Unit 2 Review 17, 19, 20, 21

A nurse responsible for staffing a medical-surgical unit must consider what factors (Select all that apply.) a. The patient census b. Physical layout of the unit c. Complexity of care required d. Educational level of all staff e. Task preferences of the nurses

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

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

ANS B: A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis, procedure, or health condition.

A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified using what term? a. Root cause b. Sentinel event c. Variation in performance d. Causal factor

ANS B: A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay. A root cause or causal factor is the factor that resulted in a sentinel event. A variation in performance is the action that includes the occurrence or possible occurrence of a sentinel event.

Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is documented using what tool? a. Pareto chart b. Control chart c. Deployment chart d. Top-down flowchart

ANS B: The control chart is a run chart that has a centerline and added statistical control limits that help to detect specific types of change needed to improve a process. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added. A top-down flowchart shows the sequence of steps in a job or process such as medication administration.

The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is referred to as what? a. Cause-and-effect diagram b. Run chart c. Pareto chart d. Flowchart

ANS C: Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized. A cause-and-effect diagram is used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a fishbone diagram because it looks like the skeleton of a fish. Flowcharts?4 are pictures of the sequence of steps in a process. Different steps or actions are represented by boxes or other symbols. Run charts, also known as time plots, are graphs of data points as they occur over time.

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

ANS D: To be effective, positive reinforcement should (1) be specific, with praise given for a task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment.

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

ANS: A A run plot, or time plot, graphs data in time order to identify any changes that occur over time. A cause-and-effect diagram is used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a fishbone diagram because it looks like the skeleton of a fish. Flowcharts?4 are pictures of the sequence of steps in a process. Different steps or actions are represented by boxes or other symbols.

The surgical team arrives in the operating room and one-member states, "Everyone stop. Let's identify the patient and operative site. Now does anyone have any questions or concerns?" This process is referred to by what term? a. Time-out b. A critical pathway c. Special cause variation d. Lean methodology

ANS: A A time-out occurs in the operating room to ensure the entire surgical team identifies the patient, operative site, and possible concerns or questions about the procedure.

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

ANS: A An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue.

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

ANS: A Autocratic/authoritative management style revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place.

A nurse is interested in studying the rituals of a tribe living in remote areas of Africa. The researcher is accepted into the tribe and observes firsthand the rituals practiced. Themes were analyzed to arrive at a description of the culture including rituals. The nurse is practicing which type of research? a. Qualitative, ethnography b. Qualitative, phenomenology c. Quantitative, quasi-experimental d. Quantitative, secondary data analysis

ANS: A Ethnography is a method used to study phenomena from a cultural perspective. Ethnographers spend time in the cultural setting with the research participants to observe and better understand their experience. Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. In quasi-experimental studies, a control group, randomization, or the manipulation of one or more variables is missing. Secondary analysis involves asking new questions of data collected previously.

A nurse is reading an abstract about a study related to Rocky Mountain Spotted Fever. The purpose is stated as follows: "To examine the generalizability of two randomized placebo-controlled clinical trials in patients with Rocky Mountain Spotted Fever to determine whether steroid therapy resulted in the positive outcomes." The nurse knows generalizability refers to what outcome? a. The conclusion that findings can be generalized from the sample to the entire population b. The fact that the group of steroids used is from the same organic compounds c. The possibility that the subjects were carefully selected and that outside influence is thus suspected d. The fact that the type of bacteria carried by ticks is universal

ANS: A Generalizability is the deduction that findings from one study can be applied to other populations not involved in the actual research.

Nurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system? a. Total patient care b. Partnership nursing c. Team nursing d. Functional nursing

ANS: A In total patient care nurses provide all aspects of patient care. This is not true of the other options.

When considering online communication etiquette, which nurse demonstrates a primary rule that should be adhered to by all? a. "My friend's wedding was lovely and anyone wanting to see pictures can view them on my website." b. "I'm not familiar with the details so I'm not going to get into the discuss of whose right or wrong." c. "My cousin's prom dress costed $3,000 and worth every penny her parents spent on it." d. "I got this information at the workshop I attended last month; I'm posting the power points for everyone to review."

ANS: A Interactions online are guided by the same sense of decency that any other style of communication dictates. Certainly, don't fan the flame of conflict or anger. The other options are not respectful of privacy, or potentially copyright laws.

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

ANS: A Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery.

A new nurse researcher is interested in tracing the history of nursing research. The researcher learns that nursing research began with what event? a. The work of Florence Nightingale during the Crimean War b. Studies between 1900 and 1940 following Nightingale's work c. Studies to improve patient care by doctorally prepared nurses d. Studies based on the naturalistic paradigm

ANS: A Nursing research began with the Nightingale during the Crimean War—more can be read in Chapter 1 of this text.

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

ANS: A Only the RN can perform and sign the admission assessment, although some components such as monitoring vital signs may be delegated.

When a nurse uses a criteria such as "high risk for falls," "infection protocols," and "special communication needs" to determine the mix and number of staff needed on a telemetry unit, what is the nurse is using? a. A patient classification system b. Diagnostic-related groups c. Case management d. Clinical pathways

ANS: A Patient classification systems group patients according to care needs to determine safe staffing levels

According to the Quality Chasm report what statement is true? a. Health care providers should be proactive rather than reactive to patient needs. b. Common needs rather than individual preferences should be the priority. c. Medical information should be confined to the primary care provider. d. Specialized providers or case managers should control health care decisions.

