Chapter 16 Emergency Preparedness and Response for Today’s World
1. Nurses and community officials are working together to ensure that churches and schools
have needed supplies to provide shelter for large numbers of individuals in the event of a
natural or manmade disaster. These activities represent which phase of a disaster
continuum?
a. Preparedness
b. Relief response
c. Recovery
d. Crisis intervention
ANS: A6
2. A nurse at a school notice that several students have “blisters” on their bodies. Further
investigation reveals that a terrorist incident has occurred, causing smallpox. If the
chemical, biologic, radiologic, nuclear, and explosive (CBRNE) agent categories are
used, this incident would be classified as:
a. chemical.
b. biologic.
c. radiologic.
d. nuclear.
ANS: B
3. The Metropolitan Medical Response System (MMRS):
a. is totally financed by the federal government national disaster fund.
b. consists of responders who have obtained specialized training and equipment to deal with
mass casualty events.
c. has a storehouse of medications and antidotes to be used during response in times of national
emergencies.
d. arranges for patient admissions to federal hospitals.
ANS: B
4. A community in the New Madrid fault zone experiences an earthquake resulting in
injuries from propelled objects and abrasions for many victims. The local supply of
antibiotics is quickly exhausted. Local authorities would contact the:
a. Commissioned Corps Readiness Force.
b. Strategic National Stockpile.
c. Department of Homeland Security.
d. local Young Men’s Christian Association (YMCA).
ANS: B
5. During the relief response phase of a disaster resulting from a “dirty bomb”:
a. treatment for burns and poisoning is provided for victims.
b. emergency plans are coordinated between agencies.
c. reconstruction of destroyed facilities and homes begins.
d. food stores are collected for potential victims.
ANS: A
6. A nurse learns of a mass casualty disaster following a known terrorist attack. On arriving
at the scene, the nurse knows that:
a. the response of local hospitals will be dictated by the federal government.
b. the same ground rules practiced in other settings and during smaller crises will be applicable.
c. the least experienced nurses will be assigned to triage low-risk victims and victims who have
no chance of survival.
d. multiple incident commanders ensure a quick, effective response.
ANS: B
7. Nurses caring for the victims of a mass casualty incident:
a. determines the common terminology to be used by hospitals and participating agencies.
b. take charge of communicating with the news media.
c. determines whether there is a credible threat of a terrorist attack.
d. give priority for care to those with the greatest chance of survival rather than those most
critically ill.
ANS: D
8. During a community health fair, the disaster medical assistance team (DMAT) informs
participants that every community must be ready to provide disaster care. A participant
asks, “In a disaster, the local community cannot possibly be effective, so why not have a
plan to call federal agencies immediately to provide relief?” The correct response by the
DMAT is:
a. “Unless known terrorist activities involving mass destruction occur, the federal government
does not become involved.”
b. “The community is essentially the ‘first responder’ to any disaster.”
c. “The preparedness phase of a disaster is the responsibility of the community, the relief
response phase is assigned to state agencies, and the recovery phase is the responsibility of
federal agencies.”
d. “Unless local health care facilities are incapacitated, state and federal agencies will withhold
assistance.”
ANS: B
9. A nurse who is conducting a staff in-service on the phases of a disaster continuum
teaches participants that, during the impact/response stage, activities focus on:
a. community awareness in anticipation of a terrorist attack or natural disaster.
b. determining the effectiveness of the disaster medical assistance team (DMAT).
c. the use of an all-hazards approach.
d. initiating response activities.
ANS: D
10. Following a terrorist attack, victims are exhibiting posttraumatic stress syndrome, and
care providers are exhibiting compassion fatigue. Which federal response system should
be initiated?
a. Strategic National Stockpile
b. Metropolitan Medical Response System (MMRS)
c. Commissioned Corps Readiness Force
d. National Disaster Medical System
ANS: B
11. The crisis communication officer may first inform the public or health care facility of a
disaster or an act of terrorism. This representative has the responsibility to:
a. contains the facts to within the administration group.
b. incites the public to quickly take cover and obtain emergency supplies.
c. provides understandable and straightforward facts about the event within the facility and
possibly to the news media.
d. informs the public that no information can be released until it has been confirmed by state and
federal agencies.
ANS: C
12. The disaster medical assistance team works quickly to contain contaminants from a
chemical plant explosion. Afterward, personnel undergo a special process to remove
harmful chemicals from equipment and supplies. This removal process is known as:
a. containment.
b. decontamination.
c. triage.
d. scene assessment.
