Exam 4

Which of the following actions is consistent with a nurse leader? a. A nurse who encourages staff to give excellent patient care b. A nurse who performs chart audits on the staff c. A nurse who writes yearly staff evaluations d. A nurse who always gives medication on time

ANS: A A nurse leader is someone who influences others, such as a nurse who encourages staff to give excellent patient care. A nurse who performs chart audits and writes staff evaluations is functioning as a nurse manager. Giving medications is a function of the staff or bedside nurse.

Determine which of the following situations would be a provider barrier to the nurse developing cultural competence. a. A nurse who is unaware of personal biases to other ethnic groups b. No family rooms to accommodate a critically ill patient's family c. A nurse who seeks encounters with individuals from other cultures d. A health care provider who incorporates alternative therapies in health care

ANS: A A nurse who is unaware of personal biases to other ethnic groups represents a provider barrier. "No family rooms" is an example of a system barrier. Nurses who seek encounters with individuals from other cultures and who incorporate alternative therapies into health care have a developed sense of cultural competence.

What ethical principle is implemented, or supported, when the nurse encourages a patient to be involved in planning and implementing self-care? a. Autonomy b. Fidelity c. Justice d. Veracity

ANS: A A patient's right to self-determination implies the freedom to make choices and decisions about one's own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Fidelity involves keeping the information confidential and maintaining privacy and trust. Veracity is the duty to tell the truth.

The nurse interprets which characteristic as the forefront of discussion about nursing's professionalism? a. Education b. Altruism c. Social values d. Code of ethics

ANS: A According to Pavalko, education is one of the eight dimensions used to describe a profession, as in professional nursing. Altruism, social values, and the code of ethics are not considered to be the forefront of discussion about nursing's professionalism. Although the other options also are part of Pavalko's eight dimensions, nursing continues to debate the educational entry level for professional nursing, since the 1965 ANA position paper. There is agreement about the relevance the profession has to social values, altruism, and having a code of ethics.

Based on the assessment data, the nursing diagnosis for a patient is spiritual distress related to loneliness or social alienation. What would be included in spiritual nursing interventions? a. Participate in active listening. b. Identify the level of functioning. c. Assist with activities of daily living. d. Evaluate ability to understand events.

ANS: A Active listening is an example of a spiritual nursing intervention. Other interventions include the following: prayer, presence, scripture reading, peaceful environment, meditation, music, pastoral care, inspiring hope, validation of the patient's thoughts and feelings, values clarification, sensitive responses to patient beliefs, and developing a trusting relationship. Identifying the level of functioning and ADLs addresses basic human needs. Evaluating the ability to understand events is addressing cognitive function

A nurse is educating a new nurse on grievances. The teaching has been effective when the new nurse states a. "I can file a grievance." b. "My employer cannot file a grievance." c. "The nursing union cannot file a grievance." d. "My coworkers cannot file a grievance."

ANS: A Any nurse, the employer, or the nursing union can file a grievance

A nurse is concerned about the personal level of cultural and linguistic competence in personal practice. What action does the nurse take first? a. Take an implicit bias assessment. b. Take a course in culture and health care. c. Learn to speak a foreign language. d. Volunteer at a refugee service agency.

ANS: A Assessing one's own values and biases is an important first step toward cultural and linguistic competency. However, many people hold biases about which they are totally unaware. The Institute for Healthcare Improvement suggests taking an implicit bias test to become aware of these. The other options are good ideas, but the first step must be self-assessment.

A charge nurse is providing education to coworkers on state nursing associations. The charge nurse judges that the teaching has been effective when a coworker states which of the following? a. "These professional associations address nursing practice." b. "These professional associations have limited ability to support nursing." c. "These professional associations protect the rights of physicians." d. "These professional associations are managed by hospital administrators."

ANS: A State nursing associations have represented nurses since 1946. They are multipurpose and are involved in many activities such as addressing nursing practice. These organizations do not protect the rights of physicians and are not managed by hospital administrators.

The nurse manager is giving a presentation on the disadvantages of democratic leadership in group functioning. Which statement shows an understanding of this type of leadership? a. "Requires more time and effort to make decisions and accomplish goals" b. "Discourages participation from quieter members of the group" c. "Increases the possibility of 'scapegoating' or argumentative behavior" d. "Is difficult to control the outcomes and decisions of the group"

ANS: A Because of the encouragement of participation in decision making and the democratic leadership's emphasis on group function, decision making becomes more involved with consensus and is less timely. Democratic leadership encourages group participation and works to reduce any type of scapegoating behavior among members because everyone has equal voice. The group democratically makes decisions and determines outcomes that are not controlled by management.

A nurse has been studying Levenstein's characteristics of a profession. The nurse demonstrates adequate understanding when interpreting which of the following components as part of the model? a. A code of ethics b. A systematic, defined progression of education c. An accreditation process d. Publications or journal for the profession

ANS: A Both Levenstein's model and Pavalko's model call for a code of ethics within a profession. The models do not call for a systematic, defined progression of education, an accreditation process, or publications or journals.

Which of the following actions causes health care disparities? a. Refusal of treatment b. Provider-patient relationships c. Trust in the health care system d. Provider bias and discrimination

ANS: A Disparities in health care can include both provider and patient variables. Patient variables are mistrust of the health care system and refusal of treatment.

A nurse is attending a lecture on health disparities. The education has been effective when the nurse states which of the following? a. "Inequalities in income and education are the root of many health disparities." b. "Today, there are no longer inequalities preventing access to health care." c. "Low-education and low-income levels are the cause of all health disparities." d. "Higher income is associated with more health disparities than lower income."

ANS: A Inequalities in income and education are the root of many health disparities. Individuals with low-education and low-income levels often have higher rates of health disparities (although there are other factors), and higher income is associated with fewer health disparities.

What action can each nurse take to improve the image of nursing during his or her career? a. Provide public education on what nurses really do. b. Ignore the negative image of nurses. c. Not contribute to the negative image of nurses. d. Remain silent when someone speaks negatively about nursing.

ANS: A It is important that the nurse provides public education on what nurses really do. This, along with maintaining professionalism, will continue to improve the image of nursing. Ignoring the negative images, remaining silent, and just not contributing will not help improve the negatives projected onto the image of nursing.

Which action by the nurse indicates placement in the unfreezing phase of Lewin's Change Theory? a. The nurse reconsiders if he or she is resistant to change. b. The nurse begins the process of implementing change. c. The change has become routine. d. The change is permanent.

ANS: A Lewin's Change Theory consists of three phases: unfreezing, moving, and refreezing. In the unfreezing phase, the nurse reconsiders what has caused him or her to be resistant to change. In the moving phase, the nurse begins the process of implementing change. In the refreezing phase, the change has become a permanent, routine part of the nurse's life.

What do the responsibilities of the nurse manager include? a. Planning and organizing how nursing care can most effectively be delivered b. Establishing the nursing care standards to be implemented on the unit c. Developing educational programs to assist staff to meet licensure requirements d. Assisting staff to adhere to organizational policies and procedures

ANS: A Managers must be attentive to both dimensions of their job: the mission and goals of the organization and planning with the staff to meet the nursing care goals of the unit within the overall goals of the institution. Both levels must be addressed—the organization as well as the needs of the individuals. Other options are not as comprehensive and could be included within the first option

Which actions by the nurse can help create a professional image? (Select all that apply.) a. Maintain effective communication skills. b. Maintain a positive attitude. c. Maintain a professional appearance. d. Be prepared to interact with the public. e. Keep one's and opinions to one's self.

ANS: A, B, C, D The nurse can help create a professional image by maintaining effective communication skills, maintaining a positive attitude, maintaining a professional appearance, and being prepared to interact with the public. Keeping opinions to one's self does not help promote a positive image of nursing if the nurse is ignoring poor images.

What types of changes in management can be anticipated with the introduction of generations X and Y to the nursing workforce? a. More flexible work time and increased personal responsibility for work outcomes b. Increased loyalty to the institution and the need for a well-defined work environment c. Increased interest in the goals and needs of the institution d. Increased structure within the nursing environment to more effectively predict outcomes

ANS: A Members of Generations X and Y are more independent and place a higher value on personal time. They are not characteristically team players, but they are very creative and want to be responsible for their work outcomes. Baby Boomers are focused on building careers and are invested in organizational loyalty. The silent or veteran generation places a high value on loyalty, discipline, teamwork, and respect for authority.

A nurse wants to improve cultural competence. What action shows progress toward this goal? a. Uses an evidence-based cultural assessment tool b. Tries to treat all patients the same c. Prioritizes care based on cultural needs d. Wants to learn more about other ethnic groups

ANS: A One action nurses can take to improve cultural competence is to learn how to use cultural assessment tools. The other actions are good steps but do not demonstrate progress to the stated goal as well as using an evidence-based tool.

