Part Seven: Professional Practice
Chatper 58 Ethical Issues 1. A patient who has recently undergone a bone marrow transplant is in the intensive care unit (ICU) receiving aggressive treatment. A source of moral distress in the nurse caring for the patient may include which one of the following? A. availability of technology that may result in overtreatment B. collaboration between physician and nurse about treatment C. a request by the patient to continue treatment D. actively helping the patient to complete an advance directive
1. Answer: A Rationale: Increased technology and availability of life support measures increases the likelihood of aggressive care longer, contributing to concerns of overtreatment. Effective collaboration between the physician and nurse about treatment and a request by the patient to continue treatment would not cause moral distress in the nurse. Helping the patient complete an advance directive would not cause moral distress. Nurses who lack knowledge and time to help the patient make an autonomous decision might put the nurse at risk for moral distress.
59 Professional Issues 1. Collaborative partnerships are critical in optimizing the care of oncology patients. Which one of the following is an example of an obstacle to building a collaborative relationship? A. Interdisciplinary team meetings involving doctors, nurses, social workers, and leadership B. Lack of recognition of the knowledge and expertise of the oncology nurse C. Relationship building with team members other than the physician D. Initiation of change of shift reporting guidelines
1. Answer: B Rationale: Barriers to building a collaborative relationship include a lack of clearly defined, distinct domain of influence, a lack of understanding regarding scope of practice, overlapping and changing domains of practice that produce competition, lack of recognition of knowledge and expertise of a profession, and legal responsibilities. Interdisciplinary team meetings provide an opportunity for collaboration and team building among professionals. Developing and initiating change of shift reporting practices promotes nurse to nurse collaboration.
Chapter 60 Compassion Fatigue 1. An oncology nurse's coworker has been exhibiting increased behaviors of emotional distress after several patient deaths. The oncology nurse is concerned that these symptoms may be signs of which one of the following? A. chronic job stress B. compassion fatigue C. moral distress D. hyperactivity
1. Answer: B Rationale: Compassion fatigue is a state of physical and emotional distress, or apathy which results from caring for those experiencing pain or is a result of the constant demands of caring for other. For example, those patients seen on an inpatient oncology unit or in a busy infusion area are populations with constant demanding care needs. Exhaustion, cynicism, and inefficacy from chronic job stress are symptoms of burnout. Compassion fatigue is often correlated with burnout, but there are differences. C and D are not syndromes relating to any problem.
Chapter 54 Standards of Practice 1. To best understand the standards for professional practice in various oncology settings, the nurse should refer to which one of the following? A. Standards of Oncology Nursing Education: Generalist and Advanced Practice Levels B. Oncology Nursing Scope and Standards of Practice C. American Society of Clinical Oncology (ASCO)/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards D. a nurse recruiter at a Commission on Cancer Accredited Cancer Center
1. Answer: B Rationale: The Oncology Nursing Society Scope and Standards of Practice describe the expectations for oncology nursing practice across various care settings. For each standard, criteria for demonstrating competence are provided at the RN level that apply to all nurses who provide care to patients with cancer or practice in an oncology setting. Additional standards that apply to graduate-level prepared nurses and advanced practice registered nurses are included for some standards. The Standards of Oncology Nursing Education were developed to guide educators in the oncology nursing setting and schools of nursing about preparing nurses to care for cancer survivors across many settings. The ASCO/ONS Chemotherapy Administration Safety Standards are interprofessional standards outlining best practices for reducing errors related to chemotherapy processes. The nurse recruiter represents the institution's job specification not origin of professional standards.
Chapter 57 Legal Issues 1. The enforcement of Nurse Practice Acts to guide nursing practice is regulated by which one of the following? A. National Council of State Boards of Nursing (NCSBN) B. Nurse Practice Acts C. State Boards of Nursing (BoN) D. National Council Licensure for Registered Nurses (NCLEX)
1. Answer: C Rationale: State Boards of Nursing (BoN) provide oversight of nursing practice by enforcing the state nurse practice act to protect the health, welfare, and safety of the public. The National Council of State Boards of Nursing (NCSBN) develops the National Council Licensure for Registered Nurses (NCLEX) examination. The NCSBN also encourages and facilitates consistency among state boards of nursing. Nurse practice acts define nursing role, titles and scopes of practice. The NCLEX is the licensing examination not a regulating body. The NCLEX is a standardized exam that each state board of nursing uses to determine whether or not a candidate is prepared for entry-level nursing practice
Chapter 55 Evidence-Based Practice 1. Which one of the following statements accurately describe evidence-based practice (EBP)? A. EBP has been implemented throughout the United States consistently. B. EBP contradicts pay-for-performance programs. C. Evolution of evidence is limited. D. Nonpayment for complications model exists when EBP is not followed.
1. Answer: D Rationale: A nonpayment for complications model exists when EBP is not followed which supports pay for performance. EBP has not been implemented throughout the United States or globally consistently. EBP supports pay for performance initiatives. Evolution of evidence is not limited, but instead evolves on a continual basis.
