority to his or her peers.
C) Credentials indicate that an individual has met specific criteria and standards.
D) Credentials indicate that an individual has the authority to direct practice in a particular care setting.
7. After completing an associate degree in nursing and passing the NCLEX-RN® examination, a nurse has been granted a license to practice. A license to practice provides the nurse with
A) formal recognition of the nurse’s graduation from an accredited school of nursing.
B) legal permission to practice the nursing profession.
C) the authority to practice nursing in any state.
D) recognition of advanced learning and competence in a particular care setting.
8. The students and faculty of a school of nursing are pleased that the school has recently been granted a renewal of its current accreditation. Accreditation of a school of nursing is based primarily on which of the following?
A) The proportion of graduates who pass the NCLEX-RN®
B) The academic credentials of faculty members
C) The findings of an external review committee
D) The overall contribution of the school to the body of nursing knowledge
9. A state board of nursing is legally empowered to carry out the provisions of the Nurse Practice Act. Which of the following activities best demonstrates the mandate and jurisdiction of a state board of nursing?
A) Advocating for nurses during labor negotiations
B) Organizing information campaigns to enhance the public perception of the nursing profession
C) Specifying the way that nursing care is organized in public hospitals
D) Establishing the standards that nurses must meet in order to be licensed
10. A registered nurse who completed her education in the Philippines and who is in the process of immigrating in the United States is attempting to obtain a license to practice in New Jersey, her intended state of residence. In order to obtain a license, the nurse will primarily be in contact with
A) the New Jersey Board of Nursing.
B) the American Nurses Association (ANA).
C) one of the accredited schools of nursing in New Jersey.
D) the National Council of State Boards of Nursing, Inc. (NCSBN).
Chapter 4: Making Professional Goals a Reality
1. Which organization developed the most definitive statements on the competencies needed by the newly licensed practical nurse (PN) and the RN?
A) National Council of State Boards of Nursing (NCSBN)
B) American Association of Nurses (ANA)
C) National League for Nursing (NLN)
D) American Association of Colleges of Nursing
2. In what type of healthcare setting are the most RNs currently employed?
A) Ambulatory care centers
B) Doctor’s offices
C) Acute care hospitals
D) Long-term care facilities
3. Which of the following statements accurately reflects what employers generally should expect when hiring a newly graduated RN?
A) The RN should be proficient with the documentation system used by the institution.
B) The RN should be able to perform all nursing skills, enabling him or her to work independently.
C) The RN should function with speed comparable to that of the other nurses.
D) The RN should be able to develop plans of care and follow plans developed by the agency.
4. A nurse decides to apply for a position in a hospital in her hometown. Which of the following statements provides good advice for her job quest?
A) She should call the human resources department and speak to the person who is in charge of hiring nurses.
B) She should include a cover letter with her résumé that is no more than two pages long and briefly reiterates the information found in the résumé.
C) She should invest in a professionally prepared résumé to make a better impression on potential employers.
D) She should focus her résumé on accomplishments and use active verbs to describe her skills.
5. Which of the following is a recommended guideline when resigning a position?
A) Provide the employer with 2 weeks to seek a replacement.
B) Clearly state the details if you wish to be compensated for any vacation or holiday time accrued.
C) If resigning because of problems in the work setting, it is a good idea to put the reason in the resignation letter.
D) Place comments regarding positive factors experienced in the workplace in a separate correspondence from the resignation letter.
6. A student nurse is scheduled to graduate in a few weeks and is preparing to begin searching for employment. Which of the following statements best conveys an aspect of the current job market for nurses?
A) Most nursing graduates are expected to perform in the role of a nursing assistant or practical (vocational) nurse after graduation.
B) The majority of nursing opportunities for new graduates are in international settings.
C) Job openings in acute care have decreased in many places but long-term care openings continue to grow.
D) The increasing severity of the nursing shortage means that job opportunities for nursing graduates are greater than ever.
7. A recent nursing graduate is attempting demonstrate the competencies that she learned as a nursing students and to reconcile the expectations of her new colleagues and employer with her own abilities. Which of the following tasks is the most important and most frequently performed?
A) Helping patients and families navigate the healthcare environment
B) Applying the principles of infection control and standard precautions
C) Initiating vascular access and maintaining peripheral and/or central IV access
D) Liaising with members of other health disciplines to ensure safe and continuous care
8. Healthcare institutions expect that nursing graduates will be able to apply their theoretic knowledge for safe client care. Which of the following actions best demonstrates this?
A) Creating a nursing care plan for a newly admitted patient
B) Responding appropriately to a patient complaining of chest pain
C) Advocating for a patient’s interests with members of other disciplines
D) Conducting a thorough and thoughtful search for nursing employment
9. The expected competencies of new nursing graduates are not standardized and can vary between institutions and organizations. Most nursing and healthcare organizations, however, agree that recent graduates should be able to use the nursing process in a systematic way. Which of the following nursing activities best exemplifies this competency?
A) The nurse identifies a nursing diagnosis of Impaired Skin Integrity based on an assessment and plans to reposition the patient.
B) The nurse administers an ACE inhibitor to a patient with high blood pressure.
C) The nurse makes a referral to occupational therapy for a patient with a neurological deficit.
D) The nurse attends an inservice on pain control that is conducted by a nurse educator.
10. A patient has just been transferred to the acute medicine unit from the intensive care unit and the patient’s arterial line has not yet been discontinued. The nurse on the acute medicine unit is a recent graduate and does not have experience in caring for an arterial line. As a result, the nurse is unsure how to safely address this aspect of the patient’s care. How should the nurse best respond?
A) Look up arterial lines in the policy and procedures manual on the unit.
B) Inform the unit manager that this patient assignment is inappropriate.
C) Enlist the help of a more senior nurse on the unit.
D) Have the patient transferred back to the intensive care unit.
Chapter 5: The World of Healthcare Employment
1. What is the basic tenet of “shared governance”?
A) It allows nursing staff and management to be involved in decision-making.
B) It establishes the control of the institution over the actions of the nursing staff.
C) It allows the administrative decision area to be controlled by management.
D) It supports the traditional role of the supervisor as one who hires, evaluates, promotes, and fires.
2. A nurse is assigned for the care of each patient from the time the patient is admitted to the hospital until that patient’s discharge. What system of care delivery is most likely in place?
A) Functional care
B) Primary care
C) Modular care
D) Team care
3. Nurses working in a hospital initiate a negotiating session in which they offer to take a pay cut to allow management to provide job security and to hire more nurses to alleviate understaffing. What is the term for this type of session?
