Exam 3 - Unit 16

Nurses who are expected to work overtime as dictated by their employer are being subjected to a ___________ hazard in the workplace.

ANS: psychological Hazards in the workplace are categorized as follows: biologic, ergonomic, chemical, physical, and psychological. Included in psychological hazards are issues such as stress, shift work, mandatory overtime, and verbal abuse by patients and other health care providers.

A nurse notices that care is often withheld until an interpreter arrives, if the nurse is not multilingual. The nurse discusses this with the management team and suggests a three-part series be presented to the nursing staff to teach some commonly used medical terms in Spanish. This nurse is involved in the role of: a. change agent. b. educator. c. manager. d. coordinator.

ANS: A Correct: The role of the change agent consists of assessing health care delivery issues and creating solutions to improve health care delivery. Incorrect: b. The educator does not assess this type of issue in terms of delays in care provided c. The manager is not involved in the assessment and implementation of health care delivery problems. The manager would represent part of the solution to the issue but would not serve as the assessor or implementer. d. The coordinator of care is one who would arrange for the translator to attend to the patient; the coordinator would not assess the issues that surround delays in health care delivery.

Historically, what movement most influenced unionization in American health care agencies/hospitals? a. Immigration laws protected foreign employees from discrimination in hiring or discharge on the basis of national origin and citizenship status. b. Women entered the workforce, gaining voice to support unions. c. The Industrial Revolution led to poor working conditions and the need to protect workers. d. Nurses were exposed to communicable diseases, which led to death and disability.

ANS: C Correct: The Industrial Revolution led to people working in factories where poor and unsafe working conditions were widespread. Incorrect: a. Immigration laws protected workers rather than addressing unfair work practices. b. Although women did enter the workforce during wartime, gender was not a reason to unionize. d. Although unions provide for safe work environments, unionization was not directly related to communicable diseases.

A person from an underrepresented background in nursing is interested in entering nursing school and researches the ethnicity, age, and gender make-up of the nursing profession and finds: a. nursing is a career field that is primarily made up of women younger than 30 years. b. the number of male RNs has steadily increased and is equal to the number of female RNs. c. the majority of RNs are Caucasian or non-Hispanic. d. more than half of all RNs are ages 55 through 65.

ANS: C Correct: The majority of RNs are Caucasian or non-Hispanic (83.2%). Incorrect: a. Women comprise the largest percentage of RNs. b. The 2004 report indicates that the number of male RNs increased to 6.2% who were licensed prior to 2000 and 9.6% of those licensed in or after that time. d. The average age of half of all RNs is 48.6 years.

A group of nurses interested in unionizing decides to contact the largest union in the United States representing registered nurses, which is the: a. American Nurses Association. b. United American Nurses. c. National Nurses United. d. National Labor Relations Board.

ANS: C In 2009, the National Nurses United became the largest union representing nurses RNs as a result of a merger between the United American Nurses, California Nurses Association, National Nurses Organizing Committee, and Massachusetts Nurses Association.

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

ANS: respect

A concern that nurses were being asked to perform tasks that went beyond the state's nurse practice act was brought to the union's attention. Nurses were informed that either mediation or binding arbitration will be used to resolve the issue. A novice nurse asks about the difference between these techniques and is informed that: a. mediation is sanctioned by the National Labor Relations Board (NLRB) to formally discuss concerns with management and labor. b. binding arbitration is a formal discussion between labor and management in which the arbitrator's recommendations are compulsory. c. mediation uses a trained person to negotiate a legally binding plan. d. binding arbitration requires both labor and management to participate in discussions on the least destructive approach to allow self-governance by employees.

ANS: B Correct: Binding arbitration requires that both parties meet in formal talks, and all parties must obey the arbitrator's recommendations. Incorrect: a. Arbitration, not mediation, is sanctioned by the NLRB. c. Mediation is not legally binding. d. Binding arbitration focuses on more than self-governance.

Which nurse is more prone to burnout? The nurse who: a. graduated last in the class. b. is industrious and conscientious. c. refuses to work an extra shift even though he or she needs the money. d. volunteers to serve on only one committee and keeps in touch with schoolmates.

ANS: B Correct: Burnout is more common among nurses with type A personalities and those who are overachievers. Incorrect: a. Burnout most often occurs among students who are at the top of the class and have high grades. c. Long hours and repeated overtime can lead to burnout; thus refusing to work overtime or back-to-back long shifts may help avoid burnout. d. Prioritizing obligations and retaining friendships outside the work environment can reduce stress, thus reducing the likelihood of burnout.

A novice nurse is assigned a patient who has an order to draw blood for culture and sensitivity from a central line before antibiotic therapy is started. The novice reads and rereads the procedure manual. An hour later he stands at the bedside of the patient and stares at the central line, without knowing how to proceed. This phase of reality shock is termed: a. honeymoon. b. shock or rejection. c. recovery. d. resolution.

ANS: B Correct: During the shock or rejection phase, there is inconsistency with what was learned in school and the work environment, and the novice nurse lacks many of the skills needed to be independent in this new role. Incorrect: a. During the honeymoon phase, the novice nurse has not yet been faced with complicated tasks that he or she feels uncomfortable or incompetent to perform. c. The novice nurse lacks confidence in himself or herself, and no healing is evident. The novice nurse has not reached the recovery phase, which precedes the resolution phase. d. The novice nurse lacks confidence in himself or herself, and no healing is evident. The novice nurse has not reached the recovery phase, which precedes the resolution phase.

A large corporation employs nurses all over the United States. Nurses in one agency learned that fellow nurses in another agency are striking because they are required to work 16-hour shifts to cover for nurses who have left due to unsafe staffing practices. The union of the nonstriking agency nurses decides to stop work to support the nurses who are striking; thus, this union: a. is placing nurses at risk for a lawsuit because their direct employer did not cause the strike. b. must be an industry union representing both parties. c. is participating in a sympathy strike, which, if done correctly, is legal. d. must pay for any losses incurred by the agency during the strike.

ANS: C Correct: A sympathy strike occurs when a union stops work to support the strike of another union. Incorrect: a. Sympathy strikes are legal and policies are in place to protect clients. b. Sympathy strikes can be in support of another union. d. Policies are put in place to limit losses and ensure client safety prior to a strike.

Qualified nursing school applicants have continued to be turned away, limiting enrollment due to a shortage of faculty, which is attributed to several factors, including: a. nursing faculty are subject to high levels of burnout and job dissatisfaction. b. only the number of faculty in Associate Degree programs remain stable. c. the mean age of nursing faculty continues to decrease and older faculty mentors have left the profession. d. increasing job competition from higher paying clinical sites, especially in today's economic turndown.

ANS: D Correct: Academic institutions, especially those faced with budget cuts, generally cannot compete with nonacademic employers. Faculty salaries continue to be a major contributor to the nursing shortage. Incorrect: a. Nursing faculty are the most satisfied of all professional nurses with their jobs. b. Faculty preparing all levels of professional nurses are limited, most often due to aging. c. Nursing faculty continue to age with the mean age increasing across all faculty positions.

The time has arrived for the election to be held to decide whether to become unionized. Nurses who are anxious that they may lose their job and want the process to proceed quickly ask, "How will the election be conducted?" Place these steps in order. Put a comma and space between each answer choice (for example: a, b, c, d, e). a. For 10 days, literature is mailed to eligible employees. b. The NLRB is petitioned by the union or employer for an election and distributed to the regional NLRB director. c. The NLRB, union representative, and employer representative count ballots. d. The union submits proof that 30% of eligible nurses are interested in forming a collective bargaining unit. e. The NLRB, union representative, and employer representative review the list of those eligible to vote.

ANS: b, d, a, e, c The steps to the election process are as follows: 1. The NLRB is petitioned by the union or employer for an election and distributed to the regional NLRB director. 2. The union submits proof that 30% of eligible nurses are interested in forming a collective bargaining unit. 3. For 10 days, literature is mailed to eligible employees. 4. The NLRB, union representative, and employer representative review the list of those eligible to vote. 5. The NLRB, union representative, and employer representative count ballots.

Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. A nurse is approached to sign a union authorization card. If signed, the card: a. authorizes the union to serve as his/her legal representative. b. indicates that the person is requesting additional information about collective bargaining. c. indicates the nurse desires to share information about grievances. d. gives permission for union dues to be deducted from pay.

ANS: A Correct: A signature on a union authorization card indicates that the nurse gives the union the right to serve as legal representation. Incorrect: b. The signed union authorization card does not indicate a desire for information; rather it gives the union the right to serve as legal representative for the nurse. c. The union meets with nurses to learn about grievances during the pre-election phase prior to signing the card. d. The union authorization card does not give permission for union dues to be deducted from pay; rather it gives the union permission to serve as legal representative.

A nurse has critical care experience and is proficient in advanced cardiac life support. She often helps to lead "codes" and is an expert clinician with superior health assessment skills. Enjoying a challenge of a fast-paced environment with autonomy, this nurse would best be suited for which nursing role? a. Flight nurse b. Home health nurse c. Hospice nurse d. Occupational health nurse

ANS: A Correct: An experienced nurse with critical care experience and a desire to practice in a complex dynamic health care environment requiring clinical decision-making would thrive as a flight nurse. Incorrect: b. Home health nurses practice in a more stable setting, the patient's home. And although autonomy is a key factor, the thrill of the unknown next patient is less intense. c. Hospice nurses provide end-of-life care that is palliative rather than curative. d. The occupational health nurse's focus is on employees such as factory workers.

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

ANS: A Correct: During the honeymoon phase, the novice nurse has a positive image of nursing that coincides with the reason for becoming a nurse; this feeling is experienced immediately after the nurse begins work and often while still in orientation. Incorrect: b. During the shock or rejection phase, the novice nurse is overwhelmed by fear and a sense of incompetence. c. During the recovery phase, the novice nurse regains some confidence and begins to heal. d. At the resolution phase, the novice nurse has adjusted to the work environment and can work through change.

The forensic nurse would most likely be involved in: a. performing an assessment of rape victim and collecting specimens needed for court. b. assigning a patient with chest pain to be seen first, followed by a patient with an insect bite of unknown origin with red streaks but no respiratory distress. c. assessing a patient at home by asking the patient to place a receiver over the pacemaker to evaluate capture of pacing stimuli and transmitting the results to another state where nurse located. d. performing pediatric life support at the scene of an accident to stabilize then transport via helicopter to the nearest trauma center.

ANS: A Correct: Forensic nursing involves providing direct services to clients involved in abuse or victims of crimes and consults with medical and law enforcement. Incorrect: b. Triage nursing involves determining level of care needed and order of priority for care to be provided based on severity. c. Telehealth nursing involves use of telephone or transmitters often located in patient's home while care provider is located at another site. d. Flight nursing involves specialized skills used in trauma—often involves air rescue.

People are living longer and with older age comes a higher risk of terminal illness. Many individuals have chosen to maximize their quality of life but stop aggressive life-sustaining treatments. Nurses who work with terminally ill patients and their families to provide end-of-life care, pain management, and family support are practicing in which role? a. Hospice b. Infection control c. Coordinator d. Case manager

ANS: A Correct: Hospice nurses specialize in holistic care for the patient and family and end of life care to maximize quality rather than quantity of years of life. Incorrect: b. Infection control nurses follow patients with infectious diseases, evaluate possible sources of infection, and apply epidemiologic principles to understand prevalence of infectious disease. c. Coordinator positions coordinate and integrate the clinical and administrative roles of overseeing patients from admission to rehabilitation to home. d. Case managers coordinate resources to achieve improved outcomes based on quality, access, and cost.

Physical therapists are represented by a union, nurses are represented by a separate union, and pharmacists have yet another union within a single agency. This type of union representation is known as: a. occupational unionism. b. industrial unionisms. c. union shop. d. power sharing.

ANS: A Correct: Occupational unionism indicates separate unions for each occupation in an agency. Incorrect: b. Industrial unionism is a single union for all workers in the agency. c. A union shop is a worksite that requires all new employees within a work group to join the union. d. Power sharing refers to the right of employees to share in decision making.

A group of nurses are assembling outside a hospital protesting the use of foreign nurses after several nurses were terminated due to what the hospital called recurring "decreased census." The nurses carry signs with messages asking potential patients to seek care elsewhere. The local newspaper picked up the story, and the hospital is receiving negative press. The nurses are participating in: a. picketing. b. collective bargaining. c. a strike. d. arbitration.

ANS: A Correct: Picketing is a form of protest in which people (called picketers) congregate outside a place of work or location where an event is taking place. Often this is done in an attempt to dissuade others from going in ("crossing the picket line"), but it can also be done to draw public attention to a cause. Incorrect: b. Collective bargaining is the process by which workers organize under the representation of a union in order to share a degree of power with management to determine selected aspects of the conditions of employment. c. A strike is a work stoppage caused by the refusal of a large portion of employees to perform work; it usually takes place to enforce demands relating to employment conditions or to protest unfair labor practices. d. Arbitration is the method used for formal talks between management and labor within modern business, industry, or service organizations.

A nurse has been asked to serve as the charge nurse on the evening shift. The agency where the nurse is employed is considering unionization. If the charge nurse position is accepted, this nurse: a. can be represented by the union because charge nurses are not considered part of the management team. b. is part of the management team, so union participation would be a conflict of interest. c. can file a grievance that will be arbitrated automatically by the union. d. is ineligible for collective bargaining activities that deal with unfair labor practices.

ANS: A Correct: Serving as charge nurse is part of a nurse's professional role and not a management function. Incorrect: b. The duty of assigning clients and coordination of care is not a management function. c. A grievance deals with allegations by an employee that he or she has been treated unfairly. d. This nurse is eligible for representation through collective bargaining.

Several novice nurses share lunch breaks and have comments such as, "I have insomnia from worrying about what I forgot to do for my patient," and "I have no energy," and "I can't believe I can't do my job correctly." These novice nurses are experiencing: a. burnout. b. self-worth. c. confidence. d. resilience.

ANS: A Correct: Symptoms of burnout include extreme fatigue, headaches, difficulty sleeping, mood swings, anxiety, poor work quality, depression, and anger. Incorrect: b. These novice nurses are demonstrating low self-esteem. c. These novice nurses are uncertain about their abilities as nurses. d. These novice nurses feel defeated and lack flexibility to overcome feelings of inadequacy.

A certified oncology nurse notices that a novice nurse is unsure of decision making and lacks technical skills. The novice nurse gains confidence by sharing and learning with the experienced nurse. This relationship continues and builds, allowing the novice nurse to become more confident. This relationship is known as: a. mentoring. b. role modeling. c. a preceptorship. d. socialization.

ANS: A Correct: The experienced and novice nurses have entered into a mutually agreed upon interactive relationship to ease the transition of the novice nurse into the profession. Incorrect: b. An interactive relationship is present. c. A preceptorship is usually a short-term relationship. d. Socialization is the desired outcome of mentoring but not of actual interactions.

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

ANS: A Correct: The novice nurse is considering the legal and safety ramifications if the task is not completed. Incorrect: b. The novice nurse did not ask, "Who else can perform this task?" c. Prioritization is one part of organization but does not fully operationalize this concept. d. The novice nurse may be able to perform any required tasks but may be limited by time.

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

ANS: A Correct: The novice nurse lacks proficiency, which may be exaggerated by feelings of being overwhelmed by the new environment, causing him or her to not get the facts before asking for help. Incorrect: b. The novice nurse was able to communicate her need for help but lacked justification. c. The novice nurse was able to interact with the supervisor and was not required to interact with other members of the health care team. d. Feeling incompetent or lacking skills may lead to the feeling of being overwhelmed; however, the novice nurse was disorganized and had not accurately assessed the needs of the unit.

The primary focus of the care provider role for the nurse involves: a. using the nursing process to provide guidance to the patient in recovery. b. encouraging consumer self-responsibility and emphasizing health promotion/maintenance. c. focusing on increasing satisfaction among professional nurses. d. advancing nursing practice through research.

