Contemporary Nursing 8th Edition Cherry Test Bank 1

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Contemporary Nursing 8th Edition Cherry Test Bank

CONTEMPORARY NURSING 8TH EDITION CHERRY TEST

BANK QUESTIONS AND CORRECT ANSWERS 100% PASS
AL CHAPTERS AVAILABLE (2023-2024) A+ GURANTEED
Chapter 01: The Evolution of Professional Nursing

Cherry and Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th
Edition
MULTIPLE CHOICE
1. What accomplishment is Clara Barton best known for?

a. Becoming the first black public health nurse
b. Establishing the Henry Street Settlement
c. Founding the American Red Cross
d. Publicizing the inadequacies of hospital-based nursing schools
ANS: C
The American Red Cross was founded by Clara Barton in 1882, to be of assistance in efforts
to provide supplies to the battlefields and hospitals. Barton also sets up a postwar service to
find missing soldiers.
DIF: Knowledge
2. Students are assigned to write to their state leaders about an issue affecting their community.
One student writes about the need among rural community for greater access to acute care
services. Which piece of legislation should the student use as a reference?
a. Social Security Act
b. Hill-Burton Act
c. Sheppard-Towner Act
d. U.S. Civil Service Act
ANS: B
The purpose of the Hill-Burton Act was to provide funding to construct hospitals and to help
states in plan for other health care facilities in accordance with the needs of communities.
DIF: Knowledge
3. The practice of public health nursing and the Henry Street Settlement are credited to
a. Mary Breckenridge.
b. Mary Seacole.
c. Clara Barton.
d. Lillian Wald.
ANS: D
Lillian Wald, a pioneer in public health nursing, is best known for the development and
establishment of the Henry Street Settlement.
DIF: Knowledge
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 was a pioneer in public health nursing, and is best known for the development
and establishment of the first viable practice for public health nurses.
DIF: Comprehension
5. What historical event first led to the recognition of the contribution of blacks to nursing?
a. Florence Nightingale’s acceptance of black nurses into the first nursing school
b. The contributions of black nurses at the Pennsylvania Hospital, the first hospital in
America
c. Mary Williams and Frances Rose are listed as nurses in the City of Baltimore
Directory.
d. The work done by wives of wealthy black nobles who carried food and medicine
from house to house during the Middle Ages
ANS: C
1840—Two black women, Mary Williams and Frances Rose, who founded Nursing Sisters of
the Holy Cross, are listed as nurses in the City of Baltimore Directory.
DIF: Comprehension
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 ofN
coUmRm
SuInN
ityGhTeB
alt.
hC urM
nO ses.
ANS: C
World War I offered nurses a chance to enter new fields of specialization, as is seen in the
example of nurse anesthetists, who became part of surgical teams at the front lines.
DIF: Comprehension
7. What was an original purpose of the Social Security Act of 1935?

a. Increase research that focused on minority groups
b. Provide medical care for chemically impaired persons
c. Ensure health care for older adults through a national insurance system
d. Decrease the public’s financial burden by limiting services offered by local health
departments
ANS: C
By providing health insurance for older adults, the Social Security Act of 1935 set the
precedent for the passage of the Medicare and Medicaid Acts that followed in 1965, but the
act also provided maternal and child welfare services, rehabilitation for the mentally and
physically challenged, medical care for blind individuals and crippled children, and
unemployment benefits.
DIF: Comprehension
8. A client asks the nurse, “Can you explain the amendment to the Social Security Act called
Title XVIII to me?” The nurse demonstrates an understanding of this legislation when
providing what response?
a. It led to many hospital closings, along with a decrease in acute care hospital–based
nursing care.
b. It provided medical insurance to those younger adults or children who were not
eligible for private insurance because of catastrophic illnesses such as cancer.
c. It provided preventive care for women, infants, and children.
d. It ensured that individuals with end-stage renal disease had health care insurance.
ANS: D
The Medicare program provides hospital insurance, Part A, and medical insurance, Part B, to
all people aged 65 and older who are eligible to receive Social Security benefits; people with
total, permanent disabilities; and people with end-stage renal disease.
DIF: Comprehension
9. A comparison of nursing in the 1980s to nursing in the 1990s reveals what factor that
contributes to health care as we know it today?
a. In the 1990s nursing experienced a significant reduction occurred in preventable
diseases caused by unsafe/unhealthy lifestyles.
b. Tuberculosis was the primary concern for nursing in the 1980s, whereas the AIDS
epidemic emerged and was its focus during the 1990s.
c. A decrease in ambulatory services in the 1980s prompted an increase in public
health nurses in the 1990s.
d. The demand for advanced practice nurses increased in the 1980s and the 1990s
because of the economy aNnd R conI
cernGaboBu.
t tC
he hMealth of the nation.
ANS: D
The numbers of advanced nurse practitioners increased as evidence of their cost-effectiveness
as providers of primary and preventive health care became established.
DIF: Comprehension
10. Which statement accurately describes the historical perspective of nursing practice?
a. Nursing has existed to meet the needs of populations, individuals, and aggregates
by providing care that is determined by the needs and beliefs of society in different
historical contexts.
b. As men began to become interested in nursing, it changed into a respected
profession based on scientific fact rather than superstition.
c. Nursing has historically accepted individuals from all social and ethnic
backgrounds.
d. The United States has led the way throughout history to advance nursing and
health care by providing the first hospital and medical school.
ANS: A
Nursing has existed since biblical times to address needs ranging from contagious diseases in
early times to health prevention in the present time, with care based on health needs and
beliefs of the time.
DIF: Comprehension
11. The use of herbs, which has become a popular alternative to prescription drugs in today’s
health care milieu, had roots originating when?
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 disease; in the Middle Ages,
women used herbs. This practice has continued to today.
DIF: Comprehension
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 what time period?
a. The prehistoric period
b. Early civilization in Egypt
c. The European Renaissance
d. The Middle Ages in Asia and Africa
ANS: A
During prehistoric times, illness was thought to be caused by evil spirits that providers
attempted to scare away through rituals and dances.
DIF: Comprehension
13.13.
A prospective nursing student who researches universities that offer a baccalaureate degree in
nursing would want to ensure that the program is accredited by what agency?
a. American Nurses Association
b. Commission on Collegiate Nursing Education
c. National Institutes of Health
d. National Nursing Council
ANS: B
The Commission on Collegiate Nursing Education (CCNE) is the agency that exclusively
accredits baccalaureate and graduate-degree nursing programs.
DIF: Comprehension
14. Nursing in the 1990s was characterized by what health care focus?
a. Men leaving nursing to enter the armed services
b. Traditional 8-hour shifts to nurse burnout and compassion fatigue
c. Identifying health promotion associated with preventable diseases
d. Managing runaway health care costs
ANS: C
Health promotion and disease prevention were recognized as the means to reduce the high
number of mortalities associated with preventable diseases—Healthy People 2000 was
published as a nationwide effort to reduce preventable deaths.
DIF: Comprehension
15. A nurse is part of the policy committee for a hospital. The committee is provided with
statistics indicating that patients participating in a satisfaction survey felt they lacked
sufficient information about new drugs started while hospitalized and continued after
discharge. In addition, charts noted high recidivism rates. The committee recommended that a
formalized patient education plan be instituted to reconcile all medications and provide patient
information about new medications. The committee is using which component of the Institute
of Medicine (IOM) 2011 message?
a. Nurses should achieve higher levels of education to be effective members of an
interdisciplinary team.
b. Nurses should have a minimum of a master’s degree to sit on policy committees
that affect an entire facility.
c. Pay for nurses should be consistent with that of physicians since the committee is
interdisciplinary.
d. Policy is based on data, which provides the groundwork for decision making.
ANS: D
The IOM report initiatives include effective workforce planning and policymaking based on
better data collection and improved infrastructure.
DIF: Application
16. What was the stated goal of the Affordable Care Act of 2011?
a. Requiring that by 2020 all newly licensed nurses have a bachelor’s degree at
minimum
b. Provide health care benefits to millions who were previously uninsurable or unable
N R I G B.C M
to afford insurance
c. Cap the amount that hospitals and physicians can charge for procedures
d. Subsidizes private insurance companies, thereby reducing health care costs for the
chronically ill
ANS: B
It is anticipated that the ACA (2011) will make insurance coverage possible for millions who
have previously not had insurance or had been denied insurance.
DIF: Comprehension
17. It has been said that “history repeats itself because no one was listening the first time.” Which
statement is true when comparing the nursing care provided in the Civil War (1861 to 1865)
to that provided during the Crimean War?
a. Epidemics such as smallpox and typhoid were the primary emphasis of nursing
care in both wars.
b. Soldiers were housed in substandard conditions, but due to Nightingale’s push for
sanitary conditions, in the Civil War soldiers were housed in aseptic conditions.
c. Black nurses were widely accepted by society and the profession, receiving equal
compensation during the Civil War due in large part to the efforts of Mary Seacole
during the Crimean War.
d. Both Nightingale (Crimean War) and Dix (Civil War) completed nursing training
before accepting positions as nurses in the wars.
ANS: A
Numerous epidemics plagued the country, including syphilis, gonorrhea, malaria, smallpox,
and typhoid.
DIF: Application
MULTIPLE RESPONSE
1. What uniquely 21st century issue challenges today’s professional nurse? (Select all that
apply.)
a. Caring for an aging population
b. Increased patient acuity
c. Access to health care services
d. Expanding technology
e. Increasing intercultural patient population
ANS: A, B, D, E
Professional nurses in the 21st century are faced with many challenges including an aging
patient population. Professional nurses in the 21st century are faced with many challenges
including an increase in high acuity patients. Professional nurses in the 21st century are faced
with many challenges including an ever-expanding array of technologies that affect patient
care. Professional nurses in the 21st century are faced with many challenges including the
existence of an intercultural patient population.
DIF: Comprehension
2. A newly licensed nurse compNareR

s theIchG
alleB
ng.eC
s facMing nursing today with those faced by
U Sin 1990.
nurses when her mentor graduated N T The mentor states, “Prevention was the focus of
nursing when I graduated. We stressed preventive health measures such as smoking cessation
education to reduce preventable diseases and prevention to reduce the spread of infectious
disease such as AIDS.” The mentor asks, “What do you think the challenges will be for nurses
graduating now?” (Select all that apply.)
a. Coordinating care for a more diverse aging population who have complex health
values
b. Managing care provided by nurses who are technologically advanced and skilled at
interprofessional collaboration
c. Providing care to well-informed consumers who are younger with narrow health
values
d. Redesigning nursing care delivery models to streamline care based on fewer
generational differences
e. Focusing on care from a systems perspective
ANS: A, B, E
Our society, thus our patients/consumers, is aging and better informed about health care
options, with health values as diverse as the various populations of patients served. Nurses
educated in the 21st century are introduced to advanced technologies throughout the
curriculum, but a gap still exists between the potential benefits of technology and the use
made of it to reduce errors and improve patient care; interprofessional collaboration is a
challenge with incivility and workplace violence increasing. Today’s nurses must view health
care from a systems perspective rather than a nursing unit perspective to decrease errors/costs
that arise from system errors.
DIF: Analysis
3. What historical events helped advanced the practice of surgical nursing? (Select all that
apply.)
a. The Ancient Egyptians were the first to use anesthesia in the operating room.
b. The “Barbers” of the Middle Ages used sterile techniques to reduce wound
infections.
c. The Indian culture from 274 to 236 BC had hospitals staffed with female nurses
who practiced much like today’s nurses.
d. During the Renaissance, advances in nursing education, including surgery, were
nonexistent.
e. Following World War II, nurses practiced in mobile army surgical hospitals, where
medical and surgical techniques were further refined.
ANS: D, E
During the Renaissance, major advancements were made in pharmacology, chemistry, and
medical knowledge, including anatomy, physiology, and surgery with new emphasis given to
medical education, but nursinNg eR
U SIWar,
ducatioG
n wB
as.pC
ractically nonexistent. Following World War
II, nurses volunteered for the Korean N Twhere Ocare was provided in MASH units and
surgical techniques were defined.
DIF: Analysis
COMPLETION
1. Which group in early civilization is credited with developing a pharmacopeia 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
Chapter 02: The Contemporary Image of Professional Nursing

Edition
MULTIPLE CHOICE
1. Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by
2020?
a. Positions that historically required registered nurses will be filled by unlicensed
personnel.
b. The job growth rate for RNs will surpass job growth in all other occupations.
c. The need for hospital nurses will dramatically decrease.
d. Hospitals will finally achieve the required RN workforce.
ANS: B
With an employment rate expected to increase by more than 15%, job production for nurses is
projected to grow faster than the average of all occupations (7%) until 2020.
DIF: Knowledge
2. What effect did the movie One Flew Over the Cuckoo’s Nest have on health care?
a. Funding for mental health care increased, allowing the point of care to change
from the community to standardized institutional care.
b. The public and the nursing profession were made aware of the rights of vulnerable
populations.
c. Nurses were seen as advoN
cateRs foIr inG
divB
id.
uaC
ls wMho cannot advocate for
themselves.
d. Funding for nursing traineeships was eliminated.
ANS: B
One Flew Over the Cuckoo’s Nest reminded us that all individuals have rights and that it is the
responsibility of the public and health care professionals to ensure that these rights are
protected.
DIF: Comprehension
3. Which nurse died after deliberately acquiring two bites from yellow fever carrier mosquitoes
to enable her to provide care to soldiers with yellow fever during the Spanish-American War?
a. Florence Nightingale
b. Margaret Hoolihan
c. Clara Maas
d. Sairy Gamp
ANS: C
Clara Maas is noted as the nurse who deliberately acquired two bites from yellow fever carrier
mosquitoes to enable her to provide care to soldiers with yellow fever.
DIF: Knowledge
4. A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates
caring by holding a soldier’s head is an artistic representation of nurses who served in which
war?
a. World War I
b. World War II
c. Spanish-American War
d. Vietnam War
ANS: D
This statue represents the caring provided by nurses during the Vietnam War.
DIF: Knowledge
5. What was the purpose of the Nurse Reinvestment Act of 2002?

a. Provided disability insurance to RNs who contract a life-threatening illness while
on duty
b. Funded public service announcements that promote unlicensed caregivers as an
alternative to professional nurses
c. Focused on nurse retention and safety enhancement grants to address the current
nursing shortage
d. Provided pediatric nursing training grants
ANS: C
This act provided nursing scholarships, public service announcements promoting nursing as a
career, faculty loan cancelation programs, geriatric training grants, and nurse retention and
safety enhancement grants.
DIF: Knowledge
6. What is the best way for the individual nurse to maintain the most effective professional
image?
a. Change out of their work attire before running errands
b. Renew membership in a nursing organization
c. Earning an advanced nursing degree
d. Developing effective nurse-physician relationships
ANS: B
Professional nurses recognize that their greatest benefit—and one of the most efficient and
powerful uses for their money—is less than 1% of their salary they spend for membership in
the ANA, the National League for Nursing, Sigma Theta Tau International, and their specialty
organization. They look forward to annual meetings because such meetings provide an
excellent opportunity to meet colleagues and discuss issues and practice innovations.
DIF: Application
7. What statement accurately describes Charles Dickens’ character Sairy Gamp?

a. The character was portrayed as a trained professional individual who put others
before self.
b. The character chose nursing because there were few other avenues for
employment.
c. The character was a prostitute who cared for the sick old men in the community.
d. The character showed nurses to be at the forefront of the technology of that time.
ANS: B
Sairy Gamp endured nursing because of the lack of other opportunities.
DIF: Knowledge
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
c. Clara Maas, who found the cure for yellow fever during WWII
d. All military nurses for their service, bravery, and compassion
ANS: D
The statue the Spirit of Nursing was created to honor all military nurses.
DIF: Knowledge
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
what true nursing characteristic?
a. The skill and drive to assist doctors in caring for the wounded
b. That women possess the desire to serve one’s country that equals that of men
c. The ability of nurses to cope with the dreadfulness of war by using humor
d. The contributions of any nurse to the care of military personnel
ANS: C
The sitcom M*A*S*H did show humor as a coping mechanism for nurses in a war setting.
N R I G B.C M
DIF: Knowledge
10. With the crisis in health care and the nursing shortage, why is the image of nursing still
important?
a. Nursing care is often delivered during a time of uncertainty, and the image of
nurses during this time can reinforce trust in the nurse-patient relationship.
b. Physicians have a distinctive body of knowledge that identifies them as
professionals, whereas nursing has yet to develop a unique body of knowledge on
which to base practice.
c. Nurses must present a unified image if they hope to ever establish nursing as a
profession.
d. The dynamic state of today’s health care requires nurses to move from a caring
image to one of technologic competence.
ANS: A
A person who seeks health care is entering a world of uncertainty. The nurse provides
continuity and compassion and stabilizes the environment of the patient.
DIF: Comprehension
11. How can nurses best combat the nursing shortage?

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 cancelation
programs, geriatric training grants, and nurse retention and safety enhancement grants. This is
the best defense against the nursing shortage. Nursing graduates in many states have increased
in number, and enrollment in nursing schools is also on the rise.
DIF: Application
12. What does the demographics of the 21st century nursing population indicate?
a. A typical nursing student is a second-degree student who average 45 years of age.
b. More white nurses enter and obtain graduate degrees than any other ethnic group.
c. The highest level of nursing education for most RNs is an associate degree.
d. 61% of nurses practice in hospitals.
ANS: D
Sixty-one percent of nurses practice in hospitals.
DIF: Comprehension
13. A nursing student asks, “I woNnde

URr ifSItheNGreas
TBo.
nCthatMthe nursing shortage is so severe is that
registered nurses are unhappy with their jobs.” Which statement provides the answer provided
by the National Survey of Registered Nurses?
a. Registered nurses change employers every year to prevent burnout and to keep the
nursing shortage from increasing.
b. Nursing faculty are aging or leaving academia due to increased work demands and
generational difference from students.
c. Practicing registered nurses are satisfied with their job and most remain with same
employer they worked for the previous year.
d. Registered nurses were the least satisfied with their job of all health care providers.
ANS: C
According to the latest National Sample Survey of Registered Nurses (NSSR), 79.8% of
practicing RNs were satisfied with their job and 88.4% were with the same employer as they
had been in the preceding year (U.S. Department of Health and Human Services, 2010).
Among all RNs, nursing faculty are the most satisfied (86.6%).
DIF: Comprehension
14. A registered nurse is on break and checking e-mails. One e-mail contains a picture of a
celebrity who is a patient in the hospital, and on the same floor, where the nurse works.
Included with the photo is a message, “check out my Facebook,” which contains additional
photographs of the patient. The nurse immediately deletes the picture to prevent having to
report the “friend” to supervisors. Based on the action of the nurse who received the message,
which statement is correct?
a. The nurse is not at risk for having his or her license suspended since removing the
photos made them temporary and invisible to all others.
b. Because the nurse did not send the message and immediately deleted the photo,
there is no risk for discipline.
c. Failing to report receiving the message demonstrates poor ethical and legal
role-modeling as well as placing the nurse at risk for discipline.
d. Because the patient is on the same floor as the one on which the nurse works, the
information can be ethically and legally shared.
ANS: C
Failing to report the image can result in discipline.
DIF: Comprehension
15. A nurse executive is concerned that the hospital’s mortality rate exceeds the national average
and searches the literature finding Aiken’s 2011 Survey on the effects of nurse staffing and
education on mortality, including work environment. If Aiken’s recommendations are
followed, which change would be most effective?
a. Increasing staffing ratios to include more nurses of all levels of educational
preparation on all shifts
b. Employing bachelor’s preNparR
U SItheir
ed nursG Bh.o C
es w participate in interprofessional rounds
with attending physicians where N T O heard
voices are
c. Ensuring nurse managers and administrators have at minimum a master’s degree
d. Encouraging all unlicensed assistive personnel to attend educational programs to
be certified
ANS: B
Aiken (2011) found that simply increasing the number of RNs was not the only answer to
reduce mortality. Increasing the number of BSN-prepared nurses along with developing a
positive work environment had the most impact on reducing mortality. The impact on
reducing mortality by increasing the educational level of nurse managers/administrators and
certified unlicensed assistive personnel was not documented.
DIF: Application
16. To best improve patient outcomes on an acute care hospital unit, which intervention should
the nursing staff advocate for?
a. Staffing only 8-hour shifts on the unit
b. Decreasing the number of patients cared for on any specific unit
c. Increasing salaries for experienced nurses
d. Increasing staffing on the evening shift
ANS: D
The data clearly indicate that decreased nurse-patient ratios have been associated with higher
rates of mortality, shock, urinary tract infections, sepsis, hospital-acquired pneumonia, and
failure to rescue, especially among surgical patients.
DIF: Application
17. A physician reports to administration that the nurse working last evening is unethical, based
on observing the nurse educate the patient about a new medication ordered. The physician
demanded the nurse be reprimanded and reminded that only physicians have the educational
background to teach patients about new medications. Which comment and action by the
administrator would be most effective in changing nurse-physician relationships in this
instance?
a. Inform the nurse, “You will be suspended for 3 days for going beyond your job
description,” and enforce the 3-day suspension because the physician did not write
the order to “teach the patient about the new medication.”
b. Advise the physician that only nurses can teach patients about medications; the
physician’s role is to only prescribe. No action will be taken against the nurse.
c. After investigating the situation, thank the physician while also providing
information that patient education related to medication is within the scope of
practice of registered nurses. Share the physician’s concern and administrator’s
response with the nurse so both parties are aware of the resolution of the concerns.
d. Contact the patient’s family and ask, “Do you prefer that all teaching related to
medications be performed by the physician rather than the nurse” to determine
what action to take.
ANS: C
Investigating the situation to N
proR
videIevGidenB
ce.iC
s the first step. Once the facts are known,
action can be taken. In this instance, including theOethics committee would help ensure an
U S N T
unbiased decision.
DIF: Application
18. Which nurse best portrays nursing as a “knowledge worker”?

a. Nurse in matched scrubs with lab coat, hair back, small stud earrings
b. Nurse in mismatched scrubs, no lab coat, large hoop earrings
c. Nurse in white uniform with apron with no jewelry/hair back
d. Nurse with nose ring and eyebrow piercing with starched white uniform and cap
ANS: A
Nursing scrubs have become a popular alternative to the traditional white uniform; clean
wrinkle-free matching scrubs presented a professional image. Small stud earrings reduce risk
of injury to nurse when caring for confused or combative patients.
DIF: Application
MULTIPLE RESPONSE
1. According to current data what factors are most directly related to the nursing shortage?
(Select all that apply.)
a. Salaries of nurses are competitive with those of other professionals such as
teachers.
b. Only 19% of nurses are minorities.
c. Overall, nurses are satisfied with their jobs but leave the profession because of fear
of contracting fatal diseases.
d. The employment opportunities for nurses continue to be strong.
e. Staff nurses are returning to school to obtain certificates to teach nursing.
ANS: B, D
Only 19% of nurses are minorities. RNs have one of the highest growth rates of employment
of all occupations.
DIF: Knowledge
2. A group of new graduate nurses is asked to speak to a group of politicians to describe the
current state of professional nursing and how best to alleviate the nursing shortage. Which
statements accurately portray professional nursing today and tomorrow? (Select all that
apply.)
a. More RNs attain a bachelor’s degree than an associate degree or diploma.
b. Because of pressure to shorten length of stay in hospitals, more RNs practice in
outpatient settings and home health than in acute care settings.
c. The most popular advanced practice specialty is nurse anesthesia.
d. White nurses are more likely to enter graduate school than nurses from other ethnic
groups.
e. Nursing represents the largest health care professional group, followed by medical
doctors.
ANS: A, E
Recipients of BSN degrees reNpUreR ntItN
seS heGlT
arB
ge.
stCgO
raM
duating educational profile. Nurses make
up the largest group of health care professionals.
DIF: Comprehension
3. Which actions would result in a greater number of nurses entering and staying in practice,
given today’s state of nursing? (Select all that apply.)
a. Determine why few black women enter graduate school.
b. Provide incentives for minorities and men to enter nursing.
c. Obtain grant funding to increase the number of faculty members and scholarship
availability for students entering baccalaureate nursing programs.
d. Survey nurses to determine why their job satisfaction is lower than that of other
health care professions.
e. Develop ad campaigns that target younger students.
ANS: B, C, E
Core solutions to the nursing shortage include providing incentives for minorities and men to
enter nursing. Core solutions to the nursing shortage include obtaining grant funding to
increase the number of faculty members and scholarship availability for students entering
baccalaureate nursing programs. Core solutions to the nursing shortage include developing ad
campaigns that target younger students.
DIF: Comprehension
4. The Nurses of America’s media campaign raised awareness of which aspects of nursing?
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.
DIF: Comprehension
NURSINGTB.COM
Chapter 03: The Influence of Contemporary Trends and Issues on Nursing Education
Edition
MULTIPLE CHOICE
1. What term is used to identify that a student nurse’s competency is determined based on actual
client care rather than traditional testing methods?
a. Core practice competencies
b. Continuing competence
c. Distance learning
d. Performance-based assessment
ANS: D
Performance-based assessment is the evaluation of abilities based on an objective
demonstration of specific required competencies. This may include performance in actual or
simulated situations. Competencies are the foundation for determining competency regardless
of method. Distance learning is an education delivery format.
2. Which factor has steadily grown in its negative influence on nursing education and practice?
a. The implementation of technology
b. The narrowing scope of nursing practice
c. Societal displays of incivility
d. Distant learning programs
ANS: C N R I G B.C M
Incivility has escalated and canUbeS
demNonsTtrated bOy the common practice of text-messaging
during class and an increase in academic dishonesty learning to impaired learning and lack of
necessary competency. The scope of nursing practice has increased in current years. Neither
technology nor distant learning has demonstrated significant negative impact on nursing
education or practice.
3. Although the use of technology and the Internet provide nursing faculty and students with
unlimited resources and current information, what undesirable outcome has become
associated with this trend?
a. Getting distracted and spending a disproportionate amount of time looking for
relevant content
b. Additional time must be made available to study and revise curricula because
special skills are needed to access information via the Internet.
c. Immediate results and outcomes are expected from students and faculty, thus
enhancing time management.
d. Skills that require problem solving and reflective abilities are underdeveloped.
ANS: A
Students can easily become distracted by pursuit of the intriguing web of links they encounter
while they search websites to complete assignments or find pertinent content. None of the
other options are considered as negative outcomes as the use of technology has increased.
4. A new trend in nursing education that is consistent with real-world practice is focused on what
activity?
a. Establishing appropriate outcomes

b. Writing both cognitive and affective objectives
c. Designing patient-centered clinical goals
d. Deciding upon effective subjective appraisals
ANS: A
Outcomes and criteria establish real expectations for clinical practice and have a powerful
influence on nursing education and practice at all levels. Outcomes are used in all areas of
nursing in the nursing process. The remaining options contribute to outcomes.
5. What demographic change has the greatest impact on the practice of nurses, nursing students,
and faculty?
a. The increasing percentage of adults aged 50–55 years
b. Increasing numbers of obese children and adults
c. Changes responsible for families becoming more nuclear
d. Social programs that are essentially eliminating poverty
ANS: B
The United States is experiencing an epidemic of obesity with major consequences for health
and the health care system. None of the other options present accurate information regarding
current demographic changes.
6. What was the first university to establish a department of nursing to offer nursing graduates a
baccalaureate degree?
a. Columbia Teachers College
b. Yale University
c. Harvard University
d. The New York Regents PNroUgR mINGTB.COM
raS
ANS: B
In 1924, Yale University offered the first separate Department of Nursing, whose graduates
earned a baccalaureate degree.
7. Which nursing model is referred to as the “class without walls” since it is not limited by
geographic location?
a. Mobility
b. Career ladder (2 + 2)
c. External degree
d. Second degree
ANS: C
An external degree does not require attendance and provides no course classes; it enrolls
thousands and is accessible regardless of geographic location. None of the other options are
focused on minimizing the factor of the student’s geographic location.
8. When focusing on addressing issues identified by the 2000 Institute of Medicine report, the
nursing faculty will access information associated with which initiative?
a. Quality and Safety in Nursing Education
b. Competency Outcomes and Performance Model (COPA)
c. The National Organization of Nurse Practitioner Faculties (NONPF)
d. Academic Center for Evidence-Based Practice (ACE)
ANS: A
In response to the Institute of Medicine report (IOM, 2000), The Robert Wood Johnson
Foundation funded a national initiative, Quality and Safety in Nursing Education (QSEN), to
help nursing programs reorganize curricula to focus on patient safety and quality care. None
of the other options are based on that report.
9. The number of reported medical errors demonstrates a need for what priority intervention?
a. Simulation experiences
b. Performance competency exercises
c. Comprehensive instructor-constructed examinations
d. Detailed care planning exercises
ANS: B
The increase in reported medical-related errors vividly emphasizes the need for more effective
validation of performance competence in schools and the workplace.
10. Which trend is an effect of the nursing shortage on nursing education and ultimately a safety
issue regarding client care?
a. Only devoted qualified nurses are continuing to provide bedside nursing because
of the complexity of care required, resulting in excellent client care.
b. The number of applicants to nursing programs has risen, but enrollment is limited
because of a decrease in the number of available scholarships and grants.
c. With an increase in the number of nurses who are entering graduate school to
escape bedside nursing, students will soon enjoy a lower faculty/student ratio.
d. Students may be assigned to preceptors who have not yet developed expertise in
the field of interest.
ANS: D NURSINGTB.COM
Students are assigned to multiple and diverse community clinical settings, some of which may
be short-staffed, making it difficult for them to find qualified preceptors. Staff nurses who act
as clinical instructors or preceptors may or may not be prepared for these roles or receive
adequate orientation. None of the other options reflect accurate information or are directly
related to both nursing education and safe client care.
11. The NCLEX examination is created and administered by which nursing body?
a. American Association of Colleges of Nursing (AACN)
b. American Nurses Association (ANA)
c. National Council of State Boards of Nursing (NCSBN)
d. National League for Nursing (NLN)
ANS: C
The NCSBN coordinates licensure activities on a national level and creates and administers
the licensure examination (NCLEX).
12. Which statement accurately describes the focus of the various types of nursing programs?
a. Diploma programs focus on family and community, with an emphasis on health
promotion.
b. Most practicing RNs graduated from diploma programs because this was the first
type of RN program.
c. Baccalaureate programs focus on technical and hands-on nursing skills in diverse
community settings.
d. Master’s programs such as that for the clinical nurse leader provide entry into
practice with a focus on interdisciplinary and bedside nursing care for complex
client populations.
ANS: D
A clinical nurse leader oversees the care coordination of groups of clients and actively
provides direct client care in complex situations, evaluates client outcomes, and has the
decision-making authority to change care plans when necessary. None of the other options
provide accurate information regarding the various types of nursing education programs.
13. When preparing to complete a competency examination involving a neurologic assessment in

a simulation laboratory, the nurse reviews the critical elements, which consist of what
components?
a. The steps that propose a risk of injury or death to a client
b. The required criteria incorporated into the assessment for the desired outcome
c. The fundamental strategies unique to complex dynamic care environments
d. The objective data used to determine the likelihood that the client will recover
ANS: B
Critical elements include the application of mandatory principles that must be used according
to established practice standards in the course of achieving desired outcomes.
14. An RN with a diploma preparation wants to participate in decisions about health care and
decides the first step is to obtain a BSN. The nurse enrolls in a nursing program offering
self-scheduling and a self-paced curriculum. This nurse is taking advantage of what
characteristic of the nursing profession?
a. Educational mobility
b. Transitioning NURSINGTB.COM
c. Creative scheduling
d. Flexible progression
ANS: A
Education mobility is the movement from one level or type of education to another—in this
instance, diploma to BSN. Programs are aimed to make the transition possible through
creative flexible scheduling and progression.
15. A student asks, “What are core competencies?” The nursing instructor demonstrates an
understanding of core competencies when providing what response?
a. “They are a part of a trend used in nursing education to reduce attrition in
prelicensure students.”
b. “They are the skills necessary to provide for safe, competent nursing practice.”
c. “They are remediation for students is unable to perform psychomotor skills
correctly.”
d. “They are critical thinking exercises aimed to improve reading and math skills.”
ANS: B
Core competencies are those skills and elements that are fundamental and essential for safe,
competent practice. None of the other options accurately describe core competencies.
16. A nurse uses that health care concern as an example to best describe globalization of health
care needs?
a. The emergence of epidemic hepatitis A

b. The pandemic of H1N1 “swine flu”
c. Reemergence of polio
d. An increase in chronic illnesses
ANS: B
In 2009, there was a pandemic of H1N1 on every continent and a reemergence of
Staphylococcus aureus (MRSA).
17. A student nurse is preparing a presentation that requires identification of outcomes for the
care of heart failure patients. Which statement represents an appropriately written outcome?
a. Develop a teaching program to address physical activities that result in improved
cardiac function.
b. Discuss the clinical manifestations associated with Level 4 heart failure.
c. List the most common pharmaceutical approaches to reduce preload in heart
failure patients.
d. Recognize the economic impact that recidivism has on the patient and health care
facility.
ANS: A
Outcomes use action words, actions that nurses do, such as develop, plan, implement,
integrate, plan, or conduct.
18. A member of a nursing students study group comments, “We spend some time early in the
class discussing key facts then most of the time working through case studies, then practicing
on the simulator rather than caring for ‘real’ patients.” This teaching-learning style represents
what form of nursing education?
a. Skill-based learning NURSINGTB.COM
b. Objective Structured Clinical Examinations (OSCE)
c. Peer-to-peer learning
d. Practice-based competency
ANS: D
Practice-based competency includes active engagement and application in real practice
situations and interactive strategies such as case studies and simulation.
19. Which experience is best designed to support a nursing student’s preparation for
interprofessional team participation?
a. Attending a seminar on interprofessional team cooperation
b. Completing a preceptorship with an advanced practice nurse
c. Carrying for three patients with varying medical diagnoses
d. Presenting patient information at the daily care planning meeting
ANS: D
While interprofessional educational experiences are encouraged for all health care disciplines,
Delunas and Rouse (2014) cite the importance of preparation of students for interprofessional
educational experiences, and the need for regular meetings when students are engaged in
learning as a member of a health care team.
20. A person interested in employment in the health care sector has less than 1 year to devote to
education and wants to focus on functional aspects of patient care in a long-term facility.
Which type of nursing program should this person request information about?
a. Bachelor’s degree in nursing (BSN)
b. Licensed practical nurse (LPN)
c. Associate degree in nursing
d. Master’s degree in nursing
ANS: B
LPN programs provide basic technical bedside care and employment opportunities at
hospitals, nursing homes, home care, and doctor offices.
MULTIPLE RESPONSE
1. A nurse is concerned that the policy of using povidone-iodine to clean foot ulcers may lead to
unwarranted allergic reactions and drying of surrounding tissue. A literature review is
performed to determine the “best practice” related to care of foot ulcers. This nurse is
engaging in what activities? (Select all that apply.)
a. Applying evidence-based practice to the clinical setting
b. Using critical thinking to change procedures performed in the care of foot ulcers
c. Is participating in research to provide cost-effective care (soap is less expensive
than povidone-iodine)
d. Is demonstrating clinical competence in health assessment and in application of
theory to the clinical setting
e. Is using information to problem-solve and ensure safe, competent care
ANS: A, B, D, E NURSINGTB.COM
Critical thinking is an essential part of applying evidence-based practice —that is using
research findings to guide actual practice. There is no evidence that the nurse is actually
participating in a research project.
COMPLETION
1. The oldest, most traditional type of program that prepares a candidate for RN licensure is the
hospital-based _ program.
ANS:
diploma
The earliest training programs for nurses were hospital based and designed to meet the needs
of the institution; these were referred to as diploma programs.
2. According to Lenburg, the use of practice-based assessments in nursing education is aimed

toward achieving .
ANS:
competence
The target that students need to meet to practice safely in today’s complex health environment
is achieving critical competencies and demonstrating of practice-based skills.
Chapter 04: Nursing Licensure and Certification

Edition
MULTIPLE CHOICE
1. The advanced practice nurse who is seeking information about requirements for practice in a
specialized area should contact what nursing organization?
a. American Nurses Association (ANA)
b. National League for Nursing (NLN)
c. American Nurses Credentialing Center (ANCC)
d. National Council of State Boards of Nursing (NCSBN)
ANS: C
The nurse should contact the ANCC to determine the education, experience, and examination
requirements that must be met if one is to become certified.
DIF: Comprehension
2. What is the primary purpose of licensure for professional registered nurses?

a. Preventing the misuse of the title nurse
b. Demonstrating a specialized body of knowledge
c. Protecting the public from physical and emotional harm
d. Enhancing recognition for the nursing profession
ANS: C
Protecting the public is one oNthR
fU esI
eS ntG
seN l pBu.
iaT rpCoO
seM
s of the state board of nursing, which
regulates licensure. While appropriate none of the other options address the primary focus of
nursing licensure.
DIF: Knowledge
3. What statement presents accurate information concerning nurse practice acts?

a. They are written and passed by state legislators.
b. They cannot be influenced by special interest groups.
c. They reflect the primary concerns of professional nurses.
d. They are affected by other interprofessional practices.
ANS: A
Just as other sections of state codes are written and passed by legislators, so is the nurse
practice act of each state. None of the other statements are true when considering nurse
practice acts.
DIF: Knowledge
4. Nursing legislation is to be current and reviewed annually by specific dates. If a nurse practice
act fails to be reviewed, it is automatically rescinded under which law?
a. Nurse review act
b. Sunset legislation
c. Mandatory revocation
d. Grandfathering
ANS: B
Sunset legislation may be included in a state’s nurse practice act, and this means that the act
must be reviewed by a specific date; if not, it is automatically rescinded.
DIF: Comprehension
5. On which website would a nurse find a list of current compact states that allow for a single
license recognized in multiple states?
a. National League for Nursing (NLN)
b. National Council of State Boards of Nursing (NCSBN)
c. American Association of Colleges of Nursing (AACN)
d. Commission on Collegiate Nursing Education (CCNE)
ANS: B
The NCSBN website contains this information.
DIF: Knowledge
6. What was the first field of nursing to certify advanced practitioners?

a. Adult nurse practitioners
b. Nurse-midwifery
c. Clinical nurse specialist
d. Nurse anesthesia
ANS: D
In 1946, nurse anesthesia became the first field of nursing practice to certify advanced
practitioners. N UR SI NG TB.C OM
DIF: Knowledge
7. To request licensure to practice in France, a nurse licensed in the United States must engage in
what initial step?
a. Contacting the Graduates of Foreign Nursing Schools to complete a special
examination
b. Realizing that licensure in the United States is recognized as sufficient for practice
in most countries
c. Passing a language proficiency examination for the primary language of that part
country is required prior to licensure.
d. Contacting the International Council of Nurses (ICN) or the nursing regulatory
board of that country
ANS: D
A nurse who is interested in practicing internationally may contact the International Council
of Nurses or the nursing regulatory board of the country to familiarize themselves with the
licensure requirements.
DIF: Comprehension
8. What should the nurse who is licensed in Georgia and moves to Oregon should do initially in
preparation for seeking a nursing position as a pediatric nurse?
a. Review Oregon’s nurse practice act related to licensure for endorsement.

b. Request application forms to be grandfathered in as a licensed registered nurse in
Oregon.
c. Request certification in Oregon rather than licensure, so as not to have to retake the
NCLEX-RN.
d. Contact the American Nurses Credentialing Center to determine whether licensure
in Georgia will transfer to Oregon.
ANS: A
Endorsement refers to the original program whereby a nurse who is licensed in one state can
apply and seek licensure in another without undergoing repeat examination, in accordance
with the nurse practice act of that state. None of the other options effectively provide guidance
for the nurse in this situation.
DIF: Application
9. What statement accurately describes what it means to practice in a compact state?