A) Interest-based bargaining
B) Collective action bargaining
C) Concession bargaining
D) Good faith bargaining
4. Nurses decide to go on strike to try to force improvement in the quality of patient care in their facility. Once the strike is resolved, what are their options for being rehired by the facility under the “reinstatement privilege” that is in effect in their contract?
A) They will be rehired after the strike whether or not it is decided that the strike was lawful.
B) They will be rehired after the strike as positions become available provided they have not engaged in unfair labor practices.
C) They will be rehired to replace nurses hired during the strike who were hired to replace them.
D) They will be rehired at their former job as soon as the strike is resolved.
5. Which of the following statements accurately reflects the general use of the grievance process by nurses?
A) Grievances usually are related to interpretations of a contract or to policies and procedures.
B) Although either the management or an employee can file grievances, in most instances it is management that initiates the case.
C) A grievance involves informal talk between the management and the employee until the issue is resolved.
D) Employees may have grievances about the contract negotiation process itself.
6. As part of the development of a new inner-city clinic, a group of nurses and members of other health disciplines have drafted a mission statement for the clinic. This statement will most likely specify
A) the priorities for the health of the identified population.
B) the main goals and functions that the organizers envision for the clinic.
C) the philosophies and beliefs that underlie the existence and functioning of the clinic.
D) the health outcomes that the organizers see as currently lacking in the community.
7. Which of the following conditions must be met in order to ensure the efficient and effective operation of a healthcare organization?
A) Span of control must be kept as narrow as possible.
B) The chain of command must be explicitly and clearly delineated.
C) The formal organizational structure must closely mimic the informal relationships that exist (the “grapevine”).
D) Registered nurses must occupy positions in employee, middle management, and executive roles.
8. A nurse has concerns about some of the practices on the hospital unit and met with the unit manager to explain these concerns. After the meeting, the nurse felt misunderstood and rebuffed by the manager. How should the nurse determine who in the organization to meet with next?
A) Consult with the hospital bureaucracy
B) Enlist the help of a union representative
C) Ask colleagues about who is most influential in the organization
D) Refer to the hospital’s chain of command
9. There is general agreement on a postsurgical unit that the admission assessment template that is used is lengthy, unwieldy, and includes many parameters that are not relevant to the care of the patient population on the unit. Which of following aspects of amending the assessment template best exemplifies the concept of shared governance?
A) Managers and nurses cooperatively make a change and share accountability for the outcomes.
B) The unit manager consults with nurses and members of other disciplines prior to changing the document.
C) The decision-making process reflects the chain of command that exists at the hospital.
D) Nurses collectively present the change in practice to the manager, who is then accountable for the outcomes of the change.
10. The staff, the administrators, and the executives of a large, urban hospital are currently celebrating the fact that the hospital has recently been granted Magnet Recognition by the American Nurses Credentialing Center (ANCC). This designation suggests that the hospital
A) pays nurses higher wages than the national median.
B) has lower staff turnover than most hospitals.
C) integrates the principles of evidence-based practice into care.
D) has a committed and responsive bureaucracy.
Chapter 6: Understanding the Healthcare Environment and Its Financing
1. Which of the following clients would be a good candidate to receive care in an assisted-living facility?
A) A 30-year-old victim of a car accident who has been in a coma for the past 2 months.
B) A 78-year-old widower who is living independently but needs help with preparing meals, doing laundry, and remembering to take his medications.
C) A husband and wife approaching retirement age who have no difficulty with ADLs but desire to “age in place.”
D) A 72-year-old woman diagnosed with Alzheimer disease who is described by her daughter as having “good days and bad days.”
2. Mr. Kline is a construction worker who is recovering from surgery on his dominant hand that he injured on the job. Which member of the healthcare team would the nurse contact to help Mr. Kline learn how to feed himself using modified utensils?
A) Registered physical therapist
B) Doctor of osteopathy
C) Registered dietitian
D) Occupational therapist
3. Which of the following is a current trend related to the education and scope of practice of healthcare providers within the healthcare system?
A) The Flexner Report limited the involvement of hospitals in research and education of medical students, resulting in a decrease in internships and residencies.
B) Pressure from insurers has mandated an increased use of specialty physicians over general practice physicians.
C) There is a short supply of qualified individuals in most health occupations, including nursing.
D) As the healthcare system has grown more and more complex, it is imperative for one individual educated to a specific role, to manage all aspects of care.
4. Which of the following statements is an accurate representation of the nature of healthcare coverage available worldwide?
A) In the United States, healthcare is seen as a right or entitlement of every citizen.
B) In developing nations, healthcare is adequately provided by governmental agencies and nonprofit organizations, such as the World Health Organization.
C) The US healthcare system has been simplified by the existence of standards for funding and controlling healthcare.
D) In most of the industrialized world, governmental healthcare systems are in place to accomplish overall health outcomes.
5. Mr. Gomez is a patient on Medicare receiving care in a hospital following cardiac surgery. What method would be used to determine payment for the services provided for this client?
A) Resource utilization groups
B) Minimum data sets
D) Diagnosis-related groups
6. A nurse provides care in a hospital that is owned and operated by the Roman Catholic Church. According the classification system of healthcare organizations that is based on ownership, how would this hospital be classified?
A) Proprietary corporation
B) Sole proprietorship
C) Nonprofit organization
D) Community organization
7. The number and importance of hospitals increased greatly during the development of the American healthcare system. Which of the following phenomena have contributed to this trend? (Select all that apply.)
A) Increased health literacy of the American public
B) The development of more sophisticated medical technology
C) Increased incidence and prevalence of chronic diseases
D) The development of professional nursing
E) The growth of the health insurance industry
8. Historically, health insurance was for hospital care and related services only. What effect did this characteristic have on the health behaviors of individuals enrolled in such plans?
A) Some individuals neglected health promotion measures.
B) Many individuals began to pay out-of-pocket for superior care.
C) Individuals avoided hospitals because of the association of hospitals with illness.
D) Some individuals who qualified for Medicare did not enroll in the program.
9. In 2010 the US Congress passed the Patient Protection and Affordable Care Act, commonly referred to as the Healthcare Reform. This Act aims to change the provision of healthcare in the United States by
A) bringing the health insurance industry under the umbrella of the federal government.
B) increasing the number of nonprofit and public hospitals.
C) placing limits on healthcare costs and limits on the growth of health maintenance organizations (HMOs).
D) requiring every American to be enrolled in some type of health insurance plan.
10. A 63-year-old man has qualified for Medicaid. His qualification for Medicaid will be based primarily on what factor?
A) His medical history and present health status
B) His income
C) His employment history
D) His military service
Chapter 7: Legal Responsibilities for Practice
1. Which of the following statements accurately reflects an element of the crisis surrounding liability insurance in the United States?
A) Professional liability insurance does not provide coverage when the nurse assists in an emergency.
