cherry chapter 24

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

ANS: A During the honeymoon phase, the novice nurse has a positive image of nursing that coincides with the reason for becoming a nurse; this feeling is experienced immediately after the nurse begins work and often while still in orientation. During the shock or rejection phase, there is inconsistency with what was learned in school and the work environment, and the novice nurse lacks many of the skills needed to be independent in this new role. The novice nurse begins to understand the new culture to a certain degree, thus there is less tension and anxiety, and healing begins in the recovery phase. In the resolution phase, work expectations are more easily met, and the nurse will have developed the ability to elicit change.

12. A certified oncology nurse notices that a novice nurse is unsure of decision making and lacks technical skills. The novice nurse gains confidence by sharing and learning with the experienced nurse. This relationship continues and builds, allowing the novice nurse to become more confident. This relationship is identified by what term? a. Mentoring b. Role modeling c. A preceptorship d. Socialization

ANS: A Mentoring is a personal relationship with a more experienced person willing to guide a novice or inexperienced person. The experienced and novice nurses have entered into a mutually agreed upon interactive relationship to ease the transition of the novice nurse into the profession. Role modeling infers that an individual will serve as an example of competence to another person. Preceptors serve to orient the novice nurse to the specific nursing area, aid in socialization, and teach skills that are deemed necessary. Socialization involves the nurturing, acceptance, and integration of a person into the profession of nursing; the identification of a person with the profession of nursing.

5. Several novice nurses share lunch breaks and have comments such as, "I have insomnia from worrying about what I forgot to do for my patient," and "I have no energy," and "I can't believe I can't do my job correctly." These novice nurses are each experiencing different symptoms of what process? a. Burnout b. Low self-esteem c. Lack of confidence d. Resilience

ANS: A Symptoms of burnout include extreme fatigue, headaches, difficulty sleeping, mood swings, anxiety, poor work quality, depression, and anger. Resilience is the capacity to recover quickly from difficulties; toughness. The other options are symptoms of burnout; it is demonstrated in an individual lacking confidence and self-worth.

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

ANS: A The novice nurse is considering the legal and safety ramifications if the task is not completed. This thought process is associated with priority setting.

8. The novice nurse calls a supervisor and requests that a "float nurse" be assigned to help with all "assessments of new admissions and postoperative patients." The supervisor asks, "How many admissions and surgery patients have you received?" The novice nurse becomes flustered because she has not checked the census but simply bases the need on feeling overwhelmed. This situation best indicates a lack of what type of skills? a. Organizational b. Communication c. Interpersonal d. Clinical

ANS: A The novice nurse lacks proficiency or organization, which may be exaggerated by feelings of being overwhelmed by the new environment, causing him or her to not get the facts before asking for help. The scenario gives no information to suggest a deficiency in any of the other areas mentioned as options.

19. A novice nurse is in the "rejection phase" of stress and wonders if she/he made the right decision when deciding nursing was her/his chosen career. Which strategy would help the novice nurse cope with transition into practice and reduce stress? a. When asked by the charge nurse to accept the new admission even though she/he had no discharges, the novice nurse stops and considers if this request is acceptable and safe, then accepts the assignment based on two patients having a low acuity level. b. Refusing to eat anywhere but the hospital cafeteria to ensure a balanced diet and time to socialize with other staff and visitors. c. Avoid wasting time by listening to coworkers' problems or ideas on how to staff the unit during the upcoming holiday since the novice nurse's time is valuable and better spent getting her own work completed. d. Try to "win over" hostile or angry coworkers who find fault with the novice nurse's work performance.

ANS: A To reduce stress and cope with the rejection phase of transition, the novice nurse should think before answering—take a few minutes before answering and deciding what is best course of action.