ANS: B
13. A group of local volunteers respond to a tornado. Volunteers have completed an
emergency response course and are able to assist with triage of injured citizens. They also
participate in local health fairs to teach residents how to react during tornadoes. The
responders are members of the:
a. Medical Reserve Corps (MRC).
b. Metropolitan Medical Response System (MMRS).
c. National Disaster Medical System (NDMS).
d. Commissioned Corps Readiness Force (CCRF).
ANS: A
14. Troops from the United States participating in a peace mission in a foreign country were
the victims of suicide bombers and many soldiers were evacuated back home to receive
specialized medical care. The nation’s medical responses will be augmented by:
a. the federally coordinated National Disaster Medical System.
b. local homeland communities where troops receive care.
c. the Medical Reserve Corps, which organizes and utilizes public health, nursing, medical, and
other volunteers.
d. the National Incident Management System, which guides government, nongovernmental
organizations, and the private sector to work seamlessly during disaster situations.
ANS: A
15. A nurse is informed that the Federal Bureau of Investigation has determined that a bomb
has been detected and is in the possession of a known terrorist group. The government
buildings in the local community are the target. This situation is termed a(n):
a. all-hazards approach.
b. biologic event.
c. credible threat.
d. natural disaster.
ANS: C
16. The emergency response team responded to a terrorist attack where hundreds of people
died following symptoms of chest tightness, palpations, seizures, and finally paralysis. A
colorless odorless liquid known as Sarin (GB) was the agent, which is primarily inhaled
with limited exposure through the skin. The concentration of Sarin has not been
measured. What level is the minimum level of personal protection and safety equipment
(PPE) that would be needed?
a. A
b. B
c. C
d. D
ANS: B
17. A state is devastated by a tornado killing many people, destroying communication
systems, utility services, homes, and medical facilities. The state requests immediate
assistance from the U.S. Congress and from surrounding states. The affected state should
first contact the:
a. Emergency Management Assistance Compact (EMAC).
b. Institute of Medicine (IOM).
c. Red Cross.
d. Strategic National Stockpile.
ANS: A
18. A nurse is interested in learning the phases of the disaster continuum and realizes it has
many similarities to the nursing process. To better understand the phases of a disaster,
which is true when comparing the phases of the disaster continuum to the nursing
process?
a. The preparedness phase of the disaster continuum is consistent with the assessment and
planning steps of the nursing process.
b. The recovery phase of the disaster continuum is consistent with the planning step of the
nursing process.
c. The recovery phase of the disaster continuum is consistent with the implementation step of the
nursing process.
d. The response relief phase of the disaster continuum is consistent with the evaluation step of
the nursing process.
ANS: A
19. In the preparedness phase for disasters, the community plans for a possible terrorist attack
using anthrax as the weapon of destruction. What treatments and/or preparations would
be needed?
a. Vaccines and Level B Personal Protection Equipment (PPE)
b. Treatment for burns, decontamination, and Level A PPE
c. social distance determination, decontamination for radioactive fallout
d. Identify and detect incendiary devices, treatment for burns and propellants
ANS: A
1. Health care professionals have been activated to respond to a disaster, and the registered
nurse who is coordinating the effort realizes that: (select all that apply)
a. in the event of a mass casualty incident, care is prioritized to those who have the greatest
chance of surviving.
b. communities should use their own resources first to attempt to stabilize and organize the
response.
c. state assistance occurs any time a disaster occurs, regardless of the community’s resources.
d. the emergency operating plan developed by one central agency rather than individual facilities
should be put into operation.
e. strict protocols regarding the use of resources must be followed.
ANS: A, B
2. When teaching community preparedness for a community group, the nurse explains that
components of the National Disaster Medical System (NDMS) provide for: (select all that
apply)
a. a nationwide bomb disposal squad team for the rapid removal of explosive devices.
b. teams of health care providers who are experts and have specialized supplies and equipment.
c. structures for patient evacuation from the disaster area to an unaffected area.
d. arrangements for hospitalization in federal and volunteer nonfederal acute care hospitals.
e. providing mental health care for the community, for victims, and for health care providers.
ANS: B, C, D
COMPLETION
1. The emergency preparedness term that is used to describe the process of limiting the
emergency situation within a well-defined area is ___________.
ANS: containment
2. The term used during a pandemic disaster that refers to the attempt to contain germs by
limiting socialization and personal interactions is ___________.
ANS: social distancing
Chapter 19 Effective Communication and Conflict Resolution
1. A nurse is listening to a patient’s apical heart rate. The patient asks, “Is everything
okay?” The nurse says nothing and shrugs her shoulders. The nurse is demonstrating:
a. open communication.
b. filtration.
c. blocking.
d. false assurance.