B) Malpractice insurance premiums are not affordable for nurses in independent advanced practice and traditional nursing roles.
C) Laws in some states are being amended to restrict the monetary liability of any party according to the percentage of responsibility.
D) Nurses are being named in fewer lawsuits, but the judgments being awarded are larger.
2. The law requires that a person give voluntary and informed consent for medical treatment. Which of the following statements accurately describes this legal obligation?
A) It is the responsibility of the nurse to obtain informed consent.
B) Informed consent must be obtained in the form of written documentation.
C) A blanket consent for “any procedures deemed necessary” is usually considered adequate consent for specific procedures.
D) The courts do not accept the client’s medical condition alone as a valid reason for withholding information when seeking consent.
3. A nurse working in a hospital setting is accused of malpractice. Which statement accurately represents a legal element of this type of negligence?
A) Malpractice is present only if a breach of duty was the cause of the harm.
B) When the harm is not clear and needs to be proved in court, the legal term res ipsa loquitur is used.
C) Breach of duty is clearly defined as the expression of malicious intent.
D) A breach of duty is a failure to act as a prudent professional according to standards of care designated by the federal government.
4. An attorney representing a client in a malpractice case attends a deposition. What might occur in this proceeding?
A) A sworn, verbatim record is made by a court reporter.
B) A settlement is made out of court.
C) A legal proceeding presided over by a judge takes place in a courtroom.
D) Damages are awarded to the plaintiff.
5. A nurse is called to testify as an expert witness in a malpractice suit. Which of the following guidelines contains prudent advice for this nurse?
A) Volunteer as much information as possible when explaining medical procedure.
B) Use medical jargon as appropriate to describe the treatment provided by the defendant.
C) Pause during the testimony to allow your attorney to object if appropriate.
D) Discuss your testimony with the opposing attorney before the court date.
6. A nurse is aware that the nurse practice act in her state provides the legal framework for her scope of practice. A nurse practice act is an example of
A) common law.
B) constitutional law.
C) enacted law.
D) judicial law.
7. The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 addresses patient rights within the healthcare system. Which of the following actions may constitute a violation of HIPAA?
A) A nurse identifies a patient whom he recently cared for on his Facebook page.
B) A nurse completes a charting entry without providing her initials after the entry.
C) A nurse inserts a central venous catheter without the consent of the patient.
D) A nurse makes a crude comment to a patient while providing morning hygiene.
8. The risk manager at a large, university hospital has become aware that there may be a discrepancy between a longstanding protocol on one of the hospital units and the nurse practice act of the state. Which of the following statements regarding the legal standing of institutional policies is most accurate?
A) Institutional policies do not have legal standing.
B) Institutional policies supersede enacted law but do not supersede common law.
C) Established policies may be considered common law by a court
D) Discrepancies between policies and legislation are usually resolved by professional associations such as a board of nursing.
9. Nursing practice is subject to a wide variety of laws and regulations. Which of the following actions is the clearest violation of criminal law?
A) A nurse left a patient’s bed in a raised position and the patient subsequently fell.
B) A nurse withheld opioids from a patient and then sold them.
C) A nurse left the unit before her replacement had arrived.
D) A nurse applied restraints to a patient in alcohol withdrawal without first obtaining an order.
10. On a night shift, a nurse who provides care in an inpatient psychiatric setting admitted a patient with a recent history of violence but placed the patient in a two-bed room. The patient subsequently attacked and injured the other patient in the room. Which of the following principles will be considered in the court’s determination of liability?
A) The nurse may be held liable if institutional factors are not noted to have contributed to the situation.
B) The nurse is exempt from liability if institutional protocols specify that room allocation is a nursing responsibility.
C) The nurse may be held liable provided the action was a crime.
D) The nurse may be held liable if the action constituted a violation of the standard of care.
Chapter 8: Ethical Concerns in Nursing Practice
1. A mother and a daughter are taken to the emergency room for injuries suffered in a car accident. When the mother is taken to surgery, the nurse tells her that her daughter will be fine, even though she does not know the exact extent of the daughter’s injuries. This nurse’s actions may have been guided by which of the following ethical theories?
A) Social equity and justice
B) Natural law
2. A client has advance directives for a DNR code (do not resuscitate). When the nurse is caring for this client, the client’s wife asks him to “do everything in your power to keep my husband alive.” This nurse is most likely to experience which of the following moral challenges?
A) Values clarification
B) Ethical dilemma
C) Values conflict
3. Which of the following statements accurately reflects one of the primary provisions of the ANA Code for Nurses?
A) The administrators of the healthcare facility are responsible and accountable for individual nursing practice.
B) The physician determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.
C) The nurse’s primary commitment is to the employing agency.
D) The nurse owes the same duties to self as to others.
4. A nurse helps a client work through an ethical dilemma by using an ethical decision-making framework. Which of the following statements describes a component of this process?
A) The steps of this process are distinctly different from those of the nursing process.
B) Most ethical problems have one possible solution.
C) The nurse uses the framework of his or her own values to assist the clients to make a decision.
D) The facts of a situation make a difference in the options that are possible.
5. Which of the following is an accurate guideline for reporting the chemical dependency of a colleague?
A) Confront the person you suspect, and offer assistance in obtaining treatment.
B) Be sure beyond any doubt that a problem exists.
C) Rely on an informed supervisor to assume responsibility for the problem.
D) Be aware that help and rehabilitation are only offered to the person need it following disciplinary proceedings.
6. A nurse on a palliative care unit has attended an educational inservice on ethics. Which of the following statements most accurately describes the concept of ethics?
A) Ethics offers a process that can be used to guide behavior.
B) Ethics is the expression of social and culture values, priorities, and norms.
C) Ethics is the basis for evaluating personal character.
D) Ethics is the tangible application of religious and spiritual truths.
7. Nursing involves close interaction between nurses and patients, a situation which can create the potential for boundary violations. Which of the following situations most clearly constitutes a boundaries violation?
A) A community health nurse continues weekly visits to a former client despite the fact that the client is no longer receiving care.
B) A nurse states that she is willing to advocate to the patient’s employer than the patient was genuinely ill and not feigning health complaints to gain time off work.
C) A nurse attends a family meeting at the hospital in which the patient and his family discuss the patient’s code status.
D) A nurse contacts a social worker without the patient’s knowledge because of admissions the patient has made about her substandard living conditions.
8. A few weeks ago, a nurse worked a shift with a colleague during which three oxycodone tablets went missing from the narcotic cupboard. As well, the nurse has noted that the colleague has sometimes documented the administration of oxycodone to patients only to have the patients continue to complain of pain. The nurse suspects that the colleague is taking the oxycodone from the unit for personal use. How should the nurse best follow up these suspicions?
