Chapter: Chapter 1: Exploring the Growth of Nursing as a Profession
Multiple Choice
1. Which of the following statements most accurately describes the
practice of medicine in Greece from 800 BC to 300 BC?
A) Greek culture stressed natural causes for disease, a patient-centered
approach, and the necessity of accurate observations and record keeping.
B) Greek culture borrowed medical practices from the countries it
conquered, and physicians were often slaves.
C) Major and minor surgery, childrens diseases, and diseases of the
nervous and urinary systems were described in Greek culture.
D) Medicine men (known first as shamans and later as priests) were
responsible for curing ills of body and mind.
Ans: A
Client Needs: B
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Feedback: Hippocrates, born about 400 BC, was a Greek citizen who
became known as the Father of Modern Medicine. He emphasized natural
causes for disease, a patient-centered approach, and the necessity of
accurate observations and record keeping. These priorities influenced the
practice of medicine both in Greece and beyond. Persia was known to
utilize slaves as physicians, and Rome borrowed medical practices from
the countries it conquered. Ancient India emphasized hygiene and
prevention of sickness and described major and minor surgery, childrens
diseases, and diseases of the nervous and urinary systems. Medicine men
were characteristic of the Mayan and Aztec civilizations.
2. Florence Nightingale fostered the development of nursing as a
profession. What was the basis of her nursing theory?
A) The nurses role is to assist individuals (sick or well) to carry out those
activities that they would perform unaided if they had the necessary
strength, will, or knowledge.
B) The goal of nursing is to put the patient in the best condition for nature
to act upon him, primarily by altering the environment.
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C) The focus of nursing is the spiritual subjective aspects of both the nurse
and the patient and the caring moment relating to the time when the nurse
and the patient first come together.
D) The focus of nursing is the care of human beings who are viewed as
open systems in constant interaction with their environments.
Ans: B
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 2
Feedback: Florence Nightingale, in her Notes on Nursing: What It Is and
What It Is Not, described the nurses role as one that would put the patient
in the best condition for nature to act upon him (Nightingale, 1954, p. 133),
a definition that often is quoted today. This action was prioritized over
physically assisting the patient. Watson emphasized the spiritual
subjective aspects of the nurse and the patient, and the open systems
concept is central to Kings theory of nursing.
3. Which one of the following statements accurately describes an element
of the process of providing a definition of nursing?
A) Researchers can pinpoint the period in history when nursing first
evolved.
B) Nurses agree on a single definition of nursing, partly because of the
history of nursing.
C) There is an obvious distinction between nursing and medicine.
D) Nursing theorists developed definitions of nursing consistent with their
conceptual frameworks.
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 7, 8
Feedback: As nursing has grown into a true profession, many nursing
theorists have developed definitions of nursing consistent with their
conceptual frameworks; these frameworks provide the foundation for any
given definition of nursing. The historical emergence of nursing did not
take place at one particular time, and there are multiple definitions of
nursing. While nursing and medicine indeed differ, the distinctions
between the two professions are not always clear.
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4. A nurse wishes to document nursing actions using a standardized
language. Which of the following systems might the nurse use?
A) NANDA International (NANDA-I)
B) Nursing Outcomes Classification (NOC)
C) Minimum Data Set for Nursing Home Resident Assessment and Care
Screening (MDS)
D) Nursing Interventions Classification (NIC)
Ans: D
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 12
Nursing Interventions Classification
Feedback: Started in 1996 at the University of Iowa, the Nursing
Interventions Classification (NIC) is a comprehensive, standardized
language that describes actions that nurses perform in all settings and in
all specialties and includes both physiologic and psychosocial
interventions. NANDA and NOC provide standardized language for nursing
diagnoses and outcomes. The MDS is an assessment tool specific to longterm care settings.
5. An RN who practices in a community clinic recognizes the need for a
standardized classification and documentation system. Which of the
following systems of nursing care classification and documentation would
best fit the RNs needs?
A) NANDA International (NANDA-I)
B) Nursing Outcomes Classification (NOC)
C) The Omaha System
D) Patient Care Data Set (PCDS)
Ans: C
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 13
,The Omaha System
Feedback: The Omaha System is a research-based comprehensive practice
documentation standardized taxonomy designed to document client care
from admission to discharge. It was designed as a three-part,
comprehensive yet brief approach to documentation and information
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management for multidisciplinary healthcare professionals who practice
in community settings. NANDA and NOC provide frameworks only for
nursing diagnoses and outcomes, while the PCDS is specific to hospital
settings.
6. The number and size of nursing schools in the United States grew
significantly in the years of the early 20th century. Which of the following
characteristics was emphasized in these schools?
A) A thorough knowledge of anatomy, physiology, and epidemiology
B) Critical thinking, assertiveness, and autonomy
C) An understanding of the relationship among mind, body, and spirit
D) Religious devotion and subservience to authority
Ans: D
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 3
Characteristics of the Early Schools
Feedback: In early nursing schools, the nurse in training was expected to
yield to her superiors and demonstrate the obedience characteristics of a
good soldier with actions governed by the dedication to duty derived from
religious devotion. These expectations superseded the importance of
critical thinking, scientific knowledge, or the holistic nature of health.
7. Florence Nightingale is acknowledged as one of the individuals who
contributed most significantly to the development of nursing as a
profession. What other phenomenon contributed most to this
development?
A) Labor-saving technology that freed many women from working in the
home
B) The social recognition of the importance of public funding for the
treatment of disease
C) Increased understanding of the pathophysiology of illness and the
importance of infection control
D) The high mortality rates that existed during times of war
Ans: D
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
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The Nightingale Influence
Feedback: The death and disease that accompanied conflicts such as the
Crimean War and the Civil War provided the impetus for much of the
development of the nursing profession. Nursing did not primarily grow out
of the availability of a female workforce, public funding for health, or
increased scientific knowledge.
8. Nurses have historically had difficulty identifying a single,
comprehensive definition of nursing. What factor most accounts for this
difficulty in agreeing on a definition for nursing?
A) It can be challenging to reconcile the theoretical and practical aspects of
nursing.
B) Nursing exists in the psychomotor (hands-on) domain rather than in the
cognitive domain.
C) Compared with medicine, nursing has a relatively short history.
D) Nurses have traditionally been reluctant to acknowledge the outcomes
of their practice.
Ans: A
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Developing a Definition for Nursing
Feedback: A major factor that has made it difficult to define nursing is that
it is taught as encompassing both theoretic and practical aspects, but it is
pursued (and continues to be defined) primarily through practice, until
recently a little-studied area. Nursing spans psychomotor and cognitive
domains, and it has a very long history. Nurses have often failed to
document and publish the results of their practice, but there is no
indication that nurses tended not to acknowledge their influence on health.
9. One of the challenges that nurses have faced in the past, and which
continues to the present, is the need to distinguish the practice of nursing
from that of medicine. Which of the following statements best conveys a
defining characteristic of nursing?
A) Education within a formal, credential-granting setting
B) An emphasis on objective, rather than subjective, health assessment
C) A holistic perspective on the health of individuals
D) A recognition that health is not always attainable for all individuals
Ans: C
Client Needs: A-1
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Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 6
Distinguishing Nursing from Medicine
Feedback: Nursing is concerned with caring for the person from a holistic
perspective in a variety of health-related situations. Both nursing and
medicine are taught in formal educational settings, though these settings
differ. Nursing does not denigrate subjective health assessment nor does it
claim that health is unattainable for some individuals.
10. Society has sometimes questioned whether nursing can be considered
to be a true profession and whether nurses can be considered to be
professionals. What characteristic of nursing is among the characteristics
that social scientists use to define a profession?
A) The median annual nursing wage is greater than $45,000.
B) Nurses use the scientific method to enhance their body of knowledge.
C) Nurses can be held legally accountable for their actions.
D) Nursing has a demonstrated commitment to the well-being of the
public.
Ans: B
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 7
Table 1.8
Feedback: Social scientists have identified seven criteria for a profession,
including the use of the scientific method to enhance knowledge. Earnings
and commitment to the public are not among the defining characteristics
of a profession. Autonomy and accountability are criteria that are used to
define a profession, but legal accountability for actions is not restricted to
professionals.
11. Among the traditions that exist in nursing education is a passing of the
lamp ceremony that is sometimes conducted during graduation. This
ceremony communicates
A) the light that nursing provides in communities and society.
B) an acknowledgment of the contributions made by important nurses in
history.
C) the continuity of care from practicing nurses to newly graduated nurses.
D) the need to continually build the nurses base of knowledge.
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Ans: C
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 9
Ceremonies Associated with Nursing Programs
Feedback: Some schools use the tradition of a passing of the lamp. A
representative of the graduating class hands a lamp to a representative of
the next graduating class, thus reinforcing the concept of the continual
caring represented in nursing. This ceremony does not primarily
emphasize the light of the profession, the contribution of nurses in history
(though the lamp symbolizes the lamp carried by Florence Nightingale), or
the need to add to existing knowledge.
12. A nurse who provides care on a medical unit at a community hospital
is concerned about negative portrayals of nurses in the media. Why should
this nurse be concerned with the image of nurses and nursing?
A) A negative image of nursing can dissuade potential nurses from
entering the profession.
B) A negative image of nursing reduces patients adherence to treatment
regimens.
C) A negative image of nursing interferes with professional accountability
in hospital settings.
D) A negative image of nursing reduces the development of nursing
knowledge.
Ans: A
Client Needs: C
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 10
The Image of Nursing Today
Feedback: Negative attitudes about nursing may discourage many capable
prospective nurses, who will choose another career that offers greater
appeal in stature, status, and salary. The image of nursing is not noted to
influence patient adherence to treatment or accountability. A negative
image may indirectly limit nursing knowledge through reduced funding for
research, but this phenomenon is less pronounced than the effect on
potential nurses.
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13. Megan, a 21-year-old junior college student, has been frustrated by her
unsuccessful attempts to gain entry to the nursing program at the local
university despite her strong academic record and work experience.
Which of the following factors has most contributed to the limited number
of seats available in many nursing programs?
A) Technological developments that have decreased the projected need for
nurses
B) The tendency of practicing nurses to delay retirement until after the age
of 65 years
C) The high cost to educational institutions of providing nursing education
D) The negative image of nursing in the media and popular culture
Ans: C
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 10
Page and Header: Nursings Image and the Nursing Shortage
Feedback: A factor affecting the nursing supply is the limited number of
spaces in nursing programs. Because nursing education is costly, many
educational institutions have not been able to increase the size of their
programs in the past decade. This trend is not attributable to technological
change, increased length of service, or the negative image of nursing.
14. Mrs. Jimenez is a 28-year-old pregnant woman who is in labor. Due to
the fact that her labor was progressing very slowly, she was started on an
infusion of oxytocin, a drug used to increase the progression of her labor.
In the planning of Mrs. Jimenezs care, the nurse has documented a Risk of
Fluid Volume Excess in light of this common adverse effect of oxytocin. The
nurse has demonstrated the use of what nursing classification system?
A) The Minimum Data Set (MDS)
B) Nursing Outcomes Classification (NOC)
C) Nursing Interventions Classification (NIC)
D) NANDA International (NANDA-I)
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 12
NANDA International
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Feedback: Risk of Fluid Volume Excess is an example of a nursing
diagnosis, which is the focus of NANDA-I. This does not denote an
intervention or desired outcome. The MDS is an assessment tool specific to
long-term care settings.
15. During the years of the 20th century, there was exponential growth in
the number and quality of research studies that were conducted about
nurses and nursing. What factor provided the original motivation for these
studies?
A) The entry of larger number of men into nursing schools and the nursing
profession
B) A desire to lessen the knowledge gap between nurses and physicians
C) The low quality of nursing schools and nursing graduates
D) Allocation of federal and state funding for nursing research
Ans: C
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 11
Studies for and About Nursing
Feedback: In the early 20th century, nurses, doctors, friends, and critics of
nursing became concerned that the preparation being offered was
inadequate. Before the problem could be corrected, it was necessary to
learn more about the programs and how nurses were being used in the
employment market. To accomplish this, studies about nursing and nurses
were initiated. These studies did not primarily result from increased
funding opportunities, the entry of men into the profession, or the
knowledge gap between doctors and nurses.
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Chapter: Chapter 2: Educational Preparation for Nursing
Multiple Choice
1. Manuel has a baccalaureate degree in biology and wishes to make a
career change to eventually become an advanced practice RN. Which of the
following courses of study would be the most time-efficient choice to meet
his educational goals?
A) Masters degree in nursing
B) Baccalaureate degree in nursing
C) Doctoral degree in nursing
D) Associate degree in nursing
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Characteristics of Associate Degree Education
Feedback: Students may be admitted to masters programs in nursing with
a baccalaureate degree in another discipline and are granted a masters
degree in nursing after completing an established 2-year program of study
that prepares them for RN licensure. However, people who already possess
baccalaureate or higher degrees in other fields sometimes seek admission
to an associate degree program, often because it can be completed in a
shorter period of time than would be needed to earn another
baccalaureate degree (though accelerated baccalaureate programs are
becoming more common).
2. Which nursing report recommended that nursing education move away
from the system of apprenticeship that predominated at the time and
move toward a planned program of education similar to that offered by
other professions?
A) The Surgeon Generals Consultant Group Report on Nursing
B) The Brown Report
C) The American Nurses Association Position Paper
D) The Pew Health Profession Commission Study
Ans: B
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
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The Brown Report
Feedback: In Nursing for the Future, Brown (1948) recommended that
nursing education move away from the system of apprenticeship that
predominated at the time and move toward a planned program of
education similar to that offered by other professions. This predated the
Surgeon Generals Consultant Group Report on Nursing, the American
Nurses Association Position Paper, and the Pew Health Profession
Commission Study.
3. Which of the following accurately states a major position of the ANA
Position Paper on Educational Preparation?
A) The education of those who are licensed to practice nursing should take
place in hospitals.
B) Minimum preparation for beginning professional nursing practice at the
present time should be an associate degree in nursing.
C) Minimum preparation for beginning technical nursing practice at the
present time should be a baccalaureate degree in nursing.
D) Education for assistants in health service occupations should be short,
intensive preservice programs in vocational educational institutions.
Ans: D
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Display 2.2
Feedback: One of the four major positions of the ANA Position Paper on
Educational Preparation is that education for assistants in the health
service occupations should be short, intensive preservice programs in
vocational education institutions, rather than on-the-job training
programs. It also states that the education of all those who are licensed to
practice nursing should take place in institutions of higher education, not
in hospitals. The paper specifies an associate degree as the minimum for
technical nursing and a baccalaureate degree for professional nursing.
4. Sister Calista Roy identified an adaptation model that characterizes the
individual as being in constant interaction with a changing environment,
therefore requiring adaptation. Which of the following identifies an
adaptive mode listed in her theory?
A) Role function
B) Nutrition
C) Spirituality
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D) Genetic makeup
Ans: A
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 9
Feedback: Roy identifies four adaptive modes, or ways in which a person
adapts through: (1) physiologic needs, (2) self-concept, (3) role function,
and (4) interdependence relations. Nutrition, spirituality, and genetic
makeup are not discrete concepts within this theory.
5. Mr. Van is a 79-year-old widower who is being transferred to a longterm facility following hip replacement surgery. The nurse in charge of his
care hopes to provide holistic nursing care for him based on his response
to the interaction between his internal and external environment. This
approach represents the model of care proposed by which of the following
theorists?
A) Dorothy Johnson
B) Madeleine Leininger
C) Dorothea Orem
D) Myra Levine
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 9
Feedback: Levine supports a holistic approach to nursing based on
recognition of the total response of the person to the interaction between
the internal and the external environment. This approach is not specified
by Johnson, Leininger, or Orem.
Multiple Selection
6. A college sophomore has become disillusioned with her current field of
studies and has begun exploring careers in nursing. To her surprise, she is
unable to identify any hospital-based programs of study in her home state.
Which of the following factors have contributed to the demise of hospitalbased diploma programs? (Select all that apply.)
A) Increased patient acuity in hospitals
B) Increased popularity of college- and university-based nursing programs
C) The growth of managed care and its influence on hospital management
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D) Increased costs to hospitals for maintaining nursing programs
E) The emergence of the baccalaureate degree as the entry to technical
nursing practice
Ans: B, D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Hospital-Based Programs Today
Feedback: The elimination of hospital-based programs occurred because
hospitals could not sustain the costs of supporting the programs and
because students became more attracted to programs located in colleges
and universities. Patient acuity and managed care have not been identified
as causative factors. The baccalaureate degree has been proposed as the
entry to professional nursing practice, not technical nursing.
Multiple Choice
7. Kirsten is a 22-year-old woman who has just been granted admission to
an associate degree program at a local college. During her course of study,
Kirsten should expect to complete
A) the National Council Licensure Examination (NCLEX).
B) a preceptorship under the direction of a licensed practical (vocational)
nurse.
C) a major, original research project immediately prior to graduation.
D) numerous nonnursing courses in a variety of disciplines.
Ans: A
Client Needs: A-1
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 1
Characteristics of Associate Degree Education
Feedback: In a typical ADN program, approximately 40% of the credits
needed for the associate degree must be fulfilled by general education
courses such as English, anatomy, physiology, speech, psychology, and
sociology; the rest are to be fulfilled by nursing courses. Original research
is not a component of undergraduate nursing education, and
preceptorships are normally completely under the direction of an RN. The
NCLEX is written after graduation.
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8. Ben is a 30-year-old man who has applied for an accelerated
baccalaureate program at a university because the 15-month program of
study will allow him to accommodate his family and financial
responsibilities. In order to be granted admission, what will Ben most
likely require?
A) A varied work history that demonstrates initiative and responsibility
B) A baccalaureate degree in another field
C) A mentor or sponsor within the nursing field
D) Volunteer experience in a health-related setting
Ans: B
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Accelerated Programs
Feedback: Building on previous learning experiences, accelerated
programs are designed to transition adults with baccalaureate and
graduate degrees in other fields into nursing. A strong work history,
volunteer experience, and an available mentor in the field are all assets for
success, but these are less likely to be absolutely required for admission.
9. Julia has just graduated with her Bachelor of Science in Nursing degree
from her state university and has begun seeking employment. However,
she is anxious about her level of clinical competence due to the fact that
she completed far fewer clinical hours than many practicing nurses. Which
of the following has the potential to ease Julias transition to practice?
A) Completing a residency or internship at the hospital where she will be
employed
B) Auditing courses in a nonnursing, health-related discipline
C) Working for several months as a nursing assistant in order to gain
confidence
D) Taking online courses in advanced nursing practice
Ans: A
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Residencies and Structured Orientation for the New Graduate
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Feedback: Internships and residencies for new graduates have been
instituted by hospitals to ease the transition from the role of student to
that of staff by providing the opportunity to increase clinical skills and
knowledge as well as self-confidence. Taking more academic courses
and/or working as a nursing assistant are unlikely to increase Julias
confidence and competence in her clinical nursing role.
10. According to the ANA Position Paper on Educational Preparation,
which of the following four individuals is adequately prepared to provide
care?
A) A nursing assistant who has just completed an on-the-job training
program in a local hospital
B) A nurse who graduated from a hospital-based diploma program
C) A nurse in a high-acuity setting who possesses an associate degree in
nursing (ADN) degree
D) A nursing assistant who graduated from the training program at a
community college
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Display 2.2
Feedback: The ANA Position Paper specifies that education for assistants
in the health service occupations should be short, intensive preservice
programs in vocational education institutions, rather than on-the-job
training programs. The Paper also specifies a minimum of an ADN degree
for all nursing practice and a baccalaureate degree for professional nursing
(e.g., in high-acuity settings).
11. Nurse. L. provides care in a state that has mandatory continuing
education requirements for nurses. What are the consequences of this
policy for Nurse L.?
A) Nurse L. must demonstrate a commitment to making practice
improvements.
B) Nurse L. must have a baccalaureate degree in order to provide
professional nursing care.
C) Nurse L. is obliged to update her diploma to an associate degree.
D) Nurse L. must demonstrate continuing education for license renewal.
Ans: D
Client Needs: A-1
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Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 6
Continuing Education
Feedback: Mandatory continuing education affects licensure, meaning that
any nurse renewing a license in a state requiring (mandating) continuing
education will have to satisfy that requirement. However, this does not
necessarily mean that a nurse must update his or her degree or diploma or
undertake practice improvements.
