Test Bank Contemporary Nursing 8th
Edition Cherry
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Test Bank Contemporary Nursing 8th
Edition Cherry
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Chapter 01: The Evolution of Professional Nursing
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Clara Barton is known for:
a. becoming the first black public health nurse.
b. establishing the Henry Street Settlement.
c. founding the American Red Cross.
d. publicizing the inadequacies of hospital-based nursing schools.
ANS: C
The American Red Cross, founded by Clara Barton in 1882, assisted in efforts to continue
public health nursing.
DIF: Knowledge
REF: p. 11
2. Students are assigned to write to their state leaders about an issue affecting their community.
One student writes about the need among rural community for greater access to acute care
services. Which of the following pieces of legislation should the student use as a reference?
a. Social Security Act
b. Hill-Burton Act
c. Sheppard-Towner Act
d. U.S. Civil Service Act
ANS: B
The purpose of the Hill-Burton Act was to provide funding to construct hospitals and to help
states in plan for other health care facilities in accordance with the needs of communities.
DIF: Knowledge
REF: p. 13
3. The practice of public health nursing and the Henry Street Settlement are credited to:
a. Mary Breckenridge.
b. Mary Seacole.
c. Clara Barton.
d. Lillian Wald.
ANS: D
Lillian Wald, a pioneer in public health nursing, is best known for the development and
establishment of the Henry Street Settlement.
DIF: Knowledge
REF: p. 6
4. Occupational health nursing features beliefs similar to those of which early nursing pioneer?
a. Lillian Wald
b. Florence Nightingale
c. Clara Barton
d. Mary Seacole
ANS: A
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Lillian Wald developed the first nursing service for occupational health.
DIF: Comprehension
REF: p. 10
5. What historical event first led to the recognition of the contribution of blacks to nursing?
a. Florence Nightingale’s acceptance of black nurses into the first nursing school
b. The contributions of black nurses at the Pennsylvania Hospital, the first hospital in
America
c. Mary Seacole’s efforts to care for soldiers during the Crimean War
d. The work done by wives of wealthy black nobles who carried food and medicine
from house to house during the Middle Ages
ANS: C
Although Nightingale’s school refused Seacole, she was able to make a difference in the
Crimean War and later was recognized for her efforts.
DIF: Comprehension
REF: pp. 8-9
6. World War I contributed to the advancement of health care by:
a. increasing the number of private care hospitals and decreasing the role of public
health services.
b. employing a large number of civilians to provide care to returning soldiers through
the Red Cross.
c. introducing specialists in nursing such as nurse anesthetists.
d. increasing the number of community health nurses.
ANS: C
World War I offered nurses a chance to enter into new fields of specialization, as is seen in the
example of nurse anesthetists, who became part of surgical teams at the front lines.
DIF: Comprehension
REF: p. 11
7. The primary purpose of the Social Security Act of 1935 was to:
a. increase research that focused on minority groups.
b. provide medical care for chemically impaired persons.
c. ensure health care for older adults through a national insurance system.
d. decrease the public’s financial burden by limiting services offered by local health
departments.
ANS: C
By providing health insurance for older adults, the Social Security Act of 1935 set the
precedent for the passage of the Medicare and Medicaid Acts that followed in 1965, but the
act also provided maternal and child welfare services, rehabilitation for the mentally and
physically challenged, medical care for blind individuals and crippled children, and
unemployment benefits.
DIF: Comprehension
REF: p. 12
8. A client asks the nurse, “Can you explain Medicare, an amendment to the Social Security
Act?” The nurse responds that Medicare:
a. led to many hospital closings, along with a decrease in acute care hospital–based
nursing care.
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b. provided medical insurance to those younger adults or children who were not
eligible for private insurance because of catastrophic illnesses such as cancer.
c. provided preventive care for women, infants, and children.
d. ensured that individuals ages 65 and older and those with end-stage renal disease
or permanent disabilities had health care insurance.
ANS: D
The Medicare program provides hospital insurance, Part A, and medical insurance, Part B, to
all people ages 65 and older who are eligible to receive Social Security benefits; people with
total, permanent disabilities; and people with end-stage renal disease.
DIF: Comprehension
REF: p. 14
9. A comparison of nursing in the 1980s to nursing in the 1990s reveals that:
a. in the 1990s nursing experienced a significant reduction occurred in preventable
diseases caused by unsafe/unhealthy lifestyles.
b. tuberculosis was the primary concern for nursing in the 1980s, whereas the AIDS
epidemic emerged and was its focus during the 1990s.
c. a decrease in ambulatory services in the 1980s prompted an increase in public
health nurses in the 1990s.
d. the demand for advanced practice nurses increased in the 1980s and the 1990s as a
result of the economy and concern about the health of the nation.
ANS: D
The numbers of advanced nurse practitioners increased as evidence of their cost-effectiveness
as providers of primary and preventive health care became established.
DIF: Comprehension
REF: pp. 16-17
10. Which statement accurately describes the historical perspective of nursing practice?
a. Nursing has existed to meet the needs of populations, individuals, and aggregates
by providing care that is determined by the needs and beliefs of society in different
historical contexts.
b. As men began to become interested in nursing, it changed into a respected
profession based on scientific fact rather than superstition.
c. Nursing has historically accepted individuals from all social and ethnic
backgrounds.
d. The United States has led the way throughout history to advance nursing and
health care by providing the first hospital and medical school.
ANS: A
Nursing has existed since biblical times to address needs ranging from contagious diseases in
early times to health prevention in the present time, with care based on health needs and
beliefs of the time.
DIF: Comprehension
REF: p. 3 |pp. 18-19
11. The use of herbs has become a popular alternative to prescription drugs in today’s health care
milieu. During which other historical periods did health practices focus on the use of herbs?
a. Prehistoric times and the Middle Ages
b. Civil War period and World War I
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c. Renaissance and Reformation periods and the Colonial American period
d. Crimean War and Civil War periods
ANS: A
During prehistoric times, tribes used herbs to rid themselves of disease; in the Middle Ages,
women used herbs.
DIF: Comprehension
REF: p. 6
12. A care provider sacrifices an animal and waves an herb-filled sack over a client who is
complaining of painful joints and chest pain with exertion. This ritual represents health care
during:
a. the prehistoric period.
b. early civilization in Egypt.
c. the Renaissance.
d. the Middle Ages.
ANS: A
During prehistoric times, illness was thought to be caused by evil spirits that providers
attempted to scare away through rituals and dances.
DIF: Comprehension
REF: p. 3
13. A prospective nursing student who researches universities that offer a baccalaureate degree in
nursing would want to ensure that the program is accredited by the:
a. American Nurses Association.
b. Commission on Collegiate Nursing Education.
c. National Institutes of Health.
d. National Nursing Council.
ANS: B
The Commission on Collegiate Nursing Education (CCNE) is the agency that exclusively
accredits baccalaureate and graduate-degree nursing programs.
DIF: Comprehension
REF: p. 4, Box 1-1
14. Nursing in the 1990s was characterized by:
a. men leaving nursing to enter the armed services.
b. traditional 8-hour shifts to nurse burnout and compassion fatigue.
c. a focus on preventable diseases.
d. a decrease in nursing research.
ANS: C
Health promotion and disease prevention were recognized as the means to reduce the high
number of mortalities associated with preventable diseases—Healthy People 2000 was
published as a nationwide effort to reduce preventable deaths.
DIF: Comprehension
REF: pp. 16-17
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15. A nurse is part of the policy committee for a hospital. The committee is provided with
statistics indicating that patients participating in a satisfaction survey felt they lacked
sufficient information about new drugs started while hospitalized and continued after
discharge. In addition, charts noted high recidivism rates. The committee recommended that a
formalized patient education plan be instituted to reconcile all medications and provide patient
information about new medications. The committee is using which component of the Institute
of Medicine (IOM) 2011 message?
a. Nurses should achieve higher levels of education to be effective members of an
interdisciplinary team.
b. Nurses should have a minimum of a master’s degree to sit on policy committees
that affect an entire facility.
c. Pay for nurses should be consistent with that of physicians since the committee is
interdisciplinary.
d. Policy is based on data, which provides the groundwork for decision making.
ANS: D
The IOM report initiatives include effective workforce planning and policymaking based on
better data collection and improved infrastructure.
DIF: Application
REF: p. 16| p. 18
16. The Affordable Care Act of 2011:
a. requires that by 2020 all newly licensed nurses have a bachelor’s degree at
minimum.
b. would provide health care benefits to millions who were previously uninsurable or
unable to afford insurance.
c. caps the amount that hospitals and physicians can charge for procedures.
d. subsidizes private insurance companies, thereby reducing health care costs for
individuals who have chronic or catastrophic illness such as cancer.
ANS: B
It is anticipated that the ACA (2011) will make insurance coverage possible for millions who
have previously not had insurance or had been denied insurance.
DIF: Comprehension
REF: pp. 18-19
17. It has been said that “history repeats itself because no one was listening the first time.” Which
statement is true when comparing the nursing care provided in the Civil War (1861 to 1865)
to that provided during the Crimean War?
a. Epidemics such as smallpox and typhoid were the primary emphasis of nursing
care in both wars.
b. Soldiers were housed in substandard conditions, but due to Nightingale’s push for
sanitary conditions, in the Civil War soldiers were housed in aseptic conditions.
c. Black nurses were widely accepted by society and the profession, receiving equal
compensation during the Civil War due in large part to the efforts of Mary Seacole
during the Crimean War.
d. Both Nightingale (Crimean War) and Dix (Civil War) completed nursing training
before accepting positions as nurses in the wars.
ANS: A
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Numerous epidemics plagued the country, including syphilis, gonorrhea, malaria, smallpox,
and typhoid.
DIF: Application
REF: p. 9
MULTIPLE RESPONSE
1. What uniquely twenty-first century issue challenges today’s professional nurse. (select all that
apply)
a. Caring for an aging population
b. Increased patient acuity
c. Access to health care services
d. Expanding technology
e. Increasing intercultural patient population
ANS: A, B, D, E
Professional nurses in the twenty-first century are faced with many challenges including an
aging patient population. Professional nurses in the twenty-first century are faced with many
challenges including an increase in high acuity patients. Professional nurses in the twenty-first
century are faced with many challenges including an ever expanding array of technologies
that affect patient care. Professional nurses in the twenty-first century are faced with many
challenges including the existence of an intercultural patient population.
DIF: Comprehension
REF: p. 18
2. A newly licensed nurse compares the challenges facing nursing today with those faced by
nurses when her mentor graduated in 1990. The mentor states, “Prevention was the focus of
nursing when I graduated. We stressed preventive health measures such as smoking cessation
education to reduce preventable diseases and prevention to reduce the spread of infectious
disease such as AIDS.” The mentor asks, “What do you think the challenges will be for nurses
graduating now? The correct response would be: (select all that apply)
a. coordinating care for a more diverse aging population who have complex health
values.
b. managing care provided by nurses who are technologically advanced and skilled at
interprofessional collaboration.
c. providing care to well-informed consumers who are younger with narrow health
values.
d. redesigning nursing care delivery models to streamline care based on fewer
generational differences.
e. focusing on care from a systems perspective.
ANS: A, B, E
Our society, thus our patients/consumers, is aging and better informed about health care
options, with health values as diverse as the various populations of patients served. Nurses
educated in the twenty-first century are introduced to advanced technologies throughout the
curriculum, but a gap still exists between the potential benefits of technology and the use
made of it to reduce errors and improve patient care; interprofessional collaboration is a
challenge with incivility and workplace violence increasing. Today’s nurses must view health
care from a systems perspective rather than a nursing unit perspective to decrease errors/costs
that arise from system errors.
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DIF: Analysis
REF: pp. 18-19
3. A nurse who has practiced for 1 year on a medical-surgical unit is very interested in a position
in the operating room. She traces the nursing history of surgery to learn how nursing has
evolved in this practice. To determine if, historically, surgery methods advanced the practice
of nursing, select the correct statements. (select all that apply)
a. The Ancient Egyptians were the first to use anesthesia in the operating room.
b. The “Barbers” of the Middle Ages used sterile techniques to reduce wound
infections.
c. The Indian culture from 274 to 236 BC had hospitals staffed with female nurses
who practiced much like today’s nurses.
d. During the Renaissance, advances in nursing education, including surgery, were
nonexistent.
e. Following World War II, nurses practiced in mobile army surgical hospitals, where
medical and surgical techniques were further refined.
ANS: D, E
During the Renaissance, major advancements were made in pharmacology, chemistry, and
medical knowledge, including anatomy, physiology, and surgery with new emphasis given to
medical education, but nursing education was practically nonexistent. Following World War
II, nurses volunteered for the Korean War, where care was provided in MASH units and
surgical techniques were defined.
DIF: Application
REF: p. 7 |pp. 13-15
COMPLETION
1. Which group in early civilization__________ is credited with developing a pharmacopoeia to
classify more than 700 drugs used in caring for the sick?
ANS:
Egyptians
A pharmacopoeia that classified more than 700 drugs was written by the Egyptians to assist in
the care and management of disease.
DIF: Knowledge
REF: p. 3
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Chapter 02: The Contemporary Image of Professional Nursing
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by
2020?
a. Positions that historically required registered nurses will be filled by unlicensed
personnel.
b. The job growth rate for RNs will surpass job growth in all other occupations.
c. The need for hospital nurses will dramatically decrease.
d. Hospitals will finally achieve the required RN workforce.
ANS: B
With an employment rate expected to increase by more than 19%, job production for nurses is
projected to grow faster than the average of all occupations (11%) until 2020.
DIF: Knowledge
REF: pp. 23-24
2. What effect did the movie One Flew Over the Cuckoo’s Nest have on health care?
a. Funding for mental health care increased, allowing the point of care to change
from the community to standardized institutional care.
b. The public and the nursing profession were made aware of the rights of vulnerable
populations.
c. Nurses were seen as advocates for individuals who cannot advocate for
themselves.
d. Funding for nursing traineeships was eliminated.
ANS: B
One Flew Over the Cuckoo’s Nest reminded us that all individuals have rights and that it is the
responsibility of the public and health care professionals to ensure that these rights are
protected.
DIF: Comprehension
REF: p. 26
3. Which nurse died after deliberately acquiring two bites from yellow fever carrier mosquitoes
to enable her to provide care to soldiers with yellow fever during the Spanish-American War?
a. Florence Nightingale
b. Margaret Hoolihan
c. Clara Maas
d. Sairy Gamp
ANS: C
Clara Maas is noted as the nurse who deliberately acquired two bites from yellow fever carrier
mosquitoes to enable her to provide care to soldiers with yellow fever.
DIF: Knowledge
REF: p. 26
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4. A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates
caring by holding a soldier’s head is an artistic representation of nurses who served in which
war?
a. World War I
b. World War II
c. Spanish-American War
d. Vietnam War
ANS: D
This statue represents the caring provided by nurses during the Vietnam War.
DIF: Knowledge
REF: p. 27
5. What was the purpose of the Nurse Reinvestment Act of 2002?
a. Provided disability insurance to RNs who contract a life-threatening illness while
on duty
b. Funded public service announcements that promote unlicensed caregivers as an
alternative to professional nurses
c. Focused on nurse retention and safety enhancement grants to address the current
nursing shortage
d. Provided pediatric nursing training grants
ANS: C
This act provided nursing scholarships, public service announcements promoting nursing as a
career, faculty loan cancellation programs, geriatric training grants, and nurse retention and
safety enhancement grants.
DIF: Knowledge
REF: pp. 23-24
6. What is the best way for the individual nurse to maintain the most effective professional
image?
a. Change out of their work attire before running errands.
b. Renew membership in a nursing organization.
c. Earning an advanced nursing degree.
d. Developing effective nurse-physician relationships.
ANS: B
Professional nurses recognize that their greatest benefit—and one of the most efficient and
powerful uses for their money—is less than 1% of their salary they spend for membership in
the ANA, the National League for Nursing, Sigma Theta Tau International, and their specialty
organization. They look forward to annual meetings because such meetings provide an
excellent opportunity to meet colleagues and discuss issues and practice innovations.
DIF: Application
REF: pp. 33-34
7. Charles Dickens’ character Sairy Gamp:
a. portrayed nurses as trained professional individuals who put others before
themselves.
b. chose nursing because she had no other avenue for employment.
c. was a prostitute who took advantage of sick old men.
d. characterized nurses as being at the forefront of technology and autonomy.
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ANS: B
Sairy Gamp endured nursing because of the lack of other opportunities.
DIF: Knowledge
REF: p. 25
8. What does the Spirit of Nursing statue honor?
a. Florence Nightingale’s accomplishments in public health
b. Edith Cavell’s attempt to help the victims of the Tuskegee experiment seek
treatment
c. Clara Maas, who found the cure for yellow fever during WWII
d. All military nurses for their bravery and compassion
ANS: D
The statue the Spirit of Nursing was created to honor all military nurses.
DIF: Knowledge
REF: p. 25
9. Although the media portrayed nursing in a negative light in M*A*S*H through the character
of a promiscuous, uncaring nurse, it also provided Americans with a promising glimpse of:
a. nurses who can be promiscuous and still help doctors.
b. the fact that caring is not as important as the desire to serve one’s country.
c. the ability of nurses to cope with the dreadfulness of war by using humor.
d. the contributions of male military nurses.
ANS: C
The sitcom M*A*S*H did show humor as a coping mechanism for nurses in a war setting.
DIF: Knowledge
REF: p. 26
10. With the crisis in health care and the nursing shortage, why is the image of nursing still
important?
a. Nursing care is often delivered during a time of uncertainty, and the image of
nurses during this time can reinforce trust in the nurse-patient relationship.
b. Physicians have a distinctive body of knowledge that identifies them as
professionals, whereas nursing has yet to develop a unique body of knowledge on
which to base practice.
c. Nurses must present a unified image if they hope to ever establish nursing as a
profession.
d. The dynamic state of today’s health care requires nurses to move from a caring
image to one of technologic competence.
ANS: A
A person who seeks health care is entering a world of uncertainty. The nurse provides
continuity and compassion and stabilizes the environment of the patient.
DIF: Comprehension
REF: p. 23
11. Nurses can combat the nursing shortage by:
a. joining unions, which influence employers to provide incentives such as pay raises
and free child care, thus encouraging the large percentage of nonworking nurses to
return to the workforce.
b. demanding that the requirements of the qualifying examination for foreign nurses
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should be reduced, so they are eligible to sit for the licensure examination.
c. working more hours with a higher nurse/patient ratio.
d. advocating for funds to pay for nursing education and a safer work environment.
ANS: D
Advocating for funds to pay for nursing education and a safer work environment is a positive
strategy, as can be seen by results attained after the Reinvestment Act P.L. 107-205 provided
$20 million for nursing scholarships, public service announcements, faculty loan cancellation
programs, geriatric training grants, and nurse retention and safety enhancement grants. This is
the best defense against the nursing shortage. Nursing graduates in many states have increased
in number, and enrollment in nursing schools is also on the rise.
DIF: Application
REF: pp. 23-24
12. The demographics of the twenty-first century nursing population indicate that:
a. individuals entering nursing are second-degree students who average 45 years of
age.
b. more white nurses enter and obtain graduate degrees than any other ethnic group.
c. the highest level of nursing education for most RNs is an associate degree.
d. the majority of nurses practice in hospitals.
ANS: D
Fifty-six percent of nurses practice in hospitals.
DIF: Comprehension
REF: p. 29
13. A nursing student asks, “I wonder if the reason that the nursing shortage is so severe is that
registered nurses are unhappy with their jobs.” To research the answer, the National Survey of
Registered Nurses was reviewed and found:
a. registered nurses change employers every year to prevent burnout and to keep the
nursing shortage from increasing.
b. nursing faculty are aging or leaving academia due to increased work demands and
generational difference from students.
c. practicing registered nurses are satisfied with their job and most remain with same
employer they worked for the previous year.
d. registered nurses were the least satisfied with their job of all health care providers.
ANS: C
According to the latest National Sample Survey of Registered Nurses (NSSR), 79.8% of
practicing RNs were satisfied with their job and 88.4% were with the same employer as they
had been in the preceding year (U.S. Department of Health and Human Services, 2010).
Among all RNs, nursing faculty are the most satisfied (86.6%).
DIF: Comprehension
REF: p. 29
14. A registered nurse is on break and checking e-mails. One e-mail contains a picture of a
celebrity who is a patient in the hospital, and on the same floor, where the nurse works.
Included with the photo is a message, “check out my Facebook,” which contains additional
photographs of the patient. The nurse immediately deletes the picture to prevent having to
report the “friend” to supervisors. Based on the action of the nurse who received the message,
which statement is correct?
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a. The nurse is not at risk for having his or her license suspended since removing the
photos made them temporary and invisible to all others.
b. Because the nurse did not send the message and immediately deleted the photo,
there is no risk for discipline.
c. Failing to report receiving the message demonstrates poor ethical and legal
role-modeling as well as placing the nurse at risk for discipline.
d. Because the patient is on the same floor as the one on which the nurse works, the
information can be ethically and legally shared.
ANS: C
Failing to report the image can result in discipline.
DIF: Comprehension
REF: pp. 27-28
15. A nurse executive is concerned that the mortality rate in his or her hospital exceeds the
national average and searches the literature finding Aiken’s 2011 Survey on the effects of
nurse staffing and education on mortality, including work environment. If Aiken’s
recommendations are followed, which change would be most effective?
a. Increasing staffing ratios to include more nurses of all levels of educational
preparation on all shifts
b. Employing bachelor’s prepared nurses who participate in interprofessional rounds
with attending physicians where their voices are heard
c. Ensuring nurse managers and administrators have at minimum a master’s degree
d. Encouraging all unlicensed assistive personnel to attend educational programs to
be certified
ANS: B
Aiken (2011) found that simply increasing the number of RNs was not the only answer to
reduce mortality. Increasing the number of BSN-prepared nurses along with developing a
positive work environment had the most impact on reducing mortality. The impact on
reducing mortality by increasing the educational level of nurse managers/administrators and
certified unlicensed assistive personnel was not documented.
DIF: Application
REF: pp. 30-31
16. In order to best improve patient outcomes on an acute care hospital unit, which intervention
should the nursing staff advocate for?
a. Staffing only 8 hour shifts on the unit
b. Decreasing the number of patients cared for on any specific unit
c. Increasing salaries for experienced nurses
d. Increasing staffing on the evening shift
ANS: D
The data clearly indicate that decreased nurse-patient ratios have been associated with higher
rates of mortality, shock, urinary tract infections, sepsis, hospital acquired pneumonia, and
failure to rescue, especially among surgical patients.
DIF: Application
REF: pp. 30-31
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17. A physician complains to administration that the nurse working last evening is unethical,
based on observing the nurse educate the patient about a new medication ordered. The
physician demanded the nurse be reprimanded and reminded that only physicians have the
educational background to teach patients about new medications. Which comment and action
by the administrator would be most effective in changing nurse-physician relationships in this
instance?
a. Inform the nurse, “You will be suspended for 3 days for going beyond your job
description,” and enforce the 3-day suspension because the physician did not write
the order to “teach the patient about the new medication”
b. Advise the physician that only nurses can teach patients about medications; the
physician’s role is to only prescribe. No action will be taken against the nurse.
c. After investigating the situation, thank the physician while also providing
information that patient education related to medication is within the scope of
practice of registered nurses. Share the physician’s concern and administrator’s
response with the nurse so both parties are aware of the resolution of the concerns.
d. Contact the patient’s family and ask, “Do you prefer that all teaching related to
medications be performed by the physician rather than the nurse” to determine
what action to take.
ANS: C
Investigating the situation to provide evidence is the first step. Once the facts are known,
action can be taken. In this instance, including the ethics committee would help ensure an
unbiased decision.
DIF: Application
REF: pp. 31-32
18. Which nurse best portrays nursing as a “knowledge worker”?
a. Nurse in matched scrubs with lab coat, hair back, small stud earrings
b. Nurse in mismatched scrubs, no lab coat, large hoop earrings
c. Nurse in white uniform with apron with no jewelry/hair back
d. Nurse with nose ring and eyebrow piercing with starched white uniform and cap
ANS: A
Nursing scrubs have become a popular alternative to the traditional white uniform; clean
wrinkle-free matching scrubs presented a professional image. Small stud earrings reduce risk
of injury to nurse when caring for confused or combative patients.
DIF: Comprehension
REF: pp. 30-32
MULTIPLE RESPONSE
1. According to current data related to the nursing shortage: (select all that apply)
a. salaries of nurses are competitive with those of other professionals such as
teachers.
b. only 19% of nurses are minorities.
c. overall, nurses are satisfied with their jobs but leave the profession because of fear
of contracting fatal diseases.
d. the employment opportunities for nurses continue to be strong.
e. staff nurses are returning to school to obtain certificates to teach nursing.
ANS: B, D
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Only 19% of nurses are minorities. RNs have one of the highest growth rates of employment
of all occupations.
DIF: Knowledge
REF: pp. 23-24 |p. 29
2. A group of new graduate nurses is asked to speak to a group of politicians to describe the
current state of professional nursing and how best to alleviate the nursing shortage. Which
statements accurately portray professional nursing today and tomorrow? (select all that apply)
a. More RNs attain a bachelor’s degree than an associate degree or diploma.
b. Because of pressure to shorten length of stay in hospitals, more RNs practice in
outpatient settings and home health than in acute care settings.
c. The most popular advanced practice specialty is nurse anesthesia.
d. White nurses are more likely to enter graduate school than nurses from other ethnic
groups.
e. Nursing represents the largest health care professional group, followed by medical
doctors.
ANS: A, E
Recipients of BSN degrees represent the largest graduating educational profile (47.2%).
Nurses make up the largest group of health care professionals.
DIF: Comprehension
REF: p. 29
3. Which actions would result in a greater number of nurses entering and staying in practice,
given today’s state of nursing? (select all that apply)
a. Determine why few black women enter graduate school.
b. Provide incentives for minorities and men to enter nursing.
c. Obtain grant funding to increase the number of faculty members and scholarship
availability for students entering baccalaureate nursing programs.
d. Survey nurses to determine why their job satisfaction is lower than that of other
health care professions.
e. Develop ad campaigns that target younger students.
ANS: B, C, E
Core solutions to the nursing shortage include providing incentives for minorities and men to
enter nursing. Core solutions to the nursing shortage include obtaining grant funding to
increase the number of faculty members and scholarship availability for students entering
baccalaureate nursing programs. Core solutions to the nursing shortage include developing ad
campaigns that target younger students.
DIF: Comprehension
REF: pp. 28-29
4. The Nurses of America’s media campaign raised awareness of which aspects of nursing?
(select all that apply)
a. Nurses are expert clinicians.
b. A higher nurse/patient ratio is needed.
c. Nurses are invisible in the news media.
d. Nurses are caring.
e. Nurses are well paid.
ANS: A, C
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The campaign was designed to convey to the public that nurses are expert clinicians. A
strategically important part of the campaign raised consciousness among nurses of the
invisibility of nursing in the news media.
DIF: Comprehension
REF: p. 28
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Chapter 03: The Influence of Contemporary Trends and Issues on Nursing Education
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. A current trend is for students to be evaluated to determine whether they demonstrate
competence in the actual client care environment or with a standardized patient. This process
occurs in addition to or instead of traditional pencil-and-paper evaluations. This type of
evaluation is referred to as:
a. core practice competencies.
b. continuing competence.
c. distance learning.
d. performance-based assessment.
ANS: D
Performance-based assessment is the evaluation of abilities based on an objective
demonstration of specific required competencies. This may include performance in actual or
simulated situations.
DIF: Knowledge
REF: p. 44
2. One of the major trends that currently influences nursing education and practice is:
a. increased technology in the field of critical care.
b. a narrowing scope of practice for nurses.
c. incivility or disregard of others’ rights in social interactions.
d. a decrease in ethnicity due to international programs allowing students to study
from a distance.
ANS: C
Incivility has escalated and can be demonstrated by the common practice of text-messaging
during class and an increase in academic dishonesty.
DIF: Comprehension
REF: pp. 46-47
3. Although the use of technology and the Internet provides nursing faculty and students with
unlimited resources and current information, an outcome associated with this trend is that:
a. users of electronic resources spend a disproportionate amount of time looking for
pertinent content.
b. additional time is available to study and revise curricula because special skills are
not needed to access information via the Internet.
c. immediate results and outcomes are expected from students and faculty, thus
enhancing time management.
d. skills that require problem solving and reflective abilities are developed.
ANS: A
Students can easily become distracted by pursuit of the intriguing web of links they encounter
while they search websites to complete assignments or find pertinent content.
DIF: Analysis
REF: pp. 41-43
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4. A new trend in nursing education that is consistent with real-world practice is focused on:
a. outcomes.
b. objectives.
c. goals.
d. subjective appraisals.
ANS: A
Outcomes and criteria establish real expectations for clinical practice and have a powerful
influence on nursing education and practice at all levels. Outcomes are used in all areas of
nursing in the nursing process.
DIF: Knowledge
REF: p. 43
5. The practice of nurses, nursing students, and faculty is affected by demographic changes due
to:
a.
b.
c.
d.
the growing percentage of adults ages 50 to 55 years.
increasing numbers of obese children and adults.
changes by which families are becoming more nuclear.
social programs that are essentially eliminating poverty.
ANS: B
The United States is experiencing an epidemic of obesity with major consequences for health
and the health care system.
DIF: Knowledge
REF: p. 46
6. The first university to offer nursing graduates a baccalaureate degree was:
a. Columbia Teachers College.
b. Yale University.
c. Harvard University.
d. the New York Regents Program.
ANS: B
In 1924, Yale University offered the first separate Department of Nursing, whose graduates
earned a baccalaureate degree.
DIF: Knowledge
REF: p. 53
7. Which nursing model is referred to as the “class without walls”?
a. Articulation
b. Career ladder (2 + 2)
c. External degree
d. Second degree
ANS: C
An external degree does not require attendance and provides no course classes; it enrolls
thousands and is accessible regardless of geographic location.
DIF: Knowledge
REF: p. 56
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8. When focusing on addressing issues identified by the 2000 Institute of Medicine report, the
nursing faculty will access information associated with which initiative?
a. Quality and Safety in Nursing Education
b. Competency Outcomes and Performance Model (COPA)
c. The National Organization of Nurse Practitioner Faculties (NONPF)
d. Academic Center for Evidence-Based Practice (ACE)
ANS: A
In response to the Institute of Medicine report (IOM, 2000), The Robert Wood Johnson
Foundation funded a national initiative, Quality and Safety in Nursing Education (QSEN), to
help nursing programs reorganize curricula to focus on patient safety and quality care.
DIF: Application
REF: p. 43
9. The number of reported medical errors demonstrates a need for what priority intervention?
a. Simulation experiences
b. Performance competency exercises
c. Comprehensive instructor-constructed examinations
d. Detailed care planning exercises
ANS: B
The increase in reported medical-related errors vividly emphasizes the need for more effective
validation of performance competence in schools and the workplace.
DIF: Application
REF: p. 45
10. Which trend is an effect of the nursing shortage on nursing education?
a. Only devoted qualified nurses are continuing to provide bedside nursing because
of the complexity of care required, resulting in excellent preceptorships for
students.
b. The number of applicants to nursing programs has risen, but enrollment is limited
because of a decrease in the number of available scholarships and grants.
c. With an increase in the number of nurses who are entering graduate school to
escape bedside nursing, students will soon enjoy a lower faculty/student ratio.
d. Students may be assigned to preceptors who have not yet developed expertise in
the field of interest.
ANS: D
Qualified preceptors are few.
DIF: Analysis
REF: p. 49
11. The NCLEX® examination is created and administered by the:
a. American Association of Colleges of Nursing (AACN).
b. American Nurses Association (ANA).
c. National Council of State Boards of Nursing (NCSBN).
d. National League for Nursing (NLN).
ANS: C
The NCSBN coordinates licensure activities on a national level and creates and administers
the licensure examination (NCLEX®).
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DIF: Knowledge
REF: p. 57, Box 3-1
12. A student is planning to enroll in prerequisite courses after graduating from high school and is
researching options for nursing programs. During a career fair the student compares different
types of nursing education programs and discovers that:
a. diploma programs focus on family and community, with an emphasis on health
promotion.
b. most practicing RNs graduated from diploma programs because this was the first
type of RN program.
c. baccalaureate programs focus on technical and hands-on nursing skills in diverse
community settings.
d. master’s programs such as that for the clinical nurse leader provide entry into
practice with a focus on interdisciplinary and bedside nursing care for complex
client populations.
ANS: D
A clinical nurse leader oversees the care coordination of groups of clients and actively
provides direct client care in complex situations, evaluates client outcomes, and has the
decision-making authority to change care plans when necessary.
DIF: Comprehension
REF: p. 55
13. When preparing to complete a competency examination involving a neurologic assessment in
a simulation laboratory, the nurse reviews the critical elements, which consist of:
a. those steps that result in life or death of a client.
b. required criteria that must be incorporated into the assessment for the desired
outcome.
c. fundamental strategies unique to complex dynamic care environments.
d. objective data that can be used to determine the likelihood that the client will
recover.
ANS: B
Critical elements include the application of mandatory principles that must be used according
to established practice standards.
DIF: Comprehension
REF: p. 40
14. An RN with a diploma preparation wants to participate in decisions about health care and
decides the first step is to obtain a BSN. The nurse enrolls in a nursing program offering
self-scheduling and a self-paced curriculum. This nurse is taking advantage of:
a. educational mobility.
b. a traditional nursing program.
c. training for advanced practice nursing.
d. credit by examination.
ANS: A
Education mobility is the progressive movement from one level or type of education to
another—in this instance, diploma to BSN. Programs are aimed to make the transition
possible through creative flexible scheduling.
DIF: Application
REF: p. 56
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15. A nursing student scores 95% on the written examination for the adult health course. To be
successful in this course, this same student must then perform an indwelling catheter insertion
and wound care in a simulated environment meeting core competencies. The student asks,
“What are core competencies?” The nursing instructor replies, “Core competencies are:
a. a trend used in nursing education to reduce attrition in prelicensure students.”
b. those skills necessary for safe, competent nursing practice.”
c. educational opportunities that provide remediation when student is unable to
perform psychomotor skills correctly.”
d. critical thinking exercises aimed to improve reading and math skills.”
ANS: B
Core competencies are those skills and elements that are fundamental and essential for safe,
competent practice.
DIF: Comprehension
REF: pp. 39-40
16. A nurse realizes that a health care concern related to globalization was:
a. the emergence of epidemic hepatitis A.
b. the pandemic of H1N1 “swine flu.”
c. reemergence of polio.
d. an increase in chronic illnesses.
ANS: B
In 2009, there was a pandemic of H1N1 on every continent and a reemergence of
Staphylococcus aureus (MRSA).
DIF: Knowledge
REF: pp. 47-48
17. A student nurse is preparing a presentation that requires identification of outcomes for the
care of heart failure patients. Which is a correctly written outcome?
a. Develop a teaching program to address physical activities that result in improved
cardiac function.
b. Discuss the clinical manifestations associated with Level 4 heart failure.
c. List the most common pharmaceutical approaches to reduce preload in heart
failure patients.
d. Recognize the economic impact that recidivism has on the patient and health care
facility.
ANS: A
Outcomes use action words, actions that nurses actually do, such as develop, plan, implement,
integrate, plan, or conduct.
DIF: Application
REF: p. 43
18. A member of a nursing students study group comments, “I wish our instructor would just tell
us the important information that we will be tested on in our course and on NCLEX®. Instead,
we spend some time early in the class discussing key facts then the most of the time working
through case studies, then practicing on the simulator rather than caring for ‘real’ patients.”
This teaching-learning style represents:
a. memorization of basic facts presented early in the lecture.
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b. Objective Structured Clinical Examinations (OSCE).
c. peer-to-peer learning.
d. practice-based competency.
ANS: D
Practice-based competency includes active engagement and application in real practice
situations and interactive strategies such as case studies and simulation.
DIF: Application
REF: pp. 43-44
19. Which experience is best designed to support a nursing student’s preparation for
interprofessional team participation?
a. Attending a seminar on interprofessional team cooperation
b. Completing a preceptorship with an advanced practice nurse
c. Carrying for three patients with varying medical diagnoses
d. Presenting patient information at the daily care planning meeting on a mental
health unit
ANS: D
While interprofessional educational experiences are encouraged for all health care disciplines,
Delunas and Rouse (2014) cite the importance of preparation of students for interprofessional
educational experiences, and the need for regular meetings when students are engaged in
learning as a member of a health care team.
DIF: Application
REF: pp. 47-48
20. A person interested in employment in the health care sector has less than 1 year to pursue his
or her education and wants to focus on functional aspects of patient care. He/she desires to
work in a long-term facility. Which type of nursing program should this person request
information about?
a. Bachelor’s degree in nursing (BSN)
b. Licensed practical nurse (LPN)
c. Associate degree in nursing
d. Master’s degree in nursing
ANS: B
LPN programs provide basic technical bedside care and employment opportunities at
hospitals, nursing homes, home care, and doctor offices.
DIF: Comprehension
REF: p. 52, Table 3-2
MULTIPLE RESPONSE
1. A nurse is concerned that the policy of using povidone-iodine (Betadine) to clean foot ulcers
may lead to unwarranted allergic reactions and drying of surrounding tissue. A literature
review is performed to determine the “best practice” related to care of foot ulcers. This nurse:
(select all that apply)
a. is applying evidence-based practice to the clinical setting.
b. is using critical thinking to change procedures performed in the care of foot ulcers.
c. is minimally educated at the master’s level and participating in research to provide
cost-effective care (soap is less expensive than povidone-iodine).
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d. lacks clinical competence in health assessment and in application of theory to the
clinical setting.
e. is using information to problem-solve and ensure safe, competent care.
ANS: A, B, E
Critical thinking is an essential part of applying evidence-based practice—that is using
research findings to guide actual practice.
DIF: Analysis
REF: p. 44
COMPLETION
1. The oldest, most traditional type of program that prepares a candidate for RN licensure is the
hospital-based _________ program.
ANS:
diploma
The earliest training programs for nurses were hospital based and designed to meet the needs
of the particular institution; these were referred to as diploma programs.
DIF: Knowledge
REF: p. 52
2. According to Lenburg, the use of practice-based assessments in nursing education is aimed
toward the target of __________.
ANS:
competence
The target that students need to meet to practice safely in today’s complex health environment
is achieving critical competencies and demonstrating of practice-based skills.
DIF: Comprehension
REF: p. 45
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Chapter 04: Nursing Licensure and Certification
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. The advanced practice nurse who is seeking information about requirements for practice in a
specialized area should contact the:
a. American Nurses Association (ANA).
b. National League for Nursing (NLN).
c. American Nurses Credentialing Center (ANCC).
d. National Council of State Boards of Nursing (NCSBN).
ANS: C
The nurse should contact the ANCC to determine the education, experience, and examination
requirements that must be met if one is to become certified.
DIF: Comprehension
REF: p. 63 |p. 71
2. The primary purpose of licensure for RNs is to:
a. prevent others from using the title nurse.
b. demonstrate a specialized body of knowledge.
c. protect the public.
d. enhance recognition for the profession.
ANS: C
Protecting the public is one of the essential purposes of the state board of nursing, which
regulates licensure.
DIF: Knowledge
REF: p. 65
3. Nurse practice acts:
a. are written and passed by legislators.
b. cannot be influenced by special interest groups.
c. reflect only the concerns of RNs.
d. are affected by the practice of dentists.
ANS: A
Just as other sections of state codes are written and passed by legislators, so is the nurse
practice act of each state.
DIF: Knowledge
REF: p. 69
4. To ensure that nursing legislation is current and is reviewed by specific dates, if a nurse
practice act fails to be reviewed, it is automatically rescinded under which law?
a. Nurse review act
b. Sunset legislation
c. Mandatory revocation
d. Grandfathering
ANS: B
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Sunset legislation may be included in a state’s nurse practice act, and this means that the act
must be reviewed by a specific date; if not, it is automatically rescinded.
DIF: Comprehension
REF: p. 70
5. Current trends in telecommunications and increased mobility of nurses have led to the
approval of a mutual recognition model of nursing regulation, in which nurses are allowed to
practice in states that are compact states without obtaining a license in each state. On which
website would a nurse find a list of current compact states?
a. National League for Nursing (NLN)
b. National Council of State Boards of Nursing (NCSBN)
c. American Association of Colleges of Nursing (AACN)
d. Commission on Collegiate Nursing Education (CCNE)
ANS: B
The NCSBN website contains this information.
DIF: Knowledge
REF: pp. 70-71
6. The first field of nursing to certify advanced practitioners was the field of:
a. adult nurse practitioners.
b. nurse-midwifery.
c. clinical nurse specialist.
d. nurse anesthesia.
ANS: D
In 1946, nurse anesthesia became the first field of nursing practice to certify advanced
practitioners.
DIF: Knowledge
REF: pp. 71-72
7. A graduate of a nursing school in the United States plans to practice nursing in Paris, France.
To request licensure to practice in Paris, the nurse:
a. must contact the Graduates of Foreign Nursing Schools to complete a special
examination.
b. realizes that education in the United States is so generalized that he or she is
eligible to practice in other countries without additional licensure.
c. is required to take a language proficiency examination for the primary language of
that particular country, as well as a cultural assessment test, prior to licensure.
d. should contact the International Council of Nurses or the nursing regulatory board
of that country.
ANS: D
A nurse who is interested in practicing internationally may contact the International Council
of Nurses or the nursing regulatory board of the country in which he or she wishes to practice.
DIF: Comprehension
REF: p. 69
8. A nurse who is licensed in Georgia and moves to Oregon:
a. must check Oregon’s nurse practice act related to licensure for endorsement.
b. will automatically be grandfathered in as a licensed registered nurse.
c. may request certification in Oregon rather than licensure, so as not to have to
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retake the NCLEX-RN®.
d. should contact the American Nurses Credentialing Center to determine whether he
or she is eligible to practice in an another state.
ANS: A
Endorsement refers to the original program whereby a nurse who is licensed in one state can
apply and seek licensure in another without undergoing repeat examination, in accordance
with the nurse practice act of that state.
DIF: Application
REF: p. 68
9. When practicing in a compact state:
a. the nurse must abide solely by the practice act of the largest state.
b. patients’ rights in relation to the nurse practice act are protected by the mutual
recognition model.
c. the nurse must pay for a license in all states that participate in the mutual
recognition model.
d. the nurse must refer to the nurse practice act for the list of skills that can be
performed.
ANS: B
Nurses who practice in a compact state are responsible for following the laws and regulations
of each state in which they practice.
DIF: Comprehension
REF: pp. 70-71
10. When participating in a nurse licensure compact, the nurse:
a. is held responsible for complying with the nursing practice laws in the state where
practicing at the time care is rendered.
b. must purchase a license in each state but does not retake the licensure examination.
c. determines residency based on the state where educated as registered nurse.
d. may practice using one license in any state or territory in the United States that
recognizes the NCLEX as the source of licensure.
ANS: A
The nurse is accountable for practicing according to the state practice laws where patient care
was provided, although disciplinary action is the responsibility of the state of the nurse’s
residency.
