Leadership Final (Chapter)

1. Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by 2020?
a. Positions that historically required registered nurses will be filled by unlicensed personnel.
b. The job growth rate for RNs will surpass job growth in all other occupations.
c. The need for hospital nurses will dramatically decrease.
d. Hospitals will finally achieve the required RN workforce.ANS: B
In 2020 the United States is projected to have only 64% of the registered nursing workforce required to meet the demand for RNs.
Unlicensed personnel will not be filling positions for nurses because this group does not have the education needed to provide such care.
The need for hospital nurses will dramatically increase, not decrease.
Hospitals will not have enough nurses as stated per statistics.

DIF: Knowledge REF: Page 28

2. What effect did the movie One Flew Over the Cuckoo’s Nest have on health care?
a. Funding for mental health care increased, allowing the point of care to change from the community to standardized institutional care.
b. The public and the nursing profession were made aware of the right of vulnerable populations.
c. Nurses were seen as advocates for individuals who cannot advocate for themselves.
d. Funding for nursing traineeships was eliminated.

ANS: B
One Flew Over the Cuckoo’s Nest reminded us that all individuals have rights and that it is the responsibility of the public and health care professionals to ensure that these rights are protected.
The context for the care of patients with mental disability did not change as a
One Flew Over the Cuckoo’s Nest portrayed nurses as the enforcers of the system.
Funding for nursing traineeships was not eliminated. Rather, the Nurse Training Act was established in 1964.

DIF: Comprehension REF: Page 30

3. Which nurse died after deliberately acquiring two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever during the Spanish-American War?
a. Florence Nightingale
b. Margaret Hoolihan
c. Clara Maas
d. Sairy Gamp

ANS: C
Clara Maas is noted as the nurse who deliberately acquired two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever.
Florence Nightingale is the founder of professional nursing.
Margaret Hoolihan is a character on a TV show, not an actual nurse.
Sairy Gamp is a character in a Charles Dickens novel.

DIF: Knowledge REF: Page 30

4. A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates caring by holding a soldier’s head is an artistic representation of nurses who served in which war?
a. World War I
b. World War II
c. Spanish-American War
d. Vietnam War

ANS: D
This statue represents the caring provided by nurses during the Vietnam War.
There is no statue that represents nursing during World War I.
There is no statue that represents nursing during World War II.
There is no statue that represents nursing during the Spanish-American War.

DIF: Knowledge REF: Page 31

5. What is the purpose of the Nurse Reinvestment Act of 2002?
a. Provides disability insurance to RNs who contract a life-threatening illness while on duty
b. Funds public service announcements that promote unlicensed caregivers as an alternative to professional nurses
c. Focuses on nurse retention and safety enhancement grants
d. Provides pediatric nursing training grants

ANS: C
This act funded $20 million to provide nursing scholarships, public service announcements promoting nursing as a career, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants.
This act does not provide disability insurance to RNs.
These funds do not promote unlicensed caregivers as an alternative to professional nurses.
This act provides for geriatric training grants, not pediatric training grants.

DIF: Knowledge REF: Page 28

6. Potential nursing students are concerned about choosing a profession with job security and ask, “Because more people are choosing nursing, will I have a job in a few years?” The nurse answers, on the basis of the U.S. Bureau of Labor Statistics prediction, that by 2020,
a. positions that have historically required RNs will be filled by foreign nurses.
b. the total number of RNs will not meet the demand for the workforce number required.
c. the need for hospital nurses will dramatically decrease.
d. hospitals will finally achieve the required RN workforce.

ANS: B
According to the U.S. Bureau of Labor Statistics, the nursing profession is predicted to have only 64% of the RN workforce required to meet demands.
The number of foreign nurses arriving in the United States is not sufficient to cure the shortage, and a large number of these nurses are unsuccessful on the NCLEX-RN®, resulting in an inability of foreign RNs to practice.
More than half of all nurses practice in hospitals, and it has not been indicated that this will change.
Even by 2020, it is projected that the United States will achieve only 64% of the needed nursing workforce.

DIF: Comprehension REF: Page 28

7. Charles Dickens’ character Sairy Gamp:
a. portrayed nurses as trained professional individuals who put others before themselves.
b. chose nursing because she had no other avenue for employment.
c. was a prostitute who took advantage of sick old men.
d. characterized nurses as being at the forefront of technology and autonomy.

ANS: B
Sairy Gamp endured nursing because of the lack of other opportunities.
Sairy Gamp did not portray a professional image of nursing, but that of an untrained caregiver who profited from the sick and dying.
Sairy Gamp was a nurse who used her position to take advantage of her patients. Dicken’s portrayal of a nurse does not suggest that the nurse is at the forefront of technology and autonomy.

DIF: Knowledge REF: Page 29

8. What does the Spirit of Nursing statue honor?
a. Florence Nightingale’s accomplishments in public health
b. Edith Cavell’s attempt to help the victims of the Tuskegee experiment seek treatment
c. Clara Maas, who found the cure for yellow fever during WWII
d. All military nurses for their bravery and compassion

ANS: D
The statue the Spirit of Nursing was created to honor all military nurses.
The statue does not seek to honor Florence Nightingale.
Nurse Rivers was the nurse who attempted to help the victims of the Tuskegee experiment.
The statue does not honor Clara Maas, and Clara Maas did not find the cure for yellow fever.

DIF: Knowledge REF: Page 29

9. Although the media portrayed nursing in a negative light in M*A*S*H through the character of a promiscuous, uncaring nurse, it also provided Americans with a promising glimpse of:
a. nurses who can be promiscuous and still help doctors.
b. the fact that caring is not as important as the desire to serve one’s country.
c. the ability of nurses to cope with the dreadfulness of war by using humor.
d. the contributions of male military nurses.

ANS: C
The sitcom M*A*S*H did show humor as a coping mechanism for nurses in a war setting.
M*A*S*H’s portrayal of promiscuous nurses has no merit because nurses assist physicians.
The sitcom addressed both factors as part of the nurse’s role in the military.
D: No male nurses were portrayed in the sitcom.

DIF: Knowledge REF: Page 30

10. With the crisis in health care and the nursing shortage, why is the image of nursing still important?
a. Nursing care is often delivered during a time of uncertainty, and the image of nurses during this time can reinforce trust in the nurse-patient relationship.
b. Physicians have a distinctive body of knowledge that identifies them as professionals, whereas nursing has yet to develop a unique body of knowledge on which to base practice.
c. Nurses must present a unified image if they hope to ever move nursing to a profession.
d. The dynamic state of today’s health care requires nurses to move from a caring image to one of technologic competence.

ANS: A
A person who seeks health care is entering a world of uncertainty. The nurse provides continuity and compassion and stabilizes the environment of the patient.
Nursing has a unique body of knowledge.
Nursing is a profession. Unification will enhance the professional goals for nursing.
Caring will always be part of the nursing image and nurses have already moved into the technologic realm.

DIF: Comprehension REF: Pages 29-30

11. Nurses can combat the nursing shortage by:
a. joining unions, which influence employers to provide incentives such as pay raises and free child care, thus encouraging the large percentage of nonworking nurses to return to the workforce.
b. demanding that the requirements of the qualifying examination for foreign nurses should be reduced, so they are eligible to sit for the licensure examination.
c. working more hours with a higher nurse/patient ratio.
d. advocating for funds to pay for nursing education and a safer work environment.

ANS: D
Advocating for funds to pay for nursing education and a safer work environment is a positive strategy as can be seen by results attained after the Reinvestment Act P.L. 107-205 provided $20 million for nursing scholarships, public service announcements, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This is the best defense against the nursing shortage. Nursing graduates in many states have increased in number, and enrollment in nursing schools is also on the rise.
Unions are not the answer to the nursing shortage. This approach would make access to health care more difficult, and the nursing shortage would only increase because efforts to attract nurses from younger generations would be reduced by the fact that funding for exposure to nursing would most likely decrease.
Lowering standards would increase the chance for errors, cause patient care standards to become lower, and harm the image of nursing.
As the acuity level of patients increases, the nurse/patient ratio should be lowered. Facts reveal that lower nurse/patient ratios reduce errors and decrease mortality rates.

DIF: Application REF: Page 30

12. Today’s demographics of the RN population indicate that:
a. nurses entering the workforce do so within 2 years of completing high school.
b. more white nurses enter and obtain graduate degrees than any other ethnic group.
c. the highest level of nursing education for most RNs is an associate degree.
d. the majority of nurses practice in hospitals.

ANS: D
56% of nurses practice in hospitals.
The youngest professionals, those with a BSN, enter at age 26.
More African-Americans are entering graduate school.
The highest level of nursing education is the baccalaureate degree.

DIF: Comprehension REF: Page 34

13. The 2008 Gallop Poll ranked the four most ethical professionals in the following descending order:
a. Firemen
b. High school teachers
c. Physicians
d. Nurses
e. Pharmacists

a. A, B, C, D
b. A, D, B, E
c. E, D, C, B
d. D, E, B, C

ANS: D
Only in 2001 did firemen rank higher than the other four professions. In the 2008 Gallop Poll nurses ranked first (84%); second, pharmacists (70%); third, high school teachers (65%); and fourth were physicians (64%).

DIF: Comprehension REF: Page 33

MULTIPLE RESPONSE

1. According to current data related to the nursing shortage: (Select all that apply.)
a. salaries of nurses are competitive with those of other professionals such as teachers.
b. only 10.6% of nurses are minorities.
c. overall, nurses are satisfied with their jobs but leave the profession because of fear of contracting fatal diseases.
d. over the next decade, more than half of RNs in the United States will retire.
e. staff nurses are returning to school to obtain certificates to teach nursing.

ANS: B, D
Only 10% of nurses are minorities.
Nurses are older, with a mean age of 46.8 years.
Salaries are not a problem related to the nursing shortage. Most facilities are willing to increase salaries and benefits for nurses.
It has not been documented that nurses are afraid of contracting a fatal disease. Nurses take precautions to reduce this risk.
There is a shortage of nursing faculty, and graduate education is required rather than certificates to teach nursing.

DIF: Knowledge REF: Page 34

2. A group of new graduate nurses is asked to speak to a group of politicians to describe the current state of professional nursing and how best to alleviate the nursing shortage. Which statements accurately portray professional nursing today and tomorrow? (Select all that apply.)
a. More RNs are educated to attain an associate degree than a baccalaureate degree or diploma.
b. Because of the push to shorten length of stay in hospitals, more RNs practice in outpatient settings and home health than in acute care settings.
c. The most popular advanced practice specialty is nurse anesthesia.
d. White nurses are more likely to enter graduate school than nurses from other ethnic groups.
e. Nursing represents the second largest health care professional group, second only to medical doctors.
f. Job satisfaction is high among nurses, despite long hours, high nurse/patient ratios, and lower pay than is often earned by individuals with less education.
g. Even with the popularity of nursing as a career, the nation faces a severe deficit of RNs now and even more so in the future.

ANS: F, G
A recent job satisfaction survey found that 78% of RNs were happy with their jobs. Increasing awareness of nursing as a profession has enhanced enrollment in nursing schools and has promoted interest among high school students
Recipients of BSN degrees are younger and represent the largest graduating educational profile.
More than half of all nurses practice in acute care hospitals.
Nurse practitioners constitute the majority of advanced practice nurses (APRNs).
Minority nurses are more likely to enter graduate school than white nurses.
Nurses make up the largest group of health care professionals.

DIF: Comprehension REF: Pages 28, 34

3. Which actions would result in a greater number of nurses entering and staying in practice, given today’s state of nursing? (Select all that apply.)
a. Determine why few African-American women enter graduate school.
b. Provide incentives for minorities and men to enter nursing.
c. Obtain grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs.
d. Survey nurses to determine why their job satisfaction is lower than that of other health care professions.
e. Develop ad campaigns that target younger students.

ANS: B, C, E
Providing incentives for minorities and men to enter nursing speaks to the core of solutions to the nursing shortage.
Obtaining grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs speaks to the core of solutions to the nursing shortage.
Developing ad campaigns that target younger students speaks to the core of solutions to the nursing shortage.
Determining why few African-American women enter graduate school would not result in a greater number of nurses entering and staying in practice.
Job satisfaction among nurses is currently high.

DIF: Comprehension REF: Pages 28, 33, 34

4. The Nurses of America’s media campaign raised awareness of which aspects of nursing? (Select all that apply.)
a. Nurses are expert clinicians.
b. A higher nurse/patient ratio is needed.
c. Nurses are invisible in the news media.
d. Nurses are caring.
e. Nurses are well paid.

ANS: A, C
The campaign was designed to convey to the public that nurses are expert clinicians.
A strategically important part of the campaign raised consciousness among nurses of the invisibility of nursing in the news media.
Lower nurse/patient ratios are needed.
It was not a focus of the campaign to let the public know that nurses are caring.
The campaign did not focus on the financial aspects of being a nurse.

DIF: Comprehension REF: Page 32

Cherry: Contemporary Nursing, 5th Edition

Chapter 01: The Evolution of Professional Nursing

Test Bank

MULTIPLE CHOICE

1. Clara Barton is known for:
a. becoming the first African-American public health nurse.
b. establishing the Henry Street Settlement.
c. founding the American Red Cross.
d. publicizing the inadequacies of hospital-based nursing schools.

ANS: C
The American Red Cross, founded by Clara Barton in 1882, assisted in efforts to continue public health nursing.
Jessie Sleet Scales was the first African-American public health nurse.
Lillian Wald, a pioneer in public health nursing, is best known for the development and establishment of the Henry Street Settlement.
The Goldmark Report criticized the inadequacies of hospital-based nursing schools and recommended enhanced educational standards.

DIF: Knowledge REF: Page 13

2. Which bill provided for construction of hospitals?
a. Social Security Act
b. Hill-Burton Act
c. Sheppard-Towner Act
d. U.S. Civil Service Act

ANS: B
The purpose of the Hill-Burton Act was to provide funding to construct hospitals and to assist states in planning for other health care facilities in accordance with the needs of communities.
The main purposes of the 1935 Social Security Act were to provide (1) a national insurance system for older adults; (2) monies to states for maternal and child welfare services; (3) vocational rehabilitation services for the physically and mentally challenged; (4) medical care for crippled children and blind people; (5) a plan to boost public health services; and (6) a federal/state unemployment system.
The Sheppard-Towner Act provided federal aid for maternal and child health care.
The U.S. Civil Service Act is landmark U.S. legislation establishing the tradition and mechanism of permanent federal employment based on merit rather than on political party affiliation (the spoils system).

DIF: Knowledge REF: Page 14

3. The practice of public health nursing and the Henry Street Settlement are credited to:
a. Mary Breckenridge.
b. Mary Seacole.
c. Clara Barton.
d. Lillian Wald.

ANS: D
Lillian Wald, a pioneer in public health nursing, is best known for the development and establishment of the Henry Street Settlement.
Mary Breckenridge of Kentucky established the Frontier Nursing Service in 1925.
Mary Seacole was an African-American nurse who provided care during the Crimean War.
Clara Barton founded the American Red Cross in 1882.

DIF: Knowledge REF: Page 13

4. Occupational health nursing features beliefs similar to those of which early nursing pioneer?
a. Lillian Wald
b. Florence Nightingale
c. Clara Barton
d. Mary Seacole

ANS: A
Lillian Wald developed the first nursing service for occupational health.
Florence Nightingale is best known for contributions made during the Crimean War, efforts to improve sanitation and public health, use of statistics to provide support for health outcomes, and organization of nurse training.
Clara Barton founded the American Red Cross.
Mary Seacole was an African-American nurse who served during the Crimean War.

DIF: Comprehension REF: Page 12

5. What historical event first led to the realization of the contribution of African-Americans to nursing?
a. Florence Nightingale’s acceptance of African-American nurses into the first nursing school
b. The contributions of African-American nurses at the Pennsylvania Hospital, the first hospital in America
c. Mary Seacole’s efforts to care for soldiers during the Crimean War
d. The wives of wealthy African-American nobles who carried food and medicine from house to house during the Middle Ages

ANS: C
Although Nightingale’s school refused Seacole, she was able to make a difference in the Crimean War and later was recognized for her efforts.
Florence Nightingale’s efforts during the Crimean War were valuable and recognized, but she would not allow Seacole to join her in her efforts.
Pennsylvania Hospital was the first hospital in America and was founded in 1751; Seacole’s efforts in the Crimean War did not occur until 100 years later.
The wives of noblemen who carried food and medicine were not uniquely African-Americans.

DIF: Application REF: Page 10

6. World War I contributed to the advancement of health care by:
a. increasing the number of private care hospitals and decreasing the role of public health services.
b. employing a large number of civilians to provide care to returning soldiers through the Red Cross.
c. introducing specialists in nursing such as nurse anesthetists.
d. increasing the number of community health nurses.

ANS: C
World War I offered nurses a chance to enter into new fields of specialization, as is seen in the example of nurse anesthetists who became part of surgical teams at the front lines.
Advancements in public health were being made and the primary site for medical care was moved from the home to the hospital.
The Red Cross provided care to communities in which access was limited and eventually moved to urban areas.
Many nurses were needed in the war effort, which caused the growth in community health nursing to halt.

DIF: Application REF: Page 13

7. The primary purpose of the Social Security Act of 1935 was to:
a. increase research that focused on minority groups.
b. provide medical care for chemically impaired persons.
c. ensure health care for older adults through a national insurance system.
d. decrease the public’s financial burden by limiting services offered by local health departments.

ANS: C
The Social Security Act of 1935 set the precedent for the passage of the Medicare and Medicaid acts that followed in 1965 to provide health insurance for older adults, but it also provided maternal and child welfare services, along with rehabilitation for the mentally and physically challenged, medical care for blind individuals and crippled children, and unemployment benefits.
Increasing research for minorities was not one of the purposes of the Social Security Act of 1935.
The care of persons with substance abuse problems was not one of the first purposes addressed by the Social Security Act.
The Social Security Act provided a means by which women and children could receive care, thus increasing the numbers of public health nurses and services offered.

DIF: Comprehension REF: Page 15

8. A client asks the nurse, “Can you explain Medicare, an amendment to the Social Security Act?” The nurse responds that Medicare:
a. led to many hospital closings, along with a decrease in acute care hospital-based nursing care.
b. provided medical insurance to those younger adults or children who were not eligible for private insurance because of catastrophic illnesses such as cancer.
c. provided preventive care for women, infants, and children.
d. ensured that individuals ages 65 and older and those with end-stage renal disease or permanent disabilities had health care insurance.

ANS: D
The Medicare program provides hospital insurance, Part A, and medical insurance, Part B, to all people ages 65 and older who are eligible to receive Social Security benefits; people with total, permanent disabilities; and people with end-stage renal disease.
Medicare provides insurance for many who previously have not sought health care, resulting in an increase, not a decrease, in hospital care.
Medical insurance for young adults and children who were not eligible for private insurance is part of Medicaid.
Medicaid was the medical insurance for those families, primarily women and children, with an income at or below the federal poverty level.

DIF: Comprehension REF: Page 18

9. A comparison of nursing in the 1980s versus nursing in the 1990s reveals that:
a. the 1990s influenced nursing in that a reduction occurred in preventable diseases caused by unsafe/unhealthy lifestyles.
b. tuberculosis was the primary concern for nursing in the 1980s, whereas the AIDS epidemic emerged and was its focus during the 1990s.
c. a decrease in ambulatory services in the 1980s prompted an increase in public health nurses in the 1990s.
d. the demand for advanced practice nurses increased in the 1980s and the 1990s as a result of the economy and concern about the health of the nation.

ANS: D
The numbers of advanced nurse practitioners increased as evidence of their cost-effectiveness as providers of primary and preventive health care became established.
In the 1990s, many diseases associated with preventable causes led to mortality in the United States.
The AIDS epidemic appeared in the 1980s and tuberculosis became more of a concern in the 1990s.
The 1980s saw an increase in technology that allowed more outpatient procedures, increased use of ambulatory services, and increased demand for community health nurses in the 1990s.

DIF: Application REF: Page 22

10. Which statement accurately describes the historical perspective of nursing practice?
a. Nursing has existed to meet the needs of populations, individuals, and aggregates by providing care that is influenced by the needs and beliefs of society in different historical contexts.
b. When men became interested in nursing, this provided the impetus to change nursing into a respected profession based on scientific fact rather than superstition.
c. Nursing has historically accepted individuals from all social and ethnic backgrounds.
d. The United States has led the way throughout history to advance nursing and health care by providing the first hospital and medical school.

ANS: A
Nursing has existed since biblical times to address needs ranging from contagious diseases in early times to health prevention in the present time, with care based on health beliefs of the time.
In the beginning, men were recognized as health healers, but women changed nursing from a mystical phenomenon to a respected profession.
Nursing has had periods when criminals and prostitutes practiced and discrimination was evidenced by Nightingale’s refusal of Seacole.
The first hospital and the first medical school in North America were founded in Mexico—the Hospital of the Immaculate Conception in Mexico City and the University of Mexico Medical School.

DIF: Application REF: Pages 3-24

11. Although the use of herbs has become a popular alternative to prescription drugs in today’s health care milieu, during which other historical periods did health practices focus on the use of herbs?
a. Prehistoric times and the Middle Ages
b. Civil War period and World War I
c. Renaissance and Reformation periods and the Colonial American period
d. Crimean War and Civil War periods

ANS: A
During prehistoric times, tribes used herbs to rid themselves of the curse of disease, and in the Middle Ages, women used herbs.
During the Civil War, health care was similar to that provided in Colonial times, when epidemics were rampant, and World War I saw an increase in the advancement of nursing specialties and public health nursing.
During the Renaissance and Reformation periods, major advancements were made in pharmacology, chemistry, and medical knowledge, including anatomy, physiology, and surgery, and the Colonial American period focused on transmissible diseases.
The Crimean War era found nursing care that was focused on sanitation and environmental improvements, and with the Civil War, the nursing focus reverted to communicable diseases.

DIF: Application REF: Page 3

12. A care provider sacrifices an animal and waves an herb-filled sack over a client who is complaining of painful joints and chest pain with exertion. This ritual represents health care during:
a. the prehistoric period.
b. early civilization in Egypt.
c. the Renaissance.
d. the Middle Ages.

ANS: A
During prehistoric times, illness was thought to be caused by evil spirits that providers attempted to scare away through rituals and dances.
The Egyptians were very advanced at an early time in the use of suturing and preventive measures such as public health.
Although major advancements were made during the Renaissance in pharmacology, chemistry, and medical knowledge, this was the dark period for nursing because those who entered the profession were most often unsavory.
During the Middle Ages, health care providers who were women used herbs; however, men used purging and surgeries that were performed by unskilled individuals.

DIF: Application REF: Page 3

13. A prospective nursing student who researches universities that offer a baccalaureate degree in nursing would want to ensure that the program is accredited by the:
a. American Nurses Association.
b. Commission on Collegiate Nursing Education.
c. National Institutes of Health.
d. National Nursing Council.

ANS: B
The Commission on Collegiate Nursing Education (CCNE) is the agency that exclusively accredits baccalaureate and graduate-degree nursing programs.
The American Nurses Association focuses on professional issues but not accreditation.
The National Institutes of Health support medical research.
The National Nursing Council was a committee of six national nursing organizations whose purpose was to expand nursing education.

DIF: Comprehension REF: Page 5

14. Nursing in the 1990s was characterized by:
a. men leaving nursing to enter the armed services.
b. traditional 8-hour shifts to reduce fragmentation of care.
c. a focus on preventable diseases.
d. a decrease in nursing research.

ANS: B
Nurses wanted creative shifts with shift differential and the ability to work a second job.
Although men remained a minority in nursing, the reason was not due to war.
Health promotion and disease prevention were recognized as the means to reduce disparity and the high number of mortalities associated with diseases that were preventable.
Nursing research moved into the National Institutes of Health, leading to interprofessional collaboration and growth in nursing research.