a. The nurse must abide solely by the practice act of the largest state.
b. Patients’ rights in relation to the nurse practice act are protected by the mutual
recognition model.
c. The nurse must pay for a license in all states that participate in the mutual
recognition model.
d. The nurse must refer to the nurse practice act for the list of skills that can be
performed.
ANS: B
Nurses who practice in a compact state are responsible for following the laws and regulations
of each state in which they prNaU
ctiR
ceS. I
NNonGeToB
f t.
heCoOthMer options accurately reflect practice in a
compact state.
DIF: Comprehension
10. What action is considered a nursing responsibility when participating in a nurse licensure
compact?
a. Complying with the nursing practice laws in the state where practicing at the time
care is rendered
b. Purchasing a license in each state or retaking the licensure examination
c. Determining residency based on the state where educated as registered nurse
d. Practicing only in states or territories that recognizes the NCLEX as the source of
licensure
ANS: A
The nurse is accountable for practicing according to the state practice laws where patient care
was provided, although disciplinary action is the responsibility of the state of the nurse’s
residency. None of the other options accurately reflect nursing responsibilities in the situation
described.
DIF: Knowledge
11. A new graduate from a master’s entry program in nursing announces, “I just passed my
clinical nurse leader certification examination.” Certification as a clinical nurse leader
provides acknowledgement of what nursing achievement?
a. Earning the equivalence of a master’s level nursing degree
b. Attaining entry-level knowledge and skills
c. The right to engage in an independent primary nursing practice
d. Demonstrating advanced nursing skills and knowledge
ANS: D
Certification provides validation of achievement of advanced education and competence. This
certification does not acknowledge any of the achievements presented by the other options.
DIF: Comprehension
12. A nurse holds a license in one state but wishes to practice in a second state that is not
participating in a nurse licensure compact agreement. The nurse is granted licensure on
payment of a fee but does not retake the licensure examination. The nurse has obtained
licensure in the second state by what process?
a. Licensure by endorsement
b. Certification
c. Statutory process known as being grandfathered
d. Sunset legislation
ANS: A
Licensure by endorsement allows a nurse licensed in one state to obtain licensure to practice
in a second state without examination. None of the other options provide for nursing practice
as described.
NURSINGTB.COM
DIF: Comprehension
13. A nurse practicing in the early 1900s was awarded a permissive license. What action was
required by this type of license?
a. While licensure was voluntary; if you failed the examination, you could not use the
title RN.
b. To qualify for licensure, you were required to complete a maximum of 1 year of
formalized nurse training.
c. All candidates were required to take and pass an exam provided by the state board
of nursing.
d. The nurses were required to select either a written or an oral form of the licensure
examination.
ANS: A
These permissive licenses permitted but did not require nurses to become registered. Nurses
not passing the examination could not use the title of RN. Under permissive licensure,
educational standards were set at a minimum of 2 years of training for nurses. State boards of
nursing were established with rules for examinations as well as revocation of the license.
Under permissive licensure, educational standards were set at a minimum of 2 years of
training for nurses. State boards of nursing were established with rules for examinations as
well as revocation of the license. Nurses not passing the examination could not use the title of
RN.
DIF: Comprehension
14. A group of registered nurses with associate nursing (and) degrees are concerned that the
minimum educational standard for licensure as a registered nurse is being raised to the
bachelor’s (BSN) level. After contacting the American Nurses Association, they learn they
will be “grandfathered” in. Under the “grandfather clause,” what action will be required of
nurses with associate degrees?
a. They will be required to complete a bridge program to earn a BSN and then be
tested only on material that was not part of the ASN curriculum.
b. They will continue to use the title “registered nurse” earned by their original
success with the licensure process.
c. They will have 10 years to obtain a BSN or the license will be revoked.
d. They will use whatever title is established by their state’s board of nursing for
associate degree nurses.
ANS: B
All ASNs licensed before the change would be “grandfathered” in, allowing them to use the
title of RN.
DIF: Comprehension
15. What entity establishes the “rules” for nursing practice?

a. Individual state boards of nursing
b. Employer, based on area of practice
c. United States Department of Health and Human Services
d. Local health officials
ANS: A NURSINGTB.COM
The State Practice Act of each state establishes the rules for practice within that state.
DIF: Knowledge
16. A nurse is completing the degree requirements for an advanced practice role as a nurse
practitioner and is concerned about certification requirements. Which statement concerning
certification for advanced practice is true?
a. All states require certification for all specialty roles that are identified as advanced
practice.
b. Nurse anesthetists and nurse-midwives are the only advanced practice role that
require certification in the state nurse practice acts.
c. Scope of practice remains unclear in state nurse practice acts due to the increasing
number of new advanced practice roles.
d. Certification is automatic when the nurse applies for an advanced practice license.
ANS: A
All states require evidence of certification in the specialty area, and many require periods of
practice in the specialty prior to awarding certification status.
DIF: Comprehension
17. Nurses in Tennessee, Mississippi, and Arkansas gather for a conference related to improving
quality and safety in practice and nursing education. They are awarded continuing education
(CE) credit for participation and evaluation of the conference. One nurse from California
states, “I need these CEs to renew my license.” The nurse from Mississippi replies, “You do
not need CEs for license renewal or advance practice certification renewal.” Which statement
about CEs would help these nurses?
a. All states require proof of continuing education for renewal of license with the
number of hours varying.
b. The purpose of continuing education is to ensure competence of the workforce
after graduation, but each state determines if CEs are required.
c. Continuing education is required if nurses work across state lines.
d. Initial licensure provides evidence of a minimum safety and competence, so it is
illegal for states to require continuing education for renewal of license.
ANS: B
CE is important to ensure continued competency, and each state determines if CEs are
mandatory for renewal and how many units are needed.
DIF: Comprehension
MULTIPLE RESPONSE
1. What actions should a nurse who wishes to practice in another state take initially? (Select all
that apply.)
a. Prepare to retake the NCLEX-RN for that state.
b. Determine whether the state is a compact state.
c. Inquire about obtaining liNceUnR reIbNyG
suS enTdB
or.seCmOeM
nt.
d. Prepare to revoke the original licensure.
e. Petition the state to be “Grandfathered” a state license.
ANS: B, C
If the state is a member of a compact state, that state has established an agreement with other
states under which nurses are permitted to practice within the state without additional
licensure. Licensure by endorsement refers to the original program whereby nurses who are
licensed in one state seek licensure in another state without repeat examination. None of the
other options are accurate descriptions of the process required for the situation described.
DIF: Comprehension
2. Which statements concerning licensure as a registered nurse are correct? (Select all that
apply.)
a. Nurses who graduate from different types of nursing education programs are
granted different types of licenses, those with a baccalaureate degree having the
most expanded role.
b. A nursing license cannot be revoked, only suspended.
c. Each nurse practice act describes requirements for initial licensure.
d. It is illegal for states to ask about the mental or physical status of an applicant.
e. Students who graduate in the top 10% of their class are exempt from taking the
NCLEX-RN for licensure.
f. Candidates for licensure must present proof of graduation as required by the state.
ANS: C, F
A section of each nurse practice act describes requirements and procedures that are necessary
for initial licensure. Candidates for licensure must submit evidence of graduation as defined
by each state.
DIF: Comprehension
3. What duties are assumed by a state’s board of nursing? (Select all that apply.)
a. Grants nursing licensure.
b. Constructs the licensure examination.
c. Assigns disciplinary action when the nurse acts in a manner that results in harm to
a patient.
d. Assures qualified members are appointed to the board.
e. Conducts certification examinations for advanced practice nurses.
ANS: A, C, D
The board of nursing ensures that nursing licenses are granted and renewed. The board of
nursing assigns disciplinary action when provisions of the nurse practice act are violated.
Members are appointed to the board with attention to their qualifications. The boards are not
responsible for the creation of licensure or certification examinations.
DIF: Comprehension
4. A nursing student is in the final term of an Associate Science of Nursing (ASN) program and
is preparing for licensure. Prior to licensure the candidate must provide evidence that they
have fulfilled what requirements? (Select all that apply.)
a. Graduation from a nursing program
b. Graduation from high schNoU olRoSr hIigNhGsT
chBo.
olCeO
quM
ivalency
c. Possess current malpractice insurance
d. A plan to continue study to obtain a minimum of a BSN within 2 years
e. Validation of skills competence provided by a certifying agency
ANS: A, B
Candidates for licensure must provide evidence of graduation through transcripts of course
work or letter from the Dean/Director of the nursing program. All candidates must show
evidence of graduating from high school or earning a GED.
DIF: Comprehension
COMPLETION
1. The primary purpose of licensure is protection of the .
ANS: public
DIF: Knowledge
Chapter 05: Theories of Nursing Practice

Edition
MULTIPLE CHOICE
1. Which nursing theory might a nurse use as a conceptual framework to determine how to meet
the needs of immigrants while ensuring provision of high-quality and culturally sensitive
care?
a. Martha Rogers’ nursing theory
b. Dorothea Orem’s nursing theory
c. Hildegard Peplau’s nursing theory
d. Madeleine Leininger’s nursing theory
ANS: D
Madeleine Leininger proposed the theory of cultural care diversity and universality. This
theory of transcultural nursing comprises concepts involving caring and the components of a
cultural care theory: diversity, universality, worldview, and ethnohistory. None of the other
options are directly associated with cultural diversity and sensitivity.
DIF: Comprehension
2. What term is used to identify the process used to determine the relationships among related
concepts and a common theme?
a. Hypothesis
b. Model
c. Construct
d. Variable
ANS: B
A model is a group of concepts that are associated because of their relevance to a common
theme. None of the other terms relate to this process.
DIF: Application
3. The statement, “Nursing is a caring profession that focuses on helping people be as healthy as
possible,” is an example of what term?
a. Concept
b. Construct
c. Philosophy
d. Model
ANS: C
A philosophy is the values and beliefs of the discipline. The statement presents a value and
belief associated with nursing.
DIF: Comprehension
4. Which nursing theory served as the foundation for nursing science?

a. Rogers’ science of unitary human beings
b. Nightingale’s theory of practice

c. Watson’s theory of human caring
d. King’s theory of goal attainment
ANS: B
Florence Nightingale investigated the effect of the environment on healing, and this serves as
the foundation for nursing science.
DIF: Comprehension
5. A community health nurse has been visiting a postpartum client who experienced domestic
violence throughout the pregnancy, and now she and the infant may be at risk. The nurse
assisted the client in finding shelter and legal protection. Which conceptual framework is the
basis for the nurse’s safety interventions?
a. Change agent, according to Roy’s adaptation model
b. Translator, according to Leininger’s theory of cultural care diversity and
universality
c. Case manager, according to Peplau’s interpersonal relations model
d. Caregiver, according to Rogers’ science of unitary human beings
ANS: A
In Roy’s adaptation model, when the client incurs an insult that renders him or her in need of
environmental modification, the nurse will be the change agent in assisting the individual
with this adaptation. None of the other options deal with the basic client need for an
environmental change to assure safety.
DIF: Application
NURSINGTB.COM
6. What term is used to identify the general explanations that scholars use to explain, predict,
control, and understand commonly occurring events?
a. Theories
b. Constructs
c. Systems
d. Propositions
ANS: A
Theories are a group of related concepts that explain existing phenomena and predict events.
Theories provide us with a frame of reference, the ability to choose concepts to study, or ideas
that are within one’s practice.
DIF: Comprehension
7. Which type of theory most often guides present nursing practice?

a. Grand theory
b. Middle range theory
c. Developmental theory
d. Values theory
ANS: B
Middle range theory is a nursing theory that refers to a specific population or to a specific
situation, thereby making the theory easy to understand. An example is the theory of
unpleasant symptoms (Lenz and Pugh), which examines symptoms that are influenced by
physiologic, psychological, and situational factors as they relate to performance.
DIF: Knowledge
8. A client is hypertensive, and the doctor prescribes weight reduction. The client is excited
about beginning the diet, but on arriving home the spouse states, “You have always been fat,
and I am not going to starve because you can’t control yourself.” The client becomes anxious
and is unable to participate in the diet plan, resulting in a weight gain of 5 pounds in 2 weeks.
Which theorist could best be referred to for guidance regarding interventions in this situation?
a. Martha E. Rogers
b. Hildegard E. Peplau
c. Florence Nightingale
d. Myra Estrin Levine
ANS: B
Hildegard Peplau’s theory describes interpersonal relations as a nursing process. Nursing
intervention in Peplau’s model focuses on reducing related incapacitating stressors through
therapeutic interpersonal interaction.
DIF: Application
9. A nurse believes that humans use creativity and critical thinking to balance their connections
with their surroundings. The nurse decides to conduct a study based on this belief. Which
nursing theory would be best for this study?
NUion
a. Peplau’s interpersonal relat RSsI aGnuTrsing
asN B.CpOrocess:
M man as an organism that
exists in an unstable equilibrium
b. Roy’s adaptation model: assistance with the adaptation to stressors to facilitate the
integration process of the client
c. Orem’s self-care deficit model: self-care, self-care deficits, and nursing systems
d. Rogers’ science of unitary human beings: humans as energy fields that interact
constantly with the environment
ANS: D
Rogers’ science of unitary human beings, in which humans are energy fields that interact
constantly with the environment, is a theory in which the nurse promotes synchronicity
between human beings and their universe/environment.
DIF: Comprehension
10. A client involved in a motor vehicle accident is blinded. The nurse helps the client obtain a
guide dog so the client may continue grocery shopping and visiting friends and family. This
enables the client to cope with the handicap and perform activities of daily living. Which
nursing theory can be applied to this scenario?
a. Watson’s philosophy and science of caring and humanistic nursing
b. Mishel’s uncertainty in illness
c. Orem’s self-care deficit
d. Rogers’ science of unitary human beings
ANS: C
In Orem’s self-care deficit theory, the nurse implements measures to help clients meet
self-care needs by matching them with an appropriate supportive intervention.
DIF: Comprehension
11. A young child is having abdominal pain, and the doctor informs the parents that a computed
tomography (CT or CAT) scan of the abdomen will be ordered. The doctor tells the child,
“This CAT scan won’t hurt you.” The child is visibly upset because of a fear of cats.
According to Mishel’s uncertainty in illness theory, which stage of the framework is
represented?
a. Stimuli frame
b. Appraisal stage
c. Initiation of coping mechanisms
d. Adaptation
ANS: A
In the stimuli frame, the client reacts to some stimulus in a negative manner. The nurse at this
stage should listen carefully and then initiate, seek, and clarify concerns and questions.
DIF: Comprehension
12. A nurse researcher determines whether findings are substantial by calculating the level of
significance. Which aspect of the scientific inquiry is being conducted?
a. Hypothesis
b. Method
c. Data collection
d. Evaluation NURSINGTB.COM
ANS: D
During evaluation, results are examined with the goal of determining the relevance of
outcome data in answering the hypothesis; the significance of the data and the potential for
future research are also explored.
DIF: Application
13. At delivery the physician informs the mother who has practiced nursing for 10 years, “Your
baby has Alport syndrome, but then I don’t have to explain what that means with your
medical background.” The mother is unfamiliar with this disease and withdraws as a coping
mechanism. Which nursing theory would provide a framework to guide nursing care for this
mother?
a. Mishel’s uncertainty of illness
b. Orem’s self-care deficit model
c. Nightingale’s canons of nursing
d. Levine’s conservation model
ANS: A
In Mishel’s uncertainty of illness theory, the core position is that uncertainty in illness must be
addressed. When uncertainties are not addressed, clients’ negative perceptions will escalate
and they will suffer. Nursing responsibility based on this theory consists of reframing the
client’s perceived loss of control, or uncertainty, and helping the client develop new skills of
assimilation and accommodation.
DIF: Comprehension
14. When applying Nightingale’s theory to current practice, the nurse’s first step will be to
evaluate the hospital room’s air quality. What should be the nurse’s second step?
a. Making certain that the volume of the television is not too loud
b. Consulting the dietitian to assure that a client’s diet is meeting MyPyramid
requirements
c. Asking the family to bring family photographs and bright-colored throws for the
bed of a client’s room
d. Arrange for the client’s window blinds to remain open as appropriate
ANS: D
Nightingale believed the need for light was second only to the need for fresh air.
DIF: Application
15. A nurse develops a new nursing theory related to stress and viability. The nurse determines
the theory accounts for historical events in which soldiers suffering from the stress of
inadequate clothing to protect them from the cold and lack of correspondence from home had
an increased mortality related to gunshot wounds. The theory will predict gunshot victims’
need for proper clothing and letters from significant others as they serve in Iraq. Which
NUisRbSeing
criterion for theory acceptance INva
GT B.CO
lidated?
a. Inclusiveness
b. Consistency
c. Accuracy
d. Simplicity
ANS: C
The accuracy of a theory is its ability to explain past occurrences while being useful in
determining future outcomes.
DIF: Application
16.16.
A nurse practicing on a unit where domestic violence is common wants to learn how to apply
nursing theory to practice on this unit. The nurse considers the interrelatedness of the
constructs of Watson’s Theory of Caring and creates a design related to what?
a. Conceptual model of caring

b. Hypothesis of the impact of caring on domestic violence
c. Proposition of how caring is conceptualized
d. Theory of scientific inquiry
ANS: A
The conceptual model demonstrates how the concepts of compassion, commitment,
conscience, confidence, and competence form a theme of caring (Watson).
DIF: Comprehension
17. A nurse plans activity of daily living to prevent excessive fatigue while allowing the patient to
exercise autonomy in selecting what they wear. This nurse is best applying which theory to
practice?
a. Watson’s Theory of Caring
b. Rogers’ Theory of Unitary Humans
c. Levine’s Theory of Conservation
d. Leininger’s Theory of Transcultural Nursing
ANS: C
Certain parts of all the theories can be applied; however, all the constructs of Levine’s Model
of Conservation are applied, including energy conservation, structural integrity, personal
integrity, and social integrity. In this situation, the nurse conserved energy by planning ADLs,
conserved structural integrity through ROMs, conserved social integrity by helping patient
with appearance during family visits, thus improving the milieu for social visits.
DIF: Application
NURSINGTB.COM
18. A nurse is evaluating Levin’s Theory of Conservation to determine if it can be applied to
patients in the initial phases of chemotherapy treatment. During this phase of theory
acceptance, the nurse wants to determine if all the concepts of energy, structural integrity,
personal integrity, and social integrity are included in the care of cancer treatment. The nurse
is applying which criteria of theory acceptance?
a. Inclusiveness
b. Consistency
c. Accuracy
d. Fruitfulness
ANS: A
Inclusiveness asks the question, “Does the theory include all concepts related to the area of
interest?”
DIF: Application
19. A nurse is heard making this comment, “I believe human dignity is based on perceived
self-worth while caring is based on perceived role in society that forms the basis of nursing
practice.” This nurse’s statement is associated with what action?
a. Demonstrating a model of human dignity
b. Evaluating the relevance of Leininger’s Theory
c. Applying Mishel’s Theory of Disease Uncertainty
d. Making a proposition concerning the constructs of nursing practice
ANS: D
A proposition is a statement that proposes the relationship between and among concepts.
DIF: Application
20. A group of nurses are interested in the how to improve teaching effectiveness for patients who
have a hearing impairment and lack family involvement while hospitalized. They believe
“hearing loss decreases the teaching effectiveness while hospitalized.” The group plans to
evaluate teaching effectiveness using a 10-point Likert scale pre-post teaching, perform a
hearing test to determine degree of hearing loss on admission, and have social work evaluate
the impact of hearing impairment on patient’s ability to safely live alone prior to discharge.
The group is working in which step of the scientific process?
a. Hypothesis
b. Method
c. Results
d. Evaluation
ANS: B
During the method step, the group decides what data will be collected to answer the question
and identifies step-by-step procedures that will be used to collect these data.
DIF: Application
MULTIPLE RESPONSE
1. Which of the following are concepts related to nursing theory? (Select all that apply.)
a. Environment
b. Health
NURSINGTB.COM
c. Nursing
d. Relevance
e. Comfort
ANS: A, B, C, E
Environment is a concept, which is a label given to ideas, objects, or events; concepts become
the “pieces” that make up a conceptual model or theory. Health is a concept, which is a label
given to ideas, objects, or events; concepts become the “pieces” that make up a conceptual
model or theory. Nursing is a concept, which is a label given to ideas, objects, or events;
concepts become the “pieces” that make up a conceptual model or theory. Comfort is a
concept, which is a label given to ideas, objects, or events; concepts become the “pieces” that
make up a conceptual model or theory.
DIF: Comprehension
COMPLETION
1. The basic ingredients of theory are .
ANS:
concepts
A theory is defined as a group of related concepts that explain existing phenomena and predict
future events.
DIF: Knowledge
Chapter 06: Nursing Research and Evidence-Based Practice

Edition
MULTIPLE CHOICE
1. Institutional review boards determine whether research studies involving human subjects will
achieve what?
a. Publication
b. Increase the body of nursing knowledge
c. Avoid causing harm to research subjects
d. Funding
ANS: C
The institutional review board (also called the human subjects committee) examines research
proposals to ensure that the ethical rights of those individuals participating in the research
study are protected. This board makes sure that persons who participate in research are
assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is
protected.
DIF: Knowledge
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 to understand the “lived
experience.” These characterN isticR
s arI
e coGnsiste
B.nCt wiM
th which qualitative research method?
a. Grounded theory U S N T O
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 designed to explore
and describe a social process. Ethnography is a method used to study phenomena from a
cultural perspective. A case study is a process or record of research in which detailed
consideration is given to the development of a particular person, group, or situation over a
period of time.
DIF: Comprehension
3. The implementation of research to guide nursing practice is referred to as what?

a. Utilization
b. Dissemination
c. Generalizability
d. Analysis
ANS: A
Utilization of research guides nursing practice. Clinical agencies need to make a commitment
to implementing research findings and then developing policies and procedures to guide the
implementation process.
DIF: Comprehension
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. What type of research design is this?
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. A case study
is a process or record of research in which detailed consideration is given to the development
of a particular person, group, or situation over a period of time. Ethnography is a method used
to study phenomena from a cultural perspective. In quasi-experimental studies, a control
group, randomization, or the manipulation of one or more variables is missing.
DIF: Comprehension
5. Which organization provides federal funding for research?

a. Agency for Healthcare Research and Quality (AHRQ)
b. Robert Wood Johnson Foundation G B.C M
NURSI N T
c. W. K. Kellogg Foundation O
d. Sigma Theta Tau International
ANS: A
Two major sources of funding for nursing research are the National Institute of Nursing
Research (NINR) and the Agency for Healthcare Research and Quality (AHRQ), which are
both funded by federal congressional appropriations. Private foundations and nursing
organizations, identified in the remaining options, also provide funding for nursing research.
DIF: Knowledge
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 to group common conceptual
meanings.
DIF: Comprehension
7. A nurse researcher who is seeking funding for a study should identify of funding
agencies.
a. board members
b. priorities
c. budgets
d. accreditation
ANS: B
The priorities of funding agencies indicate their preferences for funding; these are more likely
to be funded than are studies that are not aligned with funding preferences.
DIF: Comprehension
8. A nurse studied a community to determine if there were clients who would benefit from a
hospice program if one were developed. This is an example of what type of research?
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 estimating the
needs of a group; the method is commonly used to prioritize the needs of an organization or
community. Survey is a nonexperimental research design that focuses on obtaining
information regarding the status quo of some situation, often through direct questioning of
participants. In quasi-experimental studies, a control group, randomization, or the
manipulation of one or more variables is missing. Pilot study conducts a smaller version of a
proposed study that developsNoU
rR finIeN
reS GT
smethBo.
doClO
ogM
y prior to use in a larger study.
DIF: Comprehension
9. The research hypothesis is that aromatherapy reduces stress more effectively than does
acupuncture. The researcher does not identify a control group. This study would be a(n)
design.
a. experimental
b. quasi-experimental
c. survey
d. meta-analysis
ANS: B
In quasi-experimental studies, a control group, randomization, or the manipulation of one or
more variables is missing. Survey is a nonexperimental research design that focuses on
obtaining information regarding the status quo of some situation, often through direct
questioning of participants. Meta-analysis uses the analysis of several research studies to
validate smaller studies, allowing generalization. Experimental design includes
randomization, a control group, and manipulation between or among variables to examine
probability and causality among selected variables for the purpose of predicting and
controlling phenomena.
DIF: Comprehension
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. A case study is a process or record of research in which
detailed consideration is given to the development of a particular person, group, or situation
over a period of time. Phenomenology is a qualitative research design that uses inductive
descriptive methodology to describe the lived experiences of study participants.
DIF: Comprehension
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.
Qualitative research involves ambiguous concepts. Analysis of interviews with participants
who are experiencing the phenomena enables the researcher to describe unclear phenomena.
DIF: Comprehension
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. Secondary analysis involves asking new questions of data collected
previously. A survey is a nonexperimental research design that focuses on obtaining
information regarding the status quo of a situation, often through direct questioning of
participants. Quasi-experimental is a type of quantitative research study design that lacks one
of the components of an experimental design.
DIF: Comprehension
13. A new nurse researcher is interested in tracing the history of nursing research. The researcher
learns that nursing research began with what event?
a. The work of Florence Nightingale during the Crimean War
b. Studies between 1900 and 1940 following Nightingale’s work
c. Studies to improve patient care by doctorally prepared nurses
d. Studies based on the naturalistic paradigm
ANS: A
Nursing research began with the Nightingale during the Crimean War—more can be read in
Chapter 1 of this text.
DIF: Comprehension
14. Nurses on a busy medical schedule want to reduce documentation time and improve order
entry. Additionally, patient records from previous visits are often incomplete or do not include
care from other providers. To improve patient care, a taskforce suggests using an Electronic
Medical Record for 1 month to determine whether this provides the desired outcomes. This
unit is participating in which type of study?
a. Ethnography
b. Pilot
c. Secondary data analysis
d. Phenomenology
ANS: B
Pilot studies are small-scale studies often referred to as feasibility studies to determine if a
larger more sophisticated research study is needed. Ethnography is a method used to study
phenomena from a cultural perspective. Phenomenology is a qualitative research design that
uses inductive descriptive meNthUoR
doSloIgN
yGtoTdB
es.
crC
ibOeM
the lived experiences of study participants.
Secondary analysis involves asking new questions of data collected previously.
DIF: Comprehension
15. A researcher is interested in learning if elderly persons perceive their health to be satisfactory
even with comorbidities and chronic illness. A large multisite assistive living facility will be
the site. The researcher lists residents in alphabetical order and chooses every third person on
the list. To ensure improved generalizability, the researcher will implement what process?
a. Triangulation
b. Randomization
c. Informed consent
d. A meta-analysis
ANS: B
Randomization is a method of choosing subjects based on chance alone. Triangulation is the
use of a variety of methods to collect data on the same concept—in this situation, quantitative
research through survey and qualitative research through phenomenology. Meta-analysis uses
the analysis of several research studies to validate smaller studies, allowing generalization.
Participants must sign an informed consent that explains the study and assures them of their
rights, including their right to refuse to participate or to withdraw from the study.
DIF: Comprehension
16. A researcher conducts a survey to determine the perceived health status of elderly persons
living independently at home. The same subjects participate in a telephone call in which they
describe the lived experience of living with chronic illness. When writing up the research
study, the nurse would describe using what research method?
a. Control group
b. Triangulation
c. Pilot study
d. Secondary data analysis
ANS: B
Triangulation is the use of a variety of methods to collect data on the same concept—in this
situation, quantitative research through survey and qualitative research through
phenomenology. Secondary analysis involves asking new questions of data collected
previously. Pilot study conducts a smaller version of a proposed study that develops or refines
methodology prior to use in a larger study. Control group are subjects in an experiment who
do not receive the experimental treatment and whose performance provides a baseline against
which the effects of the treatment can be measured.
DIF: Comprehension
17. A nurse is interested in learning how reminiscence therapy can improve memory in
cognitively intact persons over the age of 65 years. Findings from three groups are compared.
Group 1 receives music therapy, Group 2 receives life review therapy, and Group 3 does not
receive therapy, but data are collected from all three groups and compared. Group 3 is known
as what?
a. Pilot study
b. Survey
c. Needs assessment
NURSINGTB.COM
d. Control group
ANS: D
A control group is a set subject in an experiment who do not receive the experimental
treatment and whose performance provides a baseline against which the effects of the
treatment can be measured. Survey is a nonexperimental research design that focuses on
questioning of participants. Pilot study conducts a smaller version of a proposed study that
develops or refines methodology prior to use in a larger study. Needs assessments are used to
determine what is most beneficial to aggregates.
DIF: Comprehension
18. A nurse is reading an abstract about a study related to Rocky Mountain Spotted Fever. The
purpose is stated as follows: “To examine the generalizability of two randomized
placebo-controlled clinical trials in patients with Rocky Mountain Spotted Fever to determine
whether steroid therapy resulted in the positive outcomes.” The nurse knows generalizability
refers to what outcome?
a. The conclusion that findings can be generalized from the sample to the entire
population
b. The fact that the group of steroids used is from the same organic compounds
c. The possibility that the subjects were carefully selected and that outside influence
is thus suspected
d. The fact that the type of bacteria carried by ticks is universal
ANS: A
Generalizability is the deduction that findings from one study can be applied to other
populations not involved in the actual research.
DIF: Comprehension
19. A nurse is interested in studying the rituals of a tribe living in remote areas of Africa. The
researcher is accepted into the tribe and observes firsthand the rituals practiced. Themes were
analyzed to arrive at a description of the culture including rituals. The nurse is practicing
which type of research?
a. Qualitative, ethnography
b. Qualitative, phenomenology
c. Quantitative, quasi-experimental
d. Quantitative, secondary data analysis
ANS: A
Ethnography is a method used to study phenomena from a cultural perspective. Ethnographers
spend time in the cultural setting with the research participants to observe and better
understand their experience. Phenomenology is a qualitative research design that uses
inductive descriptive methodology to describe the lived experiences of study participants. In
quasi-experimental studies, a control group, randomization, or the manipulation of one or
more variables is missing. Secondary analysis involves asking new questions of data collected
previously.
DIF: Comprehension
NURSINGTB.COM
MULTIPLE RESPONSE
1. The informed consent documents must include what components? (Select all that apply.)
a. An explanation of potential risks and benefits to participants in the study
b. Medical terminology rather than lay terms to prevent misunderstanding of the
study
c. A statement on how the anonymity and confidentiality of participants are protected
d. Explanation of the cost of the study
e. Details on how to contact the investigator
ANS: A, C, E
Informed consent explains the study to the participants and assures them of their rights,
including their right to refuse to participate or to withdraw from the study. The informed
consent must include protection of anonymity and confidentiality, voluntary participation,
compensation, and alternative treatment. The informed consent must include specific
information on how to contact the investigator.
DIF: Comprehension
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. In
quasi-experimental studies, a control group, randomization, or the manipulation of one or
more variables is missing. Survey is a nonexperimental research design that focuses on
questioning of participants. Triangulation is the use of a variety of methods to collect data on
the same concept—in this situation, quantitative research through survey and qualitative
research through phenomenology.
DIF: Comprehension
3. A researcher seeks funding from an agency that limits studies to quantitative research. The
researcher can select from which of the following study designs? (Select all that apply.)
a. Survey
b. Grounded theory
c. Phenomenology
d. Needs assessment
e. Experimental
ANS: A, D, E
Surveys collect demographicN soRciS
s, U alIcN
haGraTcB
te.
risCtiO
csM
, behavioral patterns, and information
bases. Needs assessments are used to determine what is most beneficial to aggregates. The
experimental method establishes cause-and-effect relationships while also testing
relationships. Phenomenology is a qualitative research design that uses inductive descriptive
methodology to describe the lived experiences of study participants. Grounded theory is
designed to explore and describe a social process. Experimental is a design that includes
randomization, a control group, and manipulation between or among variables to examine
probability and causality among selected variables for the purpose of predicting and
controlling phenomena.
DIF: Comprehension
COMPLETION
1. Development and validation of the body of knowledge and foundation on which practice is
based is called .
ANS:
research
Research refines and enhances new and existing knowledge and provides accountability for
nursing practice.
DIF: Knowledge
NURSINGTB.COM
Chapter 07: Paying for Health Care in America: Rising Costs and Challenges
Edition
MULTIPLE CHOICE
1. An older adult client was admitted to the hospital with the condition classified as
“pneumonia.” Reimbursement for care was based on a predetermined fixed price. What is this
classification system referred to as?
a. Diagnosis-related groups (DRGs)
b. Subjective symptom management
c. Acuity classification system
d. Organized managed care
ANS: A
DRGs are used in reimbursement for health care services based on a predetermined fixed price
per case or diagnosis in 468 categories. Under DRGs, each Medicare client is assigned to a
diagnostic grouping based on his or her primary diagnosis at hospital admission. Medicare
limits total payment to the hospital to the amount preestablished for that DRG.
DIF: Comprehension
2. The precise classification of clients according to the highest diagnosis-related group (DRG)
has created a new role for nurses, known as a nurse.
a. case management
b. quality assurance
c. utilization review
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d. cost-control
ANS: C
Hospital-based utilization review nurses review medical records to determine the most
appropriate DRG for clients. Financial gains can be made through careful diagnosis of clients
according to their highest potential DRG classification.
DIF: Knowledge
3. Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing
what component of care?
a. Hospital admission rates
b. Length of hospital stay
c. Outpatient services
d. Specialty groups
ANS: B
Hospitals face a strong financial incentive from the DRG reimbursement system to reduce the
client’s length of stay and minimize procedures performed. If hospital costs exceed the DRG
payment for a client’s treatment, the hospital incurs a loss, but if costs are less than the DRG
amount, the hospital makes a profit.
DIF: Comprehension
4. When reviewing the literature on the effects of Medicaid on health care for the poor, what
common problem would the nurse researcher find?
a. Less access than even the uninsured
b. Receive many unnecessary treatments
c. A lack of consistent providers
d. An abuse of preventive services
ANS: C
The poor are more likely to lack a usual source of care, are less likely to use preventive
services, and are more likely to be hospitalized for avoidable conditions than are those who
are not poor.
DIF: Comprehension
5. Lack of insurance, uninsured populations, and uncompensated care are covered by charging
more to those who can pay. What term is used to refer to this practice?
a. Charity
b. Cost shifting
c. Price sharing
d. Governmental reimbursement
ANS: B
Cost shifting occurs when providers increase their charges against households and public and
private insurers who pay for their own care while making some contribution to the care of the
uninsured population.
DIF: Comprehension NURSINGTB.COM

6. A contractual agreement between the insurer and the provider in which covered members are
encouraged to use specific health care providers in return for reduced rates is referred to as
which type of arrangement?
a. Health maintenance organization
b. Preferred provider organization
c. Fee-for-service arrangement
d. Philanthropic agency
ANS: B
A preferred provider organization is an arrangement by which the member pays a premium
for a fixed percentage of expense coverage. This method includes a required deductible and a
copayment. The member may select a physician but pays less for physicians and facilities on
the plan’s preferred list.
DIF: Comprehension
7. In the triad of health care, which would be considered the third-party payer?
a. Client
b. Health care provider
c. Insurance company
d. Government agency that sets reimbursement rules for services
ANS: C
The third-party payer is an organization other than the client and the supplier (hospital or
physician), such as an insurance company, that assumes responsibility for payment of health
care charges.
DIF: Knowledge
8. A physician bills the insurance company for a computed tomography (CT) scan, laboratory
tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This
type of payment system is a payment system.
a. prospective
b. retrospective
c. diagnosis-related group
d. capitated
ANS: B
A retrospective payment system is a method of reimbursing health care providers (such as
physicians and hospitals) in which professional services are rendered and charges are billed on
the basis of each service provided; this is also known as a fee-for-service payment system.
Capitation is a method of reimbursing providers (usually primary care providers, such as
physicians or nurse practitioners) in which the insurance company pays the provider a set
payment each month to provide a defined set of health care services for the patient enrolled in
health plan. DRGs (diagnosis-related groups) is a common method of reimbursement for
health care services based on a predetermined fixed price-per-diagnosis. Prospective payment
system is a method of reimbursing health care providers (e.g., physicians, hospitals) in which
the total amount of payment for care is predetermined based on the patient’s diagnosis.
DIF: Comprehension
NURSINGTB.COM
9. A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client
undergoes coronary artery bypass grafting. The cost of care for this client is increased because
of a four-pack-per-day smoking history that resulted in extension of the client’s intensive care
unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that
under the terms of the diagnosis-related group (DRG) payment system for this diagnosis that
the client’s past history and present care needs will have what affect on reimbursement?
a. The cost of caring for this client was $5000 greater than the DRG reimbursement
fee, and the hospital will be allowed to collect the additional fees from the
insurance company.
b. Although the cost of care for this client was greater than the DRG reimbursement
amount, the hospital will be reimbursed only at the set fee.
c. The client will be required to pay back the insurance company for the extra fees
incurred because smoking is a modifiable health risk for heart disease.
d. The primary care provider who admitted the client will receive a reduced payment
to cover the loss incurred by the hospital.
ANS: B
Since 1983, if hospital costs exceed the DRG payment for a client’s treatment, the hospital
incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. Hospitals
face strong financial incentives to reduce the client’s length of stay and minimize procedures
performed.
DIF: Comprehension
10. A young mother has detected a lump in her breast, and because she lives at the poverty level,
she is covered under Medicaid. What is the most likely consequence of this woman’s
situation?
a. She will participate in mammography screening more often than individuals
covered by private insurance.
b. She has both a designated primary care provider and a specialist as sources of care.
c. She will wait to seek care increasing her risk of being diagnosed with advanced
breast cancer.
d. She has decreased access to health care when compared with the uninsured.
ANS: C
Even with improved access as compared with the uninsured, Medicaid recipients are not as
likely to obtain needed health services. The poor are more likely to lack a usual source of care,
are less likely to use preventive services, and are more likely to be hospitalized for avoidable
conditions than are those who are not poor.
DIF: Comprehension
11. A client who is reading a newspaper asks, “This article about health care states that many
providers of health care lack effectiveness. What is the difference between effectiveness and
efficiency?” The nurse best responses with what statement?
a. Effective means performing the correct test or intervention whereas efficiency
refers to the wise use of supplies and resources for the desired outcome.
b. Effective refers to competence in clinical practice and efficiency describes quick
completion of the task.
c. Efficiency means wasting and meeting a minimum standard and effectiveness refers
Nd R
to taking all the time needeU
I G B.Cations.
toSexcNeedTexpectO
M
d. Efficiency refers to speed and effectiveness refers to the usefulness of the
implementation.
ANS: A
Efficiency means using the right combination of resources—energy, time, and money—to
accomplish a task, and effectiveness means doing the right thing right in health care.
DIF: Comprehension
12. A nurse is offered several health care plans as part of employee benefits. Which plan is based
on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment
services?
a. Prospective payment system
b. Retrospective payment system
c. Single-payer system
d. Capitation
ANS: D
Capitation is a method of reimbursing providers (usually, primary care providers such as
physicians or nurse practitioners) in which the insurance company pays the provider a set
amount of money each month to provide a defined set of health care services under this plan.
Payment is generally received as a per-member–per-month payment. Defined health care
services generally include preventive, diagnostic, and treatment services.
DIF: Comprehension
13. At a local health fair, an individual asks about the difference between universal health care
and a single-payer system. The nurse explains the difference based on what fact?
a. With universal health, one universal payer, usually the government, pays all
expenses for health care.
b. Single-payer systems offer health care only to eligible persons based on income.
c. Single-payer systems rely on insurance companies to pay predetermined fees for
services.
d. With universal health, one payer is responsible for all health care costs, providing
health care to all citizens.
ANS: D
Universal health has one payer (usually the government) and provides health care for all
citizens.
DIF: Comprehension
14. An elderly person, age 80, is finding it difficult to live alone and the family is considering
long-term care. The elderly person is reasonably healthy, with only normal aging declines,
and maintains a healthy appetite. All medications are administered orally and require only
minimal assistance. She is financially secure with an income based on retirement from both
the military and factory from her deceased husband and herself. The family contacts long-term
care and is given what information, based on this patient’s situation?
a. Medicare will cover the cost of stay since skilled services are required.
b. Medicaid is only for families with dependent children.
c. Medicare will pay for hom NU RSalth
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vices shO
ould these additional services meet
the needs of the individual.
d. Medicare will pay regardless of household income or financial status for nursing
home care.
ANS: C
Medicare does cover home health care.
DIF: Comprehension
15. Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act
(PPACA) based on religious beliefs that prohibit circumcision and blood transfusions. These
individuals believe the PPACA is unconstitutional bases on what premise?
a. The act mandates that all US and legal residents must secure health insurance.
b. The act replaces current Medicare and Medicaid plans.
c. The act requires all citizens to participate in offered preventive services.
d. The act prohibits use of health practices outside of Western medicine.
ANS: A
The PPACA is a type of national health insurance program to provide funding for US citizens
and legal residents to secure health insurance beyond the current programs such as Medicare
and Medicaid.
DIF: Comprehension
16. A nurse is newly employed by a state-owned hospital that provides health care insurance
requiring a deductible paid by the employee with most of the premium cost covered by the
employer. The insurance provided to the nurse is referred to by what term?
a. Private health insurance
b. A federal insurances program known as PPACA
c. State-subsidized Medicaid insurance
d. Single-payer system coverage
ANS: A
Private health insurance is a method for individuals to maintain insurance coverage for health
care costs through a contract with a health insurance company that agrees to pay all or a
portion of the cost of a set of defined health care services and is typically provided through an
individual’s employer with a portion of the cost paid by the employer and a portion paid by
the employee.
DIF: Comprehension
17. Health care is one of the major stories in newspaper and television and a group of nurses are
interested in how the economy impacts their nursing practice. When the group critiques the
relationship between contemporary economic trends and professional nursing practice, what
fact will they discover?
a. The implementation of the DRG system led to the nursing shortage since cost of
nursing care is not billed.
b. Nursing care is focused on technologically advanced acute care rather than
preventive, patient-centered care.
c. With pay for performance, nurses have a significant effect on the quality of patient
outcomes by reducing errN orsR
andIproGvidB
in.
gCcareMbased on best practices.
U S N T O practice.
d. Economic issues have little or no impact on nursing
ANS: C
Pay for performance, where providers are reimbursed based on the quality of care, gives
nurses an opportunity to reduce costs and adopt practices that improve quality of care.
DIF: Comprehension
18. A patient is eligible to change health care providers and insurance and asks, “I am interested
in health promotion activities; I walk, swim, and eat healthy. Which health insurance plan
would support these activities rather than just pay for services when I am sick?” Which, if
any, health insurance plan would best meet the needs of this patient?
a. Health Maintenance Organization (HMO)
b. Fee for Service
c. Preferred Provider Organization (PPO)
d. None, because health insurance plans seldom cover preventive care
ANS: A
HMOs encourage preventive care.
DIF: Comprehension
19. A patient is upset because her health insurance plan refused to pay for a mammogram and
services by a women’s health specialist because the primary care physician did not order the
referral or the mammogram. Which type of insurance plan adheres to this type of payment
system?
a. Fee for Service
b. Health Maintenance Organization (HMO)
c. Preferred Provider Organization (PPO)
d. Point of Service (POS)
ANS: B
HMOs require patients to select a primary care physician approved by the HMO who then
must refer or order any test/diagnostic procedures before payment is approved or preapproval
must be sought.
DIF: Comprehension
20. A patient wants to reduce health care costs by being a model for making wise decisions that
both promote health and reduce cost. Which statement by the patient would indicate a need
for further teaching?
a. “I will ask for the brand name drug Tylenol rather than acetaminophen since it
works better and I won’t be sick as long.”
b. “I looked up urinary tract infection prevention on the Internet.”
c. “I had my weight, body fat, and blood sugar measured at a local health fair.”
d. “My allergies are really bothering me. I spoke to the pharmacist, who
recommended an over-the-counter antihistamine.”
ANS: A
Ways to reduce health care cN tsRaS
osU s aIcNoG
nsTBe.rCinOcM
um lude choosing generic drugs whenever
possible.
DIF: Analysis
21. A nurse is very interested in learning more about health care economics and how she can use
that knowledge to become a better patient advocate. She comments, “Nurses should not only
deliver care one day at a time in one facility but should coordinate patient care as they move
from acute care to rehabilitation to home care.” This nurse would be a candidate for which
nursing role?
a. Disease management program (DMP) for chronic illnesses
b. A hospital-based utilization management nurse who reviews medical records to
determine the most appropriate DRG for patients
c. Case management
d. Reviewer for Managed Care Organization
ANS: C
Case management offers nurses the opportunity to demonstrate cost-effectiveness by
coordinating patient care at the appropriate level of care across the continuum of care. Patient
advocacy and understanding current health care economics are critical to this role.
DIF: Comprehension
MULTIPLE RESPONSE
1. A nurse who speaks at a health fair states that current attempts to increase efficiency of health
care include what actions? (Select all that apply.)
a. Increasing assess to acute care, so that specialized care can be provided
b. Increasing the use of outpatient services
c. Shifting toward health promotion and prevention
d. Allowing physicians to control health care decision making
e. Using technology to educate the public about cost-effective measures
ANS: B, C, E
Economic forces are motivating the shift toward providing more services and procedures in
outpatient settings. Economic forces are motivating the shift toward a model of health
promotion and preventive. The Internet can inform and educate consumers (or clients) about
how to access health care educational resources more effectively.
DIF: Analysis
2. Medicare would be responsible for fulfilling which client need? (Select all that apply.)
a. A hospital stay following a total knee replacement for a 70-year-old client
b. Nursing home cost for a 67-year-old adult receiving hemodialysis
c. Rehabilitation care costs for a 24-year-old client with a broken femur resulting
from a fall at work
d. Prescription cost for a young mother who meets eligibility for Aid to Families with
Dependent Children (AFDC)
e. Home health services to administer heparin to a 55-year-old truck driver following
a thrombus
ANS: A, B NURSINGTB.COM
Medicare coverage is based on age and Part A covers inpatient hospital services. Medicare
eligibility is based on age and disability with hemodialysis resulting from chronic renal failure
classified as a disability.
DIF: Comprehension
COMPLETION
1. The largest single payer of hospital charges in the United States is .
ANS:
Medicare
Medicare is the largest health insurance program; it covers the disabled persons with
end-stage renal disease, and persons 65 years of age and older who qualify for Social Security.
Since enactment of this program in 1965, the population covered by Medicare has doubled.
DIF: Knowledge
2. A 72-year-old client is admitted to have the right kidney removed after a diagnosis of cancer.
The surgeon removed the left kidney. Medicare will no longer pay for preventable medical
errors known as .
ANS:
never events
Medicare identified 28 medical errors that were preventable and with serious consequences
for which they will no longer pay. These errors are called never events.
DIF: Knowledge
3. The type of insurance that shifts the largest percentage of costs for goods and services to
employees and consumers is insurance.
ANS:
private
Private insurance shifts a more costs to employees and consumers than does any other type of
insurance.
DIF: Knowledge
NURSINGTB.COM
Chapter 08: Legal Issues in Nursing and Health Care