ANS: C
2. A teenage patient is using earphones to listen to hard rock music and is making gestures
in rhythm to the music. The nurse assesses the amount of urine output in the Foley
catheter and leaves the room. What communication technique is demonstrated in both of
these situations?
a. Blocking
b. Filtration
c. Empathy
d. False assurance
ANS: B
3. In today’s world of fast, effective communication, what is the most commonly used
means of societal communication?
a. Facial expression
b. Spoken word
c. Written messages
d. Electronic messaging
ANS: B
4. Which statement accurately describes communication?
a. The components of communication are mutually exclusive.
b. Communication is linear.
c. Communication involves only the sender and the receiver; everything else is superficial.
d. When the receiver becomes the sender, the subcomponent of communication that is in use is
feedback.
ANS: D
5. A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly
graduated RN with a bachelor’s degree is hired. Before the RN arrives on the unit, the
LPN is heard saying, “She’ll try to tell everyone what to do because she makes more
money. She’ll sit at the desk and let us do all the work.” This is an example of a(n):
a. interpretation.
b. context.
c. precipitating event.
d. preconceived idea.
ANS: D
6. A new mother is experiencing pain after delivering an infant with Down syndrome. The
staff nurse states, “I don’t think she is really hurting. Let the next shift give the pain
medication.” The team leader notices the staff nurse looks agitated and anxious and asks
about any concerns in providing care to this new mom. The staff nurse admits having a
stillborn infant with Down syndrome. This is an example of which component of
communication?
a. Personal perception
b. Past experiences
c. Filtration
d. Preconceived idea
ANS: B
7. A nurse gives Dilantin intravenously with lactated Ringer’s solution containing
multivitamins. The drug precipitates and obstructs the only existing line. When the team
leader informs the nurse that these drugs cannot be mixed, the nurse states, “Everyone
just pushes the medicine slowly. No one checks for compatibility. There isn’t even a
compatibility chart on the unit.” Which type of logical fallacy has influenced the nurse?
a. Ad hominem abusive
b. Appeal to common practice
c. Appeal to emotion
d. Appeal to tradition
ANS: B
8. An RN is consistently late to work, causing reassignment of patient care and the need for
repeated shift reports. The nurse, who receives a warning for repeated tardiness, states,
“My husband left me, I have no car, no family close by, and the bus is always late, which
makes me late. The nurse manager doesn’t care how hard I try to get here, and I am
raising a child by myself.” The nurse is using which type of logical fallacy?
a. Appeal to emotion
b. Appeal to tradition
c. Hasty generalization
d. Confusing cause and effect
ANS: A
9. The new director of nurses has instituted “walking rounds” on all nursing units, rather
than the usual taped shift reports. A veteran nurse exclaims, “She doesn’t know how we
do things here!” The nurse is demonstrating:
a. appeal to emotion.
b. appeal to tradition.
c. red herring.
d. straw man.
ANS: B
10. A male nurse hired to work in the emergency department is observed throwing a
contaminated needle into the trash can. The team leader reprimands the nurse for not
appropriately disposing of sharps. The nurse states, “You don’t care that I threw the
needle in the trash. You just want an all-female staff,” putting the team leader in a
defensive position. This communication technique is known as:
a. straw man.
b. red herring.
c. slippery slope.
d. confusing cause and effect.
ANS: B
11. A nurse who was recently certified in chemotherapy administration fails to check
compatibility of phenytoin (Dilantin) before injecting into a continuous infusion of D5W
leading to occlusion of the line. Which statement by the nurse demonstrates a red
herring?
a. The nurse is upset and states, “I am sure I have injected this before without a problem” and the
supervisor interprets this to mean the nurse often take shortcuts.
b. The nurse states, “You are just upset because I am certified in chemotherapy administration
and you are not.”
c. “The nurse who started the IV didn’t get a blood return but determined the IV was the
patient’s—that is the problem.”
d. “This drug always occludes the line because it is so viscous.”
ANS: B
12. During a health history interview, the nurse listens to a patient relating the precipitating
events that led to the onset of chest pain. She focuses her attention on the patient, makes
eye contact, and acknowledges what the patient has to say. The nurse is exhibiting:
a. assertive communication.
b. active listening.
c. empathy.
d. passive communication.