3. Which statements demonstrate characteristics would be desirable in a mentor? (Select all that apply.) a. "How were you taught to do this is school?" b. "Can you think of a way to make this easier for the patient?" c. "Let me know when it's a good time to show you how to do this new scale." d. "Everybody here does it this way." e. "Today was rough but there are fewer admissions scheduled for tomorrow. "

ANS: A, B, C, E A mentor should be open and welcoming to change while being sensitive to the needs of others. A positive outlook is a characteristic that is available when mentoring others.

6. Which nurse is more prone to burnout? a. The one who graduated last in the class b. The one who accepts most offers of overtime c. The one who has worked on the oncology unit for 3 years d. The one who regularly states, "I'm not able to make it better for my patients"

ANS: B Burnout is more common among nurses with work schedules that are heavy; working overtime regularly is a likely contributing factor. The other options are likely to trigger compassion fatigue with signs and symptoms of hopelessness and low self-esteem.

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

ANS: B During the shock or rejection phase, there is inconsistency with what was learned in school and the work environment, and the novice nurse lacks many of the skills needed to be independent in this new role. During the honeymoon phase, everything is just as the new graduate imagined. The novice nurse begins to understand the new culture to a certain degree, thus there is less tension and anxiety, and healing begins in the recovery phase. In the resolution phase, work expectations are more easily met, and the nurse will have developed the ability to elicit change.

4. The novice nurse arrives on the nursing unit, is introduced to the staff, is assigned a preceptor, and is asked to participate in the next staff meeting. This introduction into nursing is appropriately identified using what term? a. Biculturalism b. Socialization c. Transition d. "Going-native"

ANS: B Socialization involves the acceptance and integration of the novice nurse into the profession of nursing, as well as the identification of the novice nurse with the profession of nursing. Biculturalism is the merging of school values with those of the workplace. Transition is the moving from one role, setting, or level of competency in nursing to another; change. Going-native occurs when nurses decide they cannot fight the experienced nurses or the administration, thus they adopt the ways of least resistance.

14. A student nurse wants to meet other nursing students from different countries and to learn of employment possibilities. The student nurse should consider doing what? a. Participating in the clinical facility's employee satisfaction task force b. Joining the Student Nurses Association c. Taking part in self-mentoring d. Postponing the licensure examination to take a tour of foreign countries

ANS: B Students who participate in pre-professional organizations such as the Student Nurses Association have an opportunity to meet students across the nation and around the world and can network with leaders to gain knowledge about employment possibilities. None of the other options provide a realistic opportunity to interact with other nursing students.

15. An experienced nurse working in oncology is shocked to realize that he/she feels little empathy when a patient explains, "I developed cancer from having to work in the dry cleaning industry since I was only 8 years old to help support my younger siblings during the depression. Now they have all moved away and refuse to help me financially, and it takes everything I have to pay for my chemotherapy medicine." What term is used to describe this situation? a. Burnout b. Compassion fatigue c. Reality shock d. Horizontal hostility

ANS: B The nurse is experiencing a gradual decline in compassion over time because of being exposed to the many events that have distressed his or her patients over the years of practice. Burnout is the physical or mental collapse caused by overwork or stress. Reality shock occurs when a person prepares for a profession, enters the profession, and then finds that he or she is not prepared. Horizontal hostility (also known as lateral hostility) is the covert or overt directing of dissatisfaction toward peers, themselves, or those less powerful.

2. Faculty comes to class to present information about joining the Student Nurses Association (SNA). A student is heard saying, "Why join this organization? It is just a bunch of students like us. I'll wait and join the real nursing organization after graduation." This student is not aware of which benefits of SNA? (Select all that apply.) a. Members are eligible to sit for the licensure examination at a reduced rate. b. Leadership skills can be refined by working with other schools of nursing. c. The National SNA provides discounted rates for study abroad opportunities. d. A global view of nursing can be obtained through networking internationally. e. Lobbying efforts are a major benefit of belonging to SNA.

ANS: B, D Leadership opportunities are available as officers and through conferences. SNA members work with other nursing students across the nation and internationally. None of the other options are accurate statements concerning this organization or its benefits.