A) Organize coworkers and the colleague’s family members to carry out an intervention
B) Contact representatives from the state board of nursing
C) Report these suspicions to the unit supervisor
D) Confront the colleague with these suspicions
9. Mr. Bains is a 70-year-old man who has been recently diagnosed with colon cancer. Mr. Bains is adamant that he does not want to undergo chemotherapy or radiotherapy, citing the unpleasant side effects and the absence of a guaranteed cure. His wife, however, is distraught that he would “give up so quickly” and begs the nurse to convince him to pursue treatment. Which of the following ethical principles would underlie the nurse’s decision to respect Mr. Bains’ informed choice?
10. An obstetrical-gynecological nurse has moved to a new region and is seeking employment. The nurse opposes the ethics of elective abortion and refuses to participate in the procedures. However, the only hospital in the immediate area is the site of numerous elective abortions. How should the nurse account for this fact when seeking employment?
A) Ask the hospital administrators to exempt her from participating in any aspect of abortion.
B) Consider applying for a nursing position that will not involve abortion.
C) Begin working at the hospital and attempt to change the hospital politically.
D) Accept a position at the hospital and then make her position known to supervisors.
Chapter 9: Bioethical Issues in Healthcare
1. A doctor performs an abortion on a woman who is unable to carry a fetus to term because of a severe risk to her health. What is the term for this type of abortion?
A) Spontaneous abortion
B) Elective abortion
C) Therapeutic abortion
D) Legal abortion
2. Which of the following statements accurately describes a characteristic of the stem cell?
A) Stem cells are not able to renew themselves.
B) Stem cells give way to specialized cells.
C) Stem cells are committed to conduct a specific function.
D) Pluripotent stem cells are derived from the patient’s own DNA.
3. A nurse is asked to obtain informed consent for a procedure to be performed on a patient who has not yet been told her cancer is terminal. Which of the following is an issue surrounding guidelines to the amount of information that should be given to this patient?
A) Under a paternalistic model of care, the locus of decision-making resides with the patient’s family, who are responsible for informing the patient.
B) Physicians basically agree on the amount and nature of the information that should be provided to the patient, but disagree on its delivery.
C) It is the responsibility of the nurse to inform the patient of matters that have not been discussed with the physician.
D) In some cultures, both physicians and families strongly believe that those who are ill should be protected from bad news.
4. Which of the following guidelines supports current practice when using behavior control on a client?
A) Methods of influence that decrease a person’s ability to think rationally should only be used when a client is not acting in his or her own best interest.
B) In many cases, the use of psychosurgery to effect a permanent change is recommended over drug therapy.
C) Methods of influence that keep relevant facts from a client should only be used with the consent of the client’s significant others.
D) Methods that work through the cognitive and affective structure of a person are preferred treatment.
5. Which of the following best describes the term rationing of healthcare?
A) Providing healthcare only to those who can afford it.
B) Providing a planned approach to the use of limited resources.
C) Asking consumers to prioritize their use of healthcare resources.
D) Requiring consumers to carry private insurance to cover healthcare not covered by the public sector.
6. During the various clinical placements that a nursing student has had during a baccalaureate program, the student has become increasingly aware of how significant bioethical issues are in the delivery of healthcare. Which of the following factors has contributed most significantly to the importance of bioethical issues in healthcare?
A) Increased health literacy among healthcare consumers
B) The development of new healthcare technologies
C) The politics of proposed universal healthcare in the United States
D) Increased incidence and prevalence of chronic health problems
7. The history of family planning in the United States has been characterized by controversies, many of which continue to the present day. Which of the following statements most accurately conveys an aspect of these controversies?
A) Protestant Christianity advocates a careful and deliberate control of the size of a population.
B) The Church of Jesus Christ of Latter Day Saints (Mormons) teach that only nonhormonal contraceptive methods may be used.
C) The Roman Catholic church states that the purpose of all sexual activity is the creation of new life.
D) Judaism teaches that family planning should be the exclusive domain of wives.
8. In vitro fertilization (IVF) is an example of assisted reproductive technology (ART) that has become more common in recent decades. However, IVF is not without controversy. Which of the following aspects of IVF is most often contentious?
A) The number of fertilized ova normally exceeds the number of children that a woman desires.
B) The success or failure of IVF rests on the genetic characteristics of sperm that comes from a man unknown to the woman undergoing the procedure.
C) IVF is most common among women who have a history of elective abortion.
D) IVF is often undertaken without the consent of a woman’s partner.
9. The advent of technology has made it increasingly difficult to define the exact point at which death occurs. Which of the following is currently the most commonly-accepted criterion for death?
A) The cessation of blood circulation
B) The inability to perform respiration spontaneously
C) Persistent lack of interaction with outside stimuli
D) The cessation of brain activity
10. After several rounds of unsuccessful in vitro fertilization (IVF), a couple has chosen to explore the use of a surrogate mother. In most states, this would involve
A) a civil court case in which a judge grants permission for the couple to proceed with surrogacy.
B) the use of a surrogate who is selected from a state-recognized list of approved surrogates.
C) the drafting of a detailed contract between the surrogate mother and the couple.
D) a covert and illegal arrangement between the couple and the potential surrogate mother.
Chapter 10: Safety Concerns in Healthcare
1. Several national organizations have addressed the issue of adverse events in healthcare settings. The National Quality Forum (NQF) of 2002 included which of the following?
A) A list of serious reportable events that was aimed at increasing public accountability
B) A cross reference of standards for nursing care with the most common adverse events in healthcare
C) A list of aims for improving the overall quality of the American healthcare system
D) An algorithm for responding appropriately to safety violations in healthcare settings
2. A nurse is aware that sentinel events that occur in the care setting must be followed up in a timely and thorough way. Which of the following occurrences would be considered a sentinel event? (Select all that apply.)
A) A nurse’s shift is cancelled at short notice.
B) A patient accesses the medication chart and takes a medication.
C) The family member of a patient physically threatens a nurse.
D) A physician makes sexually inappropriate comments to a nurse.
E) A nurse places a patient on a bedpan despite the fact that the patient can ambulate with assistance.
3. One of the safe practices identified by the National Quality Forum (NQF) is to match healthcare needs with service delivery capability. This practice is demonstrated by
A) matching the health status of a community with the specific mandate of the local hospital.
B) conducting high-risk procedures in hospitals that perform a large numbers of the same procedure.
C) encouraging Americans to seek care in healthcare institutions that have the fewest number of adverse events.
D) ensuring that hospitals are equipped and staffed to provide neither too much nor too little care.
4. The nursing leadership in the local hospital has recognized the need to minimize the number of sentinel events that occur in the hospital by implementing a number of practice improvements. These nurse leaders should recognize that the largest proportion of sentinel events involve which of the following?