12. The administrators of a large, university hospital have expressed a
commitment to differentiated nursing practice. Which of the following
most clearly exemplifies differentiated practice?
A) Each nurse performs a role that is commensurate with his or her
education and experience level.
B) Each nurse in the hospital is expected to provide competent care in a
variety of different settings.
C) Nurses demonstrate evidence of continuing education in two or more
different specialties.
D) Each nurse in the hospital possesses an ADN or baccalaureate degree in
nursing.
Ans: A
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 7
Differentiated Practice
Feedback: Differentiated nursing practice can be defined as the practice of
structuring nursing roles on the basis of education, experience, and
competence. It does not necessarily specify the provision of care in diverse
settings, evidence of continuing education, or the possession of a nursing
degree.
13. A nurse manager who oversees the provision of community-based care
to a large number of clients has been mandated to implement
differentiated care over the next year. In order to carry out this directive,
the nurse manager must be able to
A) teach each nurse to become a generalist rather than a specialist.
B) identify the evidence that underlies the nursing care that is provided.
C) clearly identify the specific roles and tasks that these nurses perform.
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D) hire more licensed practical (vocational) nurses.
Ans: C
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 7
Differentiated Practice
Feedback: Differentiated practice requires that the specific roles that are
performed in the provision of care be clearly identified and delineated.
This is necessary in order to appropriately match individual care providers
to particular tasks and functions. Nurses do not need to become
generalists nor are more practical nurses necessarily required. Evidence
underlying nursing care should be identified, but this is not necessary for
differentiated care.
14. Pressure from students and the healthcare industry has prompted the
nursing educators at a college to implement new technology into the
nursing education that they provide. Which of the following statements is
true of technological change and nursing education?
A) Technology is typically high in colleges and universities but low in
hospitals and other care settings.
B) Many of the purported educational benefits of technology have not been
demonstrated in the nursing literature.
C) Computer literacy is high among students but most nursing educators
lack computer skills.
D) The costs of integrating new technology into nursing education can be
prohibitive.
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 8
Feedback: High-technology equipment is often expensive, a fact that often
presents a challenge to educational institutions. The benefits of technology
in learning have been demonstrated and computer literacy is nearly
universal. Hospitals are high-technology work environments.
15. The faculty members of a college-based school of nursing have taken
action to increase the teaching and clinical time in the curriculum that is
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devoted to community-based nursing. Which of the following phenomena
provides the most valid rationale for this change?
A) Public mistrust of hospitals is increasing and many individuals prefer to
remain at home.
B) The number of patients who qualify for Medicare and Medicaid is
increasing.
C) Patients are typically discharged from the hospital much earlier than in
the past.
D) Evidence demonstrates that students learn more in the community than
in the hospital.
Ans: C
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 8
Increasing Community-Based Practice Experiences
Feedback: Earlier hospital discharge to the home and an increasing
emphasis on prevention has created new demands on nursing in the
community. This shift is not rooted in mistrust of hospitals, a lack of
learning in hospitals, or trends in Medicare and Medicaid.
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Chapter: Chapter 3: Credentials for Healthcare Providers
Multiple Choice
1. What is the major advantage of sunset laws?
A) Nurses can modify their standards of practice on a daily basis.
B) They guarantee that the legislature will review and evaluate agencies
and programs.
C) The legislature can close facilities that do not meet governmental
requirements.
D) Facilities must renew their accreditation in a specified amount of time.
Ans: B
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Sunset Laws and Nurse Practice Acts
Feedback: Because sunset laws are set to expire at a specified point in
time, legislatures are obligated to review and evaluate them prior to
expiry. Sunset laws do not directly influence the nurses standards of
practice, the quality of healthcare facilities, or the accreditation process.
2. A nurse who is licensed to practice in Pennsylvania decides to seek a
nursing position in Florida. This nurse would obtain this license by which
of the following methods?
A) Licensure by endorsement
B) Licensure by examination
C) Licensure by renewal
D) Reciprocal licensure
Ans: A
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 6
Obtaining a Nursing License
Feedback: The method of obtaining a license when the nurse is already
licensed in another jurisdiction is called licensure by endorsement; this is
an alternative to license by examination. This transfer is not termed
reciprocal licensure or licensure by renewal.
3. A nursing board asks the court to stop a nurse from practicing until it
investigates allegations that the nurse was providing care while under the
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influence of alcohol. What is the name of the process that allows this
action?
A) Revocation
B) Suspension
C) Injunctive relief
D) Court investigation
Ans: C
Client Needs: A-2
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 7
Grounds for Disciplinary Action
Feedback: A board of nursing may be authorized to ask a court to halt a
specific practice that it believes is contrary to the law until a full hearing
can be held. This is called injunctive relief. This term refers to the court
order called an injunction that requires an individual or organization to
stop a particular activity, such as practicing nursing. The investigation is
performed by the board, not the court. Revocation involves the removal of
a license, and suspension does not typically involve the courts.
4. Which of the following is a recommendation of the Institute of Medicine
report Health Profession Education: A Bridge to Quality (2003)?
A) Developing separate core competencies to regulate each health
profession
B) Revising the processes of accreditation bodies to require outcomes
related to core competencies
C) Allowing each profession to educate, practice, and dialogue within its
own boundaries
D) Changing healthcare workforce regulations based on what is termed a
safe focus
Ans: B
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 10
, Institute of Medicine Recommendations
Feedback: The IOM report recommended that both licensing bodies and
specialty certification bodies require health professionals to demonstrate
in some way their continued competence in the previously determined
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core competencies. The report does not advocate the development of
separate core competencies, the isolation of each profession, or changes to
workforce regulations.
5. A nurse administers insulin to a diabetic patient via an insulin pump.
Based on the NCLEX examination, this action would fall under which of the
categories of client needs?
A) Safe effective care environment
B) Health promotion and maintenance
C) Psychosocial integrity
D) Physiological integrity
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 6
Table 3.1
Feedback: The client needs category of physiological integrity
encompasses nursing actions that address a clients physical needs and the
treatment of illness. Administration of medication is not normally
considered a health promotion activity, an aspect of psychosocial integrity,
or a demonstration of safety measures.
6. A nurse who has provided care in acute settings for several years has
begun the process of gaining additional credentials. Which of the following
statements best describes credentials?
A) Credentials indicate that an individual has demonstrated a continuing
commitment to competence.
B) Credentials recognize an individuals professional superiority to his or
her peers.
C) Credentials indicate that an individual has met specific criteria and
standards.
D) Credentials indicate that an individual has the authority to direct
practice in a particular care setting.
Ans: C
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Introduction
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Feedback: Credentials indicate that an individual (or organization) has
met specific standards that are important to fulfilling a professional
mandate. This is not necessarily synonymous with a continued
commitment, though such a commitment may help facilitate the
attainment of credentials. Individual credentials do not necessarily
indicate superiority or leadership potential.
7. After completing an associate degree in nursing and passing the NCLEXRN examination, a nurse has been granted a license to practice. A license to
practice provides the nurse with
A) formal recognition of the nurses graduation from an accredited school
of nursing.
B) legal permission to practice the nursing profession.
C) the authority to practice nursing in any state.
D) recognition of advanced learning and competence in a particular care
setting.
Ans: B
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Easy
Integrated Process: Communication and Documentation
Objective: 2
Licensure
Feedback: A license is a legal credential awarded by an individual state
that grants permission to that individual to practice a given profession. A
license is normally specific to a particular jurisdiction. It does not denote
advanced learning in a specific setting. Graduation from a school of nursing
is required for licensure, but a license does not explicitly document this
education.
8. The students and faculty of a school of nursing are pleased that the
school has recently been granted a renewal of its current accreditation.
Accreditation of a school of nursing is based primarily on which of the
following?
A) The proportion of graduates who pass the NCLEX-RN
B) The academic credentials of faculty members
C) The findings of an external review committee
D) The overall contribution of the school to the body of nursing knowledge
Ans: C
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
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Integrated Process: Communication and Documentation
Objective: 3
Accreditation of Educational Institutions
Feedback: Accreditation of a school of nursing is primarily based on the
findings of nursing experts who visit the institution and appraise the
education that is provided. Other factors may be considered, such as the
success of graduates, the credentials of instructors, or the research that is
conducted, but the findings of external reviewers are paramount.
9. A state board of nursing is legally empowered to carry out the
provisions of the Nurse Practice Act. Which of the following activities best
demonstrates the mandate and jurisdiction of a state board of nursing?
A) Advocating for nurses during labor negotiations
B) Organizing information campaigns to enhance the public perception of
the nursing profession
C) Specifying the way that nursing care is organized in public hospitals
D) Establishing the standards that nurses must meet in order to be
licensed
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 5
The Role of the State Board of Nursing
Feedback: State boards of nursing perform multiple functions, including
examination and licensure of nurses. Participation in labor negotiations,
advertising to increase awareness of the profession, and specifying the
way that care is provided are activities that are normally beyond the
purview of a state board of nursing.
10. A registered nurse who completed her education in the Philippines and
who is in the process of immigrating in the United States is attempting to
obtain a license to practice in New Jersey, her intended state of residence.
In order to obtain a license, the nurse will primarily be in contact with
A) the New Jersey Board of Nursing.
B) the American Nurses Association (ANA).
C) one of the accredited schools of nursing in New Jersey.
D) the National Council of State Boards of Nursing, Inc. (NCSBN).
Ans: A
Client Needs: A-1
Cognitive Level: Application
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Difficulty: Easy
Integrated Process: Communication and Documentation
Objective: 5
The Role of the State Board of Nursing
Feedback: Licensure is one of the main responsibilities of state boards of
nursing, and a nurse seeking a license to practice in a particular state must
obtain a license from that states board of nursing. Schools of nursing, the
ANA, and the NCSBN do not directly grant licensure.
Multiple Selection
11. Amanda is a nurse who currently works in a community clinic in a city
near state lines. She is exploring employment possibilities in a neighboring
state and hopes to obtain a license through mutual recognition of
licensure. Which of the following conditions must be met in order for
Amanda to obtain a nursing license in this manner? (Select all that apply.)
A) Amandas home state must be party to the Nurse Licensure Compact.
B) Amanda must obtain a nursing license in the intended state as well as in
her home state.
C) Amanda must meet the standards for licensure in the state where she
intends to practice.
D) The state in which Amanda wishes to practice must belong to the Nurse
Licensure Compact.
E) Amanda must possess an ADN or baccalaureate degree in nursing.
Ans: A, C, D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 8
Mutual Recognition of Licensure
Feedback: Obtaining a license through mutual recognition of licensure
requires that an individuals home state and the intended state of practice
be party states. As well, an applicant must qualify for licensure in the
intended state. A diploma in nursing does not preclude transfer of
licensure, and an individual may not possess licenses in both states
simultaneously.
Multiple Choice
12. Under the provisions of the Nurse Licensure Compact (NLC), a nurse
who is licensed in Arizona has been practicing for the past year in New
Mexico. The nurse is alleged to have become involved in an inappropriate
relationship with a patient in New Mexico and grounds for disciplinary
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action appear to exist. How will the discipline of this nurse most likely
proceed?
A) The New Mexico Board of Nursing may withdraw the nurses license if
this is deemed necessary.
B) The nurses discipline is referred to the American Nurses Association
because two state boards of nursing have interest in the matter.
C) The New Mexico Board of Nursing will undertake investigation, but the
Arizona State Board of Nursing will implement appropriate discipline.
D) The New Mexico Board of Nursing will be unable to change the Arizona
licensure status of the nurse.
Ans: D
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 8
Concerns Regarding Mutual Recognition of Licenses
Feedback: A major concern with mutual recognition is the disciplinary
process. Although the board of nursing can investigate nursing practices
and enforce its own standards in the state, it cannot change the licensure
status of the person whose licensure originates in a different state. The
ANA does not participate in disciplinary matters, and a state would not
normally undertake discipline based on an investigation in another party
state.
13. Nurse T. has been notified by her state board of nursing that a
complaint has been lodged regarding her practice. How should Nurse T.
best respond to this news?
A) Retain the services of an attorney.
B) Organize a private meeting between her and the complainant.
C) Have colleagues write statements attesting to her competence.
D) Explore practice opportunities in other states.
Ans: A
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 8
Revocation of Limitation of a License
Feedback: The individual being investigated for any violation of the Nurse
Practice Act should have an attorney who is knowledgeable about
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professional disciplinary issues from the time of notification of the
complaint. This is an important action, whether or not there are grounds
for the accusation. A meeting with the complainant would be
inappropriate, and enlisting support from colleagues would be a secondary
concern compared with hiring an attorney. It would be premature, and
likely inappropriate, to explore options out-of-state at this early stage.
14. A nurse has been working in pediatrics for 6 years since graduating
from an accredited nursing school. The nurse is now interested in pursuing
American Nurses Credentialing Center certification as a pediatric Clinical
Nurse Specialist. What factor will primarily determine whether the nurse
obtains this ANCC certification?
A) Enrollment in a PhD, DNS, or DNP degree program
B) A review of the nurses marks from nursing school and interviews with
managers and colleagues
C) Completion of an original research project related to pediatric nursing
D) The demonstration of knowledge and skills in beyond those required
for licensure as an RN
Ans: D
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 9
American Nurses Credentialing Center Certification
Feedback: ANCC certification is a method of recognizing nurses who have
special expertise. Applicants must demonstrate current practice and
knowledge beyond that required for licensure as an RN. Enrollment in a
doctoral program is not necessary. Marks from nursing school, the
opinions of supervisors, and the completion of research do not form the
basis for certification.
15. The Institute of Medicine (IOM) report Health Profession Education: A
Bridge to Quality (2003) came to several conclusions around the issues
confronting health professions education. Which of the following issues
was addressed in the report?
A) The tendency of each health discipline to educate and practice
independently of the other disciplines
B) The lack of recognition of credentials and the credentialing process
outside of the field of nursing
C) The trend toward managed care and the inability of nursing educators
to adapt to this change
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D) The historical animosity between nursing and medicine and the failure
to bridge this gap
Ans: A
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 10
Institute of Medicine Recommendations
Feedback: The IOM noted that each health profession tends to educate,
practice, and dialogue within a silo. These narrowly constructed walls
make it difficult for interdisciplinary collaboration to occur. The report
does not focus on the relationship between medicine and nursing, the
trend toward managed care, or the lack of recognition of credentials.
Chapter: Chapter 4: Making Professional Goals a Reality
Multiple Choice
1. Which organization developed the most definitive statements on the
competencies needed by the newly licensed practical nurse (PN) and the
RN?
A) National Council of State Boards of Nursing (NCSBN)
B) American Association of Nurses (ANA)
C) National League for Nursing (NLN)
D) American Association of Colleges of Nursing
Ans: A
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Communication and Documentation
Objective: 2, National Council of State Boards of Nursing Competencies
Feedback: The most definitive statements on the competencies needed by
the newly licensed practical nurse (PN) and the RN have been developed
by the NCSBN based on its job analysis studies, which serve as the basis for
the NCLEX-RN and NCLEX-PN.
2. In what type of healthcare setting are the most RNs currently employed?
A) Ambulatory care centers
B) Doctors offices
C) Acute care hospitals
D) Long-term care facilities
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Ans: C
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Communication and Documentation
Objective: 1
Employment Opportunities Today
Feedback: As of 2008, over 89% of nurses worked in hospital settings,
4.8% worked in long-term care, and 4.3% worked in community-based or
ambulatory care settings. Only 1.7% of nurses indicated that they worked
in other settings.
3. Which of the following statements accurately reflects what employers
generally should expect when hiring a newly graduated RN?
A) The RN should be proficient with the documentation system used by the
institution.
B) The RN should be able to perform all nursing skills, enabling him or her
to work independently.
C) The RN should function with speed comparable to that of the other
nurses.
D) The RN should be able to develop plans of care and follow plans
developed by the agency.
Ans: D
Client Needs: D-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Employers Expectations Regarding Competencies
Feedback: New graduates should be able to develop plans of care and
follow plans, such as care pathways, that have been developed by the
agency. Proficiency, speed, and complete independence are developed over
time and with increased experience and orientation.
4. A nurse decides to apply for a position in a hospital in her hometown.
Which of the following statements provides good advice for her job quest?
A) She should call the human resources department and speak to the
person who is in charge of hiring nurses.
B) She should include a cover letter with her rsum that is no more than
two pages long and briefly reiterates the information found in the rsum.
C) She should invest in a professionally prepared rsum to make a better
impression on potential employers.
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D) She should focus her rsum on accomplishments and use active verbs to
describe her skills.
Ans: D
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 5
Employment History
Feedback: In a rsum, it is best to focus on accomplishments and use active
verbs to describe skills. Professional preparation of a rsum is not
necessary, and telephone communication is generally discouraged. A cover
letter should ideally not exceed one page in length.
5. Which of the following is a recommended guideline when resigning a
position?
A) Provide the employer with 2 weeks to seek a replacement.
B) Clearly state the details if you wish to be compensated for any vacation
or holiday time accrued.
C) If resigning because of problems in the work setting, it is a good idea to
put the reason in the resignation letter.
D) Place comments regarding positive factors experienced in the
workplace in a separate correspondence from the resignation letter.
Ans: B
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 5
Resignation
Feedback: If you have accrued vacation or holiday time and want to take
the time off or be paid for it when resigning, clearly state that. A months
notice is ideal, and a resignation letter should not go into detail regarding
the contributing problems in the workplace. Positive factors experienced
in the workplace may be included in the resignation letter.
6. A student nurse is scheduled to graduate in a few weeks and is
preparing to begin searching for employment. Which of the following
statements best conveys an aspect of the current job market for nurses?
A) Most nursing graduates are expected to perform in the role of a nursing
assistant or practical (vocational) nurse after graduation.
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B) The majority of nursing opportunities for new graduates are in
international settings.
C) Job openings in acute care have decreased in many places but long-term
care openings continue to grow.
D) The increasing severity of the nursing shortage means that job
opportunities for nursing graduates are greater than ever.
Ans: C
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 1
Employment Opportunities Today
Feedback: Positions for new graduate RNs have recently decreased. This is
due in part to the effects of the economic recession. Although hospital
vacancies have decreased in many places, those in long-term care continue
to increase. Some, but not most, graduates may find work in other roles,
and a minority of positions are in international settings.
7. A recent nursing graduate is attempting demonstrate the competencies
that she learned as a nursing students and to reconcile the expectations of
her new colleagues and employer with her own abilities. Which of the
following tasks is the most important and most frequently performed?
A) Helping patients and families navigate the healthcare environment
B) Applying the principles of infection control and standard precautions
C) Initiating vascular access and maintaining peripheral and/or central IV
access
D) Liaising with members of other health disciplines to ensure safe and
continuous care
Ans: B
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Feedback: Apply principles of infection control (e.g., hand hygiene, room
assignment, isolation, aseptic/sterile technique, universal/standard
precautions) is among the most common, and most important, nursing
actions as identified by nursing organizations. Patient advocacy,
interdisciplinary cooperation, and IV therapy are all important, but none is
performed as frequently as infection control measures.
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8. Healthcare institutions expect that nursing graduates will be able to
apply their theoretic knowledge for safe client care. Which of the following
actions best demonstrates this?
A) Creating a nursing care plan for a newly admitted patient
B) Responding appropriately to a patient complaining of chest pain
C) Advocating for a patients interests with members of other disciplines
D) Conducting a thorough and thoughtful search for nursing employment
Ans: B
Client Needs: A-2
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 3
Employers Expectations Regarding Competencies
Feedback: Responding appropriately to an emergent health threat is a
demonstration of safe care and the appropriate application of knowledge.
Patient advocacy and creating care plans are functions that are less closely
related to patient safety. Searching for a job is not linked to safe client care.
9. The expected competencies of new nursing graduates are not
standardized and can vary between institutions and organizations. Most
nursing and healthcare organizations, however, agree that recent
graduates should be able to use the nursing process in a systematic way.
Which of the following nursing activities best exemplifies this competency?
A) The nurse identifies a nursing diagnosis of Impaired Skin Integrity
based on an assessment and plans to reposition the patient.
B) The nurse administers an ACE inhibitor to a patient with high blood
pressure.
C) The nurse makes a referral to occupational therapy for a patient with a
neurological deficit.
D) The nurse attends an inservice on pain control that is conducted by a
nurse educator.