ANS: A Correct: The primary focus of the care provider's role is to use the nursing process in caring for patients. Incorrect: b. Encouraging consumer self-responsibility and emphasizing health promotion/maintenance constitute the educator and counselor roles of the nurse, not the primary role. c. The role of the care provider is not to increase satisfaction among professional nurses; this is included as part of the nurse manager's role. d. Advancing nursing practice through research is the role of the nurse researcher.

A nurse wants to become an advanced practice nurse and investigates the requirements for a: (Select all that apply.) a. nurse practitioner. b. nurse executive. c. certified nurse-midwife. d. certified registered nurse anesthetist.

ANS: A, C, D Correct: a. A nurse practitioner is considered an advanced practice nurse. c. A certified nurse-midwife is considered an advanced practice nurse. d. A certified registered nurse anesthetist is considered an advanced practice nurse. Incorrect: b. A nurse executive is not an advanced practice nurse; no additional educational degree or advancement is necessary for a nurse to be a nurse executive, and this is primarily an administrative/leadership role.

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

ANS: A Correct: To reduce stress and cope with the rejection phase of transition, the novice nurse should think before answering—take a few minutes before answering and deciding what is best course of action. Incorrect: b. The novice nurse should avoid minor stresses that drain energy. Bringing lunch and eating in a quiet space would be more helpful than spending most of the break waiting in line and eating lunch quickly or, even worse, eating on the unit. c. The nurse should rather support co-workers by being a good listener. d. The nurse should avoid people who are irritating or pessimistic.

A new role, the clinical nurse leader: (Select all that apply.) a. is a generalist prepared at the master's level. b. provides care at the bedside for complex patients. c. identifies the best resources at the lowest price to achieve best health outcomes for a client. d. serves as care coordinator whose practice is limited to acute care settings. e. is an advanced practice nurse with an earned doctorate in nursing.

ANS: A, B Correct: a. Clinical nurse leaders are prepared as generalists at the master's level. b. Clinical nurse leaders provide care to complex patients, change care plans as needed, and coordinate care to a group of patients. Incorrect: c. The case manager identifies the best resources at the lowest price to achieve best health outcomes for a client. d. Clinical nurse leaders practice in any setting. e. Clinical nurse leaders are not advanced practice nurses.

A novice nurse notices a patient is pacing the floor and twisting his hands. When the nurse enters the room, the patient stares at her and mumbles, "Can't anyone understand what I want?" while smiling and reaching out to shake the nurse's hand. The nurse recognizes a risk for violence based on which clinical findings? (Select all that apply.) a. Glaring at the nurse b. Nervousness, twisting of hands c. Murmuring when talking d. Diagnosis of a terminal illness e. Isolation, desire to be alone

ANS: A, B, C Correct: Nurses can recognize a risk for workplace violence by using the acronym STAMPEDAR (staring, tone of voice, anxiety, mumbling, pacing, emotions, disease process, assertive/nonassertive behavior, and resources). Incorrect: d. Diagnosis of a terminal illness is not a risk for workplace violence. e. Isolation or desire to be alone is not a risk factor for workplace violence and was not demonstrated in this situation.

Mandatory overtime and reduction in RN staff have resulted in decreased client satisfaction and a sentinel event. Management is unwilling to discuss a change in staffing, and collective bargaining interest is sparked. During the pre-election period, what actions by management are prohibited? (Select all that apply.) a. Seek individuals to spy on co-workers who are possible union supporters. b. Photograph employees participating in information sessions about unionization. c. Visit managers outside work to gain their perception of popularity of unionization. d. Threaten that, should the union win, the company will relocate when there is no intention to relocate. e. Require employees to declare their position on unionization prior to pick up paychecks.

ANS: A, B, D, E Correct: a. During the pre-election period, management may not solicit spying. b. During the pre-election period, management may not photograph employees engaged in union activities. d. During the pre-election period, management may not lie about what will happen if the union is the victor in an election. e. During the pre-election period, management may not question employees about their preferences regarding union activity. Incorrect: c. There are no restrictions about visiting with individuals in management or administration.

Managers at an acute care facility value the contributions of their aging nursing workforce and make recommendations to accommodate for an aging nursing workforce. They institute for which changes? (Select all that apply.) a. Supplies such as dressing change and Foley catheter kits are placed on the nursing unit. b. Teamwork and development of new roles such as admission nurse are encouraged. c. Day care centers for sick children are put into place to prevent the stress of having to find alternative day care. d. Assistive devices for lifting as recommended by ANA's Handle with Care are made available. e. A work-design consultant is hired to redesign the nursing unit to reduce wasted motion.

ANS: A, B, D, E Correct: a. Placing supplies in a decentralized area prevents the fatigue that would be caused by the need to retrieve items from a distant location. b. Nurses are integral to quality and their contributions should be noticed. d. Ill-designed units contribute to fatigue and inability of aging nurses to perform efficiently. e. Mentoring is one way to acknowledge skills of the aging workforce. Incorrect: c. Older nurses would not typically be concerned with day care centers for sick children as this would be an accommodation for younger nurses. Accommodations that address means to reduce fatigue and, value the expertise and contributions to the profession of older nurses through mentoring and development of roles that reduce fatigue and utilize these skills are key.

A hospital refused to purchase a better grade of utility gloves, even after learning that the cheaper utility gloves are easily punctured during routine use. This unsafe situation led nurses to seek unionization. During the pre-election phase for unionization, which actions by union representatives are prohibited by the National Labor Relations Board? (Select all that apply.) a. Scheduling a meeting in the agency's cafeteria to determine employees' interest in unionization b. Distributing non-documented information that female nurses receive lower annual performance evaluations than do male nurses c. Distributing information about the benefits of unionization and grievances in a public parking garage located across from the hospital d. Suggesting to workers the likelihood of job loss should the union not win the election e. Signing authorization cards for employees who are on leave

ANS: A, B, D, E Correct: a. Union representatives must meet in nonwork areas. b. Union representatives must not spread rumors of prejudices. d. Neither the union nor employers can spread falsehood about potential job loss or repercussion in the event of unionization. e. Union representatives cannot sign cards for employees. Incorrect: c. Union materials, including information about grievances, can be distributed on public property.

Hospitals surveyed nurses who terminated their employment to determine why they chose to leave. One of the most common reasons for leaving was: a. decreased pay for alternative shifts. b. that the nurse/patient ratio prevents safe care. c. that most facilities are choosing an all-RN staff, which decreases opportunities for advancement. d. that agency and foreign nurses are favored by administration over full-time nursing staff.

ANS: B Correct: A number of studies in the late 1990s focused on the work environment as a significant contributor to the difficulties involved in recruiting and retaining RNs. One of the primary factors for the increasing nurse turnover rate was identified as workload and staffing patterns. A more recent study by Aiken (2002) reported higher rates of patient complications and increased death rates when fewer nurses are assigned per patient. Incorrect: a. Substantial monetary compensation is provided for alternative shifts. c. An all-RN staff would not limit advancement opportunities. d. Use of agency and foreign nurses results in considerable expenditures by health care organizations. Many believe that these recruitment-related costs would be better spent by increasing the basic compensation levels of professional nurses.

A nurse in an acute care facility helps patients understand how to prevent diabetic neuropathies. This nurse is functioning in the role of: a. change agent. b. educator. c. manager. d. coordinator.

ANS: B Correct: A nurse functioning in the role of educator helps patients understand the complications of their disease process. Incorrect: a. A change agent is one who searches for possible alternatives regarding issues that involve patient care, safety, and motivation of the industry and who assesses cost-effective resources for use in health-related situations. c. The nurse manager does not provide education to patients, as the acute care nurse would. d. The coordinator also does not provide acute care patient education but coordinates care on an interprofessional plan.

A group of RNs wish to seek union representation that would protect all workers in the agency including non-licensed assistive personnel and non-nursing employees such as nutritionists and dietary workers. The type of union being sought is the strongest collective group and is known as a(n): a. occupational union. b. industrial union. c. union shop. d. right-to-work bargaining organization.

ANS: B Correct: An industrial unionism is a single union for all workers in the agency. Incorrect: a. In an organization that has occupational unions, there are separate unions for each occupation. c. A union shop is a worksite that requires all new employees within a work group to join the union. d. Right-to-work statutes prohibit requirement of union member dues as part of employment.