DIF: Comprehension REF: Page 22

MULTIPLE RESPONSE

1. The clinical nurse leader (CNL): (Select all that apply.)
a. requires certification as an advanced practice nurse.
b. provides care at the bedside while collaborating with other members of the health care team.
c. focuses on clinical practice rather than fulfilling the role of administrator or educator.
d. is an advanced practice nurse whose practice is limited to the acute care setting.
e. has a clinically focused doctoral degree in nursing, which provides prescriptive authority.

ANS: B, C
The CNL manages care at the bedside or point of care through an interdisciplinary approach.
The CNL is a provider of care and does not assume the role of manager.
The CNL is not an advanced practice nurse but rather a generalist.
The CNL is a generalist and is not an advanced practice nurse.
The CNL is educated at the master’s level and does not have prescriptive authority.

DIF: Comprehension REF: Page 2

COMPLETION

1. Which group in early civilization is credited with developing a pharmacopoeia to classify more than 700 drugs used in caring for the sick? ____________________

ANS:
Egyptians
A pharmacopoeia that classified more than 700 drugs was written by the Egyptians to assist in the care and management of disease.

DIF: Knowledge REF: Page 6

OTHER

1. Place the role of nurses in chronological order occurring from the Civil War to World War II.
A. Nurses who served during war were given rank as officers.
B. No nurses were formally trained.
C. Public health nursing and occupational nursing were begun.
D. The nurse anesthetist was introduced.

ANS:
B, C, D, A
It was not until 1860 that Nightingale established the first nursing school in England. Nurses were not formally trained until Nightingale’s time.
During the 1900s, prior to World War I, Lillian Wald instituted public health nursing and occupational nursing.
In 1914, with the beginning of World War I, the nurse anesthetist joined the surgical team.
Nurses were seen as a valuable part of the military and attained the ranks of officers in the Army and the Navy for their participation in World War II.

DIF: Application REF: Pages 9-13

Cherry: Contemporary Nursing, 5th Edition

Chapter 06: Nursing Research and Evidence-Based Practice

Test Bank

MULTIPLE CHOICE

1. Institutional review boards determine whether research studies involving human subjects will:
a. be published.
b. add to the body of nursing knowledge.
c. cause harm.
d. receive funding.

ANS: C
The institutional review board (also called the human subjects committee) examines research proposals to ensure that the ethical rights of those individuals participating in the research study are protected. This board makes sure that persons who participate in research are assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is protected.
Research publication is not controlled by institutional review boards.
Institutional review boards do not review the merit or significance of research to nursing knowledge.
Institutional review boards do not award grants or allocate funds.

DIF: Knowledge REF: Page 118

2. A nurse is interested in understanding the meaning of the human experience of surviving polio. Subject recruitment targets persons who have been diagnosed with the disease. The researcher reflects on the data and identifies common themes in order to understand the “lived experience.” These characteristics are consistent with the qualitative research method known as:
a. grounded theory.
b. ethnography.
c. phenomenology.
d. case study.

ANS: C
Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants.
Grounded theory is a qualitative research design that is used to collect and analyze data with the aim of developing theories grounded in real-world observations. This method is used to study a social process.
Ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection, description, and analysis of data to develop a theory of cultural behavior.
Case study is a method of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or other social unit.

DIF: Application REF: Page 109

3. The use of research to guide nursing practice is called:
a. utilization.
b. dissemination.
c. generalizability.
d. analysis.

ANS: A
Utilization of research guides nursing practice. Clinical agencies need to make a commitment to implementing research findings and then developing policies and procedures to guide the implementation process.
Dissemination is defined as the spreading of information, generally through published reports or by word of mouth.
Generalizability is when findings can be generalized from the sample to the entire population.
Analysis is the second step or phase of the nursing process.

DIF: Comprehension REF: Pages 110-111

4. A public health nurse is interested in determining which educational programs are needed in the aggregates served. The researcher personally interviews individuals who are walking on the streets in the community. This type of research design is:
a. quasi-experimental.
b. survey.
c. case study.
d. ethnography.

ANS: B
Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants.
Quasi-experimental research design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design.
Case study designs are used to present an in-depth analysis of a single subject, group, institution, or other social unit. The purpose is to gain insight and provide background information for more controlled, broader studies.
Ethnography is a qualitative research method that is used for the purpose of investigating cultures; it involves data collection and description and analysis of data for the purpose of developing a theory of cultural behavior.

DIF: Analysis REF: Page 108

5. Which organization provides federal funding for research?
a. National Institute of Nursing Research
b. Robert Wood Johnson Foundation
c. W.K. Kellogg Foundation
d. Sigma Theta Tau International

ANS: A
The National Institute of Nursing Research is a federal agency that provides federal funding for health care research.
Robert Wood Johnson is a private foundation.
W.K. Kellogg Foundation is also a private foundation.
Sigma Theta Tau International is a nursing organization.

DIF: Knowledge REF: Page 105

6. Which type of data analysis results in the non-numerical organization of data?
a. Descriptive
b. Inferential
c. Qualitative
d. Quantitative

ANS: C
Qualitative data analysis results in the organization of words or phrases, not numbers. Interviews are reviewed and are transcribed line by line in an effort to group common conceptual meanings.
Descriptive statistics consists of numerical data.
Inferential statistics consists of numerical data.
Quantitative research is a formal, objective, systematic process in which numerical data are used.

DIF: Comprehension REF: Page 108

7. A nurse researcher who is seeking funding for a study should identify:
a. board members of funding agencies.
b. priorities of funding agencies.
c. budgets of funding agencies.
d. accreditation of funding agencies.

ANS: B
The priorities of funding agencies indicate their preferences for funding; these are more likely to be funded than are studies that are not aligned with funding preferences.
Identifying the board members of funding agencies would give you information about the agencies, but would not be helpful in the preparation of a study proposal.
Learning the budgets of funding agencies would provide descriptive information about the agencies but would not be helpful in the preparation of a study proposal.
Identifying the accreditation of funding agencies would give you descriptive information about the agencies but would not be helpful in the preparation of a study proposal.

DIF: Application REF: Page 105

8. A nurse studied a community to determine if there were clients who would benefit from a hospice program if one were developed. This type of research is:
a. a survey
b. quasi-experimental.
c. a needs assessment method.
d. a pilot study.

ANS: C
A needs assessment method is a study in which the researcher collects data for the purpose of estimating the needs of a group; commonly used to prioritize the needs of an organization or community.
A survey is a research design that is used to collect demographic information, social characteristics, behavioral patterns, and other information.
Quasi-experimental research is a type of quantitative research that lacks one of the components of an experimental design.
A pilot study is a smaller version of a proposed study conducted to develop or refine methodology, such as treatment, instruments, or a data collection process, to be used in a larger study.

DIF: Analysis REF: Page 109

9. The research hypothesis is that aromatherapy reduces stress more effectively than does acupuncture. The researcher does not identify a control group. This study would be a _________ design.
a. experimental
b. quasi-experimental
c. survey
d. meta-analysis

ANS: B
In quasi-experimental studies a control group, randomization, or the manipulation of one or more variables is missing.
An experimental design must have a control group.
The purpose of a survey design is to collect information, not to compare groups.
A meta-analysis is a process whereby multiple research studies are reviewed.

DIF: Application REF: Page 109

10. A qualitative researcher reviews data collected with a grief support group to develop a theory of how widows and widowers mourn. The researcher is using which qualitative research design?
a. Phenomenology
b. Grounded theory
c. Case study
d. Hypothesis generation

ANS: B
Grounded theory is a qualitative research approach that describes a social process and has theory generation as its main purpose.
Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants.
Case study design is a type of quantitative research that is used to present an in-depth analysis of a single subject, group, institution, or social unit.
Hypothesis generation is the first step in the basic research process.

DIF: Analysis REF: Page 109

11. Which statement about qualitative research is correct?
a. Qualitative research requires less time than quantitative research because complex statistical analysis is not necessary.
b. To be statistically significant, qualitative studies must consist of large, randomly selected sample sizes.
c. Because qualitative studies deal with human concepts such as suffering and quality of life, results can be generalized.
d. Interviews are the primary means of collecting data that enable the researcher to describe unclear phenomena.

ANS: D
Qualitative research involves ambiguous concepts. Analysis of interviews with participants who are experiencing the phenomena enables the researcher to describe unclear phenomena.
Qualitative research is time consuming and costly. One-on-one interviewing takes time, and the interviews must be recorded, typed, transcribed, and analyzed.
Qualitative studies use small sample sizes that are not randomly selected.
The small sample sizes used in qualitative research do not allow results to be generalizable to the whole population.

DIF: Analysis REF: Page 108

12. A nurse interested in life satisfaction among patients receiving hemodialysis reviews databases and identifies relevant studies which are then statistically analyzed providing generalization through multiple studies. The nurse researcher is using which type of research?
a. Quasi-experimental
b. Secondary analysis
c. Meta-analysis
d. Survey

ANS: C
Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization.
The quasi-experimental method is research involving one study.
Secondary analysis is the use of data from a previous study in which new questions are asked.
A survey collects data from populations and is a single study.

DIF: Analysis REF: Page 109

MULTIPLE RESPONSE

1. The informed consent must include: (Select all that apply.)
a. potential risks and benefits to participants in the study.
b. medical terminology rather than lay terms to prevent misunderstanding of the study.
c. a statement on how the anonymity and confidentiality of participants are protected.
d. the cost of the study.
e. details on how to contact the investigator.

ANS: A, C, E
Informed consent explains the study to the participants and assures them of their rights, including their right to refuse to participate or to withdraw from the study. The informed consent must include protection of anonymity and confidentiality, voluntary participation, compensation, and alternative treatment, along with specific information on how to contact the investigator.
The informed consent must include specific information on how to contact the investigator.
Informed consent is always written in lay terminology so that participants can clearly understand.
The actual cost of the study is not included on the informed consent form.

DIF: Comprehension REF: Page 118

2. A researcher is interested in quality of life and after an extensive literature review quantitatively integrates data from identified studies and describes the findings. This researcher is using which approach? (Select all that apply.)
a. Survey
b. Triangulation
c. Meta-analysis
d. State of the science summary
e. Quasi-experimental design

ANS: C, D
Meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. State of the science summary is a merging of findings from several studies that explored the same topic
Meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. State of the science summary is a merging of findings from several studies that explored the same topic.
Survey research design is used to obtain information regarding the prevalence, distribution, and interrelationships of variables within a population.
Triangulation is defined as the use of a variety of methods to collect data on the same concept.
Quasi-experimental design is a type of quantitative research that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design.

DIF: Analysis REF: Page 109

3. A researcher seeks funding from an agency that limits studies to quantitative research. The researcher can select from which study designs? (Select all that apply.)
a. Survey
b. Grounded theory
c. Phenomenology
d. Needs assessment
e. Experimental

ANS: A, D, E
Surveys collect demographics, social characteristics, behavioral patterns, and information bases.
Needs assessments are used to determine what is most beneficial to a aggregates.
The experimental method establishes cause-and effect relationships while also testing relationships
Grounded theory explores and describes a social process such as adjusting to a chronic illness.
Phenomenology describes the “lived experience” of abstract experiences.

DIF: Analysis REF: Pages 108-109

COMPLETION

1. Development and validation of the body of knowledge and foundation on which practice is based is ____________________.

ANS:
research
Research refines and enhances new and existing knowledge and provides accountability for nursing practice.

DIF: Knowledge REF: Page 103

Cherry: Contemporary Nursing, 5th Edition

Chapter 12: Workforce Advocacy and the Nursing Shortage

Test Bank

MULTIPLE CHOICE

1. When an RN is asked to accept an assignment that he or she may not be qualified to perform, the nurse should:
a. accept the assignment as appropriate if assigned by a legitimate power.
b. be primarily concerned with the number of patients being assigned.
c. ask how other nurses have handled the assignment in the past.
d. determine whether he or she is familiar with the types of patients being assigned.

ANS: D
Nurses should always think critically about assignments so they can communicate what makes them uncomfortable about a particular assignment. If nurses do not have the knowledge or experience required for particular patient assignments, then modification of the assignments is in order to ensure patient safety.
Even if the person who makes the assignment has legitimate power, he or she may not be aware of the nurse’s work experience and training.
The nurse should not respond on the basis of the actual number of patients assigned but should consider the needs of each patient, his or her age and condition, other factors that contribute to special needs, and the resources available to meet those needs.
Each nurse possesses individual expertise. Basing decisions on the actions and capabilities of others is incorrect and is potentially unsafe for the patient.

DIF: Application REF: Page 267; Box 12-8, page 269

2. One workplace issue—the nursing shortage—is caused by several complex issues, including:
a. movement of nurses into acute care settings.
b. the use of unlicensed assistive personnel to replace RNs.
c. a mass of baby-boomers who have chosen nursing as a career.
d. an aging nursing workforce.

ANS: D
Research validates that an aging population and an aging nursing workforce are significant contributors to the nursing shortage issue.
Movement of nurses into acute care settings would actually be beneficial in terms of the nursing shortage. As patient care technology increases, the number of nurses needed in acute care settings is increasing.
Unlicensed assistive personnel cannot be used to replace RNs, although they can be placed in positions that allow them to assist RNs in providing patient care.
There has not been a mass of baby-boomers who have chosen nursing as a career.

DIF: Comprehension REF: Page 262

3. Studies conducted to determine why enrollment in nursing schools has declined found:
a. that a greater number of individuals chose nursing as a career but could not meet entrance requirements.
b. fewer young individuals are available to enter the workforce.
c. fewer career opportunities exist for women outside of nursing.
d. men have dominated the profession, and women feel that they have experienced discrimination.

ANS: B
Younger birth cohorts (those born after 1955) are smaller in population size resulting in fewer potential nursing profession candidates.
Many qualified nursing candidates are turned away because of limited enrollment in nursing schools. The shortage of nursing school faculty limits the number of applicants that can be accepted for admission.
Job opportunities are actually more numerous than ever for women.
Men remain a minority in the nursing profession.

DIF: Analysis REF: Page 259

4. Along with the shortage of enrollment reported in nursing schools is a shortage of faculty, which is attributed to several factors, including:
a. the burden of research leads to burnout.
b. that faculty choose employment where work hours are more flexible.
c. increased enrollment in doctoral programs but only in the areas of research and clinical practice, not in the specialty of education.
d. increasing job competition from higher-paying clinical sites.

ANS: D
Academic institutions, especially those faced with budget cuts, generally cannot compete with nonacademic employers. Faculty salaries continue to be a major contributor to the nursing shortage.
Faculty salaries are not substantial, and research is not a job requirement in many nursing faculty positions.
The educational setting is so desperate for nursing faculty that scheduling flexibility usually is not an issue. Most nursing faculty members actually have greater flexibility with regard to weekend and holiday scheduling than do clinical nurses.
Enrollment in doctoral programs has not increased in any specialty area because of the faculty shortage.

DIF: Comprehension REF: Page 260

5. The key to organizational success for health care facilities is:
a. hiring younger, more energetic nurses.
b. offering incentives such as sign-on bonuses.
c. hiring highly qualified advanced practice nurses.
d. retaining professional nurses.

ANS: D
Past nursing shortages have proved that retention of professional nurses is the key to any organization’s success. Nurses want to work in an environment that supports decision making and effective nurse-physician relationships. The ability of an organization to retain nurses primarily depends on the creation of an environment that is conducive to professional autonomy.
Younger nurses want flexible hours and considerable autonomy in the work environment. These options are limited in the current health care environment, where round-the-clock patient care, including on weekends and holidays, is mandatory.
Offering sign-on bonuses actually results in considerable expenditure by the health care organization. Many believe that these recruitment-related costs could be better spent by increasing basic compensation levels of professional nurses.
Hiring highly qualified advanced practice nurses does help to improve patient outcomes but does not provide the staffing needed for direct patient care.

DIF: Application REF: Pages 260-261

6. Magnet hospitals are those work environments that:
a. attract physicians but repel nurses.
b. lack appreciation for nursing certification.
c. not only attract but also retain professional nurses.
d. discourage nurses from advancing their current level of education.

ANS: C
Magnet hospitals are those that have been identified as both attracting and retaining professional nurses. A study conducted in 1983 identified workplace factors such as management style, nursing autonomy, quality of leadership, organizational structure, professional practice, career development, and quality of patient care as influencing nurse job satisfaction and turnover rates (i.e., higher retention).
Magnet hospital nurses have higher levels of autonomy, greater control over the practice setting, and better relationships with physicians. Magnet hospitals actually attract both physicians and nurses.
Magnet hospitals actually recruit and reward professional nurses with specialty certification.
Magnet hospitals have programs that support nurses in advancing their education.

DIF: Comprehension REF: Page 261

7. Which situation would be considered a workforce advocacy issue that is reportable to the state nurses association or the Center for American Nurses if it is not resolved at the local level?
a. Nurses prefer to wear navy blue scrubs but the institution requires burgundy scrubs, which interferes with autonomy.
b. The cafeteria often serves fried vegetables rather than healthier baked vegetables, causing the potential for hyperlipidemia.
c. The hospital pharmacy does not fill employee prescriptions upon receiving them; instead, they fill employee prescriptions after all inpatient prescriptions have been filled.
d. The key needed to change the sharps container is locked in the supervisor’s office after 3 PM on weekdays and all day on weekends, which prevents changing of the container when needed and places nurses at risk for needlesticks.

ANS: D
A safe work environment is imperative for the safety of both nurses and patients. Correcting this work environment issue promotes job satisfaction and patient outcomes.
Dress codes do not affect nurse safety or patient outcomes; therefore advocacy intervention is not appropriate.
Food choices in the cafeteria do not affect nurse safety or patient outcomes; therefore, advocacy intervention is not appropriate.
Waiting to fill employee prescriptions until after inpatient prescriptions have been filled does not affect nurse safety or patient outcomes; therefore, advocacy intervention is not appropriate.

DIF: Analysis REF: Pages 255, 275

8. A newly hired nurse is asked to serve on a committee formed to recruit and retain nurses. At the committee meeting, the nurse learns that:
a. older nurses are being encouraged to retire, so that younger, more efficient nurses can practice.
b. Magnet hospitals are able to attract nurses with sign-on bonuses and flexible work hours but fail to retain nurses because insufficient autonomy over professional practice is provided.
c. multitasking is seldom desired by the younger generation of nurses.
d. many younger workers are less concerned with longevity and are willing to change institutions to achieve professional advancement and flexible work hours.

ANS: D
The emerging workforce, ages 18 to 35 years, has compensation expectations that differ from those of previous generations. This younger generation prefers to work in an outcomes-based environment, where pay is based on achievement or merit, not on longevity.
Older nurses are actually being recruited to stay in the employment arena to improve patient outcomes. Research advancements in ergonomics and workload have made early retirement less appealing.
Magnet hospitals definitely retain nurses by offering professional practice autonomy.
The younger generation is very adept at multitasking and at using technology.

DIF: Application REF: Page 263

9. Hospitals surveyed nurses who terminated their employment to determine why they chose to leave. One of the most common reasons for leaving was:
a. decreased pay for alternative shifts.
b. that the nurse/patient ratio prevents safe care.
c. that most facilities are choosing an all-RN staff, which decreases opportunities for advancement.
d. that agency and foreign nurses are favored by administration over full-time nursing staff.

ANS: B
A number of studies in the late 1990s focused on the work environment as a significant contributor to the difficulties involved in recruiting and retaining RNs. One of the primary factors for the increasing nurse turnover rate was identified as workload and staffing patterns. A more recent study by Aiken (2002) reported higher rates of patient complications and increased death rates when fewer nurses are assigned per patient.
Substantial monetary compensation is provided for alternative shifts.
An all-RN staff would not limit advancement opportunities.
Use of agency and foreign nurses results in considerable expenditures by health care organizations. Many believe that these recruitment-related costs would be better spent by increasing the basic compensation levels of professional nurses.

DIF: Comprehension REF: Page 265

10. A staff nurse serves on a shared governance council that has been given the authority to decide issues related to “self-scheduling” and “use of unlicensed assistive personnel.” Council chairs make all final decisions regarding nurse/patient ratios and use of agency nurses. This phase of shared governance is phase:
a. 1.
b. 2.
c. 3.
d. 4.

ANS: C
In the third developmental phase of shared governance, staff nurse representatives serve on councils that are assigned authority to handle specific functions. At this level, council chairs make up the management committee that is charged with making all final operational decisions.
Phase 1 includes staff nurse representatives who have the authority to address designated practice issues and some authority to determine roles, functions, and processes. Managers are responsible for facilitating practice through resource management and allocation. The executive committee accepts recommendations from staff nurses and managers. The chief nurse executive retains final decision-making authority.
In phase 2, staff nurse representatives serve on committees that are designated for specific management and/or clinical functions. Managers serve on the same committees with staff nurses. Committee chairs are appointed by the chief nurse executive, and the nursing cabinet makes final decisions on the basis of recommendations received from the committees.
Shared governance has passed through only three developmental phases.

DIF: Application REF: Page 272, Box 12-9

11. A nurse is concerned about safe staffing levels at her facility and observes that several units have no RN coverage but instead have RNs who float among several units. In determining whether this staffing concern should be reported to an outside agency, the nurse understands that with whistle blowing:
a. reporting unsafe staffing levels to The Joint Commission provides protection from the employer.
b. keeping copies of inappropriate staffing patterns in the nurse’s personal file is illegal.
c. when observing inappropriate staffing, the nurse should record her personal thoughts concerning the outcomes.
d. one should seek guidance from a trusted individual who can provide an objective point of view.

ANS: D
One of the many guidelines of whistle blowing specifies that one should seek counsel from a trusted individual outside the situation to gain an objective perspective.
Private groups such as The Joint Commission do not confer protection in whistle-blowing situations; a nurse must report to a state or national regulator.
Keeping copies of inappropriate staffing patterns in a personal file is not illegal.
The nurse should record objective information, not personal thoughts or interpretations.

DIF: Analysis REF: Page 276, Box 12-11

12. The occupational health and safety nurse would like to develop programs designed to decrease mortality and morbidity among the workforce. When considering factors related to mortality among female workers, the nurse should focus her efforts on prevention of:
a. suicide.
b. homicide.
c. blood-borne disease.
d. ergonomic hazards.

ANS: B
Workplace violence has become a major societal issue. Its most extreme form, homicide, is the fourth leading cause of fatal occupational injury in the United States, with 551 workplace homicides reported in 2004 out of a total of 5703 fatal work injuries (OSHA, 2006b).
Suicide is not a strong mortality issue in the workforce.
Mortality due to blood-borne pathogen exposure has decreased since the Needlestick Safety and Prevention Act was implemented.
Ergonomic hazards have decreased since safe patient handling educational programs were implemented.

DIF: Application REF: Page 278

13. According to the Needlestick Safety and Prevention Act (1991):
a. employers must mandate policies for nonmanagerial employees to prevent patients from being exposed to used needles.
b. employers are not responsible when employees fail to follow Universal Precautions, resulting in a needlestick.
c. each state must determine the degree of input sought from employees to determine safe workplace policies involving protection from sharps injuries.
d. employers are required to document how and where a sharps injury occurred, including the brand of device that was involved.

ANS: D
The Needlestick Safety and Prevention Act, passed at the federal level, requires the use of safer needle devices to protect from sharps injuries; the law requires employers to maintain a sharps injury log that contains, at a minimum, the brand of device involved in the incident, the department or work area where the exposure incident occurred, and an explanation of how the incident occurred.
The law requires employers to solicit the input of nonmanagerial employees responsible for direct patient care who are potentially exposed to sharps injuries in the identification, evaluation, and selection of effective engineering and work practice controls.
Employers are responsible for the identification, evaluation, and selection of effective engineering and work practice controls to prevent needlesticks.
The Needlestick Safety and Prevention Act is a federal law, and all states are held to this statute.

DIF: Comprehension REF: Page 277

14. A nurse is concerned because novice nurses are having their orientation period shortened and are being placed in charge nurse positions. The nurse has documented unsafe care and decisions by these novice nurses. To be protected from retaliation by the employer, this nurse must “blow the whistle” by:
a. holding a public forum in the agency cafeteria to discuss concerns.
b. reporting concerns to state and/or national agencies regulating the agency.
c. calling coworkers outside the workplace to informally discuss wrongdoing.
d. contacting The Joint Commission to report unsafe conditions.