Edition
MULTIPLE CHOICE
1. A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client
is an immigrant and is uninsured. Which act would prevent the client from being transferred
to another facility?
a. The Emergency Medical Treatment and Active Labor Law
b. Health Insurance Portability and Accountability Act
c. Patient Self-Determination Act
d. The Patient Safety and Quality Improvement Act
ANS: A
The Emergency Medical Treatment and Active Labor Law is a federal statute that was enacted
in 1986 to prohibit the transfer of unstable clients, including women in labor, from one facility
to another. This law also prohibits refusal of care for indigent and uninsured clients who seek
medical assistance in the emergency department.
DIF: Comprehension
2. A nurse is caring for a client with malignant hypertension whose blood pressure has increased
by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to
the physician. The nurse is at risk for being charged with which legal claim?
a. Negligence
b. Assault
NURSINGTB.COM
c. Defamation of character
d. Tort
ANS: A
Negligence is defined as failure to act in a reasonable and prudent manner. The most frequent
allegations of nursing negligence include failure to ensure client safety, improper treatment,
failure to monitor the client and report significant findings, medication errors, and failure to
follow the agency’s policies and procedures.
DIF: Comprehension
3. A nurse is caring for a client who just suffered a stroke and is medicated for pain. The nurse
completes the following interventions: places the client on the examining table, completes a
thorough history and physical, covers the client with a sheet, places the call button within
reach, and goes out in the hall to speak with the client’s primary care provider. The client tries
to get up to speak with his family and falls, sustaining a hematoma on the head and a broken
hip. The nurse’s actions reflect which legal claim?
a. Invasion of privacy
b. Libel
c. Slander
d. Negligence
ANS: D
The nurse is failing to ensure client safety after medication administration; this is defined as
negligence.
DIF: Comprehension
4. A nursing student planning to apply for licensure knows that being charged with which
offense would result in a misdemeanor criminal offense?
a. Solicitation of illegal drugs
b. Stealing a car
c. Failing to report elder abuse
d. Billing Medicare for services not rendered
ANS: C
Failing to report elder abuse can lead to penalty of fine or imprisonment and is tried as a
misdemeanor offense.
DIF: Comprehension
5. When differentiating between slander and libel, the nurse knows that libel is characterized by
what action?
a. Defamation caused by subjective comments written in the nurse’s notes
b. Negative subjective comments made to those who are not providing care
c. Verbally describing to the oncoming nurse assigned to the client objective data that
place the client in a negative light
d. Repeating prejudiced comments made by the primary caregiver to a neighbor at
the local supermarket
Libel is defined as comments that are written about a person that are defaming. Nurses may be
subject to a charge of libel for subjective comments meant to denigrate the client that are
placed in the medical record or in other written materials read by others. Slander refers to an
injury to one’s reputation caused by the spoken word.
DIF: Comprehension
6. A client states, “I am leaving. No one here knows what they are doing.” The nurse completing
the Against Medical Advice form must implement what intervention to best assure client
safety?
a. Notify the primary health care provider of the client’s wish to leave.
b. Alert family that the client will be leaving the facility.
c. Inform the client that leaving could result in complications and impairment.
d. Require security staff to accompany the client to the facility’s main entrance.
ANS: C
The nurse must articulate to the client the dangers associated with leaving the facility if the
primary provider is not present. The nurse’s notes on this form should reflect the specific
advice given to the client, which should include the fact that leaving the facility could
aggravate the current condition and complicate future care, resulting in permanent physical or
mental impairment or disability, or resulting in complications that can cause death. None of
the other options address the client’s known safety risks.
DIF: Application
7. When can a nurse detain a client by implementing restraints?

a. Staffing resources are insufficient to monitor a patient.
b. The client is demonstrating behaviors associated with confusion.
c. The family requests the restraints to prevent the client from leaving the facility.
d. There are current prescribed instructions for their use.
ANS: D
A written primary care provider’s prescription that is timed and dated is required for the use
of restraints. Renewal of orders must be accompanied by evidence of medical evaluation and
nursing reassessment. Restraints can only be appropriately applied as a last resort to managing
inappropriate behavior.
DIF: Comprehension
8. When the client is unable to make medical decisions, authorization that allows another person
to make these decisions is referred to by what term?
a. A living will
b. Durable power of attorney
c. Informed consent
d. Immunity
ANS: B
Durable power of attorney involves preselection by the client of a person who has been
authorized legally to make health care decisions once the client becomes incompetent to do
so. Several states have enacted a Uniform Durable Power of Attorney Act, which sanctions a
durable power of attorney forNhUeaRltS
hIcaNreG. T
NBon.eCof tM
he remaining options address the inability
to autonomously make effective medical choices.
DIF: Knowledge
9. All hospitals receiving Medicare and Medicaid funds must ask clients whether they have a
living will or a durable power of attorney. What legislative act makes this action mandatory?
a. Emergency Treatment and Active Labor Law
b. Americans with Disabilities Act
c. Uniform Health Care Decisions Act
d. Patient Self-Determination Act
ANS: C
The Uniform Health Care Decisions Act of 1993 is a federal statute that was established to
support individuals in expressing their preferences about medical treatment and making
decisions about end-of-life care.
DIF: Comprehension
10. A nurse who functions in the role of team leader can be held negligent for matters involving
what focus?
a. Adequate training
b. Policies and procedures
c. Staff discipline
d. Delegation
ANS: D
Delegation of client care tasks falls within the role of the team leader, and inappropriate
delegation of client care tasks could result in negligence. Team leaders, charge nurses, and
managers are held to the standard of care of the reasonably prudent nurse employed in that
role.
DIF: Comprehension
11. Although a hospital reversed all charges when a client was the victim of wrong site surgery,
the court awarded the client $1.5 million. The client could return to work in 6 weeks and had
no permanent damages. This monetary compensation is referred to by what term?
a. Lability
b. Punitive damages
c. Vicarious liability
d. Immunity
ANS: B
Punitive damages are monetary compensation to an injured client that is greater than amount
of loss. It is monetary compensation awarded to an injured person (patient) that goes beyond
that which is necessary to compensate for losses (e.g., the ability to function, death, income)
and is intended to punish the wrongdoer.
DIF: Application
12. A primary health provider prescribes a drug for a patient with a known allergy, it is
administered and results in anNaphRylaI
U S NG TB.C M
ctic shock. What statement is accurate regarding
disclosure of this event?
a. Disclosure of the error will result in more severe ramifications for the agency than
if the negligence is discovered by the patient or family.
b. Disclosure of the occurrence should occur before notification of the prescribing
health provider
c. Disclosure as an essential component of the national patient safety movement.
d. Disclosure to the patient’s insurance company is focused on decreasing costs.
ANS: C
The National Quality Forum identified the process of disclosure as a key element of the
national patient safety movement. None of the other options accurately describe the focus of
the disclosure.
DIF: Comprehension
13. A nurse testifies at trail that a professional with the knowledge and skill of an RN should
understand that, before administering digoxin, the client’s potassium level and pulse level is
always checked to prevent negative effects on cardiac output. The nurse’s testimony as to
what constitutes reasonable care is based on what criteria source?
a. The legal definition of standard of care
b. The legal definition of the informed consent process
c. The doctrine of res ipsa loquitur
d. The concept of governmental immunity
ANS: A
Standard of care is the legal criteria against which the nurse’s (and primary care provider’s)
conduct is compared to determine whether a negligent act or malpractice occurred. Nurses are
specialists in hospital care who, in the final analysis, hold the well-being—in some instances,
the very lives—of patients in their hands.
DIF: Comprehension
14. A blood reaction occurrence is noted in a client who did not receive pretransfusion care as
clearly documented in the facility’s policies and procedures. The nurse providing care is liable
for which legal tort?
a. Comparative negligence
b. Punitive damages
c. Criminal negligence
d. Involuntary tort
ANS: C
In this case, criminal negligence charges would be based on “reckless and wanton” disregard
for the safety, well-being, or life of an individual; behavior that demonstrates a complete
disregard for another, such that death is likely in the transfusion reaction.
DIF: Comprehension
15. A physician shares with the patient’s family that, while a central line was being inserted, the
patient’s lungs were inadvertently punctured, which required oxygen administration. The
physician also explains that a chest x-ray indicated the lung remained intact and no additional
treatment was required. The physician’s role in this instance is based on what legal principle?
a. Comparative negligence NURSINGTB.COM
b. Gross negligence
c. Disclosure
d. Emergency Medical Treatment and Active Labor Act (EMTALA)
ANS: C
Disclosure is a process in which the patient’s primary provider (physician or advanced
practice nurse) gives the patient, and when applicable, family members, complete information
about unanticipated adverse outcomes of treatment and care.
DIF: Comprehension
16. A nurse is assigned to a unit other than the one she is normally assigned due to increased
census on the alternate unit. She is assigned to care for seven patients and participates in
walking rounds where the patient’s condition and needs are discussed between oncoming and
off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending
orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall
from her pocket, which contain the above information that contains patient sensitive data. The
liabilities arising from this incident would be covered under what issue?
a. Compliance with the Health Insurance Portability and Accountability Act
(HIPAA)
b. Performance in accordance with the American Nurse’s Association (ANA) Scope
and Practice Act
c. Nursing role in the securing of implied consent
d. Personal liability with floating and cross-training
ANS: A
HIPAA protects patient information and ensures confidentiality of data.
DIF: Comprehension
MULTIPLE RESPONSE
1. Which components must be included regarding informed consent? (Select all that apply.)
a. Identification of risks for non-treatment
b. Discussion of expected benefits
c. Identification of known risks
d. Acknowledgement of alternative therapy
e. Communication of the estimate cost involved
ANS: A, B, C, D
The information that constitutes informed consent for the client includes the nature of the
therapy or procedure, expected benefits and outcomes of the therapy or procedure, potential
risks of the therapy or procedure, alternative therapies to the intended procedure and their
risks and benefits, and risks of not having the procedure. Cost is not a component of informed
consent.
DIF: Comprehension
2. Which nursing situation demonstrates the greatest need for individual malpractice insurance to
help manage professional legal risk? (Select all that apply.)
a. Accepting the role of weeNkU
enRdSuI
niN
tmGaTnB
ag.
erCOM
b. Delegating health care responsibilities to nursing staff
c. Working for the federal government attending to embassy staff
d. Being licensed in a state where sovereign immunity is in effect
e. Regularly working in the facility’s float pool
ANS: A, B, D, E
Reasons given for the purchase of malpractice insurance by RNs include the following;
expanding functions of RNs and advanced practice nurses; floating and cross-training
mandates; increasing responsibility for supervising subordinate staff; working in states where
sovereign immunity makes health care workers not health care facilities liable for neglect.
Being employed by the federal government can shield the nurse from personal liability by
federal tort statutes in some cases.
DIF: Application
3. Which types of abuse are the nurse required to report or be subject to fines and imprisonment
for not reporting? (Select all that apply.)
a. Animal
b. Child
c. Alcohol
d. Infant
e. Emotional
ANS: B, D
State laws have been created because of the 1973 Child Abuse Prevention and Treatment Act.
These laws dictate that health professionals must report infant and child abuse and specified
communicable diseases. Failure by the nurse to comply can result in fines and/or
imprisonment.
DIF: Comprehension
4. What examples should the nurse provide to best describe an advance directive? (Select all that
apply.)
a. Preserving cord blood for possible future needs of a child
b. Providing instructions about personal preferences regarding life-sustaining medical
procedures
c. Giving someone the legal right to act on one’s behalf when one becomes
incapacitated
d. Completing hospital admission paperwork before being admitted to the hospital
ANS: B, C
Advance directives document an individual’s desires regarding end-of-life care. These wishes
are generally stated through the execution of a formal document known as the living will.
Right-to-die statutes vary from state to state; therefore, nurses must become familiar with their
state-specific statute.
DIF: Application
5. A nurse learns in orientation that an incident report does not “blame” anyone but concisely
documents the events leading up to an occurrence. Which events would warrant completion of
an incident report? (Select alN haRt S
l tU apIpN
lyG
.) TB.COM
a. The client is crying and distraught when learning of a diagnosis of cancer.
b. An intravenous antibiotic given preoperatively does not infuse because of a faulty
pump.
c. The nurse is unable to carry out orders written by the specialist because of
illegibility.
d. A client falls while in the shower, after being instructed not to get up alone.
e. The registered nurse is not available to complete the preoperative checklist.
ANS: B, C, D, E
Nurses are legally bound to report critical incidents to their nurse managers, agency
administration, and risk manager through a formal intra-agency document generally titled the
“incident report.” Circumstances under which an incident report should be filed include
malfunction or failure of medical equipment.
DIF: Analysis
Chapter 09: Ethical and Bioethical Issues in Nursing and Health Care
Edition
MULTIPLE CHOICE
1. How is the term Ethics as applied to nursing best defined?

a. Doing what is best for the client
b. Making good decisions about care
c. Care based on keeping with the values of the client
d. Rules for providing competent care that is based on scientific principles
ANS: C
Nursing ethics is a system of principles intended to guide the actions of the nurse in his or her
relationships with clients, clients’ family members, other health care providers, policymakers,
and society as a whole. A nurse must make an attempt to understand what values are inherent
in the situation.
DIF: Knowledge
2. A family requests that no additional heroic measures be instituted for their terminally ill
mother who has advance directives in place. The nurse respects this decision in keeping with
the principle of what client right?
a. Accountability
b. Autonomy
c. Nonmaleficence
d. Veracity
NURSINGTB.COM
ANS: B
Autonomy is the principle of respect for the individual person. Within the concept of
autonomy, people are free to form their own judgments and perform whatever actions they
choose. They are self-determining agents who are entitled to decide their own destiny.
DIF: Comprehension
3. An older adult client is comatose and had one electroencephalogram that indicated no activity.
The daughter is very distraught and notices her mother’s hand moves when she is talking to
her. The daughter asks the nurse, “Is mother responding to my voice?” The nurse, attempting
to console the daughter, knows the movement was involuntary but states, “It does appear she
did.” The nurse is violating which principle of ethics?
a. Autonomy
b. Veracity
c. Utilitarianism
d. Deontology
ANS: B
Veracity is the principle of telling the truth in a given situation.
DIF: Comprehension
4. In attempting to decide which services should be offered to a community, the public health
nurse decides to implement hypertension screening and treatment because most of the
residents are hypertensive. This decision is based on what ethical principle?
a. Veracity
b. Values
c. Utilitarianism
d. Autonomy
ANS: C
Utilitarianism is an approach that is rooted in the assumption that an action or practice is right
if it leads to the greatest possible balance of good consequences or to the least possible
balance of bad consequences. On the basis of this principle, an attempt is made to determine
which actions will lead to the greatest ratio of benefit to harm for all persons involved in the
situation.
DIF: Comprehension
5. A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of
his or her own values as they relate to this issue. What action should the nurse take to address
this barrier to providing effective care to the client?
a. Reflect on one's personal values and how these values relate to beliefs and the
philosophy of nursing
b. Be prepared to defend his or her value system
c. Ignore his or her own values and provide care
d. Realize that values do not change and that they cannot be influenced by others and
so decline this assignment
Nurses must make a deliberate effort to recognize their own values and must learn to consider
and respect the values of others. Health care decisions are seldom made independently of
other people. Decisions are made with the client, the family, other nurses, and other health
care providers.
DIF: Application
6. When assessing an ethical issue, what is the nurse's first intervention?

a. Ask, “What is the issue?”
b. Identify all possible alternatives.
c. Select the best option from a list of alternatives.
d. Justify the choice of action or inaction.
ANS: A
The first step in the situational assessment procedure is to find out the technical and scientific
facts and assess the human dimension of the situation—the feelings, emotions, attitudes, and
opinions. Assessment can be applied to all areas of patient care, including ethics. Trying to
understand the full picture of a situation is time consuming and requires examination from
many different perspectives, but it is worth the time and effort.
DIF: Comprehension
7. A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were
associated with a survey of college sophomores. The researcher was applying which ethical
principle?
a. Beneficence
b. Human dignity
c. Justice
d. Human rights
ANS: A
Beneficence is defined as promoting goodness, kindness, and charity. In ethical terms,
beneficence means to provide benefit to others by promoting their good.
DIF: Comprehension
8. The primary health care provider who insists on providing treatment in spite of the client’s
wishes because “I know best” is reflecting an attitude referred to as what?
a. Autonomy
b. Beneficence
c. Justice
d. Paternalism
ANS: D
Paternalism is an action and an attitude wherein the provider tries to act on behalf of the client
and believes that his or her actions are justified because of a commitment to act in the best
interest of the client. Paternalism is a reflection of the “father knows best” way of thinking.
DIF: Comprehension
NURSINGTB.COM
9. The nurse who admits making a medication error and immediately files an incident report is
demonstrating what ethical principle?
a. Accountability
b. Individuality
c. An injustice
d. Values clarification
ANS: A
Accountability is an ethical duty that states that one should be answerable legally, morally,
ethically, or socially for one’s actions.
DIF: Comprehension
10. Two individuals with no health insurance or money sustained life-threatening injuries during
an automobile accident. The decision was made to provide extended care in the trauma center
after emergency surgery was performed to save their lives. The care of the two critical clients
was based on what ethical principle?
a. Utilitarianism
b. Deontology
c. Autonomy
d. Veracity
ANS: B
Deontology is an approach that is rooted in the assumption that humans are rational and act
out of principles that are consistent and objective and that compel them to do what is right.
Deontological theory claims that a decision is right only if it conforms to an overriding moral
duty and wrong only if it violates that moral duty.
DIF: Comprehension
11. A 13-year-old female is brought to the family planning clinic by her enraged father, who has
just learned that she is pregnant. The pregnant client states, “I want to have this baby and give
it up for adoption.” However, the father is adamant that she will disgrace the family and
demands that the health care providers tell his daughter that she has a physical condition that
would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a
conflict that involves what ethical principle?
a. Deontology
b. Veracity
c. Autonomy
d. Beneficence
ANS: B
Veracity is telling the truth in personal communication as a moral and ethical requirement.
DIF: Comprehension
12. During a seminar on ethics, the educator realizes that more information is needed when a
participant describes which situation as a violation of the ethical principle of autonomy?
a. An older person with advanced stages of Alzheimer’s disease is denied the right to
ambulate in the hallway. R I G B.C M
b. A mentally competent adulU N t refSuseN
s mT
edical trOeatment for the autoimmune disease
lupus erythematosus, stating that this condition reflects the will of a higher power.
c. A mentally competent visitor fell during visiting hours but refused to be examined
by the physician on call.
d. A mentally competent adult with a broken wrist refuses to be given a local
anesthetic prior to a procedure.
ANS: A
Autonomy is defined as personal freedom, the right to make choices. However, in this case,
the patient is not able to be fully informed so they can clearly understand the choices being
offered.
DIF: Application
13. A nurse who is infected with human immunodeficiency virus (HIV) while working in the
operating room seeks revenge by deliberately placing clients at risk by not adhering to
universal precautions. This nurse is violating what ethical principle?
a. Veracity
b. Beneficence
c. Nonmaleficence
d. Autonomy
ANS: C
Nonmaleficence means to abstain from injuring others and to help others further their own
well-being by removing harm and eliminating threats. The nurse is definitely violating this
principle through her actions.
DIF: Comprehension
14. A client and her husband used in-vitro fertilization to become pregnant. The unused sperm
was frozen so the couple could have more children later. The husband is killed while in
combat, and the client journals her choices and the possible ramifications. She comes to the
fertility clinic after looking at the situation from many perspectives and after considering
many alternatives. She asks that the sperm be destroyed because her husband’s faith
prohibited remarrying, and allowing another person to use the sperm would conflict with her
late husband’s beliefs. When considering this scenario, the nurse realizes what?
a. The client is in the second step of ethical decision making and that the client’s
value system is influencing her choices of alternative actions.
b. A logical line of reasoning has led to validation of the decision to destroy the
husband’s sperm.
c. The client has not been able to navigate the complicated issues inherent in this
situation.
d. A rational decision was reached that was based on reflection and on the value
systems of the wife and the husband.
ANS: D
After completing all steps in the situation assessment procedure, the client is now ready to
justify her selection. In this phase, the person will specify reasons for the action, will clearly
present the ethical basis for these reasons, will understand the shortcomings of the
justification, and will anticipN
ate oRbjeI
ctioG
ns tB
o.thC
e juM
stification.
U S N T O
DIF: Analysis
15. A client is in extreme pain after he was involved in a motor vehicle accident, and morphine
has been ordered every hour for pain. The nurse injects saline into the client’s IV line and
takes the morphine for herself. The nurse is violating which principle of ethics?
a. Autonomy
b. Utilitarianism
c. Beneficence
d. Dilemmas
ANS: C
Beneficence is providing benefit to others by promoting their good. In general terms, to be
beneficent is to promote goodness, kindness, and charity. By taking the client’s pain
medication and substituting saline, the nurse did harm, not good, for this client.
DIF: Comprehension
16. The Health Care Reform Act provides insurance for all U.S. citizens and legal residents
presenting far-reaching ethical considerations related to diverse individual patient health care
beliefs for those delivering nursing care. Nurses must consider their civil rights under the
rights of conscience and how new health care agendas such as the Patient Protection and
Affordable Care Act (PPACA) could affect their practice in situations that may conflict with
their own belief system. What action demonstrates a nurse attempt to act in accordance with
this responsibility?
a. Remembering it is one’s professional duty to render patient-centered care—even
when it is in direct conflict with the nurse’s own beliefs—or be held liable for
withholding treatment.
b. Considering whether the right to act according to one’s inner beliefs will continue
to be permissible when federal health insurance becomes fully enacted.
c. Discussing with the patient and family different options in hopes they will accept
the nurse’s health care beliefs.
d. Suggesting to the hospital administration that they not accept federal funding to
prevent controversial health practices.
ANS: B
With federal funding, many controversial health care services will be covered and provided as
part of patient care when desired by the patient; therefore, whether a nurse has autonomy to
refuse to provide care may not be as clear even when one might request another patient.
DIF: Application
17. A patient returning from a procedure was somehow “skipped” when daily baths were
performed and requests that care now be provided now. The nurse discovers the bed is
rumpled and damp. The RN jN oinR
s wiI
th sG
omeBo.thCer staff to bathe the patient, change the bed,
U S N T staffOmembers are demonstrating what ethical
and help make the patient comfortable. These
concept?
a. Altruism
b. Veracity
c. Autonomy
d. Whistle-blowing
ANS: A
Altruism is concern for the welfare of others, including willingness to help others when they
are unable to get their assignments completed to ensure that the patient receives high-quality
care.
DIF: Comprehension
18. In which case does the nurse act as “whistle-blower”?

a. One staff member on the unit covers for another nurse, who leaves the premises to
purchase illegal substances.
b. The nurse reports that another nurse is taking medications out of stock medicine
for herself or himself.
c. A nurse informs respiratory therapy that a patient is now due a treatment.
d. The nurse delegating care to unlicensed assistive personnel makes rounds to ensure
all care was rendered properly.
ANS: B
Whistle-blowing is the reporting of acts or situations that violate the principle of beneficence
such as a chemical impairment, negligence, abusiveness, incompetence, or cruelty.
DIF: Comprehension
MULTIPLE RESPONSE
1. Throughout their careers, nurses are in an ongoing state of acculturation, gaining experience
from formal nursing school classes, clinical experiences, and the ethical issues they encounter
in their clinical practice. What are the ideal outcomes of these ongoing experiences with
cultural decision making? (Select all that apply.)
a. Increased trustworthiness
b. Enhanced ability to take into consideration many aspects of ethical situations
c. Confidence to make decisions based on experience and ethical intelligence
d. Improved clinical decision making and advocacy for patient autonomy
e. Authority to make ethical decisions independently that meet personal moral beliefs
ANS: A, B, C, D
The desired outcomes of ethics acculturation across the years are integrity, personal growth,
practical wisdom, and effective problem solving on behalf of patients and their families.
These are the qualities that are characteristics of an ethically sensitive and morally mature
person. Trustworthiness is a characteristic of integrity. The ability to take into consideration
many aspects of ethical situations is due in part to personal growth and practical wisdom. The
confidence to make ethically sensitive decisions comes from experience founded on personal
growth and personal wisdom. The ability to be the patient’s advocate in ethical decision
making is one test of cultural acculturation.
NURSINGTB.COM
DIF: Application
COMPLETION
1. Practicing nurses participate in employer-sponsored professional development classes that

provide case studies related to ethical situations and decision making. Ethical considerations
are debated among teams, and an expert helps the class arrive at the “best practices.” The
nurses are experiencing ethics .
ANS:
acculturation
Ethics acculturation is the didactic and experiential process of developing ethical reasoning
abilities as a part of ongoing professional education.
DIF: Knowledge
Chapter 10: Cultural Competency and Social Issues in Nursing and Health Care
Edition
MULTIPLE CHOICE
1. A priority action for the nurse who works with culturally diverse clients to complete initially
is completion of additional form of support?
a. A sign language course
b. Cultural self-assessment
c. Cultural client assessment
d. A conversational Spanish course
ANS: B
The first step to becoming a culturally sensitive and competent health care provider is to
conduct a cultural self-assessment. Through identification of health-related attitudes, values,
beliefs, and practices, the nurse can better understand the cultural aspects of health care from
the client’s perspective.
DIF: Application
2. A nurse is caring for a recent Asian immigrant client and is overheard making the following
comment, “These rituals you believe in are false. You live in America now and must believe
in realistic health practices, like Americans do.” The nurse is exhibiting behavior associated
with what belief?
a. Stereotyping
b. Ethnocentrism
NURSINGTB.COM
c. Cultural accommodation
d. Empathy
ANS: B
Ethnocentrism is the belief that one’s own ethnic group, culture, or nation is best.
DIF: Comprehension
3. A nurse is submitting a grant application to improve access to health care and mortality for
minority groups. The grant focuses on the six causes of death that are identified as priorities
for minorities, which include what medical diagnosis?
a. Chronic obstructive pulmonary disease (COPD)
b. Malnutrition
c. Cirrhosis of the liver
d. Breast cancer
ANS: D
Cancer is identified as a leading cause of excessive death among minority group members.
The six leading causes are cancer, cardiovascular disease and stroke, chemical dependency,
diabetes, homicides/accidents, and infant mortality.
DIF: Comprehension
4. A nurse is given a referral to make a home visit to a Russian immigrant. The nurse knows
very little about the health beliefs of this ethnic group. To research this group, what term
should the nurse use in an Internet search?
a. Federally recognized minorities
b. Marginalized populations
c. Asian/Pacific Islander cultures
d. Latino cultures
ANS: B
Marginalized populations include recently arrived immigrants. Their lives and health care
needs are often kept secret and are understood only by them.
DIF: Application
5. Which statement is true regarding health care for minorities?

a. Federal legislation that provides free health insurance for minorities has resulted in
fewer minorities than members of the general population who lack health
insurance.
b. Higher costs of health care coupled with lower wages for minorities have
prevented most minorities from seeking health care.
c. Because many Mexican Americans are highly skilled workers with comparable
wages, they have the lowest uninsured rate.
d. Asians, because of their quiet demeanor and unwillingness to challenge the health
care system, have the highest rate of uninsured people.
ANS: B
Most families with racially or ethnically diverse backgrounds have a lower socioeconomic
status than is observed in theNpU
opRuS
laI
tioNnGaT
t lB
ar.
geC. O
DM
ramatic changes in technology and
specialization in the health care field have caused health care costs to skyrocket. Therefore,
not everyone can afford health care services.
DIF: Comprehension
6. While completing a masters nursing degree in Virginia, a nurse who is interested in teaching
in Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of
Mexican-Americans live there. This nurse is demonstrating what social value?
a. Cultural competence
b. Ethnocentrism
c. Prejudice
d. Stereotyping
ANS: A
Cultural competence is the responsibility of all nurses to become knowledgeable about the
values, beliefs, and health care practices of the culturally diverse groups that are dominant in
the nurse’s practice area.
DIF: Comprehension
7. A nurse plans to move to an area that is rich in immigrants from several countries and is
concerned about respecting others’ cultural beliefs. What is the nurse’s first step to ensure
cultural competence and sensitivity?
a. Enrolling in a nursing theories course to increase knowledge about transcultural

practices
b. Becoming immersed in nursing literature about culturally diverse clients
c. Participating in continuing education that focuses on health assessment variations
among cultural groups
d. Conducting a cultural self-assessment to identify biases or prejudices
ANS: D
A cultural self-assessment allows the nurse to identify attitudes about individuals from
different cultures.
DIF: Application
8. An Asian teenager is admitted with an eating disorder which she contributes to not meeting
the academic expectations of her parents. The nurse is overheard saying, “That isn’t the
reason; all Asians are really smart.” This nurse is demonstrating is which cultural biases?
a. Cultural humility
b. Stereotyping
c. Cultural assimilation
d. Acculturation
ANS: B
Stereotyping is associating certain behavior or competencies with an ethnic group without
considering the individual.
DIF: Comprehension
MULTIPLE RESPONSE NURSINGTB.COM

1. Six cultural phenomena that vary among cultural groups are known to affect health care. The
influence of the consequences of these phenomena can be seen in which of the following?
a. Asians and American Indians tend to be nonadherent with medications because
they believe that the environment has no control over their fate.
b. Some cancers such as stomach cancer occur less frequently among blacks.
c. Blacks and American Indians often resist direct eye contact.
d. Mexican Americans are more likely to stand close and touch health care providers.
e. Whites are often late for health care appointments.
ANS: C, D
The use of eye contact is a cultural communication phenomenon. Cultures such as black and
American Indian may view direct eye contact as rude behavior. Space and touch are cultural
phenomena factors. In some cultures, touching strangers is inappropriate. On the other hand,
Mexican Americans tend to be comfortable with less space because they like to touch persons
with whom they are talking.
DIF: Analysis
2. A nurse involved in researching the leading causes of death for minorities considers the
federally defined minority groups, which include what populations? (Select all that apply.)
a. Blacks
b. Russians
c. Hispanics
d. Asians or Pacific Islanders
e. Scandinavians
ANS: A, C, D
The Federally defined minority groups include blacks, Hispanics, American Indians, and
Asians or Pacific Islanders.
DIF: Comprehension
COMPLETION
1. Although communication varies among members of different cultures, the greatest obstacle to
providing multicultural care is differences in _.
ANS:
language
Language can be the greatest obstacle to providing multicultural care. If the client does not
speak the same language as the nurse, a skilled interpreter is mandatory.
DIF: Comprehension
NURSINGTB.COM
Chapter 11: Complementary and Alternative Healing