Ans: A
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 3
Employers Expectations Regarding Competencies
Feedback: The nursing process includes assessment, analysis, planning,
intervention, and evaluation. Identifying a nursing diagnosis on the basis
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of an assessment exemplifies the early stages of this process. Learning
about pain management, administering a medication, and making a
referral to another discipline may also exist within the framework of the
nursing process, but the steps of this process are not as clearly evident in
these examples.
10. A patient has just been transferred to the acute medicine unit from the
intensive care unit and the patients arterial line has not yet been
discontinued. The nurse on the acute medicine unit is a recent graduate
and does not have experience in caring for an arterial line. As a result, the
nurse is unsure how to safely address this aspect of the patients care. How
should the nurse best respond?
A) Look up arterial lines in the policy and procedures manual on the unit.
B) Inform the unit manager that this patient assignment is inappropriate.
C) Enlist the help of a more senior nurse on the unit.
D) Have the patient transferred back to the intensive care unit.
Ans: C
Client Needs: A-2
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 3
Employers Expectations Regarding Competencies
Feedback: To provide safe care, the nurse must identify when a situation
requires greater expertise or knowledge and when assistance is needed.
Asking a colleague for assistance is an appropriate demonstration of this
competency. Looking up a procedure in a policy manual is an appropriate
action but does not show a willingness to ask others for help. It would
likely be premature to refuse the care of this patient or to have him or her
transferred.
11. After several months of working on an acute care for elders (ACE) unit
following her graduation, Theresa has decided to focus her nursing career
on working with older adults. What action is most likely to help Theresa
meet this career goal?
A) Cultivating a passion for the health of the older adult population
B) Networking with prominent older adults in the community
C) Performing original research that adds to the knowledge of this
populations needs
D) Working toward certification in gerontological nursing
Ans: D
Client Needs: A-1
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Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 4
, Focusing Your Goals
Feedback: Certification in a particular nursing specialty has the potential
to increase a nurses opportunities in that field. Passion, networking, and
research may all be of some benefit, but certification is more likely to
create tangible career opportunities.
12. After identifying a job posting in his or her field of specialty, a diabetes
nurse has submitted a letter of application and a rsum. What is the primary
function of a letter of application?
A) To introduce the applicant to the employer in a personal way
B) To state why the nurse left his most recent position
C) To demonstrate the nurses work ethic
D) To summarize the content of the rsum in a succinct way
Ans: A
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 5
Letter of Application
Feedback: A letter of application provides the opportunity for a nurse to
reveal a bit of his or her personality and connects his or her experience to
the positions requirements. The purpose is not primarily to summarize the
rsum or demonstrate a work ethic. It is inappropriate to state reasons for
leaving previous positions in a cover letter.
13. During her final clinical placement, a nursing student worked with two
of her fellow students to plan a health fair that took place in a local
community center. How should she best characterize this activity on her
rsum?
A) I was a member of the steering committee for a community health fair.
B) Organized a community health fair.
C) I have strong organizational skills.
D) Assisted with the organization of a community health fair.
Ans: B
Feedback: Option B provides the most succinct and action-oriented
description of the activity. Option A lacks an action verb, while option C is
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imprecise and not descriptive. Option D is less direct and less action
oriented than option B.
14. A nursing student who has held a variety of nonnursing positions is
scheduled to graduate in a few weeks and is searching for a nursing job.
The student has responded to a posting at a local hospital that asks for two
references. Which of the following individuals would be the best choices
for these two references?
A) A trusted coworker and a nurse who supervised the student during a
preceptorship
B) A family friend who knows the student well and the associate dean of
the nursing school
C) The two work supervisors with whom the student has the strongest
rapport
D) A nursing instructor and the supervisor of the students latest job
Ans: D
Feedback: A primary reference should be an instructor from your basic
educational program. This person would be able to affirm your ability in
the nursing field. Another reference should be someone who has employed
you and who can describe your work habits and effectiveness as an
employee. Coworkers and family friends are not normally appropriate
references.
15. In response to her recent job application, a nurse has been contacted
by a member of the hospitals human resources (HR) department in order
to schedule an interview. The nurse should
A) bring several copies of her rsum to the interview.
B) ask the HR representative how she should dress for the interview.
C) do research so that she can avoid asking questions during the interview.
D) ask the interviewers about their work history and areas of career
interest.
Ans: A
Objective: 6, 7
Things to Take with You
Feedback: Take several copies of your rsum with you to the interview. You
may want to refer to it, or you may find it appropriate to leave a copy with
someone. It is best to dress formally rather than asking for direction in this
matter. It is appropriate to ask questions during an interview, but these
should not focus on the work of the interviewers.
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Chapter: Chapter 5: The World of Healthcare Employment
Multiple Choice
1. What is the basic tenet of shared governance?
A) It allows nursing staff and management to be involved in decisionmaking.
B) It establishes the control of the institution over the actions of the
nursing staff.
C) It allows the administrative decision area to be controlled by
management.
D) It supports the traditional role of the supervisor as one who hires,
evaluates, promotes, and fires.
Ans: A
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Shared Governance Model
Feedback: Shared governance may be viewed as a system in which nurses
have organizational autonomy as reflected in control over their practice,
and have input into decision relating to patient care. It is a professional
practice model in which both the nursing staff and the nursing
management are involved in decision-making, as opposed to the
administrative decision area being controlled by management. In this way,
it is an alternative to traditional supervision models and hierarchies.
2. A nurse is assigned for the care of each patient from the time the patient
is admitted to the hospital until that patients discharge. What system of
care delivery is most likely in place?
A) Functional care
B) Primary care
C) Modular care
D) Team care
Ans: B
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Primary Care Nursing
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Feedback: In a pattern of primary care, one nurse was assigned the
responsibility for the care of each patient from patient admission until that
patients discharge. The primary nurse was responsible for initiating and
updating the nursing care plan, patient teaching, and discharge planning.
An associate nurse worked with this same patient on other shifts and on
the primary nurses day off, carrying out the plan of care developed by the
primary nurse.
3. Nurses working in a hospital initiate a negotiating session in which they
offer to take a pay cut to allow management to provide job security and to
hire more nurses to alleviate understaffing. What is the term for this type
of session?
A) Interest-based bargaining
B) Collective action bargaining
C) Concession bargaining
D) Good faith bargaining
Ans: C
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 6
Bargaining and Negotiating
Feedback: Concession bargaining is a process in which there is an explicit
exchange of reduced labor costs for improvements in job security. This
specific tradeoff is not a characteristic of interest-based bargaining,
collective action bargaining, or good faith bargaining.
4. Nurses decide to go on strike to try to force improvement in the quality
of patient care in their facility. Once the strike is resolved, what are their
options for being rehired by the facility under the reinstatement privilege
that is in effect in their contract?
A) They will be rehired after the strike whether or not it is decided that the
strike was lawful.
B) They will be rehired after the strike as positions become available
provided they have not engaged in unfair labor practices.
C) They will be rehired to replace nurses hired during the strike who were
hired to replace them.
D) They will be rehired at their former job as soon as the strike is resolved.
Ans: B
Client Needs: A-1
Cognitive Level: Application
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Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 7
Reinstatement Privilege
Feedback: A reinstatement privilege is a guarantee offered to striking
employees that they will be rehired after the strike as positions become
available, provided that they have not engaged in any unfair labor
practices during the strike, and provided that the strike itself is lawful.
5. Which of the following statements accurately reflects the general use of
the grievance process by nurses?
A) Grievances usually are related to interpretations of a contract or to
policies and procedures.
B) Although either the management or an employee can file grievances, in
most instances it is management that initiates the case.
C) A grievance involves informal talk between the management and the
employee until the issue is resolved.
D) Employees may have grievances about the contract negotiation process
itself.
Ans: A
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 9
Process
Feedback: A grievance is a circumstance or action believed to be in
violation of a contract (or of policies of an institution if a contract is not in
place). Grievances usually are related to interpretations of a contract or
policies and procedures and they are usually initiated by employees.
Although resolution may begin with an informal talk, this proceeds to a
formal process if resolution is not achieved.
6. As part of the development of a new inner-city clinic, a group of nurses
and members of other health disciplines have drafted a mission statement
for the clinic. This statement will most likely specify
A) the priorities for the health of the identified population.
B) the main goals and functions that the organizers envision for the clinic.
C) the philosophies and beliefs that underlie the existence and functioning
of the clinic.
D) the health outcomes that the organizers see as currently lacking in the
community.
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Ans: B
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 1
Mission Statement and Philosophy
Feedback: The purpose of an organization is often expressed in the form of
a mission statement, which outlines what the organization plans to
accomplish, including its goals and function. This may or may not identify
the philosophy of the organization, specific health outcomes, or priorities
for the health of residents.
7. Which of the following conditions must be met in order to ensure the
efficient and effective operation of a healthcare organization?
A) Span of control must be kept as narrow as possible.
B) The chain of command must be explicitly and clearly delineated.
C) The formal organizational structure must closely mimic the informal
relationships that exist (the grapevine).
D) Registered nurses must occupy positions in employee, middle
management, and executive roles.
Ans: B
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 2
Chain of Command
Feedback: The effective operation of a healthcare organization requires a
detailed and clear chain of command. A narrow span of control is not
always preferable to broader spans of control and formal structure does
not necessarily have to replicate informal structures, though each should
be acknowledged and recognized. It is certainly possible, and potentially
beneficial, for nurses to occupy a variety of roles in the organizational
hierarchy but this is not a precondition for successful organization.
8. A nurse has concerns about some of the practices on the hospital unit
and met with the unit manager to explain these concerns. After the
meeting, the nurse felt misunderstood and rebuffed by the manager. How
should the nurse determine who in the organization to meet with next?
A) Consult with the hospital bureaucracy
B) Enlist the help of a union representative
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C) Ask colleagues about who is most influential in the organization
D) Refer to the hospitals chain of command
Ans: D
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 2
Chain of Command
Feedback: The chain of command represents the path of authority and
accountability from individuals at the top of the organization to those at
the base of the organization. The nurse should most likely meet with the
person who is above the manager in the chain of command. The hospital
bureaucracy, the union, and the persons who are informally influential are
less likely to help the nurse identify the appropriate person with whom to
meet.
9. There is general agreement on a postsurgical unit that the admission
assessment template that is used is lengthy, unwieldy, and includes many
parameters that are not relevant to the care of the patient population on
the unit. Which of following aspects of amending the assessment template
best exemplifies the concept of shared governance?
A) Managers and nurses cooperatively make a change and share
accountability for the outcomes.
B) The unit manager consults with nurses and members of other
disciplines prior to changing the document.
C) The decision-making process reflects the chain of command that exists
at the hospital.
D) Nurses collectively present the change in practice to the manager, who
is then accountable for the outcomes of the change.
Ans: A
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 3
Shared Governance Model
Feedback: Shared governance encompasses a collaborative model of
decision-making and shared accountability for the outcomes of these
decisions. It does not involve nurses announcing an independent change to
management or management being solely accountable for the decisions of
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others. Shared governance is not necessarily linked to the chain of
command in an organization.
10. The staff, the administrators, and the executives of a large, urban
hospital are currently celebrating the fact that the hospital has recently
been granted Magnet Recognition by the American Nurses Credentialing
Center (ANCC). This designation suggests that the hospital
A) pays nurses higher wages than the national median.
B) has lower staff turnover than most hospitals.
C) integrates the principles of evidence-based practice into care.
D) has a committed and responsive bureaucracy.
Ans: B
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 4
Magnet Hospitals
Feedback: While all of the given options may underlie or contribute to a
hospitals Magnet designation, low staff turnover is one of the key
attributes of such a hospital. Magnet Recognition is not explicitly based on
high wages, effective bureaucracy, or evidence-based practice.
11. A nurse who has a baccalaureate degree in nursing has begun working
at a hospital in which the principles of primary care nursing are used to
organize care. Which of the following actions should the nurse anticipate?
A) Performing the most complex nursing tasks on the unit for all of the
patients
B) Taking action to ensure that neither too much nor too little care is
provided for each patient
C) Directing a team of practical (vocational) nurses and unlicensed care
providers
D) Being responsible for specific patients from the time of their admission
to the time of discharge
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Primary Care Nursing
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Feedback: In a pattern of primary care, one nurse is assigned the
responsibility for the care of each patient from patient admission until that
patients discharge. Patient care is not fragmented according to complexity,
as in functional nursing. Collaboration of a group of RNs, PNs. and UAPs is
characteristic of team nursing. Tight control of the amount of care a patient
receives is a key characteristic of case management.
12. Collective bargaining has a long history in nursing. Which of the
following milestones in the history of collective bargaining resulted from
the 1974 amendment of the Taft-Hartley Act (Labor Management
Relations Act)?
A) Nurses were granted the right to form unions and engage in collective
bargaining.
B) The maximum length of a work week and the minimum nursing wage
were established.
C) Nursing was formally recognized as a professional occupation.
D) Nonprofit hospitals were obliged to bargain with nurses around wages
and working conditions.
Ans: D
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 8
Table 5.1
Feedback: Under the 1974 amendment of the Taft-Hartley Act, nonprofit
hospitals were required to bargain with nurses for better salaries and
working conditions. The formation of unions and the recognition of
nursing as a profession predated this act. The 1974 amendment did not
specify wages and hours of work.
13. Contracts are essential to the maintenance of high quality care in
healthcare institutions. As well, they are necessary to protect the interests
of nurses who provide this care. Which of the following issues is most
likely to be addressed in a contract for nurses?
A) The process that should be followed when distributing overtime work
B) The obligation of nurses to participate in nursing research
C) The details of the organizational structure of a hospital
D) The relationships among nurses, physicians and members of other
health disciplines
Ans: A
Client Needs: A-1
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Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 9
Issues Negotiated in Contracts
Feedback: Contracts commonly address such issues as overtime work.
Relationships between care providers, participation in research, and
organizational structure of a hospital are issues that are normally outside
the purview of a nursing contract.
14. Despite the long history of collective bargaining in the nursing
profession, many nurses have concerns regarding membership in a
collective bargaining unit. Which of the following statements by nurses
best conveys one of the primary concerns that are prevalent among
nurses?
A) I think that physicians recognize our value and sufficiently advocate for
our best interests.
B) I think that a collaborative model results in higher wages than a
confrontational model such as collective bargaining.
C) Im not sure that joining a union is congruent with the philosophy of the
nursing profession.
D) In the end, I think that the costs of being in bargaining unit outweigh the
potential benefits.
Ans: C
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 10
Issues Related to Collective Bargaining and Nursing
Feedback: Among the major issues of collective bargaining that affect the
nursing profession is the fact that some nurses see collective bargaining as
unprofessional. The other most common concerns involve the matter of
which bargaining group will represent nursing when nurses participate in
collective bargaining, the question of whether to join a union when one
exists, and the issue of the role of the supervisor.
15. Nurses, as well as individuals outside the profession, have sometimes
expressed concern around the involvement of state nurses associations in
collective bargaining. What factor most often underlies such concerns?
A) State nurses associations lack the legal authority to engage in
bargaining though this has been their traditional role.
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B) State nurses associations tend to be unaware of many of the issues that
nurses face when providing care.
C) It can be difficult to reconcile the professional obligations of nurses
associations with their role in bargaining.
D) Few practicing nurses participate in the activities of state nurses
associations.
Ans: C
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 11
Activity of the ANA
Feedback: Some individuals contend that it is not realistic for state nurses
associations to work with the professionalism aspect of nursing as well as
with the issues of wages, benefits, and working conditions. State nurses
associations do not lack the legal right to bargain and participation of
nurses in the operations of state nurses associations does not directly
affect their right or ability to bargain.
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Chapter: Chapter 6: Understanding the Healthcare Environment and Its
Financing
Multiple Choice
1. Which of the following clients would be a good candidate to receive care
in an assisted-living facility?
A) A 30-year-old victim of a car accident who has been in a coma for the
past 2 months.
B) A 78-year-old widower who is living independently but needs help with
preparing meals, doing laundry, and remembering to take his medications.
C) A husband and wife approaching retirement age who have no difficulty
with ADLs but desire to age in place.
D) A 72-year-old woman diagnosed with Alzheimer disease who is
described by her daughter as having good days and bad days.
Ans: B
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Assisted-Living Facilities
Feedback: The assisted-living facility provides care for those needing help
with up to three ADLs. In an assisted-living arrangement, the resident can
maintain maximum independence and use a shared decision-making
model to decide when additional help or support is needed. A patient in a
coma, an individual with significant cognitive deficits, and a couple with no
difficulty in achieving ADLs would not be appropriate for assisted-living.
2. Mr. Kline is a construction worker who is recovering from surgery on
his dominant hand that he injured on the job. Which member of the
healthcare team would the nurse contact to help Mr. Kline learn how to
feed himself using modified utensils?
A) Registered physical therapist
B) Doctor of osteopathy
C) Registered dietitian
D) Occupational therapist
Ans: D
Client Needs: B
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
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Roles of Healthcare Workers
Feedback: Occupational Therapists are educated in the assessment and
management of ADLs, especially when assistive devices are required. A
physical therapist focuses primarily on mobility and would not introduce
assistive devices aimed at achieving ADLs. Osteopaths and dietitians would
not manage the use of assistive devices.
3. Which of the following is a current trend related to the education and
scope of practice of healthcare providers within the healthcare system?
A) The Flexner Report limited the involvement of hospitals in research and
education of medical students, resulting in a decrease in internships and
residencies.
B) Pressure from insurers has mandated an increased use of specialty
physicians over general practice physicians.
C) There is a short supply of qualified individuals in most health
occupations, including nursing.
D) As the healthcare system has grown more and more complex, it is
imperative for one individual educated to a specific role, to manage all
aspects of care.
Ans: C
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Healthcare Worker Supply
Feedback: Nurses are not the only healthcare workers in short supply.
There are predicted shortages in almost all areas of healthcare over the
next 15 years. As the population ages and more people enter the system
due to expansion of healthcare insurance coverage, the shortages are likely
to persist. The Flexner Report increased the involvement of hospitals in
research and education of medical students. There is pressure to increase
the involvement of general practice physicians. As the healthcare system
grows more complex, it is clear that it is impossible for one individual
educated to a specific role, to manage all aspects of care.
4. Which of the following statements is an accurate representation of the
nature of healthcare coverage available worldwide?
A) In the United States, healthcare is seen as a right or entitlement of every
citizen.
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B) In developing nations, healthcare is adequately provided by
governmental agencies and nonprofit organizations, such as the World
Health Organization.
C) The US healthcare system has been simplified by the existence of
standards for funding and controlling healthcare.
D) In most of the industrialized world, governmental healthcare systems
are in place to accomplish overall health outcomes.
Ans: D
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Paying for Healthcare
Feedback: In most of the industrialized world healthcare is seen as a right,
or an entitlement, of every citizen. This stands in contrast the views of
many in the United States. Developing nations often lack basic healthcare
and the US healthcare has increased in complexity over the years.
5. Mr. Gomez is a patient on Medicare receiving care in a hospital following
cardiac surgery. What method would be used to determine payment for
the services provided for this client?
A) Resource utilization groups
B) Minimum data sets
C) Capitation
D) Diagnosis-related groups
Ans: D
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 5
Diagnosis-Related Groups
Feedback: Diagnosis-related groups (DRGs) are used to determine the
payment for each Medicare client admitted to the hospital. Payment is not
determined using resource allocation groups, minimum data sets, or
capitation.
6. A nurse provides care in a hospital that is owned and operated by the
Roman Catholic Church. According the classification system of healthcare
organizations that is based on ownership, how would this hospital be
classified?
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A) Proprietary corporation
B) Sole proprietorship
C) Nonprofit organization
D) Community organization
Ans: C
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Easy
Integrated Process: Communication and Documentation
Feedback: Healthcare institutions that are operated by religious
organizations are normally categorized as nonprofit. They are not
proprietorships or community organizations.
Multiple Selection
7. The number and importance of hospitals increased greatly during the
development of the American healthcare system. Which of the following
phenomena have contributed to this trend? (Select all that apply.)
A) Increased health literacy of the American public
B) The development of more sophisticated medical technology
C) Increased incidence and prevalence of chronic diseases
D) The development of professional nursing
E) The growth of the health insurance industry
Ans: A, B, D, E
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Difficult
Integrated Process: Nursing Process
Factors Affecting the Development of Hospitals
Feedback: The growth of the hospital as a primary healthcare institution
was the result of numerous factors, including the medical technology, the
growth of professional nursing, and the emergence of the health insurance
industry. This trend has not been closely linked to changes in health
literacy and chronic diseases.
