Test Bank for Fundamental Concepts and Skills for Nursing
6th Edition by Williams
Chapter 01: Nursing and the Health Care System
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MULTIPLE CHOICE
1. Florence Nightingale’s contributions to nursing practice and education:
a. are historically important but have no validity for nursing today.
b. were neither recognized nor appreciated in her own time.
c. were a major factor in reducing the death rate in the Crimean War.
d. were limited only to the care of severe traumatic wounds.
ANS: C
By improving sanitation, nutrition ventilation, and handwashing techniques, Florence
Nightingale’s nurses dramatically reduced the death rate from injuries in the Crimean War.
DIF: Cognitive Level: Knowledge
TOP: Nursing History
MSC: NCLEX: N/A
REF: p. 2
OBJ: Theory #1
KEY: Nursing Process Step: N/A
2. Early nursing education and care in the United States:
a. were directed at community health.
b. provided independence for women through education and employment.
c. were an educational model based in institutions of higher learning.
d. have continued to be entirely focused on hospital nursing.
ANS: B
Because of the influence of early nNuUrRsiSnIgNGleTaBd.eCrOs,Mnursing education became more formalized
through apprenticeships in Nightingale schools that offered independence to women through
education and employment.
DIF: Cognitive Level: Knowledge
TOP: Nursing History
MSC: NCLEX: N/A
REF: p. 2
OBJ: Theory #4
KEY: Nursing Process Step: N/A
3. In order to fulfill the common goals defined by nursing theorists (promote wellness, prevent
illness, facilitate coping, and restore health), the LPN must take on the roles of:
a. caregiver, educator, and collaborator.
b. nursing assistant, delegator, and environmental specialist.
c. medication dispenser, collaborator, and transporter.
d. dietitian, manager, and housekeeper.
ANS: A
In order for the LPN to apply the common goals of nursing, he or she must assume the roles
of caregiver, educator, collaborator, manager, and advocate.
DIF:
Cognitive Level: Comprehension
REF: p. 3
OBJ: Theory #2
TOP: Art and Science of Nursing
MSC: NCLEX: N/A
KEY: Nursing Process Step: N/A
4. Although nursing theories differ in their attempts to define nursing, all of them base their
beliefs on common concepts concerning:
a.
b.
c.
d.
self-actualization, fundamental needs, and belonging.
stress reduction, self-care, and a systems model.
curative care, restorative care, and terminal care.
human relationships, the environment, and health.
ANS: D
Although nursing theories differ, they all base their beliefs on human relationships, the
environment, and health.
DIF: Cognitive Level: Comprehension
TOP: Nursing Theories
MSC: NCLEX: N/A
REF: p. 4
OBJ: Theory #2
KEY: Nursing Process Step: N/A
5. Standards of care for the nursing practice of the LPN are established by the:
a. Boards of Nursing Examiners in each state.
b. National Council of States Boards of Nursing (NCSBN).
c. American Nurses Association (ANA).
d. National Federation of Licensed Practical Nurses.
ANS: D
The National Federation of Licensed Practical Nurses modified the standards published by the
ANA in 2015 to better fit the role of the LPN. In 2015 the American Nurses Association
(ANA) revised the Standards of Nursing Practice which contained 17 standards of national
practice of nursing, describing all facets of nursing practice: who, what, when, where, how.
DIF: Cognitive Level: Comprehension
TOP: Standards of Care
MSC: NCLEX: N/A
REF: p. 6
OBJ: Theory #2
KEY: Nursing Process Step: N/A
6. The LPN demonstrates an evidence-based practice by:
a. using a drug manual to check compatibility of drugs.
b. using scientific information to guide decision making.
c. using medical history of a patient to direct nursing interventions.
d. basing nursing care on advice from an experienced nurse.
ANS: B
The use of scientific information from high-quality research to guide nursing decisions is
reflective of the application of evidence-based practice.
DIF: Cognitive Level: Knowledge
TOP: Evidence-Based Practice
MSC: NCLEX: N/A
REF: p. 7
OBJ: Theory #3
KEY: Nursing Process Step: N/A
7. Lillian Wald and Mary Brewster established the Henry Street Settlement Service in New York
in 1893 in order to:
a. offer a shelter to injured war veterans.
b. found a nursing apprenticeship.
c. provide health care to poor persons living in tenements.
d. offer better housing to low-income families.
ANS: C
Henry Street Settlement Service brought the provision of community health care to the poor
people living in tenements.
DIF: Cognitive Level: Comprehension
TOP: Growth of Nursing
MSC: NCLEX: N/A
REF: p. 2
OBJ: Theory #4
KEY: Nursing Process Step: N/A
8. An educational pathway for an LPN/LVN refers to an LPN/LVN:
a. learning on the job and being promoted to a higher level of responsibility.
b. moving from a maternity unit to a more complicated surgical unit.
c. obtaining additional education to move from one level of nursing to another.
d. learning that advancement requires consistent work and commitment.
ANS: C
By broadening the educational base, an LPN/LVN may advance and build a nursing career.
DIF: Cognitive Level: Knowledge
TOP: Nursing Education Pathways
MSC: NCLEX: N/A
REF: p. 7
OBJ: Theory #7
KEY: Nursing Process Step: N/A
9. When diagnosis-related groups (DRGs) were established by Medicare in 1983, the purpose
was to:
a. put patients with the same diagnosis on the same unit.
b. attempt to contain the costs of health care.
c. increase the availability of medical care to older adults.
d. identify a patient’s condition more quickly.
ANS: B
The purpose of instituting DRGs was to contain skyrocketing costs of health care.
DIF: Cognitive Level: Knowledge
TOP: Health Care Delivery
MSC: NCLEX: N/A
REF: p. 9
OBJ: Theory #10
KEY: Nursing Process Step: N/A
10. The advent of diagnosis-related groups (DRGs) required that nurses working in health care
agencies:
a. record supportive documentation to confirm a patient’s need for care in order to
qualify for reimbursement.
b. use the DRG rather than their own observations for patient assessment.
c. be aware of the specific drugs related to the diagnosis.
d. acquire cross-training to make staffing more flexible.
ANS: A
DRGs required that nurses provide more supportive documentation of their assessments and
identified patient’s needs to qualify the facility for Medicare reimbursement. Observant
assessment might also indicate another DRG classification and consequently more
reimbursement for the facility.
DIF: Cognitive Level: Comprehension
TOP: Managed Care
MSC: NCLEX: N/A
REF: p. 10
OBJ: Theory #10
KEY: Nursing Process Step: N/A
11. If a member of a health maintenance organization (HMO) is having respiratory problems such
as fever, cough, and fatigue for several days and wants to see a specialist, the person is
required to go:
a. directly to an emergency room for treatment.
b. to any general practitioner of choice.
c. directly to a respiratory specialist.
d. to a primary care provider for a referral.
ANS: D
Participants in an HMO must see their primary provider to receive a referral for a specialist in
order for the HMO to pay for the care.
DIF: Cognitive Level: Comprehension
TOP: Managed Care
MSC: NCLEX: N/A
REF: p. 10
OBJ: Theory #11
KEY: Nursing Process Step: N/A
12. An advantage of preferred provider organizations (PPOs) is that:
a. they make insurance coverage of employees less expensive to employers.
b. there are fewer physicians to choose from than in an HMO.
c. long-term relationships with physicians are more likely.
d. patients may go directly to a specialist for care.