A nurse is discussing personal seniority with the department manager. The nurse has an adequate understanding of seniority when stating which of the following? a. "Seniority provides certain rights to those with the highest number of years of service." b. "Seniority provides the same amount of vacation time as new hires." c. "Seniority no longer provides protection in today's economy." d. "Seniority means that those with the highest number of years of service can be forced to ret

ANS: A Seniority provides specific rights, which are spelled out in the bargaining agreement, to those who have the highest number of years of service. These rights will differ with each organization.

Which of the following actions would have little to no impact in helping resolve health care disparities? a. Research on life stressors b. Access to basic health care c. Increasing diversity of health care workers d. Health promotion and wellness programs

ANS: A Some solutions to help resolve health care disparities include the following: increasing the diversity of health care providers; ensuring that all people have access to affordable, basic health care; promoting wellness and a healthy lifestyle; strengthening provider-patient relationships; increasing cultural competency of health care providers; and conducting research to determine why certain diseases affect minorities so greatly and to discover effective intervention strategies. Research on life stressors does not have an impact on resolving health care disparities.

Which statement best describes the Code of Ethics of the American Nurses Association? a. A moral statement of accountability for practicing nurses and for student nurses b. A legal document describing the responsibilities of the nurse c. A statement regarding nursing care that outlines principles for the hospital to use to evaluate the quality of care d. A document that is used as a guide for the nurse to consider in the decision-making process in legal situations

ANS: A The Code of Ethics is a moral statement of accountability for practicing nurses and for student nurses. It is a statement to society that outlines the values, concerns, and goals of the profession, thereby addressing accountability. The code provides direction for ethical decisions and behavior by repeatedly emphasizing the obligations and responsibilities that the nurse-patient relationship entails. It lacks legal enforceability and is not a legal document like licensure laws.

The nurse manager on a surgical unit receives notification that multiple victims of a plane crash will arrive at the hospital momentarily. What is the most appropriate leadership style to adopt in this situation? a. Autocratic b. Democratic c. Laissez-faire d. Eclectic

ANS: A The authoritarian or autocratic style of management has its emphasis on the tasks, which would be effective during an emergency or disaster situation; hence, the autocratic manager may be most effective in a crisis situation. The laissez-faire manager maintains a permissive climate with little direction or control exerted. This manager allows staff members to make and implement decisions independently and relinquishes most of his or her power and responsibility to them. The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. Eclectic is not a specific leadership management style

The nurse enters a patient's room to complete the discharge paperwork and finds the patient in tears. The patient reports that someone from the business office stated the patient could not leave the hospital until the bill was paid. What is the best nursing action? a. Comfort the patient and continue the preparations for discharge. b. Call the social worker for a financial evaluation. c. Call the family to arrange for the payment. d. Cancel the discharge plans and notify the physician of the s

ANS: A The best action is to comfort the patient and continue the discharge preparations. If the patient's claim is accurate, this could be false imprisonment (wrongfully making someone believe that he/she cannot leave a place). The nurse's best action is to comfort the patient and continue the discharge preparations. However, this should also be reported to the supervisor. Calling the social worker may be needed if the patient does not have the resources to pay the bill so the social worker can help explore options. Contacting the family is not appropriate.

The nursing staff in a busy unit enjoys autonomy and needs minimal direction for patient care. Which leadership style would be most effective in this unit? a. Democratic b. Authoritarian c. Laissez-faire d. Bureaucratic

ANS: A The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. The manager is also willing to take responsibility to make decisions when staff participation is not necessary. An authoritarian leader makes decisions without the input of others. The laissez-faire manager maintains a permissive environment. The bureaucratic leader follows a close set of standards to maintain order.

A nurse is educating a group of nursing students on the deontological model of ethical reasoning. The nurse determines that the teaching has been effective when a student states a. "All life is worthy of respect." b. "Abortions are ethical." c. "Euthanasia is acceptable in certain situations." d. "Lying is acceptable if it benefits the patient."

ANS: A The deontological model of ethical reasoning states that all life is worthy of respect. Abortions and euthanasia are never acceptable because they violate the duty to respect the sanctity of all life. Lying is never acceptable because it violates the duty to tell the truth.

A nurse has an adequate understanding of traditional collective bargaining when making which of the following statements? a. "The goal of traditional collective bargaining is to win something that is controlled by another." b. "The goal of traditional collective bargaining is to win something that another person has worked for." c. "The goal of traditional collective bargaining is to give all power to the nurse." d. "The goal of traditional collective bargaining is to give all powe

ANS: A The goal of traditional collective bargaining is to win something that is controlled by another. The other statements are not accurate.

What topics are part of a thorough cultural assessment? (Select all that apply.) a. Communication style b. Nutrition c. Relationships d. End-of-life care e. Personal space

ANS: A, B, C, D, E All options are considered part of a cultural assessment.

The nurse manager is beginning the process of problem solving. Which action should be taken first? a. Define the problem. b. Gather information. c. Analyze the information. d. Consider the alternatives.

ANS: A The good manager will guide the process of defining or identifying the problem by asking the what, when, and where of the problem. Before the manager can perform any of the other steps of problem solving, the problem must be identified. Importance is placed on management's ability to differentiate between facts and opinions and to attempt to break down the information to its simplest terms.

What action can the nurse take to uphold the ethical principle of fidelity? a. Report unscrupulous billing practices. b. Disclose the results of an HIV test to a patient's family. c. Make health care decisions for a patient. d. Accept an assignment that is unsafe.

ANS: A The nurse can uphold the ethical principle of fidelity by reporting unscrupulous billing practices. Disclosing the results of an HIV test to a patient's family would violate fidelity. Making health care decisions would violate autonomy. Accepting an assignment that is unsafe violates nonmaleficence.

A nurse in the OB-GYN clinic is frustrated with an expectant mother who is consistently late for appointments or doesn't come at all. What action by the nurse would be most effective when working with this patient? a. Inquire about the patient's time orientation. b. Remind the patient about the cancellation policy. c. Have her sign a contract to be on time. d. Consult a leader in the patient's community.

ANS: A The nurse should ask about the patient's time orientation. Different cultures (and individuals) view time differently, with past, future, and present orientations, all of which impact behavior. Reminding the patient of policies and having her sign a contract is disrespectful of the patient's culture and might hinder the therapeutic relationship. Consulting a community leader would be a violation of privacy.

Which action by the nurse shows an understanding of the ethical principle of autonomy? a. Allowing a patient the right to make decisions regarding his health care b. Making decisions for the patient regarding her care c. Disregarding the patient's decisions because they are not "normal" d. Consulting the attending physician to make decisions for the patient

ANS: A The nurse shows understanding of the ethical principle of autonomy by allowing patients the right to make their own health care decisions even if the nurse does not agree with their decisions. It is not up to the nurse or the attending physician to make health care decisions for patients

A nurse is educating nursing students on the teleological model of ethical reasoning. The nurse judges that the education has been effective when a student states which of the following? a. "Abortion is acceptable because it results in fewer unwanted babies." b. "Abortion is never acceptable because it violates the sanctity of life." c. "Euthanasia is never acceptable because it violates the sanctity of life." d. "The rights on individuals should not be sacrificed for the good of t

ANS: A The teleological model of ethical reasoning is interpreted as meaning "the end justifies the means." The rights of some individuals may be sacrificed for the majority. Therefore, abortion may be acceptable because it results in fewer unwanted babies. Euthanasia may be acceptable because it results in decreased suffering.

A nurse is preparing a presentation. How can the nurse explain one of the primary concerns of the proponents for a nontraditional collective bargaining unit versus the traditional union-based nursing model? a. "The traditional union-based model frequently puts nurses and employers in adversarial positions." b. "The union dictates to members what they can and cannot do within the health care institution." c. "The union-based model can initiate strikes that can be detrimental to the pro

ANS: A The traditional union-based model is adversarial and frequently puts nursing and administration in antagonistic positions. Strikes are most often the last resort and are planned well in advance so that the institution can be prepared. Nontraditional process is referred to as interest-based bargaining (IBB), or shared governance. This is a nontraditional style of bargaining that attempts to problem solve differences between labor and management. Although this style of bargaining and mediation will not always eliminate the need for the more traditional and adversarial collective bargaining, many believe this nonadversarial approach of negotiation may be closer to the basic fabric of the discipline of nursing and its ethical code. In both models, nurses pay dues.

