Role & Scope - questions

Which statement concerning nursing demographics is true? A. Most nurses practicing today have associate degrees in nursing. B. The number of males entering the profession has slightly increased. C. Nursing is not a profession that attracts ethnically diverse practitioners. D. Outpatient care settings employ the majority of practicing nurses today.

A The latest data states that 45.4% of practicing nurses have an associate degree. The other options are not true statements.

Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients who are healthy or who have chronic conditions. A. Clinical Nurse Specialist B. Nurse anesthetist C. Nurse practitioner D. Nurse-midwife

C

Nurses at a large medical center are participating in an education program led by staff educators to learn how to use an intravenous infusion pump to administer medications safely. This is which type of education? A. Continuing education B. Graduate education C. In-service education D. Professional registered nurse education

C In-service education programs are instruction or training provided by a health care agency or institution designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution. Often in-service programs are focused on new technologies such as infusion pumps or are designed to fulfill required competencies of the organization

Which nursing role is basic to the nursing profession? A. Leader and manager B. Client advocate C. Care provider D. Change agent

C The role of care provider is basic to the nursing profession. Caring is always central to nursing interventions and is an essential attribute of the expert nurse. The other options, while certainly nursing roles, are not the basic function of nursing: caring.

A widely used approach to encouraging team training in the health care professions is the use of: A. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). B. SBAR (Situation; Background; Assessment; Recommendation). C. the Robert Wood Johnson Pilot School Collaboration. D. Quality and Safety Education for Nurses (QSEN).

A A widely used team training approach for health care teams is TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety). TeamSTEPPS acknowledges that team training and enhanced communication are among the essential components of a comprehensive patient safety system. The SBAR technique provides a succinct, structured framework for communication among members of the health care team about a patient's condition. QSEN is a national program with the goal of preparing future nurses with the knowledge, skills, and attitudes (KSA) necessary to continually improve the quality and safety of the health care systems in which they work. The Robert Wood Johnson Foundation supported the Pilot School Collaborative to model how faculty could include the six competencies in prelicensure programs.

A client who insists on leaving the hospital against medical advice (AMA) after being properly advised signs the necessary form. In order to avoid legal consequences regarding the client's decision, the nurse should: A. objectively document all the details of the situation thoroughly but concisely in the client's medical record. B. notify the nursing supervisor of the client's decision and that all reasonable efforts were made to dissuade the client from leaving. C. have a member of the security staff escort the client off the facility's property and into their private vehicle or public transportation D. with the client's permission notify a contact person that the client is leaving the hospital against medical advice.

A Almost all health care facilities have an AMA form that patients are asked to sign when they decide to refuse or discontinue ordered therapy or intend to leave the facility. The value of the document in countering a claim of negligence should the patient or family later sue will depend in great part on the quality of the nurse's charting. Although the other options may be correct procedures, they are not directed towards protecting the nurse legally.

Which scenario demonstrates the preconventional level of moral development? A. Driving within the speed limit in order to avoid getting a speeding ticket B. Opening the door for an elderly woman to show her respect C. Anonymously providing money to a homeless shelter D. Cleaning up the kitchen to make your mother happy

A Moral decisions made at this level (preconventional) are simply a response to some threat of punishment. Acting out of respect or a desire to please demonstrates the conventional level, where behavior is less self-centered. Anonymously doing good is an example of the postconventional level, where motives are beyond issues of authority or reverence.

The clinical nurse leader (CNL) is best prepared to assume which of the following nursing roles? A. Responsibility for the evaluation of a client's plan of care B. Preoperative assessments on clients requiring surgical interventions C. Research to provide evidence-based practice regarding neonatal feeding practices D. Acting as advocate for an elderly, cognitively impaired client hospitalized with gastrointestinal pain

A The CNL is a master's-prepared RN who designs, implements, and evaluates client care by coordinating, delegating, and supervising the care provided by the health care team, including licensed nurses, technicians, and other health professionals. A Clinical Nurse specialist (CNS) is an advanced practice nurse who has expertise in a defined area of nursing practice such cardiac or infant and child care. The CNS engages in care as an expert clinician, educator, consultant, researcher, and administrator. The professional nurse (RN) addresses the humanistic and holistic needs of patients, acting as a care provider, advocate, and educator.

In the Middle Ages (467 BCE to 1450 AD), women delivered food, medicine, and care to the community's ill based on the: A. Christian concepts of charity and the sanctity of human life. B. need to make offerings to the gods in exchange for good health. C. emphasis being placed on the patient-centered approach to health care. D. emerging understanding of the importance of hygiene and sanitation.