Edition
MULTIPLE CHOICE
1. A patient observes the practitioner burning a dried herb on the needle during an acupuncture
session and asks about this practice. The practitioner responds by referring to this practice
using what term?
a. Doshas
b. Moxibustion
c. Yoga
d. Kapha
ANS: B
Applying heat to the acupoints is termed moxibustion. Individuals are believed to have
distinct metabolic body types called doshas; kapha is one of three body types. The word yoga
means “union”; the union of body, mind, and spirit is achieved through yoga.
DIF: Comprehension
2. An older adult diagnosed with atrial fibrillation uses imagery to alter the dysrhythmia. The
client is using which type of complementary alternative medicine (CAM)?
a. Ayurveda
b. Dosha
c. Homeopathy
d. Biofeedback
NURSINGTB.COM
ANS: D
Biofeedback is a type of mind-body intervention that is based on techniques in which the
client is taught to alter specific bodily functions such as heart rate, blood pressure, and muscle
tension. The client uses various relaxation and imagery exercises to produce desired
responses. Dosha is associated with a belief that an individual has one of three distinct
metabolic body types. Ayurveda means “the science of life” and is a system of care that
promotes spiritual, mental, and physical balance. Homeopathy is a branch of medicine
developed in the late 18th century.
DIF: Comprehension
3. A patient diagnosed with kyphosis is visiting a practitioner of chiropractic medicine for the
first time and asks, “How does this therapy work?” The practitioner replies, “I will use my
hands along with heat to correct the misalignment of your spine by placing pressure on the
nerves that have produced pain.” What term will the practitioner use to refer to the
misalignment of the spine?
a. Subluxation
b. A sprain
c. A fracture
d. Epicondylitis
ANS: A
The chiropractor corrects misalignments of the spine, called subluxations, by putting pressure
on the nerves that are causing pain.
DIF: Comprehension
4. A young adult experiencing pain states, “I want to see a chiropractor, but I don’t have any
money. However, I do have health insurance.” What is the most appropriate response the
nurse can provide regarding payment for this form of health care service?
a. “Most insurance companies will pay for chiropractic treatment.”
b. “Because chiropractors are not required to be licensed, services must be paid for
by the patient.”
c. “Chiropractic medicine is a new complementary alternative medicine (CAM)
therapy that has not yet been recognized by insurance companies.”
d. “Chiropractic medicine is more than 100 years old, but because it is preventive in
nature, it is not covered by most insurance.”
ANS: A
Chiropractic medicine is performed by a licensed professional with reimbursement privileges
and is an accepted complementary alternative medicine (CAM) therapy.
DIF: Comprehension
5. The use of plants in conventional modern medicine is evidenced by the drug atropine, which
is derived from which plant?
a. Digitalis purpurea
b. Cephaelis ipecacuanha
c. Rauwolfia serpentina
d. Atropa belladonna NURSINGT B.COM
ANS: D
Atropine is derived from the Atropa belladonna plant; it primarily affects the parasympathetic
nervous system.
DIF: Knowledge
6. The massage therapist uses kinesthesia to correct habits that cause poor posture and limited
movement. What is this type of massage called?
a. Alexander technique
b. Feldenkrais method
c. healing touch
d. Reiki
ANS: A
The Alexander technique teaches improved balance, posture, and coordination through gentle
hands-on guidance and verbal instruction. Feldenkrais method teaches movement re-education
by using gentle manipulations to heighten awareness of the body; believes each person has an
individualized optimal style of movement. Healing touch is a multilevel energy healing
program that incorporates aspects of therapeutic touch with other healing measures. Reiki is a
therapy that uses techniques to direct universal life energy to specific sites.
DIF: Comprehension
7. A nurse practices a relaxing massage technique to stimulate and apply pressure to the feet or
hands, increasing blood supply circulation to various parts of the body and relieving pain. The
massage technique used by the practitioner is referred to by term?
a. Reflexology
b. Feldenkrais method
c. Reiki
d. Rolfing
ANS: A
Reflexology produces pain relief through pressure applied to pressure points on the hands and
feet that correspond to various parts of the body. The Feldenkrais method teaches movement
re-education by using gentle manipulations to heighten awareness of the body; believes each
person has an individualized optimal style of movement. Reiki is a therapy that uses
techniques to direct universal life energy to specific sites. Rolfing uses manual manipulation
and stretching of body’s fascial tissues to establish balance and symmetry.
DIF: Comprehension
8. A patient is prescribed reserpine to decrease mild anxiety and treat hypertension. The patient
researches the medication on the Internet and finds that this medication comes from which
plant?
a. Atropa belladonna
b. Digitalis purpurea
c. Rauwolfia serpentina
d. Cephaelis ipecacuanha
ANS: C
The drug reserpine is derivedNfUroR
mSthIeNpG ntBk.
laT noCwOnMas Rauwolfia serpentina. It was used to
treat depression in the past but currently is used in the treatment of hypertension.
DIF: Comprehension
9. A person who is recovering from a stroke is becoming more forgetful and is unable to recall
people’s names. A friend suggests the use of a natural ingredient, ginkgo biloba. The nurse is
concerned about which serious risk associated with this herb?
a. Thromboembolism
b. Seizures
c. Hypertension
d. Photosensitivity
ANS: B
Ginkgo reduces the efficacy of anticonvulsants, which may lead to increased seizure activity.
DIF: Comprehension
10. Which complementary alternative medicine (CAM) may interfere with early detection of the
dementia?
a. Large doses of calcium can cause cerebral plaques to form, thereby disguising
atrophy of the brain.
b. Excess doses of folic acid can mask a vitamin B12 deficiency that led to dementia.
c. Hypnotherapy focused on current pleasant thoughts can eliminate clues to the past.
d. The electrical current from magnetic fields can interfere with normal brain waves,
resulting in confusion and inability to concentrate.
ANS: B
Individuals with Alzheimer’s often have low levels of vitamin B12; thus, large doses of folic
acid may have masked the dementia.
DIF: Comprehension
11. The nurse who presents a class on different methods of complementary alternative medicine
(CAM) differentiates between imagery and hypnosis in which of the following ways?
a. Imagery involves the dependent mental construction of a picture, whereas hypnosis
requires the patient to recall and verbally describe difficult times in his or her life.
b. Hypnosis requires a trained psychologist, but imagery can be performed by any
health care practitioner.
c. Imagery produces a temporary sense of well-being compared with hypnosis, which
evokes a permanent positive effect.
d. Although both therapies focus on specific problems and guide the patient into
relaxation, imagery requires the patient to formulate the impression, whereas the
hypnotist constructs the image for the patient.
ANS: D
Both imagery and relaxation are used to reduce anxiety and stress; however, imagery begins
with a goal that is to be achieved and a picture that is formulated by the person under
treatment, rather than beginning with the hypnotist, who conjures up a desirable image.
DIF: Comprehension
NURSINGTB.COM
12. A pregnant woman reports back pain and wants to try a complementary alternative medicine
(CAM) therapy. The nurse knows that which CAM would be contraindicated?
a. Magnet therapy
b. Aromatherapy
c. Imagery
d. Therapeutic touch
ANS: A
The effect of magnets on fetal growth has not been determined. Aromatherapy uses plant
materials and aromatic plant oils, including essential oils, and other aroma compounds for
improving psychological or physical well-being. It can be offered as a complementary therapy
or as a form of alternative medicine. Imagery is the process of creating a “picture” (image) in
the mind that can cause a specific bodily response. Therapeutic touch (commonly shortened to
“TT”), known by some as “non-contact therapeutic touch” (NCTT), is a pseudoscientific
energy therapy which practitioners claim promotes healing and reduces pain and anxiety.
DIF: Comprehension
13. Despite the presence of safety aids such as handrails in the bathrooms at an assisted living
facility, the number of fractures due to unsteady ambulation upon arising from the bed and
when attempting to perform activities of daily living has increased. Which complementary
alternative medicine (CAM) would be an effective intervention for this population?
a. Yoga
b. Acupuncture
c. Tai chi
d. Magnet therapy
ANS: C
Tai chi improves coordination, thereby reducing the number of falls and improving gait. The
word yoga means “union”; the union of body, mind, and spirit is achieved through yoga.
Acupuncture is a major therapy within traditional Chinese medicine that is based on the belief
that there are invisible channels throughout the body, called meridians, through which energy
flows. The most common uses of magnet therapy are for pain and wound healing.
DIF: Comprehension
14. A patient informs the nurse, “I burn a lavender-scented candle for an hour before bedtime to
help me relax and sleep.” The nurse realizes this patient is using what complementary
alternative medicine (CAM)?
a. The mind–body intervention of aromatherapy
b. An energy technique known as qi gong
c. The manipulative method using the Alexander technique
d. Conventional medicine, also called allopathic
ANS: A
Aromatherapy uses scents of essential oils and is a type of mind–body interaction.
DIF: Comprehension
15. What symptom would the nurse caring for a patient who practices Ayurveda assess for?
a. An increased stool osmolNalityRgaI
p reG
sultB
in.
gC M dehydration
from
U S N T
b. Petechiae resulting from fine-needle punctures
c. Use of over-the-counter remedies intended for intended symptom
d. Magnets strategically placed on affected joints
ANS: A
Individuals practicing Ayurveda may use detoxification and cleansing enemas resulting in
dehydration, which increases stool osmolality.
DIF: Comprehension
16. A patient informs the nurse, “I can’t sit in the yard for even 10 minutes without my skin
turning red and tender.” The nurse would assess for the use of which complementary
alternative medicine (CAM)?
a. St. John’s wort
b. Ginkgo biloba
c. Feverfew
d. Echinacea
ANS: A
St. John’s wort may cause photosensitivity.
DIF: Comprehension
17. A patient states, “My cancer is in remission finally after all that chemotherapy, my friend used
the same chemotherapy and wasn’t so lucky. I want to continue participating in spiritual care
and ‘mind games’ to keep my memory intact. I am also enrolled in Tai chi, but I just can’t
stop thinking about my sick lung.” This patient adheres to which principle underlying
alternative healing?
a. A negative alteration in the body produces a parallel effect on the mind and spirit.
b. The body can heal itself with the help of complementary alternative therapies.
c. Approaches to therapy are individualized.
d. There is a focus on the total lifestyle.
ANS: A
Health and healing are related to a harmony of mind, body, and spirit.
DIF: Comprehension
18. During an admission history and physical, a female patient states, “I use 5000 mg/day of
calcium to prevent osteoporosis and to maintain health.” The nurse should assess for what
possible side effect?
a. Excessive bleeding
b. Kidney stones
c. Lower blood sugar
d. Jaundice
ANS: B
Excessive calcium places individuals at risk for renal stone.
DIF: Comprehension
NURSINGTB.COM
19. A patient who is pregnant has used the herb feverfew for a history of migraine headaches. The
nurse should provide teaching related to a risk for what side effect?
a. Uterine contractions resulting in possible miscarriage
b. Reduced fetal growth
c. Insomnia
d. Tiredness the following day
ANS: A
Feverfew has the potential to cause the uterus to contact, increasing the risk for miscarriage or
premature delivery.
DIF: Comprehension
20. A patient who is just beginning to use homeopathy to treat depression is concerned because
symptoms are becoming worse with increasing sadness, anxiety, and fatigue. The practitioner
of homeopathy bases teaching on the Law of Cure and provides what instructions to the
patient?
a. Discontinue the therapy and seek another alternative therapy.
b. Concentrate the preparation to increase its potency in hopes to improve depressive
symptoms.
c. Increase the dosage of the substance to increase its effectiveness.
d. Remain on the current regimen since worsening is a positive sign that healing is
occurring.
ANS: D
The Law of Cure states a worsening of symptoms after a remedy is given is considered a
positive sign that healing is taking place. The therapy is therapeutic and should be considered.
DIF: Comprehension
21. A patient has fallen at home and complains that joints are very painful when trying to climb
stairs. The patient desires to use an alternative complementary medicine rather than pain
medication. The practitioner begins treatment with touch consisting of rocking, rhythmical
motions to loosen tense, sore muscles and joints. The patient is receiving which type of
treatment?
a. Swedish massage
b. Rolfing
c. Trager approach
d. Reflexology
ANS: C
Trager approach uses gentle, rhythmic rocking and touch to promote relaxation and energy
flow. Swedish massage is the most prevalent form of massage that uses long strokes, friction,
and kneading of muscles. Rolfing uses manual manipulation and stretching of body’s fascial
tissues to establish balance and symmetry. Reflexology is associated with the application of
pressure to pressure points on the hands and feet that correspond to various parts of the body.
DIF: Comprehension
MULTIPLE RESPONSE
1. NURSINGTB.COM
Why is the various forms of complementary alternative medicine (CAM) gaining popularity
in Western society? (Select all that apply.)
a. Consumers want knowledgeable, trained physicians to control their care.
b. CAM consumers want personalized health care.
c. Quantity, rather than quality, of life is most important in Western society.
d. Consumers have access to evidence that support CAMs.
e. Consumers want to remain indifferent to the health care provider.
ANS: B, D
Consumers are taking greater responsibility for their own health, which is based on personal
preference, and many alternative natural therapies provide evidence of their own efficacy.
DIF: Comprehension
2. A patient regularly experiences migraine headaches that are not relieved by traditional
Western medical practices. Why does the family physician suggest acupuncture? (Select all
that apply.)
a. It is based on the belief that meridians are vital for life, and when they are out of
balance, pain occurs.
b. It uses strategically placed, slender needles for pain relief.
c. It uses breathing exercises and meditation to relieve pain.
d. It corrects metabolic imbalance through purification regimens.
e. It determines distinct metabolic body types.
ANS: A, B
Acupuncture is based on the belief that invisible channels are present throughout the body
through which energy flows; these are called meridians. This energy, qi, is considered the
vital life force, and illness and symptoms occur when the flow of energy becomes blocked or
unbalanced. Health is restored when the energy is unblocked; this is achieved by stimulating
acupuncture points on affected meridian(s). Tiny needles are placed on the meridians that are
affected and are causing pain.
DIF: Comprehension
3. A patient who is interested in herbal medicine attends a seminar to learn more about
complementary alternative medicine (CAM). The nurse discusses what common belief related
to all CAMs? (Select all that apply.)
a. The body is not able to repair itself; thus, natural remedies are used to inhibit the
immune system.
b. Many different CAMs that focus on specific body parts and the mind are needed.
c. The focus of CAM is on an intervention for the diseased body part.
d. Each CAM treatment is unique to the person who is being treated.
e. Health promotion is incorporated into CAM.
ANS: D, E
Healing is individualized, and the uniqueness of each person is considered. Standing protocols
that are used to treat everyone with similar conditions in a similar way are not found in CAM.
Health promotion and positive health habits are incorporated into CAM.
DIF: Comprehension
4. A nurse investigates energy tN

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a. Qi gong
b. Osteopathy
c. Imagery
d. Healing touch
e. Magnet therapy
ANS: A, D, E
Energy therapies include Qi gong, Reiki, healing touch, healing (therapeutic) touch, and
magnet therapy.
DIF: Knowledge
Chapter 12: Palliative Care

Edition
MULTIPLE CHOICE
1. According to the Palliative Performance Scale which patient is considered to possess 70% of
normal function?
a. 40 year old diagnosed with AIDS whose condition makes it impossible to hold a
job.
b. 70 year old diagnosed with end stage renal failure who spends most of the day in
bed.
c. 50 year old diagnosed with emphysema whose disease has begun to impact normal
ambulate.
d. 30 year old diagnosed with muscular dystrophy who is bed bound.
ANS: A
70% function implies that the patient has a reduction in ambulation and the disease process
affect ability to hold a job.
DIF: Application
2. The Karnofsky prognostication scale is most appropriately used to screen patients with which
medical diagnoses?
a. Respiratory diseases
b. Cancers
c. Cardiac diseases
NURSINGTB.COM
d. AIDS
ANS: B
The Karnofsky scale is more appropriate for the patient with a cancer diagnosis.
DIF: Comprehension
3. A peaceful death is best characterized by which terminally ill patient?

a. One who is surrounded by family
b. One who uses meditation to help manage pain
c. One who has advanced directives in place
d. One who has drifted from lethargy to coma
ANS: D
A peaceful death is generally described as being peaceful and comfortable with the patient
drifting though the various stages of alertness to finally being comatose.
DIF: Application
4. Which patient’s decision-making capacity should be a concern for the palliative care nurse?
a. The one who asks, “Why do I need palliative care?”
b. The patient with a diagnosis of moderate Alzheimer’s disease
c. The one whose family is used to being consult about decisions affecting the patient
d. The patient who has expressed concerns about “all the decisions I have to make”
ANS: B
Decision-making capacity focuses on one’s ability to make decisions about their health care.
They must be able to understand the facts, appreciate the alternatives that may exist, and to
communicate these decisions to the health care team. Moderate Alzheimer’s disease is likely
to have an affect the patient’s cognitive ability.
DIF: Analysis
5. What is the primary factor that characterizes a patient receiving palliative care?
a. A diagnosis of a serious, life-threatening disease
b. Ability to make sound health care decisions
c. An interest in exploring available life-sustaining treatment options
d. A life expectancy of less than 12 months
ANS: C
Palliative care is appropriate for the patient diagnosed with a life-threatening disorder who
wishes to take advantage of any life-sustaining treatments available.
DIF: Application
6. As a patient’s condition moves toward their impending death, which nursing intervention
demonstrates how the focus of palliative care changes?
a. The patient is encouraged to discuss their spiritual needs.
b. The patient is educated concerning the physical changes associated with the dying
process.
c. The patient’s advance carNe plR
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d. The patient’s comfort needs are identified.
ANS: D
The palliative care continuum model begins comfort care at the time of diagnosis when
therapies are aggressive but as the disease progresses toward death comfort care increases.
DIF: Application
7. When first diagnosed with Parkinson disease, how can the patient and family best avoid future
ethical dilemmas concerning the patient’s care?
a. Work with the patient and family to create an advanced plan of care.
b. Explain to the family that the patient’s cognitive function will deteriorate as time
passes.
c. Discuss the patient’s religious and spiritual concerns to identify potential
problems.
d. Identify which family members will be in control of decision making for the
patient.
ANS: A
Advance care planning is a process for eliciting a patient’s values and preferences concerning
current and future health care decisions. This plan is used to establish a patient’s goals of care
during serious illness. Having such a plan in place will help minimize ethical issues regarding
how care will be determined and delivered.
DIF: Application
8. What is the initial step when addressing an ethically challenging situation?

a. Identify all those who are involved in the situation.
b. Review the overall situation to identify the core issues.
c. Gather all the relevant facts about the situations.
d. Determine what the ethical dilemma is.
ANS: B
Reviewing the overall situation to identify what is going on in this situation is the initial step
in addressing an ethically challenging situation.
DIF: Application
9. Which statement correctly applies to a person’s personal suffering?

a. Pain is the cause of suffering.
b. Suffering and pain are experienced separately.
c. Suffering can exist without the experience of pain.
d. Pain is the focus of all nursing assessments.
ANS: C
Suffering is the experience of a person while pain and other symptoms are the result of
physical body or organ changes. Suffering and pain can coexist together, although one can be
present without the other.
DIF: Comprehension
10. When working with the famiN

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ivinM
intervention? U S N T
a. Determining who will be the patient’s durable power of attorney
b. Identifying what types of help the family will need to care for the patient
c. Completely an assessment of the family’s strengths and weaknesses
d. Discuss the dynamics of the family with the patient
ANS: C
Any strategy to meet the needs of a patient’s family begins with a comprehensive family
assessment including an assessment of family strengths and weaknesses.
DIF: Analysis
11. A daughter tells the nurse that, “Mom will be as good as new when we get this advanced
cancer cured.” How can the nurse best help the daughter in the role of caregiver?
a. Working toward setting realistic goals for both her mother and herself
b. Finding the daughter in home help to assist with her mother’s care
c. Discuss with the patient the role her daughter will play in her care
d. Encourage the daughter to regularly share her feelings with her mother
ANS: A
The setting of realistic goals is vital to the physical and emotional well-being of the caregiver.
DIF: Application
12. The principle of autonomy is best supported by what intervention made available to palliative
care patients?
a. Arranging for in-home health care
b. Addressing the patient’s specific pain management needs
c. Helping the patient decide on the details of their advanced plan of care
d. Conducting a thorough performance status screening on the patient
ANS: C
Advance directives, if present, can speak for the patient and their wishes thus assuring their
autonomy in making the end of life decisions they are in agreement with.
DIF: Application
MULTIPLE RESPONSE
1. Which statements are true regarding palliative care services? (Select all that apply.)
a. Begins at the time of that a diagnosis of a serious illness occurs
b. Care can be delivered in most settings.
c. Expenses are paid for by Medicare.
d. Is appropriate for all patients regardless of age.
e. Providers are skilled in symptom management.
ANS: A, B, D, E
Palliative care does begin with a diagnosis of a serious illness and can be delivered in a wide
variety of care settings. The care is appropriate and available to patients of any age and is
provided by skilled professionals.
COMPLETION
1. occurs when a physician predicts the course and outcome of a disease

process.
ANS:
Prognostication
Prognostication occurs when a physician creates a prediction about the course and outcome of
a disease, often made with consideration of survival, symptoms, function, and quality of life
with or without treatment.
DIF: Comprehension
Chapter 13: Workforce Advocacy for a Professional Nursing Practice Environment

Edition
MULTIPLE CHOICE
1. What should the RN do when asked to accept a patient assignment that he or she may feel
unqualified to manage?
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 patient assignments, then modification of the assignments is in order
to ensure patient safety.
DIF: Application
2. What workplace factor has been found to contribute to the nursing shortage?
a. Movement of nurses into acute care settings
b. The use of unlicensed assistive personnel to replace RNs
c. A severe lack of males who have chosen nursing as a career
d. An aging nursing workfoNrce R I G B.C M
U S N T O
ANS: D
Research validates that an aging population and an aging nursing workforce are significant
contributors to the nursing shortage issue.
DIF: Comprehension
3. In the last years what have studies conducted to determine enrollment trends in nursing
schools found related to the predicted nursing shortage?
a. A greater number of individuals chose nursing as a career but could not meet
entrance requirements.
b. More young people chose to enter the profession of nursing.
c. Fewer career opportunities exist in the profession of nursing and fewer
opportunities are projected to exist for women.
d. Men have dominated the profession, and women feel that they have experienced
discrimination.
ANS: B
An unexpected number of young people entered the nursing workforce from 2002 to 2009,
causing faster growth in the supply than anticipated.
DIF: Comprehension
4. What factor has attributed to a situation where qualified nursing school applicants have
continued to be turned away, limiting enrollment due to a shortage of faculty?
a. Nursing faculties are subject to high levels of burnout and job dissatisfaction.
b. Only the number of faculty in Associate Degree programs remains stable.
c. The mean age of nursing faculty continues to decrease and older faculty mentors
have left the profession.
d. Increasing job competition from higher paying clinical sites, even as the economy
recovers
ANS: D
Academic institutions, especially those faced with budget cuts, generally cannot compete with
nonacademic employers. Faculty salaries continue to be a major contributor to the nursing
shortage.
DIF: Comprehension
5. What is the key to organizational success for health care facilities?

a. Recruiting younger, more energetic nurses
b. Offering incentives such as sign-on bonuses
c. Hiring highly qualified advanced practice nurses
d. Making effect to retaining practicing 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. NURSINGTB.COM
DIF: Comprehension
6. A new graduate nurse is applying for the exciting first position and states, “I am only applying
to Magnet hospitals because those work environments:
a. attract physicians who are the best health care providers to improve quality of
care.”
b. require all registered nurses to be certified in practice.”
c. not only attract but also retain professional nurses.”
d. discourage nurses from advancing their current level of education and I don’t want
to return to school for many years.”
ANS: C
Magnet hospitals have been identified as both attracting and retaining professional nurses.
Magnet hospital nurses have higher levels of autonomy, greater control over the practice
setting, and better relationships with physicians.
DIF: Comprehension
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
all day on weekends, preventing changing of the container when needed and places
nurses at risk for needlesticks.
ANS: D
A safe work environment is imperative for the safety of both nurses and patients. Correcting
this work environment issue promotes job satisfaction and good patient outcomes.
DIF: Analysis
8. A newly hired nurse is asked to serve on a committee formed to recruit and retain nurses.
What information is the nurse likely to learn at the committee meeting?
a. Older nurses are being encouraged to retire so that younger, more efficient nurses
can practice.
b. Magnet hospitals can 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
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those of previous generations. This younger generation prefers to work in an outcomes-based
environment, where pay is based on achievement or merit, not on longevity.
DIF: Application
9. Hospitals surveyed nurses who terminated their employment to determine why they chose to
leave. What is one of the most common reasons nurses are leaving hospital practice?
a. Decreased pay for alternative shifts
b. Nurse/patient ratio prevents safe care.
c. Facilities are choosing an all-RN staff, which decreases opportunities for
advancement.
d. 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 reported higher rates of patient complications and increased death rates
when fewer nurses are assigned per patient.
DIF: Comprehension
10. In determining whether this staffing concern should be reported to an outside agency, the
nurse understands that what statement is true concerning the process identified as
“whistle-blowing”?
a. Reporting unsafe staffing levels to The Joint Commission provides protection from
the employer.
b. Keeping copies of documented inappropriate staffing patterns in the nurse’s
personal file is illegal.
c. When observing inappropriate staffing, the nurse should record his/her personal
thoughts concerning the outcomes.
d. One should seek guidance from a trusted individual who can provide an objective
point of view.
ANS: D
One of the many guidelines regarding whistle-blowing specifies that one should seek counsel
from a trusted individual outside the situation to gain an objective perspective.
DIF: Analysis
11. The occupational health and safety nurse would like to develop programs designed to decrease
mortality and morbidity among the workforce. When considering factors related to mortality
among health care workers, the nurse should focus efforts on prevention of what most likely
outcome?
a. Suicide
b. Violence-related injury
c. Bloodborne disease
d. Ergonomic hazards
ANS: B NURSINGTB.COM
A summary of research by the National Institute for Occupational Safety and Health found
that health care workers have almost five times the risk of experiencing a violence-related
workplace injury requiring time off from work than individuals in the overall workforce.
DIF: Application
12. According to the Needlestick Safety and Prevention Act which statement is true concerning
needle safety?
a. Employers often ask nurses in managerial positions to evaluate safe needle
devices.
b. Registered nurses who sustain a needle stick are required to pass a test before
resuming medication administration.
c. Individual states must determine the type of safe needle devices to be used.
d. Employers are required to document how and where a sharps injury occurred,
including the brand of device that was involved.
ANS: D
The Needlestick Safety and Prevention Act, passed at the federal level, requires the use of
safer needle devices to protect from sharps injuries; the law requires employers to maintain a
sharps injury log that contains, at a minimum, the brand of device involved in the incident, the
department or work area where the exposure incident occurred, and an explanation of how the
incident occurred.
DIF: Comprehension
13. A nurse is concerned because novice nurses are having their orientation period shortened and
are being placed in charge nurse positions. The nurse has documented unsafe care and
decisions by these novice nurses. To be protected from retaliation by the employer, this nurse
must “blow the whistle” by doing what?
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 whistleblower is not protected until concerns are reported to the state or national
regulatory agency.
DIF: Comprehension
14. A nurse is concerned about a trend in the hospital to regularly “float” nurses to different areas
of the hospital based on staff shortage regardless of recent experience in caring for the
population on the unit. When deciding to accept a staffing assignment in this situation, the
nurse considers a “safe harbor.” What is meant by “safe harbor”?
a. In an emergency, nurses may move patients to one location designated to be areas
safe from natural disasters or acts of terrorism.
b. Nurses work in teams to care for patients who have no communicable disease and
do not pose a safety issue due to infection.
c. Horizontal violence is not tolerated and nurses report any form of violence to
administration. NURSINGTB.COM
d. It is written a notice about recurrent staffing issues that allows nurses to continue
to care for patients placed in their care but protects their nurse’s license while an
investigation is conducted.
ANS: D
Safe harbor does not mean a nurse can refuse an assignment unless it would violate the nurse
practice act, but it does provide an avenue for nurses to report unsafe staffing by filing a
written report that is investigated by administration.
DIF: Application
15. What information was provided by the Institute of Medicine report?

a. A recommendation that only physicians have the legal privilege to prescribe
medications
b. A call for increasing the number of baccalaureate-prepared nurses in the workforce
to 80% by 2020
c. A recommendation that the minimum staffing ratio be in place in no later than 10
years
d. A call for nurse technicians to provide care during the nursing shortage
ANS: B
The IOM report (2011) addresses the evolving complexities of the current health care system
and a need for 80% of the nursing workforce to be baccalaureate prepared by 2020.
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DIF: Comprehension
16. What is the priority intervention to improve work-related quality of life for nurses?
a. Providing safe harbors for unjust or unsafe work assignments
b. Improving nurse physician communications
c. Requiring professional development courses for bedside nurses
d. Improving working relationships between staff nurses and nursing administration
ANS: D
RNs ranked their relationships with administration and management the lowest in the
workplace.
DIF: Application
17. Nurses entering the workforce at a large urban hospital soon began volunteering for excessive
overtime. A focus group found that upon graduation, many of these nurses purchased
expensive cars and furniture. They lacked skills in managing their checkbook and were often
unable to pay recurring bills; this finding would be relevant to which component of the
Workforce Advocacy Ecosystem Model?
a. Staffing
b. Workflow design
c. Organizational factors
d. Personal and social factors
ANS: D
Personal and social factors include stress, job satisfaction, and professionalism and financial
literacy.
NURSINGTB.COM
DIF: Comprehension
18. An acute care facility values job satisfaction among its registered nurses by implementing a
shared governance model. Which element is a fundamental characteristic of this model?
a. Administration has an open-door policy
b. Established dispute resolution process
c. Implementation of mandatory reporting
d. Nurses have an active role in patient care decision making
ANS: D
The importance of shared governance is that such models provide an organizational
framework for nurses in direct care to become committed to nursing practice within their
organizations. The implementation of such models allows nurses to have an active role in
decision making by providing maximal participation and accountability for the outcomes of
those decisions.
DIF: Application
19. When reading about nursing as a career, a student is interested in learning about violence in
the profession. Which statement accurately reflects violence in health care and the profession
of nursing?
a. Nursing is the most trusted profession and therefore violence is rare.
b. All nurses should be advocates for violence prevention programs.
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c. Physical violence between peers constitutes lateral violence; however, verbal

assault is not recognized as violence.
d. Professional organizations have recognized a need to evaluate all nurses for the
risk of committing acts of violence.
ANS: B
Nurses in all settings must proactively advocate for interventions that ensure personal safety
and a safe work environment.
DIF: Comprehension
MULTIPLE RESPONSE
1. Managers at an acute care facility value the contributions of their aging nursing workforce and
make recommendations to accommodate for an aging nursing workforce. They institute for
which changes? (Select all that apply.)
a. Supplies such as dressing change and Foley catheter kits are placed on the nursing
unit.
b. Teamwork and development of new roles such as admission nurse are encouraged.
c. Daycare centers for sick children are put into place to prevent the stress of having
to find alternative daycare.
d. Assistive devices for lifting as recommended by ANA’s Handle with Care are
made available.
e. A work-design consultant is hired to redesign the nursing unit to reduce wasted
motion.
ANS: A, B, D, E NURSINGTB.COM
Placing supplies in a decentralized area prevents the fatigue that would be caused by the need
to retrieve items from a distant location. Nurses are integral to quality and their contributions
should be noticed. Ill-designed units contribute to fatigue and inability of aging nurses to
perform efficiently. Mentoring is one way to acknowledge skills of the aging workforce.
DIF: Application
2. A nurse is interviewing for a job and recently read the American Nurses Association’s (ANA)
recommendation for questions to ask regarding before accepting employment. Which
questions should the nurse ask? (Select all that apply.)
a. Do you have flexible scheduling?
b. What are the expectations for advancement?
c. How long do staff nurses stay before resigning?
d. What is the mission of the parent organization?
e. Does the organization have a means for staff nurses to have an active role in
decision making by participation and accountability for the outcomes of practice
decisions?
ANS: B, C, E
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According to the ANA recommendations, applicants for nursing positions should ask about
the opportunities for advancement exist in the organization. According to the ANA
recommendations, applicants for nursing positions should ask about the organization’s
turnover rate and average longevity of staff nurses. According to the ANA recommendations,
applicants for nursing positions should ask about whether the organization has a shared
governance model.
DIF: Application
COMPLETION
1. Nurses who are expected to work overtime as dictated by their employer are being subjected
to a hazard in the workplace.
ANS:
psychological
Hazards in the workplace are categorized as follows: biologic, ergonomic, chemical, physical,
and psychological. Included in psychological hazards are issues such as stress, shift work,
mandatory overtime, and verbal abuse by patients and other health care providers.
DIF: Comprehension
NURSINGTB.COM

Chapter 14: Collective Bargaining and Unions in Today’s Workplace

Edition
MULTIPLE CHOICE
1. Nurses in a unionized hospital are paid “compensatory pay” when working holidays equal to
the number of hours worked with no extra compensation. Although they have suggested
changes during the annual survey of employee satisfaction, management refuses to consider
another system for compensatory pay. A trained member listened to both nurses and
management to make recommendations that were not legally binding. This type of settlement
is referred to by what term?
a. Collective bargaining
b. Binding arbitration
c. Mediation
d. Grievance
ANS: C
Mediation enlists the help of a trained person to listen to both sides; however,
recommendations are not legally binding. Collective bargaining is a process whereby workers
organize under the representation of a union in order to share a degree of power with
management to determine selected aspects of the conditions of employment. Binding
arbitration means that all parties must obey the arbitrator’s recommendations. Grievance is a
term associated with a negative workplace event that results in an allegation by an employee
that he or she has not been treated fairly and equitably.
NURSINGTB.COM
DIF: Comprehension
2. A nurse has been asked to serve as the charge nurse on the evening shift. The agency where
the nurse is employed is considering unionization. If the nurse accepts the role, what affect
will unionization have on the nurse’s new position?
a. The nurse can be represented by the union because charge nurses are not
considered part of the management team.
b. Charge nurse is part of the management team, so union participation would be a
conflict of interest.
c. The nurse can file a grievance that will be arbitrated automatically by the union.
d. The nurse is ineligible for collective bargaining activities that deal with unfair
labor practices.
ANS: A
Serving as charge nurse is part of a nurse’s professional role and not a management function.
DIF: Comprehension
3. A nurse has heard rumors that other nurses are interested in unionizing but knows little about
the purpose of unions. What should be the nurse’s first action?
a. Contact an arbitrator who has worked with other nurses in unions.
b. Question the agency where employed to gain inside information as to why
unionization is sought.
c. Sign the dual-purpose union authorization card.

d. Review the National Nurses United website for collective bargaining information.
ANS: D
The National Nurses United website gives information about collective bargaining for nurses.
None of the other options are as likely to provide unbiased information on the topic.
DIF: Application
4. Nurses in a nonprofit hospital have expressed an interest in forming a union to secure fair
wages and ensure client safety. To form a core support group of nurses, where should the
union organizer conduct meetings to gather initial information?
a. Away from the worksite with a group of managers to learn both sides of the
situation
b. At the worksite with staff nurses who are respected leaders
c. In homes or local businesses with staff nurses
d. At the facility to discuss nursing concerns
ANS: C
The union representative meets with laborers (staff nurses) at a nonwork setting to gather
information about grievances.
DIF: Application
5. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction
and a sentinel event. Management is unwilling to discuss a change in staffing, and collective
bargaining interest is sparked. A nurse is approached to sign a union authorization card. What
is the purpose of a signed union authorization card?
a. It authorizes the union toNservRe aI
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T he.rClegaMl representative.
b. It indicates that the person is requesting additional information about collective
bargaining.
c. It indicates the nurse desires to share information about grievances.
d. It gives permission for union dues to be deducted from pay.
ANS: A
A signature on a union authorization card indicates that the nurse gives the union the right to
serve as legal representation.
DIF: Comprehension
6. A group of RNs wish to seek union representation that would protect all workers in the
agency including non-licensed assistive personnel and non-nursing employees such as
nutritionists and dietary workers. The type of union being sought is the strongest collective
group and is known by what term?
a. An occupational union
b. An industrial unionism
c. A union shop
d. A right-to-work bargaining organization
ANS: B

An industrial union is a single union for all workers in the agency. Occupational unionism is a
type of union in which each occupation within a given company has separate unions. Union
shop refers to a worksite that requires all new employees in a specific work group to join the
union. A nurse in a right-to-work state can choose not to become a union member yet receive
the benefits resulting from the union contract.
DIF: Comprehension
7. Physical therapists are represented by a union, nurses are represented by a separate union, and
pharmacists have yet another union within a single agency. This type of union representation
is known by what term?
a. Occupational unionism
b. Industrial unionisms
c. Union shop
d. Power sharing
ANS: A
Occupational unionism indicates separate unions for each occupation in an agency.
DIF: Comprehension
8. Historically, what movement most influenced unionization in American health care

agencies/hospitals?
a. Immigration laws protected foreign employees from discrimination in hiring or
discharge based on national origin and citizenship status.
b. Women entered the workforce, gaining voice to support unions.
c. The Industrial Revolution led to poor working conditions and the need to protect
workers. NURSING TB.COM
d. Nurses were exposed to communicable diseases, which led to death and disability.
ANS: C
The Industrial Revolution led to people working in factories where poor and unsafe working
conditions were widespread.
DIF: Comprehension
9. In recent Gallop Polls, nurses were voted as the most honest with the highest ethical standards
of all professions. How does this degree of professionalism affect nurses’ desire to participate
in organized strikes?
a. Nurses most often turn to collective bargaining strategies such as strikes to
emphasize client safety initiatives.
b. Nurses use evidence-based studies that reflect both management and labor views to
support participation in unionization.
c. Nurses often find union activities such as strikes in conflict with the need to serve
and protect clients and their profession.
d. Nurses who strike can be legally punished for abandonment and negligence,
considered to be professional misconduct.
ANS: C
Nurses are client advocates and promotion of professionalism is valued as evidenced by the
public’s opinion related to honesty and professionalism.

DIF: Application
10. A novice nurse asks about the difference between mediation and binding arbitration. The
response should be based on which statement?
a. Mediation is sanctioned by the National Labor Relations Board (NLRB) to
formally discuss concerns with management and labor.
b. Binding arbitration is a formal discussion between labor and management in
which the arbitrator’s recommendations are compulsory.
c. Mediation uses a trained person to negotiate a legally binding plan.
d. Binding arbitration requires both labor and management to participate in
discussions on the least destructive approach to allow self-governance by
employees.
ANS: B
Binding arbitration requires that both parties meet in formal talks, and all parties must obey
the arbitrator’s recommendations.
DIF: Comprehension
11. A large corporation employs nurses all over the United States. Nurses in one agency learned
that fellow nurses in another agency are striking because they are required to work 16-hour
shifts to cover for nurses who have left due to unsafe staffing practices. The union of the
non-striking agency nurses decides to stop work to support the nurses who are striking. Which
statement describes this action?
a. It is placing nurses at risk for a lawsuit because their direct employer did not cause
the strike. N R I G B.C M
b. The union in question mustUbe S an iN
nduT
stry uniO
on representing both parties.
c. The nurses are participating in a sympathy strike, which, if done correctly, is legal.
d. The striking nurses must pay for any losses incurred by the agency during the
strike.
ANS: C
A sympathy strike occurs when a union stops work to support the strike of another union.
None of the other options accurately describe the presented situation.
DIF: Comprehension
12. Which organization is the largest union in the United States representing registered nurses?
a. American Nurses Association
b. United American Nurses
c. National Nurses United
d. National Labor Relations Board
ANS: C
In 2009, the National Nurses United became the largest union representing nurses as a result
of a merger between the United American Nurses, California Nurses Association, National
Nurses Organizing Committee, and Massachusetts Nurses Association.
DIF: Comprehension

13. A nurse is interested in working in a large trauma center that is unionized but does not want to
join the union or pay fees. The nurse is not required to join or pay fees to the union based on
which law?
a. National Labor Relations Act
b. Right-to-work law
c. National Labor Relations Act
d. Taft-Hartley Act
ANS: B
The right-to-work law prohibits membership or payment of union dues or “fees” a condition
of employment, either before or after hiring.
DIF: Comprehension
14. A group of nurses are assembling outside a hospital protesting the use of foreign nurses after
several nurses were terminated due to what the hospital called recurring “decreased census.”
The nurses carry signs with messages asking potential patients to seek care elsewhere. The
local newspaper picked up the story, and the hospital is receiving negative press. The nurses
are participating in what action?
a. Picketing
b. Collective bargaining
c. Striking
d. Arbitration
ANS: A
Picketing is a form of protest in which people (called picketers) congregate outside a place of
work or location where an event is taking place. Often this is done to dissuade others from
going in (“crossing the pickeN inR
t lU e”S),IbN
utGitTcB
an.aClsO
oMbe done to draw public attention to a
cause.
DIF: Comprehension
MULTIPLE RESPONSE
1. A hospital is seeking a 2.5% wage reduction for all nurses as part of a new balanced budget
plan; however, the plan provides for raises for upper-level management. This plan resulted in
a call for a union to protect the nurses. When the union representative arrives, what questions
should the nurses ask? (Select all that apply.)
a. Will the dues be used to support charity care when clients are unable to pay?
b. How effective has the union been in representing nurses’ best interest?
c. What percent of dues pays union personnel salaries?
d. Are dues used to promote research for terminally ill clients?
e. If arbitration is unsuccessful and a strike occurs, will nurses receive compensation
during the strike?
ANS: B, C, E
Laborers (staff nurses) want a union with a successful track record of improving wages and
benefits. Union dues are used to support union personnel, and the amount varies among
different union groups; the higher the percentage of money that goes to pay union personnel
salaries, the less money will be available to support members. Employers are not obligated to
pay laborers during a strike, and unions may choose to pay employees while striking.