Chapter 56 Principles of Education and Learning 1. Before development of a targeted program or material, a focus group is appropriate when assessing which one of the following populations? A. Individuals B. Caregivers C. Survivors D. Community
1. Answer: D Rationale: Focus groups are used for community assessment before the development of targeted patient education programs and materials. Individual assessment would involve specific questions for that exact person to understand specific educational needs of that individual person. Caregiver assessment would involve specific questions related to care delivery or the needs of the caregiver. Survivors would be an individual assessment with specific questions for the survivor.
2. Which one of the following statements accurately describes an element of the PICOT format? A. P = Patient B. I = Improvement C. O = Opportunity D. T = Theory
2. Answer: A Rationale: P = Patient population of interest. I = is not Improvement, but Intervention or issue of interest. O = is not Opportunity, but Outcomes. T = is not Theory, but Time Frame. C = Comparison Intervention or Control Group
2. The SMART methodology for writing objectives includes which one of the following components? A. S = Survey B. M = Measurable C. A = Action D. R = Results
2. Answer: B Rationale: M = Measurable. S = Specific. A = Attainable. R = Realistic. T = Timely
2. An oncology nurse unit educator is updating a policy. In this role she is responsible for which one of the following? A. her own self-assessment to guide professional growth B. integrating evidence-based science into practice C. determining if staff affected by the policies are in agreement with changes D. supporting continuing education programs
2. Answer: B Rationale: Nursing standards of practice and professional performance (NSPPP) set expectations for competent nursing practice and serve as powerful guides for ensuring evidence-based, quality nursing care and provide direction to nurses and their employers related to expectations and development of competence. As a nurse educator, the nurse is focused on policy and development for the entire staff, not individual professional growth. Staff may or may not agree with a policy, but such policies should be based on standards and evidence-based practice. The nurse educator may also be responsible for continuing education of the staff but when working on a policy she is looking at NSPPP and promoting evidence-based practice.
2. The Affordable Care Act advocates for patient's rights in the healthcare environment to include which one of the following? A. Requiring insurers to provide coverage to dependent children if enrolled in college B. Providing coverage to patients with a history of cancer C. Placing annual limits on coverage provided D. Placing limits on lifetime coverage
2. Answer: B Rationale: The Affordable Care Act (ACA) provides coverage to Americans with pre-existing conditions (cancer is a pre-existing condition). The ACA also mandates insurers to offer dependent coverage for children to age 26 regardless of if they are in college. The ACA prohibits annual and lifetime limits on coverage. The ACA prohibits arbitrary withdrawals of insurance coverage, mandates essential health services (such as screening examinations or vaccination), and allows four tiers of benefit coverage from low to high monthly premiums and out-of-pocket costs.
2. An oncology nurse working on a bone marrow transplant unit may be at risk for developing compassion fatigue. A factor that may increase her risk includes which one of the following? A. being married with children B. overconfidence in caring for patients C. caring for high-acuity patients over a long period of time D. having more than 10 years oncology nursing experience
2. Answer: C Rationale: Caring for high acuity patients and working under high levels of stress with a large caseload on an inpatient unit such as those on a bone marrow transplant unit over a long period of time can cause compassion fatigue. Other risk factors include nurses who are young and single with less than 10 years of experience in the nursing. Overconfidence is not a risk factor; having a high level of self-judgment imposed by either the nurse or the employer puts the nurse at risk for developing compassion fatigue.
2. A nurse is about to administer a clinical trial drug and asks the patient if he has signed an informed consent and if he understands the treatment. By doing so, the nurse is requesting of the patient which one of the following? A. That he must complete the entire treatment plan and follow up B. That he acknowledges that no harm will become him during treatment C. That he understands the risks, benefits, and consequences of treatment D. That he understands that the treatment will ultimately cure him of his disease
2. Answer: C Rationale: Informed consent ensures the patient has adequate understanding of the risks, benefits, alternatives, and consequences of treatment. Completing the entire treatment plan, and guaranteeing cure of his disease are not provisions of the informed consent. The informed consent consists of risks and benefits. Therefore, there may be risks of treatment that may cause harm to the patient. The informed consent process ensures the patient has an adequate understanding of risks, benefits, alternatives, and consequences of treatment and supports autonomy and human dignity. Informed consent touches on issues of beneficence, justice, and veracity.
2. Oncology patients experience health care in many different ways. Beliefs and values surrounding the concepts of suffering, pain, and end-of-life care are unique to every individual. Ensuring that these views are respected and observed through care is an example of which one of the following? A. human advocacy B. paternalistic advocacy C. simplistic advocacy D. existential advocacy
2. Answer: D Rationale: Existential advocacy is defined as acknowledging that various experiences in healthcare such as the definition of health versus illness, pain versus suffering, and the experience of dying are highly personal. Human advocacy is a personal extension of self, such as disclosing one's own views on health issues and life as a means to connect more deeply with the patient. Paternalistic advocacy is defined as doing something for or to another without that person's consent on the premise that it serves the person's own good. Simplistic advocacy occurs when one person pleads the cause of another.