DIF: Knowledge
REF: pp. 70-71
11. A new graduate from a master’s entry program in nursing announces, “I just passed my
clinical nurse leader certification examination.” Certification as a clinical nurse leader:
a. is granted by the state board of nursing.
b. denotes minimum level of knowledge and skills to practice safely.
c. allows independent nursing practice, often in primary care.
d. recognizes achievement of advanced skills and knowledge.
ANS: D
Certification provides validation of achievement of advanced education and competence.
DIF: Comprehension
REF: p. 71
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12. A nurse holds a license in one state but wishes to practice in a second state that is not
participating in a nurse licensure compact agreement. The nurse is granted licensure on
payment of a fee but does not retake the licensure examination. The nurse obtains licensure in
the second state:
a. by licensure and by endorsement.
b. through mandatory continuing education.
c. by the statutory process known as being grandfathered.
d. through sunset legislation.
ANS: A
Licensure by endorsement allows a nurse licensed in one state to obtain licensure to practice
in a second state without examination.
DIF: Comprehension
REF: p. 68
13. A nurse practicing in the early 1900s was awarded a permissive license. These licenses:
a. were voluntary; however, a nurse who failed the examination could not use the
title RN.
b. required a maximum of 1 year of formalized nurse training.
c. allowed nurses who did not pass the licensure examination to still practice.
d. allowed nurses the choice of taking a written or oral licensure examination.
ANS: A
These permissive licenses permitted but did not require nurses to become registered.
DIF: Comprehension
REF: p. 65
14. A group of registered nurses with ADN degrees are concerned that the minimum educational
standard for licensure as a registered nurse is being raised to the bachelor’s (BSN) level. After
contacting the American Nurses Association, they learn they will be “grandfathered” in.
Under the “grandfather clause,” nurses with associate degrees will:
a. be required to complete a bridge program to earn a BSN and then be tested only on
material that was not part of the ASN curriculum.
b. continue to use the title “registered nurse.”
c. have 10 years to obtain a BSN or the license will be revoked.
d. use whatever title is established for associate degree nurses.
ANS: B
All ASNs licensed before the change would be “grandfathered” in, allowing them to use the
title of RN.
DIF: Comprehension
REF: p. 63
15. Who establishes the “rules” for nursing practice?
a. Individual state boards of nursing
b. Employer, based on area of practice
c. United States Department of Health and Human Services
d. Local health officials
ANS: A
The State Practice Act of each state establishes the rules for practice within that state.
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DIF: Knowledge
REF: pp. 68-69
16. A nurse is completing the degree requirements for an advanced practice role as a nurse
practitioner and is concerned about certification requirements. Which statement concerning
certification for advanced practice is true?
a. All states require certification for all specialty roles that are identified as advanced
practice.
b. Nurse anesthetists and nurse-midwives are the only advanced practice role that
require certification in the state nurse practice acts.
c. Scope of practice remains unclear in state nurse practice acts due to the increasing
number of new advanced practice roles.
d. Certification is automatic when the nurse applies for an advanced practice license.
ANS: A
All states require evidence of certification in the specialty area, and many require periods of
practice in the specialty prior to awarding certification status.
DIF: Comprehension
REF: p. 68
17. Nurses in Tennessee, Mississippi, and Arkansas gather for a conference related to improving
quality and safety in practice and nursing education. They are awarded continuing education
(CE) credit for participation and evaluation of the conference. One nurse from California
states, “I need these CEs to renew my license.” The nurse from Mississippi replies, “You do
not need CEs for license renewal or advance practice certification renewal.” Which statement
about CEs would help these nurses?
a. All states require proof of continuing education for renewal of license with the
number of hours varying.
b. The purpose of continuing education is to ensure competence of the workforce
after graduation, but each state determines if CEs are required.
c. Continuing education is required if nurses work across state lines.
d. Initial licensure provides evidence of a minimum safety and competence, so it is
illegal for states to require continuing education for renewal of license.
ANS: B
CE is important to ensure continued competency, and each state determines if CEs are
mandatory for renewal and how many units are needed.
DIF: Comprehension
REF: p. 68
MULTIPLE RESPONSE
1. A nurse who wishes to practice in another state: (select all that apply)
a. must retake the NCLEX-RN for that state.
b. should determine whether the state is a compact state.
c. may obtain licensure by endorsement.
d. must revoke licensure in the current state because nurses cannot be licensed in
more than one state concurrently.
ANS: B, C
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If the state is a member of a compact state, that state has established an agreement with other
states under which nurses are permitted to practice within the state without additional
licensure. Licensure by endorsement refers to the original program whereby nurses who are
licensed in one state seek licensure in another state without repeat examination.
DIF: Comprehension
REF: p. 68
2. Which statements concerning licensure as a registered nurse are correct? (select all that apply)
a. Nurses who graduate from different types of nursing education programs are
b.
c.
d.
e.
f.
granted different types of licenses, those with a baccalaureate degree having the
most expanded role.
A nursing license cannot be revoked, only suspended.
Each nurse practice act describes requirements for initial licensure.
It is illegal for states to ask about the mental or physical status of an applicant.
Students who graduate in the top 10% of their class are exempt from taking the
NCLEX-RN for licensure.
Candidates for licensure must present proof of graduation as required by the state.
ANS: C, F
A section of each nurse practice act describes requirements and procedures that are necessary
for initial licensure. Candidates for licensure must submit evidence of graduation as defined
by each state.
DIF: Comprehension
REF: pp. 67-68
3. A group of graduates were just notified that they had successfully passed the licensure
examination. During the orientation process at the hospital, one asks, “I am looking at my
license, but I don’t really know the duties performed by the board of nursing.” The staff
development nurse explains that the board of nursing: (select all that apply)
a. grants nursing licensure.
b. constructs the licensure examination.
c. assigns disciplinary action when the nurse acts in a manner that results in harm to a
patient.
d. members are appointed.
e. conducts certification examinations for advanced practice nurses.
ANS: A, C, D
The board of nursing ensures that nursing licenses are granted and renewed. The board of
nursing assigns disciplinary action when provisions of the nurse practice act are violated.
Members are appointed.
DIF: Comprehension
REF: pp. 68-69
4. A nursing student is in the final term of an Associate Science of Nursing (ASN) program and
is preparing for licensure. Prior to licensure the candidate must provide evidence of: (select all
that apply)
a. graduation from a nursing program.
b. graduation from high school or high school equivalency.
c. evidence of current malpractice insurance.
d. evidence of plan to continue study to obtain a minimum of a BSN within 2 years.
e. validation of skills competence provided by a certifying agency.
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ANS: A, B
Candidates for licensure must provide evidence of graduation through transcripts of course
work or letter from the Dean/Director of the nursing program. All candidates must show
evidence of graduating from high school or earning a GED.
DIF: Comprehension
REF: pp. 67-68
COMPLETION
1. The primary purpose of licensure is protection of the ___________.
ANS: public
DIF: Knowledge
REF: p. 65
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Chapter 05: Theories of Nursing Practice
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Which nursing theory might a nurse use as a conceptual framework to determine how to meet
the needs of immigrants while ensuring provision of high-quality and culturally sensitive
care?
a. Martha Rogers’ nursing theory
b. Dorothea Orem’s nursing theory
c. Hildegard Peplau’s nursing theory
d. Madeleine Leininger’s nursing theory
ANS: D
Madeleine Leininger proposed the theory of cultural care diversity and universality. This
theory of transcultural nursing comprises concepts involving caring and the components of a
cultural care theory: diversity, universality, worldview, and ethnohistory.
DIF: Comprehension
REF: p. 85
2. When reading Peplau’s theory, a nurse was unable to determine the relationships among
concepts. The nurse listed each concept and drew lines denoting relationships to be able to
understand the effect of each element. The nurse created a:
a. hypothesis.
b. model.
c. construct.
d. variable.
ANS: B
A model is a group of concepts that are associated because of their relevance to a common
theme.
DIF: Application
REF: p. 78
3. The statement, “Nursing is a caring profession that focuses on helping people be as healthy as
possible,” is an example of a:
a. concept.
b. construct.
c. philosophy.
d. model.
ANS: C
A philosophy is the values and beliefs of the discipline.
DIF: Comprehension
REF: p. 79, Table 5-1
4. Einstein’s theory of relativity laid the groundwork for theories of mathematics, and Freud and
Jung provided the basis for a philosophy of man. Which nursing theory served as the
foundation for nursing science?
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a.
b.
c.
d.
Rogers’ science of unitary human beings
Nightingale’s theory of practice
Watson’s theory of human caring
King’s theory of goal attainment
ANS: B
Florence Nightingale investigated the effect of the environment on healing, and this serves as
the foundation for nursing science.
DIF: Comprehension
REF: pp. 81-82
5. A community health nurse has been visiting a postpartum client who suffered domestic
violence throughout the pregnancy, and now the infant may be at risk. The nurse assisted the
client in finding shelter and legal protection. The nurse’s role and the conceptual framework
involved are:
a. change agent, according to Roy’s adaptation model.
b. translator, according to Leininger’s theory of cultural care diversity and
universality.
c. case manager, according to Peplau’s interpersonal relations model.
d. caregiver, according to Rogers’ science of unitary human beings.
ANS: A
In Roy’s adaptation model, when the client incurs an insult that renders him or her in need of
environmental modification, the nurse will be the change agent in assisting the individual
with this adaptation.
DIF: Application
REF: p. 79, Table 5-1 |p. 85
6. What are general explanations that scholars use to explain, predict, control, and understand
commonly occurring events?
a. Theories
b. Constructs
c. Systems
d. Propositions
ANS: A
Theories are a group of related concepts that explain existing phenomena and predict events.
Theories provide us with a frame of reference, the ability to choose concepts to study, or ideas
that are within one’s practice.
DIF: Comprehension
REF: p. 79, Table 5-1
7. Which type of theory most often guides present nursing practice?
a. Grand theory
b. Middle range theory
c. Developmental theory
d. Values theory
ANS: B
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Middle range theory is a nursing theory that refers to a specific population or to a specific
situation, thereby making the theory easy to understand. An example is the theory of
unpleasant symptoms (Lenz and Pugh), which examines symptoms that are influenced by
physiologic, psychological, and situational factors as they relate to performance.
DIF: Knowledge
REF: p. 79
8. A client is hypertensive, and the doctor prescribes weight reduction. The client is excited
about beginning the diet, but on arriving home the spouse states, “You have always been fat,
and I am not going to starve because you can’t control yourself.” The client becomes anxious
and is unable to participate in the diet plan, resulting in a weight gain of 5 pounds in 2 weeks.
Which theorist could best be referred to for guidance regarding interventions in this situation?
a. Martha E. Rogers
b. Hildegard E. Peplau
c. Florence Nightingale
d. Myra Estrin Levine
ANS: B
Hildegard Peplau’s theory describes interpersonal relations as a nursing process. Nursing
intervention in Peplau’s model focuses on reducing related incapacitating stressors through
therapeutic interpersonal interaction.
DIF: Application
REF: pp. 83-84, Table 5-2
9. A nurse believes that humans use creativity and critical thinking to balance their connections
with their surroundings. The nurse decides to conduct a study on the basis of this belief.
Which nursing theory would be best for this study?
a. Peplau’s interpersonal relations as a nursing process: man as an organism that
exists in an unstable equilibrium
b. Roy’s adaptation model: assistance with the adaptation to stressors to facilitate the
integration process of the client
c. Orem’s self-care deficit model: self-care, self-care deficits, and nursing systems
d. Rogers’ science of unitary human beings: humans as energy fields that interact
constantly with the environment
ANS: D
Rogers’ science of unitary human beings, in which humans are seen as energy fields that
interact constantly with the environment, is a theory in which the nurse promotes
synchronicity between human beings and their universe/environment.
DIF: Comprehension
REF: pp. 83-84, Table 5-2
10. A client involved in a motor vehicle accident is blinded. The nurse helps the client obtain a
guide dog so the client may continue grocery shopping and visiting friends and family. This
enables the client to cope with the handicap and perform activities of daily living. Which
nursing theory can be applied to this scenario?
a. Watson’s philosophy and science of caring and humanistic nursing
b. Mishel’s uncertainty in illness
c. Orem’s self-care deficit
d. Rogers’ science of unitary human beings
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ANS: C
In Orem’s self-care deficit theory, the nurse implements measures to help clients meet
self-care needs by matching them with an appropriate supportive intervention.
DIF: Application
REF: pp. 83-84, Table 5-2
11. A young child is having abdominal pain, and the doctor informs the parents that a computed
tomography (CT or CAT) scan of the abdomen will be ordered. The doctor tells the child,
“This CAT scan won’t hurt you.” The child is visibly upset because of a fear of cats.
According to Mishel’s uncertainty in illness theory, which stage of the framework is
represented?
a. Stimuli frame
b. Appraisal stage
c. Initiation of coping mechanisms
d. Adaptation
ANS: A
In the stimuli frame, the client reacts to some stimulus in a negative manner. The nurse at this
stage should listen carefully and then initiate, seek, and clarify concerns and questions.
DIF: Comprehension
REF: p. 81, Case Study 5-1
12. A nurse researcher determines whether findings are substantial by calculating the level of
significance. Which aspect of the scientific inquiry is being conducted?
a. Hypothesis
b. Method
c. Data collection
d. Evaluation
ANS: D
During evaluation, results are examined with the goal of determining the relevance of
outcome data in answering the hypothesis; the significance of the data and the potential for
future research are also explored.
DIF: Application
REF: p. 77, Box 5-1
13. A nurse who has practiced on an orthopedic unit for 10 years unexpectedly becomes pregnant.
At delivery the physician informs the mother, “Your baby has Alport syndrome, but then I
don’t have to explain what that means with your medical background.” The mother is
unfamiliar with this disease and withdraws as a coping mechanism. Which nursing theory
would provide a framework to guide nursing care for this mother?
a. Mishel’s uncertainty of illness
b. Orem’s self-care deficit model
c. Nightingale’s canons of nursing
d. Levine’s conservation model
ANS: A
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In Mishel’s uncertainty of illness theory, the core position is that uncertainty in illness must be
addressed. When uncertainties are not addressed, clients’ negative perceptions will escalate
and they will suffer. Nursing responsibility based on this theory consists of reframing the
client’s perceived loss of control, or uncertainty, and helping the client develop new skills of
assimilation and accommodation.
DIF: Comprehension
REF: p. 86
14. If a nurse applies Nightingale’s theory to current practice, the nurse’s first step will be to
evaluate the hospital room’s air quality and, second, to:
a. make certain that the volume of the television is not too loud.
b. consult the dietitian to check that essential nutrients are added to meet
requirements noted on MyPyramid.
c. ask the client’s family to bring family photographs and bright-colored throws for
the bed.
d. arrange for the client to go outside, weather permitting, while keeping the room’s
window blinds open.
ANS: D
Nightingale believed the need for light was second only to the need for fresh air.
DIF: Application
REF: p. 82
15. A nurse develops a new nursing theory related to stress and viability. The nurse determines
the theory accounts for historical events in which soldiers suffering from the stress of
inadequate clothing to protect them from the cold and lack of correspondence from home had
an increased mortality related to gunshot wounds. The theory will predict gunshot victims’
need for proper clothing and letters from significant others as they serve in Iraq. Which
criterion for theory acceptance is being validated?
a. Inclusiveness
b. Consistency
c. Accuracy
d. Simplicity
ANS: C
The accuracy of a theory is its ability to explain past occurrences while being useful in
determining future outcomes.
DIF: Application
REF: p. 77, Box 5-2
16.
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A nurse practicing on a unit where domestic violence is common wants to learn how to apply
nursing theory to practice on this unit. She considers the interrelatedness of the constructs of
Watson’s Theory of Caring and designs:
a. conceptual model of caring.
b. hypothesis of the impact of caring on domestic violence.
c. proposition of how caring is conceptualized.
d. theory of scientific inquiry.
ANS: A
The conceptual model demonstrate how the concepts of compassion, commitment,
conscience, confidence, and competence form a theme of caring (Watson).
DIF: Comprehension
REF: p. 85
17. A nurse in a rehabilitation unit plans activities of daily living to prevent excessive fatigue,
helps the patient dress before the family visits, assists with range of motion, and allows the
patient to decide which clothes to wear during the visit. This nurse is best applying which
theory to practice?
a. Watson’s Theory of Caring
b. Rogers’ Theory of Unitary Humans
c. Levine’s Theory of Conservation
d. Leininger’s Theory of Transcultural Nursing
ANS: C
Certain parts of all the theories can be applied; however, all the constructs of Levine’s Model
of Conservation are applied, including energy conservation, structural integrity, personal
integrity, and social integrity. In this situation, the nurse conserved energy by planning ADLs,
conserved structural integrity through ROMs, conserved social integrity by helping patient
with appearance during family visits thus improving the milieu for social visits.
DIF: Application
REF: p. 83, Table 5-2
18. A nurse is evaluating Levin’s Theory of Conservation to determine if it can be applied to
patients in the initial phases of chemotherapy treatment. During this phase of theory
acceptance, the nurse wants to determine if all the concepts of energy, structural integrity,
personal integrity, and social integrity are included in the care of cancer treatment. The nurse
is applying which criteria of theory acceptance?
a. Inclusiveness
b. Consistency
c. Accuracy
d. Fruitfulness
ANS: A
Inclusiveness asks the question, “Does the theory include all concepts related to the area of
interest?”
DIF: Application
REF: p. 77, Box 5-2
19. A nurse is heard making this comment, “I believe human dignity is based on perceived
self-worth while caring is based on perceived role in society that forms the basis of nursing
practice.” This nurse is:
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a.
b.
c.
d.
demonstrating a model of human dignity.
evaluating the relevance of Leininger’s Theory.
applying Mishel’s Theory of Disease Uncertainty.
making a proposition concerning the constructs of nursing practice.
ANS: D
A proposition is a statement that proposes the relationship between and among concepts.
DIF: Application
REF: p. 76 |p. 78
20. A group of nurses are interested in the how to improve teaching effectiveness for patients who
have a hearing impairment and lack family involvement while hospitalized. They believe
“hearing loss decreases the teaching effectiveness while hospitalized.” The group plans to
evaluate teaching effectiveness using a 10-point Likert scale pre-post teaching, perform a
hearing test to determine degree of hearing loss on admission, and have social work evaluate
the impact of hearing impairment on patient’s ability to safely live alone prior to discharge.
The group is working in which step of the scientific process?
a. Hypothesis
b. Method
c. Results
d. Evaluation
ANS: B
During the method step, the group decides what data will be collected to answer the question
and identifies step-by-step procedures that will be used to collect these data.
DIF: Application
REF: p. 77, Box 5-1
MULTIPLE RESPONSE
1. Which of the following are concepts related to nursing theory? (select all that apply)
a. Environment
b. Health
c. Nursing
d. Relevance
e. Comfort
ANS: A, B, C, E
Environment is a concept, which is a label given to ideas, objects, or events; concepts become
the “pieces” that make up a conceptual model or theory. Health is a concept, which is a label
given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual
model or theory. Nursing is a concept, which is a label given to ideas, objects, or events;
concepts become the “pieces” that make up a conceptual model or theory. Comfort is a
concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that
make up a conceptual model or theory.
DIF: Comprehension
REF: p. 83, Table 5-2
COMPLETION
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1. The basic ingredients of theory are ____________.
ANS:
concepts
A theory is defined as a group of related concepts that explain existing phenomena and predict
future events.
DIF: Knowledge
REF: p. 76
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Chapter 06: Nursing Research and Evidence-Based Practice
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Institutional review boards determine whether research studies involving human subjects will:
a. be published.
b. add to the body of nursing knowledge.
c. cause harm.
d. receive funding.
ANS: C
The institutional review board (also called the human subjects committee) examines research
proposals to ensure that the ethical rights of those individuals participating in the research
study are protected. This board makes sure that persons who participate in research are
assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is
protected.
DIF: Knowledge
REF: p. 102
2. A nurse is interested in understanding the meaning of the human experience of surviving
polio. Subject recruitment targets persons who have been diagnosed with the disease. The
researcher reflects on the data and identifies common themes in order to understand the “lived
experience.” These characteristics are consistent with the qualitative research method known
as:
a. grounded theory.
b. ethnography.
c. phenomenology.
d. case study.
ANS: C
Phenomenology is a qualitative research design that uses inductive descriptive methodology to
describe the lived experiences of study participants.
DIF: Comprehension
REF: p. 89 | p. 95, Table 6-2
3. The use of research to guide nursing practice is called:
a. utilization.
b. dissemination.
c. generalizability.
d. analysis.
ANS: A
Utilization of research guides nursing practice. Clinical agencies need to make a commitment
to implementing research findings and then developing policies and procedures to guide the
implementation process.
DIF: Comprehension
REF: pp. 95-96
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4. A public health nurse is interested in determining which educational programs are needed in
the aggregates served. The researcher personally interviews individuals who are walking on
the streets in the community. This type of research design is:
a. quasi-experimental.
b. survey.
c. case study.
d. ethnography.
ANS: B
Survey is a nonexperimental research design that focuses on obtaining information regarding
the status quo of some situation, often through direct questioning of participants.
DIF: Application
REF: p. 94, Table 6-1
5. Which organization provides federal funding for research?
a. National Institute of Nursing Research
b. Robert Wood Johnson Foundation
c. W. K. Kellogg Foundation
d. Sigma Theta Tau International
ANS: A
The National Institute of Nursing Research is a federal agency that provides federal funding
for health care research.
DIF: Knowledge
REF: p. 92
6. Which type of data analysis results in the non-numerical organization of data?
a. Descriptive
b. Inferential
c. Qualitative
d. Quantitative
ANS: C
Qualitative data analysis results in the organization of words or phrases, not numbers.
Interviews are reviewed and are transcribed line by line in an effort to group common
conceptual meanings.
DIF: Comprehension
REF: p. 95
7. A nurse researcher who is seeking funding for a study should identify _____ of funding
agencies.
a. board members
b. priorities
c. budgets
d. accreditation
ANS: B
The priorities of funding agencies indicate their preferences for funding; these are more likely
to be funded than are studies that are not aligned with funding preferences.
DIF: Comprehension
REF: pp. 91-92
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8. A nurse studied a community to determine if there were clients who would benefit from a
hospice program if one were developed. This type of research is:
a. a survey.
b. quasi-experimental.
c. a needs assessment method.
d. a pilot study.
ANS: C
A needs assessment method is a study in which the researcher collects data for the purpose of
estimating the needs of a group; the method is commonly used to prioritize the needs of an
organization or community.
DIF: Comprehension
REF: p. 94, Table 6-1
9. The research hypothesis is that aromatherapy reduces stress more effectively than does
acupuncture. The researcher does not identify a control group. This study would be a(n)
_________ design.
a. experimental
b. quasi-experimental
c. survey
d. meta-analysis
ANS: B
In quasi-experimental studies, a control group, randomization, or the manipulation of one or
more variables is missing.
DIF: Comprehension
REF: p. 94, Table 6-1
10. A qualitative researcher reviews data collected with a grief support group to develop a theory
of how widows and widowers mourn. The researcher is using which qualitative research
design?
a. Phenomenology
b. Grounded theory
c. Case study
d. Hypothesis generation
ANS: B
Grounded theory is a qualitative research approach that describes a social process and has
theory generation as its main purpose.
DIF: Comprehension
REF: p. 95, Table 6-2
11. Which statement about qualitative research is correct?
a. Qualitative research requires less time than quantitative research because complex
statistical analysis is not necessary.
b. To be statistically significant, qualitative studies must consist of large, randomly
selected sample sizes.
c. Because qualitative studies deal with human concepts such as suffering and quality
of life, results can be generalized.
d. Interviews are the primary means of collecting data that enable the researcher to
describe unclear phenomena.
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ANS: D
Qualitative research involves ambiguous concepts. Analysis of interviews with participants
who are experiencing the phenomena enables the researcher to describe unclear phenomena.
DIF: Comprehension
REF: p. 95
12. A nurse interested in life satisfaction among patients receiving hemodialysis reviews
databases and identifies relevant studies which are then statistically analyzed providing
generalization through multiple studies. The nurse researcher is using which type of research?
a. Quasi-experimental
b. Secondary analysis
c. Meta-analysis
d. Survey
ANS: C
Meta-analysis uses the analysis of several research studies to validate smaller studies,
allowing generalization.
DIF: Comprehension
REF: p. 94, Table 6-1
13. A new nurse researcher is interested in tracing the history of nursing research. The researcher
learns that nursing research began with:
a. the work of Florence Nightingale during the Crimean War.
b. studies between 1900 and 1940 following Nightingale’s work.
c. studies to improve patient care by doctorally prepared nurses.
d. studies based on the naturalistic paradigm.
ANS: A
Nursing research began with the Nightingale during the Crimean War—more can be read in
Chapter 1 of this text.
DIF: Comprehension
REF: p. 91
14. Nurses on a busy medical schedule want to reduce documentation time and improve order
entry. Additionally, patient records from previous visits are often incomplete or do not include
care from other providers. To improve patient care, a taskforce suggests using an Electronic
Medical Record for 1 month to determine whether this provides the desired outcomes. This
unit is participating in which type of study?
a. Ethnography
b. Pilot
c. Secondary data analysis
d. Phenomenology
ANS: B
Pilot studies are small-scale studies often referred to as feasibility studies to determine if a
larger more sophisticated research study is needed.
DIF: Comprehension
REF: p. 89 |p. 95
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15. A researcher is interested in learning if elderly persons perceive their health to be satisfactory
even with comorbidities and chronic illness. A large multisite assistive living facility will be
the site. The researcher lists residents in alphabetical order and chooses every third person on
the list. To ensure improved generalizability, the researcher is using:
a. triangulation.
b. randomization.
c. informed consent.
d. a meta-analysis approach.
ANS: B
Randomization is a method of choosing subjects based on chance alone.
DIF: Comprehension
REF: p. 89
16. A researcher conducts a survey to determine the perceived health status of elderly persons
living independently at home. The same subjects participate in a telephone call in which they
describe the lived experience of living with chronic illness. When writing up the research
study, the nurse would describe using:
a. a control group.
b. triangulation.
c. a pilot study.
d. secondary data analysis.
ANS: B
Triangulation is the use of a variety of methods to collect data on the same concept—in this
situation, quantitative research through survey and qualitative research through
phenomenology.
DIF: Comprehension
REF: p. 89|p. 95
17. A nurse is interested in learning how reminiscence therapy can improve memory in
cognitively intact persons over the age of 65 years. Findings from three groups are compared.
Group 1 receives music therapy, Group 2 receives life review therapy, and Group 3 does not
receive therapy, but data are collected from all three groups and compared. Group 3 is known
as the:
a. pilot study.
b. survey.
c. needs assessment.
d. control group.
ANS: D
A control group is a set subject in an experiment who do not receive the experimental
treatment and whose performance provides a baseline against which the effects of the
treatment can be measured.
DIF: Comprehension
REF: p. 89
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18. A nurse is reading an abstract about a study related to Rocky Mountain Spotted Fever. The
purpose is stated as follows: “To examine the generalizability of two randomized
placebo-controlled clinical trials in patients with Rocky Mountain Spotted Fever to determine
whether steroid therapy resulted in the positive outcomes.” The nurse knows generalizability
refers to the:
a. conclusion that findings can be generalized from the sample to the entire
population.
b. fact that the group of steroids used are from the same organic compounds.
c. possibility that the subjects were carefully selected and that outside influence is
thus suspected.
d. fact that the type of bacteria carried by ticks is universal.
ANS: A
Generalizability is the deduction that findings from one study can be applied to other
populations not involved in the actual research.
DIF: Comprehension
REF: p. 89
19. A nurse is interested in studying the rituals of a tribe living in remote areas of Africa. The
researcher is accepted into the tribe and observes firsthand the rituals practiced. Themes were
analyzed to arrive at a description of the culture including rituals. The nurse is practicing
which type of research?
a. Qualitative, Ethnography
b. Qualitative, Phenomenology
c. Quantitative, Quasi-experimental
d. Quantitative, Secondary data analysis
ANS: A
Ethnography is a method used to study phenomena from a cultural perspective. Ethnographers
spend time in the cultural setting with the research participants to observe and better
understand their experience.
DIF: Comprehension
REF: p. 89 |p. 95, Table 6-2
MULTIPLE RESPONSE
1. The informed consent documents must include: (select all that apply)
a. an explanation of potential risks and benefits to participants in the study.
b. medical terminology rather than lay terms to prevent misunderstanding of the
study.
c. a statement on how the anonymity and confidentiality of participants are protected.
d. explanation of the cost of the study.
e. details on how to contact the investigator.
ANS: A, C, E
Informed consent explains the study to the participants and assures them of their rights,
including their right to refuse to participate or to withdraw from the study. The informed
consent must include protection of anonymity and confidentiality, voluntary participation,
compensation, and alternative treatment. The informed consent must include specific
information on how to contact the investigator.
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DIF: Comprehension
REF: p. 102
2. A researcher is interested in quality of life and after an extensive literature review
quantitatively integrates data from identified studies and describes the findings. This
researcher is using which approach? (select all that apply)
a. Survey
b. Triangulation
c. Meta-analysis
d. State of the science summary
e. Quasi-experimental design
ANS: C, D
Meta-analysis is an advanced process whereby multiple research studies on a specific topic
are reviewed, and the findings of these multiple studies are statistically analyzed. State of the
science summary is a merging of findings from several studies that explored the same topic.
DIF: Comprehension
REF: p. 94, Table 6-1
3. A researcher seeks funding from an agency that limits studies to quantitative research. The
researcher can select from which of the following study designs? (select all that apply)
a. Survey
b. Grounded theory
c. Phenomenology
d. Needs assessment
e. Experimental
ANS: A, D, E
Surveys collect demographics, social characteristics, behavioral patterns, and information
bases. Needs assessments are used to determine what is most beneficial to aggregates. The
experimental method establishes cause-and-effect relationships while also testing
relationships.
DIF: Comprehension
REF: p. 61, Table 6-1
COMPLETION
1. Development and validation of the body of knowledge and foundation on which practice is
based is called ____________.
ANS:
research
Research refines and enhances new and existing knowledge and provides accountability for
nursing practice.
DIF: Knowledge
REF: p. 90
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Chapter 07: Paying for Health Care in America: Rising Costs and Challenges
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. An older adult client was admitted to the hospital with the condition classified as
“pneumonia.” Reimbursement was based on a predetermined fixed price. This classification
system is referred to as:
a. diagnosis-related groups (DRGs).
b. subjective symptom management.
c. acuity classification system.
d. organized managed care.
ANS: A
DRGs are used in reimbursement for health care services based on a predetermined fixed price
per case or diagnosis in 468 categories. Under DRGs, each Medicare client is assigned to a
diagnostic grouping on the basis of his or her primary diagnosis at hospital admission.
Medicare limits total payment to the hospital to the amount pre-established for that DRG.
DIF: Comprehension
REF: p. 3 |pp. 9-10 |p. 106 | pp. 108-109
2. The precise classification of clients according to the highest diagnosis-related group (DRG)
has created a new role for nurses, known as a _____ nurse.
a. case management
b. quality assurance
c. utilization review
d. cost-control
ANS: C
Hospital-based utilization review nurses review medical records to determine the most
appropriate DRG for clients. Financial gains can be made through careful diagnosis of clients
according to their highest potential DRG classification.
DIF: Knowledge
REF: p. 109
3. Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing:
a. hospital admission rates.
b. length of hospital stay.
c. outpatient services.
d. specialty groups.
ANS: B
Hospitals face a strong financial incentive from the DRG reimbursement system to reduce the
client’s length of stay and minimize procedures performed. If hospital costs exceed the DRG
payment for a client’s treatment, the hospital incurs a loss, but if costs are less than the DRG
amount, the hospital makes a profit.
DIF: Comprehension
REF: p. 109
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4. When reviewing the literature on the effects of Medicaid on health care for the poor, the nurse
researcher found that the poor:
a. have less access than even the uninsured.
b. receive many unnecessary treatments.
c. lack consistent providers.
d. abuse preventive services.
ANS: C
The poor are more likely to lack a usual source of care, are less likely to use preventive
services, and are more likely to be hospitalized for avoidable conditions than are those who
are not poor.
DIF: Comprehension
REF: p. 111
5. Lack of insurance, uninsured populations, and uncompensated care are covered by charging
more to those who can pay. This practice is referred to as:
a. charity.
b. cost shifting.
c. price sharing.
d. governmental reimbursement.
ANS: B
Cost shifting occurs when providers increase their charges against households and public and
private insurers who pay for their own care while making some contribution to the care of the
uninsured population.
DIF: Comprehension
REF: p. 111
6. A contractual agreement between the insurer and the provider in which covered members are
encouraged to use specific health care providers in return for reduced rates is which type of
arrangement?
a. Health maintenance organization
b. Preferred provider organization
c. Fee-for-service arrangement
d. Philanthropic agency
ANS: B
A preferred provider organization is an arrangement by which the member pays a premium
for a fixed percentage of expense coverage. This method includes a required deductible and a
copayment. The member may select a physician but pays less for physicians and facilities on
the plan’s preferred list.
DIF: Comprehension
REF: p. 110, Table 7-2
7. In the triad of health care, which would be considered the third-party payer?
a. Client
b. Health care provider
c. Insurance company
d. Government agency that sets reimbursement rules for services
ANS: C
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The third-party payer is an organization other than the client and the supplier (hospital or
physician), such as an insurance company, that assumes responsibility for payment of health
care charges.
DIF: Knowledge
REF: p. 107 |p. 113
8. A physician bills the insurance company for a computed tomography (CT) scan, laboratory
tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This
type of payment system is a _____ payment system.
a. prospective
b. retrospective
c. diagnosis-related group
d. capitated
ANS: B
A retrospective payment system is a method of reimbursing health care providers (such as
physicians and hospitals) in which professional services are rendered and charges are billed on
the basis of each service provided; this is also known as a fee-for-service payment system.
DIF: Comprehension
REF: p. 107| p. 110, Table 7-2
9. A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client
undergoes coronary artery bypass grafting. The cost of care for this client is increased because
of a four-pack-per-day smoking history that resulted in extension of the client’s intensive care
unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that
under the terms of the diagnosis-related group (DRG) payment system for this diagnosis:
a. the cost of caring for this client was $5000 greater than the DRG reimbursement
fee, and the hospital will be allowed to collect the additional fees from the
insurance company.
b. although the cost of care for this client was greater than the DRG reimbursement
amount, the hospital will be reimbursed only at the set fee.
c. the client will be sued to pay back the insurance company for the extra fees
incurred because smoking is a modifiable health risk for heart disease.
d. the physician who admitted the client will receive a reduced payment to cover the
loss incurred by the hospital.
ANS: B
Since 1983, if hospital costs exceed the DRG payment for a client’s treatment, the hospital
incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. Hospitals
face strong financial incentives to reduce the client’s length of stay and minimize procedures
performed.
DIF: Comprehension
REF: p. 106| pp. 108-109
10. A young mother has detected a lump in her breast, and because she lives at the poverty level,
she is covered under Medicaid. This individual:
a. is more likely to participate in mammography screening than are individuals
covered by private insurance.
b. has designated primary care and a specialist as sources of care.
c. will more likely wait to seek care and will require hospitalization for a
mastectomy, which could have been avoided if care had been sought earlier.
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d. has decreased access to health care when compared with the uninsured.
ANS: C
Even with improved access as compared with the uninsured, Medicaid recipients are not as
likely to obtain needed health services. The poor are more likely to lack a usual source of care,
are less likely to use preventive services, and are more likely to be hospitalized for avoidable
conditions than are those who are not poor.
DIF: Comprehension
REF: pp. 110-111
11. A client who is reading a newspaper asks, “This article about health care states that many
providers of health care lack effectiveness. What is the difference between effectiveness and
efficiency?” The nurse explains that:
a. effective means performing the correct test or intervention whereas efficiency refers
to the wise use of supplies and resources for the desired outcome.
b. effective refers to competence in clinical practice and efficiency describes quick
completion of the task.
c. efficiency means wasting and meeting a minimum standard and effectiveness refers
to taking all the time needed to exceed expectations.
d. efficiency refers to speed and effectiveness refers to the usefulness of the
implementation.
ANS: A
Efficiency means using the right combination of resources—energy, time, and money—to
accomplish a task, and effectiveness means doing the right thing right in health care.
DIF: Comprehension
REF: p. 115
12. A nurse is offered several health care plans as part of employee benefits. Which plan is based
on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment
services?
a. Prospective payment system
b. Retrospective payment system
c. Single-payer system
d. Capitation
ANS: D
Capitation is a method of reimbursing providers (usually, primary care providers such as
physicians or nurse practitioners) in which the insurance company pays the provider a set
amount of money each month to provide a defined set of health care services under this plan.
Payment is generally received as a per-member–per-month payment. Defined health care
services generally include preventive, diagnostic, and treatment services.
DIF: Comprehension
REF: p. 106
13. In February 2010, Congress passed legislation to support universal health care for all
Americans. At a local health fair, an individual asks about the difference between universal
health care and a single payer system. The nurse explains the difference is that:
a. with universal health, one universal payer, usually the government, pays all
expenses for health care.
b. single-payer systems offer health care only to eligible persons based on income.
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c. single-payer systems rely on insurance companies to pay predetermined fees for
services.
d. with universal health, one payer is responsible for all health care costs, providing
health care to all citizens.
ANS: D
Universal health has one payer (usually the government) and provides health care for all
citizens.
DIF: Comprehension
REF: p. 107 |p. 113
14. An elderly person, age 80, is finding it difficult to live alone and the family is considering
long-term care. The elderly person is reasonably healthy, with only normal aging declines,
and maintains a healthy appetite. All medications are administered orally and require only
minimal assistance. She is financially secure with an income based on retirement from both
the military and factory from her deceased husband and herself. The family contacts long-term
care and is told that, based on this patient’s information:
a. Medicare will cover the cost of stay since skilled services are required.
b. Medicaid is only for families with dependent children.
c. Medicare will pay for home health services should these additional services meet
the needs of the individual.
d. Medicare will pay regardless of household income or financial status for nursing
home care.
ANS: C
Medicare does cover home health care.
DIF: Comprehension
REF: p. 113
15. Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act
(PPACA) based on religious beliefs that prohibit circumcision and blood transfusions. These
individuals believe the PPACA is unconstitutional because it:
a. mandates that all U.S. and legal residents must secure health insurance.
b. replaces current Medicare and Medicaid plans.
c. requires all citizens to participate in offered preventive services.
d. prohibits use of health practices outside of Western medicine.
ANS: A
The PPACA is a type of national health insurance program to provide funding for U.S.
citizens and legal residents to secure health insurance beyond the current programs such as
Medicare and Medicaid.
DIF: Comprehension
REF: p. 106 |p. 110, Table 7-2
16. A nurse is newly employed by a state-owned hospital that provides health care insurance
requiring a deductible paid by the employee with the majority of the premium cost covered by
the employer. The insurance provided to the nurse is:
a. private health insurance.
b. a federal insurances program known as PPACA.
c. state-subsidized Medicaid insurance.
d. single-payer system coverage.
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ANS: A
Private health insurance is a method for individuals to maintain insurance coverage for health
care costs through a contract with a health insurance company that agrees to pay all or a
portion of the cost of a set of defined health care services and is typically provided through an
individual’s employer with a portion of the cost paid by the employer and a portion paid by
the employee.
DIF: Comprehension
REF: p. 106 |p. 113
17. Health care is one of the major stories in newspaper and television and a group of nurses are
interested in how the economy impacts their nursing practice. The group critiques the
relationship between contemporary economic trends and professional nursing practice and
finds:
a. the implementation of the DRG system led to the nursing shortage since cost of
nursing care is not billed.
b. nursing care is focused on technologically advanced acute care rather than
preventive, patient-centered care.
c. with pay for performance, nurses have a significant effect on the quality of patient
outcomes by reducing errors and providing care based on best practices.
d. economic issues have little or no impact on nursing practice.
ANS: C
Pay for performance, where providers are reimbursed based on the quality of care, gives
nurses an opportunity to reduce costs and adopt practices that improve quality of care.
DIF: Comprehension
REF: pp. 113-114
18. A patient is eligible to change health care providers and insurance and asks, “I am interested
in health promotion activities; I walk, swim, and eat healthy. Which health insurance plan
would support these activities rather than just pay for services when I am sick”? Which, if
any, health insurance plan would best meet the needs of this patient?
a. Health Maintenance Organization (HMO).
b. Fee for Service.
c. Preferred Provider Organization (PPO).
d. None, because health insurance plans currently cover only disease management,
not preventive care.
ANS: A
HMOs encourage preventive care.
DIF: Comprehension
REF: p. 110, Table 7-2
19. A patient is upset because her health insurance plan refused to pay for a mammogram and
services by a women’s health specialist because the primary care physician did not order the
referral or the mammogram. Which type of insurance plan adheres to this type of payment
system?
a. Fee for Service
b. Health Maintenance Organization (HMO)
c. Preferred Provider Organization (PPO)
d. Point of Service (POS)
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ANS: B
HMOs require patients to select a primary care physician approved by the HMO who then
must refer or order any test/diagnostic procedures before payment is approved or preapproval
must be sought.
DIF: Comprehension
REF: p. 110, Table 7-2
20. A patient wants to reduce health care costs by being a model for making wise decisions that
both promote health and reduce cost. Which statement by the patient would indicate a need
for further teaching?
a. “I will ask for the brand name drug Tylenol rather than acetaminophen since it
works better and I won’t be sick as long.”
b. “I looked up urinary tract infection prevention on the Internet.”
c. “I had my weight, body fat, and blood sugar measured at a local health fair.”
d. “My allergies are really bothering me. I spoke to the pharmacist, who
recommended an over-the-counter antihistamine.”
ANS: A
Ways to reduce health care costs as a consumer include choosing generic drugs whenever
possible.
DIF: Analysis
REF: pp. 115-116
21. A nurse is very interested in learning more about health care economics and how she can use
that knowledge to become a better patient advocate. She comments, “Nurses should not only
deliver care one day at a time in one facility but should coordinate patient care as they move
from acute care to rehabilitation to home care.” This nurse would be a candidate for which
nursing role?
a. Disease management program (DMP) for chronic illnesses
b. A hospital-based utilization management nurse who reviews medical records to
determine the most appropriate DRG for patients
c. Case management
d. Reviewer for Managed Care Organization
ANS: C
Case management offers nurses the opportunity to demonstrate cost-effectiveness by
coordinating patient care at the appropriate level of care across the continuum of care. Patient
advocacy and understanding current health care economics are critical to this role.
DIF: Comprehension
REF: pp. 108-109
MULTIPLE RESPONSE
1. A nurse who speaks at a health fair states that current attempts to increase efficiency of health
care include: (select all that apply)
a. an increase in acute care, so that specialized care can be provided.
b. the growing use of outpatient services.
c. shifting toward health promotion and prevention.
d. allowing physicians to control health care decision making.
e. the use of technology to educate the public about cost-effective measures.
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ANS: B, C, E
Economic forces are motivating the shift toward providing more services and procedures in
outpatient settings. Economic forces are motivating the shift toward a model of health
promotion and preventive. The Internet can inform and educate consumers (or clients) about
how to access health care educational resources more effectively.