A nurse is giving a presentation on professional negligence. Which statement indicates that the nurse understands this topic? a. "The elements of duty, breach of duty, causation, and patient injury must be present for a negligence claim." b. "Negligent nursing care and failure to follow standards must be present for a malpractice claim." c. "Failure to report, defamation, and discrimination must be present for a malpractice claim." d. "Error in judgment and invasion of privacy must

ANS: A There are four elements that must be present for a professional negligence or malpractice claim: (1) You must have a duty—there must be a professional nurse-patient relationship. (2) You must have breached a duty that was foreseeable—you must have fallen below the standard of care. (3) Your breach of duty caused patient (4) injury or damages. The other options do not indicate the nurse's understanding of malpractice.

A nurse is teaching nursing students about issues that keep nursing from becoming a profession of choice. The nurse knows that the teaching has been effective when one of the nursing students states a. "Nurses downplay their role in health care." b. "Nurses take credit for their role in health care." c. "Nurses are often seen on the news discussing their role in health care." d. "Nurses are willing to talk to the media."

ANS: A There are many factors that prevent nursing from becoming a profession of choice. These include nurses downplaying their role in health care, not taking credit for their role, and not being seen in the media.

What element in health care is most responsible for the ethical dilemma of whether health care is a privilege or a right? a. Cost b. Technology c. Consumerism d. Worker shortage

ANS: A Variables of the justice principle involve the allocation of scarce or expensive health care resources. The following questions are a few examples illustrating this principle: "What kind of access to health care should illegal immigrants receive—preventive care or only more costly emergency care?", "How should the health care of children be allocated?", and "Should all children receive the same health care regardless of ability to pay?".

A nurse and a patient are discussing the patient's wishes regarding resuscitation. The patient decides that resuscitatio n is not wanted under any circumstances. What action can the nurse take to identify the ethical issues of the situation? a. Encourage the patient to discuss his/her wishes with his/her family. b. Encourage the patient to change his/her mind. c. Coerce the patient into changing his/her mind by calling the physician to the bedside. d. Continue to treat the patient as a "full

ANS: A When identifying the ethical issues of the situation, the nurse should encourage the patient to share his/her wishes with his/her family. It is not the position of the nurse to try to change the patient's mind or force him/her to remain a "full code." The nurse should respect the patient's wishes and document them accordingly.

Which of the following actions is consistent with a manager? (Select all that apply.) a. Planning the agenda for a staff meeting b. Directing nurse assistants in how to divide up patient-care assignments c. Organizing a group of nurses to present a topic at a staff meeting d. Giving blood at the local hospital blood drive as an example to others e. Assume control of the guidelines for how hourly rounding will work on the unit

ANS: A, B, C, E Managers plan, direct, organize, and control activities designated to their staff. Giving blood at the local hospital would not be an action that is consistent with a nurse manager role.

Which of the following statements by the nurse reflect transformational leaders? (Select all that apply.) a. Lifelong learners b. Courageous change agents c. Slow to change d. Value-driven visionaries e. Hesitant to follow

ANS: A, B, D Transformational leaders are lifelong learners, courageous change agents, and value-driven visionaries. They are not slow to change or hesitant to follow.

A nurse manager is in the planning phase in a new job. Which actions show this? (Select all that apply.) a. Developing goals that reflect the mission and vision of the organization b. Defining strategies to meet the mission and vision of the organization c. Providing direction for staff to perform the work of the organization d. Retaining accountability for all work completed by the staff e. Planning for contingencies that may interfere with the work of the organization

ANS: A, B, E In the planning phase, the nurse manager will develop goals, define strategies, and plan for contingencies that may interfere with the work. The next phase of management is providing direction to staff and retaining accountability for all work completed by the staff.

The nurse is creating a plan of care for a patient. Which would be important for the nurse to consider before implementing the plan? (Select all that apply.) a. The patient's lifestyle b. The patient's insurance coverage c. The patient's value system d. The patient's religious beliefs e. The patient's ability to pay for services

ANS: A, C, D When creating a plan of care for the patient, the nurse should consider the patient's lifestyle, value system, and religious beliefs.

What actions can the registered nurse take to control personal practice? (Select all that apply.) a. Improve the professional practice of nurses and nursing assistants. b. Refrain from shared governance. c. Implement peer review. d. Identify and recommend elimination of hazards in the workplace. e. Identify and recommend processes that work to ensure the safety of patients. Common issues

ANS: A, C, D, E To control personal practice, the registered nurse can improve the professional practice of nurses and nursing assistants, implement shared governance, implement peer review, identify and recommend elimination of hazards in the workplace, and identify and recommend processes that work to ensure the safety of patients.

Throughout the 1990s, a nationwide campaign worked to strengthen the image of nurses. Which of the following action(s) during the campaign aided in this? (Select all that apply.) a. Worked to improve the image of nurses as depicted on television b. Reinforced the image of nurses as doctors' personal assistants c. Reinforced the idea that nursing required little skill d. Educated the public that nurses are critical thinkers e. Reinforced that nurses have problem-solving skills

ANS: A, D, E The campaign during the 1990s worked to improve the image of nurses as depicted on television, as well as to reinforce the idea that nurses are critical thinkers and have problem-solving skills. Because of the campaign, the nation began to see nurses as skilled, educated health care professionals.

Which of the following describe the reward power used by the nurse manager? (Select all that apply.) a. A nurse manager who allows employees to initiate schedule changes b. A nurse manager who uses salary increases to motivate staff c. A nurse manager who is perceived as an expert due to specialized knowledge d. A nurse manager who is well liked by the majority of staff e. A nurse manager who has information that others need to perform their jobs

ANS: A,B Reward power occurs when nurse managers provide or withhold rewards. A nurse manager who is perceived as an expert has expert power. A nurse manager who is well liked by the majority of the staff has referent power. A nurse manager who has information needed by others to perform their jobs has informative power. The nurse manager who uses fear of consequences is using coercive power.

A patient with cancer has decided to end treatment and is discussing end-of-life care with the family. The nurse notices that the attending physician has just ordered another dose of chemotherapy. What would be the best action for the nurse to take as an advocate for the patient? a. Send the order to the pharmacy so that the chemotherapy can be prepared. b. Call the attending physician, and request a meeting so that there can be open communication between the physician and the patient and family

ANS: B As an advocate for the patient, the nurse should advocate for the patient with the attending physician and family by facilitating communication. It would be best for all parties to be in a room together so that a discussion can take place. It would not be appropriate to send the order to the pharmacy, try to convince the patient to receive chemotherapy, or tell the patient that the drug must be given because it was already ordered.

The nurse is educating a coworker on the ethical principle of beneficence. The nurse judges the teaching to be effective when her coworker states a. "Beneficence involves allowing patient to make their own health care decisions." b. "Beneficence is the duty to actively do good for patients." c. "Beneficence is the duty to do no harm." d. "Beneficence involves treating all patients equally."

ANS: B Beneficence is the ethical principle of actively doing good for patients. Allowing patients to make their own health care decisions is autonomy. Doing no harm to the patient is nonmaleficence. Justice involves treating all patients equally.

Which statement by the nurse indicates an understanding of collective bargaining in the workplace? a. "Collective bargaining is not useful in the professional workplace." b. "Collective bargaining is used by nurses to control their practice." c. "Collective bargaining is used by managers to control nurses." d. "Collective bargaining is always an adversarial process in the workplace."

ANS: B Collective bargaining is used by nurses to control their practice by redistributing power within the health care organiz ation. It is not used by managers to control nurses. It is used in the workplace. Traditional collective bargaining has been considered an adversarial process. Nontraditional collective bargaining or interest-based bargaining (IBB) attempts to problem solve issues between staff and management in a shared governance approach.

Which action led to the "birth" of nursing theory? a. Creation of baccalaureate programs b. Dr. Peplau's nursing model publication c. Publication of Jean Watson's Caring Theory d. Martha Rogers' work on nursing theory

ANS: B Dr. Peplau's nursing model publication led to the birth of nursing theory in 1952. The work of Jean Watson and Martha Rogers occurred after Dr. Peplau's work. Having a theoretical framework on professional practice is one of Pavalko's eight dimensions to describe a profession.

Which statement best describes when collective bargaining by nurses can occur? a. Only when the nurses in the group are members of a union b. Whenever nurses see a need to organize to take collective action c. Only when the state nurses association is willing to represent nurses at a specific agency d. When the state nurses association agrees that working conditions are inappropriate

ANS: B Professional nurses organize themselves. This may occur because administrators and nursing supervisors fail to recognize and address nurses' individual and collective needs. Collective bargaining can be addressed through a formal union representative or through interest-based bargaining (IBB). The state nurses association may or may not be involved with collective bargaining

A nurse is unhappy about the way medications are being administered on the unit. What does the nurse need to do first to facilitate a change in the process? a. Initiate a new method starting with assigned patients. b. Discuss concerns with fellow nurses to determine interest in changing. c. Develop a better method to administer the medications. d. Inform the charge nurse of how it can be done better.