ANS: A
The use of PPOs allows insurance companies to keep their premiums low and in turn makes
insurance coverage less expensive for the employers. There are usually more physicians from
which to choose than from an HMO, but long-term relationships between physician and
patient cannot be established easily. Patients still must see their primary physician before
being referred to other specialties.
DIF: Cognitive Level: Knowledge
TOP: Preferred Provider Organizations
MSC: NCLEX: N/A
REF: p. 11
OBJ: Theory #11
KEY: Nursing Process Step: N/A
13. After passing the National Council Licensure Examination for Practical Nurses (NCLEX PN),
the nurse is qualified to take an additional certification in the field of:
a. pharmacology.
b. care of infants and children.
c. operating room technology.
d. community health.
ANS: A
After becoming an LPN, the nurse may apply for additional certification in pharmacology or
long-term care.
DIF: Cognitive Level: Knowledge
TOP: Educational Opportunities
MSC: NCLEX: N/A
REF: p. 7
OBJ: Theory #6
KEY: Nursing Process Step: N/A
14. Nursing interventions are best defined as activities that:
a. are taken to improve the patient’s health.
b. involve researching methods to maintain asepsis.
c. include the family in nursing care.
d. review guidelines for handling infectious wastes.
ANS: A
Interventions are actions taken to improve, maintain, or restore health.
DIF: Cognitive Level: Comprehension
REF: p. 3
OBJ: Theory #2
TOP: Art and Science of Nursing
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Detection of Disease
15. Nurse Practice Acts define the legal scope of an LPN’s practice, which are written and
enforced by:
a. American Nurses Association.
b. National Council Licensure Examiners.
c. each state.
d. each health care agency.
ANS: C
Each state writes and enforces the Nurse Practice Act, which defines the legal scope of
nursing practice.
DIF: Cognitive Level: Comprehension
TOP: Nurse Practice Act
MSC: NCLEX: N/A
REF: p. 6
OBJ: Theory #3
KEY: Nursing Process Step: N/A
16. Women volunteers were organized to give nursing care to the wounded soldiers during the
Civil War by:
a. Florence Nightingale.
b. Dorothea Dix.
c. Clara Barton.
d. Lillian Wald.
ANS: B
The Union government appointed Dorothea Dix, a social worker, to organize women
volunteers to provide nursing care for the soldiers during the Civil War.
DIF: Cognitive Level: Knowledge
TOP: Nursing History
MSC: NCLEX: N/A
REF: p. 2
OBJ: Theory #4
KEY: Nursing Process Step: N/A
17. The nursing theory presented by Sister Calista Roy is based on:
a. reduction of stress.
b. achievement of maximum level of wellness.
c. relief of self-care deficit.
d. adaptation modes.
ANS: D
Adaptation modes (physiological, psychological, sociological, and independence) are the
basis of the nursing theory of Sister Calista Roy.
DIF: Cognitive Level: Knowledge
REF: p. 5|Table 1-1
OBJ: Theory #2
TOP: Nursing Theory
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
18. The founding of the Red Cross is attributed to:
a. Lillian Wald.
b. Dorothea Dix.
c. Florence Nightingale.
d. Clara Barton.
ANS: D
Clara Barton founded the Red Cross.
DIF: Cognitive Level: Knowledge
TOP: Nursing History
MSC: NCLEX: N/A
REF: p. 2
OBJ: Theory #4
KEY: Nursing Process Step: N/A
19. The nursing theorist whose practice framework is based on 14 fundamental needs is:
a. Dorothy Johnson.
b. Jean Watson.
c. Virginia Henderson.
d. Martha Rogers.
ANS: C
Virginia Henderson’s nursing theory framework is based on 14 fundamental needs.
DIF: Cognitive Level: Knowledge
REF: p. 5|Table 1-1
OBJ: Theory #2
TOP: Nursing Theorists
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
20. The nursing theory that uses seven behavioral subsystems in an adaptation model is:
a. Betty Neumann.
b. Sister Calista Roy.
c. Dorothy Johnson.
d. Patricia Benner.
ANS: C
Dorothy Johnson’s practice framework is based on seven behavioral subsystems in an
adaptation model.
DIF: Cognitive Level: Knowledge
REF: p. 5|Table 1-1
OBJ: Theory #2
TOP: Nursing Theorists
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
a.
b.
c.
d.
advance their nursing career.
seek a scientific basis for their interventions.
deliver safe, knowledgeable care.
a leadership role.
ANS: C
The Standards of Nursing Practice are designed to guide the LPN to deliver safe,
knowledgeable care.
DIF: Cognitive Level: Knowledge
REF: p. 6
OBJ: Theory #2
TOP: Nursing Standards
KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment
22. A state’s Nurse Practice Act is designed to protect the:
a. physician.
b. nurse.
c. public.
d. hospital.
ANS: C
Nurse Practice Acts are designed to protect the public.
DIF: Cognitive Level: Knowledge
TOP: Nurse Practice Act
MSC: NCLEX: N/A
REF: p. 6
OBJ: Theory #5
KEY: Nursing Process Step: N/A
23. It is appropriate for practical nurses to provide direct patient care to persons in a hospital
under the supervision of a:
a. medical assistant.
b. registered nurse on the unit.
c. supervising nurse who is responsible for care on several units.
d. more experienced LPN on the unit.
ANS: B
Practical nurses provide direct patient care under the direct supervision of a registered nurse,
physician, or dentist.
DIF: Cognitive Level: Knowledge
TOP: Scope of Practice
MSC: NCLEX: N/A
REF: p. 7
OBJ: Theory #9
KEY: Nursing Process Step: N/A
24. An example of tertiary health care is:
a. hospice care.
b. restorative care.
c. emergency care.
d. home health care.
ANS: A
Tertiary health care includes extended care, chronic disease management, medical homes,
in-home personal care, and hospice care.
DIF: Cognitive Level: Comprehension
REF: p. 11|Box 1-2
OBJ: Theory #8
TOP: Health Care Services
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
25. Which nursing care delivery systems have some nursing schools adopted as the foundation of
their education programs?
a. Relationship-based care
b. Team nursing
c. Patient-centered care
d. Total patient care
ANS: A
Relationship-based care appeared in the early 2000s (Koloroutis, 2004) and emphasizes three
critical relationships: (a) the relationship between caregivers and the patients and families they
serve; (b) the caregiver’s relationship with him- or herself; (c) the relationship among health
team members (UCLA Department of Nursing, 2015). The motivation behind
relationship-based care was to promote a cultural transformation by improving relationships to
foster care for the patient. Some schools of nursing have adopted relationship-based care as
the foundation of their nursing education curriculum.
DIF: Cognitive Level: Knowledge
TOP: Delivery of Nursing Care
MSC: NCLEX: N/A
REF: p. 9
OBJ: Theory #8
KEY: Nursing Process Step: N/A
26. Which nursing care delivery system has been fully embraced by the nursing community and is
identified as one of the seven QSEN competencies?
a. Relationship-based care
b. Team nursing
c. Patient-centered care
d. Total patient care
ANS: C
Patient-centered care has been described since the 1950s, but came to the forefront in 2001
when the Institute of Medicine (IOM) targeted six areas for improvement in the US health
care system, including safety, effective, patient-centered, timely, efficient, and equitable
(Cliff, 2012). Patient-centered care has been fully embraced by the nursing community, and is
identified as one of the seven QSEN competencies (QSEN.org, 2015).