DIF: Application
2. During the pre-election phase for unionization, which actions by union representatives are
prohibited by the National Labor Relations Board? (Select all that apply.)
a. Scheduling a meeting in the agency’s cafeteria to determine employees’ interest in
unionization
b. Distributing nondocumented information that female nurses receive lower annual
performance evaluations than do male nurses
c. Distributing information about the benefits of unionization and grievances in a
public parking garage located across from the hospital
d. Suggesting to workers the likelihood of job loss should the union not win the
election
e. Signing authorization cards for employees who are on leave
ANS: A, B, D, E
Union representatives must meet in nonwork areas. Union representatives must not spread
rumors of prejudices. Neither the union nor employers can spread falsehood about potential
job loss or repercussion in the event of unionization. Union representatives cannot sign cards
for employees.
DIF: Application
3. It is important to realize that nurses may seek unionization if what situation occurred? (Select
all that apply.)
a. Physicians rotate on-call coverage among group members for complicated
long-term clients. N R I G B.C M
b. Adequate staffing is providU ed oSn hN
olidT
ays by O
rotation of time off for holidays
among nurses.
c. Incident report trends indicate medication errors are caused by shift reports being
taped and heard after nurses from the prior shift have left the unit.
d. Physicians, nurses, nutritionists, and physical therapists visit concurrently with
clients to plan care.
e. Staff development activities are planned daily at 8 AM for two consecutive days to
educate staff on new cardiac monitoring procedures while following normal
staffing patterns.
ANS: C, E
Policies where shift reports are taped and heard after a prior shift has left have proved to lead
to errors and unsafe care. Staff development activities should be scheduled to allow nurses to
attend, and normal staffing patterns or time of training must coincide with nurses’ availability
and ability to listen to and retain information (such as at the beginning or end of the shift
while others provide coverage).
DIF: Comprehension
4. Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction
and a sentinel event. Management is unwilling to discuss a change in staffing, and collective
bargaining interest is sparked. During the pre-election period, what actions by management
are prohibited? (Select all that apply.)
a. Seek individuals to spy on coworkers who are possible union supporters.

b. Photograph employees participating in information sessions about unionization.

c. Visit managers outside work to gain their perception of popularity of unionization.
d. Threaten that, should the union win, the company will relocate when there is no
intention to relocate.
e. Require employees to declare their position on unionization prior to pick up
paychecks.
ANS: A, B, D, E
During the pre-election period, management may not solicit spying. During the pre-election
period, management may not photograph employees engaged in union activities. During the
pre-election period, management may not lie about what will happen if the union is the victor
in an election. During the pre-election period, management may not question employees about
their preferences regarding union activity.
DIF: Comprehension
NURSINGTB.COM

Chapter 15: Information Technology in the Clinical Setting

Edition
MULTIPLE CHOICE
1. Consumers are concerned with security issues related to their confidential health information
being placed in an electronic health record (EHR). However, when the security of the EHR is
compared with that of paper-and-pencil records, the EHR has been proven to be what?
a. More secure
b. Less secure
c. Equivalent
d. Not comparable
ANS: A
Computer-based patient record systems, such as EHRs, provide better protection than
paper-based systems. The EHR allows only authorized users to view data, and access to
records can be audited for inappropriate use.
DIF: Comprehension
2. During a search for the term informatics, what should the nurse determine about the site’s
affiliation when the domain “.edu,” is noted?
a. It’s a government agency.
b. It’s a commercial site.
c. It’s an educational instituN
tionR. I G B.C M
d. It’s an internet service provUideS
r. N T O
ANS: C
The domain of an educational institution is .edu.
DIF: Knowledge
3. What statement accurately describes findings when paper-and-pencil medical records are
compared with computer-based records?
a. Paper-and-pencil records provide controls to determine who has viewed the health
information.
b. Information contained in a paper-and-pencil record has the capability of being
more in-depth than that found in computer-based records.
c. Patients have the right to know that the confidentiality of their records is strictly
maintained, regardless of the type of medical record used.
d. Patients must sign for each item of information released on the computer record.
ANS: C
Regardless of the type of record used, the Health Insurance Portability and Accountability Act
(HIPAA) protects the confidentiality of the patient’s medical information and imposes legal
consequences for those who breech confidentiality.
DIF: Comprehension

4. A nurse is preparing a scholarly publication on the worldwide prevalence of hepatitis A. The

most efficient and effective means of conducting an Internet search to gather information for
this publication is to use what resource?
a. A search engine such as Google or Yahoo
b. A consumer health website
c. A decision support system
d. MEDLINE database
ANS: D
MEDLINE is one of the scientific and research scholarly databases, and it would be the most
appropriate for use in gathering information for a scholarly publication.
DIF: Comprehension
5. A consumer is learning about electronic health records at a local health fair and states, “I am
worried that someone can read my health information and I really don’t understand the
difference between privacy and confidentiality.” The nurse provides what as an example of
confidentiality?
a. A pledge that states, “I will hold matters pertaining to my patients in strict
intimacy”
b. A patient who does not tell the primary health care provider that he or she has been
treated for a sexually transmitted disease
c. A teenager who sustains a broken arm and in the emergency department and
withholds information about personal use of recreational drugs
d. Locking medical records in cabinets to prevent unauthorized users from accessing
patient information
Confidentiality is keeping private the personal information that was given to a health care
provider, unless others have a legitimate need to know.
DIF: Application
6. A primary health care provider has installed a computer-based patient records system. An
outside care provider who requests medical information must obtain the patient’s signed
consent and then is assigned a password to gain access to the medical information. A monthly
audit is conducted to determine for whom and for what purpose patient records have been
accessed. What term is used to refer to this type of protection?
a. Privacy
b. Confidentiality
c. Security
d. Data capture
ANS: C
Security is the limitation of access to health care information through passwords and other
precautions.
DIF: Comprehension

7. A nurse walks up to a computer in the hallway and presses the index finger to the sensor,
thereby gaining access to patient data. A few moments later another nurse performs the same
steps and is granted access. A visitor who is watching from a room walks over and places the
index finger on the sensor, only to receive an “error and access denied” message. This security
feature is a result of what form of technology?
a. Robotics
b. Biometric
c. Telehealth
d. Ubiquitous computing
ANS: B
Biometric fingerprint identification uses personal characteristics to allow access to health
information.
DIF: Comprehension
8. A nurse who is teaching a class to introduce telehealth to the staff would include which
example?
a. A robot performs menial housekeeping chores for an invalid patient.
b. A computer software program alerts the nurse or physician who is reviewing
orders that an order for a new drug can cause synergy of the theophylline inhaler.
c. A physician speaks into a computer, and the admission history is recorded and
saved in the patient file.
d. While a patient in Wyoming performs peritoneal dialysis, a nurse watches
remotely from California to ensure that all steps are being followed correctly.
ANS: D
Telehealth is the delivery of N reRtoSaIpNaG
caU tieTnB.hCoOisMat a distance from the health care
tw
provider.
DIF: Application
9. An advanced practice nurse inputs into a computer software program the following clinical
manifestations: open wound with tibia exposed, petechial hemorrhage, and temporary loss of
consciousness. The computer diagnosis of fat emboli is generated by what information
associated system?
a. Decision support
b. Telehealth
c. Robotic technology
d. Biometric technology
ANS: A
Decision support systems are computer-based information systems that include
knowledge-based systems designed to support clinical decision making.
DIF: Comprehension
10. A nurse is preparing a presentation using different websites to collect information. The nurse
is concerned that contact information and the author’s credentials are not listed for one of the
websites reviewed. Which criterion required to establish a reputable website is missing?
a. Authority

b. Objectivity
c. Usability
d. Currency
ANS: A
Authority is the criterion that is related to the credentials and background that have prepared
an author to publish on the subject.
DIF: Comprehension
11. A nurse is interested in locating reliable information concerning noninvasive blood glucose
monitoring. Information is located, and the author is a scientist who conducted studies within
the last year on the effectiveness of a noninvasive blood glucose monitor. The scientist
received funding from a pharmaceutical company to support the studies. The URL indicates
the pharmaceutical company site .com. The nurse is concerned about what component
associated this information?
a. Authority
b. Objectivity
c. Accuracy
d. Currency
ANS: B
Sites sponsored by organizations such as pharmaceutical companies may influence the
content.
DIF: Comprehension
12. A nurse providing care at theNbedRsidI

e recGeivB
es.aC
n “aMlert” that a patient’s stat potassium level is
U S N T
2.5 and a dose of digoxin is scheduled. The nurse holds the medication and prevents a
possible complication. This feature of the Electronic Health Record is available through which
core function of EHR?
a. Order entry/order management
b. Decision support
c. Patient support
d. Administrative support
ANS: B
Decision support provides reminders about preventive practices, such as immunizations, drug
alerts for dosing and interactions, and clinical decision making.
DIF: Comprehension
13. A nurse works on a unit where electronic health records (EHR) are being initiated and asks,
“What is meant by ‘meaningful use’ standards that are in our education packet?” What
statement provides the best answer to the nurse’s question?
a. It identifies a set of EHR proficiencies and benchmarks that must meet assure the
process is functioning to maximum capacity.
b. It refers to training competencies that all users must achieve to be able to access
and transfer patient data/information.
c. It refers to a requirement that at least 50% plus one of all patients have data
entered into the EHR.

d. It meets the requirement that rigorous confidentiality security is in place to protect

all patient information from sources which have no right to the data.
ANS: A
Meaningful use is “A defined set of EHR capabilities and standards that EHR systems must
meet to ensure their full capacity is realized and for the users (hospitals and physician
practices) to qualify for financial incentives from Medicare.”
DIF: Application
14. A nurse is caring for a patient who is to receive an antibiotic drug that causes severe skin
damage when infiltrated. The order reads, “infuse over 1 hour by port-a-cath.” When the nurse
accesses the Personal Digital Assistant that lists the steps to access a port-a-cath, what type of
computer software is being used?
a. Electronic health records
b. Point-of-care technology
c. Data management
d. Telehealth
ANS: B
Using a Personal Digital Assist device to access information at the bedside is considered
point-of-care technology. The nurse could retrieve the steps for accessing a port-a-cath
electronically while remaining at the bedside.
DIF: Comprehension
15. The Institute of Medicine (IOM) (2003) recommends that electronic health records (EHR)
systems offer eight functionaN
litieR
s. AIpaG
tienB
T .Caddress
t has a sM
evere allergy to eggs and penicillin.
Which of the eight functions ofUtheSEHR N would O sharing this information?
a. Health information and data capture
b. Results/data management
c. Provider order entry management
d. Clinical decision support
ANS: A
The health information and data capture function includes information such as medical
history, laboratory tests, allergies, current medications, and consent forms.
DIF: Comprehension
16. A nurse interested in quality improvement tools performed a search for cause and effect
diagrams using www.ishikawa.com. A page opened that provided images and templates for
performing fishbone diagrams. Which type of search did the nurse conduct?
a. Quick and dirty
b. Advanced
c. Brute force
d. Link searching
ANS: C
Brute force is a method of searching where you type in what you think might logically be a
web address and see what happens.

DIF: Comprehension
MULTIPLE RESPONSE
1. A new nurse asks, “Since electronic medical records (EMR) can improve quality care by
having seamless data available for a patient, why doesn’t everyone just replace paper and
pencil charts”? What barriers to a universal health information infrastructure exist? (Select all
that apply.)
a. Competition from individual companies to build EMR prevents a universal
infrastructure.
b. Cost is prohibitive even with federal funding for larger health care systems.
c. Preventive health reminders for immunizations and yearly screenings such as
mammograms are used in clinical decision making.
d. Insurance companies have halted sharing of some patient data due to fear of law
suits.
e. The full capacity of EHRs has not been realized with only Stage 1 of 3 nearing
completion.
ANS: A, E
It has been recommended that only a federal-based EMR would provide an infrastructure that
allows access to comprehensive patient information. The first stage, years 2011 and 2012,
forms the foundation for electronic data capture and information sharing; stage two was
implemented in 2014 and stage three in 2017.
DIF: Comprehension
COMPLETION NURSINGTB.COM
1. Software programs that process data to produce or recommend valid choices are known as
.
ANS:
decision support systems
Decision support systems use software programs that process data to produce or recommend
decisions by linking with an electronic knowledge base.
DIF: Knowledge

Chapter 16: Emergency Preparedness and Response for Today’s World

Edition
MULTIPLE CHOICE
1. Nurses and community officials are working together to ensure that churches and schools
have needed supplies to provide shelter for large numbers of individuals in the event of a
natural or manmade disaster. These activities represent which phase of a disaster continuum?
a. Preparedness
b. Relief response
c. Recovery
d. Crisis intervention
ANS: A
Every disaster response begins as a local event known as the preparedness phase, which
consists of planning, preparedness, prevention, and warning.
DIF: Comprehension
2. A terrorist incident has occurred, resulting in a possible exposure to smallpox. What term
would be used to classify this incident?
a. Chemical
b. Biologic
c. Radiologic
d. Nuclear
NURSINGTB.COM
ANS: B
The biologic category refers to diseases such as plague or smallpox. Chemical is associated
with organic agents that spread through the air. Radiologic require the introduction of ionizing
radiation particles. Nuclear is associated with nuclear weapons.
DIF: Comprehension
3. The Metropolitan Medical Response System (MMRS) is accurately described by which

statement?
a. It is totally financed by the federal government national disaster fund.
b. It consists of responders who have obtained specialized training and equipment to
deal with mass casualty events.
c. It has a storehouse of medications and antidotes to be used during response in
times of national emergencies.
d. It arranges for patient admissions to federal hospitals.
ANS: B
The MMRS responds to disaster with trained individuals who have expertise in this type of
situation and who have the equipment required to be effective.
DIF: Comprehension

4. A community in the New Madrid fault zone experiences an earthquake resulting in injuries
from propelled objects and abrasions for many victims. The local supply of antibiotics is
quickly exhausted. Local authorities would contact which agency for access to the needed
medication?
a. Commissioned Corps Readiness Force.
b. Strategic National Stockpile.
c. Department of Homeland Security.
d. Young Men’s Christian Association (YMCA).
ANS: B
The Strategic National Stockpile provides antibiotics, antidotes, and medical and surgical
items when local and state supplies have been exhausted.
DIF: Comprehension
5. What is the focus of care during the relief response phase of a disaster resulting from a “dirty
bomb”?
a. Treatment for burns and poisoning is provided for victims.
b. Emergency plans are coordinated between agencies.
c. Reconstruction of destroyed facilities and homes begins.
d. Food stores are collected for potential victims.
ANS: A
During the relief response phase of a disaster, emergency responders aid victims and stabilize
the scene; with a dirty bomb, radioactive material causes burns and poisoning.
DIF: Application
NURSINGTB.COM
6. A nurse learns of a mass casualty disaster following a known terrorist attack. On arriving at
the scene, the nurse knows that care will be based on what fact regarding these situations?
a. The response of local hospitals will be dictated by the federal government.
b. The same ground rules practiced in other settings and during smaller crises will be
applicable.
c. The least experienced nurses will be assigned to triage low-risk victims and
victims who have no chance of survival.
d. Multiple incident commanders ensure a quick, effective response.
ANS: B
The fundamentals of nursing applied to other settings and situations can be used in a disaster.
None of the other options accurately describe how the needed care will be determined or
delivered.
DIF: Comprehension
7. Nurses caring for the victims of a mass casualty incident based on what principle?
a. Common terminology to be used by hospitals and participating agencies
b. Nurses will take charge of communicating with the news media.
c. Federal law enforcement will determine whether there is a credible threat of a
terrorist attack.
d. Triaging will give priority for care to those with the greatest chance of survival
rather than those most critically ill.

ANS: D
Care is shifted from categorizing patients at low, intermediate, and critical risk to using
resources to serve those with the greatest likelihood of survival.
DIF: Comprehension
8. During a community health fair, the disaster medical assistance team (DMAT) informs
participants that every community must be ready to provide disaster care. A participant asks,
“In a disaster, the local community cannot possibly be effective, so why not have a plan to call
federal agencies immediately to provide relief?” How should the DMAT respond to this
question?
a. “Unless known terrorist activities involving mass destruction occur, the federal
government does not become involved.”
b. “The community is essentially the ‘first responder’ to any disaster.”
c. “The preparedness phase of a disaster is the responsibility of the community, the
relief response phase is assigned to state agencies, and the recovery phase is the
responsibility of federal agencies.”
d. “Unless local health care facilities are incapacitated, state and federal agencies will
withhold assistance.”
ANS: B
Each disaster begins locally, and each community responds first and receives assistance from
state and federal agencies when local resources are not adequate for the situation.
DIF: Comprehension
9. A nurse who is conducting a staff in-service on the phases of a disaster continuum teaches
participants that, during the iN
mUpaR /rI
ctS poGnT
esN seBs.
taC
geO, M
activities focus on what?
a. Community awareness in anticipation of a terrorist attack or natural disaster
b. Determining the effectiveness of the disaster medical assistance team (DMAT)
c. The use of an all-hazards approach
d. Initiating effective, appropriate response activities
ANS: D
Response activities during the relief response phase consist of immediate actions to save lives
and meet basic human needs.
DIF: Comprehension
10. Following a terrorist attack, victims are exhibiting posttraumatic stress syndrome, and care
providers are exhibiting compassion fatigue. Which federal response system should be
initiated to begin to address victim and provider psychosocial needs?
a. Strategic National Stockpile
b. Metropolitan Medical Response System (MMRS)
c. Commissioned Corps Readiness Force
d. National Disaster Medical System
ANS: B
The MMRS is concerned with deploying trained responders who can provide mental health
care for victims and health care providers.
DIF: Comprehension

11. The crisis communication officer may first inform the public or health care facility of a
disaster or an act of terrorism. What is the primary responsibility of this representative
regarding information regarding the event?
a. To contain the facts to within the administration group
b. To facilitate the public to assist in obtaining the necessary emergency supplies
c. To provide understandable and straightforward facts about the event within the
facility and possibly to the news media
d. To assure the public that information will be released as soon as it has been
confirmed by state and federal agencies
ANS: C
The crisis communication officer is the first contact for patients, families, and employees
within the facility or news media, so they may better understand the situation and know how
to react and protect themselves.
DIF: Comprehension
12. The disaster medical assistance team works quickly to contain contaminants from a chemical
plant explosion. Afterward, personnel undergo a special process to remove harmful chemicals
from equipment and supplies. This removal process is referred to by what term?
a. Containment
b. Decontamination
c. Triage
d. Scene assessment
ANS: B
Decontamination is the physN icaUl R oI
prS ssGoT
ceN fB
re.
mCovOinMg harmful substances from personnel,
equipment, and supplies. Containment is the limitation of an emergency situation within a
well-defined area. Triage is the process of prioritizing which patients are to be treated first;
first action in any disaster response. Scene assessment is the act of reviewing the location of
an event to look for information that might help determine treatment options.
DIF: Knowledge
13. A group of local volunteers have completed an emergency response course and are able to
assist with triage of injured citizens. They also participate in local health fairs to teach
residents how to react during tornadoes. The responders are members of what organization?
a. Medical Reserve Corps (MRC)
b. Metropolitan Medical Response System (MMRS)
c. National Disaster Medical System (NDMS)
d. Commissioned Corps Readiness Force (CCRF)
ANS: A
The MRC are local volunteers trained to respond to local emergencies. None of the other
options are volunteers who work at the local level.
DIF: Comprehension

14. Troops from the United States participating in a peace mission in a foreign country were the
victims of suicide bombers and many soldiers were evacuated back home to receive
specialized medical care. The nation’s medical responses will be augmented by what
organization?
a. The federally coordinated National Disaster Medical System
b. Local homeland communities where troops receive care
c. The Medical Reserve Corps, which organizes and utilizes public health, nursing,
medical, and other volunteers
d. The National Incident Management System, which guides government,
nongovernmental organizations, and the private sector to work seamlessly during
disaster situations
ANS: A
The National Disaster Medical System supplements care for casualties evacuated back to the
United States from overseas and federally declared disasters including national disasters,
major transportation accidents, technologic disasters, and acts of terrorism.
DIF: Comprehension
15. The Federal Bureau of Investigation (FBI) has determined from a reliable source that a bomb
is in the possession of a known terrorist group and the likely target is a government building
in the local community. What term is used to identify this situation?
a. All-hazards approach
b. Biologic event
c. Credible threat
d. Natural disaster
ANS: C NURSINGTB.COM
A credible threat is a situation in which the Federal Bureau of Investigation (FBI) determines
that a terrorist threat is probable and verifies the involvement of a weapon of mass destruction
in the developing terrorist incident. All-hazards approach is a process approach for all sectors
to prepare for any emergency or disaster that may occur. Biologic events involve
microorganisms or toxins from living organisms with infectious or noninfectious properties
that produce lethal or serious effects in plants and animals. A natural disaster is one that is a
result of nature (flood, earthquake, tornado, etc.)
DIF: Comprehension
16. The emergency response team responded to a terrorist attack where hundreds of people died
following symptoms of chest tightness, palpations, seizures, and finally paralysis. A colorless
odorless liquid known as Sarin (GB) was the agent, which is primarily inhaled with limited
exposure through the skin. The concentration of Sarin has not been measured. What level is
the minimum level of personal protection and safety equipment (PPE) that would be needed?
a. A
b. B
c. C
d. D
ANS: B

Level B requires a high level of respiratory protection, but less skin protection, providing a
chemical splash–resistant suit with hood and self-contained breathing apparatus (SCBA). It
provides maximum respiratory protection but less skin protection than level A equipment.
DIF: Analysis
17. A state is devastated by a tornado killing many people, destroying communication systems,
utility services, homes, and medical facilities. The state requests immediate assistance from
the U.S. Congress and from surrounding states. The affected state should first contact what
agency?
a. Emergency Management Assistance Compact (EMAC)
b. Institute of Medicine (IOM)
c. Red Cross
d. Strategic National Stockpile
ANS: A
The EMAC is an organization authorized by the U.S. Congress through which a state
impacted by a disaster can request and receive assistance from other member states quickly
and efficiently.
DIF: Comprehension
18. A nurse is interested in learning the phases of the disaster continuum and realizes it has many
similarities to the nursing process. To better understand the phases of a disaster, which is true
when comparing the phases of the disaster continuum to the nursing process?
a. The preparedness phase of the disaster continuum is consistent with the assessment
and planning steps of the nursing process.
b. The recovery phase of theNdUisaRS INcon
ster GTtinuum
B.COisMconsistent with the planning step
of the nursing process.
c. The recovery phase of the disaster continuum is consistent with the
implementation step of the nursing process.
d. The response relief phase of the disaster continuum is consistent with the
evaluation step of the nursing process.
ANS: A
The preparedness phase requires assessing possible needs of the community and planning
appropriate interventions and is consistent with the assessment and planning steps of the
nursing process.
DIF: Comprehension
19. In the preparedness phase for disasters, the community plans for a possible terrorist attack
using anthrax as the weapon of destruction. What treatments and/or preparations would be
needed?
a. Vaccines and Level B Personal Protection Equipment (PPE)
b. Treatment for burns, decontamination, and Level A PPE
c. Social distance determination, decontamination for radioactive fallout
d. Identify and detect incendiary devices, treatment for burns and propellants
ANS: A

Anthrax is a biologic weapon and requires Level B protection since it is a known agent and
can be carried in wind or surfaces. Timing of treatment is critical and vaccines are available.
DIF: Analysis
MULTIPLE RESPONSE
1. Health care professionals have been activated to respond to a disaster, and the registered nurse
who is coordinating the effort realizes that fact about the situation? (Select all that apply.)
a. In the event of a mass casualty incident, care is prioritized to those who have the
greatest chance of surviving.
b. Communities should use their own resources first to attempt to stabilize and
organize the response.
c. State assistance occurs any time a disaster occurs, regardless of the community’s
resources.
d. The emergency operating plan developed by one central agency rather than
individual facilities should be put into operation.
e. Strict protocols regarding the use of resources must be followed.
ANS: A, B
Care is shifted to doing the most good for the most people. Efforts begin at the local level.
DIF: Comprehension
2. When teaching community preparedness for a community group, the nurse explains that
components of the National Disaster Medical System (NDMS) provide assistance in what
form? (Select all that apply.)N R I G B.C M
U Sbomb
a. Making available a nationwide N disposal
T Osquad team for the rapid removal of
explosive devices
b. Creating teams of health care providers who are experts and have specialized
supplies and equipment
c. Facilitating patient evacuation from the disaster area to an unaffected area
d. Arranging for hospitalization in federal and volunteer nonfederal acute care
hospitals
e. Providing mental health care for the community, for victims, and for health care
providers
ANS: B, C, D
The NDMS provides specially trained teams of people along with equipment designed for
disaster relief. The NDMS is responsible for removing patients from unsafe to safe areas. The
NDMS coordinates efforts to evacuate victims to federal or nonfederal volunteer hospitals that
can care for disaster victims.
DIF: Comprehension
COMPLETION
1. The emergency preparedness term that is used to describe the process of limiting the
emergency within a well-defined area is .

ANS:
containment
Containment is correct because the focus is to prevent the agent that caused the disaster from
spreading.
DIF: Knowledge
2. The term used during a pandemic disaster that refers to the attempt to contain germs by
limiting socialization and personal interactions is .
ANS:
social distancing
The term social distancing refers to the attempt to keep people as far apart as possible to limit
the possibility of spreading germs.
DIF: Knowledge
NURSINGTB.COM

Chapter 17: Nursing Leadership and Management

Edition
MULTIPLE CHOICE
1. To persuade employees to bargain for another type of health insurance, a handout is circulated
that describes the present employees’ health care insurance as being insensitive, limiting
choices of care providers, and providing inferior care. This reflects which aspect of Lewin’s
planned change?
a. Unfreeze
b. Move
c. Refreeze
d. Acceptance
ANS: A
Unfreeze is correct because the change agent promotes problem identification and encourages
awareness of the need for change. In alignment with Lewin’s stages of change (unfreezing,
moving, and refreezing), education and involvement are keys to successful change. People
must believe that improvement is possible before they will be willing to consider change.
DIF: Comprehension
2. What is the difference between a leader and a manager?

a. A leader has legitimate authority.
b. The manager motivates and inspires others.
NURSI NG TB.C OM
c. A manager focuses on coordinating resources.
d. The leader focuses on accomplishing goals of the organization.
ANS: C
The terms leadership and management are often used interchangeably, and it is difficult to
discuss one without discussing the other. However, these roles have specific traits unique to
themselves. The manager is the coordinator of resources (time, people, and supplies) needed
to achieve outcomes.
DIF: Comprehension
3. What is the first step in both the nursing and problem-solving processes?
a. Identifying the problem
b. Gathering relevant information
c. Considering the consequences of change
d. Implementing appropriate interventions
ANS: B
The nursing process, which is familiar to nurses who address patient care needs, can be
applied to all management activities that require decision making and problem solving. As in
the nursing process and the problem-solving process, one must first gather information about
the problem or situation.
DIF: Comprehension

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. These are characteristics of the autocratic style.
DIF: Comprehension
5. An RN with excellent assessment and psychomotor skills would derive power based on which
source?
a. Rewards
b. Coercion
c. Expert
d. Legitimate
ANS: C
Seven primary sources of power are known. Expert power is based on knowledge, skills, and
information.
DIF: Comprehension
6. Managers who exhibit an autN

horiR
tatiI
ve bG
ehaB
vi.
orC
al sM
t yle are most likely to use which source of
power? U S N T O
a. Informal
b. Expert
c. Coercive
d. Reward
ANS: C
Seven primary sources of power are known. Coercive power is based on fear of punishment or
failure to comply. Coercive power fits well into the authoritative behavioral style because
authoritative managers dictate the work with much control, usually ignore the ideas or
suggestions of subordinates, and provide little feedback or recognition for work accomplished.
DIF: Comprehension
7. Florence Nightingale is attributed with being intelligent (she developed statistical methods to
evaluate health care), dependable (she often worked long hours to care for the injured), and
ambitious (she fought against society’s perception of nursing). Those who depict her as a
leader based on 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.
DIF: Comprehension
8. A nurse manager is concerned with restocking the emergency cart, creating the staff schedule,
requesting floor stock from pharmacy, and checking the orders on patient charts. Which type
of leader accurately describes this nurse?
a. Transactional
b. Situational
c. Transformational
d. Contemporary
ANS: A
The transactional leader is concerned with the day-to-day operations of the facility; like those
described in the question.
DIF: Comprehension
9. According to the unit’s policy for call-ins, a nurse is suspended for 3 days because of
excessive call-ins that occur within 15 minutes of shift change. The nurse states, “You are
unfair to me.” Which theory would disprove the nurse’s statement?
a. Authoritative
b. Closed systems
c. Open systems
d. Trait NURSINGT B.COM
ANS: A
Autocratic/authoritative management style revolves around the assumption that authority
confers the right to issue commands within an organization on the basis of impersonal rules
and rights, by virtue of the management position rather than any trait ascribed to the person
who occupies that position. Other characteristics include the following: Impersonal rules
govern the actions of superiors over subordinates, all personnel are chosen for their
competence and are subject to strict rules that are applied impersonally and uniformly, and a
system of procedures for dealing with work situations is in place.
DIF: Application
10. A nurse is reading about positive reinforcement with the goal of increasing staff motivation.
Which action would demonstrate positive reinforcement?
a. Every morning at shift change, thank each employee for an excellent job.
b. Rotate a monthly “employee recognition award” among all employees on the unit.
c. Wait until the annual performance review to recognize accomplishments.
d. Give spur-of-the-moment recognition to an employee who has accomplished a
goal.
ANS: D

To be effective, positive reinforcement should (1) be specific, with praise given for a task
done well or a goal accomplished; (2) occur as close as possible to the time of the
achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose
value); and (4) be given for a genuine accomplishment.
DIF: Application
11. Which action represents the key management function of strategic planning?
a. Determining that all nurses on the unit understand the current organizational
philosophy
b. Evaluating the communication process between the pharmacy and the nursing
departments
c. Monitoring data from the quality management initiative related to the last three
orientation programs
d. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of
all nursing units
ANS: D
A strategic plan is a written document that details organizational goals, allocates resources,
assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5
years into the future.
DIF: Application
12. A hospital’s policy requires that all nurse managers must have a minimum of a bachelor’s
degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager
for the oncology unit. An RN who has worked on this unit for many years is unable to be
promoted to a nurse managerNpU osRitS
ioI
nNbeGcT
auBse.oC
fOhiM
s educational status and has been
commenting to physicians and staff, “The new nurse manager has book sense but no
leadership abilities.” What is the best approach that can be used by the new nurse manager
who is attempting to gain the trust and respect of the nursing staff on the unit?
a. Send memos to all staff except the upset nurse to invite them to a luncheon.
b. Ask management to transfer the upset nurse to another unit.
c. Assign the upset nurse to committees that do not directly affect that nursing unit.
d. Acknowledge the clinical expertise of the upset nurse and clearly explain the
expectations for teamwork and open, honest communication.
ANS: D
The best way for the new nurse manager to communicate with this employee, who may be an
informal leader, is to show respect for the individual’s clinical expertise and experience
through clear and direct communication. The new nurse manager should attempt to identify
the staff nurse’s power as an informal leader, should involve him and other staff members in
decision-making and change-implementation processes, and should clearly communicate
goals and work expectations to all staff members.
DIF: Application
13. A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary
skills to participate on a quality improvement committee. The coordinator of the quality group
invites the CNL to join the group. Which type of power is demonstrated by the coordinator of
the group?

a. Coercive
b. Transformational
c. Laissez-fair
d. Legitimate
ANS: D
The coordinator of the committee has an official position within the organizational committee;
such as being on the quality improvement committee.
DIF: Comprehension
14. A director of nursing (DON) asks the staff to list how their nursing unit can help the
organization meet its goal to “provide quality patient care with attention to compassion and
excellence.” An ad hoc committee is formed to develop a timeline of identified actions. The
DON coaches the committee to reach desired outcomes. This DON is demonstrating which
other role of leadership and management?
a. Transactional
b. Clinical consultant
c. Corporate supporter
d. Autocratic
ANS: C
The manager is embracing the mission of the organization by supporting achievement of goals
noted in the mission statement.
DIF: Comprehension
15. A staff nurse provides care bN

asedRonIintuGitioB
U S N Tn.anCd O aM
lways seems to be in control of her
personal and professional life—serving on the board of the state nurses association, serving as
the nursing unit’s representative on the ethics committee, and coaching her daughter’s soft
ball team. Many of the staff observes how she manages time and provides care. This nurse’s
power comes from which type of power?
a. Referent
b. Legitimate
c. Information
d. Connection
ANS: A
Referent power comes from the followers’ identification with the leader. Referent leaders are
admired and respected and able to influence other nurses because of their desire to emulate
her.
DIF: Comprehension
16. A staff nurse states, “I really enjoyed having dinner with the Chief of Medical Staff and the
President of the hospital. We hope to meet again soon.” Which source of power does this
nurse possess?
a. Expert
b. Legitimate
c. Connection
d. Reward

ANS: C
Connection power results from knowing or associating with power people such as the upper
administration.
DIF: Comprehension
17. A nurse manager wants his nursing unit to be a place where all nurses want to work, where
patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged
to chair taskforces to improve quality of care and he counsels staff in areas of measuring
patient outcomes. Other managers want to mimic this manager’s approach to improve their
own units. This nurse is which type of leader?
a. Transformational
b. Transactional
c. Laissez-faire
d. Authoritative
ANS: A
Transformational leaders mentor followers through a vision and are admired and emulated.
DIF: Comprehension
18. A hospital recently learned that their scorecard did not meet the national benchmark for
patient satisfaction and brought in a professional change agent to determine what their issues
were and how they could improve their score. The agent collected data and recommended that
nurses participate in interdisciplinary walking rounds and allow the patient and family to be
participants. Nurses now round every shift and perform “huddles to update the team” as
needed throughout the shift as part of best practices. Random visits are made to nursing units
to ensure all nurses are particN atR
ipU gI
inS anNdGpT
atB
ie.
ntC
sOarM
e interviewed for their involvement. These
practices are associated with which stage of Lewin’s change process?
a. Unfreeze
b. Moving
c. Refreeze
d. Resistance
ANS: C
In the refreezing stage, change becomes status quo and the agent reinforces until the change is
part of the daily process as in the above situation.
DIF: Comprehension
19. A manager just finished the last annual performance review of the staff, reviews the
unexpected expenditures for the month due to use of agency nurses, and shares the latest
quality indicators with the staff nurses. This manager is performing which management
function?
a. Directing
b. Planning
c. Organizing
d. Controlling
ANS: D

Controlling is the final management function. It includes performance evaluations, financial

activities, and tracking outcomes of care to ensure quality.
DIF: Comprehension
MULTIPLE RESPONSE
1. Registered nurses who are entering the workforce will have expanded leadership
responsibilities that include what tasks? (Select all that apply.)
a. Serving on interdisciplinary care teams
b. Being competent to work in several areas independently when dictated by patient
census
c. Attending a meeting to plan advanced training for unlicensed assistive personnel
d. Evaluating outcomes of care that are reported to a standing committee
e. Managing units with higher acuity, shorter length of stay, and more diverse
patients and staff
ANS: A, C, D, E
The new nurses will be placed in many situations that require leadership and management
skills: for example, managing a group of assigned patients, serving on a task force or
committee, acting as team leaders or charge nurses, and supervising unlicensed assistive
personnel and licensed vocational/practical nurses. Diverse patients have comorbidities and
require complex interventions delivered during shorter stays with an ever-increasing diverse
staff. The new nurses will be placed in many situations that require leadership and
management skills, for example, managing a group of assigned patients, serving on a task
force or committee, acting as team leaders or charge nurses, and supervising unlicensed
assistive personnel and licensNeU
dR caItiN
voS onGaT
l/pBr.
acC
ticOaM
l nurses. The new nurses will be placed in
many situations that require leadership and management skills, for example, managing a
group of assigned patients, serving on a task force or committee, acting as team leaders or
charge nurses, and supervising unlicensed assistive personnel and licensed
vocational/practical nurses. The new nurses will be placed in many situations that require
leadership and management skills, for example, managing a group of assigned patients,
serving on a task force or committee, acting as team leaders or charge nurses, and supervising
unlicensed assistive personnel and licensed vocational/practical nurses.
DIF: Application
2. A nurse asks, “What is meant by ‘internal’ customers?” The correct response should identify
which person or persons? (Select all that apply.)
a. Insurance companies
b. Accreditors such as The Joint Commission
c. X-ray technicians
d. Clinical pharmacist
e. Chief financial officer
ANS: C, D, E

Internal customers are employees of an organization at all levels. An x-ray technician is an

example of an internal customer. Internal customers are employees of an organization at all
levels. A clinical pharmacist is an example of an internal customer. Internal customers are
employees of an organization at all levels. A chief financial officer is an example of an
internal customer.
DIF: Comprehension
NURSINGTB.COM

Chapter 18: Budgeting Basics for Nurses

Edition
MULTIPLE CHOICE
1. A nurse manager plans the fiscal budget to include salaries for two RNs for two 12-hour shifts
with a patient census of 6 in the short-stay observation room. The nurse manager reviews the
budget report 3 months later and notes that the salary expenses are higher than was budgeted
because of higher-than-planned RN staff salaries. This additional RN staff is necessary to
meet patient care needs because the census has remained constant at 10 patients rather than
the 6 projected when the budget was developed. The difference between the planned budget
and the actual cost is referred to by what term?
a. Revenue
b. Variance
c. Zero-based budgeting
d. Capital expenditures
ANS: B
Variance is the difference between the planned budget and actual results; it can be a positive
or a negative discrepancy. Revenue is the money that a health care organization receives in
exchange for providing health care or other related services through normal business
activities; synonymous with income. Zero-based budgeting is an approach to budget
development that begins as though the budget were being prepared for the first time. Capital
expenditures are the amount spent on items that will have long-term (greater than 1 year)
value to an organization; typiN
caUllR
ySinI udGeT
clN sB
bu.
ilC ngMs and equipment.
diO
DIF: Comprehension
2. A nursing unit’s census consists primarily of long-term residents with a high risk for falls. To
meet new safety regulations, the nurse manager must plan to replace all 50 patient beds with
new beds equipped with Fall Watch electronic sensors. The manager will be involved in
which type of budgeting to replace the beds?
a. Fiscal
b. Labor
c. Operational
d. Capital
ANS: D
Capital budgets are concerned with major purchases such as equipment paid for over several
years. Fiscal is a general term used to refer to financial planning and budgeting. Labor is a
term used to refer to staff/personnel. Operational budgeting relates to the expenses and
revenue generated by, in this case, a nursing unit.
DIF: Comprehension
3. A nurse manager is preparing a budget that does not base annual budgets on the revenue and
expenditures of the prior year and has the advantage that outdated information is not
integrated into the budget. The manager is using which budget method?
a. Zero-based

b. Incremental
c. Labor
d. Operational
ANS: A
The zero-based method assumes of no volume and no resources assigned; it essentially starts
each new budget period at zero rather than building from past budgets. The incremental
approach is simply a forward trend of recent performance with adjustments for future growth
or decline in revenues or expenses.
DIF: Comprehension
4. A nurse on the unit is heard saying, “I am not going to document that I used four catheters to
start that IV; it doesn’t matter anyway.” What action can help the staff nurse understand the
financial budget goals of the unit?
a. Have the nurse work in payroll for a week.
b. Enroll the staff in continuing education units (CEU) for personal finance.
c. Ask the nurse to represent the unit on the budget planning committee.
d. Make the nurse responsible for monitoring all disposable equipment and supplies.
ANS: C
Participating on the committee will give the nurse ownership of the unit’s budget and will
provide insight into the unit’s budgetary goals.
DIF: Analysis
5. In a large health care facility, the executive administrative leaders set the budget goals to
decrease full-time equivalentNs byR3%I, elG
iminBa.
teCtheMcost of agency nurses, reduce lost revenue
U S Na 0.5%
from lost supplies by 1%, and provide T hourly salary incentive for working on a float
unit when the assigned unit has a low census. Nurse managers meet with nursing
administrators to design their unit budgets to meet these established goals. This is an example
of what type of budget approach?
a. Top-down
b. Participatory
c. Iterative
d. Incremental
ANS: A
Budget goals are established by administrators; unit managers do not contribute to goal
setting, which is the primary principle of the top-down approach. In the participatory
approach, the people responsible for achieving the budget goals are included in goal setting.
The iterative approach is a combination of the top-down and the participatory approach, with
upper management defining strategic goals and then unit leaders developing their operating
budgets to incorporate their individual goals in conjunction with the organization’s strategic
goals. The incremental approach is simply a forward trend of recent performance with
adjustments for future growth or decline in revenues or expenses.
DIF: Comprehension
6. Which component of budgeting might normally be addressed in the annual performance

evaluation for a nurse manager?

a. Including in the labor budget costs for overtime and benefits

b. Managing variances in nursing overtime costs and supply usage
c. Accurately predicting revenues based on unit-of-service
d. Providing qualitative analysis for variances in the capital budget
ANS: B
Nurse managers are often evaluated according to their success in managing nursing overtime
costs and supply usage as reflected in the unit’s budget.
DIF: Comprehension
7. A primary function of the budgeting process is to provide managers with an opportunity to do

what?
a. Insist that salary increases for all nurses are included in the annual budget.
b. Discuss concerns about resource allocation with leaders of the organization who
can resolve issues.
c. Develop a mechanism for changing from zero-based budgeting to incremental
budgeting.
d. Develop for all staff an educational program related to supply usage.
ANS: B
Coordination and communication are very important functions of budgeting that require many
different groups within an organization to come together with organizational leaders to
discuss the resources necessary to accomplish the goals of a business unit.
DIF: Application
8. Organizations measure the efN

fectR
ivenIessGof tB
h.
eirCbuM
dgets by examining actual revenues and
expenditures versus what? U S N T
a. Planned variances
b. Incremental budgets
c. Productivity metrics
d. Expected performance
ANS: D
Variance analysis is the process by which deviations from budgeted amounts are examined by
comparing actual performance results against expected, or budgeted, performance.
DIF: Comprehension
9. What is the intended action when the nurse manager conducts a qualitative analysis of budget
variances?
a. Determining the percentage increase of supply usage from the last quarter to the
current quarter
b. Identifying the overall increase in the dollar amount of salaries paid for overtime
c. Comparing productivity metrics across all nursing units in the facility
d. Reconciling with current conditions the underlying assumptions on which the
budget was based
ANS: D

Qualitative analysis of the budget explains why current conditions are different than they were
when the budget was developed; new conditions might include greater patient acuity or
additional physicians with increased admissions.
DIF: Comprehension
10. A nurse manager is working with the financial officer to develop the budget of the nursing
unit for the next fiscal year. The nurse manager tells the financial officer that which of the
following pieces of information will affect budget assumptions?
a. The capital budget request for new emergency department equipment has been
turned in for consideration by the hospital’s administrative team.
b. The patient census likely will increase during the next fiscal year because two
large physician groups have transferred their admission privileges to this hospital.
c. The participatory budgeting approach instituted last year has been helpful in
controlling supply costs.
d. Zero-based budgeting will help the managers to be more efficient in establishing
next year’s budget.
ANS: B
Budget assumptions are future predictors of performance and include the stability of the price
of supplies, the salary range needed to recruit and retain quality employees, new services
offered by competitors, and the variability of the patient census.
DIF: Comprehension
11. The nurse manager meets with upper management to share strategic goals agreed upon by her
staff for their individual nursing unit as the first step to begin budget negotiations. One
strategic goal is that staff willNhUave
RSacc
INess
GTtoB.C
techO M that will allow them to incorporate
n ology
point-of-care devices for all RNs. The second goal is to improve RNs’ ability to recognize
critical indicators that a patient’s health status is deteriorating through advanced health
assessment skills. During a meeting with the upper management, the unit manager discusses
strategy options and identifies the one that works for the unit. Which type of budget
development is being implemented?
a. Iterative
b. Top-down
c. Participatory
d. Zero-based
ANS: C
In the participatory approach, the people responsible for achieving the budget goals are
included in goal setting. Budget goals are established by administrators; unit managers do not
contribute to goal setting, which is the primary principle of the top-down approach. The
iterative approach is a combination of the top-down and the participatory approach, with
budgets to incorporate their individual goals in conjunction with the organization’s strategic
goals. The zero-based method assumes of no volume and no resources assigned; it essentially
starts each new budget period at zero rather than building from past budgets.
DIF: Comprehension

12. The nursing executive team met to review last year’s productivity metric to strategize for the
upcoming year’s metric. The team wants to be certain the productivity metric shows
productivity demonstrates what desired outcome?
a. High
b. Low
c. Balanced
d. Iterative
ANS: C
A balanced productivity is desired because it encourages quality and safety while providing
financial efficiency.
DIF: Comprehension
13. The nurse manager meets with upper administration and learns that the strategic plan for
nursing is to have 80% BSN staff within the next 3 years. The nurse manager then builds the
unit’s budget to meet the organization’s strategic goal by providing tuition reimbursement and
flexible work hours, which required some agency staffing. Which approach to budgeting is
used?
a. Iterative
b. Top-down
c. Participatory
d. Zero-based
ANS: A
The iterative approach is a combination of the top-down and the participatory approach, with
budgets to incorporate their iN
ndUivRidSuI
alNgG
oaTlsBi.
nC njM
coO unction with the organization’s strategic
goals. In the participatory approach, the people responsible for achieving the budget goals are
included in goal setting. Budget goals are established by administrators; unit managers do not
contribute to goal setting, which is the primary principle of the top-down approach. The
zero-based method assumes of no volume and no resources assigned; it essentially starts each
new budget period at zero rather than building from past budgets.
DIF: Comprehension
14.14.