ANS: B For the nurse to be successful the initial step is to consider all the factors that might cause resistance to change and to involve those who might be willing to help champion a change. Once this has been done, the team can design strategies to improve the process. The nurse cannot just start using a new process for individual patients. Developing a better method is needed, but only after some work has been done to identify support. Without a plan to create the change, informing the charge nurse of how this can be done better is likely to fail.

A nurse is caring for a patient from an unfamiliar culture and notices the patient becoming nervous and agitated when the nurse needs to be close to the patient, such as taking the morning blood pressure. What action by the nurse is best at that time? a. Tell the patient that you will be done very quickly. b. Apologize for any offense and explain why the procedure is needed. c. Ask the patient to discuss his or her cultural and spiritual beliefs. d. Reassure the patient that you are only trying

ANS: B In the moment, the nurse would apologize for offense or embarrassment and explain to the patient why the procedure is necessary. At a later time, the nurse would conduct a more thorough assessment of the patient's culture and spirituality. Telling the patient that you will be done quickly or that you are only providing good care is dismissive of the patient's cultural values and beliefs

The nurse is caring for a patient who claims little to no spirituality. What does the nurse understand about this patient? a. Will have no additional needs related to spirituality. b. May become aware of spirituality during illness. c. Does not belong to an organized religion. d. Comes from a family without a religious background.

ANS: B Individuals may become aware of spirituality during times of need, including illness. The nurse would not "shut the door" to later conversations or requests along this line. A person who identifies as nonspiritual may or may not belong to a religious organization or come from a family without a distinct religious background.

Which statement best describes effective leadership by the nurse manager? a. Directs a staff nurse to modify his/her communication skills b. Fosters behavior changes in one staff member that have positive effects on the others c. Encourages behavior changes through the annual evaluation process d. Uses the group process to determine what behavior is distressing to staff

ANS: B Leadership in established groups should be democratic and leave members feeling positive about being part of the group. This is seen in a group where one member can have a positive influence on the other members' feelings and actions. Democratic leaders do not have to be directive unless a situation arises where one person must take charge. Waiting until the annual review process to encourage positive growth is too long. Using the group process to determine distressing behavior is not conducive to democratic leadership.

A nurse is educating coworkers on the establishment of collective bargaining. The nurse knows the teaching has been successful when a coworker states which of the following? a. "Collective bargaining is still not recognized by hospitals." b. "Nurse activists believed in a unified voice for nurses." c. "Nurse activists wanted to option of working more hours." d. "Collective bargaining is not effective."

ANS: B Nurse activists created the National Nurses United because they believed in the creation of a powerful, national, independent, and unified voice for union nurses. Collective bargaining is recognized in hospitals in states where it is effective. The other statements are not accurate of collective bargaining.

A nurse is striving to control personal nursing practice. Which action does the nurse avoid? a. Recommend a new system for bedside report. b. Refrain from participating in peer review. c. Create a unit presentation on increasing patient safety. d. Identify ways to reduce hazards.

ANS: B The nurse can control personal nursing practice by recommending a new system for bedside report, participating in peer review, creating a unit presentation on how to increase patient safety, and identifying ways to reduce hazards

The nurse understands that having a stand-up meeting versus the traditional (sitting at a conference table) meeting takes less time to come to a decision based on which of the following ideas? a. Contingency-style leadership b. Evidence-based management protocols c. Autocratic management style d. Presence of a clinical nurse leader (CNL)

ANS: B Nurses are expected to practice using evidence-based protocols and interventions for clinical decision making, and managers are expected to use those management practices that are not simply based on conventional wisdom but on demonstrated outcomes. Evidence indicates that stand-up meetings took 34% less time to make decisions. Using this model could save an organization many hours a year that could be put to another productive use or could be eliminated from the payroll. Autocratic management style is authoritative. Contingency leadership style is a style of leading that is flexible to adapt to the situation.

A nurse is caring for a diabetic patient who frequently uses alternative medicine to manage ailments. The patient feels nauseous and requests ginger tea. What should the nurse be aware of before giving the patient ginger tea? a. Nothing; natural remedies do not cause unwanted side effects. b. Ginger can cause blood glucose levels to decrease. c. Ginger causes blood glucose levels to rise. d. Ginger can cause a diabetic patient to become more nauseous.

ANS: B Nurses should be aware of natural remedies and their interactions because more patients turn to these remedies as opposed to medication for management of ailments. In this scenario, the nurse should be aware of the fact that ginger can cause blood glucose levels to decrease, possibly causing harm to the diabetic patient.

A staff nurse is scheduled to work 3 to 11 PM in the cardiac step-down unit. The staff nurse realizes that he/she is the only RN who will be on duty. The staff nurse calls the supervisor to say that help will be needed. The supervisor replies that there are no available nurses to assign to this unit. What does the nurse do? a. Leave and go home rather than assume this responsibility. b. Protect him/herself by filing a written objection to the assignment. c. Call a temporary agency and arrange fo

ANS: B Nurses who disagree with an assignment should submit their objection in writing when the assignment could violate the patient protection language of the state nurse practice act. An assignment-despite-objection report is submitted to the nursing administrator and the bargaining agent simultaneously, thus officially registering the complaint. This procedure is used both in the traditional and in the nontraditional collective bargaining units. Professional responsibility would be staying with the assignment and not abandoning the work (i.e., patients). The staff nurse does not have the authority or power to contact a temporary agency for obtaining staffing. The state department of health does not review or investigate staffing issues.

A nurse is using the decision-making process. Which action should be taken first? a. Evaluate the outcome. b. Identify and evaluate options. c. Set the objective. d. Implement the options.

ANS: C Decision making requires the definition of a clear objective to guide the process. The nurse must set the objective before proceeding to the other steps in the decision-making process. The second step is to identify and evaluate alternate decisions. The third step is to make the decision and implement, and the last step is to evaluate the outcome.

The nurse understands that the following organization believes that cultural competence in nursing is necessary. a. Nurse Practice Acts of state boards of nursing b. Code of Ethics of the American Nurses Association c. Accreditation standards of the National League of Nursing d. Accreditation standards of The Joint Commission (TJC)

ANS: B The American Nurses Association indicates in its Code of Ethics the necessity of the nurse to be sensitive to individual needs. State boards of nursing are involved in the regulation and licensure of nursing practices. The National League of Nursing is involved with accreditation of nursing programs. TJC is involved with hospital accreditation.

The nurse understands the importance of the Employee Retirement Income Security Act (ERISA) of 1974 when stating which of the following? a. "It provided a standard of practice for nursing." b. "It allowed professional nursing organizations to act as unions on behalf of member nurses." c. "It established the framework for political action in legislative activities." d. "It financially supports research in nursing and education."

ANS: B The Employee Retirement Income Security Act (ERISA) opened the door for the American Nurses Association to represent nursing in collective bargaining issues. It did not provide a framework but enacted a law. Various nursing organizations support research in nursing and education.

By asking "How does your spirituality impact the way you care for your health?", the nurse is assessing which domain in the FICA Spirituality History Tool? a. Faith and Belief b. Importance c. Community d. Address in Care

ANS: B The FICA Spirituality History Tools assesses a patient's spiritual needs. Asking how spirituality impacts the way a person takes care of him/herself is part of the Importance of domain.

Which of the following actions by the nurse manager would indicate an autocratic management style? a. Allows staff members to make most of the decisions b. Makes most of the decisions without input from the staff members c. Exerts little control over staff d. Emphasizes effective group functioning

ANS: B The autocratic manager uses an authoritarian approach to direct the activities of others. This manager would make most of the decisions without input from the staff members. Allowing staff members to make most of the decisions and exerting little control over staff is a laissez-faire management style. Emphasizing effective group functioning is common for a democratic management style.

Which statement by the staff nurse shows an adequate understanding of the nurse manager role? The nurse manager a. "is given information and power through an official position." b. "coordinates group activities toward a common goal." c. "is responsible for developing goals to be accomplished." d. "selects and assumes a role among a group of peers."

ANS: B The manager coordinates the activities of the group to maintain balance and direction. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). Although it is correct to state the manager is given information and power through an official position, this is too narrow in scope to be the best answer. Goals may be developed by the manager, the group, or the organization. Leaders select their role.