A The Middle Ages saw the Christian church as the central figure in the organization and management of health care, and its concepts of charity and sanctity of human life were influential in the practice of caring for the sick. Beginning in prehistoric times, there was a belief that illness was a direct outcome of displeasing the gods, which gave rise to the practice of making offerings to the gods. In many cultures, it is still believed that illness is related to punishment from the god(s). The concept of patient-centered care and use of the scientific method of problem solving originated with the Greeks (1500 to 100 BCE). The Romans (27 BCE to 476 AD) are credited with the concepts of good hygiene and sanitation being vital to good health.

The right to identify oneself as a registered nurse (RN) is defined and protected by which component of a state's nurse practice act? A. Purpose of the act B. Licensure requirements C. Definition of nursing practice D. Description of the nurse's scope of practice

A The first purpose of a nurse practice act is to protect the health and safety of the public, the second purpose is to protect the title of RN. The legal title RN is reserved for those meeting the requirements to practice nursing. Only those licensed may use the designation of RN. Licensure requirements describe qualifications and procedures necessary for initial entry into nursing practice. The definition of nursing is of utmost importance because it delineates the scope of practice for nurses within the state, that is, each act outlines the activities nurses may legally perform within the jurisdiction.

Ethical dilemmas often arise over a conflict of opinions. Each of the following steps constitutes a correct step to take toward resolution of an ethical dilemma. What order should these steps be taken? 1. Clarify your own values about the issue. 2. Call a meeting in which those involved in the dilemma can discuss (negotiate) the possible solutions to the dilemma. 3. State the problem clearly in a way that all involved can understand. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. A. 4, 1, 3, 2 B. 4, 3, 1, 2 C. 1, 4, 2, 3 D. 1, 4, 3, 2

A The first step to the resolution of any ethical dilemma entails the gathering of all relevant information. In some cases this step may uncover valuable information that resolves the dilemma without further processing. Clarifying values helps you distinguish between your own values and opinions and those of others and the difference between value and fact. Stating the problem clearly ensures efficient discussion as you negotiate possible solutions.

There is increasing evidence that nursing needs to address the ability of its members to provide high-quality, effective care as patient-centered care needs intensify. Which nursing behavior demonstrates an understanding of how these needs will be best initially met? A. Enrolling in a Masters of Nursing Education graduate program B. Volunteering to provide community health screening at a senior citizen center C. Becoming politically active regarding the delivery of health care on the national level D. Regularly speaking to groups of high school students regarding the profession of nursing

A The need for nurses to provide the care for the influx of clients projected in the future is best addressed initially through the increase in nurses with graduate degrees. This allows for the education and training of future nurses who are introduced to nursing through effective recruiting targeted at various populations. Health screening is directed towards the early detection of health care needs. Political activism is directed towards health care policy change and enactment on national and even local government levels.

The nurse spends time with the patient and family reviewing the dressing change procedure for the patient's wound. The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role? A. Educator B. Advocate C. Caregiver D. Case manager

A The nurse is demonstrating the role of educator. An educator explains concepts and facts about health, describes the reason for routine care activities, demonstrates procedures such as home-care activities, reinforces learning or patient behavior, and evaluates the patient's progress in learning through return demonstration.

The ability to maintain appropriate professional boundaries and preserve nurse-client confidences has been most severely impacted by: A. the misuse of social media forums by nurses. B. the hesitation of state boards of nursing to discipline offenders. C. the courts' reluctance to uphold legal decisions involving professional boundaries. D. the nursing profession's inability to adequately define unacceptable behaviors.

A The ramifications of inappropriate posting of information by nursing professionals as well as nursing students via the various forms of social media has created serious problems affecting confidentiality and professional boundaries. State boards of nursing take these breaches of nursing practice seriously, revoking nurses' license to practice and expelling students from nursing programs. Currently the courts have upheld legal decisions involving such actions.

Utilitarianism is a term commonly found in ethical discourse, but it stands for only one of several different approaches to ethical discourse. Which is a true statement about the ethical philosophy of utilitarianism? A. The value of an intervention is determined primarily by its usefulness to society. B. The value of an intervention is culturally established based on predetermined measures. C. The decision to provide medical care depends on a measure of the moral life of the patient. D. Attention to relationships provides resolution to ethical dilemmas.

A Utilitarianism is based on the notion of "usefulness." "The value of an intervention is culturally established based on predetermined measures" and "Attention to relationships provides resolution to ethical dilemmas" describe other philosophical approaches to ethical discourse but not utilitarianism. "The decision to provide medical care depends on a measure of the moral life of the patient" is a false statement.

At the hospital where you work, you care for a child admitted frequently for management of cystic fibrosis. The child's family has initiated a Cystic Fibrosis Support Group page on Facebook, and they invite you to "friend" their page. Which of the following justifications would you use to explain your decision to accept or not accept the invitation? (Select all that apply.) A. Nurse-patient boundaries may be violated, harming possibility for therapeutic relationship. B. By accepting you could share nursing information online about the patient as a way to educate the support group. C. Postings can easily spread to a wider audience with the potential for HIPAA violations. D. The law prohibits your use of social networking with patients.