ANS: A Quality is based on predicting patient needs rather than reacting to needs

A staff nurse provides care based on intuition and always seems to be in control of her personal and professional life—serving on the board of the state nurses association, serving as the nursing unit's representative on the ethics committee, and coaching her daughter's soft ball team. Many of the staff observes how she manages time and provides care. This nurse's power comes from which type of power? a. Referent b. Legitimate c. Information d. Connection

ANS: A Referent power comes from the followers' identification with the leader. Referent leaders are admired and respected and able to influence other nurses because of their desire to emulate her.

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

ANS: A Standardization contributes to safety and improves individual performance of care providers.

Which task is most likely to be considered in a state's practice act as appropriate to delegate to a LPN/LVN if the patient's condition is stable and competence in the task has been established? a. Administer an enema for an elective surgery patient. b. Administer an antiarrhythmic medication IV while interpreting the patient's rhythm on the cardiac monitor. c. Develop a plan of care for a stable patient admitted for observation after a head injury. d. Teach a patient how to instill eye drops for glaucoma.

ANS: A The RN who is delegating must consider the following: (1) the delegate's current workload and the complexity of the task, (2) whether the staff member is familiar with the patient population and with the task to be performed, and (3) whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task.

A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of an inexperienced delegatee? a. Personally observe the delegatee perform the assigned task. b. Ask the delegatee how many times he/she has performed the task. c. Question the patient to confirm that the care provided was satisfactory. d. Ask other nurses if they feel the delegatee is competent.

ANS: A The best way for the nurse to determine the competency of LPNs or UAPs is to observe them perform the task.

Regardless of the term used to describe high-quality health care, what is the primary focus of quality? a. Meeting consumer needs and wants b. Providing economical care c. Utilizing technologic advancements d. Equally distributed care

ANS: A The customer determines quality based on his or her unique perception of high-quality care.

The RN instructs the LPN to "Give an enema to the discharged patient in room 327 who is reporting being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of a. direction and communication. b. task. c. person. d. circumstances.

ANS: A The directions were not clear. The RN did not specify which type of enema to give and what outcome to expect. And the RN gave no instructions related to reporting back.

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

ANS: A The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency. These are characteristics of the autocratic style.

The nurse manager is planning staffing levels and realizes that the first step is to focus on what activity? a. Knowing the intensity of care needed by patients according to physical and psychosocial factors b. Examining the educational level of the staff c. Assessing the skill level of caregivers d. Reviewing the budget to determine the financial consequences of past staffing patterns

ANS: A The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients.

A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading? a. RN b. LPN/LVN c. Unlicensed assistive personnel (UAP) d. Since all are trained, the task can be delegated to anyone

ANS: A The patient's condition is not stable; therefore, the skills of an RN are required.

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

ANS: A The transactional leader is concerned with the day-to-day operations of the facility; like those described in the question.

A nurse manager wants his nursing unit to be a place where all nurses want to work, where patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged to chair taskforces to improve quality of care and he counsels staff in areas of measuring patient outcomes. Other managers want to mimic this manager's approach to improve their own units. This nurse is which type of leader? a. Transformational b. Transactional c. Laissez-faire d. Authoritative

ANS: A Transformational leaders mentor followers through a vision and are admired and emulated.

Which organization provides federal funding for research? a. Agency for Healthcare Research and Quality (AHRQ) b. Robert Wood Johnson Foundation c. W. K. Kellogg Foundation d. Sigma Theta Tau International

ANS: A Two major sources of funding for nursing research are the National Institute of Nursing Research (NINR) and the Agency for Healthcare Research and Quality (AHRQ), which are both funded by federal congressional appropriations. Private foundations and nursing organizations, identified in the remaining options, also provide funding for nursing research.

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

ANS: A Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin's stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider change.

The implementation of research to guide nursing practice is referred to as what? a. Utilization b. Dissemination c. Generalizability d. Analysis

ANS: A Utilization of research guides nursing practice. Clinical agencies need to make a commitment to implementing research findings and then developing policies and procedures to guide the implementation process

Which statement made by an RN regarding delegation indicates the need for additional teaching? (Select all that apply.) a. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction now is unlikely. b. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD. c. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for increasing renal perfusion. d. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency. e. Responsibility can be delegated to the UAP, but the delegator retains accountability.

ANS: A, B, C The statement "UAPs can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely" indicates the need for further teaching because the patient is at highest risk of a reaction during the first few minutes of a blood transfusion; thus, the assessment skills of an RN are required. The statement "an LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD" indicates the need for further teaching because administration of intradermal medication requires the skill of an RN. Dopamine is a vasoactive drug that can have a profound effect on a patient's blood pressure and cardiac output; administration requires the assessment and evaluation skills of an RN.

Which functions can be delegated only to another RN with appropriate experience and training? (Select all that apply.) a. Assessment of skin integrity on third day of hospitalization b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises c. Nursing judgment related to withholding medication based on vital signs d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses or unlicensed assistive personnel. e. Formulation of nursing diagnosis "potential for fall"

ANS: A, B, C, E Activities like assessing skin integrity—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like evaluating patient teaching—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like deciding to withhold medication based on vital signs—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like formulating a nursing diagnosis—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN.