The nurse manager identifies which of the following as the most critical step in problem solving? a. Brainstorm all possible solutions. b. Identify the problem. c. Evaluate possible solutions. d. Choose a solution.

ANS: B The most critical step in the problem-solving process is to identify the problem. Brainstorming solutions, evaluating possible solutions, and choosing a solution occur after the problem have been identified.

What would the nurse identify as a primary difference between traditional and nontraditional collective bargaining? a. Traditional collective bargaining is not organized through the state nursing association. b. Traditional collective bargaining units are organized, and members belong to the National Nurses United. c. Nontraditional collective bargaining units are not recognized by health care organizations as a collective bargaining agency. d. Nontraditional collective bargaining has a long his

ANS: B The nontraditional collective bargaining activities in nursing are organized and supported by the Center for American Nurses, which is affiliated with the American Nurses Association. The traditional unit in the past was the United American Nurses (UAN). This union has joined other traditional bargaining units and has become the National Nurses United, which is a relatively new union (started in 2009).

A nurse manager is looking for ways to improve the cultural competency of unit staff. Which action would help the manager accomplish this? a. Propose voluntary cultural competency training. b. Hire bicultural clinical and administrative staff. c. Hire staff from the same ethnic background. d. Purchase a unit subscription to journals related to culture and health care.

ANS: B The nurse manager can improve the staff's cultural competence by hiring bicultural clinical and administrative staff to improve education, care delivery, and outcomes. The nurse manager should also propose mandatory cultural competency training and hire staff from different ethnic backgrounds.

What is the most consistent concern of the nurse as a manager? a. To develop long-range career goals b. To coordinate patient care while meeting the agency goals c. To maintain harmony within the agency d. To organize the subordinates to meet agency goals

ANS: B The role of the nurse as manager has evolved into a complex one that includes organizing patient care, directing personnel to achieve agency goals, and allocating resources. The most consistent concern of the nurse as a manager is not to develop long-range career goals, maintain harmony within the agency, or organize subordinates to meet agency goals. Although having long-range career goals is a good idea for the nurse manager, it is not a day-to-day concern. Organizing subordinates is not a role of the nurse manager, but instead, it is directing or supervising them to achieve patient-care needs.

The ethical principle of autonomy is not applicable in which patient situation? a. The patient does not speak or understand the English language. b. The patient is unaware of who or where he or she is. c. The patient has been in a long-term care facility for 10 years. d. The patient has values that conflict with the caregiver's values.

ANS: B This principle assumes rational thinking on the part of the patient, and being unaware of who and where one is, is not indicative of the ethical principle of autonomy. Autonomy is a patient's right to self-determination that implies the freedom to make choices and decisions about one's own care without interference even if those decisions are not in agreement with those of the health care team. In other situations, the patient has rational thinking even though he or she may not understand or speak English because an interpreter could assist.

What action did the Johnson & Johnson Campaign for Nursing's Future take to promote nursing? a. Identified the need for nurses in labor and delivery b. Raised visibility of nurses of varied races c. Identified the need for nurses in postpartum care d. Raised national starting wages for nurses

ANS: B To encourage young adults to enter the field of nursing, Johnson & Johnson increased the visibility of nurses of varied races, gender, and roles by providing numerous public announcements and campaigns.

A nurse is educating an adult patient on patient rights, according to the American Hospital Association. The teaching has been effective when the adult states that the patient's rights include a. "choice of diet to be eaten during hospitalization." b. "considerate and respectful care from all care providers." c. "medical care regardless of ability to pay." d. "information from nurses about diagnosis and prognosis."

ANS: B When you are a patient in the hospital, you have the right to receive considerate and respectful care. The American Hospital Association published a Patient's Bill of Rights, which is now revised and called the Patient Care Partnership. This document reflects the acknowledgment of patients' rights to participate in their health care and was developed as a response to consumer criticism of paternalistic provider care. The statements detail the patient's rights with corresponding provider responsibilities. This document reflects the increasing emphasis on patient autonomy in health care and defines the limits of provider influence and control. It does not contain information on diets, nursing diagnosis, or the ability to pay for medical care.

What action(s) can the nurse take to continue improving the image of nursing? (Select all that apply.) a. Contact sponsors of inappropriate images to protest the message. b. Uphold ethical standards for all patients, all the time. c. Maintain a professional behavior in the workplace. d. Be aware of the challenges ahead due to society's perception of nurses. e. Disregard the need to change the image of nursing and carry on as before.

ANS: B, C, D To change the image of nursing for the better, the nurse needs to take charge of the image. The nurse should be sure to uphold ethical standards for all patients and be aware of the challenges she or he will face. The nurse should present herself or himself in an appropriate manner, both in public and online. When inappropriate images appear the nurse should contact the sponsor to protest and to educate.

Which of the following actions demonstrate ways nurses can control their profession? (Select all that apply.) a. Discussing issues on their lunch break b. Joining a professional organization c. Through publishing documents d. Being active in the state boards of nursing e. Keeping issues to themselves

ANS: B, C, D Using Pavalko's eight dimensions to describe a profession, nurses can control their profession in several ways. They can join a professional nursing organization, publish documents, and be active in the state boards of nursing. Discussing issues on a lunch break or keeping issues to themselves are not ways to control their profession.

Which action would be consistent with the American Red Cross volunteer nurse? (Select all that apply.) a. Provide staffing for a local hospital. b. Provide assistance after a tornado. c. Teach first aid to a group of Girl Scouts. d. Deliver clothing to flood victims. e. Educate volunteers to assist in a local hospital.

ANS: B, C, D, E The function of the American Red Cross volunteer nurse is to provide disaster relief, teach first aid, and organize volunteers for hospitals or nursing homes. The volunteer nurse would not be responsible for providing staffing for a local hospital.

The nurse manager has an adequate understanding of the common issues in nursing when stating which of the following? (Select all that apply.) a. "There are no common issues in nursing." b. "Mandated staffing is a common issue." c. "Unsafe patient assignments are a common issue." d. "Lack of overtime is a common issue." e. "Negotiations are a common issue."

ANS: B, C, E Mandated staffing, unsafe patient assignments, and negotiations are common issues faced by nurses today. Lack of overtime is not considered to be a common issue in nursing.

A nurse manager is educating unit staff on cultural competence. The manager knows that the teaching has been effective when one of the staff members states, "Cultural competence (Select all that apply.) a. is not that important in emergency situations." b. is partly determined by one's own attitudes and behaviors." c. can be affected by system policies." d. knowing all about a patient's culture." e. enables effective work across cultures."

ANS: B, C, E The Office of Minority Health defines cultural competence as "a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations" (U.S. Department of Health and Human Services Office of Minority Health [HHS OMH], 2016, para 1). It is extremely important in emergency situations, which cause distress, and does not require becoming an expert in a particular culture.

A nurse believes that an assignment is unfair and refuses to care for the assigned patients. What could be the outcome if the nurse abandoned the patient assignment? (Select all that apply.) a. The nurse would be assigned to another group of patients. b. Untoward patient outcomes. c. Other nurses would take on the nurse's assignment. d. Disciplinary action by the Board of Nursing. e. Disciplinary action by the nurse's employer.

ANS: B, D, E Abandoning a patient assignment risks untoward patient outcomes and can result in disciplinary action by the nurse's employer and the Board of Nursing.

A nurse is educating students on physician-assisted suicide (PAS). The nurse judges that the teaching has been effective when a student states which of the following? (Select all that apply.) a. "PAS does not violate any ethical principles." b. "PAS threatens to destroy the fundamental relationship between physician and patient." c. "PAS does not involve nurses." d. "Quality of life advocates support PAS as an example of personal autonomy and control." e. "Nurses should be awar

ANS: B, D, E The American Medical Association opposes physician-assisted suicide (PAS) because it violates the most basic ethical principle: first, do no harm. Physicians have traditionally cared for living patients, and their opinion is that PAS threatens to destroy this fundamental relationship. On the other hand, quality of life advocates support PAS as an example of personal autonomy and control. Nurses working with physicians involved in PAS should be aware of the legal and ethical implications of administering lethal dosages of medications.

A nurse believes that the patient assignment received is unsafe. Which actions should be taken to correct this? (Select all that apply.) a. Leave the hospital. b. Submit a report about the assignment following protocol. c. Report the assignment to a supervisor immediately. d. Accept the assignment. e. Accept the assignment and only perform the skills that the nurse is comfortable with.

ANS: B,C The nurse should immediately report the assignment to the nurse supervisor and submit a report about the assignment following protocol. The nurse should not leave the hospital or accept the assignment if he/she cannot provide competent care.