3. According to the American Nurses Association Code of Ethics, which of the following is a provision that represents nursing's core values, duties, and accountabilities? An oncology nurse who: A. calls a physician for additional medications for a patient in pain B. joins a research group to study the effects of pain medication C. decides to go back to school to study palliative care D. arrives on time for work and completes tasks when due
3. Answer: A Rationale: Advocating for patients is of the provision of promoting, advocating, and protecting the rights, health, and safety of the patient. The other answers are part of the provisions are of the code that establishes boundaries of duty and loyalty, delineating nursing's responsibilities toward social justice, health policy and advancement of nursing as a science and profession.
3. The highest level of evidence is which one of the following levels? A. Level 1 B. Level 2 C. Level 5 D. Level 7
3. Answer: A Rationale: Level 1 is the highest level of evidence on which to base practice change. Level 1 is a systematic review of randomized control trials (RCTs). Level 2 is single-site RCT studies. Level 5 is a systematic review of descriptive or qualitative studies. Level 7 is the lowest level of evidence on which to base practice change; it is an expert opinion.
3. Suggested activities for an oncology nurse displaying symptoms of compassion fatigue might include which one of the following? A. going out for drinks and staying out late with friends B. scheduling a day at a spa for a massage and facial C. avoid talking with anyone about issues with work D. frequent resting in bed when not at work
3. Answer: B Rationale: Scheduling a day at a spa is a way of managing compassion fatigue because the nurse is doing something for herself and exhibits self-care. Other self-care activities include good nutrition and sleep. Staying out late and binge drinking are not ways of managing self-care. This may be a behavioral sign of compassion fatigue. Adequate sleep is recommended; however, lying in bed for weeks at a time is not. Getting the adequate amount of sleep along with exercise is a better way of taking care of one's self. Verbalizing feelings to friends, family, and coworkers may offer support. Speaking to facility social workers or chaplains may also provide counseling and support.
3. Certification in oncology nursing is critical for which one of the following examples? A. Obtaining higher pay B. Mandated for relicensure C. Representation of the knowledge and qualifications unique to oncology D. Required by the Board of Registered Nursing (BRN) by 2020
3. Answer: C Rationale: Certification helps assure the public that the certified nurse has the knowledge and qualifications needed to practice in his or her clinical area of nursing. It is not a guarantee of increased pay although some employers do acknowledge the value of certification with increased pay or promotion. It is not mandated for relicensure or by the BRN.
3. The ASCO/ONS Chemotherapy Administration Safety Standards are recognized by oncology nurses as which one of the following? A. a two-tiered system for nurses and physicians to report unsafe practices B. an evidence-based resource for locating current clinical trials C. interprofessional standards outlining best practices for reducing errors in administration D. a document for patients to better understand efficacy and side effects of antineoplastic therapy
3. Answer: C Rationale: The ASCO/ONS Chemotherapy Administration Safety Standards are interprofessional standards that outline best practices to reduce the risk of error during the process of chemotherapy provision. They are not tiered but interprofessional. These standards address appropriate staff and policies, planning, consent and education for patients and caregivers, ordering, preparing, administrating by parenteral and oral routes and documentation and monitoring adherence, side effects, and complications. They do not include information for locating clinical trials or information for patients/public to understand efficacy/side effects of chemotherapy.
3. Which one of the following nutritional goals are focused on an objective outcome? A. Understand nutritional impact on the body B. Prepare low-fat foods C. Maintain adequate sodium intake D. List four vegetables with high-fiber content
3. Answer: D Rationale: List four vegetables with high fiber content includes specific outcome criteria. It is specific about what (vegetables with high fiber content) and specific about the number (four). This outcome is measurable. Understand nutritional impact on body is vague, not an objective outcome. It is not clear what constitutes understanding and nutritional impact. Prepare low fat foods is vague, not an objective outcome, as it does not identify what prepare means (once, twice, without assistance etc.). Maintain adequate sodium intake is vague, not an objective outcome, as it is not specific as to what constitutes adequate sodium intake and it is not clear what maintain means (1 week, 1 month, 6 months, etc.)
3. Which one of the following is a national oncology- specific accreditation program? A. The Joint Commission (TJC) B. National Institutes of Health (NIH) C. Centers for Medicare and Medicaid (CMS) D. Quality Oncology Practice Initiative (QOPI)
3. Answer: D Rationale: Oncology specific accreditation and certification agencies and programs include the Oncology Nursing Certification Corporation (ONCC), American College of Surgeons - Commission on Cancer (ACS-COC) and the Quality Oncology Practice Initiative (QOPI). The QOPI, which is associated with the American Society of Clinical Oncology is a quality program designed for outpatient-oncology practices to promote self-assessment and improvement. The QOPI uses over 190 evidence-based quality measures and generates individual performance scores by practice, site, and provider, as well as benchmarked scores comparing all participating practices. The Joint Commission accredits and certifies healthcare organizations and programs for meeting specific performance and quality standards. The NIH is a federally funded biomedical research agency. CMS administers the Medicare program and works in partnership with state governments to administer Medicaid and other related programs.