Multiple Choice
8. Historically, health insurance was for hospital care and related services
only. What effect did this characteristic have on the health behaviors of
individuals enrolled in such plans?
A) Some individuals neglected health promotion measures.
B) Many individuals began to pay out-of-pocket for superior care.
C) Individuals avoided hospitals because of the association of hospitals
with illness.
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D) Some individuals who qualified for Medicare did not enroll in the
program.
Ans: A
Feedback: Insurance coverage for inpatient treatment created a
disincentive towards preventative measures and health promotion
activities since these were nor insured benefits. The focus on inpatient
care did not prevent participation in Medicare or dissuade people from
visiting hospitals.
9. In 2010 the US Congress passed the Patient Protection and Affordable
Care Act, commonly referred to as the Healthcare Reform. This Act aims to
change the provision of healthcare in the United States by
A) bringing the health insurance industry under the umbrella of the federal
government.
B) increasing the number of nonprofit and public hospitals.
C) placing limits on healthcare costs and limits on the growth of health
maintenance organizations (HMOs).
D) requiring every American to be enrolled in some type of health
insurance plan.
Ans: D
Feedback: Healthcare Reform set up a process through which the United
States would move toward healthcare coverage for all by requiring
everyone to be enrolled in some type of health plan. This goal of universal
coverage is not being sought through taking control of the insurance
industry, building public hospitals, or limiting the role of HMOs.
10. A 63-year-old man has qualified for Medicaid. His qualification for
Medicaid will be based primarily on what factor?
A) His medical history and present health status
B) His income
C) His employment history
D) His military service
Ans: B
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Easy
Feedback: Medicaid provides funds for healthcare for those dependent on
public assistance and certain other low-income individuals. Qualification is
not based on work history, health status, or military service.
11. A hospital is currently undergoing scrutiny in terms of a number of
hospital healthcare outcomes. Which of the following would be considered
an outcome?
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A) The ratio of care providers to managers and administrators in the
hospital
B) The incidence of nosocomial infections in the hospital
C) The demographics of the population that the hospital serves
D) The major sources of revenue for the hospital
Ans: B
Feedback: Outcome measures are specific, measurable aspects of
healthcare that show the effectiveness of the system as a whole. An
example of an important outcome measure is the incidence of nosocomial
infections in a care setting. The staffing mix, the demographics of the
community, and the revenue sources of the hospital may be important data
but they are not considered to be outcomes.
12. Historically nurses have had limited power in the healthcare system.
How can a nurse best exercise power to move the provision of healthcare
in a positive direction?
A) By participating in shared governance
B) By providing evidence-based care
C) By establishing collaborative relationships with physicians
D) By becoming accredited in a specialty area
Ans: A
Client Needs: A-1
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 7
Feedback: One of the most effective ways for nurses to effect change in the
healthcare system is by taking advantage of opportunities to participate in
shared governance. Accreditation, collaboration, and high-quality care are
all positive actions, but they are less directly related to the exercise of
power and influence.
13. There has been a great increase in the sophistication of healthcare
technology in recent decades. What effect has increased technology
primarily had on the provision of healthcare?
A) Health technologies have made healthcare more accessible to larger
numbers of Americans.
B) High-technology equipment requires a large capital investment in the
short-term but reduces healthcare costs in the long-term.
C) Health technologies improve patient care and provide an incentive for
innovative people to enter the healthcare field.
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D) Sophisticated health technologies can improve patient outcomes but
increase healthcare costs greatly.
Ans: D
Feedback: Health-related technologies often have the potential to improve
patient outcomes but they typically increase costs to healthcare
institutions and, ultimately, to healthcare consumers. They do not
normally result in decreased costs in the longer term and their ability to
directly attract innovators to the healthcare industry has not been proven.
14. Many consumers and advocacy groups in the United States have raised
concerns around the practices of the pharmaceutical industry. These
concerns are most often motivated by the fact that
A) drug research and development is conducted overseas but most drugs
are sold domestically.
B) residents of other industrialized countries have better availability of
drugs.
C) drug costs are higher in the US than in many other industrialized
countries.
D) pharmaceutical companies have shown an unwillingness to develop
new drugs.
Ans: C
Feedback: Drug companies often sell identical drugs in other countries for
far less money than what they charge consumers in the United States, a
fact that contributes to the high cost of healthcare in the United States.
Overseas research and development is not a contentious issue and drug
companies are continually active in the development of new drugs. Despite
the high costs, the availability of drugs in the United States is unmatched.
15. Nurse T. has been providing care for Mr. James for the past several
days during his admission to hospital for the exacerbation of his chronic
obstructive pulmonary disease (COPD). How can Nurse T. best help Mr.
James, and other patients, navigate the healthcare system effectively and
efficiently?
A) Encourage Mr. James to take ownership of his health and be proactive
with prevention measures.
B) Teach patients how to use technology to minimize their reliance on care
providers.
C) Educate patients about the varied roles that nurses can play in the
provision of healthcare.
D) Become familiar with the organization of healthcare and apply this
knowledge to patient teaching.
Ans: D
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Feedback: Nurses should become familiar with the complexities of
healthcare and use this knowledge to help patients and families navigate
the system. Technology and the roles of nurses of not topics that are likely
to benefits patients in a tangible way. Prevention measures are important
for health but they do not necessarily aid in navigating the system.
Chapter: Chapter 7: Legal Responsibilities for Practice
Multiple Choice
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1. Which of the following statements accurately reflects an element of the
crisis surrounding liability insurance in the United States?
A) Professional liability insurance does not provide coverage when the
nurse assists in an emergency.
B) Malpractice insurance premiums are not affordable for nurses in
independent advanced practice and traditional nursing roles.
C) Laws in some states are being amended to restrict the monetary liability
of any party according to the percentage of responsibility.
D) Nurses are being named in fewer lawsuits, but the judgments being
awarded are larger.
Ans: C
Feedback: Laws in some states are being amended to restrict the monetary
liability of any party according to the percentage of responsibility. Liability
laws continue to be a major concern for nurses, because nurses are being
named in an increasing number of suits, although the total number is still
low. Nursing liability insurance tends not to be expensive and it provides
coverage in emergency situations.
2. The law requires that a person give voluntary and informed consent for
medical treatment. Which of the following statements accurately describes
this legal obligation?
A) It is the responsibility of the nurse to obtain informed consent.
B) Informed consent must be obtained in the form of written
documentation.
C) A blanket consent for any procedures deemed necessary is usually
considered adequate consent for specific procedures.
D) The courts do not accept the clients medical condition alone as a valid
reason for withholding information when seeking consent.
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 6
Feedback: Courts do not accept the patients medical condition alone as a
valid reason for withholding complete and accurate information when
seeking consent. Obtaining consent is not normally a nursing
responsibility. Verbal consent and implied consent may have legal
standing and blanket consent is insufficient to cover any and every
procedure.
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3. A nurse working in a hospital setting is accused of malpractice. Which
statement accurately represents a legal element of this type of negligence?
A) Malpractice is present only if a breach of duty was the cause of the
harm.
B) When the harm is not clear and needs to be proved in court, the legal
term res ipsa loquitur is used.
C) Breach of duty is clearly defined as the expression of malicious intent.
D) A breach of duty is a failure to act as a prudent professional according
to standards of care designated by the federal government.
Ans: A
Feedback: One of the essential elements of malpractice is a breach of duty
by the professional. When the harm is so clear and the responsibility for
the harm so straightforward that it does not need to be proved in court,
the legal term res ipsa loquitur is used. Breach of duty is not synonymous
with malicious intent. The standards by which breach of duty is evaluated
are not defined by the federal government.
4. An attorney representing a client in a malpractice case attends a
deposition. What might occur in this proceeding?
A) A sworn, verbatim record is made by a court reporter.
B) A settlement is made out of court.
C) A legal proceeding presided over by a judge takes place in a courtroom.
D) Damages are awarded to the plaintiff.
Ans: A
Feedback: A deposition is a formal proceeding in which each attorney has
an opportunity to question a witness outside of court, and a sworn
verbatim record is made by a court reporter. A deposition is not the usual
venue for a settlement or the awarding damages. A trial, not a deposition,
is a legal proceeding presided over by a judge that takes place in a
courtroom.
5. A nurse is called to testify as an expert witness in a malpractice suit.
Which of the following guidelines contains prudent advice for this nurse?
A) Volunteer as much information as possible when explaining medical
procedure.
B) Use medical jargon as appropriate to describe the treatment provided
by the defendant.
C) Pause during the testimony to allow your attorney to object if
appropriate.
D) Discuss your testimony with the opposing attorney before the court
date.
Ans: C
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Feedback: A nurse who is testifying should listen carefully to the entire
question before answering and pause to let your attorney object if
appropriate. The nurse should not offer additional information voluntarily
or use medical jargon unless it is necessary. Testimony is not discussed
with the opposing attorney prior to a court date.
6. A nurse is aware that the nurse practice act in her state provides the
legal framework for her scope of practice. A nurse practice act is an
example of
A) common law.
B) constitutional law.
C) enacted law.
D) judicial law.
Ans: C
Feedback: Enacted law includes all bills passed by legislative bodies; nurse
practice acts in the various states are examples of enacted law at the state
level. A nurse practice act is not an example of constitutional law or
common law. Judicial law consists of decrees or judgments from the courts.
7. The federal Health Insurance Portability and Accountability Act (HIPAA)
of 1996 addresses patient rights within the healthcare system. Which of
the following actions may constitute a violation of HIPAA?
A) A nurse identifies a patient whom he recently cared for on his Facebook
page.
B) A nurse completes a charting entry without providing her initials after
the entry.
C) A nurse inserts a central venous catheter without the consent of the
patient.
D) A nurse makes a crude comment to a patient while providing morning
hygiene.
Ans: A
Feedback: HIPAA specifically addresses matters related to patient privacy
and confidentiality. Identification of a patient by a nurse would be
considered a violation of confidentiality. Failing to sign documentation is
not a contravention of HIPAA. Making inappropriate comments and
performing interventions without consent are both serious violations of
professionalism, but these are less likely to be addressed by HIPAA.
8. The risk manager at a large, university hospital has become aware that
there may be a discrepancy between a longstanding protocol on one of the
hospital units and the nurse practice act of the state. Which of the
following statements regarding the legal standing of institutional policies
is most accurate?
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A) Institutional policies do not have legal standing.
B) Institutional policies supersede enacted law but do not supersede
common law.
C) Established policies may be considered common law by a court
D) Discrepancies between policies and legislation are usually resolved by
professional associations such as a board of nursing.
Ans: C
Feedback: Established agency policies may be considered the standard of
practice for that agency and, therefore, common usage (common law) by
the court, and may become important as a basis for legal decisions.
However, policies do not normally have the power to supersede enacted
laws. Discrepancies are ultimately the jurisdiction of the courts, not
professional associations.
9. Nursing practice is subject to a wide variety of laws and regulations.
Which of the following actions is the clearest violation of criminal law?
A) A nurse left a patients bed in a raised position and the patient
subsequently fell.
B) A nurse withheld opioids from a patient and then sold them.
C) A nurse left the unit before her replacement had arrived.
D) A nurse applied restraints to a patient in alcohol withdrawal without
first obtaining an order.
Ans: B
Feedback: Thefts and the sale of controlled substances are not only
violations of professional standards but also crimes. Abandoning patients,
performing interventions without orders, or committing an action that
leads to injury are most often violations of civil law.
10. On a night shift, a nurse who provides care in an inpatient psychiatric
setting admitted a patient with a recent history of violence but placed the
patient in a two-bed room. The patient subsequently attacked and injured
the other patient in the room. Which of the following principles will be
considered in the courts determination of liability?
A) The nurse may be held liable if institutional factors are not noted to
have contributed to the situation.
B) The nurse is exempt from liability if institutional protocols specify that
room allocation is a nursing responsibility.
C) The nurse may be held liable provided the action was a crime.
D) The nurse may be held liable if the action constituted a violation of the
standard of care.
Ans: D
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Feedback: A violation of the standard of care is likely to create a situation
of legal liability for a nurse. The violation need not be a crime, however.
Institutional factors and protocols do not negate the nurses potential
liability
11. Mrs. Howe, age 59, had a bilateral mastectomy with axillary node
dissection and was discharged home 2 days later with drains in situ.
Contrary to the nurses predischarge teaching, Mrs. Howe attempted to
remove one of her drains independently once output ceased, resulting in
pain, tissue trauma, and bleeding. Mrs. Howe claims that her injuries were
the result of negligence by the nurses on the unit. How would the court
apply the principle of comparative negligence in this case?
A) The court would determine what proportion of the patients injuries was
the result of her own actions.
B) The court would compare Mrs. Howes actions with those of a
reasonable person.
C) The court would determine whether it was medically appropriate to
discharge Mrs. Howe with her drains still in situ.
D) The court would decide if the nurses on the postsurgical unit are legally
obliged to teach patients.
Ans: A
Feedback: In the application of comparative negligence, the courts
determine what percentage of injury resulted from a patients negligence
and what part rested with the nurse, and reduce the damage award
accordingly. The court would also likely examine the patients actions in
light of those of a reasonable person, but this is not a direct application of
the concept of comparative negligence. The court would not likely focus on
the appropriateness of the patients discharge or the nurses abilities to
teach patients.
12. Mr. Yamata was recently admitted to the hospital after a fall in which
he suffered a fracture of his femoral head. Over the past 2 days, he has
begun to refuse care. Which of the following factors is most significant in
the determination of Mr. Yamatas legal competence to refuse care?
A) Mr. Yamata was recently diagnosed with early-stage Alzheimer disease.
B) Mr. Yamata defers most of his important decisions to his oldest son.
C) Mr. Yamata has previously expressed a preference for complementary
and alternative therapies.
D) Mr. Yamata attempted to transfer to the commode independently,
despite the nurses instructions to the contrary.
Ans: A
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Feedback: Cognitive ability is an important consideration in the
determination of competence. The patients preference of alternative
therapies, his previous reckless behaviors, and his deference to his son are
not factors that would significantly affect his legal competence.
13. An 80-year-old woman has been admitted to the emergency
department after a sudden loss of consciousness and computed
tomography indicates a serious ischemic stroke. The patients son is
adamant that the patient would not want thrombolytic therapy. The son
would have the right to refuse this treatment on his mothers behalf if
A) there is a reasonable belief that such a treatment would not result in
improved outcomes for the patient.
B) a durable power of attorney for healthcare names the son as a
healthcare proxy.
C) the son is able to show evidence that his mother was legally
incompetent prior to her stroke.
D) there is unanimity among other immediate family members.
Ans: B
Client Needs: A-1
Feedback: A durable power of attorney for healthcare (DPOA-Healthcare)
is a document that legally designates a substitutionary decision maker,
should the person be incapacitated. This document may also be referred to
as designating a healthcare proxy. Previous disabilities, the agreement of
other family members and a low likelihood of benefit are not factors that
confer legal rights for surrogate decision-making.
14. A nurse who works in the emergency department of a large, urban
hospital often provides care for patients who must be temporarily
restrained for their own protection. Which of the following measures
lessens the chance that the nurse will be faced with a false imprisonment
suit?
A) Utilize physical restraints whenever possible and chemical restraints
only as a last resort.
B) Use the least restrictive means possible to restrain patients.
C) Delegate the management of confused and aggressive patients to
unlicensed care personnel.
D) Have all patients sign blanket consent when admitted.
Ans: B
Feedback: Any time patients pose a danger to themselves or others, the
law requires that the least restrictive means available be used to protect
patients and others. Physical restraints are not usually preferable to
chemical restraints and neither method exempts the nurse from potential
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liability. It would be inappropriate to delegate the care of patients who
pose a danger and blanket consent does not have legal standing.
15. Despite the fact that all nurses face the potential risk of being named in
a lawsuit there are measures that nurses can take to significantly reduce
this risk. Which of the following measures has the greatest potential to
prevent a malpractice claim?
A) Complete continuing competence requirements on time
B) Carry adequate liability insurance that provides comprehensive
coverage
C) Avoid interacting with clients or patients without a witness
D) Maintain a high-quality standard of nursing care
Ans: D
Feedback: There are many actions that nurses can take to prevent
lawsuits. Paramount among these is maintaining a high standard of care.
Insurance does not necessarily prevent claims, but rather mitigates the
consequences of these claims. It is normally unnecessary to avoid one-onone interaction with patients and clients and continuing competence
requirements do not necessarily prevent lawsuits.
Chapter: Chapter 8: Ethical Concerns in Nursing Practice
Multiple Choice
1. A mother and a daughter are taken to the emergency room for injuries
suffered in a car accident. When the mother is taken to surgery, the nurse
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tells her that her daughter will be fine, even though she does not know the
exact extent of the daughters injuries. This nurses actions may have been
guided by which of the following ethical theories?
A) Social equity and justice
B) Natural law
C) Deontology
D) Utilitarianism
Ans: D
A central premise of utilitarianism is that an act is right when it is useful in
bringing about a desirable or good end. In this case, instilling hope in the
mother may alleviate her stress before surgery. A deontological view
would condemn the nurses actions, since deontology proposes that ethical
decision-making is based on moral rules and unchanging principles (i.e.
that lying is categorically wrong). Social equity and natural law are not
reflected in the nurses decision to temporarily deceive the patient.
2. A client has advance directives for a DNR code (do not resuscitate).
When the nurse is caring for this client, the clients wife asks him to do
everything in your power to keep my husband alive. This nurse is most
likely to experience which of the following moral challenges?
A) Values clarification
B) Ethical dilemma
C) Values conflict
D) Nonmaleficence
Ans: B
Feedback: An ethical dilemma is any situation in which guiding moral
principles cannot determine which course of action is right or wrong. In
this case, there is a conflict between the clients wishes and that of his wife,
a situation that causes duress for the nurse. Values clarification, values
conflict, and nonmaleficence are not at the root of the situation the nurse
faces.
3. Which of the following statements accurately reflects one of the primary
provisions of the ANA Code for Nurses?
A) The administrators of the healthcare facility are responsible and
accountable for individual nursing practice.
B) The physician determines the appropriate delegation of tasks consistent
with the nurses obligation to provide optimum patient care.
C) The nurses primary commitment is to the employing agency.
D) The nurse owes the same duties to self as to others.
Ans: D
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Feedback: The nurse owes the same duties to self as to others, including
the responsibility to preserve integrity and safety, to maintain
competence, and to continue personal and professional growth. The Code
does not place primary ethical responsibility with administrators or
physicians nor does it claim that the nurses main commitment is to the
employer.
4. A nurse helps a client work through an ethical dilemma by using an
ethical decision-making framework. Which of the following statements
describes a component of this process?
A) The steps of this process are distinctly different from those of the
nursing process.
B) Most ethical problems have one possible solution.
C) The nurse uses the framework of his or her own values to assist the
clients to make a decision.
D) The facts of a situation make a difference in the options that are
possible.
Ans: D
Feedback: When attempting to make ethical decisions, it is important to
have as much information about the unique situation as possible because
the facts of the situation make a difference in what options are possible.
The steps in ethical decision-making mimic those of the nursing process.
The nurse should not impose his or her values on clients and most ethical
problems have more than one potential solution.
5. Which of the following is an accurate guideline for reporting the
chemical dependency of a colleague?
A) Confront the person you suspect, and offer assistance in obtaining
treatment.
B) Be sure beyond any doubt that a problem exists.
C) Rely on an informed supervisor to assume responsibility for the
problem.
D) Be aware that help and rehabilitation are only offered to the person
need it following disciplinary proceedings.
Ans: C
Feedback: Usually, once you have notified your supervisor, he or she will
assume responsibility for the problem. When planning to report, you do
not have to be sure beyond any doubt that a problem exists. Confrontation
is often ill-advised and rehabilitation may accompany or precede
discipline.
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6. A nurse on a palliative care unit has attended an educational inservice
on ethics. Which of the following statements most accurately describes the
concept of ethics?
A) Ethics offers a process that can be used to guide behavior.
B) Ethics is the expression of social and culture values, priorities, and
norms.
C) Ethics is the basis for evaluating personal character.
D) Ethics is the tangible application of religious and spiritual truths.
Ans: A
Feedback: Ethics offers a formal process for answering the question about
what one ought to do in a given situation. Ethics is not considered to be
simply an expression of cultural or religious principles and it does not
specify criteria for evaluating an individuals character.