The National Database of Nursing Quality Indicators (NDNQI) identifies what client focused events as outcome indicator? (Select all that apply.) a. A patient falls and fractures a hip. b. A patient develops bilateral pressure ulcers on their heels. c. A patient develops a catheter-associated urinary tract infection. d. A patient develops post-surgical delirium. e. A patient develops pneumonia related to ventilator use.

ANS: A, B, C, E Outcome indicators include patient falls, pressure injuries, catheter-associated urinary tract infections, and ventilator-associated pneumonia. Post-surgical delirium is not identified by this organization.

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

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

A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2018 National Patient Safety Goals by implementing which protocols? (Select all that apply.) a. The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed. b. Ask each member of the surgical team to provide a copy of licensure and, if applicable, certification to patient and family. c. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient. d. Mark the procedure site with "X" and again ask the patient to verify correct site. e. After arrival in the operating room, perform a "time-out" for final identification of patient and operative site along with agreement of what procedure is scheduled.

ANS: A, C, D, E The 2018 National Patient Safety Goal includes universal precautions to ensure patient safety and prevent sentinel events. Methods to identify patient and surgical procedure are required.

Registered nurses who are entering the workforce will have expanded leadership responsibilities that include what tasks? (Select all that apply.) a. Serving on interdisciplinary care teams b. Being competent to work in several areas independently when dictated by patient census c. Attending a meeting to plan advanced training for unlicensed assistive personnel d. Evaluating outcomes of care that are reported to a standing committee e. Managing units with higher acuity, shorter length of stay, and more diverse patients and staff

ANS: A, C, D, E The new nurses will be placed in many situations that require leadership and management skills: for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. Diverse patients have comorbidities and require complex interventions delivered during shorter stays with an ever-increasing diverse staff. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses.

The informed consent documents must include what components? (Select all that apply.) a. An explanation of potential risks and benefits to participants in the study b. Medical terminology rather than lay terms to prevent misunderstanding of the study c. A statement on how the anonymity and confidentiality of participants are protected d. Explanation of the cost of the study e. Details on how to contact the investigator

ANS: A, C, E Informed consent explains the study to the participants and assures them of their rights, including their right to refuse to participate or to withdraw from the study. The informed consent must include protection of anonymity and confidentiality, voluntary participation, compensation, and alternative treatment. The informed consent must include specific information on how to contact the investigator.

While participating in a task force to proactively plan for nursing care delivery over the next 20 years, a nurse learns that dramatic changes will occur because of what factor? (Select all that apply.) a. The increases in the number of minimally invasive procedures being performed for disease treatment b. Care provided for patients over an extended period in acute care settings c. The reduction in the number of nurses and other health care professionals who are available to provide care d. The widespread illiteracy and decreased self-efficacy of the aging patient population e. The need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient f. The devaluing of nursing as a means of improving patient outcomes

ANS: A, C, E Invasive surgical procedures are being replaced by laparoscopic procedures. The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population. Care will focus on the unique lifestyles and values of a diverse population.

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

ANS: A, D, E Surveys collect demographics, social characteristics, behavioral patterns, and information bases. Needs assessments are used to determine what is most beneficial to aggregates. The experimental method establishes cause-and-effect relationships while also testing relationships. Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Grounded theory is designed to explore and describe a social process. Experimental is a design that includes randomization, a control group, and manipulation between or among variables to examine probability and causality among selected variables for the purpose of predicting and controlling phenomena.

Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of "road map" that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to using what term? a. Clinical protocol b. Critical pathway c. Algorithm d. Case management

ANS: B A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis. Clinical protocols or algorithms are different from clinical pathways because they represent more of a decision path that a practitioner might take during a particular episode or need. Case management is a nursing care delivery system.

A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, "You don't care that I threw the needle in the trash. You just want an all-female staff," putting the team leader in a defensive position. This communication technique is referred to by what term? a. Straw man b. Red herring c. Slippery slope d. Confusing cause and effect

ANS: B A red herring is the introduction of an irrelevant topic for diverting attention away from the real issue.

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

ANS: B A root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences. Standardization of care is process improvement that involves developing and adhering to best-known methods and repeating key tasks in the same way, time and time again, until a better way is found, thereby creating exceptional service with maximal efficiency. Process variation is a difference in how the steps in a work process might be accomplished and/or the variables that may affect each step in the process. Variation results from the lack of perfect uniformity in the performance of any process. A deployment flowchart maps out the steps of a process under headings that designate the people or departments who carry out each step. This type is especially helpful when dealing with processes that cross multiple areas or caregivers and when there is a need for common under-standing of what the process is doing as a whole.

A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is referred to by what term? a. Deployment flowchart b. Top-down flowchart c. Pareto chart d. Control chart

ANS: B A top-down flowchart shows the sequence of steps in a job or process such as medication administration. A deployment flowchart maps out the steps of a process under headings that designate the people or departments who carry out each step. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added.

A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG). According to the clinical pathway the patient should be extubated and discharged from critical care the day after surgery. During surgery the patient's oxygen saturation decreased drastically because of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation results in what type of event? a. Patient outcome b. Variance c. Care goal d. Nursing standard

ANS: B A variance is a deviation from the planned path.

An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for what associated task? a. Delegating the task to another UAP if he or she does not have the time or skill to complete the task b. Keeping the RN informed of any abnormal blood pressure readings c. Calling the physician when the patient's vital signs are not within established parameters d. Informing the dietary department to initiate a low-sodium diet for patients who are hypertensive

ANS: B After accepting the assignment, the UAP is responsible for completing the task and reporting any patient concerns to the RN. The remaining options are the responsibility of the RN.