4. Diagnostic methods are frequently used as an assessment for which one of the following groups? A. Staff B. Patient C. Caregiver D. Community
4. Answer: A Rationale: Diagnostic methods are routinely used in testing nurses' and other staff members' competency and knowledge base in specific areas. Patients are assessed using specific questions related to the needs of the patient. Caregivers are assessed using specific questions related to their needs or the needs of the recipient of their care. The community is assessed using specific methods, such as a survey, checklist, or interviewing a focus group.
4. An oncology nurse is caring for a young woman experiencing severe hot flashes related to treatment for her breast cancer. The nurse consults the Oncology Nursing Society Symptom Interventions. Which of the following statements is true about this resource? A. Oncology Nursing Society Symptom Interventions is a standard for professional oncology nursing practice. B. Oncology Nursing Society Symptom Interventions is a clinical practice guideline. C. Oncology Nursing Society Symptom Interventions is an evidence-based protocol. D. Oncology Nursing Society Symptom Interventions is a standard for multidisciplinary oncology practice.
4. Answer: B Rationale: Clinical practice guidelines recommendations utilized to optimize patient care and are based on a systematic review of evidence and an assessment of the benefits and harms of alternative care options. The ONS Symptom Interventions are written by teams of oncology nurse scientists and summarize and synthesize available evidence on the management of symptoms commonly encountered in oncology nursing practice. Oncology nurses can access this information to guide clinical practice. Standards for professional nursing practice are statements that define the duties that all nurses, regardless of role, are expected to perform competently. Standards and clinical guidelines are not the same and are differentiated by expectations of compliance. There is an expectation of compliance with standards. There are standards specific to oncology nursing such as Oncology Nursing Scope and Standards of Practice and standards specific to oncology professionals such as the ASCO/ONS Chemotherapy Administration Safety Standards. An evidence-based protocol might be adopted by an institution based on a review of practice and literature.
4. Legal issues for individuals with cancer include which one of the following? A. ensuring insurance coverage for a bone marrow transplant B. obtaining reimbursement for prescribed oral chemotherapy C. bankruptcy D. accepting a promotion at work because they are a cancer survivor
4. Answer: C Rationale: Approximately 3% of cancer survivors file for bankruptcy which requires legal consultation. Insurance and prescription coverage would be insurance company issues and social workers, navigators and patient advocates can often assist with obtaining coverage and reimbursement. Many cancer survivors face employment discrimination which would require legal services; a promotion is not employment discrimination.
4. An oncology nurse is concerned about a long-time coworker on her nursing unit because she has become distant and distracted. When questioned, the coworker states that she is just overwhelmed and exhausted. The coworker may be experiencing which one of the following? A. chronic fatigue syndrome B. compassion fatigue C. burnout D. a cognitive disorder
4. Answer: C Rationale: Burnout occurs over a prolonged period of time and is due to chronic job stressors. Individuals with burnout may experience cognitive, emotional, or physical exhaustion, feelings of detachment and distancing from work, including social interactions. They may also have feelings of incompetence and being overwhelmed. Compassion fatigue is emotional and physical distress due to the prolonged demands of caring for high acuity individuals or those in pain. Chronic fatigue syndrome is an unexplained medical disorder. Cognitive disorders are related to cognitive disabilities and may include confusion and poor judgment.
4. An oncology nurse working on a bone marrow transplant unit is caring for Mr. R, a 75-year-old patient who had an allogenic transplant. The nurse questions why they are treating a patient of his age group. This statement by the nurse is an example of the ethical theory of which one of the following? A. utilitarianism B. ethical egoism C. deontology D. divisability
4. Answer: C Rationale: Deontology is the theory that argues that an action's goodness is derived from intention and certain actions are intrinsically right or wrong. Utilitarianism is the theory that what is good is what will result in the most benefit for most people. Ethical egoism is the theory that it is always good to promote one's own good, and divisability is not any ethical principle.
4. To ensure feasibility and sustainability, practice changes in a clinical setting should first be which one of the following? A. incorporated into policy B. published C. piloted D. reviewed by the Institutional Review Board (IRB)
4. Answer: C Rationale: Practice changes should first be implemented or piloted in one or two practice areas to ensure feasibility, sustainability and outcomes. Incorporation into a policy may take place after the pilot. Publishing may take place after the pilot. Review by the IRB would take place before research starts if patients are involved.
4. Strategies to Stop Colon Cancer in Priority Populations is an example of ________; a model for ________ A. PICOT; primary care B. PDSA; protocol standardization C. PDSA; quality improvement D. PICOT; tertiary care
4. Answer: C Rationale: The Plan-Do-Study-Act (PDSA) model is used in quality improvement studies. It typically seeks to answer three fundamental questions, which include identification of the goal, determining how a change will be recognized as an improvement, and what changes will result in improvement. It typically occurs in settings and situations where everyday care occurs. The PICOT question format is a consistent approach and strategy for developing answerable, researchable questions. P: stands for Population/patient; I: stands for Intervention/indicator (Variable of Interest). C: stands for Comparison/control. O: stands for Outcome and T: stands for Time it takes for the intervention to achieve an outcome or how long participants are observed
5. Breach of duty is best defined as which one of the following? A. deviation from a professional standard of care B. failure to meet an acceptable standard of care C. deviation from the acceptable standard of care that a reasonable person would use in a specific situation D. a cause that directly produces an event and without which the event would not have occurred
5. Answer: B Rationale: Breach of duty is defined as a failure to meet an acceptable standard of care. Malpractice is a deviation from a professional standard of care. Negligence is a deviation from the acceptable standard of care that a reasonable person would use in a specific situation. Proximate cause is a cause that directly produces an event and without which the event would not have occurred.