7. Nursing involves close interaction between nurses and patients, a
situation which can create the potential for boundary violations. Which of
the following situations most clearly constitutes a boundaries violation?
A) A community health nurse continues weekly visits to a former client
despite the fact that the client is no longer receiving care.
B) A nurse states that she is willing to advocate to the patients employer
than the patient was genuinely ill and not feigning health complaints to
gain time off work.
C) A nurse attends a family meeting at the hospital in which the patient
and his family discuss the patients code status.
D) A nurse contacts a social worker without the patients knowledge
because of admissions the patient has made about her substandard living
conditions.
Ans: A
Feedback: Continuing contact with a patient outside of the domain of care
is a boundaries violation. Informing an employer that a patient was ill is
not likely a boundaries violation, since the nurse is reporting facts with the
patients permission. Nurses often participate in family meetings and
referrals made without a patients knowledge are not a violation of
boundaries.
8. A few weeks ago, a nurse worked a shift with a colleague during which
three oxycodone tablets went missing from the narcotic cupboard. As well,
the nurse has noted that the colleague has sometimes documented the
administration of oxycodone to patients only to have the patients continue
to complain of pain. The nurse suspects that the colleague is taking the
oxycodone from the unit for personal use. How should the nurse best
follow up these suspicions?
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A) Organize coworkers and the colleagues family members to carry out an
intervention
B) Contact representatives from the state board of nursing
C) Report these suspicions to the unit supervisor
D) Confront the colleague with these suspicions
Ans: C
Feedback: Reasonable suspicions of chemical abuse should be reported to
a nurses immediate supervisor. Confrontation, either face-to-face or in a
group setting, should normally be avoided. It would be premature to
contact the state board of nursing.
9. Mr. Bains is a 70-year-old man who has been recently diagnosed with
colon cancer. Mr. Bains is adamant that he does not want to undergo
chemotherapy or radiotherapy, citing the unpleasant side effects and the
absence of a guaranteed cure. His wife, however, is distraught that he
would give up so quickly and begs the nurse to convince him to pursue
treatment. Which of the following ethical principles would underlie the
nurses decision to respect Mr. Bains informed choice?
A) Beneficence
B) Nonmaleficence
C) Fidelity
D) Autonomy
Ans: D
Feedback: Autonomy involves the right of self-determination or choice,
independence, and freedom. As such, an expression of autonomy would
involve respecting the patients wishes even if they are unusual or opposed
by family members. Beneficence and nonmaleficence denote doing good
and avoiding harm. Fidelity refers to the obligation to be faithful to the
agreements and commitments.
10. An obstetrical-gynecological nurse has moved to a new region and is
seeking employment. The nurse opposes the ethics of elective abortion and
refuses to participate in the procedures. However, the only hospital in the
immediate area is the site of numerous elective abortions. How should the
nurse account for this fact when seeking employment?
A) Ask the hospital administrators to exempt her from participating in any
aspect of abortion.
B) Consider applying for a nursing position that will not involve abortion.
C) Begin working at the hospital and attempt to change the hospital
politically.
D) Accept a position at the hospital and then make her position known to
supervisors.
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Ans: B
Client Needs
Feedback: Nurses have a responsibility to avoid situations that they know
would be personally problematic for ethical reasons. It would be
unreasonable to accept a position and expect special treatment. As well, it
would be disingenuous for the nurse to accept a position without
disclosing her stance or to accept a position with the intent of enacting a
change.
11. A patient with a long-standing diagnosis of renal failure has declared
her intention to stop hemodialysis. Because of the ethical ramifications of
this, the care team has begun the process of making an ethical decision.
This process should begin by
A) eliciting input from impartial individuals from outside the hospital
setting.
B) explaining the major concepts of ethics to the patient and her family.
C) clearly identifying the essential elements of the ethical problem.
D) confirming the patients cultural and religious background.
Ans: C
Feedback: A process for ethical decision-making begins with the clear
identification of the situation at hand. This should precede the involvement
of other individuals or an exploration of the patients culture and religion. It
would not likely be helpful to explain ethical concepts to the patient.
12. The care providers and administrators of a hospital have struggled to
find an appropriate response to a patient who has a long history of being
admitted to hospital and then leaving against medical advice. Under the
direction of the hospital ethics committee, a plan was created and
implemented. What action should the care providers and the ethics
committee take after the plan has been implemented?
A) Continue to implement the plan when necessary
B) Assess the outcomes of applying the plan
C) Seek input from the hospitals risk manager
D) Report to the state board of nursing about the manner in which the
situation was handled
Ans: B
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Feedback: Implementation of an ethical decision should always be
followed by evaluation and appraisal of the course of action that was
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chosen. Involvement of the hospitals risk manager should take place
during the planning phase. It would not normally be necessary to involve
the state board of nursing in this decision-making process.
13. A nurse is working a shift with a colleague who has a nursing student
participating in the care of the colleagues patients. The nurse notices that
the colleague has spent much of the morning on the computer at the
nurses station and is allowing the student to perform every aspect of the
patients care. How should the nurse best respond to this colleague?
A) Speak directly to the colleague about these observations.
B) Ask the nursing student if she feels like the colleagues patients are
receiving good care.
C) Report the colleague to the supervisor of the unit.
D) Create a written report recording the facts of the morning.
Ans: D
Feedback: Lapses in the quality of care are best addressed by speaking
directly and privately to the person involved. The individuals response to
this discussion would determine whether involvement by supervisors is
necessary. It would be inappropriate to involve the nursing student in this
matter, given the power differential that exists between the nurse and the
student.
14. Tom is a nurse who provides care on a busy medical unit. One of Toms
colleagues has just confided in him that she erroneously gave her patient
16 mg of immediate-release hydromorphone instead of 16 mg of extendedrelease hydromorphone. She tells Tom that she does not want to report the
incident and so she plans to simply monitor the patients level of
consciousness and respiratory status closely for the next several hours.
Which of the following statements best describes Toms required response
to this situation?
A) Tom has a professional and legal responsibility to report this.
B) Tom should strongly encourage his colleague to document this error.
C) Tom is obliged to assist his colleague with follow-up assessments.
D) Tom has no legal obligation to respond, but he should take advantage of
this teaching opportunity.
Ans: A
Feedback: Incidents that have the potential for patient harm create a legal
and moral obligation for the nurse to report. Simply encouraging the
colleague to document this matter or helping with assessments are
insufficient responses.
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15. After working for several months on a geriatric subacute medicine
unit, a nurse has come to the conclusion that substandard care has become
accepted as the norm by the majority of nurses as well as their immediate
supervisors. The nurses attempts to discuss and address some significant
and persistent lapses in care have been rebuffed by nurses and supervisors
alike. What should the nurse do next?
A) Enlist the support of current and previous patients
B) Resign from the unit
C) Contact media outlets
D) Further discuss the benefits of practice improvements with the nurses
Ans: B
Feedback: A final alternative to a workplace problem may be to resign. It is
normally inappropriate to involve patients. Further discussions with the
nurses are unlikely to be beneficial, given the systemic nature of problems
on this unit. Contacting the media is rare and appropriate response.
Chapter: Chapter 9: Safety Concerns in Healthcare
Multiple Choice
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1. Several national organizations have addressed the issue of adverse
events in healthcare settings. The National Quality Forum (NQF) of 2002
included which of the following?
A) A list of serious reportable events that was aimed at increasing public
accountability
B) A cross reference of standards for nursing care with the most common
adverse events in healthcare
C) A list of aims for improving the overall quality of the American
healthcare system
D) An algorithm for responding appropriately to safety violations in
healthcare settings
Ans: A
Feedback: In 2002, The National Quality Forum (NQF) created and
endorsed a list of serious reportable events (SREs)also referred to as
adverse or never eventsto increase public accountability and consumer
access to critical information about healthcare performance. This did not
encompass standards for nursing care, appropriate responses to specific
adverse events, or a list of general aims for the healthcare system.
Multiple Selection
2. A nurse is aware that sentinel events that occur in the care setting must
be followed up in a timely and thorough way. Which of the following
occurrences would be considered a sentinel event? (Select all that apply.)
A) A nurses shift is cancelled at short notice.
B) A patient accesses the medication chart and takes a medication.
C) The family member of a patient physically threatens a nurse.
D) A physician makes sexually inappropriate comments to a nurse.
E) A nurse places a patient on a bedpan despite the fact that the patient
can ambulate with assistance.
Ans: B, C, D
Feedback: Sentinel events encompass a wide variety of events that
threaten the safety of patients, families, and care providers. Examples
include patient access to secured drug storage and inappropriate or
threatening conduct. Late cancellation of a shift would be unlikely to
constitute a sentinel event. Substandard care, such as the inappropriate
use of a bedpan, requires correction but would not be considered a
sentinel event.
Multiple Choice
3. One of the safe practices identified by the National Quality Forum (NQF)
is to match healthcare needs with service delivery capability. This practice
is demonstrated by
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A) matching the health status of a community with the specific mandate of
the local hospital.
B) conducting high-risk procedures in hospitals that perform a large
numbers of the same procedure.
C) encouraging Americans to seek care in healthcare institutions that have
the fewest number of adverse events.
D) ensuring that hospitals are equipped and staffed to provide neither too
much nor too little care.
Ans: B
Client Needs: A-2
Feedback: A practice identified by the NQF was to match healthcare needs
with service delivery capability. Research has consistently demonstrated
that patients undergoing certain high-risk procedures have lower-thanexpected mortality rates in hospitals that perform large numbers of those
procedures, and conversely, higher-than-expected mortality in institutions
that perform low volumes of those procedures.
4. The nursing leadership in the local hospital has recognized the need to
minimize the number of sentinel events that occur in the hospital by
implementing a number of practice improvements. These nurse leaders
should recognize that the largest proportion of sentinel events involve
which of the following?
A) Lapses in communication
B) Violence
C) Violations of care providers scopes of practice
D) Gaps in education and training
Ans: A
Client Needs: A-2
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Communication and Documentation
Objective: 2
Feedback: It has been estimated that communication errors are factors in
more than 70% of sentinel events.
5. The Joint Commission has taken action to encourage healthcare
organizations to reduce the incidence and impact of errors. How has the
Joint Commission acted to facilitate these improvements in care?
A) By delineating the scope of practice for registered nurses and practical
(vocational) nurses
B) By providing a forum for patients to report errors and substandard care
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C) By funding safety education in medical schools and nursing schools
D) By standardizing the measures by which safety in hospitals is gauged
Ans: D
Client Needs: A-2
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 3
Feedback: In 2004, the Joint Commission and the Centers for Medicare &
Medicaid Services (CMS) began working together to align measures
common to both organizations. These standardized common measures,
called Hospital Quality Measures, are integral to improving the quality of
care provided to hospital patients and bringing value to stakeholders by
focusing on the actual results of care. The Joint Commission has not
directly addressed the scope of nursing practice, the healthcare education,
or the reporting process.
6. A senior nurse on a medical unit is aware of the role that she can play in
establishing a culture of safety on the unit. What characteristic is most
important to care settings that possess a culture of safety?
A) Anticoagulants, opioids, and insulin are cosigned by two nurses.
B) Physicians orders are entered into a computerized system rather than a
handwritten section of patients charts.
C) Nurses feel that they can report errors, near misses, and adverse events
without being punished or denounced.
D) Direct patient care is provided by ADN and baccalaureate nurses rather
than practical (vocational) nurses.
Ans: C
Client Needs: A-2
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Feedback: A central attribute of a culture of safety is the existence of trust
and mutual respect. This encourages healthcare providers to report errors,
near misses, and other adverse events without fear of retribution.
Cosigning medications and eliminating handwritten orders are specific
measures that may augment safety, but they are not characteristics of a
culture of safety. Excluding PNs from care is not necessary to ensure
safety.
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7. A county hospital has recently implemented a practice change in which
the SBAR technique is now used to communicate between nurses and
physicians. The nurse has contacted an elderly patients physician to report
the patients adventitious lung sounds and decreased oxygen saturation.
Which of the following statements best exemplifies the R component of the
SBAR tool?
A) Mr. Young has a do-not-resuscitate order.
B) Mr. Youngs oxygen saturation is 86% on oxygen at 3 liters per minute
by nasal prongs.
C) Mr. Young was admitted on January 14 with a diagnosis of failure to
thrive.
D) I think that we should decrease Mr. Youngs IV rate.
Ans: D
Client Needs: A-2
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 3
Feedback: The SBAR tool consists of four components: situation (S),
background (B), assessment (A), and recommendation (R). A suggested
course of action, such as reducing a patients IV rate, is an example of a
recommendation. A patients code status and original diagnosis are
examples of background and oxygen levels are assessment findings.
8. A busy operating room has begun using time outs in an effort to reduce
errors and promote patient safety. What action will the care team perform
during a time out?
A) Systematically teaching the patient about the risks of surgery while the
patient is still in the preoperation area
B) Gathering each member of the surgical team to acknowledge and
confirm that the correct surgery will be performed on the correct patient
C) Pausing to review the patients diagnosis and the indications for surgery
D) Completing a checklist that reviews the major areas for preoperative
assessment and which contains the patients consent for the procedure
Ans: B
Settings
Feedback: All relevant members of the team actively communicate during
the time-out and agree, at a minimum, that the patient identity is correct as
is the site and the procedure to be done. Time outs do not normally involve
preoperative teaching, assessment, or review of the patients diagnosis.
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9. Failure to rescue has been defined as deaths per 1,000 patients having
developed specified complications of care during hospitalization (AHRQ,
2007). A hospital that wishes to reduce the rate of failure to rescue should
prioritize what measure?
A) Encouraging nurses to spend a greater amount of time at the bedside.
B) Implementing mandatory continuing education programs.
C) Improving the communication between members of different health
disciplines.
D) Reducing distractions to nurses while they are providing care.
Ans: A
Feedback: Failure to rescue has been tied to the amount of time that the
nurse spends at the bedside with incidence of failure to rescue decreasing
when nurses spend more time at the bedside and less on other activities.
Being present at the bedside influences failure to rescue more than
continuing education, improving communication, or reducing distractions,
even though each of these measures has the potential to improve safety.
10. Alana is a registered nurse with an ADN degree who floats between
several different medical and surgical units of a hospital. Today was Alanas
fifth 12-hour shift in a row and she committed a medication error while
providing care for one of the four patients to whom she was assigned.
What factor is most likely to have contributed to this adverse event?
A) The fact that Alana has an ADN degree
B) The fact that Alana floats between several units
C) The fact that Alana was working overtime
D) The fact that Alana was responsible for four patients
Ans: C
Feedback: While it is not possible to establish causative factors without
knowing more details of this situation, there is known to be a close
correlation between overtime and adverse events. Adverse events are not
typically linked to having an ADN degree or providing care for four
patients. Unfamiliarity with a unit is a safety risk, but overtime is a more
likely cause of an error.
11. A nurse who provides care in a long-term care facility is charged with
improving the safety of residents. Which of the following measures has the
greatest potential to reduce the incidence of injuring among residents?
A) A comprehensive falls prevention program
B) A program aimed at eliminating resident-to-resident violence
C) An automated medication administration system
D) An algorithm that guides the delegation of tasks among the care team
Ans: A
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Feedback: Falls are a common cause of morbidity and the leading cause of
nonfatal injuries and trauma-related hospitalizations in the United States.
Nearly half of all residents in nursing homes fall each year, with many
sustaining fractures. As a result, a falls prevention program is more likely
to be of benefit than a violence-prevention program, automated
medication administration, or a delegation tool.
12. A nurse is transcribing a physicians new drug order on to a patients
medication administration record. In light of the potential for drug errors,
how should the nurse best record the drug order?
A) Digoxin 0.125 mg PO daily
B) Digoxin .125 mg PO daily
C) Digoxin 0.1250 mg PO daily
D) Digoxin .1250 mg PO daily
Ans: A
Feedback: The Institute for Safe Medication Practices requires that leading
zeros before the decimal point always be included and trailing zeros after a
decimal point never be used.
13. A hospital has recently implemented a barcode point of care (BPOC)
system. This system will require the nurse to
A) scan barcodes on patients charts and their wristbands before
administering drugs.
B) cross-check physicians orders and patients medication administration
records.
C) scan patient wristbands and medication containers prior to medication
administration.
D) provide an electronic record of his or her nursing activities over the
course of a shift.
Ans: C
Feedback: BPOC systems cross-check bar codes printed on patient
wristbands, nurse identification badges, and medication labels. The system
matches the providers orders with the patient identification and verifies
the six rights of medication safety by comparing the bar code on
medications with the prescribed medications. Patients medical charts are
not normally scanned and BPOC do not provide a record of most aspects of
nursing care. Comparing physicians orders to MARs is not an activity that
is limited to BPOC systems.
14. A nurse is aware that the incidence of medication errors at the hospital
is much higher than it should be and that it is possible to reduce this
incidence. Which of the following measures carries the greatest potential
to reduce medication errors?
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A) Implementing team nursing, whereby every medication is administered
by a pair of nurses
B) Attaching physicians orders to medication administration records
(MARs)
C) Keeping medication administration records (MARs) at the patients
bedsides
D) Taking action to reduce distractions to nurses while they are
administering medications
Ans: D
Client Needs: A-2
Feedback: One of the causes of errors most frequently reported by nurses
is that of interruptions while administering medications. Team nursing,
attaching MARs to orders, and keeping MARs at patient bedsides are not
measures that have been widely proposed or that have been shown to
reduce medication errors.
15. A nurse who works in a busy, university hospital is committed to
improving patient safety at the hospital. In order to meet this goal, what
action should the nurse prioritize?
A) Advocating for continuing education programs and funding of nurse
educators
B) Encouraging patients to be active participants in their care by
communicating their expectations to caregivers
C) Critically examining systems and processes at the hospital with the aim
of suggesting improvements
D) Teaching unlicensed care personnel about safety in the hospital setting
Ans: C
Feedback: In order to promote a systematic culture of safety, nurses need
to look at systems and processes to identify areas that need to be studied
and changed to be safer. This broad and holistic approach to safety likely
has a greater potential to effect change than the other cited efforts that
have more narrow focuses.
Chapter: Chapter 10: The Nursing Profession and the Community
Multiple Choice
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1. A goal of community nursing is to provide primary prevention from
disease. Which of the following nursing actions reflect this goal?
A) A nurse creates a pamphlet discussing heart-healthy foods and
distributes it in the neighborhood community center.
B) A nurse starts an intravenous line on a dehydrated baby who has been
brought to the emergency department.
C) A nurse performs range-of-motion exercises for a patient in traction.
D) A nurse repositions an elderly patient confined to a wheelchair to avoid
the formation of pressure ulcers.
Ans: A
Client Needs: B
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Feedback: Primary prevention involves the efforts to prevent disease from
ever occurring. Primary prevention can be aimed at stopping the cause of
disease. Generalized efforts to educate people regarding healthy diets are
aimed at this type of primary prevention. Tertiary prevention focuses on
preventing long-term disability and restoring functional capacity, as
exemplified by repositioning an immobile patient, rehydrating a patient, or
assisting with exercises.
2. A nurse decides to pursue a career in community-based nursing. Which
of the following statements represents the environment in which the nurse
will be working?
A) Community-based nursing is limited to work in public clinics, schools,
and industry.
B) The key to community-based settings is that the nurse is in charge.
C) The nurse serves as an educator, guide, and resource person and
determines the action taken by the client.
D) Care in the community is cost-effective.
Ans: D
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Feedback: Care in the community is cost-effective and often more
acceptable to the client because it causes less disruption in life. It takes
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place in a wide variety of settings and involves the nurse entering into a
collaborative relationship with clients.
3. The movement of a client from acute care to a long-term nursing care
facility involves planning to provide continuity of care. What is the term
for this type of planning?
A) Discharge planning
B) Comprehensive planning
C) Ongoing planning
D) Transition planning
Ans: D
Feedback: Transitions are the movement of the patient from one care
environment to another. Transition planning refers to the planning
process that takes place to assure that the patients well-being is
maintained throughout the time of transition. Organizing this transition
from one care setting to another is not termed discharge planning,
comprehensive planning, or ongoing planning.
4. A nurse is called into work to perform triage in the aftermath of an
earthquake. Which of the following are the expected responsibilities of this
nurse?
A) Set up and monitor IV lines.
B) Prepare the emergency room for multiple victims.
C) Screen victims to prioritize treatment.