DIF: Analysis
REF: p. 106 |p. 115
2. Medicare would be responsible for: (select all that apply)
a. a hospital stay following a total knee replacement for a 70-year-old client.
b. nursing home cost for a 67-year-old adult receiving hemodialysis.
c. rehabilitation care costs for a 24-year-old client with a broken femur resulting from
a fall at work.
d. prescription cost for a young mother who meets eligibility for Aid to Families with
Dependent Children (AFDC).
e. home health services to administer heparin to a 27-year-old truck driver following
a thrombus.
ANS: A, B
Medicare coverage is based on age and Part A covers inpatient hospital services. Medicare
eligibility is based on age and disability with hemodialysis resulting from chronic renal failure
classified as a disability.
DIF: Comprehension
REF: p. 110, Table 7-2
COMPLETION
1. The largest single payer of hospital charges in the United States is ___________.
ANS:
Medicare
Medicare is the largest health insurance program; it covers the disabled persons with
end-stage renal disease, and persons 65 years of age and older who qualify for Social Security.
Since enactment of this program in 1965, the population covered by Medicare has doubled.
DIF: Knowledge
REF: p. 113
2. A 72-year-old client is admitted to have the right kidney removed after a diagnosis of cancer.
The surgeon removed the left kidney. Medicare will no longer pay for preventable medical
errors known as ____________.
ANS:
never events
Medicare identified 28 medical errors that were preventable and with serious consequences
for which they will no longer pay. These errors are called never events.
DIF: Knowledge
REF: p. 114
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3. The type of insurance that shifts the largest percentage of costs for goods and services to
employees and consumers is _____________ insurance.
ANS:
private
Private insurance shifts a more costs to employees and consumers than does any other type of
insurance.
DIF: Knowledge
REF: p. 107
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Chapter 08: Legal Issues in Nursing and Health Care
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client
is an immigrant and is uninsured. Which act would prevent the client from being transferred
to another facility?
a. Emergency Medical Treatment and Active Labor Law
b. Health Insurance Portability and Accountability Act
c. Patient Self-Determination Act
d. The Patient Safety and Quality Improvement Act
ANS: A
The Emergency Medical Treatment and Active Labor Law is a federal statute that was enacted
in 1986 to prohibit the transfer of unstable clients, including women in labor, from one facility
to another. This law also prohibits refusal of care for indigent and uninsured clients who seek
medical assistance in the emergency department.
DIF: Comprehension
REF: p. 123
2. A nurse is caring for a client with malignant hypertension whose blood pressure has increased
by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to
the physician. The nurse is at risk for being charged with:
a. negligence.
b. assault.
c. defamation of character.
d. tort.
ANS: A
Negligence is defined as failure to act in a reasonable and prudent manner. The most frequent
allegations of nursing negligence include failure to ensure client safety, improper treatment,
failure to monitor the client and report significant findings, medication errors, and failure to
follow the agency’s policies and procedures.
DIF: Comprehension
REF: p. 120|p. 132
3. A nurse is caring for a client who just suffered a stroke and is medicated for pain. The nurse
completes the following interventions: places the client on the examining table, completes a
thorough history and physical, covers the client with a sheet, places the call button within
reach, and goes out in the hall to speak with the client’s physician. The client tries to get up to
speak with his family and falls, sustaining a hematoma on the head and a broken hip. The
nurse’s actions reflect:
a. invasion of privacy.
b. libel.
c. slander.
d. negligence.
ANS: D
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The nurse is failing to ensure client safety after medication administration; this is defined as
negligence.
DIF: Comprehension
REF: p. 120|p. 132
4. A nursing student planning to apply for licensure knows that being charged with which
offense would result in a minor criminal offense?
a. Solicitation of illegal drugs
b. Stealing a car
c. Failing to report elder abuse
d. Billing Medicare for services not rendered
ANS: C
Failing to report elder abuse can lead to penalty of fine or imprisonment.
DIF: Comprehension
REF: p. 150
5. When differentiating between slander and libel, the nurse knows that libel:
a. results from defamation caused by subjective comments written in the nurse’s
notes.
b. results from negative subjective comments made to those who are not providing
care.
c. occurs when the nurse verbally describes to the oncoming nurse assigned to the
client objective data that place the client in a negative light.
d. consists of repeating prejudiced comments made by the primary caregiver to a
neighbor at the local supermarket.
ANS: A
Libel is defined as comments that are written about a person that are defaming. Nurses may be
subject to a charge of libel for subjective comments meant to denigrate the client that are
placed in the medical record or in other written materials read by others.
DIF: Comprehension
REF: p. 149
6. Which statement regarding informed consent is correct? Informed consent:
a. is mandated by federal but not state law.
b. must reveal expected benefits.
c. requires concealing any known risks.
d. allows the RN to communicate information needed so that informed consent can
be provided.
ANS: B
The information that constitutes informed consent for the client includes the nature of the
therapy or procedure, expected benefits and outcomes of the therapy or procedure, potential
risks of the therapy or procedure, alternative therapies to the intended procedure and their
risks and benefits, and risks of not having the procedure.
DIF: Comprehension
REF: p. 152
7. A client states, “I am leaving. No one here knows what they are doing.” The nurse completing
the Against Medical Advice form must:
a. defer notifying the provider until the client has had ample time to leave.
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b. state in medical terms the risks of leaving.
c. inform the client that leaving could result in complications and impairment.
d. detain the person with the use of soft restraints until security arrives.
ANS: C
The nurse must articulate to the client the dangers associated with leaving the facility if the
primary provider is not present. The nurse’s notes on this form should reflect the specific
advice given to the client, which should include the fact that leaving the facility could
aggravate the current condition and complicate future care, result in permanent physical or
mental impairment or disability, or result in complications that can cause death.
DIF: Application
REF: p. 93
8. When can a nurse detain a client by using restraints?
a. Staffing resources are insufficient to monitor a patient with hemiplegia.
b. The client is confused.
c. The family requests the restraints to prevent the client from leaving the facility.
d. There are current physician orders following a medical evaluation.
ANS: D
A written physician’s order that is timed and dated is required for the use of restraints.
Renewal of orders must be accompanied by evidence of medical evaluation and nursing
reassessment.
DIF: Comprehension
REF: p. 155
9. When the client is unable to make medical decisions for himself or herself, authorization that
allows another person to make these decisions is called:
a. living will.
b. durable power of attorney.
c. informed consent.
d. immunity.
ANS: B
Durable power of attorney involves preselection by the client of a person who has been
authorized legally to make health care decisions once the client becomes incompetent to do
so. Several states have enacted a Uniform Durable Power of Attorney Act, which sanctions a
durable power of attorney for health care.
DIF: Knowledge
REF: p. 152
10. All hospitals receiving Medicare and Medicaid funds must ask clients whether they have a
living will or a durable power of attorney. This act is known as the:
a. Emergency Treatment and Active Labor Law.
b. Americans with Disabilities Act.
c. Uniform Health Care Decisions Act.
d. doctrine of res ipsa loquitur.
ANS: C
The Uniform Health Care Decisions Act of 1993 is a federal statute that was established to
support individuals in expressing their preferences about medical treatment and making
decisions about end-of-life care.
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DIF: Comprehension
REF: p. 152
11. A nurse who functions in the role of team leader can be held negligent for matters involving:
a. inadequate training.
b. lack of development of proper policies and procedures.
c. failure to discipline unsafe workers.
d. delegation of client care tasks.
ANS: D
Delegation of client care tasks falls within the role of the team leader, and inappropriate
delegation of client care tasks could result in negligence. Team leaders, charge nurses, and
managers are held to the standard of care of the reasonably prudent nurse employed in that
role.
DIF: Comprehension
REF: p. 144
12. Although a hospital reversed all charges when a client was the victim of wrong site surgery,
the court awarded the client $1.5 million. The client was able to return to work in 6 weeks and
had no permanent damages. This monetary compensation is termed:
a. res ipsa loquitur.
b. punitive damages.
c. vicarious liability.
d. immunity.
ANS: B
Punitive damages are monetary compensation to an injured client that is greater than amount
of loss.
DIF: Application
REF: p. 120 |p. 135
13. A physician orders a drug for a patient with a known allergy resulting in anaphylactic shock.
The nurse:
a. realizes that disclosure of the error will result in more severe ramifications for the
agency than if the negligence is discovered by the patient or family.
b. should disclose the occurrence before speaking with the physician who ordered the
drug or with hospital management.
c. recognizes disclosure as an essential component of the national patient safety
movement.
d. should report the occurrence to the patient’s insurance company to decrease patient
costs.
ANS: C
The National Quality Forum identified the process of disclosure as a key element of the
national patient safety movement.
DIF: Application
REF: p. 139
14. A nurse is charged with battery after helping an invalid patient back to bed and not calling for
help due to a reduced staffing level. The patient sustained excessive bruising, sore joints, and
extended stay. In this case, the:
a. patient is the plaintiff.
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b. nurse can be charged with forcefully restraining the patient without orders.
c. nurse is accountable due to the decreased level of staffing.
d. charge of invasion of privacy may be withheld.
ANS: A
The complaining person in a lawsuit is the plaintiff.
DIF: Application
REF: p. 120
15. A nurse working in a privately owned hospital is charged with a negligent act after failing to
check laboratory reports prior to giving a dose of digoxin (Lanoxin) resulting in the patient’s
condition becoming critical due to decreased cardiac output and falling leading to a broken
hip and concussion. A nurse is brought in who testifies that a professional with the knowledge
and skill of an RN should understand that, before administering this drug, potassium level and
pulse level is always checked to prevent such an occurrence. The nurse’s testimony as to what
constitutes reasonable care is based on:
a. the legal definition of standard of care.
b. the legal definition of the informed consent process.
c. the doctrine of res ipsa loquitur.
d. governmental immunity.
ANS: A
Standard of care is the legal criteria against which the nurse’s (and physician’s) conduct is
compared to determine whether a negligent act or malpractice occurred. Nurses are specialists
in hospital care who, in the final analysis, hold the well-being—in some instances, the very
lives—of patients in their hands.
DIF: Comprehension
REF: p. 120
16. On a nursing unit all assigned breaks including lunch/dinner breaks are assigned at the
beginning of the shift. A nurse caring for a patient with anemia and heart failure prepares to
hang a unit of packed red blood cells and realizes her break is in 5 minutes. She decides it is
not necessary to have another nurse check the blood against the patient’s information since the
patient’s blood type is O+ which she incorrectly remembered to be the universal donor. She
hangs the blood, noting the patient is “reading and vital signs normal.” She leaves the floor for
her break and does not report leaving or ask anyone to perform required vital signs. Upon
returning she meets a family friend who is visiting and time “just flies.” She returns to the
patient’s room after admitting a new patient. The patient is hypotensive and color is cyanotic
and anxious. She reports the findings to the charge nurse, who then contacts the physician. A
blood reaction occurrence is noted. The nurse providing care is charged:
a. with comparative negligence.
b. with a preventable adverse event.
c. with criminal negligence.
d. under the doctrine of res ipsa loquitur.
ANS: C
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In this case, criminal negligence charges would be based on “reckless and wanton” disregard
for the safety, well-being, or life of an individual; behavior that demonstrates a complete
disregard for another, such that death is likely in the transfusion reaction. Type “O” is the
universal donor rather than universal recipient; however, regardless of blood type, policy and
procedures for assessing vital signs and patient status during blood transfusion must be
followed.
DIF: Comprehension
REF: p. 120|p. 136
17. A physician shares with the patient’s family that, while a central line was being inserted, the
patient’s lungs were inadvertently punctured, which required oxygen administration. The
physician also explains that a chest x-ray indicated the lung remained intact and no additional
treatment was required. The physician’s role in this instance is based on the legal principle of:
a. comparative negligence.
b. gross negligence.
c. disclosure.
d. the Emergency Medical Treatment and Active Labor Act (EMTALA).
ANS: C
Disclosure is a process in which the patient’s primary provider (physician or advanced
practice nurse) gives the patient, and when applicable, family members, complete information
about unanticipated adverse outcomes of treatment and care.
DIF: Comprehension
REF: p. 120| p. 139
18. A nurse is assigned to a unit other than the one she is normally assigned due to increased
census on the alternate unit. She is assigned to care for seven patients and participates in
walking rounds where the patient’s condition and needs are discussed between oncoming and
off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending
orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall
from her pocket, which contain the above information that contains patient sensitive data. The
liabilities arising from this incident would be covered under:
a. the Health Insurance Portability and Accountability Act.
b. the ANA Scope and Practice Act.
c. affirmative duty failing to question order.
d. personal liability with floating and cross-training.
ANS: A
HIPAA protects patient information and ensures confidentiality of data.
DIF: Analysis
REF: p. 125
MULTIPLE RESPONSE
1. Which types of abuse are the nurse required to report or be subject to fines and imprisonment
for not reporting? (select all that apply)
a. Animal
b. Child
c. Alcohol
d. Infant
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e. Emotional
ANS: B, D
State laws have been created as a result of the 1973 Child Abuse Prevention and Treatment
Act. These laws dictate that health professionals must report infant and child abuse and
specified communicable diseases. Failure by the nurse to comply can result in fines and/or
imprisonment.
DIF: Comprehension
REF: p. 130
2. A patient asks, “What is an advance directive?” The nurse explains that examples of advance
directives are: (select all that apply)
a. preserving cord blood for possible future needs of a child.
b. providing instructions that life-sustaining medical procedures should be withheld
in the event of a terminal situation.
c. giving someone the legal right to act on one’s behalf when one becomes
incapacitated.
d. completing hospital admission paperwork before being admitted to the hospital.
ANS: B, C
Advance directives document an individual’s desires regarding end-of-life care. These wishes
are generally stated through the execution of a formal document known as the living will.
Right-to-die statutes vary from state to state; therefore, nurses must become familiar with their
state-specific statute.
DIF: Analysis
REF: p. 120|p. 151
3. A nurse learns in orientation that an incident report does not “blame” anyone but concisely
documents the events leading up to an occurrence. Which events would warrant completion of
an incident report? (select all that apply)
a. The client is crying and distraught when he learns of a diagnosis of cancer.
b. An intravenous antibiotic given preoperatively does not infuse because of a faulty
pump.
c. The nurse is unable to carry out orders written by the specialist because of
illegibility.
d. A client falls while in the shower, although she was told not to get up alone.
e. The registered nurse is not available to complete the preoperative checklist.
ANS: B, C, D, E
Nurses are legally bound to report critical incidents to their nurse managers, agency
administration, and risk manager through a formal intra-agency document generally titled the
“incident report.” Circumstances under which an incident report should be filed include
malfunction or failure of medical equipment.
DIF: Analysis
REF: p. 146
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Chapter 09: Ethical and Bioethical Issues in Nursing and Health Care
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Ethics applied to nursing can best be defined as:
a. doing what is best for the client.
b. making good decisions about care.
c. care based on what should be done in keeping with the values of the client.
d. rules for providing competent care that is based on scientific principles.
ANS: C
Nursing ethics is a system of principles intended to guide the actions of the nurse in his or her
relationships with clients, clients’ family members, other health care providers, policymakers,
and society as a whole. A nurse must make an attempt to understand what values are inherent
in the situation.
DIF: Knowledge
REF: p. 164
2. A family requests that no additional heroic measures be instituted for their terminally ill
mother who has advance directives in place. The nurse respects this decision in keeping with
the principle of:
a. accountability.
b. autonomy.
c. nonmaleficence.
d. veracity.
ANS: B
Autonomy is the principle of respect for the individual person. Within the concept of
autonomy, people are free to form their own judgments and perform whatever actions they
choose. They are self-determining agents who are entitled to decide their own destiny.
DIF: Comprehension
REF: p. 4 |pp. 169-170, Table 9-1
3. An older adult client is comatose and had one electroencephalogram that indicated no activity.
The daughter is very distraught and notices her mother’s hand moves when she is talking to
her. The daughter asks the nurse, “Is mother responding to my voice?” The nurse, attempting
to console the daughter, knows the movement was involuntary but states, “It does appear she
did.” The nurse is violating which principle of ethics?
a. Autonomy
b. Veracity
c. Utilitarianism
d. Deontology
ANS: B
Veracity is the principle of telling the truth in a given situation.
DIF: Comprehension
REF: p. 171
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4. In attempting to decide which services should be offered to a community, the public health
nurse decides to implement hypertension screening and treatment because most of the
residents are hypertensive. This decision is based on the principle of:
a. veracity.
b. values.
c. utilitarianism.
d. autonomy.
ANS: C
Utilitarianism is an approach that is rooted in the assumption that an action or practice is right
if it leads to the greatest possible balance of good consequences or to the least possible
balance of bad consequences. On the basis of this principle, an attempt is made to determine
which actions will lead to the greatest ratio of benefit to harm for all persons involved in the
situation.
DIF: Application
REF: p. 162 |p. 169
5. A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of
his or her own values as they relate to this issue. The nurse must:
a. know his or her own values and how these values relate to beliefs and the
philosophy of nursing.
b. rid the impurities in his or her value system.
c. ignore his or her own values.
d. realize that values do not change and that they cannot be influenced by others.
ANS: A
Nurses must make a deliberate effort to recognize their own values and must learn to consider
and respect the values of others. Health care decisions are seldom made independently of
other people. Decisions are made with the client, the family, other nurses, and other health
care providers.
DIF: Application
REF: p. 167
6. When assessing an ethical issue, the nurse must first:
a. ask, “What is the issue?”
b. identify all possible alternatives.
c. select the best option from a list of alternatives.
d. justify the choice of action or inaction.
ANS: A
The first step in the situational assessment procedure is to find out the technical and scientific
facts and assess the human dimension of the situation—the feelings, emotions, attitudes, and
opinions. Assessment can be applied to all areas of patient care, including ethics. Trying to
understand the full picture of a situation is time consuming and requires examination from
many different perspectives, but it is worth the time and effort.
DIF: Comprehension
REF: p. 172, Box 9-3
7. A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were
associated with a survey of college sophomores. The researcher was applying the principles
of:
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a.
b.
c.
d.
beneficence.
human dignity.
justice.
human rights.
ANS: A
Beneficence is defined as promoting goodness, kindness, and charity. In ethical terms,
beneficence means to provide benefit to others by promoting their good.
DIF: Comprehension
REF: p. 170
8. The physician who insists on providing treatment in spite of the client’s wishes because he
“knows best” is reflecting:
a. autonomy.
b. beneficence.
c. justice.
d. paternalism.
ANS: D
Paternalism is an action and an attitude wherein the provider tries to act on behalf of the client
and believes that his or her actions are justified because of a commitment to act in the best
interest of the client. Paternalism is a reflection of the “father knows best” way of thinking.
DIF: Comprehension
REF: pp. 175-176
9. The nurse who admits making a medication error and immediately files an incident report is
demonstrating:
a. accountability.
b. individuality.
c. an injustice.
d. values clarification.
ANS: A
Accountability is an ethical duty that states that one should be answerable legally, morally,
ethically, or socially for one’s actions.
DIF: Comprehension
REF: p. 162 |pp. 176-177
10. Three illegal immigrants with no health insurance or money sustained life-threatening injuries
during an automobile accident. Two of these individuals had head trauma and lacerated
internal organs. The decision was made to provide extended care in the trauma center after
emergency surgery was performed to save their lives. The third individual received only
minor injuries, which were treated in the emergency department. The care of the two critical
clients was based on the ethical principle of:
a. utilitarianism.
b. deontology.
c. autonomy.
d. veracity.
ANS: B
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Deontology is an approach that is rooted in the assumption that humans are rational and act
out of principles that are consistent and objective and that compel them to do what is right.
Deontological theory claims that a decision is right only if it conforms to an overriding moral
duty and wrong only if it violates that moral duty.
DIF: Comprehension
REF: p. 162 |p. 170
11. A 13-year-old female is brought to the family planning clinic by her enraged father, who has
just learned that she is pregnant. The pregnant client states, “I want to have this baby and give
it up for adoption.” However, the father is adamant that she will disgrace the family and
demands that the health care providers tell his daughter that she has a physical condition that
would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a
conflict that involves the ethical principle of:
a. deontology.
b. veracity.
c. autonomy.
d. beneficence.
ANS: B
Veracity is telling the truth in personal communication as a moral and ethical requirement.
DIF: Comprehension
REF: p. 170
12. During a seminar on ethics, the educator realizes that more information is needed when a
participant describes which situation as a violation of the ethical principle of autonomy?
a. An older person with advanced stages of Alzheimer’s disease is denied the right to
ambulate in the hallway.
b. A mentally competent adult refuses medical treatment for the autoimmune disease
lupus erythematosus, stating that this condition reflects the will of a higher power.
c. A mentally competent visitor fell during visiting hours but refused to be examined
by the physician on call.
d. A mentally competent adult with a broken wrist refuses to be given a local
anesthetic prior to a procedure.
ANS: A
Autonomy is defined as personal freedom, the right to make choices. However, in this case,
the patient is not able to be fully informed so they can clearly understand the choices being
offered.
DIF: Application
REF: p. 170
13. A nurse who is infected with human immunodeficiency virus (HIV) while working in the
operating room seeks revenge by deliberately placing clients at risk by not adhering to
universal precautions. This nurse is violating the ethical principle of:
a. veracity.
b. beneficence.
c. nonmaleficence.
d. autonomy.
ANS: C
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Nonmaleficence means to abstain from injuring others and to help others further their own
well-being by removing harm and eliminating threats. The nurse is definitely violating this
principle through her actions.
DIF: Comprehension
REF: p. 170
14. A client and her husband used in vitro fertilization to become pregnant. The unused sperm
was frozen so the couple could have more children later. The husband is killed while in
combat, and the client journals her choices and the possible ramifications. She comes to the
fertility clinic after looking at the situation from many perspectives and after considering
many alternatives. She asks that the sperm be destroyed because her husband’s faith
prohibited remarrying, and allowing another person to use the sperm would conflict with her
late husband’s beliefs. The nurse realizes that:
a. the client is in the second step of ethical decision making and that the client’s value
system is influencing her choices of alternative actions.
b. a logical line of reasoning has led to validation of the decision to destroy the
husband’s sperm.
c. the client has not been able to navigate the complicated issues inherent in this
situation.
d. a rational decision was reached that was based on reflection and on the value
systems of the wife and the husband.
ANS: D
After completing all steps in the situation assessment procedure, the client is now ready to
justify her selection. In this phase, the person will specify reasons for the action, will clearly
present the ethical basis for these reasons, will understand the shortcomings of the
justification, and will anticipate objections to the justification.
DIF: Analysis
REF: p. 172
15. A client is in extreme pain after he was involved in a motor vehicle accident, and morphine
has been ordered every hour for pain. The nurse injects saline into the client’s IV line and
takes the morphine for herself. The nurse is violating which principle of ethics?
a. Autonomy
b. Utilitarianism
c. Beneficence
d. Dilemmas
ANS: C
Beneficence is providing benefit to others by promoting their good. In general terms, to be
beneficent is to promote goodness, kindness, and charity. By taking the client’s pain
medication and substituting saline, the nurse did harm, not good, for this client.
DIF: Comprehension
REF: p. 170
16. The Health Care Reform Act provides insurance for all U.S. citizens and legal residents
presenting far-reaching ethical considerations related to diverse individual patient health care
beliefs for those delivering nursing care. Nurses must consider their civil rights under the
rights of conscience and how new health care agendas such as the Patient Protection and
Affordable Care Act (PPACA) could affect their practice in situations that may conflict with
their own belief system. Today’s practicing nurse must:
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a. remember it is one’s professional duty to render patient-centered care—even when
it is in direct conflict with the nurse’s own beliefs—or be held liable for
withholding treatment.
b. consider whether the right to act according to one’s inner beliefs will continue to
be permissible when federal health insurance becomes fully enacted.
c. discuss with the patient and family different options in hopes they will accept the
nurse’s health care beliefs.
d. suggest to the hospital administration that they not accept federal funding to
prevent controversial health practices.
ANS: B
With federal funding, many controversial health care services will be covered and provided as
part of patient care when desired by the patient; therefore, whether a nurse has autonomy to
refuse to provide care may not be as clear even when one might request another patient.
DIF: Application
REF: pp. 168-169
17. A nurse is assigned to a unit where 95% of all patients required total care. Most days the
assistive personnel are able to complete their assignments and provide high-quality care. A
patient returning from a procedure was somehow “skipped” when daily baths were performed
and requests that her care now be provided. The nurse discovers the bed is rumpled and damp.
The RN joins with some other staff to bathe the patient, change the bed, and help make the
patient comfortable. These staff members are demonstrating:
a. altruism.
b. veracity.
c. autonomy.
d. whistle-blowing.
ANS: A
Altruism is concern for the welfare of others, including willingness to help others when they
are unable to get their assignments completed to ensure that the patient receives high-quality
care.
DIF: Comprehension
REF: pp. 168-169, Table 9-1
18. In which case does the nurse act as “whistle-blower”?
a. One staff member on the unit covers for another nurse, who leaves the premises to
purchase illegal substances and signals her friend when she must return.
b. The nurse reports that another nurse is taking medications out of stock medicine
for herself or himself.
c. A nurse informs respiratory therapy that a patient is now due a treatment.
d. The nurse delegating care to unlicensed assistive personnel makes rounds to ensure
all care was rendered properly.
ANS: B
Whistle-blowing is the reporting of acts or situations that violate the principle of beneficence
such as a chemical impairment, negligence, abusiveness, incompetence, or cruelty.
DIF: Application
REF: pp. 176-177
MULTIPLE RESPONSE
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1. Throughout their careers, nurses are in an ongoing state of acculturation, gaining experience
from formal nursing school classes, clinical experiences, and the ethical issues they encounter
in their clinical practice. The ideal outcomes of these ongoing experiences with cultural
decision making include: (select all that apply)
a. increased trustworthiness.
b. enhanced ability to take into consideration many aspects of ethical situations.
c. confidence to make decisions based on experience and ethical intelligence.
d. improved clinical decision making and advocacy for patient autonomy.
e. authority to make ethical decisions independently that meet personal moral beliefs.
ANS: A, B, C, D
The desired outcomes of ethics acculturation across the years are integrity, personal growth,
practical wisdom, and effective problem solving on behalf of patients and their families
(Weaver et al, 2008). These are the qualities that are characteristics of an ethically sensitive
and morally mature person. Trustworthiness is a characteristic of integrity. The ability to take
into consideration many aspects of ethical situations is due in part to personal growth and
practical wisdom. The confidence to make ethically sensitive decisions comes from
experience founded on personal growth and personal wisdom. The ability to be the patient’s
advocate in ethical decision making is one test of cultural acculturation.
DIF: Application
REF: pp. 168-169
COMPLETION
1. Practicing nurses participate in employer-sponsored professional development classes that
provide case studies related to ethical situations and decision making. Ethical considerations
are debated among teams, and an expert helps the class arrive at the “best practices.” The
nurses are experiencing ethics ______________.
ANS:
acculturation
Ethics acculturation is the didactic and experiential process of developing ethical reasoning
abilities as a part of ongoing professional education.
DIF: Knowledge
REF: p. 162
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Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. When planning health care, the nurse should be mindful that members of the Asian culture
tend to:
a. miss appointments because they are present oriented and time is viewed as
flexible.
b. look to their ancestors for guidance.
c. plan ahead and be future oriented.
d. arrive early because they have no concept of time.
ANS: A
In Asian culture, individuals tend to be present oriented and time is viewed as being more
flexible than in the Western culture; being on time for appointments is not seen as a priority.
DIF: Comprehension
REF: p. 194
2. A nurse is admitting a Mexican-American child, and the mother comments that the child was
exposed to mal ojo. The nurse should expect to find which symptom associated with this
exposure?
a. Fever
b. Nervous tension
c. Bruising
d. Somnolence
ANS: A
The child has what is referred to as mal ojo or “evil eye,” which can lead to diarrhea, fever,
and even death.
DIF: Comprehension
REF: p. 198
3. A Mexican-American patient is attacked and beaten. This patient is at risk for “fright disease,”
which is known as:
a. susto.
b. empacho.
c. bilis.
d. mal ojo.
ANS: A
Susto is an emotion-based illness common among Mexicans. An unexpected fall, a barking
dog, or a car accident could cause susto. Symptoms include colic, diarrhea, high temperature,
and vomiting.
DIF: Comprehension
REF: p. 198
4. A priority action for the nurse who works with culturally diverse clients is completion of a:
a. sign language course.
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b. cultural self-assessment.
c. cultural client assessment.
d. continuing education course on how to speak Spanish.
ANS: B
The first step to becoming a culturally sensitive and competent health care provider is to
conduct a cultural self-assessment. Through identification of health-related attitudes, values,
beliefs, and practices, the nurse can better understand the cultural aspects of health care from
the client’s perspective.
DIF: Application
REF: p. 191
5. A nurse is caring for a recent Asian immigrant client and is overheard making the following
comment, “These rituals you believe in are false. You live in America now and must believe
in realistic health practices, like Americans do.” The nurse is exhibiting:
a. stereotyping.
b. ethnocentrism.
c. cultural accommodation.
d. empathy.
ANS: B
Ethnocentrism is the belief that one’s own ethnic group, culture, or nation is best.
DIF: Comprehension
REF: p. 180
6. The nurse is preparing a plan of care for an black patient who has had a change of bowel
habits from being constipated and having only two firm stools weekly to having three or more
loose stools daily. Which comment is related to cultural variation for health information?
a. The individual states, “I will need to discuss health care options with my
grandmother.”
b. The eldest male member of the family will make all health care decisions.
c. The patient has high respect for the nurse and nods approvingly, although she has
no intention of complying with instructions or plan of care.
d. The individual speaks very quietly and gently reaches to hold the nurse’s hand for
support.
ANS: A
In the African-American culture, women, especially “Granny,” play a key role in health care
decisions.
DIF: Application
REF: p. 189 |p. 191, Table 10-1
7. A nurse is submitting a grant application to improve access to health care and mortality for
minority groups. The grant focuses on the six causes of death that are identified as priorities
for minorities, which include:
a. chronic obstructive pulmonary disease.
b. malnutrition.
c. cirrhosis of the liver.
d. cancer.
ANS: D
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Cancer is identified as a leading cause of excessive death among minority group members.
The six leading causes are cancer, cardiovascular disease and stroke, chemical dependency,
diabetes, homicides/accidents, and infant mortality.
DIF: Comprehension
REF: p. 182
8. A nurse is given a referral to make a home visit to a Russian immigrant. The nurse knows
very little about the health beliefs of this ethnic group. To research this group, she can use an
Internet search engine and enter the term “Russian cultures” or “Russian health beliefs.” To
obtain more generalized information, she could also search under:
a. federally recognized minorities.
b. marginalized populations.
c. Asian/Pacific Islander cultures.
d. Latino cultures.
ANS: B
Marginalized populations include recently arrived immigrants. Their lives and health care
needs are often kept secret and are understood only by them.
DIF: Comprehension
REF: p. 182
9. Which statement is true regarding health care for minorities?
a. Federal legislation that provides free health insurance for minorities has resulted in
fewer minorities than members of the general population who lack health
insurance.
b. Higher costs of health care coupled with lower wages for minorities have
prevented most minorities from seeking health care.
c. Because many Mexican Americans are highly skilled workers with comparable
wages, they have the lowest uninsured rate.
d. Asians, because of their quiet demeanor and unwillingness to challenge the health
care system, have the highest rate of uninsured people.
ANS: B
Most families with racially or ethnically diverse backgrounds have a lower socioeconomic
status than is observed in the population at large. Dramatic changes in technology and
specialization in the health care field have caused health care costs to skyrocket. Therefore,
not everyone can afford health care services.
DIF: Comprehension
REF: p. 182
10. While completing a nursing degree in Virginia, a student who is interested in teaching in
Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of
Mexican-Americans live there. This nursing student values:
a. cultural competence.
b. ethnocentrism.
c. prejudice.
d. stereotyping.
ANS: A
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Cultural competence is the responsibility of all nurses to become knowledgeable about the
values, beliefs, and health care practices of the culturally diverse groups that are dominant in
the nurse’s particular practice area.
DIF: Application
REF: p. 188
11. A Southeast Asian woman brings her baby into the clinic because the baby is lethargic. The
nurse determines that the baby has had diarrhea and vomiting for several days, resulting in
dehydration. Physical examination reveals small, round burns on the abdomen. These burns
probably are the result of cigarettes or burning cotton used to:
a. try to quiet the child and is considered child abuse.
b. bring out toxic wind from the body.
c. balance heat loss from the body.
d. brush the body with ruda to allow spirits to return.
ANS: C
In the Southeast Asian culture, touching a burning cigarette or piece of cotton to the skin,
usually the abdomen, is done to compensate for “heat” lost through diarrhea. This type of
burning is a common part of self-care.
DIF: Comprehension
REF: pp. 196-197
12. A cultural phenomenon that is based on biologic variation would include:
a. belief that exposure of a pregnant woman to an eclipse can result in cleft lip.
b. denser bones in blacks result in less morbidity associated with osteoporosis.
c. the grandmother who determines that her grandchild has scoliosis and should seek
treatment, then informs the parents of her decision.
d. a family that participates in feasts prepared to celebrate and make decisions.
ANS: B
Biologic variations include denser bones in blacks. Biologic variations such as body build and
structure, genetic variations, skin characteristics, susceptibility to disease, and nutritional
variations exist among different cultures. Other common variations include skin color, eye
shape, hair texture, and adipose tissue deposits.
DIF: Analysis
REF: p. 191
13. A nurse plans to move to an area that is rich in immigrants from several countries and is
concerned about respecting others’ cultural beliefs. The nurse’s first step to ensure cultural
competence and sensitivity is to:
a. enroll in a nursing theories course to increase knowledge about transcultural
practices.
b. become immersed in nursing literature about culturally diverse clients.
c. participate in continuing education that focuses on health assessment variations
among cultural groups.
d. conduct a cultural self-assessment.
ANS: D
A cultural self-assessment allows the nurse to identify attitudes about individuals from
different cultures.
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DIF: Application
REF: p. 196
14. A nurse is preparing discharge teaching for an Asian-American woman with a fractured hip.
The nurse reviews the client’s diet history while hospitalized and is concerned that the patient
refused milk and yogurt, placing her at risk for osteoporosis. What cultural variation is the
nurse overlooking? Asian Americans:
a. have denser bones than other ethnic groups.
b. consume diets rich in pork bone and shells, reducing the risk of osteoporosis.
c. would participate in the practice of burning to compensate for this injury.
d. would consult a curandero for dietary consultation.
ANS: B
Pork bones and shells are rich in calcium, reducing the risk of osteoporosis.
DIF: Comprehension
REF: p. 197
15. A nurse is preparing to teach a class related to risk factors for cancer to a diverse ethnic group
attending a health fair. The nurse should be aware:
a. that Hispanic women overestimate the prevalence of cancer and strictly following
breast self-examination guidelines.
b. of the importance of risk factors such as smoking and alcohol consumption that
increase esophageal cancer when speaking with black.
c. that American-Indian women have a higher rate of ovarian cancer than the general
population.
d. that cancer as well as heart disease and stroke are lower in ethnic groups.
ANS: B
Black men have a higher risk for esophageal cancer than the general population so teaching
risk factors is needed.
DIF: Comprehension
REF: p. 191
16. A nurse performing a history and physical on a newly admitted Hispanic patient learns the
patient has just used the services of a savador to:
a. determine which herbs would best reduce hot flashes in a menopausal woman.
b. communicate with a family member who recently died.
c. receive treatments to reduce lower back pain.
d. receive acupuncture to stop smoking.
ANS: C
Hispanic patients may want the support and care of a savador, which is similar to that offered
by a chiropractor.
DIF: Comprehension
REF: p. 195
17. An Asian teenager is admitted with an eating disorder which she contributes to by not meeting
the academic expectations of her parents. The nurse is overheard saying, “That isn’t the
reason; all Asians are really smart.” This nurse is demonstrating:
a. cultural humility.
b. stereotyping.
c. cultural assimilation.
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d. acculturation.
ANS: B
Stereotyping is associating certain behavior or competencies with an ethnic group without
considering the individual.
DIF: Comprehension
REF: p. 180
18. A nurse caring for a Hispanic child admitted with diarrhea notices the child is wearing red
yarn around the wrist. The nurse compliments the child’s “jewelry,” knowing it is believed to
prevent:
a. mal ojo.
b. susto.
c. bilis.
d. empacho.
ANS: A
Mal ojo is due to “admiration” from a stranger resulting in diarrhea.
DIF: Application
REF: p. 198
19. A Hispanic patient is visited by several family members and the nurse witnessed one visitor
who pinches a piece of skin at the waist. The nurse asks the purpose and learns the “provider”
is listening for a snap from the abdominal region, which is then repeated several times. The
patient most likely suffers from:
a. mal ojo.
b. susto.
c. bilis.
d. empacho.
ANS: D
Empacho is believed to be caused by lodged food particles, causing acute stomach/intestinal
pain.
DIF: Comprehension
REF: p. 198
20. A nurse is seeking to become culturally competent in regard to obtaining information during
health history and when performing physical diagnosis. The nurse is aware that which
biologic variation is found in all of the following ethnicities: blacks, Asians, Hispanics, and
American Indians?
a. Mongolian spots
b. Sickle cell anemia
c. Lactose intolerance
d. Thalassemia
ANS: C
Lactose intolerance is found in all four of the noted ethnicities.
DIF: Application
REF: p. 193, Table 10-2
MULTIPLE RESPONSE
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1. Six cultural phenomena that vary among cultural groups are known to affect health care. The
influence of the consequences of these phenomena can be seen in which of the following?
(select all that apply)
a. Asians and American Indians tend to be nonadherent with medications because
they believe that the environment has no control over their fate.
b. Some cancers such as stomach cancer occur less frequently among blacks.
c. Blacks and American Indians often resist direct eye contact.
d. Mexican Americans are more likely to stand close and touch health care providers.
e. Whites are often late for health care appointments.
ANS: C, D
The use of eye contact is a cultural communication phenomenon. Cultures such as black and
American Indian may view direct eye contact as rude behavior. Space and touch are cultural
phenomena factors. In some cultures, touching strangers is inappropriate. On the other hand,
Mexican Americans tend to be comfortable with less space because they like to touch persons
with whom they are talking.
DIF: Analysis
REF: pp. 191-192
2. A nurse involved in researching the leading causes of death for minorities considers the
federally defined minority groups, which include: (select all that apply)
a. Blacks
b. Russians
c. Hispanics
d. Asians or Pacific Islanders
e. Scandinavians
ANS: A, C, D
The Federally defined minority groups include blacks, Hispanics, American Indians, and
Asians or Pacific Islanders.
DIF: Comprehension
REF: pp. 181-182
COMPLETION
1. On the scale from 1 to 10, with 1 being no prejudice and 10 being extreme prejudice, the
placement of hate on the continuum would be at number _____.
ANS:
10
Hate is the extreme negative manifestation of prejudice, followed by contempt, then tolerance,
which is more neutral.
DIF: Application
REF: p. 183, Figure 10-1
2. Although communication varies among members of different cultures, the greatest obstacle to
providing multicultural care is differences in _____.
ANS:
language
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Language can be the greatest obstacle to providing multicultural care. If the client does not
speak the same language as the nurse, a skilled interpreter is mandatory.
DIF: Comprehension
REF: p. 191
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Chapter 11: Complementary and Alternative Healing
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. A patient observes the practitioner burning a dried herb on the needle during an acupuncture
session and asks about this practice. The practitioner responds, “I am inciting the acupuncture
points and this is referred to as:
a. doshas.”
b. moxibustion.”
c. yoga.”
d. kapha.”
ANS: B
Applying heat to the acupoints is termed moxibustion.
DIF: Comprehension
REF: p. 205
2. An older adult has atrial fibrillation, which causes the heart to have an irregular rhythm. The
client uses imagery to alter the dysrhythmia. The client is using which type of complementary
alternative medicine (CAM)?
a. Ayurveda
b. Dosha
c. Homeopathy
d. Biofeedback
ANS: D
Biofeedback is a type of mind-body intervention that is based on techniques in which the
client is taught to alter specific bodily functions such as heart rate, blood pressure, and muscle
tension. The client uses various relaxation and imagery exercises to produce desired
responses.
DIF: Comprehension
REF: p. 207
3. A patient with kyphosis is visiting a practitioner of chiropractic medicine for the first time and
asks, “How does this therapy work?” The practitioner replies, “I will use my hands along with
heat to correct the misalignment of your spine by placing pressure on the nerves that have
produced pain. The misalignment of your spine is referred to as:
a. subluxation.”
b. a sprain.”
c. a fracture.”
d. epicondylitis.”
ANS: A
The chiropractor corrects misalignments of the spine, called subluxations, by putting pressure
on the nerves that are causing pain.
DIF: Comprehension
REF: p. 207
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4. A young adult on a limited income who is having back pain states, “I want to see a
chiropractor, but I don’t have any money. However, I do have health insurance.” The most
appropriate response that the nurse can provide is:
a. “most insurance companies will pay for chiropractic treatment.”
b. “because chiropractors are not licensed in any state, all services must be paid for
by the patient.”
c. “chiropractic medicine is a new CAM therapy that has not yet been recognized by
insurance companies.”
d. “chiropractic medicine is more than 100 years old, but because it is preventive in
nature, it is not covered by most insurance.”
ANS: A
Chiropractic medicine is performed by a licensed professional with reimbursement privileges
and is an accepted complementary alternative medicine (CAM) therapy.
DIF: Comprehension
REF: p. 207
5. The use of plants in conventional modern medicine is evidenced by the drug atropine, which
is derived from which plant?
a. Digitalis purpurea
b. Cephaelis ipecacuanha
c. Rauwolfia serpentina
d. Atropa belladonna
ANS: D
Atropine is derived from the Atropa belladonna plant; it primarily affects the parasympathetic
nervous system.
DIF: Knowledge
REF: p. 207
6. The massage therapist uses kinesthesia, or thinking about how movement is expressed, to
correct habits that cause poor posture and limited movement. This type of massage is called:
a. Alexander technique.
b. Feldenkrais method.
c. healing touch.
d. Reiki.
ANS: A
The Alexander technique teaches improved balance, posture, and coordination through gentle
hands-on guidance and verbal instruction.
DIF: Comprehension
REF: p. 214, Box 11-5
7. A nurse practices a relaxing massage technique to stimulate and apply pressure to the feet or
hands, increasing blood supply circulation to various parts of the body and relieving pain. The
massage technique used by the practitioner is referred to as:
a. reflexology.
b. Feldenkrais method.
c. Reiki.
d. Rolfing.
ANS: A
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Reflexology produces pain relief through pressure applied to pressure points on the hands and
feet that correspond to various parts of the body.
DIF: Comprehension
REF: p. 214, Box 11-5
8. A patient is placed on reserpine (Serpalan) to decrease mild anxiety and treat hypertension.
The patient researches the medication on the Internet and finds that this medication comes
from which plant?
a. Atropa belladonna
b. Digitalis purpurea
c. Rauwolfia serpentina
d. Cephaelis ipecacuanha
ANS: C
The drug reserpine is derived from the plant known as Rauwolfia serpentina. It was used to
treat depression in the past but currently is used in the treatment of hypertension.
DIF: Comprehension
REF: p. 207
9. A person who is recovering from a stroke is becoming more forgetful and is unable to recall
people’s names. A friend suggests the use of a natural ingredient, ginkgo biloba. The nurse is
concerned about the most serious risk associated with this herb, which is:
a. thromboembolism due to increased clotting.
b. seizures due to interaction with anticonvulsants.
c. hypertension due to sodium retention.
d. photosensitivity due to increased melanin production.