A) Lapses in communication
C) Violations of care providers’ scopes of practice
D) Gaps in education and training
5. The Joint Commission has taken action to encourage healthcare organizations to reduce the incidence and impact of errors. How has the Joint Commission acted to facilitate these improvements in care?
A) By delineating the scope of practice for registered nurses and practical (vocational) nurses
B) By providing a forum for patients to report errors and substandard care
C) By funding safety education in medical schools and nursing schools
D) By standardizing the measures by which safety in hospitals is gauged
6. A senior nurse on a medical unit is aware of the role that she can play in establishing a culture of safety on the unit. What characteristic is most important to care settings that possess a culture of safety?
A) Anticoagulants, opioids, and insulin are cosigned by two nurses.
B) Physicians’ orders are entered into a computerized system rather than a handwritten section of patients’ charts.
C) Nurses feel that they can report errors, near misses, and adverse events without being punished or denounced.
D) Direct patient care is provided by ADN and baccalaureate nurses rather than practical (vocational) nurses.
7. A county hospital has recently implemented a practice change in which the SBAR technique is now used to communicate between nurses and physicians. The nurse has contacted an elderly patient’s physician to report the patient’s adventitious lung sounds and decreased oxygen saturation. Which of the following statements best exemplifies the “R” component of the SBAR tool?
A) “Mr. Young has a do-not-resuscitate order.”
B) “Mr. Young’s oxygen saturation is 86% on oxygen at 3 liters per minute by nasal prongs.”
C) “Mr. Young was admitted on January 14 with a diagnosis of failure to thrive.”
D) “I think that we should decrease Mr. Young’s IV rate.”
8. A busy operating room has begun using time outs in an effort to reduce errors and promote patient safety. What action will the care team perform during a time out?
A) Systematically teaching the patient about the risks of surgery while the patient is still in the preoperation area
B) Gathering each member of the surgical team to acknowledge and confirm that the correct surgery will be performed on the correct patient
C) Pausing to review the patient’s diagnosis and the indications for surgery
D) Completing a checklist that reviews the major areas for preoperative assessment and which contains the patient’s consent for the procedure
9. “Failure to rescue” has been defined as “deaths per 1,000 patients having developed specified complications of care during hospitalization” (AHRQ, 2007). A hospital that wishes to reduce the rate of failure to rescue should prioritize what measure?
A) Encouraging nurses to spend a greater amount of time at the bedside.
B) Implementing mandatory continuing education programs.
C) Improving the communication between members of different health disciplines.
D) Reducing distractions to nurses while they are providing care.
10. Alana is a registered nurse with an ADN degree who floats between several different medical and surgical units of a hospital. Today was Alana’s fifth 12-hour shift in a row and she committed a medication error while providing care for one of the four patients to whom she was assigned. What factor is most likely to have contributed to this adverse event?
A) The fact that Alana has an ADN degree
B) The fact that Alana floats between several units
C) The fact that Alana was working overtime
D) The fact that Alana was responsible for four patients
Chapter 11: The Nursing Profession and the Community
1. A goal of community nursing is to provide primary prevention from disease. Which of the following nursing actions reflect this goal?
A) A nurse creates a pamphlet discussing heart-healthy foods and distributes it in the neighborhood community center.
B) A nurse starts an intravenous line on a dehydrated baby who has been brought to the emergency department.
C) A nurse performs range-of-motion exercises for a patient in traction.
D) A nurse repositions an elderly patient confined to a wheelchair to avoid the formation of pressure ulcers.
2. A nurse decides to pursue a career in community-based nursing. Which of the following statements represents the environment in which the nurse will be working?
A) Community-based nursing is limited to work in public clinics, schools, and industry.
B) The key to community-based settings is that the nurse is in charge.
C) The nurse serves as an educator, guide, and resource person and determines the action taken by the client.
D) Care in the community is cost-effective.
3. The movement of a client from acute care to a long-term nursing care facility involves planning to provide continuity of care. What is the term for this type of planning?
A) Discharge planning
B) Comprehensive planning
C) Ongoing planning
D) Transition planning
4. A nurse is called into work to perform triage in the aftermath of an earthquake. Which of the following are the expected responsibilities of this nurse?
A) Set up and monitor IV lines.
B) Prepare the emergency room for multiple victims.
C) Screen victims to prioritize treatment.
D) Check available blood products and assist with transfusions.
5. A client asks a nurse for help in obtaining an alternative healthcare provider. Which of the following is an accurate fact regarding alternative care that the nurse should share with this client?
A) Most alternative healthcare practitioners do not have education-based credentials to practice their medicine.
B) Alternative providers are not usually included in the federal HIPAA legislation that mandates confidentiality in conventional healthcare settings.
C) The cost of alternative therapy is never covered by insurance carriers or healthcare plans.
D) It is easy to find accurate safety and efficacy data for alternative medicine on the Internet.
6. There is an increasing trend for nursing care to move from the hospital setting into the community. Nurses who are to provide excellent care in a community setting should prioritize which of the following?
A) Integrating culture and family into the planning and delivery of care
B) Becoming more assertive in client education and the planning of client care
C) Encouraging clients to limit their interactions with physicians
D) Teaching clients to replace biomedical interventions with complementary therapies
7. In spite of the important role that hospitals play in American healthcare, there is growing importance of community-based healthcare and community-based nursing. Which of the following statements best conveys a central aspect of the philosophy of community care?
A) The client is in charge of his or her health and healthcare in the community.
B) Nurses maximize their scope of practice in noninstitutional settings.
C) Community settings allow for the greatest number and variety of treatment options.
D) The nurse becomes the key member of the healthcare team in a community setting.
8. Mr. Hammond is a 70-year-old man with a diagnosis of type 1 diabetes who developed a diabetic foot ulcer earlier this year. He has recently been discharged from the hospital and now requires regular wound care. Karen is a community health nurse who provides wound care for Mr. Hammond twice weekly. Which of Karen’s actions is most likely to empower Mr. Hammond?
A) Encourage Mr. Hammond to acknowledge his contribution to the development of his wound.
B) Provide information to Mr. Hammond that matches his expressed needs.
C) Encourage Mr. Hammond to involve members of his family in his care.
D) Delegate wound care to Mr. Hammond and reduce the frequency of her visits.
9. An elderly female client who resides in the community tends to defer decisions regarding her care to her eldest son. How should the community health nurse respond to the client’s reluctance to make independent decisions?
A) Discuss this observation with the client and her son in an open manner and explore alternatives.
B) Organize care so that it takes place at times when the son is not present in the home.
C) Accommodate this aspect of the client’s family dynamics when planning and carrying out care.