A, C Participation in online social media such as Facebook entails hazards, such as nurse-patient boundaries being violated or postings being viewed by a much wider audience with potential for HIPAA violations. These justify declining an invitation to "friend" a patient's support group online. Laws do not yet exist prohibiting nurse-patient social networking, although most health care facilities have established policies that guide participation in social media. The hazards involved in a nurse's participation in social media may not be obvious. Hazards include the interruption of relationships of trust and therefore therapeutic relationships. Postings can be shared with others outside the privacy limits established by the original user. Images and information posted innocently may violate privacy when an unintended audience views the page.

You are preparing a presentation for your nursing course on the topic of professional standards of care. Which statement(s) best describe(s) professional standards of care? (Select all that apply.) A. Describe a competent level of behavior in the professional role B. Protect the patient's confidentiality C. Are based on scientific research D. Ensure patient-centered care for all patients E. Define the principles of right and wrong to provide patient care

A, C The purpose of a professional standard of care is to describe the common level of professional nursing care to judge the quality of nursing practice. Standards of nursing care are developed and established on the basis of strong scientific research and the work of clinical nurse experts.

Which of the following actions is/are required of the nurse practicing advocacy? (Select all that apply.) A. Speak up for patient care issues even when others may disagree. B. Contribute money toward the patient's health care costs if the patient is indigent. C. Assess the patient's point of view and prepare to articulate it. D. Document all clinical changes in the medical record in a timely and legible way. E. Become an active member of professional nursing organizations.

A, C, D Advocacy involves speaking up for the patient from the nurse's point of view, even when others may disagree and the advocacy is awkward or uncomfortable. To advocate well, the nurse needs to be sensitive to the patient's point of view by listening well and articulating accurately. Documentation about acts of advocacy helps others on the health care provider team to support your advocacy. Although providing charitable contributions can be praiseworthy, that act is not necessarily a nursing act based on nursing knowledge.

Ethics in nursing practice includes an embrace of accountability or the ability to justify your actions. Even though your practice is defined in part by orders written by health care providers and policies enforced by administrators, you remain ethically accountable for your actions. Which of the following actions illustrates accountability? (Select all that apply.) A. Your patient receives a surgical procedure that is new to your facility. You ask your manager to provide an in-service about the procedure. B. A health care provider writes orders for pain-management medication even though the patient has been free of pain for 3 days. Out of respect for the health care provider's legal responsibilities, you administer the medications. C. During annual budget preparation at your facility, you advocate for annual pay increases for you and your peers. D. Your patient confides in you that she has recently lost her job and is anxious about her medical bills, including her ability to pay for medications after discharge. Health care coverage is not your area of expertise, but you know that the social worker might be able to help. You initiate a consultation request.

A, D Taking accountability for actions involves acting independently and taking initiative to remain competent and in taking initiative to act in the patient's best interest. Declining to question a health care provider's orders represents a lack of personal accountability. Asking for a pay raise is more about advocacy than accountability.

Expert clinician in a specialized area of practice such as adult diabetes care. A. Clinical Nurse Specialist B. Nurse anesthetist C. Nurse practitioner D. Nurse-midwife

B

Provides care and services under the supervision of an anesthesiologist A. Clinical Nurse Specialist B. Nurse anesthetist C. Nurse practitioner D. Nurse-midwife

B

A nurse manager of a medical-surgical unit is assisting care responsibilities for the oncoming shift. A client is awaiting transfer back to the unit from the PACU following thoracic surgery. To which staff member should the nurse assign to this client? A. Charge nurse B. RN C. Licensed practical nurse (LPN) D. Assistive personnel (AP)

B A client returning from surgery requires assessment and establishment of a plan of care. RNs are responsible for assessment (especially when a client is potentially unstable), initiation of an individualized plan of care, and identification of expected client outcomes. An RN is the appropriate choice.

Although requirements governing the practice of advance practice nursing may vary significantly, all states require: A. a master's degree in nursing. B. certification in the specialty area. C. 10 years of practice in the specialty area. D. a supervisory relationship with a physician.

B All states require evidence of certification in the specialty area. A master's degree is not required in all states. Requirements concerning supervisory and collaborative practices vary, as do requirements for years of practice in the specialty.

A nurse preserves a client's right to autonomy by: A. answering a client's questions about his prognosis truthfully. B. answering a client's questions so he can make an informed decision. C. providing medication to a trauma victim in a timely, appropriate manner. D. providing pain medication only after a needed surgical consent has been obtained.

B Autonomy is the preservation of a person's right to make his or her own decisions such as in the case of informed consent. Veracity is truthfulness even when the truth may cause the patient emotional pain. Beneficence is demonstrated in doing good, such as when providing pain relief. Nonmaleficence is often ethically challenging, as in the case of withholding pain medication until a necessary consent is obtained.