ANS: B
The whistle blower is not protected until concerns are reported to the state or national regulatory agency.
Holding a public forum does not in any way offer protection.
Reporting to state-national agencies that regulate the employer is the method to ensure whistle blower protection, and it is recommended that complaints be in writing.
Neither The Joint Commission nor the National Committee for Quality Assurance grants protection.

DIF: Comprehension REF: Page 276, Box 12-11

MULTIPLE RESPONSE

1. Managers at an acute care facility value the contributions of their aging nursing workforce. Using Hatcher’s (2006) recommendations for an aging nursing workforce, they institute which of the following changes? (Select all that apply.)
a. Supplies such as dressing change and Foley catheter kits are placed on the nursing unit.
b. Novice nurses will be mentored by peers who graduated within the last 2 years.
c. Continuing education requirements are waived for nurses within 2 years of anticipated retirement.
d. Monthly newsletter will focus on the contribution of all nurses.
e. A work-design consultant is hired to redesign the nursing unit to reduce wasted motion.

ANS: A, D, E
Placing supplies in a decentralized area prevents fatigue from securing items from a distant location.
Nurses are integral to quality and their contributions should be noticed.
Ill-designed units contribute to fatigue and inability of aging nurses to perform efficiently.
Mentoring is one way to acknowledge skills of the aging workforce.
Aging nurses want and need information related to technology and practice.

DIF: Application REF: Page 263

COMPLETION

1. Nurses who are expected to work overtime as dictated by their employer are being subjected to a ____________________ hazard in the workplace.

ANS:
psychologic
Hazards in the workplace are categorized as follows: biologic, ergonomic, chemical, physical, and psychologic. Included in psychologic hazards are issues such as stress, shift work, mandatory overtime, and verbal abuse by patients and other health care providers.

DIF: Application REF: Page 276, Box 12-12

Cherry: Contemporary Nursing, 5th Edition

Chapter 16: Nursing Leadership and Management

Test Bank

MULTIPLE CHOICE

1. In an attempt to persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees’ health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin’s planned change?
a. Unfreeze
b. Move
c. Refreeze
d. Acceptance

ANS: A
Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin’s stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider change.
Move is incorrect because at this stage, the change agent clarifies the need to change, explores alternatives, defines goals and objectives, plans the change, and implements the change plan.
Refreeze is incorrect because at this stage the change is being integrated into the organization so that it becomes recognized as the status quo. The change agent must facilitate change by monitoring adherence to the new requirements.
Acceptance is incorrect because acceptance and integration represent the final aspect of any change.

DIF: Application REF: Page 357

2. In differentiating between a leader and a manager, a:
a. leader has legitimate authority.
b. manager motivates and inspires others.
c. manager focuses on coordinating resources.
d. leader focuses on accomplishing goals of the organization.

ANS: C
The terms leadership and management are used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes.
Authority is the legitimate right to direct others that is given to a person by the organization through assignment to an authorized position such as a nurse manager.
It is the nurse leader who has the ability to guide or influence, as well as to motivate and inspire, others on the team.
Managers are assigned responsibility for accomplishing the goals of an organization.

DIF: Comprehension REF: Pages 335-336

3. The first step in the nursing process and in the problem-solving process is to:
a. identify the problem.
b. gather information.
c. consider the consequences.
d. implement interventions.

ANS: B
The nursing process, which is familiar to nurses who address patient care needs, can be applied to all management activities that require decision making and problem solving. As in the nursing process and the problem-solving process, one must first gather information about the problem or situation.
Identifying the problem is a later step in the nursing and problem-solving processes.
Considering the consequences is a later step in the nursing and problem-solving processes.
Implementing interventions is a later step in the nursing and problem-solving processes.

DIF: Comprehension REF: Page 355, Table 16-1

4. An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation?
a. Autocratic
b. Democratic
c. Laissez-faire
d. Referent

ANS: A
The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency.
Democratic is a leadership style that would not be effective in an emergency situation.
Laissez-faire is a leadership style that would not be effective in an emergency situation.
“Referent” refers to a type of power that comes from followers’ identification with the leader and is not a leadership style.

DIF: Application REF: Page 340, Box 16-3

5. An RN with excellent assessment and psychomotor skills would derive power on the basis of which source?
a. Rewards
b. Coercion
c. Expert
d. Legitimate

ANS: C
Seven primary sources of power are known. Expert power is based on knowledge, skills, and information.
Rewards power comes from the ability to reward others for complying; it may include such rewards as money, desired assignments, or recognition.
Coercive power is based on fear of punishment or failure to comply.
Legitimate power is based on holding an official position within the organization.

DIF: Application REF: Pages 336-337

6. Managers who exhibit the authoritative behavioral style are most likely to use which source of power?
a. Informal
b. Expert
c. Coercive
d. Reward

ANS: C
Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished.
Informal power is not one of the seven primary sources of power; however, informal leaders may distribute a considerable amount of power among the workers, can influence the attitude of the group, and significantly affect the efficiency and effectiveness associated with workflow, goal setting, and problem solving.
Expert power is based on knowledge, skills, and information.
Rewards power results from the ability to reward others for complying and may include such rewards as money, desired assignments, or recognition.

DIF: Application REF: Page 336; Box 16-3, page 340

7. The illustration below identifies which type of chart?

a. Productivity
b. Organizational
c. Resource
d. Staffing

ANS: B
An organizational chart is a visual picture of an organization that identifies lines of communication and authority.
Productivity is the amount of output or work that is produced with a specific quantity of input or resources.
Resources include personnel, time, and supplies needed to accomplish the goals of an organization.
Staffing is the manpower needed to complete the work.

DIF: Comprehension REF: Page 346

8. Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society’s perception of nursing). Those who depict her as a leader on the basis of these qualities are practicing which leadership theory?
a. Trait
b. Chaos
c. Bureaucracy
d. Organizational

ANS: A
Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery.
Chaos is an organizational theory that attempts to account for complexity and randomness in organizations.
Bureaucracy is part of the organizational theory that provides an understanding of authority within organizations.
Organizational theory provides the framework for an understanding of leadership and management, and for an understanding of complex organizations.

DIF: Application REF: Pages 337-338

9. A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse?
a. Transactional
b. Situational
c. Transformational
d. Contemporary

ANS: A
The transactional leader is concerned with the day-to-day operations of the facility.
Situational theory has attempted to integrate the dynamics of the interaction between the leader, the worker, and elements of the leadership situation, arguing that effective leadership depends on several variables.
The transformational leader is committed to organizational goals, has a vision, and is able to empower others with that vision.
The contemporary theories attempt to integrate the dynamics of the interaction between the leader, the worker, and elements of the leadership situation, arguing that effective leadership depends on several variables.

DIF: Application REF: Page 338, Box 16-1

10. According to the unit’s policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, “You are unfair to me.” Which theory would disprove the nurse’s statement?
a. Bureaucracy
b. Closed systems
c. Open systems
d. Trait

ANS: A
Weber’s concept of bureaucracy revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place.
Represents the systems theory of the organization. There are two views: open and closed. Closed systems theory views the system as being totally independent of outside influence.
Represents the systems theory of the organization. There are two views: open and closed. Open systems theory suggests that the organization is affected not only by internal change but also by external environmental changes that can have a direct or an indirect influence on the organization.
Trait theory, which describes intrinsic traits of leaders, is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery.

DIF: Analysis REF: Page 341

11. A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement?
a. Every morning at shift change, thank each employee for an excellent job.
b. Rotate a monthly “employee recognition award” among all employees on the unit.
c. Wait until the annual performance review to recognize accomplishments.
d. Give spur-of-the-moment recognition to an employee who has accomplished a goal.

ANS: D
To be effective, positive reinforcement should (1) be specific, with praise given for a particular task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment.
Thanking each employee for doing an excellent job lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment.
Establishing an “employee recognition award” lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment.
Waiting until the annual performance review to recognize accomplishments lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment.

DIF: Application REF: Pages 348-349

12. Which action represents the key management function of strategic planning?
a. Determining that all nurses on the unit understand the current organizational philosophy
b. Evaluating the communication process between the pharmacy and the nursing departments
c. Monitoring data from the quality management initiative related to the last three orientation programs
d. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units

ANS: D
A strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5 years into the future.
Determining that all nurses on the unit understand the current organizational philosophy is a form of current evaluation and analysis, and does not look toward the future.
Evaluating the communication process between the pharmacy and the nursing departments is a form of current evaluation and analysis, and does not look toward the future.
Monitoring data from the quality management initiative related to the last three orientation programs is a form of current evaluation and analysis, and does not look toward the future.

DIF: Comprehension REF: Pages 344-345

13. A hospital’s policy requires that all nurse managers must have a minimum of a bachelor’s degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, “The new nurse manager has book sense but no leadership abilities.” What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit?
a. Send memos to all staff except the upset nurse to invite them to a luncheon.
b. Ask management to transfer the upset nurse to another unit.
c. Assign the upset nurse to committees that do not directly affect that nursing unit.
d. Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication.

ANS: D
The best way for the new nurse manager to communicate with this employee, who may be an informal leader, is to show respect for the individual’s clinical expertise and experience through clear and direct communication. The new nurse manager should attempt to identify the staff nurse’s power as an informal leader, should involve him and other staff members in decision making and change implementation processes, and should clearly communicate goals and work expectations to all staff members.
The nurse manager would not gain the respect or trust of other nurses on the unit by excluding one of their peers from an activity.
The nurse manager must make a sincere attempt to work with the nurse, whose clinical experience is valuable to the unit. A transfer request would be the last option after all other efforts to develop a working relationship with the staff nurse have been exhausted.
The best way to work with this employee and gain the respect of other nurses on the unit is through open and direct communication.

DIF: Analysis REF: Page 337

14. A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group?
a. Coercive
b. Transformational
c. Laissez-fair
d. Legitimate

ANS: D
The coordinator of the committee has an official position within the organizational committee.
The CNL is not being threatened with punishment.
Transformational is not a type of power.
Laissez-fair is a type of management style, not a type of power.

DIF: Application REF: Page 336

15. A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet their goal of “provide quality patient care with attention to compassion and excellence.” An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management?
a. Transactional
b. Clinical consultant
c. Corporate supporter
d. Autocratic

ANS: C
Autocratic managers do not seek input from staff.
Transactional leaders are involved in day-to-day operations rather than having a vision.
The nurses are not looking to the leader as a resource for clinical advice.
The manager is embracing the mission of the organization by supporting achievement of goals noted in the mission statement.

DIF: Application REF: Page 359

MULTIPLE RESPONSE

1. Registered nurses who are entering the workforce will have expanded leadership responsibilities that include: (Select all that apply.)
a. serving on interdisciplinary care teams.
b. being competent to work in several areas independently when dictated by patient census.
c. attending a meeting to plan advanced training for unlicensed assistive personnel.
d. evaluating outcomes of care that are reported to a standing committee.

ANS: A, C, D
The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses.
The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses.
The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses.

For RNs who are entering the workforce, being competent to work in several areas independently is not a realistic expectation.

DIF: Application REF: Page 335

OTHER

1. Place the following five major management functions into correct sequential order.
A. Staffing
B. Directing
C. Planning
D. Controlling
E. Organizing

ANS:
C, E, A, B, D
Each of the management activities of planning, organizing, staffing, directing, and controlling come into play in the role of resource manager. The nurse must develop skills in the following ordered areas:
Planning for the necessary resources (primarily staff and supplies) to manage the unit; planning serves as the basis for all other management functions; thus it comes first in sequential order.
Organizing resources to meet identified goals; organizing identifies the numbers and types of staff needed to meet goals, thus must occur prior to staffing.
Staffing appropriately as determined by patient needs and the budget plan; staff must be hired and in place prior to directing.
Directing. After managers have planned what to do, organized how to do it, and staffed positions to do the work, they must direct personnel and activities to accomplish goals.
Controlling is the final management function by which managers, through staffing and directing, ensure that employees accomplish planned goals within the established organizational structure.

DIF: Analysis REF: Page 343

Cherry: Contemporary Nursing, 5th Edition

Chapter 18: Effective Communication and Conflict Resolution

Test Bank

MULTIPLE CHOICE

1. A nurse is listening to a patient’s apical heart rate. The patient asks, “Is everything okay?” The nurse says nothing and shrugs her shoulders. The nurse is demonstrating:
a. open communication.
b. filtration.
c. blocking.
d. false assurance.

ANS: C
Blocking occurs when the nurse responds with noncommittal or generalized answers.
Open communication reflects openness between two parties.
Filtration is the unconscious exclusion of extraneous stimuli in communication.
False assurance is showing a lack of concern or a lack of knowledge by responding with meaningless answers such as “don’t worry.” The patient might even conclude that the nurse is trivializing his concern or is patronizing.

DIF: Comprehension REF: Page 389

2. A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both of these situations?
a. Blocking
b. Filtration
c. Empathy
d. False assurance

ANS: B
Filtration is the unconscious exclusion of extraneous stimuli in communication.
Blocking occurs when the nurse responds with noncommittal or generalized answers.
Empathy is the ability to mentally place oneself in another person’s situation to better understand the person and to share the emotions or feelings of that person.
False assurance is showing a lack of concern or a lack of knowledge by responding with meaningless answers such as “don’t worry.” The patient might even conclude that the nurse is trivializing his concern or is patronizing.

DIF: Application REF: Page 384

3. In today’s world of fast, effective communication, what is the most commonly used means of societal communication?
a. Facial expression
b. Spoken word
c. Written messages
d. Electronic messaging

ANS: B
Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking.
Facial expression is only part of effective communication and is not the most common form of societal communication.
Written messages are only part of communication and are not the most common form of societal communication.
Electronic messaging, although it is becoming more popular, is not the most common form of societal communication; it loses the value of face-to-face communication and requires the sender to elicit feedback and/or the receiver to ask for clarification if the meaning of the communication is not clear.

DIF: Knowledge REF: Page 384

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
Communication is a process that requires certain components, including a sender, a receiver, and a message. Effective communication is a dynamic process: With a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes.
The components of communication are not mutually exclusive.
Communication is not a linear process; and many elements, including culture, education, experiences, preconceived ideas, and context, influence the communication process.
Several variables, including filtration, feedback, interpretation, and nonverbal language, influence the communication process.

DIF: Analysis REF: Page 382; Figure 18-1, page 383

5. A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor’s degree is hired. Before the RN arrives on the unit, the LPN is heard saying, “She’ll try to tell everyone what to do because she makes more money. She’ll sit at the desk and let us do all the work.” This is an example of a(n):
a. interpretation.
b. context.
c. precipitating event.
d. preconceived idea.

ANS: D
Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before having an encounter. Such ideas can dramatically affect the receiver’s acceptance and understanding of the message.
Interpretation is the individual’s analysis of communication that is based on context and environment, precipitating event, preconceived idea, personal perception, style of transmission, and past experiences.
Context refers to the entire situation that is relevant to the communication.
The precipitating event refers specifically to the event or the situation that prompted a particular communication.

DIF: Analysis REF: Page 383

6. A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, “I don’t think she is really hurting. Let the next shift give the pain medication.” The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication?
a. Personal perception
b. Past experiences
c. Filtration
d. Preconceived idea

ANS: B
With past experiences that include a variety of positive, neutral, and negative events, the influence that these experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experience cannot be overstated.
Personal perception is awareness achieved through excitation of all the senses. Perceptions can be described as all that the person knows about a situation or circumstance according to what each of the senses—taste, smell, sight, sound, touch, and intuition—discovers and interprets.
Filtration is the unconscious exclusion of extraneous stimuli in communication.
Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before an encounter takes place.

DIF: Analysis REF: Page 384

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
An appeal to common practice occurs when the argument is made that something is okay because most people do it.
Ad hominem abusive is an argument that attacks the person instead of the issue. The speaker hopes to discredit the other person by calling attention to some irrelevant fact about that person.
An appeal to emotion is an attempt to manipulate other people’s emotions for the purpose of avoiding the real issue.
An appeal to tradition is the argument that doing things a particular way is best because they’ve always been done that way.

DIF: Analysis REF: Page 390

8. An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, “My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn’t care how hard I try to get here, and I am raising a child by myself.” The nurse is using which type of logical fallacy?
a. Appeal to emotion
b. Appeal to tradition
c. Hasty generalization
d. Confusing cause and effect

ANS: A
An appeal to emotion is an attempt to manipulate other people’s emotions for the purpose of avoiding the real issue.
An appeal to tradition is the argument that doing things a certain way is best because they’ve always been done that way.
Hasty generalization involves coming to a conclusion on the basis of a very small number of examples. A hasty generalization occurs whenever an assumption is made that a small group represents the whole population.
One confuses cause and effect when he or she assumes that one event must cause another just because the two events often occur together.

DIF: Analysis REF: Pages 390-393

9. The new director of nurses has instituted “walking rounds” on all nursing units, rather than the usual taped shift reports. A veteran nurse exclaims, “She doesn’t know how we do things here!” The nurse is demonstrating:
a. appeal to emotion.
b. appeal to tradition.
c. red herring.
d. straw man.

ANS: B
An appeal to tradition is the argument that doing things a particular way is best because they’ve always been done that way.
An appeal to emotion is an attempt to manipulate other people’s emotions for the purpose of avoiding the real issue.
A red herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue.
A straw man occurs when a person’s position on a topic is misrepresented.

DIF: Analysis REF: Page 391

10. A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, “You don’t care that I threw the needle in the trash. You just want an all-female staff,” putting the team leader in a defensive position. This communication technique is known as:
a. straw man.
b. red herring.
c. slippery slope.
d. confusing cause and effect.

ANS: B
A red herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue.
A straw man occurs when a person’s position on a topic is misrepresented.
A slippery slope is the belief that one event will inevitably follow another without any real support for that belief.
Cause and effect are confused when one assumes that one event must cause another just because the two events often occur together.

DIF: Analysis REF: Page 391

11. During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting:
a. assertive communication.
b. active listening.
c. empathy.
d. passive communication.

ANS: B
In active listening, a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.
Assertive communication is an overall communication style in which the person displays the presence of positive declaration and persistently demonstrates confidence; he or she has obtained the facts, carefully considered the options, and exuded confidence while forming a point of view; active listening may be a component of assertive communication.
Empathy is the ability to mentally place oneself in another person’s situation for the purpose of better understanding a person and sharing the emotions or feelings of that person.
Passive communication is a form of communication in which the individual fails to say what is meant.

DIF: Analysis REF: Page 392

12. An older adult is unable to reach the phone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, “Can I just please stay and hold my dad’s hand? He was so afraid of dying alone.” Which response by the nurse shows empathy?
a. “You are just too late for that. Where were you when he needed you?”
b. “Did you ever consider purchasing a cell phone for your dad to prevent this from happening?”
c. “I’ll close the door so you can spend time with your dad. I will check back in a few minutes.”
d. “I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you.”

ANS: C
Empathy is demonstrated by the ability to mentally place oneself in another person’s situation to better understand the person and to share the emotions or feelings of the person.
Telling the son that he is too late to be there for his dad is an ineffective communication technique, given this situation, and does not support empathy.

Asking the son if he ever considered buying his dad a cell phone is an ineffective communication technique, given this situation, and does not support empathy.
Communication-wise, it is ineffective for the nurse to share stories, and does not support empathy.

DIF: Analysis REF: Page 387

13. 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. “Can you tell me about your exercise practices?”

ANS: D
“Can you tell me about your exercise practices?” is an open-ended question or statement that requires more information than just yes or no. This type of question augments the gathering of enough facts to build a more complete picture of the circumstances.
“Do you exercise?” is a yes and no question that limits the amount of information you can retrieve.
“Do you like to exercise?” is a yes and no question that limits the amount of information you can retrieve.
“When do you exercise?” inquires about only one item and does not lead to further discussion.

DIF: Evaluation REF: Page 388

14. Which component of an e-mail would be effective?
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 5:00 PM in the first floor auditorium. Please send items for the agenda.
Sally Smith, MSN, RN, [email protected] or ext. 5582

ANS: D
This provides a message that is concise and accurate with a clearly conveyed message for the reader and contact information from the sender, all of which are important components of effective e-mail communication.
The subject line does not convey enough information to be valuable.
Too many questions are asked in succession, making it easy for the reader to miss responding to one of the questions.
Announcing that each department must reduce staff by 2% provides sensitive information that can personally affect several staff members; sensitive information should be shared in a face-to-face meeting, not through e-mail or electronic announcement boards.

DIF: Evaluation REF: Page 397

15. During height and weight assessments at a school’s health fair, a child admits to drinking a cup of coffee with his mother every morning, and another child reports enjoying a morning cup of coffee on the commute to school. These two children are both below average on the height chart, and the nurse states, “Drinking coffee stunts a child’s growth.” This logical fallacy is referred to as:
a. appeal to common practice.
b. confusing cause and effect.
c. ad hominem abusive.
d. red herring.

ANS: B
Cause and effect are confused when one assumes that a particular event must cause another just because the two events often occur together.
Appeal to common practice occurs when the argument is made that something is okay because most people do it.
Ad hominem abusive is an argument that attacks the person instead of the issue.
A red herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue.

DIF: Analysis REF: Page 391

16. A patient’s spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, “I am so mad, how can you get cancer without smoking?” Which statement by the nurse represents empathy?
a. “Research is identifying many risk factors for cancer besides smoking.”
b. “I understand how you could feel angry about the diagnosis.”
c. “He is still a good husband.”
d. “Why do you think he got cancer?”

ANS: B
The nurse is placing herself in the wife’s position and sharing her emotions.
The nurse is not acknowledging the spouse’s feelings.
This does not place the nurse in the wife’s situation.
Asking the wife to guess why her husband got cancer does not involve empathy.

DIF: Application REF: Page 387

17. 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 is the first day of the week?

ANS: C
The patient must be able to name the day of the week rather than use answer yes or no.
“Is today Wednesday?” can be answered yes or no, which is not representative of open communication.
“Do you know what day it is?” can be answered yes or no, which is not representative of open communication.
“Do you know what is the first day of the week?” can be answered yes or no, which is not representative of open communication.

DIF: Application REF: Page 388

Cherry: Contemporary Nursing, 5th Edition

Chapter 19: Effective Delegation and Supervision

Test Bank

MULTIPLE CHOICE

1. The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to:
a. the registered nurse (RN).
b. the licensed practical/vocational nurse (LPN/LVN).
c. nursing assistive personnel (NAP).
d. all levels of staff, because the information is about the past and cannot change.

ANS: A
Only the RN can perform and sign the admission assessment, although some components such as vital signs may be delegated.
The assessment must be completed and signed by the RN; however, some components may be delegated to the LPN/LVN.
NAPs are not licensed, and only an RN can perform the initial assessment.
The assessment includes present symptoms and treatments, as well as those reported from the past, and the RN must complete the initial patient assessment.

DIF: Application REF: Page 416

2. An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN knows that:
a. the role of the LPN/LVN is the same from state to state.
b. the LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided.
c. he or she must review the state’s nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN.
d. The Joint Commission has certified and established roles for the LPN/LVN.

ANS: C
The scope of practice of the LPN/LVN varies significantly from state to state; RNs should know the LPN/LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LPN/LVN.
Each state determines the scope of practice of the LPN/LVN.
Specific tasks and roles cannot be delegated except to another RN who has received the training required to perform the task or role.
The purpose of The Joint Commission is to increase the safety and quality of care provided to consumers by providing voluntary accreditation that certifies that a hospital meets established standards.

DIF: Application REF: Page 413

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
The RN who is delegating must consider the following: (1) the delegatee’s current workload and the complexity of the task, (2) whether the staff member is familiar with the patient population and with the task to be performed, and (3) whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task.
Administration of an antiarrhythmic drug requires the skill of an RN to evaluate outcomes, especially when it is administered IV because of its fast rate of distribution.
Only an RN can develop the patient’s plan of care, although others may assist in updating information.
The task of teaching is limited to RNs.