The nurse managers of an organization are meeting with administration to plan the budget.
The above graph shows last year’s expenditures, and the team will trend the upcoming budget
knowing that, with the slowdown in the economy, patient census will be lower. Which budget
approach is being used?
a. Incremental
b. Zero-based
c. Productivity metrics
d. Capital
ANS: A
The incremental approach is simply a forward trend of current or recent performance with
adjustments for future growth or decline in revenues or expenses. The zero-based method
assumes of no volume and no resources assigned; it essentially starts each new budget period
at zero rather than building from past budgets. Capital budgets allocate funds for construction
projects and/or long-life medical equipment, such as cardiac monitors, defibrillators, and
computer hardware. A productivity metrics identifies the amount of work produced (i.e.,
hours of nursing care per patient-day) by a specific amount of input or resources (i.e., nursing
hours worked).
DIF: Comprehension
15. Nurses on a unit met with the nurse manager as part of participatory budgeting. They ask,
“What exactly is the difference between fixed and variable costs? Understanding this will help
us better understand the budgeting process.” The manager provides a definition and asks the
staff to list types of direct and indirect cost. Which example would indicate a need for further
teaching?
N R I G B.C M
a. Fixed costs would include accreditation fees.
b. Fixed cost would include thUe cS ost fN
or tT
he autoO
mated medication-dispensing system.
c. Variable cost would include the nurse manager’s salary.
d. Variable cost would include the salary expense for registered nurses.
ANS: D
Variable costs would include the salary expense for registered nurses because their number
can change.
DIF: Analysis
MULTIPLE RESPONSE
1. A nurse manager has calculated that providing 75 hours of direct nursing care per day requires
that 120 hours must be worked by nursing staff. The manager is involved in what activity?
a. Developing the capital budget
b. Applying productivity metric
c. Monitoring the labor budget
d. Incremental budgeting processes
e. Addressing budget assumptions
ANS: B, C

The nurse manager is determining the amount of work produced by calculating the actual
number of nursing hours worked, which is productivity metric. Budgets use productivity
metrics to monitor the funds budgeted for labor-related expenses.
DIF: Comprehension
2. A nurse has recently been appointed to the position of nurse manager. What should the nurse
manage do to become successful in managing the unit’s budget? (Select all that apply.)
a. Read the financial policy manual to learn more about the organization’s budgeting
process.
b. Allow the nursing administration office to manage the unit’s budget until he or she
is able to complete an online financial management course.
c. Communicate regularly with a person in the hospital’s finance office about
interpreting budget reports.
d. Pay attention to only the bottom-line numbers in budget reports rather than trying
to understand each line in these reports.
e. Discuss the process of developing budgets with other members of the management
team.
ANS: A, C, E
Knowing the organization’s financial policies is an important step toward understanding the
organization’s budget process. Building a relationship with the finance office is fundamental
to learning about the budgeting. As one participates more in the budget process, one’s
understanding of the process and related responsibilities is enhanced.
DIF: Application
NURSINGTB.COM
COMPLETION
1. The financial plan required for the distribution of resources and expenses is a .
ANS:
budget
A budget is an organization’s financial plan that expresses expected expenses (such as

personnel and supplies) and anticipated revenues for products and services over a defined
period, usually 12 months.
DIF: Comprehension

Chapter 19: Effective Communication and Conflict Resolution

Edition
MULTIPLE CHOICE
1. A nurse is listening to a patient’s apical heart rate. The patient asks, “Is everything okay?”
The nurse says nothing and shrugs her shoulders. The nurse is demonstrating what form of
negative communication?
a. Ad Hominem Abusive
b. Filtration
c. Blocking
d. False assurance
ANS: C
Blocking occurs when the nurse responds with noncommittal or generalized answers.
DIF: Comprehension
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 situations?
a. Blocking
b. Filtration
c. Empathy
d. False assurance
NURSINGTB.COM
ANS: B
Filtration is the unconscious exclusion of extraneous stimuli in communication.
DIF: Comprehension
3. In today’s world of fast, effective communication, what is the most commonly used means of
societal communication?
a. Facial expression
b. Spoken word
c. Written messages
d. Electronic messaging
ANS: B
Verbal communication, which involves talking and listening, is the most common form of
interpersonal communication. An important clue to verbal communication is the tone or
inflection with which words are spoken and the general attitude used when speaking.
DIF: Knowledge
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.
DIF: Comprehension
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 what communication
associated process?
a. Interpretation
b. Context
c. Precipitating event
d. Preconceived idea
ANS: D
Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed
before having an encounter. Such ideas can dramatically affect the receiver’s acceptance and
understanding of the message.
DIF: Comprehension
NURSINGTB.COM
6. A new mother is experiencing pain after delivering an infant with Down syndrome. The staff
nurse states, “I don’t think she is really hurting. Let the next shift give the pain medication.”
The team leader notices the staff nurse looks agitated and anxious and asks about any
concerns in providing care to this new mom. The staff nurse admits having a stillborn infant
with Down syndrome. This is an example of which component of communication?
a. Personal perception
b. Past experiences
c. Filtration
d. Preconceived idea
ANS: B
With past experiences that include a variety of positive, neutral, and negative events, the
influence that these experiences can and will have on communication may be positive, neutral,
or negative. The importance of recognizing that any reaction from the receiver may be biased
by previous experience cannot be overstated.
DIF: Application
7. A nurse gives phenytoin 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, “You’ve disliked
me since I refused to switch my vacation time last month.” Which type of logical fallacy has
influenced the nurse?

a. Ad hominem abusive
b. Appeal to common practice
c. Red herring
d. Appeal to tradition
ANS: C
Red herring is the introduction of an irrelevant topic in order to divert attention away from the
real issue.
DIF: Comprehension
8. An RN is consistently late to work, causing reassignment of patient care and the need for
repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, “My
husband left me, I have no car, no family close by, and the bus is always late, which makes
me late. The nurse manager doesn’t care how hard I try to get here, and I am raising a child by
myself.” The nurse is using which type of logical fallacy?
a. Appeal to emotion
b. Appeal to tradition
c. Hasty generalization
d. Confusing cause and effect
ANS: A
An appeal to emotion is an attempt to manipulate other people’s emotions for the purpose of
avoiding the real issue.
DIF: Application
NaUcRom
9. Which nurse is demonstrating
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e conflict resolution style?
a. The nurse who does not express feelings or ideas that conflict with those of the
administration
b. The nurse who states,” If I cover for you this weekend will you cover for me the
weekend before my vacation?”
c. The nurse overheard saying, “There is no use fighting this; one solution is as good
as another.”
d. The nurse who regularly insists they have the most insight into the problem being
discussed.
ANS: B
Compromise occurs when people give up something to get partial goal attainment; such as in
the scenario presented. The other options demonstrate avoidance, accommodation, and force
as a conflict resolution technique.
DIF: Application
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 referred to by what term?
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 diverting attention away from the
real issue.
DIF: Application
11. A nurse who was recently certified in chemotherapy administration fails to check
compatibility of phenytoin before injecting into a continuous infusion of D5W leading to
occlusion of the line. Which statement by the nurse demonstrates a red herring?
a. The nurse is upset and states, “I am sure I have injected this before without a
problem” and the supervisor interprets this to mean the nurse often take shortcuts.
b. The nurse states, “You are just upset because I am certified in chemotherapy
administration and you are not.”
c. “The nurse who started the IV didn’t get a blood return but determined the IV was
the patient’s—that is the problem.”
d. “This drug always occludes the line because it is so viscous.”
ANS: B
The nurse diverts attention away from the issue of not checking compatibility to introduce an
irrelevant topic of chemotherapy administration certification which is not related to this
situation.
DIF: Application
12. During a health history intervNiew

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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 what communication
technique?
a. Assertive communication
b. Active listening
c. Empathy
d. Passive communication
ANS: B
In active listening a number of techniques can be used by the receiver to enhance the ability to
listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3)
making eye contact, (4) noting nonverbal messages (body language), and (5) finishing
listening before one begins to speak.
DIF: Comprehension
13. What situation demonstrates a nurse engaging in active listening?

a. While assessing the patient’s vital signs, the nurse records the data and states,
“You are improving, your vital signs are normal.”
b. Eye contact is maintained while focusing on the patient as the patient describes the
current pain level and location.
c. The nurse states, “I know how you feel, I recently lost my father and I am still
hurting.”

d. The nurse has cultural values that are in opposition to the patient but shares that “I
agree with your decision to use herbs rather than the prescribed medications.”
ANS: B
This behavior demonstrates active listening. A number of techniques can be used by the
receiver to enhance the ability to listen; these include (1) providing undivided attention, (2)
giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body
language), and (5) finishing listening before one begins to speak.
DIF: Application
14. An older adult is unable to reach the telephone and is found dead at home several hours later.
The son of the deceased person arrives at the hospital and asks, “Can I just please stay and
hold my dad’s hand? He was so afraid of dying alone.” Which response by the nurse shows
empathy?
a. “Of course, you can. I’ll let you know when the funeral home is here to transport
his body.”
b. “It must be very hard to know he died alone.”
c. “I’ll close the door so you can spend time with your dad. I will check back in a few
minutes.”
d. “I lost my dad last year. He died alone. He was a policeman. I am just like you. Let
me stay here and console you.”
ANS: C
Empathy is demonstrated by the ability to mentally place oneself in another person’s situation
to better understand the person and to share the emotions or feelings of the person.
DIF: Application NURSINGTB.COM

15. A nurse is preparing an exercise program as part of a health promotion program for older
adults with osteoporosis. Which question would retrieve the most valuable information about
health practices?
a. “Do you exercise?”
b. “Do you like to exercise?”
c. “When do you exercise?”
d. “What exercise practices do you participate in?”
ANS: D
“What exercise practices do you participate in?” is an open-ended question or statement that
requires more information than just yes or no. This type of question augments the gathering of
enough facts to build a more complete picture of the circumstances.
DIF: Analysis
16. Which component of an e-mail shown below would be both effective and concise?
a. Subject: A short concise subject line: Meeting.
b. Body: I would like you to answer these questions before the next meeting: Where
would you like to meet? Do you want all the staff to attend? Can we serve
refreshments? What is one goal for our unit?
c. Body: Dear Staff, As you know, each department must reduce staff by 2%. We
will need to discuss how to inform unlicensed staff about the downsizing efforts of

the hospital.
d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the
first-floor auditorium. Please send items for the agenda.
Sally Smith, MSN, RN, [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.
DIF: Analysis
17. When considering online communication etiquette, which nurse demonstrates a primary rule
that should be adhered to by all?
a. “My friend’s wedding was lovely and anyone wanting to see pictures can view
them on my website.”
b. “I’m not familiar with the details so I’m not going to get into the discuss of whose
right or wrong.”
c. “My cousin’s prom dress costed $3,000 and worth every penny her parents spent
on it.”
d. “I got this information at the workshop I attended last month; I’m posting the
power points for everyone to review.”
ANS: A
Interactions online are guided by the same sense of decency that any other style of
communication dictates. Certainly, don’t fan the flame of conflict or anger. The other options
are not respectful of privacy, or potentially copyright laws.
NURSINGTB.COM
DIF: Application
18. A patient’s spouse was just diagnosed with lung cancer although there was no history of
tobacco use. The spouse states, “I am so mad. How can you get cancer without smoking?”
Which statement by the nurse represents empathy?
a. “Research is identifying many risk factors for cancer besides smoking.”
b. “I understand how you could feel angry about the diagnosis.”
c. “He is still a good husband.”
d. “Why do you think he got cancer?”
ANS: B
Empathy is feeling what the other person is feeling and seeing the situation as they see it;
entails believing that the other person’s feelings are valid, legitimate, and justified. The nurse
is placing herself in the wife’s position and sharing her emotions.
DIF: Application
19. A nurse wants to apply open communication to obtain a thorough history and to determine
cognitive function. Which question represents the use of open communication?
a. Is today Wednesday?
b. Do you know what day it is?
c. Tell me what day of the week today is.
d. Do you know what the first day of the week is?

ANS: C
The patient must be able to name the day of the week rather than use answer yes or no.
DIF: Application
20. The nurse caring for a patient states, “Your blood pressure is dangerously high. Are you
taking antihypertensive medicine?” The patient states, “I can’t afford my medicine. I have no
insurance.” The nurse states “I feel really sorry for that patient. I wish it wasn’t against policy
to give her money.” The nurse wants to help and places a note on Facebook that any donations
would be appreciated to help a waitress who works at the cafeteria next door to the hospital
buy her medications. The nurse posts that “She was so sick last evening when she came to the
ED. I can’t believe they don’t provide insurance. I can’t give her money but you all can help.”
This nurse’s action has what possible outcome?
a. Showing empathy and if she lets the patient know the money is not from her, she is
not violating any social media guidelines.
b. Increasing the risk for HIPAA violations
c. No legal risk since she has properly followed policy and protected the patient by
not using her name.
d. The nurse is demonstrating the logical fallacy of slippery slope.
ANS: B
The National Council State Board of Nursing’s policy on social media prohibits posting of
patient information on social media sites. This patient could be identified by knowing where
she works and the fact that she was seen in the ED the day before.
DIF: Application
21. A group of nurses are meetinN

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afM
f the upcoming holidays. Each of the four
members freely expresses thoughts about fair staffing but is willing to listen to other thoughts
and reconsider their first recommendations. The nurses are avoiding conflict and supporting
professional communication through implementation of what communication technique?
a. Empathy
b. Positiveness
c. Supportiveness
d. Accommodation
ANS: C
Supportive communication occurs when each person’s opinion/position is valued and each
participant has the freedom to express a position but is willing to change that opinion/position.
DIF: Comprehension
22. A nurse is asked to “float” to another area where the patients require total care. The nurse
smiles, picks up her stethoscope, and says, “I’ll come back and eat lunch with everyone here.”
When she enters the elevator she hits the wall and mutters, “Always me. Don’t I have any
rights”? The nurse is demonstrating which communication style?
a. Assertive
b. Aggressive
c. Passive
d. Passive-aggressive
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ANS: D
Passive-aggressive communication is represented by incongruent actions—the nurse shows
friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the
original unit; however, she shows her anger by hitting the wall and muttering.
DIF: Comprehension
23. A nurse is overhead saying, “I don’t mind working during the election and holiday. My
parents are divorced, money is tight, and honestly, I don’t trust any politicians anyway. I plan
to take a few weeks off next month.” She works independently to research strategies to
improve patient-centered care for the large number of immigrants that arrived in the area and
then works with the team to share ideas. She recommends, “Let’s think the suggestions over
and come back together next week.” This nurse’s communication style is consistent with
which generation?
a. Baby Boomers
b. Traditionalist
c. Generation X
d. Millenniums
ANS: C
Generation X individuals grew up in when there was a high rate of divorces; they tend to be
more cynical and value work-life balance and teamwork. Holidays are often associated with
family gatherings which may have been absent in this generation’s family; belief that ALL
politicians are untrustworthy may be viewed as cynical. The need to take time to form
suggestions to save time and come together to reach team decision are reflective of this
generation.
DIF: Comprehension
COMPLETION
1. The healthiest form of communication is the style.
ANS:
assertive
Assertive communicators are honest and direct while valuing and respecting other individuals’
views and seeking a win-win solution without the use of manipulation or game-playing.
DIF: Knowledge

Chapter 20: Effective Delegation and Supervision

Edition
MULTIPLE CHOICE
1. The task of completing and signing the initial assessment on a newly admitted patient who is
about to undergo minimally invasive procedures on an outpatient basis can be delegated to
whom?
a. The registered nurse (RN)
b. The licensed practical/vocational nurse (LPN/LVN)
c. Unlicensed assistive personnel (UAP)
d. All levels of staff, because the information is about the past and cannot change
ANS: A
Only the RN can perform and sign the admission assessment, although some components such
as monitoring vital signs may be delegated.
DIF: Comprehension
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 bases
decisions on what fact?
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 additionaNl onR-thI
e-joG B.inCgOisMprovided.
b train
U S N T
c. Review of the state’s nurse practice act for LPN/LVNs is vital since it defines the
role and scope of practice of the LPN/LVN.
d. The Joint Commission has certified and established roles for the LPN/LVN.
ANS: C
The scope of practice of the LPN/LVN varies significantly from state to state; RNs should
know the LPN/LVN nurse practice act in the state in which they practice and should
understand the legal scope of practice of the LPN/LVN.
DIF: Comprehension
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 delegate’s current workload
and the complexity of the task, (2) whether the staff member is familiar with the patient
population and with the task to be performed, and (3) whether the RN is able to provide the
appropriate level of supervision. The delegation decision-making tree would also support
delegation of this task.
DIF: Analysis
4. A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of
staff have been trained to assess vital signs. Given budget restrictions and proper delegation
rules, to which care provider would the RN delegate the task of obtaining the initial blood
pressure reading?
a. RN
b. LPN/LVN
c. Unlicensed assistive personnel (UAP)
d. Since all are trained, the task can be delegated to anyone
ANS: A
The patient’s condition is not stable; therefore, the skills of an RN are required.
DIF: Application
5. A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task
of assisting with oral hygiene, knowing that this assignment “does not require decisions based
on the nursing process.” The nurse is correctly using which of the five rights of delegation?
a. Supervision
b. Communication
c. Person NURSINGT B.COM
d. Circumstance
ANS: D
Right circumstance involves the delegation of tasks that do not require independent nursing
judgments.
DIF: Comprehension
6. A student nurse is concerned about delegation practices and wonders why hospitals employ
unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National
Council of State Boards of Nursing and learns that the role of these personnel is to focus on
what?
a. Supplementing the staffing pattern when an RN is not available
b. Aiding the RN by performing appropriately delegated care tasks
c. Replacing the RN when the health care facility provides long-term care
d. Providing patient teaching, allowing more direct care to be provided by the RN
ANS: B
The UAP and LPN/LVN can increase productivity of the RN by performing those tasks that
fall within their scope of practice.
DIF: Comprehension
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7. An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood
pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is
responsible for what associated task?
a. Delegating the task to another UAP if he or she does not have the time or skill to
complete the task
b. Keeping the RN informed of any abnormal blood pressure readings
c. Calling the physician when the patient’s vital signs are not within established
parameters
d. Informing the dietary department to initiate a low-sodium diet for patients who are
hypertensive
ANS: B
After accepting the assignment, the UAP is responsible for completing the task and reporting
any patient concerns to the RN. The remaining options are the responsibility of the RN.
DIF: Application
8. Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP)
provided the delegate 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.
Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a
closed drainage system is not an invasive procedure, and risk to the patient is minimal,
making the task appropriate for delegation.
DIF: Analysis
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 delegate is inexperienced or has not demonstrated an acceptable level of
competence.
DIF: Comprehension
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10. An RN is counseled by the nurse manager regarding inappropriate delegation when the RN
engages in what activity?
a. Instructing the nursing assistant to greet ambulatory surgery patients and show
them to their rooms
b. When asking a novice nursing assistant to collect a sputum specimen, the RN
states, “I will show you this time and you can show me the next time.”
c. Assigning 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. Asking an LPN/LVN who has demonstrated competence to perform a dressing
change before the patient is discharged home
ANS: C
Only an RN can initiate and complete a new plan of care; this does not fall within the scope of
practice of the LPN/LVN. The RN has violated one of the five rights of delegation.
DIF: Application
11. An RN delegates to an experienced LPN/LVN the task of administering oral medications to a

group of patients. The RN then observes the LPN/LVN recording a patient’s medication
administration just before entering the patient’s room. What is the RN’s initial intervention?
a. Checking the patient’s drug packages to ensure that the correct drugs were given.
b. Stopping the LPN/LVN immediately and nonjudgmentally discuss the possible
consequences of this action.
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 compN enR
etU cySbIuN
t vGioTlB
at.
edCoO
neMof the rights of medication administration
and is practicing unsafe care. The RN’s initial responsibility requires that he or she intervene
and identify concerns with the LPN/LVN.
DIF: Analysis
12. Which statement related to delegation is correct?

a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse
practice act.
b. Nursing practice can be delegated only when the LPN/LVN and UAP have
received adequate training.
c. Supervision is not required when routine tasks are delegated to a competent
individual.
d. The RN must be knowledgeable about the laws and regulations that govern nursing
practice, as well as those that have no clearly defined parameters, such as for UAP.
ANS: D
Accountability remains with the RN, and he or she is responsible for knowing what tasks can
be delegated and what is defined as nursing practice.
DIF: Knowledge

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 what is the basis for this practice?
a. The health care facility can override the state practice act by having all LPN/LVNs
and unlicensed assistive personnel (UAP) participate in on-site training.
b. LPN/LVNs are licensed, and accountability for their own practice rests with each
LPN/LVN.
c. The RN can determine what tasks are legally delegable to the LPN/LVNs on
his/her care team.
d. The nurse practice act and state regulations related to delegation override the
organization’s policies.
ANS: D
The state’s nurse practice act is the deciding factor regarding what can legally be delegated.
DIF: Comprehension
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.
What should the RN do to best acquire the necessary information?
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
es. G B.C M
N SRtatI
consistent across the United
U S N T O
ANS: C
If the nurse practice act lacks clarity, the state board of nursing can provide guidance.
DIF: Application
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 (UAP) is assigned the task of assisting a patient
with late stages of Huntington’s disease to ambulate.
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; this
makes it inappropriate to delegate ambulation to the UAP.
DIF: Application

16. The RN instructs the LPN to “Give an enema to the discharged patient in room 327 who is
reporting being constipated. Then be sure to document on the medication administration
record when given.” Which of the five rights was missing in this situation? The right of
a. direction and communication.
b. task.
c. person.
d. circumstances.
ANS: A
The directions were not clear. The RN did not specify which type of enema to give and what
outcome to expect. And the RN gave no instructions related to reporting back.
DIF: Comprehension
17. Which situation would be appropriate for the supervisory level of initial direction and/or
periodic inspection?
a. Experienced RNs work together to provide care for a group of patients newly
diagnosed with meningitis.
b. The RN assigns the LPN tasks within her scope of practice and checks back during
the shift to ensure the tasks are completed correctly.
c. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 g
of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse
checks on the patient status every 15 to 30 minutes and asks the graduate to
explain “next steps.”
d. No supervision is necessary since both are registered nurses.
ANS: B
When a working relationshipNisUeRstS
abIliN
shGeT
dB
an.
dCcoOmMpetencies of the delegate established, the
delegator may check in during intermittently during the shift.
DIF: Application
18. When determining the scope of practice for licensed practical nurses (LPN) and unlicensed
assistive personnel (UAP), which statement accurately describes the common policies which
exist in most state practice acts?
a. The RN is held accountable for the decision to delegate, but responsibility rests
only with the delegatee.
b. The RN may only delegate tasks that are not in the scope of practice of the LPN if
the delegatee is certain they are competent to perform the task.
c. Since the LPN is licensed, they practice professional nursing.
d. To determine what tasks can be safely delegated, the RN must first assess the
patient.
ANS: D
The stability of the patient must be determined prior to delegation. Even routine tasks such as
taking vital signs that are often delegated may need to be performed by the RN when the
patient’s condition is critical.
DIF: Comprehension

19. A nurse is concerned about the risk of delegating tasks to licensed practical nurses and
unlicensed assistive personnel. What is the best way for the nurse to determine competency of
an inexperienced delegatee?
a. Personally observe the delegatee perform the assigned task.
b. Ask the delegatee how many times he/she has performed the task.
c. Question the patient to confirm that the care provided was satisfactory.
d. Ask other nurses if they feel the delegatee is competent.
ANS: A
The best way for the nurse to determine the competency of LPNs or UAPs is to observe them
perform the task.
DIF: Application
20. Care delivery using the team-based approach is used on a telemetry nursing unit. The team
consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one
unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care
while ensuring cost containment. Which assignments would meet both criteria?
a. The RN administers all medications to all patients.
b. The LPN performs sterile dressings and IV tubing changes on all central lines.
c. The experienced UAP places telemetry electrodes and attaches to cardiac monitor.
d. The RN administers an enema to a stable patient who has an order “administer
fleet enema PRN when no bowel movement in 2 days.”
ANS: C
The UAP, when properly trained, can place patients on telemetry. This meets quality and cost
containment goals because the LPN and RN have higher salaries.
NURSINGTB.COM
DIF: Application
MULTIPLE RESPONSE
1. Which statement made by an RN regarding delegation indicates the need for additional
teaching? (Select all that apply.)
a. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5
minutes for a patient who is receiving a blood transfusion because a reaction now
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 increasing renal perfusion.
d. UAPs can transfer a patient who is being discharged home from the wheelchair to
the bed if they have received training and demonstrated competency.
e. Responsibility can be delegated to the UAP, but the delegator retains
accountability.
ANS: A, B, C

The statement “UAPs can assess vital signs during the first 5 minutes for a patient who is
receiving a blood transfusion because a reaction at this time is unlikely” indicates the need for
further teaching because the patient is at highest risk of a reaction during the first few minutes
of a blood transfusion; thus, the assessment skills of an RN are required. The statement “an
LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD”
indicates the need for further teaching because administration of intradermal medication
requires the skill of an RN. Dopamine is a vasoactive drug that can have a profound effect on
a patient’s blood pressure and cardiac output; administration requires the assessment and
evaluation skills of an RN.
DIF: Analysis
2. When considering the feasibility of an all-RN staff, a nursing administrator determines what
fact concerning the RN’s role? (Select all that apply.)
a. They are generally costlier and less efficient than LPNs.
b. They are usually more reactive than proactive to patient care errors.
c. They have a positive effect on patient outcomes when managing patient care.
d. They are effective overseers of patients’ overall health condition.
e. Their training makes them effective care delegators.
ANS: C, D, E
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 and effective delegation of care.
DIF: Comprehension
3. Which functions can be delegNaU

teR
dSonIlyNtG
oTanBo.
thC
erORMN with appropriate experience and
training? (Select all that apply.)
a. Assessment of skin integrity on third day of hospitalization
b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises
c. Nursing judgment related to withholding medication based on vital signs
d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses
or unlicensed assistive personnel.
e. Formulation of nursing diagnosis “potential for fall”
ANS: A, B, C, E
Activities like assessing skin integrity—which include the core of the nursing process and
require specialized knowledge, judgment, and/or skill—can be delegated only to another RN.
Activities like evaluating patient teaching—which include the core of the nursing process and
require specialized knowledge, judgment, and/or skill—can be delegated only to another RN.
Activities like deciding to withhold medication based on vital signs—which include the core
of the nursing process and require specialized knowledge, judgment, and/or skill—can be
delegated only to another RN. Activities like formulating a nursing diagnosis—which include
the core of the nursing process and require specialized knowledge, judgment, and/or skill—
can be delegated only to another RN.
DIF: Application

Chapter 21: Staffing and Nursing Care Delivery Models

Edition
MULTIPLE CHOICE
1. How do accrediting agencies such as The Joint Commission address staffing?

a. Imposing maximum staffing levels
b. Requiring a specific staff mix
c. Stipulating nurse-patient ratios
d. Confirming delivery of satisfactory care
ANS: D
Accrediting agencies do not address minimum staffing levels; however, they do look for
evidence that patients receive adequate care, and this can occur only with adequate staffing.
DIF: Comprehension
2. What is customer satisfaction primarily based upon?

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 affect clinical outcomes, functional
status, and even physiologic N
mUeaR
suSreIsN
oG
f hTeB
al.
thC
. OM
DIF: Knowledge
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. This is not true of the other
options.
DIF: Comprehension
4. A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive
personnel (UAP) are responsible for implementing a specific task, such as medication
administration or personal hygiene, for the entire nursing unit. What term is used to describe
this type of delivery system?
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. This is not true for the other options.
DIF: Comprehension
5. What title identifies a 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?
a. Nurse manager
b. Case manager
c. Coordinator of patient-centered care delivery
d. Team leader in team nursing care delivery
ANS: B
The case manager, in collaboration with an interdisciplinary team, oversees the use of health
care services by clients throughout a course of illness.
DIF: Comprehension
6. A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass
grafting (CABG). According to the clinical pathway the patient should be extubated and
discharged from critical care the day after surgery. During surgery the patient’s oxygen
saturation decreased drastically because of chronic tobacco abuse. Subsequently, the patient
remained on the ventilator anNaddRitioI
nalG
U S
practice guideline for CABG, this N2 dTB
situation
ay.
sCpostMoperatively. According to the clinical
results in what type of event?
a. Patient outcome
b. Variance
c. Care goal
d. Nursing standard
ANS: B
A variance is a deviation from the planned path.
DIF: Comprehension
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 by what term?
a. Patient classification system
b. Clinical pathway
c. Patient-centered plan of care
d. Diagnosis-related group (DRG)
ANS: B

A clinical pathway is a plan that specifies the timing and sequencing of major patient care
activities and interventions by the interdisciplinary team for a particular diagnosis, procedure,
or health condition.
DIF: Comprehension
8. The nurse manager determines that four RNs, five LPN/LVNs, and two unlicensed assistive
personnel (UAP) are required per shift to meet the needs of the patient population on the unit,
according to acuity and census. The nurse manager is concerned with what related process?
a. Assignments
b. Staffing
c. Output
d. Productivity
ANS: B
Staffing is the activity of determining that an adequate number and mix of health care team
members are available to provide safe, high-quality patient care.
DIF: Comprehension
9. A nurse manager is mentoring a novice nurse manager in determining staffing needs. The
mentor explains that the acuity level of the patient is determining by implementing what
process?
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.”
N R I G B.C M
ANS: B U S N T O
Patient acuity is measured by determining the amount and intensity of care required.
DIF: Comprehension
10. The nurse manager is planning staffing levels and realizes that the first step is to focus on
what activity?
a. Knowing the intensity of care needed by patients according to physical and
psychosocial factors
b. Examining the educational level of the staff
c. Assessing the skill level of caregivers
d. Reviewing the budget to determine the financial consequences of past staffing
patterns
ANS: A
The nurse manager must determine the number and mix of health care providers according to
the wide range of care requirements of individual patients.
DIF: Application
11. A hospital is concerned with nurse retention and realizes that job satisfaction is a major
influence. To best enhance employee satisfaction related to staffing, what intervention should
the management team implement?
a. Begin negotiating for additional agency nurses.

b. Propose hiring more part-time employees.

c. Adopt the concept of participatory staff involvement.
d. Regularly use “float” nurses to cover vacancies.
ANS: C
Staffing methods that include staff participation and enhance staff autonomy have been
demonstrated to play a major part in ensuring employee satisfaction.
DIF: Application
12. A patient is admitted for a hysterectomy, and the RN develops and implements the plan of
care but also delegates to the LPN/LVN the responsibility of administering oral medications.
While off duty, this RN receives a call requesting a change in the plan of care because the
patient has developed deep vein thrombosis. The nurse who originally planned the care is
practicing which type of nursing care delivery?
a. Modular
b. Primary
c. Team
d. Functional
ANS: B
The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the
patient’s care from admission through discharge but may delegate or provide primary care
during the shift when present.
DIF: Comprehension
13. When deciding which staffinN

g opRtionIto G
U S N use TBo.
nC
a nuM
Orsing unit that will open soon, the manager
recognizes what basic fact related to this issue?
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 three
consecutive days per week.
b. The use of part-time nurses provides the variability needed to meet diverse patient
needs.
c. Satisfaction of the staff equates to satisfaction of patients.
d. Nurses provide the same level of care, regardless of the work environment.
ANS: C
High nurse satisfaction is generally equated with high patient satisfaction and positive patient
outcomes.
DIF: Comprehension
14. A task force is considering factors that contribute to high-quality safe staffing. Which
statement reflects an understanding of the American Nurses Association’s (ANA)
recommendations?
a. Because patient needs remain constant on a daily shift, staffing needs at the
beginning of the shift should be sufficient to provide safe, high-quality care.
b. Staffing should allow time for the RN to apply the nursing process so decisions
result in high-quality, safe patient outcomes.
c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel

to provide routine basic care rather than increasing RNs in staff mix.
d. RN staffing is not cost-effective; thus, is it important for staffing models to limit
the number of RNs assigned per shift.
ANS: B
The ANA recommends that nurses have time to exercise professional judgment; that would
include the achievement of outcomes?
DIF: Analysis
15. A nursing unit comparing team nursing to the partnership model would find what statement to
be true?
a. With the partnership model, an RN does not have to be part of the mix.
b. Leadership abilities of the RN are a major determinant of effectiveness of care for
both models.
c. The RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to
apply the nursing process in team nursing.
d. With team nursing the RN cares for the patient while the team members work with
the family or significant others.
ANS: B
The RN leads regardless of whether partnership model or team nursing is practiced.
DIF: Comprehension
16. When a nurse uses a criteria such as “high risk for falls,” “infection protocols,” and “special
communication needs” to determine the mix and number of staff needed on a telemetry unit,
what is the nurse is using? NURSINGTB.COM
a. A patient classification system
b. Diagnostic-related groups
c. Case management
d. Clinical pathways
ANS: A
Patient classification systems group patients according to care needs to determine safe staffing
levels.
DIF: Comprehension
17. A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms
211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have half the
rooms, with one assigned to 200-215 and the second to 216-232. What term is used to identify
the care delivery model being used?
a. Team
b. Primary
c. Partnership
d. Modular
ANS: D
Modular (or geographic) assignments are based on a geographic location in the nursing unit.
DIF: Comprehension

18. A patient has decided to stop hemodialysis because his renal failure progresses and he wishes
to spend more time with family. Palliative care will continue, and the approach will be
discussed with the patient and family as needed and at change of shift. The care delivery
model in this situation is referred to by what term?
a. Partnership
b. Patient-centered
c. Case management
d. Total patient care
ANS: B
Patient-centered care models entail the health care team partnering with the patient and family
to ensure that patients’ wants, needs, and preferences are the priority while allowing the
patient and family to participate in decisions and educational needs.
DIF: Comprehension
19. A nurse plans care knowing when specific recovery milestones are expected. The nurse is
providing care via what delivery model?
a. Patient classification systems
b. Clinical pathways
c. Functional nursing
d. Case management
ANS: B
Clinical pathways plans patient care activities and interprofessional interventions and desired
patient outcomes within a specified time period for a particular diagnosis or health condition.
NURSINGTB.COM
DIF: Comprehension
20.20.
An orthopedic unit is considering different types of care delivery models and staff have an
opportunity to ask questions about how the models differ. The nurse manager provides an
overview and uses the above visual to demonstrate which model of care delivery?
a. Team
b. Partnership
c. Primary
d. Functional
ANS: D
Functional care delivery models assign tasks to each provider. In the above visual, the LPN is
responsible for oral medication administration, the unlicensed assistive personnel provide
hygiene, and the RN is assigned to task that require the nursing process.
DIF: Application

MULTIPLE RESPONSE
1. While participating in a task force to proactively plan for nursing care delivery over the next
20 years, a nurse learns that dramatic changes will occur because of what factor? (Select all
that apply.)
a. The increases 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 lifestyles and
values of a diverse population.
DIF: Comprehension
2. Which factors would be considered in the first steps in developing an effective patient
classification system? (SelectNaU
llRthS
aI pG
t aN y.B
plT ) .C OM
a. Planned procedures
b. Ethnic diversity of patients
c. Clinical competency of staff
d. Educational level of nurses
e. Age of patients
ANS: A, B, E
The first step in developing a patient classification system is to understand the intensity of
care needs, which requires identifying specific patient characteristics and care requirements.
DIF: Comprehension
3. A nurse responsible for staffing a medical-surgical unit must consider what factors (Select all
that apply.)
a. The patient census
b. Physical layout of the unit
c. Complexity of care required
d. Educational level of all staff
e. Task preferences of the nurses
ANS: A, B, C, D

The primary considerations for staffing a specific nursing unit are the number of patients; the
level of intensity of care required by those patients (commonly referred to as patient acuity);
contextual issues, such as architecture, geography of the environment, and available
technology; level of preparation and experience of the staff members providing the care; and
the quality of the nurses’ work life.
DIF: Application
NURSINGTB.COM

Chapter 22: Quality Improvement and Patient Safety

Edition
MULTIPLE CHOICE
1. A nurse is preparing to administer a medication by using the vastus lateralis site and is
unfamiliar with the process. A step-by-step reference that shows how to complete the process
is referred to by what term?
a. Deployment flowchart
b. Top-down flowchart
c. Pareto chart
d. Control chart
ANS: B
A top-down flowchart shows the sequence of steps in a job or process such as medication
administration. A deployment flowchart maps out the steps of a process under headings that
designate the people or departments who carry out each step. A Pareto chart is a type of bar
graph, with the height of bars reflecting the frequency with which events occur or the effect
events have on a process problem. A control chart is basically a run chart with statistical
control limits added.
DIF: Comprehension
2. What nonprofit organization distributes knowledge related to health care for the purpose of
improving health to governmN entaRl agIencG
ies,Bth.eCpubMlic, business, and health care
professionals? U S N T O
a. Institute for Safe Medication Practices
b. Institute of Medicine (IOM)
c. National Committee for Quality Assurance
d. The Joint Commission. (TJC)
ANS: B
The Institute of Medicine is a nonprofit organization whose mission is to advance and
disseminate to the government, the corporate sector, the professions, and the public scientific
information that will improve human health.
DIF: Comprehension
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 using what term?
a. Root cause
b. Sentinel event
c. Variation in performance
d. Causal factor
ANS: B

A sentinel event is an unexpected occurrence that could result in serious physical or

psychological injury to the patient, including the possibility of returning to surgery and a
prolonged length of stay. A root cause or causal factor is the factor that resulted in a sentinel
event. A variation in performance is the action that includes the occurrence or possible
occurrence of a sentinel event.
DIF: Comprehension
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 engaged
in what process?
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 process improvement that involves developing
and adhering to best-known methods and repeating key tasks in the same way, time and time
again, until a better way is found, thereby creating exceptional service with maximal
efficiency. Process variation Nis aRdiffI
erenGce B
in.hC
ow the steps in a work process might be
accomplished and/or the variables that may affectOeach step in the process. Variation results
U S N T
from the lack of perfect uniformity in the performance of any process. A deployment
flowchart maps out the steps of a process under headings that designate the people or
departments who carry out each step. This type is especially helpful when dealing with
processes that cross multiple areas or caregivers and when there is a need for common
under-standing of what the process is doing as a whole.
DIF: Comprehension
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
documented using what tool?
a. Pareto chart
b. Control chart
c. Deployment chart
d. Top-down flowchart
ANS: B

The control chart is a run chart that has a centerline and added statistical control limits that
help to detect specific types of change needed to improve a process. A Pareto chart is a type of
bar graph, with the height of bars reflecting the frequency with which events occur or the
effect events have on a process problem. A control chart is basically a run chart with statistical
control limits added. A top-down flowchart shows the sequence of steps in a job or process
such as medication administration.
DIF: Comprehension
6. Regardless of the term used to describe high-quality health care, what is the primary focus of
quality?
a. Meeting consumer needs and wants
b. Providing economical care
c. Utilizing technologic advancements
d. Equally distributed care
ANS: A
The customer determines quality based on his or her unique perception of high-quality care.
DIF: Knowledge
7. A team of experienced nurses work together to develop algorithms that are converted into
checklists to ensure standardization of commonly performed procedures. The focus of this
team is primarily on which Institute of Medicine (IOM) competency?
a. Safety
b. Timely
c. Equitable
d. Patient-centered care NURSINGT B.COM
ANS: A
Standardization contributes to safety and improves individual performance of care providers.
DIF: Comprehension
8. An organization’s emergency preparedness task force meets to discuss how it should react in
case of a terrorist attack and develops a disaster evacuation plan that details how each
department will assist individuals in reaching safety. This type of diagram is referred to using
what term?
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. A
top-down flowchart shows the sequence of steps in a job or process such as medication
administration. A Pareto chart is a type of bar graph, with the height of bars reflecting the
frequency with which events occur or the effect events have on a process problem. A control
chart is basically a run chart with statistical control limits added. A top-down flowchart shows
the sequence of steps in a job or process such as medication administration.