To best provide patient-centered care (PCC), especially when working with diverse populations, the nurse must initially: A. survey the individual client regarding his or her needs. B. engage in self-reflection about personal values and beliefs. C. share the principles of patient-centered care with the client. D. encourage all members of the health care team to engage in PCC.

B Because patient-centered care respects the diversity of the human experience, nurses must examine their own attitudes about working with individuals and groups whose values differ from their own. Although the other options are appropriate, they are effective only after the nurse has reflected on personal beliefs and values.

Normally, by what developmental milestone is a person expected to have learned there are consequences for making bad decisions? A. Toddler B. School age C. Middle teens D. Late teens

B By the time children reach school age, they have learned that behavior has consequences and that good behavior is associated with rewards and bad behavior with punishment. Through their experiences and social interactions with people outside their home or immediate surroundings, school-age children begin to make choices about how they will act based on an understanding of good and bad. A toddler begins to model ethical behaviors but does not have the ability to comprehend those behaviors. It is problematic psychologically if an individual has not learned or is incapable of learning right from wrong by one's middle to late teens.

The public's right to expect to receive treatment that meets the standards of nursing care is protected by: A. state law. B. federal law. C. reporting law. D. common law.

B Federal laws have a major effect on nursing practice, mandating a minimal standard of care in all health care settings that receive federal funds. Nursing practice is governed by state laws that delineate the conduct of licensed nurses and define behaviors of all health care professionals in promoting public health and welfare. Some states have enacted statutes that mandate nurses to report unsafe, illegal, or unethical practices of nursing colleagues or physicians. Common law is created through cases heard and decided in federal and state appellate courts. Throughout the years, judge-made law regarding nursing practice has accumulated in the form of written opinions.

To best address safety issues (sentinel events) that can negatively impact client health and recovery, the individual nurse must initially: A. thoroughly assess each client for possible safety risks. B. be well aware of the various types and sources of sentinel events. C. encourage all members of the client's health care team to be aware of potential risks. D. educate clients about the possible safety risks that can affect their health and recovery

B Nurses must first increase their awareness of the issues in quality and safety and apply lessons from other industries on how to identify, report, and systematically participate in analysis of a near miss or sentinel event. Although the other options may be helpful, the initial action is to become knowledgeable about the possibility of sentinel events occurring.

What event in American history influenced the role African-American women have played in the nursing profession? A. The creation of the U.S. Marine Hospital Service in 1798 B. The Civil War, beginning in 1861 C. The Army Nurse Corps, established in 1901 D. The North Carolina Nurse Practice Act of 1903

B The American Civil War allowed and encouraged African-American women to volunteer as nurses, thus setting the stage for their ultimate involvement in the profession of nursing. The U.S. Marine Hospital Service was the forerunner of today's U.S. Public Health Service. The Army Nurse Corps was an outcome of the Army Reorganization Act. North Carolina was the first state to implement the registration of nurses through its nursing practice act.

You have agreed to serve on a Policy and Procedure committee at your hospital, representing the voice of bedside nurses from your unit. The committee is discussing a revision to the staffing ratio policy at your hospital by discussing these questions: How many patients can a nurse safely and effectively care for on your unit? Does the ANA professional code of ethics support your concerns about staffing ratios? Indicate the best answer. A. No, the code describes philosophical principles that are important to ethical discourse but unrelated to staffing ratios. B. Yes, the code supports nurses' participation in conditions of employment, including the promotion of quality health care using both individual and collective action. C. No, to support staffing ratio discussions the ANA publishes journals containing research about best practices in a variety of health care settings D. No, the code is not necessary for this discussion since historical foundations of nursing as defined by Florence Nightingale established staffing ratios before the ANA code of ethics.

B The code of ethics clearly and convincingly establishes guidelines to shape nursing practice by promoting ethical behaviors, including the promotion of nursing involvement in issues that shape nursing practice beyond individual behaviors.

The image that best serves today's profession of nursing is one that portrays: A. skill and caring. B. trust and belief. C. honesty and loyalty. D. dependability and charity.

B The image most important to today's nursing professional is one that supports the public's need to trust and believe in the nurse caring for them. The individual actually providing the care often changes with each shift change and so the perception of the profession as a whole is vitally important. Although the other options represent positive traits, they all seem to be embodied in the image of trust and belief in the public's collective mind.