Studies conducted to determine enrollment trends in nursing schools have found that in the last years: a. a greater number of individuals chose nursing as a career but could not meet entrance requirements. b. more young women chose to enter the profession of nursing. c. fewer career opportunities exist in the profession of nursing and fewer opportunities are projected to exist for women. d. men have dominated the profession, and women feel that they have experienced discrimination.

ANS: B Correct: An unexpected number of young women entered the nursing workforce from 2002 to 2009, causing faster growth in the supply than anticipated. Incorrect: a. Many qualified nursing candidates are turned away because of limited enrollment in nursing schools. c. More people are living with chronic conditions, and health care reform will most likely dramatically increase the number of people accessing care. d. Men remain a minority in the nursing profession.

When reading about nursing as a career, a student is interested in learning about violence in the profession. Which statement accurately reflects violence in health care and the profession of nursing? a. Nursing is the most trusted profession and therefore violence is rare. b. Health care workers have the highest rates of nonfatal assault injuries in the workplace. c. Physical violence between peers constitutes lateral violence; however, verbal assault is not recognized as violence. d. Professional organizations have recognized a need to evaluate all nurses for the risk of committing acts of violence.

ANS: B Correct: Health care workers have the highest rates of nonfatal assault injuries with violence against emergency room nurses being prevalent. Incorrect: a. Nursing is the most trusted profession, but violence is increasing and recognized. c. Both physical and verbal assaults are considered lateral or horizontal violence. d. Professional organizations have set forth criteria to address lateral violence and steps to educate staff; however, there is no recommendation that all nurses be evaluated for a risk to commit violent acts. If inappropriate behavior is observed, the organization must determine steps to be taken.

In differentiating between interprofessional and multidisciplinary: a. multidisciplinary refers to the care of many diverse patients by one discipline. b. interprofessional involves members of many disciplines working together to provide patient care to a distinct population. c. interprofessional refers to members of the same discipline working together to provide patient care to a distinct population. d. interprofessional is the use of multiple interventions by nurses with varying levels of education.

ANS: B Correct: Interprofessional, as related to member roles, involves members of many disciplines working together to provide patient care to a distinct population. Incorrect: a. The definition of multidisciplinary is not "the care of many patients by one discipline." c. Interprofessional refers to members working together and not "the same discipline working as one to provide patient care." d. Interprofessional does not describe the use of multiple interventions.

The novice nurse arrives on the nursing unit, is introduced to the staff, is assigned a preceptor, and is asked to participate in the next staff meeting. This introduction into nursing is appropriately termed: a. biculturalism. b. socialization. c. transition. d. "going native."

ANS: B Correct: Socialization involves the acceptance and integration of the novice nurse into the profession of nursing, as well as the identification of the novice nurse with the profession of nursing. Incorrect: a. Biculturalism is the blending of school values with those of the workplace. c. Transition involves competency when moving from the school to the work environment, and this situation does not require competency on the part of the novice nurse. d. "Going native" describes an inappropriate attempt to move from the shock phase to the recovery phase in which the novice nurse mimics the unsafe practices of experienced nurses.

A student nurse wants to meet other nursing students from different countries and to learn of employment possibilities. The student nurse should: a. participate in the clinical facility's employee satisfaction task force. b. join the Student Nurses Association. c. take part in self-mentoring. d. postpone taking the licensure examination so he or she can take a tour of foreign countries.

ANS: B Correct: Students who participate in preprofessional organizations such as the Student Nurses Association have an opportunity to meet students across the nation and around the world and can network with leaders to gain knowledge about employment possibilities. Incorrect: a. The clinical facility's employee satisfaction task force is interested only in the population at the place of employment. c. Self-mentoring can help a novice become more self-sufficient but does not facilitate networking or interacting with individuals from other states or nations. d. Completing the curriculum and studying for the licensure exam is a priority-investigation study abroad as part of the curriculum is an alternative.

The Institute of Medicine Report (2011): a. recommended that only physicians have the legal privilege to prescribe medications. b. called for increasing the number of baccalaureate-prepared nurses in the workforce to 80% by 2020. c. called for a minimum staffing ratio be in place in no later than 10 years. d. called for nurse technicians to provide care during the nursing shortage.

ANS: B Correct: The IOM report (2011) addresses the evolving complexities of the current health care system and a need for 80% of the nursing workforce to be baccalaureate prepared by 2020. Incorrect: a. The IOM report does not address prescribing only by physician. c. Minimum staffing is not a recommendation of the IOM but was a recommendation in the state of California. d. The need for nurse technicians or nurse extenders were not addressed, but the IOM report recommended the highest educational level for nurses.

A nurse is interested in working in a large trauma center that is unionized but does not want to join the union or pay fees. She accepts the position but is not required to join or pay fees to the union based on which law? a. National Labor Relations Act b. Right-to-Work law c. National Labor Relations Act d. Taft-Hartley Act

ANS: B Correct: The Right-to-Work law prohibits membership or payment of union dues or "fees" a condition of employment, either before or after hiring. Incorrect: a. The National Labor Relation Act identifies acts that interfere with rights of employees or employers. c. The National Labor Relations Act gave employees the right to self-organize, to form labor unions, and to bargain collectively. d. The Taft-Hartley Act exempted charitable institutions, including nonprofit hospitals, from the 1935 NLRA Act.

A nurse who is participating in a health fair asks, "Other than nursing, what are some opportunities for careers in the health care professions, and what education is required?" The nurse informs participants that a baccalaureate degree is required as the minimum standard for the role of: a. speech therapist. b. occupational therapist c. nurse-midwife d. nurse anesthetist.

ANS: B Correct: The baccalaureate degree is the minimum requirement for an occupational therapist. Incorrect: a. A master's degree is the minimum requirement for becoming a speech therapist. c. A master's degree is the minimum requirement for becoming a nurse-midwife. d. A master's degree is the minimum requirement for becoming a nurse anesthetist.

A hospital standard states, "All intravenous (IV) sites must be rotated every 72 hours." The nurse who assesses and records variations from this standard is fulfilling which role of nursing? a. Infection control b. Quality management c. Coordinator position d. Counselor

ANS: B Correct: The basic premise is to ensure that outcomes in client care services are consistent with established standards. Incorrect: a. Assessing and recording care variations are tasks that are not included in the role of the infection control nurse. c. The coordinator is responsible for coordinating clinical and administrative requirements for the patient. d. The role of the counselor is to emphasize to the patient health promotion and maintenance.

An RN testifies at a trial where domestic violence is being investigated. She had previously assisted with specimen collection and had assessed the victim. The nurse is involved in _____ nursing. a. triage b. forensic c. flight d. entrepreneurial

ANS: B Correct: The forensic nurse provides direct services to clients and consults with and serves as an expert witness for medical and law enforcement. Incorrect: a. A triage nurse provides a decision on what level of care a client involved in a mass disaster will receive and determines priority of order patients. c. The role of the flight nurse is to care for diverse clients in an autonomous practice while using the opportunity to apply advanced skills. d. The entrepreneurial nurse would not be employed in this capacity.

A nurse is responsible for determining the incidence rates of hospital-acquired diarrhea on a pediatric ward after receiving reports that five children admitted with uncontrolled asthma had developed diarrhea while hospitalized. The nurse is working in the role of: a. quality management. b. infection control. c. occupational health. d. forensics.

ANS: B Correct: The infection control nurse is concerned with incidence of infections within the hospital. Incorrect: a. The quality control nurse ensures that patient outcomes meet established standards. c. Occupational health nurses are concerned with health of employees. d. Forensic nurses focus on trauma, abuse, and violence.

An experienced nurse working in oncology is shocked to realize that he feels little empathy when a patient explains, "I developed cancer from having to work in the dry cleaning industry since I was only 8 years old to help support my younger siblings during the depression. Now they have all moved away and refuse to help me financially, and it takes everything I have to pay for my chemotherapy medicine." The nurse is experiencing: a. burnout. b. compassion fatigue. c. reality shock. d. horizontal hostility.