DIF:
Cognitive Level: Knowledge
TOP: Delivery of Nursing Care
MSC: NCLEX: N/A
REF: p. 18
KEY:Step:
NurN/A
sing Process
OBJ: Theory #8
27. Which of the following is considered a positive aspect of the Affordable Care Act?
a. A 38-year-old mother is penalized on her taxes for not purchasing health
insurance.
b. A 42-year-old laborer who has chronic kidney disease is denied insurance
coverage.
c. Jamie, age 24, cannot continue insurance coverage on his parent’s insurance since
he has graduated from college.
d. Maria, age 60, is able to obtain health insurance at a rate that is manageable on her
income.
ANS: D
The Patient Protection and Affordable Care Act is being phased in over several years. There
are positive and negative aspects to this act, and many people have strong opinions about it.
Since 2013 there have been insurance exchanges, along with requirements for uninsured
people to purchase health insurance. Starting in 2015 people who have failed to purchase
health insurance are being penalized on their income taxes. Provisions in the bill now prevent
denial of insurance to those with preexisting illnesses who formerly could not buy health
insurance, and young adults have been allowed to remain on their parents’ insurance through
age 26. Starting in 2013 affluent people began paying an extra 3.8% tax on unearned income;
drug manufacturers and the insurance industry are paying large annual fees to help cover the
overall costs. Costs of the Medicare program will be contained by reducing payments to
hospitals and health care providers. As coverage under the Affordable Care Act has expanded,
the national uninsured rate has fallen from 16% to 11% of people under age 65 (people over
age 65 are generally have universal coverage by Medicare). People who have benefitted the
most from this coverage include people ages 18-34, blacks, Hispanics, and those living in
rural areas (Quealy and Sanger-Katz, 2014). It is expected that the emphasis on prevention
and coordinated care will produce a shift in nursing from the hospital to the community. There
are many controversial parts of the bill, and the country is divided about whether the bill
should be repealed and other health care legislation written. What happens in the Congress in
the coming years will determine if all parts of the legislation will remain.
DIF: Cognitive Level: Analysis
REF: p. 11
TOP: The Patient Protection and Affordable Care Act
MSC: NCLEX: N/A
OBJ: Theory #10
KEY: Nursing Process Step: N/A
MULTIPLE RESPONSE
1. Characteristics of primary nursing include: (Select all that apply.)
a. elimination of fragmentation of care between shifts.
b. evolved in the mid-1950s.
c. planning and direction performed by one nurse.
d. ancillary workers used to increase productivity.
e. the care plan covering the entire day.
f. associate nurses taking over care and planning when the primary nurse is off duty.
ANS: A, C, D, E, F
Primary care reduces fragmentation of care between shifts. Care is planned by one nurse to
cover a 24-hour period using ancillary workers to increase the productivity. An associate
nurse may take on direction of care in the absence of the primary nurse.
DIF: Cognitive Level: Knowledge
TOP: Nursing Care Delivery
MSC: NCLEX: N/A
REF: p. 8
OBJ: Theory #8
KEY: Nursing Process Step: N/A
2. In 1991, the American Nurses Association (ANA) published the Standards of Nursing
Practice. These standards are designed to: (Select all that apply.)
a. set standards for safe nursing care delivery.
b. define the legal scope of practice.
c. state legal requirements for clinical practice.
d. protect the nurse, patient, and health care agency.
e. regulate the nursing profession.
f.
define activities in which nurses may engage.
ANS: A, D, F
The Standards of Nursing Practice generally define activities in which nurses may engage, set
standards for nursing care and delivery, and thereby protect the nurse, patient, and health care
agency.
DIF: Cognitive Level: Knowledge
TOP: Nursing Practice
MSC: NCLEX: N/A
REF: p. 6|Box 1-1 OBJ: Theory #2
KEY: Nursing Process Step: N/A
3. An example of the role of an LPN as a delegator is: (Select all that apply.)
a. changing a patient’s wound dressing.
b. assisting a patient to complete his or her bath.
c. assigning patient care tasks to certified nursing assistants.
d. requesting the housecleaning staff to mop the floor of a patient’s room.
e. instructing the unit secretary to page a physician to the floor.
ANS: C, D, E
Delegation under the scope of the practice of an LPN is the assignment of a certified nursing
assistant to certain nursing care or other nonmedical staff to aspects of patient care.
DIF: Cognitive Level: Comprehension
TOP: Art and Science of Nursing
MSC: NCLEX: N/A
REF: p. 3
OBJ: Theory #5
KEY: Nursing Process Step: N/A
4. During the Civil War, nursing schools offered education to women both in England and in the
United States. The schools in the U
niRteSdINSGtTate
diM
ffered from those in Europe because in US
NU
B.sCO
schools: (Select all that apply.)
a. students worked without pay.
b. the core curriculum was the same.
c. instruction was presented by physicians at the bedside.
d. the educational focus was on nursing care.
e. classes were held separately from the clinical experience.
ANS: A, C
In the United States, the students staffed the hospital and worked without pay. There were no
formal classes; education was achieved through work. There was no set curriculum, and
content varied depending on the type of cases present in the hospital. Instruction was done at
the bedside by the physician and therefore came from a medical viewpoint.
DIF: Cognitive Level: Comprehension
TOP: Early Nursing Education
MSC: NCLEX: N/A
REF: p. 4
OBJ: Theory #4
KEY: Nursing Process Step: N/A
COMPLETION
1. Preferred provider organizations (PPOs) use
the physical cost of the service.
ANS:
capitated cost
to finance their services and pay
The capitated cost is the set fee that is paid to the network for each patient enrolled to finance
its services.
DIF: Cognitive Level: Knowledge
TOP: Capitated Cost
MSC: NCLEX: N/A
REF: p. 11
OBJ: Theory #8
KEY: Nursing Process Step: N/A
2. In the United States, the Young Women’s Christian Association (YMCA) in New York
opened The
School, the first practical nursing school.
ANS:
Ballard
In 1892, the YMCA opened The Ballard School, a 3-month course in practical nursing that
was the first school of practical nursing.
DIF: Cognitive Level: Knowledge
TOP: Ballard School
MSC: NCLEX: N/A
REF: p. 2
OBJ: Theory #4
KEY: Nursing Process Step: N/A
3. Such health services as surgical procedures, restorative care, and home health care would be
classified as
care.
ANS:
secondary
Surgical procedures, restorative caNrUe,RaSnIN
dGhToBm.CeOhM
ealth are part of the many services classified
as secondary care.
DIF: Cognitive Level: Comprehension
REF: p. 11|Box 1-2
OBJ: Theory #10 TOP: Health Care Services
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
Chapter 02: Concepts of Health, Illness, Stress, and Health Promotion
MULTIPLE CHOICE
1. The nurse is aware that any description of health would include the concept that:
a. health is the absence of illness, and illness is the presence of chronic disease.
b. culture, education, and socioeconomic status influence one’s definition of health or
illness.
c. illness is a biological malfunction, and health is biological soundness.
d. lifestyle factors are the major determinants of health or illness.
ANS: B
The concept of health is influenced by culture, education, and socioeconomic factors.