DIF: Analysis REF: Pages 413-414, 418

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. Nursing assistive personnel (NAP)
d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring.

ANS: A
The patient’s condition is not stable; therefore, the skills of an RN are required.
The assessment expertise of an RN is needed because of the unstable nature of the patient’s condition.
Obtaining a baseline set of vital signs for an unstable patient would be considered high-risk delegation for a NAP.
The patient’s condition is very dynamic; assessments will have to be completed by the RN on admission and then as indicated by the stability of the patient.

DIF: Application REF: Pages 416-417

5. A nurse is delegating to the newly hired nursing assistive personnel (NAP) the task of assisting with oral hygiene, knowing that this assignment “does not require decisions based on the nursing process.” The nurse is correctly using which of the five rights of delegation?
a. Supervision
b. Communication
c. Person
d. Circumstance

ANS: D
Right circumstance involves the delegation of tasks that do not require independent nursing judgments.
Right supervision of delegation involves providing feedback to monitor how the process is working and to suggest improvements to the process.
Right communication involves giving clear explanations about tasks and expected outcomes; information is provided about when the delegatee should report to the RN.
Right person involves delegating to someone who is qualified and competent, and, because the NAP is a new hire, the RN cannot evaluate the competency level of the delegatee.

DIF: Application REF: Page 419

6. A student nurse is concerned about delegation practices and wonders why hospitals employ nursing assistive personnel (NAP) 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 simple, routine patient care tasks.
c. replace the RN when the health care facility provides long-term care.
d. provide patient teaching, allowing more direct care to be provided by the RN.

ANS: B
The NAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice.
The NAP and the LPN/LVN cannot supplement staffing when the RN is not available but can assume responsibility for tasks that are simple and routine and do not require adherence to the nursing process.
An RN must oversee the care provided by NAPs and LPNs/LVNs in long-term care settings.
Only RNs can provide patient teaching.

DIF: Comprehension REF: Pages 410-411

7. An RN delegates to NAP the task of performing blood pressure checks for a group of patients on a nursing unit. The NAP accepts the task and is responsible for:
a. delegating the task to another NAP if he or she does not have the time or skill to complete the task.
b. keeping the RN informed of any abnormal blood pressure readings.
c. calling the physician when the patient’s vital signs are not within established parameters.
d. informing the dietary department to initiate a low-sodium diet for patients who are hypertensive.

ANS: B
After accepting the assignment, the NAP is responsible for completing the task and reporting any patient concerns to the RN.
The NAP cannot delegate to any member of the health care team; delegation is the responsibility of the RN.
RNs are responsible and accountable for accepting physician orders.
Dietary consults are independent nursing orders that only the RN can initiate.

DIF: Application REF: Page 411

8. Which task is appropriate for the RN to delegate to the nursing assistive personnel (NAP), provided the delegatee has had experience and training?
a. Evaluate the ability of a patient to swallow ice after a gastroscopy.
b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time.
c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious.
d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.

ANS: D
Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation.
Evaluation requires the expertise of the RN; assessing the gag response may prevent aspiration after surgery and is not within the scope of practice for NAP.
Assisting a patient who is ambulating after surgery is not an appropriate task to delegate. An RN will have to assess the patient’s tolerance and coordinate care on the basis of this assessment.
Changing the tracheotomy cannula is a skill that requires critical thinking and carries a high risk for injury, making the task inappropriate for delegation.

DIF: Analysis REF: Pages 417-418

9. An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision?
a. There is no supervision, because at times the LPN/LVN is not with the RN.
b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care.
c. Continual supervision is being provided until the RN determines competency.
d. Initial supervision is being provided because this is the LPN/LVN’s first day on the unit.

ANS: C
This level of supervision is required when the working relationship is new, the task is complex, or the delegatee is inexperienced or has not demonstrated an acceptable level of competence.
Supervision is always a required component of delegation.
The RN does not know about the training and competencies of the LPN/LVN and has not yet developed a working relationship with this staff member.
Initial supervision consists of oversight of a delegated task once a shift; however, this approach should be used when the RN knows the competencies of the LPN/LVN.

DIF: Application REF: Page 421

10. An RN is counseled by the nurse manager regarding inappropriate delegation when the:
a. RN instructs the nursing assistant to greet ambulatory surgery patients and show them to their rooms.
b. nursing assistant informs the RN that she has not been trained to collect a sputum specimen, and the RN states, “I will show you this time and you can show me the next time.”
c. RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube.
d. LPN/LVN who has demonstrated competence is asked to perform a dressing change for a patient before she is discharged home.

ANS: C
Only an RN can initiate and complete a new plan of care; this does not fall within the scope of practice of the LPN/LVN. The RN has violated one of the five rights of delegation.
The RN should provide clear directions for assigned tasks, and this assignment falls within typical job duties for nursing assistive personnel (NAP).
The RN received appropriate feedback and is providing directions and is demonstrating a skill for which the nursing assistive personnel (NAP) has not shown competency.
Routine repetitive dressing changes are within the scope of practice for the LPN/LVN who has demonstrated competency for the skill.

DIF: Application REF: Page 416

11. An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient’s medication administration just before entering the patient’s room. The priority intervention by the RN is to:
a. check the patient’s drug packages to ensure that the correct drugs were given.
b. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner.
c. contact the nurse manager and ask that the LPN/LVN’s license be suspended.
d. call the pharmacy and ask for replacement medications for the patients.

ANS: B
The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN’s responsibility requires that he or she intervenes and identifies concerns with the LPN/LVN.
Checking the patient’s drug packages to ensure that the correct drugs were given is not proactive intervening for patient safety because an inappropriate medication would have already been given.
The RN must intervene immediately to protect the patient but may later discuss with the nurse manager a plan of corrective action for the LPN/LVN.
The first step is to stop the violation of the five rights of medication administration; consequently, medications will not have to be replaced.

DIF: Analysis REF: Pages 423-424

12. Which statement related to delegation is correct?
a. The practice of nursing assistive personnel (NAP) is defined in the nurse practice act.
b. Nursing practice can be delegated only when the LPN/LVN and/or NAP 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 NAP.

ANS: D
Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated and what is defined as nursing practice.
Most state laws do not define practice for NAP.
Nursing practice cannot be delegated; only tasks can be delegated.
The RN must determine that tasks have been completed and were performed correctly.

DIF: Knowledge REF: Pages 412-413

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 nursing assistive personnel (NAPs) participate in on-site training.
b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN.
c. NAPs cannot be held responsible for their own actions or inactions.
d. the nurse practice act and state regulations related to delegation override the organization’s policies.

ANS: D
The state’s nurse practice act is the deciding factor regarding what can legally be delegated.
Although on-site training may increase the competency of the individual, legal rules of delegation remain with the state’s nurse practice act.
Accountability remains with the RN who delegated the task.
NAPs are responsible for accepting tasks for which they are competent to perform, but accountability remains with the RN.

DIF: Comprehension REF: Page 415

14. A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The RN should:
a. query the state nursing association to determine their stance on the role of LPNs.
b. ask the LPNs on the unit to list what tasks they routinely performed.
c. contact the state board of nursing to determine legal scope of practice for LPNs.
d. Refer to California’s nurse practice act because the scope of LPNs/LVNs is consistent across the United States.

ANS: C
If the nurse practice act lacks clarity, the state board of nursing can provide guidance.
The state nursing association is not the authority on the scope of practice.
The LPNs may be performing tasks that are not within the scope of practice and the RN is accountable for all tasks assigned.
Nurse practice acts vary from state to state.

DIF: Application REF: Pages 412-413

15. An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high risk delegation?
a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH insulin.
b. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a foot wound.
c. An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington’s disease to ambulate a short distance in the hallway.
d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000 mm3.

ANS: C
Risk of falling is great in later stages of Huntington’s disease due to chorea movements.
Mixing regular and NPH insulin is within the scope of practice of an RN and all insulin should be checked by an RN prior to administration, reducing the risk of a medication error.
Simple dressing changes are within the scope of practice for an LPN/LVN.
An experienced nurse from an oncology unit would be familiar with care of immunocompromised patients.

DIF: Application REF: Page 419

MULTIPLE RESPONSE

1. Which statement made by an RN regarding delegation indicates the need for additional teaching? (Select all that apply.)
a. Nursing assistive personnel (NAPs) 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. NAPs 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 NAP, but the delegator retains accountability.

ANS: A, B, C
The statement “NAPs can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely” indicates the need for further teaching because the patient is at highest risk of a reaction during the first few minutes of a blood transfusion; thus the assessment skills of an RN are required.
The statement “an LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD” indicates the need for further teaching because administration of intradermal medication requires the skill of an RN.
Dopamine is a vasoactive drug that can have a profound effect on a patient’s blood pressure and cardiac output; administration requires the assessment and evaluation skills of an RN.
The RN can delegate this responsibility if the patient is stable and the competence of the NAP has been established.
Accountability remains with the person who is delegating, but when the NAP accepts the assignment, responsibility rests with the NAP.

DIF: Analysis REF: Pages 411-416

2. A nursing administrator who is considering the feasibility of an all-RN staff reviews the report, Keeping Patients Safe: Transforming the Work Environment of Nurses (2003), and determines that RNs: (Select all that apply.)
a. are more costly and less efficient than LPNs.
b. have little or no effect by being proactive but instead are reactive to patient care errors.
c. have a positive effect on patient outcomes when managing patient care.
d. are effective overseers of patients’ overall health condition
e. lack the training to be effective delegators.

ANS: C, D
RNs are effective at coordinating care that results in improved patient outcomes.
RNs are valuable monitors of a patient’s health status—a practice that results in improved patient outcomes.
RNs improve patient safety and are cost effective, especially when delegation is used correctly.
RNs are able to intervene and prevent serious accidents and errors in patient care.

DIF: Comprehension REF: Page 410

Cherry: Contemporary Nursing, 5th Edition

Chapter 20: Staffing and Nursing Care Delivery Models

Test Bank

MULTIPLE CHOICE

1. Accrediting and licensure agencies such as The Joint Commission address staffing by:
a. imposing maximum staffing levels.
b. requiring a specific staff mix.
c. stipulating nurse/patient ratios.
d. looking for evidence that patients receive satisfactory care.

ANS: D
Accrediting agencies do not address minimum staffing levels; however, they do look for evidence that patients receive adequate care, and this can occur only with adequate staffing.
Accrediting agencies do not impose maximum staffing levels.
Staff mix is not addressed by accrediting agencies; however, long-term care facilities specify minimum RN coverage for the facility.
Agencies do not stipulate mandatory staffing ratios, with the exception of those in California, a state that recently enacted legislation mandating specific nurse/patient ratios.

DIF: Comprehension REF: Page 429

2. Customer satisfaction is primarily based on:
a. access to modern, up-to-date facilities.
b. availability of an extensive menu selection.
c. personal interactions with employees.
d. having to undergo fewer invasive procedures.

ANS: C
Interactions between employees and patients/families actually affect clinical outcomes, functional status, and even physiologic measures of health.
Customer satisfaction is primarily based on relations with employees.
As stated in A, interface with employees is the means to customer satisfaction.
Patients may fear or dislike invasive procedures, but the important consideration in customer satisfaction is the quality of interactions with employees.

DIF: Knowledge REF: Page 429

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
In total patient care, nurses provide all aspects of patient care.
Partnership nursing, or coprimary nursing, pairs the RN with a partner, usually a licensed practical/vocational nurse (LPN/LVN) or nursing assistive personnel (NAP), allowing the RN to spend more time on tasks such as assessment and patient education.
In team nursing, an RN directs the other members of the team, which can consist of care providers at various levels.
In functional nursing, staff are assigned to tasks rather than to patients.

DIF: Application REF: Pages 430-431

4. A hospital converts to a system of care delivery in which RNs, LPNs, and nursing assistive personnel (NAP) 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
In functional nursing, members of the team are assigned specific tasks such as assessment or medication administration
Total patient care involves an RN who provides every aspect of patient care.
With team nursing, the team leader, an RN, delegates care to other team members.
In primary nursing, the RN assumes 24-hour responsibility for the care of assigned patients.

DIF: Application REF: Pages 431-432

5. The nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers is called a:
a. nurse manager.
b. case manager.
c. coordinator of patient-centered care delivery.
d. team leader in team nursing care delivery.

ANS: B
The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness.
The nurse manager is responsible for handling the day-to-day operations of the nursing unit and for ensuring that the unit’s philosophy and mission are congruent with those of the parent organization.
The coordinator of patient-centered care delivery works with an interdisciplinary team in providing a wide range of services.
The team leader coordinates and delegates care for a specific group of patients.

DIF: Comprehension REF: Pages 435-436

6. A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG), and according to the clinical pathway should be extubated and discharged from critical care the day after surgery. During surgery the patient’s oxygen saturation decreased drastically as a result of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation represents a:
a. patient outcome.
b. variance.
c. goal.
d. standard.

ANS: B
A variance is a deviation from the planned path.
The patient outcome is the end result of care, not just a single specific incident or deviation.
The goal is to provide high-quality cost-effective care.
A standard is the criterion from which safe, effective care is derived.

DIF: Application REF: Page 438

7. A patient is admitted with pneumonia. The case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to as a:
a. patient classification system.
b. clinical pathway.
c. patient-centered plan of care.
d. diagnosis-related group (DRG).

ANS: B
A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis, procedure, or health condition.
A classification system categorizes patients according to specific criteria and care requirements and thus helps to quantify the amount and level of nursing care needed.
Patient centered, as used in this chapter, refers to a nursing care delivery model that is focused on interprofessional care, with the patient as the focus.
A DRG places patients into a predetermined reimbursement rate on the basis of diagnosis.

DIF: Application REF: Pages 437-438

8. The nurse manager determines that four RNs, five LPN/LVNs, and two nursing assistive personnel (NAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with:
a. assignments.
b. staffing.
c. output.
d. productivity.

ANS: B
Staffing is the activity that is involved in determining that an adequate number and mix of health care team members are available to provide safe, quality patient care.
Assignment is the distribution of work that each staff member is responsible for during a given work period; assigned activities must fall within the individual’s scope of practice and/or job description.
Output is the work produced, such as the number of patient care hours provided.
Productivity is the ratio of the amount of output produced, such as patients receiving care or home visits, to the specific amount of input (i.e., nursing hours worked) and is the measure of staffing efficiency.

DIF: Application REF: Page 427

9. A nurse manager is mentoring an inexperienced manager in determining staffing needs. The mentor explains, “We must determine the acuity level of the patient by:
a. assessing patient satisfaction with nursing care.”
b. quantifying the amount and intensity of care required.”
c. examining the skill mix and educational preparation of the staff.”
d. determining the number of hospital days required by the patients.”

ANS: B
Patient acuity is measured by determining the amount and intensity of care required.
Patient satisfaction is based on interactions or experiences while the patient is receiving care, although staffing can affect patient satisfaction.
Examination of the skill mix and educational preparation of the staff is the criterion for delegation of care.
The number of hospital days required by the patient is a criterion that is used on care pathways to predict required resources.

DIF: Comprehension REF: Page 427

10. The nurse manager is planning staffing levels and realizes that the first step is to:
a. know the intensity of care needed by patients according to physical and psychosocial factors.
b. examine the educational level of the staff.
c. assess the skill level of caregivers.
d. review the budget to determine the financial consequences of past staffing patterns.

ANS: A
The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients.
Educational level requirements must be matched to patients’ acuity levels.
Assessing the skill level of staff is necessary to match staff with patients according to patients’ acuity level.
Past staffing patterns cannot predict the needs of the current population.

DIF: Application REF: Page 427

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. prioritizes participatory management into staffing decisions.
d. uses “float” nurses to cover vacancies.

ANS: C
Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction.
The use of temporary, part-time, or agency nurses can result in a lack of continuity of care, thereby decreasing patient satisfaction, which affects employee satisfaction.
Hiring more part-time employees and the use of “float” nurses have not been demonstrated to be effective methods of increasing nurse retention.
Hiring more part-time employees and the use of “float” nurses have not been demonstrated to be effective methods of increasing nurse retention.

DIF: Comprehension REF: Page 428

12. A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery?
a. Modular
b. Primary
c. Team
d. Functional

ANS: B
The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient’s care from admission through discharge but may delegate or provide primary care during the shift when present.
In modular care delivery, a small team is assigned to a geographic location during their assigned shift.
In team nursing the RN directs members of the team who are providing care but does not assume 24-hour responsibility.
Functional nursing focuses on completion of tasks rather than on specific patients.

DIF: Application REF: Page 433

13. When deciding which staffing option to use on a nursing unit that will open soon, the manager realizes that:
a. continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on 3 consecutive days per week.
b. the use of part-time nurses provides the variability needed to meet diverse patient needs.
c. satisfaction of the staff equates to satisfaction of patients.
d. nurses provide the same level of care, regardless of the work environment.

ANS: C
High nurse satisfaction is generally equated with higher patient satisfaction and improved patient outcomes.
Errors increase with long shifts over consecutive days.
The use of part-time nurses may result in decreased patient satisfaction and lack of continuity of care.
Research has found that nurses who practice in positive and autonomous work environments provide cost-effective care of better quality.

DIF: Application REF: Pages 428-429

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) Safe Staffing Saves Lives 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 quality care.
b. Staffing should allow time for the RN to apply the nursing process so decisions result in quality safe patient outcomes.
c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix.
d. RN staffing is not cost effective, thus is it important for staffing models to limit the number of RNs assigned per shift.

ANS: B
The ANA recommends that nurses have time to exercise professional judgment.
Patient needs constantly change and staffing adjustments may be necessary.
As patient acuity levels increase, the need for RN coverage increases.
RNs have shown to be cost-effective and increase the value of care because of their contributions to improving patient outcomes.

DIF: Analysis REF: Page 427

15. A nursing unit is comparing team nursing to the partnership model and found:
a. with the partnership model, an RN does not have to be part of the mix.
b. leadership abilities of the RN is a major determinant of effectiveness of care for both models.
c. the RN teaches the LPN/LVN or nursing assistive personnel (NAP) how to apply the nursing process in team nursing.
d. with team nursing the RN cares for the patient while the team members work with the family or significant others.

ANS: B
The RN leads regardless of whether partnership model or team nursing is practiced.
An RN is the leader of the pair.
Applying the nursing process is not an appropriate role for the LPN/LVN or NAP.
The team is led by an RN, and the team provides those tasks that are not required by the RN; however, team members can also be additional RNs but they are not in a leader role.

DIF: Application REF: Pages 432, 434

MULTIPLE RESPONSE

1. While participating in a task force to proactively plan for nursing care delivery over the next 20 years, 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
Invasive surgical procedures are being replaced by laparoscopic procedures.
The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population.
Care will focus on the unique lifestyle and values of a diverse population.
Patients are discharged much more quickly and with more complex care needs, rather than having a longer stay in acute care settings.
Consumers, especially the aging baby-boomer generation, are proactive about learning and participating in health care.
Nursing is increasingly valued and has been shown to improve patient outcomes and patients’ satisfaction with care.

DIF: Application REF: Page 440

2. Which factors would be considered in the first steps of developing an effective patient classification system? (Select all that apply.)
a. Planned procedures
b. Ethnic diversity of patients
c. Clinical competency of staff
d. Educational level of nurses
e. Age of patients

ANS: A, B, E
The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements.
The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements.
The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements.

The second step is to match the skill level of staff with the care needs of patients.
The educational level of nurses is part of the second step and involves matching the educational preparation of staff with the care needs of patients.

DIF: Comprehension REF: Page 428

Cherry: Contemporary Nursing, 5th Edition

Chapter 21: Quality Improvement and Patient Safety

Test Bank

MULTIPLE CHOICE

1. A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is called a:
a. deployment flowchart.
b. top-down flowchart.
c. Pareto chart.
d. control plot.

ANS: B
A top-down flowchart shows the sequence of steps in a job or process such as medication administration.
A deployment flowchart shows the detailed steps involved in a process and the people or departments that are involved at each step in the process; this is not involved in this scenario.
The Pareto chart is used in quality improvement to indicate that 80% of problems usually stem from 20% of causes; it displays data so that a few problems are easily depicted and facilitates improvement that focuses on those few.
A control plot is a run chart that has a center-line and added statistical control limits; it helps reveal specific types of change within a process, rather than providing a sequencing of steps.

DIF: Application REF: Page 452

2. A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the:
a. Institute for Safe Medication Practices.
b. Institute of Medicine.
c. National Committee for Quality Assurance.
d. The Joint Commission.

ANS: B
The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health.
The Institute for Safe Medication Practices is a nonprofit organization that is an educational resource only for the prevention of medication errors.
The National Committee for Quality Assurance is the accrediting body for health maintenance organizations.
The Joint Commission is a national agency that conducts surveys and certifies compliance with established standards for inpatient and ambulatory facilities.

DIF: Comprehension REF: Page 443

3. A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified as a:
a. root cause.
b. sentinel event.
c. variation in performance.
d. causal factor.

ANS: B
The accident is an unexpected occurrence that could result in serious physical or psychologic injury to the patient, including the possibility of returning to surgery and a prolonged length of stay.
A root cause analysis is the process by which basic or causal factors that underlie variation in performance, such as a sentinel event, are identified, but this process is not the event itself.
A variation results from the lack of perfect uniformity in the performance of any process, but when the variation is this serious, it is referred to as a sentinel event.
Causal factors are the underlying causes of the event, not the actual event.

DIF: Application REF: Pages 444, 457-458

4. A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are performing a(n):
a. standardization of care.
b. root cause analysis.
c. process variation.
d. analysis of a deployment flowchart.

ANS: B
A root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences.
Standardization of care is the process of developing and adhering to best known methods and repeating key tasks in the same way, thereby creating exceptional service with maximum efficiency.
Process variation looks at the steps in a process to determine how variation affects each step but does not identify causal events.
A deployment flowchart analysis looks at the steps of a process and determines which department is responsible for each step, but it does not identify causal events.

DIF: Application REF: Pages 444, 458

5. Each month data on admission assessments that are based on the following standard are entered: “All patients will be assessed by an RN within 2 hours of admission.” The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is a:
a. Pareto chart.
b. control chart.
c. deployment chart.
d. top-down flowchart.

ANS: B
The control chart is a run chart that has a center-line and added statistical control limits that help to detect specific types of change needed to improve a process.
The Pareto chart is used in quality improvement to identify that 80% of problems usually stem from 20% of causes; it displays data so that a few problems are easily depicted and facilitates improvement that focuses on those few.
A deployment flowchart shows the detailed steps involved in a process and the people or departments that are involved at each step.
A top-down flowchart shows the sequence of steps in a job or process such as medication administration at a particular site, but it does not show variation limits.

DIF: Application REF: Pages 453-454

6. Regardless of the term used to describe quality health care, the focus of quality is:
a. what the consumer needs and wants.
b. economical care.
c. having the greatest technologic advancement.
d. services equally distributed among populations.

ANS: A
The customer determines quality on the basis of his or her unique perception of quality care.
Quality health care can be inexpensive, but if it does not meet the criteria established by the consumer, then it is not quality health care.
Although technologic advancements may indeed facilitate superior diagnostics, unless the patient perceives that the technology was an indicator of quality or that it improved quality, then it is not the focus.
The perception of quality is unique among individuals.

DIF: Knowledge REF: Page 447

7. A patient was admitted to the outpatient surgery unit for a urinary stent placement. The patient was cheerfully greeted, paperwork was promptly completed by the admission clerk, an intravenous (IV) line was quickly inserted, and preoperative medications were administered in a timely manner. The procedure was completed as planned with no complications. The patient rated the experience as poor because when discharged, the hospital transporter refused to place the patient’s bag in the trunk of the car and stated, “It is not my job to pack your personal items.” Which aspect of Joiner’s triangle was applied?
a. Quality
b. Scientific approach
c. Administrative support
d. Economics

ANS: A
The customer defines quality from his or her perspective, and the entire stay is tainted by this single bad experience.
The scientific approach is the way in which changes are made to achieve quality; decisions are based on sound, valid data, and those who manage the processes have a clear understanding of the nature of variation in processes.
Administrative support is important for any quality improvement initiative to be successful, but it is not one of the legs of Joiner’s triangle.
Financial influences did not affect the consumer’s perception of quality in this case.