D) Check available blood products and assist with transfusions.
Ans: C
Client Needs: A-1
Feedback: Triage involves the initial screening of victims for the purpose
of prioritizing treatment and making the most effective and efficient use of
both human and material resources. The other noted tasks are within the
scope of disaster nursing but are not triage activities.
5. A client asks a nurse for help in obtaining an alternative healthcare
provider. Which of the following is an accurate fact regarding alternative
care that the nurse should share with this client?
A) Most alternative healthcare practitioners do not have education-based
credentials to practice their medicine.
B) Alternative providers are not usually included in the federal HIPAA
legislation that mandates confidentiality in conventional healthcare
settings.
C) The cost of alternative therapy is never covered by insurance carriers or
healthcare plans.
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D) It is easy to find accurate safety and efficacy data for alternative
medicine on the Internet.
Ans: B
Feedback: Alternative providers are not normally included in the federal
Health Insurance Portability and Accountability Act of 1996 legislation that
mandates confidentiality in conventional healthcare settings. Alternative
practitioners do not necessarily lack credentials. Accurate online
information can be difficult to find and costs for treatment may be covered
by some insurance plans.
6. There is an increasing trend for nursing care to move from the hospital
setting into the community. Nurses who are to provide excellent care in a
community setting should prioritize which of the following?
A) Integrating culture and family into the planning and delivery of care
B) Becoming more assertive in client education and the planning of client
care
C) Encouraging clients to limit their interactions with physicians
D) Teaching clients to replace biomedical interventions with
complementary therapies
Ans: A
Feedback: The move to community care heightens the importance of
family-centered, culturally-competent nursing. Community nursing does
not necessarily require that a nurse become more assertive with client. It
would be simplistic, and in most cases inappropriate, to guide clients to
replace biomedical interventions or avoid doctors.
7. In spite of the important role that hospitals play in American healthcare,
there is growing importance of community-based healthcare and
community-based nursing. Which of the following statements best conveys
a central aspect of the philosophy of community care?
A) The client is in charge of his or her health and healthcare in the
community.
B) Nurses maximize their scope of practice in noninstitutional settings.
C) Community settings allow for the greatest number and variety of
treatment options.
D) The nurse becomes the key member of the healthcare team in a
community setting.
Ans: A
Feedback: A central premise of community healthcare is the fact that
patients/clients are in charge. The move toward community care is not
motivated by an increased role for nurses. There are a greater number of
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treatment options in hospitals than in the community, but this fact does
not negate the importance of community care.
8. Mr. Hammond is a 70-year-old man with a diagnosis of type 1 diabetes
who developed a diabetic foot ulcer earlier this year. He has recently been
discharged from the hospital and now requires regular wound care. Karen
is a community health nurse who provides wound care for Mr. Hammond
twice weekly. Which of Karens actions is most likely to empower Mr.
Hammond?
A) Encourage Mr. Hammond to acknowledge his contribution to the
development of his wound.
B) Provide information to Mr. Hammond that matches his expressed
needs.
C) Encourage Mr. Hammond to involve members of his family in his care.
D) Delegate wound care to Mr. Hammond and reduce the frequency of her
visits.
Ans: B
Feedback: Client empowerment is often fostered by assessing and meeting
a clients need for information. Encouraging an acknowledgement of the
clients contribution to his or her current health state is beneficial in many
circumstances, but it less likely to make the client feel empowered.
Similarly, family involvement can be beneficial but does not directly foster
empowerment. Empowerment does not necessarily mean that the nurse
does less and the client performs his or her own care; delegation may not
be appropriate.
9. An elderly female client who resides in the community tends to defer
decisions regarding her care to her eldest son. How should the community
health nurse respond to the clients reluctance to make independent
decisions?
A) Discuss this observation with the client and her son in an open manner
and explore alternatives.
B) Organize care so that it takes place at times when the son is not present
in the home.
C) Accommodate this aspect of the clients family dynamics when planning
and carrying out care.
D) Teach the client assertiveness skills that she can apply in her
interactions with her son.
Ans: C
Feedback: The nurse should respect the clients desire to organize her care
in the way that she prefers. It is not the responsibility of the nurse to
reorganize or overcome this familys dynamics.
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10. A client with a long-standing diagnosis of chronic obstructive
pulmonary disease (COPD) has been enrolled in a disease management
program. Which of the following activities will be prioritized in this
program?
A) Providing comprehensive and evidence-based care of the clients COPD
B) Creating collaborative relationships between the client and the care
team
C) Ensuring that the client qualifies for Medicare and Medicaid
D) Liaising between the client and his health maintenance organization
(HMO)
Ans: A
Feedback: Disease management focuses on providing the best evidencebased care for an individual with a specific chronic illness. This does not
necessitate enrollment in an HMO, Medicare, or Medicaid. Collaborative
relationships facilitate effective disease management but this is a means to
the end of positive health outcomes rather than an end in itself.
11. One of the expressed goals of Healthy People 2020 is to achieve health
equity and eliminate disparities. What health indicator can most accurately
gauge whether this goal is being achieved?
A) Environmental quality
B) Injury and violence
C) Mental health
D) Access to healthcare services
Ans: D
Client Needs: B
Feedback: Health equity is achieved when all Americans have equitable
access to health services and there a fewer disparities in health access and
health outcomes. Environmental quality, mental health and injury, and
violence are important health indicators but these are less directly
indicative of health equity and the elimination of disparities.
12. Nurses have the potential to positively impact the health of
communities. Which of the following actions is most likely to improve the
health of a community?
A) Publicizing the consequences of unhealthy lifestyles
B) Advocating politically for laws and policies that foster community
health
C) Ensuring that nurses are practicing to the full extent of their scope of
practice
D) Providing nursing care to individuals who are not patients or clients
Ans: B
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Feedback: One important role of nurses in the promotion of healthy
communities is as a supporter and advocate for political measures that
would improve the health of the community. Publicizing negative health
outcomes is appropriate in some contexts but this is likely less effective
than promoting broad change politically. It is not normally appropriate to
provide nursing care for individuals who are not patients or clients.
Practicing to the full extent of ones scope of practice is not likely to impact
community health in a direct way.
13. A nurse who provides care in an acute medical unit is aware of the
importance of thorough discharge planning. The discharge planning
process should begin
A) once the patient has stabilized and is assured of positive outcomes.
B) as soon as possible after the patient is admitted.
C) once the patient has received a discharge order from his or her primary
care provider.
D) 48 to 72 hours before the projected date of discharge.
Ans: B
Feedback: If possible, discharge planning should begin immediately upon
admission.
14. A hospital patient has discussed with the nurse her use of visualization,
biofeedback, and relaxation exercises in managing the chronic pain that
results from her fibromyalgia. The nurse should recognize this patients use
of what category of complementary/alternative medicine (CAM)?
A) Biologically-based practices
B) Manipulative practices
C) Traditional indigenous medicine
D) Mind-body medicine
Ans: D
Feedback: Examples of mind-body medicine include relaxation exercises,
hypnosis, meditation, dance, prayer, visualization, and biofeedback.
Biologically-based practices focus on food and dietary supplements while
indigenous medicine applies the collective health knowledge of a
particular culture. Manipulative practices involve the systematic
application of touch.
15. A hospital patient who suffered a spinal cord injury has expressed an
interest in exploring complementary/alternative therapies. The nurse
should encourage the patient to begin this process by doing which of the
following activities?
A) Asking practitioners of different therapies to provide lists of satisfied
clients
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B) Asking the patients primary care provider for permission to explore
nonbiomedical treatments
C) Finding reliable evidence regarding the safety and effectiveness of
therapies
D) Determining whether the patients health insurance would cover the
cost of alternative/complementary therapies
Ans: C
Feedback: The first step for an individual interested in
complementary/alternative therapies is to assess the safety and
effectiveness of the therapy in relationship to his or her own condition.
This must precede the identification of specific practitioners or making
financial arrangements. Communication with the care team is important,
but the patient does not need to seek permission before exploring
treatment alternatives.
Chapter: Chapter 11: Initiating the Leadership and Management Role
Multiple Choice
1. Which of the following statements accurately reflects the nurses
responsibility for patient outcomes in todays workplace?
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A) Tasks can be delegated, but accountability cannot be delegated.
B) In todays environment, authority is more often given to management.
C) Most nurses who are accountable have the authority to affect the
situation or effect change.
D) Nurses are protected against legal action being taken in cases of
malpractice in the hospital setting.
Ans: A
Feedback: Tasks can be delegated, but accountability cannot; nurses who
delegate tasks to assistive personnel continue to be accountable for that
care. Many nurses experience frustration because they must be
accountable for activities without the authority to affect the situation or
create change. Authority is often shared in contemporary care settings.
Nurses are legally responsible for the care they provide and are vulnerable
to malpractice suits.
2. Which of the following statements accurately describes a basic guideline
for using communication skillfully?
A) Managers should communicate how to perform a task even if it is
something the subordinate has already learned.
B) Managers should not be afraid of making judgmental statements when
dealing with a subordinate who has broken policy rules.
C) Managers should attempt to formulate a response to an individual who
is still speaking to avoid awkward pauses in the conversation.
D) Managers should present direction as briefly as possible while still
providing adequate data.
Ans: D
Feedback: Effective managers state the necessary information as briefly as
possible while still providing enough data to be clear. Interruptions,
judgmental statements, and repeated explanations are characteristics of
ineffective communication.
3. What is the primary objective of a performance appraisal?
A) Establish written documentation of incompetent behavior to facilitate
dismissal
B) Maintain and develop employee performance
C) Establish criteria for accreditation standards
D) Determine who receives pay raises
Ans: B
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Communication and Documentation
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Objective: 11
Feedback: The primary objectives of performance appraisal are to
maintain or improve employee performance and to enhance the
development of employees. They are not intended to be punitive measures
or criteria for accreditation. Performance appraisals may have an influence
on a nurses pay but this is not their primary objective.
4. Which of the following is a characteristic of an effective performance
evaluation system?
A) The appraisal system operates outside of the scope of administration.
B) Employees do not know in advance who will be evaluating them.
C) The final disposition of the appraisal is shared with the employee.
D) Evaluation concentrates on the personality of the employee.
Ans: C
Feedback: A sound performance appraisal is shared with the employee
who is the subject of the appraisal. The appraisal system should be
strongly supported by administration and employees should be made
aware of who will appraise them. An employees personality should not be
the focus for appraisal.
5. A nursing student finds that she has difficulty with procrastination.
Which of the following is a recommended guideline to help this student
manage her time?
A) Start working on a project for 10 minutes, and quit if tired or bored.
B) Schedule 2 or 3 days a week in which to concentrate her tasks.
C) Avoid spending the time it takes to make to-do lists.
D) Schedule down-time first and work second.
Ans: A
Client Needs: A-1
Feedback: Kanarek (1996) provides five suggestions for dealing with
procrastination. First, she suggests that you start working on a project for
10 minutes and quit if tired or bored. Work times should be prioritized
carefully and spread out over time. The creation of lists is a useful tool.
6. A nursing leader has expressed a desire to foster the characteristics and
behaviors associated with transformational leadership. Which of the
following actions best demonstrates transformational leadership?
A) The leader makes it clear to employees that positive work performance
will be rewarded and that sub-standard performance will bring
consequences.
B) The leader ensures that decisions are based on the consensus of every
employee.
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C) The leader prioritizes the needs of each individual employee over the
interests of the larger organization.
D) The leader takes action to build trust and relationships between him or
her and the employees.
Ans: D
Feedback: Leader activities associated with transformational leadership
include creating a vision, building relationships, developing trust, and
building self-esteem. An emphasis on rewards and punishment is
associated with transactional leadership. Consensus is not appropriate for
every decision, and the interests of individual employees cannot always
supersede the interests of the organization.
7. The manager of a hospital unit has unilaterally decided on a change in
the way that overtime is distributed among the nursing staff and has
followed up this decision with an e-mail to all employees. What leadership
style is exemplified by this manager?
A) Participative leadership
B) Permissive leadership
C) Laissez-faire leadership
D) Autocratic leadership
Ans: D
Feedback: In autocratic or authoritarian leadership, the leader/manager
makes the majority of the decisions without direct consultation with
employees. Laissez-faire or permissive leadership occurs when little or no
direction or guidance is provided. Participative leadership involves
extensive input from employees.
8. Experts have identified a close relationship between the practice of
transformational leadership and the empowerment of employees. What
action should a nursing leader take to foster employee empowerment?
A) Have the performance of each employee appraised by his or her peers
rather than by a manager or leader.
B) Share information as openly as possible in order to make employees
aware of problems.
C) Adopt a hands-off approach in order to allow leadership to organically
emerge from within the group of employees.
D) Eliminate the practice of conducting performance appraisals of
employees.
Ans: B
Feedback: Transformational leaders foster empowerment by openly
sharing information with workers so that everyone is aware of problems
and the need for action. Performance appraisals are not necessarily
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contrary to the philosophy or practice of transformational leadership, and
these should not be conducted by an employees peers. Transformational
leadership is characterized by constructive engagement, not a hands-off
approach.
9. Jennifer is a registered nurse who works in a busy emergency
department. As one of her goals for the current year, Jennifer has resolved
to develop her emotional intelligence. How should Jennifer best meet her
goal?
A) Try to remove emotion from her clinical decision-making whenever
possible.
B) Become more assertive when responding to the emotional responses of
patients, families, and coworkers.
C) Become more aware of the way that her emotions function and how
they influence her actions.
D) Try to limit her expressions of emotion to times when she is not
interacting with others.
Ans: C
Feedback: Self-awareness is one of the central aspects of emotional
intelligence. Emotional intelligence does not necessarily involve removing
emotion from decision-making or removing emotion from interpersonal
interactions. Awareness of others emotions is a dimension of emotional
intelligence, but the appropriate response to this is not normally increased
assertiveness.
10. A recent nursing graduate has asked an expert nurse how best to foster
her leadership abilities, since she wishes to explore leadership
opportunities later in her career. How should the expert nurse best
respond?
A) Even if you dont trust a decision that you have to make, act like you
chose the best option.
B) Become as specialized as possible in your nursing experience.
C) Develop your interpersonal skills by having a wide variety of
interactions.
D) Become as assertive as you can and take every opportunity to guide the
behavior of others.
Ans: C
Feedback: The development of sophisticated interpersonal skills is
important to building leadership abilities. Effective leadership does not
depend on feigned confidence, though self-confidence is a trait that can be
fostered. In most cases, variety and depth of experience are superior to
narrow specialization. Effective leadership is more nuanced and complex
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than simply directing the behavior of others or demonstrating
assertiveness.
11. A nurse has responded to a patients call light for the fourth time in the
past hour only to be berated by the patient for taking so long to come to
the bedside. Rather than responding in a confrontational tone the nurse
has paused to think of the best response to the patients statements. In
doing so, the nurse has exhibited
A) self-regulation.
B) sympathy.
C) manipulation.
D) self-strategy.
Ans: A
Feedback: Self-regulation refers to the ability to control inappropriate
impulses and to think before acting or speaking. Research on mindfulness
training indicates it is a positive strategy for managing emotionally
charged situations. The nurse has not acted in a manipulative way.
Sympathy involves feeling sorrow for another persons pain, a dynamic that
is not evident in this interaction.
12. A patient is receiving a transfusion of packed red blood cells and
consequently requires frequent vital signs. A set of vital signs was just due
during the nurses scheduled lunch break and so a colleague took the
patients vital signs. After returning from lunch, the nurse confirmed with
the colleague that the scheduled vital signs were taken, to which the
colleague replied, Yes, it seems like Im covering you a whole lot lately. How
should the nurse best respond to the colleagues statement?
A) I dont think thats a fair thing to say because I cant help when a set of
vitals are due.
B) If youre implying that I dont pull my weight I think that youre badly
mistaken.
C) Well, what goes around comes around, right?
D) Could you explain what you mean by that?
Ans: D
Client Needs: C
Cognitive Level: Application
Feedback: An important principle of communication is to ensure that
meanings are clearly understood by both parties. This is especially true in
the case of a statement that may be accusatory. Responding
confrontationally or sarcastically is rarely appropriate.
13. The nurse manager of a busy medical unit prioritizes effective
communication with the employees of the unit. In recent years, an
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increasing amount of this communication has involved e-mails and text
messages. When using these communication media, the nurse should
A) take action to ensure that patient confidentiality is maintained.
B) cc upper management and human resources with all e-mails.
C) avoid using a smartphone on the unit whenever possible.
D) follow up e-mails with a paper copy of important messages.
Ans: A
Feedback: Patient privacy can be difficult to ensure when communicating
electronically. As a result, nurse leaders must take measures to protect
confidentiality. Electronic messages do not always need be followed up
with paper copies and it is unnecessary to cc superiors on all
communications. Smartphones are an effective communication tool,
provided they are used in an appropriate manner.
14. It has been a frantic morning on the hospital unit and the nurse is
unsure whether she will be able to complete her required tasks on time
before her scheduled lunch break. Which of the following is the nurses
most appropriate response to this problem?
A) Skip lunch or trade her lunch break with a colleague who is scheduled
for a later break.
B) Determine if more of her tasks could be delegated to another member of
the care team.
C) Ask the unit manager for advice.
D) Explain to a colleague that she will likely be unable to complete her
required work.
Ans: B
Feedback: Delegation is an appropriate and useful strategy for effective
time management. This would be a preferred approach over changing the
lunch schedule. The nurse should attempt to delegate before approaching
her manager for a solution or resigning herself to the fact that she will not
complete her work.
Multiple Selection
15. All performance evaluations, whether formal or informal, should be
based on appropriate standards of performance. In the context of a
performance appraisal, which of the following are appropriate
performance criteria? (Select all that apply.)
A) The managers experience base
B) The nurses written job description
C) The institutions policies and procedures
D) Nursing standards of practice
E) The nurses career goals
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Ans: B, C, D
Feedback: Standards of performance include job descriptions, policies and
procedures, and professional standards of practice. A leaders personal
experience base and the nurses goals may be relevant but neither is an
objective measure for appraising the nurses performance.
Chapter: Chapter 12: Working with Others in a Leadership Role
Multiple Choice
1. The nature of healthcare requires the development of healthcare teams
and collaboration among its members. Which of the following statements
represents an element of this teamwork?
A) Each group member of a team is the leader of the team.
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B) The organization sets the goals for its teams.
C) Communication patterns in teams flow both up and down.
D) Team members are not legally responsible for decisions and outcomes.
Ans: C
Feedback: Teams may be led by facilitators or coaches, have members who
share responsibility for decisions, setting goals, and achieving outcomes,
use communication patterns that flow both up and down, and have
members who share responsibility for decisions and outcomes. Not every
member of the group is in a leadership role and goals may be set
independently. A team may be legally responsible for the decisions its
members make.
2. A client receives the care of a physician, a nurse, an occupational
therapist, and a counselor working together as a team. What is the term for
this type of healthcare?
A) Cross-discipline healthcare
B) Comprehensive healthcare
C) Holistic healthcare
D) Interdisciplinary healthcare
Ans: D
Feedback: Interdisciplinary healthcare involves collaboration and
extensive communication between members of different health disciplines.
This model is not termed cross-discipline, comprehensive, or holistic
healthcare.
3. A nurse will soon become a member of a newly-established care team.
Which of the following is a goal of team building?
A) Acknowledging individual achievements
B) Providing client care based on the direction of the team leader
C) Creating a type of synergy when addressing client care
D) Allowing care to be determined by nurses who are not too close to the
situation
Ans: C
Feedback: The goal of team building is to create a type of synergy, in which
the effect of everyone working together toward the shared goal results in a
greater total effect than could be achieved by the sum of the efforts of
everyone working individually. Individual achievements should be
acknowledged, but this is not the goal of team building. The process of
building the team does not immediately result in changes to client care
4. A registered nurse is responsible for organizing the care at a facility that
has several UAPs. Which of the following tasks can an RN delegate to a
UAP?
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A) Performing an ongoing assessment
B) Answering call lights
C) Administering medications
D) Counseling clients
Ans: B
Feedback: Any activity that requires knowledge and judgment that is
unique to the function of an RN cannot be delegated to others. Such
activities include ongoing assessment, medication administration, and
counseling clients. Answering call lights is within the scope of a UAP and
can thus be delegated.
5. A nurse recognizes the importance of safely and efficiently delegating
tasks in order to achieve a high standard of care. Which of the following is
one of the NCSBNs five rights of delegation?