D) Teach the client assertiveness skills that she can apply in her interactions with her son.
10. A client with a long-standing diagnosis of chronic obstructive pulmonary disease (COPD) has been enrolled in a disease management program. Which of the following activities will be prioritized in this program?
A) Providing comprehensive and evidence-based care of the client’s COPD
B) Creating collaborative relationships between the client and the care team
C) Ensuring that the client qualifies for Medicare and Medicaid
D) Liaising between the client and his health maintenance organization (HMO)
Chapter 12: Initiating the Leadership and Management Role
1. Which of the following statements accurately reflects the nurse’s responsibility for patient outcomes in today’s workplace?
A) Tasks can be delegated, but accountability cannot be delegated.
B) In today’s environment, authority is more often given to management.
C) Most nurses who are accountable have the authority to affect the situation or effect change.
D) Nurses are protected against legal action being taken in cases of malpractice in the hospital setting.
2. Which of the following statements accurately describes a basic guideline for using communication skillfully?
A) Managers should communicate how to perform a task even if it is something the subordinate has already learned.
B) Managers should not be afraid of making judgmental statements when dealing with a subordinate who has broken policy rules.
C) Managers should attempt to formulate a response to an individual who is still speaking to avoid awkward pauses in the conversation.
D) Managers should present direction as briefly as possible while still providing adequate data.
3. What is the primary objective of a performance appraisal?
A) Establish written documentation of incompetent behavior to facilitate dismissal
B) Maintain and develop employee performance
C) Establish criteria for accreditation standards
D) Determine who receives pay raises
4. Which of the following is a characteristic of an effective performance evaluation system?
A) The appraisal system operates outside of the scope of administration.
B) Employees do not know in advance who will be evaluating them.
C) The final disposition of the appraisal is shared with the employee.
D) Evaluation concentrates on the personality of the employee.
5. A nursing student finds that she has difficulty with procrastination. Which of the following is a recommended guideline to help this student manage her time?
A) Start working on a project for 10 minutes, and quit if tired or bored.
B) Schedule 2 or 3 days a week in which to concentrate her tasks.
C) Avoid spending the time it takes to make to-do lists.
D) Schedule down-time first and work second.
6. A nursing leader has expressed a desire to foster the characteristics and behaviors associated with transformational leadership. Which of the following actions best demonstrates transformational leadership?
A) The leader makes it clear to employees that positive work performance will be rewarded and that sub-standard performance will bring consequences.
B) The leader ensures that decisions are based on the consensus of every employee.
C) The leader prioritizes the needs of each individual employee over the interests of the larger organization.
D) The leader takes action to build trust and relationships between him or her and the employees.
7. The manager of a hospital unit has unilaterally decided on a change in the way that overtime is distributed among the nursing staff and has followed up this decision with an e-mail to all employees. What leadership style is exemplified by this manager?
A) Participative leadership
B) Permissive leadership
C) Laissez-faire leadership
D) Autocratic leadership
8. Experts have identified a close relationship between the practice of transformational leadership and the empowerment of employees. What action should a nursing leader take to foster employee empowerment?
A) Have the performance of each employee appraised by his or her peers rather than by a manager or leader.
B) Share information as openly as possible in order to make employees aware of problems.
C) Adopt a hands-off approach in order to allow leadership to organically emerge from within the group of employees.
D) Eliminate the practice of conducting performance appraisals of employees.
9. Jennifer is a registered nurse who works in a busy emergency department. As one of her goals for the current year, Jennifer has resolved to develop her emotional intelligence. How should Jennifer best meet her goal?
A) Try to remove emotion from her clinical decision-making whenever possible.
B) Become more assertive when responding to the emotional responses of patients, families, and coworkers.
C) Become more aware of the way that her emotions function and how they influence her actions.
D) Try to limit her expressions of emotion to times when she is not interacting with others.
10. A recent nursing graduate has asked an expert nurse how best to foster her leadership abilities, since she wishes to explore leadership opportunities later in her career. How should the expert nurse best respond?
A) Even if you don’t trust a decision that you have to make, act like you chose the best option.
B) Become as specialized as possible in your nursing experience.
C) Develop your interpersonal skills by having a wide variety of interactions.
D) Become as assertive as you can and take every opportunity to guide the behavior of others.
Chapter 13: Working with Others in a Leadership Role
1. The nature of healthcare requires the development of healthcare teams and collaboration among its members. Which of the following statements represents an element of this teamwork?
A) Each group member of a team is the leader of the team.
B) The organization sets the goals for its teams.
C) Communication patterns in teams flow both up and down.
D) Team members are not legally responsible for decisions and outcomes.
2. A client receives the care of a physician, a nurse, an occupational therapist, and a counselor working together as a team. What is the term for this type of healthcare?
A) Cross-discipline healthcare
B) Comprehensive healthcare
C) Holistic healthcare
D) Interdisciplinary healthcare
3. A nurse will soon become a member of a newly-established care team. Which of the following is a goal of team building?
A) Acknowledging individual achievements
B) Providing client care based on the direction of the team leader
C) Creating a type of synergy when addressing client care
D) Allowing care to be determined by nurses who are not “too close” to the situation
4. A registered nurse is responsible for organizing the care at a facility that has several UAPs. Which of the following tasks can an RN delegate to a UAP?
A) Performing an ongoing assessment
B) Answering call lights
C) Administering medications
D) Counseling clients
5. A nurse recognizes the importance of safely and efficiently delegating tasks in order to achieve a high standard of care. Which of the following is one of the NCSBN’s five “rights” of delegation?
A) Right education
B) Right assessment
C) Right circumstances
D) Right motivation
6. A nurse is aware of the pivotal role that motivation plays in the formation of effective teams and the provision of excellent nursing care. Which of the following actions is most likely to motivate a team member?
A) Ensure that the consequences of substandard performance are well-known.
B) Publicize those individuals who have made exceptional contributions and point out those who have failed to perform adequately.
C) Openly acknowledge team members who have made a particularly valuable contribution.
D) Be clear that only the highest levels of performance are acceptable to the team.
7. A registered nurse is responsible for overseeing the care that is provided in a long-term care facility. The skills mix at the facility includes the registered nurse, a practical nurse, and several unlicensed assistive personnel (UAP). Which of the following statements is true of the delegation that the RN performs?
A) The RN is accountable for the care that the other members of the team provide.
B) The RN may only delegate tasks that are outside of her own scope of practice.
C) The RN can delegate tasks that are outside the PN’s or UAPs’ scope of practice if she first provides adequate teaching.
D) Once a task is delegated, the person who performs the tasks is solely responsible for the outcomes.
8. Healthcare is a field that continues to undergo constant and profound change, both planned and unplanned. Which of these situations is an example of reactive change?