DIF: Comprehension
9. Patients with heart failure have extended lengths of stay and are often readmitted shortly after
they have been discharged. To improve quality of care, a type of “road map” that included all
elements of care for this disease and that standardized treatment by guiding daily care was
implemented. This road map is referred to using what term?
a. Clinical protocol
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. Clinical protocols or algorithms are different
from clinical pathways because they represent more of a decision path that a practitioner
might take during a particular episode or need. Case management is a nursing care delivery
system.
DIF: Knowledge
10. The staff on a nursing unit notes that patient satisfaction varies from month to month. They
plot the degree of patient satisfaction each month for 1 year to determine when the periods of
greatest dissatisfaction are occurring. The staff uses which type of graph to present this
information?
a. Time plot
b. Fish bone diagram N R I G B.C M
c. Flowchart U S N T O
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 cause-and-effect diagram is used for identifying and organizing possible causes of a
problem in a structured format. It is sometimes called a fishbone diagram because it looks like
the skeleton of a fish. Flowcharts?4 are pictures of the sequence of steps in a process.
Different steps or actions are represented by boxes or other symbols.
DIF: Comprehension
11. A group of nurses are presenting the importance of high-quality care during a system-wide
meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that
supports what?
a. Being insured has little effect on a person’s longevity and the quality of care
received.
b. Lobbyists for the drug companies can gain permission for the use of new drugs
within 1 year of their discovery.
c. Although a greater number of lawsuits stem from medication errors, more people
actually die from human immunodeficiency virus (HIV) and acquired
immunodeficiency disease syndrome (AIDS).
d. Medication-related errors place a tremendous financial burden on the U.S. health
care system.

ANS: D
Medication-related errors for hospitalized patients cost roughly $2 billion annually.
DIF: Comprehension
12. According to the Quality Chasm report what statement is true?

a. Health care providers should be proactive rather than reactive to patient needs.
b. Common needs rather than individual preferences should be the priority.
c. Medical information should be confined to the primary care provider.
d. Specialized providers or case managers should control health care decisions.
ANS: A
Quality is based on predicting patient needs rather than reacting to needs.
DIF: Comprehension
13. During the night, a patient fell in the bathroom and sustained a hip injury. The patient was
very upset because of being unable to attend a granddaughter’s wedding in 2 days. The team
looked at the process and determined that the patient had been medicated with a narcotic, had
urinary urgency so had not taken the time to put on shoes, failed to turn on the light because
the door to the hall let in some light, and stumbled over a towel that had been placed to collect
water leaks caused by construction that was in progress to replace damaged sinks. Which
factor was a special cause variation?
a. Failure to take time to put on shoes due to urgency
b. Unsteady gait due to narcotic administration
c. Poor lighting that led to decreased vision
d. Improper construction thaNt caRuseI d thG
e leB
ak.aC
nd tM
owel placement
U S N T O
ANS: D
A special cause variation is an uncommon variation that is unstable and unpredictable, is not
under statistical control, and is related to a clearly identified single source, which in this
scenario is the construction project.
DIF: Analysis
14. The number of IV site infections has more than doubled on a nursing unit. The staff determine
common causes include the site is cleaned using inconsistent methods, dressing frequently
becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and
inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in
descending order, with 80% of infections being attributed to inadequate hand washing. The
quality tool used is referred to as what?
a. Cause-and-effect diagram
b. Run chart
c. Pareto chart
d. Flowchart
ANS: C

Pareto charts are bar graphs that show causes contributing to a problem in descending order
so the leading cause is easily recognized. A cause-and-effect diagram is used for identifying
and organizing possible causes of a problem in a structured format. It is sometimes called a
fishbone diagram because it looks like the skeleton of a fish. Flowcharts?4 are pictures of the
sequence of steps in a process. Different steps or actions are represented by boxes or other
symbols. Run charts, also known as time plots, are graphs of data points as they occur over
time.
DIF: Comprehension
15. The surgical team arrives in the operating room and one-member states, “Everyone stop. Let’s
identify the patient and operative site. Now does anyone have any questions or concerns?”
This process is referred to by what term?
a. Time-out
b. A critical pathway
c. Special cause variation
d. Lean methodology
ANS: A
A time-out occurs in the operating room to ensure the entire surgical team identifies the
patient, operative site, and possible concerns or questions about the procedure.
DIF: Comprehension
16. Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with
steps known as “PDCA.” What statement should be made when explaining the steps to a
group of nurses interested in improving the process of medication reconciliation for heart
NofRrS
failure patients with high rates U
I ivis
ecidN
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a. P stands for process. Following a top-down flowchart provides the steps for
reviewing patient medications taken at home compared to those prescribed during
hospitalization.
b. D stand for deviation, which is an alteration in the expected drugs ordered.
c. C is for check if the process for change worked. Was there an improvement in
accurate reconciliation? And what was learned? A stands for algorithm, which
includes all steps of the process.
d. A stands for algorithm, which includes all steps of the process.
ANS: C
C stands for check if the change improved the process and what was learned.
DIF: Analysis

17.17.
A hospital is concerned that the number of medication errors has increased significantly in the
past year. A project revealed four causes of medication errors. The above chart was used to
help staff and administration know where to focus efforts to reduce errors. Which process
improvement tool is used in this situation?
a. Run chart
b. Pareto chart
c. Flowcharts
d. Cause-and-effect diagrams
ANS: B
Pareto charts are used to prioritize areas to reduce medication errors. Eighty percent of all
errors were caused by interruptions, so this should be the area of priority.
DIF: Comprehension
18. A nurse is asked to “float” toNa teRlemIetry

GfloBo.
r aC
nd is to place a patient on telemetry monitor.
U S NofTEKG leads
The nurse is unfamiliar with placement O and would consult which type of chart
to learn the correct placement?
a.
b.

c.
d.
ANS: C
The Pareto chart is used to prioritize interventions that caused the majority of the problems.
DIF: Application
19. Which of the following occurrences would be classified as a sentinel event?

a. A postpartum patient who elects to breastfeed only twice daily develops mastitis.
b. A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather
than the upper thigh as instructed by the patient educator.
c. A nurse assisting with the delivery of twins places the “Twin 1” name tag on the
second-born twin, causing the first-born twin to undergo surgery that was
NU
scheduled for the other twin. RS INGTB.COM
d. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin
subcutaneously, resulting in a drop in the patient’s serum glucose from 160 to 100
mg.
ANS: C
Any procedure performed on a wrong person or organ constitutes a sentinel event.
DIF: Application
20. A patient is ordered a low-protein, low-calorie diet but the patient’s family brings fish, lentils,
and unleavened bread for a meal to observe a cultural practice. The nurse works with the
dietitian to adjust the next few meals to accommodate for this variance. What term should be
used to identify this situation?
a. A sentinel event
b. An adverse event
c. Patient-centered care
d. The communication technique of “call-out”
ANS: C
The nurse and dietitian are respecting patient values, preferences, and expressed needs.
DIF: Comprehension

21. Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a
homeless person who will need wound care and follow up over the next 4 weeks. Each
member contributes based on his or her area of expertise but also recognize other members’
strengths. Which of the QSEN competencies are being demonstrated?
a. Quality improvement
b. Evidence-based practice
c. Teamwork and collaboration
d. Patient-centered care
ANS: C
An interdisciplinary team is working to prevent hand-off errors on discharge.
DIF: Comprehension
22. Which of the following statements concerning the Institute of Medicine (IOM) competencies
is correct?
a. Each competency is mutually exclusive.
b. The competencies focus on individual efforts to reduce errors.
c. Physicians lead the team to achieve each competency.
d. The competencies address both individual and system approaches to transform
care.
ANS: D
Errors and increased health care costs result from both the actions of health care workers and
the nature of the system in which they deliver care.
DIF: Comprehension
NURSINGTB.COM
23. Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review
medications prior to administration to reduce potential drug interactions. Software is also
installed that provides video clips of common procedures performed by nurses. Nurses on this
unit are best demonstrating which QSEN competencies?
a. Patient-centered care
b. Informatics
c. Teamwork
d. Quality improvement
ANS: B
Technology (PDA) is used to aid decision making and reduce errors.
DIF: Comprehension
MULTIPLE RESPONSE
1. A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM.
The surgical team adheres to the 2018 National Patient Safety Goals by implementing which
protocols? (Select all that apply.)
a. The surgical team asks the patient to verify his or her name, type of surgery, and
limb to be removed.
b. Ask each member of the surgical team to provide a copy of licensure and, if
applicable, certification to patient and family.

c. The surgical team uses the chart number and name/hospital number to ensure they
have the correct patient.
d. Mark the procedure site with “X” and again ask the patient to verify correct site.
e. After arrival in the operating room, perform a “time-out” for final identification of
patient and operative site along with agreement of what procedure is scheduled.
ANS: A, C, D, E
The 2018 National Patient Safety Goal includes universal precautions to ensure patient safety
and prevent sentinel events. Methods to identify patient and surgical procedure are required.
DIF: Application
2. The National Database of Nursing Quality Indicators (NDNQI) identifies what client focused
events as outcome indicator? (Select all that apply.)
a. A patient falls and fractures a hip.
b. A patient develops bilateral pressure ulcers on their heels.
c. A patient develops a catheter-associated urinary tract infection.
d. A patient develops post-surgical delirium.
e. A patient develops pneumonia related to ventilator use.
ANS: A, B, C, E
Outcome indicators include patient falls, pressure injuries, catheter-associated urinary tract
infections, and ventilator-associated pneumonia. Post-surgical delirium is not identified by
this organization.
DIF: Application
3. A nurse educator is explaininN

g toRlicI
enseGd stB
af.
fCthatMhealth care is no longer safe and describes
U S N T
The Quality and Safety for Nursing (QSEN) recommended competencies for educating
nursing professionals. What competency is included? (Select all that apply.)
a. Advanced health assessment techniques
b. Patient-centered care
c. Prescriptive pharmacology content
d. Quality improvement
e. Safety
ANS: B, D, E
Patient-centered care is a recommended competency, along with teamwork and collaboration,
evidence-based practice, and informatics. Quality improvement is a recommended
competency, along with patient-centered care, teamwork and collaboration, evidence-based
practice, and informatics. Safety is a recommended competency, along with patient-centered
care, teamwork and collaboration, evidence-based practice, and informatics.
DIF: Comprehension
COMPLETION
1. Quality is defined by the .
ANS:
patient

Quality is based on the perspective of the consumer or, in this instance, the patient.
DIF: Knowledge
2. While taking a shower, a patient pushes the emergency light. When the nurse arrives, the
patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient’s
walker and the patient falls, hitting the right side of the face resulting in loss of vision in the
right eye. This scenario represents a event.
ANS:
sentinel
A sentinel event is an occurrence that results in death or serious illness and requires
immediate investigation.
DIF: Comprehension

Chapter 23: Health Policy and Politics: Get Involved!

Edition
MULTIPLE CHOICE
1. A bill is pending in the state legislature that will mandate teaching health promotion related to
smoking cessation. Which action by the nurse should have the greatest impact on passage of
the bill?
a. Explain the rationale for the bill to the school board.
b. Contact the elected representative’s office by telephone to request support for the
bill.
c. Support a health advocate to run for election as state representative.
d. Tell all students about the bill.
ANS: B
Telephone calls are an effective means of communicating your support for a bill, next to a
face-to-face meeting; ask to speak to the staff person assigned to the bill or issue for which the
call is being made. After introducing yourself, give a brief and simple message such as,
“Please tell Senator/Representative [name] that I support [bill number].”
DIF: Application
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 N
the R
leasI GelyBm.eCthoM
t tim d of reaching elected officials would be
via what route? U S N T O
a. Letter
b. Telephone
c. e-mail
d. Facsimile (fax)
ANS: A
Sending letters is the least timely mode by which to communicate with elected officials;
because of the anthrax decontamination process that is now in place, delivery of U.S. mail to
Congress and to the White House may be delayed by as long as 3 months, making letters an
inefficient means of communicating with policymakers.
DIF: Comprehension
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 implement what action?
a. Educating the public about the nurse’s political platform
b. Being spontaneous and not deliver a rehearsed speech
c. Addressing the person as “candidate” rather than using a first name that implies a
working relationship
d. Learning 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.
DIF: Application
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 what organization?
a. National Registry for Candidates
b. American Nurses Association Nurses
c. National League of Nurses
d. National Council of State Boards of Nursing
ANS: B
Through legislative updates, American Nurses Association Nurses Action Center keeps
members up-to-date about background information and the platforms of candidates who are
running for national office and also provides updates about key bills as they move through the
legislative process.
DIF: Comprehension
5. Political action committees (PACs) are established for what purpose?

a. Financially supporting candidates
b. Persuading policymakers to support certain policies
c. Lobbying legislators
d. Recommending health care policy
ANS: B NURSINGTB.COM
A PAC is an arm of an organization, association, or labor union that is formed to persuade a
policymaker to support a certain policy or program or, more often, to ensure the election or
reelection of policymakers who support the organization’s goals.
DIF: Comprehension
6. When the policy process is compared with the nursing process, identifying the issue is
consistent with which step of the nursing process?
a. Assessment
b. Diagnosis
c. Planning
d. Implementation
ANS: B
The diagnosis step in the nursing process is consistent with identification of the targeted issue
in the political process. As politically active nurses soon discover, effective involvement in
policy development and political activities requires efforts similar to those used in the nursing
process. The policy process and the nursing process are systematic approaches that use the
nursing process for decision making.
DIF: Comprehension

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 can originate major policy initiatives is the branch.
a. executive
b. legislative
c. judicial
d. administrative
ANS: B
The legislative branch possesses the sole federal power to enact legislation; the legislative
branch originates and promotes major policy initiatives and has the power to override a
presidential veto.
DIF: Comprehension
8. A concerned nursing student calls the office of an elected official to voice support for the bill
to ban smoking in all public places. The secretary asks, “Are you a constituent?” What does
the term constituent mean?
a. A member of a professional organization who supports the organization’s political
issue
b. A citizen who is registered and is eligible to vote for a representative
c. An elected official who proposes legislation to be considered as a potential law
d. A member of the House of Representatives who is seeking support for a particular
bill
ANS: B
A constituent is a citizen who can vote for candidates in elections for representation at local,
state, and federal governmenN evReS
t lU ls.INGTB.COM
DIF: Knowledge
9. A person who is covered by Medicaid moves from one state to another and asks the nurse at
the health department why the benefits changed. What is the nurse’s correct response?
a. “Local government controls which benefits each county can provide to Medicaid
recipients.”
b. “The federal government does not fund any part of Medicaid, so each state must
find ways to pay for benefits.”
c. “Each state determines benefits on the basis of the present economy.”
d. “Medicaid is funded by both state and federal governments, but benefits vary from
state to state.”
ANS: D
Medicaid is a program that is funded through a combination of state and federal funds; thus,
benefits vary from state to state.
DIF: Analysis

10. Throughout the history of health care in our nation, one particular piece of federal legislation
provided funds for hospital construction. As the number of hospitals rapidly increased, the
need for nurses to staff hospitals also increased, and the shift from community-based nursing
care to hospital-based nursing care began. What fundamental piece of legislation was the basis
of this action?
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.
DIF: Comprehension
11. Members of a state’s constituent member association meet at a local restaurant to plan a Nurse
Walk to support the local food bank. When entering the restaurant, the nurses note the
environmental inspection report shows deficiencies because food handlers were not wearing
hairnets and rodents were spotted, resulting in a score of 60 out of 100. This certificate of
inspection is health policy enforced at which level of government?
a. Local
b. State
c. Federal
d. International
NURSINGTB.COM
ANS: B
Health policy at the state level is responsible for ensuring food safety in restaurants.
DIF: Comprehension
12. Soon, the largest segment of the population will be those over age 65 years. To advocate for
this vulnerable population, a nurse was a strong supporter for the Medicare Modernization Act
(Medicare Part D), which focuses on what?
a. Providing vision care benefits to elderly persons who were diagnosed as legally
blind
b. Removing limits to access to mental health/substance abuse services which are the
most commonly used service in this population
c. Providing coverage for medications for Medicare enrollees that constituted a huge
expense for the elderly
d. Expanded the practice opportunities for advanced practice registered nurses
(APRN) who provide the majority of care for this population
ANS: C
The Medicare Modernization Act provided medication benefits to Medicare recipients and
encouraged policymakers to have oversight to ensure drug effectiveness.
DIF: Comprehension

13. If a nurse practicing in a mental health agency could only belong to one professional
organization, what criteria could be used to select the organization with the biggest impact?
a. The American Nurses Association has a strong voice representing the nation’s
entire RN population.
b. Specialty organizations such as the American Psychiatric Nurses Association
lobby for higher education requirements for nurses.
c. State nursing associations have limited power because they can lobby only state
representatives.
d. Professional organizations such as The American Association for the History of
Nursing (AAHN) record the history of mental health nursing.
ANS: A
The American Nurses Association is the voice for all registered nurses.
DIF: Application
14. A group of nurses meet with a state representative to explain the importance of allowing
registered nurses the right to sign death certificates for patients who were under their care. As
constituents and nurses, they requested that the senator vote against the bill restricting this
practice. These nurses are serving in what role?
a. Lobbyists
b. Policymakers
c. Officials with regulatory power
d. Advocates for the Patient Safety and Quality Improvement Act
ANS: A
Lobbyists hope to educate anN dUcoRviI
nS ncNeGpoTliB
cy.mCaO
keMrs to respond positively to a particular
position on an issue or to follow a particular course of legislative or regulatory action.
DIF: Comprehension
MULTIPLE RESPONSE
1. A nurse is concerned about older persons living alone at home without telephone service to
contact emergency services. The nurse is advised to take part in grassroots efforts to address
the situation. The nurse would take what action to increase effectiveness of the effort? (Select
all that apply.)
a. Posting signs to support the county’s political candidates whose platform support
services for poor and underserved person such as older adults
b. Visiting with local politicians running for office and ask specific questions such as,
“Would you support providing free emergency telephone service for older adults
living alone?”
c. Limiting voting to only presidential elections in which a candidate promises to
initiate health care reform related to Medicare for older adults
d. Joining the American Nurses Association and constituent member association
e. Contacting representatives from surrounding states to garner support for free
medical alert systems for older adults
ANS: A, B, D

Working in local political campaigns is an effective grassroots effort. Visiting, e-mailing,

calling, and faxing local politicians to support free emergency telephone service for older
adults is a grassroots tactic. Joining ANA and state nursing associations supports these
organizations’ lobbying efforts and is thus a way for individual nurses to influence the issues
that nursing associations support.
DIF: Application
2. A nurse is interested in learning more about health policy and how it might impact nursing
practice. She is especially interested in The Patient Protection and Affordable Care Act
(PPACA) and how it will travel through the three branches of the federal government. When
researching the roles of the legislative branch of the federal government what does the nurse
learns about this branch? (Select all that apply.)
a. It determines which laws are constitutional, such as recently deciding the PPACA
is constitutional because it is a form of taxation.
b. It has the exclusive power to determine where federal dollars will be spent, such as
supporting the PPACA.
c. It consists of the Office of the President and 15 executive departments that
supported the PPACA.
d. It has the power to veto laws found constitutional by the Supreme Court and
therefore could veto the PPACA.
e. It can override a Presidential veto, making it possible to amend the PPACA even
without approval of the President.
ANS: B, E
The legislative branch possesses the sole power to enact legislation, tax citizens, and allocate
federal spending. The legislaN
tureRcanIovG
erridBe.aCpreM
sidential vote.
U S N T O
DIF: Application
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
2. The greatest barrier to access to health care for a poor Hispanic person living in downtown
Chicago is lack of health .
ANS:
insurance

Lack of health insurance is the greatest barrier to access to health care and it has a tremendous
impact on an individual’s health. Studies have consistently found that the uninsured receive
less than adequate health care.
DIF: Comprehension
3. Another name for an eligible voter is a .
ANS: constituent
DIF: Comprehension
NURSINGTB.COM

Chapter 24: Making the Transition From Student to Professional Nurse

Edition
MULTIPLE CHOICE
1. During orientation, a novice nurse sits and “virtually spends” the first few paychecks,
envisioning the money going into a personal bank account. In the dream state, the nurse
smiles and knows that the pain of nursing school was worth it. Which phase of reality shock is
the nurse experiencing?
a. Honeymoon
b. Shock or rejection
c. Recovery
d. Resolution
ANS: A
During the honeymoon phase, the novice nurse has a positive image of nursing that coincides
with the reason for becoming a nurse; this feeling is experienced immediately after the nurse
begins work and often while still in orientation. 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. The novice nurse
begins to understand the new culture to a certain degree, thus there is less tension and anxiety,
and healing begins in the recovery phase. In the resolution phase, work expectations are more
easily met, and the nurse will have developed the ability to elicit change.

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 identified with what
term?
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, everything is just as the new
graduate imagined. The novice nurse begins to understand the new culture to a certain degree,
thus there is less tension and anxiety, and healing begins in the recovery phase. In the
resolution phase, work expectations are more easily met, and the nurse will have developed
the ability to elicit change.
DIF: Comprehension
3. According to Kramer, nurses in the shock phase should ask themselves what?
a. “How can I fit in with other staff?”

b. “Why can’t I perform as everyone expects?”

c. “What changes can I make to make me feel good about the choice to become a
nurse?”
d. “How can I get the rest of the staff to change?”
ANS: C
During the shock or rejection phase, novice nurses must ask themselves what they must do to
become the type of nurse envisioned and to make a contribution.
DIF: Application
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 identified using what term?
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 merging of school values with those of the workplace. Transition is the
moving from one role, setting, or level of competency in nursing to another; change.
Going-native occurs when nurses decide they cannot fight the experienced nurses or the
administration, thus they adopt the ways of least resistance.

5. Several novice nurses share lunch breaks and have comments such as, “I have insomnia from
worrying about what I forgot to do for my patient,” and “I have no energy,” and “I can’t
believe I can’t do my job correctly.” These novice nurses are each experiencing different
symptoms of what process?
a. Burnout
b. Low self-esteem
c. Lack of confidence
d. Resilience
ANS: A
Symptoms of burnout include extreme fatigue, headaches, difficulty sleeping, mood swings,
anxiety, poor work quality, depression, and anger. Resilience is the capacity to recover
quickly from difficulties; toughness. The other options are symptoms of burnout; it is
demonstrated in an individual lacking confidence and self-worth.
DIF: Comprehension
6. Which nurse is more prone to burnout?

a. The one who graduated last in the class
b. The one who accepts most offers of overtime
c. The one who has worked on the oncology unit for 3 years
d. The one who regularly states, “I’m not able to make it better for my patients”

ANS: B
Burnout is more common among nurses with work schedules that are heavy; working
overtime regularly is a likely contributing factor. The other options are likely to trigger
compassion fatigue with signs and symptoms of hopelessness and low self-esteem.
DIF: Analysis
7. A nurse notices the novice 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. What role is the nurse
playing when taking his/her observations, concerns, and suggestions to the nurse manager?
a. Mentor
b. Rutter
c. Change agent
d. Role model
ANS: C
The novice nurse is working to improve the safety and patient environment and is acting as a
patient advocate and change agent. A mentor acts directing in guiding and encouraging a
nurse in the novice role. A role model is a person who serves as an example of what
constitutes a competent professional nurse. Rutters are individuals whose attitude is that they
will do only what they must to get by.
DIF: Comprehension
8. The novice nurse calls a supeN

rvUisRr aInN
oS dG quBe.
reT stsCtO
haMt a “float nurse” be assigned to help with
all “assessments of new admissions and postoperative patients.” The supervisor asks, “How
many admissions and surgery patients have you received?” The novice nurse becomes
flustered because she has not checked the census but simply bases the need on feeling
overwhelmed. This situation best indicates a lack of what type of skills?
a. Organizational
b. Communication
c. Interpersonal
d. Clinical
ANS: A
The novice nurse lacks proficiency or organization, 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 scenario gives no information to suggest a deficiency in any of the other
areas mentioned as options.
DIF: Comprehension
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.
This thought process is associated with priority setting.
DIF: Comprehension
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 what?
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 expectation
ANS: D
Outcomes are based on meeting existing criteria rather than on knowing how the outcome was
achieved.
DIF: Comprehension
11. When comparing mentoring and role modeling, the role of mentoring is represented by which
of the following situations?
a. The experienced nurse is unaware that the novice nurse is observing him or her
gathering supplies needed to start intravenous antibiotics.
b. The novice nurse mimics conversations with his or her own patients that were
unobtrusively overheard between the experienced nurse and his or her patients.
c. The novice nurse receives feedback from the experienced nurse related to the use
of a new occlusive dressiN
ng pRrodI
myself.” U SuctNGand TBis.tC
old,M“I couldn’t have done it better
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. The correct option demonstrates the experienced nurse
providing guidance/acknowledgement of the novice nurse’s skill level. The other options
demonstrate actions associated with the novice nurse looking at the experienced nurse for cues
for behaviors or acknowledging the abilities of the experienced nurse.
DIF: Analysis
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 identified by what term?
a. Mentoring
b. Role modeling
c. A preceptorship
d. Socialization
ANS: A

Mentoring is a personal relationship with a more experienced person willing to guide a novice
or inexperienced person. 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. Role modeling infers that an individual will serve as an example of competence to
another person. Preceptors serve to orient the novice nurse to the specific nursing area, aid in
socialization, and teach skills that are deemed necessary. Socialization involves the nurturing,
acceptance, and integration of a person into the profession of nursing; the identification of a
person with the profession of nursing.
DIF: Comprehension
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 an experienced nurse as 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. None of the other options provide
a realistic, safe learning environment for the reinforcement of this skill.
DIF: Application
14. A student nurse wants to meeNt U

otR
heSr I
nuNrG
sinTgBs.
tuC nM
deOts from different countries and to learn of
employment possibilities. The student nurse should consider doing what?
a. Participating in the clinical facility’s employee satisfaction task force
b. Joining the Student Nurses Association
c. Taking part in self-mentoring
d. Postponing the licensure examination to take a tour of foreign countries
ANS: B
Students who participate in pre-professional 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. None of the
other options provide a realistic opportunity to interact with other nursing students.
DIF: Comprehension
15. An experienced nurse working in oncology is shocked to realize that he/she 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.” What term is used to describe this
situation?
a. Burnout
b. Compassion fatigue
c. Reality shock

d. Horizontal hostility
ANS: B
The nurse is experiencing a gradual decline in compassion over time because of being
exposed to the many events that have distressed his or her patients over the years of practice.
Burnout is the physical or mental collapse caused by overwork or stress. Reality shock occurs
when a person prepares for a profession, enters the profession, and then finds that he or she is
not prepared. Horizontal hostility (also known as lateral hostility) is the covert or overt
directing of dissatisfaction toward peers, themselves, or those less powerful.
DIF: Comprehension
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.” What further information should the recruiter provide about a residency program?
a. It provides housing for the graduate nurse to decrease expenses until income is
established.
b. It partners a medical resident with a nurse resident to learn interprofessional care.
c. It allows new graduates to work on a higher degree in nursing while being paid
full-time.
d. It 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 to bridge the gap between the
classroom and practice.

17. A novice nurse is stressed due to always being behind with her assignments. She is overheard
saying, “No one here worries about checking nasogastric tube placement before they give
medications and hang feedings. Skipping that step would save me an extra 30 minutes to be
used for charting. If they can do it, so can I.” This nurse is experiencing which stage of reality
shock?
a. Loner
b. “Rutter”
c. Change agent
d. “Native”
ANS: D
The novice nurse is mimicking the actions of the experienced nurse taking shortcuts that were
not taught in school and not following policy and procedure. A loner adopts the attitude of
“just do the job and keep quiet.” These nurses may prefer night shifts, during which they often
are “left alone.” A rutter adopts the attitude that “I’ll just do what I have to do to get by.”
Change agents care enough to work within the system to elicit change.
DIF: Comprehension
18. A novice nurse is placed in charge just after orientation ends. Which statement by the novice
nurse would ensure a smooth delegation experience when delegating to an experienced staff
member?

a. “You have the patients in rooms 1 to 7. These patients require little skill so you
will be fine.”
b. “Your assignments are posted in writing by the nurses’ station. Be certain all your
tasks are completed so the next shift is not behind.”
c. “You have patients in rooms 5 through 10 and I will administer all IV medications.
I will let you know if I must adjust. If you see you need help let me know.”
d. “Everyone is capable of providing the best care, so please sign up for the patients
you would like to be assigned to.”
ANS: C
The nurse is clearly stating the assignments, allowing for a need to adjust both to needs of the
unit and the delegate’s needs.
DIF: Application
19. A novice nurse is in the “rejection phase” of stress and wonders if she/he made the right
decision when deciding nursing was her/his chosen career. Which strategy would help the
novice nurse cope with transition into practice and reduce stress?
a. When asked by the charge nurse to accept the new admission even though she/he
had no discharges, the novice nurse stops and considers if this request is acceptable
and safe, then accepts the assignment based on two patients having a low acuity
level.
b. Refusing to eat anywhere but the hospital cafeteria to ensure a balanced diet and
time to socialize with other staff and visitors.
c. Avoid wasting time by listening to coworkers’ problems or ideas on how to staff
the unit during the upcoming holiday since the novice nurse’s time is valuable and
Nn w
better spent getting her ow RorkIcoGmplBet.edC. M
d. Try to “win over” hostile oUr anS
gry N
cowTorkers O who find fault with the novice
nurse’s work performance.
ANS: A
To reduce stress and cope with the rejection phase of transition, the novice nurse should think
before answering—take a few minutes before answering and deciding what is best course of
action.
DIF: Analysis
MULTIPLE RESPONSE
1. In orientation, a new graduate is surprised to learn of workplace violence in health care

agencies and asks, “What kind of violence is common in hospitals?” The educator describes
workplace violence bases on what statement? (Select all that apply.)
a. It is the care of patients admitted who are victims of domestic violence.
b. It is experienced nurses withholding pertinent information from coworkers to
portray them as incompetent.
c. It encourages coworkers participating in an employee assistance program (EAP) to
learn more about anger management for adult children living at home.
d. It involves the care of persons being held for treatment prior to be incarcerated for
committing homicide.
e. It is demonstrated in statements such as “The new nurse has book sense but can’t

perform an admission physical without the help of everyone on the unit.”

ANS: B, E
Withholding information from novices or coworkers to purposely cause them to appear
inadequate or unskilled is considered workplace violence because of the anxiety and stress it
produces. This should not be tolerated and should be reported. Such statements, which belittle
employees, lead to job dissatisfaction, lack of teamwork, and burnout and are considered
lateral or workplace violence. This should not be tolerated and should be reported.
DIF: Application
2. Faculty comes to class to present information about joining the Student Nurses Association
(SNA). A student is heard saying, “Why join this organization? It is just a bunch of students
like us. I’ll wait and join the real nursing organization after graduation.” This student is not
aware of which benefits of SNA? (Select all that apply.)
a. Members are eligible to sit for the licensure examination at a reduced rate.
b. Leadership skills can be refined by working with other schools of nursing.
c. The National SNA provides discounted rates for study abroad opportunities.
d. A global view of nursing can be obtained through networking internationally.
e. Lobbying efforts are a major benefit of belonging to SNA.
ANS: B, D
Leadership opportunities are available as officers and through conferences. SNA members
work with other nursing students across the nation and internationally. None of the other
options are accurate statements concerning this organization or its benefits.
DIF: Comprehension
NURSINGTB.COM
3. Which statements demonstrate characteristics would be desirable in a mentor? (Select all that
apply.)
a. “How were you taught to do this is school?”
b. “Can you think of a way to make this easier for the patient?”
c. “Let me know when it’s a good time to show you how to do this new scale.”
d. “Everybody here does it this way.”
e. “Today was rough but there are fewer admissions scheduled for tomorrow. “
ANS: A, B, C, E
A mentor should be open and welcoming to change while being sensitive to the needs of
others. A positive outlook is a characteristic that is available when mentoring others.
DIF: Analysis
COMPLETION
1. It is important for novice nurses to know that “self-esteem = self-confidence + self-_ .”
ANS: respect
DIF: Knowledge

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

Edition
MULTIPLE CHOICE
1. When deciding whether to say no to a request that involves a time commitment, the
professional nurse must consider what initially?
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. Personal preference may be a
consideration but it is not the initial consideration. Neither of the remaining options are
significant factors to making a personal decision.
DIF: Application
2. Positive time management skills include an effective approach to what aspect of planning?
a. Maintaining an open-door policy
b. Retaining copies of paperNwoRrk I G B.C M
c. Returning telephone calls immS
U ediaN
telyT O
d. Scheduling daily activities
ANS: D
Planning is the most important step in time management. Scheduling activities allows people
to better use their time and can lead to closure in relation to those goals that will produce the
greatest internal satisfaction. An unregulated open-door policy can encourage interrupts that
affect daily work flow. The retaining of paper copies is not always necessary and is
determined by the organization and need of such references. Telephone calls need to be
prioritized and returned according to importance.
DIF: Comprehension
3. How can time be maximized to produce the best outcomes?

a. Making the first hour of each workday productive
b. Completing trivial tasks before performing important tasks
c. Eliminating recreational activities in the work environment
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. The order of task completion is reliant on priority. The remaining options are
considered barriers to efficiency.

DIF: Application
4. To conduct a productive meeting, the nurse should focus on what?

a. Providing each person all the time needed to discuss desired topics
b. Covering all emotional topics first
c. Creating an agenda with specific times allotted for each agenda item
d. Waiting for latecomers before starting the work of the meeting
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. Meetings seldom have the luxury of unlimited
time to discuss issues or to delay the start of the discussion. The agenda should be planned to
accommodate emotional topics.
DIF: Application
5. The nurse should consider delegating the task to which person?

a. The one needing to develop related skills
b. The one who is up for promotion
c. The one who has failed with similar tasks
d. The one deserving of a 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 respoNnU
siR
biSlitI
yNanGdTdB
ec.isC
ionM
making of others; (3) freeing time for
more important tasks; (4) extending results that can be accomplished from what one person
can do alone to what he or she can manage through others; and (5) ensuring that completing
the task is cost effective.
DIF: Application
6. When using the ABC system of managing time, which event should be coded A?
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. Client safety is a consideration
for A items.
DIF: Application
7. What action is appropriate when deciding whether and when a task should be completed?
a. Completing all tasks as they are received
b. Arranging according to the tasks’ time requirements

c. Asking, “What will happen if I don’t complete the task now?”

d. Viewing 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 to reach your goal. None of the other options allow for effective
prioritization.
DIF: Application
8. What principle should a nurse apply to assure effective daily planning?

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 factors carry the same weight, and adjustments will be needed.
DIF: Comprehension
9. What tactic is the inexperienced novice nurse using when prioritizing a client’s bed bath
before the need to insert a naN
sogaRstriI
c tuG
be (B
N.GC
) intM
o a client vomiting coffee ground emesis?
a. Energy management
U S N T
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. Priority setting would consider the more important task to be the NG tube
insertion. Introspection is the examination of one's own conscious thoughts and feelings.
Energy management ensures that the right amount of effort matches the right task to optimize
an outcome.
DIF: Comprehension
10. A student nurse assigned to work with the charge nurse finds the work to be satisfying and
receives several compliments from management and the nursing instructor for several creative
suggestions. The student nurse enjoys the project and attention and begins to prolong the
conclusion of the project. This behavior is indicative of what time management obstacle?
a. Need for perfection
b. Fear of losing creativity
c. Unclear project 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. Need for perfection demands extremely high standards for every single task you
undertake. The student has demonstrated creativity and has been complimented on it. There is
no indication that the goals of the task have not been met.
DIF: Comprehension
11. An inexperienced nurse feels that all tasks must be performed faultlessly, which leads to
his/her inability to complete all assigned tasks. This nurse would benefit from the seminar
focusing on what potential obstacle to efficiency?
a. Creativity
b. Perfectionism
c. Failure
d. Downtime
ANS: B
A perfectionist feels that everything should be completed at the same level of excellence. If
you demand extremely high standards for every single task you undertake, you simply will not
get everything done. None of the other options present this specific type of barrier to efficient
time management.
DIF: Comprehension
NURSINGTB.COM
12. A nurse is unable to concentrate on any one task or issue and is unable to view the health care
milieu sensibly. Which source of energy is missing in this nurse?
a. Physical
b. Mental
c. Spiritual
d. Emotional
ANS: B
Mental energy is the ability to maintain sustained concentration on a task, to move flexibly
between broad and narrow issues, and to be internally and externally focused, as needed by
the situation. It includes mental preparation, visualization, positive self-talk, effective time
management, and creativity.
DIF: Comprehension
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.
DIF: Application
14. A nurse realizes that much time is wasted during shift report when coworkers discuss personal
items such as recent movies or department store sales. Which statement would help with time
management during this critical interaction?
a. “Let’s talk only about only 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. None of the remaining options focus on solving the
problem refocusing on the task at hand.
DIF: Application
15. A nurse takes a day to travel to a state park where she/he can sit by the river alone to reflect
over recent events and put things into perspective. Time is spent recalling the time he/she was
complimented for the ability to deal with a difficult patient and another time when he/she was
NU. Th
criticized for lack of teamwork RSisInNurse
GTisB.C
impOroving which source of energy?
a. Emotional
b. Spiritual
c. Physical
d. Mental
ANS: B
Spiritual energy can be increased by taking time to reflect over events in one’s life and
allowing time to understand feelings associated with events/happenings. A quiet environment
is essential for reflection.
DIF: Comprehension
16. As part of a quality assurance project, a nurse is to round on every patient daily for 1 month to
ensure the intravenous tubing is labeled with date hung and nurse’s initials. The nurse is
hoping to be promoted to a full-time position within the quality department, and success on
this project is very important to receiving the position. The nurse retains all other assignments,
and is often interrupted to help other staff or answer call lights. The nurse discusses these
concerns with the manager, who frees him/her for 1 hour each day to make rounds. During
this 1 hour each day the nurse will organize herself/himself and environment by practicing
what organizational method?
a. Art of “no detourism”
b. Reducing stacked-desk syndrome
c. Art of “wastebasketry”

d. Managing e-mail and memo mania
ANS: A
The art of “no detourism” focuses on one task until completed.
DIF: Comprehension
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
should suggest what tips for time management? (Select all that apply.)
a. Focusing on activities to be completed, rather than on objectives
b. Planning today for tomorrow’s activities and needs
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
e. Picking five major objectives for the day and not stopping until they are achieved
ANS: B, D
Planning for the future is an effective time management strategy. Maintaining a log of how
you spend your time is an effective time management strategy.
DIF: Analysis
2. A nurse is having difficulty keeping up with the six assigned patients and serving on the ethics
committee. To take charge of both personal and work life, what activities should the nurse
focuses on improving physical energy? (Select all that apply.)
a. Telling himself/herself, “N
I pUrR idIeN
ovS saGfeTqBu.
alC
ityOcMare and will provide this level of
care to all my patients”
b. Taking a deep breath and remaining calm to develop patience
c. Keeping a bottle of water available to consume a minimum of 24 ounces each shift
d. Going into the nurse’s break room every 90 minutes to eat a healthy snack and
prioritize remaining care
e. Enrolling in the hospital-sponsored fitness program
ANS: C, D, E
Drinking plenty of water promotes physical health. Taking a break every 90 minutes,
especially during long shifts such as 12-hour shifts, provides a much-needed time to relax and
reorganize. Proper and frequent exercise promotes physical health.
DIF: Application
3. A nurse hopes to improve time management skills using the ABC prioritization approach.
Which tasks would be prioritized as “B”? (Select all that apply.)
a. Turn in time sheet due in 3 days.
b. Review dress code policy to give feedback before appointment in the morning.
c. Perform blood glucose test on a patient admitted with Kussmaul respirations and
change in level of consciousness.
d. Complete patient teaching prior to discharge in 2 hours.
e. Review procedure for inserting a PIC line to assist with procedure later this
morning.