Which actions can the nurse take during a job interview to ensure job satisfaction in the future? (Select all that apply.) a. Ask about the benefits associated with the job. b. Assess the potential employer's mission. c. Determine wages and pay increases. d. Ask questions to determine the culture of the organization. e. Question the hours that are required for a full-time status.

ANS: B,D In the job interview, it is important that the nurse focuses on questions that will help determine which job is right and will ensure job satisfaction in the future. The nurse should be prepared to assess the potential employer's mission and culture in order to determine if the job will support the nurse's professional practice and growth. Although information about compensation, benefits, and hours are needed, these are not the best predictors of job satisfaction.

In which situation would the traditional type of collective bargaining (union) be best to help nurses attain their goals? a. Management has agreed to no nursing layoffs for 1 year after reorganization. b. Nursing has received a 4% salary increase this year and next year. c. Nurses have identified workplace safety issues and health hazards. d. Management has arranged for nurse practitioners to have admitting privileges.

ANS: C A conflict regarding safety between administration and nursing is a situation that could benefit from a nurses' union. Many nurses support collective bargaining in the workplace as a way to control their practice by redistributing power within the health care organization. Salary increases, no nursing layoffs, and nurse practitioners having admitting privileges typically do not represent as important an issue as patient and staff safety.

A nurse is interested in moving into a management position. Which action would assist with accomplishing this? a. Use of reward power b. Use of coercive power c. Use of expert power d. Use of legitimate power

ANS: C An expert refers to someone who is knowledgeable, experienced, and respected in his or her area of nursing. This type of expert power would assist the nurse to advance to higher positions in nursing. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Coercive power is power derived from the fear of consequences.

The nurse manager tells the patient that he must eat his breakfast before getting out of bed. What type of power is the nurse manager using? a. Legitimate power b. Expert power c. Coercive power d. Referent power

ANS: C Coercive power is power derived from the fear of consequences. Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Referent power is the power that a person has because others closely identify with that person's personal characteristics; the person is liked and admired by others

The nurse understands what about complementary medicine? a. It takes the place of Western medicine and complements spirituality b. Provides both modern and traditional practices for a holistic approach c. Is used in conjunction with modern medical practices d. Usually involves treatments provided by shamans

ANS: C Complementary practices are used in conjunction with modern medical practices. They do not take the place of medical treatment (that is alternative medicine) and do not combine both traditions for a more holistic approach (integrative medicine). Complementary practices may or may not involve traditional healers.

What action would be an appropriate first step for the nurse to take toward becoming an effective manager? a. Learn how to effect and direct the change process. b. Assess individuals' sources of power. c. Develop communication and interpersonal skills. d. Implement effective nursing care plans.

ANS: C Effective managers have a balanced mix of management skills and leadership qualities. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). To be effective in performing these functions, a manager must develop communication and interpersonal skills.

A nurse is caring for a patient who has just been diagnosed with cancer. The patient's family has requested that the patient not be told at this time because it would be devastating. The patient asks the nurse if the diagnosis is cancer. If the nurse were to uphold the ethical principle of veracity, what would the response be? a. "No, you do not have cancer." b. "The physician is unsure of your diagnosis at this time." c. "Yes, that is the diagnosis. Let me call the doctor so that we

ANS: C If the nurse were to uphold the ethical principle of veracity, the nurse would inform the patient of the diagnosis and involve the physician in the discussion. The nurse should not lie to the patient or withhold information at the family's request; the patient has a right to know information regarding his/her health care.

A patient is in the Intensive Care Unit on a ventilator, going in and out of consciousness. In a lucid moment, the patient writes a note to the nurse asking for acupuncture. The patient's spouse explains that they always use acupuncture for health-related concerns. What action by the nurse is best? a. Explain that the patient is too sick to undertake this alternative practice. b. Tell the patient and family that visitation is only for family members. c. Collaborate with the health care team on

ANS: C In order to provide culturally and linguistically competent care, the nurse must incorporate patients' values, beliefs, and practices into health care whenever possible. In this case, although the patient is acutely ill, the nurse should collaborate with members of the health care team to make this request possible. The social worker may be involved, but the nurse must take an active role and not just pass the request on. Patients are never too ill for culturally congruent care and visiting rules can and should be changed if needed.

A nurse is caring for a patient experiencing spiritual distress. What nursing intervention would be appropriate for this patient? a. Asking the patient to reserve prayer for the hospital chaplain b. Placing the patient by the nurses' station because it will be distracting c. Developing a trusting relationship with the patient d. Allowing the patient's roommate to have visitors late into the night

ANS: C It is important that the nurse develops a trusting relationship with the patient, as well as being supportive of the patient's needs. The nurse should allow the patient a quiet environment that allows time for prayer and meditation.

A manager is educating a group of nurses on the importance of cultural competence. The manager knows that the teaching has been effective when one of the nurses states a. "Cultural competence does not impact patient care." b. "Cultural competence is not important in health care." c. "Lack of cultural competence leads to suboptimal patient outcomes." d. "Lack of cultural competence does not cause active harm to the patient."

ANS: C Lack of cultural competence is extremely important in health care because it directly impacts patient care. Lack of cultural competence leads to suboptimal care and can cause active harm to the patient.

A nurse wants to implement a change in the work environment. Which of the following actions would be the most important thing to do? a. Ask for suggestions from peers working in other institutions. b. Explain to coworkers how a different plan would work better. c. Seek input from coworkers from the beginning. d. Incorporate all suggestions into the plan before implementing.

ANS: C Seeing the input from coworkers from the beginning is an important component of initiating change in the work environment. In the unfreezing phase, all of the factors that may cause resistance to change are considered. Others who may be affected by the change are sought out to determine whether they recognize that a change is needed and to determine their interest in participating in the process. It will be important to determine whether the environment of the institution is receptive to change and then convince others to work with the group initiating the change.

A nurse is respected by peers for clinical skills and effective interpersonal relationships. The nurse has studied diabetic patient educational needs and consults with several units. What type of power does this nurse possess? a. Informational b. Legitimate c. Reward d. Expert

ANS: D Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Those who have information that others need to perform their duties have informational power. Legitimate power is based on the person's position within an organization. Reward power occurs when an individual has the power to give or withhold rewards.

A nurse manager is teaching the purpose of the nurse's Code of Ethics to a group of high school students. Which statement by one of the students indicates that the teaching has been effective? The purpose of the nurse's Code of Ethics is a. "to assist in clarifying the individual nurse's personal values and goals." b. "to differentiate between moral and immoral acts." c. "to guide the behavior of the professional nurse." d. "to identify acts that are legal for the nurse to pe

ANS: C The American Nurses Association (ANA) Code of Ethics (2015) is a statement to society that outlines the values, concerns, and goals of the profession. It should be compatible with the values and goals of each nurse. It does not outline moral or immoral acts or make statements regarding the legal aspects of nursing.

The nurse is determining which professional organizations to join. The nurse demonstrates an adequate understanding of the International Council of Nursing (ICN) when stating which of the following? a. "The ICN handles domestic nursing issues." b. "The ICN is for international nurses only." c. "The ICN is focused on worldwide health care." d. "The ICN is focused on foreign issues only."

ANS: C The International Council of Nursing (ICN) is focused on worldwide health care and nursing issues. The organization represents nurses worldwide and meets every 4 years to discuss issues and trends.

In transcribing orders for a patient, the nurse finds a new order for aspirin, 500 mg, QID. The patient has a long history of gastrointestinal bleeding. What is the best nursing action? a. Give the medication. b. Withhold the medication, and chart why it was not given. c. Call the provider, and question the order in light of the patient's history. d. Ask if the patient is allergic to aspirin.

ANS: C The nurse should call the provider and question the medication order for aspirin based on the patient's history of gastrointestinal (GI) bleeding. Claims involving medication errors are augmented when the nurse fails to recognize side effects or contraindications or fails to know a patient's allergies. The nurse would withhold the medication until the provider is notified and the order clarified. Giving the medication could cause the patient to start bleeding. Although asking for allergies is an important nursing action, the important aspect in this situation is the medical history of GI bleeding.

A nurse is caring for a young patient recovering from a traumatic car crash. The patient has lost a lot of blood and is in need of a blood transfusion. The patient states, "I'm a Jehovah's Witness" and will not accept the blood. The nurse knows the patient will likely not survive without the blood. What action should the nurse take? a. Administer the blood anyway; the patient will die without it. b. Try to talk the family into signing the consent for the blood. c. Call the physician and

ANS: C The nurse should immediately call the physician to report the patient's decision. The nurse should not administer the blood against the patient's wishes or try to talk the family into signing the consent. The nurse should continue all care for the patient except the administration of the blood.