DIF: Cognitive Level: Comprehension
REF: p. 15
OBJ: Theory #1
TOP: Views of Health and Illness
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Detection of Disease
2. The nurse takes into consideration that the patient with an admitting diagnosis of Type 2
diabetes mellitus and influenza is described as having:
a. two chronic illnesses.
b. two acute illnesses.
c. one chronic and one acute illness.
d. one acute and one infectious illness.
ANS: C
Chronic illnesses can be controlled but not cured, and are long-lasting. Acute illnesses
develop suddenly and resolve in a short time. Type 2 diabetes mellitus would be considered
chronic, whereas influenza would be considered acute.
DIF: Cognitive Level: Application
REF: p. 15
OBJ: Theory #1
TOP: Classification of Illnesses
KEY: Nursing Pr ocess Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Detection of Disease
3. The nurse explains that an idiopathic disease is one that:
a. is caused by inherited characteristics.
b. develops suddenly, related to new viruses.
c. results from injury during labor or delivery.
d. has an unknown cause.
ANS: D
Idiopathic disease is defined as disease whose cause is unknown.
DIF: Cognitive Level: Knowledge
REF: p. 15
OBJ: Theory #1
TOP: Classification of Illnesses
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Detection of Disease
4. The nurse assesses a terminal illness in:
a. a 76-year-old admitted to a nursing home with Alzheimer disease who is pacing
and asking to go home.
b. a 43-year-old with Lou Gehrig’s disease who is refusing food and fluid.
c. a 2-year-old child who burned her esophagus by drinking drain cleaner and who is
being fed by a tube.
d. a 52-year-old diagnosed with lung cancer who had part of one lung removed and
has a closed chest drainage device in place.
ANS: B
A terminal illness is defined as one in which a person will live only a few months, weeks, or
days. A person who refuses food and hydration will generally not live more than a few days.
DIF: Cognitive Level: Comprehension
REF: p. 15
OBJ: Theory #1
TOP: Stages of Illness
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
5. The nurse clarifies to a patient who now has an abscess following a ruptured appendix that the
abscess is considered to be:
a. a secondary illness.
b. a life-threatening complication.
c. an expected event following any surgery.
d. a disorder easily treated with antibiotics.
ANS: A
A secondary illness is an illness that arises from a primary disorder.
DIF: Cognitive Level: Comprehension
REF: p. 15
OBJ: Theory #1
TOP: Views of Health and Illness
KEY: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
6. The nurse uses a diagram to demonstrate how Dunn’s theory of health and illness can be
compared with a:
a. plant that grows from a seed, blossoms, wilts, and dies.
b. continuum, with peak wellness and death at opposite ends; the person moves back
and forth in a dynamic state of change.
c. ladder; from birth to death the individual moves progressively downward a ladder
to eventual death.
d. state of mind dependent on the individual perception of their own health or illness.
ANS: B
Dunn’s theory of a health continuum shows how an individual moves between peak wellness
and death in a constant process.
DIF: Cognitive Level: Knowledge
REF: p. 16
OBJ: Theory #1
TOP: Views of Health and Illness
KEY: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
7. A patient has been advised by the primary care provider to take medication for high
cholesterol and to change eating habits after discharge home. The home health nurse
discovered that the patient refused to follow the medical and nutritional directions. The
nurse’s best initial response to this situation is to:
a. emphasize to the patient how important it is to follow the doctor’s advice.
b. determine whether any cultural, socioeconomic, or religious values conflict, thus
interfering with the patient’s compliance.
c. explain that without diet and medication the condition will worsen and serious
problems will develop.
d. inform the primary care provider that the patient is unable to understand the
instructions.
ANS: B
The patient may have cultural, socioeconomic, or religious values that cause conflicts that
prevent her from following the doctor’s instructions.
DIF: Cognitive Level: Application
REF: p. 16
OBJ: Theory #5
TOP: Concepts of Health and Illness, Cultural Influences
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychological Integrity: Coping and Adaptation
8. A nurse practicing a holistic approach to nursing care must:
a. recognize that a change in one aspect of the person’s life can alter the whole of that
person’s life.
b. take responsibility for health care decisions.
c. promote state of the art technology.
d. discourage the use of more natural remedies and alternative methods of health
care.
ANS: A
Holistic nursing requires that the nurse recognizes that a change in one aspect of the patient’s
life (biological, sociological, psychological, and spiritual) will bring about changes in that
patient’s whole life.
DIF: Cognitive Level: ComprehensNioUnRSINRGETFB:.CpO.M19
OBJ: Theory #6
TOP: Holistic Approach to Caring
KEY: Nursing Process Step: Assessment
MSC: NCLEX: N/A
9. Included in Maslow’s hierarchy, physiological needs are those that:
a. nurture intimacy.
b. foster independence.
c. encourage social interaction.
d. protect from harm.
ANS: D
Physiological needs are those that are essential to human life, such as oxygenation, nutrition,
and elimination. Protection from physical harm, from a nursing standpoint, is often equivalent
in importance to physical needs.
DIF: Cognitive Level: Application
REF: p. 20
OBJ: Theory #7
TOP: Maslow’s Hierarchy of Needs
KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
10. The factors involved in assessing the importance the patient attaches to the relief of a
particular deficit include:
a. needs that the nurse must assess to prioritize care, because they may be different
from person to person.
b. ordering needs according to Maslow’s hierarchy, with lower level needs being
least compelling.
c. needs based on a hierarchy in which higher level needs are more prominent and
demand attention before lower level needs.
d. needs that are usually not known to the patient and that must be determined by the
nurse.
ANS: A
A person’s concern relative to a needs deficit must be assessed by the nurse to meet the needs
of each patient. Needs are viewed differently from one person to the next.
DIF: Cognitive Level: Comprehension
REF: p. 20
OBJ: Theory #7
TOP: Maslow’s Hierarchy of Needs
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
11. The nurse believes that patient teaching of how to give insulin and monitor blood glucose
levels will improve the level of the patient’s:
a. physiological well-being.
b. security, by providing psychological comfort.
c. self-esteem, by promoting independence and learning.
d. self-actualization, by seeking knowledge and truth.
ANS: C
Patient education activities that are to be used after discharge enhance independence and
promote self-esteem.
DIF: Cognitive Level: Application
REF: p. 27
OBJ: Theory #7
TOP: Maslow’s Hierarchy of Needs
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
12. Homeostasis can be described as:
a. the unchanging steady condition of humans in a changing external environment.
b. a tendency of biological systems toward stability of the internal environment by
continuously adjusting to survive.
c. biological wellness that comes from the ability of the body to change and respond
to physical changes in the environment.
d. a response to stress that results from a person’s choice of coping mechanisms to
deal with the stress.
ANS: B
Homeostasis results from the constant adjustment of the internal environment in response to
change; it is mental, emotional, and biological, as well as conscious and unconscious.
DIF: Cognitive Level: Comprehension
REF: p. 22
TOP: Homeostasis KEY: Nursing Process Step: Assessment
OBJ: Theory #8
MSC: NCLEX: N/A
13. A patient admitted for diagnostic tests is frightened of hospital procedures and is nervous
about the possible outcome of the tests. She states that her mouth is dry and her heart is
pounding. Her blood pressure is 168/78 mm Hg (her usual blood pressure is 140/80 mm Hg),
pulse is 112 beats/min, and respirations are 22 breaths/min. The nurse will recognize that
these signs and symptoms are:
a. indicative of serious, acute health problems and should be reported to the primary
care provider immediately.
b. most likely related to the disease for which the patient is admitted to the hospital.
c. the effects of the parasympathetic nervous system and can be ignored.
d. the effects of the sympathetic nervous system that can negatively affect the
patient’s health.