A nurse on the unit previously gave pain medication to the patient for incisional pain, which the patient rated as 7 out of 10 on the pain scale. The nurse now checks on the patient 30 minutes later and documents that the patient now rates the pain as a 1 out of 10 on the pain scale. Which standard of practice did the nurse perform? A. Diagnosis B. Evaluation C. Assessment D. Implementation

B The nurse is demonstrating the standard of evaluation. She or he evaluates the patient's progress toward the outcome of pain relief after the pain medication is administered. Evaluation is a key practice in pain management

A staff nurse routinely finds it difficult to receive clarification on prescriptions and orders written by a particular member of the medical staff. When numerous attempts to deal directly with the physician fail, the nurse most appropriately manages the problem by: A. making it known to the nurse manager that they will no longer accept the physician's clients as patients. B. documenting the problem in terms of client safety concerns and forwarding the information to both the nursing manager and chief of medical staff. C. informing the clients that any dissatisfaction with their care should be directed towards their physician for resolution. D. presenting the issues to the unit's entire nursing staff so that a unified plan can be developed to ensure the safety of the physician's clients.

B The problem will best be addressed as a medical staff problem with appropriate documentation of the problem as it affects client safety being forwarded to both nursing and medical staff administration. Refusing to treat a particular physician's clients or discussing the situation with the clients themselves is not professional behavior and so not a viable option. Involving the entire nursing staff may seem effective but it merely identifies the situation as a nursing problem rather than what it truly is—a medical problem.

The mutual recognition model of nursing regulation has been adopted by many states. Which of the following situations was an initial factor in the formation of that model? A. The introduction of the associate degree nursing program B. The growing presence of nurse-managed telehealth services C. The legal need to ensure nurses due process under the law D. The need to clarify the responsibilities and rights of professional nurses

B Through this model, individual state boards formed the NLC, a collection or compact of states that recognize a nurse's right to practice in all involved states as long as they are licensed in at least one of the compact states. This form of regulation was motivated by the increased mobility of nurses, the telehealth movement, and the necessity of caring for patients across long distances. Concerns have emerged relating to monitoring nurses' practice in multiple jurisdictions, nurse privacy, and due process rights.

Ethics of care suggests that you resolve an ethical dilemma by attention to relationships. As Madeleine Leininger described it, caring is the "central and unifying domain for the body of knowledge and practices in nursing." How does it differ from other approaches to ethical dilemmas? (Select all that apply.) A. Ethics of care applies exclusively to nursing practice. B. Ethics of care pays special attention to the stories of the people involved in an ethical issue. C. Ethics of care uses logic and intellectual analysis based on universal philosophical principles. D. Ethics of care depends less on universal principles than other approaches to analyze ethical dilemmas. E. Stories about relationships can be distracting when trying to resolve an ethical dilemma.

B, C Ethics of care focuses on relationships, logic, and narrative as a way to understand the source of ethical dilemma and the resolution of dilemmas. It is not exclusive to nursing but applies to all areas of health care. It specifically depends more on storytelling and examination of relationships than on an analysis of universal principles.

A nurse is delegating the ambulation of a client who had knee arthroplasty 5 days ago to an AP. Which of the following information should the nurse share with the AP? (Select all that apply) A. The roommate is up independently. B. The client ambulates with his slippers on over his antiembolic stockings C. The client uses a front-wheeled walker when ambulating. D. The client had pain medication 30 min. ago E. The client is allergic to codeine. F. The client ate 50% of his breakfast this morning.

B, C, D B. To complete this assignment safely, the AP should make sure the client wears stockings and slippers C. To complete this assignment safely, the AP should make sure the client uses a front wheeled walker D. To complete this assignment safely, the AP shoulld know that the client should be feeling the effects of the pain medication

A nurse is preparing an in-service program about delegation. Which of the following elements should she identify when presenting the five rights of delegation? (Select all that apply) A. Right client B. Right supervision/evaluation C. Right direction/communication D. Right time E. Right circumstances

B, C, E B. The right supervision/evaluation is one of the five rights of delegation. They also include the right task and the right person. C. Right direction/communication is one of the five rights of delegation. They also include the right task and the right person. E. The right circumstances is one of the five rights of delegation. They also include the right task and the right person.

It is true that advanced practice nurses: A. prescribe medication only in collaboration with a medical doctor. B. base their practice primarily on health promotion interventions. C. are considered expert clinicians in the specialty area. D. have earned a doctorate-level degree.

C All APNs make independent and collaborative health care decisions and engage in active practice as expert clinicians. APNs are educationally prepared through master's-level education to assume responsibility and accountability for the health promotion, assessment, diagnosis, and management of client problems, including the prescription of medication.

You are caring for a patient who will undergo a bone marrow aspiration, a difficult and painful procedure necessary to monitor the progress of recuperation after bone marrow transplantation. You are eager to minimize pain for this patient. You review the medical record for previous successful pain-management plans. You discuss the procedure with the patient. You advocate for the patient when the health care provider arrives to prepare for the procedure. Which ethical principle best describes the reasons for your actions? A. Beneficence B. Accountability C. Nonmaleficence D. Respect for autonomy

C Although all these principles are important and valuable for nursing practice, the principle of nonmaleficence best describes efforts to minimize pain, particularly when at least some pain is unavoidable. The term is Latin and translates literally as "non" indicating "not" and "maleficence" indicating "harmful act."