DIF: Application REF: Page 447

8. In differentiating between early efforts of quality assurance and present-day quality improvement efforts, which statement is correct? Quality assurance:
a. had a broad focus.
b. promoted problem solving by all members of the health care team.
c. was preventive in nature.
d. tended to occur as a reaction to a specific problem.

ANS: D
Early efforts focused on identified problems and were reactive rather than proactive.
Quality assurance focused on specific incidents rather than on broad system improvements.
With quality assurance, only a few people such as auditors focused on problems, and administration only later recognized the importance of proactive initiatives involving all members of the health care team.
Early efforts of quality assurance focused on identified problems rather than on avoiding future problems.

DIF: Application REF: Pages 449-450

9. An organization’s emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to as a(n):
a. Pareto chart.
b. control chart.
c. top-down flowchart.
d. deployment chart.

ANS: D
A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety.
The Pareto chart displays data so that a few problems that cause the greatest variance are easily depicted and facilitates improvement that focuses on those few.
A control chart distinguishes between common and special cause variations and is basically a run chart with added statistical control limits.
The top-down flowchart simply lists the main steps and substeps of a process in a linear fashion and does not detail the departments or people needed.

DIF: Application REF: Pages 452-453

10. Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of “road map” that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to as a(n):
a. benchmark.
b. critical pathway.
c. algorithm.
d. case management.

ANS: B
A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis.
A benchmark is a process used in quality improvement to evaluate different aspects of a process in relation to best practices, with the goal of improving performance.
An algorithm represents a decision path that a practitioner might take for a particular condition.
Case management is a type of health care delivery that matches the most appropriate services to the patient’s care needs in the most efficient, effective manner, often with the use of a critical pathway or a clinical guideline.

DIF: Knowledge REF: Pages 455-456

11. The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph?
a. Time plot
b. Pareto chart
c. Flowchart
d. Cause-and-effect diagram

ANS: A
A run plot or time plot graphs data in time order to identify any changes that occur over time.
A Pareto chart is used in quality improvement to display data so that a few problems that cause the greatest variance are easily depicted and facilitates improvement that focuses on those few.
A flowchart provides pictures of the sequence of steps in a process.
A cause-and-effect diagram lists potential causes, arranged by categories to show their potential impact on a problem, and is not arranged by time.

DIF: Application REF: Page 453

12. A group of nurses is presenting the importance of quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that:
a. being insured has little effect on a person’s longevity and the quality of care received.
b. lobbyists for the drug companies are able to gain permission for the use of new drugs within 1 year of their discovery.
c. although a greater number of lawsuits stem from medication errors, more people actually die from human immunodeficiency virus (HIV) and acquired immunodeficiency disease syndrome (AIDS).
d. medication-related errors place a tremendous financial burden on the U.S. health care system.

ANS: D
Medication-related errors for hospitalized patients cost roughly $2 billion annually.
Uninsured Americans exhibit consistently worse clinical outcomes than the insured, and they are at increased risk for dying prematurely.
The lag between the discovery of more effective forms of treatment and their incorporation into routine patient care averages 17 years.
Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents.

DIF: Comprehension REF: Page 446

13. According to the Quality Chasm report:
a. health care providers should be proactive rather than reactive to patient needs.
b. common needs rather than individual preferences should be the priority.
c. medical information should be confined to the primary care provider.
d. specialized providers or case managers should control health care decisions.

ANS: A
Quality is based on predicting patient needs rather than reacting to needs.
Care that is based on individual needs and preferences predicts satisfaction with care.
Providers and the patient should have access to information so they can make well-informed decisions.
The patient, not the providers/managers, should have control over health care decision making.

DIF: Comprehension REF: Page 447

14. During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter’s wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation?
a. Failure to take time to put on shoes due to urgency
b. Unsteady gait due to narcotic administration
c. Poor lighting that led to decreased vision
d. Improper construction that caused the leak and towel placement

ANS: D
A special cause variation is an uncommon variation that is unstable and unpredictable, is not under statistical control, and is related to a clearly identified single source, which in this scenario is the construction project.
Urinary urgency is not an uncommon or unpredictable variation.
Safety measures should be instituted when a narcotic is administered, especially to older adult patients whose ability to metabolize and eliminate the drug may be altered.
Lighting was available, but it was not used.

DIF: Application REF: Pages 448-449

15. The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include inconsistent methods of cleaning the site, dressing frequently becomes wet when patient showers, IV tubing not changed every 48 hours per protocol, and inadequate handwashing of RN prior to insertion. A bar graph demonstrates the frequency in descending order with 80% of infections being attributed to inadequate handwashing. The quality tool used is a:
a. cause-and-effect diagram.
b. run chart.
c. Pareto chart.
d. flowchart.

ANS: C
Pareto charts are bar graphs that show causes contributing to a problem in descending order so leading cause is easily recognized.
With the cause-and-effect diagram, all causes are listed but not in frequency of occurrence
Run charts show data over time.
Flowcharts show steps in a process.

DIF: Application REF: Pages 444, 452, 454

COMPLETION

1. A group of nurses brainstorm about why patients are not being discharged by 2 PM. Failure to discharge on time has led to decreased patient satisfaction, physician complaints, and a backlog of patients in the emergency department awaiting a hospital bed. The nurses list possible cause of delayed charges on the graph below. The nurses utilized which quality improvement tool?

___________________________.

ANS:
Cause-and-effect diagram
A cause-and-effect diagram is a quality improvement tool used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a “fish-bone” diagram because it looks like the skeleton of a fish.

DIF: Application REF: Pages 443, 452, 454

2. Quality is defined by the ____________________.

ANS:
patient
customer
Quality is based on the perspective of the consumer or, in this instance, the patient.

DIF: Knowledge REF: Page 447

Cherry: Contemporary Nursing, 5th Edition

Chapter 22: Quality and Safety Education in Nursing (QSEN)

Test Bank

MULTIPLE CHOICE

1. “Ninety-five percent of all patients presenting to the emergency department with chest pain will receive aspirin 80 mg within 15 minutes of arrival unless contraindicated.” Top hospital emergency departments use this standard to eliminated sudden death related to chest pain. Hospitals desiring to replicate these results establish compliance rates known as:
a. competencies.
b. benchmarks.
c. driving force.
d. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS).

ANS: B
A benchmark is a standard for other providers or institutions to replicate.
A competency is the ability to practice safely based on knowledge, skills, and attitudes for a certain role.
Driving forces promote change and in this example may be a desire to be a magnet hospital or simply to be recognized as a safe place to receive care.
TeamSTEPPS is a team training and communication approach that enhances patient safety.

DIF: Application REF: Page 465

2. Which of the following occurrences would be classified as a sentinel event?
a. A postpartum patient who elects to breastfeed only twice daily develops mastitis.
b. A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather than the upper thigh as instructed by the patient educator.
c. A nurse assisting with the delivery of twins places the “Twin 1” name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin.
d. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin subcutaneously that resulted in a drop in the patient’s serum glucose from 160 to 100 mg while retaining stable vital signs.

ANS: C
Any procedure performed on a wrong person or organ constitutes a sentinel event.
The infection was not due to negligence of provider.
The patient chose the site and, although not the one indicated by the nurse, it was an appropriate site.
Although a medication error occurred, the death or permanent loss of function did not occur.

DIF: Application REF: Page 465

3. A patient is ordered a low-protein, low-calorie diet but the patient’s family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. This situation would represent:
a. a sentinel event.
b. an adverse event.
c. patient-centered care.
d. the communication technique of “call-out.”

ANS: C
The nurse and dietitian are respecting patient values, preferences, and expressed needs.
Death or permanent loss of function did not occur.
No injury occurred due to medical care.
“Call out” occurs during critical situations so all members anticipate next steps in care.

DIF: Application REF: Page 468

4. During resuscitation efforts, a provider states, “I need to give a 1.5 mg/kg bolus of lidocaine because the patient is in ventricular tachycardia.” The nurse responds, “I have a lidocaine bolus equal to 1.5 mg/kg.” This communication model is known as:
a. situation background assessment recommendation (SBAR).
b. check-back.
c. hand-off check.
d. critical-language.

ANS: B
SBAR shares information during patient hand-offs.
Check-back is the process of repeating what was heard.
No checklist was used and no hand-off or transfer of care is occurring.
No problem was identified and the language would have included terms such as “I need some clarity.”

DIF: Application REF: Page 471, Box 22-1

5. Following a complicated surgery, a patient who was received in the recovery room suddenly loses consciousness and become unstable. The nurse that arrives at the scene performs assessments and makes the following comments, “The patient is nonresponsive to verbal stimuli,” “The patient is not initiating any spontaneous respiration,” and “I am unable to palpate a femoral pulse,” and other members of the health care team react to the comments. The team is using the mental model for communication known as:
a. critical language.
b. call-out.
c. check-back.
d. hand-off.

ANS: B
The nurse is providing critical information so the team can anticipate what is needed next for the patient.
There is no indication to stop and there was no evidence of language such as “I am concerned” to indicate a concern.
Members of the team were not repeating what was heard.
The patient is not being transferred to another unit or provider at this time.

DIF: Application REF: Page 471, Box 22-1

6. When planning a program to reduce the number of sentinel events in an organization, the program planner should focus on the leading cause of sentinel events, which is related to a problem with:
a. leadership or management.
b. staffing patterns.
c. environmental safety.
d. communication.

ANS: D
Approximately 65% of sentinel events are related to failed communication or problems with communication.
More than 10% but less than 20% are related to problems with leadership.
More than 20% but less than 30% are related to problems with staffing.
Less than 20% are related to environmental safety.

DIF: Comprehension REF: Pages 469, 470, Figure 22-1

7. Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on their area of expertise but also recognize other members’ strengths. Which of the QSEN competencies are being demonstrated?
a. Quality improvement
b. Evidence-based practice
c. Teamwork and collaboration
d. Patient-centered care

ANS: C
An interdisciplinary team is working to prevent hand-off errors on discharge.
The focus is on the functioning and coordination of team efforts to support care of the patient across the continuum rather than on data and improvement methods, although a well-functioning team does contribute to quality care.
Best practices” based on current evidence are not the focus.
This scenario is not considering patient preferences or incorporating the family into care.

DIF: Application REF: Page 469

8. Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct?
a. Each competency is mutually exclusive.
b. The competencies focus on individual efforts to reduce errors.
c. Physicians lead the team to achieve each competency.
d. The competencies address both individual and system approaches to transform care.

ANS: D
Errors and cost of health care result from both health care workers and the system in which they deliver care.
Each concept overlaps, and what affects one competency often impacts other competencies.
Competencies focus on team efforts as well as individual members of the team.
Nurses have key roles in transforming health care through the IOM competencies.

DIF: Application REF: Pages 466-467

9. Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies?
a. Patient-centered care
b. Informatics
c. Teamwork
d. Quality improvement

ANS: B
Technology (PDA) is used to aid decision making and reduce errors.
Patient-centered care considers values and diversity of patients and their families.
The emphasis is on the use of technology to ensure quality care.
The use of technology does continue to improve quality but not analyze data or processes for improvement.

DIF: Application REF: Page 474

10. A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency?
a. Safety
b. Timely
c. Equitable
d. Patient-centered care.

ANS: A
Standardization contributes to safety and improves individual performance of care providers.
The focus of the team was on standardization rather than timeliness and timeliness is not an IOM competency.
The focus is not on providing care that is impartial and equitable is not an IOM competency.
The focus is on safety rather than cultural or patient preferences.

DIF: Application REF: Page 473

11. During team rounds, a member states, “Ms. Jones has a positive tuberculin skin test and is scheduled for sputum cultures.” The nurse notices that the antibiotic infusing has the wrong patient name and the patient is allergic to this particular medication. The nurse tells the team, “I need some clarity” to alert the team:
a. that they have breached patient confidentiality.
b. the patient is not aware of the diagnosis of tuberculosis.
c. that the patient is contagious.
d. that there is a safety concern.

ANS: D
The phrase “I need some clarity” is used to alert the team that there is a problem.
All members are involved in patient care and privileged to patient information.
The phrase “I need some clarity” is not used to alert the team to a lack of knowledge by the patient.
The phrase “I need some clarity” is not used to indicate the risk of contracting a contagious disease.

DIF: Application REF: Page 471, Box 22-1

12. The ability to clearly demonstrate the knowledge, skills, attitudes, and professional judgment required to practice safely and ethically in a designated role and setting is termed:
a. human factors.
b. competency.
c. evidence-based practice.
d. workarounds

ANS: B
Competency is having the skill set to provide safe care within the scope of practice and context.
Human factors is the cognitive ability and social influences that affect practices.
Evidence-based practice is the use of scientific information to inform practice.
Workarounds are nonstandard work processes used by nurses and other healthcare professionals when standard work is blocked by dysfunctional processes such as unavailability of supplies or lack of information.

DIF: Knowledge REF: Page 465

MULTIPLE RESPONSE

1. A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals which include: (Select all that apply.)
a. advanced health assessment techniques.
b. patient-centered care.
c. prescriptive pharmacology content.
d. quality improvement.
e. safety.

ANS: B, D, E
Patient-centered care is a recommended competency, along with teamwork and collaboration, evidence-based practice, and informatics.
Quality improvement is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics.
Safety is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics.
Although it is important to know correct health assessment skills, advanced techniques are not an IOM competency.
Although a comprehensive pharmacology foundation is needed to administer and evaluate pharmacologic treatments, the IOM does not address prescriptive content.

DIF: Comprehension REF: Page 466

2. What are some of the driving forces for change to improve the quality and safety competencies for nursing in the United States? (Select all that apply.)
a. The U.S. health care system is one of the world’s least technically advanced systems.
b. Health care has led other industries in establishing quality and safety standards.
c. System failures occur regularly.
d. The U.S. public has confidence in its system to reduce morbidity and mortality rates.
e. Outcomes are unpredictable and costly.

ANS: C, E
Although the U.S. system has the advantage of technologic advancement, system errors are not unusual.
Outcomes of care fail to follow predicted outcomes, resulting in extended stays and increased death and illness.
The U.S. health care system is one of the world’s most technically advanced systems.
Aviation, business, and nuclear power industries have outpaced health care in setting and achieving quality and safety standards.
The public has increased knowledge about morbidity and mortality related to health care errors resulting in a loss of confidence in the U.S. health care system.

DIF: Comprehension REF: Page 466

COMPLETION

1. While taking a shower, a patient pushes the emergency light. When the nurse arrives the patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient’s walker and the patient falls, hitting the right side of the face resulting in loss of vision in the right eye. This scenario represents a _______ event.

ANS:
sentinel
A sentinel event is an occurrence that results in death or serious illness and requires immediate investigation

DIF: Application REF: Page 465

Cherry: Contemporary Nursing, 5th Edition

Chapter 23: Health Policy and Politics: Get Involved!

Test Bank

MULTIPLE CHOICE

1. A bill is pending in the state legislature that will mandate teaching health promotion related to smoking cessation. Which action by the nurse should have the greatest impact on passage of the bill?
a. Explain the rationale for the bill to the school board.
b. Contact the elected representative’s office by phone to request support for the bill.
c. Support a health advocate to run for election as state representative.
d. Tell all students about the bill.

ANS: B
Telephone calls are an effective means of communicating your support for a bill; ask to speak to the staff person assigned to the bill or issue for which the call is being made. After introducing yourself, give a brief and simple message such as, “Please tell Senator/Representative [name] that I support [bill number].”
The school board may have some interest in information about the bill, but they may or may not support the bill; the nurse will have a greater effect on passage of the bill if she directly phones the elected representative’s office.
The nurse is concerned with passing the bill now rather than later, after an election is held.
The nurse needs to communicate directly with the representative’s office to support the bill rather than just telling the students; however, telling peers and students about the bill might encourage them to call the representative to express their support.

DIF: Application REF: Pages 490-491

2. Time is becoming crucial for the nurse to address issues related to sponsoring programs to include hearing aid costs as part of Medicare coverage. The nurse involved in grassroots political actions realizes that the least timely mode by which to reach elected officials would be via:
a. letter.
b. telephone.
c. e-mail.
d. facsimile (fax).

ANS: A
Sending letters is the least timely mode by which to communicate with elected officials; because of the anthrax decontamination process that is now in place, delivery of U.S. mail to Congress and to the White House may be delayed by as long as 3 months, making letters an inefficient means of communicating with policymakers.
Phone calls are an effective means of getting your message to an elected official because they usually have a staff person who takes phone calls.
E-mail is an effective way to communicate with elected officials; e-mailed and faxed messages are some of the best ways to make sure your voice is heard in time to make a difference.
Contacting officials by fax is an effective way to communicate with elected officials; e-mailed and faxed messages are some of the best ways to make sure your voice is heard in time to make a difference.

DIF: Application REF: Page 490

3. A nurse would like to advocate for increased protective services and reporting mechanisms for elder abuse and attends the “meet the candidate” session at the town hall meeting. This is an important time for the nurse to:
a. educate the public about the nurse’s political platform.
b. be spontaneous and not deliver a rehearsed speech.
c. address the person as “candidate” rather than using a first name that implies a working relationship.
d. learn what the key issues are in the candidate’s platform.

ANS: D
Town hall gatherings with nurses allow the candidate to talk about his or her platform to a group of interested voters and afford nurses an opportunity to understand the candidate’s vision and to voice their opinions and concerns about health care issues.

Educating the public about the nurse’s political platform is an ineffective strategy in advocating for a new health policy.
Being spontaneous and not delivering a rehearsed speech is an ineffective strategy in advocating for a new health policy.
Addressing the person as “candidate” rather than a first name is an ineffective strategy in advocating for a new health policy.

DIF: Application REF: Pages 489-490

4. A nurse would like to obtain background information and learn the political platform of a candidate who is running for national office. The nurse should contact the:
a. National Registry for Candidates.
b. American Nurses Association Nurses Strategic Action Team (N-STAT).
c. National League of Nurses.
d. National Council of State Boards of Nursing.

ANS: B
Through legislative updates, N-STAT keeps members up to date about background information and the platforms of candidates who are running for national office; N-STAT also provides updates about key bills as they move through the legislative process.
There is no National Registry for Candidates.
The National League of Nurses does not have a political arm for gathering background information and political platform details of candidates.
National Council of State Boards of Nursing does not have a political arm for gathering background information and political platform details of candidates.

DIF: Application REF: Page 492

5. Political action committees (PACs) are established for the purpose of:
a. financially supporting candidates.
b. persuading policymakers to support certain policies.
c. lobbying legislators.
d. recommending health care policy.

ANS: B
A PAC is an arm of an organization, association, or labor union that is formed to persuade a policy maker to support a certain policy or program or, more often, to ensure the election or re-election of policy makers who support the organization’s goals.
The purposes of a PAC are to persuade policymakers to support certain policies and to support the election or reelection of policymakers who support the organization’s goals, even though it may be misconstrued that the PAC provides financial support, lobbying, and recommendations regarding specific legislation.
The purposes of a PAC are to persuade policymakers to support certain policies and to support the election or reelection of policymakers who support the organization’s goals, even though it may be misconstrued that the PAC provides financial support, lobbying, and recommendations regarding specific legislation.
The purposes of a PAC are to persuade policymakers to support certain policies and to support the election or reelection of policymakers who support the organization’s goals, even though it may be misconstrued that the PAC provides financial support, lobbying, and recommendations regarding specific legislation.

DIF: Comprehension REF: Page 489

6. When the policy process is compared with the nursing process, identifying the issue is consistent with which step of the nursing process?
a. Assessment
b. Diagnosis
c. Planning
d. Implementation

ANS: B
The diagnosis step in the nursing process is consistent with identification of the targeted issue in the political process. As politically active nurses soon discover, effective involvement in policy development and political activities requires efforts similar to those used in the nursing process. The policy process and the nursing process are systematic approaches that use the nursing process for decision making.
The assessment step would involve collecting information and understanding the information collected prior to actual identification of the issue.
Planning occurs after the information has been collected and the issue has been identified; generally, an effective policy plan involves input from many sources and perspectives.
Implementation occurs after an issue has been identified and a plan has been developed; this plan is then implemented through political action and a set of strategies.

DIF: Application REF: Page 486

7. It is important for nurses to know the functions of the branches of the federal government. At a local meeting of the state nurses’ association, an officer reminds members that the branch that is capable of originating major policy initiatives is the:
a. executive branch.
b. legislative branch.
c. judicial branch.
d. administrative branch.

ANS: B
The legislative branch possesses the sole federal power to enact legislation; the legislative branch originates and promotes major policy initiatives and has the power to override a presidential veto.
The role of the executive branch is to recommend legislation and promote (but not originate) major policy initiatives; the executive branch also implements laws, manages programs after they have been passed by Congress, writes regulations that interpret statutes (laws), and has the power to veto legislation passed by Congress.
The role of the judicial branch is to interpret the Constitution and the various laws that are passed and regulations that are established to ensure that they are not in violation of the Constitution.
The federal government does not have an administrative branch; the three branches of the federal government are the legislative, executive, and judicial branches.

DIF: Application REF: Page 482, Table 23-2

8. When a bill is presented to Congress, the subcommittee may choose to “mark up” the bill, meaning to:
a. obtain oral testimony about the bill from the executive branch.
b. conduct additional hearings about the bill.
c. amend the bill before recommending it to the full committee.
d. have the full committee vote on recommendations.

ANS: C
“Marking up” occurs in step 4 of the legislative process, when the subcommittee can make changes or amendments before recommending the bill to the full committee. The bill dies if the subcommittee does not refer the bill to the full committee.
Step 3 in the legislative process, not “marking up,” provides an opportunity to obtain written or oral testimony about the bill from the executive branch, experts in a related area, and supporters and opponents of the bill.
Additional hearings are not related to “marking up” of the bill; conducting additional hearings occurs in step 5 of the legislative process.
Full committee votes on recommendations is part of step 5, in which the full committee votes on recommendations to the House or Senate, a procedure known as “ordering a bill reported.”

DIF: Analysis REF: Page 483

9. To ensure that new laws are implemented as proposed, nurses must realize that:
a. regulations must be enacted exactly as intended by the U.S. Department of Health and Human Services (DHHS).
b. hearings to discuss the new laws and regulations are closed to the public, and only lobbyists are invited to attend.
c. proposed regulations are published and are open to public comment for a time before they are formally adopted.
d. final published regulations only suggest how the law will be implemented.

ANS: C
As regulations are being developed by the government agency, public hearings are held to allow individuals to comment on the content of the regulations. Once the proposed regulations have been developed, they must be published and remain open to public comment for a specified length of time before they are adopted.
After a bill is passed by Congress, it is referred to an administrative agency under the executive branch for writing of regulations; although most health-related policies fall under the jurisdiction of the DHHS, this might not always be the case. More importantly, implementation of the new legislation can often vary from what was originally intended when Congress debated and passed the bill, depending on how the regulations are written.
Hearings are open to the public.
Final published regulations carry the force of the law and dictate how the law will actually be implemented.

DIF: Analysis REF: Page 485

10. A concerned nursing student calls the office of an elected official to voice support for the bill to ban smoking in all public places. The secretary asks, “Are you a constituent?” What does the term constituent mean?
a. A member of a professional organization who supports the organization’s political issue
b. A citizen who is registered and is eligible to vote for a representative
c. An elected official who proposes legislation to be considered as a potential law
d. A member of the House of Representatives who is seeking support for a particular bill

ANS: B
A constituent is a citizen who has the opportunity to vote for candidates in elections for representation at local, state, and federal government levels.
A member of a professional organization who supports the organization’s political issue does not meet the definition of a constituent, which is a citizen who is registered and eligible to vote for a representative.
An elected official who proposes legislation to be considered as a potential law does not meet the definition of a constituent, which is a citizen who is registered and eligible to vote for a representative.
A member of the House of Representatives who is seeking support for a particular bill does not meet the definition of a constituent, which is a citizen who is registered and eligible to vote for a representative.