ANS: D
Fear stimulates the sympathetic nervous system to produce the symptoms identified in the
question. If prolonged, they negatively affect a person’s health.
DIF: Cognitive Level: Analysis
REF: p. 26|Table 2-2
OBJ: Theory #10 TOP: Stress
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
14. According to Hans Selye’s general adaptation syndrome (GAS), a person who has
experienced excessive and prolonged stress is likely to:
a. develop an illness or disease such as allergy, arthritis, or asthma.
b. become resistant to biological methods of treatment.
c. seek treatment for imagined illnesses and nonexistent symptoms.
d. be admitted to the hospital during the alarm stage.
ANS: A
Many diseases are known to be caused or exacerbated by prolonged stress. Selye concluded
that stress-induced illnesses respond to biological methods of treatment.
DIF: Cognitive Level: Comprehension
REF: p. 26|Box 2-2
OBJ: Theory #10 TOP: Adaptation
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
15. The nurse is aware that a stressor N
asUeRxSpINerGieTnBc.C
edOM
by an individual is usually perceived:
a. as a negative event or stimulus that affects homeostasis in maladaptive ways.
b. in different ways based on previous experience and personality traits.
c. as an opportunity for growth and learning.
d. in similar ways if age and education are similar.
ANS: B
Stressors are not perceived the same way by different people or even by the same person at
different times. The experience of a stressor depends on previous experience and personality,
as well as factors such as physical or emotional conditions, age, and education.
DIF: Cognitive Level: Comprehension
REF: p. 26
OBJ: Theory #9
TOP: General Adaptation Syndrome
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychological Integrity: Psychosocial Adaptation
16. In 1946, the World Health Organization redefined health as the:
a. absence of disease or infirmity.
b. state of complete physical, mental, and social well-being.
c. presence of disease or infirmity.
d. state of incomplete physical, mental, and social well-being.
ANS: B
In 1946, the World Health Organization redefined health as “the state of complete physical,
mental, and social well–being, and not merely the absence of disease or infirmity.”
DIF: Cognitive Level: Knowledge
TOP: Views of Health and Illness
MSC: NCLEX: N/A
REF: p. 28
OBJ: Theory #1
KEY: Nursing Process Step: N/A
17. The nurse assesses that a person is in the acceptance stage of illness when the patient:
a. looks to home remedies to become well.
b. reassumes usual responsibilities and roles.
c. assumes the “sick” role.
d. rejects medical treatment.
ANS: C
When a person enters the acceptance stage of illness, he or she assumes the “sick role” and
withdraws from usual responsibilities and will frequently seek medical treatment at this time.
DIF: Cognitive Level: Comprehension
REF: p. 15
OBJ: Theory #1
TOP: Acceptance Stage
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
18. The nurse instructs a patient that according to Selye’s GAS theory, when stress is strong
enough and occurs over a long enough period, the patient will enter the stage of:
a. convalescence.
b. alarm.
c. transition.
d. exhaustion.
ANS: D
The exhaustion stage in the GAS occurs when the stressor has been present for such a period
that the patient will deplete the boNdU
y’RsSrIeNsGoTuBrc.CesOM
for adaption.
DIF: Cognitive Level: Comprehension
REF: p. 24
OBJ: Theory #1
TOP: Exhaustion Stage of GAS
KEY: Nursing Process Step: Intervention
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
19. The nurse explains defense mechanisms as a patient’s attempt to:
a. justify the patient’s assumption of the “sick” role.
b. reduce anxiety.
c. problem solve.
d. increase dependence.
ANS: B
Defense mechanisms are unconscious strategies to reduce anxiety.
DIF: Cognitive Level: Knowledge
REF: p. 26
OBJ: Theory #9
TOP: Defense Mechanisms
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychological Integrity: Coping and Adaptation
20. In giving nursing care to persons of Asian origin, the nurse should:
a. keep the room warm and free of drafts.
b. look the patient directly in the eye.
c. ask permission before touching the patient.
d. warmly clasp the patient’s hand in greeting.
ANS: C
Seek permission before touching persons of Asian extraction, because they may be sensitive
to physical, personal contact.
DIF: Cognitive Level: Application
REF: p. 18|Table 2-1
OBJ: Theory #4
TOP: Cultural Sensitivity
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychological Integrity: Coping and Adaptation
21. Sickle cell anemia is an example of a biological trait found primarily in:
a. Asian populations.
b. African populations.
c. American Indian populations.
d. Hispanic populations.
ANS: B
Sickle cell anemia is a biological variation found predominantly in people of African descent.
DIF: Cognitive Level: Knowledge
REF: p. 18|Table 2-1
OBJ: Theory #5
TOP: Cultural Influences
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
22. When a young family man hospitalized after breaking his leg confides to the nurse that he is
concerned about the well-being of his family and financial stress, the nurse can best support
his sense of security by:
a. reassuring him that his leg will heal quickly.
b. actively listening to his concerns.
c. encouraging family to make frequent visits.
UsRb
SIyNsGoTcB
d. distracting him from his conceNrn
ia.C
liO
zaMtion.
ANS: B
A nurse’s ability to use active listening will enhance the sense of security when patients feel
that their needs are perceived accurately.
DIF: Cognitive Level: Application
REF: p. 21
OBJ: Theory #7
TOP: Maslow’s Hierarchy of Needs
KEY: Nursing Process Step: Intervention
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
23. The nurse assesses successful adaptation in a post stroke patient when the patient:
a. learns to walk and maintain balance with the aid of a walker.
b. consistently takes antihypertensive drugs.
c. attempts to get out of bed unassisted.
d. refuses assistance with feeding.
ANS: A
Adaptation is a readjustment in habits to limitations and disabilities. Learning to walk and
maintain balance with the aid of a walker is an example of this.
DIF: Cognitive Level: Application
REF: p. 22
OBJ: Theory #1
TOP: Adaptation
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
24. The nurse takes into consideration that in the stage of resistance in Selye’s GAS, the patient:
a.
b.
c.
d.
regresses to a dependent state.
continues to battle for equilibrium.
becomes maladaptive.
begins to develop stress-related disorders.
ANS: B
The resistance stage is the second stage in the GAS when a patient is still attempting to find
equilibrium.
DIF: Cognitive Level: Comprehension
REF: p. 24
OBJ: Theory #10
TOP: Salye’s GAS
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
25. A patient states, “I am not obese. My entire family is large.” The nurse assesses that the
patient is using the defense mechanism of:
a. sublimation.
b. projection.
c. denial.
d. displacement.
ANS: C
Denial is a defense mechanism that allows a person to live as though an unwanted piece of
information or reality does not exist. There is a persistent refusal to be swayed by the
evidence.
DIF: Cognitive Level: Application
REF: p. 27|Table 2-3
OBJ: Theory #8
TOP: Denial
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial IntegriNtyU: RCSoIpNiG
ngTBan.CdOAMdaptation
26. A child who has just been scolded by her mother proceeds to hit her doll with a hairbrush. The
nurse recognizes the child’s actions are characteristics of:
a. denial.
b. displacement.
c. rationalization.
d. repression.