A nurse plans care knowing when specific recovery milestones are expected. The nurse is providing care via what delivery model? a. Patient classification systems b. Clinical pathways c. Functional nursing d. Case management

ANS: B Clinical pathways plans patient care activities and interprofessional interventions and desired patient outcomes within a specified time period for a particular diagnosis or health condition.

Which nurse is demonstrating a common, productive conflict resolution style? a. The nurse who does not express feelings or ideas that conflict with those of the administration b. The nurse who states," If I cover for you this weekend will you cover for me the weekend before my vacation?" c. The nurse overheard saying, "There is no use fighting this; one solution is as good as another." d. The nurse who regularly insists they have the most insight into the problem being discussed.

ANS: B Compromise occurs when people give up something to get partial goal attainment; such as in the scenario presented. The other options demonstrate avoidance, accommodation, and force as a conflict resolution technique

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

ANS: B Empathy is feeling what the other person is feeling and seeing the situation as they see it; entails believing that the other person's feelings are valid, legitimate, and justified. The nurse is placing herself in the wife's position and sharing her emotions.

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

ANS: B Filtration is the unconscious exclusion of extraneous stimuli in communication.

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

ANS: B Grounded theory is a qualitative research approach that describes a social process and has theory generation as its main purpose. A case study is a process or record of research in which detailed consideration is given to the development of a particular person, group, or situation over a period of time. Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants.

During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting what communication technique? a. Assertive communication b. Active listening c. Empathy d. Passive communication

ANS: B In active listening a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.

A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. What term is used to describe this type of delivery system? a. Total patient care b. Functional nursing c. Team nursing d. Primary nursing

ANS: B In functional nursing members of the team are assigned specific tasks such as assessment or medication administration. This is not true for the other options.

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

ANS: B In quasi-experimental studies, a control group, randomization, or the manipulation of one or more variables is missing. Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization. Experimental design includes randomization, a control group, and manipulation between or among variables to examine probability and causality among selected variables for the purpose of predicting and controlling phenomena

A nurse manager is mentoring a novice nurse manager in determining staffing needs. The mentor explains that the acuity level of the patient is determining by implementing what process? a. "Assessing patient satisfaction with nursing care." b. "Quantifying the amount and intensity of care required." c. "Examining the skill mix and educational preparation of the staff." d. "Determining the number of hospital days required by the patients."

ANS: B Patient acuity is measured by determining the amount and intensity of care required.

A patient has decided to stop hemodialysis because his renal failure progresses and he wishes to spend more time with family. Palliative care will continue, and the approach will be discussed with the patient and family as needed and at change of shift. The care delivery model in this situation is referred to by what term? a. Partnership b. Patient-centered c. Case management d. Total patient care

ANS: B Patient-centered care models entail the health care team partnering with the patient and family to ensure that patients' wants, needs, and preferences are the priority while allowing the patient and family to participate in decisions and educational needs.

Nurses on a busy medical schedule want to reduce documentation time and improve order entry. Additionally, patient records from previous visits are often incomplete or do not include care from other providers. To improve patient care, a taskforce suggests using an Electronic Medical Record for 1 month to determine whether this provides the desired outcomes. This unit is participating in which type of study? a. Ethnography b. Pilot c. Secondary data analysis d. Phenomenology

ANS: B Pilot studies are small-scale studies often referred to as feasibility studies to determine if a larger more sophisticated research study is needed. Ethnography is a method used to study phenomena from a cultural perspective. Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Secondary analysis involves asking new questions of data collected previously.

A researcher is interested in learning if elderly persons perceive their health to be satisfactory even with comorbidities and chronic illness. A large multisite assistive living facility will be the site. The researcher lists residents in alphabetical order and chooses every third person on the list. To ensure improved generalizability, the researcher will implement what process? a. Triangulation b. Randomization c. Informed consent d. A meta-analysis

ANS: B Randomization is a method of choosing subjects based on chance alone. Triangulation is the use of a variety of methods to collect data on the same concept—in this situation, quantitative research through survey and qualitative research through phenomenology. Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization. Participants must sign an informed consent that explains the study and assures them of their rights, including their right to refuse to participate or to withdraw from the study.

The nurse manager determines that four RNs, five LPN/LVNs, and two unlicensed assistive personnel (UAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with what related process? a. Assignments b. Staffing c. Output d. Productivity

ANS: B Staffing is the activity of determining that an adequate number and mix of health care team members are available to provide safe, high-quality patient care.

A public health nurse is interested in determining which educational programs are needed in the aggregates served. The researcher personally interviews individuals who are walking on the streets in the community. What type of research design is this? a. Quasi-experimental b. Survey c. Case study d. Ethnography

ANS: B Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. A case study is a process or record of research in which detailed consideration is given to the development of a particular person, group, or situation over a period of time. Ethnography is a method used to study phenomena from a cultural perspective. In quasi-experimental studies, a control group, randomization, or the manipulation of one or more variables is missing.

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

ANS: B Technology (PDA) is used to aid decision making and reduce errors.

A task force is considering factors that contribute to high-quality safe staffing. Which statement reflects an understanding of the American Nurses Association's (ANA) recommendations? a. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the shift should be sufficient to provide safe, high-quality care. b. Staffing should allow time for the RN to apply the nursing process so decisions result in high-quality, safe patient outcomes. c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix. d. RN staffing is not cost-effective; thus, is it important for staffing models to limit the number of RNs assigned per shift.