A) Hospital administrators have announced a desire to implement the principles of evidence-based practice.
B) A hospital’s accreditation review revealed systemic problems and the hospital has been directed to resolve these.
C) The introduction of automated medication dispensing machines at a hospital is scheduled for later this year.
D) A transition will soon begin whereby the practical (vocational) nurses will begin to practice within their full scope.
9. Kurt Lewin’s force-field theory of change is one of the most widely accepted and remains in current use today. The central concepts of this theory of change include
A) the forces that govern intrinsic and extrinsic motivation.
B) the relationship between driving forces and restraining forces.
C) the forces of resilience and inertia in an organization.
D) the relationship between the will for change and the ability to effect change.
10. A nurse has identified glaring inefficiencies in the way that care is organized on a medical unit. Which of the following tasks will this nurse perform if he or she is to act as a change agent?
A) Informing others about the need for change
B) Ensuring that others comply with any change that is implemented
C) Establishing punishments and rewards to foster compliance with change
D) Evaluating the long-term outcomes associated with change
Chapter 14: Facing the Challenges of Today’s Workplace
1. A nurse begins to feel comfortable on her unit and views client care in terms of long-range goals. She is able to prioritize among clients and deliberately plan her actions, which may still lack speed and flexibility. Which of Benner’s levels of function has this nurse achieved?
B) Advanced beginner
2. A novice nurse apprehensively reflects on what she considers to be an impossible task of delivering quality care on her ward as it is assigned to her. What is the name of this phenomenon first coined by Marlene Kramer?
B) Reality shock
C) Culture shock
D) Job disorientation
3. A counselor diagnoses a critical care nurse with having the syndrome known as burnout. Which of the following is a characteristic of this condition?
A) Burnout occurs when a nurse first enters the workplace and is overwhelmed by the workload.
B) All of the symptoms of burnout are psychological in nature.
C) Burnout is accompanied by a decreased ability to function on the job and at home.
D) Burnout occurs less often in high-energy areas, such as critical care or burn units.
4. A hospital manager is accused of quid pro quo sexual harassment. Which of the following is an action that might have been involved?
A) Making persistent unwanted attempts to initiate a personal relationship
B) Granting job-related benefits in return for sexual favors
C) Using suggestive or obscene language
D) Making direct sexual advances
5. A hospital manager evaluates the workplace to ensure that ergonomics are working. Which of the following statements describes this scientific theory?
A) Ergonomics is the study of client outcomes related to economic theories in healthcare.
B) Ergonomics empowers clients to have a voice in their own plan of care.
C) Ergonomics ensures that jobs are fitted to the physical abilities of the employees.
D) Ergonomics provides guidelines for delegating responsibilities for client care.
6. Researchers have noted a high incidence of burnout among nurses. Which of the following nurses most likely faces the highest risk of burnout?
A) An experienced nurse who has long neglected her own physical health and who leads a sedentary lifestyle.
B) A nurse who provides pediatric palliative care and who is disillusioned with the overall quality of care on the unit.
C) A nurse who has recently graduated with an ADN degree and begun working in a busy, inner-city emergency department.
D) A nurse who is few months away from retirement from her current position in community health.
7. Melissa is a nurse who graduated earlier this year with a baccalaureate degree in nursing and immediately began working on a busy surgical unit with a high turnover of both the patients and the staff. As a result, Melissa has found the adjustment to full-time employment particularly stressful. Which of the following actions should Melissa take in order to manage the stress in her life?
A) Schedule a vacation for later in the year and focus on this upcoming trip when she is experiencing high levels of stress.
B) Reduce her workload to part-time and supplement this with casual employment on a lower-stress unit.
C) Be vigilant in personal habits that result in adequate rest, a healthy diet, and adequate physical exercise.
D) Reduce or eliminate the specific interactions in the clinical setting that cause her the most stress.
8. A recent nursing graduate has become overwhelmed with reality shock in recent weeks, despite the fact that he secured a job in the setting that was his first choice. This nurse’s best response to his experience with reality shock is to
A) confront the manager of the unit with the details of his experience.
B) reduce the performance expectations that he places on himself.
C) prioritize physical assessments and interventions over patients’ psychosocial needs.
D) seek input from a trusted nurse who can act as a coach or mentor.
9. A nurse who provides care in a busy ambulatory clinic knows that there are numerous occupational hazards associated with the provision of nursing care. What is the employer’s responsibility in minimizing the nurse’s risk of experiencing an injury or infection?
A) The employer must provide all the necessary supplies and equipment to prevent injuries and infections.
B) The employer must ensure that staffing levels are maintained at a level specified by the state board of nursing.
C) The employer must have dedicated occupational health officers present at all times.
D) The employer must release nurses from tasks that may present a threat to their health.
10. Racial and ethnic discrimination has been identified as a reality within healthcare institutions. Which of the following goals for the nursing profession is most appropriate?
A) The nursing workforce should transcend racial and ethnic categorization and should not be appraised through this lens.
B) The nursing workforce should have fewer Caucasian members and more racial/ethnic minorities.
C) The nursing workforce should be made up of members from as many cultures as possible.
D) The nursing workforce should reflect the population for whom it provides care
Chapter 15: Valuing the Political Process
1. A nurse practicing in Alabama accepts a position in Connecticut. Which of the following would be the best resource to consult for a legal definition of nursing in that state?
A) American Association of Nurses
B) Nurse Practice Act
C) The American Journal of Nursing
D) National League for Nursing
2. A nurse attempts to become more involved in the political process. Which of the following statements accurately describes the political arena in which this nurse may become involved?
A) Nurses can be involved in the political process as individuals, but they are far more effective when working in groups.
B) Most traditional nursing organizations are government-mandated groups and therefore are deeply involved in political activity.
C) Political action committees are nonprofit organizations that are registered as political action groups and are free to try to affect the political process.
D) Nurses who testify for decision-making bodies must do so as an official representative of a nursing organization.
3. Which of the following is an accurate representation of politics at the local level?
A) Once budgeted funds are allocated to an objective, more funds are made available for other projects.
B) Local budgets are generally mandated by federal agencies.
C) Support for community services may depend on whether knowledgeable nurses voice their advocacy.
D) Local political decision-making sessions are usually closed to the public.
4. A nurse decides to become a member of NANDA-International (NANDA–I). Which of the following areas of the nursing process is he or she most likely interested in developing?
5. What is the main purpose of the National Council of State Boards of Nursing (NCSBN)?
A) Provide accreditation of baccalaureate and higher degree programs
B) Recognize those with superior ability and leadership potential, and those who have made important contributions to nursing
C) Provide a forum for the legal regulatory bodies to act together in the regulation of nursing practice for the protection of the public
D) Unite the interests of nursing with those of the community in support of excellence in nursing education
6. A nurse has expressed her intention to draft a letter to her state senator but the nurse’s colleagues have characterized this effort as “a waste of time and energy”. Which of the following statements provides the most accurate rationale for nurses’ involvement in the political process?