A) Right education
B) Right assessment
C) Right circumstances
D) Right motivation
Ans: C
Client Needs: A-1
Feedback: The five rights of delegation include the right task,
circumstances, person, direction/communication, and
supervision/evaluation.
6. A nurse is aware of the pivotal role that motivation plays in the
formation of effective teams and the provision of excellent nursing care.
Which of the following actions is most likely to motivate a team member?
A) Ensure that the consequences of substandard performance are wellknown.
B) Publicize those individuals who have made exceptional contributions
and point out those who have failed to perform adequately.
C) Openly acknowledge team members who have made a particularly
valuable contribution.
D) Be clear that only the highest levels of performance are acceptable to
the team.
Ans: C
Feedback: There are numerous ways to foster motivation in others,
including the use of genuine praise and acknowledging high performance.
Negative methods, or punishments, have been shown to be less effective.
These would include emphases on consequences, shame, and threats.
7. A registered nurse is responsible for overseeing the care that is
provided in a long-term care facility. The skills mix at the facility includes
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the registered nurse, a practical nurse, and several unlicensed assistive
personnel (UAP). Which of the following statements is true of the
delegation that the RN performs?
A) The RN is accountable for the care that the other members of the team
provide.
B) The RN may only delegate tasks that are outside of her own scope of
practice.
C) The RN can delegate tasks that are outside the PNs or UAPs scope of
practice if she first provides adequate teaching.
D) Once a task is delegated, the person who performs the tasks is solely
responsible for the outcomes.
Ans: A
Feedback: It is critical to remember that although you have asked
someone else to carry out a nursing task, you are still accountable for the
care that is given. A person cannot be delegated a tasks that is outside his
or her scope of practice, regardless of whether teaching is provided. A
person cannot delegate a task that is outside of his or her own scope of
practice.
8. Healthcare is a field that continues to undergo constant and profound
change, both planned and unplanned. Which of these situations is an
example of reactive change?
A) Hospital administrators have announced a desire to implement the
principles of evidence-based practice.
B) A hospitals accreditation review revealed systemic problems and the
hospital has been directed to resolve these.
C) The introduction of automated medication dispensing machines at a
hospital is scheduled for later this year.
D) A transition will soon begin whereby the practical (vocational) nurses
will begin to practice within their full scope.
Ans: B
Feedback: Planned change has a definite design and structure established
to facilitate the process, including time lines, identification of stake
holders, goals, plans for implementation, and processes for evaluation.
Thoughtful planning often results in more effective and efficient change
processes and is essential for projects that are complex or large in scope
and that require greater time, resources, or skills. Change also may be
unplanned and occur as a reaction to another issue, such as a failed
accreditation. This is referred to as reactive change. Reactive change
occurs when some problem or event arises that requires a different way of
doing things.
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9. Kurt Lewins force-field theory of change is one of the most widely
accepted and remains in current use today. The central concepts of this
theory of change include
A) the forces that govern intrinsic and extrinsic motivation.
B) the relationship between driving forces and restraining forces.
C) the forces of resilience and inertia in an organization.
D) the relationship between the will for change and the ability to effect
change.
Ans: B
Feedback: According to Lewin, change requires an imbalance between the
forces that call for changethe driving forces, which push the system toward
change and the restraining forces that pull the system away from change.
Lewin does not explicitly address the issues of motivation, inertia,
resilience, and will for change.
10. A nurse has identified glaring inefficiencies in the way that care is
organized on a medical unit. Which of the following tasks will this nurse
perform if he or she is to act as a change agent?
A) Informing others about the need for change
B) Ensuring that others comply with any change that is implemented
C) Establishing punishments and rewards to foster compliance with
change
D) Evaluating the long-term outcomes associated with change
Ans: A
Feedback: A change agent is the person who seeks to create change and is
responsible for facilitating the change process with others. Having
gathered data, identified the problem, and decided that change is needed,
the change agent sets about making others aware of the need for change. A
change agent is not necessarily involved with evaluating a change or
ensuring compliance.
11. A nurse leader has been commissioned to implement a new electronic
documentation system in a hospital, replacing the existing paper-based
system that has been in place for decades. What is the first step that this
nurse should take toward facilitating this change?
A) Enlist the support of the physicians and advanced practice nurses in the
hospital.
B) Publicize the deficits of the existing documentation system.
C) Understand how and why individuals are often resistant to change.
D) Begin the process of evaluation before the change is implemented.
Ans: C
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Feedback: A first step in facilitating change is gaining a thorough
understanding of resistance to change. This should precede the evaluation
process, even though this should indeed begin early in the change process.
An understanding of the change process is necessary before the nurse
begins eliciting support from care providers or publicizing the deficits of
the current system.
12. Jessica is a recent nursing graduate who was able to secure a position
on the postsurgical unit where she completed the final preceptorship of
her baccalaureate degree. Jessica has just received word that there will be
sweeping changes in the organization of care on the unit, a development
that she finds intimidating since she has only recently become adept at
working in the existing system. How should Jessica best respond to this
news?
A) Elicit support from nurses who support maintaining the existing system
B) Learn as much as she can about the proposed system
C) Research alternatives to the change that has been proposed
D) Express her concerns about the proposed change to the nurse manager
Ans: C
Feedback: As a novice nurse, you should take all available opportunities to
learn about any anticipated changes. This is more beneficial that actively
or passively opposing a change and should precede a presentation of
concerns to the manager.
13. Healthcare institutions are frequently the site of conflict. Which of the
following situations exemplifies interpersonal conflict?
A) A nurse is undecided whether to pursue a management position or to
continue providing bedside care.
B) A recent graduate and a more experienced nurse disagree on the
thoroughness of the recent graduates assessments.
C) A cohort of experienced nurses have concerns about the way that
younger nurses dress and present themselves.
D) The nurses on a unit are having difficulty getting physicians to return
pages.
Ans: B
Client Needs: A-1
Conflict
Feedback: Interpersonal conflict occurs between or among individuals.
This is where differences in values, ideas, perceptions, and goals play an
important role. Intrapersonal conflict occurs within ones self in
circumstances in which a choice must be made between two alternatives.
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Intergroup conflict exists between defined groups of individuals, such as
recent nursing graduates, experienced nurses or physicians.
14. Alex is a nurse who has been taken aside by a colleague and the
colleague has described another nurse as a backstabber and battleaxe. The
colleague has gone on to give Alex details of ongoing conflict between the
colleague and this nurse. Which conflict management technique should
Alex apply in this situation?
A) Withdrawing from conflict
B) Accommodating the conflict
C) Negotiating
D) Collaborating
Ans: A
Feedback: The strategy of avoiding or withdrawing from the conflict is
employed when you choose not to address the issue at hand. There are
many times when this approach is appropriate. This includes situations in
which the conflict clearly is not your problem or when there is little or
nothing that you can do about it. This is the case when a conflict is limited
to two other individuals and does not involve patient safety.
Accommodating, negotiating, and collaborating are likely not appropriate
responses by the nurse to this interpersonal conflict.
15. The approach that a nurse chooses in the management of a conflict is
entirely dependent on many of the factors and variables involved in the
specific conflict. In which of the following situations would the nurse be
most likely justified in forcing the issue or competing?
A) A nurse is embarrassed that a colleague discovered the nurses
medication error and completed an incident report.
B) A nurse observed a colleague remove an opioid analgesic from the
locked medication cupboard and put it in her pocket.
C) A nurse disagrees with a colleague about the need for increased staffing
levels.
D) A nurse has received constructive criticism from his manager during his
latest performance appraisal.
Ans: B
Feedback: Forcing the issue might be the best approach if the nurse
observes a violation of ethical or legal standards, such as suspected
substance abuse. Interpersonal disagreements about feedback or staffing
levels are more likely to benefit from a more collaborative or constructive
conflict management technique.
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Chapter: Chapter 14: Facing the Challenges of Todays Workplace
Multiple Choice
1. A nurse begins to feel comfortable on her unit and views client care in
terms of long-range goals. She is able to prioritize among clients and
deliberately plan her actions, which may still lack speed and flexibility.
Which of Benners levels of function has this nurse achieved?
A) Novice
B) Advanced beginner
C) Competent
D) Proficient
Ans: C
Feedback: Characteristics of the competent nurse include beginning to see
the current situation in terms of long-range goals. This nurse is able to
prioritize among patients and base actions on conscious deliberate
planning but may still lack speed and flexibility. As such, the competent
nurse is more adept than the novice and advanced beginner but less skilled
than the proficient nurse.
2. A novice nurse apprehensively reflects on what she considers to be an
impossible task of delivering quality care on her ward as it is assigned to
her. What is the name of this phenomenon first coined by Marlene
Kramer?
A) Burnout
B) Reality shock
C) Culture shock
D) Job disorientation
Ans: B
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback: One problem confronted by the new graduate is the seeming
impossibility of delivering quality care within the constraints of the system
as it exists. Kramer characterized this phenomenon as reality shock, not
burnout, culture shock or job disorientation.
3. A counselor diagnoses a critical care nurse with having the syndrome
known as burnout. Which of the following is a characteristic of this
condition?
A) Burnout occurs when a nurse first enters the workplace and is
overwhelmed by the workload.
B) All of the symptoms of burnout are psychological in nature.
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C) Burnout is accompanied by a decreased ability to function on the job
and at home.
D) Burnout occurs less often in high-energy areas, such as critical care or
burn units.
Ans: C
Client Needs: C
Feedback: Burnout is accompanied by a decreased ability to function both
on the job and in the personal life. Burnout occurs more frequently in
nurses who work in particularly stressful areas of nursing, such as critical
care, oncology, or burn units. It does not typically occur early in a nurses
time in a particular setting and it can result in physical manifestations.
4. A hospital manager is accused of quid pro quo sexual harassment. Which
of the following is an action that might have been involved?
A) Making persistent unwanted attempts to initiate a personal relationship
B) Granting job-related benefits in return for sexual favors
C) Using suggestive or obscene language
D) Making direct sexual advances
Ans: B
Client Needs: C
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 8
Page and Header: 523, Sexual Harassment
Feedback: Quid pro quo sexual harassment involves the explicit offer of
job-related benefits in return for sexual favors. It is not defined by direct
advances, attempting to initiate a relationship, or suggestive language,
though some or all of these activities may be present in the exchange.
5. A hospital manager evaluates the workplace to ensure that ergonomics
are working. Which of the following statements describes this scientific
theory?
A) Ergonomics is the study of client outcomes related to economic theories
in healthcare.
B) Ergonomics empowers clients to have a voice in their own plan of care.
C) Ergonomics ensures that jobs are fitted to the physical abilities of the
employees.
D) Ergonomics provides guidelines for delegating responsibilities for client
care.
Ans: C
Client Needs: A-2
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Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 6
Page and Header: 517, Ergonomic Hazards in the Workplace
Feedback: Ergonomics is the science of fitting a task to ones physical
characteristics in order to enhance safety, efficiency, and well-being. When
the task does not conform to ones physical characteristics, musculoskeletal
stress and injuries may occur. Ergonomics does not address client
outcomes, delegation, or client autonomy.
6. Researchers have noted a high incidence of burnout among nurses.
Which of the following nurses most likely faces the highest risk of
burnout?
A) An experienced nurse who has long neglected her own physical health
and who leads a sedentary lifestyle.
B) A nurse who provides pediatric palliative care and who is disillusioned
with the overall quality of care on the unit.
C) A nurse who has recently graduated with an ADN degree and begun
working in a busy, inner-city emergency department.
D) A nurse who is few months away from retirement from her current
position in community health.
Ans: B
Client Needs: C
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Caring
Objective: 3
Page and Header: 512, Causes of Burnout
Feedback: Prominent among the causes of burnout is a conflict between
ideals and reality. As well, practice environments with high mortality rates
are associated with burnout. Poor physical health predisposes a nurse to
burnout, but this is likely less salient than the combination of
disillusionment and high acuity. New graduates and those approaching
retirement are not particularly predisposed to burnout.
7. Melissa is a nurse who graduated earlier this year with a baccalaureate
degree in nursing and immediately began working on a busy surgical unit
with a high turnover of both the patients and the staff. As a result, Melissa
has found the adjustment to full-time employment particularly stressful.
Which of the following actions should Melissa take in order to manage the
stress in her life?
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A) Schedule a vacation for later in the year and focus on this upcoming trip
when she is experiencing high levels of stress.
B) Reduce her workload to part-time and supplement this with casual
employment on a lower-stress unit.
C) Be vigilant in personal habits that result in adequate rest, a healthy diet,
and adequate physical exercise.
D) Reduce or eliminate the specific interactions in the clinical setting that
cause her the most stress.
Ans: C
Client Needs: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Page and Header: 511, Personal Stress Management
Feedback: Attending to diet, rest, and activity is important in the
management of job-related stress. These measures are more likely to be of
benefit than trying to endure until a distant vacation. Adding another
workplace has the potential to increase stress and it is not normally
realistic to eliminate stressful interactions in the workplace.
8. A recent nursing graduate has become overwhelmed with reality shock
in recent weeks, despite the fact that he secured a job in the setting that
was his first choice. This nurses best response to his experience with
reality shock is to
A) confront the manager of the unit with the details of his experience.
B) reduce the performance expectations that he places on himself.
C) prioritize physical assessments and interventions over patients
psychosocial needs.
D) seek input from a trusted nurse who can act as a coach or mentor.
Ans: D
Client Needs: C
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Caring
Objective: 3
Page and Header: 509, Preceptors, Coaches, and Mentors
Feedback: A coach or mentor can be of great assistance when recent
nursing graduates are faced with reality shock. Such a person may be of
more benefit than the manager of the unit, who may be too busy to assist
the nurse with his adjustment. Reducing the quality of care or reducing
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expectations may place the burden of the nurses reality shock on patients
themselves, which is inappropriate.
9. A nurse who provides care in a busy ambulatory clinic knows that there
are numerous occupational hazards associated with the provision of
nursing care. What is the employers responsibility in minimizing the
nurses risk of experiencing an injury or infection?
A) The employer must provide all the necessary supplies and equipment to
prevent injuries and infections.
B) The employer must ensure that staffing levels are maintained at a level
specified by the state board of nursing.
C) The employer must have dedicated occupational health officers present
at all times.
D) The employer must release nurses from tasks that may present a threat
to their health.
Ans: A
Client Needs: A-2
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 6
Page and Header: 515, Infection as an Occupational Hazard
Feedback: Employers must be held accountable for providing the supplies
and environment to make work settings safe. All risks cannot normally be
eliminated and dedicated occupational health staff may or may not be
available or necessary. Safe staffing levels are important, but these do not
necessarily mitigate the risk of workplace injuries and infections.
10. Racial and ethnic discrimination has been identified as a reality within
healthcare institutions. Which of the following goals for the nursing
profession is most appropriate?
A) The nursing workforce should transcend racial and ethnic
categorization and should not be appraised through this lens.
B) The nursing workforce should have fewer Caucasian members and
more racial/ethnic minorities.
C) The nursing workforce should be made up of members from as many
cultures as possible.
D) The nursing workforce should reflect the population for whom it
provides care
Ans: D
Client Needs: C
Cognitive Level: Application
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Difficulty: Moderate
Integrated Process: Caring
Objective: 7
Page and Header: 520, Racial/Ethnic Discrimination
Feedback: A workforce that reflects the population is more likely to meet
the healthcare needs of that population in a culturally sensitive manner. It
is simplistic to presume that the solution to discrimination lies with fewer
Caucasians and more minorities. Similarly, increasing the number of
cultures represented within nursing will not necessarily eliminate
discrimination.
11. A nurse who works in a rural hospital has become frustrated and
disillusioned at the steady increases in nurse to patient ratios at the same
time that patient acuity has increased. When planning to address this issue
with the hospitals leadership, the nurse should cite which of the following
statements about increased nurse to patient ratios?
A) Increased nurse to patient ratios are associated with a decline in patient
outcomes.
B) Reality shock is more common and severe when there are increased
nurse to patient ratios.
C) An increased nurse to patient ratio increases the incidence of disruptive
behavior in hospital settings.
D) Discrimination and stress increase when there is an increase in nurse to
patient ratios.
Ans: A
Client Needs: A-2
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 5
Page and Header: 514, Nurse Staffing Levels
Feedback: Increased nurse to patient ratios have been shown to result in
decreased patient outcomes. There are other deleterious effects on nurses,
including reality shock and stress, but patient outcomes should be the
primary consideration.
12. A nurse was helping a colleague boost a patient higher in his bed she
felt sudden pain in her lumbar region. How should the nurse follow up this
event?
A) Make an appointment with a physician and document the injury if there
are significant results.
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B) Have a trusted colleague perform a musculoskeletal assessment and
monitor the nurses range of motion for the remainder of the shift.
C) Go home immediately and take enough sick time to allow her back to
recover completely before returning to work.
D) Document the event as soon as possible using the hospitals designated
forms.
Ans: D
Client Needs: A-2
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 6
Page and Header: 519, Workers Compensation
Feedback: A nurse who suspects an injury should report the event
promptly using the appropriate paperwork. A common error is to delay
reporting in the belief that you should report something only if you know it
will be serious or require medical care. It is insufficient to leave work
without documenting the event or to rely on a colleagues assessment and
care.
13. Three times in the past several weeks a physician has commented on a
nurses body and each comment has been more explicit and sexually
suggestive than the last. How should the nurse first respond to this form of
sexual harassment?
A) Avoid contact with the physician except in locations where there are
colleagues or other witnesses.
B) Ignore the physician if more comments are made in the future.
C) Confront the physician directly and explain that such comments are
unacceptable and unwanted.
D) Document the events in detail and inform the state medical board.
Ans: C
Client Needs: A-2
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 9
Page and Header: 523, Sexual Harassment
Feedback: Individuals should take steps to stop sexual harassment by
giving clear, direct verbal messages indicating that the behavior in
question is unwanted, unpleasant, and must stop. Sometimes this action
alone stops inappropriate behavior. If clear, direct messages are not
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successful, the individual then should report the matter in writing to an
immediate supervisor. Simply avoiding the offender or attempting to
manage the behavior by reducing opportunities are not sufficient
responses.
14. Despite being seen as a safe environment where victims of violence are
treated, hospitals are the site of a large number of assaults. Which of the
following care environments is associated with the greatest risk of physical
violence?
A) Psychiatric mental health
B) Geriatrics and gerontology
C) Critical care and acute medicine
D) Labor and delivery
Ans: A
Client Needs: A-2
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 10
Page and Header: 525, Violence in the Workplace
Feedback: The majority of client assaults occur in psychiatric mental
health settings.
15. A string of recent assaults perpetrated on nurses by clients has
prompted the hospital administrators to address this disturbing trend.
What action should the administrators prioritize in an effort to reduce the
incidence of workplace violence?
A) Ensure that at least one male nurse is present at all times on each
nursing unit.
B) Teach self-defense techniques to all the nurses who provide care in
high-risk settings.
C) Train nurses how to effectively manage the behavior of aggressive
patients and clients.
D) Withhold care from patients and clients who have a history of
aggression.
Ans: C
Client Needs: A-2
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 10
Page and Header: 525, Violence in the Workplace
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Feedback: One form of violence prevention is to train employees in the
management of hostile and violent behavior. Ways of identifying hostile
and assaultive clients should be developed so that staff can be warned to
take extra personal safety precautions. This is different from teaching selfdefense techniques, which are normally physical in nature. It is not
normally possible to withhold care from an individual, even if the person
has a history of violence or aggression. The presence of male nurses is not
an adequate measure in the prevention of violence.
Chapter: Chapter 14: Valuing the Political Process
Multiple Choice
1. A nurse practicing in Alabama accepts a position in Connecticut. Which
of the following would be the best resource to consult for a legal definition
of nursing in that state?
A) American Association of Nurses
B) Nurse Practice Act
C) The American Journal of Nursing
D) National League for Nursing
Ans: B
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Communication and Documentation
Objective: 1
Page and Header: 530, Relevance of the Political Process for Nurses
Feedback: All of the philosophic discussions about the role of the nurse
must return to the reality of the nurses role as legally defined in the states
practice act. Nurse practice acts define the specific legal parameters for
nursing practice in a state. The AAN, NLN, and nursing journals do not
make these determinants.
2. A nurse attempts to become more involved in the political process.
Which of the following statements accurately describes the political arena
in which this nurse may become involved?