How can a nurse manager best foster high-quality and safe nursing care among the nursing staff? A. Praise the staff's efforts to provide care that is both safe and of high quality B. Offer incentives to those providing specific interventions that are safety and quality focused C. Create a unit culture where asking questions about health care interventions is encouraged D. Place great emphasis on how important safe, high-quality nursing care is to the client's health

C Health care organizations focusing on quality and safety encourage inquiry, making it okay to ask questions and providing resources to access information needed through various means, including informatics. Although praise and incentives are appropriate, they are not effective if the unit culture is not accepting. Placing emphasis on such interventions alone will not be successful if not supported by nursing managers and leaders.

When discussing hospital-based long-term job satisfaction with a group of senior-level nursing students, a nursing administrator shares that: A. "Follow your heart; you know right now what type of nursing you want to do." B. "Where you work isn't important; it's the work that you are doing that's important." C. "I'd suggest you get a variety of nursing experiences before deciding on your dream job." D. "You'll discover that all nursing positions have both good and bad points; that's the reality."

C If the choice of the clinical setting has been based on experiences as a student, the new graduate needs to be prepared to have different perceptions in a new role. At a minimum, experiences that are highly enjoyable on the limited-time basis of a student schedule may feel different when the new graduate functions in that role full time. It also is good to have a mix of experiences and learning opportunities before making a definitive decision.

Which nursing action best complies with the expectations for nursing care defined by the "never events" identified by the 2012 Rules of Participation for Hospitals? A. Requiring all unlicensed nursing personal to attend shift reports B. Providing care when convenient for the client whenever possible C. Attending an in-service on evidence-based practice on urinary catheter care D. Reporting suspected elder abuse to the nursing manager immediately

C Nurses are required to develop greater expertise in the provision of evidence-based patient care, case management, and discharge planning in order to avoid "never events." Although the other options are appropriate nursing actions, they are not related to "never events"; hospital-acquired conditions are considered reasonably preventable.

In what situation may a nurse deliver care that is not considered at the level of required standard of care? A. When directly ordered to do so by a physician B. When the nursing area is considered understaffed C. When the situation is determined to be an emergency D. When the client refuses care that would meet the standard of care.

C Nursing care rendered in a life-threatening emergency may breach the standard of care required under ordinary circumstances. The nurse may not knowingly provide substandard care even when ordered to do so by medical staff. Understaffing is not an acceptable reason for substandard care nor is a client's refusal to consent.

A nurse on a medical-surgical unit has received change of shift report and will care for four clients. Which of the following client's needs may the nurse assign to an assistive personnel (AP)? A. Feeding a client who was admitted 24 hr ago with aspiration pneumonia B. Reinforcing teaching with a client who is learning to walk using a quad cane. C. Reapplying a condom catheter for client who has urinary incontinence D. Applying a sterile dressing to a pressure ulcer.

C The application of a condom catheter is a noninvasive, routine procedure that the nurse may delegate to an AP

Which of the following interventions best demonstrates that a nursing administrator understands the challenges currently facing the professional nurse regarding patient safety? A. Supporting nursing interventions directed towards providing holistic care to both the client and his/her support system B. Requiring representation of the nursing staff in any discussion related to the redesign of patient care environments C. Requiring that staffing and schedules accommodate the attendance at mandatory in-services focusing on interprofessional care collaboration D. Supporting the right of the registered nurse to appropriately act as an advocate when a family disagrees with a client's wishes to limit visitors.

C The changing duties, responsibilities, and conflicts amid nursing shortages and public concern over patient safety and quality of care characterize present-day practice. These changes require professional nurses to have core competency in critical thinking and communication as well as interprofessional collaboration, assessment, leadership, and technical skills, in addition to their knowledge of health care. Although nurses support providing holistic care to both client and family and providing for appropriately designed patient rooms and common areas, ,interprofessional care collaboration has a much greater impact on the delivery of appropriate and safe client care. Although client advocacy is a nursing responsibility, the focus in this situation is on client autonomy, not safety.

Which of the following situations fails to meet the criteria for establishing nursing negligence or malpractice? A. A nurse comes to work under the influence of alcohol. B. The nurse leaves a client's bed in the raised position, resulting in a fall. C. The nurse fails repeatedly to document a client's response to pain medication. D. A nurse assigns first-time ambulation of a postop client to an aide and the client falls.

C The criteria require that the nurse-client contract be broken such as the alcohol scenario or preventable injury to the client as a result of the failure to follow good nursing practice. While failing to document is not acceptable practice, it would not be considered either malpractice or negligence unless the omission resulted in patient injury.