ANS: B Correct: The nurse is experiencing a gradual decline in compassion over time as a result of being exposed to events that have distressed his or her patients, such as working at a young age to support a family while inadvertently being exposed to carcinogens. Incorrect: a. Burnout refers to feelings of being overwhelmed and distressed, resulting in poor work quality and symptoms such as insomnia and lack of professional pride. c. Reality shock occurs when a novice nurse enters the workforce after graduating from school and is not prepared to deal with differences between school and workplace values. d. Horizontal hostility is to control, diminish, or devalue another peer or person, in this situation the nurse is not displaying nor is not the target of bullying or person insults rather is demonstrating compassion fatigue that is the result of working with complex or patient trauma over time resulting in a decline in empathy.

The nurse who organizes screenings for employees, assesses the work environment for hazards, and teaches health-promoting activities is employed in the field of: a. infection control. b. occupational health. c. informatics. d. transportation specialization.

ANS: B Correct: The occupational health nurse organizes screenings for employees, assesses the work environment for hazards, and teaches health-promoting activities. Incorrect: a. Infection control nurses assess the total incidence of infections within the hospital. c. Informatics deals with data management for decision making. d. Transportation specialist is not a current nursing area.

A nurse explaining the above graph indicates the frequency of falls in 2011 to detect and possibly explain causes of variation. The peaks in June were attributed to regular staff vacations during which agency nurses were used. The nurse is employed in which role? a. Case Manager b. Quality Manager c. Forensic Nurse d. Occupational Health Nurse

ANS: B Correct: The role of the quality manager is to improve quality of care and reduce errors. Knowledge of quality management tools is essential to the role. The run chart shown above is one such quality management tool. Incorrect: a. Case managers coordinate resources to achieve improved outcomes based on quality, access, and cost. c. Forensic nursing applies nursing science to public or legal proceedings in the scientific investigation and treatment of trauma or death of victims of violence. d. Occupational Health Nursing is delivery of nursing care within a specific occupation to improve health of employees.

A nurse is concerned because novice nurses are having their orientation period shortened and are being placed in charge nurse positions. The nurse has documented unsafe care and decisions by these novice nurses. To be protected from retaliation by the employer, this nurse must "blow the whistle" by: a. holding a public forum in the agency cafeteria to discuss concerns. b. reporting concerns to state and/or national agencies regulating the agency. c. calling co-workers outside the workplace to informally discuss wrongdoing. d. contacting The Joint Commission to report unsafe conditions.

ANS: B Correct: The whistle blower is not protected until concerns are reported to the state or national regulatory agency. Incorrect: a. Holding a public forum does not in any way offer protection. c. Reporting to state-national agencies that regulate the employer is the method to ensure whistle blower protection, and it is recommended that complaints be in writing. d. Neither The Joint Commission nor the National Committee for Quality Assurance grants protection.

The occupational health and safety nurse would like to develop programs designed to decrease mortality and morbidity among the workforce. When considering factors related to mortality among health care workers, the nurse should focus efforts on prevention of: a. suicide. b. homicide. c. blood-borne disease. d. ergonomic hazards.

ANS: B Correct: Workplace violence has become a major societal issue. Its most extreme form, homicide, is the fourth-leading cause of fatal occupational injury in the United States, with 521 workplace homicides reported in 2009 out of a total of 4551 fatal work injuries (U.S. Department of Justice, 2011). Incorrect: a. Suicide is not a strong mortality issue in the workforce. c. Mortality due to blood-borne pathogen exposure has decreased since the Needlestick Safety and Prevention Act was implemented. d. Ergonomic hazards have decreased since safe patient handling educational programs were implemented.

A nurse is interviewing for a job and recently read the American Nurses Association's (ANA) recommendation for questions to ask regarding before accepting employment. Which questions should the nurse ask? Select all that apply. a. Do you have flexible scheduling? b. What are the expectations for advancement? c. How long do staff nurses stay before resigning? d. What is the mission of the parent organization? e. Does the organization have a means for staff nurses to have an active role in decision making by participation and accountability for the outcomes of practice decisions.

ANS: B, C, E Correct: b. According to the ANA recommendations, applicants for nursing positions should ask about the opportunities for advancement exist in the organization. c. According to the ANA recommendations, applicants for nursing positions should ask about the organization's turnover rate and average longevity of staff nurses. e. According to the ANA recommendations, applicants for nursing positions should ask about the whether the organization has a shared governance model. Incorrect: a. The ANA did not recommend asking about flexible scheduling. d. The mission of the parent organization should be researched by the applicant prior to applying, not asked of the recruiter.

A hospital is seeking a 2.5% wage reduction for all nurses as part of a new balanced budget plan; however, the plan provides for raises for upper-level management. This plan resulted in a call for a union to protect the nurses. When the union representative arrives, what questions should the nurses ask? (Select all that apply.) a. Will the dues be used to support charity care when clients are unable to pay? b. How effective has the union been in representing nurses' best interest? c. What percent of dues pays union personnel salaries? d. Are dues used to promote research for terminally ill clients? e. If arbitration is unsuccessful and a strike occurs, will nurses receive compensation during the strike?

ANS: B, C, E Correct: b. Laborers (staff nurses) want a union with a successful track record of improving wages and benefits. c. Union dues are used to support union personnel, and the amount varies among different union groups; the higher the percentage of money that goes to pay union personnel salaries, the less money will be available to support members. e. Employers are not obligated to pay laborers during a strike, and unions may choose to pay employees while striking. Incorrect: a. Unions are not involved in philanthropic activities. d. Union dues are used to support activities to improve the lives of laborers, not to support research activities.

A novice nurse notices the medication nurse hurriedly gathering medications to be administered for the entire day, removing them from the packages, and placing them in a paper cup with the patient's name and room number on the cup. When one of the patients points at a pill and asks, "What is this?" and "What does this do?" the medication nurse is uncertain, because it has long since been removed from the packaging. The novice nurse speaks to the nurse manager about her observations and describes her concerns. The novice nurse has assumed the role of: a. loner. b. "rutter." c. change agent. d. "native."

ANS: C Correct: The novice nurse is working to improve the safety and patient environment and is a patient advocate. Incorrect: a. The novice nurse is interacting with the manager rather than preferring to work alone or in isolation. b. The novice nurse is taking an interest in her professional and work environment rather than viewing it as just a job. d. The novice nurse is not mimicking the actions of the experienced nurse but instead is taking action to improve patient care.

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

ANS: B, D Correct: b. Leadership opportunities are available as officers and through conferences. d. SNA members work with other nursing students across the nation and internationally. Incorrect: a. Members are not eligible for a reduced rate for the licensure exam, but some states offer a reduced membership fee after graduation to the state nursing organization. c. Members are not eligible for discounted study abroad; however, through networking opportunities may arise for study abroad or employment after graduation. e. Lobbying efforts are through the state nurses association, which can be joined after graduation.

Advanced practice nurses are prepared minimally at the master's degree level with prescriptive privileges; these professionals include: (Select all that apply.) a. clinical nurse leader. b. nurse practitioner. c. nursing administrator. d. certified nurse-midwife. e. clinical nurse specialist.

ANS: B, D, E Correct: b. A nurse practitioner requires preparation at the master's degree level. d. A certified nurse-midwife requires preparation at the master's degree level. e. A clinical nurse specialist requires preparation at the master's degree level. Incorrect: a. A clinical nurse leader is not prepared at a master's level and is not considered an advanced practice role. c. A nursing administrator is not prepared at a master's level and is not considered an advanced practice role.

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

ANS: B, E Correct: b. Withholding information from novices or co-workers to purposely cause them to appear inadequate or unskilled is considered workplace violence because of the anxiety and stress it produces. This should not be tolerated and should be reported. e. Such statements, which belittle employees, lead to job dissatisfaction, lack of teamwork, and burnout and are considered lateral or workplace violence. This should not be tolerated and should be reported. Incorrect: a. Employees are not involved in the violence, but compassion fatigue may result. c. The employee is seeking help for issues outside work. d. The inmate's violent behavior occurred prior to admission to the health care agency.

A nurse researcher is attempting to describe the demographics of today's RNs and reports that: a. less than half of all RNs work in hospital settings. b. due to aging of workforce, less than 40% continue to work full time. c. Approximately 80% of RNs are employed in nursing. d. most nurses are initially graduating with a bachelor's degree.