5. EBP is most valuable when which one of the following occurs? A. outcomes are disseminated B. clinical practice changes C. incorporated into EBP grand rounds D. presented at a national conference
5. Answer: B Rationale: EBP is most valuable when clinical practice changes and the impact of the practice on patient outcomes is communicated effectively and adopted. Information about outcomes should be disseminated such as through grand rounds, professional journals and national conferences, but impact on clinical practice and patient outcomes are most important and valuable components of EBP.
5. G. R. is a 39-year-old male who has been newly diagnosed patient with leukemia. During his office visit, he discusses treatment options for therapy with the physician. The oncology nurse understands that this type of decision making is an example of which one of the following? A. informed consent B. shared decision-making C. power of attorney D. combined decision-making
5. Answer: B Rationale: In Shared Decision-Making, the patient chooses treatment options in conjunction and with guidance from the physician. Informed consent ensures the risks and benefits of treatment, and supports an autonomous decision. Power of Attorney involves allowing another person to make decisions, and combined decision-making is not a type of decision-making.
5. Medical errors have significant financial and nonfinancial costs to the healthcare system. Which one of the following represents an opportunity for the oncology nurse to minimize this risk? A. Obtain certification B. Recognize and remove faulty equipment C. Participate on an evidence-based care committee D. Read journals in their specialty area regularly
5. Answer: B Rationale: The Institute of Medicine (IOM) provides a national focus on knowledge regarding safety and setting national safety goals and tracking their progress. Institutions should develop and implement safety systems and development of a "culture of safety" where safety is an explicit organizational goal. Recognizing and removing faulty equipment helps promote safety. Certification helps assure that the nurse has knowledge and qualification for practice in a specific area but it does not assure that medical errors will not occur. Sitting on an evidence-based care committee may increase awareness of potential problems but does not necessarily prevent individual medical errors. Reading nursing journals may increase knowledge about nursing practice but the specific content may not be at reducing medical errors.
5. Performance analysis is helpful with which one of the following phases of staff education? A. Development of the teaching plan B. Determination of teaching objectives C. Evaluation D. Content identification
5. Answer: C Rationale: Performance analysis of information from quality improvement, incident reports, and other data, such as infection control data, are used in the evaluation phase. Development of the teaching plan uses principles of adult learning elements. Determination of teaching objectives is stating the goals of education. Content identification is within the teaching plan development phase.
5. An oncology nurse working on a unit where there is a heavy caseload and high levels of stress may best be assessed for secondary distress disorders through use of which one of the following? A. Montreal Cognitive Assessment Scale B. Mini Mental Status Exam C. Professional Quality of Life Scale (ProQOL) D. Maslach Burnout Inventory—Human Services Survey MBI-HSS
5. Answer: C Rationale: While the Maslach Burnout inventory is an assessment tool used for diagnosing compassion fatigue, the Professional Quality of Life Scale (ProQOL) uses subscales including assessing for secondary stress disorder, burnout, and compassion satisfaction. The tool is easy to use and score and is the most commonly used. The secondary scales provide more extensive assessment data. The Mental Status exam and Montreal Cognitive Assessment scale are frequently used to assess cognitive changes in individuals.
5. An effective way for institutions to evaluate the required documentation of oncology care is to perform which one of the following? A. Survey the staff about ease in locating the policies related to documentation of care B. Hire a compliance consultant to review documentation policies C. Send all documents to the compliance department for review D. Do a side-by-side comparison of standards to current processes.
5. Answer: D Rationale: ONS Nursing Documentation Standards for Cancer Treatment describe nursing documentation requirements for persons with a diagnosis of cancer undergoing cancer treatment and requiring supportive care and reflect the minimal elements to include documentation about people undergoing treatment for cancer. They address chemotherapy and biotherapy administration, radiation therapy, blood and marrow transplantation, oncologic surgery, central venous access devices, blood product transfusion, and extravasation management. A side by side comparison of current documentation practices with the standards for documentation can identify gaps and potential areas for improvement. Ease of locating policies will not necessarily result in appropriate documentation. A consultant could review policies but without a side by side comparison it is not clear if the documentation is appropriate and meets the requirements of the standard. The compliance department may be more concerned with coding and reimbursement.
6. Learning that takes place by watching and imitating others is based on which one of the following learning theories? A. Social B. Cognitive C. Behavioral D. Humanistic
6. Answer: A Rationale: Social learning theory encompasses learning by watching and imitating others. Cognitive learning theory is an internal process that requires attention, thought, and reasoning. Behavioral learning theory is based on observable behaviors that are reinforced to increase the strength of the behavior. Humanistic learning theory encompasses the uniqueness of all individuals and is a learner-directed approach.