ANS: B The ANA recommends that nurses have time to exercise professional judgment; that would include the achievement of outcomes?

What nonprofit organization distributes knowledge related to health care for the purpose of improving health to governmental agencies, the public, business, and health care professionals? a. Institute for Safe Medication Practices b. Institute of Medicine (IOM) c. National Committee for Quality Assurance d. The Joint Commission. (TJC)

ANS: B The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health.

An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. What is the RN's initial intervention? a. Checking the patient's drug packages to ensure that the correct drugs were given. b. Stopping the LPN/LVN immediately and nonjudgmentally discuss the possible consequences of this action. c. Contact the nurse manager and ask that the LPN/LVN's license be suspended. d. Call the pharmacy and ask for replacement medications for the patients.

ANS: B The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN's initial responsibility requires that he or she intervene and identify concerns with the LPN/LVN.

The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse's action has what possible outcome? a. Showing empathy and if she lets the patient know the money is not from her, she is not violating any social media guidelines. b. Increasing the risk for HIPAA violations c. No legal risk since she has properly followed policy and protected the patient by not using her name. d. The nurse is demonstrating the logical fallacy of slippery slope.

ANS: B The National Council State Board of Nursing's policy on social media prohibits posting of patient information on social media sites. This patient could be identified by knowing where she works and the fact that she was seen in the ED the day before.

A nursing unit comparing team nursing to the partnership model would find what statement to be true? a. With the partnership model, an RN does not have to be part of the mix. b. Leadership abilities of the RN are a major determinant of effectiveness of care for both models. c. The RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to apply the nursing process in team nursing. d. With team nursing the RN cares for the patient while the team members work with the family or significant others.

ANS: B The RN leads regardless of whether partnership model or team nursing is practiced.

A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to focus on what? a. Supplementing the staffing pattern when an RN is not available b. Aiding the RN by performing appropriately delegated care tasks c. Replacing the RN when the health care facility provides long-term care d. Providing patient teaching, allowing more direct care to be provided by the RN

ANS: B The UAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice.

What title identifies a nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers? a. Nurse manager b. Case manager c. Coordinator of patient-centered care delivery d. Team leader in team nursing care delivery

ANS: B The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness.

A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring? a. The nurse is upset and states, "I am sure I have injected this before without a problem" and the supervisor interprets this to mean the nurse often take shortcuts. b. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not." c. "The nurse who started the IV didn't get a blood return but determined the IV was the patient's—that is the problem." d. "This drug always occludes the line because it is so viscous."

ANS: B The nurse diverts attention away from the issue of not checking compatibility to introduce an irrelevant topic of chemotherapy administration certification which is not related to this situation.

What is the first step in both the nursing and problem-solving processes? a. Identifying the problem b. Gathering relevant information c. Considering the consequences of change d. Implementing appropriate interventions

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

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

ANS: B The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge but may delegate or provide primary care during the shift when present.

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

ANS: B The priorities of funding agencies indicate their preferences for funding; these are more likely to be funded than are studies that are not aligned with funding preferences.

What situation demonstrates a nurse engaging in active listening? a. While assessing the patient's vital signs, the nurse records the data and states, "You are improving, your vital signs are normal." b. Eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. c. The nurse states, "I know how you feel, I recently lost my father and I am still hurting." d. The nurse has cultural values that are in opposition to the patient but shares that "I agree with your decision to use herbs rather than the prescribed medications."

ANS: B This behavior demonstrates active listening. A number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.

A researcher conducts a survey to determine the perceived health status of elderly persons living independently at home. The same subjects participate in a telephone call in which they describe the lived experience of living with chronic illness. When writing up the research study, the nurse would describe using what research method? a. Control group b. Triangulation c. Pilot study d. Secondary data analysis

ANS: B Triangulation is the use of a variety of methods to collect data on the same concept—in this situation, quantitative research through survey and qualitative research through phenomenology. Secondary analysis involves asking new questions of data collected previously. Pilot study conducts a smaller version of a proposed study that develops or refines methodology prior to use in a larger study. Control group are subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured.

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

ANS: B Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking.

Which situation would be appropriate for the supervisory level of initial direction and/or periodic inspection? a. Experienced RNs work together to provide care for a group of patients newly diagnosed with meningitis. b. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly. c. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 g of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse checks on the patient status every 15 to 30 minutes and asks the graduate to explain "next steps." d. No supervision is necessary since both are registered nurses.

ANS: B When a working relationship is established and competencies of the delegate established, the delegator may check in during intermittently during the shift.

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

ANS: B With past experiences that include a variety of positive, neutral, and negative events, the influence that these experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experience cannot be overstated.

A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals. What competency is included? (Select all that apply.) a. Advanced health assessment techniques b. Patient-centered care c. Prescriptive pharmacology content d. Quality improvement e. Safety

ANS: B, D, E Patient-centered care is a recommended competency, along with teamwork and collaboration, evidence-based practice, and informatics. Quality improvement is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. Safety is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics.

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

ANS: C A needs assessment method is a study in which the researcher collects data for estimating the needs of a group; the method is commonly used to prioritize the needs of an organization or community. Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. In quasi-experimental studies, a control group, randomization, or the manipulation of one or more variables is missing. Pilot study conducts a smaller version of a proposed study that develops or refines methodology prior to use in a larger study.

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

ANS: C An interdisciplinary team is working to prevent hand-off errors on discharge.