ANS: C Correct: Approximately 80% of RNs remain employed in nursing. Incorrect: a. More than half (62.2%) of all RNs work in a hospital setting. b. About 63.2% of RNs are employed full time in the profession. d. A substantial number (45.4%) of nurses graduate from associate degree nursing programs compared to 34.2% BSN and 20.4% diploma.

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

ANS: C Correct: During the shock or rejection phase, novice nurses must ask themselves what they must do to become the type of nurse envisioned and to make a contribution. Incorrect: a. "Fitting in" comes with gaining confidence, which is the issue faced by the graduate. b. Although becoming more organized and improving communication is part of resolving the shock phase, the novice should focus on positive accomplishments and should remember that a nurse cannot learn everything in school—many skills are learned after graduation. Expectations of new graduates are often unrealistic. d. Although being a change agent is beneficial, blaming others is not the best choice.

A new graduate desires a position in labor and delivery; however, no position is available. What is the best advice for this nurse? a. Continue to study to keep skills current and wait for desired position. b. Return to college until a position in labor or delivery opens. c. Accept another nursing position and transfer into labor and delivery when a position is available. d. Practice obstetrical skills in a simulation lab then present evidence of competency to potential employer.

ANS: C Correct: Entry level positions in labor and delivery may be difficulty to find. Accepting a position in another area of the hospital will allow the novice nurse an opportunity to improve her skills and develop clinical decision-making as she waits for an open position in labor and delivery. Incorrect: a. Lifelong learning is always important for all nurses and reviewing materials will keep the nurse up to date; however, much is to be gained with experience. b. Returning to school until a position in labor and delivery is available may prolong the wait time because lateral transfers from one department to another are usually before outside hires. d. Practicing obstetrical skills in a simulation lab on campus will help retain essential skills but will not help the nurse gain initial entry into the system.

A nurse working in a factory performs routine hearing tests for employees. The factory uses 90 dB as the safe limit for an 8-hour day's exposure to machine noise rather than 85 dB as recommended by the Occupational Safety and Health Administration. The nurse is functioning in the role of: a. quality management. b. informatics nurse specialist. c. occupational health nurse. d. case manager.

ANS: C Correct: The nurse in the role of occupational health focuses on health promotion and disease control of employees. Incorrect: a. The nurse functioning in the quality management ensures that patient outcomes meet established standards. b. The informatics nurse specialist focuses on management and processing of health care information. d. Case managers coordinate resources to meet desired patient outcomes.

A new graduate nurse is applying for the exciting first position and states, "I am only applying to Magnet hospitals because those work environments: a. attract physicians who are the best health care providers to improve quality of care." b. require all registered nurses to be certified in the area of practice." c. not only attract but also retain professional nurses." d. discourage nurses from advancing their current level of education and I don't want to return to school for many years."

ANS: C Correct: Magnet hospitals have been identified as both attracting and retaining professional nurses. Magnet hospital nurses have higher levels of autonomy, greater control over the practice setting, and better relationships with physicians. Incorrect: a. Magnet hospitals actually attract both physicians and nurses; however, nurses are in the best position as the largest health care profession to impact patient quality. b. Higher education level of nurses are sought (BSN as minimum preparation preferred). Magnet hospitals actually recruit and reward professional nurses with specialty certification, but it is not required of all practicing nurses. d. Magnet hospitals do not discourage nurses from advancing their current level of education; rather they seek to attract and retain nurses with higher levels of educational preparation. Magnet hospitals have programs that support nurses in advancing their education.

Nurses in a unionized hospital are paid "compensatory pay" when working holidays equal to the number of hours worked with no extra compensation. Although they have suggested changes during the annual survey of employee satisfaction, management refuses to consider another system for compensatory pay. A trained member listened to both nurses and management to make recommendations that were not legally binding. This type of settlement is termed: a. picketing. b. binding arbitration. c. mediation. d. grievance.

ANS: C Correct: Mediation enlists the help of a trained person to listen to both sides; however, recommendations are not legally binding. Incorrect: a. Picketing occurs when a group of striking employees who congregate outside the workplace to draw attention to or discourage others from entering the workplace. b. Although binding arbitrations involve talks between all parties, the recommendations are compulsory. d. A grievance is usually filed by a single employee who feels he or she has been treated unfairly.

In recent Gallop Polls, nurses were voted as the most honest with the highest ethical standards of all professions. How does this degree of professionalism affect nurses' desire to participate in organized strikes? a. Nurses most often turn to collective bargaining strategies such as strikes to emphasize client safety initiatives. b. Nurses use evidence-based studies that reflect both management and labor views to support participation in unionization. c. Nurses often find union activities such as strikes in conflict with the need to serve and protect clients and their profession. d. Nurses who strike can be legally punished for abandonment and negligence, considered to be professional misconduct.

ANS: C Correct: Nurses are client advocates and promotion of professionalism is valued as evidenced by the public's opinion related to honesty and professionalism. Incorrect: a. Nurses may feel a conflict with collective bargaining activities such as strikes. b. There are limited resources, especially evidence-based resources, that provide a thorough discussion of benefits and concerns with unionization for professional nurses. d. A 10-day notice of intent to strike is required, allowing client care to be covered; thus negligence and abandonment is avoided.

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

ANS: C Correct: The experienced nurse knowingly enters into a relationship to advocate for and to enhance the self-esteem of the novice nurse. Incorrect: a. Mentoring requires an interactive process. b. The novice nurse mimicked the experienced nurse, and the experienced nurse is most likely unaware of this role. d. The novice nurse is promoting the professional satisfaction of the experienced nurse; however, the experienced nurse is not building the confidence and self-esteem of the novice nurse in an effort to enhance his or her professional confidence.

A nurse tallies the patient satisfaction surveys and approves the use of an agency nurse because of the high census. This nurse is involved in which nursing role? a. Change agent b. Educator c. Manager d. Coordinator

ANS: C Correct: The manager is the one who assesses the need for staffing and must justify this in a substantial way. Through this approach the manager indirectly provides care for patients and families. Incorrect: a. This example does not reflect changes in health care delivery in the area of increasing staff to accommodate the higher census. b. The role of educator is not to increase staffing. d. The coordinator coordinates the care of patients, not the staffing of nurses.

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

ANS: C Correct: The novice nurse can become familiar with the technique, then can perform the skill under the supervision of an experienced nurse, ensuring competency. Incorrect: a. Although it does allow the novice to follow set steps, there is often more than one correct way to perform a skill, and this approach does not allow competency to be assessed. b. Once the student has graduated, the staff educator most likely will seek to refine the skills of the novice by demonstrating skills before asking the novice to perform them. d. Patient safety may be compromised should a critical step be forgotten.

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

ANS: C Correct: The nurse is clearly stating the assignments, allowing for a need to adjust both to needs of the unit and the delegate's needs. Incorrect: a. This could be demeaning because it could be interpreted that the delegate has few skills. b. Posting assignments in writing is a good idea; however, this may seem as a threat. d. This is not an example of smooth delegation, which should consider the credentials of the delegate and health status of the patient.

A patient is admitted for a hip replacement complicated by uncontrolled diabetes and early dementia. The nurse coordinates referrals to an endocrinologist to establish an insulin protocol and organizes out-patient physical therapy in an Alzheimer's assisted living facility upon discharge. The role of this nurse is the: a. informatics specialist. b. educator. c. case manager. d. quality manager.

ANS: C Correct: The role of the case manager includes coordination of resources to achieve the best outcomes based on quality, access, and cost. Incorrect: a. The role of the informatics specialist includes managing and processing health care information. b. The educator role includes teaching and does not include coordination of resources. d. The quality manager addresses the need for health care providers to assess opportunities for process improvement, to implement changes, and to measure outcomes.

The RN who identifies the best resources at the lowest cost to achieve optimal health outcomes for the client is fulfilling the role of: a. informatics specialist. b. educator. c. case manager. d. quality manager.

ANS: C Correct: The role of the case manager includes coordination of resources to achieve the best outcomes based on quality, access, and cost. Incorrect: a. The role of the informatics specialist includes managing and processing health care information. b. The educator role includes teaching and does not include coordination of resources. d. The quality manager addresses the need for health care providers to assess opportunities for process improvement, to implement changes, and to measure outcomes.