ANS: B
13. The nurse is demonstrating active listening when:
a. while assessing the patient’s vital signs, the nurse records the data and states, “You are
improving, your vital signs are normal.”
b. eye contact is maintained while focusing on the patient as the patient describes the current
pain level and location.
c. he or she states, “I know how you feel, I recently lost my father and I am still hurting.”
d. cultural values are in opposition to the patient but shares that “I agree with your decision to
use herbs rather than the prescribed medications.”
ANS: B
14. An older adult is unable to reach the telephone and is found dead at home several hours
later. The son of the deceased person arrives at the hospital and asks, “Can I just please
stay and hold my dad’s hand? He was so afraid of dying alone.” Which response by the
nurse shows empathy?
a. “You are just too late for that. Where were you when he needed you?”
b. “Did you ever consider purchasing a cell phone for your dad to prevent this from happening?”
c. “I’ll close the door so you can spend time with your dad. I will check back in a few minutes.”
d. “I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay
here and console you.”
ANS: C
15. A nurse is preparing an exercise program as part of a health promotion program for older
adults with osteoporosis. Which question would retrieve the most valuable information
about health practices?
a. “Do you exercise?”
b. “Do you like to exercise?”
c. “When do you exercise?”
d. “What exercise practices do you participate in?”
ANS: D
16. Which component of an e-mail shown below would be both effective and concise?
a. Subject: A short concise subject line: Meeting.
b. Body: I would like you to answer these questions before the next meeting: Where would you
like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal
for our unit?
c. Body: Dear Staff, as you know, each department must reduce staff by 2%. We will need to
discuss how to inform unlicensed staff about the downsizing efforts of the hospital.
d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first-floor
auditorium. Please send items for the agenda. Sally Smith, MSN, RN, smith@hospital.org or ext.
5582.
ANS: D
17. During height and weight assessments at a school’s health fair, a child admits to drinking
a cup of coffee with his mother every morning, and another child reports enjoying a
morning cup of coffee on the commute to school. These two children are both below
average on the height chart, and the nurse states, “Drinking coffee stunts a child’s
growth.” This logical fallacy is referred to as:
a. appeal to common practice.
b. confusing cause and effect.
c. ad hominem abusive.
d. red herring.
ANS: B
18. A patient’s spouse was just diagnosed with lung cancer although there was no history of
tobacco use. The spouse states, “I am so mad. How can you get cancer without
smoking?” Which statement by the nurse represents empathy?
a. “Research is identifying many risk factors for cancer besides smoking.”
b. “I understand how you could feel angry about the diagnosis.”
c. “He is still a good husband.”
d. “Why do you think he got cancer?”
ANS: B
19. A nurse wants to apply open communication to obtain a thorough history and to
determine cognitive function. Which question represents the use of open communication?
a. Is today Wednesday?
b. Do you know what day it is?
c. Tell me what day of the week today is.
d. Do you know what the first day of the week is?
ANS: C
20. The nurse caring for a patient state, “Your blood pressure is dangerously high. Are you
taking antihypertensive medicine?” The patient states, “I can’t afford my medicine. I
have no insurance.” The nurse states “I feel really sorry for that patient. I wish it wasn’t
against policy to give her money.” The nurse wants to help and places a note on
Facebook that any donations would be appreciated to help a waitress who works at the
cafeteria next door to the hospital buy her medications. The nurse posts that “She was so
sick last evening when she came to the ED. I can’t believe they don’t provide insurance. I
can’t give her money but you all can help.” This nurse:
a. is showing empathy and as long as she lets the patient know the money is not from her, she is
not violating any social media guidelines.
b. is at risk for HIPAA violations.
c. has properly followed policy and protected the patient by not using her name.
d. is demonstrating the logical fallacy of slippery slope.
ANS: B
21. A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the
four members freely expresses thoughts about fair staffing but is willing to listen to other
thoughts and reconsider their first recommendations. The nurses are avoiding conflict and
supporting professional communication through:
a. empathy.
b. positiveness.
c. supportiveness.
d. accommodation.