ANS: B
Displacement is a defense mechanism that characterizes discharging intense feelings for one
person onto an object or another person who is less threatening, thereby satisfying an impulse
with a substitute object.
DIF: Cognitive Level: Application
REF: p. 27|Table 2-3
OBJ: Theory #8
TOP: Defense Mechanisms
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
27. The nurse encourages a patient to participate in health maintenance by maintaining an ideal
body weight as a method of:
a. primary prevention.
b. secondary prevention.
c. tertiary prevention.
d. simple prevention.
ANS: A
Primary prevention avoids or delays occurrence of a specific disease or disorder.
DIF: Cognitive Level: Comprehension
REF: p. 27
OBJ: Theory #1
TOP: Primary Prevention
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
28. A nurse clarifies that methods of tertiary prevention are designed for:
a. rehabilitation.
b. delay of the development of a disorder.
c. screening for early detection of disease.
d. using an established protocol of therapy for a specific disease.
ANS: A
Tertiary prevention consists of rehabilitation measures after the disease or disorder has
stabilized. Latent prevention does not exist.
DIF: Cognitive Level: Comprehension
REF: p. 27
OBJ: Theory #1
TOP: Tertiary Prevention
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
29. When a new admission to an extended care facility wanders about listlessly, eats only a small
amount of each meal, and keeps himself isolated, the nurse can intervene by:
a. assisting with feeding at each meal.
b. reminding him that he is in a safe and secure area.
c. socializing with him in the privacy of his room.
d. supporting him to interact withNU
anRSeIxNeGrcTiBse.CgOrM
oup.
ANS: D
The membership and social interaction in a group may provide a means for a sense of
belonging.
DIF: Cognitive Level: Application
REF: p. 27
OBJ: Theory #11
TOP: Love and Belonging
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
MULTIPLE RESPONSE
1. When the brain perceives a situation as threatening, the sympathetic nervous system reacts by
stimulating which of the following physiological functions? (Select all that apply.)
a. Constriction of the pupils
b. Dilation of the bronchial tubes
c. Decreased heart rate
d. Dilation of the pupils
ANS: B, D
Activation of the sympathetic nervous system causes the pupils and bronchial tubes to dilate.
It also causes the heart rate to increase.
DIF: Cognitive Level: Analysis
TOP: Sympathetic Nervous System
REF: p. 23
OBJ: Theory #11
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
2. The nurse describes behaviors of the transition stage of illness, which are: (Select all that
apply.)
a. awareness of vague symptoms.
b. denial of feeling ill.
c. resorts to self-medication.
d. withdrawal from roles and responsibilities.
e. recovery from illness begins.
ANS: A, B, C
The transition stage (onset) of illness is demonstrated by the patient’s awareness of vague
symptoms, denial of feeling ill, and initiation of self-medication; however, he or she still
fulfills the roles and responsibilities of life.
DIF: Cognitive Level: Comprehension
REF: p. 15
OBJ: Theory #1
TOP: Stages of Illness
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
3. Which defines the holistic approach to caring for the sick and promoting wellness? (Select all
that apply.)
a. The nurse’s focus is specific to the disease or injury.
b. The nurse realizes that each person has a responsibility for his or her own health.
c. Health care providers are required to intervene on behalf of all persons to ensure
that health goals are met.
d. Providers combine traditional methods of health care with relaxation techniques
for pain management.
e. A change in one aspect of a person’s life may or may not alter the person as a
whole.
ANS: B, C, D, E
The holistic approach to medicine treats the patient as a whole and may use a mix of
traditional medicine and alternative medicine. Any change in one aspect of the whole may
change the entire whole.
DIF: Cognitive Level: Comprehension
TOP: Holistic Approach
MSC: NCLEX: N/A
REF: p. 19
OBJ: Theory #6
KEY: Nursing Process Step: N/A
4. The responses during the alarm stage of the general adaptation syndrome as defined by Hans
Selye include: (Select all that apply.)
a. slight increase in body temperature.
b. substantial increase in energy.
c. decreased appetite.
d. hormones released for mobilization for defense.
e. the body’s adaptation abilities temporarily overreacting.
ANS: A, C, D
The responses during the alarm stage according to the general adaptation syndrome include a
slight rise in temperature, a loss of energy, decreased appetite, and a release of hormones that
mobilizes the body’s defenses.
DIF: Cognitive Level: Comprehension
REF: p. 24
TOP: GAS
KEY: Nursing Process Step: N/A
OBJ: Theory #10
MSC: NCLEX: N/A
5. The nurse clarifies that a person who is self-actualized would have the characteristics of:
(Select all that apply.)
a. having met all other need levels.
b. being certain of their beliefs and values.
c. not being swayed by new ideas.
d. having little need for creative self-expression.
e. depending on significant others.
ANS: A, B
A self-actualized person has been able to meet all other basic need levels and is certain of his
or her beliefs and values. He or she is open to new ideas and finds many ways of creative
self-expression.
DIF: Cognitive Level: Comprehension
REF: p. 16
OBJ: Theory #7
TOP: Self Actualization
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychological Integrity: Coping and Adaptation
COMPLETION
1. Exercise can reduce stress and anxiety by the release of
ANS:
.
endorphins
The release of endorphins induces a feeling of well-being and tranquility.
DIF: Cognitive Level: Knowledge
TOP: Views of Health and Illness
MSC: NCLEX: N/A
REF: p. 26
OBJ: Theory #11
KEY: Nursing Process Step: N/A
2. Adequate
is necessary in the communication between nurse and patient in
order to meet the higher basic needs of security, love, belonging, and self-esteem.
ANS:
feedback
Adequate feedback and clarification are essential in assisting the patient meet the higher level
needs.
DIF: Cognitive Level: Comprehension
TOP: Communication
MSC: NCLEX: N/A
REF: p. 21
OBJ: Theory #7
KEY: Nursing Process Step: N/A
Chapter 03: Legal and Ethical Aspects of Nursing
MULTIPLE CHOICE
1. A student nurse who is not yet licensed:
a. may not perform nursing actions until he or she has passed the licensing
examination.
b. is not responsible for his or her actions as a student under the state licensing law.
c. are held to the same standards as a licensed nurse.
d. must apply for a temporary student nurse permit to practice as a student.
ANS: C
Student nurses are held to the same standards as a licensed nurse. This means that
although a student nurse may not perform a task as quickly or as smoothly as the licensed
nurse would, the student is expected to perform it as effectively. In other words, she must
achieve the same outcome without harm to the patient. The student is legally responsible for
her own actions or inaction, and many schools require the student to carry malpractice
insurance.
DIF: Cognitive Level: Knowledge
REF: p. 32
TOP: Practice Regulations for the Student Nurse
MSC: NCLEX: N/A
OBJ: Theory #1
KEY: Nursing Process Step: N/A
2. During an employment interview, the interviewer asks the nurse applicant about HIV status.
The nurse applicant can legally reN
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a. “No,” even though he or she has a positive HIV test.
b. “I don’t know, but I would be willing to be tested.”
c. “I don’t know, and I refuse to be tested.”
d. “You do not have a right to ask me that question.”