ANS: B
Ginkgo reduces the efficacy of anticonvulsants, which may lead to increased seizure activity.
DIF: Comprehension
REF: pp. 207-208, Box 11-2
10. An older adult woman who stops using complementary alternative medicine (CAM) becomes
disoriented and is given a diagnosis of dementia. The family is upset with the family
physician and the CAM practitioner for not diagnosing the condition earlier. Which CAM
may have interfered with early detection of the dementia?
a. Large doses of calcium caused cerebral plaques to form, thereby disguising
atrophy of the brain.
b. Excess doses of folic acid masked a vitamin B12 deficiency that led to dementia.
c. Hypnotherapy focused on current pleasant thoughts, eliminating clues to the past.
d. The electrical current from magnetic fields interfered with normal brain waves,
resulting in confusion and inability to concentrate.
ANS: B
Individuals with Alzheimer’s often have low levels of vitamin B12; thus, large doses of folic
acid may have masked the dementia.
DIF: Comprehension
REF: p. 207
11. The nurse who presents a class on different methods of complementary alternative medicine
(CAM) differentiates between imagery and hypnosis in which of the following ways?
a. Imagery involves the dependent mental construction of a picture, whereas hypnosis
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requires the patient to recall and verbally describe difficult times in his or her life.
b. Hypnosis requires a trained psychologist, but imagery can be performed by any
health care practitioner.
c. Imagery produces a temporary sense of well-being compared with hypnosis, which
evokes a permanent positive effect.
d. Although both therapies focus on specific problems and guide the patient into
relaxation, imagery requires the patient to formulate the impression, whereas the
hypnotist constructs the image for the patient.
ANS: D
Both imagery and relaxation are used to reduce anxiety and stress; however, imagery begins
with a goal that is to be achieved and a picture that is formulated by the person under
treatment, rather than beginning with the hypnotist, who conjures up a desirable image.
DIF: Comprehension
REF: p. 210
12. A pregnant woman reports back pain and wants to try a complementary alternative medicine
(CAM) therapy. The nurse knows that which CAM would be contraindicated?
a. Magnet therapy
b. Aromatherapy
c. Imagery
d. Therapeutic touch
ANS: A
The effect of magnets on fetal growth has not been determined.
DIF: Comprehension
REF: p. 210
13. Despite the presence of safety aids such as handrails in the bathrooms at an assisted living
facility, the number of fractures due to unsteady ambulation upon arising from the bed and
when attempting to perform activities of daily living has increased. Which complementary
alternative medicine (CAM) would be an effective intervention for this population?
a. Yoga
b. Acupuncture
c. Tai chi
d. Magnet therapy
ANS: C
Tai chi improves coordination, thereby reducing the number of falls and improving gait.
DIF: Comprehension
REF: p. 213
14. A patient informs the nurse, “I burn a lavender-scented candle for an hour before bedtime to
help me relax and sleep.” The nurse realizes this patient is using:
a. the mind-body intervention of aromatherapy.
b. an energy technique known as qi gong.
c. the manipulative method using the Alexander technique.
d. conventional medicine, also called allopathic.
ANS: A
Aromatherapy uses scents of essential oils and is a type of mind-body interaction.
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DIF: Comprehension
REF: p. 203 |p. 205, Box 11-1
15. The nurse caring for a patient who practices Ayurveda would assess for:
a. an increased stool osmolality gap resulting from dehydration.
b. petechiae resulting from fine-needle punctures.
c. use of over-the-counter remedies intended for intended symptom.
d. magnets strategically placed on affected joints.
ANS: A
Individuals practicing Ayurveda may use detoxification and cleansing enemas resulting in
dehydration, which increases stool osmolality.
DIF: Comprehension
REF: p. 206
16. A patient informs the nurse, “I can’t sit in the yard for even 10 minutes without my skin
turning red and tender.” The nurse would assess for the use of which complementary
alternative medicine (CAM)?
a. St. John’s wort
b. Ginkgo biloba
c. Feverfew
d. Echinacea
ANS: A
St. John’s wort may cause photosensitivity.
DIF: Comprehension
REF: pp. 208-209, Box 11-2
17. A patient states, “My cancer is in remission finally after all that chemotherapy, my friend used
the same chemotherapy and wasn’t so lucky. I want to continue participating in spiritual care
and ‘mind games’ to keep my memory intact. I am also enrolled in Tai chi, but I just can’t
stop thinking about my sick lung.” This patient adheres to which principle underlying
alternative healing?
a. A negative alteration in the body produces a parallel effect on the mind and spirit.
b. The body can heal itself with the help of complementary alternative therapies.
c. Approaches to therapy are individualized.
d. There is a focus on the total lifestyle.
ANS: A
Health and healing are related to a harmony of mind, body, and spirit.
DIF: Comprehension
REF: p. 205
18. During an admission history and physical, a female patient states, “I use 5000 mg/day of
calcium to prevent osteoporosis and to maintain health.” The nurse should assess for:
a. excessive bleeding.
b. kidney stones.
c. lower blood sugar.
d. jaundice.
ANS: B
Excessive calcium places individuals at risk for renal stone.
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DIF: Comprehension
REF: p. 207
19. A patient who is pregnant has used the herb feverfew for a history of migraine headaches. The
nurse should provide teaching related to a risk for:
a. uterine contractions resulting in possible miscarriage.
b. reduced fetal growth.
c. insomnia.
d. tiredness the following day.
ANS: A
Feverfew has the potential to cause the uterus to contact, increasing the risk for miscarriage or
premature delivery.
DIF: Comprehension
REF: pp. 208-209, Box 11-2
20. A patient who is just beginning to use homeopathy to treat depression is concerned because
symptoms are actually becoming worse with increasing sadness, anxiety, and fatigue. The
practitioner of homeopathy bases teaching on the Law of Cure and instructs the patient to:
a. discontinue the therapy and seek another alternative therapy.
b. concentrate the preparation to increase its potency in hopes to improve depressive
symptoms.
c. increase the dosage of the substance to increase its effectiveness.
d. remain on the current regimen since worsening is a positive sign that healing is
occurring.
ANS: D
The Law of Cure states a worsening of symptoms after a remedy is given is considered a
positive sign that healing is taking place. The therapy is therapeutic and should be considered.
DIF: Comprehension
REF: p. 210, Box 11-3
21. A patient has fallen at home and complains that joints are very painful when trying to climb
stairs. The patient desires to use an alternative complementary medicine rather than pain
medication. The practitioner begins treatment with touch consisting of rocking, rhythmical
motions to loosen tense, sore muscles and joints. The patient is receiving which type of
treatment?
a. Swedish massage
b. Rolfing
c. Trager approach
d. Reflexology
ANS: C
Trager approach uses gentle, rhythmic rocking and touch to promote relaxation and energy
flow.
DIF: Comprehension
REF: p. 211, Box 11-4
MULTIPLE RESPONSE
1. Complementary alternative medicine (CAM) is gaining popularity in Western society
because: (select all that apply)
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a.
b.
c.
d.
e.
consumers want knowledgeable, trained physicians to control their care.
CAM consumers want personalized health care.
quantity, rather than quality, of life is most important in Western society.
consumers have access to evidence that support CAMs.
consumers want to remain indifferent to the health care provider.
ANS: B, D
Consumers are taking greater responsibility for their own health, which is based on personal
preference, and many alternative natural therapies provide evidence of their own efficacy.
DIF: Comprehension
REF: p. 204
2. A patient experiences migraine headaches that are not relieved by traditional Western medical
practices. The family physician suggests acupuncture, which: (select all that apply)
a. is based on the belief that meridians are vital for life, and when they are out of
balance, pain occurs.
b. uses strategically placed, slender needles for pain relief.
c. uses breathing exercises and meditation to relieve pain.
d. corrects metabolic imbalance through purification regimens.
e. determines distinct metabolic body types.
ANS: A, B
Acupuncture is based on the belief that invisible channels are present throughout the body
through which energy flows; these are called meridians. This energy, qi, is considered the
vital life force, and illness and symptoms occur when the flow of energy becomes blocked or
unbalanced. Health is restored when the energy is unblocked; this is achieved by stimulating
acupuncture points on affected meridian(s). Tiny needles are placed on the meridians that are
affected and are causing pain.
DIF: Comprehension
REF: p. 205
3. A patient who is interested in herbal medicine attends a seminar to learn more about
complementary alternative medicine (CAM). The patient learns that a common belief related
to all CAMs includes that: (select all that apply)
a. the body is not able to repair itself; thus, natural remedies are used to inhibit the
immune system.
b. many different CAMs that focus on specific body parts and the mind are needed.
c. the focus of CAM is on an intervention for the diseased body part.
d. each CAM treatment is unique to the person who is being treated.
e. health promotion is incorporated into CAM.
ANS: D, E
Healing is individualized, and the uniqueness of each person is considered. Standing protocols
that are used to treat everyone with similar conditions in a similar way are not found in CAM.
Health promotion and positive health habits are incorporated into CAM.
DIF: Comprehension
REF: pp. 204-205
4. A nurse investigates energy therapies and learns that which therapies would be included?
(select all that apply)
a. Qi gong
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b.
c.
d.
e.
Osteopathy
Imagery
Healing touch
Magnet therapy
ANS: A, D, E
Energy therapies include Qi gong, Reiki, healing touch, healing (therapeutic) touch, and
magnet therapy.
DIF: Knowledge
REF: p. 205, Box 11-1
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Chapter 12: Palliative Care
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. According to the Palliative Performance Scale which patient is considered to possess 70% of
normal function?
a. 40 year old diagnosed with AIDS whose condition makes it impossible to hold a
job.
b. 70 year old diagnosed with end stage renal failure who spends most of the day in
bed.
c. 50 year old diagnosed with emphysema whose disease has begun to impact normal
ambulate.
d. 30 year old diagnosed with muscular dystrophy who is bed bound.
ANS: A
70% function implies that the patient has a reduction in ambulation and the disease process
affect ability to hold a job.
DIF: Application
REF: p. 225, Table 12-3
2. The Karnofsky prognostication scale is most appropriately used to screen patients with which
medical diagnoses?
a. Respiratory diseases
b. Cancers
c. Cardiac diseases
d. AIDS
ANS: B
The Karnofsky scale is more appropriate for the patient with a cancer diagnosis.
DIF: Comprehension
REF: p. 225
3. A peaceful death is best characterized by which terminally ill patient?
a. One who is surrounded by family
b. One who uses meditation to help manage pain
c. One who has advanced directives in place
d. One who has drifted from lethargy to coma
ANS: D
A peaceful death is generally described as being peaceful and comfortable with the patient
drifting though the various stages of alertness to finally being comatose.
DIF: Application
REF: pp. 224-225
4. Which patient’s decision-making capacity should be a concern for the palliative care nurse?
a. The one who asks, “Why do I need palliative care?”
b. The patient with a diagnosis of moderate Alzheimer’s disease
c. The one whose family is used to being consult about decisions affecting the patient
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d. The patient who has expressed concerns about “all the decisions I have to make.”
ANS: B
Decision-making capacity focuses on one’s ability to make decisions about their health care.
They must be able to understand the facts, appreciate the alternatives that may exist, and to
communicate these decisions to the health care team. Moderate Alzheimer’s disease is likely
to have an affect the patient’s cognitive abilities.
DIF: Analysis
REF: p. 220
5. What is the primary factor that characterizes a patient receiving palliative care
a. A diagnosis of a serious, life-threatening disease
b. Ability to make sound health care decisions
c. An interest in exploring available life sustaining treatment options
d. A life expectancy of less than 12 months
ANS: C
Palliative care is appropriate for the patient diagnosed with a life-threatening disorder who
wishes to take advantage of any life sustaining treatments available.
DIF: Application
REF: p. 222
6. As a patient’s condition moves toward their impending death, which nursing intervention
demonstrates how the focus of palliative care change?
a. The patient is encouraged to discuss their spiritual needs.
b. The patient is educated concerning the physical changes associated with the dying
process.
c. The patient’s advance care plan is formulated and implemented.
d. The patient’s comfort needs are identified.
ANS: D
The palliative care continuum model of begins comfort care at the time of diagnosis when
therapies are aggressive but as the disease progresses towards death comfort care increases.
DIF: Application
REF: pp. 224-225
7. When first diagnosed with Parkinson disease, how can the patient and family best avoid future
ethical dilemmas concerning the patient’s care?
a. Work with the patient and family to create an advanced plan of care.
b. Explain to the family that the patient’s cognitive function will deteriorate as time
passes.
c. Discuss the patient’s religious and spiritual concerns to identify potential
problems.
d. Identify which family members will be in control of decision making for the
patient.
ANS: A
Advance care planning is a process for eliciting a patient’s values and preferences concerning
current and future health care decisions. This plan is used to establish a patient’s goals of care
during serious illness. Having such a plan in place will help minimize ethical issues regarding
how care will be determined and delivered.
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DIF: Application
REF: p. 220
8. What is the initial step when addressing an ethically challenging situation?
a. Identify all those who are involved in the situation.
b. Review the overall situation to identify the core issues.
c. Gather all the relevant facts about the situations.
d. Determine what the ethical dilemma is.
ANS: B
Reviewing the overall situation in order to identify what is going on in this particular situation
is the initial step in addressing an ethically challenging situation.
DIF: Application
REF: p. 221, Table 12-1
9. Which statement correctly applies to a person’s suffering?
a. Pain is the cause of suffering.
b. Suffering and pain are experienced separately.
c. Suffering can exist without the experience of pain.
d. Pain is the focus of all nursing assessments.
ANS: C
Suffering is the experience of a person while pain and other symptoms are the result of
physical body or organ changes. Suffering and pain can coexist together, although one can be
present without the other.
DIF: Comprehension
REF: pp. 228-229
10. When working with the family of a patient receiving palliative care, what is the nurse’s initial
intervention?
a. Determining who will be the patient’s durable power of attorney
b. Identifying what types of help the family will need to care for the patient
c. Completely an assessment of the family’s strengths and weaknesses
d. Discuss the dynamics of the family with the patient
ANS: C
Any strategy to meet the needs of a patient’s family begins with a comprehensive family
assessment including an assessment of family strengths and weaknesses.
DIF: Analysis
REF: p. 229
11. A daughter tells the nurse that, “Mom will be as good as new when we get this advanced
cancer cured.” How can the nurse best help the daughter in the role of caregiver?
a. Working toward setting realistic goals for both her mother and herself
b. Finding the daughter in home help to assist with her mother’s care
c. Discuss with the patient the role her daughter will play in her care
d. Encourage the daughter to regularly share her feelings with her mother
ANS: A
The setting of realistic goals is vital to the physical and emotional well-being of the caregiver.
DIF: Application
REF: p. 229
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12. The principle of autonomy is best supported by what intervention made available to palliative
care patients?
a. Arranging for in-home health care
b. Addressing the patient’s specific pain management needs
c. Helping the patient decide on the details of their advanced plan of care
d. Conducting a thorough performance status screening on the patient
ANS: C
Advance directives, if present, can speak for the patient and their wishes thus assuring their
autonomy in making the end of life decisions they are in agreement with.
DIF: Application
REF: p. 230
MULTIPLE RESPONSE
1. Which statements are true regarding palliative care services? (select all that apply)
a. Begins at the time of that a diagnosis of a serious illness occurs
b. Care can be delivered in most settings.
c. Expenses are paid for by Medicare.
d. Is appropriate for all patients regardless of age.
e. Providers are skilled in symptom management.
ANS: A, B, D, E
Palliative care does begin with a diagnosis of a serious illness and can be delivered in a wide
variety of care settings. The care is appropriate and available to patients of any age and is
provided by skilled professionals.
DIF: Comprehension
REF: p. 224, Table 12-2
COMPLETION
1. ________________ occurs when a physician predicts the course and outcome of a disease
process.
ANS:
Prognostication
Prognostication occurs when a physician creates a prediction about the course and outcome of
a disease, often made with consideration of survival, symptoms, function, and quality of life
with or without treatment.
DIF: Comprehension
REF: p. 220
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Chapter 13: Workforce Advocacy for a Professional Nursing Practice Environment
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. When an RN is asked to accept an assignment that he or she may not be qualified to perform,
the nurse should:
a. accept the assignment as appropriate if assigned by a legitimate power.
b. be primarily concerned with the number of patients being assigned.
c. ask how other nurses have handled the assignment in the past.
d. determine whether he or she is familiar with the types of patients being assigned.
ANS: D
Nurses should always think critically about assignments so they can communicate what makes
them uncomfortable about a particular assignment. If nurses do not have the knowledge or
experience required for particular patient assignments, then modification of the assignments is
in order to ensure patient safety.
DIF: Application
REF: p. 245, Box 13-5
2. One workplace issue—the nursing shortage—is caused by several complex issues, including:
a. movement of nurses into acute care settings.
b. the use of unlicensed assistive personnel to replace RNs.
c. a mass of Baby Boomers who have chosen nursing as a career.
d. an aging nursing workforce.
ANS: D
Research validates that an aging population and an aging nursing workforce are significant
contributors to the nursing shortage issue.
DIF: Comprehension
REF: p. 241
3. Studies conducted to determine enrollment trends in nursing schools have found that in the
last years:
a. a greater number of individuals chose nursing as a career but could not meet
entrance requirements.
b. more young people chose to enter the profession of nursing.
c. fewer career opportunities exist in the profession of nursing and fewer
opportunities are projected to exist for women.
d. men have dominated the profession, and women feel that they have experienced
discrimination.
ANS: B
An unexpected number of young people entered the nursing workforce from 2002 to 2009,
causing faster growth in the supply than anticipated.
DIF: Comprehension
REF: pp. 239-240
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4. Qualified nursing school applicants have continued to be turned away, limiting enrollment due
to a shortage of faculty, which is attributed to several factors, including:
a. nursing faculty are subject to high levels of burnout and job dissatisfaction.
b. only the number of faculty in Associate Degree programs remain stable.
c. the mean age of nursing faculty continues to decrease and older faculty mentors
have left the profession.
d. increasing job competition from higher paying clinical sites, even as the economy
recovers.
ANS: D
Academic institutions, especially those faced with budget cuts, generally cannot compete with
nonacademic employers. Faculty salaries continue to be a major contributor to the nursing
shortage.
DIF: Comprehension
REF: p. 241
5. The key to organizational success for health care facilities is:
a. hiring younger, more energetic nurses.
b. offering incentives such as sign-on bonuses.
c. hiring highly qualified advanced practice nurses.
d. retaining professional nurses.
ANS: D
Past nursing shortages have proved that retention of professional nurses is the key to any
organization’s success. Nurses want to work in an environment that supports decision making
and effective nurse-physician relationships. The ability of an organization to retain nurses
primarily depends on the creation of an environment that is conducive to professional
autonomy.
DIF: Comprehension
REF: p. 241
6. A new graduate nurse is applying for the exciting first position and states, “I am only applying
to Magnet hospitals because those work environments:
a. attract physicians who are the best health care providers to improve quality of
care.”
b. require all registered nurses to be certified in the area of practice.”
c. not only attract but also retain professional nurses.”
d. discourage nurses from advancing their current level of education and I don’t want
to return to school for many years.”
ANS: C
Magnet hospitals have been identified as both attracting and retaining professional nurses.
Magnet hospital nurses have higher levels of autonomy, greater control over the practice
setting, and better relationships with physicians.
DIF: Comprehension
REF: pp. 250-251
7. Which situation would be considered a workforce advocacy issue that is reportable to the state
nurses association or the Center for American Nurses if it is not resolved at the local level?
a. Nurses prefer to wear navy blue scrubs, but the institution requires burgundy
scrubs, which interferes with autonomy.
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b. The cafeteria often serves fried vegetables rather than healthier baked vegetables,
causing the potential for hyperlipidemia.
c. The hospital pharmacy does not fill employee prescriptions upon receiving them;
instead, they fill employee prescriptions after all inpatient prescriptions have been
filled.
d. The key needed to change the sharps container is locked in the supervisor’s office
after 3 PM on weekdays and all day on weekends, which prevents changing of the
container when needed and places nurses at risk for needlesticks.
ANS: D
A safe work environment is imperative for the safety of both nurses and patients. Correcting
this work environment issue promotes job satisfaction and good patient outcomes.
DIF: Analysis
REF: p. 250
8. A newly hired nurse is asked to serve on a committee formed to recruit and retain nurses. At
the committee meeting, the nurse learns that:
a. older nurses are being encouraged to retire so that younger, more efficient nurses
can practice.
b. Magnet hospitals are able to attract nurses with sign-on bonuses and flexible work
hours but fail to retain nurses because insufficient autonomy over professional
practice is provided.
c. multitasking is seldom desired by the younger generation of nurses.
d. many younger workers are less concerned with longevity and are willing to change
institutions to achieve professional advancement and flexible work hours.
ANS: D
The emerging workforce, ages 18 to 35 years, has compensation expectations that differ from
those of previous generations. This younger generation prefers to work in an outcomes-based
environment, where pay is based on achievement or merit, not on longevity.
DIF: Application
REF: p. 242
9. Hospitals surveyed nurses who terminated their employment to determine why they chose to
leave. One of the most common reasons for leaving was:
a. decreased pay for alternative shifts.
b. that the nurse/patient ratio prevents safe care.
c. that most facilities are choosing an all-RN staff, which decreases opportunities for
advancement.
d. that agency and foreign nurses are favored by administration over full-time nursing
staff.
ANS: B
A number of studies in the late 1990s focused on the work environment as a significant
contributor to the difficulties involved in recruiting and retaining RNs. One of the primary
factors for the increasing nurse turnover rate was identified as workload and staffing patterns.
A more recent study by Aiken (2002) reported higher rates of patient complications and
increased death rates when fewer nurses are assigned per patient.
DIF: Comprehension
REF: p. 242
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10. A nurse is concerned about safe staffing levels at a facility and observes that several units
have no RN coverage but instead have RNs who float among several units. In determining
whether this staffing concern should be reported to an outside agency, the nurse understands
that, with whistle-blowing:
a. reporting unsafe staffing levels to The Joint Commission provides protection from
the employer.
b. keeping copies of documented inappropriate staffing patterns in the nurse’s
personal file is illegal.
c. when observing inappropriate staffing, the nurse should record her personal
thoughts concerning the outcomes.
d. one should seek guidance from a trusted individual who can provide an objective
point of view.
ANS: D
One of the many guidelines regarding whistle-blowing specifies that one should seek counsel
from a trusted individual outside the situation to gain an objective perspective.
DIF: Analysis
REF: p. 248, Box 13-6
11. The occupational health and safety nurse would like to develop programs designed to decrease
mortality and morbidity among the workforce. When considering factors related to mortality
among health care workers, the nurse should focus efforts on prevention of:
a. suicide.
b. violence related injury.
c. bloodborne disease.
d. ergonomic hazards.
ANS: B
A summary of research by the National Institute for Occupational Safety and Health (2014)
found that health care workers have almost five times the risk of experiencing a
violence-related workplace injury requiring time off from work than individuals in the overall
workforce.
DIF: Application
REF: p. 249
12. According to the Needlestick Safety and Prevention Act (2000):
a. employers ask nurses in managerial positions to evaluate safe needle devices.
b. registered nurses who sustain a needle stick are required to pass a test before
resuming medication administration.
c. each state must determine the type of safe needle devices to be used.
d. employers are required to document how and where a sharps injury occurred,
including the brand of device that was involved.
ANS: D
The Needlestick Safety and Prevention Act, passed at the federal level, requires the use of
safer needle devices to protect from sharps injuries; the law requires employers to maintain a
sharps injury log that contains, at a minimum, the brand of device involved in the incident, the
department or work area where the exposure incident occurred, and an explanation of how the
incident occurred.
DIF: Comprehension
REF: p. 248
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13. A nurse is concerned because novice nurses are having their orientation period shortened and
are being placed in charge nurse positions. The nurse has documented unsafe care and
decisions by these novice nurses. To be protected from retaliation by the employer, this nurse
must “blow the whistle” by:
a. holding a public forum in the agency cafeteria to discuss concerns.
b. reporting concerns to state and/or national agencies regulating the agency.
c. calling coworkers outside the workplace to informally discuss wrongdoing.
d. contacting The Joint Commission to report unsafe conditions.
ANS: B
The whistle-blower is not protected until concerns are reported to the state or national
regulatory agency.
DIF: Comprehension
REF: p. 247
14. A nurse is concerned about a trend in the hospital to regularly “float” nurses to different areas
of the hospital based on staff shortage regardless of recent experience in caring for the
population on the unit. When deciding to accept a staffing assignment in this situation, the
nurse considers a “safe harbor.” What is meant by “safe harbor”?
a. In an emergency situation, nurses may move patients to one location designated to
be areas safe from natural disasters or acts of terrorism.
b. Nurses work in teams to care for patients who have no communicable disease and
do not pose a safety issue due to infection.
c. Horizontal violence is not tolerated and nurses report any form of violence to
administration.
d. It is written a notice about recurrent staffing issues that allows nurses to continue
to care for patients placed in their care but protects their nurse’s license while an
investigation is conducted.
ANS: D
Safe harbor does not mean a nurse can refuse an assignment unless it would violate the nurse
practice act, but it does provide an avenue for nurses to report unsafe staffing by filing a
written report that is investigated by administration.
DIF: Application
REF: p. 239 |p. 248, Box 13-6
15. The Institute of Medicine report (2011):
a. recommended that only physicians have the legal privilege to prescribe
medications.
b. called for increasing the number of baccalaureate-prepared nurses in the workforce
to 80% by 2020.
c. called for a minimum staffing ratio be in place in no later than 10 years.
d. called for nurse technicians to provide care during the nursing shortage.
ANS: B
The IOM report (2011) addresses the evolving complexities of the current health care system
and a need for 80% of the nursing workforce to be baccalaureate prepared by 2020.
DIF: Comprehension
REF: p. 241
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16. The priority intervention to improve work-related quality of life for nurses is to:
a. provide safe harbors for unjust or unsafe work assignments.
b. improve nurse physician communications.
c. require professional development courses for bedside nurses.
d. determine strategies to improve vertical working relationships between staff nurses
and nursing administration.
ANS: D
RNs ranked their relationships with administration and management the lowest in the
workplace.
DIF: Application
REF: p. 241
17. Nurses entering the workforce at a large urban hospital soon began volunteering for excessive
overtime. A focus group found that upon graduation, many of these nurses purchased
expensive cars and furniture. They lacked skills in managing their checkbook and were often
unable to pay recurring bills; this finding would be relevant to which component of the
Workforce Advocacy Ecosystem Model?
a. Staffing
b. Workflow design
c. Organizational factors
d. Personal and social factors
ANS: D
Personal and social factors include stress, job satisfaction, and professionalism and financial
literacy.
DIF: Comprehension
REF: p. 238, Box 13-1
18. An acute care facility values job satisfaction among its registered nurses.by implementing a
shared governance model. Which element is a fundamental characteristic of this model?
a. Administration has an open door policy
b. Established dispute resolution process
c. Implementation of mandatory reporting
d. Nurses have an active role in patient care decision making
ANS: D
The importance of shared governance is that such models provide an organizational
framework for nurses in direct care to become committed to nursing practice within their
organizations. The implementation of such models allows nurses to have an active role in
decision making by providing maximal participation and accountability for the outcomes of
those decisions.
DIF: Application
REF: p. 252, Box 13-9
19. When reading about nursing as a career, a student is interested in learning about violence in
the profession. Which statement accurately reflects violence in health care and the profession
of nursing?
a. Nursing is the most trusted profession and therefore violence is rare.
b. All nurses should be advocates for violence prevention programs.
c. Physical violence between peers constitutes lateral violence; however, verbal
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assault is not recognized as violence.
d. Professional organizations have recognized a need to evaluate all nurses for the
risk of committing acts of violence.
ANS: B
Nurses in all settings must proactively advocate for interventions that ensure personal safety
and a safe work environment.
DIF: Comprehension
REF: pp. 249-250
MULTIPLE RESPONSE
1. Managers at an acute care facility value the contributions of their aging nursing workforce and
make recommendations to accommodate for an aging nursing workforce. They institute for
which changes? (select all that apply)
a. Supplies such as dressing change and Foley catheter kits are placed on the nursing
unit.
b. Teamwork and development of new roles such as admission nurse are encouraged.
c. Daycare centers for sick children are put into place to prevent the stress of having
to find alternative daycare.
d. Assistive devices for lifting as recommended by ANA’s Handle with Care are
made available.
e. A work-design consultant is hired to redesign the nursing unit to reduce wasted
motion.
ANS: A, B, D, E
Placing supplies in a decentralized area prevents the fatigue that would be caused by the need
to retrieve items from a distant location. Nurses are integral to quality and their contributions
should be noticed. Ill-designed units contribute to fatigue and inability of aging nurses to
perform efficiently. Mentoring is one way to acknowledge skills of the aging workforce.
DIF: Application
REF: pp. 241-242
2. A nurse is interviewing for a job and recently read the American Nurses Association’s (ANA)
recommendation for questions to ask regarding before accepting employment. Which
questions should the nurse ask?
a. Do you have flexible scheduling?
b. What are the expectations for advancement?
c. How long do staff nurses stay before resigning?
d. What is the mission of the parent organization?
e. Does the organization have a means for staff nurses to have an active role in
decision making by participation and accountability for the outcomes of practice
decisions?
ANS: B, C, E
According to the ANA recommendations, applicants for nursing positions should ask about
the opportunities for advancement exist in the organization. According to the ANA
recommendations, applicants for nursing positions should ask about the organization’s
turnover rate and average longevity of staff nurses. According to the ANA recommendations,
applicants for nursing positions should ask about whether the organization has a shared
governance model.
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DIF: Comprehension
REF: p. 244, Box 13-3
COMPLETION
1. Nurses who are expected to work overtime as dictated by their employer are being subjected
to a ___________ hazard in the workplace.
ANS:
psychological
Hazards in the workplace are categorized as follows: biologic, ergonomic, chemical, physical,
and psychological. Included in psychological hazards are issues such as stress, shift work,
mandatory overtime, and verbal abuse by patients and other health care providers.
DIF: Application
REF: p. 239
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Chapter 14: Collective Bargaining and Unions in Today’s Workplace
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Nurses in a unionized hospital are paid “compensatory pay” when working holidays equal to
the number of hours worked with no extra compensation. Although they have suggested
changes during the annual survey of employee satisfaction, management refuses to consider
another system for compensatory pay. A trained member listened to both nurses and
management to make recommendations that were not legally binding. This type of settlement
is termed:
a. picketing.
b. binding arbitration.
c. mediation.
d. grievance.
ANS: C
Mediation enlists the help of a trained person to listen to both sides; however,
recommendations are not legally binding.
DIF: Comprehension
REF: p. 257
2. A nurse has been asked to serve as the charge nurse on the evening shift. The agency where
the nurse is employed is considering unionization. If the charge nurse position is accepted,
this nurse:
a. can be represented by the union because charge nurses are not considered part of
the management team.
b. is part of the management team, so union participation would be a conflict of
interest.
c. can file a grievance that will be arbitrated automatically by the union.
d. is ineligible for collective bargaining activities that deal with unfair labor practices.
ANS: A
Serving as charge nurse is part of a nurse’s professional role and not a management function.
DIF: Comprehension
REF: pp. 263-264
3. A nurse has heard rumors that other nurses are interested in unionizing but knows little about
the purpose of unions. The nurse’s first action is to:
a. contact an arbitrator who has worked with other nurses in unions.
b. picket the agency where employed to gain inside information as to why
unionization is sought.
c. sign the dual-purpose union authorization card.
d. review the National Nurses United website for collective bargaining information.
ANS: D
The National Nurses United website gives information about collective bargaining for nurses.
DIF: Application
REF: p. 259
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4. Nurses in a nonprofit hospital have expressed an interest in forming a union to secure fair
wages and ensure client safety. To form a core support group of nurses, the union organizer
can conduct meetings to gather initial information:
a. away from the worksite with a group of managers to learn both sides of the
situation.
b. at the worksite with staff nurses who are respected leaders.
c. in homes or local businesses with staff nurses.
d. after photographing management meeting to discuss their strategies to decrease
interest in unionization.
ANS: C
The union representative meets with laborers (staff nurses) at a nonwork setting to gather
information about grievances.
DIF: Application
REF: p. 260
5. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction
and a sentinel event. Management is unwilling to discuss a change in staffing, and collective
bargaining interest is sparked. A nurse is approached to sign a union authorization card. If
signed, the card:
a. authorizes the union to serve as his or her legal representative.
b. indicates that the person is requesting additional information about collective
bargaining.
c. indicates the nurse desires to share information about grievances.
d. gives permission for union dues to be deducted from pay.
ANS: A
A signature on a union authorization card indicates that the nurse gives the union the right to
serve as legal representation.
DIF: Comprehension
REF: pp. 259-260
6. A group of RNs wish to seek union representation that would protect all workers in the
agency including nonlicensed assistive personnel and non-nursing employees such as
nutritionists and dietary workers. The type of union being sought is the strongest collective
group and is known as a(n):
a. occupational union.
b. industrial union.
c. union shop.
d. right-to-work bargaining organization.
ANS: B
An industrial unionism is a single union for all workers in the agency.
DIF: Comprehension
REF: p. 257
7. Physical therapists are represented by a union, nurses are represented by a separate union, and
pharmacists have yet another union within a single agency. This type of union representation
is known as:
a. occupational unionism.
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b. industrial unionisms.
c. union shop.
d. power sharing.
ANS: A
Occupational unionism indicates separate unions for each occupation in an agency.
DIF: Comprehension
REF: p. 257
8. Historically, what movement most influenced unionization in American health care
agencies/hospitals?
a. Immigration laws protected foreign employees from discrimination in hiring or
discharge on the basis of national origin and citizenship status.
b. Women entered the workforce, gaining voice to support unions.
c. The Industrial Revolution led to poor working conditions and the need to protect
workers.
d. Nurses were exposed to communicable diseases, which led to death and disability.
ANS: C
The Industrial Revolution led to people working in factories where poor and unsafe working
conditions were widespread.
DIF: Comprehension
REF: pp. 258-259
9. In recent Gallop Polls, nurses were voted as the most honest with the highest ethical standards
of all professions. How does this degree of professionalism affect nurses’ desire to participate
in organized strikes?
a. Nurses most often turn to collective bargaining strategies such as strikes to
emphasize client safety initiatives.
b. Nurses use evidence-based studies that reflect both management and labor views to
support participation in unionization.
c. Nurses often find union activities such as strikes in conflict with the need to serve
and protect clients and their profession.
d. Nurses who strike can be legally punished for abandonment and negligence,
considered to be professional misconduct.
ANS: C
Nurses are client advocates and promotion of professionalism is valued as evidenced by the
public’s opinion related to honesty and professionalism.
DIF: Application
REF: p. 262
10. A concern that nurses were being asked to perform tasks that went beyond the state’s nurse
practice act was brought to the union’s attention. Nurses were informed that either mediation
or binding arbitration will be used to resolve the issue. A novice nurse asks about the
difference between these techniques and is informed that:
a. mediation is sanctioned by the National Labor Relations Board (NLRB) to
formally discuss concerns with management and labor.
b. binding arbitration is a formal discussion between labor and management in which
the arbitrator’s recommendations are compulsory.
c. mediation uses a trained person to negotiate a legally binding plan.
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d. binding arbitration requires both labor and management to participate in
discussions on the least destructive approach to allow self-governance by
employees.
ANS: B
Binding arbitration requires that both parties meet in formal talks, and all parties must obey
the arbitrator’s recommendations.
DIF: Comprehension
REF: p. 257
11. A large corporation employs nurses all over the United States. Nurses in one agency learned
that fellow nurses in another agency are striking because they are required to work 16-hour
shifts to cover for nurses who have left due to unsafe staffing practices. The union of the
nonstriking agency nurses decides to stop work to support the nurses who are striking; thus,
this union:
a. is placing nurses at risk for a lawsuit because their direct employer did not cause
the strike.
b. must be an industry union representing both parties.
c. is participating in a sympathy strike, which, if done correctly, is legal.
d. must pay for any losses incurred by the agency during the strike.
ANS: C
A sympathy strike occurs when a union stops work to support the strike of another union.
DIF: Comprehension
REF: p. 257
12. A group of nurses interested in unionizing decides to contact the largest union in the United
States representing registered nurses, which is the:
a. American Nurses Association.
b. United American Nurses.
c. National Nurses United.
d. National Labor Relations Board.
ANS: C
In 2009, the National Nurses United became the largest union representing nurses RNs as a
result of a merger between the United American Nurses, California Nurses Association,
National Nurses Organizing Committee, and Massachusetts Nurses Association.
DIF: Comprehension
REF: p. 259
13. A nurse is interested in working in a large trauma center that is unionized but does not want to
join the union or pay fees. She accepts the position but is not required to join or pay fees to the
union based on which law?
a. National Labor Relations Act
b. Right-to-work law
c. National Labor Relations Act
d. Taft-Hartley Act
ANS: B
The right-to-work law prohibits membership or payment of union dues or “fees” a condition
of employment, either before or after hiring.
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DIF: Comprehension
REF: p. 257 | p. 260
14. A group of nurses are assembling outside a hospital protesting the use of foreign nurses after
several nurses were terminated due to what the hospital called recurring “decreased census.”
The nurses carry signs with messages asking potential patients to seek care elsewhere. The
local newspaper picked up the story, and the hospital is receiving negative press. The nurses
are participating in:
a. picketing.
b. collective bargaining.
c. a strike.
d. arbitration.
ANS: A
Picketing is a form of protest in which people (called picketers) congregate outside a place of
work or location where an event is taking place. Often this is done in an attempt to dissuade
others from going in (“crossing the picket line”), but it can also be done to draw public
attention to a cause.
DIF: Comprehension
REF: p. 257
MULTIPLE RESPONSE
1. A hospital is seeking a 2.5% wage reduction for all nurses as part of a new balanced budget
plan; however, the plan provides for raises for upper-level management. This plan resulted in
a call for a union to protect the nurses. When the union representative arrives, what questions
should the nurses ask? (select all that apply)
a. Will the dues be used to support charity care when clients are unable to pay?
b. How effective has the union been in representing nurses’ best interest?
c. What percent of dues pays union personnel salaries?
d. Are dues used to promote research for terminally ill clients?
e. If arbitration is unsuccessful and a strike occurs, will nurses receive compensation
during the strike?
ANS: B, C, E
Laborers (staff nurses) want a union with a successful track record of improving wages and
benefits. Union dues are used to support union personnel, and the amount varies among
different union groups; the higher the percentage of money that goes to pay union personnel
salaries, the less money will be available to support members. Employers are not obligated to
pay laborers during a strike, and unions may choose to pay employees while striking.
DIF: Application
REF: p. 263, Box 14-1
2. A hospital refused to purchase a better grade of utility gloves, even after learning that the
cheaper utility gloves are easily punctured during routine use. This unsafe situation led nurses
to seek unionization. During the pre-election phase for unionization, which actions by union
representatives are prohibited by the National Labor Relations Board? (select all that apply)
a. Scheduling a meeting in the agency’s cafeteria to determine employees’ interest in
unionization
b. Distributing nondocumented information that female nurses receive lower annual
performance evaluations than do male nurses
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c. Distributing information about the benefits of unionization and grievances in a
public parking garage located across from the hospital
d. Suggesting to workers the likelihood of job loss should the union not win the
election
e. Signing authorization cards for employees who are on leave
ANS: A, B, D, E
Union representatives must meet in nonwork areas. Union representatives must not spread
rumors of prejudices. Neither the union nor employers can spread falsehood about potential
job loss or repercussion in the event of unionization. Union representatives cannot sign cards
for employees.
DIF: Application
REF: p. 259
3. It is important to realize that nurses may seek unionization if: (select all that apply)
a. physicians rotate on-call coverage among group members for complicated
long-term clients.
b. scheduling is presented that provides adequate staffing on holidays by rotation of
time off for holidays among nurses.
c. incident report trends indicate medication errors are caused by shift reports being
taped and heard after nurses from the prior shift have left the unit.
d. physicians, nurses, nutritionists, and physical therapists visit concurrently with
clients to plan care.
e. staff development activities are planned daily at 8 AM for 2 consecutive days to
educate staff on new cardiac monitoring procedures while following normal
staffing patterns.
ANS: C, E
Policies where shift reports are taped and heard after a prior shift has left have proved to lead
to errors and unsafe care. Staff development activities should be scheduled to allow nurses to
attend, and normal staffing patterns or time of training must coincide with nurses’ availability
and ability to listen to and retain information (such as at the beginning or end of the shift
while others provide coverage).
DIF: Comprehension
REF: p. 262
4. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction
and a sentinel event. Management is unwilling to discuss a change in staffing, and collective
bargaining interest is sparked. During the pre-election period, what actions by management
are prohibited? (select all that apply)
a. Seek individuals to spy on coworkers who are possible union supporters.
b. Photograph employees participating in information sessions about unionization.
c. Visit managers outside work to gain their perception of popularity of unionization.
d. Threaten that, should the union win, the company will relocate when there is no
intention to relocate.
e. Require employees to declare their position on unionization prior to pick up
paychecks.
ANS: A, B, D, E
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During the pre-election period, management may not solicit spying. During the pre-election
period, management may not photograph employees engaged in union activities. During the
pre-election period, management may not lie about what will happen if the union is the victor
in an election. During the pre-election period, management may not question employees about
their preferences regarding union activity.
DIF: Comprehension
REF: p. 261
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Chapter 15: Information Technology in the Clinical Setting
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Consumers are concerned with security issues related to their confidential health information
being placed in an electronic health record (EHR). However, when the security of the EHR is
compared with that of paper-and-pencil records, the EHR is:
a. more secure.
b. less secure.
c. equivalent.
d. not comparable with the paper-and-pencil record.
ANS: A
Computer-based patient record systems, such as EHRs, provide better protection than
paper-based systems. The EHR allows only authorized users to view data, and access to
records can be audited for inappropriate use.
DIF: Comprehension
REF: p. 271
2. During a search for the term informatics, when the nurse finds the domain “.edu,” the site is
affiliated with a(n):
a. government agency.
b. commercial site.
c. educational institution
d. Internet service provider.
ANS: C
The domain of an educational institution is .edu.
DIF: Knowledge
REF: p. 276
3. When paper-and-pencil medical records are compared with computer-based records:
a. paper-and-pencil records provide controls to determine who has viewed the health
information.
b. information contained in a paper-and-pencil record has the capability of being
more in-depth than that found in computer-based records.
c. patients have the right to know that the confidentiality of their records is strictly
maintained, regardless of the type of medical record used.
d. patients must sign for each item of information released on the computer record.
ANS: C
Regardless of the type of record used, the Health Insurance Portability and Accountability Act
(HIPAA) protects the confidentiality of the patient’s medical information and imposes legal
consequences for those who breech confidentiality.
DIF: Comprehension
REF: p. 271
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4. A nurse is preparing a scholarly publication on the prevalence of hepatitis A worldwide. The
most efficient and effective means of conducting an Internet search to gather information for
this publication is to use:
a. a search engine such as Google or Yahoo.
b. a consumer health website.
c. a decision support system.
d. MEDLINE database.
ANS: D
MEDLINE is one of the scientific and research scholarly databases, and it would be the most
appropriate for use in gathering information for a scholarly publication.