ANS: C
22. A nurse is asked to “float” to another area where the patients require total care. The nurse
smiles, picks up her stethoscope, and says, “I’ll come back and eat lunch with everyone
here.” When she enters the elevator, she hits the wall and mutters, “Always me. Don’t I
have any rights”? The nurse is demonstrating which communication style?
a. Assertive
b. Aggressive
c. Passive
d. Passive-aggressive
ANS: D
23. A nurse is overhead saying, “I don’t mind working during the election and holiday. My
parents are divorced, money is tight, and honestly, I don’t trust any politicians anyway. I
plan to take a few weeks off next month.” She works independently to research strategies
to improve patient-centered care for the large number of immigrants that arrived in the
area and then works with the team to share ideas. She recommends, “Let’s think the
suggestions over and come back together next week.” This nurse’s communication style
is consistent with which generation?
a. Baby Boomers
b. Traditionalist
c. Generation X
d. Millenniums
ANS: C
COMPLETION
1. The healthiest form of communication is the ________ style.
ANS: assertive
Chapter 20 Effective Delegation and Supervision
1. The task of completing and signing the initial assessment on a newly admitted patient
who is about to undergo minimally invasive procedures on an outpatient basis can be
delegated to:
a. the registered nurse (RN).
b. the licensed practical/vocational nurse (LPN/LVN).
c. unlicensed assistive personnel (UAP).
d. all levels of staff, because the information is about the past and cannot change.
ANS: A
2. An RN recently relocated to another region of the country and immediately assumed the
role of charge nurse. When determining the appropriate person to whom to delegate, the
RN knows that:
a. the role of the LPN/LVN is the same from state to state.
b. the LPN/LVN can be taught to perform all the duties of an RN if approved by the employer
and if additional on-the-job training is provided.
c. he or she must review the state’s nurse practice act for LPN/LVNs, because each state defines
the role and scope of practice of the LPN/LVN.
d. The Joint Commission has certified and established roles for the LPN/LVN.
ANS: C
3. Which task is most likely to be considered in a state’s practice act as appropriate to
delegate to a LPN/LVN if the patient’s condition is stable and competence in the task has
been established?
a. Administer an enema for an elective surgery patient.
b. Administer an antiarrhythmic medication IV while interpreting the patient’s rhythm on the
cardiac monitor.
c. Develop a plan of care for a stable patient admitted for observation after a head injury.
d. Teach a patient how to instill eye drops for glaucoma.
ANS: A
4. A patient is admitted with hypotension, shortness of breath, flushing, and hives. All
levels of staff have been trained to assess vital signs. Given budget restrictions and proper
delegation rules, to which care provider would the RN delegate the task of obtaining the
initial blood pressure reading?
a. RN
b. LPN/LVN
c. Unlicensed assistive personnel (UAP)
d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic
monitoring.
ANS: A
5. A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the
task of assisting with oral hygiene, knowing that this assignment “does not require
decisions based on the nursing process.” The nurse is correctly using which of the five
rights of delegation?
a. Supervision
b. Communication
c. Person
d. Circumstance
ANS: D
6. A student nurse is concerned about delegation practices and wonders why hospitals
employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to
the National Council of State Boards of Nursing and learns that the role of these
personnel is to:
a. supplement the staffing pattern when an RN is not available.
b. aid the RN by performing appropriately delegated care tasks.
c. replaces the RN when the health care facility provides long-term care.
d. provides patient teaching, allowing more direct care to be provided by the RN.
ANS: B
7. An RN delegates to the unlicensed assistive personnel (UAP) the task of performing
blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task
and is responsible for:
a. delegating the task to another UAP if he or she does not have the time or skill to complete the
task.
b. keeping the RN informed of any abnormal blood pressure readings.
c. calling the physician when the patient’s vital signs are not within established parameters.
d. informing the dietary department to initiate a low-sodium diet for patients who are
hypertensive.
ANS: B
8. Which task is appropriate for the RN to delegate to the unlicensed assistive personnel
(UAP) provided the delegatee has had experience and training?
a. Evaluate the ability of a patient to swallow ice after a gastroscopy.
b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first
time.
c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if
secretions are thick and tenacious.
d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed
drainage system.
ANS: D
9. An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN
checks with the LPN/LVN often throughout the shift to provide support and determine if
assistance is needed. The RN is providing which level of supervision?
a. There is no supervision, because at times the LPN/LVN is not with the RN.
b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the
need to evaluate care.
c. Continual supervision is being provided until the RN determines competency.
d. Initial supervision is being provided because this is the LPN/LVN’s first day on the unit.
ANS: C
10. An RN is counseled by the nurse manager regarding inappropriate delegation when the:
a. RN instructs the nursing assistant to greet ambulatory surgery patients and show them to their
rooms.
b. nursing assistant informs the RN that she has not been trained to collect a sputum specimen
and the RN states, “I will show you this time and you can show me the next time.”
c. RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who
was admitted for routine replacement of a feeding tube.
d. LPN/LVN who has demonstrated competence is asked to perform a dressing change for a
patient before she is discharged home.