The nurse attends the interdisciplinary team meeting as director of the cardiac service line. The director presents information on the budget for the service line and the strategic directions for the next fiscal year. The nurse is acting in what professional role? A. Educator B. Nurse administrator C. Nurse manager D. Caregiver

C The nurse is in the professional role of nurse administrator. The nurse administrator needs to be skilled in business and management and understand all aspects of nursing and patient care. Functions of administrators include budgeting, staffing, strategic planning of programs and services, employee evaluation, and employee development.

The play Miss Evers' Boys was one of the first literary presentations that depicted nurses as: A. trained professionals. B. caring and charitable. C. client advocates. D. self-sacrificing.

C The play and eventual television movie Miss Evers' Boys tells the story of the now-infamous Tuskegee experiment that focused on the treatment of syphilis among African-American men between1932 and 1972. Miss Evers was the nurse in charge of recruiting subjects. The play describes how her request for the inclusion of penicillin into the treatment plan was denied, even though penicillin was the treatment of choice for the disease after 1947.

Which of the following scenarios demonstrates a nurse engaging in value clarification? A. A client is reassured by the nurse who states, "I will stay with you as long as you want." B. A novice nurse regularly asks a veteran nurse, "What would you do if you were in my place?" C. A nurse reflects on the question, "What would be important to me if I was told my cancer was terminal?" D. When a client asks for advice, the nurse responds, "What can I do to help you make this decision?"

C The process of values clarification attempts to examine the values one holds and how each of those values functions as part of a whole. Nurses must acknowledge their own values by considering how they would act in a particular situation. Reassuring the client is a means of providing emotional support. Asking the advice of a more experienced nurse is an example of role modeling. Asking clients what they need to achieve their goals is a way to encourage autonomy and independence.

A nurse meets with the registered dietitian and physical therapist to develop a plan of care that focuses on improving nutrition and mobility for a patient. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? A. Patient-centered care B. Safety C. Teamwork and collaboration D. Informatics

C This is an example of the competency of teamwork and collaboration. This competency focuses on the nurse functioning effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.

The primary purpose of nursing licensure is to: A. raise nursing to the level of a profession. B. recognize the knowledge and skills of the professional nurse. C. provide the public with protection against poorly trained nurses. D. identify all persons who have graduated from a school of nursing.

C When it became evident that nursing programs varied greatly in their entry criteria and academic requirements, it became necessary to address the resulting confusion and so licensure was adapted as a means of protecting the public. It is true the licensure acknowledges the skills and academic expertise of those who have successfully graduated from a school of nursing, but those are not the primary purpose of the license. Licensure is not the only criteria for attaining professional status.

You are working in an intensive care unit on the night shift. You have been caring for the same patient for three nights in a row. The patient's mother sleeps at the patient's bedside. Over time the mother has come to trust you, as evidenced by her long conversations with you while her child sleeps. Earlier in the week, in the presence of health care providers during morning rounds, she consented to an experimental surgical intervention for her child. But in conversation with you, she shares her doubts and confusions about the intervention. In the morning you ask the health care provider to consider an ethical consultation. What is the value of this nurse participating in discussions about ethical dilemmas? (Select all that apply.) A. Most state laws require that ethics committees include a nurse representative. B. The principal of beneficence promotes kindness in nurses. C. Nurses provide unique insight about patients that can be critical to the resolution of ethical dilemmas. D. Nurses can help articulate a patient's point of view based on specific nursing knowledge. E. Health care providers generally do not participate in ethical discourse.

C, D Nurses assess patients in ways that are unique to nursing. Furthermore they often find opportunity for communication with patients that differs in quantity and quality from other health care providers. As a result, nurses obtain information that other professionals may not notice or appreciate.

Provides independent care including pregnancy and gynecological services. A. Clinical Nurse Specialist B. Nurse anesthetist C. Nurse practitioner D. Nurse-midwife

D

According to annual assessments performed by the Federal Government, certain groups of people in the United States have poor or no access to health care. You decide to write an editorial to your local newspaper expressing your opinion about this situation. Which ethical principle would you incorporate into your editorial? A. Accountability because as the nurse you are accountable for the well-being of all patient groups B. Respect for autonomy because autonomy is violated if care is not accessible C. Ethics of care because the caring action would be to provide resource access for all D. Justice since this concept addresses questions about the fair distribution of health care resources

D Accountability, respect for autonomy, and ethics of care are valuable and could be incorporated into a discussion about access, but the fundamental principle that shapes thinking about access to care is the principle of justice.

Which statement made by a nurse demonstrates the appropriate attitude regarding the implementation of evidence-based practice (EBP)? A. "I've asked other nurses and they tell me this is how it's done here at this facility." B. "I'll ask the client how he feels this particular health issue should be best handled." C. "The client's general health has improved so much since the team has addressed her care." D. "I lack direct experience with this type of problem, so I'll bring it up at the team meeting."