DIF: Comprehension
REF: p. 276
5. A consumer is learning about electronic health records at a local health fair and states, “I am
worried that someone can read my health information and I really don’t understand the
difference between privacy and confidentiality.” The nurse explains that an example of
confidentiality would be:
a. a pledge that states, “I will hold matters pertaining to my patients in strict
intimacy.”
b. a patient who does not tell the physician that he has been treated for a sexually
transmitted disease.
c. a teenager who sustains a broken arm and in the emergency department and
withholds information about her use of recreational drugs.
d. locking medical records in cabinets to prevent unauthorized users from accessing
patient information.
ANS: A
Confidentiality is keeping private the personal information that was given to a health care
provider, unless others have a legitimate need to know.
DIF: Application
REF: p. 271
6. A physician has installed a computer-based patient records system. An outside care provider
who requests medical information must obtain the patient’s signed consent and then is
assigned a password to gain access to the medical information. A monthly audit is conducted
to determine for whom and for what purpose patient records have been accessed. This
protection is referred to as:
a. privacy.
b. confidentiality.
c. security.
d. data capture.
ANS: C
Security is the limitation of access to health care information through passwords and other
precautions.
DIF: Comprehension
REF: p. 271
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7. A nurse walks up to a computer in the hallway and presses the index finger to the sensor,
thereby gaining access to patient data. A few moments later another nurse performs the same
steps and is granted access. A visitor who is watching from a room walks over and places the
index finger on the sensor, only to receive an “error and access denied” message. Security is
being maintained by:
a. robot technology.
b. biometric technology.
c. telehealth.
d. ubiquitous computing.
ANS: B
Biometric fingerprint identification uses personal characteristics to allow access to health
information.
DIF: Comprehension
REF: p. 277
8. A nurse who is teaching a class to introduce telehealth to the staff would include which
example?
a. A robot performs menial housekeeping chores for an invalid patient.
b. A computer software program alerts the nurse or physician who is reviewing
orders that an order for a new drug can cause synergy of the theophylline inhaler.
c. A physician speaks into a computer, and the admission history is recorded and
saved in the patient file.
d. While a patient in Wyoming performs peritoneal dialysis, a nurse watches
remotely from California to ensure that all steps are being followed correctly.
ANS: D
Telehealth is the delivery of care to a patient who is at a distance from the health care
provider.
DIF: Application
REF: p. 273
9. An advanced practice nurse inputs into a computer software program the following clinical
manifestations: open wound with tibia exposed, petechial hemorrhage, and temporary loss of
consciousness. The computer diagnosis of fat emboli is generated by a system known as:
a. decision support.
b. telehealth.
c. robotic technology.
d. biometric technology.
ANS: A
Decision support systems are computer-based information systems that include
knowledge-based systems designed to support clinical decision making.
DIF: Comprehension
REF: pp. 268-269
10. A nurse is preparing a presentation using different websites to collect information. The nurse
is concerned that contact information and the author’s credentials are not listed for one of the
websites reviewed. Which criterion required to establish a reputable website is missing?
a. Authority
b. Objectivity
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c. Usability
d. Currency
ANS: A
Authority is the criterion that is related to the credentials and background that have prepared
an author to publish on the subject.
DIF: Comprehension
REF: p. 276
11. A nurse is interested in locating reliable information concerning noninvasive blood glucose
monitoring. Information is located, and the author is a scientist who conducted studies within
the last year on the effectiveness of a particular noninvasive blood glucose monitor. The
scientist received funding from a pharmaceutical company to support the studies. The URL
indicates the pharmaceutical company site.com. The nurse is concerned about this
information’s:
a. authority.
b. objectivity.
c. accuracy.
d. currency.
ANS: B
Sites sponsored by organizations such as pharmaceutical companies may influence the
content.
DIF: Comprehension
REF: p. 276
12. A nurse providing care at the bedside receives an “alert” that a patient’s stat potassium level is
2.5 and digoxin (Lanoxin) is scheduled. The nurse holds the medication and prevents a
possible complication. This feature of the Electronic Health Record is available through which
core function of EHR?
a. Order entry/order management
b. Decision support
c. Patient support
d. Administrative support
ANS: B
Decision support provides reminders about preventive practices, such as immunizations, drug
alerts for dosing and interactions, and clinical decision making.
DIF: Comprehension
REF: pp. 268-269
13. A nurse works on a unit where electronic health records (EHR) are being initiated and asks,
“What is meant by ‘meaningful use’ standards that are in our education packet?” The best
answer is that “meaningful use”:
a. identifies a set of EHR proficiencies and benchmarks that EHR systems must meet
to be certain that they are functioning to their maximum capacity and meeting this
standard allows companies/organizations to qualify for funds to defray cost of the
EHR from Medicare.
b. refers to training competencies that all users must achieve to be able to access and
transfer patient data/information.
c. refers to a requirement that at least 50% plus one of all patients have data entered
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into the EHR.
d. the requirement that rigorous confidentiality security is in place to protect all
patient information from sources which have no right to the data.
ANS: A
Meaningful use is “A defined set of EHR capabilities and standards that EHR systems must
meet to ensure their full capacity is realized and for the users (hospitals and physician
practices) to qualify for financial incentives from Medicare.”
DIF: Application
REF: p. 271
14. A nurse is caring for a patient who is to receive an antibiotic drug that causes severe skin
damage when infiltrated. The order reads, “infuse over 1 hour by portacath.” The nurse
accesses the Personal Digital Assistant for software that lists the steps to access a portacath.
The nurse is using:
a. electronic health records.
b. point-of-care technology.
c. data management.
d. telehealth.
ANS: B
Using a Personal Digital Assist device to access information at the bedside is considered
point-of-care technology. The nurse was able to retrieve the steps for accessing a portacath
electronically while remaining at the bedside.
DIF: Comprehension
REF: p. 273
15. The Institute of Medicine (IOM) (2003) recommends that EHR systems offer eight
functionalities. A patient has a severe allergy to eggs and penicillin. Which of the eight
functions of the EHR would address sharing this information?
a. Health information and data capture
b. Results/data management
c. Provider order entry management
d. Clinical decision support
ANS: A
The health information and data capture function includes information such as medical
history, laboratory tests, allergies, current medications, and consent forms.
DIF: Comprehension
REF: p. 269, Table 15-1
MULTIPLE RESPONSE
1. A new nurse asks, “Since Electronic Medical Records can improve quality care by having
seamless data available for a patient, why doesn’t everyone just replace paper and pencil
charts”? Barriers to a universal health information infrastructure include the fact that: (select
all that apply)
a. competition from individual companies to build EMR prevent a universal
infrastructure.
b. cost is prohibitive even with federal funding for larger health care systems.
c. preventive health reminders for immunizations and yearly screenings such as
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mammograms are used in clinical decision making.
d. insurance companies have halted sharing of some patient data due to fear of law
suits.
e. the full capacity of EHRs has not been realized with only Stage 1 of 3 nearing
completion.
ANS: A, E
It has been recommended that only a federal-based EMR would provide an infrastructure that
allows access to comprehensive patient information. The first stage, years 2011 and 2012,
forms the foundation for electronic data capture and information sharing.
DIF: Comprehension
REF: p. 271
2. A nurse interested in quality improvement tools performed a search for cause and effect
diagrams using www.ishikawa.com. A page opened that provided images and templates for
performing fishbone diagrams. Which type of search did the nurse conduct?
a. Quick and dirty
b. Advanced
c. Brute force
d. Link searching
ANS: C
Brute force is a method of searching where you type in what you think might logically be a
web address and see what happens.
DIF: Comprehension
REF: p. 275
COMPLETION
1. Software programs that process data to produce or recommend valid choices are known as
______________.
ANS:
decision support systems
Decision support systems use software programs that process data to produce or recommend
decisions by linking with an electronic knowledge base.
DIF: Knowledge
REF: p. 269
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Chapter 16: Emergency Preparedness and Response for Today’s World Cherry
& Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Nurses and community officials are working together to ensure that churches and schools
have needed supplies to provide shelter for large numbers of individuals in the event of a
natural or manmade disaster. These activities represent which phase of a disaster continuum?
a. Preparedness
b. Relief response
c. Recovery
d. Crisis intervention
ANS: A
Every disaster response begins as a local event known as the preparedness phase, which
consists of planning, preparedness, prevention, and warning.
DIF: Comprehension
REF: p. 285
2. A nurse at a school notices that several students have “blisters” on their bodies. Further
investigation reveals that a terrorist incident has occurred, causing smallpox. If the chemical,
biologic, radiologic, nuclear, and explosive (CBRNE) agent categories are used, this incident
would be classified as:
a. chemical.
b. biologic.
c. radiologic.
d. nuclear.
ANS: B
The biologic category refers to diseases such as plague or smallpox.
DIF: Comprehension
REF: p. 284, Table 16-1
3. The Metropolitan Medical Response System (MMRS):
a. is totally financed by the federal government national disaster fund.
b. consists of responders who have obtained specialized training and equipment to
deal with mass casualty events.
c. has a storehouse of medications and antidotes to be used during response in times
of national emergencies.
d. arranges for patient admissions to federal hospitals.
ANS: B
The MMRS responds to disaster with trained individuals who have expertise in this type of
situation and who have the equipment required to be effective.
DIF: Comprehension
REF: p. 286
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4. A community in the New Madrid fault zone experiences an earthquake resulting in injuries
from propelled objects and abrasions for many victims. The local supply of antibiotics is
quickly exhausted. Local authorities would contact the:
a. Commissioned Corps Readiness Force.
b. Strategic National Stockpile.
c. Department of Homeland Security.
d. local Young Men’s Christian Association (YMCA).
ANS: B
The Strategic National Stockpile provides antibiotics, antidotes, and medical and surgical
items when local and state supplies have been exhausted.
DIF: Comprehension
REF: p. 287
5. During the relief response phase of a disaster resulting from a “dirty bomb”:
a. treatment for burns and poisoning is provided for victims.
b. emergency plans are coordinated between agencies.
c. reconstruction of destroyed facilities and homes begins.
d. food stores are collected for potential victims.
ANS: A
During the relief response phase of a disaster, emergency responders provide assistance to
victims and stabilize the scene; with a dirty bomb, radioactive material causes burns and
poisoning.
DIF: Analysis
REF: p. 288
6. A nurse learns of a mass casualty disaster following a known terrorist attack. On arriving at
the scene, the nurse knows that:
a. the response of local hospitals will be dictated by the federal government.
b. the same ground rules practiced in other settings and during smaller crises will be
applicable.
c. the least experienced nurses will be assigned to triage low-risk victims and victims
who have no chance of survival.
d. multiple incident commanders ensure a quick, effective response.
ANS: B
The fundamentals of nursing applied to other settings and situations can be used in a disaster.
DIF: Comprehension
REF: p. 283
7. Nurses caring for the victims of a mass casualty incident:
a. determine the common terminology to be used by hospitals and participating
agencies.
b. take charge of communicating with the news media.
c. determine whether there is a credible threat of a terrorist attack.
d. give priority for care to those with the greatest chance of survival rather than those
most critically ill.
ANS: D
Care is shifted from categorizing patients at low, intermediate, and critical risk to using
resources to serve those with the greatest likelihood of survival.
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DIF: Comprehension
REF: p. 283
8. During a community health fair the disaster medical assistance team (DMAT) informs
participants that every community must be ready to provide disaster care. A participant asks,
“In a disaster, the local community cannot possibly be effective, so why not have a plan to call
federal agencies immediately to provide relief?” The correct response by the DMAT is:
a. “Unless known terrorist activities involving mass destruction occur, the federal
government does not become involved.”
b. “The community is essentially the ‘first responder’ to any disaster.”
c. “The preparedness phase of a disaster is the responsibility of the community, the
relief response phase is assigned to state agencies, and the recovery phase is the
responsibility of federal agencies.”
d. “Unless local health care facilities are incapacitated, state and federal agencies will
withhold assistance.”
ANS: B
Each disaster begins locally, and each community responds first and receives assistance from
state and federal agencies when local resources are not adequate for the situation.
DIF: Comprehension
REF: p. 285
9. A nurse who is conducting a staff in-service on the phases of a disaster continuum teaches
participants that, during the impact/response stage, activities focus on:
a. community awareness in anticipation of a terrorist attack or natural disaster.
b. determining the effectiveness of the disaster medical assistance team (DMAT).
c. the use of an all-hazards approach.
d. initiating response activities.
ANS: D
Response activities during the relief response phase consist of immediate actions to save lives
and meet basic human needs.
DIF: Comprehension
REF: p. 288
10. Following a terrorist attack, victims are exhibiting posttraumatic stress syndrome, and care
providers are exhibiting compassion fatigue. Which federal response system should be
initiated?
a. Strategic National Stockpile
b. Metropolitan Medical Response System (MMRS)
c. Commissioned Corps Readiness Force
d. National Disaster Medical System
ANS: B
The MMRS is concerned with deploying trained responders who are able to provide mental
health care for victims and health care providers.
DIF: Comprehension
REF: p. 286
11. The crisis communication officer may first inform the public or health care facility of a
disaster or an act of terrorism. This representative has the responsibility to:
a. contain the facts to within the administration group.
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b. incite the public to quickly take cover and obtain emergency supplies.
c. provide understandable and straightforward facts about the event within the facility
and possibly to the news media.
d. inform the public that no information can be released until it has been confirmed
by state and federal agencies.
ANS: C
The crisis communication officer is the first contact for patients, families, and employees
within the facility or news media, so they may better understand the situation and know how
to react and protect themselves.
DIF: Comprehension
REF: p. 289
12. The disaster medical assistance team works quickly to contain contaminants from a chemical
plant explosion. Afterward, personnel undergo a special process to remove harmful chemicals
from equipment and supplies. This removal process is known as:
a. containment.
b. decontamination.
c. triage.
d. scene assessment.
ANS: B
Decontamination is the physical process of removing harmful substances from personnel,
equipment, and supplies.
DIF: Knowledge
REF: p. 280
13. A group of local volunteers respond to a tornado. Volunteers have completed an emergency
response course and are able to assist with triage of injured citizens. They also participate in
local health fairs to teach residents how to react during tornadoes. The responders are
members of the:
a. Medical Reserve Corps (MRC).
b. Metropolitan Medical Response System (MMRS).
c. National Disaster Medical System (NDMS).
d. Commissioned Corps Readiness Force (CCRF).
ANS: A
The MRC are local volunteers trained to respond to local emergencies.
DIF: Comprehension
REF: p. 285
14. Troops from the United States participating in a peace mission in a foreign country were the
victims of suicide bombers and many soldiers were evacuated back home to receive
specialized medical care. The nation’s medical responses will be augmented by:
a. the federally coordinated National Disaster Medical System.
b. local homeland communities where troops receive care.
c. the Medical Reserve Corps, which organizes and utilizes public health, nursing,
medical, and other volunteers.
d. the National Incident Management System, which guides government,
nongovernmental organizations, and the private sector to work seamlessly during
disaster situations.
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ANS: A
The National Disaster Medical System supplements care for casualties evacuated back to the
United States from overseas and federally declared disasters including national disasters,
major transportation accidents, technologic disasters, and acts of terrorism.
DIF: Comprehension
REF: pp. 286-287
15. A nurse is informed that the Federal Bureau of Investigation has determined that a bomb has
been detected and is in the possession of a known terrorist group. The government buildings
in the local community are the target. This situation is termed a(n):
a. all-hazards approach.
b. biologic event.
c. credible threat.
d. natural disaster.
ANS: C
A credible threat is a situation in which the Federal Bureau of Investigation (FBI) determines
that a terrorist threat is probable and verifies the involvement of a weapon of mass destruction
in the developing terrorist incident.
DIF: Comprehension
REF: p. 280
16. The emergency response team responded to a terrorist attack where hundreds of people died
following symptoms of chest tightness, palpations, seizures, and finally paralysis. A colorless
odorless liquid known as Sarin (GB) was the agent, which is primarily inhaled with limited
exposure through the skin. The concentration of Sarin has not been measured. What level is
the minimum level of personal protection and safety equipment (PPE) that would be needed?
a. A
b. B
c. C
d. D
ANS: B
Level B requires a high level of respiratory protection, but less skin protection, providing a
chemical splash–resistant suit with hood and self-contained breathing apparatus (SCBA). It
provides maximum respiratory protection but less skin protection than level A equipment.
DIF: Analysis
REF: p. 289
17. A state is devastated by a tornado killing many people, destroying communication systems,
utility services, homes, and medical facilities. The state requests immediate assistance from
the U.S. Congress and from surrounding states. The affected state should first contact the:
a. Emergency Management Assistance Compact (EMAC).
b. Institute of Medicine (IOM).
c. Red Cross.
d. Strategic National Stockpile.
ANS: A
The EMAC is an organization authorized by the U.S. Congress through which a state
impacted by a disaster can request and receive assistance from other member states quickly
and efficiently.
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DIF: Comprehension
REF: p. 280
18. A nurse is interested in learning the phases of the disaster continuum and realizes it has many
similarities to the nursing process. To better understand the phases of a disaster, which is true
when comparing the phases of the disaster continuum to the nursing process?
a. The preparedness phase of the disaster continuum is consistent with the assessment
and planning steps of the nursing process.
b. The recovery phase of the disaster continuum is consistent with the planning step
of the nursing process.
c. The recovery phase of the disaster continuum is consistent with the
implementation step of the nursing process.
d. The response relief phase of the disaster continuum is consistent with the
evaluation step of the nursing process.
ANS: A
The preparedness phase requires assessing possible needs of the community and planning
appropriate interventions and is consistent with the assessment and planning steps of the
nursing process.
DIF: Comprehension
REF: p. 285
19. In the preparedness phase for disasters, the community plans for a possible terrorist attack
using anthrax as the weapon of destruction. What treatments and/or preparations would be
needed?
a. Vaccines and Level B Personal Protection Equipment (PPE)
b. Treatment for burns, decontamination, and Level A PPE
c. Social distance determination, decontamination for radioactive fallout
d. Identify and detect incendiary devices, treatment for burns and propellants
ANS: A
Anthrax is a biologic weapon and requires Level B protection since it is a known agent and
can be carried in wind or surfaces. Timing of treatment is critical and vaccines are available.
DIF: Analysis
REF: pp. 282-284, Table 16-1
MULTIPLE RESPONSE
1. Health care professionals have been activated to respond to a disaster, and the registered nurse
who is coordinating the effort realizes that: (select all that apply)
a. in the event of a mass casualty incident, care is prioritized to those who have the
greatest chance of surviving.
b. communities should use their own resources first to attempt to stabilize and
organize the response.
c. state assistance occurs any time a disaster occurs, regardless of the community’s
resources.
d. the emergency operating plan developed by one central agency rather than
individual facilities should be put into operation.
e. strict protocols regarding the use of resources must be followed.
ANS: A, B
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Care is shifted to doing the most good for the most people. Efforts begin at the local level.
DIF: Comprehension
REF: pp. 283-284
2. When teaching community preparedness for a community group, the nurse explains that
components of the National Disaster Medical System (NDMS) provide for: (select all that
apply)
a. a nationwide bomb disposal squad team for the rapid removal of explosive devices.
b. teams of health care providers who are experts and have specialized supplies and
equipment.
c. structures for patient evacuation from the disaster area to an unaffected area.
d. arrangements for hospitalization in federal and volunteer nonfederal acute care
hospitals.
e. providing mental health care for the community, for victims, and for health care
providers.
ANS: B, C, D
The NDMS provides specially trained teams of people along with equipment designed for
disaster relief. The NDMS is responsible for removing patients from unsafe to safe areas. The
NDMS coordinates efforts to evacuate victims to federal or nonfederal volunteer hospitals that
can care for disaster victims.
DIF: Comprehension
REF: p. 286
COMPLETION
1. The emergency preparedness term that is used to describe the process of limiting the
emergency situation within a well-defined area is ___________.
ANS:
containment
Containment is correct because the focus is to prevent the agent that caused the disaster from
spreading.
DIF: Knowledge
REF: p. 280
2. The term used during a pandemic disaster that refers to the attempt to contain germs by
limiting socialization and personal interactions is ___________.
ANS:
social distancing
The term social distancing refers to the attempt to keep people as far apart as possible so as to
limit the possibility of spreading germs.
DIF: Knowledge
REF: p. 291
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Chapter 17: Nursing Leadership and Management
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. In an attempt to persuade employees to bargain for another type of health insurance, a handout
is circulated that describes the present employees’ health care insurance as being insensitive,
limiting choices of care providers, and providing inferior care. This reflects which aspect of
Lewin’s planned change?
a. Unfreeze
b. Move
c. Refreeze
d. Acceptance
ANS: A
Unfreeze is correct because the change agent promotes problem identification and encourages
awareness of the need for change. In alignment with Lewin’s stages of change (unfreezing,
moving, and refreezing), education and involvement are keys to successful change. People
must believe that improvement is possible before they will be willing to consider change.
DIF: Comprehension
REF: p. 311
2. One difference between a leader and a manager is that a:
a. leader has legitimate authority.
b. manager motivates and inspires others.
c. manager focuses on coordinating resources.
d. leader focuses on accomplishing goals of the organization.
ANS: C
The terms leadership and management are often used interchangeably, and it is difficult to
discuss one without discussing the other. However, these roles have specific traits unique to
themselves. The manager is the coordinator of resources (time, people, and supplies) needed
to achieve outcomes.
DIF: Comprehension
REF: p. 296
3. The first step in the nursing process and in the problem-solving process is to:
a. identify the problem.
b. gather information.
c. consider the consequences.
d. implement interventions.
ANS: B
The nursing process, which is familiar to nurses who address patient care needs, can be
applied to all management activities that require decision making and problem-solving. As in
the nursing process and the problem-solving process, one must first gather information about
the problem or situation.
DIF: Comprehension
REF: pp. 309-310
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4. An explosion just occurred at the local factory, and hundreds of employees have sustained
varying degrees of injury. Which type of nursing leadership is most effective in this situation?
a. Autocratic
b. Democratic
c. Laissez-faire
d. Referent
ANS: A
The dynamics of the situation demand that the leader take control and direct employees to
specific actions in response to the emergency.
DIF: Comprehension
REF: p. 300, Box 17-3
5. An RN with excellent assessment and psychomotor skills would derive power on the basis of
which source?
a. Rewards
b. Coercion
c. Expert
d. Legitimate
ANS: C
Seven primary sources of power are known. Expert power is based on knowledge, skills, and
information.
DIF: Comprehension
REF: p. 297
6. Managers who exhibit an authoritative behavioral style are most likely to use which source of
power?
a. Informal
b. Expert
c. Coercive
d. Reward
ANS: C
Seven primary sources of power are known. Coercive power is based on fear of punishment or
failure to comply. Coercive power fits well into the authoritative behavioral style because
authoritative managers dictate the work with much control, usually ignore the ideas or
suggestions of subordinates, and provide little feedback or recognition for work accomplished.
DIF: Application
REF: p. 300, Box 17-3
7. Florence Nightingale is attributed with being intelligent (she developed statistical methods to
evaluate health care), dependable (she often worked long hours to care for the injured), and
ambitious (she fought against society’s perception of nursing). Those who depict her as a
leader on the basis of these qualities are practicing which leadership theory?
a. Trait
b. Chaos
c. Bureaucracy
d. Organizational
ANS: A
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Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that
leaders were born with particular leadership characteristics. Other traits found to be associated
with this leadership theory include intelligence, alertness, dependability, energy, drive,
enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery.
DIF: Comprehension
REF: p. 298
8. A nurse manager is concerned with restocking the emergency cart, creating the staff schedule,
requesting floor stock from pharmacy, and checking the orders on patient charts. Which type
of leader accurately describes this nurse?
a. Transactional
b. Situational
c. Transformational
d. Contemporary
ANS: A
The transactional leader is concerned with the day-to-day operations of the facility.
DIF: Comprehension
REF: p. 298, Box 17-1
9. According to the unit’s policy for call-ins, a nurse is suspended for 3 days because of
excessive call-ins that occur within 15 minutes of shift change. The nurse states, “You are
unfair to me.” Which theory would disprove the nurse’s statement?
a. Authoritative
b. Closed systems
c. Open systems
d. Trait
ANS: A
Autocratic/authoritative management style revolves around the assumption that authority
confers the right to issue commands within an organization on the basis of impersonal rules
and rights, by virtue of the management position rather than any trait ascribed to the person
who occupies that position. Other characteristics include the following: Impersonal rules
govern the actions of superiors over subordinates, all personnel are chosen for their
competence and are subject to strict rules that are applied impersonally and uniformly, and a
system of procedures for dealing with work situations is in place.
Represents the systems theory of the organization.
DIF: Application
REF: p. 300, Box 17-3
10. A nurse is reading about positive reinforcement with the goal of increasing staff motivation.
Which action would demonstrate positive reinforcement?
a. Every morning at shift change, thank each employee for an excellent job.
b. Rotate a monthly “employee recognition award” among all employees on the unit.
c. Wait until the annual performance review to recognize accomplishments.
d. Give spur-of-the-moment recognition to an employee who has accomplished a
goal.
ANS: D
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To be effective, positive reinforcement should (1) be specific, with praise given for a
particular task done well or a goal accomplished; (2) occur as close as possible to the time of
the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose
value); and (4) be given for a genuine accomplishment.
DIF: Application
REF: p. 306
11. Which action represents the key management function of strategic planning?
a. Determining that all nurses on the unit understand the current organizational
philosophy
b. Evaluating the communication process between the pharmacy and the nursing
departments
c. Monitoring data from the quality management initiative related to the last three
orientation programs
d. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of
all nursing units
ANS: D
A strategic plan is a written document that details organizational goals, allocates resources,
assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5
years into the future.
DIF: Application
REF: pp. 301-302
12. A hospital’s policy requires that all nurse managers must have a minimum of a bachelor’s
degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager
for the oncology unit. An RN who has worked on this unit for many years is unable to be
promoted to a nurse manager position because of his educational status and has been
commenting to physicians and staff, “The new nurse manager has book sense but no
leadership abilities.” What is the best approach that can be used by the new nurse manager
who is attempting to gain the trust and respect of the nursing staff on the unit?
a. Send memos to all staff except the upset nurse to invite them to a luncheon.
b. Ask management to transfer the upset nurse to another unit.
c. Assign the upset nurse to committees that do not directly affect that nursing unit.
d. Acknowledge the clinical expertise of the upset nurse and clearly explain the
expectations for teamwork and open, honest communication.
ANS: D
The best way for the new nurse manager to communicate with this employee, who may be an
informal leader, is to show respect for the individual’s clinical expertise and experience
through clear and direct communication. The new nurse manager should attempt to identify
the staff nurse’s power as an informal leader, should involve him and other staff members in
decision-making and change-implementation processes, and should clearly communicate
goals and work expectations to all staff members.
DIF: Application
REF: pp. 297-298
13. A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary
skills to participate on a quality improvement committee. The coordinator of the quality group
invites the CNL to join the group. Which type of power is demonstrated by the coordinator of
the group?
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a.
b.
c.
d.
Coercive
Transformational
Laissez-fair
Legitimate
ANS: D
The coordinator of the committee has an official position within the organizational committee.
DIF: Comprehension
REF: p. 297
14. A director of nursing (DON) asks the staff to list how their nursing unit can help the
organization meet its goal to “provide quality patient care with attention to compassion and
excellence.” An ad hoc committee is formed to develop a timeline of identified actions. The
DON coaches the committee to reach desired outcomes. This DON is demonstrating which
other role of leadership and management?
a. Transactional
b. Clinical consultant
c. Corporate supporter
d. Autocratic
ANS: C
The manager is embracing the mission of the organization by supporting achievement of goals
noted in the mission statement.
DIF: Comprehension
REF: p. 311
15. A staff nurse provides care based on intuition and always seems to be in control of her
personal and professional life—serving on the board of the state nurses association, serving as
the nursing unit’s representative on the ethics committee, and coaching her daughter’s soft
ball team. Many of the staff observes how she manages time and provides care. This nurse’s
power comes from which type of power?
a. Referent
b. Legitimate
c. Information
d. Connection
ANS: A
Referent power comes from the followers’ identification with the leader. Referent leaders are
admired and respected and able to influence other nurses because of their desire to emulate
her.
DIF: Comprehension
REF: p. 297
16. A staff nurse states, “I really enjoyed having dinner with the Chief of Medical Staff and the
President of the hospital. We hope to meet again soon.” Which source of power does this
nurse possess?
a. Expert
b. Legitimate
c. Connection
d. Reward
ANS: C
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Connection power results from knowing or associating with power people such as the upper
administration.
DIF: Comprehension
REF: pp. 297-298
17. A nurse manager wants his nursing unit to be a place where all nurses want to work, where
patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged
to chair taskforces to improve quality of care and he counsels staff in areas of measuring
patient outcomes. Other managers want to mimic this manager’s approach to improve their
own units. This nurse is which type of leader?
a. Transformational
b. Transactional
c. Laissez-faire
d. Authoritative
ANS: A
Transformational leaders mentor followers through a vision and are admired and emulated.
DIF: Comprehension
REF: p. 298
18. A hospital recently learned that their scorecard did not meet the national benchmark for
patient satisfaction and brought in a professional change agent to determine what their issues
were and how they could improve their score. The agent collected data and recommended that
nurses participate in interdisciplinary walking rounds and allow the patient and family to be
participants. Nurses now round every shift and perform “huddles to update the team” as
needed throughout the shift as part of best practices. Random visits are made to nursing units
to ensure all nurses are participating and patients are interviewed for their involvement. This
stage of Lewin’s change is:
a. unfreeze.
b. moving.
c. refreeze.
d. resistance.
ANS: C
In the refreezing stage, change becomes status quo and the agent reinforces until the change is
part of the daily process as in the above situation.
DIF: Comprehension
REF: p. 311
19. A manager just finished the last annual performance review of the staff, reviews the
unexpected expenditures for the month due to use of agency nurses, and shares the latest
quality indicators with the staff nurses. This manager is performing which management
function?
a. Directing
b. Planning
c. Organizing
d. Controlling
ANS: D
Controlling is the final management function. It includes performance evaluations, financial
activities, and tracking outcomes of care to ensure quality.
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DIF: Comprehension
REF: p. 307
MULTIPLE RESPONSE
1. Registered nurses who are entering the workforce will have expanded leadership
responsibilities that include: (select all that apply)
a. serving on interdisciplinary care teams.
b. being competent to work in several areas independently when dictated by patient
census.
c. attending a meeting to plan advanced training for unlicensed assistive personnel.
d. evaluating outcomes of care that are reported to a standing committee.
e. managing units with higher acuity, shorter length of stay, and more diverse
patients and staff.
ANS: A, C, D, E
The new nurses will be placed in many situations that require leadership and management
skills: for example, managing a group of assigned patients, serving on a task force or
committee, acting as team leaders or charge nurses, and supervising unlicensed assistive
personnel and licensed vocational/practical nurses. Diverse patients have comorbidities and
require complex interventions delivered during shorter stays with an ever-increasing diverse
staff. The new nurses will be placed in many situations that require leadership and
management skills, for example, managing a group of assigned patients, serving on a task
force or committee, acting as team leaders or charge nurses, and supervising unlicensed
assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in
many situations that require leadership and management skills, for example, managing a
group of assigned patients, serving on a task force or committee, acting as team leaders or
charge nurses, and supervising unlicensed assistive personnel and licensed
vocational/practical nurses. The new nurses will be placed in many situations that require
leadership and management skills, for example, managing a group of assigned patients,
serving on a task force or committee, acting as team leaders or charge nurses, and supervising
unlicensed assistive personnel and licensed vocational/practical nurses.
DIF: Application
REF: pp. 296-297
2. A nurse asks, “What is meant by ‘internal’ customers?” The correct response is: (select all that
apply)
a. insurance companies
b. accreditors such as The Joint Commission
c. X-ray technicians
d. clinical pharmacist
e. chief financial officer
ANS: C, D, E
Internal customers are employees of an organization at all levels. An x-ray technician is an
example of an internal customer. Internal customers are employees of an organization at all
levels. A clinical pharmacist is an example of an internal customer. Internal customers are
employees of an organization at all levels. A chief financial officer is an example of an
internal customer.
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DIF: Comprehension
REF: p. 308
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Chapter 18: Budgeting Basics for Nurses
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. A nurse manager plans the fiscal budget to include salaries for two RNs for two 12-hour shifts
with a patient census of 6 in the short-stay observation room. The nurse manager reviews the
budget report 3 months later and notes that the salary expenses are higher than was budgeted
because of higher-than-planned RN staff salaries. This additional RN staff is necessary to
meet patient care needs because the census has remained constant at 10 patients rather than
the 6 projected when the budget was developed. The difference between the planned budget
and the actual cost is known as:
a. revenue.
b. variance.
c. monitoring.
d. capital expenditures.
ANS: B
Variance is the difference between the planned budget and actual results; it can be a positive
or a negative discrepancy.
DIF: Comprehension
REF: p. 316
2. A nursing unit’s census consists primarily of long-term residents with a high risk for falls. To
meet new safety regulations, the nurse manager must plan to replace all 50 patient beds with
new beds equipped with Fall Watch electronic sensors that will detect when patients get out of
bed. The manager will be involved in which type of budgeting to replace the beds?
a. Fiscal
b. Labor
c. Operational
d. Capital
ANS: D
Capital budgets are concerned with major purchases such as equipment paid for over several
years.
DIF: Comprehension
REF: pp. 320-321
3. A nurse manager is preparing a budget that does not base annual budgets on the revenue and
expenditures of the prior year and has the advantage that outdated information is not
integrated into the budget. The manager is using which budget method?
a. Zero-based
b. Incremental
c. Labor
d. Operational
ANS: A
The zero-based method is based on the assumption of no volume and no resources assigned; it
essentially starts each new budget period at zero rather than building from past budgets.
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DIF: Comprehension
REF: p. 321
4. A nurse on the unit is heard saying, “I am not going to document that I used four catheters to
start that IV; it doesn’t matter anyway.” What action can help the staff nurse understand the
financial budget goals of the unit?
a. Have the nurse work in payroll for a week.
b. Enroll the staff in continuing education units (CEU) for personal finance.
c. Ask the nurse to represent the unit on the budget planning committee.
d. Make the nurse responsible for monitoring all disposable equipment and supplies.
ANS: C
Participating on the committee will give the nurse ownership of the unit’s budget and will
provide insight into the unit’s budgetary goals.
DIF: Analysis
REF: p. 326
5. In a large health care facility, the executive administrative leaders set the budget goals to
decrease full-time equivalents by 3%, eliminate the cost of agency nurses, reduce lost revenue
from lost supplies by 1%, and provide a 0.5% hourly salary incentive for working on a float
unit when the assigned unit has a low census. Nurse managers meet with nursing
administrators to design their unit budgets to meet these established goals. The budget
approach that is being used is the _____ approach.
a. top-down
b. participatory
c. iterative
d. incremental
ANS: A
Budget goals are established by administrators; unit managers do not contribute to goal
setting, which is the primary principle of the top-down approach.
DIF: Comprehension
REF: pp. 321-322
6. Which component of budgeting might normally be addressed in the annual performance
evaluation for a nurse manager?
a. Including in the labor budget costs for overtime and benefits
b. Managing variances in nursing overtime costs and supply usage
c. Accurately predicting revenues on the basis of unit-of-service
d. Providing qualitative analysis for variances in the capital budget
ANS: B
Nurse managers are often evaluated according to their success in managing nursing overtime
costs and supply usage as reflected in the unit’s budget.
DIF: Application
REF: p. 319
7. A primary function of the budgeting process is to provide managers with an opportunity to:
a. insist that salary increases for all nurses are included in the annual budget.
b. discuss concerns about resource allocation with leaders of the organization who are
capable of resolving issues.
c. develop a mechanism for changing from zero-based budgeting to incremental
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budgeting.
d. develop for all staff an educational program related to supply usage.
ANS: B
Coordination and communication are very important functions of budgeting that require many
different groups within an organization to come together with organizational leaders to
discuss the resources necessary to accomplish the goals of a business unit.
DIF: Application
REF: p. 318
8. Organizations measure the effectiveness of their budgets by examining actual revenues and
expenditures versus:
a. planned variances.
b. incremental budgets.
c. productivity metrics.
d. expected performance.
ANS: D
Variance analysis is the process by which deviations from budgeted amounts are examined by
comparing actual performance results against expected, or budgeted, performance.
DIF: Comprehension
REF: p. 323
9. When the nurse manager conducts a qualitative analysis of budget variances, he or she is:
a. determining the percentage increase of supply usage from the last quarter to the
current quarter.
b. identifying the overall increase in the dollar amount of salaries paid for overtime.
c. comparing productivity metrics across all nursing units in the facility.
d. reconciling with current conditions the underlying assumptions on which the
budget was based.
ANS: D
Qualitative analysis of the budget explains why current conditions are different than they were
when the budget was developed; new conditions might include greater patient acuity or
additional physicians with increased admissions.
DIF: Application
REF: p. 323
10. A nurse manager is working with the financial officer to develop the budget of the nursing
unit for the next fiscal year. The nurse manager tells the financial officer that which of the
following pieces of information will affect budget assumptions?
a. The capital budget request for new emergency department equipment has been
turned in for consideration by the hospital’s administrative team.
b. The patient census likely will increase during the next fiscal year because two
large physician groups have transferred their admission privileges to this hospital.
c. The participatory budgeting approach instituted last year has been helpful in
controlling supply costs.
d. Zero-based budgeting will help the managers to be more efficient in establishing
next year’s budget.
ANS: B
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Budget assumptions are future predictors of performance and include the stability of the price
of supplies, the salary range needed to recruit and retain quality employees, new services
offered by competitors, and the variability of the patient census.
DIF: Application
REF: p. 322
11. The nurse manager meets with upper management to share strategic goals agreed upon by her
staff for their individual nursing unit as the first step to begin budget negotiations. One
strategic goal is that staff will have access to technology that will allow them to incorporate
point-of-care devices for all RNs. The second goal is to improve RNs’ ability to recognize
critical indicators that a patient’s health status is deteriorating through advanced health
assessment skills. During the meeting the manager discusses the strategy options and selecting
the one that works for the unit. Which type of budget development is used?
a. Iterative
b. Top-down
c. Participatory
d. Zero-based
ANS: C
In the participatory approach, the people responsible for achieving the budget goals are
included in goal setting.
DIF: Comprehension
REF: p. 322
12. The nursing executive team met to review last year’s productivity metric to strategize for the
upcoming year’s metric. The team wants to be certain the productivity metric shows
productivity was:
a. high.
b. low.
c. balanced.
d. iterative.
ANS: C
A balanced productivity is desired because it encourages quality and safety while providing
financial efficiency.
DIF: Comprehension
REF: p. 320
13. The nurse manager meets with upper administration and learns that the strategic plan for
nursing is to have 80% BSN staff within the next 3 years. The nurse manager then built her
budget to meet the organization’s strategic goal by providing tuition reimbursement and
flexible work hours, which required some agency staffing. Which approach to budgeting is
used?
a. Iterative
b. Top-down
c. Participatory
d. Zero-based
ANS: A
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The iterative approach is a combination of the top-down and the participatory approach, with
upper management defining strategic goals and then unit leaders developing their operating
budgets to incorporate their individual goals in conjunction with the organization’s strategic
goals.
DIF: Comprehension
REF: pp. 321-322
14.
The nurse managers of an organization are meeting with administration to plan the budget.
The above graph shows last year’s 2011 expenditures, and the team will trend the upcoming
budget knowing that, with the slowdown in the economy, patient census will be lower. Which
budget approach is being used?
a. Incremental
b. Zero-based
c. Productivity metrics
d. Capital
ANS: A
The incremental approach is simply a forward trend of current or recent performance with
adjustments for future growth or decline in revenues or expenses.
DIF: Comprehension
REF: p. 321
15. Nurses on a unit met with the nurse manager as part of participatory budgeting. They ask,
“What exactly is the difference between fixed and variable costs? Understanding this will help
us better understand the budgeting process.” The manager provides a definition and asks the
staff to list types of direct and indirect cost. Which example would indicate a need for further
teaching?
a. Fixed costs would include accreditation fees.
b. Fixed cost would include the cost for the automated medication-dispensing system.
c. Variable cost would include the nurse manager’s salary.
d. Variable cost would include the salary expense for registered nurses.
ANS: D
Variable costs would include the salary expense for registered nurses because their number
can change.
DIF: Analysis
REF: p. 326
MULTIPLE RESPONSE
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1. A nurse manager has calculated that providing 75 hours of direct nursing care per day requires
that 120 hours must actually be worked by nursing staff. The manager is involved in: (select
all that apply)
a. developing the capital budget.
b. applying productivity metric.
c. monitoring the labor budget.
d. incremental budgeting processes.
e. addressing budget assumptions.
ANS: B, C
The nurse manager is determining the amount of work produced by calculating the actual
number of nursing hours worked, which is productivity metric. Budgets use productivity
metrics.
DIF: Application
REF: p. 320
2. A nurse has recently been appointed to the position of nurse manager. To become successful
in managing the unit’s budget, the new nurse manager should: (select all that apply)
a. read the financial policy manual to learn more about the organization’s budgeting
process.
b. allow the nursing administration office to manage the unit’s budget until he or she
is able to complete an online financial management course.
c. communicate regularly with a person in the hospital’s finance office about
interpreting budget reports.
d. pay attention to only the bottom-line numbers in budget reports rather than trying
to understand each line in these reports.
e. discuss the process of developing budgets with other members of the management
team.
ANS: A, C, E
Knowing the organization’s financial policies is an important step toward understanding the
organization’s budget process. Building a relationship with the finance office is fundamental
to learning about the budgeting. As one participates more in the budget process, one’s
understanding of the process and related responsibilities is enhanced.
DIF: Application
REF: p. 323, Box 18-3
COMPLETION
1. The financial plan required for the distribution of resources and expenses is a _________.
ANS:
budget
A budget is an organization’s financial plan that expresses expected expenses (such as
personnel and supplies) and anticipated revenues for products and services over a defined
period, usually 12 months.
DIF: Comprehension
REF: p. 316
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Chapter 19: Effective Communication and Conflict Resolution
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. A nurse is listening to a patient’s apical heart rate. The patient asks, “Is everything okay?”
The nurse says nothing and shrugs her shoulders. The nurse is demonstrating:
open communication.
filtration.
blocking.
false assurance.
a.
b.
c.
d.
ANS: C
Blocking occurs when the nurse responds with noncommittal or generalized answers.
DIF: Comprehension
REF: p. 335
2. A teenage patient is using earphones to listen to hard rock music and is making gestures in
rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and
leaves the room. What communication technique is demonstrated in both of these situations?
a. Blocking
b. Filtration
c. Empathy
d. False assurance
ANS: B
Filtration is the unconscious exclusion of extraneous stimuli in communication.
DIF: Comprehension
REF: p. 331
3. In today’s world of fast, effective communication, what is the most commonly used means of
societal communication?
a. Facial expression
b. Spoken word
c. Written messages
d. Electronic messaging
ANS: B
Verbal communication, which involves talking and listening, is the most common form of
interpersonal communication. An important clue to verbal communication is the tone or
inflection with which words are spoken and the general attitude used when speaking.