ANS: C
11. An RN delegates to an experienced LPN/LVN the task of administering oral medications
to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the
LPN/LVN has had the training and has acquired the skills needed to complete the task.
The RN then observes the LPN/LVN recording a patient’s medication administration just
before entering the patient’s room. The priority intervention by the RN is to:
a. checks the patient’s drug packages to ensure that the correct drugs were given.
b. stops the LPN/LVN immediately and discuss the possible consequences of his actions in a
nonjudgmental manner.
c. contacts the nurse manager and ask that the LPN/LVN’s license be suspended.
d. calls the pharmacy and ask for replacement medications for the patients.
ANS: B
12. Which statement related to delegation is correct?
a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse practice act.
b. Nursing practice can be delegated only when the LPN/LVN and UAP have received adequate
training.
c. Supervision is not required when routine tasks are delegated to a competent individual.
d. The RN must be knowledgeable about the laws and regulations that govern nursing practice,
as well as those that have no clearly defined parameters, such as for UAP.
ANS: D
13. During orientation, an RN learns that LPN/LVNs in the facility receive additional
training to perform some tasks such as hanging continuously infusing intravenous fluids
that have no additives. It is important for the RN to understand that:
a. the health care facility can override the state practice act by having all LPN/LVNs and
unlicensed assistive personnel (UAP) participate in on-site training.
b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN.
c. UAPs cannot be held responsible for their own actions or inactions.
d. the nurse practice act and state regulations related to delegation override the organization’s
policies.
ANS: D
14. A nurse moves from California to Arkansas and due to having 20 years of experience as a
registered nurse is immediately placed in charge of the telemetry unit. The staffing
consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope
of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks
clarity on some tasks. The RN should:
a. query the state nursing association to determine their stance on the role of LPNs.
b. asks the LPNs on the unit to list what tasks they routinely performed.
c. contacts the state board of nursing to determine legal scope of practice for LPNs.
d. refers to California’s nurse practice act because the scope of LPNs/LVNs is consistent across
the United States.
ANS: C
15. An RN makes the following assignments at the beginning of the shift. Which assignment
would be considered high-risk delegation?
a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH
insulin.
b. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a
foot wound.
c. An unlicensed assistive person is assigned the task of assisting a patient with late stages of
Huntington’s disease to ambulate a short distance in the hallway.
d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000
mm3.
ANS: C
16. The RN instructs the LPN to “Give an enema to the patient in room 327 who is being
discharged but is complaining of being constipated. Then be sure to document on the
medication administration record when given.” Which of the five rights was missing in
this situation? The right of:
a. direction and communication.
b. task.
c. person.
d. circumstances.
ANS: A
17. Which of the following situations would be appropriate for the supervisory level of initial
direction and/or periodic inspection?
a. Experienced RNs work together to provide care for a group of patients newly diagnosed with
meningitis.
b. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to
ensure the tasks are completed correctly.
c. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 g of
hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse checks on the
patient status every 15 to 30 minutes and asks the graduate to explain “next steps.”
d. No supervision is necessary since both are registered nurses.
ANS: B
18. A registered nurse (RN) is assigned as charge nurse for the first time. She knows to
consult the state board of nursing to determine scope of practice for licensed practical
nurses (LPN) and unlicensed assistive personnel (UAP). She also realizes there are
common policies which exist in most state practice acts that include:
a. the RN is held accountable for the decision to delegate, but responsibility rests only with the
delegatee.
b. the RN may only delegate tasks that are not in the scope of practice of the LPN if the
delegatee is certain they are competent to perform the task.
c. since the LPN is licensed, they practice professional nursing.
d. to determine what tasks can be safely delegated, the RN must first assess the patient.
ANS: D
19. A nurse is concerned about the risk of delegating tasks to licensed practical nurses and
unlicensed assistive personnel. What is the best way for the nurse to determine
competency of an inexperienced delegatee?
a. Actually observe the delegatee perform the assigned task.
b. Ask the delegatee how many times he/she has performed the task.
c. Ask the patient if the care provided was satisfactory.
d. Ask other nurses if they feel the delegatee is competent.
ANS: A
20. Care delivery using the team-based approach is used on a telemetry nursing unit. The
team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one
unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care
while ensuring cost containment. Which assignments would meet both criteria?
a. The RN administers all medications to all patients.
b. The LPN performs sterile dressings and IV tubing changes on all central lines.
c. The experienced UAP places telemetry electrodes and attaches to cardiac monitor.
d. The RN administers an enema to a stable patient who has an order “administer fleet enema
PRN when no bowel movement in 2 days.”