A) Nurses can be involved in the political process as individuals, but they
are far more effective when working in groups.
B) Most traditional nursing organizations are government-mandated
groups and therefore are deeply involved in political activity.
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C) Political action committees are nonprofit organizations that are
registered as political action groups and are free to try to affect the
political process.
D) Nurses who testify for decision-making bodies must do so as an official
representative of a nursing organization.
Ans: A
Feedback: Legislators consider the views of individual constituents when
making political decisions. However, the views of organized groups are
more likely to influence a policymaker. Most traditional nursing
organizations are nonprofit groups and therefore are limited in their
political activity. PACs are registered as political action groups and are free
to try to affect the political process. Nurses may testify as individuals.
3. Which of the following is an accurate representation of politics at the
local level?
A) Once budgeted funds are allocated to an objective, more funds are made
available for other projects.
B) Local budgets are generally mandated by federal agencies.
C) Support for community services may depend on whether
knowledgeable nurses voice their advocacy.
D) Local political decision-making sessions are usually closed to the public.
Ans: C
Client Needs: A-1
Cognitive Level: Analysis
Feedback: In many communities, decisions about the allocation of federal
money are made at the local level. Support for health-related community
services may depend on whether those who are knowledgeable about the
benefits of these services are willing to voice their advocacy in local
decision-making bodies. When funds are allocated they are no longer
available for other purposes and projects. The local political decisionmaking process is normally open to the public.
4. A nurse decides to become a member of NANDA-International
(NANDAI). Which of the following areas of the nursing process is he or she
most likely interested in developing?
A) Assessment
B) Diagnosis
C) Implementation
D) Evaluation
Ans: B
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Feedback: The purpose of NANDA-I is to work toward uniform
terminology and definitions to be used in nursing diagnosis and to share
ideas and information regarding this topic.
5. What is the main purpose of the National Council of State Boards of
Nursing (NCSBN)?
A) Provide accreditation of baccalaureate and higher degree programs
B) Recognize those with superior ability and leadership potential, and
those who have made important contributions to nursing
C) Provide a forum for the legal regulatory bodies to act together in the
regulation of nursing practice for the protection of the public
D) Unite the interests of nursing with those of the community in support of
excellence in nursing education
Ans: C
Feedback: The purpose of the NCSBN is to provide a forum for the legal
regulatory bodies (whatever their particular state titles might be) of all
states, the District of Columbia, and the US territories to act together in the
regulation of nursing practice for the protection of the public. It does not
perform accreditation or leadership in education programs or
acknowledge influential nurses.
6. A nurse has expressed her intention to draft a letter to her state senator
but the nurses colleagues have characterized this effort as a waste of time
and energy. Which of the following statements provides the most accurate
rationale for nurses involvement in the political process?
A) Involvement in the political process can lead to the effective allocation
of resources.
B) Political action increases the status and influence of the nursing
profession as a whole.
C) Involvement in the political process demonstrates responsibility and
accountability by nurses.
D) Political involvement by nurses increases the influence of women in
society and in government.
Ans: A
Feedback: With many voices competing to be heard in the decision-making
circles of any nation, the person who understands power and politics, and
who participates in this process, is the one most likely to obtain the
resources needed to accomplish desired ends. Political involvement is not
primarily motivated by the desire to increase the status of nurses and/or
women and it is not simply an activity performed out of obligation or
responsibility.
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7. A nurse has become aware of sweeping changes that are proposed for
the state budget which may have ramifications for the funding of the innercity clinic where the nurse provides care. In order to influence the
decision-making process the nurse should first
A) tell clients of the clinic that their healthcare is in jeopardy.
B) clearly communicate her views on the matter to the appropriate
legislators.
C) examine the systems and processes at the clinic to see where efficiency
could be improved.
D) approach the media with examples of the way that funding changes will
hurt patient and client outcomes.
Ans: B
Feedback: One of the most basic, and important, ways to influence the
political process is to explicitly communicate ones views to the
government leaders who determine policy. Examining the efficiency of the
clinic is a useful exercise but not one that is likely to influence political
decisions. It is likely premature and alarmist to go to the media or begin
telling clients that their care is in jeopardy.
Multiple Selection
8. The federal government operates in the healthcare field in complex
ways that involve dozens of agencies. Which of the following groups are
examples of the involvement of the federal government in healthcare?
(Select all that apply.)
A) Centers for Disease Control and Prevention (CDC)
B) Department of Health and Human Services (HHS)
C) National Institutes of Health (NIH)
D) Center for Medical & Medicare Services (CMS)
E) National League of Nursing (NLN)
Ans: A, B, C, D
Client Needs: A-1
Feedback: The Department of Health and Human Services (HHS) is a
cabinet-level administrative unit of the federal government with four
major service divisions and many different sections. The Public Health
Service includes the Centers for Disease Control and Prevention (CDC). The
National Institutes of Health (NIH), the Food and Drug Administration, the
Health Resources Administration, and the Center for Medical & Medicare
Services (CMS) are all part of HHS. The NLN is not a department or agency
affiliated with the federal government.
Multiple Choice
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9. A group of nurses have organized with the purpose of promoting an
amendment to the nurse practice act that governs the profession. This
group should direct their efforts toward what level of government?
A) Local
B) State
C) Federal
D) Regional
Ans: B
Feedback: Nurse practice acts are pieces of legislation that exist at the
state level.
10. A nurse has initiated a letter-writing campaign in an effort to increase
the funding for school nursing programs in local high schools. A colleague
of the nurse, however, has pointed out that the monies for such programs
originate with the federal government. Which of the following statements
best describes the relationship between federal funding and local
healthcare programs?
A) Federal funding is made available only in cases where the local tax base
is insufficient to fund programs.
B) Local contributions to health promotion programs are matched by the
Department of Health and Human Services.
C) Decisions around the allocation for federal funding are often made at
the local level.
D) Federal representatives control budgets at a local level but are obliged
to consider input from local residents.
Ans: C
Feedback: In many communities, decisions about the allocation of federal
money are made at the local level. Recent congressional actions have
leaned toward enhancing state and local control through creating large
block grants where priorities would be decided locally. Federal funding is
not dependent on a lack of local funding and the DHHS does not normally
match local funding. Local budgets are not normally under the direction of
federal officials.
11. In 2010, the Quality and Affordable Care Act was passed, beginning the
process of providing health coverage for all legal residents of the United
States. This legislation has numerous ramifications for nurses, including
A) the replacement of most general practice physicians with nurse
practitioners.
B) the creation of incentives for advanced practice nursing education.
C) the creation of a common scope of practice for practical (vocational)
nurses and registered nurses.
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D) the establishment of mandatory overtime for nurses in acute care
settings.
Ans: B
Feedback: The Quality and Affordable Care Act creates incentives for
nurses to seek advanced education. This legislation does not create a
uniform scope of practice for PNs and RNs or advocate the elimination of
general practice physicians. As well, the act does not establish mandatory
overtime for nurses.
12. A nursing student has expressed exasperation at the bewildering
number and variety of nursing organizations that exist in the United States.
Why are there so many nursing organizations?
A) The nursing profession itself is large, diverse, and complex.
B) Nursing has long been defined by competing political interests.
C) Nursing is governed by a combination of local, state, and federal laws.
D) The nursing profession has traditionally been influenced by the
interests of other political organizations.
Ans: A
Feedback: The existence of a large number of diverse organizations for
nurses is, in many ways, a reflection of nursing itself. The profession offers
a wide variety of employment opportunities to its members, with distinct
and varied contributions and interests in healthcare. When nurses become
committed to a particular specialty group, they have a tendency to want to
advance the purposes and interests of the people working in that area.
This variety and diversity is reflected in the number of nursing
organizations. It is not necessarily a result of competition, outside
influences, or the variety of legislation that affects nursing practice.
13. After many years of providing bedside care in a variety of settings, a
nurse has become involved in the leadership of the American Nurses
Foundation (ANF). In this role, the nurse will be primarily involved in
A) supporting nursing research.
B) enhancing the public perception of the nursing profession.
C) advancing the scope of practice for registered nurses.
D) lobbying for improved wages and benefits.
Ans: A
Feedback: The ANF is a tax-exempt, nonprofit corporation that exists for
the purpose of supporting research related to nursing. It is not primarily
involved in promoting the image of nursing, lobbying for wages and
benefits, or determining the scope of practice.
14. During his baccalaureate program in nursing, Mark became passionate
about excellence in nursing education. Now that he has graduated and
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begun acting as a preceptor for nursing students, he wishes to become
politically involved in issues relating to nursing education. What nursing
organization should Mark most likely join?
A) American Nurses Foundation (ANF)
B) National Council of State Boards of Nursing, Inc. (NCSBN)
C) NANDA-International (NANDA-I)
D) National League for Nursing (NLN)
Ans: D
Feedback: The NLN seeks to unite the interests of nursing with those of
the community in support of excellence in nursing education. The NCSBN,
ANF, and NANDA-I are not primarily focused on matters relating to
nursing education.
15. The Quality and Affordable Care Act of 2010 addresses a large variety
of issues and policies related to the provision of healthcare in the United
States. Which of the following situations is most likely to be affected by the
provisions of this act?
A) A new resident of a small town has been unable to find a family
physician who is accepting new patients.
B) A citizen has been falsifying documents and tax returns in order to
qualify for Medicare.
C) A man is engaged in a dispute with his health maintenance organization
(HMO) over reimbursement for an emergency procedure.
D) A woman is unsure where to bring her daughter for an annual influenza
vaccination.
Ans: B
Feedback: The Quality and Affordable Care Act addresses the Medicare
and Medicaid programs, aiming to increase availability and eliminate
waste and fraud. The act does not directly address the functioning of HMOs
or the availability of specific aspects of care.
Chapter: Chapter 15: Applying Research and Technology to Nursing Practice
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Multiple Choice
1. A nurse has conducted a literature review in an effort to identify the effect of
handwashing on the incidence of nosocomial (hospital-acquired) infections in acute
care settings. An article presented findings at a level of significance of <0.01. This
indicates that
A) the control group and the experimental group were more than 99% similar.
B) the findings of the study have less than 1% chance of being attributable to
chance.
C) the effects of the intervention were nearly zero.
D) the clinical significance of the findings was less than 1:100.
Ans: B
Client Needs: A-1
Cognitive Level: Evaluation
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Feedback: The level of significance is the level at which the researcher believes that
the study results most likely represent a nonchance event. A level of significance of
<0.01 indicates that there is less than 1% probability that the result is due to chance.
2. A nurse has read a qualitative research study in order to understand the lived
experience of parents who have a neonatal loss. Which of the following questions
should the nurse prioritize when appraising the results of this study?
A) How well did the authors capture the personal experiences of these parents?
B) How well did the authors control for confounding variables that may have
affected the findings?
C) Did the authors use statistical measures that were appropriate to the
phenomenon in question?
D) Were the instruments that the researchers used statistically valid and reliable?
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Ans: A
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Feedback: Qualitative studies are judged on the basis of how well they capture and
convey the subjective experiences of individuals. Statistical measures and variables
are not dimensions of a qualitative methodology.
3. A nurse has expressed skepticism to a colleague about the value of nursing
research, claiming that nursing research has little relevance to practice. How can the
nurses colleague best defend the importance of nursing research?
A) The existence of nursing research means that nurses are now able to access
federal grant money, something that didnt use to be the case.
B) Nursing research has allowed the development of masters and doctoral programs
and has greatly increased the credibility of the profession.
C) The growth of nursing research has caused nursing to be viewed as a true
profession, rather than simply as a trade or a skill.
D) The application of nursing research has the potential to improve nursing practice
and patient outcomes.
Ans: D
Feedback: The greatest value of nursing research lies in the potential to improve
practice and, ultimately, to improve patient outcomes. This supersedes the
contributions of nursing research to education programs, grant funding, or the
public view of the profession.
4. Tracy is a nurse with a baccalaureate degree who works in the labor and delivery
unit of a busy urban hospital. She has noticed that many new mothers abandon
breast-feeding their babies when they experience early challenges and wonders
what could be done to encourage more women to continue breast-feeding. What
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role is Tracy most likely to play in a research project that tests an intervention
aimed at promoting breast-feeding?
A) Applying for grant funding for the research project
B) Posing the clinical problem to one or more nursing researchers
C) Planning the methodology of the research project
D) Carrying out the intervention and submitting the results for publication
Ans: B
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 3
Page and Header: 569, A Staff Nurses Role in the Research Process
Feedback: A major role for staff nurses is to identify questions or problems for
research. Grant applications, methodological planning, and publication submission
are normally carried out by nurses who have advanced degrees in nursing.
5. A patient signed the informed consent form for a drug trial that was explained to
patient by a research assistant. Later, the patient admitted to his nurse that he did
not understand the research assistants explanation or his own role in the study.
How should this patients nurse respond to this revelation?
A) Explain the research process to the patient in greater detail.
B) Describe the details of a randomized controlled trial for the patient.
C) Inform the research assistant that the patients consent is likely invalid.
D) Explain to the patient that his written consent is now legally binding.
Ans: C
Client Needs: C
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Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 3
Page and Header: 569, A Staff Nurses Role in the Research Process
Feedback: Just as the staff nurse is not responsible for medical consent, the staff
nurse is not responsible for research consent. If patients who have agreed to
participate exhibit ambivalence or uncertainty about participating, do not try to
convince them to participate. Ask the person from the research team who is
managing consents to speak with concerned patients about the study, even after a
patient has signed the consent forms.
Multiple Selection
6. A nurse leader is attempting to increase the awareness of evidence-based practice
(EBP) among the nurses on a unit. A nurse who is implementing EBP integrates
which of the following? (Select all that apply.)
A) Interdisciplinary consensus
B) Nursing tradition
C) Research studies
D) Patient preferences and values
E) Clinical expertise
Ans: C, D, E
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Page and Header: 571, Establishing a Definition of Evidence-Based Nursing
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Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a
problem-solving approach to the delivery of healthcare that integrates the best
evidence from studies and patient care data with clinician expertise and patient
preferences and values.
Multiple Choice
7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been
extremely slow to heal and which now poses a threat of osteomyelitis. The wound
care nurse who has been working with Mrs. Mayes applies evidence-based practice
(EBP) whenever possible and has proposed the use of maggot therapy to debride
necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantly
opposes this treatment despite the sizable body of evidence supporting it. How
should the nurse reconcile Mrs. Mayes views with the principles of EBP?
A) The nurse should explain that reliable and valid research evidence overrides the
patients opinion.
B) The nurse should explain the evidence to the patient in greater detail.
C) The nurse should integrate the patients preferences into the plan of care.
D) The nurse should involve the patients family members in the decision-making
process.
Ans: C
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 4
Page and Header: 571, Establishing a Definition of Evidence-Based Nursing
Feedback: Patient preferences should be integrated into EBP and considered
alongside research evidence and the nurses clinical expertise; evidence does not
trump the patients preferences. The family should be involved, but this is not an
explicit dimension of EBP. Similarly, explaining the evidence in more detail is not a
demonstration of EBP.
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8. The administrators of a long-term care facility are considered the use of
specialized, pressure-reducing mattresses in order to reduce the incidence of
pressure ulcers among residents. They have sought input from the nurses on the
unit, all of whom are aware of the need to implement the principles of evidencebased practice (EBP) in this decision. Which of the following evidence sources
should the nurses prioritize?
A) A qualitative study that explores the experience of living with a pressure ulcer
B) A case study that describes the measures that nurses on a geriatric unit took to
reduce pressure ulcers among patients
C) Testimonials from experienced clinicians about the effectiveness of the mattress
in question
D) A randomized controlled trial that compared the pressure-reducing mattress
with standard mattresses
Ans: D
Client Needs: A-1
Cognitive Level: Evaluation
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Page and Header: 572, Determining Adequate Evidence
Feedback: The most reliable evidence is considered RCTs. Qualitative studies, case
studies, and expert opinion are low on the hierarchy of evidence.
9. Hospital administrators are applying the principles of evidence-based practice
(EBP) in their attempt to ascertain the most efficient and effective way to
communicate between nurses who are on different units, a project that will consider
many types of evidence. Which of the following information sources should the
administrators prioritize?
A) A systematic review about communication in nursing contexts
B) Nurses ideas about communication methods
C) The results of a chart review
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D) The hospitals accreditation status
Ans: A
Feedback: Systematic reviews are assigned a high value in EBP. Reviews would be
prioritized over nurses ideas or a chart review, though both are potential
considerations. The hospitals accreditation status is not a relevant consideration.
10. A nurse has resolved to apply the evidence-based practice (EBP) process to the
way that admission assessments are conducted and documented on a unit. How
should the nurse begin the process of establishing EBP?
A) Gather evidence showing the shortcomings of current practices
B) Formulate a clear and concise question to be addressed
C) Elicit support from the nurses who are most often responsible for admissions
D) Search the literature for evidence that is potentially relevant to the practice need
Ans: B
Feedback: The first step in applying EBP is to ask a clear, focused question. This
should precede a search of the literature or the recruitment of participants. An
assessment of the shortcomings of the current system is not an explicit component
of the EBP process.
11. Which of the following questions best exemplifies the PICOT format for asking
evidence-based questions?
A) What affect does parents alcohol use have on the alcohol use of their teenage
children?
B) Among postsurgical patients, what role does meditation rather than
benzodiazepines have on anxiety levels during the 48 hours following surgery?
C) Among high school students, what is the effectiveness of a sexual health
campaign undertaken during the first 4 weeks of the fall semester as measured by
incidence of new sexually transmitted infections?
D) In children aged 68, is the effectiveness of a descriptive pain scale superior to a
numeric rating scale in the emergency room context?
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Ans: B
Feedback: The correct answer includes a population (postsurgical patients),
intervention (meditation), comparison (benzodiazepines), outcome (anxiety levels),
and a time frame (48 hours). No other option contains each of the five elements of a
PICOT question.
12. A nurse has made plans to implement the University of North Carolina (UNC)
model of 5 As during the process of applying evidence-based practice (EBP) to a
practice problem. What is the final step that the nurse will take in applying this
model?
A) Analyze the results of the EBP process
B) Advocate for others to embrace the identified change
C) Adopt the changes identified in the review process
D) Assess the outcomes of the new practice
Ans: D
Client Needs: A-1
Feedback: The final step in the UNC rubric is to Assess the change using the quality
improvement process in place in the institution.
13. A nurse has been asked to make a presentation to a group of high school
students on the subject of sexual health. However, the nurse does not have a
background in this practice area and requires rapid access to evidence-based
guidelines. Which of the following strategies is most likely to provide the nurse with
valid and reliable evidence in a time-efficient manner?
A) Search the Cochrane Library of Systematic Reviews
B) Google search terms such as sexual health teens and sexual education
C) Search Medline using PubMed and order relevant articles
D) Scan the most recent issues of nursing journals that address this area of practice
Ans: A
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Client Needs: A-1
Cognitive Level: Application
Feedback: For some problems, a systematic review may be available from a source
such as the Cochrane Library. Often this review is done by an expert panel providing
excellent information on which to base decisions. This approach is more likely to
produce valid and reliable results than a Google search and is more efficient than
searching journal manually or ordering articles through PubMed.
14. The nurses at a university hospital have been informed that a computerized
record system will be implemented over the next 12 months. The nurses should be
aware that such as system presents particular challenges in the area of
A) vulnerability to errors in charting and the inability to make changes.
B) patient privacy and confidentiality of records.
C) enforcing compliance with the system on the part of nurses.
D) ensuring compatibility with different computer operating systems.
Ans: B
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Feedback: Concerns about privacy become magnified when information is available
to many people in many sites far removed from where the patient is located, a
situation that exists when computerized records are used. This is usually considered
a more important concern than issues of compliance, compatibility, or vulnerability
to errors.
15. A nurse is nervous about the impeding introduction of computerized nursing
care records at the hospital because he does not consider himself to be
technologically adept. How should this nurse best respond to this situation?
A) Take courses in advanced practice nursing to build his knowledge.
B) Explore employment opportunities in settings that use written documentation
systems.
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C) Advocate for a delay in the introduction of the proposed system.
D) Seek out opportunities to learn the relevant knowledge and practice the
necessary skills.
Ans: D
Client Needs: A-1
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Communication and Documentation
Feedback: A nurse who lacks technological knowledge or skills should seek out
opportunities to expand these. This is preferable to finding a job elsewhere,
studying advanced practice nursing, or attempting to delay the change.
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