DIF: Knowledge
REF: p. 331
4. Which statement accurately describes communication?
a. The components of communication are mutually exclusive.
b. Communication is linear.
c. Communication involves only the sender and the receiver; everything else is
superficial.
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d. When the receiver becomes the sender, the subcomponent of communication that
is in use is feedback.
ANS: D
Communication is a process that requires certain components, including a sender, a receiver,
and a message. Effective communication is a dynamic process: With a response (feedback),
the sender becomes the receiver, the receiver becomes the sender, and the message changes.
DIF: Comprehension
REF: p. 330, Figure 19-1
5. A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly
graduated RN with a bachelor’s degree is hired. Before the RN arrives on the unit, the LPN is
heard saying, “She’ll try to tell everyone what to do because she makes more money. She’ll
sit at the desk and let us do all the work.” This is an example of a(n):
a. interpretation.
b. context.
c. precipitating event.
d. preconceived idea.
ANS: D
Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed
before having an encounter. Such ideas can dramatically affect the receiver’s acceptance and
understanding of the message.
DIF: Application
REF: p. 330
6. A new mother is experiencing pain after delivering an infant with Down syndrome. The staff
nurse states, “I don’t think she is really hurting. Let the next shift give the pain medication.”
The team leader notices the staff nurse looks agitated and anxious and asks about any
concerns in providing care to this new mom. The staff nurse admits having a stillborn infant
with Down syndrome. This is an example of which component of communication?
a. Personal perception
b. Past experiences
c. Filtration
d. Preconceived idea
ANS: B
With past experiences that include a variety of positive, neutral, and negative events, the
influence that these experiences can and will have on communication may be positive, neutral,
or negative. The importance of recognizing that any reaction from the receiver may be biased
by previous experience cannot be overstated.
DIF: Application
REF: p. 331
7. A nurse gives Dilantin intravenously with lactated Ringer’s solution containing multivitamins.
The drug precipitates and obstructs the only existing line. When the team leader informs the
nurse that these drugs cannot be mixed, the nurse states, “Everyone just pushes the medicine
slowly. No one checks for compatibility. There isn’t even a compatibility chart on the unit.”
Which type of logical fallacy has influenced the nurse?
a. Ad hominem abusive
b. Appeal to common practice
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c. Appeal to emotion
d. Appeal to tradition
ANS: B
An appeal to common practice occurs when the argument is made that something is okay
because most people do it.
DIF: Application
REF: p. 336
8. An RN is consistently late to work, causing reassignment of patient care and the need for
repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, “My
husband left me, I have no car, no family close by, and the bus is always late, which makes
me late. The nurse manager doesn’t care how hard I try to get here, and I am raising a child by
myself.” The nurse is using which type of logical fallacy?
a. Appeal to emotion
b. Appeal to tradition
c. Hasty generalization
d. Confusing cause and effect
ANS: A
An appeal to emotion is an attempt to manipulate other people’s emotions for the purpose of
avoiding the real issue.
DIF: Application
REF: p. 336
9. The new director of nurses has instituted “walking rounds” on all nursing units, rather than the
usual taped shift reports. A veteran nurse exclaims, “She doesn’t know how we do things
here!” The nurse is demonstrating:
a. appeal to emotion.
b. appeal to tradition.
c. red herring.
d. straw man.
ANS: B
An appeal to tradition is the argument that doing things a particular way is best because
they’ve always been done that way.
DIF: Application
REF: p. 336
10. A male nurse hired to work in the emergency department is observed throwing a contaminated
needle into the trash can. The team leader reprimands the nurse for not appropriately
disposing of sharps. The nurse states, “You don’t care that I threw the needle in the trash. You
just want an all-female staff,” putting the team leader in a defensive position. This
communication technique is known as:
a. straw man.
b. red herring.
c. slippery slope.
d. confusing cause and effect.
ANS: B
A red herring is the introduction of an irrelevant topic for the purpose of diverting attention
away from the real issue.
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DIF: Application
REF: pp. 336-337
11. A nurse who was recently certified in chemotherapy administration fails to check
compatibility of phenytoin (Dilantin) before injecting into a continuous infusion of D5W
leading to occlusion of the line. Which statement by the nurse demonstrates a red herring?
a. The nurse is upset and states, “I am sure I have injected this before without a
problem” and the supervisor interprets this to mean the nurse often take shortcuts.
b. The nurse states, “You are just upset because I am certified in chemotherapy
administration and you are not.”
c. “The nurse who started the IV didn’t get a blood return but determined the IV was
the patient’s—that is the problem.”
d. “This drug always occludes the line because it is so viscous.”
ANS: B
The nurse diverts attention away from the issue of not checking compatibility to introduce an
irrelevant topic of chemotherapy administration certification which is not related to this
situation.
DIF: Application
REF: pp. 336-337
12. During a health history interview, the nurse listens to a patient relating the precipitating events
that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact,
and acknowledges what the patient has to say. The nurse is exhibiting:
a. assertive communication.
b. active listening.
c. empathy.
d. passive communication.
ANS: B
In active listening a number of techniques can be used by the receiver to enhance the ability to
listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3)
making eye contact, (4) noting nonverbal messages (body language), and (5) finishing
listening before one begins to speak.
DIF: Comprehension
REF: p. 337
13. The nurse is demonstrating active listening when:
a. while assessing the patient’s vital signs, the nurse records the data and states, “You
are improving, your vital signs are normal.”
b. eye contact is maintained while focusing on the patient as the patient describes the
current pain level and location.
c. he or she states, “I know how you feel, I recently lost my father and I am still
hurting.”
d. cultural values are in opposition to the patient but shares that “I agree with your
decision to use herbs rather than the prescribed medications.”
ANS: B
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The behavior demonstrates active listening. A number of techniques can be used by the
receiver to enhance the ability to listen; these include (1) providing undivided attention, (2)
giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body
language), and (5) finishing listening before one begins to speak.
DIF: Application
REF: p. 337
14. An older adult is unable to reach the telephone and is found dead at home several hours later.
The son of the deceased person arrives at the hospital and asks, “Can I just please stay and
hold my dad’s hand? He was so afraid of dying alone.” Which response by the nurse shows
empathy?
a. “You are just too late for that. Where were you when he needed you?”
b. “Did you ever consider purchasing a cell phone for your dad to prevent this from
happening?”
c. “I’ll close the door so you can spend time with your dad. I will check back in a few
minutes.”
d. “I lost my dad last year. He died alone. He was a policeman. I am just like you. Let
me stay here and console you.”
ANS: C
Empathy is demonstrated by the ability to mentally place oneself in another person’s situation
to better understand the person and to share the emotions or feelings of the person.
DIF: Application
REF: p. 334
15. A nurse is preparing an exercise program as part of a health promotion program for older
adults with osteoporosis. Which question would retrieve the most valuable information about
health practices?
a. “Do you exercise?”
b. “Do you like to exercise?”
c. “When do you exercise?”
d. “What exercise practices do you participate in?”
ANS: D
“What exercise practices do you participate in?” is an open-ended question or statement that
requires more information than just yes or no. This type of question augments the gathering of
enough facts to build a more complete picture of the circumstances.
DIF: Analysis
REF: p. 334
16. Which component of an e-mail shown below would be both effective and concise?
a. Subject: A short concise subject line: Meeting.
b. Body: I would like you to answer these questions before the next meeting: Where
would you like to meet? Do you want all the staff to attend? Can we serve
refreshments? What is one goal for our unit?
c. Body: Dear Staff, As you know, each department must reduce staff by 2%. We
will need to discuss how to inform unlicensed staff about the downsizing efforts of
the hospital.
d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the
first floor auditorium. Please send items for the agenda.
Sally Smith, MSN, RN, smith@hospital.org or ext. 5582.
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ANS: D
This provides a message that is concise and accurate with a clearly conveyed message for the
reader and contact information from the sender, all of which are important components of
effective e-mail communication.
DIF: Analysis
REF: p. 339
17. During height and weight assessments at a school’s health fair, a child admits to drinking a
cup of coffee with his mother every morning, and another child reports enjoying a morning
cup of coffee on the commute to school. These two children are both below average on the
height chart, and the nurse states, “Drinking coffee stunts a child’s growth.” This logical
fallacy is referred to as:
a. appeal to common practice.
b. confusing cause and effect.
c. ad hominem abusive.
d. red herring.
ANS: B
Cause and effect are confused when one assumes that a particular event must cause another
just because the two events often occur together.
DIF: Application
REF: p. 336
18. A patient’s spouse was just diagnosed with lung cancer although there was no history of
tobacco use. The spouse states, “I am so mad. How can you get cancer without smoking?”
Which statement by the nurse represents empathy?
a. “Research is identifying many risk factors for cancer besides smoking.”
b. “I understand how you could feel angry about the diagnosis.”
c. “He is still a good husband.”
d. “Why do you think he got cancer?”
ANS: B
The nurse is placing herself in the wife’s position and sharing her emotions.
DIF: Application
REF: p. 334
19. A nurse wants to apply open communication to obtain a thorough history and to determine
cognitive function. Which question represents the use of open communication?
a. Is today Wednesday?
b. Do you know what day it is?
c. Tell me what day of the week today is.
d. Do you know what the first day of the week is?
ANS: C
The patient must be able to name the day of the week rather than use answer yes or no.
DIF: Application
REF: p. 334
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20. The nurse caring for a patient states, “Your blood pressure is dangerously high. Are you
taking antihypertensive medicine?” The patient states, “I can’t afford my medicine. I have no
insurance.” The nurse states “I feel really sorry for that patient. I wish it wasn’t against policy
to give her money.” The nurse wants to help and places a note on Facebook that any donations
would be appreciated to help a waitress who works at the cafeteria next door to the hospital
buy her medications. The nurse posts that “She was so sick last evening when she came to the
ED. I can’t believe they don’t provide insurance. I can’t give her money but you all can help.”
This nurse:
a. is showing empathy and as long as she lets the patient know the money is not from
her, she is not violating any social media guidelines.
b. is at risk for HIPAA violations.
c. has properly followed policy and protected the patient by not using her name.
d. is demonstrating the logical fallacy of slippery slope.
ANS: B
The National Council State Board of Nursing’s policy on social media prohibits posting of
patient information on social media sites. This patient could be identified by knowing where
she works and the fact that she was seen in the ED the day before.
DIF: Application
REF: p. 344
21. A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four
members freely expresses thoughts about fair staffing but is willing to listen to other thoughts
and reconsider their first recommendations. The nurses are avoiding conflict and supporting
professional communication through:
a. empathy.
b. positiveness.
c. supportiveness.
d. accommodation.
ANS: C
Supportive communication occurs when each person’s opinion/position is valued and each
participant has the freedom to express a position but is willing to change that opinion/position.
DIF: Comprehension
REF: p. 346
22. A nurse is asked to “float” to another area where the patients require total care. The nurse
smiles, picks up her stethoscope, and says, “I’ll come back and eat lunch with everyone here.”
When she enters the elevator she hits the wall and mutters, “Always me. Don’t I have any
rights”? The nurse is demonstrating which communication style?
a. Assertive
b. Aggressive
c. Passive
d. Passive-aggressive
ANS: D
Passive-aggressive communication is represented by incongruent actions—the nurse shows
friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the
original unit; however, she shows her anger by hitting the wall and muttering.
DIF: Comprehension
REF: p. 341
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23. A nurse is overhead saying, “I don’t mind working during the election and holiday. My
parents are divorced, money is tight, and honestly I don’t trust any politicians anyway. I plan
to take a few weeks off next month.” She works independently to research strategies to
improve patient-centered care for the large number of immigrants that arrived in the area and
then works with the team to share ideas. She recommends, “Let’s think the suggestions over
and come back together next week.” This nurse’s communication style is consistent with
which generation?
a. Baby Boomers
b. Traditionalist
c. Generation X
d. Millenniums
ANS: C
Generation X individuals grew up in when there was a high rate of divorces; they tend to be
more cynical and value work-life balance and teamwork. Holidays are often associated with
family gatherings which may have been absent in this generation’s family; belief that ALL
politicians are untrustworthy may be viewed as cynical. The need to take time to form
suggestions to save time and come together to reach team decision are reflective of this
generation.
DIF: Comprehension
REF: p. 343
COMPLETION
1. The healthiest form of communication is the ________ style.
ANS:
assertive
Assertive communicators are honest and direct while valuing and respecting other individuals’
views and seeking a win-win solution without the use of manipulation or game-playing.
DIF: Knowledge
REF: pp. 340-341
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Chapter 20: Effective Delegation and Supervision
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. The task of completing and signing the initial assessment on a newly admitted patient who is
about to undergo minimally invasive procedures on an outpatient basis can be delegated to:
a. the registered nurse (RN).
b. the licensed practical/vocational nurse (LPN/LVN).
c. unlicensed assistive personnel (UAP).
d. all levels of staff, because the information is about the past and cannot change.
ANS: A
Only the RN can perform and sign the admission assessment, although some components such
as monitoring vital signs may be delegated.
DIF: Comprehension
REF: p. 357
2. An RN recently relocated to another region of the country and immediately assumed the role
of charge nurse. When determining the appropriate person to whom to delegate, the RN
knows that:
a. the role of the LPN/LVN is the same from state to state.
b. the LPN/LVN can be taught to perform all the duties of an RN if approved by the
employer and if additional on-the-job training is provided.
c. he or she must review the state’s nurse practice act for LPN/LVNs, because each
state defines the role and scope of practice of the LPN/LVN.
d. The Joint Commission has certified and established roles for the LPN/LVN.
ANS: C
The scope of practice of the LPN/LVN varies significantly from state to state; RNs should
know the LPN/LVN nurse practice act in the state in which they practice and should
understand the legal scope of practice of the LPN/LVN.
DIF: Comprehension
REF: p. 354
3. Which task is most likely to be considered in a state’s practice act as appropriate to delegate to
a LPN/LVN if the patient’s condition is stable and competence in the task has been
established?
a. Administer an enema for an elective surgery patient.
b. Administer an antiarrhythmic medication IV while interpreting the patient’s
rhythm on the cardiac monitor.
c. Develop a plan of care for a stable patient admitted for observation after a head
injury.
d. Teach a patient how to instill eye drops for glaucoma.
ANS: A
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The RN who is delegating must consider the following: (1) the delegatee’s current workload
and the complexity of the task, (2) whether the staff member is familiar with the patient
population and with the task to be performed, and (3) whether the RN is able to provide the
appropriate level of supervision. The delegation decision-making tree would also support
delegation of this task.
DIF: Analysis
REF: pp. 357-358, Box 20-3
4. A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of
staff have been trained to assess vital signs. Given budget restrictions and proper delegation
rules, to which care provider would the RN delegate the task of obtaining the initial blood
pressure reading?
a. RN
b. LPN/LVN
c. Unlicensed assistive personnel (UAP)
d. Use the blood pressure obtained in the ambulance, because it was assessed via
electronic monitoring.
ANS: A
The patient’s condition is not stable; therefore, the skills of an RN are required.
DIF: Application
REF: pp. 357-358, Box 20-3
5. A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task
of assisting with oral hygiene, knowing that this assignment “does not require decisions based
on the nursing process.” The nurse is correctly using which of the five rights of delegation?
a. Supervision
b. Communication
c. Person
d. Circumstance
ANS: D
Right circumstance involves the delegation of tasks that do not require independent nursing
judgments.
DIF: Comprehension
REF: p. 360
6. A student nurse is concerned about delegation practices and wonders why hospitals employ
unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National
Council of State Boards of Nursing and learns that the role of these personnel is to:
a. supplement the staffing pattern when an RN is not available.
b. aid the RN by performing appropriately delegated care tasks.
c. replace the RN when the health care facility provides long-term care.
d. provide patient teaching, allowing more direct care to be provided by the RN.
ANS: B
The UAP and LPN/LVN can increase productivity of the RN by performing those tasks that
fall within their scope of practice.
DIF: Comprehension
REF: p. 353
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7. An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood
pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is
responsible for:
a. delegating the task to another UAP if he or she does not have the time or skill to
complete the task.
b. keeping the RN informed of any abnormal blood pressure readings.
c. calling the physician when the patient’s vital signs are not within established
parameters.
d. informing the dietary department to initiate a low-sodium diet for patients who are
hypertensive.
ANS: B
After accepting the assignment, the UAP is responsible for completing the task and reporting
any patient concerns to the RN.
DIF: Application
REF: p. 354
8. Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP)
provided the delegatee has had experience and training?
a. Evaluate the ability of a patient to swallow ice after a gastroscopy.
b. Assist a patient who is postoperative hip replacement to ambulate with a walker for
the first time.
c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy
patient if secretions are thick and tenacious.
d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected
to a closed drainage system.
ANS: D
Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a
closed drainage system is not an invasive procedure, and risk to the patient is minimal,
making the task appropriate for delegation.
DIF: Analysis
REF: pp. 357-358, Box 20-3
9. An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks
with the LPN/LVN often throughout the shift to provide support and determine if assistance is
needed. The RN is providing which level of supervision?
a. There is no supervision, because at times the LPN/LVN is not with the RN.
b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is
relieved of the need to evaluate care.
c. Continual supervision is being provided until the RN determines competency.
d. Initial supervision is being provided because this is the LPN/LVN’s first day on
the unit.
ANS: C
This level of supervision is required when the working relationship is new, the task is
complex, or the delegatee is inexperienced or has not demonstrated an acceptable level of
competence.
DIF: Comprehension
REF: p. 362
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10. An RN is counseled by the nurse manager regarding inappropriate delegation when the:
a. RN instructs the nursing assistant to greet ambulatory surgery patients and show
them to their rooms.
b. nursing assistant informs the RN that she has not been trained to collect a sputum
specimen and the RN states, “I will show you this time and you can show me the
next time.”
c. RN assigns the float LPN/LVN the task of completing a plan of care for a stable
patient who was admitted for routine replacement of a feeding tube.
d. LPN/LVN who has demonstrated competence is asked to perform a dressing
change for a patient before she is discharged home.
ANS: C
Only an RN can initiate and complete a new plan of care; this does not fall within the scope of
practice of the LPN/LVN. The RN has violated one of the five rights of delegation.
DIF: Application
REF: p. 357
11. An RN delegates to an experienced LPN/LVN the task of administering oral medications to a
group of patients. The LPN/LVN accepts the assignment, and the RN knows that the
LPN/LVN has had the training and has acquired the skills needed to complete the task. The
RN then observes the LPN/LVN recording a patient’s medication administration just before
entering the patient’s room. The priority intervention by the RN is to:
a. check the patient’s drug packages to ensure that the correct drugs were given.
b. stop the LPN/LVN immediately and discuss the possible consequences of his
actions in a nonjudgmental manner.
c. contact the nurse manager and ask that the LPN/LVN’s license be suspended.
d. call the pharmacy and ask for replacement medications for the patients.
ANS: B
The LPN/LVN has the competency but violated one of the rights of medication administration
and is practicing unsafe care. The RN’s responsibility requires that he or she intervene and
identify concerns with the LPN/LVN.
DIF: Analysis
REF: p. 363
12. Which statement related to delegation is correct?
a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse
practice act.
b. Nursing practice can be delegated only when the LPN/LVN and UAP have
received adequate training.
c. Supervision is not required when routine tasks are delegated to a competent
individual.
d. The RN must be knowledgeable about the laws and regulations that govern nursing
practice, as well as those that have no clearly defined parameters, such as for UAP.
ANS: D
Accountability remains with the RN, and he or she is responsible for knowing what tasks can
be delegated and what is defined as nursing practice.
DIF: Knowledge
REF: p. 354
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13. During orientation, an RN learns that LPN/LVNs in the facility receive additional training to
perform some tasks such as hanging continuously infusing intravenous fluids that have no
additives. It is important for the RN to understand that:
a. the health care facility can override the state practice act by having all LPN/LVNs
and unlicensed assistive personnel (UAP) participate in on-site training.
b. LPN/LVNs are licensed, and accountability for their own practice rests with each
LPN/LVN.
c. UAPs cannot be held responsible for their own actions or inactions.
d. the nurse practice act and state regulations related to delegation override the
organization’s policies.
ANS: D
The state’s nurse practice act is the deciding factor regarding what can legally be delegated.
DIF: Comprehension
REF: p. 355
14. A nurse moves from California to Arkansas and due to having 20 years of experience as a
registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of
LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the
LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The
RN should:
a. query the state nursing association to determine their stance on the role of LPNs.
b. ask the LPNs on the unit to list what tasks they routinely performed.
c. contact the state board of nursing to determine legal scope of practice for LPNs.
d. refer to California’s nurse practice act because the scope of LPNs/LVNs is
consistent across the United States.
ANS: C
If the nurse practice act lacks clarity, the state board of nursing can provide guidance.
DIF: Application
REF: pp. 354-355
15. An RN makes the following assignments at the beginning of the shift. Which assignment
would be considered high-risk delegation?
a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of
regular and NPH insulin.
b. An LPN is assigned an older adult with pneumonia and who requires dressing
changes on a foot wound.
c. An unlicensed assistive person is assigned the task of assisting a patient with late
stages of Huntington’s disease to ambulate a short distance in the hallway.
d. A float RN from the oncology unit is assigned a patient with a white blood cell
count of 4000 mm3.
ANS: C
Risk of falling is great in later stages of Huntington’s disease due to chorea movements.
DIF: Application
REF: pp. 359-360
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16. The RN instructs the LPN to “Give an enema to the patient in room 327 who is being
discharged but is complaining of being constipated. Then be sure to document on the
medication administration record when given.” Which of the five rights was missing in this
situation? The right of:
a. direction and communication.
b. task.
c. person.
d. circumstances.
ANS: A
The directions were not clear. The RN did not specify which type of enema to give and what
outcome to expect. And the RN gave no instructions related to reporting back.
DIF: Application
REF: p. 360
17. Which of the following situations would be appropriate for the supervisory level of initial
direction and/or periodic inspection?
a. Experienced RNs work together to provide care for a group of patients newly
diagnosed with meningitis.
b. The RN assigns the LPN tasks within her scope of practice and checks back during
the shift to ensure the tasks are completed correctly.
c. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 g
of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse
checks on the patient status every 15 to 30 minutes and asks the graduate to
explain “next steps.”
d. No supervision is necessary since both are registered nurses.
ANS: B
When a working relationship is established and competencies of the delegate established, the
delegator may check in during intermittently during the shift.
DIF: Application
REF: p. 361
18. A registered nurse (RN) is assigned as charge nurse for the first time. She knows to consult
the state board of nursing to determine scope of practice for licensed practical nurses (LPN)
and unlicensed assistive personnel (UAP). She also realizes there are common policies which
exist in most state practice acts that include:
a. the RN is held accountable for the decision to delegate, but responsibility rests
only with the delegatee.
b. the RN may only delegate tasks that are not in the scope of practice of the LPN if
the delegatee is certain they are competent to perform the task.
c. since the LPN is licensed, they practice professional nursing.
d. to determine what tasks can be safely delegated, the RN must first assess the
patient.
ANS: D
The stability of the patient must be determined prior to delegation. Even routine tasks such as
taking vital signs that are often delegated may need to be performed by the RN when the
patient’s condition is critical.
DIF: Comprehension
REF: pp. 354-355, Box 20-1
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19. A nurse is concerned about the risk of delegating tasks to licensed practical nurses and
unlicensed assistive personnel. What is the best way for the nurse to determine competency of
an inexperienced delegatee?
a. Actually observe the delegatee perform the assigned task.
b. Ask the delegatee how many times he/she has performed the task.
c. Ask the patient if the care provided was satisfactory.
d. Ask other nurses if they feel the delegatee is competent.
ANS: A
The best way for the nurse to determine the competency of LPNs or UAPs is to observe them
perform the task.
DIF: Application
REF: p. 361
20. Care delivery using the team-based approach is used on a telemetry nursing unit. The team
consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one
unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care
while ensuring cost containment. Which assignments would meet both criteria?
a. The RN administers all medications to all patients.
b. The LPN performs sterile dressings and IV tubing changes on all central lines.
c. The experienced UAP places telemetry electrodes and attaches to cardiac monitor.
d. The RN administers an enema to a stable patient who has an order “administer
fleet enema PRN when no bowel movement in 2 days.”
ANS: C
The UAP, when properly trained, can place patients on telemetry. This meets quality and cost
containment goals because the LPN and RN have higher salaries.
DIF: Application
REF: pp. 353-354
MULTIPLE RESPONSE
1. Which statement made by an RN regarding delegation indicates the need for additional
teaching? (select all that apply)
a. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5
minutes for a patient who is receiving a blood transfusion because a reaction at this
time is unlikely.
b. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a
positive PPD.
c. When dopamine is ordered continuously, the LPN/LVN can administer dopamine
at a low dose for the purpose of increasing renal perfusion.
d. UAPs can transfer a patient who is being discharged home from the wheelchair to
the bed if they have received training and demonstrated competency.
e. Responsibility can be delegated to the UAP, but the delegator retains
accountability.
ANS: A, B, C
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The statement “UAPs can assess vital signs during the first 5 minutes for a patient who is
receiving a blood transfusion because a reaction at this time is unlikely” indicates the need for
further teaching because the patient is at highest risk of a reaction during the first few minutes
of a blood transfusion; thus the assessment skills of an RN are required. The statement “an
LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD”
indicates the need for further teaching because administration of intradermal medication
requires the skill of an RN. Dopamine is a vasoactive drug that can have a profound effect on
a patient’s blood pressure and cardiac output; administration requires the assessment and
evaluation skills of an RN.
DIF: Analysis
REF: pp. 357-358, Box 20-3
2. A nursing administrator who is considering the feasibility of an all-RN staff reviews the
report, Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) and
determines that RNs: (select all that apply)
a. are more costly and less efficient than LPNs.
b. have little or no effect by being proactive but instead are reactive to patient care
errors.
c. have a positive effect on patient outcomes when managing patient care.
d. are effective overseers of patients’ overall health condition.
e. lack the training to be effective delegators.
ANS: C, D
RNs are effective at coordinating care that results in improved patient outcomes. RNs are
valuable monitors of a patient’s health status—a practice that results in improved patient
outcomes.
DIF: Comprehension
REF: p. 353
3. Which functions can be delegated only to another RN with appropriate experience and
training? (select all that apply)
a. Assessment of skin integrity on third day of hospitalization
b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises
c. Nursing judgment related to withholding medication based on vital signs
d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses
or unlicensed assistive personnel
e. Formulation of nursing diagnosis “potential for fall”
ANS: A, B, C, E
Activities like assessing skin integrity—which include the core of the nursing process and
require specialized knowledge, judgment, and/or skill—can be delegated only to another RN.
Activities like evaluating patient teaching—which include the core of the nursing process and
require specialized knowledge, judgment, and/or skill—can be delegated only to another RN.
Activities like deciding to withhold medication based on vital signs—which include the core
of the nursing process and require specialized knowledge, judgment, and/or skill—can be
delegated only to another RN. Activities like formulating a nursing diagnosis—which include
the core of the nursing process and require specialized knowledge, judgment, and/or
skill—can be delegated only to another RN.
DIF: Application
REF: pp. 361-362
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Chapter 21: Staffing and Nursing Care Delivery Models
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Accrediting agencies such as The Joint Commission address staffing by:
a. imposing maximum staffing levels.
b. requiring a specific staff mix.
c. stipulating nurse-patient ratios.
d. looking for evidence that patients receive satisfactory care.
ANS: D
Accrediting agencies do not address minimum staffing levels; however, they do look for
evidence that patients receive adequate care, and this can occur only with adequate staffing.
DIF: Comprehension
REF: p. 369
2. Customer satisfaction is primarily based on:
a. access to modern, up-to-date facilities.
b. availability of an extensive menu selection.
c. personal interactions with employees.
d. having to undergo fewer invasive procedures.
ANS: C
Interactions between employees and patients/families actually affect clinical outcomes,
functional status, and even physiologic measures of health.
DIF: Knowledge
REF: p. 369
3. rNurses on a unit provide personal hygiene, administer medications, educate the patient and
family about treatments, and provide emotional support. These nurses provide patient care
based on which nursing delivery system?
a. Total patient care
b. Partnership nursing
c. Team nursing
d. Functional nursing
ANS: A
In total patient care nurses provide all aspects of patient care.
DIF: Comprehension
REF: p. 370
4. A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive
personnel (UAP) are responsible for implementing a specific task, such as medication
administration or personal hygiene, for the entire nursing unit. This type of delivery system is:
a. total patient care.
b. functional nursing.
c. team nursing.
d. primary nursing.
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ANS: B
In functional nursing members of the team are assigned specific tasks such as assessment or
medication administration.
DIF: Comprehension
REF: pp. 370-371
5. The nurse who is responsible for following the patient from admission through discharge or
resolution of illness while working with a broad range of health care providers is called a:
a. nurse manager.
b. case manager.
c. coordinator of patient-centered care delivery.
d. team leader in team nursing care delivery.
ANS: B
The case manager, in collaboration with an interdisciplinary team, oversees the use of health
care services by clients throughout a course of illness.
DIF: Comprehension
REF: p. 373
6. A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass
grafting (CABG). According to the clinical pathway the patient should be extubated and
discharged from critical care the day after surgery. During surgery the patient’s oxygen
saturation decreased drastically as a result of chronic tobacco abuse. Subsequently, the patient
remained on the ventilator an additional 2 days postoperatively. According to the clinical
practice guideline for CABG, this situation represents a:
a. patient outcome.
b. variance.
c. goal.
d. standard.
ANS: B
A variance is a deviation from the planned path.
DIF: Comprehension
REF: p. 375
7. A patient is admitted with pneumonia. The case manager refers to a plan of care that
specifically identifies dates when supplemental oxygen should be discontinued,
positive-pressure ventilation with bronchodilators should be changed to self-administered
inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of
assessment findings. This plan of care is referred to as a:
a. patient classification system.
b. clinical pathway.
c. patient-centered plan of care.
d. diagnosis-related group (DRG).
ANS: B
A clinical pathway is a plan that specifies the timing and sequencing of major patient care
activities and interventions by the interdisciplinary team for a particular diagnosis, procedure,
or health condition.
DIF: Application
REF: pp. 374-375
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8. The nurse manager determines that four RNs, five LPN/LVNs, and two unlicensed assistive
personnel (UAP) are required per shift to meet the needs of the patient population on the unit,
according to acuity and census. The nurse manager is concerned with:
a. assignments.
b. staffing.
c. output.
d. productivity.
ANS: B
Staffing is the activity of determining that an adequate number and mix of health care team
members are available to provide safe, high-quality patient care.
DIF: Comprehension
REF: p. 367
9. A nurse manager is mentoring a novice nurse manager in determining staffing needs. The
mentor explains, “We must determine the acuity level of the patient by:
a. assessing patient satisfaction with nursing care.”
b. quantifying the amount and intensity of care required.”
c. examining the skill mix and educational preparation of the staff.”
d. determining the number of hospital days required by the patients.”
ANS: B
Patient acuity is measured by determining the amount and intensity of care required.
DIF: Comprehension
REF: p. 367
10. The nurse manager is planning staffing levels and realizes that the first step is to:
a. know the intensity of care needed by patients according to physical and
psychosocial factors.
b. examine the educational level of the staff.
c. assess the skill level of caregivers.
d. review the budget to determine the financial consequences of past staffing patterns.
ANS: A
The nurse manager must determine the number and mix of health care providers according to
the wide range of care requirements of individual patients.
DIF: Application
REF: p. 367
11. A hospital is concerned with nurse retention and realizes that job satisfaction is a major
influence. To enhance employee satisfaction related to staffing, the management team:
a. negotiates for additional agency nurses.
b. hires more part-time employees.
c. includes participatory management into staffing decisions.
d. uses “float” nurses to cover vacancies.
ANS: C
Staffing methods that include staff participation and enhance staff autonomy have been
demonstrated to play a major part in ensuring employee satisfaction.
DIF: Application
REF: p. 368
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12. A patient is admitted for a hysterectomy, and the RN develops and implements the plan of
care but also delegates to the LPN/LVN the responsibility of administering oral medications.
While off duty, this RN receives a call requesting a change in the plan of care because the
patient has developed deep vein thrombosis. The nurse who originally planned the care is
practicing which type of nursing care delivery?
a. Modular
b. Primary
c. Team
d. Functional
ANS: B
The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the
patient’s care from admission through discharge but may delegate or provide primary care
during the shift when present.
DIF: Comprehension
REF: p. 372
13. When deciding which staffing option to use on a nursing unit that will open soon, the manager
realizes that:
a. continuity of care is enhanced and errors are reduced when nurses provide care
over longer shifts and consecutive workdays, such as 12-hour shifts on 3
consecutive days per week.
b. the use of part-time nurses provides the variability needed to meet diverse patient
needs.
c. satisfaction of the staff equates to satisfaction of patients.
d. nurses provide the same level of care, regardless of the work environment.
ANS: C
High nurse satisfaction is generally equated with high patient satisfaction and positive patient
outcomes.
DIF: Comprehension
REF: p. 368
14. A task force is considering factors that contribute to high-quality safe staffing. Which
statement reflects an understanding of the American Nurses Association’s (ANA)
recommendations?
a. Because patient needs remain constant on a daily shift, staffing needs at the
beginning of the shift should be sufficient to provide safe, high-quality care.
b. Staffing should allow time for the RN to apply the nursing process so decisions
result in high-quality, safe patient outcomes.
c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel
to provide routine basic care rather than increasing RNs in staff mix.
d. RN staffing is not cost-effective; thus is it important for staffing models to limit
the number of RNs assigned per shift.
ANS: B
The ANA recommends that nurses have time to exercise professional judgment.
DIF: Analysis
REF: p. 367
15. A nursing unit is comparing team nursing to the partnership model and finds that:
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a. with the partnership model, an RN does not have to be part of the mix.
b. leadership abilities of the RN is a major determinant of effectiveness of care for
both models.
c. the RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to
apply the nursing process in team nursing.
d. with team nursing the RN cares for the patient while the team members work with
the family or significant others.
ANS: B
The RN leads regardless of whether partnership model or team nursing is practiced.
DIF: Comprehension
REF: p. 371 |p. 372
16. A nurse groups patients with criteria such as “high risk for falls,” “infection protocols,” and
“special communication needs” to determine the mix and number of staff needed on a
telemetry unit. The nurse is using:
a. a patient classification system to determine safe staffing levels.
b. diagnostic-related groups for Medicare billing.
c. case management to coordinate care.
d. clinical pathways to determine care.
ANS: A
Patient classification systems group patients according to care needs to determine safe staffing
levels.
DIF: Comprehension
REF: p. 367
17. A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms
211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have half the
rooms, with one assigned to 200-215 and the second to 216-232. The care delivery model
used in this situation is:
a. team.
b. primary.
c. partnership.
d. modular.
ANS: D
Modular (or geographic) assignments are based on a geographic location in the nursing unit.
DIF: Comprehension
REF: p. 372
18. A patient has decided to stop hemodialysis because his renal failure progresses and he wishes
to spend more time with family. Palliative care will continue, and the approach will be
discussed with the patient and family as needed and at change of shift. The care delivery
model in this situation is termed:
a. partnership.
b. patient-centered.
c. case management.
d. total patient care.
ANS: B
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Patient-centered care models entail the health care team partnering with the patient and family
to ensure that patients’ wants, needs, and preferences are the priority while allowing the
patient and family to participate in decisions and educational needs.
DIF: Comprehension
REF: p. 373
19. A nurse plans care knowing when specific recovery milestones are expected. The nurse is
providing care via:
a. patient classification systems.
b. clinical pathways.
c. functional nursing.
d. case management.
ANS: B
Clinical pathways plans patient care activities and interprofessional interventions and desired
patient outcomes within a specified time period for a particular diagnosis or health condition.
DIF: Comprehension
REF: p. 366
20.
An orthopedic unit is considering different types of care delivery models and staff have an
opportunity to ask questions about how the models differ. The nurse manager provides an
overview and uses the above visual to demonstrate which model of care delivery?
a. Team
b. Partnership
c. Primary
d. Functional
ANS: D
Functional care delivery models assign tasks to each provider. In the above visual, the LPN is
responsible for oral medication administration, the unlicensed assistive personnel provide
hygiene, and the RN is assigned to task that require the nursing process.
DIF: Application
REF: pp. 370-371
MULTIPLE RESPONSE
1. While participating in a task force to proactively plan for nursing care delivery over the next
20 years, a nurse learns that dramatic changes will occur as a result of: (select all that apply.)
a. the increase in the number of minimally invasive procedures being performed for
disease treatment.
b. care provided for patients over an extended period in acute care settings.
c. the reduction in the number of nurses and other health care professionals who are
available to provide care.
d. the widespread illiteracy and decreased self-efficacy of the aging patient
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population.
e. the need to focus on social and environmental influences, educational level, and
f.
individual characteristics and values of the patient.
the devaluing of nursing as a means of improving patient outcomes.
ANS: A, C, E
Invasive surgical procedures are being replaced by laparoscopic procedures. The demand for
nurses and other health care professionals cannot keep pace with the increased need for health
care required by the growing older population. Care will focus on the unique lifestyles and
values of a diverse population.
DIF: Comprehension
REF: p. 376
2. Which factors would be considered in the first steps in developing an effective patient
classification system? (select all that apply)
a. Planned procedures
b. Ethnic diversity of patients
c. Clinical competency of staff
d. Educational level of nurses
e. Age of patients
ANS: A, B, E
The first step in developing a patient classification system is to understand the intensity of
care needs, which requires identifying specific patient characteristics and care requirements.
DIF: Comprehension
REF: p. 368
3. A nurse responsible for staffing a medical-surgical unit must consider: (select all that apply)
a. the patient census.
b. physical layout of the unit.
c. complexity of care required.
d. educational level of all staff.
e. task preferences of the nurses.
ANS: A, B, C, D
The primary considerations for staffing a specific nursing unit are the number of patients; the
level of intensity of care required by those patients (commonly referred to as patient acuity);
contextual issues, such as architecture, geography of the environment, and available
technology; level of preparation and experience of the staff members providing the care; and
the quality of the nurses’ work life.
DIF: Application
REF: pp. 367-368
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Chapter 22: Quality Improvement and Patient Safety
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. A nurse is preparing to administer a medication by using the vastus lateralis site and is
unfamiliar with the process. A step-by-step reference that shows how to complete the process
is called a:
a. deployment flowchart.
b. top-down flowchart.
c. Pareto chart.
d. control plot.
ANS: B
A top-down flowchart shows the sequence of steps in a job or process such as medication
administration.
DIF: Comprehension
REF: p. 379 |p. 388
2. A nonprofit organization that distributes to governmental agencies, the public, business, and
health care professionals knowledge related to health care for the purpose of improving health
is the:
a. Institute for Safe Medication Practices.
b. Institute of Medicine.
c. National Committee for Quality Assurance.
d. The Joint Commission.
ANS: B
The Institute of Medicine is a nonprofit organization whose mission is to advance and
disseminate to the government, the corporate sector, the professions, and the public scientific
information that will improve human health.
DIF: Comprehension
REF: pp. 379-380
3. A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to
remove the dressing. The nurse accidentally cuts the sutures holding the incision, and
evisceration occurs. In quality improvement, this incident is best identified as a:
a. root cause.
b. sentinel event.
c. variation in performance.
d. causal factor.
ANS: B
A sentinel event is an unexpected occurrence that could result in serious physical or
psychological injury to the patient, including the possibility of returning to surgery and a
prolonged length of stay.
DIF: Comprehension
REF: p. 380
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4. A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be
weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to
the physician, and the infant falls off the scale. When evaluating the incident, the nurse and
her manager list contributory factors such as the need for two nurses when multiple births are
known, and the location of the scale so far from the delivery field. These nurses are
performing a(n):
a. standardization of care.
b. root cause analysis.
c. process variation.
d. analysis of a deployment flowchart.
ANS: B
A root cause analysis is a process by which factors that underlie variation in performance,
including the occurrence or possible occurrence of a sentinel event, are identified. The
purpose of root cause analysis is to identify improvements that can be implemented to prevent
future occurrences.
DIF: Application
REF: p. 380
5. Each month data on admission assessments that are based on the following standard are
entered: “All patients will be assessed by an RN within 2 hours of admission.” The target goal
for this standard is 97% compliance. Data are displayed on a graph that shows number and
time of admission assessments and compliance variation limits. This pictorial representation
is:
a. Pareto chart.
b. control chart.
c. deployment chart.
d. top-down flowchart.
ANS: B
The control chart is a run chart that has a centerline and added statistical control limits that
help to detect specific types of change needed to improve a process.
DIF: Comprehension
REF: p. 380
6. Regardless of the term used to describe high-quality health care, the focus of quality is:
a. what the consumer needs and wants.
b. economical care.
c. having the greatest technologic advancement.
d. services equally distributed among populations.
ANS: A
The customer determines quality on the basis of his or her unique perception of high-quality
care.
DIF: Knowledge
REF: p. 382
7. A team of experienced nurses work together to develop algorithms that are converted into
checklists to ensure standardization of commonly performed procedures. The focus of this
team is primarily on which Institute of Medicine (IOM) competency?
a. Safety
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b. Timely
c. Equitable
d. Patient-centered care
ANS: A
Standardization contributes to safety and improves individual performance of care providers.
DIF: Application
REF: p. 381
8. An organization’s emergency preparedness task force meets to discuss how it should react in
case of a terrorist attack and develops a disaster evacuation plan that details how each
department will assist individuals in reaching safety. This type of diagram is referred to as a:
a. Pareto chart.
b. control chart.
c. top-down flowchart.
d. deployment chart.
ANS: D
A deployment flowchart would show the detailed steps involved in the process and the people
or departments that are to be involved at each step to assist individuals in reaching safety.
DIF: Comprehension
REF: p. 385
9. Patients with heart failure have extended lengths of stay and are often readmitted shortly after
they have been discharged. To improve quality of care, a type of “road map” that included all
elements of care for this disease and that standardized treatment by guiding daily care was
implemented. This road map is referred to as a(n):
a. benchmark.
b. critical pathway.
c. algorithm.
d. case management.
ANS: B
A critical pathway determines the best order and timing of interventions provided by health
care team members for a particular diagnosis.
DIF: Knowledge
REF: pp. 388-389
10. The staff on a nursing unit notes that patient satisfaction varies from month to month. They
plot the degree of patient satisfaction each month for 1 year to determine when the periods of
greatest dissatisfaction are occurring. The staff uses which type of graph?
a. Time plot
b. Pareto chart
c. Flowchart
d. Cause-and-effect diagram
ANS: A
A run plot, or time plot, graphs data in time order to identify any changes that occur over time.
DIF: Comprehension
REF: p. 388
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11. A group of nurses is presenting the importance of high-quality care during a system-wide
meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that:
a. being insured has little effect on a person’s longevity and the quality of care
received.
b. lobbyists for the drug companies are able to gain permission for the use of new
drugs within 1 year of their discovery.
c. although a greater number of lawsuits stem from medication errors, more people
actually die from human immunodeficiency virus (HIV) and acquired
immunodeficiency disease syndrome (AIDS).
d. medication-related errors place a tremendous financial burden on the U.S. health
care system.
ANS: D
Medication-related errors for hospitalized patients cost roughly $2 billion annually.