Nurses in a nonprofit hospital have expressed an interest in forming a union to secure fair wages and ensure client safety. To form a core support group of nurses, the union organizer can conduct meetings to gather initial information: a. away from the worksite with a group of managers to learn both sides of the situation. b. at the worksite with staff nurses who are respected leaders. c. in homes or local businesses with staff nurses. d. after photographing management meeting to discuss their strategies to decrease interest in unionization.

ANS: C Correct: The union representative meets with laborers (staff nurses) at a nonwork setting to gather information about grievances. Incorrect: a. When initiating union efforts, meetings take place at nonwork settings with laborers who are leaders to gather information about grievances. b. Meetings are initially conducted at nonwork settings. d. There is no policy about photographing management; however, management cannot photograph employees who may be interested or meeting about unionization.

It is important to realize that nurses may seek unionization if: (Select all that apply.) a. physicians rotate on-call coverage among group members for complicated long-term clients. b. scheduling is presented that provides adequate staffing on holidays by rotation of time off for holidays among nurses. c. incident report trends indicate medication errors are caused by shift reports being taped and heard after nurses from the prior shift have left the unit. d. physicians, nurses, nutritionists, and physical therapists visit concurrently with clients to plan care. e. staff development activities are planned daily at 8 AM for 2 consecutive days to educate staff on new cardiac monitoring procedures while following normal staffing patterns.

ANS: C, E Correct: c. Policies where shift reports are taped and heard after a prior shift has left have proved to lead to errors and unsafe care. e. Staff development activities should be scheduled to allow nurses to attend, and normal staffing patterns or time of training must coincide with nurses' availability and ability to listen to and retain information (such as at the beginning or end of the shift while others provide coverage). Incorrect: a. Coverage is provided, and communication about client conditions can be shared. b. Client care is ensured, and nurses have the opportunity to have time off on holidays shared among staff. d. Such reports, commonly known as walking rounds or interdisciplinary rounds, allow a team approach to plan care.

Which situation would be considered a workforce advocacy issue that is reportable to the state nurses association or the Center for American Nurses if it is not resolved at the local level? a. Nurses prefer to wear navy blue scrubs, but the institution requires burgundy scrubs, which interferes with autonomy. b. The cafeteria often serves fried vegetables rather than healthier baked vegetables, causing the potential for hyperlipidemia. c. The hospital pharmacy does not fill employee prescriptions upon receiving them; instead, they fill employee prescriptions after all inpatient prescriptions have been filled. d. The key needed to change the sharps container is locked in the supervisor's office after 3 PM on weekdays and all day on weekends, which prevents changing of the container when needed and places nurses at risk for needlesticks.

ANS: D Correct: A safe work environment is imperative for the safety of both nurses and patients. Correcting this work environment issue promotes job satisfaction and good patient outcomes. Incorrect: a. Dress codes do not affect nurse safety or patient outcomes; therefore, advocacy intervention is not appropriate. b. Food choices in the cafeteria do not affect nurse safety or patient outcomes; therefore, advocacy intervention is not appropriate. c. Waiting to fill employee prescriptions until after inpatient prescriptions have been filled does not affect nurse safety or patient outcomes; therefore, advocacy intervention is not appropriate.

When an RN is asked to accept an assignment that he or she may not be qualified to perform, the nurse should: a. accept the assignment as appropriate if assigned by a legitimate power. b. be primarily concerned with the number of patients being assigned. c. ask how other nurses have handled the assignment in the past. d. determine whether he or she is familiar with the types of patients being assigned.

ANS: D Correct: Nurses should always think critically about assignments so they can communicate what makes them uncomfortable about a particular assignment. If nurses do not have the knowledge or experience required for particular patient assignments, then modification of the assignments is in order to ensure patient safety. Incorrect: a. Even if the person who makes the assignment has legitimate power, he or she may not be aware of the nurse's work experience and training. b. The nurse should not respond on the basis of the actual number of patients assigned but should consider the needs of each patient, his or her age and condition, other factors that contribute to special needs, and the resources available to meet those needs. c. Each nurse possesses individual expertise. Basing decisions on the actions and capabilities of others is incorrect and is potentially unsafe for the patient.

A nurse is concerned about safe staffing levels at a facility and observes that several units have no RN coverage but instead have RNs who float among several units. In determining whether this staffing concern should be reported to an outside agency, the nurse understands that, with whistle blowing: a. reporting unsafe staffing levels to The Joint Commission provides protection from the employer. b. keeping copies of documented inappropriate staffing patterns in the nurse's personal file is illegal. c. when observing inappropriate staffing, the nurse should record her personal thoughts concerning the outcomes. d. one should seek guidance from a trusted individual who can provide an objective point of view.

ANS: D Correct: One of the many guidelines regarding whistle blowing specifies that one should seek counsel from a trusted individual outside the situation to gain an objective perspective. Incorrect: a. Private groups such as The Joint Commission do not confer protection in whistle-blowing situations; a nurse must report to a state or national regulator. b. Keeping copies of inappropriate staffing patterns in a personal file is not illegal; it is actually recommended. c. The nurse should record objective information, not personal thoughts or interpretations, and reserve judgment until adequate documentation establishing wrongdoing is collected.

In distinguishing between evaluation methods used in school versus those used in the work environment, it is noted that the work environment evaluation includes: a. determining whether steps are logical. b. formulating increments in correct order. c. efficiently organizing stages of the procedure. d. appraising outcomes according to policy.

ANS: D Correct: Outcomes are based on meeting existing criteria rather than on knowing how the outcome was achieved. Incorrect: a. The step "determining whether steps are logical" represents the school environment, in which steps are performed on the basis of sound rationales. b. The step "formulating increments in correct order" represents the school environment evaluation, which stems from the "correct step" aspect. c. The step "appraising outcomes according to policy" represents the school environment, in which each step is evaluated, rather than indicating the overall outcome.

The key to organizational success for health care facilities is: a. hiring younger, more energetic nurses. b. offering incentives such as sign-on bonuses. c. hiring highly qualified advanced practice nurses. d. retaining professional nurses.

ANS: D Correct: Past nursing shortages have proved that retention of professional nurses is the key to any organization's success. Nurses want to work in an environment that supports decision making and effective nurse-physician relationships. The ability of an organization to retain nurses primarily depends on the creation of an environment that is conducive to professional autonomy. Incorrect: a. Younger nurses want flexible hours and considerable autonomy in the work environment. These options are limited in the current health care environment, where round-the-clock patient care, including on weekends and holidays, is mandatory. b. Offering sign-on bonuses actually results in considerable expenditure by the health care organization. Many believe that the money allotted to recruitment could be better spent by increasing basic compensation levels of professional nurses. c. Hiring highly qualified advanced practice nurses does help to improve patient outcomes but does not provide the staffing needed for direct patient care.

Nurses entering the workforce at a large urban hospital soon began volunteering for excessive overtime. A focus group found that upon graduation, many of these nurses purchased expensive cars and furniture. They lacked skills in managing their checkbook and were often unable to pay recurring bills; this finding would be relevant to which component of the Workforce Advocacy Ecosystem Model? a. Staffing b. Workflow design c. Organizational factors d. Personal and social factors

ANS: D Correct: Personal and social factors include stress, job satisfaction, and professionalism and financial literacy. Incorrect: a. The component of staffing refers to job assignments. b. The component of workflow design deals with interactions among workers and the nature and scope of the work. c. Organizational factors involve processes within the organization such as the use of teams, divisions of labor, shared beliefs, and an increasing leadership capacity among nurses.

The priority intervention to improve work-related quality of life for nurses is to: a. provide safe harbors for unjust or unsafe work assignments. b. improve nurse physician communications. c. require professional development courses for bedside nurses. d. determine strategies to improve vertical working relationships between staff nurses and nursing administration.

ANS: D Correct: RNs ranked their relationships with administration and management the lowest in the workplace. Incorrect: a. Safe harbors provide an opportunity for nurses subjected to unsafe staffing patterns a means to have the situation investigated. b. Nurse-physician relationships were rated second only to relationships with other RNs. c. Relationships with other RNs were rated highest quality.