A) Involvement in the political process can lead to the effective allocation of resources.
B) Political action increases the status and influence of the nursing profession as a whole.
C) Involvement in the political process demonstrates responsibility and accountability by nurses.
D) Political involvement by nurses increases the influence of women in society and in government.
7. A nurse has become aware of sweeping changes that are proposed for the state budget which may have ramifications for the funding of the inner-city clinic where the nurse provides care. In order to influence the decision-making process the nurse should first
A) tell clients of the clinic that their healthcare is in jeopardy.
B) clearly communicate her views on the matter to the appropriate legislators.
C) examine the systems and processes at the clinic to see where efficiency could be improved.
D) approach the media with examples of the way that funding changes will hurt patient and client outcomes.
8. The federal government operates in the healthcare field in complex ways that involve dozens of agencies. Which of the following groups are examples of the involvement of the federal government in healthcare? (Select all that apply.)
A) Centers for Disease Control and Prevention (CDC)
B) Department of Health and Human Services (HHS)
C) National Institutes of Health (NIH)
D) Center for Medical & Medicare Services (CMS)
E) National League of Nursing (NLN)
9. A group of nurses have organized with the purpose of promoting an amendment to the nurse practice act that governs the profession. This group should direct their efforts toward what level of government?
10. A nurse has initiated a letter-writing campaign in an effort to increase the funding for school nursing programs in local high schools. A colleague of the nurse, however, has pointed out that the monies for such programs originate with the federal government. Which of the following statements best describes the relationship between federal funding and local healthcare programs?
A) Federal funding is made available only in cases where the local tax base is insufficient to fund programs.
B) Local contributions to health promotion programs are matched by the Department of Health and Human Services.
C) Decisions around the allocation for federal funding are often made at the local level.
D) Federal representatives control budgets at a local level but are obliged to consider input from local residents.
Chapter 16: Applying Research and Technology to Nursing Practice
1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on the incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented findings at a level of significance of <0.01. This indicates that
A) the control group and the experimental group were more than 99% similar.
B) the findings of the study have less than 1% chance of being attributable to chance.
C) the effects of the intervention were nearly zero.
D) the clinical significance of the findings was less than 1:100.
2. A nurse has read a qualitative research study in order to understand the lived experience of parents who have a neonatal loss. Which of the following questions should the nurse prioritize when appraising the results of this study?
A) “How well did the authors capture the personal experiences of these parents?”
B) “How well did the authors control for confounding variables that may have affected the findings?”
C) “Did the authors use statistical measures that were appropriate to the phenomenon in question?”
D) “Were the instruments that the researchers used statistically valid and reliable?”
3. A nurse has expressed skepticism to a colleague about the value of nursing research, claiming that nursing research has little relevance to practice. How can the nurse’s colleague best defend the importance of nursing research?
A) “The existence of nursing research means that nurses are now able to access federal grant money, something that didn’t use to be the case.”
B) “Nursing research has allowed the development of masters and doctoral programs and has greatly increased the credibility of the profession.”
C) “The growth of nursing research has caused nursing to be viewed as a true profession, rather than simply as a trade or a skill.”
D) “The application of nursing research has the potential to improve nursing practice and patient outcomes.”
4. Tracy is a nurse with a baccalaureate degree who works in the labor and delivery unit of a busy urban hospital. She has noticed that many new mothers abandon breast-feeding their babies when they experience early challenges and wonders what could be done to encourage more women to continue breast-feeding. What role is Tracy most likely to play in a research project that tests an intervention aimed at promoting breast-feeding?
A) Applying for grant funding for the research project
B) Posing the clinical problem to one or more nursing researchers
C) Planning the methodology of the research project
D) Carrying out the intervention and submitting the results for publication
5. A patient signed the informed consent form for a drug trial that was explained to patient by a research assistant. Later, the patient admitted to his nurse that he did not understand the research assistant’s explanation or his own role in the study. How should this patient’s nurse respond to this revelation?
A) Explain the research process to the patient in greater detail.
B) Describe the details of a randomized controlled trial for the patient.
C) Inform the research assistant that the patient’s consent is likely invalid.
D) Explain to the patient that his written consent is now legally binding.
6. A nurse leader is attempting to increase the awareness of evidence-based practice (EBP) among the nurses on a unit. A nurse who is implementing EBP integrates which of the following? (Select all that apply.)
A) Interdisciplinary consensus
B) Nursing tradition
C) Research studies
D) Patient preferences and values
E) Clinical expertise
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow to heal and which now poses a threat of osteomyelitis. The wound care nurse who has been working with Mrs. Mayes applies evidence-based practice (EBP) whenever possible and has proposed the use of maggot therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantly opposes this treatment despite the sizable body of evidence supporting it. How should the nurse reconcile Mrs. Mayes’ views with the principles of EBP?
A) The nurse should explain that reliable and valid research evidence overrides the patient’s opinion.
B) The nurse should explain the evidence to the patient in greater detail.
C) The nurse should integrate the patient’s preferences into the plan of care.
D) The nurse should involve the patient’s family members in the decision-making process.
8. The administrators of a long-term care facility are considered the use of specialized, pressure-reducing mattresses in order to reduce the incidence of pressure ulcers among residents. They have sought input from the nurses on the unit, all of whom are aware of the need to implement the principles of evidence-based practice (EBP) in this decision. Which of the following evidence sources should the nurses prioritize?
A) A qualitative study that explores the experience of living with a pressure ulcer
B) A case study that describes the measures that nurses on a geriatric unit took to reduce pressure ulcers among patients
C) Testimonials from experienced clinicians about the effectiveness of the mattress in question
D) A randomized controlled trial that compared the pressure-reducing mattress with standard mattresses
9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their attempt to ascertain the most efficient and effective way to communicate between nurses who are on different units, a project that will consider many types of evidence. Which of the following information sources should the administrators prioritize?
A) A systematic review about communication in nursing contexts
B) Nurses’ ideas about communication methods
C) The results of a chart review
D) The hospital’s accreditation status
10. A nurse has resolved to apply the evidence-based practice (EBP) process to the way that admission assessments are conducted and documented on a unit. How should the nurse begin the process of establishing EBP?
A) Gather evidence showing the shortcomings of current practices
B) Formulate a clear and concise question to be addressed
C) Elicit support from the nurses who are most often responsible for admissions
D) Search the literature for evidence that is potentially relevant to the practice need
AND MUCH MORE