DIF: Comprehension
REF: pp. 381-382
12. According to the Quality Chasm report:
a. health care providers should be proactive rather than reactive to patient needs.
b. common needs rather than individual preferences should be the priority.
c. medical information should be confined to the primary care provider.
d. specialized providers or case managers should control health care decisions.
ANS: A
Quality is based on predicting patient needs rather than reacting to needs.
DIF: Comprehension
REF: pp. 381-382
13. During the night, a patient fell in the bathroom and sustained a hip injury. The patient was
very upset because of being unable to attend a granddaughter’s wedding in 2 days. The team
looked at the process and determined that the patient had been medicated with a narcotic, had
urinary urgency so had not taken the time to put on shoes, failed to turn on the light because
the door to the hall let in some light, and stumbled over a towel that had been placed to collect
water leaks caused by construction that was in progress to replace damaged sinks. Which
factor was a special cause variation?
a. Failure to take time to put on shoes due to urgency
b. Unsteady gait due to narcotic administration
c. Poor lighting that led to decreased vision
d. Improper construction that caused the leak and towel placement
ANS: D
A special cause variation is an uncommon variation that is unstable and unpredictable, is not
under statistical control, and is related to a clearly identified single source, which in this
scenario is the construction project.
DIF: Application
REF: p. 383
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14. The number of IV site infections has more than doubled on a nursing unit. The staff determine
common causes include the site is cleaned using inconsistent methods, dressing frequently
becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and
inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in
descending order, with 80% of infections being attributed to inadequate hand washing. The
quality tool used is a:
a. cause-and-effect diagram.
b. run chart.
c. Pareto chart.
d. flowchart.
ANS: C
Pareto charts are bar graphs that show causes contributing to a problem in descending order
so the leading cause is easily recognized.
DIF: Comprehension
REF: pp. 385-386
15. The surgical team arrives in the operating room and one member states, “Everyone stop. Let’s
identify the patient and operative site. Now does anyone have any questions or concerns?”
This process is known as:
a. time-out.
b. a critical pathway.
c. special cause variation.
d. lean methodology.
ANS: A
A time-out occurs in the operating room to ensure the entire surgical team identifies the
patient, operative site, and possible concerns or questions about the procedure.
DIF: Comprehension
REF: p. 391, Box 22-2
16. Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with
steps known as “PDCA.” When explaining the steps to a group of nurses interested in
improving the process of medication reconciliation for heart failure patients with high rates of
recidivism, the instructor states:
a. P stands for process. Following a top-down flowchart provides the steps for
reviewing patient medications taken at home compared to those prescribed during
hospitalization.
b. D stand for deviation, which is an alteration in the expected drugs ordered.
c. C is for check if the process for change worked. Was there an improvement in
accurate reconciliation? And what was learned? A stands for algorithm, which
includes all steps of the process.
d. A stands for algorithm, which includes all steps of the process.
ANS: C
C stands for check if the change improved the process and what was learned.
DIF: Analysis
REF: p. 397, Figure 22-7
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17.
A hospital is concerned that the number of medication errors has increased significantly in the
past year. A project revealed four causes of medication errors. The above chart was used to
help staff and administration know where to focus efforts to reduce errors. Which process
improvement tool is used in this situation?
a. Run chart
b. Pareto chart
c. Flowcharts
d. Cause-and-effect diagrams
ANS: B
Pareto charts are used to prioritize areas to reduce medication errors. Eighty percent of all
errors were caused by interruptions, so this should be the area of priority.
DIF: Comprehension
REF: pp. 385-386
18. A nurse is asked to “float” to a telemetry floor and is to place a patient on telemetry monitor.
The nurse is unfamiliar with placement of EKG leads and would consult which type of chart
to learn the correct placement?
a.
b.
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c.
d.
ANS: C
The Pareto chart is used to prioritize interventions that caused the majority of the problems.
DIF: Application
REF: p. 387, Figure 22-3
19. Which of the following occurrences would be classified as a sentinel event?
a. A postpartum patient who elects to breastfeed only twice daily develops mastitis.
b. A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather
than the upper thigh as instructed by the patient educator.
c. A nurse assisting with the delivery of twins places the “Twin 1” name tag on the
second-born twin, causing the first-born twin to undergo surgery that was
scheduled for the other twin.
d. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin
subcutaneously, resulting in a drop in the patient’s serum glucose from 160 to 100
mg.
ANS: C
Any procedure performed on a wrong person or organ constitutes a sentinel event.
DIF: Application
REF: p. 380 |p. 391
20. A patient is ordered a low-protein, low-calorie diet but the patient’s family brings fish, lentils,
and unleavened bread for a meal to observe a cultural practice. The nurse works with the
dietitian to adjust the next few meals to accommodate for this variance. This situation would
represent:
a. a sentinel event.
b. an adverse event.
c. patient-centered care.
d. the communication technique of “call-out.”
ANS: C
The nurse and dietitian are respecting patient values, preferences, and expressed needs.
DIF: Comprehension
REF: pp. 381-382
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21. Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a
homeless person who will need wound care and follow up over the next 4 weeks. Each
member contributes based on his or her area of expertise but also recognize other members’
strengths. Which of the QSEN competencies are being demonstrated?
a. Quality improvement
b. Evidence-based practice
c. Teamwork and collaboration
d. Patient-centered care
ANS: C
An interdisciplinary team is working to prevent hand-off errors on discharge.
DIF: Application
REF: p. 393
22. Which of the following statements concerning the Institute of Medicine (IOM) competencies
is correct?
a. Each competency is mutually exclusive.
b. The competencies focus on individual efforts to reduce errors.
c. Physicians lead the team to achieve each competency.
d. The competencies address both individual and system approaches to transform
care.
ANS: D
Errors and increased health care costs result from both the actions of health care workers and
the nature of the system in which they deliver care.
DIF: Comprehension
REF: p. 381
23. Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review
medications prior to administration to reduce potential drug interactions. Software is also
installed that provides video clips of common procedures performed by nurses. Nurses on this
unit are best demonstrating which QSEN competencies?
a. Patient-centered care
b. Informatics
c. Teamwork
d. Quality improvement
ANS: B
Technology (PDA) is used to aid decision making and reduce errors.
DIF: Comprehension
REF: p. 393
MULTIPLE RESPONSE
1. A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM.
The surgical team adheres to the 2012 National Patient Safety Goals by implementing which
protocols? (select all that apply)
a. The surgical team asks the patient to verify his or her name, type of surgery, and
limb to be removed.
b. Ask each member of the surgical team to provide a copy of licensure and, if
applicable, certification to patient and family.
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c. The surgical team uses the chart number and name/hospital number to ensure they
have the correct patient.
d. Mark the procedure site with “X” and again ask the patient to verify correct site.
e. After arrival in the operating room, perform a “time-out” for final identification of
patient and operative site along with agreement of what procedure is scheduled.
ANS: A, C, D, E
The 2012 National Patient Safety Goal includes universal precautions to ensure patient safety
and prevent sentinel events. Methods to identify patient and surgical procedure are required.
DIF: Application
REF: p. 391, Box 22-2
2. An interdisciplinary team is evaluating the hospital’s care of patients admitted with a
myocardial infarction (heart attack) compared to national standards. The team analyzes the
hospital’s clinical indicator, which would be: (select all that apply)
a. aspirin order within 24 hours of discharge.
b. patient teaching related to stopping smoking completed prior to discharge.
c. beta blocker administered upon arrival.
d. support of employer to modify stress in workplace.
e. patient’s willingness to adhere to a strict cardiac diet after discharge.
ANS: A, B, C
Clinical indicators are measurable items that reflect the quality of care provided and
demonstrate the degree to which desired clinical outcomes are accomplished. National
benchmarks are established according to guidelines related to quality care for patients
admitted with heart attack and include: aspirin within 24 hours of admission, angiotensin
receptor blocker at discharge, stop smoking instruction given, and beta blocker administered
upon arrival and discharge. These are all measurable.
DIF: Application
REF: p. 385
3. A nurse educator is explaining to licensed staff that health care is no longer safe and describes
The Quality and Safety for Nursing (QSEN) recommended competencies for educating
nursing professionals. These include: (select all that apply)
a. advanced health assessment techniques.
b. patient-centered care.
c. prescriptive pharmacology content.
d. quality improvement.
e. safety.
ANS: B, D, E
Patient-centered care is a recommended competency, along with teamwork and collaboration,
evidence-based practice, and informatics. Quality improvement is a recommended
competency, along with patient-centered care, teamwork and collaboration, evidence-based
practice, and informatics. Safety is a recommended competency, along with patient-centered
care, teamwork and collaboration, evidence-based practice, and informatics.
DIF: Comprehension
REF: p. 393
COMPLETION
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1. Quality is defined by the ____________.
ANS:
patient
Quality is based on the perspective of the consumer or, in this instance, the patient.
DIF: Knowledge
REF: pp. 382-383
2. While taking a shower, a patient pushes the emergency light. When the nurse arrives, the
patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient’s
walker and the patient falls, hitting the right side of the face resulting in loss of vision in the
right eye. This scenario represents a _______ event.
ANS:
sentinel
A sentinel event is an occurrence that results in death or serious illness and requires
immediate investigation.
DIF: Comprehension
REF: p. 380
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Chapter 23: Health Policy and Politics: Get Involved!
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. A bill is pending in the state legislature that will mandate teaching health promotion related to
smoking cessation. Which action by the nurse should have the greatest impact on passage of
the bill?
a. Explain the rationale for the bill to the school board.
b. Contact the elected representative’s office by telephone to request support for the
bill.
c. Support a health advocate to run for election as state representative.
d. Tell all students about the bill.
ANS: B
Telephone calls are an effective means of communicating your support for a bill, next to a
face-to-face meeting; ask to speak to the staff person assigned to the bill or issue for which the
call is being made. After introducing yourself, give a brief and simple message such as,
“Please tell Senator/Representative [name] that I support [bill number].”
DIF: Application
REF: p. 407
2. Time is becoming crucial for the nurse to address issues related to sponsoring programs to
include hearing aid costs as part of Medicare coverage. The nurse involved in grassroots
political actions realizes that the least timely method of reaching elected officials would be
via:
a. letter.
b. telephone.
c. e-mail.
d. facsimile (fax).
ANS: A
Sending letters is the least timely mode by which to communicate with elected officials;
because of the anthrax decontamination process that is now in place, delivery of U.S. mail to
Congress and to the White House may be delayed by as long as 3 months, making letters an
inefficient means of communicating with policymakers.
DIF: Comprehension
REF: p. 407
3. A nurse would like to advocate for increased protective services and reporting mechanisms for
elder abuse and attends the “meet the candidate” session at the town hall meeting. This is an
important time for the nurse to:
a. educate the public about the nurse’s political platform.
b. be spontaneous and not deliver a rehearsed speech.
c. address the person as “candidate” rather than using a first name that implies a
working relationship.
d. learn what the key issues are in the candidate’s platform.
ANS: D
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Town hall gatherings with nurses allow the candidate to talk about his or her platform to a
group of interested voters and afford nurses an opportunity to understand the candidate’s
vision and to voice their opinions and concerns about health care issues.
DIF: Application
REF: p. 406
4. A nurse would like to obtain background information and learn the political platform of a
candidate who is running for national office. The nurse should contact the:
a. National Registry for Candidates.
b. American Nurses Association Nurses Strategic Action Team (N-STAT).
c. National League of Nurses.
d. National Council of State Boards of Nursing.
ANS: B
Through legislative updates, N-STAT keeps members up-to-date about background
information and the platforms of candidates who are running for national office; N-STAT also
provides updates about key bills as they move through the legislative process.
DIF: Comprehension
REF: p. 408
5. Political action committees (PACs) are established for the purpose of:
a. financially supporting candidates.
b. persuading policymakers to support certain policies.
c. lobbying legislators.
d. recommending health care policy.
ANS: B
A PAC is an arm of an organization, association, or labor union that is formed to persuade a
policymaker to support a certain policy or program or, more often, to ensure the election or
reelection of policymakers who support the organization’s goals.
DIF: Comprehension
REF: p. 406
6. When the policy process is compared with the nursing process, identifying the issue is
consistent with which step of the nursing process?
a. Assessment
b. Diagnosis
c. Planning
d. Implementation
ANS: B
The diagnosis step in the nursing process is consistent with identification of the targeted issue
in the political process. As politically active nurses soon discover, effective involvement in
policy development and political activities requires efforts similar to those used in the nursing
process. The policy process and the nursing process are systematic approaches that use the
nursing process for decision making.
DIF: Application
REF: p. 405
7. It is important for nurses to know the functions of the branches of the federal government. At
a local meeting of the state nurses’ association, an officer reminds members that the branch
that is capable of originating major policy initiatives is the _____ branch.
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a.
b.
c.
d.
executive
legislative
judicial
administrative
ANS: B
The legislative branch possesses the sole federal power to enact legislation; the legislative
branch originates and promotes major policy initiatives and has the power to override a
presidential veto.
DIF: Comprehension
REF: p. 403, Table 23-2
8. A concerned nursing student calls the office of an elected official to voice support for the bill
to ban smoking in all public places. The secretary asks, “Are you a constituent?” What does
the term constituent mean?
a. A member of a professional organization who supports the organization’s political
issue
b. A citizen who is registered and is eligible to vote for a representative
c. An elected official who proposes legislation to be considered as a potential law
d. A member of the House of Representatives who is seeking support for a particular
bill
ANS: B
A constituent is a citizen who has the opportunity to vote for candidates in elections for
representation at local, state, and federal government levels.
DIF: Knowledge
REF: p. 398
9. A person who is covered by Medicaid moves from one state to another and asks the nurse at
the health department why the benefits changed. The correct response by the nurse is:
a. “Local government controls which benefits each county can provide to Medicaid
recipients.”
b. “The federal government does not fund any part of Medicaid, so each state must
find ways to pay for benefits.”
c. “Each state determines benefits on the basis of the present economy.”
d. “Medicaid is funded by both state and federal governments, but benefits vary from
state to state.”
ANS: D
Medicaid is a program that is funded through a combination of state and federal funds; thus
benefits vary from state to state.
DIF: Analysis
REF: p. 400
10. Throughout the history of health care in our nation, one particular piece of federal legislation
provided funds for hospital construction. As the number of hospitals rapidly increased, the
need for nurses to staff hospitals also increased, and the shift from community-based nursing
care to hospital-based nursing care began. This fundamental piece of legislation was the:
a. Sheppard-Towner Act.
b. Hill-Burton Act.
c. Veterans Bill.
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d. Access to Health Care Bill.
ANS: B
The Hill-Burton Act, also known as the Hospital Survey and Construction Act, was enacted in
1950. This act provided funding that resulted in a boom in the construction of hospitals across
the country. As the number of hospitals increased rapidly, so did the need for nurses to staff
the hospitals. Thus the nurse’s role was shifted from community and public health settings to
the acute care setting.
DIF: Comprehension
REF: p. 401
11. Members of a state’s constituent member association meet at a local restaurant to plan a Nurse
Walk to support the local food bank. When entering the restaurant, the nurses note the
environmental inspection report shows deficiencies because food handlers were not wearing
hairnets and rodents were spotted, resulting in a score of 60 out of 100. This certificate of
inspection is health policy enforced at which level of government?
a. Local
b. State
c. Federal
d. International
ANS: B
Health policy at the state level is responsible for ensuring food safety in restaurants.
DIF: Comprehension
REF: p. 400
12. In the near future, the largest segment of the population will be those over age 65 years. To
advocate for this vulnerable population, a nurse was a strong supporter for the Medicare
Modernization Act (Medicare Part D), which:
a. provided vision care benefits to elderly persons who were diagnosed as legally
blind.
b. removed limits to access to mental health/substance abuse services which are the
most commonly used service in this population.
c. provided coverage for medications for Medicare enrollees that constituted a huge
expense for the elderly.
d. expanded the practice opportunities for advanced practice registered nurses
(APRN) who provide the majority of care for this population.
ANS: C
The Medicare Modernization Act provided medication benefits to Medicare recipients and
encouraged policymakers to have oversight to ensure drug effectiveness.
DIF: Comprehension
REF: p. 401, Table 23-1
13. If a nurse practicing in a mental health agency could only belong to one professional
organization, what criteria could be used to select the organization with the biggest impact?
a. The American Nurses Association has a strong voice representing the nation’s
entire RN population.
b. Specialty organizations such as the American Psychiatric Nurses Association
lobby for higher education requirements for nurses.
c. State nursing associations have limited power because they can lobby only state
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representatives.
d. Professional organizations such as The American Association for the History of
Nursing (AAHN) record the history of mental health nursing.
ANS: A
The American Nurses Association is the voice for all registered nurses.
DIF: Application
REF: p. 408
14. A group of nurses meet with a state representative to explain the importance of allowing
registered nurses the right to sign death certificates for patients who were under their care. As
constituents and nurses, they requested that the senator vote against the bill restricting this
practice. These nurses are serving as:
a. lobbyists.
b. policymakers.
c. officials with regulatory power.
d. advocates for the Patient Safety and Quality Improvement Act.
ANS: A
Lobbyists hope to educate and convince policymakers to respond positively to a particular
position on an issue or to follow a particular course of legislative or regulatory action.
DIF: Comprehension
REF: p. 398
MULTIPLE RESPONSE
1. A nurse is concerned about older persons living alone at home without telephone service to
contact emergency services. The nurse is advised to take part in grassroots efforts to address
the situation. The nurse would: (select all that apply)
a. post signs to support the county’s political candidates whose platform support
services for poor and underserved person such as older adults.
b. visit with local politicians running for office and ask specific questions such as,
“Would you support providing free emergency telephone service for older adults
living alone?”
c. limit voting to only presidential elections in which a candidate promises to initiate
health care reform related to Medicare for older adults.
d. join the American Nurses Association and constituent member association.
e. contact representatives from surrounding states to garner support for free medical
alert systems for older adults.
ANS: A, B, D
Working in local political campaigns is an effective grassroots effort. Visiting, e-mailing,
calling, and faxing local politicians to support free emergency telephone service for older
adults is a grassroots tactic. Joining ANA and state nursing associations supports these
organizations’ lobbying efforts and is thus a way for individual nurses to influence the issues
that nursing associations support.
DIF: Application
REF: pp. 405-408
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2. A nurse is interested in learning more about health policy and how it might impact nursing
practice. She is especially interested in The Patient Protection and Affordable Care Act
(PPACA) and how it will travel through the three branches of the federal government. She
researches the roles of the legislative branch of the federal government and learns that this
branch: (select all that apply)
a. determines which laws are constitutional, such as recently deciding the PPACA is
constitutional because it is a form of taxation.
b. has the exclusive power to determine where federal dollars will be spent, such as
supporting the PPACA.
c. consists of the Office of the President and 15 executive departments that supported
the PPACA.
d. has the power to veto laws found constitutional by the Supreme court and therefore
could veto the PPACA.
e. can override a Presidential veto, making it possible to amend the PPACA even
without approval of the President.
ANS: B, E
The legislative branch possesses the sole power to enact legislation, tax citizens, and allocate
federal spending. The legislature can override a presidential vote.
DIF: Application
REF: p. 403, Table 23-2
COMPLETION
1. A nurse who is interested in graduate school wants to learn about recently passed legislation
regarding changes in Medicare reimbursement for care provided by clinical nurse specialists.
The best source for information on changes in federal programs is the ________________.
ANS:
Federal Register
The Federal Register is the best source of information about proposed rules and regulations
for newly enacted legislation and about changes to existing rules for federal programs
(www.fr.cos.com).
DIF: Knowledge
REF: pp. 404-405
2. The greatest barrier to access to health care for a poor Hispanic person living in downtown
Chicago is lack of health ____________________.
ANS:
insurance
Lack of health insurance is the greatest barrier to access to health care and it has a tremendous
impact on an individual’s health. Studies have consistently found that the uninsured receive
less than adequate health care.
DIF: Comprehension
REF: p. 409
3. Another name for an eligible voter is a _________.
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ANS: constituent
DIF: Comprehension
REF: p. 398
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Chapter 24: Making the Transition from Student to Professional Nurse Cherry
& Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. During orientation, a novice nurse sits and “virtually spends” the first few paychecks,
envisioning the money going into a personal bank account. In the dream state, the nurse
smiles and knows that the pain of nursing school was worth it. Which phase of reality shock is
the nurse experiencing?
a. Honeymoon
b. Shock or rejection
c. Recovery
d. Resolution
ANS: A
During the honeymoon phase, the novice nurse has a positive image of nursing that coincides
with the reason for becoming a nurse; this feeling is experienced immediately after the nurse
begins work and often while still in orientation.
DIF: Comprehension
REF: pp. 416-417
2. A novice nurse is assigned a patient who has an order to draw blood for culture and sensitivity
from a central line before antibiotic therapy is started. The novice reads and rereads the
procedure manual. An hour later he stands at the bedside of the patient and stares at the central
line, without knowing how to proceed. This phase of reality shock is termed:
a. honeymoon.
b. shock or rejection.
c. recovery.
d. resolution.
ANS: B
During the shock or rejection phase, there is inconsistency with what was learned in school
and the work environment, and the novice nurse lacks many of the skills needed to be
independent in this new role.
DIF: Comprehension
REF: pp. 416-417
3. According to Kramer, nurses in the shock phase should ask themselves:
a. “How can I fit in with other staff?”
b. “Why can’t I perform as everyone expects?”
c. “What changes can I make to make me feel good about the choice to become a
nurse?”
d. “How can I get the rest of the staff to change?”
ANS: C
During the shock or rejection phase, novice nurses must ask themselves what they must do to
become the type of nurse envisioned and to make a contribution.
DIF: Application
REF: pp. 416-417
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4. The novice nurse arrives on the nursing unit, is introduced to the staff, is assigned a preceptor,
and is asked to participate in the next staff meeting. This introduction into nursing is
appropriately termed:
a. biculturalism.
b. socialization.
c. transition.
d. “going native.”
ANS: B
Socialization involves the acceptance and integration of the novice nurse into the profession
of nursing, as well as the identification of the novice nurse with the profession of nursing.
DIF: Comprehension
REF: p. 414
5. Several novice nurses share lunch breaks and have comments such as, “I have insomnia from
worrying about what I forgot to do for my patient,” and “I have no energy,” and “I can’t
believe I can’t do my job correctly.” These novice nurses are each experiencing different
symptoms of:
a. burnout.
b. low self-esteem.
c. lack of confidence.
d. resilience.
ANS: A
Symptoms of burnout include extreme fatigue, headaches, difficulty sleeping, mood swings,
anxiety, poor work quality, depression, and anger.
DIF: Comprehension
REF: pp. 417-418
6. Which nurse is more prone to burnout? The nurse who:
a. graduated last in the class.
b. is industrious and conscientious.
c. refuses to work an extra shift even though he or she needs the money.
d. volunteers to serve on only one committee and keeps in touch with schoolmates.
ANS: B
Burnout is more common among nurses with type A personalities and those who are
overachievers.
DIF: Application
REF: pp. 417-418
7. A novice nurse notices the medication nurse hurriedly gathering medications to be
administered for the entire day, removing them from the packages, and placing them in a
paper cup with the patient’s name and room number on the cup. When one of the patients
points at a pill and asks, “What is this?” and “What does this do?” the medication nurse is
uncertain, because it has long since been removed from the packaging. The novice nurse
speaks to the nurse manager about her observations and describes her concerns. The novice
nurse has assumed the role of:
a. loner.
b. “rutter.”
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c. change agent.
d. “native.”
ANS: C
The novice nurse is working to improve the safety and patient environment and is a patient
advocate.
DIF: Comprehension
REF: p. 418
8. The novice nurse calls a supervisor and requests that a “float nurse” be assigned to help with
all “assessments of new admissions and postoperative patients.” The supervisor asks, “How
many admissions and surgery patients have you received?” The novice nurse becomes
flustered because she has not checked the census but simply bases the need on feeling
overwhelmed. This situation best indicates a lack of _____ skills.
a. organizational
b. communication
c. interpersonal
d. clinical
ANS: A
The novice nurse lacks proficiency, which may be exaggerated by feelings of being
overwhelmed by the new environment, causing him or her to not get the facts before asking
for help.
DIF: Comprehension
REF: pp. 422-423
9. When the novice nurse asks, “What will happen if this task is not completed,” which skill is
being demonstrated?
a. Priority setting
b. Delegation
c. Organization
d. Clinical skills
ANS: A
The novice nurse is considering the legal and safety ramifications if the task is not completed.
DIF: Comprehension
REF: pp. 423-424
10. In distinguishing between evaluation methods used in school versus those used in the work
environment, it is noted that the work environment evaluation includes:
a. determining whether steps are logical.
b. formulating increments in correct order.
c. efficiently organizing stages of the procedure.
d. appraising outcomes according to policy.
ANS: D
Outcomes are based on meeting existing criteria rather than on knowing how the outcome was
achieved.
DIF: Application
REF: p. 420
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11. When comparing mentoring and role modeling, the role of mentoring is represented by which
of the following situations?
a. The experienced nurse is unaware that the novice nurse is observing him or her
gathering supplies needed to start intravenous antibiotics.
b. The novice nurse mimics conversations with his or her own patients that were
unobtrusively overheard between the experienced nurse and his or her patients.
c. The novice nurse receives feedback from the experienced nurse related to the use
of a new occlusive dressing product and is told, “I couldn’t have done it better
myself.”
d. An experienced nurse is nominated for outstanding employee of the month by the
novice nurse.
ANS: C
The experienced nurse knowingly enters into a relationship to advocate for and to enhance the
self-esteem of the novice nurse.
DIF: Analysis
REF: p. 425
12. A certified oncology nurse notices that a novice nurse is unsure of decision making and lacks
technical skills. The novice nurse gains confidence by sharing and learning with the
experienced nurse. This relationship continues and builds, allowing the novice nurse to
become more confident. This relationship is known as:
a. mentoring.
b. role modeling.
c. a preceptorship.
d. socialization.
ANS: A
The experienced and novice nurses have entered into a mutually agreed upon interactive
relationship to ease the transition of the novice nurse into the profession.
DIF: Comprehension
REF: p. 425
13. A novice nurse is unsure how to correctly administer an injection using the Z-track method.
What is the best approach for learning this procedure?
a. Read the procedure manual and follow the steps exactly.
b. Make an appointment at the skills laboratory of the former nursing school to
practice.
c. Ask to observe the skill as it is being performed; then perform it under direct
supervision.
d. Try to remember how the task was previously performed during a simulation.
ANS: C
The novice nurse can become familiar with the technique, then can perform the skill under the
supervision of an experienced nurse, ensuring competency.
DIF: Application
REF: p. 429
14. A student nurse wants to meet other nursing students from different countries and to learn of
employment possibilities. The student nurse should:
a. participate in the clinical facility’s employee satisfaction task force.
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b. join the Student Nurses Association.
c. take part in self-mentoring.
d. postpone taking the licensure examination so he or she can take a tour of foreign
countries.
ANS: B
Students who participate in preprofessional organizations such as the Student Nurses
Association have an opportunity to meet students across the nation and around the world and
can network with leaders to gain knowledge about employment possibilities.
DIF: Comprehension
REF: pp. 426-427
15. An experienced nurse working in oncology is shocked to realize that he feels little empathy
when a patient explains, “I developed cancer from having to work in the dry cleaning industry
since I was only 8 years old to help support my younger siblings during the depression. Now
they have all moved away and refuse to help me financially, and it takes everything I have to
pay for my chemotherapy medicine.” The nurse is experiencing:
a. burnout.
b. compassion fatigue.
c. reality shock.
d. horizontal hostility.
ANS: B
The nurse is experiencing a gradual decline in compassion over time as a result of being
exposed to events that have distressed his or her patients, such as working at a young age to
support a family while inadvertently being exposed to carcinogens.
DIF: Comprehension
REF: pp. 417-418
16. A recruiter is explaining benefits to a group of nursing externs who are highly sought for
employment. The recruiter states, “We are the only hospital in town that offers a residency
program.” The recruiter further explains that a residency program:
a. provides housing for the graduate nurse to decrease expenses until income is
established.
b. partners a medical resident with a nurse resident to learn interprofessional care.
c. allows new graduates to work on a higher degree in nursing while being paid
full-time.
d. offers extended time for both theory and clinical activities that promote problem
solving and clinical decision making.
ANS: D
Residency programs offer a longer precepted orientation period (often 12 months) to bridge
the gap between the classroom and practice.
DIF: Comprehension
REF: pp. 425-426
17. A novice nurse is stressed due to always being behind with her assignments. She is overheard
saying, “No one here worries about checking nasogastric tube placement before they give
medications and hang feedings. Skipping that step would save me an extra 30 minutes to be
used for charting. If they can do it, so can I.” This nurse is experiencing which stage of reality
shock?
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a.
b.
c.
d.
loner.
“rutter.”
change agent.
“native.”
ANS: D
The novice nurse is mimicking the actions of the experienced nurse taking shortcuts that were
not taught in school and not following policy and procedure.
DIF: Comprehension
REF: p. 417
18. A novice nurse is placed in charge just after orientation ends. Which statement by the novice
nurse would ensure a smooth delegation experience when delegating to an experienced staff
member?
a. “You have the patients in rooms 1 to 7. These patients require little skill so you
will be fine.”
b. “Your assignments are posted in writing by the nurses’ station. Be certain all your
tasks are completed so the next shift is not behind.”
c. “You have patients in rooms 5 through 10 and I will administer all IV medications.
I will let you know if I have to adjust. If you see you need help let me know.”
d. “Everyone is capable of providing the best care, so please sign up for the patients
you would like to be assigned to.”
ANS: C
The nurse is clearly stating the assignments, allowing for a need to adjust both to needs of the
unit and the delegate’s needs.
DIF: Application
REF: pp. 422-423
19. A novice nurse is in the “rejection phase” of stress and wonders if she made the right decision
when deciding nursing was her chosen career. Which strategy would help the novice nurse
cope with transition into practice and reduce stress?
a. When asked by the charge nurse to accept the new admission even though she had
no discharges, the novice nurse stops and considers if this request is acceptable and
safe, then accepts the assignment based on two patients having a low acuity level.
b. Refusing to eat anywhere but the hospital cafeteria to ensure a balanced diet and
time to socialize with other staff and visitors.
c. Avoid wasting time by listening to coworkers’ problems or ideas on how to staff
the unit during the upcoming holiday since the novice nurse’s time is valuable and
better spent getting her own work completed.
d. Make an effort to “win over” hostile or angry coworkers who find fault with the
novice nurse’s work performance.
ANS: A
To reduce stress and cope with the rejection phase of transition, the novice nurse should think
before answering—take a few minutes before answering and deciding what is best course of
action.
DIF: Analysis
REF: pp. 416-417
MULTIPLE RESPONSE
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1. In orientation, a new graduate is surprised to learn of workplace violence in health care
agencies and asks, “What kind of violence is common in hospitals?” The educator describes
workplace violence as: (select all that apply)
a. care of patients admitted who are victims of domestic violence.
b. experienced nurses withholding pertinent information from coworkers to portray
them as incompetent.
c. coworkers participating in an employee assistance program (EAP) to learn more
about anger management for adult children living at home.
d. care of persons being held for treatment prior to be incarcerated for committing
homicide.
e. statements such as “The new nurse has book sense but can’t perform an admission
physical without the help of everyone on the unit.”
ANS: B, E
Withholding information from novices or coworkers to purposely cause them to appear
inadequate or unskilled is considered workplace violence because of the anxiety and stress it
produces. This should not be tolerated and should be reported. Such statements, which belittle
employees, lead to job dissatisfaction, lack of teamwork, and burnout and are considered
lateral or workplace violence. This should not be tolerated and should be reported.
DIF: Application
REF: p. 424
2. Faculty comes to class to present information about joining the Student Nurses Association
(SNA). A student is heard saying, “Why join this organization? It is just a bunch of students
like us. I’ll wait and join the real nursing organization after graduation.” This student is not
aware of which benefits of SNA? (select all that apply)
a. Members are eligible to sit for the licensure examination at a reduced rate.
b. Leadership skills can be refined by working with other schools of nursing.
c. The National SNA provides discounted rates for study abroad opportunities.
d. A global view of nursing can be obtained through networking internationally.
e. Lobbying efforts are a major benefit of belonging to SNA.
ANS: B, D
Leadership opportunities are available as officers and through conferences. SNA members
work with other nursing students across the nation and internationally.
DIF: Comprehension
REF: pp. 426-427
3. A novice nurse notices a patient is pacing the floor and twisting his hands. When the nurse
enters the room, the patient stares at her and mumbles, “Can’t anyone understand what I
want?” while smiling and reaching out to shake the nurse’s hand. The nurse recognizes a risk
for violence based on which clinical findings? (select all that apply)
a. Glaring at the nurse
b. Nervousness, twisting of hands
c. Murmuring when talking
d. Diagnosis of a terminal illness
e. Isolation, desire to be alone
ANS: A, B, C
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Nurses can recognize a risk for workplace violence by using the acronym STAMPEDAR
(staring, tone of voice, anxiety, mumbling, pacing, emotions, disease process,
assertive/nonassertive behavior, and resources).
DIF: Application
REF: pp. 428-429
COMPLETION
1. It is important for novice nurses to know that “self-esteem = self-confidence + self-______.”
ANS: respect
DIF: Knowledge
REF: pp. 426-427
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Chapter 25: Managing Time: The Path to High Self-Performance
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. In deciding whether to say no to a request that involves a time commitment, the professional
nurse must consider:
a. the cost-benefit ratio.
b. the time commitment of coworkers.
c. ways to buffer saying no.
d. personal preference.
ANS: A
The first step in learning the art of saying no is determining when to say it. The cost/benefit
ratio of each opportunity must be evaluated in relation to the overall goal. If the activity will
provide an overall benefit, obviously it must be given careful consideration. If it will not result
in significant benefit, decline gracefully but emphatically.
DIF: Application
REF: p. 446
2. Positive time management skills include:
a. maintaining an open-door policy.
b. retaining all paperwork.
c. returning all telephone calls immediately.
d. scheduling daily activities.
ANS: D
Planning is the most important step in time management. Planning allows people to better use
their time and can lead to closure in relation to those goals that will produce the greatest
internal satisfaction.
DIF: Comprehension
REF: pp. 441-442
3. Time can be maximized to produce the best outcomes by:
a. making the first hour of each workday productive.
b. completing trivial tasks before performing important tasks.
c. eliminating all recreational activities.
d. omitting breaks until the entire task has been completed.
ANS: A
Making sure that the first hour of every workday is productive sets the tone for achieving
goals.
DIF: Comprehension
REF: p. 447, Box 25-2
4. To conduct a productive meeting, the nurse should:
a. provide each person all the time needed to discuss desired topics.
b. cover all emotional topics first.
c. create an agenda with specific times allotted for each agenda item.
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d. wait for latecomers and ask for their excuse for being late.
ANS: C
You need to preplan for the meeting so it can be conducted in a timely manner. One way to
have a productive meeting is to prepare a meeting agenda with time allotted for each item and
the name of the person responsible for reporting on each item. Send out the agenda prior to
the meeting so attendees can come prepared.
DIF: Application
REF: p. 439, Box 25-1
5. When choosing to delegate, the nurse should delegate the task to the most qualified person or
to the person he or she wishes to:
a. develop.
b. promote.
c. punish.
d. reward.
ANS: A
Delegating is giving other people tasks to be accomplished. The benefits of delegation involve
(1) assisting in developing the initiative, skills, knowledge, and competence of others; (2)
maintaining the level of responsibility and decision making of others; (3) freeing time for
more important tasks; (4) extending results that can be accomplished from what one person
can do alone to what he or she can manage through others; and (5) ensuring that completing
the task is cost effective.
DIF: Comprehension
REF: p. 445
6. When using the ABC system of managing time, those items coded A include:
a. calling the pharmacy to see whether a drug insert is available for a patient.
b. checking to see why a ventilator is alarming.
c. organizing the medication cart.
d. writing memos to remind everyone to contribute to the boss’s birthday gift.
ANS: B
A items should stand out from other items because of their worth and high level of
importance. A items are most urgent and may require more energy and time, but they should
be completed before any of the B or C items are performed.
DIF: Application
REF: p. 441
7. When deciding whether and when a task should be completed, a nurse must:
a. complete all tasks as they are thought of to prevent having to take time to consider
which is most important.
b. procrastinate and hope that someone will volunteer to do it.
c. ask, “What will happen if I don’t complete the task now?”
d. view large projects holistically and not as many small pieces.
ANS: C
Stopping to evaluate what is going on is important because you may have to readjust your
plan and reprioritize in order to reach your goal.
DIF: Application
REF: p. 444
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8. When planning, a nurse should:
a. delay planning until the “first task of the morning” has been completed.
b. recognize that rewarding oneself has a negative consequence.
c. rotate between several tasks to stimulate creativity.
d. remember that most tasks take longer than anticipated to complete.
ANS: D
One must consider many factors when planning a project. Some of the following factors
influence how priorities should be established: (1) urgency of a situation, (2) demands of
others, (3) closeness of deadlines, (4) existing time frame, (5) degree of familiarity with the
task, (6) ease of task completion, (7) amount of enjoyment involved, (8) consequences
involved, (9) size of the task, and (10) congruence with personal goals. When the use of time
is considered, not all of these factors carry the same weight, and adjustments will be needed.
DIF: Comprehension
REF: p. 440
9. A novice nurse is unsure of his ability to insert a nasogastric tube for one of the assigned
patients who is vomiting coffee ground emesis. The novice nurse waits, hoping that someone
with more experience will volunteer to do the job, or he just waits until the end of the shift.
This nurse is practicing:
a. energy management.
b. priority setting.
c. procrastination.
d. introspection.
ANS: C
Procrastination is evident when a person is faced with an unpleasant task, a difficult task, or a
difficult decision. Usually procrastination is easily recognizable because it involves
completing low-priority tasks rather than high-priority ones, and it always welcomes
interruptions. Procrastination is the art of “never doing today what can be put off until
tomorrow.” The result consists of less productivity, less internal satisfaction, and increased
stress.
DIF: Comprehension
REF: pp. 443-444
10. A student nurse assigned to work with the charge nurse is given the opportunity to help revise
the nursing assessment form. She receives several compliments from management and her
nursing instructor for her creative suggestions. The student nurse enjoys the project and
attention she is receiving and begins to prolong the conclusion of the project. Although she
constantly adds new information, she filters this out slowly to others. The student nurse is
subject to the time management obstacle of:
a. need for perfection.
b. fear of losing creativity.
c. unclear goals.
d. fear of completion.
ANS: D
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Fear of completion is a time management obstacle that may occur if you are afraid of
completing a project that is creative and fun. To overcome this obstacle, take the time to
understand why you are not completing the task or major project that has been with you for
some time.
DIF: Comprehension
REF: p. 437
11. An inexperienced nurse has heard of other novice nurses who take shortcuts in providing
patient care. This nurse feels that this is unacceptable and that all tasks must be performed
faultlessly, which leads to her inability to complete all assigned tasks. This nurse would
benefit from the seminar “Obstacles to Time Management: How to Deal with:
a. Creativity.”
b. Perfectionism.”
c. Failure.”
d. Downtime.”
ANS: B
If you are a perfectionist and feel that everything should be completed at the same level of
excellence, you are not keeping things in perspective. If you demand extremely high standards
for every single task you undertake, you simply will not get everything done.
DIF: Comprehension
REF: p. 437
12. An experienced nurse volunteers to serve on a task force intended to improve the quality of
care because she possesses excellent patient care skills and has selected a career goal of
working in quality management. However, the nurse is unable to concentrate on any one task
or issue and is unable to view the health care milieu sensibly. Which source of energy is
missing in this nurse?
a. Physical
b. Mental
c. Spiritual
d. Emotional
ANS: B
Mental energy is the ability to maintain sustained concentration on a task, to move flexibly
between broad and narrow issues, and to be internally and externally focused, as needed by
the situation. It includes mental preparation, visualization, positive self-talk, effective time
management, and creativity.
DIF: Comprehension
REF: pp. 438-439
13. After keeping a log of activities designed to improve time management, the nurse divides the
distractions into internal and external sources. The nurse would classify which distraction as
internal?
a. Responding to recurring crises at work or in one’s personal life
b. Unsuccessful attempts to communicate with the unit manager
c. Talking with potential faculty candidates
d. Being given unclear job responsibilities
ANS: A
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An internal distraction is one that can be controlled only by the person affected; it is
important for each of us to recognize and understand the distracters that inhibit our ability to
complete tasks and to meet our objectives and goals.
DIF: Application
REF: p. 439, Box 25-1
14. A nurse realizes that much time is wasted during shift report when coworkers discuss personal
items such as recent movies or department store sales. Which statement would help with time
management during this critical interaction?
a. “Let’s talk only about one movie you recently watched.”
b. “I like to know about department store sales, but we need to get through this
report, so let’s talk about sales as we walk between patient rooms.”
c. “I know your shift has been busy. What went wrong?”
d. “I have the list of patients; let’s start with revisions to the plan of care and
scheduled activities for the next shift.”
ANS: D
The statement “I have the list of patients; let’s start with revisions to the plan of care and
scheduled activities for the next shift” focuses the conversation during report, keeping
personal conversations to a minimum.
DIF: Application
REF: p. 439, Box 25-1
15. A nurse takes a day to travel to a state park where she can sit by the river alone to reflect over
recent events and put things into perspective. She recalls the time she was complimented for
her ability to deal with a difficult patient and another time when she was criticized for lack of
teamwork. This nurse is improving which source of energy?
a. Emotional
b. Spiritual
c. Physical
d. Mental
ANS: B
Spiritual energy can be increased by taking time to reflect over events in one’s life and
allowing time to understand feelings associated with events/happenings. A quiet environment
is essential for reflection.
DIF: Comprehension
REF: pp. 438-439
16. As part of a quality assurance project, a nurse is to round on every patient daily for 1 month to
ensure the intravenous tubing is labeled with date hung and nurse’s initials. The nurse is
hoping to be promoted to a full-time position within the quality department, and her success
on this project is very important to her receiving the position. The nurse retains all other
assignments, and she is often interrupted to help other staff or answer call lights. The nurse
discusses her concerns with the manager, who frees her for 1 hour each day to make rounds.
During this 1 hour each day the nurse will organize herself and environment by practicing the:
a. art of “no detourism.”
b. reducing stacked-desk syndrome.
c. art of “wastebasketry.”
d. managing e-mail and memo mania.
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ANS: A
The art of “no detourism” focuses on one task until completed.
DIF: Comprehension
REF: pp. 442-443
MULTIPLE RESPONSE
1. A nurse is having difficulty managing assignments at work, which results in a feeling of
“failure” and tasks that are not completed or that are not completed satisfactorily. The mentor
suggests some tips for time management. These include: (select all that apply)
a. focusing on activities to be completed, rather than on objectives.
b. planning for tomorrow today.
c. making certain that the last hours are the most productive in tying up loose ends.
d. maintaining a log of how the nurse spends time (no need to worry about using
complete sentences).
e. picking five major objectives for the day and not stopping until they are achieved.
ANS: B, D
Planning for the future is an effective time management strategy. Maintaining a log of how
you spend your time is an effective time management strategy.