ANS: C
MULTIPLE RESPONSE
1. Which statement made by an RN regarding delegation indicates the need for additional
teaching? (Select all that apply)
a. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a
patient who is receiving a blood transfusion because a reaction at this time is unlikely.
b. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive
PPD.
c. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low
dose for the purpose of increasing renal perfusion.
d. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if
they have received training and demonstrated competency.
e. Responsibility can be delegated to the UAP, but the delegator retains accountability.
ANS: A, B, C
2. A nursing administrator who is considering the feasibility of an all-RN staff reviews the
report, Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) and
determines that RNs: (select all that apply)
a. is more costly and less efficient than LPNs.
b. has little or no effect by being proactive but instead are reactive to patient care errors.
c. has a positive effect on patient outcomes when managing patient care.
d. are effective overseers of patients’ overall health condition.
e. lacks the training to be effective delegators.
ANS: C, D
3. Which functions can be delegated only to another RN with appropriate experience and
training? (Select all that apply)
a. Assessment of skin integrity on third day of hospitalization
b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises
c. Nursing judgment related to withholding medication based on vital signs
d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses or unlicensed
assistive personnel
e. Formulation of nursing diagnosis “potential for fall”
ANS: A, B, C, E
Chapter 21 Staffing and Nursing Care Delivery Models
1. Accrediting agencies such as The Joint Commission address staffing by:
a. imposing maximum staffing levels.
b. requiring a specific staff mix.
c. stipulating nurse-patient ratios.
d. looking for evidence that patients receive satisfactory care.
ANS: D
2. Customer satisfaction is primarily based on:
a. access to modern, up-to-date facilities.
b. availability of an extensive menu selection.
c. personal interactions with employees.
d. having to undergo fewer invasive procedures.
ANS: C
3. nurses on a unit provide personal hygiene, administer medications, educate the patient
and family about treatments, and provide emotional support. These nurses provide patient
care based on which nursing delivery system?
a. Total patient care
b. Partnership nursing
c. Team nursing
d. Functional nursing
ANS: A
4. A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed
assistive personnel (UAP) are responsible for implementing a specific task, such as
medication administration or personal hygiene, for the entire nursing unit. This type of
delivery system is:
a. total patient care.
b. functional nursing.
c. team nursing.
d. primary nursing.
ANS: B
5. The nurse who is responsible for following the patient from admission through discharge
or resolution of illness while working with a broad range of health care providers is
called a:
a. nurse manager.
b. case manager.
c. coordinator of patient-centered care delivery.
d. team leader in team nursing care delivery.
ANS: B
6. A patient is admitted with coronary artery disease and is scheduled for coronary artery
bypass grafting (CABG). According to the clinical pathway the patient should be
extubated and discharged from critical care the day after surgery. During surgery the
patient’s oxygen saturation decreased drastically as a result of chronic tobacco abuse.
Subsequently, the patient remained on the ventilator an additional 2 days postoperatively.
According to the clinical practice guideline for CABG, this situation represents a:
a. patient outcome.
b. variance.
c. goal.
d. standard.
ANS: B
7. A patient is admitted with pneumonia. The case manager refers to a plan of care that
specifically identifies dates when supplemental oxygen should be discontinued, positive
pressure ventilation with bronchodilators should be changed to self-administered inhalers,
and antibiotics should be changed from intravenous to oral treatment, on the basis of
assessment findings. This plan of care is referred to as a:
a. patient classification system.
b. clinical pathway.
c. patient-centered plan of care.
d. diagnosis-related group (DRG).
ANS: B
8. The nurse manager determines that four RNs, five LPN/LVNs, and two unlicensed
assistive personnel (UAP) are required per shift to meet the needs of the patient
population on the unit, according to acuity and census. The nurse manager is concerned
with:
a. assignments.
b. staffing.
c. output.
d. productivity.
ANS: B
9. A nurse manager is mentoring a novice nurse manager in determining staffing needs. The
mentor explains, “We must determine the acuity level of the patient by:
a. assessing patient satisfaction with nursing care.”
b. quantifying the amount and intensity of care required.”
c. examining the skill mix and educational preparation of the staff.”
d. determining the number of hospital days required by the patients.”
ANS: B
10. The nurse manager is planning staffing levels and realizes that the first step is to:
a. knows the intensity of care needed by patients according to physical and psychosocial factors.
b. examines the educational level of the staff.
c. assesses the skill level of caregivers.
d. reviews the budget to determine the financial consequences of past staffing patterns.