D Acknowledging one's own limitations in knowledge and clinical expertise before determining when to deviate from evidence-based best practice demonstrates good nursing practice. Discussing care with team members, especially when addressing EBP, is demonstrating sound judgment. Relying only on how things were done in the past is not necessarily reflective of EBP. Although including the client in decisions regarding care is appropriate, there are limits to the value of the client's input, particularly when it comes to treatment-related issues regarding aspects of which they have no expertise.

A nurse demonstrates client-centered altruism when: A. reporting a nurse who has reported to work impaired by alcohol or drugs. B. making sure the client receives all medications on time and as prescribed. C. advocating for a client whose mental illness causes him to be a target of bullies. D. spending time each evening with a client who has expressed feelings of sadness and loneliness.

D Altruism is showing true concern for the welfare of another: giving a lonely client individualized, personal attention demonstrates altruism. Reporting an impaired nurse and advocating for a client are examples of social justice. Providing appropriate nursing care is a nursing responsibility.

Where can a registered nurse (RN) find the most reliable guidelines regarding the appropriate delegation of activities or tasks to unlicensed nursing personnel? A. The National Council of State Boards of Nursing (NCSBN) B. The American Nurses Credentialing Center (ANCC) C. The American Nurses Associate (ANA) D. That state's Nurse Practice Act

D Guidelines for delegation have been developed by many nursing organizations, including the ANA and NCSBN. Although the professional organizations' guidelines are helpful, it is the nurse practice acts of individual states that establish the legal definitions of appropriate delegation practices. Because regulations differ among states, each nurse must identify and understand the regulations for the state in which he or she practices. The ANCC is an organization that focuses on the certifications of nurses in various areas of nursing practice.

Which of the current perceptions of nursing most likely accounts for the lagging numbers of males in the profession? A. Poor income potential B. Work is routine and boring C. Lack of professional autonomy D. Viewed as a female profession

D Nursing continues to be viewed as a female profession although the number of males entering the profession is steadily increasing. The public views nursing as an interesting and meaningful profession that provides good job security but does not provide job independence. The perception of job independence affects both male and females equally.

An RN is making assignments for client care to a licensed practical nurse (LPN) at the beginning of the shift. Which of the following assignments should the LPN question? A. Assisting a client who is 24 hr postoperative to use an incentive spirometer. B. Collecting a clean-catch urine specimen from a client who was admitted on the previous shift C. Providing nasopharyngeal suctioning for a client who has pneumonia D. Replacing the cartridge and tubing on a patient-controlled analgesia (PCA) pump

D The RN is responsible for maintaining the PCA pump

A patient on the surgical unit develops a surgical wound infection. The nurse irrigates the surgical wound and changes the dressing every 8 hours. Which standard of practice is performed? A. Planning B. Evaluation C. Assessment D. Implementation

D The nurse is demonstrating the standard of practice of implementation. The registered nurse implements the identified plan of regular wound care and dressing change to achieve the outcome of wound healing.

The nurses on an acute care medical floor notice an increase in the number of patient falls. The unit introduces a new patient rounding program. The nurse assigned to the project gathers data to monitor the effectiveness of the rounding program over a 6-month period. The nurse is practicing in which nursing role? A. Nurse manager B. Nurse administrator C. Nurse educator D. Nurse researcher

D The nurse is functioning in the roll of nurse researcher. The nurse researcher investigates problems such as patient falls to improve nursing care and further define and expand the scope of nursing practice.

A nurse, acting as the coordinator of the interprofessional health care team of a client who recently experienced a stroke, will consult with which member of the team to help address the client's problem with swallowing? A. Registered dietitian B. Respiratory therapist C. Occupational therapist D. Speech-language pathologist

D The speech-language pathologist assists clients who are communicatively impaired by intervening in speech, language, and/or swallowing disorders. The dietitian provides nutritional therapy and support to ensure that the nutritional needs of the client are met with consideration to any problems the client may have with swallowing. The respiratory therapist is responsible for assessment and maintenance of the client's airway and respiratory equipment used for diagnosis and therapy of respiratory disorders. The occupational therapist plans activities that assist and teach clients with physical disabilities to become independent in activities of daily living, such as dressing, grooming, bathing, and eating.

A nurse conducted a literature review on effective methods for patient teaching. Based on the literature search, the nurse develops a unit-based protocol for using the teach-back method when providing patient teaching. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? A. Patient-centered care B. Safety C. Teamwork and collaboration D. Evidence-based practice

D This is an example of the competency of evidence-based practice. The nurse integrates best current evidence about patient teaching with clinical expertise and patient/family preferences and values for delivery of optimal health care.