The nurse manager oversees a busy unit that has experienced several major changes recently. The manager notes the staff comply with the changes but seem depressed and lack energy. What action by the manager is the best? a. Remind them that the changes were for the best. b. Explain why the changes were needed. c. Allow nurses to move at their own paces. d. Give weekly pep talks and bring treats.

ANS: C These nurses are in a state of resignation. While they continue to comply with the changes, their energy is low. The manager needs to let them work at their own pace, and since they are complying, no reminders of why the changes were needed or pep talks with treats are necessary. Eventually, the changes will become ingrained and the energy level will rebound.

A young woman has come to the hospital requesting medication to induce an abortion. The nurse assigned finds it too hard to provide care to this patient because it violates the nurse's ethical principles. Which action would be the best for the nurse to take? a. Continue to provide care for the patient but refuse to administer the medication. b. Administer the medication because the doctor ordered it. c. Find another nurse to provide care for the patient. d. Try to talk the patient out of takin

ANS: C To ensure care for the patient without violating the nurse's ethical principles, the nurse should find another nurse to care for the patient. Because the patient has rights, it would be inappropriate to try to talk the patient out of receiving the medication or to deny the patient's access to the medication.

Which actions by hospitals in the 1940s began the journey to collective bargaining for nurses? (Select all that apply.) a. Allowed nurses to work 40-hour work weeks b. Compensated nurses for overtime c. Scheduled nurses to work 50- to 60-hour work weeks d. Subjected nurse to arbitrary schedules e. Did not offer sick or personal time

ANS: C, D, E During the 1940s, nurses working in hospitals were subjected to arbitrary schedules, did not have sick or personal time, and were scheduled to work 50- to 60-hour work week

A nurse manager is speaking to a group of nurses about how to choose their representative if they wish to participate in traditional or nontraditional collective bargaining. The nurse manager knows that the teaching has been effective if the nurses select which of the following as ways to choose their representative? (Select all that apply.) a. Service Employees International Union b. The National League for Nursing c. Their state nurses association d. The American Federation of Teachers e. Nati

ANS: C,E The professional association has the means and responsibility to represent nurses. The national professional organization for nursing is the American Nurses Association (ANA) with its constituent units, the state, and territorial nursing associations. Nurses can enjoy the benefit of representation by nurses either through a traditional organized union, such as the National Nurses United (NNU). The CAN has been integrated into the ANA.

A nurse is learning about the ANA Code of Ethics. Which action by the nurse would be unethical, according to the ANA Code of Ethics? a. Joining unions or bargaining units b. Engaging in lobbying related to health care issues c. Reporting an incompetent or impaired colleague d. Refusing to care for a patient who is diagnosed as HIV positive

ANS: D ANA Code Provision 1: "The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person." Nurses have the right to engage in collective bargaining and lobbying for health care issues. Nurses have a legal responsibility based on the Nurse Practice Act in their states to report an incompetent or impaired colleague.

In order to ensure a patient's spirituality is respected and incorporated in the health care experience, which question by the nurse is the best? a. "How important is spirituality in your life?" b. "Do you consider yourself spiritual or religious?" c. "Are you part of a spiritual community?" d. "How would you like me to include spirituality in your care?"

ANS: D All options are good questions for assessing spirituality, but asking the patient directly how he or she wants it incorporated into the health care experience is the best way to get this information without assuming an answer from other questions

A nurse manager has an adequate understanding of this nursing role when making which of the following statements? a. "A manager selects or assumes a role." b. "I have the same function as a floor nurse." c. "I have the same authority as the director of the hospital." d. "I was appointed to my role."

ANS: D Although a manager is assigned or appointed to a role, a leader selects or assumes a role. The nurse manager functions differently from a floor nurse, and although the nurse manager has some authority, it is less than the director of the hospital

A nurse is educating a new nurse on grievance mechanisms. The nurse judges that the teaching has been effective when the new nurse states a. "Nurses do not need representation at meeting where they may be disciplined." b. "The nurse must ask a supervisor to file a grievance." c. "As a new nurse, I cannot file a grievance." d. "Any nurse can file a grievance."

ANS: D Any nurse can file a grievance. The nurse does not have to ask permission from a supervisor. The nurse should be represented in any meeting where discipline may be given.

The nurse is very busy caring for a large caseload. An adult patient mentions that by having slow mobility, "people just do things for me rather than allowing me to do as much as possible on my own." To solve the dilemma of needing to conserve time versus supporting the patient's involvement in self-care, what principle may help the nurse? a. Veracity b. Fidelity c. Justice d. Autonomy

ANS: D Autonomy implies the freedom to have choices and make decisions about one's own care without interference. Just because this patient is slow, it does not mean that he/she cannot make choices and participate in self-care. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Veracity is the duty to tell the truth. Fidelity involves keeping the information confidential and maintaining privacy and trust.

Advance directives such as the health care proxy and living will support what ethical principle? a. Veracity b. Advocacy c. Beneficence d. Autonomy

ANS: D Autonomy implies the freedom to make choices and decisions about one's own care without interference even if those decisions are not in agreement with those of the health care team. Veracity is the duty to tell the truth. Beneficence is the duty to actively do good for patients. Speaking out on behalf of the patient is an essential part of the advocacy role of the nurse.

A nurse has an adequate understanding of the barriers to cultural competence when making which of the following statements? a. "Barriers to cultural competence no longer exist in today's society." b. "The barriers to cultural competence cannot be broken down." c. "Provider barriers include only having some knowledge about a culture's customs regarding health care." d. "System barriers exist when an agency's structure and policies are not designed to support cultural diversity

ANS: D Barriers to cultural competence exist in today's society and can be broken down with the help of health care providers. Provider barriers include having a lack of knowledge about a custom's culture regarding health care. System barriers exist when an agency's structure and policies are not designed to support cultural diversity.

A union nurse is educating a new nurse on common issues faced by nurses today. The union nurse knows that the teaching has been effective when the new nurse states a. "There are no common issues; nurses face different issues based on their jobs." b. "Today, there are no issues because of the advancement of technology." c. "Hospitals are well staffed so personnel shouldn't be an issue." d. "Hospitals frequently mandate nurse overtime due to staffing shortages."

ANS: D Common issues today include staffing shortages that lead to mandating nurses to work overtime. Nursing shortages create issues that cannot be fixed by advances in technology and leave hospitals inadequately staffed. Although each nurse faces different issues based on the job, collectively nurses experienced many of the same issues in their day-to-day nursing activities.

A patient who has a terminal illness wants to be able to take a prescription medication to end life when suffering becomes unbearable. The patient asks the nurse for advice. Operating from a deontological point of reference, what action does the nurse take? a. Advises the patient about local providers willing to participate b. Assesses the patient for more information about the situation c. Determines what kind of insurance the patient has before acting d. Tells the patient that he/she cannot pa

ANS: D Deontology is rule-bound and inflexible, obtaining moral authority from absolutes revealed by God. To preserve the sanctity of life, the nurse cannot participate in this situation. Advising the patient of providers to see is working from a teleological viewpoint because the end (patient death) might be seen as outweighing the means (helping the patient find a provider to provide a lethal prescription of drugs). Assessing the situation to see how the patient is affected (versus how some other patient would be affected) is situational. Determining financial status is not related to a specific philosophical outlook but might violate the principle of justice.

A nurse is educating a nurse aide on patient confidentiality. The nurse believes the teaching to be effective when the nurse aide states that confidentiality will be maintained by a nurse who believes in and values the ethical principle of a. veracity. b. autonomy. c. justice. d. fidelity.

ANS: D Fidelity involves keeping the information confidential and maintaining privacy and trust. Veracity means to tell the truth. Autonomy involves the patient making an informed decision and implies the freedom to make choices and decisions about one's own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables.

In the 1950s, belonging to a professional organization was popular. What has contributed to the decline in membership of the American Nurses Association? a. The ANA has increased membership dues that nurses cannot afford. b. Nurses do not want to be associated with an organization that represents unions. c. The association does not have state and local organizations. d. The increase in popularity of specialty organizations

ANS: D Historically, as specialty organizations have increased their membership numbers, the membership of the ANA has decreased. The theory is that nurses are seeking a specialty area that more directly addresses their area of practice. The decrease in ANA membership is not related to increased membership dues, a desire to avoid unions, or lack of state and local organizations.

A nurse is educating a patient's family on holistic nursing. Which statement by a family member leads the nurse to determine that more education is needed? a. "Holistic nursing is an attitude." b. "Holistic nursing is a way of being." c. "Holistic nursing focuses on healing the person as a whole." d. "Holistic nursing focuses on healing the system causing the ailment."