ANS: D
In employment practice, it is illegal to discriminate against people with certain diseases or
conditions. Asking a question about health status, especially HIV or AIDS infection, is illegal.
DIF: Cognitive Level: Application
TOP: Discrimination
KEY:
MSC: NCLEX: N/A
REF: p. 34
OBJ: Clinical Practice #1
Nursing Process Step: N/A
3. An example of a violation of criminal law by a nurse is:
a. taking a controlled substance from agency supply for personal use.
b. accidentally administering a drug to the wrong patient, who then has a serious
reaction.
c. advising a patient to sue the doctor for a supposed mistake the doctor made.
d. writing a letter to the newspaper outlining questionable or unsafe hospital
practices.
ANS: A
Theft of a controlled substance is a federal crime and consequently a crime against society.
DIF:
Cognitive Level: Application
REF: p. 32
OBJ: Theory #2
TOP: Criminal Law
MSC: NCLEX: N/A
KEY: Nursing Process Step: N/A
4. The LPN (LVN) assigns part of the care for her patients to a nursing assistant. The LPN is
legally required to perform which of the following for the residents assigned to the assistant?
a. Toilet the residents every 2 hours and as needed.
b. Feed breakfast to one of the residents who needs assistance.
c. Give medications to the residents at the prescribed times.
d. Transport the residents to the physical therapy department.
ANS: C
Toileting, feeding, and transporting residents or patients are tasks that can be legally assigned
to a nurse’s aide. Administering medications is a nursing act that can be performed only by a
licensed nurse or by a student nurse under the supervision of a licensed nurse.
DIF: Cognitive Level: Application
REF: p. 33
OBJ: Theory #3
TOP: Delegation
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
5. If a nurse is reported to a state board of nursing for repeatedly making medication errors, it is
most likely that:
a. the nurse will immediately have his or her license revoked.
b. the nurse will have to take the licensing examination again.
c. a course in legal aspects of nursing care will be required.
d. there will be a hearing to determine whether the charges are true.
ANS: D
The nurse may have his or her liceNnUsR
e SrIeNvG
okTeBd.CoOrMbe required to take a refresher course, but
this would be based on the evidence presented at a hearing. The licensing examination is not
usually required as a correction of the situation as described.
DIF: Cognitive Level: Knowledge
TOP: Professional Discipline
MSC: NCLEX: N/A
REF: p. 33
OBJ: Theory #3
KEY: Nursing Process Step: N/A
6. A nurse co-worker arrives at work 30 minutes late, smelling strongly of alcohol. The fellow
nurses’ legal course of action is to:
a. have the nurse lie down in the nurses’ lounge and sleep while others do the work.
b. state that, if this happens again, it will be reported.
c. report the condition of the nurse to the nursing supervisor.
d. offer a breath mint and instruct the nurse co-worker to work.
ANS: C
Nurses must report the condition. It is a nurse’s legal and ethical duty to protect patients from
impaired or incompetent workers. Allowing the impaired nurse to sleep enables the impaired
nurse to avoid the consequences of his or her actions and to continue the risky behavior.
Threatening to report “the next time” continues to place patients at risk, as does masking the
signs of impairment with breath mints.
DIF: Cognitive Level: Application
TOP: Professional Discipline
MSC: NCLEX: N/A
REF: p. 33
OBJ: Theory #3
KEY: Nursing P rocess Step: N/A
7. When a student nurse performs a nursing skill, it is expected that the student:
a. performs the skill as quickly as the licensed nurse.
b. achieves the same result as the licensed nurse.
c. not be held to the same standard as the licensed nurse.
d. always be directly supervised by an instructor.
ANS: B
Students are not expected to perform skills as quickly or as smoothly as experienced nurses,
but students must achieve the same result in a safe manner.
DIF: Cognitive Level: Comprehension
REF: p. 33
TOP: Practice Regulations for the Student Nurse
MSC: NCLEX: N/A
OBJ: Theory #1
KEY: Nursing Process Step: N/A
8. If a nurse receives unwelcome sexual advances from a nursing supervisor, the first step the
nurse should take is to:
a. send an anonymous letter to the nursing administration to alert them to the
situation.
b. tell the nursing supervisor that she is uncomfortable with the sexual advances and
ask the supervisor to refrain from this behavior.
c. report the nursing supervisor to the state board for nursing.
d. resign and seek employment in a more comfortable environment.
ANS: B
The first step in dealing with sexual harassment in the workplace is to indicate to the person
that the actions or conversations are offensive and ask the person to stop. If the actions
continue, then reporting the occurN
reUnRcSeItNoGtThBe .C
suOpMervisor or the offender’s supervisor is
indicated.
DIF: Cognitive Level: Application
TOP: Sexual Harassment
MSC: NCLEX: N/A
REF: p. 34
OBJ: Clinical Practice #1
KEY: Nursing Pr ocess Step: N/A
9. A person who has been brought to the emergency room after being struck by a car insists on
leaving, although the doctor has advised him to be hospitalized overnight. The nurse caring
for this patient should:
a. have him sign a Leave Against Medical Advice (AMA) form.
b. tell him that he cannot leave until the doctor releases him.
c. immediately begin the process of involuntary committal.
d. contact the person’s health care proxy to assist in the decision-making process.
ANS: A
A person has the right to refuse medical care, and agencies use the Leave AMA to document
the medical advice given and the patient’s informed choice to leave against that advice.
DIF: Cognitive Level: Application
TOP: Patient Rights
MSC: NCLEX: N/A
REF: p. 39
OBJ: Clinical Practice #3
KEY: Nursing Pr ocess Step: Implementation
10. The information in a patient’s medical record may legally be:
a. copied by students for use in school reports or case studies.
b. provided to lawyers or insurers without the patient’s permission.
c. shared with other health care providers at the patient’s request.
d. withheld from the patient, because it is the property of the doctor or agency.
ANS: C
A release or consent is required to provide information from a patient’s medical record to
anyone not directly caring for that patient. The patient must provide consent to provide
information to insurers, lawyers, or other health care agencies or providers. The patient has
the right to access the information in his or her medical record (copies), but the agency or
doctor retains ownership of the document.
DIF: Cognitive Level: Application
TOP: Legal Documents
MSC: NCLEX: N/A
REF: p. 39
OBJ: Theory #5
KEY: Nursing P rocess Step: N/A
11. If a patient indicates that he is unsure if he needs the surgery he is scheduled for later that
morning, the nurse would best reply:
a. “Your doctor explained all of that yesterday when you signed the consent.”
b. “Your doctor is in the operating room; she can’t talk to you now.”
c. “You should have the surgery; your doctor recommended that you have it.”
d. “I will call the doctor to speak with you before you go to the operating room.”
ANS: D
A consent can be withdrawn at any time before the treatment or procedure has been started.
The primary care provider should be notified by the supervising nursing staff of the unit.
DIF: Cognitive Level: Application
REF: p. 38
OBJ: Clinical Practice #4
TOP: Informed Consent
rocess
Step: Implementation
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MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
12. A 16-year-old boy is admitted to the emergency room after fracturing his arm from falling off
his bike while visiting with his stepfather who is not the custodial parent. The nurse is
preparing him to go to the operating room but must obtain a valid informed consent by:
a. having the patient sign the consent for surgery.
b. obtaining the signature of his stepfather for the surgery.
c. declaring the patient to be an emancipated minor.
d. obtaining permission of the custodial parent for the surgery.