ANS: B, D, E
Task that falls within Priority B includes the medium-value items, such as tasks that are not
urgent but most likely will not “fall” off the list. Since the dress code must be reviewed and
feedback constructed for a morning appointment, this would be level B, it is not urgent nor
will it likely fall off the list. Completing patient teaching for a patient to be discharged in 2
hours must be completed but does not take priority over “A” tasks. Reviewing a procedure to
be performed later in the day is Level “B.”
DIF: Application
4. The first task assigned by the time management coach is for the nurse to list all external
distractors that prevent organization and completion of tasks. What would the nurse include
on this list? (Select all that apply.)
a. Waiting for oncoming shift to start walking rounds
b. Failing to delegate tasks to the team members but instead, completing task herself
c. Talking with a patient’s family member who is also a personal friend
d. Spending time thinking about the vacation to the beach
e. Using the Internet to read about a new drug that will be administered
ANS: A, C
Waiting, such as for meetings or oncoming shift, is an external distraction. Socializing with
visitors is an external distraction.
DIF: Application
COMPLETION
NURSINGTB.COM
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

Chapter 26: Contemporary Nursing Roles and Career Opportunities

Edition
MULTIPLE CHOICE
1. What should be the primary focus of the care provider role for the nurse?
a. Using the nursing process to provide guidance to the patient in recovery
b. Encouraging both consumer self-responsibility and 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. While appropriate, the remaining options are relevant only after the nursing process
is implemented and needs are identified.
DIF: Comprehension
2. A nurse researcher is attempting to describe the demographics of today’s RNs and reports that
relevant information?
a. Less than half of all RNs work in hospital settings.
b. The average age for an RN is 50 years.
c. Approximately 25% of RNs are male.
d. Most RNs are entering practicing with a bachelor’s degree.
A substantial number (48.6%) of nurses enter practice with a BSN.
DIF: Comprehension
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. The infection control nurse assesses the total incidence of infections
within the hospital. The nurse in coordinator position is responsible for the coordination and
integration of the clinical and administrative requirements of specific types of patients. A
counselor is a person trained to give guidance on personal, social, or psychological problems.
DIF: Comprehension
4. The nurse who organizes screenings for employees, assesses the work environment for
hazards, and teaches health-promoting activities is employed in what field of nursing?

a. Infection control
b. Occupational health
c. Informatics
d. Quality control
ANS: B
The occupational health nurse organizes screenings for employees, assesses the work
environment for hazards, and teaches health-promoting activities. Quality managers assess
opportunities for process improvement, implement changes, measure outcomes. The infection
control nurse assesses the total incidence of infections within the hospital. Nursing informatics
(NI) focuses on management and processing of health care information.
DIF: Comprehension
5. The RN who identifies the best resources at the lowest cost to achieve optimal health
outcomes for the client is fulfilling the responsibilities of what role?
a. Informatics specialist
b. Nursing 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. Quality managers assess opportunities for process
improvement, implement changes, measure outcomes. Nursing informatics (NI) focuses on
management and processing of health care information. Nursing educators assume leadership
in curriculum development, instruction, and evaluation.
NURSINGTB.COM
DIF: Comprehension
6. A patient is admitted for a hip replacement complicated by uncontrolled diabetes and early
dementia. The nurse coordinates referrals to an endocrinologist to establish an insulin protocol
and organizes out-patient physical therapy in an Alzheimer’s assisted living facility upon
discharge. This is included in what nursing role?
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. Quality managers assess opportunities for process
improvement, implement changes, measure outcomes. Nursing informatics (NI) focuses on
management and processing of health care information. Nursing educators assume leadership
in curriculum development, instruction, and evaluation.
DIF: Comprehension
7. An RN testifies at a trial where domestic violence is being investigated. She had previously
assisted with specimen collection and had assessed the victim. The nurse is involved in
nursing.

a. triage
b. forensic
c. flight
d. entrepreneurial
ANS: B
The forensic nurse provides direct services to clients and consults with and serves as an expert
witness for medical and law enforcement.
DIF: Comprehension
8. The forensic nurse would most likely be involved in what task?

a. Performing an assessment of rape victim and collecting specimens needed for
court.
b. Assigning a patient with chest pain to be seen first, followed by a patient with an
insect bite of unknown origin with red streaks but no respiratory distress.
c. Assessing a patient at home by asking the patient to place a receiver over the
pacemaker to evaluate capture of pacing stimuli and transmitting the results to
another state where nurse located.
d. Performing pediatric life support at the scene of an accident to stabilize then
transport via helicopter to the nearest trauma center.
ANS: A
Forensic nursing involves providing direct services to clients involved in abuse or victims of
crimes and consults with medical and law enforcement.
DIF: Application
NURSINGTB.COM
9. A nurse in an acute care facility helps patients understand how to prevent diabetic
neuropathies. This nurse is functioning in what nursing role?
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. The change agent determines alternative and explore possible outcomes
of the alternatives; and assess cost-effective resources in infinite health-related situations.
Managers manage multiple resources in a health care facility. Coordinators are responsible for
the coordination and integration of the clinical and administrative requirements of specific
types of patients.
DIF: Comprehension
10. A nurse notices that care is often withheld until an interpreter arrives, if the nurse is not
multilingual. The nurse discusses this with the management team and suggests a three-part
series be presented to the nursing staff to teach some commonly used medical terms in
Spanish. This nurse is involved in what nursing role?
a. Change agent
b. Educator

c. Manager
d. Coordinator
ANS: A
The role of the change agent consists of assessing health care delivery issues and creating
solutions to improve health care delivery.
DIF: Comprehension
11. A nurse tallies the patient satisfaction surveys and approves the use of an agency nurse
because of the high census. This nurse is involved in which nursing role?
a. Change agent
b. Educator
c. Manager
d. Coordinator
ANS: C
The manager is the one who assesses the need for staffing and must justify this in a
substantial way. Through this approach, the manager indirectly provides care for patients and
families.
DIF: Comprehension
12. In differentiating between interprofessional and multidisciplinary which statement is true?

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 toNmeRmbI
ers G
of thBe.sC
ameMdiscipline working together to
U S population.
provide patient care to a distinct N T O
d. interprofessional is the use of multiple interventions by nurses with varying levels
of education.
ANS: B
Interprofessional, as related to member roles, involves members of many disciplines working
together to provide patient care to a distinct population.
DIF: Knowledge
13. A person from an underrepresented background in nursing is interested in entering the nursing
profession and researches the ethnicity, age, and gender make-up of the nursing profession
and finds which fact most interesting?
a. Nursing is a career field that is primarily made up of women younger than 30
years.
b. The number of male-registered nurses has steadily increased and is equal to the
number of female registered nurses.
c. 30% of students in advanced nursing education programs represent minority
populations.
d. More than half of all registered nurses are ages 55 through 65.
ANS: C
It is true that advance nursing programs see a 30% enrollment of minority population students.

DIF: Knowledge
14. A nurse who is participating in a health fair asks, “Other than nursing, what are some
opportunities for careers in the health care professions, and what education is required?” The
nurse informs participants that a master’s degree is required as the minimum standard for
which nursing role?
a. Clinical nurse specialist
b. Occupational nurse practitioner
c. Nurse-midwife
d. Nurse anesthetist
ANS: B
Certification as nurse practitioner is achieved via written examination after the completion of
a master’s-level program.
DIF: Knowledge
15. A nurse is interested in practicing in a faith-based community; when researching the role of
the parish nurse, the nurse finds which statement to be true?
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.
N R I G B.C M
ANS: D
U S N T O
The role of parish nurse has become a recognized specialty in a growing professional practice.
In 1998, the ANA established the scope and standards of this professional practice.
DIF: Comprehension
16. A nurse is responsible for determining the incidence rates of hospital-acquired diarrhea on a
pediatric ward after receiving reports that five children admitted with uncontrolled asthma had
developed diarrhea while hospitalized. The nurse is working in the nursing role?
a. Quality management
b. Infection control
c. Occupational health
d. Forensics
ANS: B
The infection control nurse is concerned with incidence of infections within the hospital.
DIF: Comprehension
17. A nurse working in a factory performs routine hearing tests for employees. The factory uses
90 dB as the safe limit for an 8-hour day’s exposure to machine noise rather than 85 dB as
recommended by the Occupational Safety and Health Administration. The nurse is
functioning in what nursing role?

a. Quality management
b. Informatics nurse specialist
c. Occupational health nurse
d. Case manager
ANS: C
The nurse in the role of occupational health focuses on health promotion and disease control
of employees.
DIF: Comprehension
18. People are living longer and with older age comes a higher risk of terminal illness. Many
individuals have chosen to maximize their quality of life but stop aggressive life-sustaining
treatments. Nurses who work with terminally ill patients and their families to provide
end-of-life care, pain management, and family support are practicing in which field of nursing
practice?
a. Hospice
b. Infection control
c. Coordinator
d. Case manager
ANS: A
Hospice nurses specialize in holistic care for the patient and family and end-of-life care to
maximize quality rather than quantity of years of life.
DIF: Comprehension
NURSINGTB.COM
19.19.
A nurse explaining the above graph indicates the frequency of falls in 2017 to detect and
possibly explain causes of variation. The peaks in June were attributed to regular staff
vacations during which agency nurses were used. The nurse is employed in which role?
a. Case Manager
b. Quality Manager
c. Forensic Nurse
d. Occupational Health Nurse
ANS: B
The role of the quality manager is to improve quality of care and reduce errors. Knowledge of
quality management tools is essential to the role. The run chart shown above is one such
quality management tool.
DIF: Application
20. A new graduate desires a position in labor and delivery; however, no position is available.
What is the best advice for this nurse?
a. Continue to study to keep skills current and wait for desired position.

b. Return to college until a position in labor or delivery opens.

c. Accept another nursing position and transfer into labor and delivery when a
position is available.
d. Practice obstetrical skills in a simulation lab then present evidence of competency
to potential employer.
ANS: C
Entry level positions in labor and delivery may be difficult to find. Accepting a position in
another area of the hospital will allow the novice nurse an opportunity to improve her skills
and develop clinical decision making as she waits for an open position in labor and delivery.
DIF: Application
21. An RN has critical care experience and is proficient in advanced cardiac life support and often
helps to lead “codes” and is an expert clinician with superior health assessment skills.
Enjoying a challenge of a fast-paced environment with autonomy, this nurse would best be
suited for which nursing role?
a. Flight nurse
b. Home health nurse
c. Hospice nurse
d. Occupational health nurse
ANS: A
An experienced nurse with critical care experience and a desire to practice in a complex
dynamic health care environment requiring clinical decision making would thrive as a flight
nurse.

22. The role of the Clinical Nurse Leader (CNL) would include what nursing task?
a. Diagnosing a patient with pneumonia and prescribing antibiotics
b. Teaching members of a faith community how to avoid skin cancer and referring
those with suspicious lesions
c. Participating in the team who is investigating possible abuse of elderly persons by
members of a gang known to sell illegal drugs
d. Coordinating care of a patient admitted 4 days ago with stage IV heart failure and
chronic bronchitis by revising care plan to include ambulation 50 feet with
assistance
ANS: D
The CNL is not an advanced practice nurse but is an advanced generalist who provides care
and coordination of care for patients with complex needs and revises care plan to meet desired
outcomes.
DIF: Application
MULTIPLE RESPONSE
1. A nurse wants to become an advanced practice nurse and investigates the requirements for
which role. (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. While important in the advancement of the profession, nurse
executives are not generally considered advance practices nurses.
DIF: Knowledge
2. Advanced practice nurses are prepared minimally at the master’s degree level with
prescriptive privileges; these professionals include which nursing professionals? (Select all
that apply.)
a. Clinical nurse leader
b. Nurse practitioner
c. Nursing administrator
d. Certified nurse-midwife
e. Clinical nurse specialist
ANS: B, D, E
A nurse practitioner requires preparation at the master’s degree level. A certified
nurse-midwife requires preparation at the master’s degree level. A clinical nurse specialist
requires preparation at the master’s degree level.
DIF: Knowledge
NURSINGTB.COM
3. What characteristics are associated with the clinical nurse leader? (Select all that apply.)
a. Is a generalist prepared at the master’s level
b. Provides care at the bedside for complex patients
c. Identifies the best resources at the lowest price to achieve best health outcomes for
a client
d. Serves as care coordinator whose practice is limited to acute care settings
e. Is an advanced practice nurse with an earned doctorate in nursing
ANS: A, B
Clinical nurse leaders are prepared as generalists at the master’s level. Clinical nurse leaders
provide care to complex patients, change care plans as needed, and coordinate care to a group
of patients.
DIF: Comprehension

Chapter 27: Job Search: Finding Your Match

Edition
MULTIPLE CHOICE
1. When should a follow-up letter be written to a recruiter?

a. Before the interview to thank him or her for granting you the interview
b. Approximately 2 weeks after you did not get the job to inquire
c. A few days after the interview
d. When you are sure you got the position
ANS: C
A follow-up letter thanking the recruiter is a courtesy and a reminder of the nurse’s interest in
receiving a timely response.
DIF: Knowledge
2. What statement about a cover letter is true?

a. It should signify an interest in the employer and let the employer know that you
took time to research the organization.
b. It must be handwritten so the employer can determine whether charting will be
legible.
c. It should be limited to one paragraph because time is of the essence.
d. It should let the employer know your desired salary, shift, and area of practice.
The purpose of the cover letter is to show the recruiter that the applicant has an interest in the
facility and that he or she did homework to learn more about the facility.
DIF: Knowledge
3. A nurse interested in an entry level position as a registered nurse prepares the cover letter.
Which statement is an example of a correctly written cover letter?
a. “I am interested in a position where community outreach is valued as noted in your
organization’s mission statement.”
b. “I am highly educated and have several degrees including an Associate Degree in
accounting, a certification in word processing, a Bachelor’s degree in journalism,
and a Bachelor’s degree in nursing.”
c. “I am looking for a position that will allow me to develop my skills and still have a
balanced home and work life.”
d. “I am widowed, a Christian, a single parent, and due to the downturn in the
economy will be willing to work any shift or nursing unit.”
ANS: A
Letting the potential employer know you have researched the organization shows a sincere
interest. The other options provide information that is initially irrelevant.
DIF: Comprehension

4. To determine basic competency, the interview for a nursing position may include a test to
evaluate what area of knowledge?
a. Pathophysiology
b. Writing appropriate nursing diagnoses
c. Pharmacology
d. General 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 as well as dosage and drip rate calculating.
DIF: Knowledge
5. When the job applicant is asked to identify weaknesses, one appropriate reply for the novice
nurse might be to provide what response?
a. “I have no significant weaknesses.”
b. “I find that to be a biased question”
c. “I sometimes find delegating to peers a challenge.”
d. “Caring requires a person to demonstrate weakness and compassion.”
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 and are prepared to help with those
weaknesses. All nurses can improve in their profession.
DIF: Application
NURSINGTB.COM
6. What action by the nurse is a valuable tool for determining whether a potential employer is
suitable for personal career goals?
a. Calling The Joint Commission (TJC) to ask whether the organization meets
required standards
b. Assessing the work climate by walking through the facility
c. Reviewing financial statements of the institution
d. Asking what they can do for you rather than what you can do for them
ANS: B
By observing the staff when taking a tour of the unit, the applicant can get an accurate feel for
the culture and personality of the nursing unit. The applicant can assess the manager’s
interactions with staff and can see how nurses respond to each challenge. Options A and C
would not likely provide the in-depth information one is seeking. The final option would
likely be viewed as arrogant by the interviewer.
DIF: Application
7. Many nursing professionals have portfolios that include what professionally applicable
documentation?
a. Family pictures to stress commitment
b. Letters of commendation to support skills and experience
c. Journal articles that describe one’s professional connection to health care
d. High school achievements to demonstrate commitment to continuous learning

ANS: B
A portfolio includes letters from supervisors and patients, congratulatory messages from
peers, and evaluations documented by supervisors. The other options focus on information
less relevant to the interviewer.
DIF: Knowledge
8. What testing should a potential applicant be prepared to submit to during a preemployment

physical?
a. Cholesterol screening
b. Pregnancy testing
c. Urine drug screening
d. Vision and hearing tests
ANS: C
A preemployment physical examination is often required, and this includes routine blood
tests, urine drug screening, and sometimes a chest radiograph.
DIF: Knowledge
9. What expectation should a graduate nurse have when beginning a job search?
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.
NURSINGTB.COM
ANS: C
The nursing shortage has caused institutions to find unique ways to lure nursing graduates to
their place of employment. These include sign-on bonuses, expense-paid weekend visits to the
facility, tuition reimbursement, and low-interest loans. Although health care costs are a
concern, attracting nurses is currently a priority, with little worry about associated costs.
DIF: Comprehension
10. While performing a job search, why would a nurse reviews the list of Magnet hospitals of the
American Nurses Credentialing Center?
a. These hospitals generally retain most 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. None of the other options accurately describe
Magnet hospitals.

DIF: Comprehension
11. According to the Hallmarks of the Professional Nursing Environment, what question should a
nurse ask a potential employer?
a. “How do salaries here compare with those of larger facilities?”
b. “What benefits are provided to RNs that are not available to other health care
providers?”
c. “What is the role of nurses in determining the quality of patient care being
delivered?”
d. “How has the administration as the employer planned 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 rather than related to salaries, benefits, or economic security.
DIF: Comprehension
12. According to the Hallmarks of the Professional Nursing Environment, a nurse who wants to
be certain that the first position is rewarding and allows for growth as a registered nurse
should ask what question?
a. “What is the facility’s philosophy related to clinical care used to determine the role
of RNs in deciding outcomes related quality outcomes?”
b. “Are professional development opportunities supported here through paid leave
and tuition reimbursement?”
c. “How do compensation packages here compare to others in the same area and
nationally?” NURSING TB.COM
d. “What is the projected need for RNs is in the next 5 years as well as the current
turnover rate?”
ANS: A
The hallmark that suggests the role nurses have in determining the quality of care is noted in
the philosophy of clinical care. The remaining options focus on nursing benefits and support.
DIF: Application
13. A nurse who is applying for a position contacts an expert on writing résumé and cover letters
and is given what advice?
a. Use correction fluid sparingly.
b. 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. Limit margins to one half inch so that the page appears full of information.
d. Be concise and 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. Correction fluid should not be used. The method of correction noted
refers to clinical documentation. A half inch margin is too small.
DIF: Knowledge

14. What is 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?
a. “To Whom It May Concern”
b. “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.
DIF: Application
15. What format should be used when preparing the education section of a resume?
a. List high school, followed by the first college attended.
b. Include all colleges attended, even if a degree was not awarded.
c. Omit the address of the university unless requested by the potential employer.
d. List in reverse chronologic order the names, dates, and addresses of universities
that awarded degrees.
ANS: D
Details about education should include degrees and diplomas awarded, names and locations of
schools awarding them, and graduation dates, starting with the most recent graduation and
degree.
DIF: Knowledge
NURSINGTB.COM
16. A nurse should be concerned about the legality of which question when asked by the
recruiter?
a. “Have you been convicted of a crime other than a minor traffic violation?”
b. “Do you 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. “An operating room positions requires that you must be able to be on call. How
many children are you responsibility?”
ANS: D
It is illegal for the recruiter or interviewer to ask number of children or dependents prior to
making a job offer.
DIF: Application
17. A nurse is interested in working where cultural diversity is appreciated. The applicant feels
that accepting this interview was the right choice when the recruiter states, “We do not
discriminate based on sex, race, or age and practice inclusiveness of diversity.” Which
question would reflect this statement?
a. “Nurses must work a master schedule where one month is Monday through Friday
and the next month is the weekend shift. What is your religious belief about
working on Sunday?”
b. “We offer many benefits for employees such as educational benefits and health

insurance.”
c. “Our mission is to provide patient-centered care that reflects the belief of the
patient and family with an aim to win them over to Western medicine and less
superstition, don’t you agree?”
d. “Do you have any issues with working with patients who are from a disadvantaged
background because we have many people who refuse to work then want free
care?”
ANS: B
Sharing information about employee benefits is not asking about discriminatory issues—it just
informs the applicants of availability.
DIF: Application
18. Which message would be appropriate to leave on answering systems where you work?
a. “You have reached 910-999-1212. Please leave your name and number and I look
forward to returning your call as soon as possible.”
b. While we view your call as important we can’t answer it right now.
c. “Hi, I’m not here. Sorry you missed me. Please call again.”
d. “I am interviewing for positions, hope to be available soon. If you are calling about
an interview, please leave your name, number, and possible positions available.”
ANS: A
A professional or appropriate message that lets the person know they have reached the correct
number and that you will return the call as soon as available.
DIF: Application
NURSINGTB.COM
MULTIPLE RESPONSE
1. What should the nurse include when preparing a portfolio? (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 nursing achievement tests
e. A copy of the voter’s registration card
ANS: A, B, D
Traditional documents, such as copies of diplomas, college transcripts, and recognition letters,
are included in the portfolio.
DIF: Knowledge
2. To present oneself professionally, a new graduate nurse preparing for an interview will focus
on what guidelines? (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 dialog establishes a means for the graduate to recall achievements that will lead to
success in the first nursing position. Jobs such as cashier at a convenience store or dog-sitting
can demonstrate responsibility such as handing cash or arriving on time. Arriving too early
may cause the recruiter to feel rushed and arriving too late may demonstrate lack of time
management and professionalism.
DIF: Application
3. To effectively identify the culture of the potential employer, who should the nurse network
with? (Select all that apply.)
a. The executives at the competing agency
b. Alumni that graduated from the same school and work in the area
c. Nurses currently working in the agency
d. People who have been patients at the agency
e. Nurses who are former employees
ANS: B, C, D, E
Networking is a valuable way to gain perspective on the work environment and culture of
potential employers. Alumni that graduated from the same school and work in the area would
most likely have your best interests in mind. Nurses working the agency have first-hand
information. It might be best to ask more than one to get unbiased information. Friends or
people who have been patienN tsUkR
noSwItN
heGcT
arB
e.reC
ceOivMed and often can determine the nurses’
attitude and pick up clues about the quality of patient contact. Nurses who are former
employees have experienced the culture and can tell you from their perspective about the
work culture and environment, but keep in mind that, if they left involuntarily, their
perspective may be skewed.
DIF: Comprehension
4. How does applying online via the Internet compare to applying by more traditional methods?
a. Regardless of how one applies, it is important to check the resume for correctness.
b. Follow-up with Internet applications is no sooner than 90 days compared to a
1-week follow-up for traditional applications.
c. Researching the mission and philosophy of the agency is not necessary with
Internet searches and applications.
d. The resume and cover letter should be reviewed by someone with excellent skills
in grammar and writing to ensure the first impression is one of professionalism and
attention to detail.
e. Internet applications should include specific questions to be answered prior to
accepting an interview such as pay, shifts available, nurse-patient ratio, and
autonomy of practice.
ANS: A, D

The resume and cover letter must be free of errors regardless if mailed, faxed, presented in
person, or submitted online and both should be one page. The typical recruiter spends little
time reviewing documents, so clarity and conciseness is important.
DIF: Comprehension
5. A nurse should incorporate what information about resume writing when creating such a
document? (Select all that apply.)
a. Margins should be equal on all four sides.
b. Paper should be bright colored to catch the attention of the recruiter.
c. Legal size paper may be used when applicants have an extensive work history.
d. Standardized cover letters present a professional image as opposed to those that
stress the applicant’s perspective too heavily.
e. Include in the cover letter that after researching other position, this is the
applicant’s preference.
ANS: A, E
Ample margins—minimum of 0.5 inch (1 inch preferred)—should be used on all four sides to
prevent appearing cluttered. A statement declaring this position is one’s first choice should be
included. The remaining options fail to demonstrate professionalism, provide irrelevant
information, or lack appropriate personalization.
DIF: Comprehension
COMPLETION
1. The key to a successful intervNiewRis I

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

Chapter 28: The NCLEX-RN® Examination

Edition
MULTIPLE CHOICE
1. When may the graduates from approved schools of nursing sign their charting as registered
nurses (RNs)?
a. After passing the National Council Licensure Examination for Registered Nurses
(NCLEX-RN)
b. When the State Board has been provided with evidence of mental competency
c. After supplying written proof of physical fitness to their employer
d. When they 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. None of the other options provide that legal
proof.
DIF: Comprehension
2. Which statement concerning the National Council Licensure Examination for Registered
Nurses (NCLEX-RN) examination is correct?
a. Graduates from all three types of nursing programs (diploma, associate degree, and
baccalaureate degree) takN
e thR
e saI
me G
N TB.
NCLEXC-RM N examination.
b. The NCLEX-RN is scored U S interval
on an scale rather than on a pass-fail basis.
c. The NCLEX-RN examination is offered twice a year in major urban areas.
d. The candidate gets their NCLEX-RN results by mail.
ANS: A
The purpose of the NCLEX-RN examination is to determine safe practice and the ability of
candidates to perform at the entry level. Candidates from all three types of nursing programs
must demonstrate the same competencies. None of the other options present accurate
information about this licensure exam.
DIF: Knowledge
3. What does the phrase computerize nursing focused adaptive testing imply?
a. The candidate must be computer literate.
b. Competency is determined based on the difficulty of questions, knowledge of the
nursing process, and the number of questions answered correctly.
c. That the testing facilities have been adapted so the physically challenged candidate
has easy access.
d. That the questions cannot be adapted to the individual 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. None of the other options present accurate information about this form of
testing.
DIF: Comprehension
4. On the National Council Licensure Examination for Registered Nurses (NCLEX-RN)

examination, when the candidate is asked to set goals in collaboration with other members of
the health care team, the nurse is being tested on what area of nursing practice?
a. Assessment
b. Planning
c. Analysis
d. Implementation
ANS: B
Setting goals is one of the first steps in the planning process. Planning is the third phase of the
nursing process and includes setting realistic and measurable mutual goals, developing
interventions to meet or resolve identified patient needs or problems, and modifying goals as
necessary. The fourth phase of the nursing process is implementation. This stage includes
initiating and carrying out nursing interventions or nursing actions to achieve the goals set in
the planning phase of the nursing process. Analysis is the second step or phase of the nursing
process. Client-related data gathered during assessment provide the basis for analysis. During
this phase, the nurse classifies or groups assessment data and identifies actual or potential
client problems.
DIF: Comprehension
NURSINGTB.COM
5. What is the length of the National Council Licensure Examination for Registered Nurses
(NCLEX-RN) examination based upon?
a. The method of random selection
b. The location of testing
c. The candidate’s educational preparation
d. The performance of the candidate
ANS: D
The length of the examination is based on the ability of candidates to provide 95% confidence
that they are safe practitioners and have acquired a minimal level of knowledge about the
nursing process. The length of the examination ranges from 75 to 265 questions, and it takes
up to 6 hours to complete.
DIF: Application
6. What is the primary purpose of the National Council Licensure Examination for Registered
Nurses (NCLEX-RN) examination?
a. Ensuring that practitioners have the minimum skills and knowledge needed to
provide care that will produce the best patient care outcomes
b. Effective regulation of nursing education
c. To determine the mandatory educational level required for nurses to practice
d. The basis of accreditation process for schools of nursing

ANS: A
The purpose of the NCLEX-RN examination is twofold: (1) to safeguard the public from
unsafe practitioners and (2) to determine whether candidates can perform entry level skills.
DIF: Comprehension
7. A student nurse who is preparing to graduate and take the licensure examination asks, “What
is compulsory licensure?” What is the appropriate response of the nursing advisor?
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 a registered nurse (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.
DIF: Knowledge
8. The National Council of State Boards of Nursing determines acceptable National Council
Licensure Examination for Registered Nurses (NCLEX-RN) examination questions based on
what criteria?
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 NURSINGTB.COM
ANS: B
Periodically, the National Council of State Boards of Nursing surveys health care providers to
identify nursing care activities of entry level nurses.
DIF: Comprehension
9. Although the NCLEX-RN examination has new formats for questions, what is the most
common format?
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 examination questions have three distracters and one correct answer, but
the examination allows all four levels of Bloom’s taxonomy to be tested.
DIF: Knowledge

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.
DIF: Analysis
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. What should be the nurse’s first action?
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 is the lowesN tUanRdSsiI
mNplG
esTt B
le.
veCofMlearning within the cognitive domain, and
lO
it is demonstrated by remembering or recalling information. Comprehension, the second level
of Bloom’s cognitive domain, is the fundamental level of understanding or the ability to grasp
or summarize information or material or restate in one’s own words. The third cognitive level,
application, refers to the ability to use learned information in new situations.
DIF: Comprehension
12. A candidate who is taking the NCLEX-RN examination received only 75 questions before the
test was stopped. She called her professor and stated, “I passed. I had to answer only 75
questions.” The professor correctly provides what response?
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

Seventy-five questions is the minimum number of questions that can determine 95%
competency of the candidate; however, receiving 75 questions can indicate that the candidate
passed and was able to answer a broad range of questions covering the nursing process at
higher cognitive levels, or it can mean that the candidate failed, answered even the lowest
cognitive level questions incorrectly, and was unprepared in area/s of the nursing process.
DIF: Application
13. Which statement accurately describes an expectation of the NCLEX-RN examination tester?
a. They will have to answer more than 75 questions to be 95% certain that they are
above the passing standard.
b. They will be required to submit a 100-word essay on an important nursing topic to
evaluate safe nursing practice.
c. They 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. They 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.
DIF: Application
14. In the National Council Licensure Examination for Registered Nurses (NCLEX-RN)
examination test plan, client N
neU RSform
eds INGthTe B.C
organO
izing framework of the examination 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.
DIF: Comprehension
15. Which action would help a student successfully prepare for the National Council Licensure
Examination for Registered Nurses (NCLEX-RN) examination?
a. Making note cards that can easily be retrieved to list only facts
b. Avoiding timing oneself while studying and when in the actual testing mode to
decrease anxiety
c. Asking peers for help because they had the same resources; especially seek their
help for difficult concepts requiring critical thinking
d. Practicing taking NCLEX-RN examination–type questions and reviewing

rationales for correct and incorrect answers

ANS: D
Practicing helps the student learn how questions are presented and what level of difficulty
should be anticipated. Reviewing rationales for the answers is a teaching/learning opportunity
that enables the student to judge whether the rationale used to answer the question is valid.
DIF: Application
16. The nurse prepares to apply sterile gloves needed for a procedure. After introducing self and
verifying patient information, the nurse performs hand hygiene. The nurse should open the
outer package and then perform the following steps in order: (items on left will be moved in
correct order on the right)
Open inner package, taking care not to touch inner surface.
Put the glove on the nondominant hand using the sterile gloved hand.
Put glove on dominant hand by grasping folded cuff edge, touching only inside of cuff.
Adjust each glove carefully by sliding finders under the cuffs.
The above question represents which type of alternate-format question written at which level
of Bloom’s taxonomy?
a. Drag-and-drop item, comprehension
b. Chart/exhibit item, analysis
c. Multiple-response, application
d. Hot-spot item, knowledge
ANS: A
The drag-and-drop format questions require the candidate to place options in a specific order,
moving them from left to right using the mouse. The level is comprehension because it
requires the student to have aNfU
unRdSIeNntGalTlB
am ev.
elCoO
fM
understanding and summarize the material.
DIF: Analysis
17. A graduate is preparing for the National Council Licensure Examination for Registered
Nurses (NCLEX-RN) examination. Based on the latest practice survey, the candidate would
focus the most amount of time on which content?
a. Stages of grief
b. Pharmacologic pain management
c. Practices to promote rest and sleep
d. Prioritization of workload to manage time effectively
ANS: B
The current NLN test blueprint indicates that pharmacologic and parental therapies account
for between 12% and 18% of the examination.
DIF: Application
18. Which strategy would promote a high rate of success on the National Council Licensure
Examination for Registered Nurses (NCLEX-RN) examination?
a. Since the examination is time limited, skip questions when unsure of the answer
and return later if time permits.
b. Work quickly through the examination to answer as many questions as possible.
c. Mark questions that may need to have the answer reviewed to make it possible to

quickly go back and make change after answering all questions.

d. Read the entire question and all possible answer options before selecting an
answer.
ANS: D
Candidates should carefully read the entire question and all answers before selecting an
answer. None of the other options are as likely to result in correctly answering the question
since none address the need to focus effectively on each question completely before
answering.
DIF: Comprehension
19. A candidate is taking the NCLEX-RN examination when the computer turns off. The
candidate was aware they had reached the 6-hour time limit. A count of completed questions
had been recorded on the note pad, and 100 questions were answered. How will the
examination be scored?
a. The computer will analyze the last 60 questions and if above the passing standard,
the candidate passes.
b. The candidate will be administered an additional 50 questions to determine ability
to reach the 95% confidence interval.
c. If the time runs out, the candidate automatically fails the examination because it is
impossible to determine if candidate is safe.
d. The candidate has the option to complete a simulated examination to show
competence.
ANS: A
Run-out-of-time rule: if the candidate has answered the minimum number of questions, the
computer analyzes the last 60NqUuR tiI
esS sG
onN toTdB
et.
erC
mOinM
e if these questions were above or below
the passing standard.
DIF: Comprehension
20.20.
The order reads: Administer 500 mg of cefazolin sodium intramuscular. Using information
located on the medication vial above, the nurse will administer how many mL?
a. Multiple-response item, comprehension level
b. Hot-spot item, application level
c. Chart/exhibit item, analysis level
d. Drag-and-drop item, knowledge level
ANS: C

The chart/exhibit presents the candidate with a chart or exhibit with information needed to
answer the question. The question is at the analysis level since the candidate must calculate
the correct amount to be given using a label requiring dilution.
DIF: Comprehension
21. A patient with end-stage renal disease has a potassium level of 7.5 mEq/L. Based on this
laboratory result, the nurse interprets which symptom as significant prompting which action?
a. Drowsiness, stimulate the patient every 30 minutes
b. Confusion, ask the patient to state their name and date of birth
c. Irregular heartbeat, evaluate the patient’s capillary refill
d. Muscle cramps, elevate the affected limb
ANS: A
It is important to remember that candidates have specified laboratory values for which they
must know the normal range and clinical manifestations when values are high, low, or critical.
This question addresses an alteration in body system homeostasis. The student must know the
normal lab value for potassium and common symptoms, as well as the correct nursing action.
DIF: Analysis
NURSINGTB.COM
22.22.
A patient presents with chest pain that increases when lying flat and a low-grade fever.
Assessment reveals muffled heart sounds, tachycardia, and 3+ edema in the lower extremities.
The nurse asks the patient to learn forward, which eases respiratory efforts. The nurse then
places the stethoscope at which area on the chest to facilitate auscultation?
a. Multiple-response item, comprehension level
b. Hot-spot item, analysis level
c. Chart/exhibit item, application level
d. Drag-and-drop item, knowledge level
ANS: B
This is a hot-spot item; students are presented with a figure on which they must indicate the
answer by clicking the mouse over the area. The student would place the mouse over the left
sternal border. It is analysis level because the student must take data from many sources to
provide a complete assessment of the patient’s condition.
DIF: Comprehension
OTHER

1. The nurse prepares to apply sterile gloves needed for a procedure. After introducing self and
verifying patient information, the nurse performs hand hygiene. The nurse should open the
outer package and then perform steps in which order. Put a comma and space between each
answer choice (e.g., a, b, c, d).
a. Open inner package, taking care not to touch inner surface.

b. Put the glove on the nondominant hand using the sterile gloved hand.
c. Put glove on dominant hand by grasping folded cuff edge, touching only inside of cuff.
d. Adjust each glove carefully by sliding finders under the cuff.
ANS:
A, C, B, D
The nurse should open the inner package first, then put the glove on the dominant hand before
the nondominant hand before adjusting the gloves.
DIF: Application

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Contemporary Nursing 8th Edition Cherry Test Bank

CONTEMPORARY NURSING 8TH EDITION CHERRY TEST

Contemporary Nursing 8th Edition Cherry Test Bank

Chapter 01: The Evolution of Professional Nursing

1. What accomplishment is Clara Barton best known for?

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

6. World War I contributed to the advancement of health care by

7. What was an original purpose of the Social Security Act of 1935?

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

2. A newly licensed nurse compNareR

Contemporary Nursing 8th Edition Cherry Test Bank

1. Which group in early civilization is credited with developing a pharmacopeia to

Contemporary Nursing 8th Edition Cherry Test Bank

Chapter 02: The Contemporary Image of Professional Nursing

Contemporary Nursing 8th Edition Cherry Test Bank

5. What was the purpose of the Nurse Reinvestment Act of 2002?

7. What statement accurately describes Charles Dickens’ character Sairy Gamp?

Contemporary Nursing 8th Edition Cherry Test Bank

8. What does the Spirit of Nursing statue honor?

11. How can nurses best combat the nursing shortage?

Contemporary Nursing 8th Edition Cherry Test Bank

return to the workforce

13. A nursing student asks, “I woNnde

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

18. Which nurse best portrays nursing as a “knowledge worker”?

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

a. Establishing appropriate outcomes

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

13. When preparing to complete a competency examination involving a neurologic assessment in

Contemporary Nursing 8th Edition Cherry Test Bank

a. The emergence of epidemic hepatitis A

Contemporary Nursing 8th Edition Cherry Test Bank

2. According to Lenburg, the use of practice-based assessments in nursing education is aimed

Contemporary Nursing 8th Edition Cherry Test Bank

Chapter 04: Nursing Licensure and Certification

2. What is the primary purpose of licensure for professional registered nurses?

3. What statement presents accurate information concerning nurse practice acts?

Contemporary Nursing 8th Edition Cherry Test Bank

6. What was the first field of nursing to certify advanced practitioners?

Contemporary Nursing 8th Edition Cherry Test Bank

a. Review Oregon’s nurse practice act related to licensure for endorsement.

9. What statement accurately describes what it means to practice in a compact state?

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

15. What entity establishes the “rules” for nursing practice?

Contemporary Nursing 8th Edition Cherry Test Bank

Contemporary Nursing 8th Edition Cherry Test Bank

1. The primary purpose of licensure is protection of the .

Contemporary Nursing 8th Edition Cherry Test Bank