ANS: D Holistic nursing is an attitude, a way of being, and is focused on healing the person as a whole. It is not focused on the system causing the ailment.

Which of the following predicts the outcome if the nursing profession continues to be devalued by demeaning or comical images of nurses? a. Nurses will be able to request higher wages. b. The nursing shortage will end. c. There will not be enough jobs for new graduates. d. The nursing shortage will extend.

ANS: D If the nursing professional continues to be devalued by demeaning or comical images of nurses, the profession will suffer. The shortage will extend, and it will discourage talented individuals from entering the profession.

If many complaints arise about a newly developed procedure, what is the best way to handle them? a. Discontinue the change because it is not working. b. Persuade a few friends to talk positively about it. c. Consider the complaints as indications that change is being resisted. d. Analyze the complaints and alter the plan as needed.

ANS: D In handling complaints about a new procedure, consideration should be given to bringing in a person with expert power or back to the group with the complainers' input and returning to the moving phase for analysis and adjustment of the procedure if needed. Because a complaint occurs does not mean that the change is being resisted. Refreezing cannot occur if the change is abandoned. Until the complaint is investigated, the change should continue; it should not be discontinued until the issue is fully determined and resolved about the newly developed procedure.

What is a correct statement regarding a nurse who acts beyond the scope of practice? a. Demonstrates what a good nurse he/she can be b. Provides enriched services to patients who would not otherwise receive them c. May make other nurses angry because of the increased expectations created d. Maybe disciplined by the board of nursing TOP: False imprisonment

ANS: D States may regulate nursing practice by controlling the scope of practice and determining the specific activities for each level of nursing. In most states, the Nurse Practice Act provides definitions and scope of practice for each level of nursing practice. The power of the board to discipline can have an adverse effect on the nurse's ability to practice. Practicing beyond the scope of practice does not demonstrate what a good nurse the person is and does not provide enriched services. Other nurses would not be angry at increased expectations but at the foolishness of the nurse practicing beyond the scope of practice.

What is an example of a system barrier to cultural competence? a. Lack of knowledge regarding kosher diet options on menu b. No sinks in every patient room c. No privacy curtains in exam rooms d. A strict and enforced policy against more than one visitor in the ICU

ANS: D System barriers are due to the agency's structure and policies that do not support cultural diversity. A strict and enforced ICU visitor policy, for example, will impact those cultures with a strong emphasis on the extended family. Provider barriers are those such as a nurse may have, including lack of information about a culture. A lack of knowledge about a culturally specific diet is an example. Facility issues such as sinks and privacy curtains are not specifically related to culture but are needed for every patient.

A nurse wants to represent nursing in legislative activities. Which national nursing organization would be most important to join? a. International Congress of Nursing b. American Red Cross c. American Academy of Nursing d. American Nurses Association

ANS: D The American Nurses Association (ANA) has been at the forefront of policy issues and represents nursing in practice for both the generalist and the specialist. The International Congress of Nursing focuses on worldwide health care and nursing issues. The American Academy of Nursing is an honorary organization for nurses who have made special contributions to the profession. The American Red Cross is an international voluntary organization that assists with disaster relief and education.

A nurse is giving a lecture on the primary problem that decreases the power of both types of collective bargaining models. The nurse knows that the teaching has been effective when a colleague states which of the following is the biggest problem? a. "The small number of states that recognize either type of collective bargaining" b. "The political influences of the American Hospital Association on nursing organizations" c. "The adversarial goals of each of the respective organizations o

ANS: D The lack of membership in the majority of practicing nurses decreases the power of both types of collective bargaining models. Most people join an organization in response to a particular need. Almost 80% of nurses do not belong to any professional nursing organization. The traditional union-based model is more adversarial than the nontraditional model. The American Hospital Association's political influence does not decrease or increase power in either model. The other options do not accurately show the primary problem that decreases the power of the collective bargaining models.

A nurse manager has received a report that indicates the infection rate on the unit has gone up by 25% in the past month. What action by the manager is best? a. Post the report for staff to read. b. Pull a couple of the nurses aside and discuss the issue with them. c. Require staff to attend an infection prevention conference. d. Provide a mandatory hand hygiene in-service to all staff.

ANS: D The nurse manager has a duty to implement and mandate interventions to reduce infection rates for the unit. Providing a mandatory hand hygiene in-service to all staff is the best way to do this and to ensure that every staff member is competent. The other options may be used in the process for the nurse manager to set up or reinforce the hand hygiene in-service program.

A nurse is gathering data on a patient of a different culture. Which action can the nurse take to enhance communication while gathering cultural data? a. Focus on the reason for hospital admission. b. Use hand gestures to get points across to the patient. c. Use closed-ended questions to gather information. d. Determine the patient's level of fluency in English.

ANS: D The nurse would determine the patient's level of fluency in English to enhance communication. If needed, the nurse will obtain an interpreter. The nurse would not avoid the patient's culture during the assessment by focusing only on the reason for admission. Hand gestures should not be used because they could be offensive to the patient. The nurse should use open-ended questions or questions phrased in different ways as a method to gather data.

Which of the following organizations would the nursing advisor recommend that the nursing student join to best meet the student's current needs? a. National League for Nursing b. American Nurses Association c. International Council of Nurses d. National Student Nurses Association

ANS: D The organization that would best meet the student nurse's current needs is the National Student Nurses Association. The association mentors the professional development of future nurses and facilitates their entrance into the profession. The other associations listed are for the professional nurse

A nurse manager is educating a group of staff nurses about genetics and genomics. The nurse manager judges that the teaching has been effective when one of the staff nurses states a. "Health outcomes and treatment of disease processes have not increased with the study of genetics and genomics." b. "Only researchers benefit from the study of genetics and genomics." c. "This area of study has nothing to do with nurses." d. "Genetics and genomics have increased the ability of health c

ANS: D The study of genetics and genomics has increased the ability of health care professionals to assist patients in improving health outcomes. Nurses involved in this area of health care educate patients and provide support and treatments based on the most current research.

The nurse has an adequate understanding of ethical issues regarding transplantation when stating which of the following? a. "There are few Americans on the transplantation list." b. "Everyone on the transplantation list receives the organ he/she needs." c. "There is an overabundance of organ donors." d. "Most people on the transplantation list die due to the shortage of organs."

ANS: D There are over 122,000 Americans on the transplantation list, and the majority of them will die without a transplant because of the shortage of available organs.

Which provision—if labor management included it in a contract—would not be to nursing's advantage? a. A workforce retraining provision b. Seniority rights c. A grievance procedure d. Wage adjustments based on bed occupancy Collective bargaining

ANS: D Unions may stimulate better hospital management by fostering formal, central, and consistent personnel policies with better lines of communication. Consistent personnel policies include a consistent wage base, regardless of bed occupancy. Workforce retraining, seniority rights, and a grievance procedure would be important provisions in a labor contract that would be advantageous to nursing.

Which of the following assesses how nursing has relevance to social values? a. Nurses have professional degrees. b. Nurses perform community service. c. Nursing licensure requires a baccalaureate degree. d. Nurses are teachers of health promotion and wellness.

ANS: D Using Pavalko's eight dimensions to describe a profession, nursing is extremely relevant to social values. As the focus of health care shifts to primary prevention, nursing will become increasingly important because of nurses' ability to be teachers of health promotion activities and managers of wellness, activities that have an impact on social values.

Which ethical principle is applied when the nurse acts to safeguard the patient and the public by reporting poor nursing practice? a. Autonomy b. Fidelity c. Justice d. Veracity

ANS: D Veracity—the duty to tell the truth—is represented in this situation. Autonomy is the right of the patient to make an informed decision. Fidelity means to act in a way that is loyal, such as keeping information private and confidential. Justice requires the nurse to treat all patients fairly without regard to age, socioeconomic status, or other variables

Which statement by the nurse shows understanding of the primary advantage in using the group process in decision making? "The process a. increases the time spent discussing alternatives." b. eliminates opposition to decisions by administrators." c. allows additional time for the planning process." d. promotes acceptance of the decision by the group."

ANS: D When the group has input in the decision-making process, there is more acceptance of the group's decision. Groups can be beneficial to the decision-making process. Groups generally offer the benefits of a broader knowledge base for defining objectives and more creativity in identifying alternatives. The effectiveness of the group decision-making process is dependent on the dynamics of the group. When a group is involved in the decision-making process, there may be additional time spent discussing alternatives, and more time may be allowed for planning; however, this is not a specific advantage. It may not necessarily eliminate opposition to the decision by the administration, but when the group makes a decision, it may be easier to deal with administrative opposition.