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

ANS: C Any procedure performed on a wrong person or organ constitutes a sentinel event.

A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating what form of negative communication? a. Ad Hominem Abusive b. Filtration c. Blocking d. False assurance

ANS: C Blocking occurs when the nurse responds with noncommittal or generalized answers.

Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." What statement should be made when explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism? a. P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization. b. D stand for deviation, which is an alteration in the expected drugs ordered. c. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process. d. A stands for algorithm, which includes all steps of the process.

ANS: C C stands for check if the change improved the process and what was learned.

A staff nurse states, "I really enjoyed having dinner with the Chief of Medical Staff and the President of the hospital. We hope to meet again soon." Which source of power does this nurse possess? a. Expert b. Legitimate c. Connection d. Reward

ANS: C Connection power results from knowing or associating with power people such as the upper administration.

An older adult is unable to reach the telephone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy? a. "Of course, you can. I'll let you know when the funeral home is here to transport his body." b. "It must be very hard to know he died alone." c. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." d. "I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you."

ANS: C Empathy is demonstrated by the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of the person

A nurse is overhead saying, "I don't mind working during the election and holiday. My parents are divorced, money is tight, and honestly, I don't trust any politicians anyway. I plan to take a few weeks off next month." She works independently to research strategies to improve patient-centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends, "Let's think the suggestions over and come back together next week." This nurse's communication style is consistent with which generation? a. Baby Boomers b. Traditionalist c. Generation X d. Millenniums

ANS: C Generation X individuals grew up in when there was a high rate of divorces; they tend to be more cynical and value work-life balance and teamwork. Holidays are often associated with family gatherings which may have been absent in this generation's family; belief that ALL politicians are untrustworthy may be viewed as cynical. The need to take time to form suggestions to save time and come together to reach team decision are reflective of this generation.

When deciding which staffing option to use on a nursing unit that will open soon, the manager recognizes what basic fact related to this issue? a. Continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on three consecutive days per week. b. The use of part-time nurses provides the variability needed to meet diverse patient needs. c. Satisfaction of the staff equates to satisfaction of patients. d. Nurses provide the same level of care, regardless of the work environment.

ANS: C High nurse satisfaction is generally equated with high patient satisfaction and positive patient outcomes.

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

ANS: C If the nurse practice act lacks clarity, the state board of nursing can provide guidance.

A hospital recently learned that their scorecard did not meet the national benchmark for patient satisfaction and brought in a professional change agent to determine what their issues were and how they could improve their score. The agent collected data and recommended that nurses participate in interdisciplinary walking rounds and allow the patient and family to be participants. Nurses now round every shift and perform "huddles to update the team" as needed throughout the shift as part of best practices. Random visits are made to nursing units to ensure all nurses are participating and patients are interviewed for their involvement. These practices are associated with which stage of Lewin's change process? a. Unfreeze b. Moving c. Refreeze d. Resistance

ANS: C In the refreezing stage, change becomes status quo and the agent reinforces until the change is part of the daily process as in the above situation.

What is customer satisfaction primarily based upon? a. Access to modern, up-to-date facilities b. Availability of an extensive menu selection c. Personal interactions with employees d. Having to undergo fewer invasive procedures

ANS: C Interactions between employees and patients/families affect clinical outcomes, functional status, and even physiologic measures of health.

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

ANS: C Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization. Secondary analysis involves asking new questions of data collected previously. A survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants. Quasi-experimental is a type of quantitative research study design that lacks one of the components of an experimental design.

An RN is counseled by the nurse manager regarding inappropriate delegation when the RN engages in what activity? a. Instructing the nursing assistant to greet ambulatory surgery patients and show them to their rooms b. When asking a novice nursing assistant to collect a sputum specimen, the RN states, "I will show you this time and you can show me the next time." c. Assigning the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube d. Asking an LPN/LVN who has demonstrated competence to perform a dressing change before the patient is discharged home

ANS: C Only an RN can initiate and complete a new plan of care; this does not fall within the scope of practice of the LPN/LVN. The RN has violated one of the five rights of delegation.

A nurse is interested in understanding the meaning of the human experience of surviving polio. Subject recruitment targets persons who have been diagnosed with the disease. The researcher reflects on the data and identifies common themes to understand the "lived experience." These characteristics are consistent with which qualitative research method? a. Grounded theory b. Ethnography c. Phenomenology d. Case study

ANS: C Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Grounded theory is designed to explore and describe a social process. Ethnography is a method used to study phenomena from a cultural perspective. A case study is a process or record of research in which detailed consideration is given to the development of a particular person, group, or situation over a period of time.

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

ANS: C Qualitative data analysis results in the organization of words or phrases, not numbers. Interviews are reviewed and are transcribed line by line to group common conceptual meanings.

A nurse gives phenytoin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "You've disliked me since I refused to switch my vacation time last month." Which type of logical fallacy has influenced the nurse? a. Ad hominem abusive b. Appeal to common practice c. Red herring d. Appeal to tradition

ANS: C Red herring is the introduction of an irrelevant topic in order to divert attention away from the real issue.

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

ANS: C Risk of falling is great in later stages of Huntington's disease due to chorea movements; this makes it inappropriate to delegate ambulation to the UAP.

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

ANS: C Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished

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

ANS: C Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished.

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

ANS: C Seven primary sources of power are known. Expert power is based on knowledge, skills, and information.