DIF: Knowledge REF: Page 478

11. A person who is covered by Medicaid moves from one state to another and asks the nurse at the health department why the benefits changed. The correct response by the nurse is:
a. “Local government controls which benefits each county can provide to Medicaid recipients.”
b. “The federal government does not fund any part of Medicaid, so each state must find ways to pay for benefits.”
c. “Each state determines benefits on the basis of the present economy.”
d. “Medicaid is funded by both state and federal governments, but benefits vary from state to state.”

ANS: D
Medicaid is a program that is funded through a combination of state and federal funds; thus benefits vary from state to state.
Local governments do not establish rules related to Medicaid; this occurs at the state level.
Medicaid is funded through a combination of state and federal funds.
The state of the economy might be only one of many issues that states consider when determining Medicaid benefits.

DIF: Analysis REF: Page 480

12. Throughout the history of health care in our nation, one particular piece of federal legislation provided funds for hospital construction. As the number of hospitals rapidly increased, the need for nurses to staff hospitals also increased, and the shift from community-based nursing care to hospital-based nursing care began. This fundamental piece of legislation was the:
a. Sheppard-Towner Act.
b. Hill-Burton Act.
c. Veterans Bill.
d. Access to Health Care Bill.

ANS: B
The Hill-Burton Act, also known as the Hospital Survey and Construction Act, was enacted in 1950. This act provided funding that resulted in a boom in the construction of hospitals across the country. As the number of hospitals increased rapidly, so did the need for nurses to staff the hospitals. Thus the nurse’s role was shifted from community and public health settings to the acute care setting.
The Sheppard-Towner Act of 1921 was the first federal policy that provided funding for nursing services and established prenatal and child health centers staffed by public health nurses, with the goal of reducing maternal and infant mortality rates by teaching women about personal hygiene and infant care.
“Veterans Bill” is an invented term and not the name of any bill passed by Congress.
“Access to Health Care Bill” is an invented term and not the name of any bill passed by Congress.

DIF: Comprehension REF: Page 480

13. Nurses in a nonunionized health care facility are concerned about patient safety because of the requirement for nurses to work overtime. Which organization can address the needs of these nurses?
a. United American Nurses
b. Center for American Nurses
c. Occupational Safety and Health Administration (OSHA)
d. American Association for Mandatory Overtime

ANS: B
CAN, established in 2003, addresses the needs of individual nurses who are not represented by labor unions by offering tools, services, and strategies designed to make nurses their own best advocates in their practice environments.
UAN is the labor union for nurses that represents 104,000 RNs nationwide and is a full-fledged affiliate of both the American Nurses Association and the American Federation of Labor-Congress of Industrial Organizations (AFL-CIO).
OSHA is a U.S. government agency that sets and enforces standards related to safety in the workplace; however, this agency does not address mandatory overtime requirements.
The American Association for Mandatory Overtime does not exist.

DIF: Application REF: Page 491

14. Members of a state’s constituent member association meet at a local restaurant to plan a Nurse Walk to support the local food bank. When entering the restaurant, the nurses note the environmental inspection report shows deficiencies because food handlers were not wearing hairnets and rodents were spotted, resulting in a score of 60 out of 100. This certificate of inspection is health policy enforced at which level of government?
a. Local
b. State
c. Federal
d. International

ANS: B
Health policy at the state level is responsible for ensuring food safety in restaurants.
Local policies vary to meet specific needs of residents such as costs of immunization based on income.
Federal policy focuses on funding for research and health professional education. “International” is not a level of government.

DIF: Application REF: Page 480

MULTIPLE RESPONSE

1. A nurse is concerned about older persons living alone at home without telephone service to contact emergency services. The nurse is advised to take part in grassroot efforts to address the situation. The nurse would: (Select all that apply.)
a. Post signs to support the county’s political candidates whose platform support services for poor and underserved person such as older adults.
b. Visit with local politicians running for office and ask specific questions such as “Would you support providing free emergency phone service for older adults living alone?”
c. Limit voting to only presidential elections in which the President promises to initiate health care reform related to Medicare for older adults.
d. Join the American Nurses Association and constituent member association.
e. Contact representatives from surrounding states to garner support for free medical alert systems for older adults.

ANS: A, B, D
Working in local political campaigns are effective grassroots efforts.
Visiting, emailing, calling, and faxing local politicians to support free emergency telephone service for older adults is a grassroots tactic.
Joining ANA and state nursing associations supports lobbying and individual nurses can influence the issues that nursing associations support.
Grassroots efforts require the nurse to vote in all elections.
Grassroots efforts are at the local level.

DIF: Application REF: Pages 488-491

COMPLETION

1. A nurse who is interested in graduate school wants to learn about recently passed legislation regarding changes in Medicare reimbursement for care provided by clinical nurse specialists. The best source for information on changes in federal programs is the ____________________.

ANS:
Federal Register
The Federal Register is the best source of information about proposed rules and regulations for newly enacted legislation and about changes to existing rules for federal programs (www.fr.cos.com).

DIF: Knowledge REF: Page 485

2. The greatest barrier to access to health care for a poor Hispanic person living in downtown Chicago is ____________________.

ANS:
lack of health insurance
Lack of health insurance is the greatest barrier to access to health care and it has a tremendous impact on an individual’s health. Studies have consistently found that the uninsured receive less than adequate health care.

DIF: Analysis REF: Page 492

Cherry: Contemporary Nursing, 5th Edition

Chapter 24: Making the Transition from Student to Professional Nurse

Test Bank

MULTIPLE CHOICE

1. During orientation a novice nurse sits and “virtually spends” the first few paychecks, envisioning the money going into a personal bank account. In the dream state, the nurse smiles and knows that the pain of nursing school was worth it. Which phase of reality shock is the nurse experiencing?
a. Honeymoon
b. Shock or rejection
c. Recovery
d. Resolution

ANS: A
During the honeymoon phase the novice nurse has a positive image of nursing that coincides with the reason for becoming a nurse; this feeling is experienced immediately after the nurse begins work and often while still in orientation.
During the shock or rejection phase, the novice nurse is overwhelmed by fear and a sense of incompetence.
During the recovery phase, the novice nurse regains some confidence and begins to heal.
At the resolution phase, the novice nurse has adjusted to the work environment and can work through change.

DIF: Application REF: Pages 499-501

2. A novice nurse is assigned a patient who has an order to draw blood for culture and sensitivity from a central line before antibiotic therapy is started. The novice reads and rereads the procedure manual. An hour later he stands at the bedside of the patient and stares at the central line, without knowing how to proceed. This phase of reality shock is termed:
a. honeymoon.
b. shock or rejection.
c. recovery.
d. resolution.

ANS: B
During the shock or rejection phase, there is inconsistency with what was learned in school and the work environment, and the novice nurse lacks many of the skills needed to be independent in this new role.
During the honeymoon phase, the novice nurse has not yet been faced with complicated tasks that he or she feels uncomfortable or incompetent to perform.
The novice nurse lacks confidence in himself or herself, and no healing is evident. The novice nurse has not reached the recovery phase, which precedes the resolution phase.

DIF: Application REF: Page 499

3. According to Kramer, nurses in the shock phase should ask themselves:
a. “How can I fit in with other staff?”
b. “Why can’t I perform as everyone expects?”
c. “What changes can I make to make me feel good about the choice to become a nurse?”
d. “How can I get the rest of the staff to change?”

ANS: C
During the shock or rejection phase, novice nurses must ask themselves what they must do to become the type of nurse envisioned and to make a contribution.
“Fitting in” comes with gaining confidence, which is the issue faced by the graduate.
Although becoming more organized and improving communication is part of resolving the shock phase, the novice should focus on positive accomplishments and should remember that a nurse cannot learn everything in school—many skills are learned after graduation. Expectations of new graduates are often unrealistic.
Although being a change agent is beneficial, blaming others is not the best choice.

DIF: Comprehension REF: Page 499

4. The novice nurse arrives on the nursing unit, is introduced to the staff, is assigned a preceptor, and is asked to participate in the next staff meeting. This introduction into nursing is appropriately termed:
a. biculturalism.
b. socialization.
c. transition.
d. “going native.”

ANS: B
Socialization involves the acceptance and integration of the novice nurse into the profession of nursing, as well as the identification of the novice nurse with the profession of nursing.
Biculturalism is the blending of school values with those of the workplace.
Transition involves competency when moving from the school to the work environment, and this situation does not require competency on the part of the novice nurse.
“Going native” describes an inappropriate attempt to move from the shock phase to the recovery phase in which the novice nurse mimics the unsafe practices of experienced nurses.

DIF: Application REF: Page 504

5. Several novice nurses share lunch breaks and have comments such as, “I have insomnia from worrying about what I forgot to do for my patient,” and “I have no energy,” and “I can’t believe I can’t do my job correctly.” These novice nurses are experiencing:
a. burnout.
b. self-worth.
c. confidence.
d. resilience.

ANS: A
Symptoms of burnout include extreme fatigue, headaches, difficulty sleeping, mood swings, anxiety, poor work quality, depression, and anger.
These novice nurses are demonstrating low self-esteem.
These novice nurses are uncertain about their abilities as nurses.
These novice nurses feel defeated and lack flexibility to overcome feelings of inadequacy.

DIF: Application REF: Page 500

6. Which nurse is more prone to burnout? The nurse who:
a. graduated last in the class.
b. is industrious and conscientious.
c. refuses to work an extra shift even though he or she needs the money.
d. volunteers to serve on only one committee and keeps in touch with schoolmates.

ANS: B
Burnout is more common among nurses with type A personalities and those who are overachievers.
Burnout most often occurs among students who are at the top of the class and have high grades.
Long hours and repeated overtime can lead to burnout; thus refusing to work overtime or back-to-back long shifts may help avoid burnout.
Prioritizing obligations and retaining friendships outside the work environment can reduce stress, thus reducing the likelihood of burnout.

DIF: Comprehension REF: Page 500

7. A novice nurse notices the medication nurse hurriedly gathering medications to be administered for the entire day, removing them from the packages, and placing them in a paper cup with the patient’s name and room number on the cup. When one of the patients points at a pill and asks, “What is this?” and “What does this do?” the medication nurse is uncertain, because it has long since been removed from the packaging. The novice nurse speaks to the nurse manager about her observations and describes her concerns. The novice nurse has assumed the role of:
a. loner.
b. “rutter.”
c. change agent.
d. “native.”

ANS: C
The novice nurse is working to improve the safety and patient environment and is a patient advocate.
The novice nurse is interacting with the manager rather than preferring to work alone or in isolation.
The novice nurse is taking an interest in her professional and work environment rather than viewing it as just a job.
The novice nurse is not mimicking the actions of the experienced nurse but instead is taking action to improve patient care.

DIF: Application REF: Page 501

8. The novice nurse calls a supervisor and requests that a “float nurse” be assigned to help with all “assessments of new admissions and postoperative patients.” The supervisor asks, “How many admissions and surgery patients have you received?” The novice nurse becomes flustered because she has not checked the census but simply bases the need on feeling swamped. This situation best indicates a lack of:
a. organizational skills.
b. communication skills.
c. interpersonal skills.
d. clinical skills.

ANS: A
The novice nurse lacks proficiency, which may be exaggerated by feelings of being overwhelmed by the new environment, causing him or her to not get the facts before asking for help.
The novice nurse was able to communicate her need for help but lacked justification.
The novice nurse was able to interact with the supervisor and was not required to interact with other members of the health care team.
Feeling incompetent or lacking skills may lead to the feeling of being overwhelmed; however, the novice nurse was disorganized and had not accurately assessed the needs of the unit.

DIF: Application REF: Page 506

9. When the novice nurse asks, “What will happen if this task is not completed,” which skill is being demonstrated?
a. Priority setting
b. Delegation
c. Organization
d. Clinical skills

ANS: A
The novice nurse is considering the legal and safety ramifications if the task is not completed.
The novice nurse did not ask, “Who else can perform this task?”
Prioritization is one part of organization but does not fully operationalize this concept.
The novice nurse may be able to perform any required tasks but may be limited by time.

DIF: Comprehension REF: Pages 506-507

10. In distinguishing between evaluation methods used in school versus those used in the work environment, it is noted that the work environment evaluation includes:
a. determining whether steps are logical.
b. formulating increments in correct order.
c. efficiently organizing stages of the procedure.
d. appraising outcomes according to policy.

ANS: D
Outcomes are based on meeting existing criteria rather than on knowing how the outcome was achieved.
The step “determining whether steps are logical” represents the school environment in which steps are performed on the basis of sound rationales.
The step “formulating increments in correct order” represents the school environment evaluation, which stems from the “correct step” aspect.
The step “appraising outcomes according to policy” represents the school environment, in which each step is evaluated, rather than indicating the overall outcome.

DIF: Application REF: Pages 503-504

11. When comparing mentoring and role modeling, the role of mentoring is represented by:
a. the experienced nurse is unaware that the novice nurse is observing him or her gathering supplies needed to start intravenous antibiotics.
b. the novice nurse mimics conversations with his or her own patients that were unobtrusively overheard between the experienced nurse and his or her patients.
c. the novice nurse receives feedback from the experienced nurse related to the use of a new occlusive dressing product and is told, “I couldn’t have done it better myself.”
d. an experienced nurse is nominated for outstanding employee of the month by the novice nurse.

ANS: C
The experienced nurse knowingly enters into a relationship to advocate for and to enhance the self-esteem of the novice nurse.
Mentoring requires an interactive process.
The novice nurse mimicked the experienced nurse, and the experienced nurse is most likely unaware of this role.
The novice nurse is promoting the professional satisfaction of the experienced nurse; however, the experienced nurse is not building the confidence and self-esteem of the novice nurse in an effort to enhance his or her professional confidence.

DIF: Application REF: Page 509

12. A certified oncology nurse notices that a novice nurse is unsure of decision making and lacks technical skills. The novice nurse gains confidence by sharing and learning with the experienced nurse. This relationship continues and builds, allowing the novice nurse to become more confident. This relationship is known as:
a. mentoring.
b. role modeling.
c. a preceptorship.
d. socialization.

ANS: A
The experienced and novice nurses have entered into a mutually agreed upon interactive relationship to ease the transition of the novice nurse into the profession. An interactive relationship is present.
A preceptorship is usually a short-term relationship.
Socialization is the desired outcome of mentoring but not of actual interactions.

DIF: Knowledge REF: Page 509

13. A novice nurse is unsure how to correctly administer an injection using the Z-track method. What is the best approach for learning this procedure?
a. Read the procedure manual and follow the steps exactly.
b. Make an appointment at the skills laboratory of the former nursing school to practice.
c. Ask to observe the skill as it is being performed, then perform it under direct supervision.
d. Try to remember how the task was previously performed during a simulation.

ANS: C
The novice nurse can become familiar with the technique, then can perform the skill under the supervision of an experienced nurse, ensuring competency.
Although it does allow the novice to follow set steps, there is often more than one correct way to perform a skill, and this approach does not allow competency to be assessed.
Once the student has graduated, the staff educator most likely will seek to refine the skills of the novice by demonstrating skills before asking the novice to perform them.
Patient safety may be compromised should a critical step be forgotten.

DIF: Application REF: Page 505

14. A student nurse wants to meet other nursing students from different countries and to learn of employment possibilities. The student nurse should:
a. participate in the clinical facility’s employee satisfaction task force.
b. join the Student Nurses Association.
c. take part in self-mentoring.
d. postpone taking the licensure examination so he or she can take a tour of foreign countries.

ANS: B
Students who participate in preprofessional organizations such as the Student Nurses Association have an opportunity to meet students across the nation and around the world and can network with leaders to gain knowledge about employment possibilities.
The clinical facility’s employee satisfaction task force is interested only in the population at the place of employment.
Self-mentoring can help a novice become more self-sufficient but does not facilitate networking or interacting with individuals from other states or nations.
Posting a resume may result in a job offer in another country, but this does not allow interactions with other nurses, or it may limit information acquired about the role of registered nurses in other countries that might be learned through networking.

DIF: Comprehension REF: Page 510

15. An experienced nurse working in oncology is shocked to realize that he feels little empathy when a patient explains, “I developed cancer from having to work in the dry cleaning industry since I was only 8 years old to help support my younger siblings during the depression. Now they have all moved away and refuse to help me financially, and it takes everything I have to pay for my chemotherapy medicine.” The nurse is experiencing:
a. burnout.
b. compassion fatigue.
c. reality shock.
d. Benner’s expert stage.

ANS: B
The nurse is experiencing a gradual decline in compassion over time as a result of being exposed to events that have distressed his or her patients, such as working at a young age to support a family while inadvertently being exposed to carcinogens.
The nurse is experiencing a gradual decline in compassion over time as a result of being exposed to events that have distressed his or her patients, such as working at a young age to support a family while inadvertently being exposed to carcinogens.
Burnout refers to feelings of being overwhelmed and distressed, resulting in poor work quality and symptoms such as insomnia and lack of professional pride.
Reality shock occurs when a novice nurse enters the workforce after graduating from school and is not prepared to deal with differences between school and workplace values.
The expert nurse has intuition, and this scenario does not portray a lack of intuition.

DIF: Application REF: Page 500

16. A recruiter is explaining benefits to a group of nursing externs who are highly sought for employment. The recruiter states, “We are the only hospital in town that offers a residency program.” The recruiter further explains that a residency program:
a. provides housing for the graduate nurse to decrease expenses until income is established.
b. partners a medical resident with a nurse resident to learn interprofessional care.
c. allows new graduates to work on a higher degree in nursing while being paid full-time.
d. offers extended time for both theory and clinical activities that promote problem solving and clinical decision making.

ANS: D
Residency programs offer a longer precepted orientation period (often 12 months) to bridge the gap between the classroom and practice.
Housing is not the focus of residency programs but moving expenses may be negotiated as part of the employment process.
Interprofessional education may be content for the residency program but partnerships are not included.
Residency programs focus on content/activities that help the novice move to a higher level of confidence rather than focusing on higher education.

DIF: Comprehension REF: Page 510

MULTIPLE RESPONSE

1. In orientation, a new graduate is surprised to learn of workplace violence in healthcare agencies and asks, “What kind of violence is common in hospitals?” The educator describes workplace violence as: (Select all that apply.)
a. care of patients admitted who are victims of domestic violence.
b. experienced nurses withhold pertinent information from coworkers to portray them as incompetent.
c. coworkers participate in employee assistance program (EAP) for support to learn more about anger management for adult children living at home.
d. care of persons being held for treatment prior to be jailed incarcerated for committing homicide.
e. Statements such as “The new nurse has book sense but can’t perform an admission physical without the help of everyone on the unit.”

ANS: B, E
Withholding information from novices or coworkers to purposely cause them to appear inadequate or unskilled is considered workplace violence due to anxiety and stress it produces. This should not be tolerated and should be reported.
Such statements that belittle employees lead to job dissatisfaction, lack of teamwork, and burnout and are considered lateral or workplace violence. This should not be tolerated and should be reported.
Employees are not involved in the violence but compassion fatigue may result.
The employee is seeking help for issues outside work.
Care of the inmate with a history of violent behavior occurred prior to admission to the health care agency.

DIF: Application REF: Pages 511-513

Cherry: Contemporary Nursing, 5th Edition

Chapter 25: Managing Time: The Path to High Self-Performance

Test Bank

MULTIPLE CHOICE

1. In deciding whether to say no to a request that involves a time commitment, the professional nurse must consider:
a. the cost/benefit ratio.
b. the time commitment of coworkers.
c. ways to buffer saying no.
d. personal preference.

ANS: A
The first step in learning the art of saying no is determining when to say it. The cost/benefit ratio of each opportunity must be evaluated in relation to the overall goal. If the activity will provide an overall benefit, obviously it must be given careful consideration. If it will not result in significant benefit, decline gracefully but emphatically.
Considering only the time commitment of peers does not address the overall goals of the request.
Figuring out how to say no to protect yourself or the feelings of others focuses on one’s personal preference, but does not consider the overall goals of the request.
Considering one’s own personal preference, but does not consider the overall goals of the request.

DIF: Application REF: Pages 535-536

2. Positive time management skills include:
a. maintaining an open-door policy.
b. retaining all paperwork.
c. returning all phone calls immediately.
d. scheduling daily activities.

ANS: D
Planning is the most important step in time management. Planning allows people to better use their time and can lead to closure in relation to those goals that will produce the greatest internal satisfaction.
Having an open-door policy lends to multiple distractions, which may hamper goal completion.
If you retain all paperwork, your desk or files become cluttered, and this may have a negative effect on work completion.
Returning all calls immediately disrupts completion of work.

DIF: Knowledge REF: Page 527

3. Time can be maximized to produce the best outcomes by:
a. making the first hour of each workday productive.
b. completing trivial tasks before performing important tasks.
c. eliminating all recreational activities.
d. omitting breaks until the entire task has been completed.

ANS: A
Making sure that the first hour of every workday is productive sets the tone for achieving goals.
Completing trivial tasks first further compromises the important tasks at hand. The bottom line is that you will still have to complete the important task, so avoid procrastination.
Recreational activities can sometimes help clear the mind and make you more productive; however, the first hour is the most critical one.

A break can sometimes help clear the mind and make you more productive; however, the first hour is the most critical one.

DIF: Comprehension REF: Page 537, Box 25-3

4. To conduct a productive meeting, the nurse should:
a. provide each person all the time needed to discuss desired topics.
b. cover all emotional topics first.
c. create an agenda with specific times allotted for each agenda item.
d. wait for latecomers and ask for their excuse for being late.

ANS: C
You need to preplan for the meeting so it can be conducted in a timely manner. One way to have a productive meeting is to prepare a meeting agenda with time allotted for each item and the name of the person responsible for reporting on each item. Send out the agenda prior to the meeting so attendees can come prepared.
Providing unlimited time to each person will hinder the timeliness and effectiveness of the meeting, as well as its productiveness.
Covering all emotional topics first hinders the timeliness and effectiveness of the meeting, as well as its productiveness.
Waiting for latecomers and asking why they are late will hinder the timeliness and effectiveness of the meeting, as well as its productiveness.

DIF: Application REF: Pages 534-535, Box 25-2

5. When choosing to delegate, the nurse should delegate the task to the most qualified person or to the person he or she wishes to:
a. develop.
b. promote.
c. punish.
d. reward.

ANS: A
Delegating is giving other people tasks to be accomplished. The benefits of delegation involve (1) assisting in developing the initiative, skills, knowledge, and competence of others; (2) maintaining the level of responsibility and decision making of others; (3) freeing time for more important tasks; (4) extending results that can be accomplished from what one person can do alone to what he or she can manage through others; and (5) ensuring that completing the task is cost effective.
Delegating an activity to a person for promotion is not appropriate; the act of delegating requires multiple considerations, and promotion is not one of them.
You do not want to delegate to punish a person; that person may sabotage your goal to be accomplished.
Delegating is a process that is used to attain a goal, not to reward a person for a job well done.

DIF: Application REF: Page 533

6. When using the ABC system of managing time, those items coded A include:
a. calling the pharmacy to see whether a drug insert is available for a patient.
b. checking to see why a ventilator is alarming.
c. organizing the medication cart.
d. writing memos to remind everyone to contribute to the boss’s birthday gift.

ANS: B
A items should stand out from other items because of their worth and high level of importance. A items are most urgent and may require more energy and time, but they should be completed before any of the B or C items are performed.
Calling the pharmacy to see whether a drug insert is available for a patient is of lower importance at this time.
Organizing a medication chart is of lower importance at this time.
Memo writing is of lower importance at this time.

DIF: Application REF: Page 528

7. When deciding whether and when a task should be completed, a nurse must:
a. complete all tasks as they are thought of to prevent having to take time to consider which is most important.
b. procrastinate and hope that someone will volunteer to do it.
c. ask, “What will happen if I don’t complete the task now?”
d. view large projects holistically and not as many small pieces.