ANS: D
The patient is a minor and cannot legally sign his own consent unless he is an emancipated
minor; the guardian for this patient is the custodial parent. A step parent is not a legal
guardian for a minor unless the child has been adopted by the step parent. The hospital does
not have the authority to declare the patient an emancipated minor.
DIF: Cognitive Level: Application
REF: p. 38
OBJ: Clinical Practice #3
TOP: Consent
KEY: Nursing Pro cess Step: Interventio n
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
13. A patient has advance directives spelled out in a durable power of attorney, with the
appointment of his daughter as his health care agent. The daughter will be responsible for:
a. paying all the medical bills associated with the father’s illness.
b. making all informed consent decisions for her father.
c. making all choices about her father’s health care if the father is unable.
d. paying only for those health care decisions based on the advance directives.
ANS: C
A health care agent makes decisions for the patient only when a patient is unable, according to
the wishes made known by the patient in advance directives. A health care agent is not
responsible for financial decisions or payments.
DIF: Cognitive Level: Application
TOP: Advance Directives
MSC: NCLEX: N/A
REF: p. 39
OBJ: Clinical Practice #5
KEY: Nursing Pr ocess Step: N/A
14. A patient has signed a do-not-resuscitate (DNR) order. If a nurse performs cardiopulmonary
resuscitation (CPR) when the patient stops breathing and then successfully revives the patient,
the:
a. nurse could be found guilty of battery.
b. patient would have no grounds for legal action.
c. patient could charge the nurse with false imprisonment.
d. nurse could be found guilty of assault.
ANS: A
A nurse who attempts CPR on a patient who had a doctor’s order for a DNR could be found
guilty of battery.
DIF: Cognitive Level: Comprehension
REF: p. 39
TOP: DNR
KEY: Nursing Process Step: N/A
OBJ: Clinical Practice #3
MSC: NCLEX: N/A
15. A patient refuses to take his medicNaUtiRoSnIsNoGrTtBo.CeO
atMhis breakfast. He is alert, mentally
competent, and fairly comfortable. The nurse should:
a. give the medications by injection if the patient will not take them orally.
b. respect the patient’s right to refuse medications or food, because he is competent.
c. tell the patient that he must cooperate with his care.
d. contact the doctor to insert a feeding tube to supply both medicine and food.
ANS: B
The competent patient has the right to refuse medicine, food, treatments, and procedures.
Giving (or threatening to give) medications by injection over the patient’s objections is
considered battery. Threatening the patient or overriding the patient’s wishes is a violation of
the patient’s bill of rights and constitutes assault or battery.
DIF: Cognitive Level: Application
TOP: Patient’s Rights
MSC: NCLEX: N/A
REF: p. 40
OBJ: Clinical Practice #3
KEY: Nursing Pr ocess Step: N/A
16. A nurse remarks to several people that “Dr. X must be getting senile because she makes so
many mistakes.” If that remark results in some of Dr. X’s patients changing to another doctor,
Dr. X would have grounds to sue the nurse for:
a. slander.
b. libel.
c. invasion of privacy.
d. negligence.
ANS: A
A person who makes untrue, malicious, or harmful remarks that damage a person’s reputation
and cause injury (loss of business) is guilty of defamation and slander. Libel is defamation
that is written.
DIF: Cognitive Level: Application
TOP: Defamation/Slander
MSC: NCLEX: N/A
REF: p. 40
OBJ: Clinical Practice #5
KEY: Nursing Process Step: N/A
17. A licensed nurse is liable for charges of malpractice when she:
a. does not show up for work and fails to call to notify the agency.
b. clocks in for another nurse to prevent that nurse from having pay docked.
c. falsifies data, causing the patient to suffer problems resulting in death.
d. assists in performing CPR that is unsuccessful, and the patient dies.
ANS: C
Malpractice is professional negligence or, in this case, doing (falsifying) something the
reasonable and prudent nurse would not do. It is the proximate cause of the patient injury.
This is a case of causation.
DIF: Cognitive Level: Application
REF: p. 40|Box 3-6
OBJ: Theory #5
TOP: Negligence and Malpractice
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
18. A postoperative patient in the intensive care unit (ICU) is so confused and agitated that staff
have not been able to safely care for him. He has pulled out his central line once, and he slides
to the bottom of the bed, where he attempts to climb out, pulling and disrupting the various
tubes and monitors. The nurse’s bNesUtRcSoIuNrGseTBo.fCaOcM
tion is to:
a. place him in a protective vest device.
b. use a sheet to tie him in a chair at the nurses’ station.
c. request that the doctor write an order for a protective device and/or medication.
d. call a family member to stay with the patient.
ANS: C
A protective device may not be used (except in an emergency) without a doctor’s order, and it
is used only when other less restrictive means do not provide safety for the patient.
DIF: Cognitive Level: Application
REF: p. 41
OBJ: Clinical Practice #3
TOP: False Imprisonment
KEY: Nursing Pr ocess Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control
19. An elderly, slightly confused patient sustains an injury from a heating pad that was wrongly
applied by the nurse. The nurse should:
a. pretend to be unaware of the injury to the patient.
b. report the incident to the risk management team via an incident report.
c. document in the patient’s medical record that an incident report was filled out.
d. not document anything about the injury in the patient’s medical record.
ANS: B
When an incident occurs that has potential for a future lawsuit, the risk management team
should be aware of it as soon as possible. An incident report should be filled out, and the
patient medical record should be documented to describe the injury. No mention of the
incident report is usually made in the patient medical record. Honesty and a forthright
explanation to the patient reduce the risk of lawsuits.
DIF: Cognitive Level: Application
TOP: Incident Reports
MSC: NCLEX: N/A
REF: p. 43
OBJ: Theory #5
KEY: Nursing P rocess Step: N/A
20. Nursing liability insurance is a policy purchased and put into effect by the nurse for the
purpose of:
a. providing protection against being sued.
b. reducing the chance of litigation.
c. paying attorney fees and any award won by the plaintiff.
d. providing the hospital with added protection.
ANS: C
Nursing liability insurance pays attorney fees and any award won by the plaintiff.
DIF: Cognitive Level: Comprehension
TOP: Nursing Ethics
MSC: NCLEX: N/A
REF: p. 43
OBJ: Theory #5
KEY: Nursing Process Step: N/A
21. Ethics and law are different from each other in that ethics:
a. bear a penalty if violated.
b. are voluntary.
c. rarely change.
d. can always direct all decisions.
ANS: B
Ethics are voluntary and are based on values. Ethics may change as parameters of health care
change. There is no penalty for violation.
DIF: Cognitive Level: Analysis
TOP: Nursing Ethics
MSC: NCLEX: N/A
REF: p. 43
OBJ: Theory #6
KEY: Nursing P rocess Step: N/A
22. To best protect himself or herself from being sued, the nurse should:
a. continue to do procedures as taught in school.
b. purchase malpractice insurance.
c. maintain competency.
d. use evidence-based practice.
ANS: C
Keeping up with continuing education, maintaining competency, and seeking to improve
one’s own practice by self-evaluation will best protect the nurse.
DIF: Cognitive Level: Comprehension
REF: p. 42|Box 3-7
OBJ: Theory #5
TOP: Avoiding Lawsuits
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A