A hospital is concerned with nurse retention and realizes that job satisfaction is a major influence. To best enhance employee satisfaction related to staffing, what intervention should the management team implement? a. Begin negotiating for additional agency nurses. b. Propose hiring more part-time employees. c. Adopt the concept of participatory staff involvement. d. Regularly use "float" nurses to cover vacancies.

ANS: C Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction.

A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through implementation of what communication technique? a. Empathy b. Positiveness c. Supportiveness d. Accommodation

ANS: C Supportive communication occurs when each person's opinion/position is valued and each participant has the freedom to express a position but is willing to change that opinion/position.

Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria? a. The RN administers all medications to all patients. b. The LPN performs sterile dressings and IV tubing changes on all central lines. c. The experienced UAP places telemetry electrodes and attaches to cardiac monitor. d. The RN administers an enema to a stable patient who has an order "administer fleet enema PRN when no bowel movement in 2 days."

ANS: C The UAP, when properly trained, can place patients on telemetry. This meets quality and cost containment goals because the LPN and RN have higher salaries.

Institutional review boards determine whether research studies involving human subjects will achieve what? a. Publication b. Increase the body of nursing knowledge c. Avoid causing harm to research subjects d. Funding

ANS: C The institutional review board (also called the human subjects committee) examines research proposals to ensure that the ethical rights of those individuals participating in the research study are protected. This board makes sure that persons who participate in research are assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is protected.

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

ANS: C The manager is embracing the mission of the organization by supporting achievement of goals noted in the mission statement.

A patient is ordered a low-protein, low-calorie diet but the patient's family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. What term should be used to identify this situation? a. A sentinel event b. An adverse event c. Patient-centered care d. The communication technique of "call-out"

ANS: C The nurse and dietitian are respecting patient values, preferences, and expressed needs.

A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what the first day of the week is?

ANS: C The patient must be able to name the day of the week rather than use answer yes or no.

An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN bases decisions on what fact? a. The role of the LPN/LVN is the same from state to state. b. The LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided. c. Review of the state's nurse practice act for LPN/LVNs is vital since it defines the role and scope of practice of the LPN/LVN. d. The Joint Commission has certified and established roles for the LPN/LVN.

ANS: C The scope of practice of the LPN/LVN varies significantly from state to state; RNs should know the LPN/LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LPN/LVN.

What is the difference between a leader and a manager? a. A leader has legitimate authority. b. The manager motivates and inspires others. c. A manager focuses on coordinating resources. d. The leader focuses on accomplishing goals of the organization.

ANS: C The terms leadership and management are often used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes.

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

ANS: C This level of supervision is required when the working relationship is new, the task is complex, or the delegate is inexperienced or has not demonstrated an acceptable level of competence

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

ANS: C, D Meta-analysis is an advanced process whereby multiple research studies on a specific topic are reviewed, and the findings of these multiple studies are statistically analyzed. State of the science summary is a merging of findings from several studies that explored the same topic. In quasi-experimental studies, a control group, randomization, or the manipulation of one or more variables is missing. Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. Triangulation is the use of a variety of methods to collect data on the same concept—in this situation, quantitative research through survey and qualitative research through phenomenology.

A nurse asks, "What is meant by 'internal' customers?" The correct response should identify which person or persons? (Select all that apply.) a. Insurance companies b. Accreditors such as The Joint Commission c. X-ray technicians d. Clinical pharmacist e. Chief financial officer

ANS: C, D, E Internal customers are employees of an organization at all levels. An x-ray technician is an example of an internal customer. Internal customers are employees of an organization at all levels. A clinical pharmacist is an example of an internal customer. Internal customers are employees of an organization at all levels. A chief financial officer is an example of an internal customer.

When considering the feasibility of an all-RN staff, a nursing administrator determines what fact concerning the RN's role? (Select all that apply.) a. They are generally costlier and less efficient than LPNs. b. They are usually more reactive than proactive to patient care errors. c. They have a positive effect on patient outcomes when managing patient care. d. They are effective overseers of patients' overall health condition. e. Their training makes them effective care delegators.

ANS: C, D, E RNs are effective at coordinating care that results in improved patient outcomes. RNs are valuable monitors of a patient's health status—a practice that results in improved patient outcomes and effective delegation of care.

A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? a. "Do you exercise?" b. "Do you like to exercise?" c. "When do you exercise?" d. "What exercise practices do you participate in?"

ANS: D "What exercise practices do you participate in?" is an open-ended question or statement that requires more information than just yes or no. This type of question augments the gathering of enough facts to build a more complete picture of the circumstances.

A nurse is interested in learning how reminiscence therapy can improve memory in cognitively intact persons over the age of 65 years. Findings from three groups are compared. Group 1 receives music therapy, Group 2 receives life review therapy, and Group 3 does not receive therapy, but data are collected from all three groups and compared. Group 3 is known as what? a. Pilot study b. Survey c. Needs assessment d. Control group

ANS: D A control group is a set subject in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants. Pilot study conducts a smaller version of a proposed study that develops or refines methodology prior to use in a larger study. Needs assessments are used to determine what is most beneficial to aggregates.

An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to using what term? a. Pareto chart b. Control chart c. Top-down flowchart d. Deployment chart

ANS: D A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety. A top-down flowchart shows the sequence of steps in a job or process such as medication administration. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added. A top-down flowchart shows the sequence of steps in a job or process such as medication administration.