ANS: C
Stopping to evaluate what is going on is important because you may have to readjust your plan and reprioritize in order to reach your goal.
Completing tasks as they are remembered is not a good time management strategy, and may sabotage and hinder completion of the task at hand.
Procrastination is not a good time management strategy, and may sabotage and hinder completion of the task at hand.
Viewing large projects holistically is not a good time management strategy, and may sabotage and hinder completion of the task at hand.

DIF: Application REF: Pages 528-529

8. When planning, a nurse should:
a. delay planning until the “first task of the morning” has been completed.
b. recognize that rewarding oneself has a negative consequence.
c. rotate between several tasks to stimulate creativity.
d. remember that most tasks take longer than anticipated to complete.

ANS: D
One must consider many factors when planning a project. Some of the following factors influence how priorities should be established: (1) urgency of a situation, (2) demands of others, (3) closeness of deadlines, (4) existing time frame, (5) degree of familiarity with the task, (6) ease of task completion, (7) amount of enjoyment involved, (8) consequences involved, (9) size of the task, and (10) congruence with personal goals. When the use of time is considered, not all of these factors carry the same weight, and adjustments will be needed.
Delaying planning until the “first task of the morning” has been completed is not a good time management strategy and may inhibit appropriate planning and goal achievement.
Recognizing that rewarding oneself has a negative consequence is not a good time management strategy and may inhibit appropriate planning and goal achievement.
Rotating between several tasks to stimulate creativity is not a good time management strategy and may inhibit appropriate planning and goal achievement.

DIF: Application REF: Pages 527-528

9. A novice nurse is unsure of his ability to insert a nasogastric tube for one of the assigned patients who is vomiting coffee ground emesis. The novice nurse waits, hoping that someone with more experience will volunteer to do the job, or he just waits until the end of the shift. This nurse is practicing:
a. energy management.
b. priority setting.
c. procrastination.
d. introspection.

ANS: C
Procrastination is evident when a person is faced with an unpleasant task, a difficult task, or a difficult decision. Usually procrastination is easily recognizable because it involves completing low-priority tasks rather than high-priority ones, and it always welcomes interruptions. Procrastination is the art of “never doing today what can be put off until tomorrow.” The result consists of less productivity, less internal satisfaction, and increased stress.
Energy management means ensuring that the right amount of effort matches the right task so that outcomes can be optimized, while the amount of personal energy expended/taxed to achieve the desired result is gauged.
Priority setting is establishing superiority in rank, a preferential rating, or the state of “coming first” in order or ahead of others in a process by which that order will represent the execution of the raked items.
Introspection is the act of examining one’s own thoughts and emotions by concentrating on the inner self.

DIF: Application REF: Page 532

10. A student nurse assigned to work with the charge nurse is given the opportunity to help revise the nursing assessment form. She receives several compliments from management and her nursing instructor for her creative suggestions. The student nurse enjoys the project and attention she is receiving and begins to prolong the conclusion of the project. Although she constantly adds new information, she filters this out slowly to others. The student nurse is subject to the time management obstacle of:
a. need for perfection.
b. fear of losing creativity.
c. unclear goals.
d. fear of completion.

ANS: D
Fear of completion is a time management obstacle that may occur if you are afraid of completing a project that is creative and fun. To overcome this obstacle, take the time to understand why you are not completing the task or major project that has been with you for some time.
If you are a perfectionist and feel that everything should be completed at the same level of excellence, you are not keeping things in perspective. If you demand extremely high standards for every single task you undertake, you simply will not get everything done.
Many creative people think that an organized time management structure or approach to life may squelch their creative nature or tendencies.
The student’s goal is clear: to revise the assessment form; however, if goals are unclear, managing time to meet your desires becomes a futile task.

DIF: Analysis REF: Page 522

11. An inexperienced nurse has heard of other novice nurses who take shortcuts in providing patient care. This nurse feels that this is unacceptable and that all tasks must be performed faultlessly, which leads to her inability to complete all assigned tasks. This nurse would benefit from the seminar “Obstacles to Time Management: How to Deal With:
a. Creativity.”
b. Perfectionism.”
c. Failure.”
d. Downtime.”

ANS: B
If you are a perfectionist and feel that everything should be completed at the same level of excellence, you are not keeping things in perspective. If you demand extremely high standards for every single task you undertake, you simply will not get everything done.
Many creative people think that by creating an organized time management structure or approach to life, their creative nature or tendencies will be squelched.
When you are unable to get to the things that are important to you and are unable to meet your personal goals, you may be afraid of failure. It can be very upsetting to go after your dreams and find that you cannot reach them. Sometimes it is easier to avoid making the effort.
Some individuals fear the possibility of standing still too long. They feel guilty about “time-outs” or time off.

DIF: Application REF: Page 522

12. An experienced nurse volunteers to serve on a task force intended to improve the quality of care because she possesses excellent patient care skills and has selected a career goal of working in quality management. However, the nurse is unable to concentrate on any one task or issue and is unable to view the health care milieu sensibly. Which source of energy is missing in this nurse?
a. Physical
b. Mental
c. Spiritual
d. Emotional

ANS: B
Mental energy is the ability to maintain sustained concentration on a task, to move flexibly between broad and narrow issues, and to be internally and externally focused, as needed by the situation. It includes mental preparation, visualization, positive self-talk, effective time management, and creativity.
Physical energy consists of the key components of successful transition to a productive, highly energizing experience by paying attention to physical energy through routine or proper eating, adequate sleep and exercise, and frequent breaks during long shifts, as well as by drinking plenty of water and focusing on one activity while collecting thoughts about what to prioritize next.
Spiritual energy requires presence in a quiet place, often to help one identify his or her vision of life as well as purpose and direction.
Emotional energy is dependent on physical, mental, and spiritual energy for building emotional capacity. Managing emotions skillfully in the service of high positive energy and full engagement is called emotional intelligence.

DIF: Analysis REF: Page 524

13. After keeping a log of activities designed to improve time management, the nurse divides the distractions into internal and external sources. The nurse would classify which distraction as internal?
a. Responding to recurring crises at work or in one’s personal life
b. Unsuccessful attempts to communicate with the unit manager
c. Talking with potential faculty candidates
d. Being given unclear job responsibilities

ANS: A
An internal distraction is one that can be controlled only by the person affected; it is important for each of us to recognize and understand the distracters that inhibit our ability to complete tasks and to meet our objectives and goals.
Unsuccessful attempts to communicate with the unit manager count as an external distractions because they involve other people and may be more difficult to control.
Talking with potential faculty candidates counts as an external distraction because it involves other people and may be more difficult to control.
Being given unclear job responsibilities is an external distraction because it involves other people and may be more difficult to control.

DIF: Analysis REF: Page 525, Box 25-1

14. A nurse realizes that much time is wasted during shift report when coworkers discuss personal items such as recent movies or department store sales. Which statement would help with time management during this critical interaction?
a. “Let’s only talk about one movie you recently watched.”
b. “I like to know about department store sales but we need to get through this report, so let’s talk about sales as we walk between patient rooms.”
c. “I know your shift has been busy. What went wrong?”
d. “I have the list of patients; let’s start with revisions to the plan of care and scheduled activities for the next shift.”

ANS: D
The statement “I have the list of patients; let’s start with revisions to the plan of care and scheduled activities for the next shift.” focuses the conversation during report keeping personal conversations to a minimum.
Shift report allows the nurse to prioritize the upcoming shift and discussing anything personal should occur at break or after the end of the shift.
The time available between each patient is a time to organize thoughts and plan care.
Asking what went wrong in a shift opens up a lengthy conversation that may not provide essential information needed to provide care.

DIF: Application REF: Pages 527-529

MULTIPLE RESPONSE

1. A nurse is having difficulty managing assignments at work, which results in a feeling of “failure” and tasks that are not completed or that are not completed satisfactorily. The mentor suggests some tips for time management; these include: (Select all that apply.)
a. focusing on activities to be completed, rather than on objectives.
b. planning for tomorrow today.
c. making certain that the last hours are the most productive in tying up loose ends.
d. maintaining a log of how the nurse spends time (no need to worry about using complete sentences).
e. picking five major objectives for the day and not stopping until they are achieved.

ANS: B, D
Planning for the future is an effective time management strategy.
Maintaining a log of how you spend your time is an effective time management strategy.

Focusing on activities to be completed, rather than on objectives is not a good time management strategy.
Making certain that the last hours are the most productive in tying up loose ends is not a good time management strategy.
Picking five major objectives for the day and not stopping until they are achieved is not a good time management strategy.

DIF: Analysis REF: Pages 527, 537, Box 25-3

2. A nurse is having difficulty keeping up with the six assigned patients and serving on the ethics committee. In order to take charge of both personal and work life, the nurse focuses on improving physical energy by: (Select all that apply.)
a. telling herself, “I provide safe quality care and will provide this level of care to all my patients.”
b. taking a deep breath and remaining calm to develop patience.
c. keeping a bottle of water available to consume a minimum of 24 ounces each shift.
d. going into the nurse’s break room every 1 1/2 hours to eat a healthy snack and prioritize remaining care.
e. enrolling in the hospital’s fitness program, Nurses Need Nurturing.

ANS: C, D, E
Drinking plenty of water promotes physical health.
Taking a break every 90 minutes especially during long shifts such as 12-hour shifts provides a much needed time to relax and reorganize.
Proper and frequent exercise promotes physical health.
Positive self-talk promotes mental energy.
Patience is associated with spiritual energy.

DIF: Application REF: Pages 523-524

COMPLETION

1. The most important step in time management is ____________________.

ANS:
planning
It is important to plan before beginning any task, project, or day’s activities. Planning involves (1) setting goals and establishing priorities, (2) scheduling activities, and (3) making to-do lists.

DIF: Comprehension REF: Page 527

Cherry: Contemporary Nursing, 5th Edition

Chapter 26: Contemporary Nursing Roles and Career Opportunities

Test Bank

MULTIPLE CHOICE

1. The primary focus of the care provider role for the nurse involves:
a. using the nursing process to provide guidance to the patient in recovery.
b. encouraging consumer self-responsibility and emphasizing health promotion/maintenance.
c. focusing on increasing satisfaction among professional nurses.
d. advancing nursing practice through research.

ANS: A
The primary focus of the care provider’s role is to use the nursing process in caring for patients.
Encouraging consumer self-responsibility and emphasizing health promotion/maintenance constitute the educator and counselor roles of the nurse, not the primary role.
The role of the care provider is not to increase satisfaction among professional nurses; this is included as part of the nurse manager’s role.
Advancing nursing practice through research is the role of the nurse researcher.

DIF: Comprehension REF: Page 541

2. A nurse researcher is attempting to describe the demographics of today’s RNs and reports that:
a. less than 50% hold active licenses.
b. most continue to work full time.
c. younger nurses are rapidly entering the workforce.
d. most nurses are initially graduating with a bachelor’s degree.

ANS: B
Approximately 83.2% are employed in nursing, and 16.8% are not. About 58.3% of this group are employed full time in the profession, and 25% of nurses work part time.
No data are available to support this percentage.
The largest group of nurses in 2004 consisted of those between 45 and 49 years of age. No data are available to represent an influx of younger nurses into the profession.
A substantial increase in the number of nurses graduating from associate degree nursing programs has been noted during the past decade.

DIF: Analysis REF: Page 546

3. A hospital standard states, “All intravenous (IV) sites must be rotated every 72 hours.” The nurse who assesses and records variations from this standard is fulfilling which role of nursing?
a. Infection control
b. Quality management
c. Coordinator position
d. Counselor

ANS: B
The basic premise is to ensure that outcomes in client care services are consistent with established standards.
Assessing and recording care variations are tasks that are not included in the role of the infection control nurse.
The coordinator is responsible for coordinating clinical and administrative requirements for the patient.
The role of the counselor is to emphasize to the patient health promotion and maintenance.

DIF: Application REF: Page 551

4. The nurse who organizes screenings for employees, assesses the work environment for hazards, and teaches health-promoting activities is employed in the field of:
a. infection control.
b. occupational health.
c. informatics.
d. transportation specialization.

ANS: B
The occupational health nurse organizes screenings for employees, assesses the work environment for hazards, and teaches health-promoting activities.
Infection control nurses assess the total incidence of infections within the hospital.
Informatics deals with data management for decision making.
Transportation specialist is not a current nursing area.

DIF: Knowledge REF: Page 550

5. The RN who identifies the best resources at the lowest cost to achieve optimal health outcomes for the client is fulfilling the role of:
a. informatics specialist.
b. educator.
c. case manager.
d. quality manager.

ANS: C
The role of the case manager includes coordination of resources to achieve the best outcomes based on quality, access, and cost.
The role of the informatics specialist includes managing and processing health care information.
The educator role includes teaching and does not include coordination of resources.
The quality manager addresses the need for health care providers to assess opportunities for process improvement, to implement changes, and to measure outcomes.

DIF: Knowledge REF: Page 551

6. An RN testifies at a trial where domestic violence is being investigated. She had previously assisted with specimen collection and had assessed the victim. The nurse is involved in:
a. triage nursing.
b. forensic nursing.
c. flight nursing.
d. entrepreneurial nursing.

ANS: B
The forensic nurse provides direct services to clients and consults with and serves an expert witness for medical and law enforcement.
A triage nurse provides a decision on what level of care a client may need after performing telephone or physical assessment.
The role of the flight nurse is to care for diverse clients in an autonomous practice while using the opportunity to apply advanced skills.
The entrepreneurial nurse would not be employed in this capacity.

DIF: Comprehension REF: Page 552

7. A nurse in an acute care facility helps patients understand how to prevent diabetic neuropathies. This nurse is functioning in the role of:
a. change agent.
b. educator.
c. manager.
d. coordinator.

ANS: B
A nurse functioning in the role of educator helps patients understand the complications of their disease process.
A change agent is one who searches for possible alternatives regarding issues that involve patient care, safety, and motivation of the industry and who assesses cost-effective resources for use in health-related situations.
The nurse manager does not provide education to patients, as the acute care nurse would.
The coordinator also does not provide acute care patient education but coordinates care on an interprofessional plan.

DIF: Knowledge REF: Page 541

8. A nurse notices that care is often withheld until an interpreter arrives, if the nurse is not multilingual. The nurse discusses this with the management team and suggests a three-part series be presented to the nursing staff to teach some commonly used medical terms in Spanish. This nurse is involved in the role of:
a. change agent.
b. educator.
c. manager.
d. coordinator.

ANS: A
The role of the change agent consists of assessing health care delivery issues and creating solutions to improve health care delivery.
The educator does not assess this type of issue in terms of delays in care provided.
The manager is not involved in the assessment and implementation of health care delivery problems. The manager would represent part of the solution to the issue but would not serve as the assessor or implementer.
The coordinator of care is one who would arrange for the translator to attend to the patient; the coordinator would not assess the issues that surround delays in health care delivery.

DIF: Comprehension REF: Page 541

9. A nurse tallies the patient satisfaction surveys and approves the use of an agency nurse because of the high census. This nurse is involved in which nursing role?
a. Change agent
b. Educator
c. Manager
d. Coordinator

ANS: C
The manager is the one who assesses the need for staffing and must justify this in a substantial way. Through this approach the manager indirectly provides care for patients and families.
This example does not reflect changes in health care delivery in the area of increasing staff to accommodate the higher census.
The role of educator is not to increase staffing.
The coordinator coordinates the care of patients, not the staffing of nurses.

DIF: Comprehension REF: Page 541

10. In differentiating between interprofessional and multidisciplinary:
a. multidisciplinary refers to the care of many diverse patients by one discipline.
b. interprofessional involves members of many disciplines working together to provide patient care to a distinct population.
c. interprofessional refers to members of the same discipline working together to provide patient care to a distinct population.
d. interprofessional is the use of multiple interventions by nurses with varying levels of education.

ANS: B
Interprofessional, as related to member roles, involves members of many disciplines working together to provide patient care to a distinct population.
The definition of multidisciplinary is not “the care of many patients by one discipline.”
Interprofessional refers to members working together and not “the same discipline working as one to provide patient care.”
Interprofessional does not describe the use of multiple interventions.

DIF: Knowledge REF: Page 542

11. A person who is interested in entering nursing school researches the educational preparation of RNs and finds that according to the Bureau of Health Professions in 2004:
a. nursing is a career field that is primarily made up of women younger than 30 years.
b. jobs in nursing are less prevalent than those in pharmacy.
c. the majority of nurses have part-time positions.
d. the number of men working as RNs has increased to 5.7%.

ANS: D
The number of men working as RNs has increased from 5.4% in 2000 to 5.7% in 2004.
The largest group of nurses is 45 to 49 years of age.
Nursing represents the largest health care occupation, with more than 2.4 million nurses nationwide; projections indicate that nursing will continue to provide the largest number of new jobs in a hospital setting.
Approximately 58.3% of nurses are employed full time in the profession of nursing.

DIF: Knowledge REF: Page 546

12. A nurse who is participating in a health fair is asks, “Other than nursing, what are some opportunities for careers in the health care professions, and what education is required?” The nurse informs participants that a baccalaureate degree is required as the minimum standard for the role of:
a. speech therapist.
b. occupational therapist
c. nurse-midwife
d. nurse anesthetist.

ANS: B
The baccalaureate degree is the minimum requirement for an occupational therapist.
A master’s degree is the minimum requirement for becoming a speech therapist.
A master’s degree is the minimum requirement for becoming a nurse-midwife.
A master’s degree is the minimum requirement for becoming a nurse anesthetist.

DIF: Knowledge REF: Page 545

13. A nurse is interested in practicing in a faith-based community; when researching the role of the parish nurse, the nurse finds that:
a. certification is available at a basic level after a qualifying examination is completed and a set number of practice hours have been worked, as defined by the state’s nurse practice act.
b. this advanced practice role focuses on health promotion and disease prevention.
c. this role has no set standards or scope of practice but instead follows the doctrine of the denomination being served.
d. this role is recognized by the American Nurses Association (ANA) as a specialty with a defined set of practice guidelines.

ANS: D
The role of parish nurse has become a recognized specialty in a growing professional practice. In 1988, the ANA established the scope and standards of this professional practice.
No further examination is needed for this role.
Parish nursing is not an advanced practice role.
The parish nurse incorporates the values and spiritual dimension of the human being into the practice of nursing and health promotion.

DIF: Comprehension REF: Pages 552-553

14. A nurse is responsible for determining the incidence rates of hospital-acquired diarrhea on a pediatric ward after receiving reports that five children admitted with uncontrolled asthma had developed diarrhea while hospitalized. The nurse is working in the role of:
a. quality management.
b. infection control.
c. occupational health.
d. forensics.

ANS: B
The infection control nurse is concerned with incidence of infections within the hospital.
The quality control nurse ensures patient outcomes meet established standards.
Occupational health nurses are concerned with health of employees.
Forensic nurses focus on trauma, abuse, and violence.

DIF: Application REF: Page 547

15. A nurse working in a factory performs routine hearing tests for employees. The factory uses 90 dB as the safe limit for an 8-hour day’s exposure to machine noise rather than 85 dB as recommended by the Occupational Safety and Health Administration. The nurse is function in the role of:
a. quality management.
b. informatics nurse specialist.
c. occupational health nurse.
d. case manager.

ANS: C
The nurse in the role of occupational health focuses on health promotion and disease control of employees.
The nurse functioning in the quality management ensures that patient outcomes meet established standards.
The informatics nurse specialist focuses on management and processing of health care information.
Case managers coordinate resources to meet desired patient outcomes.

DIF: Application REF: Pages 550-551

MULTIPLE RESPONSE

1. A nurse wants to become an advanced practice nurse and investigates the requirements for a: (Select all that apply.)
a. nurse practitioner.
b. nurse executive.
c. certified nurse-midwife.
d. certified registered nurse anesthetist.

ANS: A, C, D
A nurse practitioner is considered an advanced practice nurse.
A certified nurse-midwife is considered an advanced practice nurse.
A certified registered nurse anesthetist is considered an advanced practice nurse.
A nurse executive is not an advanced practice nurse; no additional educational degree or advancement is necessary for a nurse to be a nurse executive, and this is primarily an administrative/leadership role.

DIF: Knowledge REF: Page 554

2. Advanced practice nurses are prepared minimally at the master’s degree level with prescriptive privileges; these professionals include: (Select all that apply.)
a. clinical nurse leader.
b. gerontologic nurse practitioner.
c. nursing administrator.
d. certified nurse-midwife.
e. clinical nurse specialist.

ANS: B, D, E
A gerontologic nurse practitioner requires preparation at the master’s degree level.
A certified nurse-midwife requires preparation at the master’s degree level.
A clinical nurse specialist requires preparation at the master’s degree level.
A clinical nurse leader is not prepared at a master’s level and is not considered an advanced practice role.
A clinical nurse leader is not prepared at a master’s level and is not considered an advanced practice role.

DIF: Knowledge REF: Page 554

Cherry: Contemporary Nursing, 5th Edition

Chapter 27: Job Search: Finding Your Match

Test Bank

MULTIPLE CHOICE

1. When should a follow-up letter be written to a recruiter?
a. Before the interview to thank him/her for granting you the interview
b. Approximately 2 weeks after you did not get the job to inquire why
c. A few days after the interview
d. When you are sure you got the position

ANS: C
The question asks about a follow-up letter, and this choice describes contact before the interview.
It is inappropriate to inquire by letter about why the job was not given to the applicant.
A follow-up letter thanking the recruiter is a courtesy and a reminder of the nurse’s interest in receiving a timely response.
The follow-up letter is sent to thank the agency for interviewing the applicant.

DIF: Knowledge REF: Page 576

2. Cover letters:
a. should signify an interest in the employer and let the employer know that you took time to research the organization.
b. must be handwritten so the employer can determine whether charting will be legible.
c. should be limited to one paragraph because time is of the essence.
d. let the employer know your desired salary, shift, and area of practice.

ANS: A
The purpose of the cover letter is to show the recruiter that the applicant has an interest in the facility and that he or she did homework to learn more about the facility.
All cover letters should be typewritten.
The cover letter should provide a foundation on which all other interaction with the facility will be built. Three paragraphs should be written to emphasize several points intended to intrigue the reader so he or she will review the resume.
The cover letter is not the place to express the applicant’s desire for any benefits the facility offers. The cover letter is a way to show interest in the facility and to prompt the person who is responsible for hiring to take a closer look at the enclosed resume.

DIF: Knowledge REF: Page 566

3. To determine basic competency, the interview for a nursing position may include a test in:
a. pathophysiology.
b. correctly writing nursing diagnoses.
c. pharmacology.
d. computer skills.

ANS: C
Preemployment pharmacology testing is common. Institutions often give a quiz to assess basic knowledge of routinely administered medications, their purposes, and associated adverse effects.
Pathophysiology is not basic knowledge that would be tested at a place of employment.
Writing nursing diagnoses is a method of thinking, not an actual practice matter.
Computer skills are not at the crux of nursing practice; therefore, they can be learned on the job, and in some settings they are not part of the job expectations.

DIF: Knowledge REF: Page 579

4. When the job applicant is asked to identify weaknesses, one appropriate reply for the novice nurse might be:
a. “I have no weaknesses.”
b. “Are you trying to set me up?”
c. “Delegating to peers.”
d. “Caring requires weakness.”

ANS: C
It is best to be honest about weaknesses the applicant may have. The employer does not expect the graduate nurse to have only strengths. All nurses can improve in their profession.
All nurses/applicants have weaknesses. This response shows lack of insight.
“Are you trying to set me up” is a question, not a response. It also is a defensive stance for the applicant to take.
Caring is not a weakness; it is a strength and forms the foundation of nursing.

DIF: Knowledge REF: Page 574

5. A valuable tool for determining whether a potential employer is suitable for your career goals is to:
a. call The Joint Commission (TJC) to ask whether the organization meets required standards.
b. assess the work climate by walking through the facility.
c. review financial statements of the institution.
d. ask what they can do for you rather than what you can do for them.