6. Standards of Oncology Practice include which one of the following set of components? A. Planning, coordination of care, ethics, and outcomes identification B. Assessment, diagnosis, coordination of care, health teaching, and health promotion C. Communication, collaboration, leadership, quality of practice D. Coordination of care, health teaching and health promotion, resource utilization, ethics
6. Answer: B Rationale: Standards of Oncology Practice include the following components: assessment, diagnosis, outcomes identification, planning, implementation, coordination of care, health teaching and health promotion, and evaluation. Standards of Oncology Professional Performance include the following components: ethics, culturally congruent care, collaboration, communication, leadership, education, evidence-based practice and research, quality of practice, professional practice evaluation, resource utilization, and environmental health.
6. Reasons for litigation against nurses include which one of the following? A. following established standards of care and hospital policies and procedures B. performing a patient assessment and reporting the findings to a physician C. advocating for a patient's right to refuse treatment D. witnessing an informed consent when the nurse didn't hear what was explained to the patient
6. Answer: D Rationale: Common causes of litigation against nurses include issues associated with lack of informed consent, improper operation of a medical device, not following standards of care, failure to communicate appropriately, inadequate or inappropriate patient assessment, inadequate teaching, lack of patient advocacy, medication errors, inappropriate delegation or supervision, inadequate documentation, and working while impaired. Following standard of care is not a litigation risk. Communicating effectively/appropriately is not a litigation risk factor nor is advocating for patients.
6. Which one of the following is an example of a self-reflection exercise that a nurse could try as part of self-care management? A. Indulging in a massage B. Exercise (recommend three to four times weekly for 20-30 minutes) C. Enjoying a hobby, listening to music, humor, and enjoying nature D. Making time for prayer and meditation
6. Answer: D Rationale: Making time for prayer and meditation is an example of a self-reflection exercise that a nurse can try as part of self-care management. Spending time in prayer or in mediation is a good way to center thoughts and allow for self-reflection. Indulging in a massage, spending time exercise (recommend three to four times weekly for 20-30 minutes), and enjoying a hobby, listening to music, humor, and enjoying nature are all activities that emphasize self-care.
6. Which one of the following types of advocacy is exemplified when the nurse provides education about a chemotherapy agent and a hormonal treatment to a woman recently diagnosed with metastatic breast cancer? A. Human advocacy B. Paternalistic advocacy C. Simplistic advocacy D. Consumer advocacy
6. Answer: D Rationale: Paternalistic advocacy is defined by doing something for or to another without that person's consent on the premise that it serves the person's own good. An example of that type of advocacy could be paying for someone's transportation to a medical appointment or even raising funds to help with medical costs, without their knowledge. Simplistic advocacy is personally pleading a case on someone's behalf. Consumer advocacy is ensuring that patients have adequate informationHuman advocacy is the extension of self and involves disclosing a person's own beliefs on issues related to healthcare, such as advocating for equal access to health or reducing costs for certain treatments.
6. A characteristic of qualitative research is which one of the following? A. focus on outcome B. focus on objective C. focus on generalizable results D. focus on process
6. Answer: D Rationale: Qualitative research is used to describe or explore phenomena or gain understanding into some aspect of the patient/provider care experience. Characteristics of qualitative research are that it is process-focused, subjective, and not generalizable. Types of qualitative research include descriptive, survey, phenomenology, and content analysis. Quantitative research to describe relationships between variables, examine cause and effect, and identify facts. Characteristics of quantitative research are that it is outcome-focused, objective, and may be generalizable. Types of quantitative research include quasi-experimental, experimental, and correlational.
6. Which one of the following ethical principles is defined by the duty to not harm others? A. Beneficence B. Autonomy C. Justice D. Nonmaleficence
6. Answer: D Rationale: The ethical principle that is defined by the duty to not harm others is nonmaleficence. Nonmaleficence, in nursing terms, can mean ensuring that the benefits of treatment outweigh the potential harm. Beneficence is doing good or do what is of benefit. However, this term is often shaded in grey, for what is good or one person may not be of benefit to another person, so trying to act with beneficence may prove ethically challenging for some nurses. Autonomy is showing respect to an individual for their right to choose or their right to self-determination. Autonomy in nursing, according to the American Nurses Association, stems from a core value of giving a patient their dignity. Justice, as it relates to medical and nursing care, is allowing each patient, no matter what their life circumstances or morality, access to the same resources.
7. H. R. is a 50-year-old male who has recently been diagnosed with prostate cancer. To learn more about his disease, he conducts an internet search prior to his next appointment. A patient performing an independent internet search for their specific cancer diagnosis is an example of which one of the following learning theories? A. Operant conditioning B. Motivational C. Adult learning D. Pedagogic learning
7. Answer: C Rationale: Adult learning theory is described as someone who is self-directed, independent, and problem-centered which includes the internet search example. Operant conditioning is also known as behavioral learning and is based on observable behaviors that are reinforced to increase the strength of the behavior. Motivational theory is focused on how human behavior is activated. Pedagogy (teaching children) is the opposite of andragogy (adult learning).