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

ANS: B, E Withholding information from novices or coworkers to purposely cause them to appear inadequate or unskilled is considered workplace violence because of the anxiety and stress it produces. This should not be tolerated and should be reported. Such statements, which belittle employees, lead to job dissatisfaction, lack of teamwork, and burnout and are considered lateral or workplace violence. This should not be tolerated and should be reported.

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

ANS: C During the shock or rejection phase, novice nurses must ask themselves what they must do to become the type of nurse envisioned and to make a contribution.

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

ANS: C The experienced nurse knowingly enters into a relationship to advocate for and to enhance the self-esteem of the novice nurse. The correct option demonstrates the experienced nurse providing guidance/acknowledgement of the novice nurse's skill level. The other options demonstrate actions associated with the novice nurse looking at the experienced nurse for cues for behaviors or acknowledging the abilities of the experienced nurse.

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

ANS: C The novice nurse can become familiar with the technique, then can perform the skill under the supervision of an experienced nurse, ensuring competency. None of the other options provide a realistic, safe learning environment for the reinforcement of this skill.

7. A nurse notices the novice medication nurse hurriedly gathering medications to be administered for the entire day, removing them from the packages, and placing them in a paper cup with the patient's name and room number on the cup. When one of the patients points at a pill and asks, "What is this?" and "What does this do?" the medication nurse is uncertain, because it has long since been removed from the packaging. What role is the nurse playing when taking his/her observations, concerns, and suggestions to the nurse manager? a. Mentor b. Rutter c. Change agent d. Role model

ANS: C The novice nurse is working to improve the safety and patient environment and is acting as a patient advocate and change agent. A mentor acts directing in guiding and encouraging a nurse in the novice role. A role model is a person who serves as an example of what constitutes a competent professional nurse. Rutters are individuals whose attitude is that they will do only what they must to get by.

18. A novice nurse is placed in charge just after orientation ends. Which statement by the novice nurse would ensure a smooth delegation experience when delegating to an experienced staff member? a. "You have the patients in rooms 1 to 7. These patients require little skill so you will be fine." b. "Your assignments are posted in writing by the nurses' station. Be certain all your tasks are completed so the next shift is not behind." c. "You have patients in rooms 5 through 10 and I will administer all IV medications. I will let you know if I must adjust. If you see you need help let me know." d. "Everyone is capable of providing the best care, so please sign up for the patients you would like to be assigned to."

ANS: C The nurse is clearly stating the assignments, allowing for a need to adjust both to needs of the unit and the delegate's needs.

10. In distinguishing between evaluation methods used in school versus those used in the work environment, it is noted that the work environment evaluation includes what? a. Determining whether steps are logical b. Formulating increments in correct order c. Efficiently organizing stages of the procedure d. Appraising outcomes according to policy expectation

ANS: D Outcomes are based on meeting existing criteria rather than on knowing how the outcome was achieved.

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

ANS: D Residency programs offer a longer precepted orientation period to bridge the gap between the classroom and practice.

17. A novice nurse is stressed due to always being behind with her assignments. She is overheard saying, "No one here worries about checking nasogastric tube placement before they give medications and hang feedings. Skipping that step would save me an extra 30 minutes to be used for charting. If they can do it, so can I." This nurse is experiencing which stage of reality shock? a. Loner b. "Rutter" c. Change agent d. "Native"

ANS: D The novice nurse is mimicking the actions of the experienced nurse taking shortcuts that were not taught in school and not following policy and procedure. A loner adopts the attitude of "just do the job and keep quiet." These nurses may prefer night shifts, during which they often are "left alone." A rutter adopts the attitude that "I'll just do what I have to do to get by." Change agents care enough to work within the system to elicit change.

1. It is important for novice nurses to know that "self-esteem = self-confidence + self-______."

ANS: respect