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

ANS: D A special cause variation is an uncommon variation that is unstable and unpredictable, is not under statistical control, and is related to a clearly identified single source, which in this scenario is the construction project.

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

ANS: D A strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5 years into the future.

Which statement related to delegation is correct? a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse practice act. b. Nursing practice can be delegated only when the LPN/LVN and UAP have received adequate training. c. Supervision is not required when routine tasks are delegated to a competent individual. d. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.

ANS: D Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated and what is defined as nursing practice.

How do accrediting agencies such as The Joint Commission address staffing? a. Imposing maximum staffing levels b. Requiring a specific staff mix c. Stipulating nurse-patient ratios d. Confirming delivery of satisfactory care

ANS: D Accrediting agencies do not address minimum staffing levels; however, they do look for evidence that patients receive adequate care, and this can occur only with adequate staffing.

Which statement accurately describes communication? a. The components of communication are mutually exclusive. b. Communication is linear. c. Communication involves only the sender and the receiver; everything else is superficial. d. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.

ANS: D Communication is a process that requires certain components, including a sender, a receiver, and a message. Effective communication is a dynamic process: With a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes.

A manager just finished the last annual performance review of the staff, reviews the unexpected expenditures for the month due to use of agency nurses, and shares the latest quality indicators with the staff nurses. This manager is performing which management function? a. Directing b. Planning c. Organizing d. Controlling

ANS: D Controlling is the final management function. It includes performance evaluations, financial activities, and tracking outcomes of care to ensure quality.

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

ANS: D Errors and increased health care costs result from both the actions of health care workers and the nature of the system in which they deliver care.

An orthopedic unit is considering different types of care delivery models and staff have an opportunity to ask questions about how the models differ. The nurse manager provides an overview and uses the above visual to demonstrate which model of care delivery? a. Team b. Partnership c. Primary d. Functional

ANS: D Functional care delivery models assign tasks to each provider. In the above visual, the LPN is responsible for oral medication administration, the unlicensed assistive personnel provide hygiene, and the RN is assigned to task that require the nursing process.

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

ANS: D Medication-related errors for hospitalized patients cost roughly $2 billion annually.

A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms 211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. What term is used to identify the care delivery model being used? a. Team b. Primary c. Partnership d. Modular

ANS: D Modular (or geographic) assignments are based on a geographic location in the nursing unit.

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

ANS: D Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation.

A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style? a. Assertive b. Aggressive c. Passive d. Passive-aggressive

ANS: D Passive-aggressive communication is represented by incongruent actions—the nurse shows friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the original unit; however, she shows her anger by hitting the wall and muttering.

5. A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor's degree is hired. Before the RN arrives on the unit, the LPN is heard saying, "She'll try to tell everyone what to do because she makes more money. She'll sit at the desk and let us do all the work." This is an example of what communication associated process? a. Interpretation b. Context c. Precipitating event d. Preconceived idea

ANS: D Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before having an encounter. Such ideas can dramatically affect the receiver's acceptance and understanding of the message.

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

ANS: D Qualitative research involves ambiguous concepts. Analysis of interviews with participants who are experiencing the phenomena enables the researcher to describe unclear phenomena.

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

ANS: D Right circumstance involves the delegation of tasks that do not require independent nursing judgments.

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

ANS: D The best way for the new nurse manager to communicate with this employee, who may be an informal leader, is to show respect for the individual's clinical expertise and experience through clear and direct communication. The new nurse manager should attempt to identify the staff nurse's power as an informal leader, should involve him and other staff members in decision-making and change-implementation processes, and should clearly communicate goals and work expectations to all staff members.

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

ANS: D The coordinator of the committee has an official position within the organizational committee; such as being on the quality improvement committee.

When determining the scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP), which statement accurately describes the common policies which exist in most state practice acts? a. The RN is held accountable for the decision to delegate, but responsibility rests only with the delegatee. b. The RN may only delegate tasks that are not in the scope of practice of the LPN if the delegatee is certain they are competent to perform the task. c. Since the LPN is licensed, they practice professional nursing. d. To determine what tasks can be safely delegated, the RN must first assess the patient.

ANS: D The stability of the patient must be determined prior to delegation. Even routine tasks such as taking vital signs that are often delegated may need to be performed by the RN when the patient's condition is critical.

During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that what is the basis for this practice? a. The health care facility can override the state practice act by having all LPN/LVNs and unlicensed assistive personnel (UAP) participate in on-site training. b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. c. The RN can determine what tasks are legally delegable to the LPN/LVNs on his/her care team. d. The nurse practice act and state regulations related to delegation override the organization's policies.

ANS: D The state's nurse practice act is the deciding factor regarding what can legally be delegated.

Which component of an e-mail shown below would be both effective and concise? a. Subject: A short concise subject line: Meeting. b. Body: I would like you to answer these questions before the next meeting: Where would you like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal for our unit? c. Body: Dear Staff, As you know, each department must reduce staff by 2%. We will need to discuss how to inform unlicensed staff about the downsizing efforts of the hospital. d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first-floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582.

ANS: D This provides a message that is concise and accurate with a clearly conveyed message for the reader and contact information from the sender, all of which are important components of effective e-mail communication.

Development and validation of the body of knowledge and foundation on which practice is based is called ____________.

ANS: research

The healthiest form of communication is the ________ style.

Assertive communicators are honest and direct while valuing and respecting other individuals' views and seeking a win-win solution without the use of manipulation or game-playing.