7. Which one of the following is an example of managing self-care through grief counseling and support? A. Nutrition and eating well B. Send cards to the family, reminisce about time spent with patients, sometimes attend the funeral of patients with whom there has been a close bond C. Activities that focus a person's attention on the present experience, becoming more aware of one's physical, mental, and emotional condition, in a way that is nonjudgmental. D. Schedule preventive and medical care appointments
7. Answer: C Rationale: An example of managing self-care through grief counseling and support are through activities that focus a person's attention on the present experience, becoming more aware of one's physical, mental, and emotional condition, in a way that is nonjudgmental. Mindfulness has been shown to be effective at reducing stress. The interventions can be offered individually or in a group setting. Establishing good nutrition and eating well, as well as scheduling preventive and medical care appointments, are examples of emphasizing self-care. Sending cards to the family, reminiscing about time spent with patients, sometimes attending the funeral of patients with whom there has been a close bond, is a self-reflective exercise.
7. Which one of the following is a definition for standards for professional nursing practice? A. Statements that include recommendations for optimal patient care. B. Authoritative statements of the duties that subspecialties of nurses are expected to perform with competence. C. Authoritative statements of the duties that all registered nurses are expected to perform with competence. D. Recommendations of the duties that all registered nurses are expected to perform with competence.
7. Answer: C Rationale: The full definition for standards for professional nursing practice, as stated by the American Nurses Association (ANA), is an "authoritative statements of the duties that all registered nurses [RNs], regardless of role, population, or specialty, are expected to perform competently" (ANA, 2015a, p. 3). According to the Institutes of Medicine (IOM), clinical practice guidelines are defined as "statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options" (IOM, 2011, p. 15). Therefore, any statement with a recommendation is not defined as a standard. Finally, the standards of professional nursing are meant for all nurses, including, and not limited to, subspecialties.
7. Which one of the following represents the highest level of evidence in a quantitative study? A. Single-site randomized control studies (RCT) studies B. Case or cohort studies C. Single descriptive study D. Systemic review of RCTs
7. Answer: D Rationale: A systemic review of randomized control studies (RCT) studies is the highest level of evidence on which to base practice change. Single-site randomized control studies (RCT) studies are considered at a level 2 of evidence. A single descriptive study or qualitative study is a level 6, while a case or cohort study is a level 4. Other levels include quasi-experimental studies (level 3), systematic review of descriptive or qualitative studies (level 5), and expert opinion (level 7) and the lowest level on which to base practice change.
7. Nurses can utilize strategies for minimizing risk of malpractice or disciplinary action. Which one of the following strategies involves the development of skills in interpersonal communication? A. Attending relevant continuing education programs B. Obtaining specialty certifications C. Becoming involved in patient advocacy programs and listening to patient concerns D. Communicating clearly when educating patients and families
7. Answer: D Rationale: Communicating clearly when educating patients and families is an example of the development of interpersonal communication, while fostering positive relationships with patients and their families can minimize risk of malpractice. When a nurse has clearly explained and educated a patient on, for example, treatments, their potential side effects, and how to effectively manage those side effects, the nurse improves the level of patient care, but also lessens her chances for malpractice or disciplinary risk later in the patient's journey, since the patient has been well-educated and informed. Attending continuing education programs, obtaining specialty certifications, and becoming involved in patient advocacy programs are examples of maintaining knowledge and skills, another strategy in minimizing personal risk for nurses.
7. Which one of the following is an example or a definition of the ethical principle of justice? A. Ensuring the benefits of a patient's treatment outweighs the harm. B. Showing compassion toward a patient in a nurse's care. C. Respect for a person's right to choose their own destiny, or, in medical terms, their own plan of care. D. Allocating the same resources to each patient, no matter their socioeconomic status, race, religion, or moral standing.
7. Answer: D Rationale: Justice is allocating the same resources to each patient, no matter their socioeconomic status, race, religion, or moral standing. In nursing care, that means making available the same level of care or treatment to the rich and the poor, the morally just and those who have committed crimes. It is the same resources for all. Ensuring the benefits of a patient's treatment outweighs the harm is an example of nonmaleficence. Showing compassion toward a patient in a nurse's care is an example of beneficence, while respect for a person's right to choose their own destiny, or, in medical terms, their own plan of care, is an example of autonomy.
7. Which one of the following best describes the Individual Mandate as framed as part of the Affordable Care Act? A. Individuals must undergo health screenings annually. B. Individuals must participate in wellness programs offered by their health insurance. C. Individuals must participate in prevention education for diseases such as diabetes and cancer. D. Individuals must sign up for health insurance.
7. Answer: D Rationale: The Individual Mandate as part of the Affordable Care Act requires individuals to sign-up for health insurance or face a tax penalty. The Individual Mandate was repealed in 2017 as part of an effort to repeal and replace the Affordable Care Act. The other options - annual health screenings, wellness programs, and prevention education - are all false.