One workplace issue—the nursing shortage—is caused by several complex issues, including: a. movement of nurses into acute care settings. b. the use of unlicensed assistive personnel to replace RNs. c. a mass of baby boomers who have chosen nursing as a career. d. an aging nursing workforce.

ANS: D Correct: Research validates that an aging population and an aging nursing workforce are significant contributors to the nursing shortage issue. Incorrect: a. Movement of nurses into acute care settings would actually be beneficial in terms of the nursing shortage. As patient care technology increases, the number of nurses needed in acute care settings is increasing. b. Unlicensed assistive personnel cannot be used to replace RNs, although they can be placed in positions that allow them to assist RNs in providing patient care. c. There has not been a mass of baby boomers who have chosen nursing as a career.

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

ANS: D Correct: Residency programs offer a longer precepted orientation period (often 12 months) to bridge the gap between the classroom and practice. Incorrect: a. Housing is not the focus of residency programs, but moving expenses may be negotiated as part of the employment process. b. Interprofessional education may be part of the residency program's content, but partnerships are not included. c. Residency programs focus on content/activities that help the novice move to a higher level of confidence rather than focusing on higher education.

A nurse is concerned about a trend in the hospital to regularly "float" nurses to different areas of the hospital based on staff shortage regardless of recent experience in caring for the population on the unit. When deciding to accept a staffing assignment in this situation, the nurse considers a "safe harbor." What is meant by "safe harbor"? a. In an emergency situation, nurses may move patients to one location designated to be areas safe from natural disasters or acts of terrorism. b. Nurses work in teams to care for patients who have no communicable disease and do not pose a safety issue due to infection. c. Horizontal violence is not tolerated and nurses report any form of violence to administration. d. It is written a notice about recurrent staffing issues that allows nurses to continue to care for patients placed in their care but protects their nurse's license while an investigation is conducted.

ANS: D Correct: Safe harbor does not mean a nurse can refuse an assignment unless it would violate the nurse practice act, but it does provide an avenue for nurses to report unsafe staffing by filing a written report that is investigated by administration. Incorrect: a. Safe Harbor does not address staffing during natural disasters. b. Safe Harbor does not directly relate to infectious disease unless a staffing issue deals with unsafe assignments of such patients. c. Horizontal violence is not addressed in safe harbor.

The role of the Clinical Nurse Leader (CNL) would include: a. diagnosing a patient with pneumonia and prescribing antibiotics. b. teaching members of a faith community how to avoid skin cancer and referring those with suspicious lesions. c. participating in the team who is investigating possible abuse of elderly persons by members of a gang known to sell illegal drugs. d. coordinating care of a patient admitted 4 days ago with stage IV heart failure and chronic bronchitis by revising care plan to include ambulation 50 feet with assistance.

ANS: D Correct: The CNL is not an advanced practice nurse but is an advanced generalist who provides care and coordination of care for patients with complex needs and revises care plan to meet desired outcomes. Incorrect: a. The nurse practitioner or advanced practice nurse, not the CNL, has authority to diagnose and prescribe. b. Parish nursing would work within a faith community to teach and refer. c. Forensic nursing involves investigation of abuse and criminal activity.

A nurse has heard rumors that other nurses are interested in unionizing but knows little about the purpose of unions. The nurse's first action is to: a. contact an arbitrator who has worked with other nurses in unions. b. picket the agency where employed to gain inside information as to why unionization is sought. c. sign the dual-purpose union authorization card. d. review the National Nurses United website for collective bargaining information.

ANS: D Correct: The National Nurses United website gives information about collective bargaining for nurses. Incorrect: a. An arbitrator is the person who negotiates for both sides and may provide information. However, to gain a foundation of understanding it is important that a nurse first contact either the National Nurses United or the National Labor Relations Board. b. Picketing the agency places the nurse in a position to join the union, and those picketing may resent having someone who does not truly support their cause as a representative. c. Signing the dual-purpose union authorization card is a request for an election and indicates the nurse is applying for union membership, which (without information) may not be the best choice.

According to the Needlestick Safety and Prevention Act (2000): a. employers ask nurses in managerial positions to evaluate safe needle devices. b. registered nurses who sustain a needle stick are required to pass a test before resuming medication administration. c. each state must determine the type of safe needle devices to be used. d. employers are required to document how and where a sharps injury occurred, including the brand of device that was involved.

ANS: D Correct: The Needlestick Safety and Prevention Act, passed at the federal level, requires the use of safer needle devices to protect from sharps injuries; the law requires employers to maintain a sharps injury log that contains, at a minimum, the brand of device involved in the incident, the department or work area where the exposure incident occurred, and an explanation of how the incident occurred. Incorrect: a. The law requires employers to solicit the input of nonmanagerial employees responsible for direct patient care who are potentially exposed to sharps injuries in the identification, evaluation, and selection of effective engineering and work practice controls. Employers are responsible for the identification, evaluation, and selection of effective engineering and work practice controls to prevent needlesticks. b. Registered nurses are not required to take an exam prior to or after a needlestick. c. Selection of safe needle devices is controlled by those who provide direct care, not the state.

An acute care facility values job satisfaction among its registered nurses and pay for membership dues in the state nurses association. Which element identified by The Nursing Organizations Alliance is supported by this support? a. A collaborative practice culture b. Communication-rich culture c. Shared decision-making at all levels d. Encouragement of professional practice and continued growth and development

ANS: D Correct: The element of encouragement of professional practice and continued growth and development includes support for continuing education and certification, participation in professional association, and an information-rich environment. Incorrect: a. The element of collaborative practice culture is supported by respectful collegial communication and behavior, team orientation, presence of trust, and respect for diversity. b. The element of communication-rich culture is supported by communication that is clear and respectful, open and trusting. c. The element of shared decision-making at all levels is supported by nurses participating in system, organizational, and process decisions; formal structure exists to support shared decision making, and nurses have control over their practice.

A newly hired nurse is asked to serve on a committee formed to recruit and retain nurses. At the committee meeting, the nurse learns that: a. older nurses are being encouraged to retire so that younger, more efficient nurses can practice. b. Magnet hospitals are able to attract nurses with sign-on bonuses and flexible work hours but fail to retain nurses because insufficient autonomy over professional practice is provided. c. multitasking is seldom desired by the younger generation of nurses. d. many younger workers are less concerned with longevity and are willing to change institutions to achieve professional advancement and flexible work hours.

ANS: D Correct: The emerging workforce, ages 18 to 35 years, has compensation expectations that differ from those of previous generations. This younger generation prefers to work in an outcomes-based environment, where pay is based on achievement or merit, not on longevity. Incorrect: a. Older nurses are actually being recruited to stay in the employment arena to improve patient outcomes. Research advancements in ergonomics and workload have made early retirement less appealing. b. Magnet hospitals definitely retain nurses by offering professional practice autonomy. c. The younger generation is very adept at multitasking and at using technology.

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

ANS: D Correct: The novice nurse is mimicking the actions of the experienced nurse taking shortcuts that were not taught in school and not following policy and procedure. Incorrect: a. The "loner" stage occurs when the nurse prefers to be alone and often works night shift. b. The "rutter" stage occurs when the nurse just views her work as a job rather than a profession—"Just let me make it through 8 hours and I'll go home." c. The "change agent" would be working with administration to improve processes to streamline tasks to ensure time for reflection and other tasks

A nurse is interested in practicing in a faith-based community; when researching the role of the parish nurse, the nurse finds that: a. certification is available at a basic level after a qualifying examination is completed and a set number of practice hours have been worked, as defined by the state's nurse practice act. b. this advanced practice role focuses on health promotion and disease prevention. c. this role has no set standards or scope of practice but instead follows the doctrine of the denomination being served. d. this role is recognized by the American Nurses Association (ANA) as a specialty with a defined set of practice guidelines.

ANS: D Correct: The role of parish nurse has become a recognized specialty in a growing professional practice. In 1988, the ANA established the scope and standards of this professional practice. Incorrect: a. No further examination is needed for this role. b. Parish nursing is not an advanced practice role. c. The parish nurse incorporates the values and spiritual dimension of the human being into the practice of nursing and health promotion.