DIF: Analysis
REF: p. 447, Box 25-3
2. A nurse is having difficulty keeping up with the six assigned patients and serving on the ethics
committee. In order to take charge of both personal and work life, the nurse focuses on
improving physical energy by: (select all that apply)
a. telling herself, “I provide safe quality care and will provide this level of care to all
my patients.”
b. taking a deep breath and remaining calm to develop patience.
c. keeping a bottle of water available to consume a minimum of 24 ounces each shift.
d. going into the nurse’s break room every 90 minutes to eat a healthy snack and
prioritize remaining care.
e. enrolling in the hospital’s fitness program, Nurses Need Nurturing.
ANS: C, D, E
Drinking plenty of water promotes physical health. Taking a break every 90 minutes,
especially during long shifts such as 12-hour shifts, provides a much needed time to relax and
reorganize. Proper and frequent exercise promotes physical health.
DIF: Application
REF: p. 438
3. A nurse hopes to improve time management skills using the ABC prioritization approach.
Which tasks would be prioritized as “B”? (select all that apply)
a. Turn in time sheet due in 3 days.
b. Review dress code policy to give feedback before appointment in the morning.
c. Perform blood glucose test on a patient admitted with Kussmaul respirations and
change in level of consciousness.
d. Complete patient teaching prior to discharge in 2 hours.
e. Review procedure for inserting a PIC line to assist with procedure later this
morning.
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ANS: B, D, E
Task that falls within Priority B includes the medium-value items, such as tasks that are not
urgent but most likely will not “fall” off the list. Since the dress code must be reviewed and
feedback constructed for a morning appointment, this would be level B, it is not urgent nor
will it likely fall off the list. Completing patient teaching for a patient to be discharged in 2
hours must be completed but does not take priority over “A” tasks. Reviewing a procedure to
be performed later in the day is Level “B.”
DIF: Application
REF: pp. 440-441
4. A nurse is hoping for a promotion and seeks the help of a coach to improve time management
skills. The first task assigned by the coach is for the nurse to list all external distractors that
prevent organization and completion of tasks. The nurse would include:
a. waiting for oncoming shift to start walking rounds.
b. failure to delegate tasks to the licensed practical nurse and unlicensed assistive
personnel and instead, completing task herself.
c. talking with a patient’s family member who is also a personal friend.
d. spending time thinking about the vacation to the beach.
e. using the Internet to read about a new drug that will be administered; then taking
time to look for news about the profession, new legislation about the Patient
Protection and Affordable Care Act, and new uniforms for the season.
ANS: A, C
a. Waiting, such as for meetings or oncoming shift, is an external distraction.
c. Socializing with visitors is an external distraction.
DIF: Application
REF: p. 439, Box 25-1
COMPLETION
1. The most important step in time management is ____________.
ANS:
planning
It is important to plan before beginning any task, project, or day’s activities. Planning involves
(1) setting goals and establishing priorities, (2) scheduling activities, and (3) making to-do
lists.
DIF: Comprehension
REF: p. 440
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Chapter 26: Contemporary Nursing Roles and Career Opportunities
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. The primary focus of the care provider role for the nurse involves:
a. using the nursing process to provide guidance to the patient in recovery.
b. encouraging consumer self-responsibility and emphasizing health
promotion/maintenance.
c. focusing on increasing satisfaction among professional nurses.
d. advancing nursing practice through research.
ANS: A
The primary focus of the care provider’s role is to use the nursing process in caring for
patients.
DIF: Comprehension
REF: p. 451
2. A nurse researcher is attempting to describe the demographics of today’s RNs and reports
that:
a. less than half of all RNs work in hospital settings.
b. the average age for an RN is 50 years.
c. approximately 25% of RNs are male.
d. most RN are practicing with a bachelor’s degree.
ANS: D
A substantial number (55%) of nurses practice with a BSN
DIF: Comprehension
REF: pp. 454-455
3. A hospital standard states, “All intravenous (IV) sites must be rotated every 72 hours.” The
nurse who assesses and records variations from this standard is fulfilling which role of
nursing?
a. Infection control
b. Quality management
c. Coordinator position
d. Counselor
ANS: B
The basic premise is to ensure that outcomes in client care services are consistent with
established standards.
DIF: Application
REF: p. 456
4. The nurse who organizes screenings for employees, assesses the work environment for
hazards, and teaches health-promoting activities is employed in the field of:
a. infection control.
b. occupational health.
c. informatics.
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d. transportation specialization.
ANS: B
The occupational health nurse organizes screenings for employees, assesses the work
environment for hazards, and teaches health-promoting activities.
DIF: Comprehension
REF: pp. 457-458
5. The RN who identifies the best resources at the lowest cost to achieve optimal health
outcomes for the client is fulfilling the role of:
a. informatics specialist.
b. educator.
c. case manager.
d. quality manager.
ANS: C
The role of the case manager includes coordination of resources to achieve the best outcomes
based on quality, access, and cost.
DIF: Comprehension
REF: p. 459
6. A patient is admitted for a hip replacement complicated by uncontrolled diabetes and early
dementia. The nurse coordinates referrals to an endocrinologist to establish an insulin protocol
and organizes out-patient physical therapy in an Alzheimer’s assisted living facility upon
discharge. The role of this nurse is the:
a. informatics specialist.
b. educator.
c. case manager.
d. quality manager.
ANS: C
The role of the case manager includes coordination of resources to achieve the best outcomes
based on quality, access, and cost.
DIF: Comprehension
REF: p. 459
7. An RN testifies at a trial where domestic violence is being investigated. She had previously
assisted with specimen collection and had assessed the victim. The nurse is involved in _____
nursing.
a. triage
b. forensic
c. flight
d. entrepreneurial
ANS: B
The forensic nurse provides direct services to clients and consults with and serves as an expert
witness for medical and law enforcement.
DIF: Comprehension
REF: pp. 459-460
8. The forensic nurse would most likely be involved in:
a. performing an assessment of rape victim and collecting specimens needed for
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court.
b. assigning a patient with chest pain to be seen first, followed by a patient with an
insect bite of unknown origin with red streaks but no respiratory distress.
c. assessing a patient at home by asking the patient to place a receiver over the
pacemaker to evaluate capture of pacing stimuli and transmitting the results to
another state where nurse located.
d. performing pediatric life support at the scene of an accident to stabilize then
transport via helicopter to the nearest trauma center.
ANS: A
Forensic nursing involves providing direct services to clients involved in abuse or victims of
crimes and consults with medical and law enforcement.
DIF: Application
REF: pp. 459-460
9. A nurse in an acute care facility helps patients understand how to prevent diabetic
neuropathies. This nurse is functioning in the role of:
a. change agent.
b. educator.
c. manager.
d. coordinator.
ANS: B
A nurse functioning in the role of educator helps patients understand the complications of
their disease process.
DIF: Comprehension
REF: p. 451
10. A nurse notices that care is often withheld until an interpreter arrives, if the nurse is not
multilingual. The nurse discusses this with the management team and suggests a three-part
series be presented to the nursing staff to teach some commonly used medical terms in
Spanish. This nurse is involved in the role of:
a. change agent.
b. educator.
c. manager.
d. coordinator.
ANS: A
The role of the change agent consists of assessing health care delivery issues and creating
solutions to improve health care delivery.
DIF: Comprehension
REF: p. 451
11. A nurse tallies the patient satisfaction surveys and approves the use of an agency nurse
because of the high census. This nurse is involved in which nursing role?
a. Change agent
b. Educator
c. Manager
d. Coordinator
ANS: C
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The manager is the one who assesses the need for staffing and must justify this in a
substantial way. Through this approach, the manager indirectly provides care for patients and
families.
DIF: Comprehension
REF: p. 451
12. In differentiating between interprofessional and multidisciplinary:
a. multidisciplinary refers to the care of many diverse patients by one discipline.
b. interprofessional involves members of many disciplines working together to
provide patient care to a distinct population.
c. interprofessional refers to members of the same discipline working together to
provide patient care to a distinct population.
d. interprofessional is the use of multiple interventions by nurses with varying levels
of education.
ANS: B
Interprofessional, as related to member roles, involves members of many disciplines working
together to provide patient care to a distinct population.
DIF: Knowledge
REF: p. 450
13. A person from an underrepresented background in nursing is interested in entering nursing
school and researches the ethnicity, age, and gender make-up of the nursing profession and
finds:
a. nursing is a career field that is primarily made up of women younger than 30 years.
b. the number of male RNs has steadily increased and is equal to the number of
female RNs.
c. the majority of RNs are white or non-Hispanic.
d. more than half of all RNs are ages 55 through 65.
ANS: C
The majority of RNs are white or non-Hispanic (75%).
DIF: Knowledge
REF: p. 454
14. A nurse who is participating in a health fair asks, “Other than nursing, what are some
opportunities for careers in the health care professions, and what education is required?” The
nurse informs participants that a baccalaureate degree is required as the minimum standard for
the role of:
a. speech therapist.
b. occupational therapist.
c. nurse-midwife.
d. nurse anesthetist.
ANS: B
The baccalaureate degree is the minimum requirement for an occupational therapist.
DIF: Knowledge
REF: pp. 452-453, Box 26-2
15. A nurse is interested in practicing in a faith-based community; when researching the role of
the parish nurse, the nurse finds that:
a. certification is available at a basic level after a qualifying examination is
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completed and a set number of practice hours have been worked, as defined by the
state’s nurse practice act.
b. this advanced practice role focuses on health promotion and disease prevention.
c. this role has no set standards or scope of practice but instead follows the doctrine
of the denomination being served.
d. this role is recognized by the American Nurses Association (ANA) as a specialty
with a defined set of practice guidelines.
ANS: D
The role of parish nurse has become a recognized specialty in a growing professional practice.
In 1998, the ANA established the scope and standards of this professional practice.
DIF: Comprehension
REF: p. 460
16. A nurse is responsible for determining the incidence rates of hospital-acquired diarrhea on a
pediatric ward after receiving reports that five children admitted with uncontrolled asthma had
developed diarrhea while hospitalized. The nurse is working in the role of:
a. quality management.
b. infection control.
c. occupational health.
d. forensics.
ANS: B
The infection control nurse is concerned with incidence of infections within the hospital.
DIF: Comprehension
REF: p. 456
17. A nurse working in a factory performs routine hearing tests for employees. The factory uses
90 dB as the safe limit for an 8-hour day’s exposure to machine noise rather than 85 dB as
recommended by the Occupational Safety and Health Administration. The nurse is
functioning in the role of:
a. quality management.
b. informatics nurse specialist.
c. occupational health nurse.
d. case manager.
ANS: C
The nurse in the role of occupational health focuses on health promotion and disease control
of employees.
DIF: Comprehension
REF: pp. 457-458
18. People are living longer and with older age comes a higher risk of terminal illness. Many
individuals have chosen to maximize their quality of life but stop aggressive life-sustaining
treatments. Nurses who work with terminally ill patients and their families to provide
end-of-life care, pain management, and family support are practicing in which role?
a. Hospice
b. Infection control
c. Coordinator
d. Case manager
ANS: A
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Hospice nurses specialize in holistic care for the patient and family and end-of-life care to
maximize quality rather than quantity of years of life.
DIF: Comprehension
REF: pp. 456-457
19.
A nurse explaining the above graph indicates the frequency of falls in 2011 to detect and
possibly explain causes of variation. The peaks in June were attributed to regular staff
vacations during which agency nurses were used. The nurse is employed in which role?
a. Case Manager
b. Quality Manager
c. Forensic Nurse
d. Occupational Health Nurse
ANS: B
The role of the quality manager is to improve quality of care and reduce errors. Knowledge of
quality management tools is essential to the role. The run chart shown above is one such
quality management tool.
DIF: Application
REF: pp. 458-459
20. A new graduate desires a position in labor and delivery; however, no position is available.
What is the best advice for this nurse?
a. Continue to study to keep skills current and wait for desired position.
b. Return to college until a position in labor or delivery opens.
c. Accept another nursing position and transfer into labor and delivery when a
position is available.
d. Practice obstetrical skills in a simulation lab then present evidence of competency
to potential employer.
ANS: C
Entry level positions in labor and delivery may be difficulty to find. Accepting a position in
another area of the hospital will allow the novice nurse an opportunity to improve her skills
and develop clinical decision making as she waits for an open position in labor and delivery.
DIF: Application
REF: p. 455
21. An RN has critical care experience and is proficient in advanced cardiac life support and often
helps to lead “codes” and is an expert clinician with superior health assessment skills.
Enjoying a challenge of a fast-paced environment with autonomy, this nurse would best be
suited for which nursing role?
a. Flight nurse
b. Home health nurse
c. Hospice nurse
d. Occupational health nurse
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ANS: A
An experienced nurse with critical care experience and a desire to practice in a complex
dynamic health care environment requiring clinical decision making would thrive as a flight
nurse.
DIF: Comprehension
REF: p. 459
22. The role of the Clinical Nurse Leader (CNL) would include:
a. diagnosing a patient with pneumonia and prescribing antibiotics.
b. teaching members of a faith community how to avoid skin cancer and referring
those with suspicious lesions.
c. participating in the team who is investigating possible abuse of elderly persons by
members of a gang known to sell illegal drugs.
d. coordinating care of a patient admitted 4 days ago with stage IV heart failure and
chronic bronchitis by revising care plan to include ambulation 50 feet with
assistance.
ANS: D
The CNL is not an advanced practice nurse but is an advanced generalist who provides care
and coordination of care for patients with complex needs and revises care plan to meet desired
outcomes.
DIF: Application
REF: pp. 460-461
MULTIPLE RESPONSE
1. A nurse wants to become an advanced practice nurse and investigates the requirements for a:
(select all that apply)
a. nurse practitioner.
b. nurse executive.
c. certified nurse-midwife.
d. certified registered nurse anesthetist.
ANS: A, C, D
A nurse practitioner is considered an advanced practice nurse. A certified nurse-midwife is
considered an advanced practice nurse. A certified registered nurse anesthetist is considered
an advanced practice nurse.
DIF: Knowledge
REF: pp. 461-462
2. Advanced practice nurses are prepared minimally at the master’s degree level with
prescriptive privileges; these professionals include: (select all that apply)
a. clinical nurse leader.
b. nurse practitioner.
c. nursing administrator.
d. certified nurse-midwife.
e. clinical nurse specialist.
ANS: B, D, E
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A nurse practitioner requires preparation at the master’s degree level. A certified
nurse-midwife requires preparation at the master’s degree level. A clinical nurse specialist
requires preparation at the master’s degree level.
DIF: Knowledge
REF: pp. 461-462
3. What characteristics are associated with the clinical nurse leader? (select all that apply)
a. Is a generalist prepared at the master’s level.
b. Provides care at the bedside for complex patients.
c. Identifies the best resources at the lowest price to achieve best health outcomes for
a client.
d. Serves as care coordinator whose practice is limited to acute care settings.
e. Is an advanced practice nurse with an earned doctorate in nursing.
ANS: A, B
Clinical nurse leaders are prepared as generalists at the master’s level. Clinical nurse leaders
provide care to complex patients, change care plans as needed, and coordinate care to a group
of patients.
DIF: Comprehension
REF: pp. 460-461
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Chapter 27: Job Search: Finding Your Match
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. When should a follow-up letter be written to a recruiter?
a. Before the interview to thank him or her for granting you the interview
b. Approximately 2 weeks after you did not get the job to inquire
c. A few days after the interview
d. When you are sure you got the position
ANS: C
A follow-up letter thanking the recruiter is a courtesy and a reminder of the nurse’s interest in
receiving a timely response.
DIF: Knowledge
REF: p. 472
2. Cover letters:
a. should signify an interest in the employer and let the employer know that you took
time to research the organization.
b. must be handwritten so the employer can determine whether charting will be
legible.
c. should be limited to one paragraph because time is of the essence.
d. let the employer know your desired salary, shift, and area of practice.
ANS: A
The purpose of the cover letter is to show the recruiter that the applicant has an interest in the
facility and that he or she did homework to learn more about the facility.
DIF: Knowledge
REF: p. 471
3. A nurse interested in an entry level position as a registered nurse prepares the cover letter. A
correctly written cover letter might include:
a. “I am interested in a position where community outreach is valued as noted in your
organization’s mission statement.”
b. “I am highly educated and have several degrees including an Associate Degree in
accounting, a certification in word processing, a Bachelor’s degree in journalism,
and a Bachelor’s degree in nursing.”
c. “I am looking for a position that will allow me to develop my skills and still have a
balanced home and work life.”
d. “I am married, a Christian, a single parent, and due to the downturn in the
economy will be willing to work any shift or nursing unit.”
ANS: A
Letting the potential employer know you have researched the organization shows a sincere
interest.
DIF: Application
REF: pp. 471-472
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4. To determine basic competency, the interview for a nursing position may include a test in:
a. pathophysiology.
b. correctly writing nursing diagnoses.
c. pharmacology.
d. computer skills.
ANS: C
Preemployment pharmacology testing is common. Institutions often give a quiz to assess basic
knowledge of routinely administered medications, their purposes, and associated adverse
effects.
DIF: Knowledge
REF: p. 483
5. When the job applicant is asked to identify weaknesses, one appropriate reply for the novice
nurse might be:
a. “I have no weaknesses.”
b. “Are you trying to set me up?”
c. “Delegating to peers.”
d. “Caring requires weakness.”
ANS: C
It is best to be honest about weaknesses the applicant may have. The employer does not
expect the graduate nurse to have only strengths. All nurses can improve in their profession.
DIF: Application
REF: pp. 478-479
6. A valuable tool for determining whether a potential employer is suitable for your career goals
is to:
a. call The Joint Commission (TJC) to ask whether the organization meets required
standards.
b. assess the work climate by walking through the facility.
c. review financial statements of the institution.
d. ask what they can do for you rather than what you can do for them.
ANS: B
By observing the staff when taking a tour of the unit, the applicant can get an accurate feel for
the culture and personality of the nursing unit. The applicant can assess the manager’s
interactions with staff and can see how nurses respond to each challenge.
DIF: Application
REF: p. 479
7. Many nursing professionals have portfolios that include:
a. family pictures.
b. letters of commendation.
c. articles that describe lack of quality in health care.
d. high school achievements.
ANS: B
A portfolio includes letters from supervisors and patients, congratulatory messages from
peers, and evaluations documented by supervisors.
DIF: Knowledge
REF: p. 474
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8. A potential applicant reviews the application process and learns that preemployment physicals
often include:
a. cholesterol screening.
b. pregnancy testing.
c. urine drug screening.
d. vision and hearing tests.
ANS: C
A preemployment physical examination is often required, and this includes routine blood
tests, urine drug screening, and sometimes a chest radiograph.
DIF: Knowledge
REF: p. 483
9. A graduate nurse should begin the job search knowing that:
a. few jobs are available for RNs because of a failing health care economy.
b. it would be more promising to apply to a rural hospital than to an urban hospital.
c. although efforts have been made to reduce expenditures for health care, the need
for RNs remains stable.
d. the demand for nurses to work in acute care hospitals has decreased because most
services are being shifted to outpatient and ambulatory settings.
ANS: C
The nursing shortage has caused institutions to find unique ways to lure nursing graduates to
their place of employment. These include sign-on bonuses, expense-paid weekend visits to the
facility, tuition reimbursement, and low-interest loans. Although health care costs are a
concern, attracting nurses is currently a priority, with little worry about associated costs.
DIF: Comprehension
REF: pp. 468-469
10. While performing a job search, a nurse reviews the list of Magnet hospitals of the American
Nurses Credentialing Center because:
a. these hospitals are able to hold on to revenue gained from patient care.
b. nursing longevity, autonomy, and self-governance are important features of these
institutions.
c. all RNs have a minimum of a master’s degree and are credentialed in the area in
which they provide care.
d. these hospitals have the most up-to-date diagnostic equipment such as magnetic
resonance imagery.
ANS: B
Magnet hospitals demonstrate excellence in areas such as low RN turnover rates, adherence to
standards of nursing care as defined by the American Nurses Association, and mechanisms in
place for staff participation in decision making.
DIF: Comprehension
REF: p. 469
11. According to the Hallmarks of the Professional Nursing Environment, a nurse should ask a
potential employer:
a. how salaries compare with those of larger facilities.
b. what benefits are provided to RNs that are not available to other health care
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providers.
c. what role nurses have in determining the quality of care.
d. how the employer plans to provide long-term economic security to RNs.
ANS: C
The hallmark that suggests the role nurses have in determining the quality of care is noted in
the philosophy of clinical care.
DIF: Comprehension
REF: p. 469
12. A nurse entering the job market wants to be certain that the first position is rewarding and
allows for growth as a registered nurse. According to the Hallmarks of the Professional
Nursing Environment, the nurse should ask:
a. about the philosophy related to clinical care to determine the role of RNs in
deciding outcomes related quality outcomes.
b. if professional development opportunities are supported through paid leave and
tuition reimbursement.
c. how compensation packages compare to others in the same area and nationally.
d. what the projected need for RNs is in the next 5 years and current turnover rate.
ANS: A
The hallmark that suggests the role nurses have in determining the quality of care is noted in
the philosophy of clinical care.
DIF: Application
REF: p. 469
13. A nurse who is applying for a position contacts an expert on writing résumé and cover letters
and is told:
a. to use correction fluid sparingly.
b. that when an error is made, a single line should be used to cross through the
mistake, and initials should be inserted above the error.
c. to limit margins to one half inch so that the page appears full of information.
d. to be concise, limit the resume to a single page.
ANS: D
A resume is an effective, compressed one-page summary of the nurse’s education and
employment history.
DIF: Knowledge
REF: pp. 472-473
14. The appropriate procedure for addressing a cover letter when the applicant is unsure of the
name and title of the person to whom the letter should be addressed is to:
a. address the letter to “To Whom It May Concern.”
b. address the letter to “Nurse Recruiter.”
c. call the facility to inquire about the name and title of the person.
d. leave the salutation blank if the name and the title are unknown.
ANS: C
The letter should be addressed to a specific person. If the person’s name or title is unknown,
refer to a marketing brochure, or call the recruitment office and ask for the correct title and
spelling of the person’s name.
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DIF: Application
REF: p. 471
15. When preparing the education section of a resume:
a. list high school, followed by the first college attended.
b. include all colleges attended, even if a degree was not awarded.
c. omit the address of the university unless requested by the potential employer.
d. list in reverse chronologic order the names, dates, and addresses of universities that
awarded degrees.
ANS: D
Details about education should include degrees and diplomas awarded, names and locations of
schools awarding them, and graduation dates, starting with the most recent graduation and
degree.
DIF: Knowledge
REF: p. 473
16. A new graduate arrives for the first interview feeling prepared and excited about beginning a
nursing career but quickly becomes concerned when the recruiter asks which illegal question?
a. “Have you been convicted of a crime other than a minor traffic violation?”
b. “We are very interested in hiring you but you do understand the position is
contingent on the results of the preemployment physical and background check?”
c. “What do you consider to be your major weaknesses for this particular position?”
d. “Because you are applying for a position in the operating room, you must be able
to be on call. How many children do you have responsibility for at home?”
ANS: D
It is illegal for the recruiter or interviewer to ask number of children or dependents prior to
making a job offer.
DIF: Application
REF: p. 477, Box 27-6
17. A new graduate secures the first interview and wants to work where cultural diversity is
appreciated. The applicant feels that accepting this interview was the right choice when the
recruiter states, “We do not discriminate based on sex, race, or age and practice inclusiveness
of diversity.” Which question would reflect this statement?
a. “Nurses must work a master schedule where one month is Monday through Friday
and the next month is the weekend shift. What is your religious belief about
working on Sunday?”
b. “We offer many benefits for employees such as educational benefits and health
insurance.”
c. “Our mission is to provide patient-centered care that reflects the belief of the
patient and family with an aim to win them over to Western medicine and less
superstition, don’t you agree?”
d. “Do you have any issues with working with patients who are from a disadvantaged
background because we have many people who refuse to work then want free
care?”
ANS: B
Sharing information about employee benefits is not asking about discriminatory issues—it just
informs the applicants of availability.
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DIF: Application
REF: p. 477, Box 27-6
18. Which message would be appropriate to leave on answering systems?
a. “You have reached 910-999-1212. Please leave your name and number and I look
forward to returning your call as soon as possible.”
b. Music that has messages that might be offensive to some callers downloaded as the
response when applicant is unavailable.
c. “Hi, I’m not here. Sorry you missed me. Call again.”
d. “I am interviewing for positions, hope to be home soon. If you are calling about an
interview, please leave your name, number, and possible positions available.”
ANS: A
A professional or appropriate message that lets the person know they have reached the correct
number and that you will return the call as soon as available.
DIF: Application
REF: p. 477
MULTIPLE RESPONSE
1. When preparing a portfolio, the nurse should include: (select all that apply)
a. copies of diplomas awarded by colleges/universities.
b. copies of college transcripts.
c. a personal photograph, if not included with the application.
d. letters of recognition for scoring high on national achievement tests while in
nursing school.
e. a copy of the voter’s registration card.
ANS: A, B, D
Traditional documents, such as copies of diplomas, college transcripts, and recognition letters,
are included in the portfolio.
DIF: Knowledge
REF: pp. 473-474
2. A new graduate nurse is preparing for an interview for her first position and knows that:
(select all that apply)
a. the primary goal for the first job is to complete orientation and should be
considered as an extension of nursing school.
b. appointments for interviews should be scheduled immediately after graduation to
avoid rushing into a position.
c. self-confidence can be improved with self-talk, which reminds the graduate that
peers from her school are effective practitioners.
d. work history of even nonmedical positions can demonstrate commitment and
reliability so letters from these employers should be in portfolio.
e. it is best to arrive 10 to 15 minutes before the scheduled interview dressed for
success.
ANS: C, D, E
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Internal dialogue establishes a means for the graduate to recall achievements that will lead to
success in the first nursing position. Jobs such as cashier at a convenience store or dog-sitting
can demonstrate responsibility such as handing cash or arriving on time. Arriving too early
may cause the recruiter to feel rushed and arriving too late may demonstrate lack of time
management and professionalism.
DIF: Application
REF: p. 476
3. A new graduate is excited about finding the first job but doesn’t want to make the costly
mistake of taking the first job offered or taking a job that doesn’t meet her career goals. She
learns the best way to know the culture of the potential employer is networking with:
a. the executives at the competing agency.
b. alumni that graduated from the same school and work in the area.
c. nurses currently working in the agency.
d. friends or people who have been patients at the agency.
e. nurses who are former employees.
ANS: B, C, D, E
Networking is a valuable way to gain perspective on the work environment and culture of
potential employers. Alumni that graduated from the same school and work in the area would
most likely have your best interests in mind. Nurses working the agency have first-hand
information. It might be best to ask more than one to get unbiased information. Friends or
people who have been patients know the care received and often can determine the nurses’
attitude and pick up clues about the quality of patient contact. Nurses who are former
employees have experienced the culture and can tell you from their perspective about the
work culture and environment, but keep in mind that, if they left involuntarily, their
perspective may be skewed.
DIF: Comprehension
REF: pp. 470-471
4. A new nurse decides to use the Internet to apply for possible positions. How does applying
online compare to applying by more traditional methods? (select all that apply)
a. Regardless of how one applies, it is important to check the resume for correctness.
b. Follow-up with Internet applications is no sooner than 90 days compared to a
1-week follow-up for traditional applications.
c. Researching the mission and philosophy of the agency is not necessary with
Internet searches and applications.
d. The resume and cover letter should be reviewed by someone with excellent skills
in grammar and writing to ensure the first impression is one of professionalism and
attention to detail.
e. Internet applications should include specific questions to be answered prior to
accepting an interview such as pay, shifts available, nurse-patient ratio, and
autonomy of practice.
ANS: A, D
The resume and cover letter must be free of errors regardless if mailed, faxed, presented in
person, or submitted online and both should be one page. The typical recruiter spends little
time reviewing documents, so clarity and conciseness is important.
DIF: Comprehension
REF: pp. 470-471
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5. A nurse preparing a resume for the first position is anxious to demonstrate all achievements,
which included completing a rigorous accelerated program and maintaining a high GPA while
also serving in many community projects and leadership positions. The applicant finds it
impossible to include all the accolades on one page and researches tips for professional cover
letters and resumes and learns:
a. margins should be at least 0.5 inch on all four sides, making conciseness
important.
b. paper should be bright colored to catch the attention of the recruiter.
c. legal size paper may be used when applicants have many accolades or extensive
work history.
d. standardized cover letters present a professional image as opposed to those that
stress the applicant’s perspective too heavily.
e. include in the cover letter that after researching other position, this is the
applicant’s preference.
ANS: A, E
Ample margins—minimum of 0.5 inch (1 inch preferred)—should be used on all four sides to
prevent appearing cluttered. A statement declaring this position is one’s first choice should be
included.
DIF: Comprehension
REF: pp. 472-473
COMPLETION
1. The key to a successful interview is being ____________.
ANS:
prepared
Being prepared is the best way to feel confident about the interview and to be ready for
questions that the interviewer may ask. Rehearsing potential questions will ease the
applicant’s fears about how he or she should answer these questions. Dressing appropriately
and arriving on time are behaviors that take preparation; these steps, if done well, will help the
applicant do well during the interview.
DIF: Knowledge
REF: p. 476
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quiz
s
113/19
Chapter 28: The NCLEX-RN® Examination
Cherry & Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. Graduates from approved schools of nursing cannot sign their charting as registered nurses
(RNs) until they:
a. pass the National Council Licensure Examination for Registered Nurses
(NCLEX-RN®).
b. provide evidence of mental competency.
c. supply written proof of physical fitness.
d. have signed an employment contract with a health care facility.
:
ANS: A
A compulsory license requirement must be met to legally practice or work as a registered
nurse in any state or U.S. territory. Licenses are granted only after an applicant has
successfully passed the NCLEX-RN examination.
DIF: Comprehension
REF: p. 486
2. Which statement concerning the National Council Licensure Examination for Registered
Nurses (NCLEX-RN) examination is correct?
a. Graduates from all three types of nursing programs (diploma, associate degree, and
baccalaureate degree) take the same examination.
b. The examination is scored on an interval scale rather than on a pass-fail basis.
c. The examination is offered twice a year in major urban areas.
d. The candidate has the option of choosing a pencil-and-paper format.
ANS: A
The purpose of the NCLEX-RN examination is to determine safe practice and the ability of
candidates to perform at the entry level. Candidates from all three types of nursing programs
must demonstrate the same competencies.
DIF: Knowledge
REF: p. 487
3. Computerized adaptive testing implies that:
a. the candidate must be computer literate.
b. competency is determined on the basis of difficulty of questions, knowledge of the
O
nursing process, and the number of questions answered correctly.
c. testing facilities have been adapted for the physically challenged candidate.
d. questions cannot be adapted to the needs of the student.
ANS: B
Computerized adaptive testing is based on the measurement theory, by which the candidate
must prove with a score of 95% that he or she is safe and knowledgeable at entry into the
practice level.
DIF: Comprehension
REF: pp. 487-488
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4. On the National Council Licensure Examination for Registered Nurses (NCLEX-RN)
examination, when the candidate is asked to set goals in collaboration with other members of
the health care team, the nurse is being tested in the area of:
a. assessment.
b.
0 planning.
c. analysis.
d. implementation.
ANS: B
Setting goals is one of the first steps in the planning process.
DIF: Application
REF: p. 493
5. The length of the National Council Licensure Examination for Registered Nurses
(NCLEX-RN) examination is based on the:
a. last four numbers of the candidate’s social security number.
b. location of testing.
c. candidate’s educational preparation.
d. performance of the candidate.
:
ANS: D
The length of the examination is based on the ability of candidates to provide 95% confidence
that they are safe practitioners and have acquired a minimal level of knowledge about the
nursing process. The length of the examination ranges from 75 to 265 questions, and it takes
up to 6 hours to complete.
DIF: Application
REF: pp. 487-488
6. The primary purpose of the National Council Licensure Examination for Registered Nurses
(NCLEX-RN) examination is to:
a. ensure that practitioners have the minimum skills and knowledge needed to
provide care that will produce the best patient care outcomes.
b. regulate nursing education.
c. determine the mandatory educational level required for nurses to practice.
d. accredit schools of nursing.
ANS: A
The purpose of the NCLEX-RN examination is twofold: (1) to safeguard the public from
unsafe practitioners and (2) to determine whether candidates can perform entry level skills.
DIF: Comprehension
REF: p. 487
7. A student nurse who is preparing to graduate and take the licensure examination asks, “What
is compulsory licensure?” The appropriate response of the nursing advisor is which of the
following?
a. All candidates wishing to take the licensure examination must pass a drug screen.
b. Candidates must not have a felony conviction.
c. To practice as an RN, the nurse must be licensed as an RN.
O
d. An impaired nurse must sign a legal document to acknowledge limitations on his
or her practice.
ANS: C
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Licensure is a prerequisite for practice to ensure public safety.
DIF: Knowledge
REF: p. 486
8. The National Council of State Boards of Nursing determines acceptable National Council
Licensure Examination for Registered Nurses (NCLEX-RN) examination questions on the
basis of:
a. the geographic location of the candidate.
b. research that indicates needed skills for positions in which most entry level nurses
are employed.
c. surveys conducted by employers to determine the weaknesses of entry level
nurses.
d. surveys of physicians performed to determine what nurses must know to provide
safe care.
ANS: B
Periodically, the National Council of State Boards of Nursing surveys health care providers to
identify nursing care activities of entry level nurses.
DIF: Comprehension
REF: p. 487
9. Although the NCLEX-RN examination has new formats for questions, the most common
format is the:
a. fill-in-the-blank item because candidates are not provided with clues from
distracters.
b. multiple-choice question item, which allows candidates to select the one correct
answer.
c. multiple-response item because these questions require a higher level of critical
thinking.
d. hot-spot item because these questions are written at the application level of
Bloom’s analysis.
:O
ANS: B
Most NCLEX-RN examination questions have three distracters and one correct answer, but
the examination allows all four levels of Bloom’s taxonomy to be tested.
DIF: Knowledge
REF: pp. 488-489
10. When delegating care, the RN assigns one nurse to care for a patient with shingles and a
different nurse to care for a patient with human immunodeficiency virus/acquired
immunodeficiency disease syndrome (HIV/AIDS). This represents which category of nursing
care?
a. Safe and effective care environment
b. Health promotion and maintenance
c. Psychosocial integrity
d. Teaching/learning
ANS: A
The nurse is safeguarding the patient with immunosuppression from the possible transmission
of an infection.
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DIF: Analysis
REF: p. 492
11. A patient is brought to the unit with mediastinal chest tubes with no fluctuation in the water
seal chamber; arterial blood gas results reveal pH, 7.55; CO2, 55; HCO, 28 mEq/L, and O2,
98%. Carotid artery pulsation is visible with the head of the bed elevated and the use of
tangential lighting. The first action of the nurse is to:
The above question represents which level of Bloom’s taxonomy?
a. Knowledge
that
is
data
the
b. Comprehension
Analyze
c. Application
d. Analysis
O
given
.
ANS: D
In analysis, the candidate must make a judgment call after determining relationships among
data.
DIF: Application
REF: p. 491
12. A candidate who is taking the NCLEX-RN examination received only 75 questions before the
test was stopped. She called her professor and stated, “I passed. I had to answer only 75
questions.” The professor correctly responds by saying:
a. “You are now officially licensed; you answered the more difficult questions
correctly.”
b. “It is possible to receive only 75 questions and not be successful; however, we will
O
keep a positive attitude.”
c. “If you were given only 75 questions, you will have to retest because this is not
enough to determine competency.”
d. “You must have been extremely close to the passing standard because the
computer shut off.”
ANS: B
Seventy-five questions is the minimum number of questions that can determine 95%
competency of the candidate; however, receiving 75 questions can indicate that the candidate
passed and was able to answer a broad range of questions covering the nursing process at
higher cognitive levels, or it can mean that the candidate failed, answered even the lowest
cognitive level questions incorrectly, and was unprepared in area/s of the nursing process.
DIF: Application
REF: pp. 487-488
13. On the basis of changes effective with the April 2010 test plan, candidates who take the
NCLEX-RN examination:
a. will have to answer more than 75 questions to be 95% certain that they are above
the passing standard.
b. will be required to submit a 100-word essay on an important nursing topic to
evaluate safe nursing practice.
Oc. should study and take practice examinations written at the application and analysis
level to ensure that they can meet the higher standards of nursing care and health
care delivery.
d. will have additional time to complete the examination because most questions will
be prepared in the alternate format, thereby requiring critical thinking.
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ANS: C
In April 2007, the difficulty of the examination was increased, which would require higher
cognitive level questions at the application and analysis level.
DIF: Application
REF: p. 490
14. In the National Council Licensure Examination for Registered Nurses (NCLEX-RN)
examination test plan, client needs form the organizing framework of the examination with
questions in four categories: safe and effective care environment, health promotion and
maintenance, psychosocial integrity, andephysiologic integrity. Certain processes are then
integrated throughout the categories of client needs. Which process is integrated into all client
need categories?
O
a. Teaching/learning
b. Health promotion
c. Infection control
d. Pharmacology
-
-
ANS: A
Teaching and learning are the processes that are integrated, along with the nursing process,
caring, communication, and documentation.
DIF: Comprehension
REF: p. 492
15. Which action would help a student successfully prepare for the National Council Licensure
Examination for Registered Nurses (NCLEX-RN) examination?
a. Make note cards that can easily be retrieved to list only facts.
b. Avoid timing oneself while studying and when in the actual testing mode to
decrease anxiety.
c. Ask peers for help because they had the same resources; especially seek their help
for difficult concepts requiring critical thinking.
d. Practice taking NCLEX-RN examination–type questions and reviewing rationales
for correct and incorrect answers.
ANS: D
Practicing helps the student learn how questions are presented and what level of difficulty
should be anticipated. Reviewing rationales for the answers is a teaching/learning opportunity
that enables the student to judge whether the rationale used to answer the question is valid.
:
DIF: Application
REF: p. 495
16. The nurse prepares to apply sterile gloves needed for a procedure. After introducing self and
verifying patient information, the nurse performs hand hygiene. The nurse should open the
outer package and then perform the following steps in order: (items on left will be moved in
correct order on the right)
Open inner package, taking care not to touch inner surface.
Put the glove on the nondominant hand using the sterile gloved hand.
Put glove on dominant hand by grasping folded cuff edge, touching only inside of cuff.
Adjust each glove carefully by sliding finders under the cuffs.
The above question represents which type of alternate-format question written at which level
of Bloom’s taxonomy?
a. Drag-and-drop item, comprehension
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b. Chart/exhibit item, analysis
c. Multiple-response, application
d. Hot-spot item, knowledge
ANS: A
The drag-and-drop format questions require the candidate to place options in a specific order,
moving them from left to right using the mouse. The level is comprehension because it
requires the student to have a fundamental level of understanding and summarize the material.
DIF: Analysis
REF: pp. 489-490
17. A graduate is preparing for the National Council Licensure Examination for Registered
Nurses (NCLEX-RN) examination. Based on the latest practice survey, the candidate would
focus the most amount of time on which content?
a. Stages of grief
0 Pharmacologic pain management
b.
c. Practices to promote rest and sleep
d. Prioritization of workload to manage time effectively
ANS: B
The current NLN test blueprint indicates that pharmacologic and parental therapies account
for between 12% and 18% of the examination.
DIF: Application
REF: p. 492
18. Which strategy would promote a high rate of success on the National Council Licensure
Examination for Registered Nurses (NCLEX-RN) examination?
a. Since the examination is time limited, skip questions when unsure of the answer
and return later if time permits.
b. Work quickly through the examination to answer as many questions as possible.
c. Mark questions that may need to have the answer reviewed to make it possible to
quickly go back and make change after answering all questions.
d. Read the entire question and all possible answer options before selecting an
answer.
:
ANS: D
Candidates should carefully read the entire question and all answers before making a
selection.
DIF: Comprehension
REF: p. 488
19. A candidate is taking the NCLEX-RN examination when the computer turns off. The
candidate was aware they had reached the 6-hour time limit. A count of completed questions
had been recorded on the note pad, and 100 questions were answered. How will the
examination be scored?
a. The computer will analyze the last 60 questions and if above the passing standard,
the candidate passes.
b. The candidate will be administered an additional 50 questions to determine ability
to reach the 95% confidence interval.
c. If the time runs out, the candidate automatically fails the examination because it is
impossible to determine if candidate is safe.
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d. The candidate has the option to complete a simulated examination to show
competence.
ANS: A
Run-out-of-time rule: if the candidate has answered the minimum number of questions, the
computer analyzes the last 60 questions to determine if these questions were above or below
the passing standard.
DIF: Comprehension
REF: p. 488
20.
The order reads: Administer 500 mg of Kefzol (cefazolin sodium) Intramuscular. Using
information located on the medication vial above, the nurse will administer how many mL?
The above question represents which type of alternate-format question written at which level
of Bloom’s taxonomy?
a. Multiple-response item, comprehension level
b. Hot-spot item, application level
0c. Chart/exhibit item, analysis level
d. Drag-and-drop item, knowledge level
ANS: C
The chart/exhibit presents the candidate with a chart or exhibit with information needed to
answer the question. The question is at the analysis level since the candidate must calculate
the correct amount to be given using a label requiring dilution.
DIF: Application
REF: pp. 490-491
21. “A patient with end-stage renal disease has a potassium level of 7.5 mEq/L. Based on this
laboratory result, the nurse interprets which symptom as significant prompting which action?
°a. Drowsiness, stimulate the patient every 30 minutes
b. Confusion, ask the patient to state their name and date of birth
c. Irregular heartbeat, evaluate the patient’s capillary refill
d. Muscle cramps, elevate the affected limb”
gesso
ANS: A
It is important to remember that candidates have specified laboratory values for which they
must know the normal range and clinical manifestations when values are high, low, or critical.
This question addresses an alteration in body system homeostasis. The student must know the
normal lab value for potassium and common symptoms, as well as the correct nursing action.
DIF: Analysis
REF: p. 491
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22.
A patient presents with chest pain that increases when lying flat and low-grade fever.
Assessment reveals muffled heart sounds, tachycardia, and 3+ edema in the lower extremities.
The nurse asks the patient to learn forward, which eases respiratory efforts. The nurse then
places the stethoscope at which area on the chest to facilitate auscultation?
The above question represents which type of alternate-format question written at which level
of Bloom’s taxonomy?
a. Multiple-response item, comprehension level
b. Hot-spot item, analysis level
c. Chart/exhibit item, application level
d. Drag-and-drop item, knowledge level
:
ANS: B
This is a hot-spot item; students are presented with a figure on which they must indicate the
answer by clicking the mouse over the area. The student would place the mouse over the left
sternal border. It is analysis level because the student must take data from many sources to
provide a complete assessment of the patient’s condition.
DIF: Analysis
REF: p. 489
OTHER
1. The nurse prepares to apply sterile gloves needed for a procedure. After introducing self and
verifying patient information, the nurse performs hand hygiene. The nurse should open the
outer package and then perform steps in which order. Put a comma and space between each
answer choice (e.g., a, b, c, d).
a. Open inner package, taking care not to touch inner surface.
b. Put the glove on the nondominant hand using the sterile gloved hand.
c. Put glove on dominant hand by grasping folded cuff edge, touching only inside of cuff.
d. Adjust each glove carefully by sliding finders under the cuff.
ANS:
A, C, B, D
The nurse should open the inner package first, then put the glove on the dominant hand before
the nondominant hand before adjusting the gloves.
DIF: Application
REF: pp. 489-490
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