ANS: A
11. A hospital is concerned with nurse retention and realizes that job satisfaction is a major
influence. To enhance employee satisfaction related to staffing, the management team:
a. negotiates for additional agency nurses.
b. hires more part-time employees.
c. includes participatory management into staffing decisions.
d. uses “float” nurses to cover vacancies.
ANS: C
12. A patient is admitted for a hysterectomy, and the RN develops and implements the plan
of care but also delegates to the LPN/LVN the responsibility of administering oral
medications. While off duty, this RN receives a call requesting a change in the plan of
care because the patient has developed deep vein thrombosis. The nurse who originally
planned the care is practicing which type of nursing care delivery?
a. Modular
b. Primary
c. Team
d. Functional
ANS: B
13. When deciding which staffing option to use on a nursing unit that will open soon, the
manager realizes that:
a. continuity of care is enhanced and errors are reduced when nurses provide care over longer
shifts and consecutive workdays, such as 12-hour shifts on 3 consecutive days per week.
b. the use of part-time nurses provides the variability needed to meet diverse patient needs.
c. satisfaction of the staff equates to satisfaction of patients.
d. nurses provide the same level of care, regardless of the work environment.
ANS: C
14. A task force is considering factors that contribute to high-quality safe staffing. Which
statement reflects an understanding of the American Nurses Association’s (ANA)
recommendations?
a. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the
shift should be sufficient to provide safe, high-quality care.
b. Staffing should allow time for the RN to apply the nursing process so decisions result in highquality, safe patient outcomes.
c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide
routine basic care rather than increasing RNs in staff mix.
d. RN staffing is not cost-effective; thus, is it important for staffing models to limit the number
of RNs assigned per shift.
ANS: B
15. A nursing unit is comparing team nursing to the partnership model and finds that:
a. with the partnership model, an RN does not have to be part of the mix.
b. leadership abilities of the RN are a major determinant of effectiveness of care for both models.
c. the RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to apply the
nursing process in team nursing.
d. with team nursing the RN cares for the patient while the team members work with the family
or significant others.
ANS: B
16. A nurse groups patients with criteria such as “high risk for falls,” “infection protocols,”
and “special communication needs” to determine the mix and number of staff needed on
a telemetry unit. The nurse is using:
a. a patient classification system to determine safe staffing levels.
b. diagnostic-related groups for Medicare billing.
c. case management to coordinate care.
d. clinical pathways to determine care.
ANS: A
17. A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has
rooms 211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have
half the rooms, with one assigned to 200-215 and the second to 216-232. The care
delivery model used in this situation is:
a. team.
b. primary.
c. partnership.
d. modular.
ANS: D
18. A patient has decided to stop hemodialysis because his renal failure progresses and he
wishes to spend more time with family. Palliative care will continue, and the approach
will be discussed with the patient and family as needed and at change of shift. The care
delivery model in this situation is termed:
a. partnership.
b. patient-centered.
c. case management.
d. total patient care.
ANS: B
19. A nurse plans care knowing when specific recovery milestones are expected. The nurse is
providing care via:
a. patient classification systems.
b. clinical pathways.
c. functional nursing.
d. case management.
ANS: B
20. An orthopedic unit is considering different types of care delivery models and staff have
an opportunity to ask questions about how the models differ. The nurse manager provides
an overview and uses the above visual to demonstrate which model of care delivery?
a. Team
b. Partnership
c. Primary
d. Functional
ANS: D
MULTIPLE RESPONSE
1. While participating in a task force to proactively plan for nursing care delivery over the
next 20 years, a nurse learns that dramatic changes will occur as a result of: (select all
that apply.)
a. the increase in the number of minimally invasive procedures being performed for disease
treatment.
b. care provided for patients over an extended period in acute care settings.
c. the reduction in the number of nurses and other health care professionals who are available to
provide care.
d. the widespread illiteracy and decreased self-efficacy of the aging patient population.
e. the need to focus on social and environmental influences, educational level, and individual
characteristics and values of the patient.
f. the devaluing of nursing as a means of improving patient outcomes.
ANS: A, C, E
2. Which factors would be considered in the first steps in developing an effective patient
classification system? (Select all that apply)
a. Planned procedures
b. Ethnic diversity of patients
c. Clinical competency of staff
d. educational level of nurses
e. Age of patients
ANS: A, B, E
3. A nurse responsible for staffing a medical-surgical unit must consider: (select all that
apply)
a. the patient census.
b. physical layout of the unit.
c. complexity of care required.
d. educational level of all staff.
e. task preferences of the nurses.
ANS: A, B, C, D