8. Which one of the following legal terms is defined by the "deviation from the acceptable standard of care that a reasonable person would use in a specific situation?" A. Malpractice B. Negligence C. Defamation D. Breach of duty
8. Answer: B Rationale: The correct answer is negligence. Negligence is the deviation from the acceptable standard of care that a reasonable person would use in a specific situation. Malpractice, on the other hand, is a deviation from a professional standard of care. The two terms are often confused and the line between them is thin, but distinct. Defamation involves harming the reputation of someone by making false statements to a third person. Breach of duty, unlike malpractice and negligence, is the failure to meet an accepted standard of care.
8. Which one of the following statements is a definition of the education component in the Standards of Professional Performance? A. The oncology nurse partners with the patient and family, the interprofessional team, and community resources to optimize cancer care. B. The oncology nurse seeks and expands personal knowledge and competence that reflect the current evidence-based state of cancer care and oncology nursing. C. The oncology nurse identifies clinical dilemmas and problems appropriate for study while supporting research efforts. D. The oncology nurse considers factors related to safety, efficiency, effectiveness, and cost in planning and delivering care to patients.
8. Answer: B Rationale: The definition for the education component in the Standards of Professional Performance is the oncology nurse seeks and expands personal knowledge and competence that reflect the current evidence-based state of cancer care and oncology nursing and contributes to the professional development of peers, assistive personnel, and interprofessional colleagues. Collaboration is defined as the oncology nurse partners with the patient and family, the interprofessional team, and community resources to optimize cancer care. The definition of evidence-based practice and research is the oncology nurse integrates relevant research into clinical practice and identifies clinical dilemmas and problems appropriate for study while supporting research efforts. Finally, resource utilization is defined as the oncology nurse considers factors related to safety, efficiency, effectiveness, and cost in planning and delivering care to patients.
8. Learning that is activated through internal and external cues is based on which one of the following learning theories? A. Social B. Cognitive C. Motivational D. Humanistic
8. Answer: C Rationale: Motivational learning is activated through internal and external cues. The foundation of motivational learning is studying the processes that explain the "why" and the "how" human behavior is activated and directed through external and internal cues. An internal cue could be an inner drive to stop smoking for a person's health or to "be there for my family." An external cue could be the cost of cigarettes or having to work around a nonsmoking policy in a person's workplace. Social learning theory revolves around watching and learning from the behavior of others. Cognitive learning is an internal process that requires attention, repetition, and ultimately, retention. Humanistic learning theory is a learner-directed approach, with a foundation based upon the theory that everyone is unique and learn in different ways.
8. Which one of the following is the third step in identifying ethical concerns? A. Explore practical alternatives. B. Analyze the problem using ethical theories. C. Gather the information from key participants and obtain the facts. D. Evaluate the process and outcome.
8. Answer: C Rationale: Step 3 in identifying ethical concerns is to analyze the problem using ethical theories or approaches. In this step, nurses are to discuss what principles, codes, laws, or perspectives are relevant. Exploring practical alternatives is the fourth step. Nurses are to discuss possible courses of action, with the goal of an action that is ethically reasonable and most likely to achieve the desired outcome with the least harm. Gathering the information and obtaining the facts is the first step in the process towards identifying ethical concerns. Finally, the last step in the process (Step 5) is evaluating the process and outcome. Debriefing sessions with those involved are critical for exploring whether the problem was adequately resolved, and for discussing implications for future similar situations. In Step 1, the nurse gathers information from key participants and obtains the facts to understand the multiple complex perspectives of the ethical problem. In Step 2, the nurse identifies the type of ethical problem that exists.
8. An oncology nurse is interested in creating a culture of evidence-based practice (EBP) at her workplace and begins a journal club with her colleagues. Which one of the following is a journal club in the multistep process of using evidence to support clinical practice? A. Identifying a problem or trigger B. Searching and critiquing the literature for relevant studies C. Identifying information and stakeholders needed to solve the problem D. Creating a sense of inquiry and create an EBP culture
8. Answer: D Rationale: Starting journal clubs, ongoing evidence-based practice (EBP) education, and access to key databases is an example of creating a sense of inquiry and create an EBP culture, which is also the first step in the multistep process of using evidence to support clinical practice. Identifying a problem or trigger is a second step in the process, which can be either problem-focused or knowledge-focused. Searching and critiquing the literature for relevant studies, and identifying of information and stakeholders needed to solve the problem are steps later in the process.
9. Which one of the following legal terms is defined by the "deviation from a professional standard of care?" A. Negligence B. Slander C. Malpractice D. Duty
9. Answer: C Rationale: Malpractice is the deviation from a professional standard of care. Examples of medical malpractice include a misdiagnosis or a failure to diagnosis. Negligence is the deviation from the acceptable standard of practice. An example of negligence in nursing is misusing equipment or perhaps taking a personal phone call in the middle of a patient's treatment. Slander is defined as making a defamatory statement expressed in a transitory form, especially speech. Duty is a care relationship between a patient and provider.