ANS: B
By observing the staff when taking a tour of the unit, the applicant can get an accurate feel for the culture and personality of the nursing unit. The applicant can assess the manager’s interactions with staff and can see how nurses respond to each
Calling TJC is not helpful for the applicant who wishes to obtain information about the facility that will affect nursing care on a daily basis. TJC standards consist of more than nursing practice standards.
Review of the financial statements of an institution will not provide the nurse graduate any information about the staff, manager, or standard of nursing care.
Asking such a question shows arrogance and a lack of dedication to the institution and to patient care. This would not help the applicant in any way to meet his/her career goals.

DIF: Application REF: Page 576

6. Many nursing professionals have portfolios that include:
a. family pictures.
b. letters of commendation.
c. articles that describe lack of quality in health care.
d. high school achievements.

ANS: B
A portfolio includes letters from supervisors and patients, congratulatory messages from peers, and evaluations documented by supervisors.
Family pictures are not appropriate for professional documentation.
Articles about health care are not part of the portfolio of a graduate nurse.
Inclusion of high school achievements is not appropriate for a nursing portfolio; the portfolio should demonstrate the best features of the applicant in terms of nursing education.

DIF: Knowledge REF: Page 570

7. A potential applicant reviews the application process and learns that preemployment physicals often include the following:
a. cholesterol screening.
b. pregnancy testing.
c. urine drug screening.
d. vision and hearing tests.

ANS: C
A preemployment physical examination is often required, and this includes routine blood tests, urine drug screening, and sometimes a chest radiograph.
Cholesterol screening is not included in routine blood tests.
A pregnancy test is not a routine blood test.
Vision and hearing tests are not part of the preemployment examination.

DIF: Knowledge REF: Page 579

8. A graduate nurse should begin the job search knowing that:
a. few jobs are available for RNs because of a failing health care economy.
b. it would be more promising to apply to a rural hospital than to an urban hospital.
c. although efforts have been made to reduce expenditures for health care, the need for RNs remains stable.
d. the demand for nurses to work in acute care hospitals has decreased because most services are being shifted to outpatient and ambulatory settings.

ANS: C
The nursing shortage has caused institutions to find unique ways to lure nursing graduates to their place of employment. These include sign-on bonuses, expense-paid weekend visits to the facility, tuition reimbursement, and low-interest loans. Although health care costs are a concern, attracting nurses is currently a priority, with little worry about associated costs.
RNs comprise the largest health care occupation.
Both urban and rural hospitals are in need of nurses.
The demand is high for nurses to work in acute care hospitals. The majority of nurses work in acute care settings.

DIF: Comprehension REF: Page 562

9. While performing a job search, a nurse reviews the list of Magnet hospitals of the American Nurses Credentialing Center because:
a. these hospitals are able to hold on to revenue gained from patient care.
b. nursing longevity, autonomy, and self-governance are important features of these institutions.
c. all RNs have a minimum of a master’s degree and are credentialed in the area in which they provide care.
d. these hospitals have the most up-to-date diagnostic equipment such as magnetic resonance imagery.

ANS: B
Magnet hospitals demonstrate excellence in areas such as low RN turnover rates, adherence to standards of nursing care as defined by the American Nurses Association, and mechanisms in place for staff participation in decision making.
Salaries are not included as part of the Magnet status.
Magnet status does not require that all nurses be master’s prepared or certified.
Whether a hospital has the most up-to-date diagnostic equipment is not a factor in determining a favorable work environment for nurses.

DIF: Knowledge REF: Page 564

10. According to the Hallmarks of the Professional Nursing Environment, a nurse should ask a potential employer:
a. how salaries compare with those of larger facilities.
b. what benefits are provided to RNs that are not available to other health care providers.
c. what role nurses have in determining the quality of care.
d. how the employer plans to provide long-term economic security to RNs.

ANS: C
The hallmark that suggests the role nurses have in determining the quality of care is noted in the philosophy of clinical care.
Salaries are not one of the hallmarks discussed.
Benefits are not discussed in the hallmarks document.
Long-term economic security is not part of the Hallmarks of the Professional Nursing Environment.

DIF: Knowledge REF: Page 563

11. A nurse who is applying for a position contacts an expert on writing resumes and cover letters and is told:
a. to use correction fluid sparingly.
b. that when an error is made, a single line should be used to cross through the mistake, and initials should be inserted above the error.
c. to limit margins to one half inch so that the page appears full of information.
d. to be concise, limit the resume to a single page.

ANS: D
A resume is an effective, compressed one-page summary of the nurse’s education and employment history.
The use of correction fluid is inappropriate. A sloppy resume will cast doubt on one’s abilities to be proactive as a professional nurse.
When an error is made, the resume should be redone or spell/grammar-checked on a word processor.
The resume of a graduate nurse can be full of information without the need for nonstandard margins.

DIF: Knowledge REF: Page 568

12. The appropriate procedure for addressing a cover letter when the applicant is unsure of the name and title of the person to whom the letter should be addressed is to:
a. address the letter to “To Whom It May Concern.”
b. address the letter to “Nurse Recruiter.”
c. call the facility to inquire about the name and title of the person.
d. leave the salutation blank if the name and the title are unknown.

ANS: C
The letter should be addressed to a specific person. If the person’s name or title is unknown, refer to a marketing brochure, or call the recruitment office and ask for the correct title and spelling of the person’s name.
The letter should be addressed to a specific person.
The letter should be addressed to a specific person.
Leaving the salutation blank is not acceptable. The letter should be written to a specific person.

DIF: Knowledge REF: Page 565

13. When preparing the education section of a resume:
a. list high school, followed by the first college attended.
b. include all colleges attended, even if a degree was not awarded.
c. omit the address of the university unless requested by the potential employer.
d. list in reverse chronologic order the names, dates, and addresses of universities that awarded degrees.

ANS: D
Details about education should include degrees and diplomas awarded, names and locations of schools awarding them, and graduation dates, starting with the most recent graduation and degree.
The most recent degree or diploma is listed first.
Only educational institutions where degrees were awarded should be included, not those attended at which no degree was awarded.
When an educational institution is listed, it is preferred that the location of the educational institution be included.

DIF: Knowledge REF: Page 568

14. A new graduate arrives for the first interview feeling prepared and excited about beginning a nursing career but quickly becomes concerned when the recruiter asks which illegal question?
a. “Have you been convicted of a crime other than a minor traffic violation?”
b. “We are very interested in hiring you but you do understand the position is contingent on the results of the preemployment physical and background check?”
c. “What do you consider to be your major weaknesses for this particular position?”
d. “Because you are applying for a position in the operating room, you must be able to be on call. How many children do you have responsibility for at home?”

ANS: D
It is illegal for the recruiter or interviewer to ask number of children or dependents prior to making a job offer.
Employers can ask questions about criminal convictions but not arrests.
Job offers are contingent on the applicant passing required tests and background check.
Interviewers often seek to determine individual candidates self-evaluation of skills needed for the position.

DIF: Knowledge REF: Page 571

MULTIPLE RESPONSE

1. When preparing a portfolio, the nurse should include: (Select all that apply.)
a. copies of diplomas awarded by colleges/universities.
b. copies of college transcripts.
c. a personal photograph, if not included with the application.
d. letters of recognition for scoring high on national achievement tests while in nursing school.
e. a copy of the voter’s registration card.

ANS: A, B, D
Traditional documents, such as copies of diplomas, college transcripts, and recognition letters, are included in the portfolio.
Traditional documents, such as copies of diplomas, college transcripts, and recognition letters, are included in the portfolio.
Traditional documents, such as copies of diplomas, college transcripts, and recognition letters, are included in the portfolio.
It is not necessary to include a personal photograph in the portfolio.
A copy of the voter’s registration card is not acceptable.

DIF: Knowledge REF: Page 561

2. A new graduate nurse is preparing for an interview for her first position and knows that: (Select all that apply.)
a. the primary goal for the first job is to complete orientation and should be considered as an extension of nursing school.
b. appointments for interviews should be scheduled immediately after graduation to avoid rushing into a position.
c. self-confidence can be improved with self-talk, which reminds the graduate that peers from her school are effective practitioners.
d. work history of even nonmedical positions can demonstrate commitment and reliability so letters from these employers should be in portfolio.
e. it is best to arrive 10 to 15 minutes before the scheduled interview dressed for success.

ANS: C, D, E
Internal dialogue establishes a means for the graduate to recall achievements that will lead to success in the first nursing position.
Jobs such as cashier at a convenience store or dog-sitting can demonstrate responsibility such as handing cash or arriving on time.
Arriving too early may cause the recruiter to feel rushed and arriving too late may demonstrate lack of time management and professionalism.
The primary goal for the first job is to find good match that fits the nurse’s abilities, lifestyle and career aspirations.
Interviews should be set up prior to graduation.

DIF: Application REF: Pages 570-573

COMPLETION

1. The key to a successful interview is being ____________________.

ANS:
prepared
Being prepared is the best way to feel confident about the interview and to be ready for questions that the interviewer may ask. Rehearsing potential questions will ease the applicant’s fears about how he or she should answer these questions. Dressing appropriately and arriving on time are behaviors that take preparation; these steps, if done well, will assist the applicant to do well during the interview.

DIF: Knowledge REF: Page 573

Cherry: Contemporary Nursing, 5th Edition

Chapter 28: NCLEX-RN® Examination

Test Bank

MULTIPLE CHOICE

1. Graduates from approved schools of nursing cannot begin their careers and practice as registered nurses until they:
a. pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
b. provide evidence of mental competency.
c. supply written proof of physical fitness.
d. have signed an employment contract with a health care facility.

ANS: A
A compulsory license requirement must be met to legally practice or work as a registered nurse in any state or U.S. territory. Licenses are granted only after an applicant has successfully passed the NCLEX-RN examination.
Licensure is designed to protect the public by providing safe practitioners, but it does not evaluate the individual candidate’s mental competency.
Preadmission/preemployment physicals are part of the employment process; however, nurses with physical limitations may attain employment.
Graduates cannot practice as registered nurses until they pass the NCLEX-RN exam even if they have signed an employment contract. Some graduates may not seek employment until after they have successfully completed the NCLEX-RN and have become licensed.

DIF: Comprehension REF: Page 582

2. Which statement concerning the NCLEX-RN exam is correct?
a. Graduates from all three types of nursing programs (diploma, associate degree, and baccalaureate degree) take the same examination.
b. The examination is scored on an interval scale rather than on a pass-fail basis.
c. The examination is offered twice a year in major urban areas.
d. The candidate has the option of choosing a pencil-and-paper format.

ANS: A
The purpose of the NCLEX-RN exam is to determine safe practice and the ability of candidates to perform at the entry level. Candidates from all three types of nursing programs must demonstrate the same competencies.
The examination is adapted according to the candidate’s ability to answer questions on the basis of degree of difficulty and area of the nursing process.
The examination is offered at more than 3400 Pearson Professional Centers at a candidate’s convenience.
The examination is computerized; however, special accommodations are available for qualifying candidates.

DIF: Knowledge REF: Page 582

3. Computerized adaptive testing implies that:
a. the candidate must be computer literate.
b. competency is determined on the basis of difficulty of questions, knowledge of the nursing process, and the number of questions answered correctly.
c. testing facilities have been adapted for the physically challenged candidate.
d. questions cannot be adapted to the needs of the student.

ANS: B
Computerized adaptive testing is based on the measurement theory, by which the candidate must prove with a score of 95% that he or she is safe and knowledgeable at entry into the practice level.
Candidates are required only to click to record an answer or to type in numbers 1 through 5 when prioritizing; they may also ask for assistance at any time during the testing process. Fill-in-the-blank questions at present are limited to entry of numeric values for dosage calculations.
Although accommodations are available for qualified candidates, computerized adaptive testing is based on how the examination is scored, not on accommodations made for the individual candidate.
As a candidate answers questions on the examination, the computer adaptive testing adapts to the level of the candidate’s knowledge and skills.

DIF: Comprehension REF: Page 583

4. On the NCLEX-RN exam, when the candidate is asked to set goals in collaboration with other members of the health care team, the nurse is being tested in the area of:
a. assessment.
b. planning.
c. analysis.
d. implementation.

ANS: B
Setting goals is one of the first steps in the planning process.
Assessment involves data collection, as is achieved through diagnostic tests and physical assessment.
Analysis is the “breakdown” of data to establish a nursing diagnosis.
Implementation is carrying out the plan of care.

DIF: Application REF: Page 590

5. The length of the NCLEX-RN exam is based on the:
a. last four numbers of the candidate’s social security number.
b. location of testing.
c. candidate’s educational preparation.
d. performance of the candidate.

ANS: D
The length of the examination is based on the ability of candidates to provide 95% confidence that they are safe practitioners and have acquired a minimal level of knowledge about the nursing process. The length of the examination ranges from 75 to 265 questions, and it takes up to 6 hours to complete.
A candidate’s social security number is not part of the evaluation process.
The examination is administered at Pearson facilities, and the examination is comparable across the United States and its territories.
All three types of nursing programs have the same criteria for success on the NCLEX-RN exam.

DIF: Application REF: Page 587

6. The primary purpose of the NCLEX-RN exam is to:
a. ensure that practitioners have the minimum skills and knowledge needed to provide care that will produce the best patient care outcomes.
b. regulate nursing education.
c. determine the mandatory educational level required for nurses to practice.
d. accredit schools of nursing.

ANS: A
The purpose of the NCLEX-RN exam is twofold: (1) to safeguard the public from unsafe practitioners and (2) to determine whether candidates can perform entry level skills.
The NCLEX-RN exam is based on a survey conducted to determine what skills entry level nurses must perform. This may indirectly guide education but is not the purpose of the NCLEX-RN exam.
All three types of nursing programs have the same criteria for success on the NCLEX-RN exam.
Accreditation is provided by the National League for Nursing and the American College of Nurses; however, accreditation may be withheld if a school’s pass rate on the NCLEX-RN consistently falls below 85%.

DIF: Comprehension REF: Page 582

7. A student nurse who is preparing to graduate and take the licensure examination asks, “What is compulsory licensure?” The appropriate response of the nursing advisor is as follows:
a. All candidates wishing to take the licensure examination must pass a drug screen.
b. Candidates must not have a felony conviction.
c. To practice as an RN, the nurse must be licensed as an RN.
d. An impaired nurse must sign a legal document to acknowledge limitations on his or her practice.

ANS: C
Licensure is a prerequisite for practice to ensure public safety.
Not all states require drug testing prior to licensure.
Although a background check is performed on all candidates, state boards of nursing evaluate the type and disposition of the crime.
Impaired nurses must complete a program as specified by the state board of nursing to address limitations, but this is not the meaning of compulsory licensure.

DIF: Knowledge REF: Pages 581-582

8. The National Council of State Boards of Nursing determines acceptable NCLEX-RN exam questions on the basis of:
a. the geographic location of the candidate.
b. research that indicates needed skills for positions in which most entry level nurses are employed.
c. surveys conducted by employers to determine the weaknesses of entry level nurses.
d. surveys of physicians performed to determine what nurses must know to provide safe care.

ANS: B
Periodically, the National Council of State Boards of Nursing surveys health care settings to identify nursing care activities of entry level nurses.
All candidates in the United States and its territories take comparable examinations. Many states allow nurses once licensed to be licensed in another state without retaking the NCLEX-RN exam; therefore, examinations cannot be geographically specific.
The NCLEX-RN exam focuses on the skills and knowledge most commonly required for entry level work, not on weaknesses.
Nursing has its own body of knowledge; however, physicians may serve on advisory boards to suggest changes/additions to nursing preparation.

DIF: Comprehension REF: Pages 582-583

9. Although the NCLEX-RN exam has new formats for questions, the most common format is the:
a. fill-in-the-blank item, because candidates are not provided with clues from distracters.
b. multiple-choice question item, which allows candidates to select the one correct answer.
c. multiple-response item, because these questions require a higher level of critical thinking.
d. hot-spot item, because these questions are written at the application level of Bloom’s analysis.

ANS: B
Most NCLEX-RN exam questions have three distracters and one correct answer, but the examination allows all four levels of Bloom’s taxonomy to be tested.
Currently, completion or fill-in-the-blank questions focus on entering the correct answer for dosage calculation problems.
Only about 10% of the NCLEX-RN exam contains alternate-format questions, which are most often written at a higher cognitive level.
Prioritization is becoming more frequent on the NCLEX-RN exam because it requires a higher level of critical thinking; however, it is not the most common type of question.

DIF: Knowledge REF: Page 584

10. When delegating care, the RN assigns one nurse to care for a patient with shingles and a different nurse to care for a patient with human immunodeficiency virus/acquired immunodeficiency disease syndrome (HIV/AIDS). This represents which category of nursing care?
a. Safe and effective care environment
b. Health promotion and maintenance
c. Psychosocial integrity
d. Teaching/learning

ANS: A
The nurse is safeguarding the patient with immunosuppression from the possible transmission of an infection.
Health promotion and maintenance is focused on early detection and prevention of health-related problems.
Psychosocial integrity focuses on the emotional, mental, and social well-being of clients.
Teaching and learning are integrated processes that can be incorporated into the four categories of nursing care.

DIF: Analysis REF: Page 588

11. A patient is brought to the unit with mediastinal chest tubes with no fluctuation in the water seal chamber; arterial blood gas results reveal pH, 7.55; CO2, 55; HCO, 28 mEq/L, and O2, 98%. Carotid artery pulsation is visible with the head of the bed elevated and the use of tangential lighting. The first action of the nurse is to _____.

The above question represents which level of Bloom’s taxonomy?
a. Knowledge
b. Comprehension
c. Application
d. Analysis

ANS: D
In analysis the candidate must make a judgment call after determining relationships among data.
Knowledge requires simply recalling information and does not require understanding or judgment.
In comprehension the information is not restated but instead requires the candidate to make a judgment.
In application the candidate is not being asked to apply information in a new context.

DIF: Analysis REF: Page 587

12. A candidate who is taking the NCLEX-RN exam received only 75 questions before the test was stopped. She called her professor and stated, “I passed. I had to answer only 75 questions.” The professor correctly responds by saying:
a. “You are now officially licensed; you answered the more difficult questions correctly.”
b. “It is possible to receive only 75 questions and not be successful; however, we will keep a positive attitude.”
c. “If you were given only 75 questions, you will have to retest because this is not enough to determine competency.”
d. “You must have been extremely close to the passing standard because the computer shut off.”

ANS: B
75 questions is the minimum number of questions that can determine 95% competency of the candidate; however, receiving 75 questions can indicate that the candidate passed and was able to answer a broad range of questions covering the nursing process at higher cognitive levels, or it can mean that the candidate failed, answered even the lowest cognitive level questions incorrectly, and was unprepared in area/s of the nursing process.
Although answering only 75 questions is promising and the applicant was most likely successful, it is not always an indication of passing.
75 questions can determine 95% competency of the candidate.
The computer would not shut off at 75 questions; it would continue until time runs out or the maximum number of questions is provided, should the candidate be close to the passing range.

DIF: Application REF: Page 587

13. On the basis of changes effective with the April 2010 test plan, candidates who take the NCLEX-RN exam:
a. will have to answer more than 75 questions to be 95% certain that they are above the passing standard.
b. will be required to submit a 100-word essay on an important nursing topic to evaluate safe nursing practice.
c. should study and take practice examinations written at the application and analysis level to ensure that they can meet the higher standards of nursing care and health care delivery.
d. will have additional time to complete the examination because most questions will be prepared in the alternate format, thereby requiring critical thinking.

ANS: C
In April 2007 the difficulty of the examination was increased, which would require higher cognitive level questions at the application and analysis level.
The difficulty of the questions, not the number of questions, has increased.
Essays are not part of the new testing plan.
The time limit is not affected by the new testing plan.

DIF: Application REF: Page 587

14. In the NCLEX-RN exam test plan, client needs forms the organizing framework of the exam with questions in four categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiologic integrity. Certain processes are then integrated throughout the categories of client needs. Which process is integrated into all client need categories?
a. Teaching/learning
b. Health promotion
c. Infection control
d. Pharmacology

ANS: A
Teaching and learning are the processes that are integrated, along with the nursing process, caring, communication, and documentation.
Health promotion is a category of client need.
Infection control is a category of client need.
Pharmacology is a category of client need.

DIF: Comprehension REF: Page 591

15. Which action would help a student successfully prepare for the NCLEX-RN examination?
a. Make note cards that can easily be retrieved to list only facts.
b. Avoid timing oneself while studying and when in the actual testing mode to decrease anxiety.
c. Ask peers for help because they had the same resources; especially seek their help for difficult concepts requiring critical thinking.
d. Practice taking NCLEX-RN exam-type questions and reviewing rationales for correct and incorrect answers.

ANS: D
Practicing helps the student learn how questions are presented and what level of difficulty should be anticipated. Reviewing rationales for the answers is a teaching/learning opportunity that enables the student to judge whether the rationale used to answer the question is valid.
Students should focus on concepts rather than on isolated facts.
Because the NCLEX-RN exam is a timed examination, it is possible for a candidate to run out of time before demonstrating competency. Timing oneself during practice will reveal whether the candidate is spending too much time on questions.
Faculty members or the facilitator of formal review courses are the best resource for difficult concepts requiring critical thinking. Peers may not understand the material as well as they think they do.

DIF: Application REF: Page 592

16. The nurse prepares to apply sterile gloves needed for a procedure. After introducing self and verifying patient information, the nurse performs hand hygiene. The nurse should open the outer package and then perform steps in which order:

1. Open inner package, taking care not to touch inner surface
2. Put the glove on the nondominant hand using the sterile gloved hand
3. Put glove on dominant hand by grasping folded cuff edge, touching only inside of cuff
4. Adjust each glove carefully by sliding finders under the cuff.

a. 1,3,2,4
b. 1,2,3,4
c. 1,4,3,2
d. 2,3,1,4

ANS: A
1,3,2,4 is correct because the nurse should open the inner package first, then put the glove on the dominant hand before the nondominant hand before adjusting the gloves.

DIF: Application REF: Pages 585-586

17. The nurse prepares to apply sterile gloves needed for a procedure. After introducing self and verifying patient information, the nurse performs hand hygiene. The nurse should open the outer package and then perform the following steps in order (items on left will be moved in correct order on the right):

Place in correct order.
Open inner package, taking care not to touch inner surface.
Put the glove on the nondominant hand using the sterile gloved hand.
Put glove on dominant hand by grasping folded cuff edge, touching only inside of cuff.
Adjust each glove carefully by sliding finders under the cuffs.

The above question represents which type of alternate-format question written at which level of Bloom’s taxonomy?

a. Drag-and-drop item, comprehension
b. Chart exhibit item, analysis
c. Multiple-response, application
d. Hot-spot item, knowledge

ANS: A
A
The drag-and-drop format questions require the candidate to place options in a specific order moving them from left to right using the mouse. The level is comprehension because this level requires the student to have a fundamental level of understanding and summarize the material.
A chart exhibit requires the candidate to seek additional information in a patient’s chart.
Multiple-response questions ask the candidate to check all responses that are correct for a given statement.
The hot-spot question requires the candidate to identify one or more areas on a picture or graph.

DIF: Analysis REF: Pages 585-586

OTHER

1.

A patient presents with chest pain that increases when lying flat and low-grade fever. Assessment reveals muffled heart sounds, tachycardia and 3+ edema in the lower extremities. The nurse asks the patient to learn forward, which eases respiratory efforts. The nurse then places the stethoscope at which area to facilitate auscultation?

The above question represents which type of alternate-format question written at which level of Bloom’s taxonomy?
A. Multiple-response item, comprehension level
B. Hot-spot item, analysis level
C. Chart exhibit item, application level
D. Drag-and-drop item, knowledge level

ANS:
B
This is a hot-spot item; students are presented with a figure on which they must indicate the answer by clicking the mouse over the area. The student would place the mouse over the left sternal border. It is analysis level because the student must take data from many sources to provide a complete assessment of the patient’s condition.
Multiple-response questions ask the candidate to check all responses that are correct for a given statement.
A chart exhibit requires the candidate to seek additional information in a patient’s chart.
The drag-and-drop format questions require the candidate to place options in a specific order, moving them from left to right using the mouse.

DIF: Analysis REF: Pages 584, 587

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